The first nomination goes to Vince Cable. This surprises me, as he is one of the few politicians we have who more often than not actually talks sense. Nonetheless, earlier this month he gave a speech in which he gave the statistic that “graduates, on average, could expect to earn £100,000 more in their life-time than non-graduates”.

Now, I don’t know whether that figure is realistic or not, although clearly it’s reasonable to expect graduates to earn more than non-graduates. However, it does strike me that it must be very hard to measure just how much that difference is. To obtain such a figure reliably would have to  involve following up graduates for decades after graduation. Perhaps that has been done in the past, but the profile of university graduates has changed beyond all recognition in recent years, now that a much higher proportion of the population goes to university than in times gone by. Any such figures, if they exist, almost certainly are not generalisable to today’s graduates.

But there is a further problem: reporting this statistic in the context of arguing in favour of a graduate tax (subsequently abandoned) only really makes sense if you believe the relationship is causal. It almost certainly isn’t. Sure, graduates earn more money than non-graduates, but is that because of their degrees or is it just that they are generally higher-calibre individuals who would earn more money anyway? We are not told where the statistic came from, but I doubt it would represent a genuine causal effect of a university education.

My second nomination goes to the BBC and Ipsos Mori, who today have published the results of a poll claiming to show that the majority of Londoners support the 2012 Olympics being held here.

I would be surprised if that were true. Personally, I think it was a crazy idea to spend all those billions on hosting the Olympics, and pretty much everyone I know agrees with me. Of course, my circle of friends is certainly not representative of the general population, so I acknowledge that it’s just possible that my experience is unusual, that the BBC poll could be right, and that Londoners really do support the games.

However, I note that no details of the methods are published with the results. How was the sample selected? What was the precise wording of the questions? Did any preliminary questions help to frame the questions in a way that could have biased the results? Without knowing those things, the results are meaningless. My guess is that there was something seriously dodgy about them. Why would they not publish the methods if they had nothing to hide?

But despite that stiff competition, the winner of July’s “dodgy statistic of the month competition” goes to Experian. On the home page of their website, they tell us that “1 in 8 people are victims of identity theft”. That sounds alarming, doesn’t it? Perhaps you might even think that they want us to be alarmed, although I can’t think why. The statistic links to a service that supposedly helps to protect you against identity theft for only £4.99 per month, but surely that couldn’t have anything to do with it, could it?

There is no information on the Experian website to say where this figure comes from. I did email Experian’s PR department to ask them, and at first it looked like they might send some data justifying their statistics, as I had a phone message from them saying they had tried to reply but been blocked by our spam filter (which they may well have been, as it can be rather aggressive). So I unblocked them, but my subsequent phone call and email asking them to resend the data have still gone unanswered. If they do send the data at some stage in the future I’ll post an update.

So, where might we get statistics on identity theft? Well, CIFAS seems to be, as far as I can tell, a bona-fide organisation working in this area. According to their statistics,  there were 77,600 cases of identity fraud in 2008 (the most recent year currently available). Given that the adult population of the UK (and let’s be charitable and assume that Experian really only meant adults) is about 48 million, that means that your risk of identity theft in a given year is about 1 in 600.

So, given the total lack of justification for the statistic of 1 in 8, and the almost a hundred-fold difference with my own (admittedly extremely crude) calculation, Experian can consider themselves a worthy winner.

Elise was kind enough to show me her article before she published it, and we had some interesting discussions about the best way to describe plagiarism. Is it theft? Is it evil? Is it just lazy? What we both agreed on strongly, however, was that the title of the article was absolutely spot on: whatever else plagiarism may be, it certainly hurts is victim, always on a personal level, if not financially.

Plagiarism may or may not be unlawful, but it is always unethical, and says some deeply unpleasant things about its perpetrator. Now, one may not always wish to judge the plagiarist too harshly. Plagiarism in an undergraduate essay, for example, may not be the result of evil, but simply laziness and a failure to understand the ethical norms of writing. This would be a good opportunity for the student to be taught just how unacceptable plagiarism is.

