The Physiological Society Benevolent (Financial Hardship) Fund

This not a blog... just a plug for the Physiological Society's hardship fund called the Benevolent Fund (or BenFund for short).  If you have an extreme financial crisis and work or study in a Physiology type of discipline, it might be worth checking it out.  I am now the Chair.
The link is here

Placebo; something about nothing!

I am sorry to dissent from the general chorus of both lay and scientific praise for the Horizon placebo program (Medicine's of the Mind "Power of the Placebo"). Many people seem to have found it fascinating, I'm not one of them. I thought it was all nonsense (if you are quick you can still watch it here)!

One of the disappointing things science can do is take a really simple phenomenon and make it more complex. Science should attempt to do the opposite.  So to clarify; most lay people have never (IMHO) had a problem understanding any of the following cliches:

• If something excites you (not like THAT) your heart to beats faster.
• You get a performance boost from confidence and/or positive mental attitude.
• Under-performance can result from under confidence.
• Fear can turn your stomach.
• Fear can make you go weak at the knees.
• In a fight situation, humans and other animals can suppress pain and don't really hurt until they are out of the danger zone....

There are so many of these its crazy. Placebo is just another one of these; if you truly believe you will feel better, you will feel at least a little better.

In teaching its a critical factor.  Telling students they will all do well WILL improve their performance.  And if you are my students worry not, it's no trick, I don't mind if you read this because I am absolutely sure you WILL do well.  There is nothing like confidence for optimum performance.  I have seen students in the past so nervous they couldn't even write their own name on the front of the papers.  Guess what?  They do terribly in the rest of the exam too.  Listen to my voice my students:  you WILL do well, really you will!

Now the program went to great lengths to show that there were real chemical changes in the body whilst this was happening (after people took placebo). But HELLO!! we are little more than a collection of chemicals. Everything you sense, think or do involves changes of chemicals. If you see something, glutamate is released in the eye and various neurotransmitters are released throughout the brain. If you think or imagine something, chemical changes take place in the brain. If you believe you will feel better, of course chemicals will change. If you lift your own leg... chemical changes take place in the process.
A couple of specific points about the program; the cyclists performing better and/or feeling they performed better?  Well people are absolutely hopeless at assessing their own feelings to start with (as I discussed here), and any good coach would know a bit of appropriate inspiration at the right moment will improve performance.  Why do people break so many world records at the Olympics?  This is exactly the same as the benefit of a so called "pep talk".  The the "mystery" of the placebo was further illustrated with a patient who's symptoms improved even though she was told she was going to get placebo.  All that matters is whether you feel you will feel better.  ...and typically of course the disease they chose was IBS "irritable bowl syndrome".  This is notorious for being a "there's nothing wrong with you get out of my surgery" type of disease.  Frequently people can be really ill with it too of course, and disturbingly, my guess would be that people "diagnosed" with IBS are frequently suffering from undiagnosed Crohn's or coeliac disease. Nonetheless, in many cases it the GPs way of saying, "I don't deny there is something wrong with you, but I can find anything to account for the symptoms you are reporting".  Bottom line (pun intended).. its not a great vehicle for demonstrating the magic of placebos.  

So giving people placebo, results in them thinking differently to non-placebo people and this change in thinking results in change of chemicals. To me, it is no big deal.

So why am I so evidently wound up by this? For two reasons.

(1) The idea that we are anything other than a collection of swirling chemicals and electricity is patent nonsense.  I feel there is no place for such arcane pre-science gobbledygook.  If you are surprised that chemicals change in the body when people "think positive" where have you been!? ...and if you thought that and you are even a biological scientist... Wow.

(2) Throwing your hands up in the air with amazement when someone shows that thinking changes chemicals in the brain is opening the door for woo. Why do I say that? ...because the next thing will be TV showing how people feel better after taking homeopathic remedies (aka water) and correlating this to chemical changes in the brain. Look they will say, homeopathy changes chemicals in the brain... So it was true all along. Well no it wasn't. Homeopathy is nonsense and just try and remember chemicals are constantly changing within the body. And will do so until well after we all die.

