Sunday, 6 September 2015

Skeptical about drug laws – Part 2

Welcome to part 2 of my skeptical about drug laws series, based on a talk I gave at Birmingham Skeptics in the Pub open mic night on May 27th.  In part 1 I gave an overview of the problems encountered when medical researchers attempt to conduct research using schedule 1 drugs on any level, which in turn makes the research very expensive, surrounded in red tape and generally slows the progress of research into some serious medical issues to a halt.  I then looked at why the compounds in question were designated schedule 1 in the first instance – supposedly it related to their harm and abuse potential, however, this was shown to be completely out of line with the scientific data and research.

So now it is time to address these compounds individually, to explore the effects of these compounds, look at their harm potential in more detail and discuss what role they might play in medicine if drug laws are allowed to be based on actual science.  The first to be explored is MDMA.


MDMA is more commonly referred to as “ecstasy” or “molly”.  Chemically, it is described as 3,4-methylenedioxy-methamphetamine.

MDMA was first synthesized by Merck chemicals way back in 1912 as an intermediate in the development of an anti-haemorrhagic drug.  It lay in obscurity until its rediscovery by the late great chemist Alexander Shulgin in the 1960s.  Alexander Shulgin was a pioneering chemist who synthesized in excess of 200+ novel compounds with psychoactive activity from a lab in his back garden in Lafeyette , California, and was renowned for self-administering the compounds that he synthesized!  He and his wife authored the books PIHKAL (Phenylethlamines I Have Known and Loved) and TIKHAL (Tryptamines I Have Known and Loved) as well as The Shulgin Index – a comprehensive textbook of chemical synthesis and data concerning psychedelic compounds.  Shulgins story is worthy of a long article in itself (see the link at the end for “Dirty Pictures”, a documentary about Shulgins life and legacy), but suffice to say he acted as a mentor to some of today’s leading neuropsychopharmacologists, and the compounds he developed may yet still hold many potential benefits.

But back to MDMA – after Shulgins rediscovery, recreational use started to be evidenced in the 1970s.  Typically the effects of MDMA include euphoria, increased well-being, sociability, self-confidence and extroversion.  It is also often described as an entactogen – increasing empathy or the feelings of closeness with others.  With this in mind it is not hard to see why it found a welcome home in the rave and dance scenes.  As well as recreational use, many psychiatrists and therapists were also finding utility in the drug, as they began to implement MDMA-based therapy into their sessions as they found it to have positive effects and outcomes with their patients, and was favoured due to its lack of hallucinatory effects, shorter duration of action and allowing the user to stay cognitive throughout the therapy sitting (LSD visuals were found to be rather distracting!). This was noticed to the point where Leo Zeff, a psychotherapist, came out of retirement to travel America introducing psychiatrists to the drug to promote its use in therapy.  MDMA was made a schedule I drug in 1985, despite the protest of many well respected psychiatrists on the basis that they had seen its medicinal benefits first hand.

MDMA Mechanism of action

Above you can see the chemical structure of MDMA, along with some of the main neurotransmitters present in the brain.  Note the similarity in shape and similar atoms present – in very general terms this is how MDMA mediates its actions within the brain, by resembling already existing structures such that it binds in a lock-and-key fashion, the slight differences in chemical composition affecting receptor activity and downstream processes.  A detailed explanation of MDMAs action in the brain isn’t really necessary here, but suffice to say it induces serotonin release and stimulates serotonin receptors which is largely responsible for producing its subjective effects. It also increases levels of oxytocin, prolactin and cortisol, effecting areas of the brain relating to mood and fear response.

MDMA Safety

So once again we approach the subject of MDMA safety.  One of the main arguments for the danger of MDMA is that it is neurotoxic (Parrott 2014).  The validity of such claims is hampered by bad study design.  Actually, that’s being overly kind.  The main study that got all of the press was a 2002 paper published in the well-respected Science journal (Ricaurte et al 2002), which stated that even a single dose of MDMA could lead to permanent neurological damage with a similar profile to that seen with Parkinsons patients.  The paper was later retracted, because it turned out that due to a mix up, instead of the experiments being run with MDMA, the scientists had in fact been using Methamphetamine (Crystal Meth for all you Breaking Bad fans).  I think at this stage it’s important to point out that despite MDMA having methamphetamine in its name, the two compounds are very different in their effects and mechanisms under which they work, and this is common in chemistry (Dimethyltryptamine, a powerful hallucinogen, differs from the neurotransmitter Serotonin (5-Hydroxytryptamine) by only two carbon atoms, one oxygen atom and four hydrogen atoms, for example).

So bad study design doesn’t quite cover the complete screw up evidenced here.  The retraction didn’t get nearly as much press, and in the meantime several laws were introduced in America on the basis of the original paper which meant club owners would be held accountable for any patrons using MDMA in their premises, ultimately putting MDMA users in more danger, and these remained in place after the retraction.

There are other issues with MDMA neurotoxicity studies in that animal models don’t match up well with human models in terms of the receptors present and the concentrations of drug required to observe the detrimental effects.  Moreover, my own issue with these studies is that they are based on recreational drug users – these will be people who have used the drug many times, on consecutive weeks for durations lasting weeks, months and even years.  This I believe means it is in no way reflective of the type of long term effects that may be observed in a therapeutic MDMA user, since the dosage and frequency of administration does not come anywhere close to that of the recreational user.  In addition, we cannot possibly hope to account for the quality and consistency of street sourced MDMA with regards to its purity – frequently powders and pills sold as MDMA are found to contain 5% or less and are often substituted with other stimulants such as BZP, mephedrone or methamphetamine, so to use “MDMA” users as a data set when an untold number of drugs may be at play in regards to detrimental effects witnessed is not reflective in any way of the actual safety profile of MDMA itself.  As we saw in Part 1 – clinical trials require pure compounds in order to perform research, so to disregard this rule when looking at safety data is, quite frankly, ludicrous and detrimental to medical research.

