Alcohol, bad science, and sophistry

In an article in the Guardian today, Professor Nutt made a series of statements about alcohol that are deeply depressing, and not for the reasons one might perhaps think. They were as follows, with the reasons for despair after each:

"Alcohol is a toxin that kills cells such as microorganisms, which is why we use it to preserve food and sterilise skin, needles etc. Alcohol kills humans too. A dose only four times as high as the amount that would make blood levels exceed drink-driving limits in the UK can kill. The toxicity of alcohol is worsened because in order for it to be cleared from the body it has to be metabolised to acetaldehyde, an even more toxic substance. Any food or drink contaminated with the amount of acetaldehyde that a unit of alcohol produces would be immediately banned as having an unacceptable health risk."

Where to begin with the tawdry idiocy of this? Perhaps simply replacing 'alcohol' with sodium chloride (or table salt as the less pretentious apparently refer to it) is as good a place as any, giving us - "Sodium chloride is a toxin that kills cells such as microorganisms, which is why we use it to preserve food and steralise skin, needles etc [not so much the second, but salt water is a good, if nippy, way to steralise a wound]. Sodium chloride kills humans too." But only if you give them it in doses that are vastly higher than that which one would normally consume in or with one's food. Alcohol is a toxin and acetaldehyde is nasty, but at the doses that one normally consumes alcohol our body is quite clearly able to process them. What Prof. Nutt has done here is analogous to the famous case in which people were convinced to try and ban dihydrogen monoxide (H2O) because of the dangers it posed. That he is trying to pass off the equivalent of such a prank as serious comment is tragically disingenuous. 

Like all the best lies, each sentence has an element of truth to them (or, rather, they are all true, but do not apply to the context that he is putting them forward in) - if one was not slightly educated in science then one would probably read them and accept them as entirely reasonable. Somebody who has been given the gift of an intellect and education that has taken them to the top of academia should not be abusing the ignorance (used in an entirely non-pejorative sense) of others in this way.

"Although most people do not become addicted to alcohol on their first drink, a small proportion do. As a clinical psychiatrist who has worked with alcoholics for more than 30 years, I have seen many people who have experienced a strong liking of alcohol from their very first exposure and then gone on to become addicted to it. We cannot at present predict who these people will be, so any exposure to alcohol runs the risk of producing addiction in some users."

A supposed scientist putting forward an anecdote as evidence, putting him in the esteemed company of creationists, militant anti-abortionists, homeopaths, et al. Not only that, but his anecdote and surrounding statements are what can only be described as bullshit (cf. Frankfurt, 1986). 

Firstly, nobody and nothing (with the usual caveats about freak outliers) has become addicted to anything upon their first exposure. They may have become dependent upon their first exposure, but they did not become addicted. Again, most people may not know the difference, but as a pharmacologist Prof. Nutt most certainly does. Glossing over that, yes, a great many of people who liked alcohol the first time they tried it went on to become addicted. But a great many that liked it didn't go on to be addicted. And a great many who hated it the first time will have gone on to be addicted, and some who liked it a little, although perhaps it could have done with a little more ice, will have gone on to be addicted (and some not). None of this is relevant to anything, other than to a description of all the possible combinations of liking something the first time (or not) and getting addicted to it (or not). It is rhetoric, nothing more.

Does any of this matter though if the outcome for the individual is the same? Well, yes. Politicians and journalists may bend and abuse words to fit their needs and blind people into doing what they want them to be doing, but we should - nay, must - be able to expect better from a member of the academy. Being a scientist and an academic is to a small part of a great cooperative entity striving towards truth. When one member of this effort sullies this enterprise by resorting to lies and half-truths in this way it belittles all the other members and moves us all as a species that little bit further back into the darkness.  

"The supposed cardiovascular benefits of a low level of alcohol intake in some middle-aged men cannot be taken as proof that alcohol is beneficial. To do that one would need a randomised trial where part of this group drink no alcohol, others drink in small amounts and others more heavily. Until this experiment has been done we don't have proof that alcohol has health benefits. A recent example of where an epidemiological association was found not to be true when tested properly was hormone replacement therapy. Population observations suggested that HRT was beneficial for post-menopausal women, but when controlled trials were conducted it was found to cause more harm than good."

