Dr Mark Post, head of physiology at Maastricht University, plans to unveil a complete burger – produced at a cost of more than £200,000 – this October.

He hopes Heston Blumenthal, the chef and owner of the three Michelin-starred Fat Duck restaurant in Berkshire, will cook the offering for a celebrity taster as yet unnamed.

Independent:

The technical challenges have included giving the meat a pinkish colour and the right texture for cooking and eating, as well as ensuring that it feels and tastes like real meat.

Dr Post admitted to being nervous about the final result. “I am a little worried, but seeing and tasting is believing,” he said.

I wrote about in vitro meat previously – I think it could be a great idea. Firstly, because it means every time we want to eat meat it doesn’t have to involve raising a sentient animal so we can kill it. Secondly, because it could greatly reduce the horrendous environmental pressures of meat production, such as by reducing land use, deforestation, greenhouse gas emissions and water use. And thirdly (while Australia generally grows its livestock on pastures), in lots of places they inefficiently feed grain to livestock, which could otherwise be feeding the planet.

What’s normal meat vs cultured meat?

Basically with normal meat (your everyday steak or hamburger), you combine a couple of cells (a sperm and an egg), incubate them, feed them milk/grass/grain until they grow into a whole animal, kill it, extract its muscles (discarding unwanted parts like its brain), cook the muscles and eat them. If you want more muscle-meat then you must produce new whole animals.

With cultured meat, you need one animal grown by the aforementioned process, and you extract muscle cells (called stem cells, which are capable of dividing to produce more cells), grow them in a nutrient broth so they multiply and turn into lots of muscles, producing plenty of meat. For details and difficulties, read my last post.

Dystopian problems?

Current meat reproduction technology

Of course, as I discussed in my last post, the lessons of GM food and the like teach us that there could be problems with the introduction of a new food technology, especially if consumer concerns aren’t addressed – it’s just asking for Greenpeace to start running around hysterically shouting Frankenfood.

Although anyone arguing that selectively breeding animals over thousands to years to generate genetic mutations for increased domesticity and meat production, pumping them full of growth hormones and antibiotics, fattening them up in concrete feedlots, and then killing them to eat is wholesome because it’s natural … okay, I’m dramatising the point, but, really, what the hell does ‘natural’ vs ‘Frankenfood’ mean? I bet no one who says ‘Frankenfood’ has ever chased down a bison and killed it with their bare hands and teeth, or spent their days collecting tiny seeds from wild grains that are pre-10,000 years of agricultural genetic modification.

Think no one is going to be Franken-hysterical? There’s already been this article in the Independent invoking “dystopian” sci-fi analogies about “Frankenfoods like lab-grown meat” [if a fear-or-incomprehension-catch-all-phrase like 'Frankenfood' is referenced in terms of Canadian literature, apparently it becomes highbrow broadsheet commentary], so just imagine what could happen in the hands of the tabloids.

And one of the earliest adopters of this technology is likely to be fast-food restaurants which don’t disclose their suppliers.

This is actually an excellent point. I think one of the best ways to allay potential consumer ‘what are you doing to my food’ concerns is to ensure that, at least in the initial adoption phase, anything containing cultured meat it clearly labelled. For anyone with ethical/environmental concerns it will be a selling point, and for anyone else they have a right to choose and can’t complain that they’re getting it sneakily slipped into their food.

But what happens with secondary sellers, like a fast food chain? I think that if the meat manufacturers don’t want a consumer backlash the first time cultured meat is found to be ‘hiding’ in a fast food burger, then they should require any third-party using their product to also declare to consumers that it’s cultured meat.

That way you know what you’re getting, and hopefully it would gain public acceptance and increasing numbers of consumers would make the ethical or environmental decision not to have a whole animal grown and killed for their sausage.

Image via Wikipedia

So RMIT has a Master of Wellness, which is mildly amusing and a bit depressing that you can get a MASTERS studying subjects like yoga COTH2162, CAM COTH2148 and Mindbody Wellness BESC1482:

A 2010 report estimates the global wellness industry to be worth more than $1.9 Trillion with beauty worth $679b, Fitness $390b, Nutrition $276b, Preventive Health $243b, Complementary Medicine $113b, Wellness Tourism $106b, Spa $60b, Medical Tourism $50b and Workplace Wellness $30b.

Work opportunities include the spa and wellness industry, the complementary healthcare sector, conventional healthcare and community health settings, the corporate sector and private practice as a wellness consultant.

Now we get to the good bit – Energy Medicine (MEDS2139). The RMIT School of Health Sciences takes the pseudoscience prize for the week, for teaching a course containing the ultimate canard (a canard is the SI unit for quackery). That’s right – RMIT has a health course that includes the word ‘quantum’ (and a bonus point for ‘holistic’).

Wow. At a university. Just wow. It’s really like a Hollywood script – you know the bit in the sci fi movie where they need to explain how the spaceship works and so they babble a whole pile of sciencey terms – “we’ve got to realign the subspace thrusters or else the alpha radiation from the quantum feedback is going to blow us to smithereens”. Or the forensics TV show equivalent – “I’ve extracted the organic gases from the dog poo at the murder scene and have used the mass spectrometer measure their bandwidth and determine whether the gut bacteria inside the rat the dog ate had been feeding on Totallius ridiculosi beetles, which is an endangered beetle only found in 2 square metres of a swamp upstate”.

They’d be better off saying that Energy Medicine, from a non-linear, non-subjective viewpoint, is like a big ball of wibbly wobbly timey wimey stuff. [Thanks imdb.]

And I’m guessing how the university justifies it is this:

So they’re giving these students a solid enough grounding in real physics, chemistry, human physiology or scientific method to be able to critique the contents of this course? Refute the egregious invocation of quantum mechanics? Funnily enough, I didn’t notice any science subjects as a prerequisite.

When I Googled it the search also came up with plenty of videos from the course co-ordinator Mark Abadi. If anyone with time and a lot more patience than me really wants to torture themselves with some skeptical analysis, then there are lots of videos he’s posted on YouTube. I only opened one, clicked at a random spot and came up with him acting out a neuron firing and (very rough transcription):

what they found was that people could not sleep after having a phone conversation. So insomniacs, I know there are a few in the audience, don’t have a phone conversation before you go to bed. Don’t sleep next to your mobile phone because the waves, the electromagnetic pulse waves, from your mobile phone for a fact increase alpha waves in your brain which are not conducive to sleep. OK? Little simple there.

piezoelectric EM waves travel through the body. Information waves from the brain moves through living crystal matrix (collagen fibres). Million trillion cells are almost instantly and intrinsically linked. Ampère’s law important to know.

I can’t listen to any more pseudoscience!

Here are some skeptical articles on Energy Medicine on the Guardian, Skeptic’s Dictionary and an in-depth review. Here’s another .edu.au website talking about teaching energy medicine. And what on earth was Aunty thinking when they uncritically ran this Energy Medicine story – this is what happens when universities endorse this wibbly wobbly stuff.

Now I’m off to watch some less ridiculous and more enjoyable NCIS.

