Over the last couple of days I have been taking part in what the BBC is calling a twitter war. I have to say it has been most empowering

Should people from the US read it they will find see several of their mythconceptions about the NHS blown apart. Daniel Hannan (a Tory MEP) has come in for some serious criticism too after his appearance on FOX news.

Now this is political dynamite in the UK where saying any change is needed to the NHS is rightly controversial But for any politician to refer to the NHS as a mistake is political suicide for the politician and hurts his or her party too.

But that is what I want to say. I want to note how powerful Twitter has been in this debate. I very much doubt if David Cameron would be under the pressure he is now under but for the ability of Twitter to allow campaigns to snowball very quickly. #WeLoveTheNHS has been top trending (no 1 topic worldwide) on twitter for most of today and yesterday.

Why is this - 140 characters, from which you lose 13 for the hashtag, shouldn't be long to make a point should it? The really surprising thing is that it is!! To give you an example this is one of mine: "@ShielaGF This is crap, my Dad is 88 recently collapsed in the street ambulance < 10 mins, pacemaker fitted next day. #welovethenhs".

The 140 characterlimit was actually helpful and I hope you'll agree that my point in response to someone who said that the NHS killed old people was well made.

This of course would mean nothing if we didn't get to the audience we want persuade. There are signs that we are - the twitter feed has received publicity on US TV. Whether this comes to anything remains to be seen.

For those of us who want to campaign in the new media world Twitter can be a very useful tool indeed.

Pakistan is not usually somewhere I associate with good news on LGBT rights.

However I got a message on Twitter pointing me at an article in New American Media. It is an absolutely fascinating report, apparently the Pakistan Supreme Court have held the transsexuals have rights in Pakistan!! Now I knew about the confusing situation in Iran where a transsexual has all the rights of her/his correct gender including the right to be beaten up by the Basij. But I was until this morning entirely unaware that Pakistan offered similar rights to transsexuals

The full report from the English language Pakistani newspaper The Dawn is here and is somewhat confused a splattering of references to 'transvestites' and 'eunuchs' and we think we have problems with the press!!

Just watch.

I was struck by this story on the BBC website for several reasons.

1. I am a card carrying atheist who thinks Richard Dawkins is too polite as such I would personally react very badly to such an offer.


2. The only study I know of on the effect of prayer on health produced a negative effect with patients suffering more post-operative complications if prayed for.

So given that the only evidence we have is that knowing you're being prayed for may have a negative effect on health why do the Doctors and Nurses want to do offer such services? If I were unkind I might wander if they want to increase demand for their medical services by doing something apparently innocent which would have at best a neutral effect on patients. But they couldn't be that cynical, could they?

I suppose my real objection here is that I can see that some patients might get very depressed - hell the Docs given up hope, he's praying - ahhhhhhhhhhhhhhhhhhhhhhhh!

Done the Nerd test

try it yourself

I was going to call this piece 'the good and the bad' but... well... the Daily Mail being stupid is hardly news and just inevitable but in true Kirsty Wark style more on that story later.

The good news is that Ben Goldacre's book 'Bad Science' has made it to number 10 in the Sunday Time non-fiction best seller list!! And when you see the disappointing new that 11,765 of this important book have been sold comfort yourself with the news that 25% of those were last week and that this edition has only been out for a month.

Now for two of Ben's bete noire's - the MMR hoax and the Daily Mail.

The Daily Mail has this article wherein they say that using a current news story in an exam to test pupils ability to assess scientific evidence is 'brainwashing' and the Government is behind it. Now it is certainly true that the Daily Mail has an interest in people not being able to assess scientific evidence. If people could do that they would see what a rubbish paper the Daily Mail is and stop buying it. But there is something more here.

It seems that we live in a world where science has made a huge contribution to our well being and our enjoyment of our lives. And yet there is an anti-science movement, lead by the mid market tabloids to be sure, but supported by left and right wing 'quality' newspapers. In my last entry in this blog I complained about Simon Jenkins' anti-science stance on the Guardian Christopher Booker does a similar job on the Telegraph particularly on Global Warming. Why is this? Could it just be that the newspaper industry has an interest in keeping the masses who buy their papers ignorant? No, if they did Ben Goldacre wouldn't have been given house room. Are they looking for 'balance' - on one side a sensible view on the other a completely mad one? I don't think so.

For me the answer is simpler but more insidious. The newspaper industry thinks that controversy sells. Science is a good source of controversy. And when the scientific dust settles and the controversies have been resolved, as they have with Global Warming? Keep it going with some off the wall loonies!! If there actually is no controversy at all, as there wasn't with MMR Make one up, find a biased piece of research funded by lawyers and well who cares if it doesn't actually show what you want it to - the public will never read the original paper will they? And if they do they won't understand it will they? Oh dear science education is improving! Better stop that.

RANT

I have been struck by two things this week the first is how good and bad us humans are at assessing risk. The second is how the apparently growing tide of cynicism is making people ignore some very real risks.

The assessment of risk

This is something that human beings do rather well on a local spacetime subset. On a short timescale in our immediate spacial environment we assess the risks of crossing a road, changing lanes on a motorway, climbing a steep hill, knowing how close to go to a cliff edge etc. For a remarkably high percentage of these risk assessments we get the answer right which is just as well given the consequences of getting it wrong.

What individual humans who have not trained in maths and science are not generally good at is assessing risk on a more remote scale. I was struck forcefully by this yesterday when I read this entry on the Harry's Place blog and Simon Jenkins's article in the Guardian to which it refers.

