Saturday, April 26, 2014

Skeptic Toolkit - Peer Reviewed Science

Before we begin, you have to ask yourself: Do you want to believe or do you want to investigate?

This is the first in a series of posts I plan to do about the tools and practice of being skeptical. This first time around I intend to highlight one of the most important tools in the toolkit: Science. More specifically, peer reviewed science which is not to be confused with the mainstream reporting of science which often focuses on the sensationalistic headline at the cost of explaining the actual findings. More on that in a bit.

Let's begin by defining skepticsm. According to Wikipedia :

Skepticism is “generally any questioning attitude towards knowledge, facts, or opinions/beliefs stated as facts, or doubt regarding claims that are taken for granted elsewhere.”

Philosophical skepticism is an overall approach that requires all information to be well supported by evidence. Classical philosophical skepticism derives from the ‘Skeptikoi', a school who “asserted nothing”. Adherents of Pyrrhonism, for instance, suspend judgment in investigations. Skeptics may even doubt the reliability of their own senses. Religious skepticism, on the other hand, is “doubt concerning basic religious principles (such as immortality, providence, and revelation)”).

I think I'd emphasize the skepticism of opinions and beliefs stated as facts as well as the importance of evidence in evaluating information in a general sort of way. Of course evaluating information requires a certain toolset, a framework for evaluation. With ever increasing internet access has come access to a vast ocean of “information”, much of it nothing more than mis-information, rumor and opinion. Unfortunately it would seem that many people are not equipped with the tools which are not only helpful but necessary in evaluating information. Add to this the relatively recent development of easy to use social media such as Facebook and the spread of misinformation happens even faster and to greater effect. Of course, I don't mean to suggest that such misinformation is only to be found on the internet or social media, just that it seems to spread quickly through such media. It can easily be found in our face-to-face relationships often in areas we might not expect.

Let's start with a recent conversation I had with a family member about health issues and she brought up that her family's pediatrician had recommended that she give her kids honey. Why I asked? She responded that it was really good, really healthy according to the doctor. But I wanted to hear more specifically about the benefits so I asked again looking for something specific. She couldn't recall that he offered any specifics but said that he recommended 1–2 tablespoons a day. I've read and heard many things said in favor of honey as something good to take for a variety of issues - so many things in fact that it could be called a “cure all” given all the supposed uses. It's an old standby used by “holistic” practitioners.

Let me say again that this is her family pediatrician encouraging her. Now, generally speaking, I like the idea of being able to trust the opinion of a medical professional. They have far more training than I. That said, I'd like to see some solid, scientific proof behind the claims so I did a bit of digging. I started with this article at the Mayo Clinic and another article at WebMD. My intent with these two sources was to look at an overview of the peer reviewed scientific research on honey and what I found is that there is little to no evidence supporting the notion that honey is beneficial for anything other than a cough suppressant. Use it to sweeten coffee but don't expect anything more from it, and, most important, don't give it to infants younger than one year of age though. According to the WebMD article (among other sources) “It's been shown very clearly that honey can give infants botulism,” a paralytic disorder in which the infant must be given anti-toxins and often be placed on a respirator.

I wonder how many people that sing the praises of honey on Facebook know that it should not be given to infants less than 12 months of age? When they are advocating the use of honey for this or that scenario are they also offering the appropriate caution? But this is just one example. There is a bountiful supply of such “information” to be found and it is often presented as fact.

Let's talk for a moment about the importance of peer reviewed scientific research when discussing medical issues or any other issues which fall within the sphere of science. To put it simply because it really is very simple, if the topic at hand is something which is being investigated by a field of science then that is where we turn for answers. What is “peer reviewed science”?

Northern Arizona University:

“For college-level research, you might be asked to cite only scholarly or peer-reviewed articles for your research projects. These terms are often used interchangeably, but they amount to much the same thing. A scholarly journal is a journal that contains articles authored by experts. Articles that report on new research findings are peer-reviewed to ensure the quality and accuracy of those findings. This means that before an article gets published, it is sent out to other researchers with relevant expertise, and these researchers evaluate the merits of the article. The article will be published only if it passes this peer review process. The ”peers“ who evaluate articles before they are published are called referees; sometimes you will hear the phrase refereed journal rather than peer-reviewed journal – don't worry, they mean the same thing.”