In other news this week:

Listen to Friends of Science in Medicine co-founder Prof Rob Morrison (known to many once upon a time as the scientist from The Curiosity Show) talking about FSM and its goals on the Token Skeptic podcast.

Homeopathy @ Southern Cross University

Southern Cross University have updated the website for their clinic that I wrote about previously. The naturopathy page I linked to is gone and has been re-written here (but you can see it how it was at the Webarchive). They’ve added a Thomas Edison quote, dropped in the word ‘professional’, removed the section on homeopathy and added a disclaimer:

A naturopath will advise on any condition that is not life-threatening, that is one that does not constitute a medical emergency.

That really doesn’t counteract the fact that the homeopathy page is still up, and they’re still saying homeopathy can treat potentially deadly conditions like asthma and if your symptoms get worse after homeopathic treatment that’s a sign the remedy is working.

The VC of SCU has come out and defended the university’s teaching of homeopathy – if you want to read a good critique of his comments go here.

Herbalists & naturopaths – an anti-vaxxer oops.

I noticed some of the National Herbalists Association of Australia members noticing me on their media & public relations discussion board, was mildly amused and mentioned it at the end of my previous post. To cut a long story short, it lead me what a ‘University trained naturopath’ wrote on a The Conversation article:

“FSM and some of the people here would do very well to spend 5 minutes over at greenmedinfo.org [she later corrects it to .com] – a repository of evidence based research through which the potential or actual therapeutic value of vitamins, minerals, herbs and foods can be determined. They also provide an alternative toxicology database which enables users to access information on the harmful properties of drugs, chemicals, vaccines, etc., which is not readily available elsewhere. “

Only problem is I checked on The Conversation and another sympathetic commenter is a little embarrassed that she posted that link – the supposedly “evidence based” resource about the harms of vaccination also contains anti-vaxxer info. The site needs to come with a public health warning.

Thanks to my colleague who sent me this article about a kiwi school girl doing a speech on farts. If you look in the last column you’ll see the erudite Ms Paterson identifies the source of  fart smell correctly, as even university lecturers have failed to do.

I can’t vouch for the rest of her factoids, but really it’s only the smell issue that’s important … haha! Every blog needs a ongoing pet peeve, and it’s much more fun having a totally ridiculous and farcical one.

FSM - someone should offer to design them a website and better logo!

Wow! Friends of Science in Medicine certainly got lots of people Googling for more information. FSM really should get their own website explaining their principles, so everyone who’s looking for information isn’t getting it from second-hand sources, such as the news, blogs, and their opponents. Plus then the public could go there to vent their spleen, rather than on my little blog. [Update: looks like FSM are discussing creating a website]

I usually like to keep my posts varied, but since this has been such a big issue, I’m going to address a few points that arose underneath my previous articles on this topic (here, here, here and here).

1. Prove it doesn’t work! – unless you do, we can include it science degrees
2. They’re trying to ban us completely! We’re oppressed!! Totalitarianism!!!!!!
3. You can’t reject all alternative medicines – some of them work!
4. It’s a big pharma conspiracy because they make so much money out of patents
5. Poor ickle wickle complementary and alternative remedies don’t have any money for research to show that they work
6. You should, like, keep an open mind if you’re a scientist, even if they’ve been disproven they could still turn out to be right, y’know …
7. Placebos and appropriate controls don’t apply to us
8. It’s natural so it must be good for you and have no side effects
9. Helicobacter pylori was ignored by the establishment for, like, decades and it was true
10. Modern medicine doesn’t work and these remedies have been around for thousands of years so they must be right

1. Prove it doesn’t work! – unless you do, we can include it science degrees.

So you’ve waffled on about how homeopathy is wonderful (preferably with an anecdote) and haven’t actually provided any decent evidence (or provided the one small badly conducted study that appears to be positive, rather than the body of evidence as a whole), and then you turn around and say that the onus is on the people telling you to get out of taxpayer-funded science degrees to prove that you’re wrong.

Nup. You’ve got it the wrong way around (and fairly conclusively demonstrated you don’t have the first clue about science).

I need an imaginary example to help illustrate this.

Okay, say there are universities teaching a BHSc(Exorcism). You might think I’m being silly, but it’s a popular health remedy belief with a long history of apparently curing people of illnesses by realigning spirits, which apparently is less dangerous if performed by trained professionals. The leadership of the world’s largest branch of Christianity endorses it; Roman Catholicism has more than a billion followers so it would be politically expedient to be nice to them, let them into universities and fund their ‘research’ into exorcism.

So what if there were Catholic priests running publicly funded degrees in health sciences training up exorcism professionals? It’s no different from homeopathy practitioners in a BHSc training up true believers in homeopathy practice. And what if a group called Friends of Science in Medicine said there was no evidence that exorcisms worked and that as it’s all about spirit flows it has no plausible scientific grounding, and we should be getting it out of publicly funded science degrees?

Official Vatican exorcist. Image:telegraph.co.uk

The burden of proof would be on the Catholic exorcists to show they’re a science, and as they would inevitably fail to do so, they would be unceremoniously booted out of science degrees.

The Catholic exorcism priests would still be able to train students in their own non-taxpayer funded exorcism seminaries, and any one who wanted could spend their own time (and a small donation to the Church) getting an exorcism done. But it wouldn’t be subsidised by the taxpayer, or have faith taught in universities as science.

Yes, alt remedies should be discussed in a university health science courses. The  remedies with evidence for their efficacy should be taught in with the rest of the health science. And the remainder could be included in a few of lectures about popular folk remedies that either have no evidence that they work (and you’re welcome to conduct properly designed studies to find out more) or have been shown not to work and lead into a lovely discussion of all the ethical issues vs. health benefits arising from taking advantage of the placebo effect.

Anybody who wants to train as a therapist in a completely discredited area, like homeopathy, is welcome to go to a natural therapy college for training. But in terms of conducting taxpayer-funded ‘science’ courses that uncritically teach students to believe, and train them to become practitioners, in faith-based remedies – like exorcisms or homeopathy – the burden of proof is on the proponents to show that they work and are science, not on the people calling their bluff.

2. They’re trying to ban us completely! We’re oppressed!! Totalitarianism!!!!!!

No they are not. Check the evidence before you start claiming persecution. The FSM states:

We are not trying to stop public access to alternative therapies if they are fully informed about their lack of, or minimal evidence for, safety and efficacy.

We hope to … help the public make informed choices in medical care and not be subjected to false claims of efficacy nor take unnecessary risks of harm from unproven therapies or from delay in seeking proven treatment.

They’re not trying to stop you from practicing – people can pay for whatever sort of treatment they like – but what they are saying is that taxpayer funding should be directed towards remedies with evidence for their efficacy. And are you seriously suggesting that it’s okay to tell patients things that are demonstrably untrue?

[We seek to] reverse the currently trend which sees government-funded tertiary institutions offering health care ‘science’ courses not based on scientific principles nor supported by scientific evidence.

