Stop Manto

She's at it again (still?)

The Minister of Health of South Africa, Manto Tshabalala-Msimang, is trying her luck. She has put forward a bill apparently intended to improve the process surrounding the registration and certification of new medicines.

I have to put in my disclaimer here: I'm not an attorney, advocate or judge. I'm not a legal expert at all, and the sum total of my legal training was a course in copyright law at college. What follows is my reasonably well-informed lay interpretation of this piece of proposed legislation. I welcome any opinions or insights more enlightened than my own.

This bill is a pretty detailed document, encompassing a number of seemingly subtle changes to the existing legislation... some of which are potentially beneficial, many of which are very troubling.

I'll start with the good news.

The bill begins by redefining the substances that should be regulated as medicines. The definition has been expanded from only commercial pharmaceuticals to include just about anything about which medical claims are made, including foodstuffs and diagnostic machines.

This is good news because under this bill all quacks are subject to regulation just like real medicine is. Homeopaths, naturopaths, acupuncturists, sangomas, electrodiagnosticians, chiropractors, Danie Krugel, Matthias Rath and all other quacks will need to satisfy the same burden of proof as Adcock Ingram and GSK.

More good news is that efficacy is one of the items specifically listed by which any and all such interventions will be measured. In other words, the person seeking certification for their specific intervention will have to show, to the satisfaction of the registering body, that their gadget or pill does what it claims to do. If their product fails to be certified, they may not advertise it along with those medical claims.

I think this represents a remarkable step forward in consumer protection in our country. The same processes designed to protect the public from dishonest peddlers of pharmaceuticals is to be expanded to encompass anyone who claims that their magic product can cure a rainy day.

But as far as I see it, that's where the good news ends.

One of the primary aims of the bill is to change the whole process by which these products are regulated. It effectively dissolves the Medicines Control Council, and establishes a new office called the South African Health Products Regulatory Authority. This in itself isn't necessarily a bad thing. The problem comes in with how it's organized.

The Chief Executive Officer of the Authority is appointed by, and serves at the pleasure of the Minister of Health. There doesn't appear to be any formal selection process defined, other than an interview between the applicant and the Minister herself. This means that Manto gets to decide, all by herself, who she thinks is the best person for the job. That CEO is then responsible for appointing all staff and committees within the Authority, which means we have a single point of failure for the organization: the CEO. The CEO is accountable only to the Minister, and not to the general public or the scientific community.

It gets worse.

Assuming that by some fluke, Manto appoints a scientifically-minded and intelligent person to the position of Authority CEO, that person is still not the only one to decide if any given intervention should be certified or not. Once the CEO and his minions are ready to certify a given intervention, he must submit it to the Minister who has the right to exercise veto power over the application.

On the surface this may not seem like such a bad thing. Rather err on the side of fewer interventions making it through the process than getting false positives, right? Not so much.

Take this hypothetical situation as an example:

Big Pharma develops an HIV vaccine that has passed a great many clinical trials. The vaccine has demonstrated that it is safe (to within acceptable levels) and effective (also to within acceptable levels). It renders 95% of patients immune to HIV infection with minimal side effects. In other words, it's been proven to be a safe and effective intervention.

The CEO of the Authority is satisfied with the evidence presented along with the application, and approves it, sending it off to the Minister for certification. The Minister, being an ideologically motivated idiot with genocidal tendencies who believes that vegetables are a better treatment for HIV than anti-retrovirals, decides that she doesn't like the idea of an HIV vaccine, and rejects the application - thus sentencing millions of South Africans to a slow and painful death.

One need only run a Google News search on Manto to see that this hypothetical situation is far from unlikely. The fate of South African lives should not be left in the hands of any one person, least of all a stupid politician. (Not all politicians are stupid, but this one is)

The only way of making this approval process even close to effective is by employing a panel of qualified experts from a variety of medical and scientific disciplines, and submitting every request to a consensus-vote by them, not unlike the referee process employed by scientific journals.

