The newest Richard Cheese album is available for pre-order, featuring lounge-ified versions of "Supersonic," "Bohemian Rhapsody," "Light My Fire," "Freebird," and "My Neck, My Back."
Brad Templeton, chairman of the board of the Electronic Frontier Foundation, has produced his own "Downfall" parody video, making fun of the fact that Constantin Films has issued DMCA notices to remove all of the "Downfall" parody videos from YouTube:
This is part four of my summary of the Science-Based Medicine conference at TAM7, which will be followed by a summary of TAM7 itself. Part one, Dr. Steven Novella's introduction, is here. Part two, Dr. David Gorski on cancer quackery, is here. Part three, Dr. Harriet Hall on chiropractic, is here.
The next session was Dr. Kimball Atwood, an anesthesiologist who is also board-certified in internal medicine and associate editor of the Scientific Review of Alternative Medicine. He spoke on "Why Evidence-Based Medicine is not yet Science-Based Medicine," or "Do Clinical Studies of Highly Implausible Methods Help or Hinder?"
Dr. Atwood's talk made some points right at the start similar to the critique of evidence-based medicine (EBM) given in Dr. Novella's introduction--that EBM makes the mistake of devaluing what he called "pre-clinical knowledge." Unlike Dr. Novella, however, he also stated that random controlled trials (RCTs) "cannot, by themselves, overturn well-established medical principles." I'm not sure that his talk actually demonstrated that point--as stated, it sounds like "well-established medicalscientific principles" are part of a "hard core" of medical theory (in Imre Lakatos' sense) that cannot be refuted even if found to be in conflict with empirical results, because they are shielded by the addition of auxiliary hypotheses to salvage it. I don't think that was his intent, as surely even "well-established medical principles" should be eligible for revision in light of contrary empirical evidence. Instead, what I think he meant by "pre-clinical knowledge" and "well-established medical principles" is really more like a demand for consilience with the rest of scientific knowledge, adherence to logic and mathematical principles, and having a plausible mechanism (or at least not having a purported mechanism in conflict with other known facts). More on that in the "Q&A" section, below. [UPDATE (July 21, 2009): As Dr. Atwood notes in the comments, I incorrectly transcribed what his slide said. Also note his further discussion on what he means by a "plausible mechanism.]
He began his talk with an overview of EBM--EBM advocates, to quote EBM pioneer David Sackett, "use of the best available evience, especially from patient-centered clinical research." It relies on randomized controlled trials and systematic reviews. Dr. Atwood gave two examples of successes of EBM. First was the standard practice of giving heart attack patients anti-arrhythmia drugs post-myocardial infarction, which EBM trials showed causes excess deaths and was an incorrect practice. Second was the Women's Health Initiative study on hormone replacement theory, which showed that risks exceed benefits for taking estrogen. (I'm no authority, but I am skeptical of this claim based on my understanding of the flaws in that study from conversations with the late Chris Heward, who is co-author on a paper in Fertility and Sterility that challenged the WHI study for methodological flaws which made it unable to detect cardioprotective effects.)
The four steps of "pull" EBM are:
formulate an answerable question
track down the best evidence
critically appraise the evidence
individualize, based on clinical expertise and patient concerns
Atwood stated that those in practice the longest perform the worst, by not keeping up to date with their fields.
Cochrane Collaboration Atwood next turned to the Cochrane Collaboration, the organization that maintains a library of EBT results, classified by type of evidence and evaluated with reviews in the form of evidence statements and recommendations. He gave a few examples, such as a statement about the effect of physical activity on dementia: "[There is] insufficient evidence to determine the effectiveness of ... physical activity programs in managing or improving ... dementia." And a seemingly equivalent statement about the use of homeopathy for the same purpose: "In view of the absence of evience, it is not possible to comment on the use of ... homeopathy in treating dementia." This, according to Dr. Atwood, is B.S. -- Bogus Science. Why don't they just say that homeopathy doesn't work? Because there are no sound clinical trials in the database.
