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Press Complaints Commission upholds homeopaths complaint Siouxsie Wiles Apr 16

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Tauranga homeopath Clive Stuart has had part of his complaint against an article on homeopathy (Homeopathy – Trick or Treatment?) by Stacey Anyan, published in the July 2012 edition of North & South, upheld by the Press Complaints Commission (PCC)*. While the PCC did not agree with his complaint that balance needed to be numerically equivalent (there were quotes from two people critical of homeopathy and one defending) or that his letter to the editor should not have been accompanied by a response from a critic of homeopathy (Dr Shaun Holt), they did uphold his complaint that the article was wrong to say that “homeopathic remedies have failed every randomised, evidence-based scientific study seeking to verify their claims of healing powers”.

The article title is a reference to the excellent book ‘Trick or Treatment? Alternative Medicine on Trial’ by Dr Simon Singh and Prof Edzard Ernst. Prof Ernst is a doctor and former homeopath who was the world’s first professor of complementary medicine, at the University of Exeter. This is what they conclude about homeopathy:

“Hundreds of trials have failed to deliver significant or convincing evidence to support the use of homeopathy for the treatment of any particular ailment. On the contrary, it would be fair to say that there is a mountain of evidence to suggest that homeopathic remedies simply do not work. This should not be such a surprising conclusion when we recall that they typically do not contain a single molecule of any active ingredient.”

But lets not take their word for it. In 2009-2010 the UK House of Commons Science and Technology Committee performed an ‘evidence check‘ on homeopathy, calling defenders and critics alike to present the evidence for and against homeopathy. Their conclusion:

“…the evidence base shows that homeopathy is not efficacious (that is, it does not work beyond the placebo effect) and that explanations for why homeopathy would work are scientifically implausible.”

It would seem from these that the scientific evidence points to homeopathy having no effect beyond placebo, when evaluated using methodologically sound protocols by people without a vested interest in homeopathy. However, the PCC:

“found the article inaccurate in so far as the state of scientific research into homeopathy is not
as conclusive as North & South had suggested.”

If only Stacey Anyan had included the words ‘well-designed’ in her sentence. What a difference a couple of little words would have made. There is certainly an important lesson for journalists in this debacle.

It is interesting to read in the judgement* how the PCC came to their conclusion. They seem to have been swayed by a 7 page letter from a Dr David St George. We’ll get to who he is in a moment. This is what the PCC say:

Dr St George believed the statement in North & South’s article arose from a misunderstanding of the Lancet study, which had compared 110 published placebo-controlled trials of homeopathy with the same number of published placebo-controlled trials of conventional medical drug treatments. He said most of the 110 homeopathy trials in that study were “randomised, evidence-based scientific studies” which demonstrated an effect beyond a placebo effect.

Actually the Lancet study Dr St George is quoting concluded “Biases are present in placebo-controlled trials of both homoeopathy and conventional medicine. When account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.”

Two disturbing things come to light from this case. The first is that the PCC breached its own rules by accepting Dr St George’s letter which was the third submission in this case (two submissions are allowed by both sides) so it will be interesting to see why this was allowed. The second is finding out who Dr David St George is and what he does for a living. Dr St George has a medical degree from the University of Auckland and a degree in epidemiology from McGill University in Montreal, Canada. He worked as a consultant clinical epidemiologist at the Royal Free Hospital in London and then as Director of Research and Clinical Effectiveness at Southampton University Hospital. He was also the first Director of Research at the Foundation for Integrated Health, a controversial charity founded in 1993 by the Prince of Wales to promote alternative and complementary medicine, lobbying for its inclusion in the UK’s National Health Service. The charity closed in 2010 after it’s finance director, accountant George Gray, was convicted of theft and sentenced to three years in prison. It is unclear what research, if any, the Foundation undertook.

