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Job’s QALY problem: Is the life of an existing child worth more than two future children?

Gabriel Andrade
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Job’s QALY problem: Is the life of an existing child worth more than two future children?

Religion is often criticised for being exploitative. Priests teach you to bow your head and accept the gods’ superiority, and in so doing, they soften you so as to obey the tyrant’s commands.

But here and there, religions do challenge the gods. The Book of Job is one such case. It tells the story of Job, a man who has suffered many misfortunes. Some “friends” try to convince Job that he has nobody to blame but himself, as sinners get their just punishment. Job does not accept this argument; he reminds his “friends” that he has always been a virtuous person, and in fact, he furiously protests God.

Many Biblical scholars think that many generations later, an editor was shocked by Job’s protests. So, two sections were added to the text. First, in the prologue, God and Satan agree to test Job’s faith. As part of the ordeal, Job’s ten children are killed. Second, in the epilogue, God confronts Job for his protests, and Job acquiesces. God decides that Job has passed the test, so “the Lord blessed the latter part of Job’s life more than the former part”, by giving him ten new children.

This is supposed to be a happy ending. But any reasonable person can see how terrible the story is. Why would God, being omniscient, need to test Job? And why would such a test require killing innocent children? In fact, the Book of Job presents the children as if they were simply replaceable commodities. Biblical scholar Bart Ehrman meaningfully asks:

What was this author thinking? That the pain of a child’s death will be removed by the birth of another? That children are expendable and replaceable like a faulty computer or DVD player? What kind of God is this? Do we think that everything would be made right if the six million Jews killed in the Holocaust were “replaced” by six million additional Jews born in the next generation?

Indeed, this God is a moral monster, reflecting the kind of archaic mentality that, ever since the Enlightenment, we have attempted to overcome. But skeptics should realise that, to some extent, we modern people still have that mentality, even in unsuspected places.

Suppose that at the beginning of the test, God presented a dilemma to Job. Job could choose to preserve his newborn child, or he could let God kill him, and in return, he would receive two newborn children. In other words, Job would have to choose between preventing infant mortality, or increasing fertility. I – and I hope most people – would choose the former. But many of our institutions do not always reflect this choice.

Consider medicine. Medical resources are always scarce, so we must decide how to properly allocate them. Many countries follow the QALY (Quality of Life-Adjusted Years) system. As explained by the National Institute for Healthcare and Excellence (NICE) a QALY is

a measure of the state of health of a person or group in which the benefits, in terms of length of life, are adjusted to reflect the quality of life. One quality-adjusted life year (QALY) is equal to 1 year of life in perfect health. QALYs are calculated by estimating the years of life remaining for a patient following a particular treatment or intervention and weighting each year with a quality-of-life score (on a 0 to 1 scale).

When it comes to deciding what treatment must be prioritised in funding, those that increase QALY units the most get priority.

So, ultimately, medical resource allocation is all about adding QALYs to the population. According to this criterion, what should Job do? If he chooses to save his living child he will add, say, 60 QALYs. But if he lets God do his murderous deed, he receives two children, and in that case, he will add 120 QALYs. If Job is to follow the QALY approach, must he comply with the be-fruitful-and-multiply Biblical commandment to the letter, even if it pains him losing his newborn child?

QALYs operate under the principle of total utilitarianism. If, as the utilitarians would have it, we must seek the greatest amount of happiness for the greatest amount of people, then one way of getting there is by increasing the number of people in the world. Philosopher John Harris explains:

If what matters most is the number of life-years the world contains, then the best thing we can do is devote our resources to increasing the population. Birth control, abortion and sex education come out very badly on the QALY scale of priorities.

By the same token, under QALY rules, fertility should be prioritised above the curbing of infant mortality.

Some philosophers have tried to solve this problem by arguing that QALYs only concern the already living. But in accepting this caveat, aren’t we dismissing the rights of future generations? If we should only care about the current generation, why even bother with funding of fertility treatments at all? More disturbingly, if we have no obligations towards future generations, what is the point in trying to avert ecological collapse if, after all, our current generation will likely not suffer the effects of global warming?

Even if we dismiss obligations towards future generations, the use of QALY measures still has weird implications. Suppose that with X amount of money, you could either save the life of one newborn child with a rare disease, or alleviate lower back pain of 200 persons. Because of the large number of beneficiaries for the lower back pain treatment, that option will likely generate more QALYs. Are we therefore willing to sacrifice the child?

This indicates that utilitarianism might not always be the best answer to our ethical problems. Some things are beyond numbers. This is especially the case with the saving of lives. Death is a harm. And while it can be quantified (five deaths are worse than one death), its harm cannot be compared to other non-lethal harms, even if in the aggregate, the death of one person removes fewer utility units than other harms.

Religion may be the opium of the people, and the stubborn adherence to the doctrine of the sanctity of life – a typically religious belief – is an obstacle to sensible decisions in topics such as abortion and euthanasia. But religion’s emphasis on life-saving and averting the harm of death does at least provide some necessary input in making moral decisions about resource allocation in medicine. God seemed to think of Job’s children as replaceable DVD players. We should know better.

The Simpson’s prophecies: no, the long-running cartoon can’t predict the future

Mike Hall
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The Simpson’s prophecies: no, the long-running cartoon can’t predict the future

The longest running scripted prime-time series in the US is The Simpsons, the animated sitcom which started its regular run in December 1989. Barring a writer’s strike here or a cast walkout there, The Simpsons has been in regular production since – and with the same principal cast (though as a feat it is arguably beaten out by Last of the Summer Wine, which ran for 37 years with the same cast before its cancellation in 2010).

Much as I would love to make this the inaugural installment of ‘Mike Talks About Old TV’, I actually wanted to talk about a long-standing myth – one which has turned up in several social media memes and clickbait listicles this year – that being The Simpson’s apparent uncanny ability to predict the future. The most obvious of these is the ‘prediction’ of the election of Donald Trump as president of the United States.

A common juxtaposition you will see is a picture of Homer Simpson standing behind Donald Trump, as the latter descends an escalator to the cheers of fans. This still is often purported to have been taken from an episode named Bart to the Future, which aired in March 2000. And if a comparison is made between that still and the real-life footage of Trump announcing his presidential run from June 2015, the similarities are remarkable. The escalator, the cheering fans holding signs, the camera angle, and so on.

