Click to view this issue of Critical Links as a webpage, or check out the CL archive .

In this Edition of Critical Links:

Dates of Interest

CFIC News and Events

Science Check

Secular Check

Think Check

Books and Authors

Dates of Interest

November 11 is Remembrance Day. Read more in this month’s Secular Check article: “If you Value your Freedom”.

November 25 is the International Day for the Elimination of Violence Against Women , and marks the beginning of 16 Days of Activism Against Gender-Based Violence, which inclu des the National Day of Remembrance and Action on Violence Against Women on December 6 and ends on December 10, International Human Rights Day.

Contrary to traditional wisdom and old jokes, there really is a Children's Day, on November 20.

Though one might think it should be in March, November 28 is “Red Planet Day”, in commemoration of the 1964 launch of the spacecraft Mariner 4 (more information here).

If you celebrate any of these, please drop us a line or send us a picture to [email protected]

News & Events

Reasons and Ways to Donate to CFIC

CFIC brings people together to promote critical thinking and evidence-based decision making. We do this to build a more just, secular, and compassionate society, and to help people protect themselves from those who make false statements and bogus claims. We need your help. You can be a part of this. Your financial support ensures that CFIC can be the voice of reason in an irrational world.

Did you know that you can direct your United Way contribution to Centre for Inquiry Canada?

 

Churches, which have charitable status for the purpose of promoting religion, receive immense financial support. Stats Canada reports that in 2013, 31% of all Canadians donated to religious organizations. They receive 41% (a total of $5.2 billion) of funds donated to all causes in Canada. Compare this to the number of Canadians who donate to causes such as ours. Only 3% of Canadians donate to organizations that promote human and other rights or advocate for social and political interests.

Did you know:

With each donation our voice of reason gets stronger and more influential. As we grow in numbers, so does our influence with government decision makers and the public opinion that guides them. Without us, the major influencers will continue to be the large, self-interested groups and institutions that benefit from making baseless claims and spreading nonsense.

We are Canada’s only national non-profit with the mission of promoting critical thinking, science, and secularism. Please consider supporting CFIC .

Living Without Religion Relaunches in Toronto

 

Have you given up your faith? Maybe you never had faith. Has your newfound or longstanding lack of faith been the source of difficulties? Has your lack of faith created conflicts with family? Friends? Neighbors? Coworkers?

 

Because the human skull is the ultimate echo chamber — and often not a friendly one — meeting, listening to, and sharing with others experiencing similar situations can help. Why not take part in a peer support group where you can get things off your chest?

 

No higher powers, no dogma. Just free expression, empathy, understanding, without judgment. We’re here for you. We are Living Without Religion, and you can too.

 

Thursday, November 15, we meet again. Join the discussion in the Hague Room at Swansea Town Hall Community Centre, 95 Lavinia Avenue, near the corner of Windermere Ave and Bloor Street West, between the Jane and Runnymede TTC stations.

 

Come join the discussion!

Do Us a Solid!

 

Get the flu shot! Read everything you need to know here:

 

https://www.ontario.ca/page/flu-facts

Contest Results

Congratulations to Janalee Morris, of Calgary, Alberta, winner of the tickets to the recent Pangburn Philosophy event “An evening with Richard Dawkins and Carolyn Porco” in Calgary on October 22.

Science Check

A Nuance of Scientific Language

Zack Dumont

 

What are people really saying when they say “guidelines say”? Well, in short, it’s not as simple as it sounds. “Guidelines say” is actually reductive language, often used by media; however, healthcare providers (HCPs) don’t do ourselves any favours when we occasionally use this phrase outside the setting of authority-to-authority communications. An HCP has the training and ability to understand the complexities of “guidelines say”; they will hold the thought with a critical mind. But, it shouldn’t be expected that non-HCPs can do the same.