So if MDMA is so safe, why has it been attributed to so many deaths in newspapers?  The main problems encountered with recreational drug use are threefold:
  • Hyperthermia – Due to vigorous dancing in poorly ventilated areas with inadequate water intake.

  • Hyponatremia – Due to overconsumption of water.  A classic example of ecstasy being attributed to death in the UK would be the 1996 case of 18 year old Leah Betts, whose picture was on the front page of many newspapers showing her attached to life support equipment after taking ecstasy which prompted a strong campaign against ecstasy use.  What was less published was the fact that after taking ecstasy, she consumed 7 litres of water in a 90-minute period.  This leads to the dilution of electrolytes within the blood, and as such water enters into the cell due to a higher sodium concentration gradient, and those cells swell as a result.  When those cells happen to be brain cells, the result is cerebral oedema, leading to coma and death.  MDMA also has an antidiuretic effect due to promoting secretion of anti-diuretic hormone (ADH) which in essence stops the kidneys from releasing water in the urine, furthering the dilution effect of sodium in the blood, which exacerbated the situation.  This I believe is more a testament to poor education in drug safety than lack of safety of the drug itself.  People have died from water intoxication when no MDMA has been involved 
  • In addition we have again the problem whereby there is no way to verify what is being sold as MDMA actually is MDMA.  In recent media a lot of deaths attributed to “bad ecstasy” have been because what was consumed was actually a compound called PMA (para-methoxyamphetamine) which has a very narrow window between the dosage that would be used for recreational purposes and that which is toxic.  To call this “bad ecstasy” is akin to me filling a beer glass with bleach and giving it to someone to drink, and calling the fallout the result of a “dodgy pint”.

In either case, the therapeutic setting is not a rave, and dancing is not encouraged as far as I’m aware, and excessive water consumption is completely unnecessary in this scenario so these issues do not come into play, and therefore are not valid arguments against the safety of MDMAs use in therapy in my opinion

Medical use of MDMA

So what are the potential medical benefits of MDMA?

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a debilitating anxiety disorder characterised by re-experiencing of trauma, hyperarousal and avoidance symptoms, and is a major worldwide public health problem.  It is seen frequently in war veterans and army personnel, rape victims, victims of child molestation and violent crime, as well as first-responders such as paramedics, fire fighters and police.  It can occur due to any traumatic event.  To give a scale of the seriousness of this condition, one study indicated that there is an average of one suicide per 65 minutes in US veterans with additional studies attributing this to a higher degree of PTSD suffered by those that had experienced combat or dealing with post-combat guilt (Sher et al 2012).  The death rate of soldiers is four times higher as a result of suicide than of those killed in the line of duty.  Clearly, there is a problem here that is not being resolved with conventional treatment.  I’m not sure if we need studies to confirm any suspicions that being a victim of rape or child molestation would leave lingering issues, so I think it’s safe to assume they suffer the same kind of mental anguish on a daily basis.

The current treatments available for PTSD include serotonin-selective reuptake inhibitors (SSRIs) – the same drugs primarily used to treat depression - cognitive behavioural therapy and other psychotherapies, though these all have limited efficacy. 
MDMA is thought to be useful in treating PTSD since it allows the patient to stay emotionally engaged while revisiting previous traumatic incidents without being overwhelmed by anxiety, allowing psychotherapy to occur within the window of tolerance.

The MAPS (Multidisciplinary Association for Psychedelic Studies) organisation is currently carrying out a number of studies with the end goal to get MDMA listed as a FDA approved medicine by 2021.  These include an already completed pilot study which involved 20 patients with chronic PTSD refractory from both psychotherapy and psychopharmacology, with an 83% positive response rate in the non-placebo group (Mithoefer et al 2010) with zero adverse effects.  An additional 5 studies are currently in progress.  All are conducted under double-blind placebo conditions and adhere to proper experimental design.  An additional point that I think is worthwhile taking into consideration is that the CAPS score (the gold standard measurement of PTSD severity) was reduced by an average of 53.2 points across participants taking MDMA compared to 20.5 for the placebo control group (those who unknowingly did not take the drug).  This is important because Zoloft, an SSRI, is an FDA approved treatment for PTSD and was shown to reduce CAPS score by just 10.2 overall across 187 participants (Brady et al 2000).  It is also very important to note that MDMA use in therapy consists of 2-3 sessions spaced out over a number of weeks with non-drug therapy before, in-between and after.  It is not intended as a regular prescription and the patient will not be dependent on its use.    I encourage you to look into the common side effects of taking a regular prescription of Zoloft when contemplating the harm potential of MDMA in a therapeutic setting and have a think about which has the greater risk.  You might find yourself rather disturbed or surprised.  Or both.  This is not to say that SSRIs like Zoloft and others are not without their uses and benefits even when potential adverse effects are taken into consideration, but if nothing else it seems nonsensical to approve the use of a low efficacy drug whilst denying the medical utility of one which has been shown to be 5 times more effective based on what I believe is non-justified safety concerns.

