Proposed constitutional changes for NZ Skeptics

The following changes to the constitution of the NZ Skeptics have been proposed and will be considered at the Annual General Meeting in Christchurch on Sunday, 28 August 2011. This notice is published in accordance with the society”s rules which require 21 days” written notice of any such change.

Motion 1
That clause 11(a) be rewritten to reflect the current financial year used by the society.
Current: (a) The financial year of the Society shall commence on the first day of April and terminate on the last day of March next following.
Proposed: (a) The financial year of the Society shall commence on the first day of January and terminate on the last day of December next following.
Proposed by: Michelle Coffey
Motion 2
That clauses 11(b), (c) and (d) be rewritten to change from there being a requirement for an annual auditor’s report, to giving the committee responsibility for reviewing financial statements, and asking for them to be audited if it sees fit.
Current:
(b) The Treasurer shall prepare a Statement of Accounts and Balance Sheet as soon as possible after the end of each financial year and such statement and Balance Sheet shall after consideration by the Committee be submitted to the Auditor who shall report thereon in writing.
(c) The Statement of Accounts and Balance Sheet together with the Auditor’s report thereon shall be submitted to the Annual General Meeting next following its preparation and shall be open for discussion thereat. The audited Statement and Balance together with the Chairperson’s report on the year’s activities shall be sent to members with the notice of Annual General Meeting.
(d) An Auditor shall be appointed by each Annual General Meeting or if not so appointed then by the Committee and shall hold office until the termination of the Annual General Meeting next following his or her appointment. The remuneration of the auditor may be fixed by the Committee.
Proposed:
(b) The Treasurer shall prepare a Statement of Accounts and Balance Sheet as soon as possible after the end of each financial year and such statement and Balance Sheet shall be considered by the Committee. The Statement of Accounts and Balance Sheet may be approved by the Committee or may from time to time as determined by the Committee be subject to submission to the Auditor who shall report thereon in writing.
(c) The Statement of Accounts and Balance Sheet shall be submitted to the Annual General Meeting next following its preparation and shall be open for discussion thereat. The Statement and Balance together with the Chairperson’s report on the year’s activities shall be supplied to members at the Annual General Meeting, along with any Auditor’s report that may be prepared on request of the Committee.
(d) The Auditor shall be appointed at the Annual General Meeting or if not so appointed then by the Committee from time to time as deemed necessary and shall hold office until the termination of the Annual General Meeting next following his or her appointment. The remuneration of the auditor may be fixed by the Committee.
Proposed by: Michelle Coffey

Dealing with wingnuts – which way to turn?

It’s not a hopeless cause to engage with proponents of the irrational – but some ways of doing this are more effective than others. This article is based on a presentation to the 2010 NZ Skeptics conference.

There has never been a time in history when the public understanding of science and rational thinking has been so important. Science has revealed new challenges for humankind, such as climate change and depletion of resources, while new technologies are often accompanied by ethical and social implications that need to be carefully considered. In response to these challenges science communicators spend more time trying to carefully explain science and related issues to the public. However, these efforts to make science more understandable are being confounded by ‘wingnuts’ who use misinformation to confuse public understanding of science.

The term wingnuts has been used by a number of people to describe those who propagate misinformation for a variety of reasons. In his book Wingnuts’ how the lunatic fringe is hijacking America, John Avlon describes a wingnut as “someone on the far-right wing or far-left wing of the political spectrum – the professional partisans and the unhinged activists, the hardcore haters and the paranoid conspiracy theorists.” This is probably a fair summation of the groups that skeptics often confront. Specific examples include Jenny McCarthy for her misinformed and vehement opposition to vaccines, Suzanne Somers for her advocacy of dodgy and dangerous “natural” therapies, Peter Duesberg with his HIV denialism, and Christopher Monckton for his use of misinformation in opposing global warming.

With wingnuts attacking many areas of science and undermining attempts to educate the public, the question has to be asked – How should we deal with these purveyors of irrationality? Some skeptics advocate an aggressive counterattack – personally attacking the wingnuts, in the same way that they have attacked science and science communicators. Others suggest a purely educational and rational approach, relying on the ideal that the truth will win out in the end. For myself, I see the first approach as dangerous in that it muddies the waters – one only has to look at the mess that has resulted in the climate change debate. Personal attacks from both sides of the debate – accusations of conspiracy, impropriety, etc – have confused the public and risk having climate change dismissed as ‘too hard’ to deal with. On the other hand, taking a purely rational approach overlooks the fact that human behaviour is not always rational and prone to being swayed by emotive arguments.

In trying to sort out the best way for me to respond to wingnuts I have developed a list of 10 rules as a guide.

1) Know what you are talking about

Many wingnuts are well versed in their area of ‘expertise’. Debating them without adequate knowledge of the subject as well as an understanding of the typical wingnut ploys is risky. It is worth noting, however, that when exchanging views with a wingnut via blog comments this does give one the opportunity to do research between exchanges.

2) Use precise, simple and neutral language

It is easy to be misunderstood, especially via written language. So, one should keep the language as precise and simple as possible. A choice of neutral language helps maintain a calm exchange of ideas. Emotive language can readily escalate an exchange of ideas into an irrational argument. We have over 600,000 words in the English language to choose from, so why not take some care in deciding how we explain things to others.

3) Respond to rudeness in a calm manner

Some people, including skeptics, see debating ideas as an opportunity to insult others. In my opinion, snide remarks, personal attacks and swearing detract from any rational exchange and serve to both escalate any exchange of thoughts into irrationality as well as hardening the views on both sides of the debate.

When confronted with rudeness, I try to focus on repeating factual information. There is also value in pointing out the rude behaviour. This can be done in an assertive, non-threatening way by making comments about the wingnut’s behaviour and not about them personally. For example by saying “I find it offensive, when you claim that scientists are shills for big pharma” followed by a list of supporting facts, instead of “you are a rude and obnoxious #[email protected]&”. Most people will accept criticism of their behaviour far more readily than what they feel is a personal attack, particularly when the person making the comment ‘owns’ the effect of the behaviour.

It is also worth remembering that it is difficult for someone to continue being rude if you do not reply in kind. If you can maintain being polite to someone who is being rude, in most cases the rudeness will dissipate and one can return to a calm exchange of ideas.

4) Remember – wingnuts are people too

No one is completely rational. We all have our own biases which may result in irrational behaviour. Whether it is a result of our environment or our biology, many of us engage in irrational behaviour without even recognising it. So while we may often assume that a wingnut is being purposely irrational, it is usually the case that they consider their actions to be completely rational. In his book Why we Believe, Michael Shermer describes such behaviour as “intellectual attribution bias” – where those with opposing views typically consider their own actions as being rationally motivated, whereas they see those of their opponents as more emotionally driven.

A simple rule to remember – challenge the ideas, not the person.

5) Ask questions … and listen to the answers

When someone appears to express a view counter to what we believe it is easy to respond by bombarding them with counter arguments. However, this will not only put them on the defensive, it also relies on the fact that you have understood their point of view correctly (see point 7, below). If one takes the time to explore their beliefs further by asking questions, it not only gives you time to assess the extent of their beliefs, if done in a friendly manner it helps establish rapport, allowing for a more rational exchange of ideas. If we leap into an argument with a limited understanding of the other person’s position we can find ourselves trying to convince them of something they already agree with.

6) Leave your ego at the door

In my experience once you start taking comments personally, rationality goes out the window. There are times when the comments of some wingnuts make me furious. At such times the best option is to take time to calm down before responding.

“Science is the search for truth – it is not a game in which one tries to beat his opponent, to do harm to others.” – Linus Pauling

7) Expect misunderstandings

No matter how carefully we think we have phrased something, those hearing or reading them will often misunderstand at least part of what we have said. So one always needs to be ready to rephrase. In order to clarify what we are saying a number of techniques can be used:

a) Counter anecdotes with anecdotes. Follow up by explaining this is why anecdotes are not particularly good as evidence.

b) Use analogies to explain difficult concepts.

c) Apologise when you make a mistake. While some may view apologising as a loss of face, it can actually establish a better rapport. It is far more honest and trust-inspiring than trying to cover up or justify a mistake you have made. There is nothing wrong with acknowledging that we all make mistakes.

d) Acknowledge points of agreement. In any argument there are often points that both parties agree on. If we can identify these up front and acknowledge them, it not only makes it easier to explore the points of difference, it again establishes some rapport by saying “look, there are some points on which we can agree.”

8) Don’t make the same mistakes we criticise them for

There is nothing more frustrating than seeing other ‘skeptics’ debate a wingnut by erecting their own strawmen, using ad hominem attacks or other irrational arguments. An experienced wingnut will quickly turn these mistakes to his or her own advantage. It always pays to carefully think through all of your own arguments before using them.

9) Be persistent and don’t expect to change their views overnight

Most wingnuts have spent years developing and reinforcing their positions. Some probably have the psychological equivalent of Fort Knox built around their ideological positions.

So if we can’t easily change their minds, what is the point in debating with them?

Debates with wingnuts seldom take place in a vacuum. Whether they are arguing their point via a letter to the editor, on a blog or amongst a group of friends or workmates, there is always an audience. If their points go unchallenged some of the audience will be swayed by their arguments. So challenging the arguments of a wingnut is less about changing their point of view, and more about educating any audience they have about the flaws and fallacies of their argument. One should aim to win over any such audience with superior knowledge, civility and by pointing out how your position benefits them.

10) Learn more about persuasion

Many skeptics have a great respect for facts and rational debate. However, when it comes to making decisions human beings tend to be more readily swayed by their emotions. Psychologists have spent decades researching how people make decisions. Such research has been embraced and effectively used by marketers and salespeople to get us to buy things we don’t need or want. If the Journal of Marketing Research refer to books like Robert Cialdini’s Influence: the Psychology of Persuasion as “the most important book written in the last 10 years” then perhaps we should also be reading it, not only to help us work out appropriate ways to better present a skeptical viewpoint, but to also immunise us against some of the less scrupulous methods of persuasion.

Some persuasive techniques directly applicable to debating with wingnuts include”

a) Appealing to self interest. Everyone naturally looks at how anything benefits themselves. So when we advocate for vaccination use, rejection of dangerous or ineffective ‘alternative medicines’ and other wingnut ideas we need to focus on the benefits of our positions.

b) Creativity. In a world where we are bombarded with many demands for our attention, the creative ideas stand out. One only has to consider the incredible amounts of money companies spend on novel advertising campaigns to understand this.

c) Repetition. Many wingnuts rely on the idea that if you repeat a lie often enough it will be believed. If this is the case, then surely if you repeat the truth often enough it will also be believed.
d) Soundbites. Many science communicators are now recognising the value of sound bites – short memorable statements outlining key points. Most people are more likely to remember sound bites than the long and complex (albeit more accurate( explanations preferred by many scientists.
e) Be positive. It has been demonstrated that most people remember positive messages more accurately. Thus is it more effective to say that “vaccines save millions of lives each year” as opposed to “vaccines are not dangerous.” Over time, a negative message can become confused and may be remembered instead as “vaccines are dangerous.”

A good example of clever use of such techniques was the 10:23 campaign in January 2010 to educate the public about homeopathy. The public ‘overdose’ on homeopathic remedies by skeptics was a creative way to draw the attention of the media and the public to the irrationality of homeopathy. Clever sound bites such as :ten dollars for a teaspoon of water: were not only memorable but focused on financial self interest. The event also caused several homeopaths or homeopathic organisations to state outright that they don’t know how homeopathy works, a remarkable and useful soundbite (for skeptics( in itself.

Conclusion

This 10-point list outlines my own approach to wingnuts. Others may have different, possibly even contrary rules. I believe it is important that we, as skeptics, share and discuss these ideas rationally and with the view of what will best encourage better and more rational thinking by the general public.

Whether you agree with all of my rules or not, there is hopefully one thing we can agree on. We cannot afford to ignore the wingnuts.

“All that is necessary for the triumph of evil is that good men do nothing.” – Edmund Burke

“We have to create the future or others will do it for us.” – Susan Ivanova, character, Babylon 5 TV series.

Even Psychics Can Only Be Medium

Englishwoman Doris Stokes was a medium – by which I don’t mean her dress size was between small and large. She claimed she spoke to people “on the other side,” to use the euphemistic jargon of the darkened drawing room. She was a sort of cosmic Telecom operator, only I suspect her charges were a good deal higher than 99c a minute plus GST.

I use the past tense because Doris herself has moved on into the spirit world with which she had so long claimed to communicate. Nothing has been heard from her since she died, which I think is pretty contemptuous of her fellow media (the plural of medium(.

Doris became world famous and made a lot of money travelling around linking people up with restless ghosts, using what often sounded like an old country-town party-line system. You could never be quite sure who would answer the call or whether some celestial storm had brought the line down.

