Saturday, 30 January 2010

Trick or Treatment?

You know what they call alternative medicine that's been proved to work?
- Tim Minchin, "Storm"

Which rather encapsulates my problem with so-called complementary and alternative medicine. It is, at least in principle, not that hard to test whether a given medical treatment works or not, and anything that falls into the "alternative" camp has generally either not been tested at all, or if it has, has tended to fail the test. My view is that, if you're going to make medical claims you really ought to be able to back them up. And that's really the bottom line.

For instance, I see no particular reason why herbal medicines, for instance, shouldn't work. But they really ought to be tested to check exactly what they do (and what side effects they have, if any) and should only be sold and advertised based on what the evidence actually says. As a professional healthcare worker, this is something I do regard as important. Because the danger is that someone might take an inert treatment for a serious condition, and delay real treatment that might genuinely help them. There should be no double standards. (And that, incidentally goes for any malfeasance that the regular pharmaceutical companies might engage in).

So, anyway, I was obviously going to be interested in the latest event to be held by CFI London at Conway Hall. The "Trick or Treatment?" was a series of three talks on the subject of alternative medicine, and was well up the usual standard.

As it so happened, this was the same day selected by the 10:23 campaign to conduct a mass overdose to protest the selling of homoeopathic remedies by Boots the Chemist as if they were real remedies. Boots have been singled out here because, on 25th November 2009, Paul Bennett, the Professional Standards Director of the company testified before the House of Commons Science and Technology Committee that he did not personally believe homoeopathy worked, but that he was happy to sell it if people wanted to buy it. This strikes me as a pretty irresponsible attitude.

The overdosing had nothing to do with the event at Conway Hall, although some of the campaigners were outside. [Video of short discussion here]. But it does illustrate where this sort of thing can be useful. It's not going to convince the homoeopaths to change their mind, or anything like that. Nor any of their customers who have already made an informed decision (albeit, in my view, an erroneous one). But one has to wonder how many users know what homoeopathy really is. Do they, perhaps, think, that a homoeopathic preparation labelled, say, "Belladonna", actually contains any... well, Belladonna? Once they realise that, in all but the "weaker" preparations, it actually doesn't, then they might be in a better position to make that informed choice. And then it's up to them.

Anyway, the actual event opened with Simon Singh talking about acupuncture, chiropractice, and, of course, libel law. Acupuncture, as I probably don't need to explain, is the hypothesis that the human body contains channels, or "meridians" of magical energy called "Chi", and that by altering this flow by inserting needles into specific points along the meridians, it is possible to alleviate pain, and maybe also cure disease.

It's interesting to note, as a later speaker did, that this method may not be quite as ancient as commonly thought. Earlier references to the method apparently actually refer to cutting into patients with flint knives, which isn't quite what we think of today. Although, in fairness, the underlying concept is much the same. Some forms of acupuncture are even more modern. "Auricular acupuncture" only dates from the 1950s, when it was realised that the human ear looks quite like a foetus - and that it therefore obviously followed that, if you stuck needles in the parts of the ear that corresponded to where the meridian points would be if it were a whole body, the therapeutic effects should be the same.

Uh huh.

That aside, it has to be said that an interesting problem arises when we look at testing acupuncture to see how effective it is. To rule out the possibility of a placebo effect, with any proposed treatment it's important to test two groups of patients: one actually receiving the treatment, and another who think they are, but actually aren't. That's easy enough with a pill, but most people can tell if you've stuck a needle into them or not.

The problem isn't completely intractable however. The meridian lines are supposed to be quite deep, so you could just make a very shallow puncture, and see if that makes a difference. Or you could use fake needles, rather like stage daggers, that appear to stick into you, but, in fact, just retract. Or you could just put the needles in the wrong place - if acupuncture theory says they should go into the hand, put them into the feet, for instance. (Obviously this last one doesn't work if the patient knows enough about acupuncture to realise what you're up to).

And, guess what - when you do these sorts of studies, the "fake" treatments work pretty much as well as the real acupuncture. Which isn't to say that they don't work at all, just that acupuncture appears to be a fairly effective way of harnessing the placebo effect, and that all the stuff about Qi and meridians has no bearing on that.

Chiropractice was originally based on the theory that the body maintains its health by channelling vital energy through the spinal nerves. Virtually all disease, claimed its founder, Daniel David Palmer, was due to misalignments, or "subluxations" of the spine, blocking the passage of this vital energy to the relevant body parts. Now, not all chiropractors today necessarily believe that, but some it seems, still do, and claim that manipulating the spine can cure, for example, ear infections. One would have thought there was quite enough money in curing just back pain, but there you go.