And on that cheerie note, I think I shall go and buy a high fat pizza and bring my own demise a little closer!!

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Bad Pharma and Negative Data

Negative clinical data.

This is a topic getting a lot of airplay and a lot of words! Here are a lot more (sorry). There is a huge issue with clinical trials failing to report the failure of a drug. There are also a number of quack remedies which have been tested frequently and usually deliver negative results that are never published. If ever, by the effect of pure chance, they do appear provide some marginal benefit, this is shouted from the rooftops. So how how are your sports team doing? There are two ways you could assess that, you could say they are 100% winners. To get this value you simply report the results where they won. However, a fairer assessment would be to report all the results and then you would see that if it were baseball, most likely, they loose half the time and win half the time. More-or-less. The withholding of negative clinical trials data is thus wicked, but I think outside of the people who do it, it is already universally condemned! This was discussed at great length by Ben Goldacre in his book Bad Pharma. It is indeed an excellent book and very important. Although I feel I can make four criticisms since I am pretty certain he would never follow me on Twitter!!! ...

"Reps may do bad things I suppose, unlike me. I do good things, but I just do them badly!"

(1) Bad Pharma was painfully long and I was quite frankly on my knees by the time I approached the end. (2) Ben is really horrid about drug reps. Ben seems to think they are evil, but I have known people go into drug repping and from my experience they were just ordinary people searching for a job. They may not love their job like the rest of us do, but they have to do it because it is their livelihood! I would blame the system that allows Vets and Medics to be ill equipped to handle the high pressure sales and gobbledygook "science talk". I feel sorry for drug reps trying to sell their wares to hospitals/GPs/Vets. (3) There were not many laughs in there, given how long the book is! (4) I don't think he quite gets the situation with negative preclinical data. So here's my bit on that.

"The Bad Pharma book by Ben Goldacre highlighted problems with negative data, but it treated clinical sciences and basic research just the same."

Negative Preclinical Data

It is not the same. I know the Journal Editors (I also Edit!), will all say negative data is perfectly acceptable, but the reality is; it is just not as hot.

"List all the Nobel Prize Winners you can think of that got the Prize by showing that their own theory was untrue"

Firstly, even I accept that negative data is less exciting; we knock about ideas in my lab... we wonder if this works like that. We do an experiment and we find.... it doesn't. No one can really pretend that is going to be a widely exciting read for others. RBJ had this great idea: His group spent months testing it and turn out to be wrong. Sure if there is some huge piece of dogma you can debunk you could probably publish this IF you also included an alternative positive set of data. Not true? OK lets have a competition, you list all the Nobel Prize winners who got their Nobel Prizes for the failure to discover something? OK I'll even allow you to throw in the discovery that something they thought might work.. doesn't work. Meanwhile, I will start to list Prize winners who were elected on the basis of positive data. Its all nonsense. A hypothesis constructed, tested and verified (positive data) is nearly always going to be easier to publish in a mainstream journal than "we tried this... it didn't work".

Am I complaining? Not about the fact that negative scientific data is tricky to publish, it has always been like that. My gripe is that (a) Ben and others seem to think this is in someway scientific corruption. (b) Editors need to have the courage to say, generally positive PRE-clinical data is more interesting and publishable than negative. I can have 10 new theories before breakfast, when tested, most of them will prove untrue I am sure, we can't fill the literature with disproving of all our own theories!

"None of us want to spend our days reading about how Jo Blogs tested his own private theory and found it to be untrue!"

The last point, wouldn't it be useful to have access to negative data to stop scientists around the world keep trying the same things and getting the same negative results? Oh yes indeed. Little journals or peer-review repositories which specialise in negative data are the way to go. They exist already, so lets just use them (if you are a scientist) and stop confusing the shocking hiding of negative clinical data, with the quite legitimate low profile publishing of negative data and broken hypotheses.

There feel better now.

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