Evidence-Based Ambridge

Ahh. Sunday mornings. They can mean only one thing: bacon.
Okay, two things: bacon and tea
Whoops, no let's make that three things: bacon, tea, and The Archers omnibus. 

So welcome to the first instalment of an occasional series (probably so occasional that this is the only one), in which I critically examine the treatment choices of the fictional residents of Ambridge. 

In today's omnibus, Hell-on's child falls over. There is much hysterical panic, and much bewailing the fact that she wasn't watching him properly. Apparently its hard to look after a child and gaze lovingly off into the distance in the direction of Rob Titchener's house. Who knew. 

But never fear, Hell-on's mother, Pat (who doesn't appear to have noticed that her husband has been kidnapped and replaced by an interloper), is on hand to reassure her that she has done her best with the arnica. 

Arguably, I'd say arnica is one of the most accepted forms of woo in the UK. Arnica cream is a standard item in many pharmacies, and I would say that many people know that it is supposed to be useful for bruises. I wonder just how many first aid boxes have a tube of arnica languishing in them, but I reckon it is quite a few.

Its also a poster boy for the sort of confusion that reigns between the public perception of homeopathy and herbal medicine. herbal arnica cream often sits side by side homeopathic versions with no explanation of the difference. 

Even Nelson's seem rather confused about which modality to use, with both herbal and homeopathic arnica sitting in their "Arnicare" range of products. I can't quite get my head around this to be honest. Imagine going into an off-license and seeing two bottles of Smirnoff, one of which contains vodka and one of which contains water, though the only difference on the label is that one says Smirnoff Vodka 30C. Hmm.

Does the distinction matter? Yes, I think it does. I think its pure, outright deception to sell a homeopathic product to someone expecting a herbal medicine. One has arnica in, one doesn't. 

Anyway, all of this is by the by. Obviously there is no evidence that homeopathic arnica works for bruising. It's homeopathy. It has nothing in it. 

And as for herbal arnica? there's also no evidence that it works, although there is a little bit of prior plausibility, in that some of the chemicals in the arnica plant have an anti-inflammatory and anti-platelet action. There is, however, no information on how clinically significant these actions are, and whether rubbing a bit of cream into an area would get these potentially useful chemicals to the right place in any meaningful amounts.
Let's not forget that bruises are self-limiting. They go away of their own accord (and probably at the same pace), regardless of whether or not you rub some gunk into them. herbal arnica isn't risk free: the cream can cause  contact itchiness, dry skin, and rash. Orally, arnica can be pretty nasty stuff, even causing coma and death in extreme cases. 

So, my evidence-based advice to Helen would be: kiss it better, and leave it be. Henry is a small child, and falling over is pretty common in that age group. Don't apply an ineffective treatment which could rarely lead to side effects, and save your money. 

I don't pray often, but when I do, it tends to go like this...

Our Cochrane Collaboration,
Hallowed be thy aim.

Please have answered my question
In your systematic review

So I don't have to do a full literature search.

Amen.

(Idea shamelessly stolen from Nancy. Check out her blog, Evidence-based Skepticism. Also much thanks to David James for improving the wording.)

Blowing A Raspberry

Imagine there is a door in front of you. There is a person standing next to the door:
       
"Hey there, pudgy, do you want to be thin and beautiful without having to do any exercise at all? All you have to do is hand me some cash and step through that door there."

This person goes on to explain that if you step through the magic door, you will step out of the other side with a perfect, slim figure. You won't need to change your diet or do any exercise. You just need to walk through the door. They show you some glossy before and after pictures. There are pictures of beautiful, smiling people holding out the waistbands of their old elasticated tracksuit bottoms, so you can see just how much more skinny they are now.

There is a slight rumble from behind the door. You ask what is behind it.

"Oh, we don't know. But honestly, it'll work."
                                 
"But is it safe?" you ask. 

"Oh yes, its perfectly safe" is the reply. "All you need to do is go through that door, and you will definitely lose all of that stubborn weight and absolutely nothing bad will happen to you whatsoever. Now if you'll just hand me your money there, that'll be great."   

Sounds great, right? You excitedly take a step towards the door.

But before you step through the door, you take a moment to consider what might be behind it.  You don't know, and the person telling you to go through the door doesn't know what'a in there either. 

No one has studied what's behind the door. There are no photos and  no videos of what's in there. All you have is this person's word that it is safe, and it will work. 

Broadly speaking, there are three possibilities of what's behind the door:

1) Nothing. Its just a room. You go through the door, and nothing happens. You don't lose any weight, but you have lost your money.
       
2) It works. You step through the door and emerge as a smiling, happy, beautiful, skinnier you. You quickly run home to find some horrible grey tracksuit so you can smugly show everyone how marvellous you are now you're skinny.