More misrepresentation here. The study that I assume that he is referring to here (Rossouw, 2002) did find an increased risk of breast cancer, heart disease, stroke, and pulmonary embolism in subjects who were more than five years post-menopausal; but it also found a reduced risk of colon cancer and hip fracture in this group, as well as a reduced risk of heart disease for those subjects who were less then five years post-menopausal. So, as with most science, the results were complicated and do not in their entirety support the claim that he makes. If one is to go around cherry-picking results that suit then one could equally just chose the results from this trial that refer to heart disease in women that are less than five years post-menopausal and say that HRT definitely does more good than harm. 

Almost as depressing is his willful misrepresentation of the scientific method (I can't bring myself to believe that he might genuinely understand it). Certainly it is true that a (double-blind) randomised controlled trial would be the best method of establishing whether alcohol has health benefits or not, but to claim that we have no proof prior to this is just silly. The trials that have been done so far tell us something - not everything, but something - within what will have been carefully delineated set of limitations. They do not give us proof (in a strong sense of the word), but nor would the randomised trial that he says is necessary before we can say anything. All of which brings us into the domain of questions about truth and science, an area that I suspect he is not seeking to take his argument into (especially given that many if not all of the trials that he will say show that dangers of alcohol will not meet the artificial standards of proof that he has set out here).  

Finally, implying that there is only evidence for health benefits for alcohol intake in middle aged men and in the context of cardiovascular disease is unashamedly dishonest. The conditions for which alcohol has been suggested to have a protective effect range from stroke (to the common cold (Takkouche, 2002). This is not to say that these results are not complex and controversial, nor that alcohol consumption does not cause serious health problems - both of these things are obviously true, it is just that the implicit claim that Prof. Nutt makes quite obviously is not. 

For all other diseases associated with alcohol there is no evidence of any benefit of low alcohol intake – the risks of accidents, cancer, ulcers etc rise inexorably with intake.

A final weaselly sentence. No, there is no evidence that low doses of alcohol are of benefit in liver cirrhosis - but no-one in their right mind would suggest that there was (although that doesn't prove anything - has an experiment been done?). It takes a fairly close reading of the sentence to see what he is doing here though. By definition diseases associated with alcohol are not helped by alcohol consumption, but that says nothing about those diseases that are not associated with alcohol. As to the accidents etc, a whole series of questions arise if one stops to think about what he is trying to say. Does that risk of accidents increase with intake in an acute sense or accumulitively over ones life? The first is quite obvious, and isn't saying much at all, whilst the latter is patently absurd. What does he mean by ulcers? Duodenal? But as every biology undergrad knows, such ulcers are to an extremely high degree caused by H. pylori and not diet. Again this is writing that one would expect from a politician or a tabloid journalist - half truths, obfuscation, and the exploitation of lay ignorance.

This article, then, is both sad and dangerous. It is sad because it is evidence of somebody who should know better sullying the whole enterprise of science for measly rhetorical advantage. It is dangerous for this reason too. People are not stupid, and some at least will see through the deceptions. When they do, and when they see Prof. Nutt producing them from his position as an expert, they will grow further distrustful of all those who make any claims from a position of expertise. In doing so we move further towards a world where learning and work are utterly devalued, and where people are entirely unwilling to accept guidance from those who have knowledge, relying instead on instinct or the word of those who can talk the loudest or the smoothest. Such a world would drive one to drink.


References
Frankfurt, H. On Bullshit. Raritan Quarterly Review 1986; 6(2)

Rossouw JE, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial., JAMA. 2002; 288(3):321-33.

