Chinese Herbal Medicine for Endometriosis

Media outlets are reporting that Chinese herbs may relieve symptoms of endometriosis, using a Cochrane review of 2 research articles. Headlines read “Chinese herbs show early promise for endometriosis”  and  “Chinese Herbs May Relieve Endometriosis Symptoms, Review Finds”  .

Endometriosis is a medical condition in which some of the endometrial cells (typically found in the uterus under the fluctuating influence of female hormones) are found outside of the uterine cavity. Symptoms include many nonspecific complaints such as pelvic pain, infertility, nausea, unusual menstruation, chronic fatigue, mood swings, back pain, ovarian cysts, constipation, urinary tract infections, diarrhea, anemia, etc. Appropriate diagnosis is by laparoscopic biopsy – a doctor will use a laparoscopic instrument to remove suspected extrauterine endometrial cells and examine them.  Treatments vary and can include hormonal treatments or surgery to remove the cells. In China, treatment of this disorder with Chinese herbal medicine (CHM) is routine.

Both of the media reports linked to above say that the Cochrane reviewers found some evidence that CHM has comparable benefits to conventional drug therapy after laparoscopic surgery for people with endometriosis but that the review has limitations. The primary author of the study is quoted as saying “"I think the positive message is that Chinese herbal medicine may offer equivalent benefits to conventional medicine but with fewer side effects.”

I found the Cochrane review [1] and noted that reviewers collected 110 studies for review and graded them based on methodological criteria. They dropped all but two of the 110 studies due to excluding trials with poor methodology, unconfirmed randomization procedures or ones diagnosing endometriosis without an appropriate laparoscopic biopsy.

Did the two retained articles feature research with superior methodology? First, let’s look at what those two articles were, and what the author concluded from this review:

The first article [2] had two treatment arms: women treated with CHM orally (2x/day) and via enema (1x/day) after laparoscopic surgery versus women treated with gestrinone (2x/wk) after laparoscopic surgery for 3 months. The results showed no difference between rates of symptom relief or pregnancy in either group.

The second article [3] had three treatment arms: women treated with CHM orally(2x/day), women who treated with CHM orally and via enema(1x/day), and women treated with danazol(1x/day) for 3 months. These women did not undergo laparoscopic surgery, but instead were only biopsied for diagnostic purposes.  Women obtained greater symptomatic relief with oral and oral plus enema CHM versus danazol, oral plus enema CHM shower a greater reduction in dysmenorrhoea pain scores than danazol and shrinkage of adenexal masses. There were no differences for other factors (lumbrosacral pain, rectal discomfort, vaginal nodules).

The author concluded that post-surgical administration of CHM may have comparable benefits to gestrinone but with fewer side effects, that oral CHM may be better for treatment than danazol and may be more effective at relieving dysmenorrheal and shrinking adnexal masses when used with a CHM enema.

So, what are our weaknesses?

1.    No placebo control: There was no arm of the first study which looked at women receiving laparoscopic surgery alone without CHM or danazol, and no arm of the second study which looked at women receiving no treatment or a placebo pill treatment.

2.    Poor blinding: I should not have to point out that if you enroll in a study that has a pill treatment arm and an enema treatment arm, it is impossible for the participants to be blinded to which treatment group they are in. And enema, as you probably know, is a procedure in which liquids are forced into the rectum through the anus. It might be possible to blind participants to whether or not they are getting CHM versus the other medications, but I bet most people can tell the difference between a Chinese medicine pill and the other pills in the study. The researchers were also not blinded as to which treatment group women were in, though the paper indicates the assessors were blinded to which treatment group the women were in.

3.    Inadequate comparison treatments: Danazol is no longer commonly used as a treatment for endometriosis, and gestrinone is not available in the USA. These studies would have been much more robust had they compared it to typical drug treatments for endometriosis. In the world of conventional treatments for endometriosis, these two drugs can hardly be called conventional.

4.    Poor outcome measures: In both of the studies, a clinical outcome of “no effect” was recorded if there were no change in symptoms or if the symptoms became worse. Recording worsening symptoms as “no effect” biases the data toward a positive outcome.


I think that the most appropriate take home message or finding of the study is this: the massive stockpile of clinical trials that explore CHM for treating endometriosis have serious methodological shortcomings. 

The author’s main conclusion (and the conclusion parroted by the press), that CHM may work to alleviate symptoms of endometriosis, seems spurious in light of this. Additionally, it appears that researchers used a specific mixture of herbs (Nei Yi) in the two studies, which raises the question: why the author did not title his paper “Nei Yi for endometriosis”?  Perhaps he wanted his readers to focus on the fact that this was a Chinese herbal medicine versus a “conventional” medicine.

Lastly, it is worth noting that although the authors of the review state that there is no conflict of interest in the publication of this review, the primary author is an acupuncture and Chinese medicine practitioner at a center for Chinese medicine in the UK.

References:

[1] Flower A, Liu JP, Chen S, Lewith G, Little P. Chinese herbal medicine for endometriosis. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006568. DOI: 10.1002/14651858.CD006568.pub2.

[2] Wu SZ,Chen XL,Chen WZ, Li SY.Clinical analysis of the treatment of endometriosis using Nei Yi pills and Nei Yi enema. Journal of Liaoning University of TCM 2006;8(7):5–6.