However, when the plagiarist is a professional journalist, there can be absolutely no excuse. Plagiarism in those circumstances cannot be described as anything other than an egregious breach of ethical standards.  And if the journalist in question works for BBC Radio 4’s Today programme, normally a shining example of some of the best journalism in the world, and one of the few parts of the BBC that has steadfastly resisted the dumbing down that seems to be pervading ever more of the rest of the Corporation, then to find plagiarism is unbelievably shocking.

So, imagine just how shocked I was when I read this article by Today’s Tom Fielden, and saw its remarkable similarity to an article written a few days before for the Smithsonian Magazine by Brian Switek, a freelance science writer and blogger from the US. You can see just how similar the two articles are in this graphic (thanks to @fakelvis).

Now, we shouldn’t jump to conclusions. Perhaps there is a perfectly innocent explanation for the suspicious amount of overlap between the two articles. I do hope so. I have always had the utmost respect for Today, but if that innocent explanation doesn’t soon materialise, then that respect will be destroyed.

For this latest updates on the story, you should look at Brian Switek’s Twitter feed.

OK, now we’re all up to date, I have just finished reading the documents I received in response to my FOI request from both the Department of Health and the ethics committee that approved the UK Biobank study.

I am not reassured.

Before the main UK Biobank study was approved, the UK Biobank team did a pilot study to investigate the feasibility of their study procedures. You can read the pilot study report here (546 KB pdf). That pilot study was submitted as part of the ethics application for the main UK Biobank project.

To give at least some credit to the UK Biobank team, they did identify in their ethics application that obtaining data from the NHS was one of the main ethical issues in the study.

Oh yes.

However, they then go on to say “Experience in the integrated pilot study showed that this approach was well received by potential participants”. Hm. We’ll come back to that.

As well as applying for ethics approval, the UK Biobank team also applied to the (now defunct) Patient Information Advisory Group (PIAG) for permission to obtain identifiable patient data without consent, as required by the Health and Social Care Act 2001 (now superseded, but in force at the time). Permission was sought (and granted) to obtain the data from central NHS registers. The justification given for this was that in the pilot study, in which they requested the data from individual Primary Care Trusts (PCTs), the response from PCTs was variable.

The pilot study contacted 4 PCTs to ask for the data (I believe the necessary approvals to do this were in place at the time). One of the PCTs sent the data rapidly, one sent it after several weeks’ delay, and the other 2 did not send it at all. We are not told why not, but perhaps it is because the data controllers at those PCTs believed it was unethical to release confidential patient details without the consent of the patients.

If I had been on the ethics committee, I would have asked questions about that. The difficulties in persuading data controllers to release patient data should suggest to anyone who is awake when reviewing the ethics that there could be ethical problems, but that aspect was ignored, and the reluctance of PCT data controllers to release confidential data was apparently seen as no more than an administrative difficulty. The ethics committee’s minutes do not contain anything to suggest that anyone asked about the reasons for the PCTs’ declining to disclose patient data.

Now, both the application to the ethics committee and to PIAG stated that the recruitment method was “well received” in the pilot study. Let’s see if that claim stacks up. In the pilot study, they sent nearly 60,000 invitation letters. Of those who declined to participate in the study, 57 gave the reason for declining as being concerned about their contact details being provided by the NHS without consent or about it being an invasion of privacy.  In the PIAG application, UK Biobank state that because only 57 of 60,000 invitees declined for this reason, only 0.1% of participants were concerned.

On the face of it, that sounds reasonable. Surely it’s OK to go ahead with this recruitment method if only 0.1% of invitees object? But hang on a minute: only about 7,000 of the original 60,000 gave a reason for declining. So using 60,000 as the denominator is totally inappropriate. It would be more accurate to say that about 1% of invitees were concerned about the breach of privacy. Isn’t it a bit worrying that the people in charge of running a major, multi-million pound epidemiology project could make such a schoolboy error in epidemiology?

But even if 1% objected, that’s still not very many, is it?

Possibly not. But it’s crucially important that only about 25% of invitees responded to the invitation letter at all. With a 25% response rate, the potential for response bias is huge. It is reasonable to assume that those who didn’t respond to the letter at all were less enthusiastic about the project than those who did respond. So the proportion who objected to their privacy being breached among the non-responders could have been far higher than 1%.

