Neuroskeptic Irreverent and Sometimes Profane, Study Finds

I was most surprised and honored to find out this morning that the Annals of Neurology has declared Neuroskeptic to be

Irreverent, sometimes profane, and can skirt the boundaries of good taste. Nonetheless, Neuroskeptic covers a rich mixture of important, engaging, or amusing topics focusing on the basic and clinical neurosciences, and does so in a data-driven, user-friendly, and comment-enabled format. Neuroskeptic is only one of a number of increasingly used web sites and blogs dedicated to promoting public education, rational discourse, and a healthy dose of skepticism around important issues in the neurosciences...

No really: Scientific literacy and the media. They also list a small number of other neuroblogs, although they leave out many outstanding ones including the blog that most inspired this one, and that everyone confuses me with, The Neurocritic.

Anyway, the editorial goes on to note that:

Last April, a series of sensationalist stories reporting the “creation of life” and a newfound capability to “play God” appeared in the national media following the demonstration that synthetic DNA could transform a mycoplasma species from one to another subtype(ref). This represented a tour de force of DNA synthesis, but probably only a modest step forward for the science of genetic engineering.

In response, President Obama directed his Presidential Commission for the Study of Bioethical Issues to prepare a comprehensive advisory report to help frame policies about synthetic biology(ref).

The Commission noted that sensationalist headlines may attract readers to scientific topics but do a terrible disservice by promoting “claims that fail to convey accurately to the public the current state of the field, the implications of research results, and the limits of scientists' present knowledge and abilities.” The Presidential Commission recommended creating a well-funded, interactive website... to monitor claims about new scientific discoveries and technologies.

Ideally, such a site would be only part of a wider effort to promote scientific literacy and critical thinking across all segments of society... In the coming years, scientific innovation is certain to play an increasingly large role in the global economy... The public discourse on these and related matters needs to be rational, evidence-based, and accurate.

Broadly speaking, this is why I write this blog, because it is indeed extremely important. Well, ok, the real reason is that it gives me an excuse to make funny pictures with MS Paint (someone accused me of using Photoshop to do those once - no, that would be too advanced). However, if a few people understand neuroscience a bit better in the process, I can live with that...

Hauser, S., & Johnston, S. (2011). Scientific literacy and the media Annals of Neurology, 69 (3) DOI: 10.1002/ana.22410

British Government Fails Maths, Economics

The British government has decided to change the way English universities are funded. They say that this will improve teaching quality; I doubt it. Worse, however, is that the new scheme, the stated justification for which was to save money, is now seriously at risk of being too expensive. From next year universities will be allowed to charge up to £9,000 per year for undergraduate courses, up from the current limit of just over £3,000. However the government is also cutting their basic funding allowance by 80% to compensate. So government pays less and students pay more - eventually; the government will pay all the money up front in the form of a loan to the students.

The government's cost projections assumed that the mean fee at English universities, and hence the mean size of their loans, would be £7,500 per year. Why, no-one seems to know. Sources are unanimous that this was what they assumed, but no-one links to any kind of report explaining why. Maybe they gazed into a magic crystal ball. Parliament, performing a separate analysis, also worked under the assumption of £7,500, and their reason was that

we have assumed that... this fee covers the 80% reduction in [central government funding]. The average fee... is assumed to be £7,500 per annum for an undergraduate degree.

However, this is just silly. For averagefees to be £7,500, anyone charging some amount more than that, would have to be balanced out by someone charging the same amount less. That's what an average is.

However, no-one can afford to charge less, even if they wanted to, because they need to charge £7,500 to pay for their teaching and break even. £7,500 is the minimum not the average. But plenty will want to charge more. Oxford and Cambridge, for instance, were blatantly going to charge the top amount, because they're "top" universities. As a result, every other university which aspires to be elite will have to charge £9k, to keep up with Oxbridge.

Hence a domino effect goes down the line: every university will want to charge as much as the ones immediately ahead of them, so as not to look cheap. (The alternative, that they'd try to undercut them in price, makes no sense when you consider the amounts of money involved; the savings to the students would be minimal but the message - "we are cheap, therefore not very good" - would be loud and clear.)

I've whipped up a little plot showing all the universities which have currently announced their fees along with their position in the latest university rankings. A few small institutions are unranked and so don't appear.

The rankings go up to 115 so if the universities ranked over 58 charge over £7.5k, the others would have to charge less to cancel them out. I'll try to update this chart when fees are announced, but I think it's a forgone conclusion that this won't happen. Last updated 06/04/2011 10 am. See also here for a frequently-updated expert analysis.