Social Anxiety in Autistic Adults

Social anxiety is characterized by a fear of scrutiny and avoidance of social interactions and is frequently observed in those with autism.  Higher functioning autistic adults have a greater risk for developing psychiatric problems including social anxiety, due to the lack of obvious autistic traits and an expectation to conform to societal norms.  Increased oxytocin leads to an increased ability to infer emotions from facial cues and thus react more appropriately to a give interaction – in autism, interpretation of non-verbal communication is at a much lower level than those who do not have autism.  It isn’t hard to see how this can lead to awkward and misinterpreted social interactions, particularly when coupled with an inability to understand abstract concepts and metaphors and idioms (phrases such as “its raining cats and dogs” or “I have got butterflies in my stomach” are likely to be taken literally, and thus make no sense – a good comparison is Dave Batistas character Drax in the Guardians of the Galaxy film).  MDMA increases oxytocin levels and therefore assists effective interpretation of feelings and intents.

Early work from the 1960s/1970s indicates that the positive effects of MDMA could help relieve symptoms and feelings of social anxiety and its related issues to due increased openness, talkativeness and increased social interaction that is observed under the influence of MDMA.  It is hoped that better study design and improved ethics, safety, monitoring and follow up will show MDMA as a viable treatment in alleviating the symptoms of social anxiety in autistic adults (Danforth et al 2015).


What I hoped to have demonstrated in the above paragraphs is that MDMA has a very real medicinal potential for treating conditions which affect a huge number of the population, for which the current treatments aren’t satisfactorily effective.  Thus they remain suffering from their conditions – and I think it is important to take into consideration that it is not only themselves that are effected by their illness – as with so many mental health problems, those close to them also feel the brunt, whether it be in relation to job performance or ability to function as a husband/wife/father/mother.  The science doesn’t seem to justify to restrictions placed on research using MDMA, and I think that the research is vital and needs to be done urgently to clarify exactly to what extent we can use the compounds we have available to us now in a safe manner.  Once again I will state my belief that current drug laws, based on politics and not science, have caused far more harm than they have ever prevented.


BRADY K., PEARLSTEIN T., ASNIS G.M., BAKER D., ROTHBAUM B., SIKES C.R. and FARFEL G.M (2000)  Efficacy and safety of sertraline treatment of posstraumatic stress disorder.  A randomized controlled trial.  The Journal of the American Medical Association.  Vol.283, No.14, pp1837-pp1844.

DANFORTH A.L., STRUBLE C.M., YAZAR-KLOSINSKI B., and GROB C.S. (2015) MDMA-assisted therapy:  A new treatment model for social anxiety in autistic adults.  Progress in Neuro-Psychopharmacology and Biological Psychiatry.

MITHOEFER M.C., WAGNER M.T., MITHOEFER A.T, JEROME L. and DOBLIN R. (2011)  The safety and efficacy of 3,4-methylenedioxymethamphetamine assisted psychotherapy in subjects with chronic, treatment-resistant post-traumatic stress disorder: the first randomized controlled pilot study. Journal of psychopharmacology, Volume 25, No.4, pp439-pp452.

PARROTT A.C (2014) The potential dangers of using MDMA for psychotherapy.  Journal of Psychoactive Drugs, Volume 46, Iss.1, pp37-pp43.

RICAURTE G.A., YUAN J., HATZIDIMITRIOU G., CORD B.J. and MCCANN U.D (2002) Severe dopaminergic neurotoxicity in primates after a common recreational dose regimen of MDMA (“Ecstasy”).  Science, Vol.297, No.5590, pp2260-pp2263.

SHER L., BRAQUEHAIS M.D. and CASAS M (2012)  Posttraumatic stress disorder, depression, and suicide in veterans.  Cleveland Clinic Journal of Medicine, Vol.79, No.2, pp92-pp97.

Useful links

Dirty Pictures – Alexander Shulgin Documentary

Podcasts featuring Rick Doblin from MAPS:

Tangentially Speaking No. 98 -

Sunday, 19 July 2015

Skeptical About Drug Laws - Part 1

Phil Walsh at the Open Mic
On May 27th 2015 I decided to try my hand at giving a talk at Birmingham Skeptics in the Pub  (SitP) open mic night.  SitP have regular guest speakers who come to give presentations relating to an area of their expertise centred around dispelling misconceptions about a particular topic and focussing on good scientific enquiry.  Their open mic nights give us mere mortals a shot at presenting a topic of our choosing.

The presentation I gave was based on the current drug laws regarding certain compounds, and how these laws prevent vital medical research being carried out, and as such prevent treatments for some very serious medical conditions being available to those who need them the most.  I felt this was relevant to the spirit of SitP since skeptics by nature are very keen to dispel myths regarding bogus “miracle cures” and charlatans selling false hope, or worse, driving people to actually cause themselves harm.  My argument was that we don’t need to look far to find bad science regarding medicine – we have it right on our doorsteps governed by law right this moment, and that fact is worthy of equal scrutiny.

Typically we are asked to give a 15 minute talk, I think I was clocking in around 25 minutes before I threw myself off stage as it wasn’t fair to the other presenters that evening to hog all the stage time.  And I still had plenty of slides left.

With this in mind, I thought I would provide an overview of the topics covered in my presentation in blog form – this will allow me to go a little more in-depth on some parts, so that those that didn’t have a chance to attend the evening won’t miss out on what was presented, and those that were in attendance get a refresher with additional material.

To keep this interesting I will break the article into 3-4 parts, which should hopefully allow some time to reflect on the information being presented before the next part goes live. Without further ado, here is:

Skeptical about drug laws, Part 1:  The Current situation.

Currently in the UK, when British law states that a particular drug or compound is illegal, it is classified into both classes and schedules.  Classes you’ll likely be familiar with – these dictate the degree of punishment dealt if a person is found to be in possession of, producing, trafficking or distributing a particular drug.  Schedules however state the potential harm, and any medical utility of a given drug.