Science, and particularly scientific medicine is not a matter of policy, politics or ideology - it is a matter of life and death. Can we, as a developing nation suffering under the weight of this deadly pandemic, stand by and allow these incompetent politicians continue to make decisions about whether our children live or die?

GHAAA!

"Leverage" is not a verb. It is a noun.

That is all.

More Number Portability Hijinks

In the previous episode, Provider A had invoiced me for a ridiculously large
"penalty fee", and I was awaiting a call from their support people.

The call never came.

On Friday night, I received an automated message from my bank to inform me
that Nashua Mobile (I'm done protecting them) had withdrawn over R4000 from
my account, despite the fact that I told them not to.

I was a little upset.

First thing on Saturday morning I went to the bank and reversed the payment,
after I left a steaming comment on www.hellopeter.com (search for it).

This morning I got en email from someone claiming to work in the office of
the Managing Director of Nashua Mobile. If I was the MD I would be pretty
embarrassed about the spelling and grammar being used on my behalf. But I
digress.

This person was about as helpful as everyone else at Nashua Mobile has been
to me lately: not at all. He pretty much continued to treat me like a
naughty child, and didn't provide any evidence supporting his claim. He
tries the old "It's not us, it's the Network Provider" bait and switch, but
I'm not buying it. I'm still with the same network, just a different
middle-man. Why would my network want to punish a loyal and long-standing
subscriber for wanting to switch middle-men?

It would be like Coca-Cola charging me a fine for buying my Coke from Pick
'n Pay instead of Shoprite. It's just plain stupid. Of course it's possible
that MTN really is that stupid, but I think it's more likely that Nashua is
trying to pull a fast one.

I informed him in no uncertain terms that he was to provide me with all the
supporting documentation, as well as the recordings of all the conversations
I've had with his minions over this issue. It's only been about six hours
since then, and no response yet. I guess not everyone checks their email
more than once a day. least of all marketing people in the
telecommunications industry.

As I said, I've lost my patience with this ridiculous situation. Either they
must produce proof that I really am obliged to pay them this amount, or they
must give up.

Lexicon for Debate

One thing I particularly enjoy is having discussions around differences in world-view. It affords me an opportunity to formulate and clarify my own point of view, and also to practice the art of debate. But I've noticed a particular obstacle that tends to get in the way of meaningful discussion, and that is the variable definitions of words.

Discussions of this nature tend to employ a number of words that have similar or related meanings, to the extent that in everyday conversation those words are often used interchangeably. The problem is that the English language (as described by your average dictionary) isn't precise enough to differentiate between some of these complicated concepts reliably.

The result of this tends to be that the participants in the debate end up talking at cross purposes, which is essentially a failure in communication. No meaningful discussion takes place if the two debaters are using different definitions of the same words.

In order to facilitate the most effective and productive debate, it's necessary for the participants to agree on a set of definitions first, so that each may be certain the other understands what they are saying. This almost never happens, since just about everyone assumes that since they have
a language in common, that work has already been done. It hasn't.

What I would like to do here is propose a basic lexicon for these kinds of discussions. I aim to employ this lexicon (or one like it) in my own debates, but what I put forward here is only a guideline - a starting point. Any given discussion or any given debating partner might require some modifications to this list, and that must be discussed and agreed at the outset of any debate. Please feel free to use it yourself and modify it accordingly.

These definitions are based on those that tend to be employed by people in the scientific, sceptical and atheist communities. I like these because they are very specific - much more so than those found in the Oxford Dictionary.

Without further ado, the words:

• Believe: To hold an opinion that a given idea is true. Belief in an idea is not necessarily dependant on evidence, but it may be informed by it.
• Faith: To hold a belief without evidence or in spite of evidence to the contrary.
• Trust: To have a high degree of confidence in the reliability of an idea.
• Know: To be certain that an idea is true.
• Theory: An idea that is supported by evidence and makes specific, testable claims which have been validated by experiment and peer review.
• Hypothesis: A precursor to a theory - an idea that provides some explanatory power to a given phenomenon, along with testable predictions, but may or may not have been validated by evidence yet.
• Fact: An observed phenomenon.
  
