Do Herbs Get a Bad Press?

An neat little study in BMC Medicine investigates how newspapers report on clinical research. The authors tried to systematically compare the tone and accuracy of write-ups of clinical trials of herbal remedies with those of trials of pharmaceuticals. The results might surprise you.

The research comes from a Canadian group, and most of the hard slog was done by two undergrads, who read through and evaluated 105 trials and 553 newspaper articles about those trials. (They didn't get named as authors on the paper, which seems a bit mean, so let's take a moment to appreciate Megan Koper and Thomas Moran.) The aim was to take all English language newspaper articles about clinical trials printed between 1995 and 2005 (as found on LexisNexis). Duplicate articles were weeded out and every article was then rated for overall tone (subjective), the number of risks and benefits reported, whether it reported on conflicts of interest or not, and so forth. The trials themselves were also rated.

As the authors say

This type of study, comparing media coverage with the scientific research it covers is a well recognized method in media studies. Is the tone of reporting different for herbal remedy versus pharmaceutical clinical trials? Are there differences in the sources of trial funding and the reporting of that issue? What about the reporting of conflicts of interest?

There were a range of findings. Firstly, newspapers were generally poor at reporting on important facts about trials such as conflicts of interest and methodological flaws. No great surprise there. They also tended to understate risks, especially in regards to herbal trials.

The most novel finding was that newspaper reports of herbal remedy trials were quite a lot more likely to be negative in tone than reports of pharmaceutical trials. The graphs here show this: out of 201 newspaper articles about pharmaceutical clinical trials, not one was negative in overall tone, and most were actively positive about the drug, while the herbs got a harsh press, with roughly as many negative articles as positive ones. (Rightmost two bars.)

This might partly be explained by the fact that slightly more of the herbal remedy trials found a negative result, but the difference in this case was fairly small (leftmost two bars). The authors concluded that

Those herbal remedy clinical trials that receive newspaper coverage are of similar quality to pharmaceutical clinical trials ... Despite the overall positive results and tone of the clinical trials, newspaper coverage of herbal remedy clinical trials was more negative than for pharmaceutical clinical trials.

Bet you didn't see that coming - the media (at any rate in Britain) are often seen as reporting uncritically on complementary and alternative medicine. These results suggest that this is a simplification, but remember that this study only considered articles about specific clinical trials - not general discussions of treaments or diseases. The authors remark:

[The result] is contrary to most published research on media coverage of CAM. Those studies consider a much broader spectrum of treatments and the media content is generally anecdotal rather than evidence based. Indeed, journalists are displaying a degree of skepticism rare for medical reporting.

So, it's not clear why journalists are so critical of trials of herbs when they're generally fans of CAM the rest of the time. The authors speculate:

It is possible that once confronted with actual evidence, journalists are more critical or skeptical. It may be considered more newsworthy to debunk commonly held beliefs and practices related to CAM, to go against the trend of positive reporting in light of evidence. It is also possible that journalists who turn to press releases of peer-reviewed, high-impact journals have subtle biases towards scientific method and conventional medicine. Also, journalists turn to trusted sources in the biomedical community for comments on clinical trials, both herbal and pharmaceutical, potentially leading to a biomedical bias in reporting trial outcomes.

If you forgive the slightly CAM-ish language (biomedical indeed), you can see that they make some good suggestions - but we don't really know. This is the problem with this kind of study (as the authors note) - the fact that a story is "negative" about herbs could mean a lot of different things. We also don't know how many other articles there were about herbs which didn't mention clinical trials, and because this article only considered articles referring to primary literature, not meta-analyses (I think), it leaves out a lot of material. Meta-analyses are popular with journalists and are often more relevant to the public than single trials are.

Still, it's a paper which challenged my prejudices (like a lot of bloggers I have a bit of a persecution complex about the media being pro-CAM) and a nice example of empirical research on the media.

Tania Bubela, Heather Boon, Timothy Caulfield (2008). Herbal remedy clinical trials in the media: a comparison with the coverage of conventional pharmaceuticals BMC Medicine, 6 (1) DOI: 10.1186/1741-7015-6-35

My First Experience of Matsuri in Japan

When I first visited the Sensoji Temple of Asakusa in Tokyo, I was lucky to be there on the weekend that one of the three big festivals in Tokyo was held. It is called the Sanja Matsuri and it is normally held on a weekend in mid May, and I happened to be there this year on 17^th May.