Emberson, JR.; Bennett, DA. Effect of alcohol on risk of coronary heart disease and stroke: causality, bias, or a bit of both?. Vasc Health Risk Manag. 2006; 2(3): 239–49 

Takkouche B, et al. Intake of Wine, Beer, and Spirits and the Risk of Clinical Common Cold. Am. J. Epidemiol. 2002; 155(9): 853-858 

Eccentric does not equal being a dick

Much is made in an article in Wired about the 'eccentricity' of Amy Bishop, the University of Alabama in Huntsville scientist who shot and killed three of her colleagues. Reading about her behaviour, however, makes one rather wonder about the definition of eccentric that is being used. 

Academia is, on the whole, tolerant to those that deviate somewhat from the norm, and a good thing too (although it is, by all accounts, far less tolerant than it once was, and getting worse). With its entire purpose being the advancement of knowledge, discriminating against those who are not content to accept that which is currently held as normal would be fatal. Thus I had an anatomy lecturer who would flit through the streets of Glasgow, academic's cloak streaming behind him; or the astronomy lecturer who could not countenance the use of the phrase "the naked eye", it being in his opinion "too rude". Different, certainly, but also two of the best teachers that I had. 

The manner in which Amy Bishop is described as habitually acting in could not be further from that of these benign and brilliant characters. Rather than having innocent quirks that, if anything, improved their teaching, she is described as being arrogant and abusive to a degree that interfered with her ability to do her job. 

Being obnoxious most definitely does not equal being eccentric, nor would anyone in academia ever be inclined to confuse the two and tolerate the abuse. This is reflected in the fact that she was not kept on in a number of positions, and was not awarded tenure in Alabama. 

What is more telling from the point of view of why she was tolerated and not flagged up as a potential risk  is the description given in the article of the response of the Ipswich community to her behaviour (not that I particularly believe that we should be going around flagging people who aren't very nice as being in some way a risk). By the other residents' accounts, she treated them in an equally obnoxious manner as she did her academic colleagues and students, yet they too tolerated this behaviour for five years. They may have held a spontaneous party upon the departure of the Bishop family, but there seems to be little evidence of them coming together to confront the bully in the midst of their suburban harmony. (Bringing to mind the points made about suburban living made by, for example, Eric Fromm  and Richard Sennett.)


Thus, this sad case does not represent an example of academia tolerating an eccentric, and should in no way be seen in that light. Instead what it represents is an apparent society-wide tolerance of bullies and bullying, or at least an unwillingness of society to work together to confront and ameliorate such individuals - either being a far more disturbing and telling conclusion than those being drawn by the majority of commentators.

Hypocrisy, faith and state

Islam is often held up by Western commentators as a particulary pernicious religion from the perspective of the possibility of political secularism. The lack of differentiation between the religious and the political in Islam is said to be uniquely dangerous, leading to the sort of situations such as exist in Saudi Arabia and Pakistan where the primacy and privilege of religion has played a major role in causing great injustice and suffering.

The dangers of an institutionalised conflation of faith and politics is undeniable, but that this is a unique issue for Islam would seem debatable.

Historically, of course, there has always been an intertwining of religion and politics in the West. The Pope is, and always has been, a head of state (no matter how dubious that position now is). Similarly, the clergy have always been a powerful section of the ruling class, with, for example, Anglican bishops sitting in the House of Lords in the UK.

The changes in the West since the Enlightenment are widely held as having fundamentally altered all that, however, ostensibly leaving us in a healthily secular environment - the very sort of environment that Islam is held up as being such a threat to.

However, the recent paedophile scandal within the Catholic Church casts some doubt upon this idea. A fundamental feature of this scandal is evidence for the same belief in the primacy and privilege of religion within the Western systems it has occured in as is bemoaned in Islamic ones. Throughout the scandal the tacit assumption has been that the problem of child-rape that involves clergy is in some way different from secular child-rape. The Church has attempted - and, on the whole, been allowed - to keep investigations and punishments (rare as they are) internal to its organisation. For example, a bishop (of Bruges) has admitted publically to the rape of several boys with no repercussions at all.

Here then is clear evidence of a privileged situation for religion in the Western political/legal system. Western commentators could thus afford to be less smug about their perceived superiority to their Muslim targets and to bear in mind the closeness in underlying attitudes to religion and society that, in many contexts, exist.