Doris Stokes was a professional name. She was born Marilyn Dashing in London but her first manager pointed out that if she wanted to make money bringing messages back from the other side to suckers on Earth, most of the clients would be ordinary and wouldn’t trust anyone who looked and sounded smart or had intellectual pretensions. So Doris changed her name, burned her grammar school diploma, threw away her tight skirts and blouses and bought half a dozen cardies and several strings of paste pearls.
… I remember some years ago when Doris was in New Zealand promoting a book, a radio interviewer asked her if anyone on the other side had described in detail for her what heaven was really like. Doris shocked me to the very soul by verbally painting a setting and ambience almost exactly identical to an inner suburb of Christchurch on a fine Sunday morning. I was gripped by a deep spiritual crisis, wondering if trying to be a good bloke was worth it after all.
Originally published in NZ Skeptic 19, March 1991.

Ones for the history books

In the aftermath of the Christchurch earthquakes, Ken Ring’s predictions were widely, though often inaccurately, reported. David Riddell looks at Ring’s writings, and compares them with actual events.

Of the many stories coming out of the Christchurch earthquake, the claims and counter-claims surrounding long-range weather forecaster Ken Ring’s alleged quake predictions gained a surprising amount of media coverage.

Ring claims earthquakes are more likely to occur at times of New and Full Moons, with solar activity also playing a part in triggering tremors. The basic idea of tidal forces setting off quakes is not unreasonable, but has been thoroughly investigated by seismologists and found to be invalid. The forces involved are just too weak to have an effect, and there is no correlation between the timing of quakes and the position of the moon.

Skeptics should have no trouble recognising the perceived link between Ring’s predictions and actual events as a case of subjective validation, sometimes referred to as the Barnum Effect. Humans are terribly good at detecting correlations between events, even where there is no direct linkage. Ring predicted many things, most of which did not eventuate. He missed other, major events. Those who were predisposed to believe him remembered the times his predictions bore a resemblance to later occurrences (in fact often misremembering the prediction as more accurate than it was), while forgetting the misses.

Ken Ring’s website (www.predictweather.com) records his predictions, so it is a fairly straightforward process to check what he actually said, rather than relying on media reports. Here, then, is a timeline of events over the past few months, with edited highlights from Ring’s writings.

September 4, 4.35am: a 7.1 magnitude earthquake strikes Canterbury, 40km west of Christchurch.

7 September: Ring states: ” …the next full moon [24 September] may present as an earthquake potential time … for New Zealand only N Cant/Marl may be in the zone.” Although: ” … nothing would eventuate if the 24 Sept tremors occur about 100kms down.” He continues: ” … a potential for earthquakes on the evening of the 1st” . And: ” Next year, the morning of 20 March 2011 sees the South island again in a big earthquake risk … As that date coincides with lunar equinox this will probably be an east/west faultline event this time, and therefore should be more confined to a narrower band of latitude. The only east/west fault lines in NZ are in Marlborough and N Canterbury. All factors should come together for a moon-shot straight through the centre of the earth and targeting NZ. The time will be just before noon. It could be another for the history books.

24 September: With magnitude 4+ aftershocks striking the Canterbury region at a rate of more than one per day (18 between September 16 and September 30), Ring claims a 4.6 aftershock near Rolleston as confirmation of the above prediction for this date.

27 September: Ring says the moon’s position on September 30 indicates a “potent time” for earthquakes. “And that will cover 1-3 Oct. If we get whales coming ashore somewhere around our coastline we can assume quakes near to NZ. Then we have 6-8 October which is when the moon is in new moon…”

7 October: >Ring begins to withdraw from the 20 March 2011 prediction, while playing down the possibility of another large quake for Christchurch: ” …it is again more likely than not that a significant shake may affect the South Island in March next year… We have not said an earthquake is certain on 20 March 2011, but there is potential for possible activity on an E/W fault line around the time and likely to be in the upper half of the South Island… But I don’t think we should live our lives in fear – we have to accept sometime that earthquake damage has always been a reality living in NZ and Christchurch got its turn recently. No doubt somewhere else will cop it next time. Yet we can observe in hindsight that the Napier earthquake didn’t come back to buzz Napier, nor have the Murchison and the Edgecumbe shakes returned to the same place. In fact we can confidently say quite the opposite, like the measles once you have had it you probably won’t get it again in your lifetime. So on the basis of historical probability, next March Christchurch might well be one of the safest places.”

Ring also predicts the Hokitika Wildfoods Festival will be hit by extreme weather: ” Gale westerlies and much rain is expected…”

12 October:…the next lot [of quakes] expected around the 13th.”

18 October: Ring repeats: ” I would still not consider that another massive earthquake is certain, in fact I think it’s more likely not to be the case in Christchurch.” Then he hedges: ” For another disastrous event, Christchurch may or may not be in the firing line again; it could be Wellington or anywhere, and it may not even happen.

20 October:… on the 27th, if there are cluster-shakes … they may be less close to Christchurch … these aftershocks will end soon for Christchurch, probably around the end of November.”

27 October: ” After tomorrow, the 28th, once the northern declination has passed, the numbers of shakes should decrease again, but should return with some of higher magnitude in the first week of November. (Emphasis in original.)

13 November:… it is reasonable to relax and asume that another devastating shake is unlikely to repeat anytime soon, despite a seismology-department knee-jerk reaction that a 6+ mag. earthquake aftershock could be arriving in the district at any time.”

22 November: ” There is no reason to suppose any aftershocks of significance will occur until [solar] flares climb again…”

26 December: Christchurch is rattled by a series of strong aftershocks, up to 4.9.

26 December: Ring writes: ” Today is the perigee, … Perigees bring earthquakes” (Emphasis in original.)

27 December:… the Christchurch shake is not part of some lasting new development, reaffirming that the activity of the past couple of days has probably been just remnants of general global disturbance due to the recent lunar eclipse. The main hits seem to have been to Vanuatu and Japan, and possibly NZ copped something because we share similar longitude. In a day or so things should be back to normal.”

14 February: ” [the] area of the sun that corresponds to NZ is again seeing some activation. The window of 15-25 February should be potent for all types of tidal action, not only kingtides but cyclone development and ground movement. The 18th may be especially prone. The possible earthquake risk areas are N/S faults until after 16 February, then E/W faults until 23rd. The moon will be full on the 18th and in perigee on the 19th. This perigee will be the fifth closest for the year. The 15th will be nodal for the moon. On the 20th the moon crosses the equator heading south. Strong winds and swells may arrive around 22nd to NZ shorelines. … For an earthquake to occur many factors have to come together, but sun activity, full moon and perigee are arguably the most potent, and they are all starting to chime now. Over the next 10 days a 7+ earthquake somewhere is very likely. This could also be a time for auroras in the northern hemisphere and in the southern tip of NZ. It may also be a time for whale strandings because of increases in underwater earthquakes. The 7+ is sure to be somewhere in the ” Ring of Fire” , where 80% of all major earthquakes seem to occur, and NZ is at the lower left of this Ring. The range of risk may be within 500kms of the Alpine Fault.” Note that this prediction does not mention Christchurch.

22 February: Christchurch is struck by a destructive 6.3 aftershock. Several claim it as confirmation of Ring’s 14 February prediction.

11 March: A magnitude 9.0 earthquake strikes northern Japan. The moon is a week away from full, and mid-way between apogee and perigee, one of the safest times for earthquakes by Ring’s prediction method.

12 March: The Hokitika Wildfoods Festival goes ahead in warm, sunny weather.

20 March: As thousands flee the city in advance of Ring’s predicted “one for the history books“, a lunch to mark the occasion is held at the Sign of the Kiwi on the Port Hills. Journalist Sean Plunket is master of ceremonies, with MP Nick Smith and several Skeptics in attendance. The largest of the aftershocks, still occurring daily in the city, comes at 9.47pm, with a magnitude of 5.1. Some claim this confirms Ring’s prediction.
Photo credit: New Zealand Defence Force

Opening a Dore?

A learning difficulties programme that claims to re-train the cerebellum makes some impressive claims which don’t stand close scrutiny.

DORE is an organisation that claims to treat learning difficulties without drugs. Their programmes supposedly

“… tackle the root cause of learning difficulties by improving the efficiency of the cerebellum – the brain’s ‘skill development centre’ – and the part of the brain now understood to play a significant role in learning, coordination, emotional control and motor skills.”

Recently the company held a series of information sessions to coincide with the opening of a new Dore centre in Lower Hutt, to go with their existing centres in Auckland and Christchurch. I attended a session to see what it was all about.

As we entered the room, video testimonials were playing, showing parents and their children claiming dramatic results for a range of learning disabilities and conditions, such as Asperger’s syndrome. An information pack was handed out, which included newspaper clippings and another testimonial. It claimed that Dore gets to the “core of learning difficulties”, “actively improves ability to learn”, is drug-free, based on scientific principles, is personally tailored and is not a “quick fix” or “soft option”. A FAQ stated that people who successfully complete the programme did the exercises accurately and consistently and if improvements don’t occur this is mainly because people are not sticking to the routine.

A video introduced Wynford Dore, who stated his daughter had learning problems, for which he searched for a solution. Then a mother and her son related how the son had dyslexia and behavioural problems at school which the mother was only made aware of after a few years when a teacher spoke to her. The child was already on a three-year programme with SPELD when the family discovered Dore; they followed this programme for a year concurrently with SPELD. They claimed significant improvement about three months after starting Dore.

The presentation went on to claim that approximately 16 percent of the New Zealand population had learning difficulties, with only four percent diagnosed; these were said to affect one in six New Zealanders. It was difficult to locate comparative figures, but SPELD estimates that seven percent of children have a specific learning disability, which would equate to about 50,000 school children.

The Dore programme claimed to assist with dyslexia, ADD/ADHD, dyspraxia (motor skills) and Asperger’s syndrome, and is targeted at people aged seven and over. The presenter briefly went over the typical feelings of those struggling with learning difficulties, and described how they thought these conditions manifest – as a multitude of literacy, numeracy, memory, attention, coordination, social and emotional problems. This was all claimed to be due to an inefficient cerebellum. Dore, they said, addresses underlying causes rather than symptoms (where have I heard that before I wonder?).

The conditions treated all allegedly have a physiological basis and nothing to do with other factors. Figures were presented, said to be from the Otago University longitudinal study and purporting to show that dyslexics were significantly disadvantaged compared with peers (with the consequent implication that treatment would help prevent this disadvantage).

Dyslexic students were more likely to leave school with no qualifications, much less likely to have a Bachelors degree, and none achieved Masters/Doctorate levels. Average income was more than $10,000 less than their peers. However, there was no word on whether this lack of achievement could be generalised to all people suffering dyslexia, given the long time period of the study and the considerable changes in educational services over that time.

In a further video presentation a Dr Sara Chamberlain claimed the cerebellum governs the automatic performance of simple tasks, and that this facility can be enhanced through exercise. We then heard about Dore’s assessment process. Following an initial phone consultation, prospective clients fill out a questionnaire, and there are a variety of tests and a medical assessment. Posture and ocular-motor skills are tested, and then dyslexia is screened for, apparently using a standard tool. Other conditions such as ADD/ADHD are assessed using the DSM-IV manual; the whole initial appointment takes three to four hours. The programme, it appears, is not suitable for everyone. Clients then have 1.5-hour interviews at three-monthly intervals and on completion of the course.

It was claimed that many scientific papers link the cerebellum with learning, attention, etc; these can be found on their website. They say they have done research themselves and written papers, and will provide details on request. They mentioned ongoing studies into ADHD at Ohio State University and by another US office; the Ohio State University testing appears to be a pilot study, but I couldn’t find any references to the other. A testimonial was introduced from a Dr Edward Hallowell, presented as an expert in ADD and ADHD. When I checked on this later, he appears to be involved with the Dore programme and would hardly be an unbiased commenter.

We were presented with figures from self-evaluation claiming to show 86.5 percent of children and 88.5 percent of adults showed progress in literacy and numeracy after taking the Dore programme. For coordination the respective figures were 81 percent and 75.4 percent, and for social skills 78.1 percent and 72.6 percent. The exercise programme was claimed to be individualised, unlike other programmes like ‘Brain Gym’ that aren’t (for more information on Brain Gym see Ben Goldacre’s Bad Science blog(.

The regime

The exercises take 10 minutes twice daily, with a mandatory four-hour break between; they have 400 exercises and 16 levels that could be completed. These involve such things as using a wobble board, or an exercise ball, or throwing and catching mini bean bags. Again, the cerebellum was claimed to be receiving, processing and automating sensory information from somatosensory, visual and vestibular inputs. The cerebral cortex (the thinking part of the brain) is apparently supposed to integrate all of this but with the conditions Dore say they treat, it is claimed the cerebellum isn’t working with the cerebral cortex.