Schedule 1 drugs are described as such:
Drugs belonging to this schedule are thought to have no therapeutic value and therefore cannot be lawfully possessed or prescribed. These include LSD, MDMA (ecstasy) and cannabis. Schedule 1 drugs may be used for the purposes of research but a Home Office licence is required
Schedule 2 drugs are described as such:
Can be prescribed and therefore legally possessed and supplied by pharmacists and doctors. They can also be possessed lawfully by anyone who has a prescription. It is an offence contrary to the 1971 Act to possess any drug belonging to Schedule 2 or 3 without prescription or lawful authority. Examples of schedule 2 drugs are methadone and diamorphine (heroin). Schedule 3 drugs include subutex and most of the barbiturate family

Schedule 4 drugs are prescription only, and schedule 5 are over-the-counter medications and so require no prescription.

What we are concerned with is the statement for schedule 1 compounds Schedule 1 drugs may be used for the purposes of research but a Home Office licence is required.

What this means is that in practice, conducting medical research using schedule 1 compounds is virtually impossible, because obtaining a home office licence is a lengthy and arduous process.  And here’s why:

In order to obtain a home office licence, you must:
  • Apply for and pay for a home office licence this costs between £3000-5000 and lasts for 1 year. 
  • Adhere to the necessary storage and security requirements the compounds require storage in a designated secure location with careful management of who has access to them.
  • Carry out DBS checks for all personnel its not good for your application if your lead researcher happens to have a raging drug addiction after all!

So far, so good – these requirements aren’t unreasonable, and I don’t think anybody is suggesting that these compounds available on a free for all basis, but it should be noted that each of these adds to the administrative burden and cost of obtaining the licence and performing research.

The problems begin to arise when:

  • Additional costs come in the form of import licences – the majority of compounds will be sourced from overseas, simply due to availability.  This then requires an import/export licence to be obtained at the cost of the research group.
  • The compounds will likely also have to be manufactured to Good Manufacturing Practice (GMP) these are a set of guidelines that dictate a specific protocol for the manufacture of a particular compound in order to ensure quality and consistency.  This therefore means that the manufacturer must be approved to produce the compound to GMP specification.  Very few manufacturers, if any, will have this approval for the compounds in question this makes sense when you think about it: since no one is purchasing the drug (due to the difficulties being described here) then the manufacturer has no incentive to go to the expense and labour of obtaining GMP status for that drug, and as such are unable to offer the drug, so no one can buy the drug.and so it goes round and round in a circle.
  • Even if a suitable manufacturer is found, the price for a given product is usually astronomical – and example being  £10,000 for 1g of Psilocybin quoted by one manufacturer, which is quite remarkable when it is relatively simple to grow a mushroom containing this compound in its natural form at bigger quantities for 1/300th of the cost.
  • Once a compound is sourced and transported back to the UK, it will require tableting and dispensing from a schedule licenced site -  only 4 hospitals in the entire UK hold such a licence, therefore producing an array of logistical problems.
  • In addition, many documents have a time limit –as such, should a given task in the entire process take longer than expected or meet delays (and believe me, in R&D, there are no shortages in unexpected delays and circumstances) then it may be that the time limit for a given document expires, and thus the process has to be started from the beginning.
  • Funding is also an issue – government funding is little to none, and pharmaceutical companies have no incentive due to patents for these compounds being long expired, and therefore will not turnover a worthwhile profit for any investment.

In practice, obtaining a schedule 1 licence for the purpose of research takes several years at typically costs 10-fold above that for legal drugs (Nutt 2015). It should also be noted that the stigma attached to these drugs reduces enthusiasm for research groups to take them on, so the added red tape and administrative workload does nothing to encourage research groups from taking on a research project using these compounds.

So why are these compounds listed as schedule 1?

The rationale for placing any drug in a schedule 1 category is supposedly because these compounds have a high risk for harm and abuse, and therefore are restricted in this fashion in order to reduce their recreational use and abuse.

…….but how accurate is this?

Some may recall that Professor David Nutt was sacked from his position as chairman in the Advisory Council on the Misuse of Drugs (ACMD), triggered by his claims that ecstasy was statistically less harmful than horse riding based on a 2007 study on drug harm published in The Lancet (Nutt et al 2007), and ultimately because he argued that drug laws were not based on science but led by politics.  The findings of this study were in agreement with other studies across Europe which had reached similar conclusions (Van Amsterdam et al 2010).

I think it is important to note here that in response to his sacking, Dr Les King (advisor to the Department of Health and senior ACMD chemist), Marion Walker (Clinical Director of Berkshire Healthcare NHS foundation Trusts substance misuse service and Royal Pharmaceutical Society’s representative on the ACMD), Dr Simon Campbell (former president of the Royal Society of Chemistry and subsequent CBE and knighthood recipient for services to chemistry), Ian Ragan (scientific consultant) and psychologist Dr John Marsden all handed in their resignation form the ACMD in protest.  I mention this to highlight that Professor Nutt was not some lone maverick with leftfield ideas, but a respected scientist whose views and opinions were held in high regard by peers of equal esteem.

Following this dismissal, he set up the Independent Scientific Committee on Drugs (ISCD).  A 2010 study brought together a team of experts, who reviewed drug harms using a ranking system which based the harm potential of 20 drugs using a 16 category matrix, 9 of which related to drug harms towards the individual and 7 related to drug harm towards others (Nutt et al 2010). This then produced a rank of the most harmful drugs based on their cumulative scores out of a maximum of 100.

A pint of the Victoria Pubs finest Longhorn IPA to whoever can guess which drug came out ranking as the most harmful overall……

(image sourced from Nutt et al 2010).

That’s right friends, as the graph about demonstrates, alcohol is by far the leading contender for most harmful drug out of all those we see listed.  The following graph shows the same data with the categories under which each drug was scored.