EBT categorizes evidence into three classes. Class I evidence involves randomized controlled trials (RCTs). Class II involves controlled trials without randomization (or several other forms of case-control studies). Class III involves one or more case studies of a treatment without a control group and is considered insufficient for a treatment to be called "evidence-based medicine." Within each class there are further divisions, for example, Class I is broken down further, with systematic reviews of RCTs at the top (1a), followed by individual RCTs (1b), and so forth.
Atwood objected that this devalues pre-clinical knowledge by making "evidence" synonymous with clinical trials, and that therefore EBM "is not based on all of the evidence." He provided a few more examples of complementary and alternative medicine (CAM) treatments from Cochrane, described with terms like "Not enough evidence to ...," "little evidence," and, in the case of laetrile as a cancer treatment, "No studies found that met inclusion criteria." There was, however, a 1982 New England Journal of Medicine clinical trial on 180 patients which yielded a negative result and the conclusion that the treatment is dangerous, but this constituted a case study at the lowest level of evidence in EBM.
Atwood quoted a statement from Edzard Ernst, co-author with Simon Singh on the chiropractic-critical book, Trick or Treatment, to the effect that "a priori plausibility has become less and less important" as a result of EBM (which Ernst advocates).
He then continued with more CAM treatments in Cochrane, such as craniosacral therapy, reflexology, Kirlian photography ("may be more reliable than chance"), and therapeutic touch ("remains controversial").
Homeopathy Atwood then described the case of homeopathy in order to make his central argument critical of EBM. Samuel Hahnemann invented homeopathy in 1796, on the basis of two principles. The first principle is "similia similibus curantur," or "like cures like," or the "law of similars." This claims that if you find a substance that gives you symptoms similar to an illness, that's the substance you use to cure that illness. Hahnemann read in William Cullen's "A treatise of the materia medica" that cinchona bark could be used to treat malaria (now known to be true because of quinine in the bark). He gave himself a sample of that bark while healthy and observed that he developed symptoms that were similar to malaria. From this single example, he concluded that all medicines produce symptoms in healthy people similar to the symptoms of diseases they effectively treat.
The second principle of homeopathy is the "law of infinitesimals." He reasoned that dosages sufficient to produce overt symptoms were too high, so the substances should be diluted in order to provide an effective treatment, and in fact the more diluted, the more powerful the cure. Homeopathic remedies of 24X (or 12C) are the equivalent of diluting 0.36mL of salt into a volume of water the size of the Atlantic Ocean. Hahnemann most commonly recommended an even greater dilution of 60X (30C). For all intents and purposes, homeopathic remedies of standard dilutions are indistinguishable from the water used to dilute them.
Atwood went on to note that homeopaths do not agree on prescriptions for various maladies.
On top of that, the outcome of all trials to date have been failures. This is a long list of powerful reasons for rejecting homeopathy, but the last one is the only one EBM considers relevant. There is clearly a very low degree of plausibility for homeopathy independently of such trials, and homeopathy is a clear case in point that "some hypotheses are too implausible to spend time on (or spend more time on)."
Prior Probabilities Atwood offered the following set of broad categories of prior probability and types of treatments that fall into them:
Prior probability of about zero: homeopathy, neurocranial restructuring (putting balloons up your nose and inflating them).
Prior probability significantly lower than (<<) 1: metabolic therapies for cancer, detoxification, chiropractic for any purpose other than back pain Prior probability very low: acupuncture for pain most popular herbal claims (St. John's wort, echinacea) Prior probability moderate to high: massage, relaxation techniques for anxiety reduction and chronic pain Prior probability depends on:
basic science
cogency of theory
previous studies
source
He then discussed Bayes' Theorem, which says that the odds of a hypothesis being true given certain evidence is equal to the odds of the hypotheses (prior probability) multiplied by the Bayes factor, which is the probability of the evidence given the hypothesis divided by the probability of the evidence given the null hypothesis. If the prior probability is near zero, then much greater evidence is needed in the Bayes factor to result in a probability of the hypothesis being true. (Note that Atwood gave the theorem partly in terms of odds rather than probability for the purposes of his talk. Odds = probability / (1 - probability).)
