I came across a rather thought provoking article directed not at the question of Megrahi's guilt but at the wisdom (or not) of freeing him on compassionate grounds and at the hypocrisy of some of those who criticise this decision.
I tweeted a link to this "interesting" article and a number of fellow tweeters kindly re-tweeted my link. One re-tweeter, however, prefaced her re-tweet with the words: "The right decision". This is not a phrase I should necessarily go along with.
If I thought Megrahi were guilty beyond reasonable doubt of murdering 270 people, I think my feelings about releasing him on "compassionate" grounds would be (at the very least) equivocal - especially given his complete failure to exhibit any remorse or repentance.
The problem is, I am not convinced beyond reasonable doubt that Megrahi is guilty. Nor, I suspect, is Kenny MacAskill or anyone else in the higher echelons of the Scottish or British governments. Even if they are (or at one stage were) the impending second appeal - referred back by the Scottish Criminal Cases Review Commission - must have been concentrating minds.
In a rather silly (for him) article and even sillier follow up comment, Michael White of the Guardian suggests that we should put our trust in the judges (NB not a "conviction by jury" as FBI chief Robert Mueller claims) who originally found Megrahi guilty and that anyone who suggests otherwise is some kind of conspiracy theorist.
In response to Michael White I think it should be pointed out that miscarriages of justice have (historically) been the rule rather than the exception in high profile UK terrorist trials (even going back to the days of the Angry Brigade trials after which one of those convicted said that at least, in his case, "they framed a guilty man") and that the Scottish Criminal Cases Review Commission do not immediately strike me as being the sort of people who would concoct some kind of "it was all done by the CIA in league with the Martians" scenario.
As this article also argues, it is reasonable to assume that Megrahi was freed in order to avoid an appeal that. at the very least, would have raised serious questions over the Scottish justice system and the Lockerbie inquiry.
I tend to find that what politicians avoid talking about is more instructive than the things they do talk about. It is interesting that there is no mention whatsoever of the Scottish Criminal Cases Review Commission in Kenny MacAskill's statement on Megrahi.
Odd that, is it not?
2009-08-23
Lockerbie, Compassion, and Truth
On 1986 April 15, the USA bombed a number of targets in Libya killing 40 people (including Gaddafi's 15-month-old adopted daughter Hanna) and injuring many (including two of Gaddafi's sons). This attack was in retaliation for terrorists attacks such as the Achille Lauro hijacking of 1985 October 7, the Rome and Vienna airport attacks of 1985 December 27, and the 1986 April 5 bomb attack on a West Berlin disco, "La Belle", that killed two American servicemen and a Turkish woman and wounded 200 others. Libya (it was alleged, though this is denied by Libya) had a hand in each of these outrages (ref).
In 1993 October Margaret Thatcher (the UK prime minister from 1979 to 1990 and thus PM during the events related above) published her memoires: "The Downing Street Years". In this book she indicates her support for the bombing of Libya saying that, following this bombing raid "Libya never again mounted a serious attack on the West". Now this is a rather odd thing to say, because in 1988 December 21, flight Pan Am 103 was blown out of the sky half an hour after take-off by a suitcase-bomb (with - according to the "official" account - a long delay "Mebo" timer) allegedly sent from Malta to Frankfurt to London by Libyan intelligence officer Abdelbaset Ali al-Megrahi. This action resulted in 270 deaths - including that of Jim Swire's eldest daughter, Flora.
When Dr Swire wrote to Margaret Thatcher to ask about this apparent contradiction in her book, he "got a pompous letter back saying she had nothing to add." (ref).
Why has Margaret Thatcher "nothing to add"? The only possible explanation is that she knows something that she is reluctant to talk about.
Since she will not tell us what she knows, we shall have to speculate.
I speculate that she knows that Libya was not behind the Lockerbie attack.
If she knows this, then, I further speculate, so does Gordon Brown.
Let's look at the curious choreography of events: The withdrawal of al-Megrahi's appeal - an appeal that could have continued in spite of al-Megrahi's compassionate release or (alternatively) al-Megrahi's death in custody - followed by al-Megrahi's compassionate release; followed by a deafening silence from Number 10.
Forget "compassion" for someone who supposedly murdered 270 people; forget "oil deals"; the British and Scottish governments (I submit) know al-Megrahi is innocent and they fear that the appeal would have established this - with all the embarrassing consequences that such an outcome would imply. They have chosen the "least-worst" way out.
(Anyone inclined to dismiss all this a some kind of nutty conspiracy theory needs to bear in mind that any skulduggery practised by British and US intelligence was not intended to frame al-Megrahi in a trial that nobody (at the time) thought would ever take place, it was simply intended make Libya look bad. This sort of thing - spreading misinformation for geopolitical ends - goes on all the time. You can read what the chap who played the main role in setting up the al-Megrahi's trail (Robert Black QC) now thinks about the whole thing here: THE LOCKERBIE CASE.)
In 1993 October Margaret Thatcher (the UK prime minister from 1979 to 1990 and thus PM during the events related above) published her memoires: "The Downing Street Years". In this book she indicates her support for the bombing of Libya saying that, following this bombing raid "Libya never again mounted a serious attack on the West". Now this is a rather odd thing to say, because in 1988 December 21, flight Pan Am 103 was blown out of the sky half an hour after take-off by a suitcase-bomb (with - according to the "official" account - a long delay "Mebo" timer) allegedly sent from Malta to Frankfurt to London by Libyan intelligence officer Abdelbaset Ali al-Megrahi. This action resulted in 270 deaths - including that of Jim Swire's eldest daughter, Flora.
When Dr Swire wrote to Margaret Thatcher to ask about this apparent contradiction in her book, he "got a pompous letter back saying she had nothing to add." (ref).
Why has Margaret Thatcher "nothing to add"? The only possible explanation is that she knows something that she is reluctant to talk about.
Since she will not tell us what she knows, we shall have to speculate.
I speculate that she knows that Libya was not behind the Lockerbie attack.
If she knows this, then, I further speculate, so does Gordon Brown.
Let's look at the curious choreography of events: The withdrawal of al-Megrahi's appeal - an appeal that could have continued in spite of al-Megrahi's compassionate release or (alternatively) al-Megrahi's death in custody - followed by al-Megrahi's compassionate release; followed by a deafening silence from Number 10.
Forget "compassion" for someone who supposedly murdered 270 people; forget "oil deals"; the British and Scottish governments (I submit) know al-Megrahi is innocent and they fear that the appeal would have established this - with all the embarrassing consequences that such an outcome would imply. They have chosen the "least-worst" way out.
(Anyone inclined to dismiss all this a some kind of nutty conspiracy theory needs to bear in mind that any skulduggery practised by British and US intelligence was not intended to frame al-Megrahi in a trial that nobody (at the time) thought would ever take place, it was simply intended make Libya look bad. This sort of thing - spreading misinformation for geopolitical ends - goes on all the time. You can read what the chap who played the main role in setting up the al-Megrahi's trail (Robert Black QC) now thinks about the whole thing here: THE LOCKERBIE CASE.)
2009-08-19
Should the scientists counter-sue the chiropractors?
Let's just remind ourselves, the British Chiropractors Association is suing science writer Simon Singh because he wrote that the chiroprators don't have any evidence for many of their "treatments" but go ahead and use them anyway. (read Simon's side of the story here)
The BCA insisted that they did have evidence and went on to publish it. This "evidence" was promptly demolished by various bloggers: (see here for one of the demolition jobs and links to others)
But here's the thing:
Simon Singh also pointed out that chiropractic manipulation is not risk free and may, for example, be a cause of stroke
The BCA did not sue Simon over this, but if you go the the site of the General Chiropractic Council, you find a letter from one of their board members to Dr Miriam Stoppard (who had mentioned this danger in a Daily Mirror article):
The bit about confusing association and causality is itself confused. Consistent association between A and B does imply causality - it's just that the causality may be from A to B; from B to A; or from C to both A and B.
