“Blinded by Science: How ‘Balanced’ Coverage Lets the Scientific Fringe Hijack Reality” | The Intersection

In the science world, if there is an overwhelming complaint about the media, it is that journalists tend to be too “balanced”–in other words, they give roughly 50-50 time to opposing viewpoints even when one side lacks credibility, as in the creationism-evolution battle.

In 2004 in Columbia Journalism Review, I did a major article critiquing this problem in science coverage–an article that I guess a lot of people read and liked, since it is still mentioned to me regularly. Recently, in fact, John Fleck emailed to ask why it wasn’t available online–and I decided to do something about that.

So here it is, “Blinded by Science,” a kind of classic critique of “phony balance” in science coverage:

BLINDED BY SCIENCE: How ‘Balanced’ Coverage Lets the Scientific Fringe Hijack Reality

Columbia Journalism Review, Nov/Dec2004, Vol. 43, Issue 4

On May 22, 2003, the Los Angeles Times printed a front-page story by Scott Gold, its respected Houston bureau chief, about the passage of a law in Texas requiring abortion doctors to warn women that the procedure might cause breast cancer. Virtually no mainstream scientist believes that the so-called ABC link actually exists — only anti-abortion activists do. Accordingly, Gold’s article noted right off the bat that the American Cancer Society discounts the “alleged link” and that anti-abortionists have pushed for “so-called counseling” laws only after failing in their attempts to have abortion banned. Gold also reported that the National Cancer Institute had convened “more than a hundred of the world’s experts” to assess the ABC theory, which they rejected. In comparison to these scientists, Gold noted, the author of the Texas counseling bill — who called the ABC issue “still disputed” — had “a professional background in property management.”

Gold’s piece was hard-hitting but accurate. The scientific consensus is quite firm that abortion does not cause breast cancer. If reporters want to take science and its conclusions seriously, their reporting should reflect this reality — no matter what antiabortionists say.

But what happened next illustrates one reason journalists have such a hard time calling it like they see it on science issues. In an internal memo exposed by the Web site LAobserved.com, the Times’s editor, John Carroll, singled out Gold’s story for harsh criticism, claiming it vindicated critics who accuse the paper of liberal bias. Carroll specifically criticized Gold’s “so-called counseling” line (”a phrase that is loaded with derision”) and his “professional background in property management” quip (”seldom will you read a cheaper shot than this”). “The story makes a strong case that the link between abortion and breast cancer is widely discounted among researchers,” Carroll wrote, “but I wondered as I read it whether somewhere there might exist some credible scientist who believes in it …. Apparently the scientific argument for the anti-abortion side is so absurd that we don’t need to waste our readers’ time with it.”

Gold declined to comment specifically on Carroll’s memo, except to say that it prompted “a sound and good discussion of the standards that we all take very seriously.” For his part, Carroll — now editing his third newspaper — is hardly so naive as to think journalistic “balance” is synonymous with accuracy. In an interview, he nevertheless defended the memo, observing that “reporters have to make judgments about the validity of ideas” but that “a reporter has to be broad-minded in being open to ideas that aren’t necessarily shared by the crowd he or she happens to be hanging around with.” Carroll adds that in his view, Gold needed to find a credible scientist to defend the ABC claim, rather than merely quoting a legislator and then exposing that individual’s lack of scientific background. “You have an obligation to find a scientist, and if the scientist has something to say, then you can subject the scientist’s views to rigorous examination,” Carroll says.

The trouble is, the leading proponent of the idea that abortions cause breast cancer, Dr. Joel Brind of Baruch College at the City University of New York, underwent a pro-life religious conversion that left him feeling “compelled to use science for its noblest, life-saving purpose,” as he put it in Physician, a magazine published by a conservative religious group called Focus on the Family. Brind’s dedication to the ABC theory has flown in the face of repeated negative critiques of that theory by his scientific peers. When the National Cancer Institute convened the world’s experts to assess the question in February 2003, Brind was the only dissenter from the group’s conclusions.

Nevertheless, a later article by Gold suggests he may have taken Carroll’s lesson to heart (though Gold says the piece “certainly wasn’t a direct response, or an attempt to change anything or compensate” following Carroll’s memo). On November 6, 2003, Gold reported on a push in Texas to revise the way biology textbooks teach the scientific theory of evolution, which some religious conservatives don’t accept. Gold opened with a glowing profile of one William Dembski, described as a “scientist by trade” but “an evangelical Christian at heart who is convinced that some biological mechanisms are too complex to have been created without divine guidance.” But according to his Web site, Dembski is a philosopher and mathematician, not a biologist. Moreover, he’s a leader of the new “intelligent design” crusade against Darwin’s theory, an updated form of creationism that evolutionary biologists have broadly denounced. (He recently took a job running the Center for Science and Theology at the Southern Baptist Theological Seminary.) The American Association for the Advancement of Science, the world’s largest scientific society and publisher of Science, the highest-circulation general scientific journal, has firmly stated that proponents have “failed to offer credible scientific evidence to support their claim” that the intelligent design theory “undermines the current scientifically accepted theory of evolution.”

Scott Gold had it exactly right on abortion and breast cancer. Then he produced an article on “intelligent design” so artificially “balanced” it was downright inaccurate and misleading.

* * * * *

The basic notion that journalists should go beyond mere “balance” in search of the actual truth hardly represents a novel insight. This magazine, along with its political Web site, Campaign Desk, has been part of a rising chorus against a prevalent but lazy form of journalism that makes no attempt to dig beneath competing claims. But for journalists raised on objectivity and tempered by accusations of bias, knowing that phony balance can create distortion is one thing and taking steps to fix the reporting is another.