Calling a Christmas party a spade

Does calling an event a Christmas party mean that it is automatically associated with the Christian religion?

This is the question that an email sent out to members of the Biology department asking what they would like their “Christmas party” to be referred to as forces one to consider. (The poll was instigated by objections to the use of this phrase raised by a member of faculty.) 

At the most simplistic level, the answer must be yes – the clues in the name –but to take such a view would be to completely ignore or misunderstand the realities of language and culture. 

Words and ideas evolve constantly as the world and the people in it change. Cultures borrow from each other as they develop, to a degree that is all too rarely admitted. What meant one thing at one time can very quickly come to mean something entirely different.

For example, consider the form and content of the Christian festival of Christmas itself. 

The idea of a virgin birth on the 25^th of December is identical to the pre-existing birth myth of the Persian/Roman god Mithras, with that myth being in turn markedly similar to the even older story of the origins of Zoroaster (virgin births also being credited to Krishna and Quetzalcoatl, amongst others).

The date itself is a few days after the winter solstice, an event associated with some form of festival in a large proportion of the world’s cultures, past and present. Just as Christmas marks a new beginning for Christians, these winter festivals generally involve ideas of renewal and rebirth as people look forward to the return of spring.

As final examples, it is from such pagan winter festivals that we get the Christmas trees that we put in the corner of our rooms, as well as the mistletoe that hangs from our ceilings.

The Christmas festival thus provides a perfect illustration of the way in which ideas and practices are borrowed by groups of people to create something new. 

The phrase “Christmas party” should also be seen in that light. Whilst it may once have referred to a religious event, the phrase has evolved to mean something quite different – and entirely secular – to the majority of people. When we hear it we do not think of church: we think of tinsel and presents and perhaps a little too much mulled wine.

Of course, language is not a zero-sum game, and the phrase can continue to have religious connotations for those who are members of the Christian religion. There is no need for a battle for meanings – our language is adaptive enough to accommodate them all, just as we are sensible enough to identify the correct one through context. 

It is this flexibility that makes language so wonderful, and this potential plurality of concurrent viewpoints that any true secularist should be seeking to advance. 

Drugs and the pain of existence

Reading this article in the Guardian brought tears to my eyes.

Beyond agreeing entirely with the points concerning both the futility of criminalisation and the increased harm it inflicts upon both addicts and society, I felt that the really telling sentences in the article were those that stated:

His conversation was always about the pain of existence in a world where two-thirds starved so one-third could live well. He hated war, poverty and injustice, and felt powerless to alter things. But he would always try to get back home for the family Christmas, and we took heart from that, happy that he hadn't rejected us completely.

These three sentences seem to me to encapsulate a huge part of the whole issue of substance abuse (and, indeed, use).

History would seem to support the proposition that humanity has always enjoyed the use of substances that alter reality in some way for us. Indeed, history would seem to further support the idea that we as a species have always been willing to go to some effort in order to achieve a state of altered consciousness. Evidence for this can arguably be found in, for example, the complex brewing and distilling procedures that many cultures have come up with, as well as the arguably even more complex combinations of plants and minerals that particular tribes have developed (such as the combination of coca leaves and the alkali in ash and suchlike that Andean cultures developed, or the DMT based substances that Amazonian tribes use that require the correct combination of several different plants).

There is thus a natural propensity to using mind-altering substances. What there is not necessarily, however, is a natural propensity towards using such substances to the extent that one becomes addicted to them. (Bearing in mind that we are speaking very much in the general - different physiological makeups will obviously incline some people more towards addiction than others. This is also speaking in the wide sense of human behaviour, where choice and preferences are possibilities.)

The sentences quoted above are telling because they capture perfectly the very human nature of addiction. What I mean by this is that the individual in question was just one of a number of boys who were trying different drugs - he was, however, the only one who became an addict. This fact can undoubtably be explained to some degree by differing biology; but I would argue that the greater explanatory factor is the "pain of existence" that this one individual describes experiencing.