On the way to the temple through the forever busy shopping street Nakamise, I saw a Japanese monk on the street seeking for donation from the passersby.

There were also temporary stages set up along the way to the temple where performers offered their music to the deities.

The temple was closed to the public due to the procession going on. All the spectators had to stand at a distance away from where the procession was held. Being one of the three main festivals in Japan, the whole place was filled with locals and tourists.

I had a hard time getting myself through to witness the procession. I was literally shoulder to shoulder with the other spectators.

During this day, all the deities from other temples were brought out on Mikoshi (palanquins).

Each Mikoshi is carried by a group of people, on their shoulders, males and females alike.

This is the only time of the year that the deities get to leave the temple. It is the only holiday for the deities when they are carried around on their Mikoshi to roam the streets.

Each Mikoshi is elaborately decorated. Most of them have a phoenix statue on top. Gold seems to be the dominant colour in decorating a Mikoshi.

As I was witnessing the procession, I was also pushed around by the Mikoshi carriers and the spectators. Be prepared to be pushed back and forth by the crowd if you are going for it.

I got too carried away in taking photographs that I didn't even know I dropped my Lonely Planet travel guide on Tokyo that Marlene passed to me when she left Japan. I lost my Tokyo city map together with it too.

However, I didn't lose my way home without the travel guide and city map. I picked up another copy of the travel guide at the bookshop near the train station before heading home. Maybe it was fated for me to pay for that travel guide.

The Spooky Case of the Disappearing Crap Science Article

Just a few hours ago, I drafted a post about a crap science study in the Daily Telegraph called "Stress of modern life cuts attention spans to five minutes".

The pressures of modern life are affecting our ability to focus on the task in hand, with work stress cited as the major distraction, it said.
Declining attention spans are causing household accidents such as pans being left to boil over on the hob, baths allowed to overflow, and freezer doors left open, the survey suggests.
A quarter of people polled said they regularly forget the names of close friends or relatives, and seven per cent even admitted to momentarily forgetting their own birthdays.
The study by Lloyds TSB insurance showed that the average attention span had fallen to just 5 minutes, down from 12 minutes 10 years ago.
But the over-50s are able to concentrate for longer periods than young people, suggesting that busy lifestyles and intrusive modern technology rather than old age are to blame for our mental decline.
"More than ever, research is highlighting a trend in reduced attention and concentration spans, and as our experiment suggests, the younger generation appear to be the worst afflicted," said sociologist David Moxon, who led the survey of 1,000 people.

Almost identical stories appeared in the Daily Mail (no surprise) and, for some reason, an awful lot of Indian news sites. So I hacked out a few curmudgeonly lines - but before I posted them, the story had vanished! (Update: It's back! See end of post). Spooky. But first, the curmudgeonry:

• Crap science story in "crap" shocker
  

The term "attention span" is meaningless - attention to what? Are we so stressed out that after five minutes down the pub, we tend to forget our pints and wander home in a daze? You could talk about attention span for a particular activity, so long as you defined your criteria for losing attention - for example, you could measure the average time a student sits in a lecture before he starts doodling on his notes. Then if you wanted you could find out if stress affects that time. I wouldn't recommend it, because it would be very boring, but it would be a scientific study.

This news, however is not based on a study of this kind. It's based on a survey of 1,000 people i.e. they asked people how long their attention span was and whether they felt they were prone to accidents. No doubt the questions were chosen in such a way that they got the answers they wanted. Who are "they"? - Lloyds TSB insurance, or rather, their PR department, who decided that they would pay Mr David Moxon MSc. to get them the results they wanted. He obliged, because that's what he does. Then the PR people wrote up Moxon's "results" as a press release and sent it out to all the newspapers, where stressed-out, over-worked journalists (there's a grain of truth to every story!) leapt at the chance to fill some precious column inches with no thinking required. Lloyds get their name in the newspapers, their PR company gets cash, and Moxon gets cash and his name in the papers so he gets more clients in the future. Sorted!