[3] Wu SZ, Chen XL, Chen WZ. Clinical observation of Nei Yi pills combined with Nei Yi enema in the treatment of endometriosis. Chinese Archives of TCM 2006;24(3):431–3.

Homeopathy and the curse of the scientific method Pt1

I really wish I could find a free version of this journal article so that I could share it with you all - it is single the best piece of writing I have ever seen concerning homeopathy and the placebo effect.

Buried in the pages of The Veterinary Journal is an absolute treasure known as Overall (2009). In this article the authors first outline something very important: how to understand the role of bias in selecting populations for use in drug or medication trials. If a researcher approaches an individual to ask them to take part in a trial of a homeopathic medication, there are three main types of people a researcher can encounter, with respect to belief about the efficacy of homeopathy:

1. People who believe homeopathy is effective.
2. People who are unsure.
3. People who believe homeopathy is ineffective.

Of these three people, type 1 is the most likely type to agree to participate in a trial, especially one that is time consuming or involves a lot of work or effort on the part of the participant. When randomizing such a pool, it is highly unlikely that individuals in each respective pool will think (in this case) that homeopathy is ineffective. They are much more likely to believe homeopathy is effective. If they do not know much about homeopathy, they may assume that since this is not a trial to see if homeopathy works, but a trial to see if a particular homeopathic medication works, that homeopathy is therefore evidence based, and researchers are trying to prove that a particular remedy is effective. Either way, most people will be hoping and looking for positive results.

In animal trials in which owners are taking part in the evaluation of the behaviors of their own pets, they are likely to be quite biased or report different results based on their belief in the efficacy of the treatment. This is especially true if the changes in animal behavior are more subjective rather than objective. An owner who believes that a remedy is working may notice things like panting, drooling, or pacing less than an owner who has no such belief.

People often say that animals do not suffer from a placebo effect – that is, if you treat an animal with a medication it does not really know you are giving it something that should make it feel better. If the animal is in pain, it is not likely to feel less pain if you give it a sugar pill. This is basically true, but completely irrelevant, especially when observations of changes in animal behavior (indicative of an effect on the animal) are reported by people not trained in objectivity.

There is a problem in medical literature known as inter-rater reliability. Inter-rater reliability is the measure of different observers’ ability to report similar findings using the same measurement tool. A measurement tool is said to have good inter-rater reliability when several different individuals report very similar results. Inter-rater reliability relies on training in how to use the measurement tool and how to report findings objectively.

For example, several individuals grading a true or false quiz would have very high inter-rater reliability; that is several individuals, if given a key with the answers, will very likely give the same person the same grade. Inter-rater reliability may be reduced if the graders aren’t given an answer key and have to decide if the answers are correct based on their own knowledge. Inter-rater reliability could be extremely low if the tests are given to graders who have no answer key and varying levels of knowledge of the test material.

Similarly, trained investigators using a measure to observe the behaviors of animals may have high inter-rater reliability, whereas a trained investigator observing little Rover’s behaviors versus Mrs. MyDogIsMyChild observing Rover’s behaviors may have very low inter-rater reliability.

So, this is why we must use double blind placebo controlled testing for animals. The owners of animals are very likely to report their findings based on how much they believe the remedy will work. Just think about all of the times a dog owner reported that their dog “looked depressed because daddy went on a business trip”, or “pooped on the floor out of spite”. We’re very good at projecting emotions onto our animals that are not there.

The pet may not know that they are participating in an experiment, but the pet owner knows, and the pet owner is the one reporting perceived effects of treatment. This is why placebo-controls in veterinary medicine are as essential as they are in human medicine.

A placebo is pretty well defined by the Oxford English Dictionary: “A drug, medicine, therapy, etc., prescribed more for the psychological benefit to the patient of being given treatment than for any direct physiological effect; esp. one with no specific therapeutic effect on a patient's condition, but believed by the patient to be therapeutic (and sometimes therefore effective). Also: a substance with no therapeutic effect used as a control in testing new drugs, etc.; a blank sample in a test”

Obviously, since the placebo effect can be so powerful, especially with respect to pain, anxiety, and other subjective issues, placebo trials must be conducted in order to separate remedies or medicines which affect physiology directly from remedies or medications which affect someone psychologically – it does mot matter if the pill is a sugar pill, a starch pill, a lactose pill or – dare I say – a homeopathic pill chemically identical to a sugar pill – the individual took a pill, and their belief that the pill will relieve their symptoms causes their symptoms to be relived. That’s a placebo.

Now, if a homeopathic, herbal, or X-type of medicine remedy has the same effects as a sugar pill, one can reasonably conclude that the remedy is inert physiologically. That is, it has no effect beyond the same effects seen in a sugar pill.

So, when companies market their remedies as being “80% effective”, but don’t tell you that the placebo arm of their study was also “80% effective”, people are being misled. Yet this is what homeopathic practitioners often do. In conventional medicine, if there is no difference between the effects of a placebo and the effects of a new type of medicine, then that medicine is discarded in favor of medicines in which there is an actual effect beyond the placebo effect. Complimentary and Alternative Medicine, on the other hand, seems to absolutely rely on the placebo effect to the point at which we may as well rename it to, “Complementary and Alternative Placebos” save for the fact that their effect will be diminished if people are aware they are being treated with placebo medicine.

Tomorrow, we discuss the importance of effect size!

Overall, K., Dunham, A., Homeopathy and the curse of the scientific method. The Veterinary Journal(2009)  180: 141-148
Online abstract

Carnival of Bogus* ; Homeopet: A rep emails me.