Political reporting hardly presents the only challenge for journalists seeking to go beyond he said/she said accounts, or even the most difficult one. Instead, that distinction may be reserved for media coverage of contested scientific issues, many of them with major policy ramifications, such as global climate change. After all, the journalistic norm of balance has no corollary in the world of science. On the contrary, scientific theories and interpretations survive or perish depending upon whether they’re published in highly competitive journals that practice strict quality control, whether the results upon which they’re based can be replicated by other scientists, and ultimately whether they win over scientific peers. When consensus builds, it is based on repeated testing and retesting of an idea.

Journalists face a number of pressures that can prevent them from accurately depicting competing scientific claims in terms of their credibility within the scientific community as a whole. First, reporters must often deal with editors who reflexively cry out for “balance.” Meanwhile, determining how much weight to give different sides in a scientific debate requires considerable expertise on the issue at hand. Few journalists have real scientific knowledge, and even beat reporters who know a great deal about certain scientific issues may know little about other ones they’re suddenly asked to cover.

Moreover, the question of how to substitute accuracy for mere “balance” in science reporting has become ever more pointed as journalists have struggled to cover the Bush administration, which scientists have widely accused of scientific distortions. As the Union of Concerned Scientists, an alliance of citizens and scientists, and other critics have noted, Bush administration statements and actions have often given privileged status to a fringe scientific view over a well-documented, extremely robust mainstream conclusion. Journalists have thus had to decide whether to report on a he said/she said battle between scientists and the White House — which has had very few scientific defenders — or get to the bottom of each case of alleged distortion and report on who’s actually right.

No wonder scientists have often denounced the press for giving credibility to fringe scientific viewpoints. And without a doubt, the topic on which scientists have most vehemently decried both the media and the Bush administration is global warming. While some scientific uncertainty remains in the climate field, the most rigorous peer-reviewed assessments — produced roughly every five years by the United Nations’ Intergovernmental Panel on Climate Change (IPCC) — have cemented a consensus view that human greenhouse gas emissions are probably (i.e., the conclusion has a fairly high degree of scientific certainty) helping to fuel the greenhouse effect and explain the observed planetary warming of the past fifty years. Yet the Bush administration has consistently sought to undermine this position by hyping lingering uncertainties and seeking to revise government scientific reports. It has also relied upon energy interests and a small cadre of dissenting scientists (some of whom are funded, in part, by industry) in formulating climate policy.

The centrality of the climate change issue to the scientific critique of the press does not arise by accident. Climate change has mind-bogglingly massive ramifications, not only for the future of our carbon-based economy but for the planet itself. Energy interests wishing to stave off action to reduce greenhouse gas emissions have a documented history of supporting the small group of scientists who question the human role in causing climate change — as well as consciously strategizing about how to sow confusion on the issue and sway journalists.

In 1998, for instance, John H. Cushman, Jr., of The New York Times exposed an internal American Petroleum Institute memo outlining a strategy to invest millions to “maximize the impact of scientific views consistent with ours with Congress, the media and other key audiences.” Perhaps most startling, the memo cited a need to “recruit and train” scientists “who do not have a long history of visibility and/or participation in the climate change debate” to participate in media outreach and counter the mainstream scientific view. This seems to signal an awareness that after a while, journalists catch on to the connections between contrarian scientists and industry. But in the meantime, a window of opportunity apparently exists when reporters can be duped by fresh faces.

“There’s a very small set of people” who question the consensus, says Science’s executive editor-in-chief, Donald Kennedy. “And there are a great many thoughtful reporters in the media who believe that in order to produce a balanced story, you’ve got to pick one commentator from side A and one commentator from side B. I call it the two-card Rolodex problem.”

The Stanford climatologist Stephen Schneider echoes this concern. A scientist whose interactions with the media on the subject of climate change span decades, Schneider has reflected at length on the subject, especially in his 1989 book Global Warming. Schneider’s climate-change Web site also devotes a section to what he calls “Mediarology,” where he notes that in science debates “there are rarely just two polar opposite sides, but rather a spectrum of potential outcomes, oftentimes accompanied by a considerable history of scientific assessment of the relative credibility of these many possibilities. A climate scientist faced with a reporter locked into the ‘get both sides’ mindset risks getting his or her views stuffed into one of two boxed storylines: ‘we’re worried’ or ‘it will all be okay.’ And sometimes, these two ‘boxes’ are misrepresentative; a mainstream, well-established consensus may be ‘balanced’ against the opposing views of a few extremists, and to the uninformed, each position seems equally credible.”

Academics have studied media coverage of climate change, and the results confirm climate scientists’ longstanding complaints. In a recent paper published in the journal Global Environmental Change, the scholars Maxwell T. Boykoff and Jules M. Boykoff analyzed coverage of the issue in The New York Times, The Washington Post, The Wall Street Journal, and the Los Angeles Times between 1988 and 2002. During this fourteen-year period, climate scientists successfully forged a powerful consensus on human-caused climate change. But reporting in these four major papers did not at all reflect this consensus.

The Boykoffs analyzed a random sample of 636 articles. They found that a majority — 52.7 percent — gave “roughly equal attention” to the scientific consensus view that humans contribute to climate change and to the energy-industry-supported view that natural fluctuations suffice to explain the observed warming. By comparison, just 35.3 percent of articles emphasized the scientific consensus view while still presenting the other side in a subordinate fashion. Finally, 6.2 percent emphasized the industry-supported view, and a mere 5.9 percent focused on the consensus view without bothering to provide the industry/skeptic counterpoint.

Most intriguing, the Boykoffs’ study found a shift in coverage between 1988 — when climate change first garnered wide media coverage — and 1990. During that period, journalists broadly moved from focusing on scientists’ views of climate change to providing “balanced” accounts. During this same period, the Boykoffs noted, climate change became highly politicized and a “small group of influential spokespeople and scientists emerged in the news” to question the mainstream view that industrial emissions are warming the planet. The authors conclude that the U.S. “prestige-press” has produced “informationally biased coverage of global warming … hidden behind the veil of journalistic balance.”