Of course, the very obvious rebuttal is that the still is not from Bart to the Future at all. It’s not even from an episode of The Simpsons! It is from a ninety-second short released directly to YouTuBe named Trumptastic Voyage, which sees Homer get caught in Donald Trump’s hair. This was published to YouTube on July 7 2015, almost a month after the real-life event which inspired it.

Even by the standards of psychic predictions, it’s a stretch to call something a prediction when it is made after the predicted event.

So why do people so often claim this still is from an episode which aired in March 2000? In Bart to the Future, Bart Simpson is given a glimpse into the year 2030, where he learns that his sister Lisa has just become president of the United States. In this sequence, Lisa makes a throwaway reference to having just succeeded President Trump.

Okay, this isn’t as strong as the escalator still, but nevertheless this is The Simpsons mentioning Donald Trump being president, some sixteen years before it happened, right? Except that this was just a gag, with Simpson’s writer Al Jean being on record as saying they just wanted a funny celebrity. Moreover, even in 2000 a Trump presidency wasn’t a stretch.

Until the late 60s, Ronald Reagan was just an actor. He became governor of California in 1967 and then eventually US president in 1981, this fact being the basis of a joke in the film Back to the Future, from which Bart to the Future takes its name. So the idea of a celebrity becoming US president certainly wasn’t new.

Not only that, but Trump had been publicly flirting with the idea of running for President as far back as late 80s, even making a brief run in the New York primaries in 1999. He eventually aborted that presidential bid on February 14 2000, just a month before Bart to the Future aired. Though given the long lead times typical to animation, it’s probable that Trump’s early presidential bid was still alive and well at the time the episode was written and animated.

Another prediction often touted by these sorts of lists is a sight-gag from a 2014 episode called The War of Art. In that episode, we briefly see Richard Branson floating in a spaceship, admiring a painting on the wall. But Richard Branson didn’t actually go into space until 2021 – some seven years later.

Except that Branson started Virgin Galactic, with the stated intention of running passenger flights into space, to great fanfare and publicity, in 2004 – a decade before The War of Art aired. It was no secret that Branson was one of a handful of individuals financing a private space programme. This wasn’t a prediction, it was a pop culture reference, something you would expect from a comedy like The Simpsons which features elements of satire.

So-called predictions of this flavour are actually very common. The supposed prediction of a viral pandemic caused by a new virus originating in China — which featured in the episode Marge in Chains from 1993 — certainly did pre-date COVID-19 by some margin. But didn’t predate the H3N2 flu pandemic of 1968, upon which the plot was based, according to the writer of that episode Bill Oakley. Nor did it pre-date the general warnings from experts that viral pandemics like this are inevitable and we should prepare for them, warnings which go back decades.

Another claimed prediction is that of Facetime and Zoom, from a 1995 episode which features a fortune teller who predicts Lisa’s future and includes Marge calling her on video. Sure, this pre-dated FaceTime, which was announced by Apple in 2010, but it doesn’t pre-date the idea of adding video to a phone call. Star Trek had video calling back in the 60s, so did Doctor Who, and a dozen other sci-fi stories.

Even outside the realm of fiction, there were publicly marketed products which featured video calling — albeit primitive — marketed as far back as the 1980s. The concept of video-conferencing was so obvious and natural a next-step in telephone technology, there are even references to it in the 1800s. This wasn’t the Simpsons “predicting FaceTime”.

Some of these predictions are even more tenuous. In the episode The City of New York vs Homer Simpson, which aired in 1997, Lisa holds up a pamphlet advertising a coach trip from Springfield to New York City for just $9. On the front cover of the pamphlet is the phrase New York, a big price flash saying $9 – and behind it the New York skyline, including the empire state building and — this being 1997 — of course the towers of the World Trade Center.

But some people claim that the big 9, alongside the towers which themselves look like an 11, means this is a reference to 9/11 — even though this was four years before it happened. Therefore this is a prediction of the future, or maybe evidence the whole thing was planned by the Illuminati, who decided for some reason to foreshadow it in an episode of The Simpsons.

Of course, this doesn’t say 9/11. It is an advert for a bus trip to New York for $9 – so of course, it has a picture of a bus, of New York, and the price of $9. The writer of this episode, Bill Oakley, commented on twitter “$9 was picked as a comically cheap fare… to make an ad for it, the artist logically chose to include a silhouette of NYC. It’s pretty self explanatory.”

I must admit, this is one of the hardest of the ‘predictions’ for me to understand, because it predicts no such thing. It doesn’t predict an attack, or the towers falling… it doesn’t even say 9/11. It just says 9 and a picture of New York. Everything else is in the imagination of the viewer.

The final alleged prediction I want to talk about is from the episode When You Wish Upon a Star, which aired in 1998.  Again, this features a brief sight-gag where we see the logo of 20th Century Fox — and underneath is the strapline, “A division of the Walt Disney Company”. Of course, Disney did eventually purchase 20th Century Fox in 2017. So, again, was this a prediction?

Well, unlike the others we have talked about, it’s not like Disney had been publicly saying, hey we’re thinking about buying Fox for a couple of decades before going through with it. But, again, there is a historic context which makes this just a satirical sight-gag, not an eerie prediction of the future.

The US has four major broadcast networks – NBC, CBS, ABC, and Fox. There are a handful of others, like PBS, or the CW, but those are the major ones. NBC is currently owned by Comcast, CBS by Paramount, Fox is owned by the Fox Corporation — which comprises the parts of Fox which Disney did not buy. And ABC is owned by Disney.

ABC wasn’t founded by Disney, but it was acquired by Disney in 1996, just two years before When You Wish Upon A Star aired. As with a Trump Presidency, the notion of Disney buying up television networks wasn’t exactly groundbreaking. Exactly that had happened just before the episode was made. To joke about one of the other four studios being bought up too — and that studio being Fox, which at the time made the Simpsons — isn’t exactly a stretch.

There are many many more of these. The Simpsons predicted three-eyed fish. The Simpson’s predicted Kamala Harris’s outfit. The Simpsons predicted the Findus horse meat scandal. The Simpsons predicted Go-Pros or the Apple Watch. But when a show has been running for over thirty years, producing over 700 episodes, plus films, shorts, specials, comics, video games etc. That’s a whole lot of predictions – deliberate or otherwise – and confirmation bias will take care of the rest. Fans remember the hits and forget the misses, which makes the hits seem that much more remarkable.

As Simpson’s producer Al Jean told the NME, if you throw enough darts, you’re going to get some bullseyes.