It's time for another installment of the Ziztur vs Homeopet saga.

For those of you who don't recall, Homeopet is a homeopathic veterinary product company that sells homeopathic products purported to help with animal ailments such as anxiety, cough, digestive upsets, hot spots, bladder incontinence, flea bite itch, travel anxiety, worms, bovine mastitis, etc.

I first came upon Homeopet's products ordering pet supplies online. Not long ago, they claimed to be the only homeopathic veterinary company to be approved by the FDA. As it turns out, they had approved labeling, but not FDA approval as such, because no homeopathic products are approved by the FDA and all products marketed as medication have to have approved labeling.

To give you an idea, if you make a substantial claim for efficacy (such as, "shrinks your tumors 50% in 2 weeks) you have to prove that your product can do this. If you make an unsubstantiated claim (such as, "boosts immunity!") then you don't have to prove your product can perform because your language is ambiguous. The FDA will approve the labeling of products with claims such as this, because essentially the labels aren't saying anything. The products are not approved, but the labels for the products are approved. This may sound like a small difference, but it prevents people from claiming that their drug can cure diseases it can't actually cure. What it does not prevent is a company making nonspecific and vague but scientific-sounding claims.

Homeopet also used to claim that their products were organic. To claim your product is organic, you have to have approval from the USDA. They did not have such approval.

Homeopet has since removed FDA approval claims and organic claims from their product page. You can find my original four blog posts on the subject here, here, here and here.

The other day I received an email from a marketing rep for Homeopet. Said marketing rep said these things:

1. They are an evidence-based company, given that they have funded and documented double blind placebo controlled trials "conducted in Universities by veterinary professors".

I am especially happy that this company has funded such robust trials, because they indeed have conducted double blind, placebo controlled trials. However I was only able to located the published article of one of the trials, and the results indicate (quote directly from article):  "No evidence for the specific efficacy of homeopathy for the treatment of fear of noises was found in this study."  My original thoughts on this article are here, and an online abstract is here.

Overall (2009) similarly concluded that there was no evidence for the efficacy of the homeopathic treatment in this study, suggesting that the conclusions could be made to be more robust, I.E. "there is no effect of the homeopathic 'treatment'" and that "dogs suffering from fear associated with the noise of fireworks will not benefit from the 'treatment' with the homeopathic preparation". I will be writing up my thoughts on the Overall article in a future post, because it was an extremely well written account of why medicine must move past observation and into the testing of mechanisms and hypothesis if it is to be robust science. To put it bluntly - if a treatment does not work any better than a placebo, then the treatment doesn't work.

In order to make an informed decision, individuals need to not only know that these studies were carried out, but the methodology and results of these studies. This information can best be covered by access to published research articles, publications indicating the ratio of unpublished articles to published articles, the ratio of studies with positive findings to neutral or negative findings, etc. Thus far, all of the evidence I have leads me to conclude that the treatment testes is no more effective than a placebo. Homeopet asserts on their website that they have conducted double blind trials of their products, but does not tell the consumer the methodology and results of said trials.

2. Homeopet keeps very complete records of products they sell, and no adverse effects have ever been reported.

Lack of adverse effects does not tell me about the efficacy of a product. If the product were chemically identical to a water solution, one would not expect adverse effects from it. If the product has no evidence of an effect, one would assume it would also have no evidence of adverse effects.

3. The rep sent me the abstract of a presentation in which results of another study would be presented. The abstract told me a few things, but I still feel the evidence for the efficacy of their treatments is lacking.

4. The rep gave me the names of individuals who had published research related to Homeopet, but gave me so little information that I was unable to locate journal articles. Perhaps my readers can help me locate the articles written by these people:

a. Peter Knowlan, published somethin in the Irish Veterinary Journal
b. Dr. Kersti Seskel, giving a presentation at the AVA conference
(I found information on someone named Kirsty Seksel giving a presentation on homeopathy at the conference (ref)
c. Dr. C. Edgar Schaefer, published a paper on bovine mastitis.
d. Dr. Shelia Andrew also published a mastitis treatment paper in Blackwell

I e-mailed them back and thanked them for the info. The rep responded, telling me I should ask the FDA for copies of their labeling approvals. The rep also said that as a research student I should understand that they could not provide copies of articles.

I replied, telling them that I did understand that, but nothing should preclude them from providing me with complete references. I gave an example of what a complete reference looked like by giving them the reference from the one article I was able to locate.

The rep responded, saying that the particular article I referenced (the one that said there was no evidence for the efficacy of their remedy) should be a great example of their research. He told me he would ask someone else (on vacation currently) to provide me with complete references and told me to review the case studies at the Homeopet pro site. Last, he mentioned that samples of the products are given out to veterinary professionals, and asked me to "ponder the logic in any company sending out ineffective products to a professional."

I am not sure why he cannot provide me with the research articles itself, and the Pro site gives a bunch of case studies anecdotes, which are such weak evidence that they can hardly be labeled as such.

Later, he e-mailed me again to let me know that they are the first veterinary homeopathic company to apply for drug registration in Canada, that they have a marketing permit in Australia and the UK.