Dr St George’s other ‘achievements’ include helping Middlesex University set up an undergraduate degree in traditional Chinese medicine**, being research committee chairman of the (now defunct) Scottish School of Herbal Medicine and a former member of the British Acupuncture Accreditation Board***. But now he is back in New Zealand and working for the NZ Ministry of Health as ‘Chief Advisor – Integrative Care’. I wonder if this swayed the PCC at all into accepting his unorthodox, rather lengthy and over technical submission. This is what it says on the Ministry’s website about Dr St George’s role:

Dr David St George’s role is to provide professional leadership, direction and advice on complementary and alternative medicine (CAM), and on the integration of CAM with conventional health care, particularly in the area of primary care and chronic care conditions.

Oh dear. I think we need to find out exactly what ‘direction and advice’ Dr St George has been giving to the Ministry for Health. Because by his submission to the PCC I’m not entirely confident it will be based on unbiased methodologically sound scientific evidence. Dr Prue Williams, General Manager of Science Investments for the Ministry of Business, Innovation and Employment, announced at the recent NZ Association of Scientists annual meeting in Wellington that there are plans for all ministries to have scientific advisors in place. I suggest whoever is appointed for the Ministry of Health starts by looking into Dr David St George.

*It’s case 2320, the judgement for which isn’t up on the PCC website yet.

[Update: 14:20 on 16/04/2013 - judgement now available online here]

***On the subject of Traditional Chinese Medicine (TCM) Singh and Ernst conclude: “Some elements may be effective for some conditions, while others (e.g. cupping) are unlikely to offer any benefit above placebo. Many aspects of TCM are potentially harmful. Some individual herbs used in TCM (e.g. liquorice, giner, ginko) undoubtedly have pharmacological effects.. On the other hand, some.. are toxic … may also contain non-herbal ingredients (e.g. endangered animals), contaminants (e.g. heavy metals) or adulterants (e.g. steroids).”

***On the subject of acupuncture Singh and Ernst conclude: “..there is no evidence at all to demonstrate the existence of Ch’i or meridians [the basis for acupuncture points]. There are some high-quality trials that support the use of acupuncture for some types of pain and nausea, but there are also high-quality trials that contradict this conclusion. In short, the evidence is neither consistent nor convincing – it is borderline.”

Reference:
Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M (2005). Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 366(9487):726-32.

What Kiwis die of – Part III: Changes with age Siouxsie Wiles Feb 15

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Over the last month we have been looking at the data on the primary causes of death recorded by the Ministry of Health for the 29,204 people who died in New Zealand in 2009. First we looked at what people thought they would die of, and then we looked at differences in the causes of death recorded for men and women. Accompanying each post was a gorgeous infographic by Mike Dickison.

This week we decided to look at how causes of death differ with age. We’ll start with a table of the total numbers of people who died in each age bracket:

I was interested to see that the number of people who died under the age of 80 was really similar to the number of people over 80 (14,371 under 80 versus 14,833). Striking also to see the greater numbers of males dying than females for all age brackets, except the over 80′s.

To show how some of the causes change with age, Mike has chosen to represent as little line graphs:

No surprises for dementia and Alzheimer’s, with the graphs skewed towards the upper age brackets. And probably no surprises that the deaths from traffic accidents peaks for people in their the 20′s. But I’m blown away by the data on assaults. I would never have expected there to be such a huge peak for children, similar to the number of people assaulted in their 30′s. Shocking.

To see if people’s perceptions tallied up with reality, again we took to social media and asked people what they thought was the major cause of death for different ages*. So what did the Kiwis we surveyed think? Results are summarised in the slideshare presentation below.



People were pretty much spot on with the major cause of death for children under five being accidents. But interestingly, while of our survey respondents were right thinking traffic accidents were the major cause of death for people on their 20′s, the number of people committing suicide is almost the same (98 versus 95). For people in their 30′s the major cause of death is cancer, but less than 20% of our survey participants picked this option. More popular choices were accidental death and transport accidents (with about 30% of the votes each). For people in their 40′s, cancer is again the biggest killer, by quite a margin. But again only 20% of our respondents picked this option. The most popular choice was circulatory diseases (heart attacks and strokes). I wonder if this misperception around cancer means those in their 30′s and 40′s are more less likely to miss early warning signs.

* We used Twitter, Facebook, and email to entice over 100 people to fill out our survey using the SurveyMonkey website. Like all online surveys, ours should not be considered representative of the population of New Zealand, but rather of people on social media who were happy to fill out our survey.