Antimicrobial Resistance, homeopathy and the Soil Association

Robyn Lowe
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Antimicrobial Resistance, homeopathy and the Soil Association

The Soil Association was one of the founders of the global organic movement and developed some of the world’s first organic standards. Their intent is to protect producers, consumers and the soil by endorsing ‘nature-friendly’ farming methods and practices.

The Soil Association aims to develop high standards for food, farming, health and beauty, and textiles, as well as to protect forestry. They work across Europe to influence legislation, and through their work with the International Federation of Organic Agriculture Movements (IFOAM), they aim to support organic farming methods internationally.

In a way, this parallel focus on animal welfare, human health, and safeguarding the environment encapsulates the idea of ‘one health’; an approach that recognises that our health is closely connected to the health of animals and our shared environment. The COVID-19 pandemic has shown us just how devastating diseases can be, and with our lives interlinked with animals, livestock, and the environment, and with an ever-increasing population with its growing demand on resources, the Soil Association are incredibly aware of the importance to protect from both from disease, and from antibiotic overuse.

Antimicrobial Resistance

The World Health Organization states that antimicrobial resistance (AMR) is a global health and development threat, requiring urgent multisectoral action. Of course, antibiotic overuse and resistant bacteria are not just issues in human healthcare – many farming practices involve the use of antibiotic treatments.

Antimicrobial resistant organisms are found in people, animals, food, plants and the environment (in water, soil and air). They can spread from person to person, or between people and animals, including from food of animal origin.

The WHO states that the main drivers of antimicrobial resistance include the misuse and overuse of antimicrobials; lack of access to clean water, sanitation and hygiene for both humans and animals; poor infection and disease prevention and control in health-care facilities and farms; poor access to quality, affordable medicines, vaccines and diagnostics; lack of awareness and knowledge; and lack of enforcement of legislation.   

While in the UK we restrict prescribed treatments for the management of disease, some countries (particularly the USA) allow farmers to give livestock a low dose of antibiotics to prevent illnesses and even to promote growth. The EU banned such use of antibiotics in 2006.

Furthermore, as well as using antibiotics only when needed, there are a number of things the agricultural sector can do to reduce disease risk in their animals – which ultimately can lead to even less disease and antibiotic usage.

Antibiotics Stewardship

In 2017, farm animals accounted for around 30% of all antibiotics used in the UK. Despite this, agricultural use in the UK is among the lowest in Europe – although historically, dairy, beef and sheep sectors have struggled to provide evidence of their levels of use.

Currently, dairy farms are well on course to meet targets for reduction in antibiotic use. A report tracking usage on dairy farms across the British herd from 2017 to 2020 found that the use of injectable Highest Priority Critically Important Antibiotics (HPCIAs) has fallen by 96%. Overall, sales of antibiotics for use in livestock have reduced by 55% since 2014 to the lowest ever recorded level.

Antimicrobials and Soil Association

Organic farming aims to maintain animal health through prevention of disease and minimising the use of veterinary medicines. Overall, this is a laudable aim, as veterinary professionals always strive for prevention over cure. There are a number of factors which play into the health and welfare of our farm animals, and there are dietary, healthcare and husbandry measures that can all help reduce the instance of disease.

The basis that disease management must be based on preventative measures is sound. The Soil Association allows famers to draw up a health plan to show how they will build health and reduce disease, where their preventative measures include:

  • Breed and strain selection
  • Husbandry management practices
  • High quality feed and exercise
  • Appropriate stocking density
  • Adequate and appropriate housing maintained in hygienic conditions
  • Biosecurity measures
  • Grazing and range management
  • Stockmanship
  • Welfare assessments
  • Breeding and culling management

My concern

While this all seems enormously positive and sensible, the concern here lies in the wording of the Soil Association’s position. The SA states that a farmer “must be able to demonstrate that [they] are treating animals affected by disease, injury or ill-health quickly and effectively” and “that the use and application of treatments should be given under professional guidance”.

This sentiment will be mirrored by veterinary professionals, who want to ensure that livestock have access to quick and effective treatment, to alleviate unnecessary pain and suffering.

But here is the snag, and where the removal of a single word could improve guidance substantially, to bring it into line with evidence-based medicine, and to mirror the values of the Soil Associate to treat livestock with effective treatment. The guidance goes on to say:

When treating you must use phytotherapeutic and homeopathic products and the trace elements, vitamins and minerals listed in standard in preference to chemically-synthesised allopathic veterinary treatment or antibiotics, provided that their healing effect works for the animal species and the condition you are treating.

The inclusion of homeopathic products in this statement is hugely problematic. Homeopathy is a “treatment” based on the use of highly diluted substances, which practitioners claim can cause the body to heal itself. There is sufficient body of evidence to support the conclusion that homeopathy has no medicinal properties, and works no better than a placebo.

There is no reliable evidence from research in humans that homeopathy is effective for treating health conditions, and such is the case within the veterinary field too: studies of a robust nature reported that homeopathy was not more effective than placebo. Overall, there is weak evidence in favour of homeopathic remedies, but (as expected) strong evidence for specific effects of conventional evidence-based interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.

In their standards, the Soil Association clearly state:

[the farm] must be able to demonstrate that they are treating animals affected by disease, injury or ill-health quickly and effectively

Here, I believe the standards are self-contradictory – we cannot have quick and effective treatment while promoting the use of homeopathy in preference to conventional veterinary treatment.

The aims of the Soil Association are commendable, and based on the concerns of many within the human medicine, veterinary medicine and agricultural sector, to ensure the health and welfare of livestock, as well the protection of the wider health of our society and environment. However, the inclusion of homeopathy in the guidance fundamentally undermines their aims – to treat effectively, but treat first with a substance known to be no more effective than placebo? This is hopelessly contradictory.

For the Soil Association to live up to their laudable aims, they need to update their standards to remove any endorsement of homeopathy, and align instead with the most current and up to date evidence base.

When we enforce our taboo against inbreeding, we shouldn’t pretend that nature agrees

James Williams
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When we enforce our taboo against inbreeding, we shouldn’t pretend that nature agrees

The ‘balance of nature’ is a persistent and widespread idea. The suggestion is that nature is a stable self correcting system, and what’s more, nature is fair, ordered and rational. Animals are noble, driven solely by evolutionary drives, and mother nature is in harmony. In actuality, the ‘balance of nature’ is an enduring myth, and one that perhaps persists because of our tendency to commit the ‘appeal to nature’ fallacy, which assumes that nature is, by definition, ‘good’. The reality is that the natural world is messy and complicated, and not always a good and noble system. Nature is characterised by constant flux, with chaotic and dynamic change being the norm. 