They’re not trying to stop the teaching of unproven alternative therapies at natural health colleges, as long as it’s not funded by taxpayer dollars which could more effectively spent elsewhere.

The remedies highlighted by FSM, such as homeopathy are iridology, are ones for which there is good evidence that they don’t work and/or they violate the evidence-based physical laws of the universe. And they’re saying we shouldn’t be teaching remedies that don’t work as ‘science’ degrees in taxpayer-funded universities. When they’re the total opposite of science. It’s the same reason priests, astrologers, and people who believe aliens landed in Area51 aren’t running entire university science courses teaching their evidence-free faith.

3. You can’t reject all alternative medicines – some of them work!

The FSM didn’t criticise all alternative remedies – just the ones that have been shown not to work, or make claims of efficacy without any evidence. Where there isn’t any evidence yet, they are “in favour of … the testing of these therapies in well-designed trials” to determine which ones work.

A ‘natural’ or ‘alternative’ remedy which has been shown to work simply becomes part of health science, and should be taught as medicine, for example, aspirin comes from willow bark. The big problem here is with people uncritically teaching things as real that have been shown not to work (and some have no plausible way they can work) in our universities as ‘science’. In science degrees, students should be taught to use research and evidence to separate fact from fantasy. Believing in something against all available evidence is the opposite of science.

If you want to check out the overall evidence for a particular alternative therapy before you claim that it works, a good place to start is here: NCCAM. Good luck.

The problem is that some CAM practitioners seem to ideologically cling on to all ‘alternative therapies’ (whatever than means) and won’t accept that some things get shown to work, and others get shown not to work or discredited and you need to let go of those discredited ideas if you want health science to continuing moving forward and improving.

It does seem that while some alternative remedy academics want to be taken as evidence-based researchers (e.g. making comments, like “CAM is not a “homogenous entity” … [t]here is a lot of crap, but there’s good stuff”), they don’t actually name what is crap compared to what is evidence-based. If they really do want to be a considered a health scientist (not an ideologue) establishing an evidence base for efficacy and better practice guidelines for alternative therapies, then they will have to be willing to delineate between, and publicly name, the things that: have good evidence that they work; that plausibly could work but do not yet have evidence; and the specific things that have been shown not to work time and time again.

Yet time and time again, the ‘academic’ defenders of CAM start by citing things that have some evidence for/against them, e.g. acupuncture, then show their true stripes by moving on to homeopathy (as I’ve already said, it does not work better than a placebo and is pseudoscience as it violates the evidence-based physical laws of the universe) – so they are incapable of differentiating between what does and doesn’t have evidence, yet hypocritically whinge that we’re the ones lumping all alt remedies into the same basket.

4. It’s a big pharma conspiracy because they make so much money

Yep, big pharmaceutical companies aren’t known for being paragons of virtue. But some of the biggest skeptics of pseudoscience are also some of the big critics of some of the dodgier practices of the medical/pharmaceutical industry.

Pointing at pharmaceutical companies is just trying to distract everyone from the problems in your own house. Stop changing the topic. And arguing that someone else is bad too doesn’t make you right.

If you’re criticising ‘big pharma’ for making money then you’re throwing stones from a glasshouse – CAM in Australia claims it has an industry turnover of AU$1.5-2.5 billion annually, and the global market is estimated to be US$ 83 billion annually. What should we call it? Big alter? Big quack?

And don’t start complaining there’s no research because it can’t be patented. Firstly, in some cases novel uses can be patented. Secondly, the CAM industry and all those supplement sellers, like Blackmore’s, are making billions of dollars without a patent in sight. The problem is that because they’re effectively unregulated and can sell billions of dollars of product without evidence, relying on the power of marketing and ideological faith/wishful thinking, there’s no financial incentive for them to spend money on research.

Also, I couldn’t care less about what irrelevant accusations you want to throw at medical practitioners – we’re talking about science here, and in our universities there are many, many scientists researching human health who have never received a dollar of pharmaceutical industry funding (I know of more who’ve received CAM industry funding than big pharma funding!).

5. Poor ickle wickle complementary and alternative remedies don’t have any money for research to show that they work

Firstly, the FSM do support research:

We are in favour of discussing the place of alternative therapies, their placebo effect and the testing of these therapies in well-designed trials. [emphasis added]

Secondly, see previous section. Annual turnover for CAM is billions nationally and US$83 billion internationally. Not so poor.

Thirdly, in terms of government funding for research, competitive proposals for research into natural remedies gets funded in mainstream grant schemes – lots of natural substances are being tested for medicinal properties all the time. There are scientists in universities all over the world (who have never received a dollar from ‘big pharma’ or a patent) who would love to research any breakthrough in disease treatment that looked genuinely promising (see point 8.).

Plus CAM get their own special funding: the US National Center for Complementary and Alternative Medicine (NCCAM) has received billions in  funding since it was set up in the 90s (with little or no success – a very poor return on investment), and a quick Google search finds other special government funds, such as the £1.3 million fund in the UK and $7 million recently from Australia’s NHMRC.

Testing any remedy:

It's not perfect, but creating it kept me amused during a day of advanced statistics lectures

Plus there is also an unclaimed million dollar prize available to anyone who can conclusively demonstrate that any of the magic remedies really work (note: I’m not saying all alt remedies break the laws of the physical universe – before you start complaining, learn to tell the difference between the ones that aren’t magic (eg. willow bark for pain) and the ones that are (homeopathy)).

6. You should, like, keep an open mind if you’re a scientist, even if they’ve been disproven they could still turn out to be right, y’know …

Then there’s practical reality. Do you worry if you take a plane flight to England that there’s a chance you could fall off a flat earth? Nup, because despite the beliefs of flat earthers, most of us regard it as ‘proven’ that the Earth is round. In real life, at some point you have to decide the evidence in conclusive enough to reject a theory (even if some people ‘believe’ in it) and move on – otherwise you’ll keep on believing every idea in history: an excellent treatment for most illnesses is blood letting, Iraq had WMDs, mental illness should be treated with trepanning, or the sun rises each day pushed by a dung beetle.

Things that violate the known laws of the physical universe (like homeopathy) are not very likely to be found to work. If you think homeopathy can work and science’s understand of the universe is wrong, then perhaps you should try this physics experiment: to check if gravity is working try jumping off the 2nd floor balcony of a building. If you’re right and science is wrong, you’ll float. Or if you’ve tried the experiment and failed, then, like a true homeopathy believer, just keep repeating it over and over again. You’re sure to prove science wrong sooner or later, right?

7. Placebos and appropriate controls don’t apply to us

So, you’re ‘special’ are you? Your magic doesn’t work if someone is looking?

Yes, finding appropriate controls can be hard sometimes, but there are ways to control for the placebo effect, for example, by sham needling for acupuncture.