This importance of the individuals experience of the world, and their relationship to it, in the path to addiction is borne out by personal experience.

Firstly, I used a wide range of drugs frequently for years without developing any sort of unhealthy relationship with any of them. They were fun and I enjoyed them very much, but they took up no more of my life than the time that I was taking for fun and enjoyment. When I entered a paticular period of depression and hurt, however, I did quite quickly develop a reliance upon those substances that could make things seem better (or at least make me oblivious to everything, including the pain). This reliance could arguably be said to continue to this day, with a continuing bad situation going hand in hand with an unhealthy relationship to those chemicals that can make my reality seem just a little bit better.

Secondly, in my time working with injecting drug users, the one factor that linked all of the people that I had contact with was the desperateness of their situation, both before and after they started using the particular substances that they had become addicted to (whether this be alcohol, heroin, crack, or whatever). Their stories of growing up in Glasgow's worst schemes, in homes and communities saturated in violence and hopelessness, made it almost understandable that they had turned to chemicals to provide some release.

The stories of others who had not grown up in such environments, but who had experienced some massive upset in their lives that had made any hope seem alien to them, added weight to the idea that what was pushing people (including myself) towards dependance was not biology nor particular surroundings, but instead was this "pain of existence".

I do not remember speaking to a single person who had become an addict through simply an overdoing of their recreational usage (which is not to say that this cannot happen, just that it is not hugely common).

Addiction is a serious problem - it is not a criminal problem though. At some level it is a public health issue, and work that reduces the health impact of it is of vital importance and utilty. Fundamentally though, it is an issue of people's circumstances.

With people living existences berift of hope or typified by pain, that they are addicts is not a question of there being substances available that will remove them temporarily from this existence (such substances always have been available, and always will be); it is a question of these circumstances being allowed to exist in the first place, without any other mechanism through which they can escape them being practically available.

Removing this social and personal aspect - this human aspect - from discussions of addiction reduces the liklihood of either a rational discussion (for example is one sees the issue as some sort of moral/criminal one) or an effective approach to minimising the problem (if one sees the problem as a purely biological one, treating an individual's addiciton, but returning them to the circumstances that lead to the addicition in the first place). Similarly, making changes that make the treatment of addiction more available and that remove the criminal aspect to substance abuse will ultimately be futile if no efforts are also made to alter the world so that people do not have to grow up in environments that are empty of hope but are full of the pain of existence.

Trams and the monopoly of violence

Tuesday, October 21, 2008
Trams and the monopoly of violence

After foolishly not stamping my ticket upon boarding a tram a few nights ago (whether that was due to forgetfulness or my innate stingyness, I will leave open), I came to the attention of the roaving conductors.

At this point it should be explained that, unlike everywhere else I have been in the world, these conductors are not personable government employees; instead being extremely large private security contractors, from whom any sort compassion or pliability has been excised by a combination of illicit horse hormones and right-wing political views (although the former could just be me unfairly tarring all oversized skinheads in black bomber jackets with the same brush).

Those that I was with tried to talk my way out of the situation for me, but to no avail. Indeed, their explanation that I was from the UK and had only just arrived in the town merely lead to the guard asking to see my passport. Obviously I didn't have this on me - I have other forms of identification in my wallet, and so would never carry my passport on the off chance that I would have to prove my age or somesuch. Rather unexpectedly, the guard then began saying that he would have to call the police as it was illegal for me, as a foreigner, to be outside without my passport (by this time all four of the guards had gathered around to join in the fun, giving the impression of some sort of Kristallnacht barbershop quartet).

Handing over the €40 fine was, thankfully, sufficient to placate them, and we carried on to our destination, somewhat poorer, but with a valuable fund of things to moan about. The experience got me thinking, however, as it provided me with a direct experience (although admittedly a very minor one) of two, interelated, considerations that have excised me from a previously purely conceptual standpoint.