I like to think I’m aware of the messy imperfection of nature. As a skeptic who specialises in researching taboos, I’m no stranger to bizarre animal behaviour. But even I fell for the trick of believing in a wise and good natural order, when I came to research the topic of inbreeding. 

Inbreeding is the production of offspring from the mating of organisms that are closely genetically related, such as family or ‘kin’. Humans have been known to practise inbreeding, most notably as part of royal families or hereditary dynasties. Powerful families throughout history have practised mating with kin in an attempt to preserve their bloodline, or to consolidate power. Intentional inbreeding is often practised in agriculture, where farmers may encourage individual livestock to inbreed in order to select for, or against, certain traits. 

But does inbreeding occur in animals outside of the purview of humans? Surely not, I thought. I was aware of the phenomenon of ‘Inbreeding depression’. This is when a species can suffer from ill effects and a reduced ability to survive as a result of inbreeding. This includes effects such as high mortality, low fertility & hereditary diseases. Inbreeding depression happens because inbreeding results in more recessive genes becoming expressed in offspring. Recessive traits in offspring can only occur if the recessive gene is present in both parent’s genomes. Thus the more genetically similar the parents, the more recessive traits appear in their descendents. In nature this often happens due to population bottlenecks.

So nature, I assumed, being balanced and good, would self correct, and animals would have an innate avoidance of inbreeding. And perhaps I shouldn’t be blamed for holding this view. In academic circles, it has long been believed that inbreeding avoidance is the norm in nature, and treated as a given in experimental studies. Species would have evolved mechanisms for avoiding inbreeding, such as sex-based dispersal or active mate choice. Such was the prevailing hypothesis until a paper titled ‘Meta-analytic evidence that animals rarely avoid inbreeding’ was published in Nature Ecology & Evolution in 2021. The meta-analysis analysed 677 effects sizes from 139 experimental studies, investigating inbreeding avoidance between kin and non-kin. These papers covered 40 years of research, spanning 88 different species, including organisms from multiple different classes, vertebrates & invertebrates, and internal & external fertilisers. 

It showed that according to the available scientific literature, there is little support for the widely held view that animals avoid mating with kin. The analysis found no difference in kin avoidance between males and females, choice and no-choice experiments, or mated and virgin animals. The paper analysed the data in multiple different ways, but whichever way they looked at it, the effects sizes were either negalible or even negative (suggesting in some cases an active preference for mating with kin). Where positive effect sizes suggested animals engage in kin avoidance, closer inspection of the dataset revealed that those effects were not robust. Unbiased mating with regards to kinship appears widespread across animals and experimental conditions. In short, animals are not ‘hardwired’ to avoid mating with relatives.

But how can this be when we know that inbreeding depression is a real phenomenon? As the paper explains, long-standing theoretical models can help make sense of this. They suggest that animals should avoid inbreeding only when the costs associated with inbreeding depression are high. Therefore a lack of inbreeding avoidance in animals is due to the costs of inbreeding depression being low in most of the species included in the dataset. Low costs of inbreeding depression would generate little selective pressure for animals to avoid mating with relatives. Moreover, if inbreeding depression costs are low, then animals may prefer incestuous matings in order to gain kin-selected fitness benefits.

It appears that while inbreeding avoidance mechanisms do appear in nature, they are variable across species, and only evolve when the cost of inbreeding depression is high. Furthermore, recessive traits are not necessarily deleterious. Inbreeding can increase the probability of fixing beneficial recessive traits, as well as negative ones. Inbreeding can also result in the purging of deleterious genes from a population through ‘purifying selection’. The reality is that inbreeding genetics are incredibly complicated, and are still being researched and understood.

So why has inbreeding avoidance been the assumption for so long? The analysis also revealed a substantial publication bias in the literature, which skewed in favour of studies showing kin avoidance. While several studies demonstrated kin preference and numerous studies demonstrated no kin bias, the authors detected an over representation of studies demonstrating kin avoidance. Where a positive effect for inbreeding avoidance did seem to exist, these effects disappeared when accounting for the publication bias. The paper notes that “Such publication bias is a testament to the power of a single prevailing hypothesis”, and postulated that “the assumption that inbreeding avoidance is widespread in animals remains, possibly due to human moral judgement against incest”.

In a final fascinating tidbit, the study also found no difference in kin avoidance between humans and animals. The analysis took results from human studies where facial characteristics were modified to resemble either the participant (self-resemblance ‘kin’) or another participant (unrelated ‘non-kin’), and the experiments quantified the participant’s attractiveness response to these stimuli. There was no statistically significant difference in effect size estimates between humans and other animals. Now this is only one experiment type, and a relatively small dataset, but it does raise an interesting question: if there is no ‘natural law’ that forbids inbreeding, and inbreeding risk is population- and context-specific, do humans avoid breeding with kin? The intuitive answer appears to be yes, but as we know this is not always a good guide. The answer becomes more complex the longer you look at it. 

International incest

Globally it is estimated that at least 8.5% of children have consanguineous parents; ‘consanguineous’ meaning people who are biologically related as second cousins or closer. And an estimated 1 billion people live in communities with a preference for consanguineous marriage. Consanguineous marriage is traditional and respected in most communities of North Africa, Middle East and West Asia. 

Countries located on the Arabian Peninsula display some of the highest rates of consanguineous marriages in the world – specifically first-cousin marriages, which may account for up to 25-30% of all marriages. In these cultures, marrying within a family is believed to strengthen family ties, aid cultural continuity and reduce the risk of hidden uncertainties in health and financial issues. 

As in non-human animals, inbreeding could theoretically increase the relative fitness of a population under specific ecological conditions. Sometimes the overall genetic benefits may exceed genetic costs of inbreeding. In populations endemic with malaria for example, the prevalence of consanguineous marriages and the frequency of alleles protective against malaria are both very high.

Inbreeding is seen as a gross taboo in many parts of the world, and it is tempting to assume therefore that our whole species must share this same outlook, and that our values, ethics and behaviours are universally adopted. But we are incredibly widespread, having settled to every corner of the globe, across almost every environment. We exist across many different populations and contexts, and if inbreeding risk and avoidance is ultimately dependent on those things, we shouldn’t be surprised to find a variety of inbreeding strategies in our own species.

This meta analysis is a cautionary skeptical tale to not let our own qualms and moral judgements cloud our assessment of the world around us. We must be careful not to idealise nature, or impose on it our ideas of good and balanced. Like telescopes peering into the night sky, one of the greatest challenges we face in gaining a clear picture of the unknown is the distortion created by our own atmosphere.