The idea that defects in the cerebellum cause learning difficulties would seem to be a classic case of correlation not necessarily equating with causation. As noted by Oxford University psychologist Dorothy Bishop in her 2007 paper “Curing dyslexia and ADHD by training motor co-ordination: Miracle or myth?”, cause and effect would seem to be not so simple as presented at the session.

“The notion that the cerebellum might be implicated in some children’s learning difficulties is not unreasonable: both post-mortem and imaging studies have reported cerebellar abnormalities. Furthermore, some studies have reported behavioural deficits involving balance and automatisation of motor skills in a subset of people with dyslexia, consistent with a cerebellar deficit hypothesis. However, it is premature to conclude that abnormal cerebellar development is the cause of dyslexia, rather than an associated feature. Many people with dyslexia do not show any evidence of motor or balance problems. Furthermore, the cerebellum is a plastic structure which can be modified by training, raising the possibility that cerebellar abnormalities might be a consequence of limited experience in hand-writing in those with poor literacy.”

The programme used to use a book, but is now web-based. Exercises are carried out and then “marked” according to their criteria. They stressed that compliance was key, along with parental support. Times for completion vary, but are usually 12-14 months, with a weaning process at the end of the programme where the exercises are gradually wound down. The course is expensive, costing almost $5,400 or a little less for a one-off payment. They did say that they gave three “sponsored” places per month, but didn’t describe what exactly this entailed, outside of mentioning that it was for low income families and that children with a medical diagnosis could apply for a disability allowance through WINZ which could be used to access their programme.

A few questions

During question time, they were asked how they could be sure the child in the video testimonial had improved because of Dore and not the other programme he was on. The answer was fudged: they said they didn’t diagnose but looked for “sensory processing problems” and it was those they treated, which then enabled the person to learn. In other words, if there was improvement, it was Dore, not any other intervention specifically targeted at helping the person learn to overcome their disability and learn to read.

Another questioner asked why it was so costly given that the programme is mostly self-directed. They equivocated, talking about staffing costs, the website, and having support available. They said that braces cost much more and that that is basically cosmetic, when their programme “benefited a person for life” so was worth the investment. Yet another question was about the doctors – why wouldn’t they use paediatricians and other suitably qualified professionals? They stated that for their purposes, the level of medical expertise was sufficient.

Dore has obviously learned from experience following actions taken by overseas advertising standards authorities, and no longer make claims of “100 percent cure” and “miracle cure” for the conditions they claim to treat. In fact they seemed to be reasonably realistic in introducing caveats such as “it doesn’t work for everyone”. Despite this, they still claim to be proven to help overcome learning difficulties even though the evidence base is weak to non-existent. Although they make many claims to be “scientific” and have an extensive list of papers on their website, when the UK Advertising Standards Authority considered a complaint against Dynevor, Dore’s parent company, they assessed the studies submitted in support as poor, lacking control groups, and not supporting the treatment claims made:

“The ASA noted Dynevor’s interpretation of the ad. We considered, however, in the absence of any qualifying text to the contrary, that consumers were likely to understand the claim “Need help with Dyslexia, ADHD, Dyspraxia or Asperger’s?” to mean that the DORE programme could help treat the named conditions. We also considered that we would need to see robust, scientific evidence to support the claim. We noted that the two studies provided by Dynevor assessed the effect of the exercise-based DORE programme on children with reading difficulties and children and adults with ADHD respectively…

“… As neither the first nor second study referred to Asperger’s syndrome and only two participants in the first study had dyspraxia, we considered that the evidence was inadequate to support claims to treat those conditions. With regards to dyslexia and ADHD, we did not consider that the studies were sufficiently robust to support the treatment claims for those conditions, and we therefore concluded that the claim was misleading…”

The average person would have trouble verifying claims about the role of the cerebellum and the ability of an exercise programme to improve function. If it really was that easy everyone would be using Dore’s exercises. Their claim that dyslexia, dyspraxia, ADD/ADHD and Asperger’s syndrome have one cause, one cure, is insufficient. The conditions they claim to treat are disparate and cause and effect is not established. There was little discussion of how cerebellar function or dysfunction is assessed, or of the relevance of their testing of such things as eye tracking, and no discussion at all of how the exercises impact on the cerebellum or how outcomes are measured. Bishop says:

“The gaping hole in the rationale for the Dore Programme is a lack of evidence that training on motor-coordination can have any influence on higher-level skills mediated by the cerebellum. If training eye-hand co-ordination, motor skill and balance caused generalized cerebellar development, then one should find a low rate of dyslexia and ADHD in children who are good at skateboarding, gymnastics or juggling. Yet several of the celebrity endorsements of the Dore programme come from professional sportspeople.”

There is little real involvement from the company once the programme has commenced, with only a few appointments to follow up after the initial assessment. Many who join the programme don’t apparently have a formal diagnosis of the conditions Dore claims to treat, and they won’t get that from the company, as they state they don’t diagnose anything other than the alleged cerebellar problems.

It’s not surprising that some would see benefits though – the commitment and parental support required to do the programme would alone benefit some children. Then there is regression to the mean, the Hawthorne effect (subjects modify an aspect of their behaviour being experimentally measured simply in response to being studied) and natural improvements with growing maturity. On retesting later, there may appear to be improvements due to the client having done the test before and being aware of what is required. Many would concurrently use other services such as reading recovery, and Dore themselves recommend that if the child has spare time, that it is spent practising reading and writing. That extra practice reading could be extremely beneficial.

The high cost of the programme is concerning, especially when they acknowledge that not everyone will benefit. Despite this, they had parents travelling from the Wellington region to undertake assessments in Auckland – hence the opening of an office in the region. There may also be a financial risk to participants; Dore UK and Australia have both failed, leaving clients out of pocket. In New Zealand Dore was placed in liquidation in 2009 and the Companies Office states: “This Company currently has Liquidators, Receivers or Voluntary Administrators appointed” with the liquidators due to report again in May 2011.

Orthodoxy? – Revisiting the Cartwright Report (Part 2)

NZ Skeptic issues 96, 97 and 98 contained articles presenting different viewpoints on the ‘Unfortunate Experiment’ at National Women’s Hospital and its aftermath. Wellington registered nurse and NZ Skeptics treasurer Michelle Coffey continues the discussion in this web-only special.

When I wrote my original article (NZ Skeptic 97), it was written with the intention that it could stand alone as a more thorough discussion of the findings of the Cartwright Report and later research. This was because there were a number of important issues raised as a result of the report which have been almost lost in the debate, many of them systemic ones. While I’m sure that readers interested enough can source the relevant material and judge for themselves, in Skeptic 98, Linda Bryder has responded and the statements made merit a response to clarify several points. I referenced the Bryder’s book for a complete review of the topic, but did not address it in the original article as while it does deal with aspects of the ‘Unfortunate Experiment’ the book ultimately fails to provide any complete assessment of the matter due to the book omitting to investigate key figures such as McIndoe or dealing with the health care system (in particular it’s politics) as opposed to social movements.

1. “There was no medical certainty about the proportion of cases of CIS…”

None of the references support the contention that there was no medical certainty about the proportion of CIS cases that would advance to invasion, and in any case proportion of cases isn’t the point – it’s whether CIS was considered to be a precursor of invasive cancer. This appears to be the case. In the Cartwright Report1 (p23) a compilation of studies was introduced into evidence giving figures that indicate over time, a significant proportion would progress to invasion.

The 1976 Editorial2 cited is discussing screening and states “The report faces up to the problems which still cause fierce controversy – those of the natural progression and regression of early lesions, the discrepancy between total [CIS] cases and the combined number of number of clinical invasive cases, and the incidence and mortality rates.” The Walden Report3 it is referring to states unequivocally that “The significance of [CIS] as a precursor of invasive disease has been recognised for more than 3 decades. Several series of patients, followed for months or years, have demonstrated progression from [CIS] to invasive disease at rates ranging from 25 to 70%.” The issue of where earlier dysplastic changes fit appears to be where any “controversy” laid rather than the concept of progression from pre-invasive lesion to invasion. The report placed these earlier changes a decade or so prior to invasive disease as a precursor state stating “the concept that progressive degrees of cervical dysplasia are part of the natural history of neoplastic disease of the cervix now seems firm.” This is relevant to developing a screening programme given that there is a window of many years in which the condition could be detected and treated. Ostor4 in his statement “The ultimate fate of patients with CIN is the most controversial issue facing investigators interested in cervical neoplasia.” is discussing similar issues to that discussed in the Walden report which is relevant in terms of assessing the relevance of findings and being able to predict the behaviour of these ‘atypias’. Most studies ended at the point of CIS. Ostor looked at not only progression to invasion but the likelihood of regression, persistence and progression to CIN3 (11% in the case of CIN1) with the conclusion that the probability of invasion increases with severity of dysplasia, but there is potential for regression which reflects on therapy.

One man’s dysplasia is another man’s carcinoma #40;notably without insertions to influence the reader to place a particular meaning on it) is a statement that crops up frequently. One issue is the correlation between cytology and histological confirmation, while this wasn’t perfect it was generally agreed that smears could reliably indicate an existing lesion. Histological confirmation was required, but there could be a lack of agreement between pathologists and laboratories on the histological criteria meaning that the precise differentiation between dysplasia and CIS varied. These uncertainties don’t seem to have impacted on the confidence of pathologists regarding screening for cervical malignancies and grading of a lesion was seen by surgical pathologists as more a statement of probability of progression which had limited applicability in clinical management as noted in Löwy’s history5. The precise definition didn’t matter as much as understanding that it was the same disease that was being managed. This is nothing other than a fairly typical debate as biology and medicine rarely, if ever, give certainties.

1. ” Coffey cites 1958 ” official policy… to show this.”

It’s important to note for clarity that there could be variation in policies in other areas but what is more critical in this case was policy at NWH, the hospital where Green practised which set the standard of care. Policies at NWH evolved over a period of time. In 1955 the formation of a cancer team to which all cases of carcinoma of the cervix were to be referred to for treatment was unanimously supported. Over the next ten years, policies regarding the diagnosis and treatment of CIS and invasive cancer were regularly reviewed. This wasn’t just agreed to at a meeting of “…only nine senior consultants…”the decision was made a formal meeting of the Hospital Medical Committee, with a majority which indicates that the committee was happy with the level of evidence for the policy. The clear majority and evolving policy don’t seem to fit too well with the narrative that there was considerable medical uncertainty and controversy about CIS and its progression.

2. “Professor Barbara Heslop explained this more appropriately…”

Heslop’s6 article is one to which I referred to in writing my article as I found some aspects of it informative. However, it is based in the opinions of the author so it’s unsafe to use this article to make certain statements about Green. Heslop considers that Green was doing research but seeks to place this in context stating “Herb Green aimed to ‘prove’ his hypothesis by carefully observing that dysplasia did not lead to cancer…Unfortunately, the proposed methodology was equally appropriate for showing dysplasia did lead to cancer. Paradoxically, and I am sure unintentionally, he ended up demonstrating…more convincingly than had been done before, the transition of dysplasia to cancer.” It was demonstrable that Green considered his work as a study initiated to test a theory and his 1974 paper said (p65) “This…represents the nearest approach yet to the classical method of deciding such an issue as the change or not of a disease from one state to another – the randomised controlled trial. It has not been randomised and it is not well controlled but it has at least been prospective…”

While Baker may have had the presumption that the therapeutic relationship would predominate, little suggests this happening in the case of Green. Whether he knew about such things as falsifiability, Green set out to prove his ‘dormant cancer’ idea despite indications early on that following such patients was unsafe (such as three cases of invasive disease in patients followed with positive cytology occurring by 1969). If the therapeutic relationship was predominant, those cases should have prompted reconsideration of the hypothesis; instead they were reclassified and removed from the study.

3. The 1966 management protocol was to “extend” conservative treatment…”

What seems to be being said here is that under 35 doesn’t mean that, but that it means older patients can be included as well. It should mean what it says as this was a safeguard intended to protect patients which Green then breached. When aging occurs, physiological changes mean it is more difficult to view areas of abnormality and Green and his colleagues were aware of this and the additional risks. The report (p37) stated “As a woman gets older, the squamocolumnar junction is more likely to lie in the endocervical canal and therefore be invisible to the colposcopist.” This means that it can’t be determined whether lesions extending further are suspicious and it was impossible to get a sample without a cone biopsy. Older women were more likely to have unsuspected invasive carcinoma. The use of words like treat is misleading as the intention was not to extend conservative treatment, but to monitor women with positive cytology to fulfil the aim of the proposal. As an example the proposal stipulated punch biopsies and used the word treat and treated (p 21 “four have been treated by punch biopsy alone.”) however this was regarded as a diagnostic procedure. The only way a punch biopsy could be a ‘treatment’ is if somehow by accident or design, the biopsy managed to obliterate a small lesion.