It is interesting that Homeopet sells so many different products, but have only tested a few of them. The evidence for the efficacy of these few products is thus lacking, and so I feel that I can appropriately apply the title of bogus* to the use of homeopathic remedies to treat ailments in animals (and also humans, for that matter). It stands to reason that given the 95% confidence intervals commonly used in various research studies, that if all of a company's ineffective products were tested, 5% of the tests would result in a false positive. I'd like people to ponder the logic of claiming that a product a company sells is effective when it's efficacy has not been tested. I'd like to see companies doing research on all of their products, not just a select few, and I'd like to see more robust, repeatable results.

*deliberate deception not implied

Refs:
Overall, K., Dunham, A., Homeopathy and the curse of the scientific method. The Veterinary Journal (2009) 180: 141-148
Online abstract

Faith reduces errors on psychology test

From World Science

At least for one type of test, be­lief in God can help re­duce mis­takes and anx­i­e­ty, ac­cord­ing to new re­search that al­so shows dis­tinct brain ac­ti­vity pat­terns in be­liev­ers.

In two stud­ies led by Uni­ver­s­ity of To­ron­to psy­cholo­g­ist Mi­chael In­zlicht, par­ti­ci­pants per­formed a Stroop task, a well-known psy­chological test that as­s­eses cog­ni­tive con­trol. Mean­while, elec­trodes meas­ured brain ac­ti­vity in the test-takers.

At least for one type of test, be­lief in God can help re­duce mis­takes and anx­i­e­ty, ac­cord­ing to new re­search that al­so shows dis­tinct brain ac­ti­vity pat­terns in be­liev­ers.

Com­pared to non-be­liev­ers, In­zlicht found, re­li­gious par­ti­ci­pants showed sig­nif­i­cantly less ac­ti­vity in a part of the brain called the an­te­ri­or cin­gu­late cor­tex. This struc­ture is be­lieved to help mod­i­fy be­hav­ior by sig­nal­ing when at­ten­tion and con­trol are needed, usu­ally as a re­sult of some anx­i­e­ty-producing event like mak­ing a mis­take.

The stronger their re­li­gious zeal and faith, the less cell ac­ti­vity in that zone-and the few­er er­rors sub­jects made, In­zlicht and col­leagues re­ported. They de­tailed the find­ings in the cur­rent on­line is­sue of the re­search jour­nal Psy­cho­log­i­cal Sci­ence.

The anterior cingu­late cor­tex might be thought of as an "alarm bell" that rings when some­one "has just made a mis­take or ex­pe­ri­ences un­cer­tain­ty," said In­zlicht. "We found that re­li­gious peo­ple or even peo­ple who simply be­lieve in the ex­ist­ence of God show sig­nif­i­cantly less brain ac­ti­vity in rela­t­ion to their own er­rors. They’re much less anx­ious and feel less stressed when they have made an er­ror."

These cor­rela­t­ions re­mained strong af­ter tak­ing in­to ac­count per­son­al­ity and cog­ni­tive abil­ity, In­zlicht re­marked. The find­ings, he added, show re­li­gious be­lief has a calm­ing ef­fect on its devo­tees, which makes them less likely to feel anx­ious about mak­ing er­rors or fac­ing the un­known.

The Stroop task meas­ures a per­son's abil­ity to in­hib­it one re­ac­tion in or­der to do or say some­thing else that gives a cor­rect an­swer. For in­stance, a test-taker might be asked to quickly state the col­or ink in which a word is printed, though the word it­self names a dif­fer­ent col­or.

In­zlicht de­clined to ex­trap­o­late too much from the test re­sults to real life, cau­tion­ing that anx­i­e­ty is a "double-edged sword" that is some­times nec­es­sary and help­ful. Ex­ces­sive anx­i­e­ty may leave you "par­a­lyzed with fear," he not­ed, but "it al­so serves a very use­ful func­tion in that it alerts us when we’re mak­ing mis­takes." With­out that, "what im­pe­tus do you have to change or im­prove your be­hav­iour so you don’t make the same mis­takes again and again?"

I think that the last paragraph here about excessive anxiety or no anxiety is taking two extreme cases and commenting on them, which really says very little about typical people. I also find this test amusing because I don't fit the results - I do very well on stroop tests - I really freaked out fellow students when we took them in groups during class to learn about them with an "inhuman" ability to fly through them. I wonder what that says about me?

Twinkie Torture: Update

Finally!

This Twinkie has been sitting outside on my windowsill forever!

For those of you just joining us, in the middle of December I decided to stick a Twinkie on my outdoor windowsill, and stick another Twinkie above the door in my apartment.  The original post is here, where I photographed the Twinkies to show that after two weeks of exposure, they were exactly the same.

My most recent update showed the outdoor Twinkie covered in snow, but nontheless still a complete snack food. The post can be found here.

After eight and a half weeks, something has finally changed:

 

Feast your eyes on this! It appears that some birds finally decided that the Twinkie had aged enough to be worth eating. You can see little bits of it picked off, and crumbs nearby. It looks like they nibbled at the cakey outside but didn't touch the cream inside. 

The one above my windowsill is, if course, the same. The other day I picked it up and it was rock-solid.

Faith Infiltration: New Testament Fellowship

You've got to admit, any church that has fractals on it's homepage gets at least one point. Such is the case with New Testament Fellowship Church, our first "non-denominational" faith infiltration.