But that’s not all. The form that invitees were given to respond asked them to indicate the main reason(s) for not wanting to participate, and provided a fairly small box for the response in which it would be hard to list more than one reason. If some participants were concerned about the privacy aspects of the invitation but also had other reasons for not participating, they may well not have reported their privacy concerns, even if they did go to the trouble of returning the form.

It’s important to note that participants were not specifically asked about their attitude to having their details released by the NHS.

Given the low overall response rate and the way reasons for non-participation were collected, I think the fact that as many as 57 invitees specifically volunteered the information that they were concerned about privacy should alert anyone who is awake that there could be a concern here.

But as we’ve already established, the ethics committee showed no signs of being awake.

Of course, obtaining data from the NHS central registers without patients’ consent is a big deal, and it needed approval from government ministers to make it happen. My FOI requests have turned up some interesting documents.

The earliest is the minutes of a ministerial meeting held in 2005 at which the UK Biobank study was discussed. The minutes contain the sentence “It was agreed the first contact should come from the DH or the NHS, not UK Biobank”. However, the invitation letter for the study very clearly comes from UK Biobank (although it is counter-signed by a representative of the Department of Health), so it seems that that agreement was subsequently overturned. How, I do not know.

There is also a letter, written by representatives of UK Biobank and its main funders in May 2007, to Lord Hunt, a health minister at the time, asking him to intervene to make it possible to obtain the details from the NHS centrally, and repeats the line that the invitation was “well received by the public”.

The response from Lord Hunt makes interesting reading. The tone of the letter suggests that he was perfectly aware there was something dodgy about the NHS disclosing patient data, but was going to go ahead anyway. He states “we must all of us be ready to explain clearly and consistently why it is right for the Department of Health to contact NHS patients for research”. He also says that he has asked the Department of Health’s communications team to work with the UK Biobank and its funders “to get the right messages across”.

You have to wonder why it would be important to have your communications team “get the right messages across” if you were confident that what you were doing was ethically defensible.

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Now, the intention behind this idea is entirely laudable. We all know (we do know this, right?) that the results of a single clinical trial are usually meaningless without being put into context. If I report a trial of an intervention that finds it is effective in a certain condition, then you might be inclined to believe the intervention is effective. However, if 25 previous high quality trials of the same intervention in the same condition had found it to be useless, I hope you wouldn’t take too much notice of my one positive trial, which in those circumstances would look like a bit of a fluke.

So, by including the results of a systematic review in a research paper, the journal will make it much easier for readers to judge the reliability of any conclusions drawn in those papers, as a result of being able to see those results in their proper context.

There is, however, a catch.

A systematic review, if it’s going to be done properly, is not a trivial exercise. Obviously it depends on the intervention being studied and how much is already known about it, but it can sometimes take several months to complete a systematic review on a subject for which there is already copious literature. This will dramatically increase the costs of preparing the paper.

Now, put in the grand scheme of things, that shouldn’t matter too much. The costs of writing the paper are normally utterly trivial compared with the overall costs of doing the research that the paper describes, and even if the costs of the paper increase tenfold (which they easily could), it probably doesn’t have too great an impact on the overall costs of the research project.

Of course, it’s also good practice to do a systematic review of a subject before starting a new trial, to be sure that the trial is really needed, but in practice that isn’t always done, and even if it is, then it might well be out of date by the time the research has finished and the paper is being written.

On balance, I approve of what The Lancet is proposing (declaration of competing interests: sometimes people pay us to write systematic reviews, so this could be an extra source of business for us), but if it is to be successful, then research funders will need to change the way they think about writing up their results. Although the costs of writing up research are tiny compared with the costs of doing research, the fact is that budgets for writing the research are usually fixed and small (or even non-existent), and if that remains the same, including the systematic reviews is going to be impossible. Research funders will need to understand that writing up the research for publication is important, that even with a systematic review it is a very small part of the overall budget, and that it is something that needs to be adequately funded if it is going to be done in a way that will advance medical science to the high standards that The Lancet are seeking to achieve.