(image sourced from Nutt et al 2010)

This perhaps isn’t so surprising – imagine if the papers tomorrow announced the rise in use of a new drug which caused lowered inhibitions, had high abuse and addictive potential, overdose could lead to organ failure, coma or even death, users were known to become violent and if driving under the influence posed serious danger to all around them, amongst a myriad of other consequences and lets not forget -in true tabloid fashion – THIS DRUG IS AVAILABLE IN YOUR CORNER SHOP AND TO YOUR KIDS NOW!  Well, we’d expect this drug to banned with immediate effect.  Yet all the above can be attributed to alcohol, and it has zero medicinal benefit.  This isn’t a bash at alcohol though – hundreds of thousands of people can and do enjoy a tipple without consequence every weekend up and down the country.  I simply use it to highlight that the laws which govern scientific research using certain compounds is not in line with the scientific evidence for potential harm and abuse.

The data presented isn’t perfect though – it only analyses the harm potential, and does not take into account any medical utility or benefit.  Were this to be factored in, we would expect substances like heroin, cocaine and cannabis to drop a few points (these do have legitimate medicinal uses) whereas compounds such as alcohol, tobacco and crack cocaine would remain where they are.  It also should be taken into consideration that for some points of harm to society, which factors in the cost of processing through the judicial system, prisons and customs.  This is not adjusted for the scale of use, so with cannabis as an example, the usage is far higher amongst the population than say GHB, and thus there will statistically be a far higher number of arrests and criminal charges brought up against cannabis related offences, which will subsequently skew the points ranking, making cannabis appear to be more harmful than compounds such as mephedrone, butane and benzodiazepines, which in realistic terms I do not believe to be the case, and I don’t think the evidence would agree with either.

Clearly, from what we have seen so far, the harm potential of a particular drug is not in line with the restrictions placed upon it.  It can be strongly argued that the holding back of medical research has caused far more harm than it has ever prevented.  As a result, research using certain drugs is made exceedingly difficult, and as such, potential therapies for a range of conditions go unexplored.

In part 2, I shall give an overview of some of the compounds in question which are currently subject to the restrictions discussed above detailing the evidence that shows they have the potential to become vital medicines for a range of very serious illnesses that affect thousands of people up and
down the country every day.

In the meantime, if you like the subject matter here, I encourage you to check out my previous blog post reviewing a previous talk given at SitP on the subject of lying by Dr Mike Drayton, and also to check out the SitP website to keep up to date on upcoming talks and articles of interest.

References used in this post:

NUTT D.J. (2015) Illegal drug laws: clearing a 50-year-old obstacle to research.  Public Library of Science Biology, Volume 13, Supp.1.
NUTT D.J., KING L.A., SAULSBURY W. and BLAKEMORE C. (2007) Development of a rational scale to assess the harm of drugs of potential misuse.  The Lancet, Volume 369, No.9566, pp1047-pp1053.
NUTT D.J, KING L.A. and PHILLIPS L.D. (2010) Drug harms in the UK: a multicriteria decision analysis.  The Lancet, Volume 376, No.9752,pp1558-1565.
VAN AMSTERDAM, J., OPPERHUIZEN A., KOETER M. and VAN DER BRINK W. (2010) Ranking the harm of alcohol, tobacco and illicit drugs for the individual and the population.  European Addiction Research, Volume 16, No.4, pp202-pp207.

This post was contributed by SitP regular Phil Walsh.

Wednesday, 17 June 2015

Cancer Quackery in Birmingham

Brian Clement is speaking at the Buddhist Centre this weekend. If you don’t know him he is the director of the Hippocrates Health Institution in Florida and peddles all kind of quackery from enemas to naturopathic diets and a whole load more. The claims that he makes for his cures are extreme and in this country possibly even illegal given the ruling of the Cancer Act which forbids people to claim that they can cure cancer.

Yet claim this he does and has done, to the point of persuading a family to halt the curative chemotherapy that had a good chance of beating the leukaemia that their daughters had. The effect of this was all too predictable and all too disastrous. A very full account of much of what is known about Brian Clement can be found over at Science Based Medicine.

Brian Clement has law suits outstanding against him, he uses the title Doctor, despite having no professional medical qualifications and he claims to be able to cure cancer. He makes a lot of money from people’s illness and offers them spurious remedies and unproven and unsuccessful curatives for what can be very serious conditions.

Other venues on this speaking tour have cancelled his events in light of the concerns that people have. There is only a short time before he is due to talk but if you think that Brian shouldn’t be spreading his misinformation in Birmingham you could contact the Buddhist Centre and let them know, it’s very possible that they are not aware of the extent of Brian’s claims and may be as concerned as we are. You might also want to tell trading standards or the local MP what you think about his assertion to be able to conquer cancer.

This blog post was written by Patrick Redmond one of the organisers of Birmingham Skeptics in the Pub

Sunday, 14 June 2015

A White Lie Can't Hurt......Right?

On Wednesday 10th of June at Birmingham Skeptics in the pub, Dr Mike Drayton graced us with his presence in order to give a fascinating talk on the psychology of lies and lie detecting.

Dr Mike Drayton is an organisational development consultant, a clinical psychologist and expert in negotiation.  He has a Doctorate in Psychology from the University of Birmingham and a BSc in Social Psychology from LSE.  He is a Fellow of the Royal Society of Medicine and an Associate Fellow of the British Psychological Society, and spent 20 years working in mental health within the NHS before working as an independent consultant psychologist.