4. “Coffey presents this as a negative outcome, as if it was unnecessary outcome for the women.”

It was. There is a difference between ongoing monitoring which often can be done at primary care level and repeated attendances at a hospital over many years for multiple tests and interventions. Patient 4M (p44) was first admitted in 1970 with abnormal smears. In between 1970 and 1983 she had 38 appointments and six biopsies (wedge, ring, cone, surface) were performed with two occasions being histologically incomplete. A review of patient notes (p42) showed many women had more than one cone biopsy and in some cases up to six. Testimony showed that doing this more than twice was not considered unless under exceptional circumstances and doing this procedure could have effects such as stenosis or haemorrhage and make later evaluation difficult. Bonham testified that this was a dangerous practice and with the third or fourth conisation, it was probably a greater risk than hysterectomy.

Nothing in medicine is benign, and there are obligations to treat patients ethically. This includes minimising as far as possible unnecessary medical procedures as there are a number of risks entailed every time intervention is made. In a condition as treatable as CIS that could have been simply excised that means that over a period of time many women had a number of procedures that were unnecessary and posed excess risk to them that still left them with positive cytology resulting in risk of progression with its own complications. The associated disruption, pain and discomfort of these multiple interventions shouldn’t be trivialised.

5. Regarding the infant vaginal swabs, a press release by Judge Cartwright’s counsel stated “Mothers were told of the tests.”

Any kind of consent would have sufficed. Judge Cartwright stated (p141) “&#8230 there was no provision made to comply with the fundamental requirement that children are not included in research with the consent of their guardians.” This was not a test but a trial and was non-therapeutic research that held no benefit for the infant. Green quickly realised after 200 babies had undergone the procedure that it was a waste of time and lost interest in the study without communicating this to the nursing staff leading to over 2000 babies being subjected to an unnecessary and potentially harmful vaginal vault smear for the purposes of research without the consent of their parent or guardian.

With randomisation of Green’s 1972 “R series” radiotherapy and hysterectomy trial it is difficult to see that it conformed to international practice. Randomisation is aimed at preventing systematic differences between groups and preventing bias but in this case, the selection criteria were made in advance but there was no allocation of patients prior to anaesthesia, grading and decision on surgical treatment so no concealment. Enrolment could have been influenced by biases such as the need to enrol sufficient patients into the study along with the potential for further bias to be added with the use of coin tossing. The patients were not given any opportunity to consent, and were mislead about the treatment decision. Testimony on p170 states “Dr Green and myself and others discussed this question of informing women in the trial about it when it was initiated in 1972. We decided in the end not to tell patients about the trial. We told them they would be examined under anaesthetic when the most appropriate mode of treatment would be decided and then we would proceed accordingly.”

I can contrast this lack of any kind of consent from the parents or “R series” patients with the oral consent obtained by Sir Liley for his intra-uterine infusions where he sufficiently informed the patient of the possible risks and that the treatment was experimental. His case study published in 19637 states “the patient and her husband were an intelligent couple, and the prognosis for the foetus, the possibility and uncertainty of intrauterine transfusion, and the potential hazards to the mother were fully explained to and discussed with them.” This was not the case with Green and his research projects, as no real attempt was made to provide any kind of informed consent.

6. “Despite writing this, Coffey herself makes it clear that the two groups…had nothing to do with the two groups whose records Green analysed.”

This is an assertion and no reason is given as to why you state this. As such, there is nothing there to counter other than to say they had everything to do with those groups. McIndoe et al8 was retrospective while Green’s research was prospective, which made a difference in how the study was conducted but they were measuring the same thing as Green’s 1974 paper (p65) describes: “This series of 750 cases of in situ cervical cancer, and the following of 96 of them with positive cytology for at least two years…” The McIndoe paper was also a comparison of two groups of women, one with normal follow-up cytology and one without and was the final paper that Green never wrote that completed follow-up on the patients that were the subjects of his study. In my discussion, I highlighted the summary in the paper of patients who were included in the punch biopsy special series and that alone should make it clear the relationship between the “special series” and the study. I’m sure if Green could have asserted the same he would have, but couldn’t. The report didn’t rest on this paper alone but reviewed 1200 patient files and 226 were used as exhibits.

7. “Cartwright accepted this as “accurately reflect[ing] the findings of the 1984 McIndoe paper.”

Except Judge Cartwright did not. This is selective quotation that distorts the statements in the report and falls short of what you would expect from an historian whom you would expect to take care to fairly represent the context and statements in documents. The statement is from Ch4 “Expressions of Concern” where the article is addressed as it was the subject of public comment and had prompted the Hospital Board to request an inquiry. This put the article under scrutiny and criticism by some witnesses. Under the title “Was the magazine article accurate?” It is stated that the manuscript was submitted and editorial changes explained but there were some errors in the article that was finally published. This section states:

1.Significant editorial changes: The matter of accuracy was raised firstly by the authors themselves. In her evidence Sandra Coney drew attention to two editing changes which she considered substantially altered the meaning of sentences in the magazine article.

a. “Twelve of the total number of women had died from invasive cancer as had four, or 0.5%, of the group-one women, and eight, or 6% of the group-two women who had limited or no treatment.”

In the original manuscript the authors had written: “Twelve of the total number of women died from invasive carcinoma. Four (0.5%) of the Group-one women, and eight (6%) of the Group-two women who had limited or no treatment. Thus women in the limited treatment group were twelve times more likely to die as the fully treated group.”

I accept that the unedited material more accurately reflects the findings of the 1984 McIndoe paper. The edited version is not accurate.

It’s clear when looked in context that the statement was sourced from the original manuscript of the article and those words cannot be attributed to Cartwright. Cartwright is accepting that the original manuscript more accurately reflected the findings of the paper and is being misquoted to say something else. It is of note that in Bryder9 p33 that this statement is used to say “Cartwright too suggested differential treatment. In her report she quoted Coney and Bunkle’s statement that: ‘Twelve of the total number of women died from invasive carcinoma… [etc]” Cartwright accepted that this accurately reflected the findings of the 1984 McIndoe paper.” This statement is again used misleading to say something other than what it actually says and is being used inconsistently.

8.“How had they “returned to negative cytology”

McIndoe did not say treatment did not enter the study. The citation in Bryder used to reference this says only “The detailed management of patients is not under consideration in this paper…” The paper looks at the initial management and in some cases more detailed management of patients as Bryder would be aware. Here, it does become evident that there were differences, for instance in group 1 cone biopsies excision was incomplete in 24%, but in group 2, 74% were incomplete with the difference likely to be largely due to management where complete excision is not a necessity. The paper states “…any examination of the natural history of CIS of the cervix must depend on a representative, though incomplete, biopsy specimen on which to base the initial diagnosis. Thereafter, meticulous long-term follow-up of all patients using techniques such as clinical examination, cytology, and colposcopy, and if indicated biopsy, is required.” The paper detailed some limitations, such as small biopsies or possibly trauma eradicating lesions, or inadequate biopsies missing abnormalities. So in answer to that question, it was because initial management in group 1 patients either intentionally or unintentionally was adequate in treating the lesion and restoring them to negative cytology. Of this group only 0.7% had recurrence of CIS. In group 2, follow-up showed continuing positive cytology after initial management either by limited biopsy or incomplete treatment which was ideal for studying the natural history of CIS as set out in the 1966 proposal.

9. “Coffey refers to the 1986 paper…as critical of conservative treatment…”

This paper10 was only briefly mentioned before moving on with discussion of McIndoe et al as there was insufficient space to deal with it in detail. Here long term follow-up of vulvar carcinoma shows that of 31 patients managed by surgical excision, there were 4 recurrences and one developed a vulvar carcinoma 17 years later. 4 women managed only by biopsy progressed to invasion in 2-8 years and one additional patient managed with incomplete excision after a lengthy period of observation progressed to invasion. The paper demonstrated that untreated lesions have significant invasive potential. This approach was an extension of Green’s study of CIS of the cervix, and in this case a biopsy cannot be considered treatment at all. While the authors were advocating conservative treatment this was excision of the lesion not biopsies or incomplete excision.

10.“Would a modern gynaecologist agree with this assessment?”

The relevant sentence is presented as a statement, but it omits a significant portion of the sentence which is “This needs to be explained, as those figures strongly suggest the progression of CIS to invasion when it is and was a totally curable lesion.” Gynaecologists would accept the statement that CIS is a curable lesion which can be readily treated with a variety of local destructive methods with complete removal of the lesion and reversion to negative cytology which then prevents the risk of the lesion progressing. In the quoted statement McIndoe et al is referring to group 1 patients, whose cytology had returned to normal. It states “However, contrary to what would be expected, of the 139 group 1 patients with incomplete excision of the original lesion, only five (3.5%) later developed invasive carcinoma. Thus whether or not the lesion is completely excised does not appear to influence the possibility of invasion occurring subsequently.” In this case it didn’t, the rate of recurrence was unexpectedly small probably due to the initial intervention influencing the condition.

Treatment of a diagnosed lesion is then conflated with cervical cancer at a population level in asking for an explanation of why cervical cancer hasn’t been completely eliminated. In an ideal world this might be possible, but in the real world there are a number of difficulties to be faced in ensuring the entire population at risk is screened and treated if necessary. Green’s conclusion was that screening was not effective, however the conclusion was unjustified. The report discusses this on page 56 and crucially treatment needs to improve the prognosis as if subsequent cases are not adequately treated there is little value in screening in the first place. Also, if screening is done in low risk cases and high risk populations are missed, that means screening will be limited in being able to affect morbidity and mortality. In McIndoe et al, the age-standardised incidence of invasive carcinoma in group 2 was 1141/100,000 compared with 18.2/100,000 in the general population in 1975. This has since dropped considerably.

11. “As stated above, group 1 and group 2 had a similar range of treatments…”

My statements stand on this matter that “this ignores that while many women were treated with various procedures, there was evidence of continuing disease, demonstrating that the intervention was inadequate. This was not followed up, posing a high risk of development of invasive disease.” To prove that CIS is not a premalignant disease necessitated the area is sampled for diagnosis, but done in a way that left the lesion available for further study. In some cases there was no treatment, for instance the punch biopsy series which only used a diagnostic method. The criteria included that “the colpscopically-significant area is large enough not to be completely excised by the diagnostic punch biopsy.” The intention was to leave the lesion as undisturbed as possible. The use of cone biopsy is covered in q 5 and 9 as this could also be diagnostic. Of the hysterectomy series, only 4 out of 25 had the procedure for CIS so the procedure was done but not often specifically for CIS. Either way, women were left with positive cytology which put them at risk.

12. ” The methodology of the 2008 paper has been questioned by Sandercock and Burls…”

I would be embarrassed to cite this letter11 as an example of “questioning”. Every paper is flawed to a degree but this isn’t the right criticism to make. They cite a secondary source and claim this explains what they say is a problem with McIndoe et al – “He points out that, not only were the two group retrospectively divided on the basis of persistent abnormal cytology during follow-up and not prospectively as experimental groups for the comparison of different treatment strategies…” They misread the letter12 which does not appear to state anything regarding type of study and apparently draw from Overton’s misleading statement that “…Green and other senior NWH clinicians endorsed policy changes in dysplasia management. Younger women were to be continuously monitored, by repeat smears, colposcopy, lesser biopsies and appropriate more major surgery if evidence of early cancer.” which omits mention of Green’s role and his published studies. Sandercock and Burls then make an erroneous conclusion that McIndoe’s research should have been prospective and be following different treatments without realising that prospective research had already been done by Green. They cannot have read McIndoe et al despite citing the paper otherwise they would have seen the paper outlined the 1966 proposal. A few minutes reading would have shown the difference in between the statements which if they were honestly critiquing the study they should have checked.

Sandercock and Burls then claim a similar “problem” with McCredie et al even though they are aware it was retrospective. This might be correct to say for prospective studies that ask a question and look forward such as Green’s as this type of study should assess outcomes relative to interventions but retrospective studies are meant to pose a question and then look back. McIndoe et al looked at the question of outcomes for patients with CIS with the patient groups defined by presence of positive or negative cytology which categorised according to the risk they had persistent disease. McCredie13 takes this a step further with the approach being to look at the question of outcomes for patient groups classified by management that was adequate or inadequate. There is no problem with this approach; the problem lies with Sandercock and Burls.