3) Something harmful is in there. Maybe there is a big pile of dog poo right behind the door, and you are destined to step in it, which will be mildly unpleasant for you. Or the door could be perched on top of a cliff, below which is a mesh of razor blades that will cut you into little pieces. Worse than that, perhaps Piers Morgan is through there.

Do you step through the door? 

Now, I really do want to lose weight. But I also don't like being deceived, and I really don't like being harmed. I also really don't like Piers Morgan. 

All of which brings me nicely on to this season's most fashionable weight- loss aid, Raspberry ketone. Its the chemical contained in raspberries that makes them smell nice. Its widely used as a flavouring and fragrance agent in foods, which begs the question: if its so effective, why don't we already lose weight when we eat food that it is in?

You've probably heard about it already. By which I mean that you've probably seen someone on Twitter tweeting about how they lost 3000 kg using raspberry ketone, along with a handy link to a website where you can buy it. You've also then probably seen the follow up tweets, that go something along the lines of "Urgh, my account has been hacked. I've changed my password now, sorry."

And there's the first warning sign. People who make real medicines which work don't tend to need to resort to hacking people's social media accounts in a desperate bid to get people to buy their wares. You don't see Pfizer or Glaxo, for all their faults, hacking into random peoples' accounts and mass tweeting "My cancer is in remission thanks to Drug X. Buy it here!!!!". 

Its not a particularly ethical way to sell healthcare products.

Putting all of that aside, is there any evidence that raspberry ketones work as a weight loss aid?

In short: no, except for 18 mice and a difference of about 5 grams at most. Which also means there is no evidence that it is safe. There are no human studies out there at all. All of this hype about it is based on the fact that its chemical structure looks a bit like two other chemicals (capsaicin and synephrine) which might have some effects on weight loss.

That's a bit of a stretch. Human bodies are complicated things, and we can't always predict how they will react to medicines. Even when we theoretically think that something might work for good, plausible reasons, there's no guarantee that it will (COX-2 inhibitors come to mind as an example). Marketing raspberry ketone as a foolproof weight loss aid just because it looks a bit like some other chemicals is like finding a random key on a street and expecting it to work without fail on your front door, just because it looks a bit similar to your front door key. 

If you were to decide to take raspberry ketone, you would essentially be walking through that door. You might lose a bit of weight, or you might not. You might be harmed, or you might not. There's just no way of knowing right now.

Hxxx

The Ultimate Christmas Album for the Existentially Wounded

"It's why, it's why we hang lights so high

and gaze at the glow of silver birches in the snow

Because of the dark, we see the beauty in the spark

We must be alright  if we could make up Christmas night"

-Tracey Thorn, Joy. 

Now, I'll admit that at this time of year, I can get rather annoying.

I love Christmas, I really do. I'm often to be found wearing antlers and tinsel. I put my decorations up at the first opportunity humanely possible, and start on the mince pies in September. This year, I excitedly bought myself a Lego advent calendar, despite the incredulity of the guy behind the counter in the shop. I also have snowman hoodie which yes, I shall wear out in public.

As a child-free, cynical, atheist adult, it might seem like this is a hard time of year to enjoy. And, to be honest, you're probably right. It would be a whole lot easier to throw in the towel and grumble about how commercial it all is, and how I just wish it was over and done with and everything can go back to normal. But I refuse to give into this, and put quite a bit of effort into maintaining my child-like delight at the festive season.

Obviously, its nothing to do with god. And don't get me wrong, I love the presents too (dear parents, if you are reading this, please do take note that I shall never be too old for Lego). But my desperation to enjoy this time of year runs somehow deeper than all that. I don't need to link it to religion, nor do I need to experience it through a child or partner. Christmas reminds me of my own, hard-won personality.

For me, it is about traditions. And these traditions, as they shift and change slightly each year, somehow reinforce my own self to me. Back in what now seems like a lifetime ago, my ex-husband and I took joy in forming new traditions together at this time of year. It was a way of reinforcing ourselves as a couple unit, of forging our own little family ways. Small things, like buying a new special decoration for the tree each year, came to mean a lot to us.

When my marriage broke down on Boxing Day 2010, I had to start again. Everything I had known up until that point fell apart, and my hopes and dreams, which I had been carrying like a shield all my life, shattered in a matter of hours. I had to begin again from scratch, and it was often the smallest of things that seemed to make all the difference to me.

The next year, my new, empty Christmas tree seemed somehow symbolic of how I had to start to collect some traditions of my very own. These traditions would belong to me, and me alone. I started picking up little decorations here and there, and now I have a rather lovely collection of bits and pieces to adorn my home with. And I've done the same with traditions: baking certain things at certain times, (including my beloved Christmas pie), drinking startlingly strong fruit wine in a particular pub on Christmas Eve with my friends, seeing Rare Exports at the cinema, taking part in a gingerbread contest, and many others. Some of us even go so far as to throw ourselves into the freezing North Sea on Boxing Day which not only washes away any vestiges of hangover cobwebs, but also distracts me from the awfully sad memories I would otherwise be thinking about.