• Science: The best system of obtaining knowledge yet discovered. It is performed by generating a hypothesis, testing its claims and collecting evidence. In science the rigour of the process is more important that the conclusions it produces, and all conclusions are perpetually provisional, pending the discovery of contradictory evidence.

Those are the ones I come across most often. There aren't many, but these are some pretty important and complicated concepts. To mix up definitions of these words is to invite miscommunication.

Do you have some suggestions on how to improve these definitions? Can you think of any other words that should be added to this list?

What, ME? Worry!

This is the second in the series of medically themed posts that I will be venturing. This time, instead of focusing on a bogus intervention, I'll be looking at what is largely a bogus diagnosis: Myalgic Encephalomyelitis AKA Chronic Fatigue Syndrome.

Before I begin, I want to remind you that I am not a qualified physician. I'm just a blogger with an interest in science and a fairly good baloney-detector. My comments here should not be taken as medical advice, but rather as something to think about. If you have any questions about this, please consult your doctor. And by "doctor", I mean your MD, not your Homeopath, Accupuncturist, Dietician or Reflexologist.

Myalgic Encephalomyelitis (ME) is a poorly understood disorder that makes life pretty difficult for a great many people. As the alternate name 'Chronic Fatigue Syndrome' suggests, it manifests itself in the form of severe and ongoing tiredness, often associated with some sort of mild respiratory distress.

You're probably thinking "Hey, I'm tired all the time, and I had that cough the other day... maybe I have ME!"
And this is exactly the problem.

These symptoms are so common that many physicians call them "symptoms of life". In other words, they are states that everyone experiences from time to time as a simple result of possessing a human body. This is what makes ME so difficult to diagnose. But it's the very vagueness of the symptoms that makes it easy to misdiagnose. And anyone who has only a passing familiarity with the condition can easily mistake a slight cold, bronchitis or even depression for ME.

Enter the quacks.

Because the symptoms of ME are so common amongst other lesser pathologies (or no pathology at all), CAM practitioners (Complimentary and Alternative Medicine practitioners - also known as "quacks") have a perfect opportunity to move in and exploit a fancy-sounding term. Quacks like words with lots of syllables: they scare customers (note, I said "customers", not "patients") into spending money on all manner of quack remedies in order to clear that horrible word from their psyches.

How does this happen?

Let's say Jane Doe is feeling really tired. She feels exhausted most of the time, and often has coughs or sniffles. Her friend, who once had similar symptoms, tells Jane that she may have ME, and recommends her favourite quack. Jane visits the quack, and after waving his magic stick around, he tells her that she does indeed have ME. He gives her some magic water, pricks her with magic pins or tells her to change her diet unnecessarily and sends her on her way. A week later she feels much better.

So what happened?

What I didn't tell you at first is that Jane is in her mid thirties, has three children and runs her own business. Her daily stress-levels are pretty high, and it's been years since she's gotten a good night's sleep. The reason Jane was tired all the time was not because she had anything physically wrong with her, she was simply a victim of the stressful society she lived in. She was tired all the time because she was tired all the time! Coughs and sniffles happen to everyone.

When she received her magic intervention, she believed she was receiving good treatment for an actual physical problem. Once she believed the physical problem was fixed, there was no more need for the symptoms, and she expected to start feeling better, Because she expected it, she started feeling better. Thus she was miraculously cured of a condition she never actually had.

So what's the harm?

In our example, Jane Doe was having a hard time of life. She saw a service provider who sold her a product that made her feel better. She was "cured". So what if the quack used some fancy words and bogus treatments? The end justifies the means, doesn't it? Well yes, in cases like Jane's it probably does. And that's fine. The problem is that not every case is like Jane's.

What about Jack who is suffering from depression? He feels tired and ill all the time because he's depressed, but he lacks the ability to self-diagnose. So he hears a buzz-word and seeks treatment for a condition that isn't the one he's suffering from. The placebo affect alone might be enough to get him over his depression, but what if it doesn't work? Jack is likely to fall even deeper into depression because he has an apparently incurable disease.