In a rich irony, a UPI report on August 30, 2004, about the Boykoffs’ study covered it in — that’s right — a thoroughly “balanced” fashion. The article gave considerable space to the viewpoint of Frank Maisano, a former spokesman for the industry-sponsored Global Climate Coalition and a professional media consultant, who called the Boykoffs’ contentions “absolutely outrageous” and proceeded to reiterate many of the dubious criticisms of mainstream climate science for which the “skeptic” camp is so notorious. In the process, the UPI piece epitomized all the pathologies of U.S. coverage of climate change — pathologies that aren’t generally recapitulated abroad. Media research suggests that U.S. journalists cover climate change very differently from their European counterparts, often lending much more credence to the viewpoints of “skeptics” like Maisano.

In an interview, Maxwell Boykoff — an environmental studies Ph.D. candidate at the University of California at Santa Cruz — noted that if there’s one American journalist who cuts against the grain in covering the climate issue, it’s Andrew C. Revkin of The New York Times. That’s revealing, because Revkin happens to be the only reporter at any of the major newspapers studied who covers “global environmental change” as his exclusive beat, which Revkin says means writing about climate change “close to half” of the time. Revkin has also been covering global warming since 1988 and has written a book on the topic. (This fall he began teaching environmental reporting as an adjunct at Columbia’s Graduate School of Journalism.)

Revkin agrees with the basic thrust of the Boykoff study, but he also notes that the analysis focuses only on the quantitative aspect of climate-change coverage, rather than more subtle qualitative questions such as how reporters “characterize the voices” of the people they quote.

After all, the issue isn’t just how many column inches journalists give to the perspective of climate-change “skeptics” versus the mainstream view. It’s also how they identify these contrarian figures, many of whom have industry ties. Take a January 8, 2004, article by The Washington Post’s Guy Gugliotta, reporting on a study in the journal Nature finding that global warming could “drive 15 to 37 percent of living species toward extinction by mid-century.” Gugliotta’s story hardly suffered from phony balance. But when it did include a “skeptic” perspective — in a thoroughly subordinate fashion in the ninth paragraph — the skeptic’s industry ties went unmentioned:

One skeptic, William O’Keefe, president of the George C. Marshall Institute, a conservative science policy organization, criticized the Nature study, saying that the research ‘ignored species’ ability to adapt to higher temperatures’ and assumed that technologies will not arise to reduce emissions.

What Gugliotta didn’t say is this: the Marshall Institute receives substantial support from oil giant ExxonMobil, a leading funder of think tanks, frequently conservative in orientation, that question the scientific consensus on climate change. Moreover, O’Keefe himself has chaired the anti-Kyoto Protocol Global Climate Coalition, and served as executive vice president and chief operating officer of the American Petroleum Institute. Senate documents from 2001 through 2003 also list him as a registered lobbyist for ExxonMobil. (To be fair, when I discussed this matter with O’Keefe while working on a previous article, he said that he registers as a lobbyist “out of an abundance of caution” and keeps his ExxonMobil and Marshall Institute work “separate.”)

Asked about all of this, Gugliotta said he simply didn’t know of O’Keefe’s industry connections at the time. He said he considered O’Keefe a “reasoned skeptic” who provided a measured perspective from the other side of the issue. Fair enough. His industry ties don’t necessarily detract from that, but readers still should know about them.

The point isn’t to single out Gugliotta — any number of other examples could be found. And such omissions don’t merely occur on the news pages. Some major op-ed pages also appear to think that to fulfill their duty of providing a range of views, they should publish dubious contrarian opinion pieces on climate change even when those pieces are written by nonscientists. For instance, on July 7, 2003, The Washington Post published a revisionist op-ed on climate science by James Schlesinger, a former secretary of both energy and defense, and a former director of Central Intelligence. “In recent years the inclination has been to attribute the warming we have lately experienced to a single dominant cause — the increase in greenhouse gases,” wrote Schlesinger. “Yet climate has always been changing — and sometimes the swings have been rapid.” The clear implication was that scientists don’t know enough about the causes of climate change to justify strong pollution controls.

That’s not how most climatologists feel, but then Schlesinger is an economist by training, not a climatologist. Moreover, his Washington Post byline failed to note that he sits on the board of directors of Peabody Energy, the largest coal company in the world, and has since 2001. Peabody has resisted the push for mandatory controls on greenhouse gas emissions, such as those that would be required by the Kyoto Protocol. In a 2001 speech, the Peabody executive John Wootten argued that “there remains great uncertainty in the scientific understanding of climate,” and that “imposition of immediate constraints on emissions from fossil-fuel use is not warranted.”

Funny, that’s pretty much what Schlesinger argued.

* * * * * *

For another group of scientists, the grievances with the press have emerged more recently, but arguably with far greater force. That’s because on an issue of great concern to these scientists — the various uses and abuses of somatic cell nuclear transfer, or cloning — journalists have swallowed the claims of the scientific fringe hook, line, and sinker.

Consider the great 2002 cloning hoax. In the media lull following Christmas, one Brigitte Boisselier — the “scientific director” of Clonaid, a company linked to the UFO-obsessed Raelian sect, and already a semi-celebrity who had been profiled in The New York Times Magazine — announced the birth of the world’s first cloned baby. At her press conference, covered live by CNN, MSNBC, and Fox, Boisselier could not even produce a picture of the alleged child — “Eve” — much less independent scientific verification of her claims. She instead promised proof within eight or nine days. Needless to say, the whole affair should have made the press wary.

