Saturday, December 12, 2009

Tamiflu not effective? Didn't we already know it....?

So Tamiflu is not effective for H1N1? At least not as effective as once was hyped? Ho-hum......

"Conclusion: Neuraminidase inhibitors have modest effectiveness against the symptoms of influenza in otherwise healthy adults. The drugs are effective postexposure against laboratory confirmed influenza, but this is a small component of influenza-like illness, so for this outcome neuraminidase inhibitors are not effective. Neuraminidase inhibitors might be regarded as optional for reducing the symptoms of seasonal influenza. Paucity of good data has undermined previous findings for oseltamivir’s prevention of complications from influenza. Independent randomised trials to resolve these uncertainties are needed." BMJ 2009;339:b5106

There never was any real data of true efficacy. I had posted on this before. Yes, it reduced the number of days of 1.3 days!! But we were repeatedly told that Tamiflu was the 'miracle drug' that was going to save the world from this vile and super-virulent H1N1 pandemic. Governments stockpiled tons of Tamiflu. And Roche was laughing all the way to the bank.

So now we are told that supporting detailed data has been concealed by Roche.

Hospital errors - more action needed

Salma Khalik of the Straits Times picks up the thread again today on hospital errors in a report entitled "Make hospital and docs more accountable". Well done.

I had posted a comment on this previously.

The restructured hospitals have generally done well in making their systems and procedures more accountable. But not necessarily more transparent. Much of the accountability, unfortunately, appear to have been put in place only for accreditation purposes.

The vogue at the moment is to seek accreditation with the US based Joint Commission International (JCI). In this accreditation exercise, reduction of hospital errors is one of the parameters assessed. It therefore became important that the hospitals have systems in place to deal with hospital errors. Or at least have the semblance of being able to deal with errors. But do the hospitals really want to know? If they really want to know they must have in place s system not just for reporting, but one also to audit the reporting, and not just expect to randomly uncover cases of non-reporting.

What do hospitals and the MOH do with these numbers? Do they really want to know the true incidences of errors? Just because there are reporting processes in place, and we can crank out statistics of some sort, shouldn't lull us into thinking that risks of hospital errors have been adequately mitigated.

Anecdotally, I know of cases of obvious practice errors, that go unreported. Recently, a wife of a friend of mine had to be wheeled back into theatre because of an error committed during surgery. I am quite certain the incident was not reported.

Reporting systems need to be audited, and the audit findings made public. Otherwise it will remain a sham. So should it be for hospital reporting - be it for surgical errors, medication errors or nocosomial infections.

Thursday, December 10, 2009

Richard Feynman - What can we learn about the science in Climategate?

Richard Feynman was a bit of a hero to me when I was first getting into science. He was a great physicist and Nobel Prize laureate, and possibly one of the great scientist of our times. Although not a physicist I was drawn to his writings for that rare and genuine love for science he shared, and the honesty and integrity that he expressed in the science that he practiced.

The following are some of Feynman's quotations that are instructive to us:

"No government has the right to decide on the truth of scientific principles, nor to prescribe in any way the character of the questions investigated. Neither may a government determine the aesthetic value of artistic creations, nor limit the forms of literacy or artistic expression. Nor should it pronounce on the validity of economic, historic, religious, or philosophical doctrines. Instead it has a duty to its citizens to maintain the freedom, to let those citizens contribute to the further adventure and the development of the human race.

"The first ... has to do with whether a man knows what he is talking about, whether what he says has some basis or not. And my trick that I use is very easy. If you ask him intelligent questions — then he quickly gets stuck. It is like a child asking naive questions. If you ask naive but relevant questions, then almost immediately the person doesn't know the answer, if he is an honest man."

"The exception tests the rule. Or, put another way, "The exception proves that the rule is wrong." That is the principle of science. If there is an exception to any rule, and if it can be proved by observation, that rule is wrong."

"Religion is a culture of faith; science is a culture of doubt."