What is a peer reviewed journal? Again, from Northern Arizona University:

“In a peer-reviewed journal, article manuscripts submitted to the journal are critically reviewed by other scholars (peers). The reviewers might reject the manuscript outright, or require that the author make corrections or alterations before the manuscript is accepted for publication. This process helps ensure that only high-quality, accurate articles get published. The ”peers“ who evaluate articles are called referees; sometimes you will hear the phrase refereed journal rather than peer-reviewed journal – but they mean the same thing.”

Another great example of misinformation which can be countered by peer reviewed science is climate change. The most accurate knowledge will not to be found on political blogs or popular media publications nor should you turn to think-tanks of any variety. The answers are to be found by those publishing the latest in climate science research. It is important to know the difference between who is publishing the actual science (peer reviewed journals) as opposed to those reporting on the science. If we are not ourselves scientists it can be daunting and sometimes nearly impossible to find and read the actual journal articles which often require journal subscriptions. So we often rely on others to report the science but who can be trusted to accurately report the actual peer reviewed research in its proper context?

Want to practice? I hopped over to Natural News, a site notorious for posting health-related misinformation advocating alternative medicine, and picked an article from the front page with the headline “Active Release Technique' provides safe, effective healing for common injuries”. There are other such articles to choose from every single day. The site seems to be based on misinformation. Here's the introductory paragraph:

Active Release Technique, also known as ART, provides an effective alternative treatment for soft tissue and nerve damage injuries. Commonly treated injuries include plantar fasciitis, carpal tunnel syndrome and tennis elbow. These injuries are often treated by conventional medicine with steroid injections and surgeries, with long recovery times. The use of the targeted massage treatment known as ART can significantly shorten healing time for these injuries.

Note the assertion that ART provides an effective alternative treatment in the first sentence and the last sentence: “The use of the targeted massage treatment known as ART can significantly shorten healing time for these injuries.” Hmm. Let me put my skeptic hat on. Thus far, we have nothing but an assertion, no actual evidence. We dive deeper and find this:

Dr. Michael Leahy, DC discovered this successful technique approximately 25 years ago through observation and use with patients. He was able to obtain a 90 percent success rate in his patients with various ailments and later trained others in his technique. There are now hundreds of trained practitioners worldwide.

Still, no actual peer reviewed science but now we have a “doctor” who lends the appearance of authority though there are many that would not consider a Doctor of Chiropractic a legitimate medical doctor. No mention in the article of anything he might have published just that he obtained a 90% success rate. Reading through the rest of the article there is zero reference to any kind of actual peer reviewed science carried out by Leahy or anyone else. The qualifications of the author? She “is a mental health therapist who incorporates holistic approaches into her counseling practice. She became passionate about holistic health, healing and politics, after immersing herself into the world of alternative medicine looking for answers to a family member's health crisis.”

The article provides no references to any kind of scientific evidence to back up the claims made for the technique. None. And yet, on the surface, without skepticism, some would likely be inclined to come to a conclusion that this treatment is safe and helpful.

Here's another, the Seven health benefits of ginseng which starts with this very excited paragraph:

It's simply amazing how natural herbs and foods can have multiple, wonderful health benefits! Take for instance ginseng (usually Korean/Asian Red Ginseng, Panax ginseng), it lives up to its cure-all description (Panax means “all-curing/healing” in Greek)! Add another health benefit to the list! Recently published research in Nutrients has demonstrated that ginseng can help treat and prevent influenza!

The article goes on to make a variety of fantastic claims most of which have little science associated with them. Some of the points which do have a connection to actual science are taken out of context. Like honey, ginseng is being treated as a kind of cure all. Let's focus on the study referenced under a large heading towards the top of the article.

Research found that using red ginseng daily over the long term can prevent the effects of influenza A. Influenza is a deadly respiratory illness that affects millions each year with new strains having the capability of spreading rapidly worldwide! Over the long term, daily oral administration of red ginseng improved the survival of lung epithelial cells infected with influenza and also reduced associated inflammation! The researchers hypothesized that this could be due to the immune-modifying effects of red ginseng that prevented or reduced the symptoms of the flu!