Nevertheless, a media frenzy ensued, with journalists occasionally mocking and questioning the Raelians while allowing their claims to drive the coverage. CNN’s medical correspondent, Sanjay Gupta, provided a case in point. When he interviewed Boisselier following her press conference, Gupta called Clonaid a group with “the capacity to clone” and told Boisselier, credulously, “We are certainly going to be anxiously awaiting to see some of the proof from these independent scientists next week.”

Perhaps most outspoken in criticizing the press during the Clonaid fiasco was Arthur Caplan, the University of Pennsylvania biomedical ethicist. As one of the nation’s most quoted bioethicists, Caplan had the advantage of actual access to the media during the feeding frenzy. Yet that familiarity made little difference. As Caplan complained in an MSNBC.com column following the Raelians’ announcement, no one wanted to listen to his skepticism because that would have required dropping the story: “As soon as I heard about the Raelians’ cloning claim, I knew it was nonsense,” wrote Caplan. “The media have shown themselves incapable of covering the key social and intellectual phenomena of the 21st century, namely the revolution in genetics and biology.”

Caplan observed that Clonaid had no scientific peer-reviewed publications to prove its techniques were up to snuff, and that cloning had barely worked in live animal species, and then only after countless initial failures. Nevertheless, Clonaid had implausibly claimed a stunning success rate — five pregnancies in ten attempts — in its experiments.

The Clonaid fiasco shows the media at their absolute worst in covering scientific issues. Reviewing the coverage two years later is a painful exercise. As even Gupta later admitted, “I think if we had known … that there was going to be no proof at this press conference, I think that we probably would have pulled the plug.” Later on, even the Raelians themselves reportedly laughed at how easy it was to get free publicity.

But this wasn’t just fun and games. The political consequences of the press’s cloning coverage were considerable. Widespread fear of human cloning inevitably lends strength to sweeping legislation that would ban all forms of cloning, despite the fact that many scientists think the cloning of embryos for research purposes holds significant medical promise; it would allow for the creation of embryonic-stem-cell lines genetically matched to individual patients. Thus, on an issue where one side of the debate thrives on fear, the media delivered exactly what these cloning-ban advocates desired. Where the press’s unjustifiable addiction to “balance” on climate change produces a political stalemate on a pressing issue of global consequence, its addiction to cloning cranks provided a potent political weapon to the enemies of crucial research.

None of those examples of poorly “balanced” science reporting arise from precisely the same set of journalistic shortcomings. In Scott Gold’s case at the Los Angeles Times, he appears to have known the scientific issues perfectly well. That gave his writing an authority that set off warning bells in an editor wary of bias. That’s very different from the Clonaid example, where sheer credulousness among members of the media — combined with sensationalism and a slow news period — were the problem. And that’s different still from the problem of false balance in the media coverage of climate change in the U.S., which has been chronic for more than a decade.

Yet in each case, the basic journalistic remedy would probably be the same. As a general rule, journalists should treat fringe scientific claims with considerable skepticism, and find out what major peer-reviewed papers or assessments have to say about them. Moreover, they should adhere to the principle that the more outlandish or dramatic the claim, the more skepticism it warrants. The Los Angeles Times’s Carroll observes that “every good journalist has a bit of a contrarian in his soul,” but it is precisely this impulse that can lead reporters astray. The fact is, nonscientist journalists can all too easily fall for scientific-sounding claims that they can’t adequately evaluate on their own.

That doesn’t mean that scientific consensus is right in every instance. There are famous examples, in fact, of when it was proved wrong: Galileo comes to mind, as does a lowly patent clerk named Einstein. In the vast majority of modern cases, however, scientific consensus can be expected to hold up under scrutiny precisely because it was reached through a lengthy and rigorous process of professional skepticism and criticism. At the very least, journalists covering science-based policy debates should familiarize themselves with this professional proving ground, learn what it says about the relative merits of competing claims, and “balance” their reports accordingly.

NCBI ROFL: Did you hear about the penis microbiome? It’s got lots of cocci. | Discoblog

The effects of circumcision on the penis microbiome.

“METHODOLOGY/PRINCIPAL FINDINGS: We assessed the penile (coronal sulci) microbiota in 12 HIV-negative Ugandan men before and after circumcision… …Among the 42 unique bacterial families identified, Pseudomonadaceae and Oxalobactericeae were the most abundant irrespective of circumcision status. Circumcision was associated with a significant change in the overall microbiota (PerMANOVA p = 0.007) and with a significant decrease in putative anaerobic bacterial families (Wilcoxon Signed-Rank test p = 0.014)…. …[The] reduction in putative anaerobic bacteria after circumcision may play a role in protection from HIV and other sexually transmitted diseases.”

penisome

Next they should sequence the micropenis microbiome.

Thanks to Matt for today’s ROFL!


You. You. Who are you calling a You You?

The YOU Docs, for those of you (YOU?) who are unaware, are Doctors Mehmet Oz and Mike Rolzen, authors of books about YOU and a weekly newspaper column called The YOU Docs. It’s all about YOU.

There are two areas of the knowledge where I have more than passing understanding: infectious diseases and SCAM’s. It always concerns me when I read nonsense in the few areas where I have some expertise. I have to wonder about the validity of other information in the paper like war and the economy. You know, important stuff. It could probably be argued that since the YOU Docs is in the “How We Live” section, the same section that carries horoscopes, the movie and TV reviews, the weather report — the fiction section — it should not taken seriously. After all, it is usually adjacent to the People’s Pharmacist, and my father always told me that you can judge a person by the company they keep.

The YOU Docs had a column with the headline: “Research backs acupuncture for a range of ills“. More fiction? Research backs acupuncture? News to me, but they are, after all, YOU Docs, and therefore may have information not accessible to mere docs with a small ‘d’. I grant up front to the authors that it is hard to be rigorous, or even coherent, in a 452 word essay. I am over 3,200 words for this entry. There are also no references, so I have to assume I found the correct research mentioned by the hints in the text.

