Square One   …travelling but never arriving

Can we trust traditional peer review? If it’s broken, how might we fix it?

Former BMJ editor Richard Smith, Medscape founder Peter Frishauf, peer review researcher Liz Wager, health policy researcher Alex Jadad, and computer scientist Thomas (Bo) Adler discuss peer review in this podcast by the Journal of Participatory Medicine (JPM).

This stimulating discussion follows two interesting articles on the subject in JPM’s inaugural issue: In Search of an Optimal Peer Review System, by Richard Smith, and Reputation Systems: A New Vision for Publishing and Peer Review by Peter Frishauf.

The podcast and its transcript can be downloaded here.

Muza Gondwe from Malawi is presently on a six-month fellowship at the Centre of African Studies on the Public Understanding of Science in Africa in Cambridge. She writes on BMJ Blogs about her project which seeks to develop ways of engaging science through communication in Malawi and to identify and celebrate distinguished black African pioneers of science. She was motivated to do this after reading these:

“It will be seen that when we classify mankind by colour, the only one of the primary races, given by this classification, which has not made a creative contribution to any one of our twenty-one civilizations is the Black Race.” – Dr. Arnold Toynbee, The Study of History, Vol. I, page 233. (Vol I: Introduction; The Geneses of Civilizations (Oxford University Press 1934).

“[I am] inherently gloomy about the prospect of Africa” because “all our social policies are based on the fact that their intelligence is the same as ours – whereas all the testing says not really.” James Watson, in 2007 in an interview with the Sunday Times.

And what does she find?

In my investigation I have learnt some startling facts: no black African has won any of the Nobel prizes in science; the UK has six times as many researchers as Sub-Saharan Africa; and, according to the Mathematicians of the African Diaspora (MAD), 0.1% of the total number of mathematicians in the world are of black African heritage.

The full post is here.

Muza Gondwe’s personal blog, “Communicating science, the African way” is here.

Richard Lehman’s Journal Blog on BMJ points attention to this wonderful JAMA article on nutrition this week. In Richard’s words, “this one-and-a half-page commentary article contains more sense than most large books on Clinical Nutrition.”

Here is an excerpt:

Body weight remains stable as long as the number of calories consumed equals the number expended through physical activities and metabolic processes. When energy intake increases above expenditure, the excess is used to build new tissue, and weight gain results. However, weight gain does not continue indefinitely. Carefully controlled overfeeding experiments show that calorie expenditure increases progressively because of the energetic costs of maintaining the newly created tissue.

A person who consumes an extra cookie every day will initially experience weight gain, but over time an increasing proportion of the cookie’s calories will go into repairing, replacing, and carrying the extra body tissue. After a few years of daily cookie eating, weight gain will level off at approximately 2.7 kg. Thus, a one-time step-up in caloric intake will cause body weight to increase asymptotically to a new, stable level.

The converse occurs when an individual reduces food intake. As body size diminishes, so does the amount of fuel needed to maintain and move it, and weight settles at a new steady level. In addition, weight loss produces changes in hormones, the autonomic nervous system, and the intrinsic efficiency of muscle that serve to conserve energy. Therefore, additional weight loss can only be achieved by a more severe diet or a more arduous physical activity routine. Most individuals do the opposite: after having achieved some weight loss, they resume their original diet and exercise habits. Consequently, weight gain recurs rapidly.

The body indeed does have a remarkable ability to keep itself “stable”; a huge evolutionary advantage for any species that is so endowed! The full article is here.

It is itself a surprise to me that we are responding to the issue of the alleged Nigerian suicide bomber/terrorist as if it was totally unpredictable. We want to condemn it, we are disappointed by what Umar is alleged to have done and the added shame and disrepute that has brought upon Nigeria, but it would be wrong to suggest that there are no fundamentalist strains in Nigeria. They abound.

The recent Boko Haram incident, and the way muslims in Northern Nigeria reacted to the 2005 Danish cartoons of Prophet Mohammed (PBUH) by setting churches on fire suggest that we must have been breeding this kind of people, and we are probably more capable of breeding them with possibly little outside influence than we presently imagine.