The denial of the placebo effect leads to some really daft arguments, like in that acupuncture paper, where they’re using evidence of a placebo effect to argue that they don’t need a placebo:

In regard to scientific trials, there is the obvious difficulty of finding an appropriate placebo. To address this, some trials have used a sham needle (1).This is where a superficial needling technique is used at non-acupuncture points. The problem with this is that these non-acupuncture points may still lie on a channel and of course the sun luo and fen luo, the little capillary network of vessels of the jingluo, connect the surface to the interior jingluo/channels and this may indeed induce a response. Other researchers have used a sham needle that does not penetrate the skin at all, and although it is apparently realistic (for the patient), since some acupuncture techniques only lightly stimulate the point, even this might be enough to exert an effect.

So they agree it has the same effects whether or not you use acupuncture points or stick needles in. Wouldn’t any member of the reality-based community conclude this means you can have the same positive effect without sticking needles into people? Isn’t this a good thing?

Never mind that this screams placebo effect (again and again and again).  Pretend acupuncture has an even bigger placebo effect than a placebo pill.   And having a nice sympathetic chat with someone and telling them you’re going to treat them is the other main component of the placebo effect.

The placebo effect is incredibly well established and if you want anyone to take you seriously then you need to show that your remedy is more effective than the combined effects of having a nice chat and thinking it will work. And if every time something doesn’t work, instead of considering it disproven, you claim that you’re not bound by reality, then congratulations you’ve just proved FSM right and you don’t belong in university science courses.

8. It’s natural so it must be good for you and have no side effects

Please swallow this natural concoction I made containing cassava root extract and herbal leaf tea brewed from Atropa belladonna. I’ll enjoy collecting your Darwin Award.

If a remedy is biologically active then it’ll probably have side effects, such as stomach problems from willow bark extract.

It’s a bizarre distinction to call some therapies ‘natural’ and others not. If a herbal remedy has pills of Willow bark extract (ie aspirin of not so well regulated purity and dose) it’s natural, but if you get it in a pill packet that says ‘Aspirin’ (with a carefully controlled quality, purity and dose) then that’s unnatural? Is an osteopath giving you exercises ‘natural’, while a physio giving you exercises ‘unnatural’? What about once there’s some evidence that a particular osteopathy or chiropractic technique could help with lower back pain and a physio takes these bits (stripped of any pseudoscience ideology) and amalgamates them into mainstream evidence-based treatment for lower back pain – is that now unnatural because it’s evidence-based and being done by a physio?

This widespread belief that everything that can be claimed to be ‘natural’ is good for you is a marketer’s dream, both for remedies like herbal supplements and, as the belief has become pervasive, in other industries as well.

Funnily enough, you can even get side effects from remedies that work no better than a placebo. For example, I was criticising a terrible acupuncture study and someone in the comments tried arguing the whole ‘well alt remedies are good because they have no side effects’. Evidence? Well if you actually looked at the study you’d find there was the same number of adverse events in the acupuncture and control group – and the same occurred in this properly conducted study – it’s called the nocebo effect.

It's natural so it must be good for you and have no side-effects, like all natural products: arsenic, blue-green algae, ebola and tiger snakes.

9. Helicobacter pylori was ignored by the establishment for, like, decades and it was true

Don’t try to pull that myth on me – I’ve worked with Hp.  Why do you repeat myths without checking – and then put the onus on the person you’re talking to to waste time showing you’re wrong?

Go to Pubmed. Type in “Campylobacter pyloridis”. (H. pylori’s original name). Search. Click ‘Last’. You’ve now found the oldest studies.

Barry Marshall and Robin Warren first discovered it in 1982 and then worked on producing evidence that it caused stomach ulcers. Its first widespread dissemination within Australia was a presentation at the Gastroenterological Society of Australia conference in 1984. The world first saw it when it was published in the prestigious and selective medical journal The Lancet in June 1984. Yes it was controversial amongst medicos, but big claims require big proof and replication before being widely accepted, and being published in “one of the world’s best known, oldest, and most respected general medical journals”, hardly constitutes rejection by the establishment. And really, anyone who tries suggesting that bacteria can’t grow in any given extreme environment (as long as it’s not violating the laws of physics) is just being silly and asking to be proved wrong.

Now, if you look at the Pubmed search you prepared earlier, you’ll see lots of scientists from around the world investigating Campylobacter pyloridis from 1985 onwards.  I’ve just found that someone else investigating this myth has even produced a graph of the bucket loads of papers published on H. pylori in the 1980s.

So Nobel prize winners Marshall&Warren managed to produce enough evidence to begin getting mainstream scientific acceptance in just a couple of years.

In contrast, pseudoscience remedies like homeopathy have been around for hundreds of years, and no matter how much money and belief is wasted on them, the evidence shows time and time again that they work no better than a placebo.

H. pylori

10. Modern medicine doesn’t work and these remedies have been around for thousands of years so they must be right.

Seriously? You actually want to live under medieval medicine when your life expectancy would have been decades younger? Died horrifically of a disease which modern medicine could cure? Do you want to die drowning in your own blood like your ancestors did, or would you like to be treated for tuberculosis? How about shitting yourself to death with one of the many gastrointestinal diseases, such as cholera, which can now be dealt with using antibiotics and/or oral rehydration therapy? Or perhaps you’d like to watch your child being paralysed by polio so that they can’t walk or breathe, which is getting closer to being eradicated from the planet thanks to massive vaccination drives.

We live lives that are decades longer and healthier thanks to health care which a couple of hundred years ago even Kings could only have dreamed of (and people in many third-world countries still dream of). The ultimate irony is having eradicated many of the deadliest diseases from the first world and living decades longer, thanks to evidence based treatments and public health measures, we now have people walking around claiming that we’re unhealthier and convincing us to buy useless medieval placebo remedies. And asking for taxpayer funding to do it. (Funnily enough it seems to be more romantic/exotic/exciting to embrace other cultures’ medieval remedies, like ‘Eastern medicine’.) Instead we could spend that money on quality research to improve our healthcare even more. Or even, for a wild suggestion, spend some of that wasted money on providing real health care with real remedies to treat deadly and debilitating diseases in third world countries.

Polio before vaccination - iron lung to breathe

60 years since the vaccine we're getting closer to eradicating polio, but not there yet. Worldwide it has decreased from an estimated 400,000 cases in 1980 (Unicef) to 1,294 cases in 2010.

.

New links to news stories about FSM since I first posted on it:

• This ‘balanced’ article in the SMH has a poll: Should universities teach alternative medicine?
  Previously on the SMH: Scientists urge unis to axe alternative medicine courses.
• New York Times: Australian Universities Defend Alternative-Medicine Teaching
• Simon Singh Pointing the bone at chiropractic quackery – lessons from the UK
• The Punch: Why do our universities teach shonky “magic”?

Blogs:

• Science, Medicine, and Academia
• This dissects the arguments of popularity and antiquity: Defending CAM with Bad Logic and Bad Data.
• Watered down science being taught in Aussie universities
• SCU’s links with big drug company Blackmore’s: Introducing…Hahnemanocrates!
• More on quackery at SCU.