I should perhaps explain that my hackles had already been raised by this headline in the Daily Mail. Yeah I know, really I do, that by the standards of the Daily Mail this is an objective piece of health reporting, but that is what is so depressing about it. This 'objective' piece is predicated on the assumption that genetics is destiny, that there are genes for something. Zoe Brain provided some sanity on her blog about this later in the day. Having these genetic variants may increases the risk that someone will suffer autism they don't make it certain nor is it likely that their absence will reduce the risk to zero.

So by the time I got to the piece by Simon Jenkins I was already in a bad mood. But, well really. This is the man who says maths is a waste of time and that science should not be compulsory in schools. His article today illustrated exactly why his two earlier articles were 100% wrong.

Fortunately Ben Goldacre has written a piece too which lends some sanity.

Risk assessment on the scales required to assess the risk from something like swine flu requires an understanding of both the science of how disease spreads (epidemiology) and the maths of shades of grey (known as probability theory).

Some people are saying things like 'well SARS and bird flu didn't become the promised pandemics so there is no risk this time' and they are getting it wrong big time. Bird flu isn't over, people are still dying of it, the reason it didn't become a pandemic is because of the decisive action of the Hong Kong health authorities.

Now swine flu may not become a pandemic but we should reduce the risk by taking effective action now. We are fortunate in that the head of the WHO is the person who headed the Hong Kong health authorities during the high tide of bird flu.

The danger is that scepticism, which is healthy becomes the decidedly unhealthy cynicism of conspiracy theorists like Simon Jenkins who seem to want to replace proper scientific assessment with prejudice.

I can almost hear the neolithic equivalent arguing that the fire should be nearer to the wall 'cause there is no risk that straw will catch alight only wood does that, really all this straw might catch fire business is the Chieftain's and the Medicine Man's hype aimed at increasing the Medicine Man's share of the bone supply.

If Simon Jenkins really wants maths and science left to specialists he should believe the specialists when they tell him that a risk is real, if he doesn't want to do that he should learn the maths and science required to assess the risks properly.

edited to remove a stray word

The new edition has the (much needed) index missing from the first edition which I reviewed and an additional chapter which Ben has released under a Creative Commons Licence. This chapter was not included in the original book because he was being sued by Matthias Rath at the time and he case only finished last September.

The story that unfolds in the chapter is an illustration of why I get so cross when the value of science is run down. It costs lives.

I have reproduced the new chapter below from badscience.net under the terms of the Creative Commons Licence.

-----

The Doctor Will Sue You Now

This chapter did not appear in the original edition of this book, because for fifteen months leading up to September 2008 the vitamin-pill entrepreneur Matthias Rath was suing me personally, and the Guardian, for libel. This strategy brought only mixed success. For all that nutritionists may fantasise in public that any critic is somehow a pawn of big pharma, in private they would do well to remember that, like many my age who work in the public sector, I don’t own a flat. The Guardian generously paid for the lawyers, and in September 2008 Rath dropped his case, which had cost in excess of £500,000 to defend. Rath has paid £220,000 already, and the rest will hopefully follow. Nobody will ever repay me for the endless meetings, the time off work, or the days spent poring over tables filled with endlessly cross-referenced court documents.

On this last point there is, however, one small consolation, and I will spell it out as a cautionary tale: I now know more about Matthias Rath than almost any other person alive. My notes, references and witness statements, boxed up in the room where I am sitting right now, make a pile as tall as the man himself, and what I will write here is only a tiny fraction of the fuller story that is waiting to be told about him. This chapter, I should also mention, is available free online for anyone who wishes to see it.

Matthias Rath takes us rudely outside the contained, almost academic distance of this book. For the most part we’ve been interested in the intellectual and cultural consequences of bad science, the made-up facts in national newspapers, dubious academic practices in universities, some foolish pill-peddling, and so on. But what happens if we take these sleights of hand, these pill-marketing techniques, and transplant them out of our decadent Western context into a situation where things really matter?

In an ideal world this would be only a thought experiment. AIDS is the opposite of anecdote. Twenty-five million people have died from it already, three million in the last year alone, and 500,000 of those deaths were children. In South Africa it kills 300,000 people every year: that’s eight hundred people every day, or one every two minutes. This one country has 6.3 million people who are HIV positive, including 30 per cent of all pregnant women. There are 1.2 million AIDS orphans under the age of seventeen. Most chillingly of all, this disaster has appeared suddenly, and while we were watching: in 1990, just 1 per cent of adults in South Africa were HIV positive. Ten years later, the figure had risen to 25 per cent.

It’s hard to mount an emotional response to raw numbers, but on one thing I think we would agree. If you were to walk into a situation with that much death, misery and disease, you would be very careful to make sure that you knew what you were talking about. For the reasons you are about to read, I suspect that Matthias Rath missed the mark.

This man, we should be clear, is our responsibility. Born and raised in Germany, Rath was the head of Cardiovascular Research at the Linus Pauling Institute in Palo Alto in California, and even then he had a tendency towards grand gestures, publishing a paper in the Journal of Orthomolecular Medicine in 1992 titled “A Unified Theory of Human Cardiovascular Disease Leading the Way to the Abolition of this Disease as a Cause for Human Mortality”. The unified theory was high-dose vitamins.

He first developed a power base from sales in Europe, selling his pills with tactics that will be very familiar to you from the rest of this book, albeit slightly more aggressive. In the UK, his adverts claimed that “90 per cent of patients receiving chemotherapy for cancer die within months of starting treatment”, and suggested that three million lives could be saved if cancer patients stopped being treated by conventional medicine. The pharmaceutical industry was deliberately letting people die for financial gain, he explained. Cancer treatments were “poisonous compounds” with “not even one effective treatment”.