The government is now seriously talking about having to cut what little direct university funding remains, in order to avoid losing money - from a policy which was supposed to save money. Yet this was always going to happen given what I said above. Indeed this policy, which was sold to the country as a cost-cutting measure, was always going to, at best, break even until the graduates repay their loans, and they won't even start doing that until the first batch graduate, in 2015 which is the next election year.

So there seem to be only two possible options. Maybe they knew it wouldn't save money, but in that case, why did they do it? It's not winning them any votes, so there must be a long-term plan, but what? The other possibility is that they genuinely thought it would save money. So it's a question of bungling incompetence vs. mysterious scheme. I'm not sure which is worse.

Fake Clinical Trial - Real Problems

Here at Neuroskeptic we've seen our fair share of dubious clinical trials over the years, but the Indian Journal of Psychiatry has just published one which really takes the biscuit, because it was completely made up.



Luckily, the trial is actually a rather neat spoof paper, written for educational purposes to highlight bad practices in the design and writing up of clinical trials. It's accompanied by a serious piece which analyzes these problems. They're both open access so you can take a look.

The sham study is ostensibly a trial of a new antidepressant, "placeboxetine", compared to an older drug for depression - but it was really written by one of the Editors of the journal via "Common shortcomings in manuscripts submitted to the Indian Journal of Psychiatry were collated into a single manuscript". These shortcomings are certainly not limited to Indian papers.

The problems included:

• No placebo group. This is extremely common in trials comparing two drugs, so it's "accepted practice", but it's still a bad thing.
  
• The "placeboxetine" was given at a higher dose, relative to its dose range, than the comparison drug but they don't say why.
• Side effects are reported but they don't explain how these were assessed. If you specifically ask about them you find a lot more than if you rely on patients to spontaneously complain.
• Subtle, but important, issues with the statistics, such as reliance on t-tests over more appropriate methods.
• The trial had some unusual features for a depression trial - with no explanation. Most patients were males in their 20s, while the norm is for about 65% females and an average age in the 40s; very few people dropped out; very few people who were screened were excluded, whereas most trials exclude loads of people for all kinds of reasons.
• The effectiveness of both drugs was remarkably high (75% cure rate over 6 weeks - better than any treatment, drug or therapy, would be expected to show.) Yet they don't mention this.
• It was badly written. The title in particular was far too long and clumsy.
• It turns out that the trial was sponsored by the fictional pharmaceutical company, and was probably conducted to help get placeboxetine sold in India - but we only find this out in the small print at the end.
• Hot pink and white is not a good color scheme for your graphs, or for anything except marshmallows. (I may have added this myself.)
  

Overall I think this kind of thing is extremely valuable. The author's final comments, however, are a bit questionable. He advises people running clinical trials to base their research protocol, and their paper, on previously published studies of a similar nature published in good journals. Unfortunately, even leading journals publish stuff which suffers from some of these problems...

Andrade C (2011). A 6-week, multicentre, randomized controlled clinical trial to evaluate the safety and efficacy of placeboxetine hydrochloride in the treatment of major depressive disorder in an Indian setting. Indian journal of psychiatry, 53 (1), 69-72 PMID: 21431013

Andrade C (2011). Placeboxetine for major depressive disorder: Researcher, author, reader, and reviewer perspectives on randomized controlled trials. Indian journal of psychiatry, 53 (1), 73-6 PMID: 21431014

A Stroke Of Good Fortune Cures OCD?

A 45 year old female teacher had a history of severe obsessive-compulsive disorder, along with other problems including ADHD. Her daughter, and many other people in her family, had suffered the same problems and in a few cases had Tourette's Syndrome.But all that changed - when she suffered a stroke. This is according to a brief case report from Drs. Diamond and Ondo of Texas:

[she] had a long history of constant intrusive and obsessive thoughts that interrupted her daily activities and sleep. She had constant unfounded fears that something bad would happen to her family and had persistent violent thoughts of using knives to harm family members. She would check the door locks up to 15 times a day. In addition to her OCD symptoms, she had ... inattention, poor concentration, and difficulty sitting still.

She had never been treated for the OCD, despite how it interfered with her life, because she feared losing her job as a teacher if she sought psychiatric help. But then...

Nine months before approaching us, she developed the acute onset of paresthesia [weird sensations] and weakness in the left upper extremity and face, associated with slurred speech. Initially, she was unable to lift her arm against gravity.