Dr Drayton ran through some common misconceptions about the nature of lying and how good (or rather how bad) we are at detecting lies – it seems we underestimate how good we think we are at lying, and conversely overestimate our abilities to detect lies.  This addressed the commonly thought ways of detecting when someone is lying to us – things such as avoiding eye contact (he tells us that in fact, a person lying will hold an unnatural degree of eye contact as a form of overcompensation), the person in question shifting in their seat and other subconscious cues like scratching of the head, placing their hand over their mouth and so forth.  It turns out that these aren’t so much signs of deception but more signs of anxiety – likely to be experienced by anyone undergoing interrogation regardless of whether they are telling the truth or not.  Better ways of determining if a person is being truthful or not are by asking seemingly irrelevant questions relating to the matter, since a liar has formed a storyline and timeline in their mind and this will throw them off their course, as will asking the person to recount the events in reverse order.  He discussed the motivations for lying – self gain, making others feel better, the so called “groupthink” whereby in order to avoid tension and conflict a group of people may accept lies at face value without employing any form of critical evaluation.

The effectiveness of devices such as the polygraph machine –which measures heart rate, blood pressure, respirator rate and galvanic skin response – was called into question.  Whilst the basis under which they detect lies seems plausible – establishing a baseline response to fairly normal questions such as name, place of birth, mother’s maiden name etc – there is actually very little established evidence with regards to their efficacy.  He also raised an interesting point in that psychopaths would pass such a test with ease due to their lack of empathy or emotion, and as such would not exhibit the typical responses we might expect to observe in someone trying to be deceitful.

What does have more credence is the analysis of what are termed Microexpressions – tiny, fleeting facial expressions that occur in 1/25 to 1/15 of a second so as to be barely perceivable in normal conversation.  Research into this field was pioneered by Dr Paul Eckman in the 1990s.  The process generally relies on catching these microexpressions  (usually be means of slowed down video footage) which seem to betray what a person is saying, as if the real story is told on the subconscious level.  As an example of this put into practice, a short video clip was shown which related to the story of Karen Matthews who in 2008 faked the kidnapping of her daughter.  In the video shown, when the footage is slowed down, we can see moments where she very momentarily smiles during a press conference relating to the disappearance of her daughter – not the sort of behaviour one would expect from a mother whose daughter was missing and her status unknown.  Other examples included video footage of Ted Haggard – an American evangelical minister who was recently accused of purchasing and using crystal meth as well as having homosexual relations with a male escort (relevant due to his condemnation of homosexuals as part of the beliefs that he preaches) and how his facial expressions contradicted his statements regarding the allegations.

Other examples of patterns exhibited during the telling of lies included head movement directly opposite to what was being said (a politician stating he would be happy to take paternity tests to determine the legitimacy of a child he was alleged to have fathered whilst shaking his head the whole time) and the language patterns used to distance oneself from the event in question (Bill Clintons classic “I Did.Not.Have.Sex with that woman” – note the emphasised words that don’t flow like normal conversation and the use of “that woman” as opposed to “Monica” or “Miss Lewkinsy” as would typically be expected when referring to a person).

Another interesting point brought up during the discussion was the question of whether it is ever ok to lie, by which we mean so called “white lies”.  I had read an essay by neuroscientist and philosopher Sam Harris (whose works and books I thoroughly recommend) and the subject of white lies.  In the essay, Harris argues that, when given some thought, it is actually quite hard to really justify any white lie.  Take for example a wife asking her husband if she looks fat in particular dress – now; any man alive knows he is in for a rough night in the doghouse should he respond with anything other than “You look wonderful dear”.  But let’s think about this for a moment – if indeed the wife is perhaps a little overweight, and you informed her so (in a nice manner of course) then this may prompt her to take action – maybe start eating more healthily, taking up exercise and generally improving her lifestyle.  In turn she can expect to lose weight, generally feel better about herself and reward herself with better health and improved health prospects – diabetes and coronary heart disease are no joke – perhaps more so if the couple have a family who they want to see grow up, and the children surely don’t want their mother to pass away at an early age.  So here we have to ask ourselves – are we really doing our partner any favours by lying to them?

Another example that Harris gives is when a friend produced a screenplay for him to read and review.  The screenplay was of significant length and clearly the friend had put a lot of time and effort into it.  Any good friend might be economical with the truth if they thought it was not good and severely lacking in some departments, but not wanting to hurt their friends feelings told them they thought it was ok and worth presenting to some Hollywood big shot who might turn it into a production.  But again, let’s think about this.  This friend might have one shot at presenting their work to the big director, and if they come forth with relative garbage, the director might turn them away, and disregard instantly any further work that person brings their way, effectively ending this persons career before it has even started.  Would it not be better to give an honest opinion, so that the friend may then go back and work on the shortcomings, to make it the best possible piece of work that they can produce, and then submit it to the director?  In the grand scheme of things, you are being far kinder to the friend by being honest than you are by saving them a short moment of embarrassment and disappointment that they will need to go back and rework their piece.

When Dr Drayton asked the audience for examples of where a white lie might be acceptable, one audience member replied “Santa Claus” – after all, it’s just a bit of fun right?  Well, we could argue that the inevitable revelation of the non-existence of Santa Claus might lead to a certain building of mistrust between the child and their parent – a lie ongoing for years without much justification that a child can comprehend.  It’s worthwhile taking the time to try and think of ways in which a white lie would be acceptable and then try to find reasons why, actually, they might not be, though implementing this into your daily routine would be no mean feat I’m sure.

This brings me back to the discussion of microexpressions – I recall reading an article in New Scientist where Dr Eckman said one of the pitfalls of being able to do this is that you can’t really turn it off once you have turned it on, so you can never effectively be lied to again – he gave an example of asking his wife if she enjoyed the dinner he had prepared, whereby she responded that it was wonderful, whereas her microexpressions told a different story.  This begs an interesting question in my mind – would we want to live in a world where we couldn’t be lied to?  Maybe sometimes we are content with the answers we are given, regardless of whether they are sincere or not.