13. “…It should be noted a study on outcomes cannot make such pronouncements…”

It can however tell a story, one that is further strengthened by understanding what the author is trying to achieve. Papers are meant to be considered in the light of all the evidence and that includes context. McCredie et al shows half the cancers in women initially managed with punch/wedge biopsy were diagnosed within 5 years of a finding of CIN3. It can be judged objectively there that merely doing a diagnostic procedure in patients with CIN3 leads to a high risk of developing cancer in a relatively short period of time, while the context shows up much more and shows the unethical nature of the original research which meant they were managed in that manner.

14. “Yet Green’s achievement was to encourage an openness to look at the evidence.”

Which story is it that is being referred to? The one where there is a controversy in medicine? If so, he wasn’t the spirited free-thinker he is being cast as. If it is the one where Green was the controversial one, willing to question modern medicine then the controversy wasn’t in medicine. If he is going to be cast as Galileo type of figure, persecuted for his heresy, the critical point is that Galileo was proven correct. So where are his papers? Even his supporters never present his papers to support their claims. Their resort is to complain about everything else.

Green’s ‘achievement’ was the reverse. On p108 of the report, in an Auckland Star article in 1972 it was reported that “Professor Green asserted that a woman with a positive cervical smear showing what is called [CIS] is no more likely to develop invasive or malignant cancer of the cervix than any other woman of the same age. In other words, in situ cancer is not a forerunner of invasive cancer, and the smear test is over-rated.” There is no shift in attitude over time, despite that over the years, much more would have been studied on the matter and medical practice would have changed. Green’s set views were taught, leading to Registrars and other staff being under the impression that screening for cancer precursors was a waste of time. Apparently he kept an Ogden Nash quotation on his blackboard for many years saying “My mind is made up – don’t confuse me with the facts”. None of this shows any willingness to debate the evidence; on the contrary when faced with evidence of patients with invasive cancer that he had originally diagnosed with CIS though not a trained pathologist, he reclassified them and excluded them from the study. They did not fit, so he changed the evidence to suit his theory. True scepticism is not about holding an idea or defending a position but about being open to the evidence and being willing to examine it and change if necessary. Hitting on the hard edges of scientific debate is a tough experience but it serves no one if the record is distorted to hold an untenable position and legitimate questioning of this is taken to be persecution instead of honestly examining whether the position is, in fact, a correct one to hold.

References

  1. “The Cartwright Report”: http://www.nsu.govt.nz/current-nsu-programmes/3233.asp
  2. “Screening for cervical cancer” 1976: BMJ 659-60
  3. The Walden Report: June 5, 1976: CMA Journal Vol. 114 1003-1012
  4. Ostor, AG 1993: Intern. J. Gyn. Path. 12, 2, 186-92
  5. Lowy, I July 2010 Historia, Ciencias, Saude – Manguinhos V. 17, supl. 1, 53-67
  6. Heslop, B 2004: NZMJ 117,1199
  7. Liley, A.W. 2 November 1963: BMJ Vol 2, Issue 5365 1107-1108
  8. McIndoe, WA; McLean, MR; Jones, RW; Mullins, PR 1984: Obstet Gynecol. 64, 4, 454.
  9. Bryder, L 2009: A history of the ‘Unfortunate Experiment’ at National Women’s Hospital, Auckland University Press, Auckland
  10. Jones, RW; McLean, MR; 1986: Obstet Gynecol. 68, 4, 499-503.
  11. Sandercock, J. Burls, A. 2010, NZMJ 123, 1320
  12. Overton, G.H. 2010, NZMJ 123, 1319
  13. McCredie, M. 2010, NZMJ 123, 1321

Cartwright Report a plank in advocacy

I’m a men’s health promoter working out of Christchurch and have some reflections after reading the discussions about the Cartwright report.

I’m staggered at times by the difference in response by health and social systems to men’s and women’s needs, despite there being arguably worse health and social outcomes overall for men.

I point to the rich legacy of Women’s Health Centres and Women’s Support Centres around the country over the last 20 years. I note the health promotion campaigns run through the community that are targeted wholly at women (see Appetite for Life), or framed to be less accessible by men (Green Prescription). I’m staggered when I see a “Parent’s” Breast-Feeding programme, and a migrant/refugee health programme that is once again wholly for women.

I came in late to seeing the current social work/ health promotion environment, but it’s hard for me not to conclude that a lot of advocacy has occurred for women to get these services, and that the Cartwright Report was one plank in that advocacy, regardless of whether it was valid or not.

So, I’ll acknowledge in my sympathy for men, being smug to see the report challenged, and at the same time uncomfortable with having that response. I wish a skeptical eye had been put onto all of the public money spent on our health and social dollar and am glad that the NZS took this one on.

Donald Pettitt
Manager,
Canterbury Men’s Centre,
www.canmen.org.nz

Manipulation, chiropractic, and the idols of Francis Bacon

Chiropractic has had a colourful history since its invention in the 19th Century.

Chiropractic has had an extraordinary history, but the vehement response of its practitioners to criticisms of its claims is nothing if not human. These unwelcome aspects of human behaviour – a readiness to believe and a violent reaction to well-founded criticism – were recognised and categorised by Francis Bacon 400 years ago.

Chiropractic has been defined as “a system of treating bodily disorders by manipulation of the spine and other parts”.1 The Oxford English Dictionary gives a number of meanings for manipulation, including “The act of operating upon or managing persons or things with dexterity, especially with disparaging implications, unfair management or treatment”. Manipulate, among other meanings, is “to manage by dexterous contrivance or influence, especially to treat unfairly or insidiously for one’s own advantage”.

[Until 1818 English dictionaries gave only one meaning for manipulation: the method of digging for silver ore.]

The practice of chiropractic began in the US in 1885. It is one of a number of strange behaviours and belief systems which have had their origins in that country, including osteopathy, craniosacral manipulation, applied kinesiology, scientology, creationism science, Christian Science, and Mormon beliefs. It was in that country too that homeopathy received its greatest support after its invention in Europe. Why this should have happened is an interesting question. An American friend says that it springs from an overwhelming desire to avoid the perceived errors of Europe with its suppression of religious freedom.

David Daniel Palmer was born in Ontario in 1845, and brought his family to the US where by 1865 they were living in Davenport, Iowa. He was a grocer, and a bee-keeper, and had a deep interest in spiritualism. He practised ‘magnetic healing’ and called himself ‘Doctor’. 2, 3, 4

He later said that the idea of chiropractic came to him as ‘received wisdom’ at a séance in 1885, from a certain Dr. Jim Atkinson, deceased at that time. Shortly after this, on 18 September, 1885, he treated a man who had been deaf for 17 years. He said: “I examined him and found a vertebra racked from its normal position – I racked it into position by using the spinous process as a lever, and soon the man could hear as before.” He went on: “There was nothing crude about this adjustment; it was specific, so much so that no chiropractor has equalled it”.

Palmer called the spinal irregularity he had found a “subluxation”, a term borrowed from orthodox medicine where it means a partial dislocation of a joint. Only chiropractors can find, feel, or see their patients’ abnormalities, which they proceed to correct.

Palmer decided there must be a single cause for all diseases: “I then began a systematic investigation for the cause of all diseases and have been amply rewarded.” He had a friend coin the word ‘chiropractic’ from the Greek ‘cheir’, hand, and ‘praxis’, action. He said that the free flow of the body’s ‘innate intelligence’ (or ‘psychic energy’) to all parts of the body was interrupted by spinal vertebral subluxations, and this was the cause of 95 percent of all illnesses.

He said: “I occupy in chiropractic a similar position to Mrs [Mary Baker] Eddy in Christian Science. Mrs Eddy claimed to receive her ideas from the other world and so do I. I am the fountainhead.”

Palmer was hugely successful. In 1897 he opened the ‘Palmer School of Care’ in Davenport. Admission was by payment of tuition fees and no other qualification. In 1905 it was renamed ‘The Palmer School of Chiropractic’ and it has gone on to occupy a large campus on what is now called Palmer’s Hill, in Davenport.

His son, Bartlett Joshua (‘BJ’), took over the business in 1906, while his father was in prison for practising osteopathy and medicine without a licence. DD and BJ fell out and DD opened a rival school.

By 6 August 1908, the US congress was considering a bill to regulate the practice of chiropractic and to licence chiropractors.

David Daniel Palmer died in 1916 a short while after being run over by BJ in an automobile. The death certificate said ‘typhoid fever’.

Bartlett Joshua Palmer made a fortune, and promoted chiropractic in Canada, Australia, and the United Kingdom. He stressed salesmanship as he taught, and his classrooms were decorated with such slogans as:

“The world is your cow, but you must do the milking”

and

“Early to bed and early to rise, work like hell and advertise”.

BJ marketed a patented machine called the Neurocalometer which he said could detect subluxations, whether or not the patient had symptoms. It is still sold today as the Nervoscope and costs about $US799.

BJ founded a radio station, WOC (Wonders of Chiropractic) in 1924.

In 1926, HJ Jones in Healing by Manipulation stated there were more than 8000 chiropractors in the US and Canada.

BJ died a multimillionaire in 1961.

This story is one of extremely successful entrepreneurship in the best tradition of American showmanship. It has nothing to do with science, and a lot to do with evangelical know-how.

In 2007 there were 19 colleges of chiropractic in the US, two in the UK, at least one in Australia and one in New Zealand.

Repeated examinations of x-rays, MRI scans and autopsy material have failed to show any evidence for existence of the ‘subluxation complex’. The American Association of Chiropractic Colleges states that “the subluxations are evaluated, diagnosed, and managed through the use of chiropractic procedures”.

Because of Palmer’s initial dogma, many chiropractors reject the role of infectious agents in disease and hence deny the value of vaccination.5 Chiropractic neck manipulation is associated with an increased risk of vertebro- basilar vessel damage.6 Chiropractors insist on spine x- rays even when the risk of unnecessary exposure to radiation is raised, and this despite the absence of x- ray changes consistent with a ‘subluxation’.

A careful examination of all the scientific evidence7 has resulted in the conclusion that chiropractic offers some help for low back pain but otherwise has no more effect than that of a placebo for any other complaint.

In 1999 an American chiropractor, Samuel Homola, published Inside Chiropractic: a Patient’s Guide8. He supported manipulation for back pain, but rejected what he described as chiropractic dogma. He confirmed that the chiropractic profession had little tolerance of dissent.

“Its nonsense remains unchallenged by its leaders, and has not been denounced in its journals. Although progress has been made, the profession still has one foot planted lightly in science, and the other firmly rooted in cultism.”

He was labelled a ‘heretic’ by his colleagues.

Some commentators divide chiropractors into ‘straight’ dogmatists and ‘mixers’ who will use some science.

Chiropractors and defense by legal action: the American Medical Association Saga

In the US, doctors encouraged the arrest of chiropractors for practising medicine without a licence. By 1940 it is said that 15,000 prosecutions had been brought. However 80 percent of these had failed, with the United Chiropractors’ Association, encouraged by BJ Palmer, giving financial support to the defendants.

The AMA Committee on Quackery lobbied in 1963 to have chiropractors relegated to a non- medical status. The committee argued that chiropractic should not be recognised by the US Office of Education, citing the lack of scientific evidence, the denial of germ theory, the claim to be able to treat 95 percent of all diseases, and the use of the ‘E- meter’.

In 1976 the Chiropractors’ Association, having become aware of further action planned by the AMA, brought a suit against the association on the grounds that it planned to limit chiropractors’ practice, and this was in breach of anti- trust legislation as it was anti-competitive.

In 1987 the Court found in favour of the chiropractors, and an appeal by the AMA in 1990 failed.

The chiropractors had shifted the issue from science to rights of commercial practice. This was totally in keeping with their history of astute business acumen – and lack of scientific evidence.

The 1978 NZ Royal Commission of Inquiry into Chiropractic

In a context of legal and political mechanisms, the NZ Chiropractors’ Association with its supporters, and the NZ Medical Association and its supporters, battled for and against official recognition of chiropractic as a national health resource, and the access of its practitioners to the rewards from the Accident Compensation scheme.

The chiropractors bolstered their position with hundreds of letters to the commission from satisfied customers, and the NZMA responded by scathing and dismissive comments as to the worth of such letters, and by decrying the lack of science in the practice of chiropractic.

Kevin Dew9 suggests that the result was a negotiated settlement exchanging a proposal by chiropractors to restrict their practice to musculoskeletal conditions, in return for official Government recognition, and the addition of chiropractic to New Zealand’s health resources.

The controversy was resolved without any resolution as to the scientific validity of the claims of chiropractic. It was thought there were only 100 chiropractors in New Zealand at that time.

Recent publications6show that the majority of chiropractors in the English- speaking world continue to make claims for their treatment which extend well beyond the realm of musculo- skeletal disorders.

There were 391 chiropractors advertising in the Yellow Pages in New Zealand in August, 2010.