In fact, it's probably worth mentioning that, regardless of what it might do for ear infections and the like, there does seem to be some reasonable evidence that chiropractice can help to relieve back pain. Perhaps surprisingly, it's not terribly good at doing even this - but in fairness, neither is anything else (such as, say, mainstream physiotherapy). In this particular respect, I'm not aware of any clear evidence that it's any different from the various alternatives, and at least some of the time, it does seem to work.

This brings me back to the point I made earlier about informed knowledge. Many people, it seems, are unaware that chiropractors aren't MDs, and that, at least when it comes to conditions other than back pain, there really isn't an awful lot of evidence that the technique works.

Given that my verbosity has once again got the better of me, I'll move onto the other two speakers at a later time.

Sunday, 24 January 2010

Lords of the West: Update 1

Well, things have been a lot more encouraging than I had feared. I am not going to give specific details here, since I would not want to seem to be making promises on behalf of other people. However, I can say that there has been a fair degree of interest from Gloranthan publishers in getting the material out there.

I should also stress that Moon Design have been helpful in this regard. While they no longer have any interest in publishing my work, they have been supportive in attempts to get it published by other means. For example, material that I did not originally write, but was supplied to me by Issaries has been cleared for publication along with those elements that I did write.

So, without going into specifics of proposed publication dates or issue numbers, here is what has already been agreed since the beginning of the week:

  • The Junora chapter of LotW3, which is largely self-contained, has been definitively accepted for publication in one of the Glorantha magazines. It will almost certainly be the first release, and could be considered a "teaser" for the rest.
  • The remainder of LotW3 (the Loskalm book) has also been accepted for publication, barring some specifically HQ1 rules sections. I would say that things are looking good for a time frame that I think most people will be pleased with.
  • Most of the material in LotW2 (Kingdom of the Flamesword) has been accepted for publication in principle, and I am confident that this will also see the light of day before too long.
  • LotW1 (Heroes of Malkion), ironically may be the last part to be released. An agreement has been made to publish around half of this, although another large section remains unclaimed at this time.
  • I have received permission from Moon Design to publish, free of charge, at my own website, any outstanding material that is not picked up by any of the licensed magazine publishers.
Obviously, I would have preferred my writings to be published, as originally intended, in book form. And I would have liked them to become, at least in part "official" or "canonical", neither of which will now happen. However, I do think that we have a very positive outcome here, from a situation that looked quite bleak just one week ago. It is, in fact, highly likely that this material will now be published sooner than would otherwise have been the case - since MD would, naturally enough, have been working on the Pavis Book and other high priority projects.

I would like to say thank you to all of those involved in moving this forward, who hopefully know who they are! I will, of course, give more specific details once the publishers concerned have decided to release it. For everyone who has been giving me words of encouragement over the last week, I would also like to say a big thank you, and I hope you are all pleased with the final result when it appears.

Further Mini-Update:

I can now reveal, to those who haven't noticed, that the Junora article will be appearing in Hearts in Glorantha #4. Note the expected release date of "March/April 2010"!

Tuesday, 19 January 2010

Lords of the West cancelled

Or at least, the version(s) of it I produced have been; Moon Design may well decide to produce their own version with a different writer at some point in the future. Obviously, having worked for seven and a half years on this, this is pretty disappointing for me. In the end, Moon Design's vision of what they wanted shifted too far from the original agreement (which was not, of course, made by them) for continuing on the project to be worthwhile, and they chose to pull the plug.

Indeed, in general, I have a feeling that since the production of HeroQuest 2, the whole Gloranthan project has shifted from something I enjoy to something that's less so. This is not, of course, to blame any of those directly involved in that change. Change does happen, and whenever it does, people get left out in the cold. It happened before with RQ3 with respect to RQ2 fans, and again with HW with respect to RQ2/3 fans. It's inevitable to some extent, and more so when there is a major change in gaming philosophy involved.

It's hard at times like this, when one is on the losing end, not to feel abandoned or rejected by the Gloranthan 'tribe' that they keep talking about. But that's probably largely unfair. I certainly intend to go to Continuum this year, and hopefully have a good time, overcoming the doubtless unavoidable tinge of disappointment and regret. Heck, after seven and a half years of repeating cycles of hard work and frustration, I was hardly on my most diplomatic behaviour by the end. So, if anyone reading this feels that I have offended them over the course of the last year or so, I offer my sincere apologies.

So, enough moping; where do we go from here? Well, the good news is that I am currently negotiating for publication of at least some of the material through other channels. In fact, some of it may even appear earlier than might otherwise have been the case. I can't give further details yet, as nothing has been definitely agreed beyond an expression of interest from one respected source in the Gloranthan community. Stay tuned for updates as they become available.