There was nowhere near enough time in the evening to tap all of Dr Draytons wealth of knowledge and experience and I don’t think I would be alone in hoping to hear more from him in the near future.

Be sure to check out the Birmingham Skeptics webpage for details of the next upcoming talk which is sure to be as intringuing and thought provoking as that given by Dr Mike Drayton.

You can follow Dr Mike Drayton on Facebook here
And on twitter here: @mikedrayton

You might also be interested in looking up an Infinite Monkey Cage podcast from January 19th 2015 entitled “Deception” that covers many of these point.

This blog post was written by SitP regular Phil Walsh

Sunday, 26 April 2015

Open Mic Night - May 27th 2015

It's our fantastic open mic night and we've got five brave volunteers who have come forward for your education and edification. You can find details of them and their talks below. This is a really enjoyable event and takes the place of our monthly social, but we will be hanging around for a drink  or two afterwards.

We start at 7.30pm and each speaker gets 15 minutes. It'd be great to see you there and you can let us know you're coming on Facebook  if you use that  social medium.

Why Internet Dating Doesn’t Work – Dr Martin Graff

Romantic relationships play a huge part in our physical, social and emotional well-being.  Successful relationships promote better health and even aid in faster recovery from illnesses.   Not surprisingly, most of us seek to find a romantic relationship.  However, should we resort to online dating to find this?  Drawing on psychological research, this talk focuses on seven reasons why we shouldn’t.  Some of the principal considerations are that we make bad decisions in online dating and people are certainly not what they seem to be meaning that such a matching system is not a good predictor for the sustainability of relationships in a face-to-face context.
Dr Martin Graff is Reader and Head of Research in Psychology at the University of South Wales.  He is an associate fellow of the British Psychological Society and a Chartered Psychologist.  Over the years he has carried out research in the areas of cognitive processes in web-based learning, individual differences in website navigation, online interaction and the formation and dissolution of romantic relationships online and offline.  He has also carried out research in the areas of online persuasion, and online disinhibition, and has supervised several doctoral degrees in this area.

From Richard Dawkins to Freud’s Death Instinct - Mike Waller

Dawkins says we are exquisitely refined organisms whose evolutionary function is to transmit copies of our genes. In this context, the evolutionary persistence of depression seems to make no sense. Apart from its psychological effects, it is heavily implicated in many life-threatening behaviours and illnesses. In "Family stigma, sexual selection and the evolutionary origins of severe depression's physiological consequences" (JSECP, 2010,4(2): 94-114) I build on Hamilton's suggestion that a badly impaired embryo might be "programmed" to self-eliminate if its condition would impede the aggregated reproductive prospects of its kin.

Stockbreeders know that family merit is the best guide to successful breeding, a reality unlikely to have been missed by natural selection. If so, individuals perceived as performing relatively badly in respect of close kin might well impose (by way of impaired family reputation) a reproductive penalty on their kin group well in excess of their own potential gene throughput. Here too, deeply unpleasant though the idea is, self-elimination would make sound evolutionary sense. With WHO identifying depression as the illness that, globally, causes most disability, I believe this an idea that should be full explored as a key guide to treatment. 

Mike Waller has had an interesting and varied academic and professional career studying government, management and psychology. A fully paid up Dawkinsite he became interested in the problem of depression. His peer reviewed paper on this subject was published in the Journal of Social, Evolutionary, and Cultural Psychology (4(2): 94-114) in 2010.

Skeptical about Drug Laws – Phil Walsh

There are a plethora of instances where science is absent when it comes to so called medicines and treatments for a variety of ailments – from homeopathy to bogus cancer treatments which can actually cause harm.....but what about when science is absent from the laws which govern the progress of medicine? This is worthy of equal scrutiny and in this short presentation I hope to give a brief review of the problems encountered when trying to perform research with certain compounds and highlight some which show great potential for therapeutic use but are hindered by the issues described.

Phil Walsh is 31 years old and holds an honours degree in pharmaceutical chemistry and a master’s degree in clinical biochemistry. He has been working in research and development within the immunodiagnostics industry for the past 9 years. His other interests are based in neuroscience, psychology and an unhealthy penchant for podcasts.

The Great Porn Phallusies - Rachel

Rachel is a regular consumer and occasional creator of pornography; she became excited when she realised that the field of pornography was an apparently untapped well of pseudoscience and logical fallacies. Tonight she intends to celebrate naughtiness, challenge assumptions, and look at the facts behind what 'everybody knows' about porn

Rachel says that there will be no explicit images in this talk although there may be some page 3 type content. It will also include some frank discussions of porn, sex, sexual assault, drugs, addiction, and use of adult language.

Skeptical Activism: Why and how to get involved - Richard Sutherland

From naive atheism at age 8, Richard became aware of the skeptical community and movement around 2005 via discovering the James Randi Educational Foundation site and forum, as well as the now defunct UK Skeptics forum. He was then inspired to get involved in campaigning, initially targeting 'psychics such as Gary Mannion the 'psychic' healer. This included getting BBC Children in Need to withdraw support from an event he was attending, and being interviewed for a BBC documentary on Mannion. He subsequently carried out an email campaign to theatres hosting 'psychic' shows making sure that many who did not already started to incorporate disclaimers on publicity material. 

In 2008, alerted by a JREF Million Dollar Challenge, Richard started a UK campaign against the sellers of fake bomb detectors, which contributed to media coverage of the issue, and played a minute part in the perpetrators finally being brought to Justice some 5 years later, and seeing 3 of 5 jailed, and one receiving a suspended sentence. 