Simon Singh and the British Chiropractors’ Association

In 2008, Simon Singh and Edzard Ernst published a book called Trick or Treatment.7

On 19 April 2008, Singh wrote an article in The Guardian, pursuing the topic canvassed in the book, that chiropractic was alternative medicine and there was no evidence for any effect except on lower back pain.

“The British Chiropractors’ Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections and prolonged crying even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession, yet it happily promotes bogus treatments”.

The BCA quickly sued him for libel, and on 7 May 2009 the court handed down a verdict in favour of the chiropractors.

Meanwhile in New Zealand

On 25 July 2008, the NZ Medical Journal published a paper by Andrew Gilbey reporting evidence that some chiropractors in NZ were using the title ‘Doctor’ in a manner which could mislead the public. In the same issue an editorial by David Colquhoun appeared, critical of chiropractic, and the qualifications of its practitioners. He wrote:

“For most forms of alternative medicine, including chiropractic and acupuncture the evidence is now in. There is now better reason than ever before to believe that they are mostly elaborate placebos, and at best are no better than conventional treatment.”

In the next issue of the NZMJ the editor published a letter from a lawyer, Paul Radich, representing the NZ Chiropractors’ Association, threatening legal action under the NZ Defamation Act, against the journal, Gilbey, and Colquhoun. The letter demanded apologies from all parties, and outlined the financial penalties for all.10 The tone was intimidatory.

In his comments about the position of the NZMJ as a scientific publication, the editor, Frank Frizelle, invited the chiropractors to an evidence- based debate with these words: “Let’s hear your evidence, not your legal muscle”.

The NZMJ published an invited response from the NZ College of Chiropractic in its next issue11 and I understand there has been no further correspondence from the lawyer (personal communication from the editor, NZMJ, September 2010).

Back to London

A month after the initial court procedure in London, Simon Singh announced his intention to appeal the finding in favour of the BCA.

On 1 April 2010 the Appeal Court handed down its verdict. The Lord Chief Justice of England and Wales, The Master of the Rolls, and Lord Justice Sedley stated that Singh(s comments were not libellous, and that they were matters of opinion backed by evidence. They went on to quote an American judge, Judge Easterbrook, now Chief Justice of the US 7th Circuit Court of Appeals.

In Underwager v Salter 22 Fed.3d 730 (1994):

“Plaintiffs cannot, by simply filing suit and crying ‘character assassination’ silence those who hold divergent views, no matter how adverse those views may be to the plaintiff’s interests. Scientific controversies must be settled by the methods of science, rather than by the methods of litigation. More papers, more discussion, and more satisfactory models – not larger awards of damages – mark the path toward superior understanding of the world around us.”

Back to New Zealand

As it happens, nine days after Singh’s appeal was upheld, Ernst and Gilbey authored a paper in the NZMJ: “Chiropractors’ Claims in the English-speaking World”.5 They examined 200 individual chiropractors’ websites and nine chiropractic association sites in Australia, Canada, New Zealand, the UK and the US. They concluded:

“The majority of chiropractors and their associations in the English-speaking world seem to make claims which are not supported by sound evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.”

On 11 June 2010, Shaun Holt and Andrew Gilbey wrote a letter to the editor of the NZMJ12 drawing attention to the wider public scrutiny of chiropractic claims and nature following the success of Simon Singh’s appeal.

Francis Bacon and his ‘idols’

Francis Bacon (1561-1626) lived at a time when the new empiricism was disturbing the security and comfort taken in accepting the opinions of established authorities. He was a lawyer, a legal theorist, a judge, and a writer. He became Lord Chancellor, but was charged by Parliament with corruption, and having taken bribes from those appearing before him in court. He pleaded guilty and wrote: “I was the justest judge that was in England these fifty years, but it was the justest censure in Parliament these two hundred years.”13

Bacon wrote a series of ‘Axioms’ towards the end of his life. I would like to use some of these to examine aspects of human behaviour that the history of chiropractic reveals. It has been a considerable surprise to me to realise the prescience of this man.

He used the term ‘idols’ to list aspects of human behaviour.

Axiom 41: “The Idols of the Tribe”

These have their foundation in human nature itself.

“For it is a false assertion that the sense of man is the measure of things. On the contrary, all perceptions, as well of the sense as of the mind, are according to the measure of the individual, and not according to the measure of the universe.”

We are all subject to our nature, and seek security and certainty, and believe the evidence of our eyes. If we get better after manipulation, then clearly the manipulation made us better. Emma Young says: “We are causal determinists – we assume that outcomes are caused by preceding events”.14

Axiom 42: “The Idols of the Cave”

These are the idols of the individual man, due to our own peculiar natures, our education, our own experiences, or to reading from authorities we admire. “The spirit of man is in fact a thing variable and full of perturbation”. If we are told by our parents or teachers that someone else is better after manipulation, then we will believe that it is a ‘true’ relationship.

Axiom 43: “The Idols of the Marketplace”

“Formed by the intercourse and association of men with each other. For it is by discourse that men associate, and words are imposed according to the apprehension of the common understanding. The ill and unfit choice of words wonderfully obstructs the understanding. Words plainly force and overrule the understanding, and throw all into confusion and lead men away into numberless empty controversies and idle fancies.”

The choice of the word ‘subluxation’ for example, to describe an undemonstrable change! Or the claim for the existence of ‘psychic energy’. A radio station extolling the “Wonders of Chiropractic” is a wonderful Idol of the marketplace.

To take legal action and gain the publicity which is sure to follow with extensive argument about the meaning of, for example, ‘happily’ has great appeal in the marketplace.

Axiom 44: “The Idols of the Theatre”

“Which have migrated into men’s minds from various dogmas, and the wrong laws of demonstration. All the received systems are but so many stage plays – many more plays of the same kind may yet be composed.”

How well aware of this human trait are all showmen and charlatans. The Palmers, father and son, exploited this behaviour. To claim that new knowledge has come from beyond the grave is wonderful ‘theatre’, full of drama and mystery. To maintain the dogma of the wonderful in the face of evidence to the contrary is so much easier than to examine the evidence.

All these human behaviours can be seen in the history of chiropractic, and in so many other catastrophes such as the anti- vaccination campaign, the Peter Ellis trial, the Cartwright affair, the anti- fluoridation campaign and so on and on.

The history of chiropractic, and the response of chiropractors to criticism about the absence of science in their beliefs, illustrate the profound insights of Francis Bacon about our nature. It is our nature which results in the persistence of the perverse, and which resists the truth.

The responses of those without objective evidence for their personal beliefs often include ad hominem attacks, threat of legal action and financial injury, professional ridicule, and public invective. All these are seen in the chiropractors’ responses.

References

  1. Collins’ Concise Dictionary of the English Language (1988).
  2. Shapiro, R 2009: Suckers: How Alternative Medicine Makes Fools of Us All. Vintage Press, London.
  3. Carroll, RT 2003: The Skeptics’ Dictionary; A Collection of Strange Beliefs, Amazing Deceptions and Dangerous Delusions. John Wiley & Sons, NJ.
  4. Goldacre, B 2008: Bad Science. Fourth Estate, London.
  5. Ernst, E; Gilbey, A 2010: NZMJ, 123(1312) 36-44.
  6. Ernst, E 2007: J. R. Soc. Med. 100(7) 330-338.
  7. Singh, S; Ernst, E. 2008: Trick or Treatment: Alternative Medicine on Trial. Transworld Publishers, London.
  8. Homola, S 1999: Inside Chiropractic: A Patient’s Guide.
  9. Dew, K 2000: Sociology of Health & Illness, 22(3) 310-330.
  10. Editorial, 2008: NZMJ, 121(1279) 16-18.
  11. Roughan, S 2008: NZMJ, 121 (1280)72-74.
  12. Gilbey, A 2010: NZMJ, 123(1316) 126-127.
  13. Hollander, J; Kermode, F 1973: Oxford Anthology of English Literature. OUP, London & New York.
  14. Young, E 2010: New Scientist 2720.

Orthodoxy Restated

Linda Bryder responds to an article in our last issue.

The article by Michelle Coffey (NZ Skeptic, 97) restates the conclusions of the Cartwright Report which are not, as she seems to imply, unassailable facts. Indeed many of the points Coffey highlights are contestable and have been effectively contested. Some examples (Coffey’s statements in italics) are as follows:

“The report found that Green… aimed to prove a point that even at the time was known not to be the case. A 1961 compilation of studies…showed CIS progressed to invasive cancer in 28.3 percent of cases.”

There was no medical certainty about the proportion of cases of CIS which would advance to invasive cancer, either in 1961 or subsequently. In 1976 the British Medical Journal described this very question as a “fierce controversy”.1 Studies, with accompanying disagreements relating to appropriate treatment, continued throughout the period under discussion. In 1993 an Australian researcher reviewed all the studies of the progression of CIS that he could find since 1955. He commented on how controversial it was. He concluded that the studies showed the invasive potential of CIN1 to be 1 percent, CIN2 to be 5 percent and CIN3 or CIS to be 12 percent or possibly more.2 The reality was even more complicated, as pathologists constantly disputed the allocation of dysplasia into the various grades of CIN1, 2 and 3. As American professor of gynecology Leopold Koss stated in 1979, “Truly it can be repeated that one man’s dysplasia (CIN1( is another man’s carcinoma in situ (CIN3).”3

2 “Standard treatment of the time involved excising all affected tissue and the ‘conservative’ treatment conisation was in use well prior to 1966.”

Coffey cites 1958 “official policy”, as did Judge Silvia Cartwright, to show this. This National Women’s “official policy” was agreed to at a meeting of only nine senior consultants (including one paediatrician) with two dissenting voices.4 Many doctors, in New Zealand and overseas, still opted for the more invasive hysterectomy as treatment for CIS. A 1983 study noted that in the USA hysterectomy had been the most common treatment since the 1950s.5 In fact Coffey acknowledges this variation in preferred treatments in the next paragraph when she writes, “During this period, some centres were beginning to use cone biopsy as effective treatment; however there were limitations to its use.”

3. “Cartwright concluded that Green’s 1966 proposal was a ‘research proposal’.”

Professor Barbara Heslop explained this more appropriately in its historical context when she wrote: “The investigation was basically a collection of clinical cases whose attributes were to be reported retrospectively.” 6 Green certainly planned to publish in international medical journals (he had an academic post which held expectations of scientific publications) but he was, as Professor Heslop wrote, a “clinical collector”. He himself used the term “medical cartography” to describe his research.7 Sir William Liley told Green in 1975:”Your dogged long term data collection lacks the instant appeal of some of the other exploits about the place.”8 Green was first and foremost a gynaecologist however, and as American professor of bioethics, Robert Baker, wrote of the 1960s, it was presumed at that time that “the therapeutic relationship would automatically predominate over the scientist”subject relationship.”9 That certainly applied to Green.

4. “In addition, patients over the age of 35 were included in the research in breach of the protocol.”

The 1966 management protocol was to “extend” conservative treatment to all those under the age of 35, which did not mean that such management was restricted to that age group. Indeed, the protocol shows the extent to which clinical decisions predominated over any research objectives. The conservative treatment regime was extended to cover at least all young women, who could be most harmed by excessive intervention, but it was never intended that conservative treatment would only apply to young women; the choice of treatment was done on a case”by”case basis.

5. ” Patients also had to return for repeated tests and other invasive procedures.”

Coffey presents this as a negative outcome, as though it was an unnecessary encumbrance for the women. However, in her recommendations, Judge Cartwright (p 210) wrote: “Any woman who has received a diagnosis of CIS … must have her condition monitored for life.”

6. “… new”born babies had their vaginas swabbed without formal consent from the parents.

Regarding the infant vaginal swabs, a press release by Judge Cartwright’s counsel stated “Mothers were told of the tests.” In her report, Cartwright commented on the lack of consent.10 By this she must have meant written consent. Yet oral consent was also the format for Sir William Liley’s intra”uterine blood transfusions from the early 1960s and Sir Graham Liggins’s infusion of corticosteroids from the late 1960s, at the same institution, which were internationally acclaimed. These need to be placed in the context of the times. Similarly the trial of radiotherapy and hysterectomy for cervical cancer, initiated in 1972, which Coffey refers to, complied with international practice for randomised controlled trials and the principle of equipoise.11

7. “The patients were divided retrospectively into two groups which overlapped strongly but not completely with groups defined by Green, that he called ‘special series’.”

Despite writing this, Coffey herself makes it clear that the two groups created by Dr Bill McIndoe et al in 1984 (numbering 817 and 131) had nothing to do with the two groups whose records Green analysed (numbering 27 and 25).

8. “While Coney and Bunkle may have made a mistake [thinking there were two groups], it’s clear the judge didn’t.”