A series of troubling but interesting events happened in close succession, within the space of two years, when I was a student at Obafemi Awolowo University, (OAU) Ile-Ife. For those who are not very familiar with Nigeria, OAU is arguably the most Yoruba and also possibly the most politically active and intellectually progressive of Nigerian universities.

Obafemi Awolowo Hall (popularly called Awo Hall) is well known as the most politically active, hilarious, fun loving and liberal residential hall within the university. Awo Hall also has a long standing tradition, dating back about twenty years or more, of the free screening of pornography videos in the hall’s TV Room every Friday evening. There is incidentally a make shift mosque just across the lawn from the TV Room in what used to be the kitchen attached to a dinning cafe where students used to eat when the Nigerian government provided free food for university students. The tradition of Friday evening porn predates the existence of the make shift mosque, which according to the university was even an illegal creation in the first place. Suddenly one Friday evening the leaders of the Muslim group in the hall stormed into the TV room and seized the DVD player. The incident eventually degenerated into a free for all fight that resulted in a two-week university closure.

There was another occasion when a girl was beaten up for dressing “inappropriately” while visiting the hall (Awo is a male residential hall). The muslim brothers retreated into the mosque after the onslaught and they wouldn’t allow anyone who wasn’t a muslim to approach for questions and a demand of apopogy. They held sticks and other weapons, prepared to attack the uninvited. It was strange and scary. I had to step in, having been a rather good friend of the Awo Hall mosque as I had been spotted entring the mosque to take part in prayers, and having subsequently attracted a couple of the more senior members of the mosque who tried to convert me to Islam, albeit unsuccessfully. Thankfully, we were able to get them to apologise in the long run, an act that eventually that brought the mattter to rest.

A third one occured when a girl was married off to a fellow student by fellow students within one of Mosques in the university without the knowledge of either party’s parents. The girl subsequently decided to cut off all communication with her family. After several weeks of failed attempts at reaching her, the girl’s parents had to visit the university to confirm what had happened to their daughter. She had been transformed from a regular muslim lady to one that covers her face, she was already pregnant and she wasn’t going to see her parents when they eventually visited.

I once had a “friend,” a Nigerian who told me that he would kill me in the event of a holy war! He wasn’t joking.

Mild as these incidents were, what they show is that for these to happen in the liberal south, at the very bastion of southwestern Nigeria liberalism, you can imagine what possibly goes on in the north where some states already practice the Islamic Sharia legal system.

I don’t think that Umar did what he is alleged to have done simply because he is from a rich, privileged family or from northern Nigeria. He simply had good access to radicalising influences, or is it the other way round? There are thousands of Nigerians, I’m sure, who would go the same way if only they had the same kind of access Umar Farouk Abdulmutallab had, and we should not be oblivious of this important fact as we discuss this unfortunate incident.

It can’t take a joke,
find a star, make a bridge.
It knows nothing about weaving, mining, farming,
building ships, or baking cakes.

In our planning for tomorrow,
it has the final word,
which is always beside the point.

It can’t even get the things done
that are part of its trade:
dig a grave,
make a coffin,
clean up after itself.

Preoccupied with killing,
it does the job awkwardly,
without system or skill.
As though each of us were its first kill.

Oh, it has its triumphs,
but look at its countless defeats,
missed blows,
and repeat attempts!

Sometimes it isn’t strong enough
to swat a fly from the air.
Many are the caterpillars
that have outcrawled it.

All those bulbs, pods,
tentacles, fins, tracheae,
nuptial plumage, and winter fur
show that it has fallen behind
with its halfhearted work.

Ill will won’t help
and even our lending a hand with wars and coups d’etat
is so far not enough.

Hearts beat inside eggs.
Babies’ skeletons grow.
Seeds, hard at work, sprout their first tiny pair of leaves
and sometimes even tall trees fall away.

Whoever claims that it’s omnipotent
is himself living proof
that it’s not.

There’s no life
that couldn’t be immortal
if only for a moment.

Death
always arrives by that very moment too late.