He started attending Birmingham SitP in 2012

Friday, 24 April 2015

Astrology is Balls

On 17th April on Radio 4's satirical programme “The Vote Now Show” Jon Holmes presented a pre-recorded piece with the aim of seeing if he could find anyone to predict the result of the forthcoming UK General Election.

He first visited the polling company YouGov followed by David Cowling, Editor, BBC Political Research. Neither could give definitive answers.

He then visited, well, let Jon take up the story... [Transcription below]

So, to recap,

1       The job of an astrologer is to keep him/herself popular by making positive predictions which everybody likes the sound of;

2       Astrologers can be very successful if their predictions are so vague that you could read anything you wanted into them;

3       If they are sufficiently vague they can never get into trouble;

4       Being vague is something astrologers should be proud of;

5       Astrology is balls.

You can catch the full episode on BBC Radio 4 Extra for the next few days and on the iPlayer for the next three weeks here.


JH     The polls can't tell me, he can't tell me. Where next? The next logical step, of course. Time to meet Jonathan Cainer the astrologer from the Daily Mail

JC     Of course the trouble predicting an election or the outcome of any competitive sport or activity is that you deeply upset the people who'd rather wish that the event went the other way.

JH     Yes, I suppose you do but that's part of the job though isn't it so you've got to, um...

JC     Not really

JH     Oh

JC     The thing is you... The job of an astrologer is to keep yourself popular by making positive predictions which everybody likes the sound of. If I were to stick my neck out and predict the result of this election not only would I upset all the people who didn't want that to be the result but at the same time I'd lay myself open to terrible mockery should I turn out to be wrong.

JH     But again, isn't that part of the risk of your job anyway?

JC     Not if you can avoid it, I mean Nostradamus made a very successful career out of giving his predictions in cryptic French and Latin puzzles and therefore anyone could interpret anything into (sic) and so he was always right when you wanted him to be right and never got into trouble for saying anything which you could hold him to account for.

JH      Which is basically saying astrology is balls and so I just say what I think people will like. But on your behalf I persisted.

JH      So the answer is that you can't predict the outcome of the General Election

JC      Astrologers have a long, proud tradition of being vague wherever possible and I would be absolutely insane to stick my neck on the line for it.

JH      But look, I wasn't going to give up right 'cause he's got mystical powers, so I asked him again outright, “Who is going to win the Election?”

JC      I'm trying to steer as clear as I can of answering that question.

JH      I can tell that, yep. What's the... I'm Taurus

JC      Are you?

JH      So what's the... what am I typically? What are typical Taurean...

JC      To be a Taurean is to be tenacious; it's to be very fond of...

JH      Asking questions that people don't want to answer?

JC      Absolutely, you wouldn't give up. So this could be a long interview.

JH      It wasn't because I've stopped him there. You know, fat lot of help that was; we're still no closer.

Posted by @christheneck

Thursday, 1 January 2015

Thank you WHSmith

Happy New Year to all you out there!
This is a good time for showing people how much you appreciate their gifts and deeds, and our friends at the Good Thinking Society have asked us to pass on a request for you to quickly and easily send out just one more thank you letter...

In October, WHSmith stopped selling the magazine What Doctors Don’t Tell You. Although we are not aware if this was as a result of complaints from those who support evidence-based medicine, we applaud this decision heartily.
What Doctors Don’t Tell You has since been campaigning for a return, untruthfully claiming to have been “banned” following a “relentless campaign by Pharma-sponsored trolls” and urging readers to complain to
This strategy seems to have been successful once already – Tesco had stopped selling What Doctors Don’t Tell You but appeared to reverse the decision following pressure from the magazine’s supporters.
We therefore encourage everyone to write to the same address,, in order to thank WHSmith for removing this magazine from the shelves and to remind the company of our reasons for concern.
We have provided a template email below. Please feel free to either use this in its entirety or, preferably, edit it to make it your own. Individual personal emails may be more likely to have an impact. Just tweaking the opening paragraph makes a huge difference, e.g., As a regular visitor to your branch in Exeter, I write to…
Just take the text below, cut and paste it into an email, add your name at the bottom and send it to (this link will automatically send us a copy of your letter to WHSmith – if you’d rather not share it with us, simply remove us from the bcc option).
Many thanks,
Laura Thomason
Project Leader
Good Thinking Society

Dear WHSmith,
I write to congratulate you on the decision to stop selling What Doctors Don’t Tell You. As several medical experts have pointed out, this magazine is consistently misleading, often dangerously so. I feel that it is potentially damaging for reputable mainstream retailers to give this magazine the credibility of a place on their shelves.
This magazine challenges well known and effective health interventions and advocates unproven pseudoscientific alternatives. Previous articles have wrongly claimed that the HPV vaccine has killed up to1700 girls, that Vitamin C is an all-purpose elixir which could cure polio and AIDS and that homeopathy “reverses cancer”.
The advertising is equally problematic. The Advertising Standards Authority found that eleven of the ads in just two issues of the magazine were in breach of advertising guidelines on several counts. A further eleven ads from the same two issues were also problematic, with the advertisers agreeing to amend future advertising.
It is this sort of behaviour that has resulted in strongly negative coverage of the magazine on social media and in mainstream media (including The Times and BBC Radio 4).
I am aware that the publishers of What Doctors Don’t Tell You have been lobbying to persuade you to change your mind, urging readers to complain and falsely claiming that they have been “banned” from WHSmith following a campaign by “Pharma-sponsored trolls”. The truth is that I am just one of a huge number of concerned customers who does not want other customers to be misled and potentially harmed by flawed medical articles and adverts.
I trust that you will understand that the concerns regarding this magazine are legitimate and justified and that the responsible decision is to continue to not stock What Doctors Don’t Tell You.
Yours sincerely,