References

Is it time to stop using Body Mass Index as a diagnostic tool?

Elissar Gerges
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Is it time to stop using Body Mass Index as a diagnostic tool?

This conversation is not new: Body Mass Index (BMI) is junk science. For the past ten years, experts in the media have repeatedly pushed against this diagnostic tool, labeling it as a scam and a terrible measure of health.

Established in the nineteenth century by the Belgian social scientist and statistician Lambert Adolphe Jacques Quetelet, the body mass index, formerly referred to as Quetelet’s index, is a mathematical construct that was derived based on a population of White European (French and Scottish) participants. Notably, Quetelet was not a medical doctor or a health practitioner, and he had no interest in obesity. He is known for introducing the concept of ‘‘social averages.’’ His work describes “l’homme moyen” or “the average man”, and the distribution of various human characteristics around the ‘‘average man” to obtain a bell-shaped curve or normal distribution.

BMI is derived by dividing the weight in kilograms by the height in meters squared. The result falls into one of six categories. A BMI of 25 is considered “pre-obese”, while a BMI of 30 is in the “obesity I” category. These cutoff values are arbitrary, and it is unclear why those ranges were chosen or what they represent.

BMINutritional Status
Below 18.5Underweight
18.5–24.9Normal weight
25.0–29.9Pre-obesity
30.0–34.9Obesity class I
35.0–39.9Obesity class II
Above 40Obesity class III

There is an agreement in the medical literature that BMI is inaccurate and inherently flawed. It does not distinguish fat from muscles and bones (fat-free mass) and does not indicate the location or distribution of fat. Since weight and adiposity are different measures, BMI overestimates fatness in individuals who have a high muscle mass. For example, Sprinter Usain Bolt’s BMI, calculated as 24.5, is only just within the “normal weight” range – bordering on “pre-obese”. This is clearly nonsensical, and results like this could actually harm public health policies on obesity: when BMI is ridiculed for classifying athletes as obese, the public may become increasingly skeptical that obesity is a public health issue.

Yet, BMI is deeply integrated into healthcare systems around the world. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) define obesity in terms of BMI, despite the debate among experts on its effectiveness as a measure and concerns that is not applicable to all people – for example, BMI produces unhelpful results when applied to people with high muscle-mass, women, and seniors.

BMI also does not reflect ethnic variations in body composition. Several studies indicate that BMI inaccurately classifies African Americans in particular as obese, thus overestimating the prevalence of obesity and overstating the difference in obesity rates between white people and African Americans. A measure built by and for white people is not necessarily accurate for people of colour, and can even lead to misdiagnosis and mistreatment. A 2003 study on obesity showed that, compared to white people, Black people are at a lower risk and Asians are at a higher risk at the same BMI. Consequently, BMI overestimates health risks for Black people, and underestimates health risks for Asian communities.

BMI is not a measure of the current health risks of individuals. Quetelet’s work was clearly intended to be used as a population evaluation tool, rather than to assess the health of individual people. Its prevalence in clinical settings can mostly be attributed to its convenience in offering a measurement via a simple formula based on easily collected data (height and weight of an individual). While it can be a useful tool in epidemiologic research, BMI does not accurately describe individual health.

Science has repeatedly debunked several myths about weight, diet, and health. Yet, BMI is still the current criterion used to label individuals as “healthy” or “unhealthy” in popular discourse, and in media further reinforcing “the stigma of fat bodies as diseased bodies”. Being a convenient metric contributes to its widespread use, despite its theoretical limitations that challenge its reliability as a “proxy for healthy weight”.

As a single measure, BMI is a misleading indicator of health and must be used in context with other data for any given individual. It is time to look beyond the BMI and adopt a more accurate metric that encompasses confounding variables such as gender, ethnicity, age, genetic factors, comorbidities, and other factors. Rooted in racist assumptions, BMI lacks demographic and cultural generalisability. BMI is a product of its time – it is not a valid diagnostic of fatness, or of an individual’s overall health.

Netflix’s Ancient Apocalypse with Graham Hancock: from alien conspiracies to antisemitism

Aaron Rabinowitz
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Netflix’s Ancient Apocalypse with Graham Hancock: from alien conspiracies to antisemitism

Last year, Netflix released a series called Ancient Apocalypse, hosted by Graham Hancock, and they really shouldn’t have. The show, which copies the Ancient Aliens format popularised by The History Channel, is another unfortunate example of the mainstreaming of conspiracism by content platforms desperate to pull in audiences.

Some may dismiss content like this as harmless filler, while others may see it as valuable in documenting alternative positions on controversial issues, but I believe it’s inappropriate for Netflix to allow Hancock to present his conspiracy-riddled theories with zero pushback. This sort of conspiracy content, where folks like Hancock hide their power level, increases the likelihood of stochastic conspiracism, especially when it’s promoted by nominally non-conspiratorial platforms like Netflix. By obscuring all the red flags around Hancock’s work, Ancient Apocalypse provides an on-ramp that is likely to start or accelerate a conspiracism spiral for some number of people.

Most people are likely to be unfamiliar with Hancock’s work. I certainly was, despite having spent a good bit of time in Ancient Aliens spaces. Hancock is certainly less famous than Von Daniken’s Chariot of the Gods, David Icke’s (((reptilians))), or Giorgio Tsoukalos’ hair, but that doesn’t make him less harmful.

Meme with a man looking very confused. The words read "I'm not saying it's aliens...but it's aliens".

Hancock is a British conspiracy theorist who self-identifies as a journalist and believes authorities are suppressing evidence of a highly advanced prehistoric civilisation. Hancock has written over 20 books on his ‘advanced ancients’ hypothesis, and has appeared on over a dozen episodes Ancient Aliens to promote the theory.

In his most influential work, Fingerprints of the Gods: The Evidence of Earth’s Lost Civilization, Hancock argues that a technologically-advanced prehistoric civilisation was destroyed by a catastrophic meteor strike, and that the survivors travelled the world spreading stories and techniques to try to help humans avoid the same fate. Hancock claims that the existence of this Ur civilisation explains commonalities between seemingly disconnected cultures, such as the existence of pyramids and other superstructures around the world. His work inspired several movies, including the big budget disaster film 2012 about a prophesied apocalypse, and the prehistoric action movie 10,000 BC.

