Monthly Archives: January 2015

Cancer, Dodgy reporting, Politics, Psychology

The Saatchi Bill

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I was disappointed to see yesterday that the Saatchi Bill (or Medical Innovations Bill, to give it its official name) passed its third reading in the House of Lords.

The Saatchi Bill, if passed, will be a dreadful piece of legislation. The arguments against it have been well rehearsed elsewhere, so I won’t go into them in detail here. But briefly, the bill sets out to solve a problem that doesn’t exist, and then offers solutions that wouldn’t solve it even if it did exist.

It is based on the premise that the main reason no progress is ever made in medical research (which is nonsense to start with, of course, because progress made all the time) is because doctors are afraid to try innovative treatments in case they get sued. There is, however, absolutely no evidence that that’s true, and in any case, the bill would not help promote real innovation, as it specifically excludes the use of treatments as part of research. Without research, there is no meaningful innovation.

If the bill were simply ineffective, that would be one thing, but it’s also actively harmful. By removing the legal protection that patients  currently enjoy against doctors acting irresponsibly, the bill will be a quack’s charter. It would certainly make it more likely that someone like Stanislaw Burzynski, an out-and-out quack who makes his fortune from fleecing cancer patients by offering them ineffective and dangerous treatments, could operate legally in the UK. That would not be a good thing.

One thing that has struck me about the sorry story of the Saatchi bill is just how dishonest Maurice Saatchi and his team have been. A particularly dishonourable mention goes to the Daily Telegraph, who have been the bill’s “official media partner“. Seriously? Since when did bills going through parliament have an official media partner? Some of the articles they have written have been breathtakingly dishonest. They wrote recently that the bill had “won over its critics“,  which is very far from the truth. Pretty much the entire medical profession is against it: this response from the Academy of Royal Medical Colleges is typical. The same article says that one way the bill had won over its critics was by amending it to require that doctors treating patients under this law must publish their research. There are 2 problems with that: first, the law doesn’t apply to research, and second, it doesn’t say anything about a requirement to publish results.

In an article in the Telegraph today, Saatchi himself continued the dishonesty. As well as continuing to pretend that the bill is now widely supported, he also claimed that more than 18,000 patients responded to the Department of Health’s consultation on the bill. In fact, the total number of responses to the consultation was only 170.

The dishonesty behind the promotion of the Saatchi bill has been well documented by David Hills (aka “the Wandering Teacake”), and I’d encourage you to read his detailed blogpost.

The question that I want to ask about all this is why? Why is Maurice Saatchi doing all this? What does he have to gain from promoting a bill that’s going to be bad for patients but good for unscrupulous quacks?

I cannot know the answers to any of those questions, of course. Only Saatchi himself can know, and even he may not really know: we are not always fully aware of our own motivations. The rest of us can only speculate. But nonetheless, I think it’s interesting to speculate, so I hope you’ll bear with me while I do so.

The original impetus for the Saatchi bill came when Saatchi lost his wife to ovarian cancer. Losing a loved one to cancer is always difficult, and ovarian cancer is a particularly nasty disease. There can be no doubt that Saatchi was genuinely distressed by the experience, and deserves our sympathy.

No doubt it seemed like a good idea to try to do something about this. After all, as a member of the House of Lords, he has the opportunity to propose new legislation. It is completely understandable that if he thought a new law could help people who were dying of cancer, he would be highly motivated to introduce one.

All of that is very plausible and easy to understand. What has happened subsequently, however, is a little harder to understand.

It can’t have been very long after Saatchi proposed the bill that many people who know more about medicine than he does told him why it simply wouldn’t work, and would have harmful consequences. So I think what is harder to understand is why he persisted with the bill after all the problems with it had been explained to him.

It has been suggested that this is about personal financial gain: his advertising company works for various pharmaceutical companies, and pharmaceutical companies will gain from the bill.

However, I don’t believe that that is a plausible explanation for Saatchi’s behaviour.

For a start, I’m pretty sure that the emotional impact of losing a beloved wife is a far stronger motivator than money, particularly for someone who is already extremely rich. It’s not as if Saatchi needs more money. He’s already rich enough to buy the support of a major national newspaper and to get a truly dreadful bill through parliament.

And for another thing, I’m not at all sure that pharmaceutical companies would do particularly well out of the bill anyway. They are mostly interested in getting their drugs licensed so that they can sell them in large quantities. Selling them as a one-off to individual patients is unlikely to be at the top of their list of priorities.

For what it’s worth, my guess is that Saatchi just has difficulty admitting that he was wrong. It’s not a particularly rare personality trait. He originally thought the bill would genuinely help cancer patients, and when told otherwise, he simply ignored that information. You might see this as an example of the Dunning Kruger effect, and it’s certainly consistent with the widely accepted phenomenon of confirmation bias.