One interesting little thing to note in closing: the Centre for Reviews and Dissemination are planning to start a prospective register of all systematic reviews. This is certainly an excellent idea, which should help to reduce bias in systematic reviews. However, I’m not sure whether they intend that all “built-in” systematic reviews in Lancet submissions should be registered.

So given that walking tours are usually so much fun, it’s astonishing that after living in London for about 16 years I went on my first walking tour here only yesterday evening. I guess it’s always a danger of living somewhere that you never get round to doing the things that tourists do, even if they are fascinating.

Yesterday, I went on the first of a series of scientific-themed walking tours organised by the Royal Society. It was fascinating. Led by our excellent guide Barabara from Tales of Two Cities, we started at St Bartholemew’s Hospital (which I learned was the oldest hospital in Britain), and wandered around the surrounding area, learning many interesting facts about the history of medicine as we went. The most surprising bit for me was learning about how anatomy classes for medical students in times gone by were heavily dependent on a thriving trade in grave-robbing.

It was also rather a treat to see some hidden gems of the City of London, and find some beautifully tranquil green spaces in places where you really wouldn’t expect to find them. The sort of thing you never do if you live in a city, but to which an expert guide can really open your eyes.

I have decided that I really should spend more time getting to know the city in which I’ve lived for the last 16 years. Luckily, the Royal Society’s series of walks has only just started, so I should be able to go to one or two more of them.

By law, public bodies are required to respond to Freedom of Information requests within 20 working days. I finally received the documents I asked for this week. That’s a lot more than 20 working days since January. It took several reminders and a formal complaint to the bit of the NHS that held the documents before I received them, but I got there in the end. I have no idea whether the reluctance to send the documents was because they have something to hide or simply good old-fashioned inefficiency.

Anyway, better late than never. I’m also happy to report that the Department of Health have also sent their documents, and did so much more promptly, well within the 20-day limit.

There’s a lot to look at. I shall report back here when I have done so.

By an amazing coincidence, the research was funded by Weight Watchers. Who’d have thought it?

Now, that doesn’t necessarily mean the research is wrong. Maybe it was incredibly well conducted research and Weight Watchers is indeed a remarkably effective way to lose weight.

But here’s the thing: I don’t know whether it was or not,  because the research has not yet been published. So I’m willing to bet that none of the journalists who wrote about it knows whether the research is trustworthy either. It is going to be presented at a conference this week, but a peer-reviewed article is not yet available. Without seeing a full description of the methods and results of the research, it is impossible to know whether it is reliable.

Seems that the journalists were simply regurgitating a press release without bothering to check whether the research was credible. But that’s a much easier way to write a story than to actually have to think about something, isn’t it guys?

Now, this may come as a surprise to anyone who is familiar with my views on homoeopathy, but I’m going to mount a partial defence of it here.

Don’t worry, I haven’t completely taken leave of my senses. Let’s start by being clear about the scientific basis of homoeopathy:  it has none. There are some people who believe that diluting a substance until it is so dilute that there is absolutely none of the original substance left confers magical powers on the water you used for the dilution. Some may say that those people reject the paradigm of Popperian critical rationalism on which mainstream science is based, opting instead for a more sociologically based paradigm of individual existentialism, although personally, I prefer to say that they’re just talking complete bollocks. If anyone isn’t familiar with just how much bollocks the supposed science behind homoeopathy really is, Richard Dawkins has a nice video explanation of it here.

Much clinical research has been done on homoeopathy. Occasionally, people have found that it is effective, although that’s mainly because of poor study design, for example lack of randomisation or blinding, that biases the study in favour of homoeopathy. Even with impeccable study design, if enough studies are done comparing homoeopathy with placebo, you would expect some to show benefits of homoeopathy just by chance, and supporters of homoeopathy may leap on those as evidence that homoeopathic magic potions really do have magical powers. However, if you look at the totality of the evidence (there’s a good review here), the message is pretty clear:  homoeopathy is no better than placebo. Not at all surprising really, because homoeopathic remedies are pharmacologically inert. They are placebos, so obviously they’re no better than placebos.