Or what about Stacy who is suffering from something even more dangerous like Insulin Resistance? Stacy feels tired and ill most of the time, receives a quack treatment for ME and convinces herself to feel better. In the mean-time, Stacy's undiagnosed and untreated Insulin Resistance turns into full-blown Diabetes and Stacy's life is changed forever. If Stacy had visited a real doctor instead of an Electrodiagnostician, she may have been able to treat the Insulin Resistance before it became a problem. But she spent unnecessary time and money on useless nonsense interventions, and fell victim to the fraudulent marketing messages of quackery.

And there's another class of victims here: the few people who are genuinely suffering from ME. What if such a person were to visit a quack, who honestly (albeit incorrectly) believes that he can treat their condition. They pay over heaps of money for bogus therapy that does nothing for their condition. Such a person, who, under the influence of such a debilitating condition, would find it difficult to earn a living, and would therefore be at the mercy of whichever ineffective practitioner they selected to help them with their problem.

Conclusion

ME is one of a number of actual pathologies that have come into fashion with the quack movement. The quacks latch onto the current fad diagnosis and ride it for all it's worth, until the public becomes too well informed, Oprah's producers decide it's not helping their ratings anymore, and the next fad begins.

The positive feedback loop part of the cycle is currently in full effect for ME. Hopefully in the coming months, real information about the nature of this illness will start to become more widely known, and quacks will have to find a different fancy word to hang their hats on. When that happens, we'll be waiting to expose that one too.

Part 2 of the Number Portability Saga

As I reported several weeks ago, I underwent to port my number from one service provider to another.

This is what has happened so far. (Names of the companies concerned are hidden to protect the innocent... for now)

My contract with Provider A was set to expire on the 25th of June. This is a little ambiguous. Does that mean that from the 25th of June it is no longer in effect, or does it mean that after the 25th of June it is no longer in effect? None of the documentation I had provided any clarity on that question.

So, in the first week of June I called Customer Support at Provider A to find out how to go about porting my number to Provider B. Provider A told me that all I had to do was sign a form indicating my intention to port, and to fax the signed form back to them before signing my contract with Provider B.

This raises an interesting question: Provider A is a telecommunications company that claim to pride themselves on their Internet solutions. Why, then, would they insist on a fax, as opposed to a scanned email? I asked. A scanned email wasn't even an option. No explanation was given. This is not surprising, and this level of service is why I decided to leave Provider A to begin with. But I digress.

To be sure, I called Customer Service at Provider B and asked them the same question. They gave me a similar answer... that all I needed to do was inform Provider A of my intention to port, and it would magically happen. Also that I should wait until closer to the time to process the documentation.

Awesome.

So, on Friday the 20th of June, I got my forms ready. I had the port notice to Provider A printed, I signed it and had it faxed to their offices. I then went to Provider B and signed up for my new contract. Provider B told me that when the port went through, I would be notified to come in and fetch my new phone.

On Monday the 23rd, Provider A called me. Probably for the first time ever. They informed me that if Provider B pushed the number port before my contract with Provider A expired on the 25th, I would be liable for a R4000 penalty to ICASA.

I made it clear that I was not happy about not having been informed about this little detail beforehand, but that I would contact Provider B and ask them to delay the port, if possible. I contacted Provider B, and they told me that the process had already been set in motion, and could not be stopped. But that it usually took several days to process, so it shouldn't be a problem. I then sent Provider A an email to their Customer Service department informing them that I was not able to change the date of the port, that I was not happy about this lack of information, and that under no circumstances would I pay any penalty. I have yet to receive a response to that email.

On the morning of the 25th I awoke to find my old phone no longer working. This was good news, as it meant my old SIM card had been deactivated, and I was to go to Provider B to fetch my new one. So I did. And it is awesome. But that's a story for another post.