This leads the reader to the conclusion that they can take red ginseng to prevent the effects of influenza A. True? Let's look a bit further. I took a look at the primary source and as it turns out, it was a press release from the University of Georgia: Ginseng Can Treat And Prevent Influenza And Respiratory Virus, Researcher Finds . That's a bold claim. I googled that headline and found that, as usual with such sensational proclamations, it was picked up and republished all over the place. No actual reporting, just a repeat of the press release. There is an assumption made by those republishing the release that what it contains is true.The research comes out of the University of Georgia's Institute for Biomedical Sciences and seems legitimate. Let's dig a bit. According to the release his research was done in "cooperation with a university and research institutes in South Korea that wanted international collaborative projects to study if ginseng can be used to improve health and protect against disease because of the potential benefit in fighting these viruses." There's no mention of who the research institutes are but reading between the lines I ask, is this actual science or is it more of the same pseudo science that often surrounds such natural remedies? From the press release:

Ginseng can help treat and prevent influenza and respiratory syncytial virus (RSV), a respiratory virus that infects the lungs and breathing passages, according to research findings by a scientist in Georgia State University’s new Institute for Biomedical Sciences.

Again, the average reader might take this to mean that they can purchase ginseng and use it as a treatment. So, this research consisted of human trials and was peer reviewed? No. Not at all. The research is preliminary and was, as is often the case, conducted on mice. I'll grant at this point that they may be headed in a direction that could prove useful but as of this study? No, not yet. Something else to consider: what journal was it published in? Is it a reputable journal that publishes peer reviewed science? Hmmm. It was published in an "open access" journal, Nutrients. This isn't necessarily a problem but open access journals are a new development and do not operate in the established tradition of science publishing. The problem is that unlike traditional journals which are supported by subscriptions, open access journals are supported by fees paid by those submitting articles. In other words, they have to pay to be published. From the front page of the Nutrients site:

Rapid publication: manuscripts are peer-reviewed and published within 58 days (average Jan-Jun 2013), accepted papers are immediately published online.

The point of peer review is to ensure quality research. When I read the above I see an emphasis not on quality but on speedy publishing. In recent years there have been real problems with the quality of science being published in open access journals so I consider this a red flag. Of open access journals, Steven Novella writes:

Open access journals frequently make their money by charging a publication fee of the author. This creates an incentive to publish a lot of papers of any quality. In fact, if you could create a shell of a journal, with little staff, and publish many papers online with little cost, that could generate a nice revenue stream. Why not create hundreds of such journals, covering every niche scientific and academic area?

This, of course, is what has happened. We are still in the middle of the explosion of open access journals. At their worst they have been dubbed “predatory” journals for charging hidden fees, exploiting naive academics, and essentially being scams.

John Bohannon decided to run a sting operation to test the peer-review quality of open access journals. I encourage you to read his entire report, but here’s the summary.

He identified 304 open access journals that publish in English. He created a fake scientific paper with blatant fatal flaws that rendered the research uninterpretable and the paper unpublishable. He actually created 304 versions of this paper by simply inserting different variables into the same text, but keeping the science and the data the same. He then submitted a version of the paper to all 304 journals under different fake names from different fake universities (using African names to make it seem plausible that they were obscure).

The result? – over half of the papers were accepted for publication. I think it’s fair to say that any journal that accepted such a paper for publication is fatally flawed and should be considered a bogus journal.

This, of course, is a huge problem. Such journals allow for the flooding of the peer-reviewed literature with poor quality papers that should never be published. This is happening at a time when academia itself is being infiltrated with “alternative” proponents and post-modernist concepts that are anathema to objective standards.

Combine this with the erosion of quality control in science journalism, also thanks to the internet. Much of what passes as science reporting is simply cutting and pasting press releases from journals, including poor-quality open access journals hoping for a little free advertising.

I'm not suggesting that this is the case with this particular journal article or even that the journal Nutrients is of poor quality, I'm just pointing out different variables which should be considered in evaluating the quality of information. In looking for information about the journal I did discover that the publisher, MDPI, is on a list of suspected predatory journals.

The unfounded conclusion of the article?