Enter the sanctuary, and you're greeted with... a rock concert for Jesus. They had it all - huge projection screen, a drummer behind a drum shield that still managed to be loud, electric guitars and bass, keyboards and the like, with a male singer belting out tunes in a gravely voice. The sanctuary had a black ceiling with lighting equipment exposed, and more contemporary graphics like the ones on the website. No crosses. No stained glass. No pews. People dancing in their seats. The guitarist even ran through the congregation and stood on a chair to rock out.

A song ended, and the projection screen above the pulpit went black. Sing along if you know the words, the leader said - and then they broke into an impressively good cover of Collective Soul's "Shine". The lead vocalist was nearly a clone of the lead singer of Collective Soul.

Music ended, and the sermon began - it was all about prayer. The pastor was a young guy wearing a hip shirt and jeans, and he spoke of how one can be best blessed by praying for others. It was generally a feel good message with a couple of interesting things thrown in:

1. The pastor told the congregation that there are "liberals out there in the left wing that really loathe Christianity." It's interesting how lots of Christians think that anytime someone disagrees with them it is hatred or loathing, and that this hatred or loathing is something that strengthens them, rather than making them question exactly why people speak out about Christianity. The Bible spoke of persecution, so any persecution proves the Bible was right. There are always going to be people that disagree with you, and generally they are not disagreeing with Christians because they are "bad" or "lost" and Christians are "good" or "saved".

2. The pastor told the congregation not to use prayer as a hammer - and he spoke of "abortionists" as the example. Rather than pray that they be "judged", pray that the lord bless them. This was, if not tolerant, at least more ethically acceptable to me than some of the other things I have heard churches say about abortion supporters.

3. The pastor actually used the A-word (!!), which is the first time we've heard it uttered by a pastor as part of a sermon. He said something like this, while on the topic of having faith, "Now, I know people will say they are atheists, and go ahead and let them say that because if they get into a jam, they'll pray too".  Okay, great. This is about the same as me saying, "Now, I know people will say they are theists, and go ahead and let them say it because when things get bad they'll admit they don't believe in God"

4. The pastor said that in this church, they aren't afraid to talk about whether or not prayer is really effective. Okay, cool. He actually cited a study (woa!) by Randolph Byrd, M.D. (and the dude actually said the name of the guy responsible for the study, he gets another point) that looked at intercessory prayer of cardiac patients in 1988. The study used about 400 patients, divided them into two groups, and had one group prayed for while the other group was not prayed for. The patients did not know they were being prayed for. The study was fairly sound in methodology but the significance of it was highly exaggerated. A good critique can be found here, but let's just say that the results were not impressive and not replicable. The study tracked 26 categories, and only six showed any significance, those six were related to one-another, and the significance was very small and easily traced to unperceived differences in the two groups or chance.

While the pastor was talking about tithing, he actually claimed that tithing for this church had a 90-day money-back guarantee. He said that if any new member of the church tithed for 3 months and then decided that God was a liar, he'd give them their money back. I'm not really sure what to think of this. I guess I can't be eligible because a non-existent thing can't lie.

He also decided to bring up the one story that gets Flimsy and my blood boiling - but I'll let Flimsy rant about tithing and Abraham in his section:

*Flimsyman:

Anyone who's followed this blog continuously might remember how much I hate Genesis 22.  This is the story of God commanding Abraham to kill his own son.  He gives no reason why, except, apparently, to test Abraham's loyalty to him.  This story is repulsive.  As I told Ziztur after the service earlier today, what amazes me about this story is how much Christians love it.  We've heard this story discussed in the sermon three times out of the few months we've been doing the faith infiltrations.  For the love of fuck, WHY?  This story is fucking disgusting!  Don't these people realize how absurd this story portrays their god as being?  Are they that blind?  FUCK.

Sigh.  Needless to say, I basically DON'T think highly of a church, ever, who mentions this story in a positive light.  They didn't help my opinion of them by using this story to illustrate that you should donate to the church.  The guy talked for ten minutes about how you should give because if you do God will give back to you and "You cannot out-give God."  Horseshit.  Your god is a monster, and your own sacred text demonstrates it.

Know anyone with quadriplegia who uses a manual wheelchair?

Hey!

Do you know anyone who lives in the St. Louis area who uses a manual wheelchair and has quadriplegia?

I am recruiting more people for a motion analysis experiment. The gist of it is that I am going to put reflective markers on my subjects and have them propel their wheelchair on 3 different surfaces (belted treadmill, roller treadmill, Over the ground) and look at the differences in the pattern their hand makes.

I need people with quadriplegia (due to spinal cord injury, CP, transverse myelitis, or whatever diagnosis) who use manual wheelchairs at least part of the time. The sudy takes place at Paraquad and will take about an hour and a half. My subjects will be compensated - You get $20.

Homeopet: curing anxiety (of dogs) with water

UPDATE: Homeopet is NOT FDA approved. They have since removed their FDA approval and organic claims. Their labeling is approved, but in my opinion this doesn't say much.


The other day I was on the website that I use to order dog and cat food. Yes, I order my dog food online. Why would I do that? Because it is actually cheaper. I don't feed my animals cheap food, mostly because cheap food is cheap due to being primarily made out of corn by products. Cats are obligate carnivores and while dogs are not, I prefer to feed my zoo with better food, not colorful corn nuggets sprayed with fats so the animals will eat them. The food I get for them is cheaper online and delivered to my house than if I bought it from the local store.

So I was browsing said website when I came across a line of products called HOMEOPET.