Since then I haven't heard a peep from either Provider A or B until last week. I received an automated text message informing me that my last month's phone bill was payable, and the amount of it... which was considerably less than a normal month, which told me all was well with the world. Until yesterday.

Yesterday I received an automated email from Provider A informing me that my electronic statement had been issued. Guess what I saw on it. R4000.

So I, once again, wrote an email to their Customer Services department informing them that under no circumstances would I pay it, and that they were to adjust the balance on my account.

So far no response. It will be two weeks before the automated debit order deducts the money from my account. If I haven't heard from them by Monday, I'll cancel the Debit Order. I'm going to assume that this has been a simple clerical error. I'll give them the benefit of that doubt and see whether or not they cooperate.

If they don't, you guys will be the first to know. Stay tuned!

Knock it off!

Over the past few weeks, two of the videos in my Homeopathic Suicide Attempt series have been flagged as inappropriate by YouTube users.

Fortunately none of them have yet been taken down by YouTube, and well they shouldn’t, because I haven’t violated their terms of use.

But it’s curious that some folks out there think it’s necessary to flag them. I wonder why.

Is it because of the “suicide” in the title? If they watched the videos, they would see that in fact no suicide takes place... that despite my best homeopathic efforts, I am still none the worse for wear.

Is it because the videos are depicting drug abuse? Again, watching them should tell you that I didn’t actually take any drugs. All I took was 48 placebos!

So, that leaves me with two hypotheses:

1. People watching the videos think they’re so awesome that they try to mark them as Favourites, but click the wrong button by mistake.
2. People are somehow ideologically offended that I would deign to debunk the world-wide fraud that is homeopathy. Because they’re offended, they assume that I must be breaking a rule somewhere, and they flag it as inappropriate in the hopes that I am. (I’m not).
   

I prefer Number 1. Which do you think it is?

Electrodiagnosis

I tend to shy away from posts dealing specifically with medical topics and quackery. I have no medical training of my own, so I have little option but to rely on the expert opinions of others when dealing with it. The only notable exception being my recent suicide attempt, which I could conduct in the safety of my own home.

But it seems that this is a side of scientific scepticism that I can't, in good conscience, continue to avoid. People in my life are being harmed, to varying degrees, by various forms of medical quackery. I, as an outspoken sceptic, can't continue to stand by and watch it happening around me.

So, in the interests of furthering this objective, I present to you what will be the first in a series of medically themed posts. I would like to stress very firmly that I am not a doctor. I have no formal medical training in anything more complicated than first aid, and you should always consult your qualified physician before taking any actions that could affect your health. All I claim to have is a wealth of knowledge that I have accumulated from various expert sources that I believe to be credible. I leave it to you to judge the reliability of those sources for yourself, but I urge you to carefully consider my arguments before disregarding them.

As the title of this post indicates, I want to start this series by discussing Electrodiagnosis.

Electrodiagnosis has more names than I could possibly list here, and there appear to be more of them popping up with increasing frequency. The name under which I first encountered it was SCIO (although SCIO seems to be an acronym, I couldn't find what it's supposed to stand for. Please let me know if you happen to have that information). But it can appear in the form of just about any random combination of pseudoscientific buzzwords you can imagine: Quantum Testing, Allergy Resistance Meter, Bio-feedback Agency Detection... you name it.

The concept is the same throughout. Electrodiagnosis practitioners employ a device called a galvanometer to measure slight variations in the electrical conductivity of the human body. A similar mechanism is employed in some lie detectors (and even by the Church of Scientology), as the galvanic response is affected by autonomic nervous system activity.

The Electrodiagnosis paradigm dictates that medical diagnoses can be made by measuring these galvanic responses. They will often refer to specific pathologies "vibrating" on particular "frequencies" which they can detect using their device. This is, of course, a meaningless statement. By saying this, they are trying to invoke the New Age definition of energy, which is inaccurate and misleading. When someone uses "energy" as a noun on its own, and not as a property of matter (in terms of E=MC²) then what they are really describing is magic.