Also some members on a National Herbalists Association of Australia forum discussing the “Campaign against uni courses in Australia” seem to be feeling a little worried (I only noticed because they link to a blogger – me (haha! ridiculous) – and keep visiting my post). What do I have to say to them? Herbs can be great sources of medication: digitalis (foxglove), quinine (Chinchona tree), morphine (poppy), qalantamine (daffodil), reserpine (Indian snakeroot), vincristine (periwinkle) and paclitaxel (Pacific yew). You won’t have a problem with FSM if you either: use remedies with evidence for their efficacy; for remedies where there is not yet good quality evidence for/against, then inform patients (or, in the case of FSM, university students) that there is no evidence; and do not promote the effectiveness of remedies for which there is evidence that they do not work any better than a placebo. What could there possibly be to feel worried about?

The article’s uncritical he-said-she-said reporting – normal practice for ‘unbiased’ journalism and a site which is trying to provoke a ‘conversation’ – is a bit disappointing when you consider that The Conversation was set up by CSIRO and universities to be an independent news source based on evidence. In the words of Prof Peter Doherty (according the to Herald Sun, anyway):

Whether in science, history or the arts, those who have the capacity to discuss complex issues from the basis of evidence rather than opinion tend to be found in Australia’s universities and scientific research institutes. … That’s why I think that the idea behind The Conversation is terrific.

Why am I disappointed? Surely an important feature of an evidence-based discussion is to hyperlink to the peer-reviewed research, so readers can check out the evidence – it’s a great advantage the internet has over print publications. It should be what distinguishes the opinion on The Conversation, from, say, an Andrew Bolt opinion column.

However, the only links in the article are in relation to a controversy over whether or not Steve Jobs took alternative therapies for his cancer – which is an anecdote, not scientific evidence. Helpfully, a commenter below the article did post a link to the cited acupuncture study, allowing me to investigate further.

What the alternative therapist said in The Conversation article:

However, Dr Myers said that CAM research at RMIT was conducted in a thoroughly scientific manner, with the NHMRC funding clinical trials of alternative medicines. …

The NHMRC had also granted A$400,000 for a project in which the university was collaborating with three Melbourne hospitals on a three-year clinical trial of acupuncture for pain management in emergency departments, Dr Myers said. “The project follows the promising results of pilot studies by RMIT researchers, in which more than 1,000 patients received acupuncture treatment for acute pain relief at the emergency department of the Northern Hospital.”

I searched on Pubmed and I couldn’t find that emergency department pilot study, but I’ve got the commenter’s handy link:

A Prospective, Randomised Control Trial of Acupuncture for Select Common Conditions within the Emergency Department

Acupuncture “control”

The study’s introduction says:

In regard to scientific trials, there is the obvious difficulty of finding an appropriate placebo. To address this, some trials have used a sham needle (1).This is where a superficial needling technique is used at non-acupuncture points. The problem with this is that these non-acupuncture points may still lie on a channel and of course the sun luo and fen luo, the little capillary network of vessels of the jingluo, connect the surface to the interior jingluo/channels and this may indeed induce a response. Other researchers have used a sham needle that does not penetrate the skin at all, and although it is apparently realistic (for the patient), since some acupuncture techniques only lightly stimulate the point, even this might be enough to exert an effect.

Image via Wikipedia

Hahahaha … sorry, I’ll try to take that seriously. If stimulating the point without needing to stick a needle into you patient has the same effect, then shouldn’t this be a wonderful giant leap forward for acupuncture? And if sticking a needle in anywhere will have the same effect, then what’s the point of acupuncture points?

Sham acupuncture is a commonly used control in studies, and ‘sham’ shallow needling not on acupuncture points has been previously used as a control by the acupuncture research group at RMIT, so there’s really no excuse for not having a control group.

What could this study conclude about the effectiveness of acupuncture?

Absolutely nothing, because there was no sham acupuncture control group. The supposed ‘control’ group was patients given conventional emergency department treatment. The acupuncture patients were given an extra “consultation lasting 30-40minutes”. This is a problem because:

• Response to acupuncture is highly susceptible to the placebo effect; sham acupuncture ‘treats’ self reported pain/symptoms significantly better than a placebo pill. (BMJ 2006)
• A supportive interaction with a practitioner is one of the most potent components of the placebo effect and produces a clinically significant improvement in the patient’s health. The consultation placebo effect may be due to factors such as warmth, empathy, duration of interaction, and the communication of a positive expectation. (BMJ 2008)

What does the study find?

There was no significant difference in any of the outcome measures (pain score, respiratory rate, heart rate, and systolic and diastolic blood pressure), between the normally treated group and the acupuncture group. At best this shows that acupuncture isn’t any improvement on current practices.

What can you conclude from this study?

Nothing – you should treat someone using standard practice in an emergency department. (Or you could add in a nice chat and a cup of tea and have … exactly the same effect. I’m really a bit disappointed that the massive potential placebo effect, from taking the patients out for a 40 minute consult and offering them the positive expectation of a therapy, didn’t produce some improvement.)

What did they conclude?

• These results demonstrate that acupuncture and conventional treatment are equally effective to reduce pain, however the acupuncture group received a significantly higher rate of patient satisfaction with the treatment.
• This type of trial could be applied to other departments within the public hospital system such as the orthopaedic, neurological and maternity wards.
• Given that the results have proven positive for the treatment of acute pain, this style of trial could be applied in frontline emergency relief situations with practitioners working alongside Westerns doctors with triage nurses.
• The results of this trial paved the way for RMIT acupuncture students to provide treatment for pain relief in the emergency department of the Northern Hospital.

Groan.

**For further discussion of the apparent equal effectiveness of acupuncture in this study, see the comments below by AJ and sansscience(me).

Okay, they did electroacupuncture on humans, but the cat photo is so much cuter. Image: holisticvetmed.co.uk

NHMRC funding

I couldn’t find an emergency department acupuncture pilot study at Northern Hospital on Pubmed, so it looks like the NHMRC has provided $400,000 based on an uncontrolled pilot study published in a journal which isn’t indexed on Pubmed and has no ISI impact factor.

This paper appears to be the study design of their new NHMRC-funded study, and it also has no sham acupuncture control group – so the study has no control for any of the important acupuncture/consultation placebo effects, discussed above. If this is correct, then this study will be absolutely useless for determining the effectiveness of acupuncture (which should also be disappointing for acupuncture proponents, because even if it does appear to show a positive result for acupuncture, it won’t be possible to know if it’s real or a placebo effect).

If this is the sort of pilot data on which NHMRC funding was based, and the sort of uncontrolled study it’s funding, then it’s an appalling waste of $400,000 of NHMRC funds, which could be spent on so many other worthy (and placebo controlled) projects. [We get so annoyed about this not just because it's a waste of money, but because it's taking money away from other funding. We all know good scientists with lots of quality publications who didn't have their NHMRC renewed, and right now their postdocs & RAs are out of work, wasting decades of training and expertise, and some of them are leaving science because they don't want to have to put up with the horrendous uncertainty of our funding system, playing Russian roulette with their job every few years.]

RMIT Chief Investigator Prof Charlie Xue says: “The importance of delivering effective analgesia to patients with acute emergency presentations and the lack of evidence for acupuncture in this setting points to a gap in the current knowledge base, which our research aims to fill”.