 

It’s often incorrectly assumed that guidelines are simply for or against (or silent on) particular healthcare decisions, as if it’s a simple binary position to take. What is lost when anyone says “guidelines say” is that guidelines take positions and make statements with varying levels of certainty and traction — sometimes referred to as confidence and strength in recommendations. Further, there are different gradients and different taxonomies to classify each level. One such classification system is GRADE (“Grading of Recommendations Assessment, Development and Evaluation”) ¹ , which aims to provide a common grading system for healthcare recommendations. It has been widely adopted by many healthcare organizations because of its sensible and transparent approach, and thus, we’re seeing more and more guidelines using GRADE scoring. How this plays out is that a specialty group, such as the American College of Chest Physicians (ACCP), will make a recommendation with scores that reflect being either strong (“1”) or weak (“2”), and based on high (“A”), moderate (“B”), low (“C”), or very low (“D”) quality evidence. For example:

 

Bear with us a moment: “For patients at high risk for venous thromboembolism (6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C).” ²

 

In other words: If you’re at risk of a blood clot (e.g., hospitalized and immobile), they recommend a certain drug therapy to prevent it; and, this is a strong recommendation based on moderate-quality evidence (i.e., Grade 1B). However, they go on to make a weak recommendation, based on low quality evidence, in favour of special therapeutic socks (i.e., Grade 2C).

 

When a recommendation is strong, it’s usually because there’s enough science to feel confident that the truth has mostly been exposed or that risks are low (e.g., it’s pretty clear that the benefits of a drug therapy outweigh the risks). When a recommendation is weak, it’s often because of a lack of confidence in the existing science, and any new study might show us some different course of action.

 

So what language should be used? Using the ACCP example above, if someone were to say, “ Guidelines say to use therapeutic socks/stockings,” an appropriate rebuttal might be, “Yes, but, that’s a fairly weak recommendation, and not likely to be cause for mass implementation at the expense of other possible healthcare interventions.” We and the media can still say “guidelines say”, but this phrase should always be accompanied by the level of confidence and strength of recommendation. One doesn’t necessarily have to state the technical score, but the wording certainly should be comprehensible. Anything less is a potentially dangerous over-simplification.

 

References:

¹ GRADE Working Group. http://www.gradeworkinggroup.org .

² Gould MK, Garcia DA, Wren SM, et al . Prevention of VTE in Nonorthopedic Surgical Patients. CHEST February 2012; 141(2): e227S–e277S. Available from: https://journal.chestnet.org/article/S0012-3692(12)60125-1/fulltext .

Should Healthy Older People Take Aspirin for Preventing Heart Attacks and Strokes? Why Scientists Sometimes Change Their Minds

Beverly Carter and Zack Dumont

According to principal investigator of the recently published ASPREE trial ^1,2,3 , Professor John McNeil of Monash University, Australia, the findings will result in a rethinking of global guidelines relating to the use of acetylsalicylic acid, commonly known as Aspirin or ASA, to prevent common conditions associated with aging. “Rethinking” may sound like a regular course correction to some, but to naysayers of rational thought, it could be pinned as “science changing its mind,” flip-flopping, or worse — proof of faults in the scientific method.

 

For people who have experienced a heart attack or stroke, the evidence is relatively clear that long-term anti-thrombotic therapy, such as daily ASA, is required. This is because, for most, the benefits (e.g., reduction of more cardiovascular events) outweigh the risks (e.g., bruising and bleeding). When used in this clinical scenario, it’s known as “secondary prevention,” because it comes after an event or onset of disease.

 

However, for those who have never experienced a change in health status (i.e., “primary prevention”), the evidence has conflicted for a number of years. Some suggests there’s a benefit, some does not. When conflict like this occurs, we’re fortunate if we have a large randomized controlled trial (RCT) to answer our questions. In the meantime, or when no such RCTs are available, we look to guidelines for interpretation of the existing evidence. In the case of primary prevention with ASA, guideline groups have remained on the fence, usually suggesting case-by-base risk assessments (e.g., risk scoring). Few, if any, have outright suggested against use.