The decision to embark on treatment for cancer can be the most difficult that an individual or a family will ever take, representing a close balance between well-documented benefits and equally well-documented side-effects. Adverts like these might play especially strongly on your conscience if your mother has just lost all her hair to chemotherapy, for example, in the hope of staying alive just long enough to see your son speak.

There was some limited regulatory response in Europe, but it was generally as weak as that faced by the other characters in this book. The Advertising Standards Authority criticised one of his adverts in the UK, but that is essentially all they are able to do. Rath was ordered by a Berlin court to stop claiming that his vitamins could cure cancer, or face a €250,000 fine.

But sales were strong, and Matthias Rath still has many supporters in Europe, as you will shortly see. He walked into South Africa with all the acclaim, self-confidence and wealth he had amassed as a successful vitamin-pill entrepreneur in Europe and America, and began to take out full-page adverts in newspapers.

˜The answer to the AIDS epidemic is here,” he proclaimed. Anti-retroviral drugs were poisonous, and a conspiracy to kill patients and make money. “Stop AIDS Genocide by the Drugs Cartel said one headline. “Why should South Africans continue to be poisoned with AZT? There is a natural answer to AIDS.” The answer came in the form of vitamin pills. “Multivitamin treatment is more effective than any toxic AIDS drug. Multivitamins cut the risk of developing AIDS in half.”
Rath’s company ran clinics reflecting these ideas, and in 2005 he decided to run a trial of his vitamins in a township near Cape Town called Khayelitsha, giving his own formulation, VitaCell, to people with advanced AIDS. In 2008 this trial was declared illegal by the Cape High Court of South Africa. Although Rath says that none of his participants had been on anti-retroviral drugs, some relatives have given statements saying that they were, and were actively told to stop using them.

Tragically,Matthias Rath had taken these ideas to exactly the right place. Thabo Mbeki, the President of South Africa at the time, was well known as an “AIDS dissident”, and to international horror, while people died at the rate of one every two minutes in his country, he gave credence and support to the claims of a small band of campaigners who variously claim that AIDS does not exist, that it is not caused by HIV, that anti-retroviral medication does more harm than good, and so on.

At various times during the peak of the AIDS epidemic in South Africa their government argued that HIV is not the cause of AIDS, and that anti-retroviral drugs are not useful for patients. They refused to roll out proper treatment programmes, they refused to accept free donations of drugs, and they refused to accept grant money from the Global Fund to buy drugs. One study estimates that if the South African national government had used anti-retroviral drugs for prevention and treatment at the same rate as the Western Cape province (which defied national policy on the issue), around 171,000 new HIV infections and 343,000 deaths could have been prevented between 1999 and 2007. Another study estimates that between 2000 and 2005 there were 330,000 unnecessary deaths, 2.2 million person years lost, and 35,000 babies unnecessarily born with HIV because of the failure to implement a cheap and simple mother-to-child-transmission prevention program. Between one and three doses of an ARV drug can reduce transmission dramatically. The cost is negligible. It was not available.

Interestingly, Matthias Rath’s colleague and employee, a South African barrister named Anthony Brink, takes the credit for introducing Thabo Mbeki to many of these ideas. Brink stumbled on the “AIDS dissident” material in the mid-1990s, and after much surfing and reading, became convinced that it must be right. In 1999 he wrote an article about AZT in a Johannesburg newspaper titled “a medicine from hell”. This led to a public exchange with a leading virologist. Brink contacted Mbeki, sending him copies of the debate, and was welcomed as an expert.

This is a chilling testament to the danger of elevating cranks by engaging with them. In his initial letter of motivation for employment to Matthias Rath, Brink described himself as “South Africa’s leading AIDS dissident, best known for my whistle-blowing exposé of the toxicity and inefficacy of AIDS drugs, and for my political activism in this regard, which caused President Mbeki and Health Minister Dr Tshabalala-Msimang to repudiate the drugs in 1999″.

In 2000, the now infamous International AIDS Conference took place in Durban. Mbeki’s presidential advisory panel beforehand was packed with “AIDS dissidents”, including Peter Duesberg and David Rasnick. On the first day, Rasnick suggested that all HIV testing should be banned on principle, and that South Africa should stop screening supplies of blood for HIV. “If I had the power to outlaw the HIV antibody test,” he said, “I would do it across the board.” When African physicians gave testimony about the drastic change AIDS had caused in their clinics and hospitals, Rasnick said he had not seen “any evidence” of an AIDS catastrophe. The media were not allowed in, but one reporter from the Village Voice was present. Peter Duesberg, he said, “gave a presentation so removed from African medical reality that it left several local doctors shaking their heads”. It wasn’t AIDS that was killing babies and children, said the dissidents: it was the anti-retroviral medication.

President Mbeki sent a letter to world leaders comparing the struggle of the “AIDS dissidents” to the struggle against apartheid. The Washington Post described the reaction at the White House: “So stunned were some officials by the letter’s tone and timing during final preparations for July’s conference in Durban that at least two of them, according to diplomatic sources, felt obliged to check whether it was genuine. Hundreds of delegates walked out of Mbeki’s address to the conference in disgust, but many more described themselves as dazed and confused. Over 5,000 researchers and activists around the world signed up to the Durban Declaration, a document that specifically addressed and repudiated the claims and concerns–at least the more moderate ones–of the “AIDS dissidents”. Specifically, it addressed the charge that people were simply dying of poverty:

The evidence that AIDS is caused by HIV-1 or HIV-2 is clearcut, exhaustive and unambiguous… As with any other chronic infection, various co-factors play a role in determining the risk of disease. Persons who are malnourished, who already suffer other infections or who are older, tend to be more susceptible to the rapid development of AIDS following HIV infection. However, none of these factors weaken the scientific evidence that HIV is the sole cause of AIDS… Mother-to-child transmission can be reduced by half or more by short courses of antiviral drugs … What works best in one country may not be appropriate in another. But to tackle the disease, everyone must first understand that HIV is the enemy. Research, not myths, will lead to the development of more effective and cheaper treatments.

