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Prof Healy blogs on Sense about Science, LM/Spiked, RCTs etc.

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The first two of five planned blogs that involve some issues and people I expect many people here will be aware of. I often find with Healy's stuff that I agree with bits and disagree with bits, but thought that they may be of interest to people here.

Sense about Science: Follow the Rhetoric

http://davidhealy.org/sense-about-science-follow-the-rhetoric/


I actually thought that this blog was pretty good about the way in which MMR has been used politically, and made these points well.
Sense about Science: First Admit no Harm

http://davidhealy.org/sense-about-science-first-admit-no-harm/

I don't normally agree with, or really even understand, a lot of Healy's criticism of RCTs, but I thought that this was a fair point:

RCTs work for industry because they focus on one of the ninety-nine effects a drug has. Focusing on this one effect they nevertheless claim that they have told us all we need to know about this drug.

A lot of the other stuff in that blog I didn't agree with, but I'm going to hold off really commenting on this until all the blogs are up.

Also of interest is a Tracey Brown post defending herself here:

http://www.senseaboutscience.org/blog.php/36/where-sense-about-science-comes-from

Seems pretty disingenuous to me, eg on Fiona Fox and the SMC:

Another connection made with Sense About Science being set up is the beginning, around the same time in 2002, of the Science Media Centre at the Royal Institution. This was set up by Susan Greenfield (who had also been in contact with Dick Taverne about his articles and apparently they agreed that there was a need for something to get scientists to contribute more to the media (as well as something for the public more broadly). A connection gets made because Fiona Fox, director of the SMC, is sister of Claire Fox who runs Institute of Ideas. This is a coincidence and not a relevant one, though it’s probably not a coincidence that both Sense About Science and the SMC were set up around that time – they both respond to the problems identified in the House of Lords Science and Technology Committee report into Science and Society, and both Dick Taverne and Susan Greenfield were part of those discussions in the Lords. This report was given to me as my frame of reference on starting. Sense About Science interacts with the SMC, we like them very much but we’re not part of a grand plan! In fact we probably don’t talk as often as we should – it’s one of the worst features of overworked organisations that we go around saying ‘we must have coffee’ to people but don’t arrange it.

A connection is made not just because Fiona Fox is the sister of Claire Fox (who was mentioned earlier as a LM member), but also because Fiona Fox was a key member herself, and even wrote the article on which led to LM getting shut down.

Perhaps of interest to people here is the letter Tracey Brown sent selling herself to British American Tobacco, which says:

I have included, for interest, a number of relevant cuttings and press releases
kindly supplied by Frank Furedi, Tony Eaton and Simon Wessely. Everyone is
obviously very busy, but I thought it useful to provide some background material, in
case you have the time and inclination to cast an eye over it .

http://davidhealy.org/wp-content/uploads/2014/06/TB-BAT-memo.pdf

Healy said that he was sympathetic to much of what he read from LM... I've got to say that most of what I've read from them has seemed pretty repellent.
 
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Part III is up: http://davidhealy.org/sense-about-science-follow-the-lawsuit/

I'm not really sure what I think about this, so am not commenting much. This bit I'd have thought everyone would agree with, especially after the spin we've seen from PACE:

Partnering Pharma
I’ve been a consultant to pharma and an expert for both plaintiffs and pharmaceutical companies in lawsuits. These contacts definitely bias me – as much by virtue of the people you meet as the money you might be paid. Under oath when asked if I’m biased I have always said yes – absolutely.

But I’ve never thought when it comes to science that it matters whether I or anyone linked to RxISK are moral or even nice people. Science might be better served if I’ve got some strange biases or am being paid to try and find the flaws in an argument. The key thing is access to the data, and given access to the data the more biases the better. Sometimes it takes a true weirdo to see how the data hangs together.

Being motivated whether because you have suffered an adverse event or because you’re being paid makes a difference to the effort you put in to solving problems. But at the end of the day, if you aren’t free to access the data it’s not science. If you’re a doctor and accept not being given access to the data – such as all doctors and statins – that’s quackery not medicine.

Science moves ahead, when people with different biases have their views challenged by the data. This is the very definition of science as opposed to philosophy or the humanities or business.

Medicine moves ahead when things happen to patients and when doctors and patients work to understand what has happened.

Business would likely do better in the long run if it built on this framework of doctors and patients working together to generate new knowledge. But instead at the moment business is not open for business on this issue. Why?

One thing that has always concerned me about All Trials, and their link to Sense About Science, is that there has been reassuring noises (for pharma) made about compensation. I think that if people have been making money from treatments which they've misrepresented the efficacy of, then they should have to pay some price for this, rather than be allowed to get away with it. This blog hinted at a concern here, but didn't go into much detail, citing only:

The Cowardice of a Pampered Society
Tracey Brown and Dick Taverne of Sense about Science (SAS) have a publication:

Over-precautionary Tales: The precautionary principle represents the cowardice of a pampered society.

Is this Sense about Science?

What would the real SAS – the Short Arm Squad – say?

See SAS to Lisbeth

Furedi's (the guy seen as being at the heart of LM) work on compensation culture has always seemed like a poor defence of abuses of power, built upon a few anecdotes. Exactly the sort of left-winger big business would be keen on!
 
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Part 4: http://davidhealy.org/sense-about-science-follow-the-patient/

I didn't think this part was as interesting or good. I often find with Healy that I agree with a lot of his criticisms of others, but not with the alternatives he proposes. I like restricting the ways doctors can treat their patients, as I think loads of doctors are terrible, and patients are often so desperate to get better that they'll try anything.

Healthcare Kill
Everything is aimed at stopping a doctor and patient working freely together. This is the moment that should create value for the economy, for science, for the doctor and for the patient. It is increasingly the moment when value is destroyed, and lives are impoverished as a consequence.

Key to what has happened is the climate changing effects of a fetish for RCTs and the operations of groups like Sense about Science. In the 1960s, drugs were poisons and the doctor and patient fully expected things to go wrong. The magic lay in bringing something good out of the use of a poison. Now that poisons have been put through the clinical trials blender and become fertilizers, no-one expects anything to go wrong. When something does go wrong, the patient becomes a loser and is ostracised. The herd moves on leaving the wounded animal to the hyenas.

I actually thought that was interesting emotionally - I often think that we are not sufficiently wary of medical interventions. Given the difficulty of identifying unknown and rare side-effects, problems with social response bias, etc, it seems fair to assume that medical interventions will often cause problems we're not aware of, and so we should have really good evidence of real benefit before we start to assume that they will do more good than harm overall - the idea of seeing medicine as a poison which needs to be carefully handled rather appeals to me, at least compared to what seems to be the current emotional assumption: that medicine is 'care', and must be a good thing. (There is certainly a danger of taking this too far, and letting fear of intervening become unreasonable).