 

The ASPREE trial is the largest primary prevention ASA study ever undertaken in healthy older people. From March 2010 through December 2014, a total of 19,114 persons from Australia and the United States were enrolled in the trial, with half receiving low-dose ASA (100 mg) and half receiving placebo. The trial was designed to find out whether the daily use of ASA would prolong the healthy life span of older adults. The investigators found that use of ASA did not differ significantly from placebo in influencing the rate of survival free from dementia or persistent physical disability after approximately 4.7 years of daily use.

 

Further, death rates were mathematically higher in the ASA group than in the placebo group, largely a result of higher cancer-related death, with death due to severe bleeding contributing only a small amount. Though statistically significant, the risk appears to be extremely small. In other words, there’s no reason to rush to the emergency room if you take ASA; rather, it may simply be time to book an appointment with your care team to reassess the risk/benefit ratio on a case-by-case basis. That said, if you’ve never had a cardiovascular event and no legitimate healthcare provider has ever told you to take ASA, now would not be the time to start.

 

The trial was stopped on June 12, 2017, at the request of the funding agency, the National Institute on Aging, because results thus far indicated that it was extremely unlikely that continuation of the trial would reveal a net benefit. Strengths of this trial include the large number of participants, particularly the majority who were 70 years of age or older, and the access to clinical records, which allowed the underlying causes of death to be identified accurately in most cases. The limitation of the trial is the relatively short duration (about 4.7 years), which may have ended before the possible observation of the proposed cancer-preventing effects of ASA. This trial also focused on a specific age range and had limited statistical power on which to base firm conclusions about the effect of ASA in subgroups. Subgroup results can be relevant because they allow us to hypothesize if smaller unique patient populations with certain conditions may benefit, while others may not.

 

Other primary prevention trials of low-dose ASA have not shown similar higher mortality. As such, ASPREE may provide new and different results. In addition, these other trials have not shown higher cancer-related mortality, which only became evident after four or five years of continuous therapy. Despite limited periods of intervention (typically five years or less), the preventative effect of ASA was maintained for at least 15 years. In these other trials, there was also evidence of a lower risk of death from metastatic spread of cancer among participants who received ASA than among those who received placebo. These trials also differed from the ASPREE trial in their inclusion of relatively small numbers of participants 70 years of age or older. In short, the ASPREE trial may not have observed participants long enough, or it might have used a different enough patient population, that it may be difficult to compare it to the other trials.

The American College of Cardiology, in its review of the ASPREE trial, concluded that among the trial’s healthy elderly patients, low-dose ASA therapy was not beneficial. Concurrently, it cautioned that the findings have not been observed previously and should likely be interpreted with caution prior to broad implementation. Many other guideline-producing medical organizations have reiterated this. In the end, guideline recommendations, which were transparently based on weak evidence and with low confidence, may change… and they may not.



What is apparent is that when faced with the clinical question, “Is this otherwise healthy older patient in front of me likely to benefit from ASA?”, more doubt has been cast. Where we may have previously declared that the overall probability of beneficial effects was uncertain but may be worth any potential risks, we’ll more cautiously make individualized decisions. Involving the patient in the decision-making process has never been more emphasized. Everyone values risks and benefits differently, and thus, making paternalistic or blanket recommendations is difficult if not impossible.

 

This study is a great example of how health recommendations come into question, and sometimes change. Although people get frustrated about it, or twist these wavering moments into something nefarious, it is necessary to know that science is always testing its knowledge. Science is a process, which, unlike ideology, is distinguished by intellectual flexibility and by acceptance of the need to change as our world and our understanding of the world evolves. One possible explanation of the idea that science is  less trustworthy  because it adjusts its claims in response to new information could have its roots in religious dogma. Compared to the fixed dogma of most belief systems, scientific probability-based knowledge is suspect. And we wouldn’t want it any other way.

 

References:

¹ McNeil JJ, Woods RL, Nelson MR, et al . Effect of Aspirin on Disability-free Survival in the Healthy Elderly. N Engl J Med 2018; 379:1499-1508. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa1800722?query=featured_home .