It did them no good. Until 2003 the South African government refused, as a matter of principle, to roll out proper antiretroviral medication programmes, and even then the process was half-hearted. This madness was only overturned after a massive campaign by grassroots organisations such as the Treatment Action Campaign, but even after the ANC cabinet voted to allow medication to be given, there was still resistance. In mid-2005, at least 85 per cent of HIV-positive people who needed anti-retroviral drugs were still refused them. That’s around a million people.

This resistance, of course, went deeper than just one man; much of it came from Mbeki’s Health Minister, Manto Tshabalala-Msimang. An ardent critic of medical drugs for HIV, she would cheerfully go on television to talk up their dangers, talk down their benefits, and became irritable and evasive when asked how many patients were receiving effective treatment. She declared in 2005 that she would not be “pressured” into meeting the target of three million patients on anti-retroviral medication, that people had ignored the importance of nutrition, and that she would continue to warn patients of the sideeffects of anti-retrovirals, saying: “We have been vindicated in this regard. We are what we eat.”

It’s an eerily familiar catchphrase. Tshabalala-Msimang has also gone on record to praise the work of Matthias Rath, and refused to investigate his activities. Most joyfully of all, she is a staunch advocate of the kind of weekend glossy-magazine-style nutritionism that will by now be very familiar to you. The remedies she advocates for AIDS are beetroot, garlic, lemons and African potatoes. A fairly typical quote, from the Health Minister in a country where eight hundred people die every day from AIDS, is this: “Raw garlic and a skin of the lemon–not only do they give you a beautiful face and skin but they also protect you from disease.” South Africa’s stand at the 2006 World AIDS Conference in Toronto was described by delegates as the “salad stall”. It consisted of some garlic, some beetroot, the African potato, and assorted other vegetables. Some boxes of anti-retroviral drugs were added later, but they were reportedly borrowed at the last minute from other conference delegates.

Alternative therapists like to suggest that their treatments and ideas have not been sufficiently researched. As you now know, this is often untrue, and in the case of the Health Minister’s favoured vegetables, research had indeed been done, with results that were far from promising. Interviewed on SABC about this, Tshabalala-Msimang gave the kind of responses you’d expect to hear at any North London dinner-party discussion of alternative therapies.

First she was asked about work from the University of Stellenbosch which suggested that her chosen plant, the African potato, might be actively dangerous for people on AIDS drugs. One study on African potato in HIV had to be terminated prematurely, because the patients who received the plant extract developed severe bone-marrow suppression and a drop in their CD4 cell count–which is a bad thing–after eight weeks. On top of this, when extract from the same vegetable was given to cats with Feline Immunodeficiency Virus, they succumbed to full-blown Feline AIDS faster than their non-treated controls. African potato does not look like a good bet.

Tshabalala-Msimang disagreed: the researchers should go back to the drawing board, and “investigate properly”. Why? Because HIV-positive people who used African potato had shown improvement, and they had said so themselves. If a person says he or she is feeling better, should this be disputed, she demanded to know, merely because it had not been proved scientifically? “When a person says she or he is feeling better, I must say ‘No, I don’t think you are feeling better’? I must rather go and do science on you’?” Asked whether there should be a scientific basis to her views, she replied: “Whose science?”

And there, perhaps, is a clue, if not exoneration. This is a continent that has been brutally exploited by the developed world, first by empire, and then by globalised capital. Conspiracy theories about AIDS and Western medicine are not entirely absurd in this context. The pharmaceutical industry has indeed been caught performing drug trials in Africa which would be impossible anywhere in the developed world. Many find it suspicious that black Africans seem to be the biggest victims of AIDS, and point to the biological warfare programmes set up by the apartheid governments; there have also been suspicions that the scientific discourse of HIV/AIDS might be a device, a Trojan horse for spreading even more exploitative Western political and economic agendas around a problem that is simply one of poverty.

And these are new countries, for which independence and self-rule are recent developments, which are struggling to find their commercial feet and true cultural identity after centuries of colonisation. Traditional medicine represents an important link with an autonomous past; besides which, anti-retroviral medications have been unnecessarily – offensively, absurdly – expensive, and until moves to challenge this became partially successful, many Africans were effectively denied access to medical treatment as a result.

It’s very easy for us to feel smug, and to forget that we all have our own strange cultural idiosyncrasies which prevent us from taking up sensible public-health programmes. For examples, we don’t even have to look as far as MMR. There is a good evidence base, for example, to show that needle-exchange programmes reduce the spread of HIV, but this strategy has been rejected time and again in favour of “Just say no.” Development charities funded by US Christian groups refuse to engage with birth control, and any suggestion of abortion, even in countries where being in control of your own fertility could mean the difference between success and failure in life, is met with a cold, pious stare. These impractical moral principles are so deeply entrenched that Pepfar, the US Presidential Emergency Plan for AIDS Relief, has insisted that every recipient of international aid money must sign a declaration expressly promising not to have any involvement with sex workers.

We mustn’t appear insensitive to the Christian value system, but it seems to me that engaging sex workers is almost the cornerstone of any effective AIDS policy: commercial sex is frequently the “vector of transmission”, and sex workers a very high-risk population; but there are also more subtle issues at stake. If you secure the legal rights of prostitutes to be free from violence and discrimination, you empower them to demand universal condom use, and that way you can prevent HIV from being spread into the whole community. This is where science meets culture. But perhaps even to your own friends and neighbours, in whatever suburban idyll has become your home, the moral principle of abstinence from sex and drugs is more important than people dying of AIDS; and perhaps, then, they are no less irrational than Thabo Mbeki.