"Looking back at the worst times, it always seems that they were times in which there were people who believed with absolute faith and absolute dogmatism in something. And they were so serious in this matter that they insisted that the rest of the world agree with them. And then they would do things that were directly inconsistent with their own beliefs in order to maintain that what they said was true."

"Science is a way of trying not to fool yourself. The first principle is that you must not fool yourself, and you are the easiest person to fool."

"Learn from science that you must doubt the experts. As a matter of fact, I can also define science another way: Science is the belief in the ignorance of experts."

"The only way to have real success in science, the field I’m familiar with, is to describe the evidence very carefully without regard to the way you feel it should be. If you have a theory, you must try to explain what’s good and what’s bad about it equally. In science, you learn a kind of standard integrity and honesty. "

He also related an interesting account of the now infamous oil drop experiment which was also associated with 'tricks' that scientists use:

"We have learned a lot from experience about how to handle some of the ways we fool ourselves. One example: Millikan measured the charge on an electron by an experiment with falling oil drops, and got an answer which we now know not to be quite right. It's a little bit off because he had the incorrect value for the viscosity of air. It's interesting to look at the history of measurements of the charge of an electron, after Millikan. If you plot them as a function of time, you find that one is a little bit bigger than Millikan's, and the next one's a little bit bigger than that, and the next one's a little bit bigger than that, until finally they settle down to a number which is higher.

Why didn't they discover the new number was higher right away? It's a thing that scientists are ashamed of - this history - because it's apparent that people did things like this: When they got a number that was too high above Millikan's, they thought something must be wrong - and they would look for and find a reason why something might be wrong. When they got a number close to Millikan's value they didn't look so hard. And so they eliminated the numbers that were too far off, and did other things like that. We've learned those tricks nowadays, and now we don't have that kind of a disease."

As it is, the physicists of the American Physics Society are themselves embroiled in the Climategate controversy, with charges of interest conflicts. Quite obviously they do not consider the sciences as being settled in any way. See here and here. They physicists in the APS should learn from Feynman.

Tuesday, December 8, 2009

Flat earth

Third Medical School - Quo Vadis?

Things have been very quiet ever since the last announcement in September 09 about a possible tie up between NTU, TTSH and Imperial College (some people say Karolinska?) for a 3rd Medical School in Singapore.

Word has it that progress has been slow because of turf issues. Not surprising though, if that were true. There are a lot more turf issues here then there were with Duke-NUS. Who sits in the driver's seat is critically important. There are 3 players here, Imperial College (or KI?), NTU and Tan Tock Seng Hospital. Imperial College would want to have a big say if they are to be tempted to come in. But unlike Duke-NUS, where SGH provided an easy walkover, the TTSH would not be so pliant I think. And understandably so too. TTSH over the years have built an almost enviable iconic role in doctor training. Students love going to TTSH for their posting, and rank them highest among the hospitals. They would not (and should not) lie down so easily and give away their core mission to a foreign institution.

But I am only speculating here. I really have no idea what's happening here and what state of discussion the 3rd Medical School at. But I worry that there is some element of truth in my conjectures. I don't want to see TTSH lose their mission, and submit to an external agency. If I had my way, I would like to see TTSH firmly in the driver' seat. NUS/NUH had somehow disappointingly sold their soul, and seem to have lost their mission for medical education. I hope the mistake will not be repeated for TTSH.

Procrustes and the climate

In Greek mythology, Procrustes was a not so nice guy who prey on tourist passing through his territory. He had an iron bed (actually 2...) where he made his 'guests' lie in. He would essentially work on each guest to make them fit the bed. If the legs were too long, he would just amputate them...etc...

In science, this is called committing a Procrustean crime. Wikipedia explains a Procrustean solution as being:
"the undesirable practice of tailoring data to fit its container or some other preconceived stricture. A common example from the business world is embodied in the notion that no résumé should exceed one page in length.