Judge Cartwright most definitely accepted Coney and Bunkle’s interpretation; on page 95 Cartwright wrote:

“Twelve of the total number of women died from invasive carcinoma. Four (0.5%) of the Group- one women, and eight (6%) of the Group- two women who had limited or no treatment. Thus the women in the limited treatment group were twelve times more likely to die as the fully treated group” [my italics].

Cartwright accepted this as “accurately reflect[ing] the findings of the 1984 McIndoe paper.” She therefore accepted unequivocally that there were two groups, one of which had “limited or no treatment”.

9. “… the proportion of invasive cancer in those inadequately treated was much higher compared with those who had returned to negative cytology”.

How had they “returned to negative cytology”? There is no evidence that their treatment was any different from the others (indeed McIndoe himself told Coney that treatment did not enter their study12) but their disease had disappeared. The distinction was not “inadequately treated” and “adequately treated”, but rather “positive cytology” and “negative cytology”. The McIndoe paper stated: “The 131 patients in group 2 continued to produce abnormal cytology …irrespective of the initial management or the histologic completeness of excision of the lesion”.13

10. “… there was a further paper in 1986 regarding CIS of the vulva. The same method used by Dr Green to group women by cytology after diagnosis and treatment was used…”

Coffey refers to the 1986 paper on carcinoma of the vulva as critical of conservative treatment, yet overlooks the conclusion of this paper which advised caution in treatment: “Although a small proportion of recurrences will occur, mutilating vulvectomy [should be] avoided.”14 Coffey actually confuses the two studies (1984 and 1986), when she reverts to a discussion of the 1984 McIndoe paper.

11. “CIS is and was a totally curable lesion.”

Would a modern gynaecologist agree with this assessment? If so, how does one explain that cervical cancer has not been eliminated from our population? Indeed the McIndoe paper stated: “Thus, whether or not the lesion is completely excised does not appear to influence the possibility of invasion occurring subsequently.”15

12. “evidence of continuing disease, demonstrating that the intervention was inadequate… this differs from group 1 patients, who were successfully treated at the outset.”

As stated above, Group 1 and Group 2 had a similar range of treatments, the differences did not relate to treatment but rather whether or not they had continuing disease.

13. “This paper [McCredie et al. 2008] gave a direct estimate of the rate of progression from CIN3 to invasive cancer. For 143 women that were managed by only punch or wedge biopsy the cumulative incidence was 31.3 percent at 30 years and 50.3 percent in a subgroup who had persistent disease at 24 months.

The methodology of the 2008 paper has been questioned by Sandercock and Burls, who wrote: “This paper states clearly that the authors divided their sample into adequately and inadequately treated groups. However, a major problem in their methods is that they use the outcome following treatment as part of the classification system.” Sandercock and Burls cite the 2008 paper:

“Any procedure followed by a positive smear in the following 6-24 months was classified as inadequate treatment (Figure 1). Four women who developed cancer within 2 years of CIN3 diagnosis, but who had no follow-up cytology, were assumed to have had inadequate treatment.”

Sandercock and Burls comment that: “Given that they partially base the classification of adequacy of treatment on outcomes, it is totally unsurprising and uninformative that the authors should find that women who are classified as ‘inadequately treated’ have poorer outcomes. It is difficult to follow exactly what this paper was trying to prove, but as a means to demonstrate that conservative treatment led to worse outcomes, the methods are wholly inadequate.”16

14. “This study [McCredie study] is important as it shows the medical experience of the women, where they were subjected to many interventions that were not meant to treat but rather to monitor.

Apart from the questionable methodology referred to above, it should also be noted that a study on outcomes cannot make such pronouncements on what the intentions were of those who managed the women’s conditions.

15. “[Green’s] ‘atypical’ viewpoint was also promoted in the scientific literature and in the press, creating confusion within the medical scene and with the public.

For Coffey this included undergraduate and postgraduate medical students. Yet Green’s achievement was to encourage an openness to look at the evidence. In this, he followed Thomas McKeown, the British Professor of Social Medicine who questioned the role of modern medicine by studying data on causes of death over a 200- year period (this included a questioning of the role of cervical screening).17 Far from creating confusion, Green’s willingness to debate the evidence and to question modern medicine and technological interventions is exactly what a modern democratic society should seek to promote, and this should certainly be a goal of the Skeptics Society.

References

  1. Leading article 1976: BMJ 2, 659-60.
  2. Östör, AG 1993: Intern. J. Gyn. Path. 12, 2, 1993, 186-92.
  3. Koss, LG 1978: Obstet Gynecol. 51, 377.
  4. Bryder, L 2009: A History of the ‘Unfortunate Experiment’ at National Women’s Hospital, Auckland University Press, Auckland.
  5. Larsson, G 1983: Acta Obstetricia et Gynecologica Scandinavia, Supplement 114, Lund, 9-10.
  6. Heslop, B 2004: NZMJ 117, 1199 (www.nzma.org.nz.ezproxy.auckland.ac.nz/journal/117-1199/1000).
  7. Cited in Bryder, 128.
  8. Cited in Bryder, 88.
  9. Baker, R 1998: in cooperation with Herych, E (eds), Ethics Codes in Medicine: Foundations and Achievements of Codification since 1947, Ashgate, Aldershot, 322-4.
  10. Bryder, 132-3.
  11. Bryder, 71-2.
  12. Bryder, 33.
  13. McIndoe, WA; McLean, MR; Jones, RW; Mullins, PR 1984: Obstet Gynecol. 64, 4, 454.
  14. Jones, RW; McLean, MR 1986: Obstet Gynecol. 68, 4, 499-503.
  15. Mcindoe et al, 457.
  16. Sandercock, J; Burls, A 2010: NZMJ 123, 1320; ISSN 1175 8716, 119. (www.nzma.org.nz/journal//123-1320/4280/)
  17. McKeown, T 1976: The Role of Medicine: Dream, mirage or nemesis? Nuffield Provincial Hospitals Trust, London
  18. McKeown, T; Knox, EG 1968: ‘The Framework Required for Validation of Prescriptive Screening’, in McKeown, T (ed.), Screening in Medical Care: reviewing the Evidence: A collection of Essays, Nuffield Provincial Hospitals Trust, Oxford University Press, London.

Yet more reasons why people believe weird things

Research at Victoria University of Wellington is shedding light on the often irrational processes by which people assess new information. This article is based on presentations to the 2010 NZ Skeptics conference.

Jacqui Dean was alarmed. The Otago MP had received an email reporting the deaths of thousands of people – deaths caused by the compound dihydrogen monoxide. Dihydrogen monoxide is commonly used as an industrial solvent and coolant, it is fatal if inhaled, and is a major component of acid rain (see dhmo.org for more facts about dihydrogen monoxide). Only after she declared her plans to ban dihydrogen monoxide did she learn of its more common name: water (NZ Herald, 2007).

Ms Dean’s honest mistake may be amusing, but when large groups of people fail to correctly assess the veracity of information that failure can have tragic consequences. For example, a recent US survey found 25 percent of parents believe that vaccines can cause autism, a belief that may have contributed to the 11.5 percent of parents refusing at least one recommended vaccine for their child (Freed et al, 2010).

Evidence from experimental research also demonstrates the mistakes people can make when evaluating information. Over a number of studies researchers have found that people believe:

  • that brand name medication is more effective than generic medication;
  • that products that cost more are of higher quality;
  • and that currency in a familiar form – eg, the US dollar bill, is more valuable than currency in a less familiar form – eg, a dollar coin (Alter & Oppenheimer, 2008; for a review, see Rao & Monroe, 1989).

Why is it that people believe these weird things and make mistakes evaluating information?

Usually people can evaluate the veracity of information by relying on general knowledge. But when people have little relevant knowledge they often turn to feelings to inform their decisions (eg Unkelbach, 2007). Consider the following question: Are there more words in the English language that start with the letter K or have K in the third position? When Nobel prize winner Daniel Kahneman and his colleague Amos Tversky (1973) asked this question most people said there are more words that start with the letter K. And they were wrong. People make this error because words that start with the letter K, like kite, come to mind more easily than words that have a K in the third position, like acknowledge, so they judge which case is true based on a feeling – the experience of ease when generating K examples.

Generally speaking, information that is easy to recall, comprehend, visualise, and perceive brings about a feeling of fluent processing – the information feels easy on the mind, just like remembering words such as kite (Alter & Oppenheimer, 2009). We are sensitive to feelings of fluent processing (fluency), and we use it as a cue to evaluate information. For example, repeated information feels easy to bring to mind, and tends to be judged as more true than unrepeated information; trivia statements written in high colour contrast (Osorno is the capital of Chile) are easier to perceive and are judged as more true than statements written in low colour contrast (Osorno is the capital of Chile); and financial stocks with easy to pronounce ticker symbols (eg KAR) outperform those with difficult to pronounce ticker symbols such as RDO (Alter & Oppenheimer, 2006; Hasher et al, 1977; Reber & Schwarz, 1999).

Most of the time, fluently processed information is evaluated more positively – we say it is true, we think it is more valuable. And on the face of it, fluency can be a great mental shortcut: decisions based on fluency are quick and require little cognitive effort. But feelings of fluency can also lead people to make systematic errors. In our research, we examine how feelings of fluency affect beliefs, confidence, and evaluations of others. More specifically, we examine how photos affect people’s judgements about facts; how repeated statements affect mock- jurors’ confidence; and how the complexity of a name affects people’s evaluations of that person.

Can decorative photos influence your beliefs about information?

If we told you that the Barringer Crater is on the northern hemisphere of the moon, would that statement be more believable if we showed you a photo of the Barringer Crater? Because the photo is purely decorative – that is, it doesn’t actually tell you anything about the location of the Barringer Crater (which is in fact in Arizona) – you probably wouldn’t expect it to influence your beliefs about the statement.

Yet, evidence from fluency research suggests that in the absence of relevant knowledge, people rely on feelings to make decisions (eg Unkelbach, 2007). Thus, not knowing what the Barringer Crater is or what it looks like, you might turn to the photo when considering whether the statement is true. The photo might bring about feelings of fluency, and make the statement seem more credible by helping you easily picture the crater and bring to mind related information about craters – even though this would still give you no objective information about where the crater is located. In our research, we ask whether decorative photos can lead people to be more willing to believe information.

How did we answer our research question?

In one experiment, people responded true or false to trivia statements that varied in difficulty; some were easy to answer (eg, Neil Armstrong was the first person to walk on the moon), some were more difficult (eg, Turtles are deaf). Half of the time, statements were paired with a related photo (eg, a turtle). In a second study, people evaluated wine labels and guessed whether each of the wine labels had won a medal. We told people that the wine companies were all based in California. In fact, we created all of the wine names by pairing an adjective (eg, Clever) with a noun (eg, Clever Geese). Some of the wine labels contained familiar nouns (eg, Flower) and some contained unfamiliar nouns (eg, Quills). Half of the wine labels appeared with a photo of the noun.

What did we find?

Overall, when people saw trivia statements or wine names paired with photos, they were more likely to think that statements were true or that the wines had won a medal. However, photos only exerted these effects when information was difficult – that is, for those trivia statements that were difficult to answer and wine names that were relatively unfamiliar. Put more simply, decorative photos can lead you to believe claims about unfamiliar information.

Is one eyewitness repeating themselves as believable as three?

If you were a juror in a criminal case, you would probably be more willing to convict a man based on the testimony of multiple eyewitnesses, rather than the testimony of a single eyewitness. But why would you be more likely to believe multiple eyewitnesses? On the one hand, you might think that the converging evidence of multiple eyewitnesses is more accurate and more convincing than evidence from a single eyewitness, and indeed, multiple eyewitnesses are generally more accurate than a single eyewitness (Clark & Wells, 2008).

On the other hand, as some of the fluency research discussed earlier suggests, you may be more likely to believe multiple eyewitnesses simply because hearing from multiple eyewitnesses means hearing the testimony multiple times (Hasher et al, 1977). Put another way, it may be the repetition of the testimony, rather than the number of independent eyewitnesses, that makes you more likely to believe the testimony. In our research, we wanted to know whether it is the overlap of statements made by multiple eyewitnesses or the repetition of those statements that makes information more believable.

How did we answer our research question?

We asked subjects to read three eyewitness reports about a fictitious crime. We told half of the subjects that each report was written by a different eyewitness, and we told the other half that all three reports were written by the same eyewitness. In addition, half of these subjects read some specific claims about the crime (eg, The thief read a Newsweek magazine) in one of the eyewitness reports, while the other half read those same specific claims in all three reports. Later, we asked subjects to tell us how confident they were that certain claims made in the eyewitness reports really happened during the crime (eg, How confident are you that the thief read a Newsweek magazine?).

What did we find?