So this was the situation into which the vitamin-pill entrepreneur Matthias Rath inserted himself, prominently and expensively, with the wealth he had amassed from Europe and America, exploiting anti-colonial anxieties with no sense of irony, although he was a white man offering pills made in a factory abroad. His adverts and clinics were a tremendous success. He began to tout individual patients as evidence of the benefits that could come from vitamin pills – although in reality some of his most famous success stories have died of AIDS. When asked about the deaths of Rath’s star patients, Health Minister Tshabalala-Msimang replied: “It doesn’t necessarily mean that if I am taking antibiotics and I die, that I died of antibiotics.”

She is not alone: South Africa’s politicians have consistently refused to step in, Rath claims the support of the government, and its most senior figures have refused to distance themselves from his operations or to criticise his activities. Tshabalala-Msimang has gone on the record to state that the Rath Foundation “are not undermining the government’s position. If anything, they are supporting it.”

In 2005, exasperated by government inaction, a group of 199 leading medical practitioners in South Africa signed an open letter to the health authorities of the Western Cape, pleading for action on the Rath Foundation. “Our patients are being inundated with propaganda encouraging them to stop life-saving medicine,” it said. “Many of us have had experiences with HIV infected patients who have had their health compromised by stopping their anti-retrovirals due to the activities of this Foundation.” Rath’s adverts continue unabated. He even claimed that his activities were endorsed by huge lists of sponsors and affiliates including the World Health Organization, UNICEF and UNAIDS. All have issued statements flatly denouncing his claims and activities. The man certainly has chutzpah.

His adverts are also rich with detailed scientific claims. It would be wrong of us to neglect the science in this story, so we should follow some through, specifically those which focused on a Harvard study in Tanzania. He described this research in full-page advertisements, some of which have appeared in the New York Times and the Herald Tribune. He refers to these paid adverts, I should mention, as if he had received flattering news coverage in the same papers. Anyway, this research showed that multivitamin supplements can be beneficial in a developing world population with AIDS: there’s no problem with that result, and there are plenty of reasons to think that vitamins might have some benefit for a sick and frequently malnourished population.

The researchers enrolled 1,078 HIV-positive pregnant women and randomly assigned them to have either a vitamin supplement or placebo. Notice once again, if you will, that this is another large, well-conducted, publicly funded trial of vitamins, conducted by mainstream scientists, contrary to the claims of nutritionists that such studies do not exist. The women were followed up for several years, and at the end of the study, 25 per cent of those on vitamins were severely ill or dead, compared with 31 per cent of those on placebo. There was also a statistically significant benefit in CD4 cell count (a measure of HIV activity) and viral loads. These results were in no sense dramatic – and they cannot be compared to the demonstrable life-saving benefits of anti-retrovirals – but they did show that improved diet, or cheap generic vitamin pills, could represent a simple and relatively inexpensive way to marginally delay the need to start HIV medication in some patients.

In the hands of Rath, this study became evidence that vitamin pills are superior to medication in the treatment of HIV/AIDS, that anti-retroviral therapies “severely damage all cells in the body–including white blood cells”, and worse, that they were “thereby not improving but rather worsening immune deficiencies and expanding the AIDS epidemic”. The researchers from the Harvard School of Public Health were so horrified that they put together a press release setting out their support for medication, and stating starkly, with unambiguous clarity, that Matthias Rath had misrepresented their findings.

To outsiders the story is baffling and terrifying. The United Nations has condemned Rath’s adverts as “wrong and misleading”. “This guy is killing people by luring them with unrecognised treatment without any scientific evidence,” said Eric Goemaere, head of Médecins sans Frontières SA, a man who pioneered anti-retroviral therapy in South Africa. Rath sued him.

It’s not just MSF who Rath has gone after: he has also brought time-consuming, expensive, stalled or failed cases against a professor of AIDS research, critics in the media and others.

But his most heinous campaign has been against the Treatment Action Campaign. For many years this has been the key organisation campaigning for access to anti-retroviral medication in South Africa, and it has been fighting a war on four fronts. Firstly, TAC campaigns against its own government, trying to compel it to roll out treatment programmes for the population. Secondly, it fights against the pharmaceutical industry, which claims that it needs to charge full price for its products in developing countries in order to pay for research and development of new drugs – although, as we shall see, out of its $550 billion global annual revenue, the pharmaceutical industry spends twice as much on promotion and admin as it does on research and development. Thirdly, it is a grassroots organisation, made up largely of black women from townships who do important prevention and treatment-literacy work on the ground, ensuring that people know what is available, and how to protect themselves. Lastly, it fights against people who promote the type of information peddled by Matthias Rath and his ilk.

Rath has taken it upon himself to launch a massive campaign against this group. He distributes advertising material against them, saying “Treatment Action Campaign medicines are killing you” and “Stop AIDS genocide by the drug cartel”, claiming–as you will guess by now–that there is an international conspiracy by pharmaceutical companies intent on prolonging the AIDS crisis in the interests of their own profits by giving medication that makes people worse. TAC must be a part of this, goes the reasoning, because it criticises Matthias Rath. Just like me writing on Patrick Holford or Gillian McKeith, TAC is perfectly in favour of good diet and nutrition. But in Rath’s promotional literature it is a front for the pharmaceutical industry, a “Trojan horse” and a “running dog”. TAC has made a full disclosure of its funding and activities, showing no such connection: Rath presented no evidence to the contrary, and has even lost a court case over the issue, but will not let it lie. In fact he presents the loss of this court case as if it was a victory.