Alternative therapy of the gaps

There have been criticisms of the billions of dollars the NIH’s NCCAM has spent investigating alternative therapies, for no major positive outcomes. Part of the problem with alternative therapies is that they tend to claim to be able to treat every disease under the sun. They can quite correctly claim that their particular therapy hasn’t been scientifically tested against a long list of diseases and therefore scientists can’t say it doesn’t work against them (ie. Test XXX against arthritis. Does it work better than a placebo? No. Try diabetes. Try irritable bowel syndrome. Try lower back pain. etc. etc.) Instead of God of the gaps, it’s CAM of the gaps.

Many scientists say that unconventional treatments hold promise and deserve serious study, but that the federal center needs to be more skeptical and selective. “There’s not all the money in the world and you have to choose” what most deserves tax support, said Barrie Cassileth, integrative medicine chief at Memorial Sloan-Kettering Cancer Center in New York. – ABC news

Friends of Science in Medicine

Friends of Science in Medicine

Their position:

We are not trying to stop public access to alternative therapies if they are fully informed about their lack of, or minimal evidence for, safety and efficacy.

We are in favour of discussing the place of alternative therapies, their placebo effect and the testing of these therapies in well-designed trials.

A naturopathy academic in The Conversation article:

The world of CAM is not a “homogenous entity”, said Dr Wardle. “There is a lot of crap, but there’s good stuff, and treating it like it’s all the same thing is very, very fraught.

Very occasionally alternative therapies are shown to work by rigorous research and become part of medicine – what is not acceptable is for entire Australian university degrees to be teaching disproved nonsense as ‘science’. The naturopath also argues that CAM degrees at universities teach basic health science making practitioners less dangerous – making them a bit less dangerous doesn’t make it okay to teach university science courses in pseudoscience, like homeopathy, iridology and kinesiology. And if he isn’t willing to publicly delineate these courses as pseudoscience, then how can he expect all alternative medicine academics not to be lumped into the same basket?

For example, at Australian universities students are taught that homeopathy can treat serious, or sometimes deadly, medical conditions, such as asthma, autism, diabetes, mental illnesses, and influenza and other infectious diseases. It can’t be argued they’re being taught to think about CAM critically, because these examples come from the university health clinics where students are being taught to put this dangerous nonsense into practice on real patients.

Either students are being taught to think critically about evidence-based science, in which case they’re doing a whole degree in fairy studies and coming out the other end understanding that most/all of their course was a waste of time (cognitive dissonance, much?), or these universities are teaching students to believe in and practice woo and mumbo jumbo.

There’s a summary of acupuncture treatment effectiveness, with references, on the NIH NCCAM site.

And in my travels on Pubmed I found this amusing emergency department case report: Pain in the Neck: the Enigmatic Presentation of an Embedded Acupuncture Needle .

The Adelaide preachers' banners. Image:outviewonline.com

The preachers were holding forth quite regularly in Rundle Mall, and the Adelaide City Council tried to move them on, but the preachers won a Supreme Court appeal on implied constitutional freedom of political communication grounds. I find this odd since firstly the council can regulate everyone else in the Mall (eg buskers) and secondly there don’t seem to be any legal problems with moving on political protesters, such as the Occupy protesters evicted from public spaces in Melbourne.

Their preaching in the Mall resulted in counter-protests, with banners (supporting homosexuals, against religion, etc) and noise-making instruments to drown out the preaching.

The preachers are suing Adelaide City Councillor Ann Moran, who criticised the message of their preaching, and also ABC TV for repeating her remarks. Remarkably, The Advertiser reprinted her remarks (but, whatever the weather, I certainly won’t be repeating them here or adding any comments of my own):

Street preacher says Adelaide City councillor defamed his character

THE leader of Adelaide’s controversial street preachers is suing Adelaide City councillor Anne Moran for defamation because she accused the group of [deleted].

Court documents obtained by The Advertiser show Street Church spokesman Caleb Corneloup is demanding Ms Moran pay $40,000 in damages.

He is also suing ABC TV, which telecast the comments. In August, the Supreme Court ruled that the group – which has brandished placards in Rundle Mall warning “sins” like homosexuality, adultery and fornication will lead to damnation – were allowed to continue their activities. …

The preachers have also lodged another defamation suit against the Sunday Mail and Mr Corneloup yesterday said there “will be a lot more (defamation suits) to come”. …

Ms Moran said the council was assessing whether to grant her a ratepayer-funded defence.

Iridology: who knew diagnosing cancer could be like spotting the shape of a bunny rabbit or a sailing ship in a cloud. Image:iridology.com.cn

I previously posted examples of the horrific proliferation of Australian universities teaching accredited and Federally funded  science degrees in mumbo-jumbo and hogwash. Around Christmas there was a letter to the editor in The Advertiser from Rob Morrison saying that a group calling themselves “Friends of Science in Medicine” were starting up to combat exactly this sort of pseudoscience being taught in our universities.

It seems like things are starting to kick off with FSM, and a post by Rob on the Australian Science Communicators list explains a bit more about the group (since it’s a public mailing list with content published on the asc website I’m assuming he won’t mind me re-posting it):

The recently formed “Friends of Science in Medicine” (FSM) has quickly acquired 300+ members, including influential supporters from overseas,  and is growing fast.
…

FSM is hoping to influence universities (at least the reputable ones) to declare their support for science courses that are in fact evidence-based and adhere to accepted scientific methodology. It will then have a go at trying to influence the government, which helps fund these courses and uses taxpayers’ money to allow health fund rebates for “treatments” with these demonstrably ineffective pseudoscientific therapies.

19 out of Australia’s 39 universities now offer these pseudoscience degrees and courses as science or health science, including  Homeopathy, Iridology, Reflexology, Kinesiology, Healing touch therapy, Aromatherapy and ‘Energy Medicine’.

That is the sort of “science” we might be better off without.

Hear, hear. 19/39 is a depressing score – looks like they’ve got a battle against a lot of money-making courses on their hands. And the sooner someone gets hold of some really dodgy course material to embarrass them into closing the better (none of the 19 are here in SA).

A screen grab from Southern Cross University's website

I’ve also found an excellent ABC radio interview from yesterday explaining what FSM is doing, with a long list of alleged pseudoscience offenders, including RMIT, University of Queensland, Charles Sturt University, Macquarie University, Curtin, Edith Cowan, Murdoch, University of Newcastle, Canberra Institute and University of Sydney.

Having recruited (“Join us!“) a Prof-heavy list of supporters and started contacting the offending universities, it’ll be interesting to see what they do next and how much success they have. And universities justifying uncritically teaching pseudoscience should be named and shamed.