This post is the second in a series inspired by the Guardian newspaper’s infographic ‘What we die of’ and is a collaboration between myself, chief number cruncher Dr Paul Gardner and data visualisation extraordinaire Dr Mike Dickison. Dr Paul Gardner (@ppgardne) is a Royal Society of NZ Rutherford Discovery Fellow and Senior Lecturer in Bioinformatics at the University of Canterbury’s School of Biological Sciences. He gets very excited about RNA. Dr Mike Dickison (@adzebill) is a freelance information designer with a PhD on the evolution of giant flightless birds. He quite likes ukuleles too. Dr Siouxsie Wiles (@SiouxsieW) is a Health Research Council of NZ Hercus Fellow at the University of Auckland’s Faculty of Medical & Health Sciences. She is rather keen on nasty bacteria and anything that glows in the dark.

What Kiwis die of – Part II: The battle of the sexes Siouxsie Wiles Jan 31

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Two weeks ago, we asked Kiwis what they thought they would die of, and compared their responses to the primary causes of death recorded by the Ministry of Health for the 29,204 people who died in New Zealand in 2009. Mike Dickison produced a beautiful infographic* of the causes that were responsible for more than 1% of those deaths. Obviously this data reflects what was recorded on the death certificate which may not always be the immediate cause of death. In fact, there was some discussion afterwards about the reality of ‘old age’ being an unacceptable cause of death here!

This week we decided to take a look at differences for causes of death recorded for men and women. Mike has worked his magic again and produced the infographic below. This time the little coffins each represent 25 people.

Its striking that more men die of prostate cancer than women die of ovarian, and twice as many men than women die from cancer of the bladder and kidney. But lots more women die of cerebrovascular diseases, that is strokes and brain haemorrhages, and dementia. To see if people’s perceptions tallied up with reality, we took to social media and asked people whether they thought there were any differences between what men and women died of**. So what did the Kiwis we surveyed think? Results are summarised in the slideshare presentation below.



The first striking thing to come from our survey participants is that the majority thought that more men die than women, and that more men die of diabetes, cerebrovascular diseases, traffic accidents and suicide. But not skin cancer. In actual fact, the numbers of men and women who died in 2009 was very similar, 14,615 men and 14,589 women. As you can see from the infographic, more men died in traffic accidents and diabetes, or committed suicide. But our respondents were way off with cerebrovascular diseases. And with the fact that skin cancer killed more men than women. The other question we asked related to breast cancer deaths in men. 8.2% of our respondents thought that men couldn’t get breast cancer. In fact, in New Zealand in 2009, 1 in 100 breast cancer deaths were in men.

As several people pointed out with our first infographic, these differences between perception and reality could be dangerous if they mean resources are diverted away from where they are really needed.

*Head on over to Mike’s Pictures of Numbers blog to see how the infographic came about and for a downloadable version.

** We used Twitter, Facebook, and email to entice over 100 people to fill out our survey using the SurveyMonkey website. Like all online surveys, ours should not be considered representative of the population of New Zealand, but rather of people on social media who were happy to fill out our survey.

This post is the second in a series inspired by the Guardian newspaper’s infographic ‘What we die of’ and is a collaboration between myself, chief number cruncher Dr Paul Gardner and data visualisation extraordinaire Dr Mike Dickison. Dr Paul Gardner (@ppgardne) is a Royal Society of NZ Rutherford Discovery Fellow and Senior Lecturer in Bioinformatics at the University of Canterbury’s School of Biological Sciences. He gets very excited about RNA. Dr Mike Dickison (@adzebill) is a freelance information designer with a PhD on the evolution of giant flightless birds. He quite likes ukuleles too. Dr Siouxsie Wiles (@SiouxsieW) is a Health Research Council of NZ Hercus Fellow at the University of Auckland’s Faculty of Medical & Health Sciences. She is rather keen on nasty bacteria and anything that glows in the dark.