² McNeil JJ, Wolfe R, Woods RL, et al . Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. N Engl J Med 2018; 379:1509-1518. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa1805819 .

³ McNeil JJ, Nelson MR, Woods RL, et al . Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. N Engl J Med 2018; 379:1519-1528. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa1803955 .

Secular Check

If You Value your Freedom: A Reflection on Remembrance Day by a CFIC Member and Soldier

Tony Keene

Veterans Affairs has a new ad campaign for Remembrance Day which has left some of the test subjects dazed and confused.

That’s because there is a lot wrong with it. In fact, it’s all wrong. And not only the ads; there’s a lot wrong with Remembrance Day too.

The First World War, a pointless slaughter, has been over for a century, but the mythology to justify it persists. Millions died (60,000 in our uniform) in a protracted horror that had no territorial or moral reason, but was largely about ego and national pride.

Those who came home couldn’t face that it had been for nothing, except to create chaos, destroy entire nations, and presage an apocalyptic pandemic. They conjured myths and rituals of righteousness, fraught with maudlin Edwardian sentiment and Christian symbology, which remain almost unchanged to this day.

Three-quarters of a century after the end of the Second World War, we are still using “O Valiant Hearts,” Laurence Binyon’s lachrymose “To the Fallen,” and John McCrae’s virile war cry “In Flanders Fields.”

Unpack them, and see what they really mean.

 “O Valiant Hearts” is a Christian hymn. It contains the following lines: “All you had hoped for, all you had, all you gave; To save Mankind — yourselves you scorned to save.”

This embodies perhaps the most enduring myth about soldiers: the idea that they are self-sacrificial. That soldiers go to war willing to get killed is, on the face of it, ludicrous. Personal survival is the foremost concern of all, whether in a horrific war, or on a dangerous peace-support operation. Everyone wants to come home in one piece.

Self-sacrifice is what Christianity is all about, and it is why Christian prayer, Bible readings, and sermons make up much of Remembrance Day ceremonies, except in major centres. The Royal Canadian Legion, which promotes Christianity almost everywhere, has brainwashed generations with it. In a society where Christmas is mainly about Santa, and Easter is about bunnies and chocolate (bad as some might think that to be), we have been persuaded that it is impossible to mark Remembrance Day without a white cross and a preacher.

And this excludes and discriminates against a great many of our veterans who are not Christian.

The main text is almost always the Book of John: “Greater Love hath no Man than this, that he lay down his life for his friends.” It’s irrelevant to military service and death in war. Think on it. We have a veteran Sikh as Minister of National Defence. The Forces are one of the most, if not the most, diverse military organizations on Earth. Yet Remembrance Day, in most communities, is solidly, and often exclusively, Christian.

We must remember those who died, because we sent them to die. We must remember our veterans, especially those bearing wounds both visible and invisible. They number in the hundreds of thousands, and we will be caring for some of them until children not yet born are grandparents. They don’t want our thanks, but they need our help.

Our soldiers did not give us our freedoms, and they do not defend them. Our freedoms were not won in battle, but on picket lines, in the courtroom, and on the university campus, and in our Parliament and legislatures.

Those freedoms came under threat in October 1970, when the cops got carte blanche to round up anyone who had looked at them sideways. Did the Forces come to the rescue? Of course not. They were too busy backing up the cops. And if it ever happens again, they’ll be right there making sure you do as you are told.

That’s what soldiers do. They serve the government, which realistically is the only entity that can take our freedoms away from us.

As for the Binyon poem , it was written in 1914, before the slaughter really got going, and today we recite a few lines of it as the Act of Remembrance. The poem itself is an over-the-top orgy of Edwardian twaddle. And it’s really about England, not Canada.

Then there’s “In Flanders Fields.” It is not a lament on the horrors of war; it is a battle cry for the slaughter to continue.

“Take up our quarrel with the foe; to you with failing hands we throw the torch.”