When Bayes' Theorem is taken into account, the p-value of a statistical result can become much less impressive. For example, with a p-value of .05, which means that a result would be expected to occur by chance 5 times in 100 with a Bayes factor of 2.7, if the prior probability is only 1%, that result only raises the posterior probability to 3%. If the prior probability is 20%, it raises it to only 40%. With a p-value of .01, a result expected to occur by chance only 1 time in 100, and a Bayes factor of 15, a prior probability of 1% is raised to 13%; a prior probability of 20% raised to 78%. Dr. Atwood provided a table with more detail that went up to p=.001 (result expected by chance 1 in 1000 times).
Dr. Atwood advocated that "prior probability ought to be formally considered in EBT," and gave the further example of a "positive" trial for intercessory prayer in the critical care unit (CCU) with an 11% reduction in some harm with a p-value of .04, and noted that if the prior probability was 1%, this still produces less than 6% odds of a genuine effect. A few other similar examples were given involving acupuncture, homeopathy, and distant healing, the final example of which had Edzard Ernst as a study co-author and concluded that it "warrants further study," but which he subsequently backed away from after "some positive trials [were] found to be fraudulent."
Finally, he noted that pre-trial knowledge is not sufficient, but is necessary for a treatment claim.
Q&A I asked Dr. Atwood if, in his final statement, he was saying that you have to have a plausible mechanism for a treatment in order for a treatment to be justified (a positive requirement), or if he only wanted to impose a negative requirement that the proposed mechanism or method did not contradict known facts from other realms. His initial answer was that he thought those would be equivalent, but I observed that we can discover cause-effect relationships without having any knowledge of the underlying mechanism, such as Mendel's discovery of genetics. At that point, he agreed that he just wanted to require the negative condition. Another audience member then suggested that this might be accomplished by creating a categorization scheme for levels of plausibility that in some way parallels the levels of evidence scheme.
Another questioner asked how to standardize assignment of prior probabilities and address bias, to which Dr. Atwood said that you could just pick neutral prior probabilities, since if you do enough studies the posterior probability of each study becomes the prior probability for the next.
EXTRA: As appropriate for a talk that touched on homeopathy, prior to Dr. Atwood's presentation this excerpt from the fourth episode of season three of "That Mitchell and Webb Look" was shown to the audience:
(Part five of my conference summary, on chronic Lyme disease, is here. Part six, on online health and social media, and the closing Q&A panel, is here.)
Bristol Palin held her first interview since giving birth Monday night with Greta Von Susteren. The 18 year old daughter of Alaska Governor Sarah Palin talked about her experience as a mother and her mother’s policies towards education.
“Mom says that science and stuff is too hard to force kids to learn. That the world is too complicated to have just happened by accident, and things like an eyeball show signs of a designer. She’s right, Bio is totally hard. But if you work at it, it does kinda make sense.”
She then went on a diatribe about carbon dating, genetic transference, and paleoanthropology.
Bristol held up her Lisa Frank notebook filled with equations and diagrams which categorically disprove the possibility of Intelligent Design.
“It’s a nice idea, but it’s just not realistic. I mean, Lucy? The entire pre-hominid fossil record? Hello??”
Sarah Palin, who was sitting in the room at the time, looked increasingly more uncomfortable. Eventually she broke the silence saying:
“Well now none of us were there so we can’t know for sure…”
“Omigod Mom, it’s called Gene Mapping, don’t even get me started!”
The two sat in an awkward silence until Sarah went into a speech thanking Von Susteren and the other personalities at Fox News for being the last saviors of Democracy. Bristol rolled her eyes and mumbled math equations under her breath.
Mike Nelson of Mystery Science Theater 3000 is behind Rifftrax, a website that allows you to download commentaries to play along with DVDs you watch. One of the commentaries currently available is for Ocean's Eleven and features Mike Nelson and our friend Richard Cheese. Many of the commentaries also feature MST3K writer and the voice of Tom Servo, Kevin Murphy, and MST3K writer and the voice of Crow, Bill Corbett.