In vain it tugs at the knob
of the invisible door.
As far as you’ve come
can’t be undone.

By Wislawa Szymborska
From “The People on the Bridge” 1986
Translated by S. Baranczak & C. Cavanagh from the Polish

Futurology is at best systematic guesswork, and at worst facile hubris. “Prediction is very difficult, especially about the future,” Niels Bohr (1885-1962) once quipped, but if you think about how successful science-fiction has been, you might be tempted to take Bohr’s piece of wisdom with a grain of salt. Is it really so difficult to predict the future?

HG Wells (1866–1946), one of the earliest writers of science-fiction, most popular of which were The Time Machine (1895) and The War of the Worlds (1898) made many predictions in his life time. He wrote his  most clearly and decidedly futuristic work, “Anticipations: An Experiment in Prophecy” (1901), where he predicted what the world would be like in the year 2000.

He got it right that trains and cars would result in population dispersal, that there would be much greater sexual freedom, that Germany will be defeated, and there would be a European Union. Expectedly, there were many misses: he said there wouldn’t be a successful aircraft before 1950, and that there would never be a successful submarine. For one of the fathers of the science-fiction genre, you expect it would be the other way round.

There was one more thing, partly scientific, he did get right though, which I think he is not being given enough credit for: the Internet, and the eventual creation of Wikipedia. Of course, he didn’t use the Wiki word, but his accuracy was stunning. The following are excerpts from his contribution to the new Encyclopédie Française in 1937, titled “World Brain: The Idea of a Permanent World Encyclopaedia,” reissued in a separate volume World Brain:

A microfilm, coloured where necessary, occupying an inch or so of space and weighing little more than a letter, can be duplicated from the records and sent anywhere, and thrown enlarged upon the screen so that the student may study it in every detail.

This in itself is a fact of tremendous significance. It foreshadows a real intellectual unification of our race. The whole human memory can be, and probably in a short time will be, made accessible to every individual.

Its uses will be multiple and many of them will be fairly obvious. Special sections of it, historical, technical, scientific, artistic, e.g. will easily be reproduced for specific professional use. Based upon it, a series of summaries of greater or less fullness and simplicity, for the homes and studies of ordinary people, for the college and the school, can be continually issued and revised.

In the hands of competent editors, educational directors and teachers, these condensations and abstracts incorporated in the world educational system, will supply the humanity of the days before us, with a common understanding and the conception of a common purpose and of a commonweal such as now we hardly dare dream of.

This concisely is the sober, practical but essentially colossal objective of those who are seeking to synthesize human mentality today, through this natural and reasonable development of encyclopaedism into a Permanent World Encyclopaedia.

If you substitute ‘computer’ for ‘microfilm’, what you have is the internet, and the makings of Wikipedia. There is however another of Wells’ scientific predictions, published in World Brain where he predicted that for an educated citizenship in a modern democracy, statistical thinking would be as indispensable as reading and writing.

Unfortunately, here is another HG Wells prediction failure, one that I would wish above all other scientific predictions was successful. Prediction has always been hubris.

Two weeks ago, it was reported that Arsenal FC (Competing Interest: I am a committed Gunner!) striker Robin van Persie would be traveling to Serbia to see Belgrade-based healer Marijana Kovacevic (Marianna the Therapist) for the horse placenta treatment of his ankle injury that has pretty much, amongst other things, destroyed the season for Arsenal. Frank Lampard, Yossi Benayoun, Albert Riera, Fabio Aurelio and Glen Johnson have also tried her out following reports that Serbia forward Danko Lazovic had been cured faster than expected by the massage that involves fluid from horse placenta.

Kamran Abbasi begins his editorial in this month’s issue of the  Journal of the Royal Society of Medicine titled “The Year of the Horse Placenta” by writing, “We are in the Chinese year of the ox but in the UK this could end up being the year of the horse placenta,” and later says, “This fashion for horse placenta therapy shows how the world of medical science is quickly marginalized by more powerful arguments of politics and money. Here the concern is league position and money, money and television rights deals.”