They start with the usual appeal to antiquity:

Acupuncture has been around a long, long time: Archeologists have unearthed 5,000-year-old stone needles in Inner Mongolia.

If it is old, it must be efficacious. People would not use ineffective treatments for centuries, would they? This, of course, assumes that the Chinese, and other ancient healing modalities, had at their disposal an organized, consistent way to keep track of data to judge the efficacy of a therapy. While the use of acupuncture may stretch into antiquity, clinical and epidemiologic studies from ancient times are non-existent. The ancients only had anecdotes to guide them, and if there is no other lesson to be learned from SBM, the three most dangerous words in medicine remain “in my experience.”

One indirect way to evaluate the benefits of acupuncture and Chinese medicine in general is life expectancy. In 1900 it was 30 years. Good job traditional Chinese medicine. Now life expectancy is 71. Why?

“This can be attributed to the advancement of science and technology, especially in medical science,” said Zhao Baohua, vice-director of China Association for Aged People.

Goodness gracious. Reductionist Western Medicine more than doubling life expectancy. If only they had relied on acupuncture, perhaps population control would not have become such an important issue in the Peoples Republic.

As an aside, I cannot find anything but secondary references about the 5,000-year-old stone needles used for acupuncture. How it is ascertained that these needles were not used for sewing and were in fact used for acupuncture I cannot discover. A 5000-year-old package insert? I find one argument that these 5,000-year-old needles were used as scalpels and not for acupuncture.

The YOU Docs proceed to

But we like this popular form of energy medicine because it’s backed by an impressive body of 21st-century research. Energy medicine? Yes, it seems to change the electric currents or nerve impulses in your body.

That is what is nice about alternative medicine, a lack of consistency in terminology. Usually the term ‘Energy Therapy’ refers to energies that no one has ever measured, not altering nerve conduction. The NCCAM definitions are as good as any:

Energy Medicine

Energy therapies involve the use of energy fields. They are of two types:

Biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include qi gong, Reiki, and Therapeutic Touch.

Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.

Usually I do not think of nerve impulses as being part of energy therapy, but that just may be me.

So as I am given to understand the YOU Docs, the mechanism of action of acupuncture is to alter nerve impulses. It would also suggest, then, that the cause of the diseases treated by acupuncture is due to altered nerve impulses, or perhaps the acupuncturist is only treating symptoms and not the underlying disease. All those diseases treated by one intervention that alters nerve conduction. And I thought aspirin was the wonder drug that works wonders. The YOU Docs have a different understanding of physiology than I learned at school.

What is the data to support the effect of acupuncture on diseases and symptoms by altering nerve conduction? It would be simple enough. Pick a disease or symptom. Nerve impulse measured before treatment. Acupuncture. Resolution of disease or symptom. Nerve impulse altered.

There is one study, small (which I could not get before the post went up), that demonstrates this effect in diabetic neuropathy. There are studies that show alterations in nerve function in rats and MRI studies that show CNS changes with acupuncture. But the simple temporal relationship that would suggest a cause and effect does not exist for any other process treated by acupuncture.

BTW: electroacupuncture doesn’t count as acupuncture for the purpose of this discussion. That is not acupuncture as defined in the article. To the best of my understanding the ancient Chinese lacked electricity.

This therapy involves inserting hair-thin needles into specific points on the body to treat countless problems, ranging from easing chronic pain and insomnia to reducing the side effects of cancer treatments and helping smokers quit.

Note “specific points.” A consistent result of recent acupuncture studies is that the effects of acupuncture do not depend on where the needles are placed or even if the needles break the skin. I realize that it is a short article, but we are only a few paragraphs in and it appears the YOU Docs lack a good command of the literature concerning acupuncture. I may be picky, but precision of understanding is important in medicine. You wouldn’t want your, oh, I don’t know, heart surgeon to say, “We are going to bypass one of your arteries, somewhere there in your chest.”

As to smoking cessation? Not so much.

The significant short-term effect was lost with the random-effects model for pooling, or by removing the outlying study that led to heterogeneity. The long-term result shows no effect of acupuncture compared with sham acupuncture. There was no consistent evidence that acupuncture is superior to no treatment, and no evidence that the effect of acupuncture was different from that of other anti-smoking interventions, or that any particular acupuncture technique is superior to other techniques.

The YOU Docs go on to give specific examples of acupuncture efficacy, managing, with awesome consistency, to get it wrong every time. I come to this with a slightly unforgiving attitude. I am a specialist. What defines a specialist is, in part, is mastery, or an attempt at mastery, of the relevant medical literature. I also work in a teaching hospital. I expect my residents and medical students, when reading a paper, to get the basic concepts of the paper correct and understand some the nuance of the papers they read. It is expected that the teaching attendings, when quoting the literature, will get it right, understand the nuance of the medical literature, and not cherry pick.

Just months ago, a Hong Kong University study of 60 insomniacs found those who got acupuncture fell asleep faster and were more likely to stay that way than those who got a fake version of the treatment.

I guess they are referring to “Electroacupuncture for primary insomnia: a randomized controlled trial” which, while not being acupuncture, does meet the criteria as mentioned for being the correct reference.

The authors conclusion of the study?

MEASUREMENTS AND RESULTS: Self-reported questionnaires, 1-week sleep diaries, and 3-day actigraphy were collected at baseline and 1 week after treatment. The Insomnia Severity Index was used as the primary outcome measure. Both groups showed significant improvement compared with the pretreatment baseline. One-way analysis of covariance adjusted for baseline scores showed that there were significantly greater improvements in sleep efficiency by sleep diary and actigraphy in the electroacupuncture group. However, no significant between-group differences were observed in the Insomnia Severity Index and other outcome measures. The proportions of subjects having less than 30 minutes of wake after sleep onset and a sleep efficiency of at least 85% at the posttreatment visit were significantly higher in the electroacupuncture group. All adverse events were mild in severity.