The founder of TAC is a man called Zackie Achmat, and he is the closest thing I have to a hero. He is South African, and coloured, by the nomenclature of the apartheid system in which he grew up. At the age of fourteen he tried to burn down his school, and you might have done the same in similar circumstances. He has been arrested and imprisoned under South Africa’s violent, brutal white regime, with all that entailed. He is also gay, and HIV-positive, and he refused to take anti-retroviral medication until it was widely available to all on the public health system, even when he was dying of AIDS, even when he was personally implored to save himself by Nelson Mandela, a public supporter of anti-retroviral medication and Achmat’s work.

And now, at last, we come to the lowest point of this whole story, not merely for Matthias Rath’s movement, but for the alternative therapy movement around the world as a whole. In 2007, with a huge public flourish, to great media coverage, Rath’s former employee Anthony Brink filed a formal complaint against Zackie Achmat, the head of the TAC. Bizarrely, he filed this complaint with the International Criminal Court at The Hague, accusing Achmat of genocide for successfully campaigning to get access to HIV drugs for the people of South Africa.

It’s hard to explain just how influential the “AIDS dissidents” are in South Africa. Brink is a barrister, a man with important friends, and his accusations were reported in the national news media –and in some corners of the Western gay press–as a serious news story. I do not believe that any one of those journalists who reported on it can possibly have read Brink’s indictment to the end.

I have.

The first fifty-seven pages present familiar anti-medication and “AIDS-dissident” material. But then, on page fifty-eight, this “indictment” document suddenly deteriorates into something altogether more vicious and unhinged, as Brink sets out what he believes would be an appropriate punishment for Zackie. Because I do not wish to be accused of selective editing, I will now reproduce for you that entire section, unedited, so you can see and feel it for yourself.

The document was described by the Rath Foundation as “entirely valid and long overdue”.

This story isn’t about Matthias Rath, or Anthony Brink, or Zackie Achmat, or even South Africa. It is about the culture of how ideas work, and how that can break down. Doctors criticise other doctors, academics criticise academics, politicians criticise politicians: that’s normal and healthy, it’s how ideas improve. Matthias Rath is an alternative therapist, made in Europe. He is every bit the same as the British operators that we have seen in this book. He is from their world.

|Despite the extremes of this case, not one single alternative therapist or nutritionist, anywhere in the world, has stood up to criticise any single aspect of the activities of Matthias Rath and his colleagues. In fact, far from it: he continues to be fêted to this day. I have sat in true astonishment and watched leading figures of the UK’s alternative therapy movement applaud Matthias Rath at a public lecture (I have it on video, just in case there’s any doubt). Natural health organisations continue to defend Rath. Homeopaths’ mailouts continue to promote his work. The British Association of Nutritional Therapists has been invited to comment by bloggers, but declined. Most, when challenged, will dissemble.”Oh,” they say, “I don’t really know much about it.” Not one person will step forward and dissent.

The alternative therapy movement as a whole has demonstrated itself to be so dangerously, systemically incapable of critical self-appraisal that it cannot step up even in a case like that of Rath: in that count I include tens of thousands of practitioners, writers, administrators and more. This is how ideas go badly wrong. In the conclusion to this book, written before I was able to include this chapter, I will argue that the biggest dangers posed by the material we have covered are cultural and intellectual.

I may be mistaken.

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I see that over a month has gone by since I last posed here.

It has been a busy month - I've started the latest part of my Open University MSc in maths., non-linear differential equations may not be everyone's idea of fun, but they are rapidly becoming mine. I've now worked through my feelings about the trial of the the man who murdered a friend in 1997.

Ada Lovelace Day is approaching so I am preparing a blog entry about Ingrid Daubechies for that day. I am also working on a post about Darwin and evolution.

In other matters Ben Goldacre got threatened with legal action by LBC with the inevitable consequence that Ben's views on the MMR hoax and Jeni Barnett's attempt to keep it going got wider publicity than they would have had. In particular Stephen Fry got involved and pretty soon Barnett was sounding... well she's removed the entries from her blog!! but you never can loose anything even if you want to.

Last Wednesday evening I went to LSE to listen to a talk by GP and Guardian Columnist Ben Goldacre.

Ben's column is called 'Bad Science' past column's are archived here. They are well worth reading. He has also written a book which I have already reviewed.

The lecture theatre which holds 400 was full. The other thing was how mixed the audience was. If anything there were slightly more women than men, ages ranged from early twenties to late seventies. There was also a mix of ethnic origins.

Ben started his talk with an example of bad science from the LSE! Then went on to discuss the way the media will get an academic to write an equation for them (they pay and tell the academic what to say).

Ben then got serious with the Durham Fish Oil trial (or was it).

He then went onto Gillian McKeith (to give her her full medical title). He also talked about Patrick Holford.

He continued a highly entertaining talk with Media's MMR hoax. He was very clear that this was the media's fault not Dr Wakefield's. He also pointed out with examples that vaccine scares obey passport control, being entirely contained within national boundaries. For instance there was a hepatitis B vaccine scare in France in the 1990's that did not afflict the rest of the world.

But his final section, for me, raised the most interesting questions. Why oh why is it that newspaper editors feel that science needs to be dumbed down when literature need not (at least in the quality papers)? Why are we so badly served by our media in science? Even where specialised sections exist (eg the Guardian's technology section or the BBC website's Science and Environment section) the information in them is dumbed down almost beyond meaning.