Winter is a dark and often terrifying time for many of us. Dark mornings and dark nights make it easy for the sadness and emptiness to creep in. Getting home to a cold, dark, empty, one-bedroomed flat can start to feel like a failure. But then I pop on the tree lights, and I have something to focus on, some little pinpricks of hope that, in the end, the world is full of good people, and I will be able to spend some quality time with those who I love most- my friends and my family. And I will have an excuse to fill my flat with sparkly things, and wear glitter eyeliner.

Christmas is, to me, an acknowledgement that times will be dark and hard ahead, but that I will get through those times, with the help of those around me. It reminds me of how far I've come, and how proud I am of myself. It reminds me of all the good I have found in the world, of all the little bits of help I have gotten from the most unexpected sources, of all the new people I have met and the pride I have in my oldest friendships. If humankind has the presence of mind to plonk a huge celebration in the middle of the darkest season (even if they have done so on the pretence of a god I don't believe in), then that's fine by me, and I shall do my damnedest to make sure I embrace it with gusto.

I love the standard Christmas songs. I'll dance about to a bit of Slade with the best of them. But the saccharine jingle bells of most of the tunes you'll find on Now Thats What I Call The Ultimate Best Ever Christmas Tunes In World... Vol 3 don't seem to quite catch the nuances of the festive season for me. I've only come across a few songs which do, and I have collected them here for your auditory pleasure. I'm keen to know of more, so if you have any you would like to recommend, please do let me know, either in the comments, by email, or by tweeting me (@SparkleWildfire). What I would like to do is create a playlist of genuinely good, beautiful songs that evoke both the joy and the darkness of Christmas.

Joy by Tracey Thorn.
Tracey Thorn's (of Everything But The Girl fame) Christmas album Tinsel and Lights, which she released last year, was a total revelation to me. Its a gorgeous, calming album which hits just the right pitch of melancholy and joy for this time of year. I think this song says it all really.

Snowglobe by Dean Owens.
I saw Dean play at the Tyneside Cinema just before that fateful christmas of 2010. This is a lovely, sad little song about having depression or mental health issues over Christmas time. It serves as a reminder that mental health issues don't instantaneously resolve over the festive period, and that this time of enforced happiness can be extremely hard for many.

December Will Be Magic Again by Kate Bush
You may already know by now that I absolutely adore Kate Bush. Even the title of this song is poignant. This song has the same theme to me as Joy: its about using tradition to cover the darkness of the winter.

Winter by John Smith
This is simply the best, most beautiful song about the baby Jesus that I have ever heard. I first saw John play as support for John Martyn, and I have since seen him live several times and been reduced to tears by him. I absolutely adore his voice. I don't mind that this is a song about the nativity: to me it is a song about a story, and I just love how plaintively he sings that "I was there" line.

A Christmas Fable by The Selecter
I love a bit of ska. I've spent a full day agonising over which song to go for from this single. Then it occurs to me: its a double A-side, so I can legitimately have both. The songs are supposed to symbolise the light and dark sides of christmas, so they're pretty perfect for my playlist. Skank 'Til Christmas is all about letting your hair down when everything else in life has gone to shit (I love the references to the current financial situation), whilst a Christmas Fable is about a rather distressing family breakdown on Christmas day.

River by Madeleine Peyroux & K.D. Lang
A cover of this track also appears on the aforementioned Tinsel and Lights album. Thanks to the ever marvellous Ian Robinson (@eyeswideshut75) for suggesting it.

White Wine in the Sun by Tim Minchin
Thanks to Steve Haigh for reminding me of this. There's so much truth and humour in this gorgeous little tune, and it really sums up a good old family Christmas.

The Atheist Christmas Carol by Vienna Teng
This is just gorgeous.Thanks to Jackie (@Jackpot73- one of those new people so I am so thankful for having met this year) for

Silent Night/ 7 O'clock News by Simon and Garfunkel
Pretty self explanatory.

Love is All We've Got by Paul Fisher
I have loved Paul's music since the first time I saw him at a folk night when I was still underage drinking. I can remember being completely astounded by the noises that were coming out of this guy on the tiny stage upstairs in the Egypt Cottage pub. Turns out he has made a beautiful, gorgeous, poignant Christmas song this year which I will be listening to over and over.

Candle Song 3 by Mojave 3.

Tar Barrel in Dale by Rachel Unthank and the Winterset
Another one suggested by the lovely Jackie. A New Year's song about a Northumberland tradition. This year has been so cruel to so many of my friends and people I know, so I listen to this hoping that the new one brings those who I love some luck.

Hxxx

P.S. Here's my Sparkle Wildfire Top Festive Tip for the year: mulled wine liquid soap might seem like a good idea in the shop, but its really not. You end up smelling like a wino.