Hancock is often portrayed as a less extreme or harmful conspiracy theorist than folks like David Icke, but this reputation is incongruous with his actual body of work. For example, on Hancock’s wiki there’s no mention of his many appearances on Ancient Aliens, nor are Aliens ever mentioned on Ancient Apocalypse. You might think that’s because Hancock is skeptical of Alien involvement with ancient humans, especially when you add in misleading quotes found in Hancock’s work, such as:

My own view is that all of the anomalies of history and prehistory pointed to by advocates of the ancient astronaut hypothesis are far better and more elegantly explained as emanating from a lost, advanced HUMAN civilization of prehistoric antiquity than from high-tech alien visitors from another planet.

The reason this is so misleading is that Hancock actually does believe in aliens, he just thinks they’re not from outer space. In episode three of Ancient Aliens (01:10:00), in a section of the show arguing that our DNA was shaped by aliens, Hancock claims that DNA couldn’t have come together on Earth by chance. He argues that it’s more plausible that aliens would leave coded messages in our DNA than leave messages on physical monuments. Hancock’s claims are immediately supported by Von Däniken himself. I’ve discussed previously how alien gene editing is a staple of Hotep conspiracism, and often goes hand in hand with the history of racist theorising about human origins and eugenics.

Moreover, in the final moments of season one of Ancient Aliens, Hancock outright says he believes humans have made contact with aliens:

I believe through the experiences that shamans have been documenting and reporting for tens of thousands of years that we are in contact with entities and beings that are not of this earth. Precisely what those entities and beings are remains to be established.

Hancock is a vocal advocate for legalising the use of psychedelics, promoting the idea on multiple episodes of the Joe Rogan Podcast as well as in a TEDx talk that was unpublished from YouTube but is still available on the TEDx website. Hancock believes psychedelics allow for communication with extraterrestrial entities. Hancock even claims that the entities have shown him firsthand the truth of his advanced ancients hypothesis.

That’s not even his most extreme or harmful view. Hancock’s books often aim to tie his advanced ancients theory to anything that’s popular in current culture, usually while adding nothing novel to the existing conspiracism beyond another safe-looking entry point. While it’s unsurprising that he uses his advanced ancients theory to explain the existence of pyramids, or the prevalence of flood myths and stories like Atlantis, he also speculates that his advanced ancients may have built monuments on Mars and that NASA covered up the evidence.

Most would consider that a particularly outlandish claim, but critics highlight that Hancock’s theories about Mars appear to mostly repackage claims from The Monuments of Mars, by Richard Hoagland, and that Hancock’s book was written primarily to create a tie in between his advanced ancients and the Mars mission that was capturing popular attention at the time. For some reason, the Netflix series doesn’t include an episode where Hancock lays out his Martian monuments theory.

Things go from outlandish to disturbing when you get to Hancock’s book The Master Game: Unmasking the Secret Rulers of the World, coauthored by Robert Bauval and originally released under the name Talisman: Sacred Cities, Secret Faith. Hancock’s website claims the book reveals a “secret religion that has shaped the world”, and if you’re a regular reader you know exactly where this is going.

However, I need to be careful, because The Master Game really puts the (((J))) in JAQing Off. As David Barrett puts it in his review of the book, the incoherent mess of an argument culminates in the authors promoting “the old Jewish-Masonic plot so beloved by ultra-right-wing conspiracy theorists”. The authors might object that they are only talking about Zionist connections to the Freemasons, not all Jews, this seems no different than Icke’s response to accusations of antisemitism, nor to Cooper’s absurd reprinting of the Protocols of Zion with the caveat that it’s not really about Jews.

It’s difficult to convey how the disjointed nature of the writing might provide for endless deniability without quoting at length, but consider these passages from the final page of the book:

Nonetheless, we can hardly avoid posing the obvious question: is it possible that the Roosevelt and Truman administrations took the ‘Masonic experiment’ all the way and actually ‘rebuilt’ the Jewish Solomonic state in Palestine? As farfetched and incredible as it seems, there is something else in the background that justifies such an outrageous question.

These dangerous questions and dark pronouncements culminate in the concluding line of the book’s main text:

As has several times been the case during our years of research for this book, we felt the ghostly lifting of a veil brush against our faces. Yet this time the revelation of what lay behind the veil was so sinister, so worrying and so misunderstood by so many that at first we thought it best to let it be, to ignore it, to delete it from our thoughts let we be branded as “conspiracy theorists” only after much consideration have we reached the conclusion that we must bring this strange and frightening issue to attention.

This strikes me as an egregious example of cheap talk skepticism. The authors seem to lend credence to dangerous conspiracism where the harm is unlikely to fall on them directly.

Ultimately, Hancock’s work is about repackaging existing pseudoscientific conspiracy theories for mainstream audiences, which is why it’s so unethical for Netflix to promote him as legitimate. What ties Hancock’s work together is his overarching narrative that he is simply a disinterested journalist asking important questions, and that he’s constantly being prevented from getting answers by academics and organisations like NASA. This theme is front and centre from the start of Ancient Apocalypses, and it’s presented with zero pushback. Hancock claims that archaeologists refuse to engage with his theories, despite ample debunking of his work, and while he never explicitly states the motivations behind the cover up, he makes clear that a nefarious conspiracy of some sort is the only plausible explanation.

It isn’t just Netflix and Hancock claiming he’s speaking truth to shadowy powers. Joe Rogan, patron saint of conspiracism, shows up in person to stand in a field with Hancock and nod along to the theory and wonder why professional archaeology won’t debate alternative narratives. Rogan, who shares Hancock’s love of both conspiracism and psychedelics, has played a significant role in promoting Hancock’s work, inviting him onto his hugely-popular podcast many times, so it’s not totally surprising that he shows up in the special to lend his influence. Again and again, it cannot be overstated the significance of the Joe Rogan podcast as a nexus for conspiracism.

What makes the Netflix special worse than just for-profit conspiracism mongering is something like stochastic conspiracism. Stochastic conspiracism, like it’s close relation stochastic terrorism, is a situation where predictable harm occurs because of speech, but we’re unable to limit the speech or impose consequences because of the probabilistic nature of the harms it causes. Meaning, we can’t know how many people or which people in particular will first encounter Hancock’s work through Ancient Apocalypse and end up reading The Master Game, but it’s likely the number is larger than zero. Perhaps they come to the show from Rogans podcast, or they’re familiar with Rogan and they see Rogan constantly nodding along to Hancock’s claims, and they take away social reinforcement that Hancock’s claims are reasonable. So, when they get to his theory about the Masonic-Zionist secret cult that caused 9/11, they’re more likely to take it seriously. For folks not caught up in the spiral, that might sound absurd, but from within the worldview it can all seem quite reasonable.