Homeo...Pet. I wondered if this might be homeopathic remedies for pets. The products are all $10.99 for a 15ml bottle (about half an ounce) and claim to cure all sorts of ailments - anxiety, cough, digestive upsets, hot spots, bladder incontinence, flea bite itch, travel anxiety, deworming, etc.

There is, and continues to be no sound scientific evidence that homeopathy works better than a placebo, which makes perfect sense. Homeopathy is often compared to traditional vaccines - with a vaccine, a small, safe amount of the sickness-inducing virus or bacteria is introduced into the body, and the body responds by building up an immunity. However homeopathy does not quite work this way. Homeopathic preparations as such typically uses minute amounts of a sickness inducing substance to reduce negative affects.

There is also a little bit of magic involved. Homeopathic remedies are diluted, and homeopaths claim that the MORE a remedy is diluted, the more powerful it becomes at healing. Counterintuitive, no? Some remedies are diluted so much that no trace of the active ingredients can be found in the homeopathic preparation. Homeopaths claim that water retains a "memory" of the once-there and now not there ingredients. Of course, this is a slap in the face to physicists everywhere, but it might make sense to the sub-science literate public.

So basically, if your kid has trouble with bed-wetting, if I drop one drop of a diuretic (A diuretic is any drug that elevates the rate of urination. Caffeine is one example) in gallon of water, shake it up, dilute it in a gallon of water, shake that up, and continue to do so until the formula is one part per trillion (there are one trillion ml of water in 34 thousand olympic-sized swimming pools...) and sell it in 15oz vials for $10.99 and have your kid put 10 drops of it under his tongue before he goes to bed, it's supposed to help him stop bedwetting. The only magic here, if you'll pardon my ad hominem, is that anyone actually would buy this shit.

Onward.
I decided to pay a visit to Homeopet's website. you'll notice they use phrases like, "veterinary experts agree", world-renowned researchers", "eminent scientists" and "notable Universities" without telling use who any of these people are. They also claimed at the time I wrote this post to have FDA approval.

I searched the FDA website for any information on this company. I found only a warning letter which basically stated to the company that they were making unapproved claims about their products. This counts as FDA approval? If you sell a product to treat an ailment, if it makes any solid claims, you must have proof to make those claims in order to have FDA approval. Or, you can make spurious claims like, "helps boost immunity" that don't really mean anything and get approval that way.

I also decided to read the research article on one single product published in regard to this company. (Cracknell 2007) I was impressed, because it was actually a good study! It was a double-blind placebo controlled study with 75 dogs who were afraid of fireworks, and the study took place during a holiday in the UK where fireworks go off for about 3 weeks on a nightly basis. It makes my neurons tingle happily when people actually conduct good scientific studies. So there are, of course, results! The super short summary of the results: the product in question has the same affect as a placebo. In simpler words, it doesn't work. A quote from the article directly:

"No evidence for the specific efficacy of homeopathy for
the treatment of fear of noises was found in this study."

I find it quite amusing how the company interprets this study. A quote from the site now:

"Of those 25 dogs, the owners reported that 23 (92%) benefited from treatment (Figure 2). These owners indicated that they would use the product again, providing substantial evidence for the client satisfaction that can come from use of HomeoPet products."

Would you pay $10.99 for 15ml of.. water and various minutes amounts of other things? With magical properties that do.. what exactly? Ahh... the placebo affect... What a powerful force.

Homeopet products are sold everywhere online. A Google search of the word "Homeopet" revealed 125,000 hits. I did a quick scan and noted the first twenty pages were all sites selling this product. Homeopathy is a confusing branch of non-evidence based medicine that was unfortunately grandfathered in to the FDA - why they don't grandfather it the hell out, I don't know.

Reference:
Cracknell, N., Mills, D. A double-blind placebo-controlled study into the efficacy of a homeopathic remedy for fear of firework noises in the dog (Canis familiaris) The Veterinary Journal (2008) 177:80-88

(Un)scientific Testing, day3
Flimsy: H1: 50:5/10 (total: 150:28/5.35) H2: (50:8/6.25 (total 150:29/5.17)
Ziztur H1 50:9/5.55 (total : 150:19/5.35) H2: 50:11/4.54 (total 150:28/5.35)
(Click link for explanation.)

(Un)scientific psychic testing, V2.0!

Ever since Flimsy and I decided to roll some dice and try to see if we could guess the numbers, we've been curious about the results. Here were the results out of 40 rolls:

Me: 11 correct guesses - I guessed correctly 1: 3.63 times (Chance is 1:6)
Flimsy: 3 correct guesses. He guessed correctly 1:13 times.
Combined: Combined, we guessed correctly 1:6.15 (pretty much chance)

We've been playing Confrontation and Warhammer (I prefer Confrontation...) and seriously, Flimsy rolls TONS of ones. Last time we played Confrontation, I had the last man standing only because he was rolling ones like one out of every three rolls. I rolled maybe 3 ones during the entire 5 hour game. We always just grab random dice so I don't think it's the particular dice we use. Or is it?