Moreover the statement that there is "no evidence" is untrue (see for example: here, here, here, and here - Thanks to @Blue_wode for these!)
Perhaps some pro-chiropractic bloggers might like to demolish these references.
But to come (finally) to the point (and leaving aside the question of who is right and who really has evidence) we have here a strange asymmetry:
Scientist accuses chiropractors of having no evidence and chiropractors sue.
Chiropractor accuses scientist of having no evidence and scientists don't sue.
Perhaps we should ;)
Jack?
At the very least, we should expose their hypocrisy - which I hope I've just done.
The BCA insisted that they did have evidence and went on to publish it. This "evidence" was promptly demolished by various bloggers: (see here for one of the demolition jobs and links to others)
But here's the thing:
Simon Singh also pointed out that chiropractic manipulation is not risk free and may, for example, be a cause of stroke
Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection. (ref)
The BCA did not sue Simon over this, but if you go the the site of the General Chiropractic Council, you find a letter from one of their board members to Dr Miriam Stoppard (who had mentioned this danger in a Daily Mirror article):
There is no evidence that examination or manipulation of the neck causes stroke. Journalists, and a few others, routinely confuse association with cause but as a registered medical practitioner you will be aware of the distinction. (ref)
The bit about confusing association and causality is itself confused. Consistent association between A and B does imply causality - it's just that the causality may be from A to B; from B to A; or from C to both A and B.
Moreover the statement that there is "no evidence" is untrue (see for example: here, here, here, and here - Thanks to @Blue_wode for these!)
Perhaps some pro-chiropractic bloggers might like to demolish these references.
But to come (finally) to the point (and leaving aside the question of who is right and who really has evidence) we have here a strange asymmetry:
Scientist accuses chiropractors of having no evidence and chiropractors sue.
Chiropractor accuses scientist of having no evidence and scientists don't sue.
Perhaps we should ;)
Jack?
At the very least, we should expose their hypocrisy - which I hope I've just done.
2009-08-16
How I survived the Aporkalypse
I could be pretentious and describe this as a "case-study", but it is really more a rambling anecdote and, as "eni fule kno" (apart, of course, from the BCA and other assorted purveyors of woo) anecdotal evidence is not the sort of thing you should base health policy on.
The subject of this blog was suggested by @carmenego and, since I am quite incapable of resisting flattery from attractive young women, here it is:
I can only assume that I picked up the H1N1 virus at Manchester Airport when dropping off my wife and kids. They were bound for three weeks in Germany with my parents in law. I was bound for three weeks of peace and quiet back home and chance to get a few things done – like building a garden wall.
First sign that anything was amiss was a slight sore throat a few days later. A couple of days after that, the sore throat was much much worse and accompanied by fever, headache, coughing on a scale I've never previously experienced, and those aches and pains and chills that go though every bone and joint in your body.
I got up to feed the cats and myself every so often, but for five days I could do little more than lie in bed. Couldn’t really enjoy TV (though that could have been to do with the fact that 90% of TV is utter rubbish) or reading or anything. I just didn't have the concentration.
Of course the same flu can affect different people in different ways: anywhere on a scale from not noticing you have it to being dead. It all depends on your immune status and what else might be wrong with you. I am in my early 50s and, like most men, suffer from hypochondria. I wasn’t always a hypochondriac. When I was young, I thought I was invulnerable; but then I started getting all sorts of nasty things wrong with me and this made me start to worry about things like my health.
One thing I had wrong with me was sarcoidosis. I won’t bore you with the gory details, but sarcoidosis is not great for your lungs and the fact of getting it rather suggests that something is awry with your immune system. So I worry about things like flu and new insults to my lungs.
I went on the internet and checked the list of symptoms. Of course, I had all of them and several more besides. I have an encyclopaedia of "Family Health" on my book shelf. I have the symptoms of everything in it. I am just like Jerome K Jerome in this respect, except that I have house-maid’s knee too. As I said, I’m a hypochondriac – though I never go near a doctor unless forced to by my wife.
Of course I have not been tested for the H1N1 virus, but H1N1 seems to be the only virus currently doing the rounds whose constellation of symptoms matches what I had.
Anyway, if you tick all the right boxes on the website, and fill in your details, they give you a reference number to pick up a supply of antivirals from your nearest distribution centre. They also said I should ring my GP, but certainly not go there. So I rang my wife for instructions. She also said I should contact the GP (I decided against this; what would be the point? In any case you can never get through to my GP) and that I should collect the Tamiflu. Max (aged 14) suggested that I re-sell the Tamilflu on the US eBay site (I hope he was joking). I decided to go and lie down instead. When I woke up I felt much worse and I decided that I needed something to supplement my diet of analgesics and tap water – and the occasional rum toddy.
Now it ought to be easy to kill viruses. It’s easy enough to destroy nucleic acids and that’s (by and large) what viruses are made out of. Trouble is, nucleic acid is also what some rather vital bits of us are made of too. Viruses can only work if they get inside your cells. Once they are inside a cell, that cell is basically buggered, but to move on to another cell, each virus (having made squillions of copies of itself inside the cell) has to build itself a new protein envelope and escape from the dying host cell. One of the ways of trying to stop viruses (none of which work terribly well) is to try to interfere with the process I’ve described. This is what Tamiflu does …… a bit.
So I rang up my "flu buddy" (she didn't actually know that she was my flu buddy until I rang her up but she very kindly "stepped up to the plate") and sent her off with my reference number, my photo driving licence (swabbed with CD cleaner); and her photo ID to collect my Tamiflu.
My flu buddy "@fiftynotout" came round, posted the Tamiflu through the letterbox, left me a bag of groceries, and painted a black cross on the door. She has been keeping me supplied with groceries all week since she drives out each day with her daughter who is learning to drive. I gather that if you don’t have anyone who can collect the anti-virals for you, you can arrange for somebody from the NHS (or "Death Panel" as Sarah Palin and co would have it) to drop you some off at your home.
(BTW @fiftynotout does not tweet very much. I think she joined because she had a crush on @StephenFry – though I gather she may have transferred her affections to @ProfBrianCox)
Did the Tamiflu work in my case? Impossible to say of course; it’s like the old joke about the man sprinkling elephant powder. But I did get better after taking it: post hoc but not necessarily propter hoc. The first two doses did seem to make me feel very queasy for while, but I did not actually vomit. From the third dose on, I had no problems – they give you ten doses to last five days.
Of course, given that Tamiflu is not terribly effective, can (like any drug) cause side effects (though these seem to be minimal), and will (sooner or later) almost certainly promote the emergence of resistance in the HIN1 virus, there is still an ongoing debate as to the wisdom of mass distribution. On the other hand, H1N1 can be fatal, Tamiflu may already be saving lives, and H1N1 may suddenly mutate a get a lot worse - if we did not have a working distribution system in place we'd be stuffed when this happened. Also, scientist are busy developing a vaccine - which will be very effective in preventing infection. The use of Tamiflu is just a stop-gap.
How bad is swine flu? Well again, I can only report my experience – which may not be yours. Apart from the coughing, I’d say that the acute symptoms get 8/10 – where the worse flu I ever had gets 10/10. The duration of incapacity and general malaise – eight days and counting – and the coughing are, however, much worse than anything I’ve experienced with normal seasonal flu.
Tweeting certainly helps with flu. It provides the vicarious sensation of having lots of people around expressing concern and interacting with you – not to be sneezed at (hah!) when you are stuck at home on your own. Also, though you can’t concentrate (or, in my case, even stay awake) for long enough to read a chapter of a book or watch a TV programme, you can sit up in bed with your laptop for five minutes and fire off the odd flurry of 140 character messages.