So to repeat, homoeopathic remedies have no active substance in them, they have no scientific basis, and they are no better than placebo.

So why do I say I’m defending homoeopathy? Well, it may be no better than placebo, but of course it is also no worse than placebo, and placebo can actually be quite effective.

With many medical conditions, if you give a patient a placebo, the patient will get better. There are two quite distinct reasons why that may happen, and it’s important to be aware of the difference. The first is that the patient may simply get better anyway because of the natural history of the disease. A good example would be the common cold. Most people who have a common cold recover within a few days. So, if you give patients with the common cold a placebo treatment, they will get better. But they would have done anyway, so this is not a true placebo effect. The true placebo effect is when a patient’s expectation of benefit from treatment causes some physiological change which really does make them better. A good example of this would be patients with depression. Many patients with depression show dramatic improvements on placebo treatment, and indeed a recent paper in JAMA concluded that antidepressants offer little additional advantage over placebo for milder forms of the disorder.

Now, clearly giving placebo treatment is inappropriate if proven effective treatments exist. When homoeopaths offer to protect children against measles by giving homoeopathic treatments as an alternative to vaccination, that is mind-bogglingly irresponsible, and anyone who does so deserves the strongest condemnation, and possibly even locking up. Same goes for homoeopaths who offer to treat cancer homoeopathically as an alternative to potentially curative surgery.

But there are many conditions for which placebo is a reasonable treatment option. Mild depression is an obvious example, but there are many others. Plenty of gastrointestinal complaints have no obvious treatable cause, and yet can respond to placebo treatment. Placebo treatment has the advantage of being cheap and safe, so in those cases where the efficacy is as good as any conventional treatments (ie because no effective conventional treatments are available), you can make a very good case for prescribing it.

The trouble is that you get into very difficult ethical territory if you knowingly prescribe placebo. What do you say to the patient? It’s hard to imagine that many patients would be impressed if you said “Here is a placebo pill. It is totally lacking in any medicinal properties, but if you believe in it, it might make you better.” That, however, is the only truly honest thing that you can say when prescribing a placebo, but that honesty probably destroys any chance of the placebo effect working. Perhaps if you prescribe a placebo and tell the patient that it is a highly effective treatment then the patient will improve. However, that is dishonest. Trust is very important in the doctor-patient relationship, and it is not hard to see trust being very quickly destroyed by such practices.

Does homoeopathy offer a way round this problem? Homoeopathy is a placebo. It is also quite an effective placebo: the strength of the placebo effect depends on many factors, but one of them is the strength of the relationship between patient and healer. As homoeopaths typically spend far longer in consultation than conventional doctors, that relationship is stronger, which helps to maximise the placebo effect.

So is homoeopathy a reasonable way to prescribe placebos in those circumstances where placebos are justified? This is where it starts to get really tricky, and I’m honestly not sure exactly what I think about the ethics of this situation. Do you nicely circumvent the ethical problems normally inherent in prescribing placebo by calling a placebo a homoeopathic treatment? Or is that just as dishonest, given that we know that homoeopathic treatments really are placebos?

If you believe that telling patients who might benefit from placebo that a homoeopathic treatment may help them is ethical, then perhaps you can make a case for allowing it on the NHS after all.

What do you think? Let me know via the comments form below.

However, sometimes I really despair about the way ethics committees are managed. Today, I have received a letter from NRES, asking me to take part in a consultation. Is this consultation about important ethical issues in clinical research?

No.

Believe it or not, I am being asked to consider what term should be used to refer to ethics committee members in official documentation. Seriously. I’m not making this up. We are being given the choice of “NRES independent committee members”, “NRES volunteer committee members”, or “NRES committee members”. Why would anyone think that this matters? More to the point, why would anyone actually spend public money on worrying about it? Have NRES not noticed that public money is a bit short at the moment?

But it gets worse. In the same letter, I am being asked to comment on the NRES mission statement.

Our government are currently looking for ways to save money. Perhaps NRES would be a good place to start, if they have so much time on their hands they can apparently afford to worry about such trivialities.