Ginseng truly is an amazing plant and lives up to its name as a cure-all! Although it has been used medicinally for at least 5,000 years, we are still discovering its uses! Next time you are experiencing anything from fatigue to hair loss, take a look at this natural cure-all!

The article has been shared on Facebook 2,171 times as of this writing.

Here's another one of my favorites from the same site: High-dose vitamin C injections shown to annihilate cancer.This one has 48,000+ shares on Facebook since being published on February 19, 2014.

Groundbreaking new research on the cancer-fighting potential of vitamin C has made the pages of the peer-reviewed journal Science Translational Medicine. A team of researchers from the University of Kansas reportedly tested the effects of vitamin C given in high doses intravenously on a group of human subjects and found that it effectively eradicates cancer cells while leaving healthy cells intact.

Oh, but wait, this article claims to be based on peer-reviewed science. Maybe it's legit?

“Patients are looking for safe and low-cost choices in their management of cancer,” stated Dr. Jeanne Drisko, a co-author of the study, to BBC News concerning the findings. “Intravenous vitamin C has that potential based on our basic science research and early clinical data.”

Wow. You mean we might be able to treat cancer with intravenous vitamin C? Then in bold, across the page:

Researchers admit more human trials on intravenous vitamin C unlikely because drug companies cannot patent vitamins

Oh, I see, this is one of those big conspiracies the site is fond of promoting. Due to the drug companies we will never know. The claim here as that medical research can only happen if it is funded by large drug companies and that obviously there would be no interest in in this because there would be no profit. Or, it may just be that there are other problems with this proposed treatment? David Gorski over at Science Based Medicine has written about the science of using vitamin C many times over the years.

As it turns out, a good bit of peer reviewed work has been done and the conclusion is that there is not currently evidence that vitamin C is effective. In his most recent article that deals specifically with intravenous vitamin C delivered in high doses he writes:

A good drug for cancer is, at the very minimum, active at low or reasonable concentrations against the cancer cells being targeted, and vitamin C fails miserably on that count. Worse, there are at least indications that in some cases vitamin C might interfere with chemotherapy.

He goes on to offer a detailed critique of the study, the kind one might expect from an actual expert in the field:

So what we have here is a small clinical trial with a 19% dropout rate that wasn’t even blinded. It reported zero difference in overall survival (both were, as one would expect for ovarian cancer at this stage, abysmal), and zero statistically significant difference in time to relapse/progression. In all fairness, there would have had to have been an enormous effect to produce a statistically significant effect on survival or progression in such a small study, but these are the two “hard” endpoints that would be least affected by the lack of blinding, although one notes that time to progression could be affected by lack of blinding when the definition depends on interpreting scans.

The entire article is an excellent read which provides many of the details that might be fleshed out by a skeptical reading of such studies.

What we have here is a great example in the differences in quality of information. The first is a website that often sources from mainstream media, in this case the BBC, and often just copy/pastes text from releases. The writers don't understand the science and purposely (I suppose it could be accidental in some cases but I am inclined to think it intentional given the frequency) take it out of context to support conspiracy theories and agendas. The second is an expert in the field that actually digs into the study (as well as the long history of related studies on the subject) and offers a scientifically relevant critique of the work. It is an excellent example of the contrasting quality of information.

Unfortunately, it is the conspiracy-minded tripe that is shared on Facebook tens of thousands of times. Why? My hunch is that it is an easy, entertaining read. But it's not just that. Some people enjoy a good (or evil) conspiracy and they want to believe (to quote Fox Moulder) that there are easy cures to what might one day cause their death. Wishful thinking is convenient and comforting. Why do the difficult work of researching sources, why take the time to tediously read through longer, more difficult articles that fail to provide clear cut answers that reassure us and calm our fear? Because the truth is better than the delusion even if it is not comforting. Ultimately, real knowledge and understanding are more valuable to our survival as individuals as well as a species. Understanding ourselves and our Universe not only allows us to make better decisions but also provides us with a greater appreciation for the beauty that surrounds us.

My intent is to provide a series of posts, “The Skeptic Toolkit” which will explore a variety of resources and techniques freely available to anyone interested in learning to be a better skeptic. Stay tuned.

 

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