In statistics, instead of finding the best fit line to a scatter plot of data, first choose the line you want, then select only the data that fits it, disregarding data that does not, so to "prove" some point you are making. Its a form of deception that rhetoricians make so to forward their own interests at the expense of others. The unique goal of the Procrustean solution is not win-win, but rather that Procrustes wins AND the other loses. In this case, the defeat of the opponent justifies the deceptive means."

Sound familiar? Seems to me that this was what the climate scientists were doing. They had a model of global that they knew had to be right. Just too bad that some of the data didn't quite fit in with the model. So they just did what Procrustes did.

Interestingly there is actually a Procrustes analysis of climate data. Even though the context is a little different. :)

There is a nice simple write up about theoretical thinking here.... something even I can understand; even though the climate scientists seem to have difficulty with these concepts.

"The second reason you can't prove a theory true is that there is never just one theory that fits the facts. A theory is really just a narrative. A tale that explains. But stories can be told very differently. In a sense, there are always an infinite number of theories that fit the facts."

But for climate science, we are told repeatedly that the science is settled. Theory proven.

Procrustes would have been proud.

Climate change and flat-earthers - the emergence of dogma.

Did anyone else notice the Straits Times editorial today about climate change? It was entitled "To climate control, add thought control".

The opinions expressed in the editorial was reasonable enough but what was really scary was the leader to the editorial, on the top left hand corner of Page 2, under the caption Viewpoints....

"The science of climate change and its conclusions are settled. The sceptics must be denied, or precious time will be lost in futile disputation."

Conclusions settled? Sceptics must be denied? Seems to me that AGW has indeed moved from a scientific hypothesis to become scientific dogma and orthodoxy. It is ironic that they label sceptics as flat-earthers.

Just to make things clear with regards to my position....I have no vested interest in taking sides in this debate. I am inclined to believe global warming is happening, but I remain unconvinced that it is entirely man-made.

Thursday, December 3, 2009

ClimateGate - a small critter's view

This ClimateGate thing swirling around has forced me to think through some issues that I had previously been content to just let float around the back of my mind. Too lazy to force myself to take a position. But here are some of these thoughts I think should be put on the table:

A] Global warming?
I used to be convinced that global warming was real. But now I am not so sure. If the data was fudged, how can one be certain? If climate scientists were happily excluding data that was uncomfortable to their starting hypothesis, and bully dissenting voices into silence, how can we now accept their proof of global warming? How can it be that raw data of such importance is not made publicly available so that this globally crucial issue can be analyzed from as many perspectives as possible, and proper conclusions drawn? How can such important data be held hostage to commercial and proprietary interests?

But let me be clear about something - this new found skepticism does not in any way lessen my conviction that there is far too much consumption/wastage in our society and too much pollution. There is no doubt whatsoever that we need to learn how to manage our environment, and to preserve the world for our future generations. But this is independent of issues with respect to global warming, and its causes (if it indeed is warming). (My personal impression for many years had been that, yes, there is global warming but this is not necessarily due to human activity. So ClimateGate has not done much to change my views here.)

B] The corruption of Science
Whether science is indeed dying, I do not know. I guess we will find out when it is finally dead. But it is clear that science is corrupted and sick. Once, we could depend on scientists to speak their opinions, and we could count on their being 'objective' (within limits of course). But nowadays, these limits have shrunk. Science has sold its soul to big business and is now the pawn of big corporations and governments. Can anything they opine be objective? If the scientific community as typified by the University of East Anglia (apparently the NASA of Climatology) bigwigs be so petty, conniving and corrupted, what can we expect of lesser mortals whose careers and livelihoods be dependent on lifelines handed out by granting agencies with big commercial/governmental agendas? How do we deal with this scientific hegemony that has been driven by big money?

For the sake of our future generations, we need to weed out these negative and destructive forces now at play in the scientific environment. For this small critter, this is a far more important issue than whether or not there is global warming.