McCrae was not asking us to honour the Fallen, but urging those not in uniform to get with the program, pick up a gun, and get killed as well. The war was in full force when he wrote the poem; it is a recruiting pitch. It’s nothing else. The survey audience got it right.

It’s time for a new Remembrance Day, a secular and inclusive observance that, while not forgetting those wars and those soldiers, deals with their memory alongside an understanding of what military service is really like, both then and today.

Remembrance Day is for everyone. It is not just for men, whites, or the adherents of one religion. It’s time to take this day back from the failing organization which has had a death grip on it since the 1920s. (The Royal Canadian Legion has lost more than 10,000 members per year for the past 30 years, and there is no sign of a let-up.)

We need a new secular and inclusive model to recognize the sacrifices of today’s veterans, without abandoning those of the past.

Veterans Affairs should scrap these ads, and have a real hard think about it.

Tony Keene is veteran journalist and soldier, and has served on multiple NATO missions.

Political Activity Ruling: What it Means for Secularists

Sandra Dunham

In August we brought you the news that the Ontario Superior Court of Justice overturned the rule limiting charities’ spending on political activity. This was initially seen as good news for the charitable sector. However, more recently, the purpose of the political activity constraint and the implications of the ruling have been called into question.

President and CEO of Imagine Canada, Bruce MacDonald heralds the move as a positive one . “This announcement … represents real progress for the charitable sector.” The March 2017 Consultation Panel on the Political Activities of Charities made several recommendations to reduce the restrictions placed on charities’ involvement in non-partisan political activities. On the surface, allowing the charitable sector to wade into discussions of policy that directly impact their causes seems logical and democratic.

However, like most things in life, there are two sides to this story. Gail Picco, charity strategist, raises concerns about the potential for the very wealthy to fund public education campaigns aligned with their special interests and the tax break that they can receive from doing so. Picco believes that the spending limit actually levels the playing field to prevent the people with the most money from “driving the legislative agenda any more than they already do.”

Picco uses some examples that may be near and dear to our readers’ hearts: Spending to argue against public education by private school charities and spending to oppose universal healthcare by charities in the “alternative healthcare” industry. Picco also raises the alarm that “faith-based charities make up 31% of all charities and 41% of all charitable revenues ($110.8 billion ) have the potential to significantly influence public policy.



This entire issue has become confused. The Government of Canada has indicated that it intends to challenge this court decision but move forward with lifting regulations anyway.

Think Check

A Brave New World of Depression Diagnosis?

Edan Tasca

Researchers at MIT presented a paper recently outlining a neural-network that has been shown to impressively diagnose depression. Sounds like sci fi, right?

The program analyses speech patters — audio and text — to detect certain signals. These include what we might think of as obvious: expressions of sadness, hopelessness, or loneliness, for example. Signals, however, also include preponderance of pronouns like “I” or “me”, which are thought to reveal a preoccupation with the self. Based on the preponderance (or lack thereof) of certain signals, the program will offer a diagnosis of depression or not.

The program has shown impressive validity. According to the researchers, it was tested on a dataset of 142 conversations containing video interactions, audio-only interactions, and text interactions with folks suffering from mental-health issues as well as virtual agents controlled by humans.

The program was evaluated using metrics of precision and recall. Precision measures which of the depressed subjects identified by the model were diagnosed as depressed. Recall measures the accuracy of the model in detecting all subjects who were diagnosed as depressed in the entire dataset. In precision, the model scored 71 percent and, on recall, scored 83 percent. The averaged combined score for those metrics, considering any errors, was 77 percent. In the majority of tests, the researchers’ model outperformed nearly all other models. The program, interestingly, was far quicker to diagnose based on text data than it was on audio data.

If this seems freaky to you, consider that similar research at the University of Pennsylvania has suggested that depression can be diagnosed before a person even looks into treatment. How? Facebook.

The research is still in its early stages, but the AI in question looked for “depression-associated language markers” in over 500,000 Facebook posts by people with a depression diagnosis and another 500,000-plus posts by users without such a diagnosis and compared the datasets. This sounds expansive, but keep in mind that these posts came from fewer than 700 users. However, there were approximately five times as many users without a diagnosis of depression, which properly reflects depression rates in clinical populations, and therefore offers more generalizability of the data.

