Ben Goldacre

The Guardian

Saturday October 4 2008

Important and timely news from the Journal of Medical Hypotheses this week: ejaculating could be “a potential treatment of nasal congestion in mature males.” My reason for bothering you with this will become clear later.

The first thing to note is that this is not an entirely ludicrous idea, but it is a tenuous one. Most decongestant pills work by increasing the activity in something called the “sympathetic nervous system”, which is involved in lots of largely automatic things in the body, like sweating, blood pressure, and pupil size as well as the “fight or flight” mechanism. More activitity in the sympathetic system causes the vessels of the nasal mucosa to constrict, reducing their volume and so clearing the blockage, but they can also have lots of fairly unpleasant side effects, because they tend to affect the whole of the sympathetic nervous system.

The argument from Dr Zarrintan is as follows. “The emission phase of ejaculation is under the control of the sympathetic nervous system… ejaculation will stimulate adrenergic receptors… and stimulation of your adrenergic receptors will give you relief from your cold.” It’s a chain of reasoning that would make a nutritionist blush, and has already been responded to by a letter, entitled: “Ejaculation as a treatment for nasal congestion in men is inconvenient, unreliable and potentially hazardous” (in which it is explained that ejaculation increases blood pressure and heart rate, which has its own side effects, increases androgens in the body which could increase prostate cancer, and so on).

Now I genuinely love the Journal of Medical Hypotheses, published by Elsevier. Last year, you will remember, they carried an almost surreally crass paper in which two italian doctors argued that “mongoloid” really was an appropriate term for people with Down syndrome after all, because such people share many characteristics with oriental populations (including: sitting cross legged; eating small amounts of lots of different types of food with MSG in it; and an enjoyment of handicrafts).

Their articles are routinely quoted with great authority in the output of antivaccination conspiracy theorists, miracle cure marketers, and other interesting characters, but it can also print some interesting stuff. In that sense it serves a useful purpose, but it also acts as an extreme example of something we should all be aware of: you’re not supposed to take everything in an academic journal as read, final, and valid.

I once had a conversation with the editor, Dr Bruce Charlton, and he raised two excellent points on the value of publishing loopy papers (my phraseology, more serious discussion from him here). The first was that academics must be free to just get on and publish things that outsiders might find weird, or misinterpret, without worrying about what the wider public might think. The Downs paper above was simply uninformative and offensive, pushing this argument to the limit, but excepting such cases, it is a view I would heartily endorse.

Academics should be free to write tenuous papers, and the infamous 1998 MMR Lancet paper is a perfect example: it described the experiences of 12 children with autism and some bowel problems, who’d had the MMR vaccine; it didn’t tell us much about MMR causing autism, but nobody should censor themselves from publishing such work on the off-chance that it might trigger a ten year long epic scare story from mischievous journalists.

But Charlton also raises a more interesting point. He feels that the ideas market requires a diverse range of publication venues, and so his journal is deliberately not “peer-reviewed”, the process where the great and the good look at your article and decide if it is worth publishing, or methodologically flawed. Peer review is a system that has worked okay, ish, to stop utter nonsense appearing in very competitive high quality journals, but it is also riddled with holes, acts as no bar to nonsense being published in obscure peer-reviewed journals (where the bar is much lower), and is also vulnerable to bullying and corruption.

Charlton’s journal publishes ideas rather than data. But we have to accept that a large amount of bad quality data is being published, in the 5,000 medical academic journals that already exist (printing 15 million papers to date), and in many respects, we have to hope that this situation will get even worse. Two weeks ago we saw that only one in four cancer trials is actually published. There are widespread demands that all negative findings must be published, so that they are at least accessible, but this will often mean that inadequately analysed data from less competent studies are placed in repositories, or published in journals that will take very poor quality papers.

The signal-to-noise ratio in the scientific literature is getting ever lower, and the simple fact that something has been “published” is becoming as meaningless as it always should have been: ideas and evidence are there to be read, and critically appraised. Science is not about arguing from authority, and the era of “it’s published so it must be true” is mercifully drawing to a close.