CONCLUSION: We found a slight advantage of electroacupuncture over placebo acupuncture in the short-term treatment of primary insomnia. Because of some limitations of the current study, further studies are necessary to verify the effectiveness of acupuncture for insomnia.

Not exactly a ringing endorsement of acupuncture for insomnia.

Of interest there is another acupuncture study for insomnia that used sham acupuncture and it was equally unimpressive.

RESULTS: No statistically significant differences were observed between the groups relating to parameters associated with the definition of insomnia. The treatment group experienced that it was easier to wake up in the morning compared with the control group (repeated-measures analysis of variance, p = 0.04). Both groups showed a statistically significant recovery in subjective sleep parameters during the study period (weeks 1-6) compared with baseline values (week 0).

CONCLUSIONS: Only modest evidence was found supporting the hypothesis that AAT may have an effect on insomnia. Least improvements were found in total sleep time and number of awakenings, 2 parameters directly associated with the definition of insomnia. AAT may have a role in the treatment of insomnia, especially in combination with other treatments such as cognitive behavioral therapy. This study provides an example of how to perform studies using alternative therapies for sleep disorders.

Funny. The treatment group woke up easier and that was a benefit for those suffering from insomnia how?

One difference between the two insomnia studies was that the second study used auricular acupuncture. They stuck the needles in the ear. So what nerve or nerves associated with sleep would warrant sticking needles in the ear in one study and sticking them in another site in a different study. According to the YOU Docs the needles were supposed to be placed in ’specific sites’. What anatomy and physiology could the two study have in common? Maybe in this context specific refers to anywhere on the patient. Or I am I trying to find a logical consistency with tooth fairy science?

And, as a final note, a Cochrane review of acupuncture and insomnia says

The small number of randomized controlled trials, together with the poor methodological quality and significant clinical heterogeneity, means that the current evidence is not sufficiently extensive or rigorous to support the use of any form of acupuncture for the treatment of insomnia.

The YOU Docs say “We like this popular form of energy medicine because it’s backed by an impressive body of 21st-century research.”

I guess it doesn’t take much to impress the YOU Docs. Actually, the totality of acupuncture studies are impressive in the same way a large pig farm can be impressive.

The YOU Docs continue.

Arthritis relief: British researchers who analyzed five well-designed studies of 1,334 people with bum knees have confirmed that acupuncture relieves debilitating joint pain related to arthritis.

What made these studies ‘well designed’? If the authors considered the acupuncture to be adequate it was well designed:

we defined acupuncture as ‘adequate’ if it consisted of at least six treatments, at least one per week, with at least four points needled for each painful knee for at least 20 min, and either needle sensation (de qi) achieved in manual acupuncture, or electrical stimulation of sufficient intensity to produce more than minimal sensation.

The definition was, it seems, mostly based on the authors’ opinion. The references do not suggest the definition is derived from rigorous testing. There is, by the way, no interest in whether the same specific points are used, just that a sufficiency of needles were used. There is more to a well-defined study than the authors opinion as to what constitutes adequacy of a clinical trial. How about sample size, blinding, etc.? Multiple needles would lead to one adequate outcome.

How good was the pain control? As the authors state in the discussion,

The size of the effect on pain was not dramatic: recalculating the data as standardized mean difference, the effect size compared to sham acupuncture is 0.4 which is considered ‘moderate’

Another ringing endorsement for the efficacy of acupuncture.

The Annals of Internal Medicine meta-analysis of acupuncture for knee pain comes to an alternative conclusion.

Sham-controlled trials show clinically irrelevant short-term benefits of acupuncture for treating knee osteoarthritis. Waiting list-controlled trials suggest clinically relevant benefits, some of which may be due to placebo or expectation.

Given the great heterogeneity in the studies of acupuncture and arthritis one can probably come to any conclusion you desire if you pick the right subsets of studies. Another group of British scientists (they call themselves Oxford Scientists) did a systemic review of systemic reviews of acupuncture and concluded:

Qualified support for acupuncture was originally reported in 12 out of 35 systematic reviews, and strong support was found in another six. Applying stricter inclusion criteria, however, showed that none of the 35 reviews supported acupuncture, predominantly because there were too few patients in the randomized, double blind studies. Six reviews with more than 200 patients in randomized, double blind studies had good evidence of no benefit. Systematic reviews of acupuncture have overstated effectiveness by including studies likely to be biased. They provide no robust evidence that acupuncture works for any indication.

I guess the Oxford Scientists don’t know an adequate trial when they see one.

The YOU Docs continue:

Squelching pain: In a landmark German study of 1,162 back-pain sufferers, twice as many got relief from acupuncture as from conventional fixes such as drugs or physical therapy. Acupuncture also has been proved at least as effective as pain drugs not only for treating migraines, but for preventing them, too.

This refers to the Archives of Internal Medicine where back pain patients had ‘real’ acupuncture, fake acupuncture or standard care. The sham acupuncture was twirling a toothpick on the skin. Really.

The ‘real’ acupuncture (both individualized and standardized placement of needles, that pesky need for ’specific’ acupuncture points keeps disappearing) and the toothpick had the same improvement in pain.

Would you conclude that this is a landmark study showing the efficacy of acupuncture or conclude that whatever lead to the pain improvement, it was not specific to acupuncture? Or do twirled toothpicks alter nerve conduction? If treatment and placebo have the same effect, one usually concludes that the treatment doth not work. Unless you never bothered to read past the press release.

Also, in the landmark study

Rates of adverse experiences differed by treatment group: 6 of 157 participants for individualized acupuncture, 6 of 158 for standardized acupuncture, and 0 of 162 for simulated acupuncture.