A galvanometer can only detect galvanometric effects. It cannot detect mystical vibrations, and it certainly cannot detect magic.

After "diagnosing" your illnesses, the Electrodiagnostician will probably employ a number of other quack diagnostic techniques such as applied kinesiology, remote viewing, aura reading or waving of hands in order to "confirm" their diagnosis. They will then go about prescribing any number of interventions to treat those illnesses, such as homeopathy, acupuncture, chiropractic, aural cleansing, ear candling, detox footpads, colonic irrigation, reflexology, dietary restrictions, happy thoughts or pixie dust.

In other words, they use a machine incorrectly to derive a bullshit diagnosis. They then treat the bullshit pathology with bullshit medicine. And who suffers? You do... because the only thing they have actually succeeded in doing is surgically removing your money from your wallet.

For the most part, this is yet another money-making scam that doesn't represent much physical danger to the victim. To some true believers who are suffering from psychogenic or psychosomatic problems, the placebo effect may be sufficient to make them feel all better. For those people's sake, this sort of thing is just fine.

But then there are the exceptions... the true believers with actual medical problems that require actual medical treatment. These are the real victims of quackery. They are the ones who delay seeking valuable (sometimes life-saving) medical intervention by seeking out these "alternatives" instead.

I've said it many times before, and I'll say it again: there is no such thing as "alternative medicine". There is medicine and everything else. If electrodiagnosis worked, it would have become part of "mainstream" medical practice ages ago. But it doesn't, so it hasn't.

Let's call Electrodiagnosis what it really is: quackery and fraud.

For more detailed information on Electrodiagnosis, take a look at Dr Stephen Barrett's treatment of it over at Quackwatch.

Have you encountered this scam before? Tell us about your experience in the comments!

I Endorse Things!

Wow! It's been a pretty momentous week over here at Universe HQ. In the space of a week I received two requests for endorsements! I've never been asked to endorse anything before, so who am I to refuse?

Firstly, in response to the recent spate of xenophobic violence that has plagued informal settlements here in South Africa, I've been asked to endorse immigrant amnesty.

This is a tough one. On the surface I like the idea, but it does raise all sorts of questions when it comes to enforceability, border control, administration and that sort of thing.

So while I'm thinking about whether or not I think it's a good idea to endorse it wholly, I suggest you guys hop over to Constant Flux and see what Gustav has to say about it. Let me know what you decide!

The second thing I've been asked to endorse is consumer producty! Awesome!

As you all know, I'm a sucker for an amusing and sarcastic T-shirt. And if that T-shirt also happens to portray a message that coincides to some extent with my world-view, so much the better! Well to my delight I learned that the guys over at Agnostees.com have produced a line of T-shirts (and other goodies) that do just that! Hooray!

So go check it out, and please feel free to buy and send me T-shirts. It's my birthday soon, guys!

Number Portability

Today I am fearlessly embarking on a journey: I will attempt to port my number from one cellular operator to another.

I know it's possible, but I don't know anyone who has actually done it. I've heard tales of brave adventurers who have tried and failed. But I will succeed where they have not! And you, my beloved readers, will witness it second-hand! Lucky you!

I have been with my current cellular provider for six years now. I originally went with them because they were the only provider at the time who would offer me the handset I wanted (the Nokia 6310) on the package I wanted without having to pay extra.

For most of that time, they've been pretty good to me. But in the last year or so their service levels have gone into a steep decline. I wasn't the least bit surprised to learn that they had rescinded their early upgrade policy that would, under normal circumstances, have allowed me to replace my Nokia 6680 with the Nokia N95 six months ago. Now that my upgrade time has come at last, they are still unable to offer me the Nokia N95 8GB at a reasonable price, so I am left with little option but to take my business elsewhere.

So, I am moving on.

But the fact that I have had the same number for the last six years has made me reluctant to change it now. Those folks who change their numbers every few years annoy me no end. I refuse to be one of those people!

No, I will be brave. I will go where angels fear to tread. I will slay the dragon of number portability!