This study had two important findings. First, regardless of whether one or three different eyewitnesses ostensibly wrote the reports, subjects who read claims repeated across all three reports were more confident about the accuracy of the claims than subjects who read those claims in only one report. Second, when the claims were repeated, subjects were just as confident about the accuracy of a single eyewitness as the accuracy of multiple eyewitnesses. These findings tell us that repeated claims were relatively more fluent than unrepeated claims – making people more confident simply because the claims were repeated, not because multiple eyewitnesses made them.

Would a name influence your evaluations of a person?

Your immediate response might be that it shouldn’t – people’s names provide no objective information about their character. We hope that we make decisions about others by recalling information from memory and gathering evidence about a person’s attributes. Indeed, research shows that when we have knowledge about a topic, a person or a place, we do just that – use our knowledge to make a judgement- and we can be reasonably accurate in doing so (eg, Unkelbach, 2007).

But when we don’t know a person and we can’t draw on our knowledge, we might be influenced by their name. As we have described, when people cannot draw on memory to make a judgement, they unwittingly turn to tangential information to make their decisions. Therefore, when people evaluate an unfamiliar name, tangential information, like the complexity of that name, might influence their judgements. More specifically, we thought that unknown names that were phonologically simple – easier to pronounce – would be judged more positively on a variety of attributes than names that were difficult to pronounce.

How did we answer our research question?

We showed people 16 names gathered from international newspapers. Half of the names were easy to pronounce (eg, Lubov Ershova), and half were difficult to pronounce (eg, Czeslaw Ratynska). We matched the names on a number of factors to make sure any differences we found were not due to effects of culture or name length. So for example, people saw an easy and difficult name from each region of the world and names were matched on length. Across three experiments, we asked subjects to judge whether each name was familiar (Experiment 1), trustworthy (Experiment 2), or dangerous (Experiment 3).

What did we find?

Although the names were not objectively different from each other on levels of familiarity, trustworthiness, or danger, people systematically judged easy names more positively than difficult names. Put another way, people thought that easy-to-pronounce names were more familiar, more trustworthy, and less dangerous than difficult-to-pronounce names. So although we would like to think we would not evaluate a person based on their name, we may unwittingly use trivial information like the phonological complexity of a name in our judgements.

Conclusions

Why is it that people believe these weird things and make mistakes when evaluating information? Our research suggests that decorative photos, repetition of information, and a person’s name all influence the way people interpret information. More specifically, decorative photos lead people to think information is more credible; repetition leads mock-jurors to be more confident in eyewitness statements – regardless of how many eyewitnesses provided the statements; and an easy-to-pronounce name can lead people to evaluate a person more positively.

Relying on feelings of fluency can result in sensible, accurate decisions when we are evaluating credible facts, accurate eyewitness reports, and trustworthy people. But the same feelings can lead people into error when we are evaluating inaccurate facts, mistaken eyewitnesses, and unreliable people. More specifically, feelings of fluency might lead us to think false facts are true, be more confident in inaccurate eyewitness reports, and more positively evaluate an unreliable person.

A common finding across our studies is that the effect of fluency was specific to situations where people had limited general knowledge to draw on. In the real world, we might see these effects even when people have sufficient knowledge to draw on. That is because we juggle a lot of information at any one time and we do not have the cognitive resources to carefully evaluate every piece of information that reaches us – as a result we may turn to feelings to make some decisions. Therefore it is inevitable that we will make at least some mistakes. We can only hope that our mistakes are comical rather than tragic.

The authors thank Professor Maryanne Garry for her invaluable guidance and her inspiring mentorship on these and other projects.

References

Alter, A, Oppenheimer, D 2006: Proc. Nat. Acad. Sci. 103, 9369-9372.
Alter, A, Oppenheimer, D 2008: Psychonomic Bull. & Rev. 15, 985-990.
Alter, A; Oppenheimer, D 2009: Personality and Soc. Psych. Rev. 13, 219-236.
Clark, SE; Wells, GL 2008: Law & Human Behavior 32, 406-422.
Dihydrogen Monoxide – DHMO Homepage. (2010).dhmo.org
Freed, G; Clark, S; Butchart, A; Singer, D; Davis, M 2010: Pediatrics, 125, 653-659.
Hasher, L; Goldstein, D; Toppino, T 1977: J. Verbal Learning & Verbal Behavior 16, 107-112.
NZ Herald 2007:www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10463579
Rao, A; Monroe, K 1989: J. Marketing Research, 26, 351-357.
Reber, R; Schwarz, N 1999: Consciousness & Cognition 8, 338-342.
Tversky, A; Kahneman, D 1973: Cognitive Psych. 5, 207-232.
Unkelbach, C 2007: J. Exp. Psych.: Learning, Memory, & Cognition 33, 219-230.

Creationism in Wellington schools

Creationism is not a new problem in New Zealand schools, as this article excerpt from NZ Skeptic 18 (December 1990) illustrates.

A report of a survey conducted in 1988

In order to ascertain to what extent creationist ideas and influence have penetrated secondary school science courses, we sent the following questionnaire to secondary schools in the Wellington region.

  1. Approximately how many hours are devoted to the teaching of evolution in your school and what proportion of pupils are taught it?

  2. Are creationist ideas being taught at your school as part of a science course?

  3. Do any science teachers in your school use Creationist literature with their classes?

Nine replies were received from about 35 schools circulated. Although this provides only a small sample, and few generalisations can be made, the replies represent a good cross section, from central city large schools to “suburban” schools, and single sex and co-ed schools.

Most teachers made no comment of any concern they may have felt about the influence of Creationism in our schools, but 2 teachers specifically stated they felt there is a problem and that they are concerned about it. Most teachers expressed confidence that their 7th form pupils were able to decide for themselves on the merits or otherwise of the Creationist arguments, but one teacher specifically stated a concern that some pupils had already been “indoctrinated” and that few pupils had “the scientific background to adequately evaluate Creationist literature.” Two schools said their science teaching staff included a Creationist (and a third school, from which no reply was received, is known to us). Hence, 3 out of 10 schools have Creationists on their science teaching staff.

Evolution is clearly absent altogether from lower Form (Forms 3-5) courses, and comprises a minor part, if any, of the 6th Form Biology course. In Form 7 it constitutes a major part (generally 20-35 hours) of the Biology course, which is taken by about 20-30% of the 7th Form. This presumably represents about 3% of the school role.

In total, 4 of the 9 schools expose their pupils to Creationist ideas in the teaching of evolution – generally as a “stimulus for discussion” but, in 2 cases, to show that there are “alternatives that many people accept”. Students are encouraged to discuss the question and to “decide for themselves”. Two mentioned that they had taken classes to hear Dr Wilder-Smith (a prominent Creationist spokesman) talk, during his recent visit to New Zealand.

Roger Cooper (Paleontologist, NZ Geological Survey)
Gordon Hewitt (Biologist, School of Health Sciences, Central Institute of Technology)
Frank Andrews (Astronomer, Carter Observatory(
Dave Burton (Zoologist, Victoria University(

A new golden age?

His name is Gold, he describes himself as a post- goth Discordian web developer, and one day soon he hopes to be homeless. He’ s also the new chair entity of NZ Skeptics. Annette Taylor finds out more.

The phone is not the instrument of choice for Gold. The 39-year-old suggests Skype, although his webcam is not working; it’s been a hectic few days in Christchurch, in the aftermath of the earthquake.

Flatting – temporarily- in Richmond, 2km north-east of the city, a chimney collapsed and things were “up and down and all over the place. We spent a day or so picking stuff up; otherwise it wasn’ t too bad.”

While we’re talking he pauses and waits for an aftershock to pass. Eris, the Greek Goddess of chaos, is having a grand old time.

“When anything goes wrong, when things don’t got to plan, that’s Eris,” Gold says.

He discovered Discordianism while at Canterbury University and says it’ s all about chaos and destruction and a sense of humour.

“We worship Eris and have a Bible equivalent and tenets we follow, such as that one must eat a hot dog on a Friday, which insults almost every religion you can think of, including our own. It’s a joke religion, which is one of the things that completely sold me on it. It’ s a fun thing, and nice to have someone to blame when things go wrong.”

And “post-goth”?

“I used to be a goth. You know – black clothing, the make-up, piercings, tattoos, the great music. It was a phase, so now I refer to myself as post-goth. I’ ve kept the dress sense; the piercings are not quite as obvious anymore. The tats are a little harder to get rid of. I still have the attitude, which is what it was all about, really. And the music is still great.”

Apart from five years in Australia, Gold has lived in New Zealand all his life, much of it in Canterbury. And for most of that time, he has been a sceptic.

Currently an atheist, he didn’ t have a religious background of any sort. “And it wasn’t until early 2000 that I sort of came across skepticism as a movement, or way of thinking. Up until then I was one of those people who didn’t really know there was a label for it.”

He was living in Sydney at the time, and a close friend was a full-on, practising witch.

“While it was kind of cool, I thought that yeah, no, this may be interesting, but it’s not real. It just didn’t gel.”

What galvanised his thinking more were skeptical podcasts and blogs, which he started to “passively consume” while overseas.

He returned to New Zealand in 2005, and headed straight back to Christchurch where he now works developing websites. And, last year, started the first Skeptics in the Pub meetings. “I came across this while in Sydney. It an idea that started in the UK, about 11 years ago, as a lecture series. Afterwards, people wanted more of them, so they continued. It became a very social thing and started to spread across the UK, into the US and Australia.”

But not in New Zealand. “I was working in the central city, away from my previous social group, and thought bugger it, I’d give it a go. I paid some money and set up the first meeting, at the Twisted Hop. We got about 35 people along and it’ s kept going since then. It’s a nice way to get together with like-minded people and have a drink.”

Now there are meetings in Auckland, Wellington and Dunedin as well, but he would like to see more.

Which is a good reason to be intentionally without a home.

“One of the things about the job I’m doing is that all I need is a laptop and net access. I can work anywhere. I can travel around, and pop up somewhere. My plan is to stay in backpackers, and maybe build them a website instead of paying for a room. So, I can be a roving catalyst for getting Skeptics in the Pub meetings set up all over the country.”

He was aware of the NZ Skeptics when he arrived back in New Zealand. “Yes, I’d come across the website, and I knew Vicki. I joined, but it didn’t seem terribly active in a social sense.”

Skeptics in the Pub and the NZ Skeptics will continue to remain separate from each other. “Obviously they have similar agendas, but they serve different purposes. In the pub you have a place where you can say whatever you want, about anything and not worry about libel. The society has assets that can be taken off it, so has to be more cautious.”

As chair-entity, there are a few areas he wants to focus on, and one revolves around, little surprise, computers.

He’d like to work on the members area of the current website, so details can be added.

“Take the case of homeopathy, one of my pet peeves. Someone might find a paper touting the latest proof for it. We can put a link to that paper up, but at the same time we can add other sites that might have done research debunking it. And members can list if they have any special interests or skills on a subject, so they may be a medical doctor, or a lawyer, and have something to add. They can also flag if they are active or passive skeptics, whether they want to be involved in particular issues.”

One issue he would like the society to focus on this year is ACC’s priorities. “As everyone knows, they’re looking at making various cutbacks but on, I think, the wrong things. They still subsidise acupuncture, but are cutting back on hearing aids for elderly people. It’s something the society could have rather a large impact on, if we can get it done right.”

He’d also like to see more use made of social microblogging tools like Twitter.

“Recently I was involved with the Australian Skeptics’ campaign with the Australian Vaccination Network, who should really be called the anti-vaccination network. They’re getting a real hammering over there. By using Twitter, a whole bunch of us were able to join in, in real time, and make a difference. It’s powerful crowd-sourcing stuff.”

Similarly, the homeopathic overdose utilised the net to good advantage. “This was started by the Merseyside Skeptics, in the UK, and it pretty much went around the world. We got to kick it off, in Christchurch, because of the time zones. And that led to the NZ Council of Homeopaths admitting on national TV that there is no active ingredient in their so-called medicines. But that campaign was run online as well.”

He acknowledges Vicki’s rat-like cunning. “She’s a clever one, no doubt. I found out recently she spent some time grooming me for this role.”

There is another connection between the two. Vicki started KAOS, Killing As an Organised Sport (in which participants are given contracts to assassinate one another with toy guns), while at university in the 1980s. “Then she picked up the chair role. I was Dictator of Kaos at Canterbury University in 1996. Now I’ve picked up the chair.”

Coincidence? He thinks so. “But it’s very cool. And maybe it means I have the right qualifications for the job.”

As to the name Gold, there’s a story there which he’s happy to talk about, but he tends to save it for face-to-face.

So, if he pops up at a pub in your town go and have a yarn with the new incarnation of the Skeptics’ chair-entity. It’s bound to be illuminating.