Granted, what we’re seeing here is a pretty extreme case of confirmation bias, and has required some spectacular dishonesty on the part of Saatchi to maintain the illusion that he was right all along. But Saatchi is a politician who originally made his money in advertising, and it would be hard to think of 2 more dishonest professions than politics and advertising. It perhaps shouldn’t be too surprising that dishonesty is something that comes naturally to him.

Whatever the reasons for Saatchi’s insistence on promoting the bill in the face of widespread opposition, this whole story has been a rather scary tale of how money and power can buy your way through the legislative process.

The bill still has to pass its third reading in the House of Commons before it becomes law. We can only hope that our elected MPs are smart enough to see what a travesty the bill is. If you want to write to your MP to ask them to vote against the bill, now would be a good time to do it.

Economics, Public health

Plain packaging for tobacco

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Plain packaging for tobacco is in the news today. The idea behind it is that requiring tobacco manufacturers to sell cigarettes in unbranded packages, where all the branding has been replaced by prominent health warnings, will reduce the number of people who smoke, and thereby benefit public health.

But will it work?

That’s an interesting question. There’s a lot of research that’s been done, though it’s fair to say none of it is conclusive. For example, there has been research on how it affects young people’s perceptions of cigarettes and on what happened to the number of people looking for help with quitting smoking after plain packaging was introduced in Australia.

But for me, those are not the most interesting pieces of evidence.

What tells me that plain packaging is overwhelmingly likely to be an extremely effective public health measure is that the tobacco industry are strongly opposed to it. They probably know far more about the likely effects than the rest of us: after all, for me, it’s just a matter of idle curiosity, but for them, millions of pounds of their income depends on it. So the fact they are against it tells us plenty.

Let’s look in a little more detail at exactly what it tells us. Advertising and branding generally has 2 related but distinguishable aims for a company that sells something. One aim is to increase their share of the market, in other words to sell more of their stuff than their competitors in the same market. The other is to increase the overall size of the market, so that they sell more, and their competitors sell more as well. Both those things can be perfectly good reasons for a company to spend their money on advertising and branding.

But the difference between those 2 aims is crucial here.

If the point of cigarette branding were just to increase market share without affecting the overall size of the market, then the tobacco industry should be thoroughly in favour of a ban. Advertising and branding budgets, when the overall size of the market is constant, are a classic prisoner’s dilemma. If all tobacco companies spend money on branding, they will all have pretty much the same share as if no-one did, so they will gain nothing, but they will spend money on branding, so they’re worse off than if they didn’t. However, they can’t afford not to spend money on branding, as then they would lose market share to their competitors, who are still spending money on it.

The ideal situation for the tobacco industry in that case would be that no-one would spend any money on branding. But how can you achieve that? For all the companies to agree not to spend money on branding might be an illegal cartel, and there’s always a risk that someone would break the agreement to increase their market share.

A government-mandated ban solves that problem nicely. If all your competitors are forced not to spend money on branding, then you don’t have to either. All the tobacco companies win.

So if that were really the situation, then you would expect the tobacco companies to be thoroughly in favour of it. But they’re not. So that tells me that we are not in the situation where the total market size is constant.

The tobacco companies must believe, and I’m going to assume here that they know what they’re doing, that cigarette branding affects the overall size of the market. If branding could increase the overall size of the market (or more realistically when smoking rates in the UK are on a long-term decline, stop it shrinking quite as fast), then it would be entirely rational for the tobacco companies to oppose mandatory plain packaging.

I don’t know about you, but that’s all the evidence I need to convince me that plain packaging is overwhelmingly likely to be an effective public health measure.

Homeopathy, Psychology

Volunteers wanted for research into homeopathy

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I am planning a research project to explore the experiences of people who have used homeopathy, and if you have used homeopathy yourself then I would be really grateful if you would consider taking part in my research.

I would like to interview people who have used homeopathy, have been pleased with the results, but have encountered negative reactions to your use of homeopathy from others. Perhaps your GP has advised you not to use homeopathy, perhaps friends or family have told you that you were wasting your time, or perhaps you got into an argument with someone on the internet. It doesn’t matter who reacted negatively to your use of homeopathy: I am interested in learning about how users of homeopathy experience negative reactions in general.

The research will take the form of a short interview of about 30 minutes (which can take place in a location of your choice), in which I will ask you about your experiences and how they seemed to you. I shall be using a phenomenological approach to the research, which means that I am interested in learning about your experiences from your own point of view, rather than trying to fit them into a pre-existing theory.

This research is part of a degree in social sciences that I am doing with the Open University. Specifically, it is part of a module in social psychology.