Of course I can’t offer medical advice but, I stayed in bed, drank lots of water and took paracetamol (2x500 mg) every eight hours alternated with ibuprofen. (NB Paracetamol is extremely safe if you stick to the correct dosages and extremely dangerous if you don’t!)
In conclusion: Thanks to my family for their frequent concerned phone calls, thanks to the Death Panel of the NHS for supplying me with free anti-viral drugs, thanks to everyone on Twitter who kept my spirits up during this experience, and a really big thank you to @fiftynotout – the best flu buddy anyone could have had.
The rest of you: Keep washing your hands!
The subject of this blog was suggested by @carmenego and, since I am quite incapable of resisting flattery from attractive young women, here it is:
I can only assume that I picked up the H1N1 virus at Manchester Airport when dropping off my wife and kids. They were bound for three weeks in Germany with my parents in law. I was bound for three weeks of peace and quiet back home and chance to get a few things done – like building a garden wall.
First sign that anything was amiss was a slight sore throat a few days later. A couple of days after that, the sore throat was much much worse and accompanied by fever, headache, coughing on a scale I've never previously experienced, and those aches and pains and chills that go though every bone and joint in your body.
I got up to feed the cats and myself every so often, but for five days I could do little more than lie in bed. Couldn’t really enjoy TV (though that could have been to do with the fact that 90% of TV is utter rubbish) or reading or anything. I just didn't have the concentration.
Of course the same flu can affect different people in different ways: anywhere on a scale from not noticing you have it to being dead. It all depends on your immune status and what else might be wrong with you. I am in my early 50s and, like most men, suffer from hypochondria. I wasn’t always a hypochondriac. When I was young, I thought I was invulnerable; but then I started getting all sorts of nasty things wrong with me and this made me start to worry about things like my health.
One thing I had wrong with me was sarcoidosis. I won’t bore you with the gory details, but sarcoidosis is not great for your lungs and the fact of getting it rather suggests that something is awry with your immune system. So I worry about things like flu and new insults to my lungs.
I went on the internet and checked the list of symptoms. Of course, I had all of them and several more besides. I have an encyclopaedia of "Family Health" on my book shelf. I have the symptoms of everything in it. I am just like Jerome K Jerome in this respect, except that I have house-maid’s knee too. As I said, I’m a hypochondriac – though I never go near a doctor unless forced to by my wife.
Of course I have not been tested for the H1N1 virus, but H1N1 seems to be the only virus currently doing the rounds whose constellation of symptoms matches what I had.
Anyway, if you tick all the right boxes on the website, and fill in your details, they give you a reference number to pick up a supply of antivirals from your nearest distribution centre. They also said I should ring my GP, but certainly not go there. So I rang my wife for instructions. She also said I should contact the GP (I decided against this; what would be the point? In any case you can never get through to my GP) and that I should collect the Tamiflu. Max (aged 14) suggested that I re-sell the Tamilflu on the US eBay site (I hope he was joking). I decided to go and lie down instead. When I woke up I felt much worse and I decided that I needed something to supplement my diet of analgesics and tap water – and the occasional rum toddy.
Now it ought to be easy to kill viruses. It’s easy enough to destroy nucleic acids and that’s (by and large) what viruses are made out of. Trouble is, nucleic acid is also what some rather vital bits of us are made of too. Viruses can only work if they get inside your cells. Once they are inside a cell, that cell is basically buggered, but to move on to another cell, each virus (having made squillions of copies of itself inside the cell) has to build itself a new protein envelope and escape from the dying host cell. One of the ways of trying to stop viruses (none of which work terribly well) is to try to interfere with the process I’ve described. This is what Tamiflu does …… a bit.
So I rang up my "flu buddy" (she didn't actually know that she was my flu buddy until I rang her up but she very kindly "stepped up to the plate") and sent her off with my reference number, my photo driving licence (swabbed with CD cleaner); and her photo ID to collect my Tamiflu.
My flu buddy "@fiftynotout" came round, posted the Tamiflu through the letterbox, left me a bag of groceries, and painted a black cross on the door. She has been keeping me supplied with groceries all week since she drives out each day with her daughter who is learning to drive. I gather that if you don’t have anyone who can collect the anti-virals for you, you can arrange for somebody from the NHS (or "Death Panel" as Sarah Palin and co would have it) to drop you some off at your home.
(BTW @fiftynotout does not tweet very much. I think she joined because she had a crush on @StephenFry – though I gather she may have transferred her affections to @ProfBrianCox)
Did the Tamiflu work in my case? Impossible to say of course; it’s like the old joke about the man sprinkling elephant powder. But I did get better after taking it: post hoc but not necessarily propter hoc. The first two doses did seem to make me feel very queasy for while, but I did not actually vomit. From the third dose on, I had no problems – they give you ten doses to last five days.
Of course, given that Tamiflu is not terribly effective, can (like any drug) cause side effects (though these seem to be minimal), and will (sooner or later) almost certainly promote the emergence of resistance in the HIN1 virus, there is still an ongoing debate as to the wisdom of mass distribution. On the other hand, H1N1 can be fatal, Tamiflu may already be saving lives, and H1N1 may suddenly mutate a get a lot worse - if we did not have a working distribution system in place we'd be stuffed when this happened. Also, scientist are busy developing a vaccine - which will be very effective in preventing infection. The use of Tamiflu is just a stop-gap.
How bad is swine flu? Well again, I can only report my experience – which may not be yours. Apart from the coughing, I’d say that the acute symptoms get 8/10 – where the worse flu I ever had gets 10/10. The duration of incapacity and general malaise – eight days and counting – and the coughing are, however, much worse than anything I’ve experienced with normal seasonal flu.
Tweeting certainly helps with flu. It provides the vicarious sensation of having lots of people around expressing concern and interacting with you – not to be sneezed at (hah!) when you are stuck at home on your own. Also, though you can’t concentrate (or, in my case, even stay awake) for long enough to read a chapter of a book or watch a TV programme, you can sit up in bed with your laptop for five minutes and fire off the odd flurry of 140 character messages.
Of course I can’t offer medical advice but, I stayed in bed, drank lots of water and took paracetamol (2x500 mg) every eight hours alternated with ibuprofen. (NB Paracetamol is extremely safe if you stick to the correct dosages and extremely dangerous if you don’t!)
In conclusion: Thanks to my family for their frequent concerned phone calls, thanks to the Death Panel of the NHS for supplying me with free anti-viral drugs, thanks to everyone on Twitter who kept my spirits up during this experience, and a really big thank you to @fiftynotout – the best flu buddy anyone could have had.
The rest of you: Keep washing your hands!
2009-08-14
One of the most ridiculous pieces of "journalism" I have ever come across
Heroin laced cannabis heading to Brighton streets, police fear
8:53am Thursday 13th August 2009
By Naomi Loomes
Dealers are lacing cannabis with highly addictive heroin to get users hooked on the deadly drug.
Secret off-the-record discussions between police and a supplier in London have revealed how recreational drug users are being tricked into becoming addicted to Class A drugs.
Officers fear it could lead to a surge in addicts in Brighton and Hove, which is already known as the drug death capital of England.
They believe cannabis users are becoming accidentally dragged into heroin use.
It follows the discovery that potent, paranoia-inducing cannabis, known as skunk, was being sold in large quantities in Brighton and Hove last year.
Detective Sergeant Hari McCarthy, of Sussex Police, said: "People buy it thinking it’s just very strong weed."
"It’s not being sold as skunk, just good weed, but it’s an easy way to get users hooked on heroin."
She added that dealers mixed various chemicals with cannabis before selling it, including tranquillisers and even urine.
There are believed to be 2,300 heroin addicts in Brighton and Hove.
The revelation was made during an inquest in Brighton into the death of 34-year-old electrician Lee Donlan from a heroin overdose.