Despite the well documented criticism of Ancient Aliens for its promotion of racist conspiracism, most people likely perceive it as an absurd but harmless side show, set against a backdrop of endless Hitler documentaries. It even feels like some of the people involved were in on joke:

The meme: "I'm not saying it's aliens...but it's aliens." with the tag for "History.com" in the lower right corner.

Not so with Ancient Apocalypse; it’s played straight by all involved. Maybe that explains why it’s garnered less attention than Ancient Aliens, which is now in its 19th season, but it also means viewers are more at risk of taking it seriously enough to take the next step down the spiral. That’s why it’s so important that companies like Netflix not follow the History Channel’s model of commodifying conspiracism and pseudoscience for mainstream audiences, even if they play it off as harmless entertainment.

If you’re a content producer, you have a moral obligation to reject any version of the Ancient ______ format. Similarly, if you’re a content consumer, you should spend your precious attention on something more valuable than a copy of a copy of Chariots of the Gods.

Did earthquake guru Frank Hoogerbeets really foresee the disaster in Turkey and Syria?

Frank Visser
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Did earthquake guru Frank Hoogerbeets really foresee the disaster in Turkey and Syria?

On Monday, February 6, 2023, early in the morning, the border area between south east Turkey and north west Syria was hit by an earthquake, measuring 7.8 on the Richter scale, causing massive destruction and casualties in both countries. The death toll has already passed 21,000 and will undoubtedly rise further. Help has been offered from many countries, and rescue efforts continue.

The area is quite prone to earthquakes, as it is at the meeting point of two tectonic plates: the Arabian and the Anatolian plates. The tensions that build up between the two plates are periodically discharged in earthquakes – some small, and some large. Unfortunately, even with access to the most up to date scientific methods, it is difficult to predict exactly when each earthquake will take place, and so there is little possibility of avoiding the inevitable consequences.

In the midst of the enormous media attention that this disaster generated, the name Frank Hoogerbeets has risen to the surface. On February 3rd, a few days before the earthquake, he posted an image on Twitter in which the disaster area was circled very precisely. The tweet read:

Screenshot of the Tweet as described in the text

Sooner or later there will be a ~M 7.5 #earthquake in this region (South-Central Turkey, Jordan, Syria, Lebanon). #deprem

In a matter of days the tweet received over 45 million views. Hoogerbeets has over one million Twitter followers by now.

Leaving aside the vague phrase “sooner or later,” the accuracy of this prediction is astonishing, both in terms of time, place and intensity of the quake. Was this mere coincidence, or was it spectacular evidence of his foresight?

“Planetary Geometry”

Hoogerbeets is a self-proclaimed earthquake forecaster, who – using proprietary software that kept track of planet positions in the solar system at his own Solar System Geometry Survey (SSGeos) research institute – claims to have predicted numerous, mainly severe, earthquakes. In his opinion, these earthquakes were (partly) triggered by specific planet positions, which are known in astrology as conjunctions (0 degrees), trines (270 degrees) and oppositions (180 degrees). Thus was born the self-developed discipline of “planetary geometry.”

Hoogerbeets has made predictions about imminent earthquakes in numerous videos on YouTube in recent years. He has also analysed past earthquakes, demonstrating his theory that they are almost always preceded by certain planet positions. Of course, Hoogerbeets is familiar with the scientific theory of plate tectonics, but in his opinion specific planet positions always provided the final push.

On his SSGeos website he briefly explains his theory: he is not so much concerned with the gravitational pull exerted on the earth’s crust by the planets and the moon, but with electromagnetic forces. According to him, the influence of the planets on atmospheric conditions had already been demonstrated by radio amateur John H. Nelson, who, in the 1940s, 1950s and 1960s, had shown by means of short-wave radio communication that planet positions influence the Earth’s atmosphere. As Hoogerbeets explains:

Of nearly 1,500 atmospheric condition forecasts that he made in 1967 he had an accuracy rate of 93.2%. His forecast methods, while seemingly forgotten, have not been refuted to date.

Hoogerbeets admits that the critical planet positions do not always lead to major earthquakes – only when the tensions in the earth’s crust have run high – and that that sometimes they do not produce any discernible effect at all. Nevertheless, he advocates further investigation of these planet positions as warning signs for future quakes.

Since the earthquake, Twitter has added the following warning to some of Hoogerbeets’ tweets (with some links to earthquake science websites):

There is no scientific basis for earthquake predictions. There is always a chance for earthquakes in places with active faults, but specific forecasts perform no better than random when tested. Claims of correlation with planetary alignment have been disproven.

Hoogerbeets wearing a grey hoody and jeans stands in front of a screen with planets on it.
Hoogerbeets regularly makes predictions on his YouTube channel.

Yet science is not completely ignorant of the idea that, for example, the moon influences the occurrence of earthquakes. As reported in Nature :

Big earthquakes, such as the ones that devastated Chile in 2010 and Japan in 2011, are more likely to occur during full and new moons — the two times each month when tidal currents are highest.

The recent earthquake in Turkey and Syria also happened just after the full moon of February 5. However, crucially, this article highlights the influence of gravitational effects – it is not about electromagnetism.

If we examine the (only) source that Hoogerbeets mentions as proof of the electromagnetism hypothesis, we can see that Nelson’s research has indeed received some criticism. Nelson’s findings turn out to be largely artifacts, given that:

Randomicity tests show that the apparent association of radio disturbance days with planetary position is an artifact of Nelson’s counting method.

It is also worth noting that the link Hoogerbeets draws between atmospheric disturbances and earthquakes was never actually made by Nelson.

Express doubts

If we check where Hoogerbeets may have published about his findings, we come across the British tabloid Daily Express, whose “Weird” category regularly published sensational articles referencing the “seismic psychic” Frank Hoogerbeets. Notably, those articles were published by journalist Sean Martin, whose LinkedIn page describes his role at the paper as “developing and creating stories which have the potential to go viral”. The selection includes:

  • Earthquake WARNING: Totally DESTRUCTIVE tremor to strike NEXT WEEK – shock claim – Thu, Feb 14, 2019
  • Earthquake WARNING: ‘Huge MEGA-THRUST to strike’ by end of February –  Mon, Feb 11, 2019
  • Earthquake WARNING: Magnitude NINE tremor to hit by February 26 – shock claim – Mon, Feb 25, 2019

Invariably, these articles are concluded with the remark that scientists see no merit to Hoogerbeets’ theories, but not many readers will have noticed that. 