So if you were an ethical doctor who reads the literature carefully, if offered two treatments of equal efficacy but one treatment had no side effects, would you not choose the treatment with the least side effects? If you are going to offer advice based on a landmark study, and want to maximize efficacy and minimize side effects, how could you not recommend twirled toothpicks as the acupuncture modality of choice?

Migraines? The Cochrane review, if you want to believe them, demonstrated

Fourteen trials compared a ‘true’ acupuncture intervention with a variety of sham interventions. Pooled analyses did not show a statistically significant superiority for true acupuncture for any outcome in any of the time windows, but the results of single trials varied considerably. Four trials compared acupuncture to proven prophylactic drug treatment. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment.

When compared to sham acupuncture, ‘real’ acupuncture is no better for migraines. Do you get the impression that acupuncture is no more than an elaborate, nonspecific placebo effect and only has results with subjective endpoints and only clinically irrelevant short-term benefits?

The YOU Docs go on (with an increasing lack of confidence in the authors. If I can find so much in error in a few short paragraphs, why bother to read on? I do it for you. But not YOU. My caps lock is not stuck.

Reducing treatment side effects: Dozens of studies show acupuncture helps quell pain, nausea, fatigue, hot flashes and dry mouth in cancer patients undergoing chemotherapy, radiation or both.

And dozens do not.

Three RCTs compared the effects of manual acupuncture with sham acupuncture. One RCT showed favorable effects of acupuncture in reducing hot flash frequency, while other two RCTs failed to do so.

or

There was no difference between combined acupuncture and acupressure treatment at P6 and at the sham point for the nausea score.

Just where is this “impressive body of 21st-century research” supporting acupuncture? Acupuncture research is mostly a collection of poorly done studies that demonstrate marginal effect and a few definitive studies that show no efficacy. The body of 21st century research does not support acupuncture, at least if you bother to acquaint yourself with the details of the studies. As a rule of thumb, when there are multiple studies hovering around efficacious, some showing benefit and others not, it is unlikely that any clinically relevant effect is occurring.

“How can one therapy do so much?”

Well, because they don’t.

Eastern and Western medical philosophies merge when a licensed acupuncturist inserts those sterile, disposable needles into your skin.

The needles may be sterile, but the photographs all too often show the bare fingers right at the insertion site. Search Google images of acupuncture. If you like sterile technique, the photos will give you the heebe jebees. Looking at Google images it is not surprising that there was at least one reported outbreak of MRSA due to poor technique. Acupuncture technique evidently doesn’t bother itself with the impressive body of 21st-century research on germ theory and infection control.

The YOU Docs conclude

You don’t have to believe in it for acupuncture to work. Case in point: Veterinarians know that acupuncture often helps ailing horses, goats, cats and dogs (including Titan, the world’s biggest Great Dane) in measurable ways, such as being able to walk and run again. With animals, there’s no placebo effect. It either works or it doesn’t. Same for people. Many skeptical people who’ve tried acupuncture as a last resort become believers when they see results.

I am not as well versed in veterinary literature, although I cannot imagine that acupuncture should be any less effective in animals than it is in humans. As one review suggests “on the basis of the findings of this systematic review, there is no compelling evidence to recommend or reject acupuncture for any condition in domestic animals.” Why he lack of a firm conclusion? “The methodologic quality of these trials was variable but, on average, was low.”

I guess only the YOU Docs find the veterinary research part of an “impressive body of 21st-century research. The authors of the review did not. I will refer you Dr. Ramey for reviews on animal acupuncture and animal placebo for a more expert evaluation.

“It either works or it doesn’t. Same for people.” For acupuncture, it’s the later. That statement, from the YOU Docs, is as simple a dismissal of evidence and scientific based medicine I have ever read. Anecdote rules!

In the end I am left wondering.

Did the YOU Docs read the references and not understand them?

Did the YOU Docs read the references and choose to interpret them in an original way to ensure that the conclusion ‘acupuncture works’?

“You keep using that phrase. I do not think it means what you think it means.” – Inigo Montoya.

Did the YOU Docs not read the references and relied on second hand reports?

It is a good thing the YOU Docs are not rotating on my service this month. Such scholarship would be difficult to award a passing grade, even for a 452 word essay, since it was wrong about almost every specific. However, I am one of the grumpy, old school docs who expect MD’s to get it right, even if limited to 452 words.

Addendum

I am ever so proud that I made no L. Frank Baum references for this entry. But allow me to recommend Wicked, the Life and Times of the Wicked Witch of the West. I read it right after I having read the Wizard of Oz to my eldest. The sequels are awful and the musical is worse, but Wicked is a wonderful book.


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LPG Pipeline Size Calculation

Dear All,

Greetings of the day,

I have few queries on LPG cylinder/vessel installations at industrial customer location.

1.How to calculate the Liquid LPG Pipeline size?

2. How to calculate the Vapour LPG pipeline size?

3. What should be the maximum velocity of liquid and Vapour LPG i

Scott Brown surges ahead in very latest Poll, called a "Massive change"

Now a 4 Point Lead for Scott Brown over Martha Coakley

A scant 4 weeks ago, Republican candidate for Senate Scott Brown was as much as 30 points behind Democrat Martha Coakley in one poll. Polls released earlier this week had him down by 4, another down by 2, and 1 actually showing him ahead by a single point. Now, State Senator Brown, appears to be pulling off the impossible: Poised to win what some liberal commentators have described as the "Ted Kennedy seat," in the United States Senate.

In what's being called a "Poll Shocker" by the Boston Herald this morning, Brown has opened up a 4-point lead.

From the Boston Herald:

Brown’s 4-point lead over Democrat Martha Coakley is within the Suffolk University/7News survey’s margin of error, the underdog’s position at the top of the results stunned even pollster David Paleologos.