Neither of us believe we can intuit where the dice will roll or influence dice rolls psychically or psychokinetically. But science is not about what you believe or don't believe - ever. Science is about where evidence, observation and rational thinking lead. So we've decided to extend our dice rolling experiment. We're going to perform two experiments:

1. Hypothesis: When attempting to guess where a die will fall when rolled, we will guess correctly 1:6 times, consistent with chance.
Subjects: Myself and Flimsy
Equipment: Random die chosen out of a bag of 100 6-sided dice, my kitchen table, and this computer to record our results
Method: Each subject will pick a die out of a bag of 100 dice. The subject will sit at the table, hold the die in his or her hand, and attempt to guess which number will land facing up on the table. The subject will call out the number they think the die will land on. The subject will cup the die between two hands and shake the die for five seconds. The subject will then drop the die on the table from a height of 6 inches. The subject will do this 50-100 times each night until the number of rolled die reaches 1,000. The number of times the die is rolled will be determined before die rolling begins.
Data collection: Either Flimsy or I will record the number of dice thrown, The number the subject guessed, the number facing up when the die stops rolling, and whether or not the subject correctly guessed the number rolled on the die.
Weaknesses: Obviously, Flimsy and I could lie about the number of hits or misses. The dice, being gaming dice and not perfectly weighted dice, could roll some numbers more often than others.



2. Hypothesis: When attempting to influence the number facing up on a die when rolled psychokinetically, subjects will roll a number corresponding to the number they attempted to influence 1:6 times, consistent with chance.
Subjects: Myself and Flimsy
Equipment: Random die chosen out of a bag of 100 6-sided dice, my kitchen table, and this computer to record our results
Method: Each subject will pick a die out of a bag of 100 dice. The subject will sit at the table, hold the die in his or her hand, and attempt to influence the number that rolls psychokinetically. The subject will try to influence the way a die rolls in consecutive order, I.E. Attempting to get the die to roll a 1, then a 2, then a 3, then a 4, then a 5, then a 6 then a 1 and so on. The researcher will tell the subject which number he or she is attempting to roll. The subject will cup the die between two hands and shake the die for five seconds. The subject will then drop the die on the table from a height of 6 inches.The subject will do this 50-100 times each night until the number of rolled die reaches 1,000. The number of times the die is rolled will be determined before die rolling begins.
Data collection: Either Flimsy or I will record the number of dice thrown, The number the subject attempted to roll, the number facing up when the die stops rolling, and whether or not the number the subject was attempting to influence was the number rolled.
Weaknesses: Obviously, Flimsy and I could lie about the number of hits or misses. The dice, being gaming dice and not perfectly weighted dice, could roll some numbers more often than others.

Our guess (which you should have gathered from the hypotheses) is that our individual and combined results will be consistent with chance. So what do we do if our results are far above or below chance? What does that mean? It will be interesting to discuss flukes, coincidences, poor methodology, etc. Should we record video of each test for analysis?

I will keep you updated on the nightly numbers by posting them with my 8:00 AM post. They will appear at the bottom of the post in this format:

(Un)scientific psychic test update:
Ziztur: correct guesses out of the number of dice rolled, and ratio from the previous night and overall total.
Flimsy: correct guesses out of the number of dice rolled, and ratio from the previous night and overall total.

Therapeutic Touch: disprovable by children

Therapeutic Touch, or TT, is a practice first developed by Dr. Dolores Krieger, RN and Dora Kunz, in 1972. It is used widely by nurses as a purported means of healing the body. Many practicing nurses today have learned how to do TT, and TT is taught in seminars and college courses throughout the US and other countries. More than 100,000 people have been taught the technique.


TT practitioners claim that humans have energy fields that can be manipulated by a TT practitioner by touching the energy fields of the individual with the hands. The TT website states that the Therapeutic Touch process works like this:

Centering - bringing the body, mind, emotion to a quiet, focused state of consciousness. Centering is using the breath, imagery, meditation and/or visualizations to open one's self to find an inner-sense of equilibrium to connect with the inner core of wholeness and stillness.

Assessing - holding the hands 2 to 6 inches away from the individual's energy field while moving the hands from the head to the feet in a rhythmical, symmetrical manner.  Sensory cues such as warmth, coolness, static, blockage, pulling, tingling are described by some practitioners.
Intervention- Clearing also called unruffling - facilitating the symmetrical flow of energy through the field.  Unruffling is achieved by using hand movements from the midline while continuing to move in a rhythmical and symmetrical manner from the head to the feet. Balancing, Rebalancing - projecting, directing and modulating energy based on the nature of the living field; assisting to re-establish the order in the system.  Treatment is accomplished by moving the hands to the areas that seem to need attention - energy may be transferred where there is a deficit or energy may be mobilized or repatterned from areas of congestion.
Evaluation/Closure - finishing the treatment - using professional, informed and intuitive judgment to determine when to end the session.  Reassessing the field continuously during the treatment to determine balance and eliciting feedback from the individual are cues as to when to end the TT treatment.

 So, TT practitioners claim that humans have an energy field, and by manipulating the energy field air 2-6 inches away from the client with their hands, TT practitioners can heal people. Obviously, if nurses all across the country are getting certified as TT practitioners, there must be plenty of evidence that it works, right?

Not so much.

In the 1998, a fourth grader named Emily decided to test TT practitioners as part of a science experiment. (Rosa et al., 1998; Glickman & Gracely, 1998) She reasoned that if this human energy field existed, and if TT practitioners claimed to be able to manipulate it to help heal people, and if TT practitioners claimed to be able to feel the energy fieled (it would be pretty hard to manipulate it if you could not sense if it were there or not) then they rightfully should be able to detect it.

Her experiment was simple: get 21 TT practitioners, have them sit on one side of a cardboard screen and put both of their hands through holes in the screen. Then, she stuck her hand over either the left or the right hand of the TT practitioner, a few inches above it.