Here are a few random silly season tidbits:

A sperm whale. Image:NOAA

Sense About Science have released their annual refutation of celebrity/TV personality nonsense that featured in UK news. Some of the gems from this year were:

• “I don’t really like the beach. I hate sharks, and the water’s all whale sperm. That’s why the ocean’s salty.” -US reality TV personality Nicole ‘Snooki’ Polizzi
• “In my opinion – alright? Tide goes in, tide goes out. Never a miscommunication. You can’t explain that. You can’t explain why the tide goes in.” -Bill O’Reilly, US TV host and political commentator
• As someone who researches in gastro, it might be tempting to imagine that intestines are the cause of all illnesses [this is a common susceptibility of researchers - my supervisor believes all diseases come down to endosomes/lysosomes], but singer Suzi Quatro is taking it a little too far: “I used to get a lot of sore throats and then one of my sisters told me that all illnesses start in the colon. I started taking a daily colon cleanser powder mixed with fresh juice every morning and it made an enormous difference. I’ve been doing it for 20 years.”
• And apparently this quote from shoemaker Christian Louboutin was widely discussed in the media in the US and UK: “what is sexual in a high heel is the arch of the foot, because it is exactly the position of a woman’s foot when she orgasms. So putting your foot in a heel, you are putting yourself in a possibly orgasmic situation.”

Can I just insert a random rant here (having been trying to buy sandals at the post-Christmas sales) about how much the current fashion for ridiculously high heels infuriates me. Partly because women’s shoes, that don’t look like they’re for an unstylish grandma, are made really uncomfortable with little padding and straps (or a lack of straps) that don’t hold them on so they rub. If you just totter very short distances they won’t cause a problem. If you stride out and walk a lot, even ‘sensible’ shoes like flat sandals and ballet flats will rub/blister and you can’t run very easily.

Add to that a fashion for painfully high heels (and I say incredibly painful as someone who has done pointe work), and it’s impossible to find reasonable looking shoes that are comfortable to walk around in. How is a society that views that women look more sexually attractive when they walk around in extremely painful shoes that restrict them to dainty tottery steps (and thereby restrict physical activity compared to men’s flat shoes, such as running or walking on uneven surfaces), not similar to this:

Those feet and consequent delicate tottering walk make her sexy and marriageable Image: http://www.flickr.com/photos/24443965@N08/3462155994/in/photostream/

Reality

Okay, so high heels aren’t anything like the horrifying extremity of foot binding, but they are similar in principle – it’s based on increased female attractiveness, for this ideal women choose to inflict it on themselves, and frequent wearing of high heels causes pain and lasting damage.

Yes this has been happening for ages, but from what I’ve seen in pictures in the news (and I never read women’s mags – it’s probably far worse over there), in shoe stores and on nights out in Rundle St, our culture has recently been normalising ever more extreme heels – apparently 10 cm heels are now “not too high” daywear.

Victoria Beckham

What's the highlight of Charlize Theron's outfit? The heels, of course.

Because they're so good to walk in. Image: http://fallingontherunway.blogspot.com/

And as everyone races to be even more extreme, we’re getting shoes that really are as evil as pointe shoes, only without out the muscle strengthening and training that goes with pointe work:

How is this different ...

... to this?

How ironic is it that ballet shoes first eliminated heels to enable dancers to run and leap, and then invented something as sadistically beautiful as pointe shoes – was it inevitable that our fashion would eventually catch on to lengthening women’s legs (and hobbling them so they can’t run or leap) with pointe shoes?

Ballet en pointe. Image: David R. Tribble

When high heels or ear-piercing are normalised, people stop finding them strange. These are equally normal and sexy:

Image: www.kuoni.co.uk/en/holiday/asia/thailand/

Vaccinate children or lose money – vaccination tied to tax benefits. -Health reporter Jordanna Schriever

PARENTS who refuse to fully immunise their children will be denied more than $2100 in tax benefits from July.
But groups against vaccination have labelled the Federal Government’s latest plan to encourage immunisation a form of bribery.
The $258 maternity immunisation allowance available for fully-immunised children aged up to five will be axed in favour of the new six-stage scheme which for the first time includes immunisation against meningococcal C, pneumococcal and varicella (chicken pox).
Families who do not immunise their children fully will not be eligible for three payments of $726 available under the family tax A end-of-year supplement, totalling more than $2100.
Vaccination Information Serving Australia president Kathy Scarborough said parents could opt out from vaccinating their children – by filling out an objection form.
She said there had not been enough research into the effects of vaccines which had been shown to contain substances that could harm or kill children.
“Parents need to inform themselves of their rights,” she said.
“After a vaccination you can watch a thriving baby turn into one refusing to suckle and that is devastating.”
AVN president Meryl Dorey labelled the initiative bribery. “It’s one more attempt by the Government to bribe parents to do something that they may not think is in their best interests,” Ms Dorey said.

If you were writing copy about the government’s controversial new purchase of submarines would you interview someone from the Flat Earth Society who thinks that if they sailed too far they might fall off the edge? If you were comparing the merits of GPS navigation systems in the latest iPhones would you go and talk to someone who thinks Einstein’s theory of general relativity is a Jewish conspiracy? If you were writing a story about government works to prevent a cliff collapsing after falling rocks had killed someone driving along the road below, would you get cranks to provide colourful quotes disputing the validity of gravity? No, no and no.

A Gold Coast baby on life support with whooping cough - too young to be vaccinated he caught it from someone un-vaccinated. Image: goldcoast.com.au

But on a health story you quote a women who runs the infamous anti-vaxxer organisation AVN, which has a “PUBLIC WARNING” from the NSW Health Care Complaints Commission, has had its charitable status revoked, and has a public warning from the AMA. A woman who was accused of harassing the parents of a child who had died of whooping cough in order to preserve her delusion that whooping cough doesn’t kill babies (the child who died was too young to be vaccinated, but was living in an area with low vaccination rates due to nonsense like this).

The other organisation VISA, spouting old discredited nonsense about untested dangerous additives to vaccines, looks from their website like they’re anti-vaxxers of a similar stripe. What do they promote instead of vaccination to prevent deadly diseases? Dangerous nonsense like homeopathy, which is both as implausible as a Flat Earth and has been shown time and time again to be no more effective than a placebo.

Like it or not, when the media unnecessarily go to organisations like this for serious quotes in news stories, and credulously report their claims, it gives them publicity, credibility, legitimacy and manufactures public health scares.

Having quoted people with views that are as scientific, and as useful, for preventing diseases as sticking feathers in your hair and howling at the moon, The Advertiser story then refers to “Other groups”. Yep, just a quote from a minor other group like the Australian Medical Association, who think the Earth is round, gravity causes apples to fall, and vaccines prevent disease.

Then, just in case the article hadn’t campaigned enough for dangerous pseudoscientific hocus-pocus (with same the credibility as suggesting that Harry Potter can cure you using magic), it continues:

Naturopath and father-of-four Wayne Liebelt said there were other options to keep children healthy.
“I chose not to vaccinate and I chose to use nature to treat my children’s and my own illnesses because I strongly believe in the healing power of nature,” he said.