How do I know this? Well, mainly because I've read Ben Goldacre's Bad Science and Nick Davie's Flat Earth News, two excellent books which explain in great detail how modern journalism works and how this kind of PR junk routinely ends up on the pages of your newspapers in the guise of science or "surveys". However, even if I hadn't, I could have worked it out by just consulting Google regarding Mr Moxon. Here is his website. Here's what Moxon says about his services:

David can provide a wide range of traditional behavioural research methods on a diverse range of social, psychological and health topics. David works in partnership with clients delivering precisely the brief they require whilst maintaining academic integrity.

The more commonly provided services include:

• The development and compilation of questionnaire or survey questions

• Statistical analysis of data (including SPSS® if required)

• The development of personality typologies

• The production of media friendly tests and quizzes (always with scoring systems)

• The production of primary research reports identifying ‘top line findings’ as well as providing detailed results and conclusions.

In other words, he gets the results you want. And he urges potential customers to

Contact the consultancy which gives you fast, highly-creative and psychologically-endorsed stories that grab the headlines.

• The Disappearance

The mystery is that the story, so carefully crafted by the PR department, has gone. Both the Telegraph and the Mail have pulled it, although it was there last time I checked, a couple of hours ago. Googling the story confirms that it used to be there, but now it's gone. Variants are still available elsewhere, sadly.

So, what happened? Did both the Mail and the Telegraph suddenly experience an severe attack of journalistic integrity and decide that this story was so bad, they weren't even going to host it on their websites? It seems doubtful, especially in the case of the Mail, but it's possible.

I prefer a different explanation: my intention to rubbish the story travelled forwards in time, and caused the story to be taken down, even though I hadn't posted about it yet. Lynn McTaggart has proven that this can happen, you know.

Update 27th November 13:30: And it's back! The story has reappeared on the Telegraph website. The Lay Scientist tells me that the story was originally put up too prematurely and then pulled because it was embargoed until today. I don't quite see why it matters when a non-story like this is published - it could just as well have been 10 years ago - but there you go. And in a ridiculous coda to this sorry tale, the Telegraph have today run a second crap science article centered around the concept of "5 minutes" - according to the makers of cold and flu remedy Lemsip, 52% of women feel sorry for their boyfriends when they're ill for just five minutes or less. Presumably because this is their attention span. How I wish I were making this up.

Wordless Wednesday – Catwalk on the Street

Location: Takeshita Dori, Harajuku, Tokyo, Japan
Date taken: August 10^th, 2008
Camera equipment: Nikon D300 + Micro-Nikkor 105mm f/2.8D

Aww, monkeys!

From the hilarious and always informative climate-change-based cartoon series, Throbgoblins, comes this little reminder that there's more to life than psychology...

See also this strip which was, they tell me, inspired by something I said regarding Galileo. Thus bringing the count of awesome things that I've inspired to one.

An Orb Weaver

Bull's horn spider, Gasteracantha arcuata has the largest abdominal thorns among the kite spiders. The long horns curving upward from the "shoulder" of the abdomen can be several times as long as the body.

It is a type of orb weaver that weaves a perfect structure of orb webs, by which the common name is given to this species. Its web is large in relation to its body, often adorned near the centre with a few tufts of fluffy white silk.

We found this colourful little creature at Jambusan during our second photography outing there, so we started to make it pose for us while we kept on firing our shutter and flashlights.

Probably it was too annoyed by our illumination that it started to hang itself upside down. However, we still kept on firing our flashlights.

It finally gave up on escaping from our flashlights and started to pose for our cameras. It was such a natural poser!

Totally Addicted to Genes

Why do some people get addicted to things? As with most things in life, there are lots of causes, most of which have little, if anything, to do with genes or the brain. Getting high or drunk all day may be an appealing and even reasonable life choice if you're poor, bored and unemployed. It's less so if you've got a steady job, a mortgage and a family to look after.

On the other hand, substance addiction is a biological process, and it would be surprising if genetics did not play a part. There could be many routes from DNA to dependence. Last year a study reported that two genes, TAS2R38 and TAS2R16, were associated with problem drinking. These genes code for some of the tongue's bitterness taste receptor proteins - presumably, carriers of some variants of these genes find alcoholic drinks less bitter, more drinkable and more appealing. Yet most people are more excited by the idea of genes which somehow "directly" affect the brain and predispose to addiction. Are there any? The answer is yes, probably, but they do lots of other things beside cause addiction.