C] The corrpution of our mainstream mass media (MSM)
How sad that too, that our MSM has also been held hostage to commercial interests (government control?). Not so? Well, how do you explain then that even as this massive academic scandal swirls around the scientific community like a typhoon, the MSM is so deathly quiet. The Straits Times today can just squeak out pretty articles about Copenhagen. Surely ClimateGate is newsworthy? Afterall it is arguably the biggest academic scandal of our generation. One does not have to take sides in this controversy, but merely to report the breaking of the scandal.'s just this deathly silence.

This silence speaks louder than any possible expose of the lack of independence of the MSM. That both SPH and Mediacorp have been equally silent points perhaps to the size of those controlling interests.

ClimateGate - Science is Dying

Here's an opinion piece by Daniel Henninger of The Wall Street Journal:

Science is Dying

Surely there must have been serious men and women in the hard sciences who at some point worried that their colleagues in the global warming movement were putting at risk the credibility of everyone in science. The nature of that risk has been twofold: First, that the claims of the climate scientists might buckle beneath the weight of their breathtaking complexity. Second, that the crudeness of modern politics, once in motion, would trample the traditions and culture of science to achieve its own policy goals. With the scandal at the East Anglia Climate Research Unit, both have happened at once.

I don't think most scientists appreciate what has hit them. This isn't only about the credibility of global warming. For years, global warming and its advocates have been the public face of hard science. Most people could not name three other subjects they would associate with the work of serious scientists. This was it. The public was told repeatedly that something called "the scientific community" had affirmed the science beneath this inquiry. A Nobel Prize was bestowed (on a politician).

Global warming enlisted the collective reputation of science. Because "science" said so, all the world was about to undertake a vast reordering of human behavior at almost unimaginable financial cost. Not every day does the work of scientists lead to galactic events simply called Kyoto or Copenhagen. At least not since the Manhattan Project.

What is happening at East Anglia is an epochal event. As the hard sciences—physics, biology, chemistry, electrical engineering—came to dominate intellectual life in the last century, some academics in the humanities devised the theory of postmodernism, which liberated them from their colleagues in the sciences. Postmodernism, a self-consciously "unprovable" theory, replaced formal structures with subjectivity. With the revelations of East Anglia, this slippery and variable intellectual world has crossed into the hard sciences.

This has harsh implications for the credibility of science generally. Hard science, alongside medicine, was one of the few things left accorded automatic stature and respect by most untrained lay persons. But the average person reading accounts of the East Anglia emails will conclude that hard science has become just another faction, as politicized and "messy" as, say, gender studies. The New England Journal of Medicine has turned into a weird weekly amalgam of straight medical-research and propaganda for the Obama redesign of U.S. medicine.

The East Anglians' mistreatment of scientists who challenged global warming's claims—plotting to shut them up and shut down their ability to publish—evokes the attempt to silence Galileo. The exchanges between Penn State's Michael Mann and East Anglia CRU director Phil Jones sound like Father Firenzuola, the Commissary-General of the Inquisition.

For three centuries Galileo has symbolized dissent in science. In our time, most scientists outside this circle have kept silent as their climatologist fellows, helped by the cardinals of the press, mocked and ostracized scientists who questioned this grand theory of global doom. Even a doubter as eminent as Princeton's Freeman Dyson was dismissed as an aging crank.

Beneath this dispute is a relatively new, very postmodern environmental idea known as "the precautionary principle." As defined by one official version: "When an activity raises threats of harm to the environment or human health, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically." The global-warming establishment says we know "enough" to impose new rules on the world's use of carbon fuels. The dissenters say this demotes science's traditional standards of evidence.

The Environmental Protection Agency's dramatic Endangerment Finding in April that greenhouse gas emissions qualify as an air pollutant—with implications for a vast new regulatory regime—used what the agency called a precautionary approach. The EPA admitted "varying degrees of uncertainty across many of these scientific issues." Again, this puts hard science in the new position of saying, close enough is good enough. One hopes civil engineers never build bridges under this theory.