In the interests of transparency, I should tell you that I am sceptical of the benefits of homeopathy. However, my intention in this research is not to challenge your views about homeopathy, it is to come to a better understanding of them.

If you decide you want to take part but later change your mind, that is fine. In that case, any materials from your interview would be returned to you or destroyed, as you prefer, and your interview would not be used in my research.

Please be assured that your participation in the study would be kept strictly confidential.

If you are interested in taking part in my research or if you would just like to know more about about the project, please feel free to contact me.

Thank you for taking the time to read this.

Adam Jacobs

Update 29 January 2015:

Many thanks to everyone who volunteered for this project. I now have enough data, and so I no longer need any more volunteers.

Cancer, Dodgy reporting, Epidemiology

Are two thirds of cancers really due to bad luck?

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A paper published in Science has been widely reported in the media today. According to media reports, such as this one, the paper showed that two thirds of cancers are simply due to bad luck, and only one third are due to environmental, lifestyle, or genetic risk factors.

The paper shows no such thing, of course.

It’s actually quite an interesting paper, and I’d encourage you to read it in full (though sadly it’s paywalled, so you may or may not be able to). But it did not show that two thirds of cancers are due to bad luck.

What the authors did was they looked at the published literature on 31 different types of cancer (eg lung cancer, thyroid cancer, colorectal cancer, etc) and estimated 2 quantities for each type of cancer. They estimated the lifetime risk of getting the cancer, and how often stem cells divide in those tissues.

They found a very strong correlation between those two quantities: tissues in which stem cells divided frequently (eg the colon) were more likely to develop cancer than tissues in which stem cell division was less frequent (eg the brain).

The correlation was so strong, in fact, that it explained two thirds of the variation among different tissue types in their cancer incidence. The authors argue that because mutations that can lead to cancer can occur during stem cell division purely by chance, that means that two thirds of the variation in cancer risk is due to bad luck.

So, that explains where the “two thirds” figure comes from.

The problem is that it applies only to explaining the variation in cancer risk from one tissue to another. It tells us nothing about how much of the risk within a given tissue is due to modifiable factors. You could potentially see exactly the same results whether each specific type of cancer struck completely at random or whether each specific type were hugely influenced by environmental risk factors.

Let’s take lung cancer as an example. Smoking is a massively important risk factor. Here’s a study that estimated that over half of all lung cancer deaths in Japanese males were due to smoking. Or to take cervical cancer as another example, about 70% of cervical cancers are due to just 2 strains of the HPV virus.

Those are important statistics when considering what proportion of cancers are just bad luck and what proportion are due to modifiable risk factors, but they did not figure anywhere in the latest analysis.

So in fact, interesting though this paper is, it tells us absolutely nothing about what proportion of cancer cases are due to modifiable risk factors.

We often see medical research badly reported in the newspapers. Often it doesn’t matter very much. But here, I think real harm could be done. The message that comes across from the media is that cancer is just a matter of luck, so changing your lifestyle won’t make much difference anyway.

We know that lifestyle is hugely important not only for cancer, but for many other diseases as well. For the media to claim give the impression that lifestyle isn’t important, based on a misunderstanding of what the research shows, is highly irresponsible.

Edit 5 Jan 2015:

Small correction made to the last paragraph following discussion in the comments below. Old text in strikethrough, new text in bold.

Dodgy advertising, Pseudoscience

Detox: it’s all a con

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At this time of year you will no doubt see many adverts for “detox” products. It’s a nice idea. Most of us have probably eaten and drunk rather more than we should have done over the last week or so. Wouldn’t it be nice if we could buy some nice helpful thing that would “flush all the toxins out of our system”?

This one is pretty typical. It claims to “cleanse the body from inside out”. There’s just one problem with this claim, and indeed with the claims of any other detox product you care to mention: it’s total bollocks.

Let me explain with this handy diagram:

Detox

 

There may well be things in our system that would be better off not in our system. Alcohol immediately springs to mind. But here’s the thing: millions of years of evolution have given us a liver and a pair of kidneys which, between them, do a remarkably good job of ridding the body of anything that shouldn’t be in it.

There is no scientific evidence whatsoever that any “detox” product will provide even the slightest improvement on your liver and kidneys.

If someone tries to sell you a detox product, perhaps you could ask which specific toxins it helps to remove. I have never seen that specified, but surely that is the first step to being able to show whether it works or not.

And then, in the unlikely event that this snake-oil detox salesman does tell you which toxin(s) the product is supposed to remove, ask for the evidence that it does. I guarantee you that you will not get a sensible answer.

So if your new year’s resolution is to “detox” yourself, then that’s great. Eat a healthy balanced diet, don’t drink too much alcohol, take plenty of exercise, and don’t smoke. But any money you spend on “detox” products will be 100% wasted.

Happy new year.