Clinical and forensic toxicologist Peter Sharpe confirmed that taking mixtures of drugs was becoming more and more common in Brighton and Hove, in particular the highly dangerous combination known as speedballing.
He said: “There’s a mixture called speedballing – it’s heroin with a bit of cocaine, usually injected into the arm or ankle.
"People like the mixture of heroin and cocaine because the cocaine reduces the low that comes after the heroin."
Okay, lets take the first claim:
"Dealers are lacing cannabis with highly addictive heroin to get users hooked on the deadly drug" - an urban myth that I can remember doing the rounds as far back as the early 1970s.
Let's think this one through: I am a cannabis dealer (I'm not BTW, I'm just pursuing a thought experiment). I start somehow mixing heroin (usually a brown powder) with my cannabis (a brown or black resin or - more likely these days - a green herbal substance). I do this in such a way that my customers don't notice the extra brown powder. Because heroin is quite expensive in relation to the profit I normally make on my cannabis and because I am not telling my customers about the heroin and therefore can't charge for it, I am now selling my cannabis at a loss .... but I have a cunning plan. Providing my customers don't notice that the cannabis I'm selling them has a completely different effect from normal cannabis and keep coming back to me to buy their cannabis for several months, I shall, one day be able to say to them: "Ha! I've been giving you heroin all these months and now you are addicted so you will have to keep buying heroin from me now." Okay, they had been regular customers in order for me to get this far, but this will absolutely ensure their continued customer loyalty .. unless, of course, they beat me to a pulp with my bong and go and buy their heroin elsewhere.
I'm sorry, but this is complete and utter nonsense.
Second claim (part of the first one in fact): "heroin is a deadly drug" - at least I assume this is what the author intended to imply. The claim is worded as though she believes that cannabis is the deadly drug.
Heroin causes constipation. That's about it. It's addictive and street heroin (cf the legal kind that addicts could get if we did not have such crazy drug laws) is full of crap. I suppose that the point being made here is that you can overdose on heroin, but, again, much of the problem here arises from the fact that heroin is traded on the black market and there are therefore no controls on strength and purity. Heroin is certainly not a deadly drug in the sense that tobacco is.
I'm not suggesting anyone takes heroin by the way. It's much better to do something worthwhile with your life.
Third claim: "Dealers mix various chemicals with cannabis before selling it, including tranquillisers and even urine"
Tranquillizers usually come as white pills these days. They are far less readily available than they used to be since it was discovered that they can lead to addiction. They are sold on the black (or "grey" - as it is sometimes called) market in their own right as recreational drugs. But, according to this article, some dealers are crushing them up and mixing the resulting white powder with cannabis. I'm not sure what effect the cannabis smokers (who are presumably too stoned to notice the white powder) are supposed to derive from inhaling the smoke from burning valium and lactose, but I can't imagine it's a very peasant effect.
And as for urine.....
So the dealer urinates over his cannabis supply - which he then has to dry out again. To what end? To increase the weight of the weed with a few milligrams of urea? I think I'd just reach for the oregano and sprinkle a bit of that in.
Claim three: "People like the mixture of heroin and cocaine because the cocaine reduces the low that comes after the heroin."
The effects of heroin wear off after several hours. The effects of cocaine start wearing off after about twenty minutes. Hard to imagine cocaine injected at the same time as heroin would help much with any come-down after the heroin wore off.
The rest of the article (which I've not reproduced) goes on to list the names of various people who have died from drug overdoses and includes some confused nonsense about dosages. The correct information is that the LD50 for heroin is between 1 and 5 mg/kg of body weight.
I suppose that there is an argument that, because we all wish to see (especially young people) taking as few drugs as possible and suffering as little harm as possible, it's perfectly okay to write complete nonsense about drugs. Anything that puts people off! But this argument only holds water if we assume that everyone is as stupid as the author of this article. In fact, most young people will read this sort of thing, and fall about laughing. While this would be the most appropriate response in this case, there is always the danger that other articles on the dangers of drugs (written by people who actually know what they are talking about) will elicit a similar response.
There is growing evidence that cannabis in general (and skunk in particular) may have long term deleterious effect on young people whose brains are still developing. (By the way, the problem with skunk is not really its strength - high strength, leads to less being smoked and therefore less lung damage - but the particular balance of psychoactive compounds it contains; though more research is required on this.)
How on earth are we going to get this genuine science across to young people who have grown up on the diet of tripe provided by newspapers like the Brighton & Hove Argus?
2009-08-08
Harry Patch, War, and Human Nature
I caught part of "Any Answers" today (2009-08-08) on Radio 4. They were discussing Harry Patch’s misgivings about war – something which had presumably been discussed in the antecedent edition of "Any Questions" which I did not hear.
The first caller opined that the propensity to engage in war was a fundamental part of human nature and that the hope for a future without war was futile. Other callers took the view that human nature was not like this at all.
I think the first caller, rather than the others, was actually correct (at least partially) in his analysis of human nature; but I think his conclusion was false. I think he was making an mistake analogous to one of the mistakes people make when discussing Richard Dawkin’s "selfish gene".
The warlike disposition of groups of hunter-gathers (ancient and modern) is discussed by (inter alia) Stephen Pinker in his excellent book The Blank Slate. I do not agree with everything Pinker says in this book and I think that he somewhat overstates his case when it comes to his forthright rejection of the notion of the notion of the "noble savage". Nevertheless, I think that Pinker is probably right in concluding that humans almost certainly do have an innate disposition to declare "We are tribe X; tribe Y are over there and they are not tribe X; let’s go and kick the shit out of them all".
Variations on this theme have played out throughout human history and we see examples of this disposition even in modern times: in Rwanda; in the behaviour of the (Gentile) German population during Kristallnacht; in Northern Ireland; in the behaviour of football hooligans; and in many other situations.
The good news is that humans are also capable of deciding that, actually, the members of tribe Y are members of “our” tribe after all; and the communication age has made this easier then ever. Of course we still have vile organizations like the BNP, but most British people today cry as many tears over the TV picture of a dying child, with a different skin colour, on the other side of the world as they do over the TV picture of a dying child, with the same skin colour, in the next county.
It is these considerations (and others) that make the segregation of school children along religious lines so utterly pernicious.
Anyway, back to Harry Patch. Does our innate warlike nature (assuming this is our nature) make war inevitable? Let’s take a recent example: the Iraq War. Did the Brits all work themselves up into frenzy and decide: "Let’s go off and kill the Iraqis, they’re not a bit like us."? Urm, "No!". That’s not how it happened. Tony Blair decided to go to war. Okay, he had the support of the Cabinet, but (so far as one could tell) not one single Cabinet member really thought it was a good idea. Tony Blair then got the support of Parliament but, again, one had the impression that most MPs were thinking about their careers rather than baying for Iraqi blood.
Did Tony then lead his tribe into battle with the other tribe? No; he stayed safely at home and made vacuous speeches on TV.
Did the troops behave like a bunch of hunter gatherers intent on murder and mayhem in the enemy "tribe’s" camp? Well actually, in one or two cases, they may have done. But these really were isolated incidents. By and large, they went off to war because they had been ordered to do so and were not driven by a sense of hatred towards the Iraqi people or by a sense that the Iraqis were "other" and therefore worthless.
We could say the same (concerning the gap between the decision makers and the people going off to do the actually fighting) about almost any large scale modern conflict.
In other words, while it may well be true that humans organized in small groups of hunter gatherers - which have little contact with other groups – are genetically predisposed (because of the way we evolved) to violence in certain circumstances; the notion that the genesis of modern wars is somehow an expression of that propensity is highly questionable.
It is rather like the wrong-headed argument that because genes are (metaphorically) selfish and because human behaviour is (to a large extent) determined by our genetic make-up, humans must be innately selfish.
There are lots of reasons why "selfish" genes lead to altruistic behaviour in humans and there are many reasons why an innate propensity for violence toward "the other" in individual humans does not lead inevitably towards war between nation states.