A report just published in the American Journal of Medical Genetics by Argawal et. al. (2008), found an association between a certain variant in the CNR1 gene, rs806380, and the risk of cannabis dependence. They looked at a sample of 1923 white European American adults from six cities across the U.S, and found that the rs806380 "A" allele (variant) was more common in people with self-reported cannabis dependence than in those who denied having such a problem. A couple of other variants in the same gene were also associated, but less strongly.

As with all behavioural genetics, there are caveats. (I've warned about this before.) The people in this study were originally recruited as part of an alcoholism project,COGA. In fact, all of the participants were either alcohol dependent or had relatives who were. Most of the cannabis-dependent people were also dependent on alcohol. However, this is true of the real world as well, where dependence on more than one substance is common.

The sample size of nearly 2000 people is pretty good, but the authors investigated a total of eleven different variants of the CNR1 gene. This raises the problem of multiple comparisons, and they don't mention how they corrected for this, so we have to assume that they didn't. The main finding does corroborate earlier studies, however. So, assuming that this result is robust, and it's at least as robust as most work in this field, does this mean that a true "addiction gene" has been discovered?

Well, the gene CNR1 codes for the cannabinoid type 1 (CB1) receptor protein, the most common cannabinoid receptor in the brain. Endocannabinoids, and the chemicals in smoked cannabis, activate it. Your brain is full of endocannabinoids, molecules similiar to the active compounds found in cannabis. Although they were discovered just 20 short years ago, they've already been found to be involved in just about everything that goes on in the brain, acting as a feedback system which keeps other neurotransmitters under control.

So, what Argawal et. al. found is that the cannabinoid receptor gene is associated with cannabis dependence. Is this a common-sense result - doesn't it just mean that people whose receptors are less affected by cannabis are less likely to want to use it? Probably not, because what's interesting is that the same variant in the CNR1 gene, rs806380, has been found to be associated with obesity and dependence on cocaine and opioids. Other variants in the same gene have shown similar associations, although there have been several studies finding no effect, as always.

What makes me believe that CNR1 probably is associated with addiction is that a drug which blocks the CB1 receptor, rimonabant, causes people to lose weight, and is also probably effective in helping people stop smoking and quit drinking (weaker evidence). Give it to mice and they become little rodent Puritans - they lose interest in sweet foods, and recreational drugs including alcohol, nicotine, cocaine and heroin. Only the simple things in life for mice on rimonabant. (No-one's yet checked whether rimonabant makes mice lose interest in sex, but I'd bet money that it does.)

So it looks as though the CB1 receptor is necessary for pleasurable or motivational responses to a whole range of things - maybe everything. If so, it's not surprising that variants in the gene coding for CB1 are associated with substance dependence, and with body weight - maybe these variants determine how susceptible people are to the lures of life's pleasures, whether it be a chocolate muffin or a straight vodka. (This is speculation, although it's informed speculation, and I know that many experts are thinking along these lines.)

What if we all took rimonabant to make us less prone to such vices? Wouldn't that be a good thing? It depends on whether you think people enjoying themselves is evidence of a public health problem, but it's worth noting that rimonabant was recently taken of the European market, despite being really pretty good at causing weight loss, because it causes depression in a significant minority of users. Does rimonabant just rob the world of joy, making everything else less fun? That would make anyone miserable. Except for neuroscientists, who would look forward to being able to learn more about the biology of mood and motivation by studying such side effects.

Arpana Agrawal, Leah Wetherill, Danielle M. Dick, Xiaoling Xuei, Anthony Hinrichs, Victor Hesselbrock, John Kramer, John I. Nurnberger, Marc Schuckit, Laura J. Bierut, Howard J. Edenberg, Tatiana Foroud (2008). Evidence for association between polymorphisms in the cannabinoid receptor 1 (CNR1) gene and cannabis dependence American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 9999B DOI: 10.1002/ajmg.b.30881

Otaru: Street Strolling and Blowing

Other than the picturesque Canal District, Otaru has a street lined with shops transformed from warehouses. This street is called Ironai Odori. The buildings themselves are really beautiful and unique enough for me to take a series of photos.

This street is also a great place to shop for local food, souvenirs and handicrafts of Otaru.

Apart from shopping, there are art galleries along the street for those who fancy art appreciation.

There is even a workshop which teaches glassware making called K's Blowing. A glass-blowing lesson will set you back around ¥2,000, but you can bring back the masterpiece that you have made through the lesson.