In theory, Health Canada could enlist Facebook to let it monitor posts and identify users who are, say, at risk for suicide, based on high rates of displaying depression-suggesting posts. In fact, Facebook already monitors for posts suggesting the potential for self-harm. They will then alert this user about suicide prevention resources. Google prompts the same kind of alerts when it notices a user has been searching for topics in the realm of depression and suicide.

What happens when technology like this starts getting used on job interviews, first dates, and other places we might not want it to? Time will tell. 

Read about the MIT study here .

Read about the Pennsylvania study here .

Books and Authors

More Harm Than Good? The Moral Maze of Complementary and Alternative Medicine

Andrea Palmieri



Professor Edzard Ernst is no stranger to the subject of complementary and alternative medicine (CAM). In fact, he was the very first professor of complementary medicine in the world, and also founded two medical journals dedicated to CAM research. However, when tasked to examine the evidence for and against various alternative treatment modalities through a scientific lens, he found major flaws — and this resulted in his publication of thousands of papers and dozens of books over the last 20 years, examining all the treatments, practices, and methods known in CAM. The following is a brief review of his new book published earlier this year. 

“More Harm Than Good?” delves deep inside the world of CAM, thoroughly analyzing and identifying the numerous and serious ethical issues associated with the practices and modalities involved within. Written with the intent to inform (it has an academic textbook feel to it), Edzard Ernst and bioethicist Kevin Smith compel readers to think about and understand the “moral, ethical, and legal principles that are being violated by those who provide, recommend or sell CAM."

The authors begin by laying out the basic requirements that must be fulfilled to align with the principles of medical ethics: Practitioners in all areas of healthcare must be competent and adequately educated; their practice must be plausible and based on science-based evidence; patients’ autonomy must be respected along with informed consent; CAM professionals should behave honestly; and patients and consumers must never be exploited. Each chapter is devoted to explaining each precept in detail and offering robust reasons as to why CAM falls short in meeting these criteria. 

Through a utilitarian approach, the authors pose thoughtful questions at every turn, from, “What does competent mean?” to, “Why would CAM practitioners peddle untruths?” They include various stories, hypothetical scenarios, and published articles drawn from many varieties of CAM — featuring common practices such as homeopathy, chiropractic, and acupuncture — to support their argument that CAM is unethical. To demonstrate all the problems with CAM research, the authors lay out what differentiates good versus bad research: for example, the myriad of problems with anecdotal evidence; the features of a rigorous randomized controlled trial; and the importance of data analysis and oft-misunderstood significance of the P-value.

Chapter four sets out the fundamental elements of good education in healthcare and asks whether CAM education can ever be valid, suggesting that CAM education “frequently displays similar attitudes towards its students as a religious cult displays towards its followers.” The following chapters expose the failure of CAM practitioners to obtain true informed consent from patients, and rebut the many justifications that are used when "confronted with evidence that their CAM modality is not as effective or safe as they claim.” In the final chapter on exploitation, the authors explain the ways that CAM harms consumers through physical damage, mental distress, and financial loss.

In summary, this book provides readers with an in-depth, go-to resource for understanding the inadequacies of CAM in a logical and dispassionate way. It is an excellent read for those interested in philosophy, clinical research, and medicine; however, some readers may find it incredibly dense and challenging. It is a lengthy read that warrants multiple revisits and study to absorb the information presented. I personally will have to read it a few more times to capture the breadth and depth of all the arguments made. This brilliant piece of work will indubitably add to the many others in the fight against pseudoscience and all the ethically reprehensible damage it can cause to society.

Have you read a good book lately? One that made you think more critically? One that changed your outlook? Something that used science to call into question misinformation? Critical Links is looking for book reviewers to share their thoughts on books that other members will enjoy.

If you would like more information on the type of book reviews we are interested in, please email: [email protected]