Some articles in the media are just attempts to scare people. Even where they refer to scientific research it is not unusual for the research paper to give the exact opposite conclusion to the one the newspaper article implies (a recent example was the Guardian's attempt to reignite the “LHC will destroy Earth story”) the paper referred to in the article is here. To quote from the abstract: “[b]ased on this analysis, we argue against the possibility of catastrophic black hole growth at the LHC. ”.

Suw Charman is asking all bloggers to take part in Ada Lovelace Day by blogging about a woman in tech they admire. Sign the pledge!

Thanks to Gia Milnovich for this one.

Oh and p.s. Ada, Countess of Lovelace, the only legitimate child of Lord Byron, was Babbage's 'programmer'.

Some of you may have seen the BBC programme 'Einstein and Eddington' recently. A couple of friends of mine saw it and made the mistake of saying they didn't understand Einstein's theory. I wrote a summary of the main points of General Relativity for them which I thought I would share here.

Background

I think that from the earliest times man must have asked him/herself about the nature of movement and what sticks us to the earth. It is such a fundamental thing to ask: why don’t we float off into space? Why when I put down a mug of coffee does the coffee stay in the mug?

From such questioning comes the idea that the earth must be attracting things to its surface. We call this phenomenon ‘gravity’.

In the 1600’s Sir Isaac Newton came to the view that the same phenomenon kept the Earth (and the other planets) in orbit around the Sun and from his, Galileo’s and others' observations of the orbits of the planets was able to show that gravity was a mutual interaction between all forms of matter. Now that means that not only do we have gravitational attraction to the earth but to each other as well!

Newton considered that gravity was an ‘instant’ attraction. To see why this is important consider the Earth and the Sun – the light from the Sun takes about 8 minutes to get to the Earth, if the Sun were to disintegrate in an instant the Earth would leave its current path but the Sun would still light and warm the Earth for slightly more than another eight minutes!

By 1905 Newton’s picture of the Universe was beginning to creak a little. The main issue for us is that whilst most of the planets have the orbits his theory predicted, the orbit of Mercury, closest to the Sun, was not quite as predicted. It was out by an incredibly small amount but nonetheless out.

Then came a Swiss patent clerk called Albert Einstein. In one year Einstein proved that the atom existed, that matter and energy are equivalent, extended Newton's Laws of Motion with his theory of special relativity and explained the photo-electric effect which makes TV and digital cameras possible. The paper on the photo-electric effect won him the Nobel Prize for physics in 1921.¹

Before we proceed we need a definition:

‘Reference Frame’(RF) :(roughly) this is an object, for example the Earth’s surface, in relation to which another object moves

In his theory of special relativity Einstein, using experimental data, made two ‘assumptions’:

1. That no ‘reference frame’ is absolute²

2. That the speed of light is the same in all reference frames³

Of course he didn't just pluck those assumptions out of thin air!!

The first one comes from the view that everything in the universe is moving, and indeed accelerating, Think about it. To use the example of London. My home town is at about 51 degrees north. It goes around the earth once in 24 hours. The distance it travels is 6.378×10⁶×cos51×π×2=2.5759×10⁷ meters giving a speed of 2.9814×10²ms^-1 but it also goes around the sun once a year at an average speed of 2.79×10⁴ms^-1and the sun goes round the galaxy and the galaxy... So what is the absolute reference frame? Einstein came to the conclusion that there wasn't one.

In 1887 Albert Michelson and Edward Morley conducted an experiment. It is well documented here and I don't propose to spend time discussing the details. The important point was that the light had travelled through space that was moving at different speeds, indeed being accelerated at different rates, and didn't show any relative speed difference and thus supported Einstein's second 'assumption'.

However his 1905 papers left one important phenomenon out of the theory: gravity!

The Problem of Gravity

Gravity is an extraordinary phenomenon. It is most decidedly not a force.⁴ It acts on all bodies. As Galileo showed on the earth a feather and a sledgehammer will fall to earth at the same time if released from the same distance above the earth in a vacuum. Incorporating gravity into any theory of motion is difficult. For instance quantum mechanics, which is the theory of motion for atoms and smaller particles currently ignores gravity.

Einstein tried unsuccessfully to merge gravity into special relativity for 10 years. In 1914 he was persuaded by Max Planck to move to Berlin. It was here that he received a letter from British astronomer Arthur Eddington. This correspondence was remarkable, the two men lived in countries that were at war with each other! Eddington asked Einstein what his theory predicted for the orbit of Mercury. From there Einstein was able to merge gravity into special relativity giving general relativity.

Now we come to the meat!!

Einstein’s view of gravity

I said above that Newton thought gravity was an instant attraction. In the special theory of relativity Einstein had argued that: firstly we could not know if two events happened simultaneously, and secondly that nothing can travel faster than light. In particular gravity cannot ‘travel’ faster than the speed of light.

Einstein therefore had to completely re-think what gravity meant. Was it a property of mass as Newton thought? Einstein concluded that it was not. It was, Einstein concluded, a property of space.

Einstein’s conclusion was that massive (by which I mean bodies that have mass – ie anything other than light, heat or radio waves) bodies distort space. Now that is amazing!! Space can be distorted!! And is routinely by (almost) everything!!

This is mind blowing. It means that the straight lines of space become curves near a massive object. It also has an important consequence. Light will be affected by gravity despite having (as far as we know) no mass.

This means that the light from a distant star will bend around the Sun. It is this bending that Sir Arthur Eddington measured in his expedition to observe the 1919 total eclipse of the Sun.

Did Einstein's theory prove Newton had got it wrong?

Einstein thought it didn't. He quoted Newton's oft misunderstood aphorism that he was 'standing on the shoulders of giants'.⁵ Indeed Einstein points out in his own popular work on Relativity that although his expression for kinetic energy looks quite different from Newton's they are in fact quite similar.⁶ I think the clincher is that Newton's theory continues to be taught in school's and universities the world over because for most normal matter in most normal circumstances it is close enough.