Unsurprisingly, then, the recent earthquake is also covered by this paper (though Martin has moved to pastures new), and again it comes with the disclaimer:

However, Mr Hoogerbeets predictions has been slammed by critics within the scientific community who claimed the theory is not universally accepted

A search by “Frank Hoogerbeets” on the Express website produces an incredible 76 articles of hits, each more sensational than the next, stretching back to 2015. It should be clear that these publications are deadly to one’s scientific reputation.

Earthquakology

If we generally look at what is known about whether earthquakes can actually be predicted, the Wikipedia page “Earthquake prediction” offers little hope:

There have been around 400 reports of possible precursors in scientific literature, of roughly twenty different types, running the gamut from aeronomy to zoology. None have been found to be reliable for the purposes of earthquake prediction.

And a recently published report on earthquake forecasting draws an equally sober conclusion:

The search for diagnostic precursors has not yet produced a successful short-term prediction scheme.

It appears that Hoogerbeets will have to substantiate and publish his theory, if he is to be taken seriously. In particular, he must be able to demonstrate how electromagnetic disturbances in the atmosphere can influence earthquakes (something that would almost certainly be far more difficult than affecting radio communication).

Although Hoogerbeets is not an astrologer, he borrows concepts like conjunction and opposition between planets, to which he attributes far-reaching influences. However, unlike horoscope astrology, his model seems to be drawn from the perspective of the sun, rather than the earth. Yet he also receives criticism from contemporary astrologers, given that the idea that planets can exert any physical influence on us at all – let alone cause major earthquakes – is considered outdated in these circles. Even astrologers, then, can see there is no merit to Hoogerbeets’ “Earthquakology”.

This article is translated from the original Dutch at kloptdatwel.nl. Disaster relief efforts are still going on, to offer aid to those affected by the earthquake. You can support the efforts by donating to organisations like Médecins Sans Frontières Emergency Fund or the Turkey Mozaik Foundation Kahramanmaras Earthquake Emergency Relief Fund.

Acupuncture remains one of the most enduring pseudo-therapies – even though it does not work

Edzard Ernst
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Acupuncture remains one of the most enduring pseudo-therapies – even though it does not work

Acupuncture is one of the oldest, most popular, and most-studied of all alternative therapies. It has thus ‘stood the test of time’ and is beyond doubt or reproach… or at least, this is what its many enthusiasts tell us. However, as so often in the realm of so-called alternative medicine (SCAM), things are not so simple.

The complexity starts with the fact that there is not one but many different forms of acupuncture. Acupuncture points can allegedly be ‘stimulated’ by sticking needles into the skin of a patient, by implanting tiny devices, by applying heat, electrical currents, ultrasound, pressure, bee-stings, injections, or light. Then there is body acupuncture, ear acupuncture, scalp acupuncture, and even tongue acupuncture.

Some therapists employ the traditional Chinese approach, while so-called ‘Western’ acupuncturists proudly claim to adhere to the principles of conventional medicine. Both camps have in common that they are based on mere hypotheses trying to explain that acupuncture might work. According to the traditional view, acupuncture is effective for virtually every condition affecting mankind, while ‘Western’ acupuncturists claim it works mostly for alleviating chronic pain. But where is the evidence for these claims?

Medline, the largest databank for medical papers currently lists more that 40,000 papers related to acupuncture. It is therefore not difficult to find some evidence for even the most outlandish claims acupuncturists tend to make. Yet, the question is, how reliable is this evidence? When trying to answer it, critical thinking is essential, and numerous caveats must be considered.

The majority of all acupuncture studies originate from China. Several investigations have disclosed that, for a range of reasons, we should take these trials with a pinch of salt: they invariably report positive results, their results are often fabricated, and they are frequently generated by illegal paper-mills. In addition, many acupuncture studies draw unwarrantedly positive conclusions on the basis of dodgy data. The combined effect of these phenomena is that the body of evidence supporting acupuncture is less than reliable.

So, how can we decide whether acupuncture works or not? Some might argue that one just needs to try it and see for oneself. However, I would caution that this is a bad idea. Acupuncture has many features that make it an ideal placebo: it is exotic, invasive, slightly painful, costs money, administered by an empathetic therapist, etc. Any symptomatic improvement after acupuncture might therefore be due to context effects and could be entirely unrelated to the therapy per se.

The best way to make sense of this convoluted evidence probably consists of conducting what experts call a systematic review. This involves firstly to locate all the available studies that exist for any given research question, and secondly to assess them critically according to their scientific rigour.

During recent years, numerous systematic reviews of acupuncture as a treatment for dozens of different conditions have emerged. Unfortunately, many are by Chinese enthusiasts and overtly biased. Those that are most transparently independent and methodologically sound are those produced by the Cochrane Collaboration.

My overview of the 54 systematic reviews published by this organisation, failed to show that acupuncture is effective for treating any condition; positive evidence emerged only for the prevention of migraines and tension type headaches. More recently, a US team used a different approach for an overall assessment of the effectiveness of acupuncture. If anything, their conclusions were even less favourable:

Despite acupuncture having been the subject of hundreds of randomized clinical trials and systematic reviews for dozens of adult health conditions, there were few conclusions that had greater than low certainty of evidence.

Ellen White on a football pitch wearing a red England football team shirt and with her blonde hair tied in a low ponytail.
Ellen White, England’s record goalscorer, retired after an acupuncturist punctured her lung. Source: James Boyes (CC 2.0).

Acupuncture is often promoted as being free of risks. Yet, mild to moderate side effects of acupuncture occur in about 10% of all patients. Much more serious complications of acupuncture are also on record. Acupuncture needles can, for instance, injure vital organs like the lungs or the heart, and they can introduce infections into the body, like hepatitis. A recent example is one of the star players of England’s women’s football team, Ellen White, who’s recent decision to retire was partly due to an incident in which an acupuncturist punctured her lung.

About 100 fatalities after acupuncture have been reported in the medical literature—a figure which, due to the lack of a monitoring system, most likely discloses just the tip of the iceberg.

Given that, for most conditions, there is no reliable evidence that acupuncture works, and that it has been associated with significant harm, its risks usually outweigh its benefits. Therefore, my advice for consumers is to think twice before paying considerable amounts of money for what seems little more than a theatrical placebo.

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Expert skeptical analysis of pseudoscience, conspiracy theory and claims of the paranormal.

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