Here in the first world vaccines have been so successful  at wiping out these diseases that we no longer see our children dying of smallpox, or crippled and only able to breathe with the aid of an iron lung due to polio, and therefore people in our population are prey to antivaccinationists’ misinformation that diseases like measles don’t exist, aren’t a threat, and vaccines aren’t important. This causes vaccination rates to drop and allows these diseases to spread again.

The article can’t even be defended on the basis of the journalistic concept of ‘balance’. I could understand if an overworked journo had copied a colourful quote from an anti-vaxxer media release and added it in towards the end, but this article has sought out quotes from three anti-vaxxers. The article never informs its readers that the anti-vaxxers are a fringe group promoting pseudoscience who have public health warnings against them and that they are not health professionals (names like ‘Australian Vaccination Network’ make them sound legit).

The article’s angle emphasises the discredited anti-vaxxers, placing them at the top of the inverted pyramid. It does not discuss the pros and cons of the public health measure – a real opposition voice might be, eg. someone in public health who doesn’t think this strategy will be effective in raising vaccination rates, or even the Liberal party proposing an alternative policy. My personal opinion is that it is fair enough to link giving parents extra public money to them acting to protect public health through herd immunity and not neglecting their own child’s health by failing to immunise against deadly diseases. It is okay to debate this trade-off; it is wrong to manufacture a debate about the effectiveness of vaccines (when they are as well established scientifically as gravity) or to scare parents with groundless, fraudulent and utterly discredited claims of dangers.

Humoring the journalistic God of Controversy is all very well and good, but a line has to be drawn somewhere. Gratuitously quoting people who deny reality might not matter, except you are helping to create a real public health disaster, especially for children too young or too immunocompromised (eg leukemia patients) to be vaccinated.

And now I’m going to indulge in some gratuitous vaccination-preventable photos in case you’ve missed the point:

Before we eradicated polio in the first world: children who’d had polio were kept in iron lungs to keep them breathing.

Polio patients in iron lungs, California (1953) Image: Wikipedia

Rubella: preventable with the MMR (measles, mumps, rubella) vaccine. In babies, congenital rubella (German measles) can cause severe mental retardation, deafness, blindness, congenital heart disease, etc. Before vaccination as many as 20,000 infants per year were severely affected in the US.

Congenital rubella. Image: Amer. Acad. Ped.

Vaccination’s greatest success story – the worldwide eradication of smallpox. Wikipedia: Of all those infected, 20–60%—and over 80% of infected children—died from the disease. As recently as 1967, the World Health Organization estimated that 15 million people contracted the disease and that two million died in that year.

Child with smallpox in Bangladesh. Image: Wikipedia

Simply Fruit Nibbles. Simply 72% sugar. Image: Uncle Tobys

What is it with otherwise intelligent people falling for marketing claims that just because lollies are made from fruit they  must be good for you? I had a feeling of  déjà vu yesterday at badminton when one of the players was eating new Uncle Tobys Simply Fruit Nibbles with pictures of fruit all over the front. I groaned and looked at the packet and sure enough the main ingredients are: concentrated apple puree (52%), concentrated apple juice (37%) (also: passionfruit juice (6%), concentrated lemon juice (2%), wheat fibre, gelling agent (pectin), flavour).

I pointed out to her that this meant it was mostly sugar, with lots of pictures of fruit to delude her into feeling good about it, but she argued that because it was made from fruit therefore it was better for you than other sweets. And why would concentrated apple juice be worse for you than eating an apple? I eventually managed to explain it to her, and I think she half believed me, but she stuck to saying that at least it was still better for you than other confectionery, like chocolate.

So let’s do some comparisons:

Cadbury milk chocolate nutrition information

Uncle Tobys Simply Fruit Nibbles nutrition information

Milk chocolate contains 56 g of sugar per 100 g. A Mars bar has 60 g of sugar per 100 g. The fruit nibbles contain 72 g of sugar per 100 g – a 35 g nibble serve contains almost 30% of an adult’s recommended daily intake of sugar.

But chocolate does have a lot more fat, so let’s make a more equivalent comparison to what a Mum might think of as a very sugary, artificial, bad for your kids’ lunchbox lolly. Pascall Jellies – Ingredients: Sugar, Wheat Glucose Syrup, Water, Gelatine, Food Acid (330), Flavours, Colours (102, 122, 133, 123, 110, 124).

Pascall jellies nutrition information

The wonderful real fruit nibbles have 72 g per 100 g of sugar, while the fruit-flavoured lollies only have 62 g per 100 g sugar. Even marshmallows have less: 66 g per 100 g sugar.

But they’re made from fruit – why are they 72% sugar?

Fruit, especially apples, do contain sugar, but the sugar is bulked out so you eat far less sugar in a serve of fruit. Whereas with these concentrated products if you eat a similar quantity you get several times the amount of sugar (and let’s face it – who sticks to a serving size of eg. 25 g = 5 squares of chocolate?).

Here’s a comparison from the USDA National Nutrient Database for Standard Reference per 100g:

Sugars are in grams (per 100 grams)
*Unfortunately it didn’t have the sugar breakdown for the AJ concentrate, so I’ve estimated it by assuming it’s the same as the AJ proportions.

The beauty of the concentrate is that rather than putting ‘sugar‘ on the ingredients list they can put ‘concentrated apple juice’ on the ingredients list. And people think it’s just like fruit.

1 tsp sugar ≈ 4 grams

Even after I point out that it’s been refined so it’s basically enormous amounts of sugar, people argue that it’s natural sugar from fruit so that makes it okay. Sugar is sugar is sugar. They’re the same chemicals. Plus sugar comes from a plant called sugarcane (sugarcane is a grass – shall I add it to your smoothie?), so how is it any less natural?

Except apple juice is notoriously high in the sugar fructose (thereby causing diarrhoea in kids ). [Background: sugar from sugarcane that you add to your cup of coffee is called sucrose - sucrose is made up of a glucose bound to a fructose.] There’s a whole health debate surrounding increasing addition of fructose to our food, which I’m not going to go into here, but basically food companies love it because it tastes sweeter than glucose or sucrose. Consumers don’t realise how high these foods are in fructose, and can’t make an informed choice, because foods aren’t required to list the sucrose/glucose/fructose breakdown in their nutrition information.

Why déjà vu?

Fruit Fix: 99% 'fruit ingredients'; 72% sugar fix. Image: Uncle Tobys

I’ve been through this before with an RA in Gastro who showed me these wonderful new fruit bars she was eating – Uncle Tobys Fruit Fix. Groan. Turn over the packet and it says 59% concentrated apple juice puree and 72.7 g per 100 g sugar. I tried explaining to her that it was mostly sugar, but to no avail.

They’re even allowed to market it as being equivalent to fruit: it’s 99% fruit, contains a serve of fruit for your child’s lunchbox (the government lets it count towards their Go for 2&5 fruit and veg initiative – while it does state that fresh fruit is best, it can be eaten instead of one of those actual pesky pieces fruit), and it even has the Heart Foundation tick of approval.

You know the term greenwashing for products/companies that market themselves as all environmentally friendly, but aren’t really? Maybe this should be called fruitwashing? … healthwashing? lunchboxwashing?