The Obama administration's new head of policy at EPA, Lisa Heinzerling, is an advocate of turning precaution into standard policy. In a law-review article titled "Law and Economics for a Warming World," Ms. Heinzerling wrote, "Policy formation based on prediction and calculation of expected harm is no longer relevant; the only coherent response to a situation of chaotically worsening outcomes is a precautionary policy. . . ."

If the new ethos is that "close-enough" science is now sufficient to achieve political goals, serious scientists should be under no illusion that politicians will press-gang them into service for future agendas. Everyone working in science, no matter their politics, has an stake in cleaning up the mess revealed by the East Anglia emails. Science is on the credibility bubble. If it pops, centuries of what we understand to be the role of science go with it.

NUS investment losses

Universities globally, especially those dependent on the revenue they get endowment investments have taken a hit. So the National University of Singapore is no exception. Even so the amount lost is mind boggling - S$677 million!!! This loss resulted in a deficit of S$589 million!

I hope they will cut the expensive salaries of their prima donnas rather than to divert much needed resources from their teaching budget.

The Nanyang Technological University has yet to 'fess up to their losses.

ClimateGate - Who's who...

Here's a cool slide show from You Tube summarizing the recent developments and email extracts....

Wednesday, December 2, 2009

Climategate - the unravelling academic scandal that threatens the credibility of the anthropogenic climate warming position

One of the greatest academic scandals of this generation is unraveling, and the mainstream media is strangely silent.

Earlier this month, the scandal now nicknamed 'Climategate' began with the publication of hacked emails from the Climatic Research Unit, University of East Anglia, showing how corrupted and conniving the climate change scientists (big guns, not small fry, mind you....from the IPCC - Intergovernmental Panel of Climate Change) have been in promoting the global warming agenda.

For details please read Lord Christopher Monckton's report.
The Daily Telegraph's report is also good reading.

For me, this is a sad indictment of how far academia has sunk. Once we could trust the objectivity of reports that came from academic centres. Or at least it did seem that way. Now, it seems the universities and research centres have all fallen prey to money wielding organizations, or self serving politicians. Can we trust academicians now?

Some may say that this is an isolated incident involving a unrepresentative group of academics, but the cynical in me believes this may in fact be more prevalent than we want to admit.The silence of the main stream media is deafening. Governments and politicians who have invested much in the global warming hypothesis have much to lose should it be proven to be a hoax. A gargantuan industry has already been built up around technologies to mitigate global warming. What will become of these should there be no global warming?

Let's not even think of the possibility that we might not have been told the whole truth about other issues such as the H1N1 pandemic, or stem cell research, or gene therapy, or the need for cancer screenings.... The list goes on.

I had made the point earlier about the need for more objective data. This is even more urgent now. The question is where will it come from?

Tuesday, December 1, 2009

Hospital errors - more details necessary

The Straits Times carried a disappointingly brief report about the reporting of hospital errors. A total of 401 errors over the last 7 years (since 2002); 339 of which was from public hospitals and 62 from private hospitals.

The fact that reports had been made compulsory by the Ministry of Health is an important one, and the Ministry should be given full credit for biting the bullet on this issue. But the question is why the need for secrecy here? This data is not found on the MOH website, and not in the public domain (unless I have been looking in the wrong places). If not for ST's report on this issue, we would not know. But ST's report is somewhat tentative and 'kiasu', for it says something, then goes silent. Why, for example, does it not report of the trend of such occurences over the last 7 years? Is it going up or coming down? These numbers should be reported for each hospital, and denominated by the hospital size so we know which hospital runs a tighter ship where error mitigation is concerned.

East vs West - Minister Khaw's endorsement of anecdotal medicine?

I have to confess I was more than a tad disappointed by Minister of Health, Khaw Boon Wan's blog about his positive experience with TCM. No doubt he was narrating a personal experience, but it sounded too much as if he was endorsing an anecdotal approach towards the practice of medicine.

Is this the death knell for evidence-based medicine?