Perhaps Harry Patch’s vision of a future without war will one day be realized.
Let us hope so.
The first caller opined that the propensity to engage in war was a fundamental part of human nature and that the hope for a future without war was futile. Other callers took the view that human nature was not like this at all.
I think the first caller, rather than the others, was actually correct (at least partially) in his analysis of human nature; but I think his conclusion was false. I think he was making an mistake analogous to one of the mistakes people make when discussing Richard Dawkin’s "selfish gene".
The warlike disposition of groups of hunter-gathers (ancient and modern) is discussed by (inter alia) Stephen Pinker in his excellent book The Blank Slate. I do not agree with everything Pinker says in this book and I think that he somewhat overstates his case when it comes to his forthright rejection of the notion of the notion of the "noble savage". Nevertheless, I think that Pinker is probably right in concluding that humans almost certainly do have an innate disposition to declare "We are tribe X; tribe Y are over there and they are not tribe X; let’s go and kick the shit out of them all".
Variations on this theme have played out throughout human history and we see examples of this disposition even in modern times: in Rwanda; in the behaviour of the (Gentile) German population during Kristallnacht; in Northern Ireland; in the behaviour of football hooligans; and in many other situations.
The good news is that humans are also capable of deciding that, actually, the members of tribe Y are members of “our” tribe after all; and the communication age has made this easier then ever. Of course we still have vile organizations like the BNP, but most British people today cry as many tears over the TV picture of a dying child, with a different skin colour, on the other side of the world as they do over the TV picture of a dying child, with the same skin colour, in the next county.
It is these considerations (and others) that make the segregation of school children along religious lines so utterly pernicious.
Anyway, back to Harry Patch. Does our innate warlike nature (assuming this is our nature) make war inevitable? Let’s take a recent example: the Iraq War. Did the Brits all work themselves up into frenzy and decide: "Let’s go off and kill the Iraqis, they’re not a bit like us."? Urm, "No!". That’s not how it happened. Tony Blair decided to go to war. Okay, he had the support of the Cabinet, but (so far as one could tell) not one single Cabinet member really thought it was a good idea. Tony Blair then got the support of Parliament but, again, one had the impression that most MPs were thinking about their careers rather than baying for Iraqi blood.
Did Tony then lead his tribe into battle with the other tribe? No; he stayed safely at home and made vacuous speeches on TV.
Did the troops behave like a bunch of hunter gatherers intent on murder and mayhem in the enemy "tribe’s" camp? Well actually, in one or two cases, they may have done. But these really were isolated incidents. By and large, they went off to war because they had been ordered to do so and were not driven by a sense of hatred towards the Iraqi people or by a sense that the Iraqis were "other" and therefore worthless.
We could say the same (concerning the gap between the decision makers and the people going off to do the actually fighting) about almost any large scale modern conflict.
In other words, while it may well be true that humans organized in small groups of hunter gatherers - which have little contact with other groups – are genetically predisposed (because of the way we evolved) to violence in certain circumstances; the notion that the genesis of modern wars is somehow an expression of that propensity is highly questionable.
It is rather like the wrong-headed argument that because genes are (metaphorically) selfish and because human behaviour is (to a large extent) determined by our genetic make-up, humans must be innately selfish.
There are lots of reasons why "selfish" genes lead to altruistic behaviour in humans and there are many reasons why an innate propensity for violence toward "the other" in individual humans does not lead inevitably towards war between nation states.
Perhaps Harry Patch’s vision of a future without war will one day be realized.
Let us hope so.
2009-08-03
Using Paypal: A cautionary tale
Executive summary:
1) Paypal is a convenient way of transferring money to people who are not set up to receive credit card payments (eg eBay sellers).
2) Paypal purports to be “safer than using your credit card, but this is highly misleading. For payments over £100 you are protected if you use your credit card by something called “Section 75”. You lose this protection if you pay using Paypal – even if your Paypal account draws from your credit card account. (Paypal does offer some protection on purchases within ebay however).
3) Paypal have poor customer service, are not interested in discussing questions about whether their sellers may be engaged in fraudulent activity, and may unilaterally close a dispute thereby preventing further buyer communication with Paypal or the seller complained about.
4) Paypal state that they do not “tolerate fraud or illegal activities”. Judging by my experience, this claim would appear to be untrue.
Our story:
My wife and daughter bought two pairs (a pair each) of “UGG” boots from http://www.australia-ugg-boots.com/ and paid using Paypal. The domain “australia-ugg-boots.com” is registered in Australia:
And the site makes the following claim:
A complication here (it should perhaps be noted) is that "UGG" is not a protected trade mark in Australia, but it is in the UK and other countries outside Australia.
When we received the boots (we did receive them) the parcel came not from Melbourne but from Shanghai. The boots were perfectly well made, but clearly counterfeit (with counterfeited "UGG" "trademarks" all over them) and lined with synthetic fur rather than sheepskin. The main problem, however, was that both pairs were each a couple of sizes smaller than ordered and than stated on the sewn in labels. Apparently this is one of the features of counterfeit UGG boots – quite why these firms can fake the boots so expertly and yet fail to size them correctly is, to say the least, puzzling. As we have real UGG boots at home we are able to compare like with not-like.
So we raised a dispute on Paypal.
AUSTRALIA-UGG-BOOTS (of China) got straight back and said we could return the boots and get a full refund. Trouble is that this costs rather a lot of money and they take no responsibility if goods are "lost in the post". The Royal Mail will only cover you up to £39 – unless you pay them shed-loads of money first.
Forgive my cynicism and scepticism, but I do not have a great deal of confidence that, if I sent these boots back to Shanghai, I would ever see my boots or my £130 again.
On to Paypal, the "safer" alternative to using your credit card.
It would by an understatement to say that Paypal have been unhelpful. They simply refused to help and then closed the case without consulting me further. This means that I can no longer communicate with them or the seller about this case. More worryingly, Paypal are (it would appear) continuing to trade with this company (which would certainly seem to be committing offences under UK law) and refusing to warn other potential buyers about the pitfalls of buying from the website in question.
As our experience illustrates, the fact that Paypal accepts a seller onto its books is no guarantee (or even indication) that that company is "kosher". In fact, the fact that a company only accepts Paypal and does not accept direct credit card payments may well be an indication that further scrutiny of that company is required before buying from it.
If you make payments over £100 using your credit card– even to companies in China – you enjoy buyer protection. If you use Paypal you lose that protection – it is not "safer" at all.
I shall, in future, use Paypal (if at all) only as a means of last resort to pay for goods and services and I suggest anyone reading this does the same.
1) Paypal is a convenient way of transferring money to people who are not set up to receive credit card payments (eg eBay sellers).
2) Paypal purports to be “safer than using your credit card, but this is highly misleading. For payments over £100 you are protected if you use your credit card by something called “Section 75”. You lose this protection if you pay using Paypal – even if your Paypal account draws from your credit card account. (Paypal does offer some protection on purchases within ebay however).
3) Paypal have poor customer service, are not interested in discussing questions about whether their sellers may be engaged in fraudulent activity, and may unilaterally close a dispute thereby preventing further buyer communication with Paypal or the seller complained about.
4) Paypal state that they do not “tolerate fraud or illegal activities”. Judging by my experience, this claim would appear to be untrue.