"It’s a Brown-out,” said Paleologos, director of Suffolk’s Political Research Center. “It’s a massive change in the political landscape."

The poll shows Brown, a state senator from Wrentham, besting Coakley, the state’s attorney general, by 50 percent to 46 percent, the first major survey to show Brown in the lead. Unenrolled long-shot Joseph L. Kennedy, an information technology executive with no relation to the famous family, gets 3 percent of the vote. Only 1 percent of voters were undecided.

Pollster Paleologos went on to say that Brown clearly had the momentum, and predicted that all signs point to him posting a stunning come-from-behind victory:

"Either Brown’s momentum accelerates and his lead widens, or this becomes a wake-up call for Coakley to become the ‘Comeback Kid’ this weekend,” Paleologos said.

Sidenote: Various polls in New Jersey, days before the Governor's election in November had Chris Christie within the margin of error, ahead by 2 to 3 points. He won by 4.5%.

(H/t Memeo)

Libertarians last minute swing to Scott Brown away from 3rd party candidate

One poll last week had the uniquely named Independent/Libertarian candidate Joe Kennedy pulling as much as 5% in the Massachusetts Senate race. But traditionally, 3rd party "spoilers," lose support at the very end. Witness the recent NJ Governor's race, where the much-touted 3rd party challenger, ended with a dissapointing 4%, much below original polling predictions of as much as 15%.

Joe Kennedy, a polished, but somewhat mild-spoken Libertarian candidate running on the Independent line, was recently featured in the NY Times article. They called him the "wild card" in the race. Reporter Michael Cooper followed his campaign, and only 12 showed up at a basement speech. In the very latest poll, his support has subsided to just 3%. Other polls have him at just 1%.

Now some well-known Libertarian Party backers are even backing away. From Independent Political Report (top site for 3rd party politics):

Trent Hill, Co-Editor, IPR:

Libertarians should be cheering on a Brown victory–not because Brown is any better, but because it will likely have the effect of stopping the healthcare bill (or at least slowing it dramatically).

Gene Berkman, a prominent leftwing Libertarian, California LP member:

I certainly hope that Joe Kennedy gets a big vote, and takes enough liberal votes to cause the Democrat to lose... he [Brown] might still oppose Obamacare...

Haiti Earthquake the result of Global Warming?

At least one prominent Hollywood Actor and some Leftwing Bloggers seem to think so

On GritTV, during an interview, Actor Danny Glover made the following comment (via the London Telegraph):

"When we see what we did at the climate summit in Copenhagen, this is the response, this is what happens, you know what I’m sayin’?"

Some leftwing bloggers are joining in.

Josh Lynch at It's Getting Hot in Here, a blog that bills itself as the Youth Movement leader on Climate change, opined:

We don’t know whether or not there is a link between climate change and Tuesday’s earthquake. As a global phenomenon, it is inherently difficult to map changes in the Earth’s climate to any specific event. What we know is that burning fossil fuels is altering the climate, increasing the likelihood that disasters like this one will occur.

And Climate Change blogger Eric Gonzalez penned the following:

Looking at the bigger picture however, this isn’t just a Haiti specific problem. Indonesia needed the same after the tsunami wreckage. There may be other catastrophes in the future which may lead to inhabitant relocation or reconstruction if climate change predictions are to be believed.

Best One-Liner from a Judge This Year

The judge presiding over the first serious challenge in federal court of a state gay-marriage ban has defined his career with an unconventional approach.

Two days into the trial over the constitutionality of California's Proposition 8 gay-marriage ban, Judge Vaughn Walker has upset some opponents of gay marriage by allowing gay couples to testify on the meaning of marriage.

The 65-year-old judge has tried to breach the longtime ban on TV cameras in federal court by ordering the trial to be posted on YouTube -- though the Supreme Court has temporarily stayed that decision.

On Monday, the first day of the trial, he repeatedly asked the lawyers: Why don't states "get out of the marriage business? It would solve the problem."

OK, that's two lines, but right on the money in any case.  Read the rest; Walker is an interesting guy.  How did a libertarian get on the federal bench?

Pipes Damage

The pipes when they were put inplace in order to be errected, they have been discovered contained damage, deformities, crookedness longitudinal asymmetry at the end joints, at which limit we can accept such problem? any mechanical solution can be taken?

Preventing Electrical Cable Theft

HI EVERYONE

IM TSOE AND I JUST WANNA SUGGEST ABOUT THE ELETRICAL CABLE THEFT.IVE BEEN THINKING A LOT ABOUT THIS AND SOMETHING JUST COME OUT OF MY MIND. I THINK THIS MESS IS CAUSED BY THIS CABLES, WHY I SAY THAT IS BECAUSE THIS THEFTS KNOWS VERY WELL THAT THIS CABLES COST A LOT, THAT IS WHY

Oil-Lubricated Compressor Condensate Drainage

I have faced a problem in oil lubricated Compressor condensate drainage, when I designed a srew compressor for auto industry , there was a problem of condensate drainage, for compressor room,so much condesate here, i have gone for polysep oil seperator, but at the auto drain trap in different loca

Required Fuel for DG Set

in case of power supply cut , if we go for a little fuel station for DG Set, what should be the fuel requirement for daily use please suggest me some standard if any or calculation hw we can calculate it

Videos: Flying SpaceShipTwo in a Centrifuge

Keith's note: Alan Stern [two videos], Dan Durda [two videos] and ten other scientist took two rides in a centrifuge located at The NASTAR Center as part of a suborbital scientist training program held on 12 & 13 January 2010. On these runs the scientists were put through simulated rides aboard Virgin Galactic's SpaceShipTwo. The first flight was at 50% acceleration. The second flight was at 100% acceleration. You will note by his commentary that Dan Durda was determined to get on NASA Watch.