What do Kiwis die of? Siouxsie Wiles Jan 18

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I have never really understood why some people are desperate for immortality. Like those crazy millionaires who have their heads frozen in liquid nitrogen. I am not afraid of dying, but I would like to die painlessly and without much fuss, and preferably with all my faculties intact*. But what am I likely to die of? We looked at figures recorded by the Ministry of Health of the primary causes of death for the 29,204 people who died in New Zealand in 2009. For simplicity, we have only looked at the causes that were responsible for more than 1% of those deaths and have summarised them in the infographic** below. It is important to bear in mind though, that the figures cover what was recorded on the death certificate which may not always be the immediate cause of death. For example, many of those who are recorded as having died of Alzheimer’s disease are more likely to have died of pneumonia or a urinary tract infection.

To see if people’s perceptions tallied up with reality, we took to social media and asked people what they thought were the biggest killers and what they were likely to die of***. So what did the Kiwis we surveyed think? Firstly, and unsurprisingly, that many would like to thought they would die of ‘old age’. Sadly this is not recognised as a cause of death by the Ministry of Health! It was also interesting how discomforting many people found the survey, with a number of people telling us that they did not want to think about how they might die, or skipping that question entirely. But many people did take the time to think about it, so how did their perceptions match the Ministry’s statistics?

31% of those surveyed thought they would die of conditions like angina, heart attacks, strokes and high blood pressure, which are classed as ‘circulatory diseases’. And they are probably right, because in 2009 circulatory diseases were New Zealand’s biggest killer, responsible for 35.5% of deaths (10,372 people).

71.8% of our survey participants underestimated the number of cancer deaths in New Zealand, although 22% of them thought that cancer would be the cause of their demise. In fact, cancer is the second largest killer, responsible for 29.1% of deaths (8,500 people) in 2009. Interestingly, 66% of those surveyed did not know that cancers of the digestive system are the most frequent cause of cancer deaths in New Zealand, though they recognised lung cancer is one of the biggest killers.

In 2009, traffic accidents and suicides were both responsible for more deaths in New Zealand than skin cancer (melanoma). Yet 48% of our survey participants perceived melanoma as the greater risk. Perhaps this shows how successful the ‘slip, slap, slop’ message has been.

Despite respiratory diseases being the third biggest killer of Kiwis, they were largely unrecognised by our survey participants with only 2.1% listing it as what they may die of.

It was very sad to see that 10 of the people we surveyed listed suicide as their cause of death, giving suicide a higher representation in our survey population than in real life. Could social media be a good forum for offering support to those struggling with thoughts of harming themselves.


Over the next few months we will be delving into the stats more closely, so if there is something you would like us to examine then please get in touch.

[Edited 18/01/2013 to correct a sentence]

*Then I would like to be buried in a shroud or biodegradable casket and return my vast store of nutrients back to the land. If space is an issue, then I quite like the idea of being cremated and popped into one of Spanish designer Martin Azua’s Bios Urns which are made from coconut shell, compacted peat and cellulose and contain the seed of a tree.

**Head on over to Mike’s Pictures of Numbers blog to see how the infographic came about and for a downloadable version.

*** We used Twitter, Facebook, SciBlogs and email to entice over 360 people to fill out our survey using the SurveyMonkey website. The full results are available on Shareshare. Like all online surveys, ours should not be considered representative of the population of New Zealand, but rather of people on social media who were happy to fill out our survey.

This post was inspired by the Guardian newspaper’s infographic ‘What we die of’ and is a collaboration between myself, chief number cruncher Dr Paul Gardner and data visualisation extraordinaire Dr Mike Dickison. Dr Paul Gardner (@ppgardne) is a Royal Society of NZ Rutherford Discovery Fellow and Senior Lecturer in Bioinformatics at the University of Canterbury’s School of Biological Sciences. He gets very excited about RNA. Dr Mike Dickison (@adzebill) is a freelance information designer with a PhD on the evolution of giant flightless birds. He quite likes ukuleles too. Dr Siouxsie Wiles (@SiouxsieW) is a Health Research Council of NZ Hercus Fellow at the University of Auckland’s Faculty of Medical & Health Sciences. She is rather keen on nasty bacteria and anything that glows in the dark.

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