Our story:
My wife and daughter bought two pairs (a pair each) of “UGG” boots from http://www.australia-ugg-boots.com/ and paid using Paypal. The domain “australia-ugg-boots.com” is registered in Australia:
Whois Record
Registrant:
Jackie Beament
PO Box 3950
Joondalup, Western Australia 6027
Australia
Domain Name: AUSTRALIA-UGG-BOOTS.COM
Created on: 28-Feb-09
Expires on: 28-Feb-10
Last Updated on: 01-Mar-09
Administrative Contact:
Beament, Jackie
PO Box 3950
Joondalup, Western Australia 6027
Australia
894048411 Fax --
Technical Contact:
Beament, Jackie
PO Box 3950
Joondalup, Western Australia 6027
Australia
894048411 Fax --
Domain servers in listed order:
NS1.AUSTRALIA-UGG-BOOTS.COM
NS2.AUSTRALIA-UGG-BOOTS.COM
And the site makes the following claim:
Australia-Ugg-Boots.com is a family business manufacturing ugg boots here in our home town Melbourne, Australia since 2007. We manufacture high quality sheepskin footwear made from first grade double faced Australian Sheepskin. Australia-Ugg-Boots.com has been successfully wholesaling and retailing to many satisfied customers within Australia and Overseas. Our website was established in 2007 successfully providing customers all over the world with our great product, cheap prices and fast, reliable, friendly customer service.
A complication here (it should perhaps be noted) is that "UGG" is not a protected trade mark in Australia, but it is in the UK and other countries outside Australia.
When we received the boots (we did receive them) the parcel came not from Melbourne but from Shanghai. The boots were perfectly well made, but clearly counterfeit (with counterfeited "UGG" "trademarks" all over them) and lined with synthetic fur rather than sheepskin. The main problem, however, was that both pairs were each a couple of sizes smaller than ordered and than stated on the sewn in labels. Apparently this is one of the features of counterfeit UGG boots – quite why these firms can fake the boots so expertly and yet fail to size them correctly is, to say the least, puzzling. As we have real UGG boots at home we are able to compare like with not-like.
So we raised a dispute on Paypal.
AUSTRALIA-UGG-BOOTS (of China) got straight back and said we could return the boots and get a full refund. Trouble is that this costs rather a lot of money and they take no responsibility if goods are "lost in the post". The Royal Mail will only cover you up to £39 – unless you pay them shed-loads of money first.
Forgive my cynicism and scepticism, but I do not have a great deal of confidence that, if I sent these boots back to Shanghai, I would ever see my boots or my £130 again.
On to Paypal, the "safer" alternative to using your credit card.
It would by an understatement to say that Paypal have been unhelpful. They simply refused to help and then closed the case without consulting me further. This means that I can no longer communicate with them or the seller about this case. More worryingly, Paypal are (it would appear) continuing to trade with this company (which would certainly seem to be committing offences under UK law) and refusing to warn other potential buyers about the pitfalls of buying from the website in question.
As our experience illustrates, the fact that Paypal accepts a seller onto its books is no guarantee (or even indication) that that company is "kosher". In fact, the fact that a company only accepts Paypal and does not accept direct credit card payments may well be an indication that further scrutiny of that company is required before buying from it.
If you make payments over £100 using your credit card– even to companies in China – you enjoy buyer protection. If you use Paypal you lose that protection – it is not "safer" at all.
I shall, in future, use Paypal (if at all) only as a means of last resort to pay for goods and services and I suggest anyone reading this does the same.
2009-07-31
My response to a pro chiropractic response to Simon Singh's article
A critique of Simon's article by Richard Lanigan can be found at: chiropracticlive.
I address some of the points Richard Lanigan makes below:
Beware the spinal trap
by Simon Singh
Simon: This is Chiropractic Awareness Week. So let’s be aware. How about some awareness that may prevent harm and help you make truly informed choices? First, you might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that, “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.
Richard: If I was going to criticise a health care profession, I would say it was important to have all my facts and provide accurate information. DD Palmer was 15 in 1860, worked as a teacher in the mid 1860s, worked as a bee keeper and small famer in the early 70s. The first mention of DD Palmers involvement in “healing” was in 1885 when he became a magnetic healer. It would seem he was in fact developing “developing his theories” in the 1880s rather 1860s, I suspect Simon Singh has confused DD with Andrew Still who founded Osteopathy and was developing his theories about manipulation in the 1860s.
DD Palmer's hypothesis was that interfering with nerve function would affect optimal well-being, he explained his theory around “displaced vertbrae”. Palmer’s understanding of the effects of spinal manipulation should be viewed in its time (the late 19th century) when surgery had a mortality rate of 76%. I know of no 21st century chiropractor who would explain chiropractic as Palmer did, or a surgeon who would operate in his street clothes without a mask. To define chiropractic along these lines is like defining medicine the way Harold Shipman practised.
In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.
Stranger things have happened. Here we have a news report in 2008 stating a chiropractor restored a mans [sic] sight. I think its fair to say if Palmer had observed Harvey Lillard getting his hearing back he may have thought that he had discover the holy grail of healing. Look at the competition at the time 1895??
Simon: You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying.
Richard: Whether sceptics want to believe it or not, I have helped children with all these problems. Lets look at “Ear infections” and I will try not to let my “ideas rise above my station”. For many years ear problems have been misdiagnosed by medics and treated ineffectively with grommets and antibiotics.
So what is a clinician to do. Angela Peel White my anatomy tutor at The Anglo European College of Chiropractic was a qualified GP. I never held it against her because she was a brilliant tutor. She told us know the anatomy of the region you are examining. If you look at the inner ear it has “drain” called the eustachian tube. Its narrower at the top, children with small little necks have only a small gradient and the tube does not drain very well. The blockage causes pain due to the discrepancy of the air pressure outside the ear drum and inside. This can also be a problem for inexperienced divers. Who are not able to “equalise” ear pressure as they decent in water.
The biological explanation as to why “manipulation” could help a child with otis media is very similar to how experienced divers equalise when the eustachian tubes are blocked and unable to relieve the pressure on the inner ear as they descend in the water. They crack their TMJ as if blowing rings smoking dope (I am a child of the 60s), this helps open the eustachian tube and equalise the pressure on the ear drum.
There is also a neurological explanation, I will spare the details suffice to say when Professor Ernst or chiropractic sceptics say there is “no biological reason why spinal manipulation should with help ear Infections” the anatomy shows clearly they are talking through their collective arses.
I have four children, young children cannot crack their jaw themselves, the adjustment requires skill and practise, not all chiropractors can do it and that’s a problem when chiropractors enter these clinical trials. I am not an academic, I am just a clinician.
Richard: Then Simon continues to the bit that upset the BCA
Simon: ……..even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.
Richard: First I would question whether the BCA leadership is the respectable face of chiropractic. No One would dispute that the “scientific evidence” is weak for these conditions, which account for a very small part of my practice 5% and I probably see more children than most chiropractors. However if we look at Professor Ernsts own “Hierarchy of Evidence” at the bottom there are “case reports” and “observational studies”. Yes the chiropractic evidence is at the bottom of Ernsts pyramid however “not a jot of evidence” would only be accurate statement if Professor Ernst were to remove the bottom of his pyramid. In addition anyone with a limited knowledge of the politics of the chiropractic profession would know that the BCA leadership with rather stick to musculoskeletal pain syndromes and probably puts childhood disorders on their website to prevent more members from leaving the association. If Simon had directed those comments at the UCA or the McTimoney association the BCA leadership would have been leading the applause.
Simon: I can confidently label these treatments as bogus because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst.
Richard: What does that prove? Margaret Thatcher was the first women prime minister we can only pray the second one is better. The chapter on chiropractic in “Trick or Treatment” has only three chiropractic references all by the co-author Professor Ernst which should have set alarm bells ringing in a science journalist with a PhD. To pad out the chiropractic chapter they finish it talking about homeopaths and vaccines. I told Simon I did not believe he had written that chapter and it was all Ernsts [sic] work but he says he did write it.
Simon: Ernst learned chiropractic techniques himself and used them as a doctor.