The results were:  The TT practitioners guessed the correct placement of her hand 44% of the time - less than chance. Emily's study was eventually published in the Journal of the American Medical Association, and she became the worlds youngest person to ever be published in a peer-reviewed research journal.

Emily's study has been criticized, of course, by the proponents of TT. Among other things, it was argued that her study contained too few subjects, and should not have been performed by Emily herself, as she developed the study design. 21 subjects is plenty, actually, and researchers often conduct studies they themselves design. If the design is sound, there is no reason for them not to do so. It was also suggested that having the intention of doing the greatest good for the person being treated was not present in a nonhealing task like choosing between two hands and therefore invalidates the findings. Intention or not, if you can't detect the energy field you claim you can detect, that seriously weakens your claim.

Another criticism of the research is that:

mainstream medical journals are grounded in money and power and not likely to publish research on alternative treatments that save consumers money.

 Here we come upon the greatest insult to medical professionals it is possible to make - that we really don't want people to be healthy and will try to suppress treatments that are effective and save money. Of course we want people to be healthy. We spend our entire lives researching ways to make people feel better, to make treatments cost effective, and to make sure the treatments we have actually work. To suggest otherwise is disgusting. Further, the beauty of "mainstream medical journals" is that they are cutthroat and peer-reviewed. We remove the ivory tower, arguments from authority by offering up our research for criticism by anyone who wants to bother to read it. The beauty of science and evidence-based medicine is that it is not grounded in money and power - the evidence leads where it leads. If research is not sound, it does not matter whose research it is.

Other studies have found that TT is no more effective than a placebo. Of course, TT practitioners make reference to quantum physics without explaining how quantum physics supports TT (Mathuna, 2002). Because quantum objects have properties not found in the macroscopic world, problems arise when people try to philosophically or metaphysically interpret quantum physics. (Spector, 1990) TT practitioners have failed to incorporate mixed or negstive findings in reports of TT efficacy, and among the research conduscted that shows a positive result of TT efficacy, most of them are methodologically flawed. As such, TT research reviews misrepresent research results. (O’Mathúna, 2000). that Mathuna studies concluded that:

it is unethical and reckless
to promote TT, or to practice TT on any patient
who has not been expressly forewarned as to the
speculative and unproven nature of its claims and
who has not been properly advised about evidence-based
alternatives to TT.

References:
Rosa L., Rosa E., Sarner L. & Barrett S. (1998) A close look at therapeutic touch. Journal of the American Medical Association, 279, 1005–1010.Spector M. (1990) Mind, matter and quantum mechanics. In: Philosophy of Science and the Occult, 2nd edn (ed. P. Grim), pp. 326–349. SUNY Press, New York.
Mathúna, D.,  Pryjmachuk, S., Spencer, W., Stanwick, M., Matthiesen, S. A critical evaluation of the theory and practice of therapeutic touch. Nursing Philosophy (2002) 163-176
O’Mathúna D.P. (2000) Evidence-based practice and reviews of therapeutic touch. Journal of Nursing
Scholarship, 32, 279–285.

What the $&#@ is an ignostic?

So what is an ignostic?

An ignostic is a person who ignores questions of the existence of god until a coherent definition of god is produced. All discussion of god is meaningless until a meaningful definition of god is established. Meaningful, in this case, refers to a definition that is capable of being falsified (I.E. Proven false)

If your definition of god cannot be falsified, then your definition is meaningless. One cannot meaningfully claim that some entity exists if one cannot coherently define it.

Since the word "god" has many different meanings, when someone says "god exists" it is possible for many different prepositions to be asserted. For each individual person's meaning of the word "god", there will be atheists, agnostics, and theists relative to that particular concept of god.

So I am ignostic with regard to your definition of god until you can formulate a coherent definition of it.

References:
Ignosticism: Internet Infidels
Wiki on ignosticism

Super (un)scientific psychic testing!

A friend of mine e-mailed me after I sent her a link to this blog proclaiming that one of us must be psychic. Her reasoning: She was thinking of starting her own blog on her own web domain yesterday, and today when she got online, she saw that I had done exactly that. She knows I don't believe in the supernatural, and that includes psychic abilities, so she joked that since I refused to admit it was me, it must be her.

So I decided to test my psychic abilities.
My guy and I performed two tests:


1. Try to guess the number that will come up on one rolled die.
Out of 40 rolls, I guessed correctly eleven times. This is actually far above chance. To be average, I would have had to have six or seven correct guesses. My Guy guessed correctly three times - far below chance.

2. Try to guess whether the other person is thinking of the number 1, or number 2. For this, my guy or I would say, "go" and then think, " 1 1 1 1 1 1 1 1 1 1 1" or " 2 2 2 2 2 2 2 2 ". The other person would try to guess. We did this 12 times each. I guessed correctly 6 times, and he guessed correctly 5 times.

Some people might say that I am slightly psychic, and my Guy is slightly unpsychic due to the dice rolling test. But statistically, even though I had an above-average number of hits, this one test alone does not put me outside of the realm of standard chance. It's simple statistics to realize that if you've got 40 dice rolles, most people will get an average number of hits, some people will get a below or above the average number of hits, and some people will be VERY above or below the average number of hits. One test is not enough to show anything at all. Now, if I performed this test 100 times and still scored above average, we might have something going on.