The main point is fairly obvious, and is as follows: The situation where one should be required to produce a particular item of identification upon request, and with apparently no real reason, with the threat of arrest should one not, cannot, in my opinion, be justified in a free society.

The second point is related to the first: The boundaries of the state should be sharply delineated, with its power being retained entirely within this strict demarcation.

Finally, discrimination between people based solely upon membership of some group is, with a few specific exceptions, wrong, and should not be government policy in any free society.

Obviously all three of these points need to be expanded upon and clarified for them to come close to being a defensible position, and I may try to do this in the future (especially the second point - which is something that I have considered in the past in relation to the use of private 'security' companies in Iraq etc). For the moment I am now the proud owner of a student card that entitles me to free transport, and so will be chalking the whole thing down to experience. Until the next time I'm asked for ID that is.

Interesting times

Friday, October 17, 2008
Interesting times

My description of the ancient Chinese curse "may you live in interesting times" was met by complete bafflement by YF today; followed by an even greater degree of bafflement as I tried to explain to her that it had probably originated in the imagination of some British writer in the 19th century. Wikipedia kind of sorted out the communication breakdown, but it could not, unfortunately, do anything to help the situation that had caused me to mention the curse in the first place.

Following the discovery of his illicit trip to China by the hospital administration, Prof. N. has resigned his position at the clinic. I must admit that my first response was to try and think of any occasion where I might have let slip that he was not in fact suffering from a sore knee (which in itself is a fairly rubbish excuse for two weeks absence, although maybe its very rubbishness was its [potential] genius), but was instead doing his cross-cultural selfhood thing in Beijing. I should have seen this coming of course - the idea that anything that I set out to do could proceed entirely smoothly is, apparently, ridiculous.

As he intended to leave the clinic around the time that his contract will now finish anyway I am not overly concerned about the impact on his plan in life, whatever that may be. It does, however, have the potential to influence the chances of being taken on by the Universities that he had been in negotiation with, which in turn influences where I will end up (obedient doctoral shadow that I am). This worries me. Quite what options are open to me should this turn out to be somewhere rubbish I don't know.

The blow of this news was tempered rather by the sight of a man in the street sporting a sublime mullet and moustache combination. Always speaking English in the lab can almost make me forget that I am living in Germany, but sights such as these bring it back to me in a most enjoyable fashion.   

I hold out hopes that my German classes will go miraculously and allow me to speak to the people around me, but deep down I know that this is unrealistic. The most obvious barrier to this is my inherent rubbishness at languages; but on top of that is my complete hopelessness at actually speaking to people, regardless of what language that might be in. Still, perhaps the relative anonymity of arriving in a new country will allow me to realise that I am allowed to be whoever I want to be, and so can overcome this crippling insularity.

Still, attending the German class has resulted in me meeting a few people, with varying degrees of success. Going for a pint with Tom was a welcome event; allowing me to meet MV, who will probably be useful contact (and although a bit of a dick in parts, and a minor enemy of Prof. N's, is probably fundamentally a good person to know). It also allowed me to strike The Lion off my list of pubs in Magdeburg to visit; although my loud explanation of neo-Nazism and the rise of the Right in Europe for Tom probably helped strike me off their list of welcome people anyway.

Most useful (that is the wrong adjective, but will do until we see how things pan out), however, has been my contact with Z - her invitation to an album launch night tomorrow evening is definitely a positive development. That it stemmed from my rather piteous description of my lonely circumstances is by the by. I do of course dislike myself for seeing it as an opportunity to meet the people that she knows and see if they are worth latching onto; but when one is newly arrived in a strange country surely such behaviour becomes less wrong? No? Besides such mercenary thoughts she is, of course, a charming girl (Woman? Lady? Is one meant to alter how one refers to others as time goes by? I am after all probably described as a man by unfamiliar others, regardless of the fact that my inner self continues in its teenage rut.) with whom I hope some form of friendship outwith the professional can develop. That this band evening clashes with the one other thing that I have been invited to is most unfortunate.

What I am writing has now definitely deviated from the title of the post and has become entirely uninteresting, and so I will stop.