Richard: I can carve a joint, this does that make me a surgeon? Chiropractors spend five years learning to adjust spinal joints. Simon has not visited the Anglo European College of Chiropractic to see how chiropractors develop their skills and Guardian readers are expected to believe professor Ernst thought himself these “chiropractic techniques” over a few weekends and it would appear he was not very good at it, many failed practitioners end up in academia.
Simon: This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.
But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.
In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.
Richard: Arthritis is a chronic condition suffered by millions of British people often it has developed because it was not managed properly when it was just a small ache ( Pain killers and anti inflammatory medication to mask a mechanical problem). In May, the National Institute for Clinical Excellence in the UK published its guidelines for the management of Low back pain http://guidance.nice.org.uk/CG88 . What was extraordinary about these guidelines is that they were stating that doctors should no longer offer; Spinal injections, Traction, Lumbar Supports, Ultrasound, Interferential, Laser and should consider a course of spinal manipulation by a chiropractor or an osteopath or acupuncture instead.
In effect NICE is stating that the orthodox methods for treating back pain has not worked and the evidence is suggesting that it would be cost effective for the NHS to pay for complementary treatments like chiropractic and acupuncture in the future.
Simon: More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.
Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.
Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.
This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Professor Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.
Bearing all of this in mind, I will leave you with one message for Chiropractic Awareness Week – if spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.
Richard: Which drugs, Viox, Celebrex, statins etc,etc. In 1998 Lazarou et al estimated that 106,000 people die each year from adverse reactions to prescribed medications. Thats [sic] the equivalent of a jumbo jet crash every 2 days and no public enquiry? Professor Ernst has spent the last ten years trying to convince the British and Irish public that chiropractic is more dangerous than medicine.
The tragic story of Laurie Mathiason who suffered a stroke ten years ago while receiving chiropractic treatment in Canada is not convincing “evidence” that chiropractic is dangerous. Every five minutes someone in England will have a stroke(National Audit Office), there are no epidemiological studies that would even hint that this finding has anything to do with chiropractic, yet Professor Ernst goes on repeating his opinion.
I have practised in the same area for almost fifteen years, I adjust the cervical spine of the vast majority of my patients and I don not recognise the “dangerous” practise Simon describes. I have never had a complaint or hurt anyone, occasionally a patient feels worse after the first visit, but thats about it. If patients were having strokes surely I would have heard something and the fact Ernst wont let poor Laurie Mathiason rest in peace because he needs this anecdote to bases the theory on which has created his media profile, dont kid youselfs Professor Ernst is not well known for his research he has become the Jordan of the EBM community, I wonder what David Sackett makes of Ernsts evidence base? The inconsistencies in these arguments by the sceptics are staggering, something happens after a vaccine and its coincidence, anything happens after a chiropractic adjustment and its the chiropractors fault. For a small profession we must be good at hiding our bodies, perhaps thats [sic] where Harold Shipman learned how to kill his patients without anyone noticing.
I address some of the points Richard Lanigan makes below:
Beware the spinal trap
by Simon Singh
Simon: This is Chiropractic Awareness Week. So let’s be aware. How about some awareness that may prevent harm and help you make truly informed choices? First, you might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that, “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.
Richard: If I was going to criticise a health care profession, I would say it was important to have all my facts and provide accurate information. DD Palmer was 15 in 1860, worked as a teacher in the mid 1860s, worked as a bee keeper and small famer in the early 70s. The first mention of DD Palmers involvement in “healing” was in 1885 when he became a magnetic healer. It would seem he was in fact developing “developing his theories” in the 1880s rather 1860s, I suspect Simon Singh has confused DD with Andrew Still who founded Osteopathy and was developing his theories about manipulation in the 1860s.
DD Palmer's hypothesis was that interfering with nerve function would affect optimal well-being, he explained his theory around “displaced vertbrae”. Palmer’s understanding of the effects of spinal manipulation should be viewed in its time (the late 19th century) when surgery had a mortality rate of 76%. I know of no 21st century chiropractor who would explain chiropractic as Palmer did, or a surgeon who would operate in his street clothes without a mask. To define chiropractic along these lines is like defining medicine the way Harold Shipman practised.
In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.
Stranger things have happened. Here we have a news report in 2008 stating a chiropractor restored a mans [sic] sight. I think its fair to say if Palmer had observed Harvey Lillard getting his hearing back he may have thought that he had discover the holy grail of healing. Look at the competition at the time 1895??
Me: Daniel David Palmer was born in 1845 (according to Wikipedia at least) so Richard my be right here and Simon may be wrong. On the other hand, the BCA is not suing Simon for getting his date wrong so I'm not sure how relevant this is. [By the way, "magnetic healing" had nothing to do with magnets and was rather a cross between massage and meridian therapies (according to this source; so Richard's suggestion that Palmer was thinking about magnets rather than manipulation at this stage is misleading.)
As for anecdotal claims that sight or hearing was restored in particular individuals by chiropractic, there is a even a name for this kind of fallacy: The "post hoc ergo propter hoc fallacy."
Simon: You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying.
Richard: Whether sceptics want to believe it or not, I have helped children with all these problems. Lets look at “Ear infections” and I will try not to let my “ideas rise above my station”. For many years ear problems have been misdiagnosed by medics and treated ineffectively with grommets and antibiotics.
So what is a clinician to do. Angela Peel White my anatomy tutor at The Anglo European College of Chiropractic was a qualified GP. I never held it against her because she was a brilliant tutor. She told us know the anatomy of the region you are examining. If you look at the inner ear it has “drain” called the eustachian tube. Its narrower at the top, children with small little necks have only a small gradient and the tube does not drain very well. The blockage causes pain due to the discrepancy of the air pressure outside the ear drum and inside. This can also be a problem for inexperienced divers. Who are not able to “equalise” ear pressure as they decent in water.
The biological explanation as to why “manipulation” could help a child with otis media is very similar to how experienced divers equalise when the eustachian tubes are blocked and unable to relieve the pressure on the inner ear as they descend in the water. They crack their TMJ as if blowing rings smoking dope (I am a child of the 60s), this helps open the eustachian tube and equalise the pressure on the ear drum.
There is also a neurological explanation, I will spare the details suffice to say when Professor Ernst or chiropractic sceptics say there is “no biological reason why spinal manipulation should with help ear Infections” the anatomy shows clearly they are talking through their collective arses.
I have four children, young children cannot crack their jaw themselves, the adjustment requires skill and practise, not all chiropractors can do it and that’s a problem when chiropractors enter these clinical trials. I am not an academic, I am just a clinician.
Me: Not quite sure how to respond to this. Yes, "cracking" your jaw can (temporarily) relieve pressure in your inner ear. There are other ways of doing this, and I am not qualified to say whether jaw cracking is the most appropriate strategy for children, but what has this got to do with neurology? Also, what has Richard's claim that he can crack kids' jaws, and some chiropractors can't, got to do with anything? Any sensibly designed clinical trial would address such considerations.
Richard: Then Simon continues to the bit that upset the BCA
Simon: ……..even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.
Richard: First I would question whether the BCA leadership is the respectable face of chiropractic. No One would dispute that the “scientific evidence” is weak for these conditions, which account for a very small part of my practice 5% and I probably see more children than most chiropractors. However if we look at Professor Ernsts own “Hierarchy of Evidence” at the bottom there are “case reports” and “observational studies”. Yes the chiropractic evidence is at the bottom of Ernsts pyramid however “not a jot of evidence” would only be accurate statement if Professor Ernst were to remove the bottom of his pyramid. In addition anyone with a limited knowledge of the politics of the chiropractic profession would know that the BCA leadership with rather stick to musculoskeletal pain syndromes and probably puts childhood disorders on their website to prevent more members from leaving the association. If Simon had directed those comments at the UCA or the McTimoney association the BCA leadership would have been leading the applause.
Me: Here we start to get to the heart of the matter. What Richard omits here is the consideration that real medicine is expected to move up the pyramid of evidence.