These are classic signs of a stroke, but it was a very mild one, because the symptoms only lasted a few minutes and were pretty much gone even before she arrived at the emergency room. She made a full recovery. More than a full recovery in fact:

Within weeks of her stroke, she realized that her obsessive and intrusive thoughts, fears, rituals, and impulsive behavior had completely resolved. In addition, there was some improvement in her temperament. There was no improvement in attention or concentration. Owing to her improvement in neuropsychiatric symptoms, she strongly felt that her stroke was beneficial. These benefits have persisted for 24 months.

Most medical case reports concern patients who died, or got really sick, in a particularly interesting fashion, but this one has a happy ending. Strokes can be devastating, of course, although people also make full recoveries - it all depends on the severity of the stroke, and whether they get prompt treatment.

There have been a few other cases of brain damage which brought unexpectedly beneficial effects. In Vietnam veterans, for example, people with damage to the vmPFC due to combat trauma seemed to be protected from depression.

Whether the stroke really cured her, or whether it was some kind of psychological "placebo" effect, we'll never know. It's hard to see why a stroke would have a placebo effect, but on the other hand, an MRI scan revealed that the stroke occured in an area of the brain - the right frontoparietal cortex - which is fairly low down on the list of "OCD-ish" areas.

The authors make some vague comments about "modulation of the cortical–subcortical circuits" but this is really the neuroscientific equivalent of saying "We guess it did something", because the entire brain is made of cortical-subcortical circuits, given that the cortex is at the top and everything else is, by definition, the sub-cortex. It's quite possible. But we really can't tell.

Diamond A, & Ondo WG (2011). Resolution of Severe Obsessive-Compulsive Disorder After a Small Unilateral Nondominant Frontoparietal Infarct. The International journal of neuroscience PMID: 21426244

British Education - Malaysian Money

The University of Wales (not in fact the only university in Wales) is a troubled place.


Last year, a BBC Wales piece provided damning evidence about three of their approved overseas courses: a Thai fashion school unaccredited in Thailand; a Malaysian business school run by a pop-star with bogus degrees, and an American Bible college which, as well as teaching fundamentalist ideas, is unaccredited - well, except by the University of Wales.

These kinds of courses are accredited to award University of Wales undergraduate and even graduate degrees. You study there - you get a degree from Wales. They've since cut ties with the offending institutions but another one, in Singapore this time, is now in the spotlight. The investigation is ongoing but here's what some Singaporeans think of the questionable college.

If this had happened once, it might be written off as an exceptional event, but given that it's happened three or four times, it's an institutional failure. Why would a university risk ruining its own reputation by associating with dodgy degree-mills? Well, the thing is - and the university admits this - these courses are a key source of funding:

"The university said the profits from its international validation programmes were invested in Welsh higher education."

So we have a conflict of interest. From a business perspective it doesn't matter if the "accredited partner" is teaching that the earth is flat, so long as they pay up.

That's bad but it gets worse. We have a British university, which is reliant on funding from overseas colleges. These colleges of course have to make a profit themselves, and they make money from their students. So the UoW is taking money from foreign students - many of them frm countries considerably poorer than Britain - to fund the British education system. Is this ethical? Are these students getting their money's worth?

Clearly every case is unique and most of the accredited courses are probably fine, but the problem is, it's hard to know. When three or four dodgy courses have managed to slip through the net, you have to ask whether the net of "quality assurance" is working

The BBC Wales program contained a reminder of the kind of issues at play here. "Dr" Fazley Yakoob "MBA", the Malaysian pop-star, at one point said that people were keen to get University of Wales degrees via his college because of the glamour attached to the fact that the Prince of Wales is Chancellor of that institution.

Now this will have had most British people laughing into their tea because over here, Charles, Prince of Wales is regarded as out-of-touch, arrogant, and a bit of a crackpot. He's best known for his views on alternative medicine, for talking to plants, and his dislike for modern architecture. Certainly he has little of the respect accorded to the Queen, or to his sons Harry (fought in Afghanistan) or William (handsome, getting married).

Yet the British monarchy is, for some reason, probably more popular outside of the UK than inside it; perhaps some people elsewhere think that the fact that the UoW is associated with Prince Charles means that their accredited courses must be legitimate.

The University of Wales seems to be reaching the end of its lifespan, with a new report saying it should probably close soon. But the industry of overseas accreditation by British universities seems unlikely to go away.

As British universities lose public funding they're being forced to seek money from elsewhere. British students of course will be first in line, which I'm not happy with but they will at least be paying a fair price for their education; universities will be limited by law to charging £9000 per year which is basically the cost price for a year's teaching (plus a thousand or so on top - but with inflation, not for long). The idea that British students could be subsidized by Malaysians, however, is very worrying.