Richard Cheese will be performing live on the radio this afternoon on Phoenix's KEDJ, 103.9 FM, at around 4:45 p.m. Arizona time, during Tim Virgin's show. You can also listen via the Internet via a link at the radio station's website.
Today's Arizona Republic has an article about Richard Cheese, who will be appearing at the Celebrity Theater on June 7 with his Lounge Against the Machine band. The article describes his roots in Arizona and the man behind the leopard-print tuxedo--who shared a table with me (we didn't have desks) in sixth grade. (Mark and I attended the same schools and were friends from third through eighth grade, then went different ways, though we have crossed paths from time to time since then, including when he got me a DJ job for ASU's campus radio station, KASR-AM, when we were both undergrads there. Sadly, KASR's call letters now belong to a sports radio station in Arkansas.)
Simon Owens at Bloggasm interviewed Michael Edmondson, creator of the "Beware the Believers" viral video that was widely acclaimed by critics of the film "Expelled" for its humor and polish. Apparently the segment was originally intended to be in "Expelled," but the producers decided to turn it into a viral video instead, since it didn't fit with the character of the film. (Insert your choice of snarky comment about how it didn't fit here.)
"Sexpelled tells of how Sex Theory has thrived unchallenged in the ivory towers of academia, as the explanation for how new babies are created. Proponents of Stork Theory claim that 'Big Sex' has been suppressing their claim that babies are delivered by storks."
Google today announced that its founders, Larry Page and Sergey Brin, have teamed up with Richard Branson of Virgin to form "Project Virgle," a project to form the first permanent human colony on Mars.
We've been watching reruns of "Millennium" on the Chiller channel, and just saw "Jose Chung's Doomsday Defense," about the fictional religion of "Selfosophy." This episode was written by Darin Morgan, who also wrote "The X-Files" episode, "Jose Chung's From Outer Space," one of the best shows of that series.
One big difference between Selfosophy and Scientology--the Selfosophists give the visiting cops copies of the Selfosophy book. Scientologists would have made them pay for it.
Charles Nelson Reilly, who played Jose Chung, just died last May. I was pleased to see that they worked a clip from the crazy Sid and Marty Krofft TV series "Lidsville" into the opening story of Selfosophy. Too bad they didn't also include a reference to "Uncle Croc's Block," which inspired me to some childhood musical creativity.
Reason is the enemy of faith, my friend
A head that's filled with knowledge
soon is too bloated with its own weight
to fit through heaven's gate
So think with your heart
it's the only organ for salvation
think with your heart
don't deduce yourself to eternal damnation
think with your heart
'cause you know that the almighty sees us
think only with your heart
whoever heard of the bleeding brain of Jesus?
think only with your heart
UPDATE (October 4, 2007): The comments on this post got way off track from what this song is saying, with olvlzl riding his own hobbyhorses to the extent that I think he completely missed the point. When he says to me, "If you don't agree with the song lyrics, I'm glad to hear it," I can only wonder if he bothered to read them. The lyrics are parody, expressing an extreme Christian anti-intellectualism that sees not only education but reason itself as something evil and in opposition to faith that must be avoided at all costs. Of course I disagree with that, as does anyone who values reason. What makes it funny is the extreme to which it takes the view--but what makes it disturbing is that there are anti-intellectual Christians who see knowledge and attempting to seek it as evil practices. They are the sort who say that all the knowledge they need is in the Bible (and these are often the King James Version only sorts, as well), so there is no need to read anything else.
olvlzl, by contrast, is looking at the reverse position, that there is no need for faith. But that's not what the song is about, or what "Moral Orel" is about.
The newest Richard Cheese album is available for pre-order, featuring lounge-ified versions of "Supersonic," "Bohemian Rhapsody," "Light My Fire," "Freebird," and "My Neck, My Back."
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