He ends by reminding us that Bertrand Russell once asked whether it was possible for a scientific society to exist, or if such a society must inevitably bring itself to destruction. In Kamran’s words: “Perhaps he should have asked a simpler question: ‘Is it possible to create a scientific society?’”

I still remember the shock when I realised that the practice of homeopathy was funded within the National Health Service (NHS) in England. I was taking a lunchtime stroll when I came across the Royal London Homeopathic Hospital, which as it turned out was one of the hospitals within the UCL Hospitals NHS trust, which also included the hospital to which the Institute of Neurology where I was studying at the time was affiliated. I almost felt ashamed.

It was particularly shocking because the United Kingdom does have a reputation for science and rationality that is hardly equalled elsewhere in the world. The experience however made it less shocking for me when I got to Sydney, Australia and found lots and lots of alternative practices, with all sorts of interesting and grand names, structured to deceive and confuse with legitimate science. However, I doubt that like in the UK, any is funded from the public purse of Australians.

Two weeks ago, I met a black woman from Jamaica (although born in London and raised in Auckland). She was the first black person I walked up to and spoke with in Sydney, and the first and only person ever to have referred to me as ‘brother’ in the restricted black folk sense of the word. It was rather strange. I had never been a ‘brother’. There are not many in Australia.

We got on the bus together. She had studied ‘alternative/complimentary medicine’ in her youth and had also received training in homeopathy. Much of the rest of the trip was spent discussing the claims of homeopathy, during which she argued that homeopathy was much like vaccination. I was so mad, but out of courtesy I had to change the topic immediately. It reminded me of Raymond Tallis‘ 2007 Sense about Science annual lecture where he said:

…and this is how it is with junk science that borrows the terminology of science, without any sense of its true meaning, and of the massive interconnected hinterland of facts and concepts and even uncertainties behind them.

…and so we have treatments such as ‘reflexology’ which expropriates a well-established, indeed central, concept in biological science, and uses it to label treatments that have no biological foundation whatsoever.

…and ‘homoeopathy’ which, being in Greek, one of the languages of science, sounds very scientific but is based on magic thinking that would shame a six year old child.

…they domesticate terms by uprooting them from a complicated nexus of hard-won concepts.

Whenever I see those Sydney shops or offices, what comes to mind is how successful alternative medicine practice/movement is in Nigeria as well, and how they feed on pretty much the same sentiments. I reckon it must indeed be a universal phenomenon. Thankfully, we are not yet at the stage where the Nigerian government will fund an alternative medical practice, but I bet we are not that far either. I am almost certain of it that the movement will soon have a ’scientific’ arm made up of people trained as much as to be able to throw terminologies around but not quite as much as to have any deep, nuanced understanding of them.

Here is an excerpt from an advertorial on the popular Doctor Akintunde Ayeni of Yem-Kem International Nigeria Limited:

…he [has] invested resources – time and money to visit renowned herbal homes in India, China, Australia, Japan and Pakistan. In similar vein, [practitioners] of alternative therapy in those countries visit him, here in Nigeria, to exchange notes. The result of these research efforts is manifested in the emergence of our three products namely (1) Blood Cure, which a blood purifier and immune boosting herbal medicine (2) M & T Capsule which is an effective herbal medicine for all chronic fever and (3) Energy 2000 which is a powerful herbal medicine for sex ability deficient patients.

The words again: ‘research’, ‘immune’, ‘capsule’, ‘doctor’, ‘discover’, et cetera. It is also interesting that Australia has its place among the visibly oriental countries that Akintunde Ayeni has visited.

John Diamond, who before his eventual death had his hopes of cure from cancer falsely raised by several alternative medicine practitioners did put what would be my summation very beautifully: “There is in reality no such thing as alternative medicine, just medicine that works and medicine that doesn’t…There isn’t an ‘alternative’ physiology or anatomy or nervous system any more than there’s an alternative map of London which lets you get to Battersea from Chelsea without crossing the Thames.”

So how do you define medicine that works? Well, the same way that Artemisinin made its way from the fields of central China to clinics everywhere chloroquine resistant Malaria is treated.