If a treatment or observation about a certain existing treatment or lifestyle is novel then “case reports” and “observational studies” do constitute a jot of evidence. If, after a hundred years plus of chiropractic, we still only have “case reports” and “observational studies” as evidence and nothing at higher levels in the pyramid (thinking here of the conditions over which Simon is being sued) then it is perfectly reasonable comment for Simon to say that there is not a jot of evidence.
There is, after all, some annecdotal evidence for almost every nutty thing that can be thought of. Are we to conclude that the phrase "not a jot of evidence for X" be banished from the language?
Simon: I can confidently label these treatments as bogus because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst.
Richard: What does that prove? Margaret Thatcher was the first women prime minister we can only pray the second one is better. The chapter on chiropractic in “Trick or Treatment” has only three chiropractic references all by the co-author Professor Ernst which should have set alarm bells ringing in a science journalist with a PhD. To pad out the chiropractic chapter they finish it talking about homeopaths and vaccines. I told Simon I did not believe he had written that chapter and it was all Ernsts [sic] work but he says he did write it.
Me: The fact that Simon has written a book proves nothing, it does, however, suggest that Simon has researched the matter thoroughly and that (given that we know that Simon is a highly respected science journalist) his views and claims are worth investigating.
Simon: Ernst learned chiropractic techniques himself and used them as a doctor.
Richard: I can carve a joint, this does that make me a surgeon? Chiropractors spend five years learning to adjust spinal joints. Simon has not visited the Anglo European College of Chiropractic to see how chiropractors develop their skills and Guardian readers are expected to believe professor Ernst thought himself these “chiropractic techniques” over a few weekends and it would appear he was not very good at it, many failed practitioners end up in academia.
Me: The fact that Edzard Ernst learned chiropractic techniques is interesting background information. As, I suppose, Richard indirectly implies, this is of little ultimate relevance to the question as to whether what Ernst says about the generally efficacy of chiropractic is true.
Simon: This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.
But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.
In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.
Richard: Arthritis is a chronic condition suffered by millions of British people often it has developed because it was not managed properly when it was just a small ache ( Pain killers and anti inflammatory medication to mask a mechanical problem). In May, the National Institute for Clinical Excellence in the UK published its guidelines for the management of Low back pain http://guidance.nice.org.uk/CG88 . What was extraordinary about these guidelines is that they were stating that doctors should no longer offer; Spinal injections, Traction, Lumbar Supports, Ultrasound, Interferential, Laser and should consider a course of spinal manipulation by a chiropractor or an osteopath or acupuncture instead.
In effect NICE is stating that the orthodox methods for treating back pain has not worked and the evidence is suggesting that it would be cost effective for the NHS to pay for complementary treatments like chiropractic and acupuncture in the future.
Me: First of all we are back to back pain here - not the subject of the libel action or of Simon's more derogatory statements concerning chiropractic. Moreover, the argument used here: "There is growing evidence that many accepted medical treatments for chronic back pain don't really work therefore we should replace them with treatments for which there is no real evidence at all" does not really hold a lot of water - even if some people at NICE are using this argument too.
To those who say that there is real evidence, I say: "show me it" - a test which the BCA have spectacularly failed (again talking of the claims which are the subject of their libel action against Simon.
Simon: More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.
Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.
Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.
This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Professor Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.
Bearing all of this in mind, I will leave you with one message for Chiropractic Awareness Week – if spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.
Richard: Which drugs, Viox, Celebrex, statins etc,etc. In 1998 Lazarou et al estimated that 106,000 people die each year from adverse reactions to prescribed medications. Thats [sic] the equivalent of a jumbo jet crash every 2 days and no public enquiry? Professor Ernst has spent the last ten years trying to convince the British and Irish public that chiropractic is more dangerous than medicine.
The tragic story of Laurie Mathiason who suffered a stroke ten years ago while receiving chiropractic treatment in Canada is not convincing “evidence” that chiropractic is dangerous. Every five minutes someone in England will have a stroke(National Audit Office), there are no epidemiological studies that would even hint that this finding has anything to do with chiropractic, yet Professor Ernst goes on repeating his opinion.
I have practised in the same area for almost fifteen years, I adjust the cervical spine of the vast majority of my patients and I don not recognise the “dangerous” practise Simon describes. I have never had a complaint or hurt anyone, occasionally a patient feels worse after the first visit, but thats about it. If patients were having strokes surely I would have heard something and the fact Ernst wont let poor Laurie Mathiason rest in peace because he needs this anecdote to bases the theory on which has created his media profile, dont kid youselfs Professor Ernst is not well known for his research he has become the Jordan of the EBM community, I wonder what David Sackett makes of Ernsts evidence base? The inconsistencies in these arguments by the sceptics are staggering, something happens after a vaccine and its coincidence, anything happens after a chiropractic adjustment and its the chiropractors fault. For a small profession we must be good at hiding our bodies, perhaps thats [sic] where Harold Shipman learned how to kill his patients without anyone noticing.
Me: All medical interventions (both conventional and so called "alternative") have potential risks and benefits. That's why we need to base medical interventions on real evidence. Real evidence is collected when researcher's move up the evidence pyramid cited above. The notion that we can have one kind of evidence to conventional medicine and another "alternative" kind of evidence for "alternative" medicine is simply nonsense.
The real difference between science and woo (in all it's forms) is not that science is all true and woo is all bollocks; the real difference is that (true) scientists (of course individual scientists can be just as irrational as anyone else) constantly revise their ideas and practices in the light of the ever growing body of evidence.
When they found out that Shipman had killed lots of people, the medical profession investigated the evidence that the case provided, concluded that administrative practices had been woefully inadequate, and changed their administrative practices to try and prevent this happening again in the future. Similarly, when the medical profession discovered that Cox-2 inhibitors had an unacceptably high risk for the (far from insubstantial) benefit they were providing, the medical profession changed their practice and stopped prescribing these drugs.
Where are the clinical studies documenting the risks and benefits of chiropractic for infant colic? where are the stories of the chiropractic "profession" changing its treatment of infant colic in response to such clinic studies? Chiropractic just doesn't work like that.
There is some evidence that (non-cracking) massage and manipulation provided by an osteopath, chiropractor, or physiotherapist might help a bit with back pains and aching joints. All the rest is woo!
2009-07-29
Simon Singh: Beware the Spinal Trap
Edited version (the "libellous" bit about chiropractic being "bogus" has been removed)of the Simon Singh 2008 Guardian article for which Simon is being personally sued for libel by the British Chiropractic Association (please re-blog):
BEWARE THE SPINAL TRAP
Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results – and can even be lethal, says Simon Singh.
You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.
In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.
You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.
I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.
But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.
In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.
More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.
Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.
Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.”
This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.
If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.
Simon Singh is a science writer in London and the co-author, with Edzard Ernst, of Trick or Treatment? Alternative Medicine on Trial.
BEWARE THE SPINAL TRAP
Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results – and can even be lethal, says Simon Singh.
You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.
In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.
You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.
I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.
But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.
In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.
More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.
Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.
Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.”
This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.
If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.
Simon Singh is a science writer in London and the co-author, with Edzard Ernst, of Trick or Treatment? Alternative Medicine on Trial.
2009-06-24
Woo in the Telegraph - a response (of sorts)
24 June 2009
Dear Dr [Schroedinger99],
I am writing in response to your email concerning Annabel Croft article, which appeared in the Telegraph.
Your comments have been passed on to our editorial team for their future reference on this topic and I would like to thank you for taking the time and trouble to write to us on this matter. We value your readership and appreciate our readers' comments.
I hope you shall continue to enjoy The Daily Telegraph.
Yours sincerely,
Andy King
hmmm........
Well, let's just say that if I ever hear that someone has died because he/she relied on ingredient-free homoeopathic remedies rather than seeking the medical intervention he/she required, I shall remind Andy King of this email.
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