Einstein's General Relativity was important when setting up the Global Positioning System (GPS) used in SatNav devices the world over. This was due to the clocks on the satellites running faster than those on Earth due to the lower gravitational attraction and thus lower acceleration.

1 It seems to be a rule that one person cannot win two Nobel Prizes in the same field of study. Those who have won two (eg Marie Curie in physics and chemistry) have won them for two different fields. I think I can put forward convincing arguments for Einstein deserving six Nobel prizes, although one would have been posthumous and that also seems to be against the rules.

2 This had been a difference between Galileo and Newton. Galileo, observing that on a large moving ship in calm seas a pendulum swings in exactly the same way it did on dry land, thought that all movement was relative. Newton thought there must be some universal or absolute frame against which all movement can be measured.

3 If two trains are approaching each other Newton says the speed of the first train relative to the second is the sum of the speeds of the trains. However the speed of light is the same on both trains! This is a very difficult concept! It means that a light beam starting on the first train will be travelling at the same speed relative that train, relative to the second train and relative to the track on which they are both travelling.

4 A force is some action which accelerate a body in inverse proportion to its mass. Gravity accelerates bodies in proportion to the product of their masses (given a constant distance between them).

5 This phrase comes from a letter that Newton wrote to Robert Hooke in February 1676 and is thought to have been intended as an insult to the short hunchbacked Hooke.

6 Einstein's expression is mc²/√(1-v²/c²) Newton's is ½mv² but when Einstein's expression is expanded by Taylor's Theorem we get mc²+½mv²+O(v⁴/c²) (the O notation means that the rest of the terms are less than a constant times v to the fourth over c squared. c is the speed of light). Newton's expression is the second term. The first term is the inertial mass-energy that Newton knew nothing about because he knew little about electro-magnetism.

 

The following is an actual question given on a University of Washington chemistry mid term. 

The answer by one student was so 'profound' that the professor shared it with colleagues, via the Internet, which is, of course, why we now have the pleasure of enjoying it as well : 


Bonus Question: Is Hell exothermic (gives off heat) or endothermic (absorbs heat)? 

Most of the students wrote proofs of their beliefs using Boyle's Law (gas cools when it expands and heats when it is compressed) or some variant. 

One student, however, wrote the following: 

First, we need to know how the mass of Hell is changing in time. So we need to know the rate at which souls are moving into Hell and the rate at which they are leaving. I think that we can safely assume that once a soul gets to Hell, it will not leave. Therefore, no souls are leaving. As for how many souls are entering Hell, let's look at the different religions that exist in the world today. 

Most of these religions state that if you are not a member of their religion, you will go to Hell. Since there is more than one of these religions and since people do not belong to more than one religion, we can project that all souls go to Hell. With birth and death rates as they are, we can expect the number of souls in Hell to increase exponentially. Now, we look at the rate of change of the volume in Hell because Boyle's Law states that in order for the temperature and pressure in Hell to stay the same, the volume of Hell has to expand proportionately as souls are added. 

This gives two possibilities: 

1. If Hell is expanding at a slower rate than the rate at which souls enter Hell, then the temperature and pressure in Hell will increase until all Hell breaks loose.
2. If Hell is expanding at a rate faster than the increase of souls in Hell, then the temperature and pressure will drop until Hell freezes over.

So which is it? 

If we accept the postulate given to me by Teresa during my Freshman year that, 'It will be a cold day in Hell before I sleep with you,' and take into account the fact that I slept with her last night, then number two must be true, and thus I am sure that Hell is exothermic and has already frozen over. The corollary of this theory is that since Hell has frozen over, it follows that it is not accepting any more souls and is therefore, extinct......leaving only Heaven, thereby proving the existence of a divine being which explains why, last night, Teresa kept shouting 'Oh my God.'*


THIS STUDENT RECEIVED AN A+.

I am sorry that this is going to be a rant.

On Sunday I was at a very pleasant dinner party during which someone, who is generally quite bright and very successful, asked whether anyone had seen the great BBC series The Story of Maths ably presented by Marcus du Sautoy.  Another guest and I piped up that we had. “Oh I’m glad someone did. When someone mentions the square on the hypotenuse I switch off” was the reply.

That someone should appear to be proud of not knowing Pythagoras’s famous theorem is bad enough. That they should expect sympathy for their view is awful. That they should  receive anything other than opprobrium is a disaster. The fact that such views are common in the UK is a danger to an economy already on the shaky foundations provided by successive Governments of humanities graduates the latest one of which is now messing up the initial conditions of the mathematically chaotic system that is the economy.

The fact is that this conversation would not have happened in France, Germany, India or China.  In the USA multiple conversations of this kind have lead to the place that creationism has in that society.

If western society is not to suffer the fate of Ancient Greece where a Christian mob ended a whole civilisation in one fell swoop by the barbaric treatment of the last mathematician of that world ripping her limb from limb and cutting her flesh from her bones with sharpened sea shells, or the fate of Islam’s Golden Age when in the 12^th century CE mathematics was declared to be the work of the devil thus ending a civilisation that  may have had electricity (see Baghdad Battery), then we must change our perception of the sciences and maths in particular.

Simon Jenkins recently wrote in the Guardian that maths was a ‘waste of time’. A waste of time that gave Britain a huge advantage in World War II, a waste of time that gave us the computer that I am writing this on, a waste of time that enables us to understand the generation and  use of electricity that has shaped the modern world. I wish Simon Jenkins would waste his time so productively.