I'm back again. This is Dr. Harriet Hall with lecture 9 in a series of 10 lectures on Science-Based Medicine. In the last few lectures, I've covered a lot of things in alternative medicine and shown that they were not based on science. Now back to the main topic, science-based medicine itself. We depend on science for our knowledge, but science isn't perfect. We can't just automatically accept something is true just because there's a scientific study that says so. Studies are carried out by imperfect humans, and humans make mistakes. In this lecture, I'm going to talk about how research can go wrong in some of the pitfalls that can lead to false conclusions. All scientific studies are not equal. That's something that's hard to explain to CAM advocates. They say, you want science? We'll give you science. And they do a study that proves to their satisfaction that their treatment works. And when we reject it, they think we're being unfair since they think we accept the same kind of study for pharmaceutical drugs. Some randomized control trials are good science. Some are not so good science. And some of them are junk science. True believers are unable or unwilling to recognize the fatal flaws in their own studies. They don't understand why we won't accept their poor quality evidence. And it's not just CAM practitioners. There are lots of doctors who don't understand what constitutes good science. They may just read the conclusion or the abstract of a study and assume the findings are true. They're too busy to read the whole study, and they probably wouldn't know what to look for if they did. Most doctors weren't taught how to critique a study in medical school. I didn't learn how until long after I graduated. Junk science includes tooth fairy studies that researchers shouldn't have bothered to do, and studies that were so poorly done that the results are useless and we can't draw any conclusions from them. Joe Schwartz's definition of junk science is, any argument that claims to have greater support than the evidence actually justifies, usually to advance a political or commercial agenda or to buttress a personal conviction. Chemistry and physics experiments are relatively straightforward. Chemical compounds and physical phenomena don't lie. Chemicals always behave the same. When you mix chemical A with chemical B, you always get compound C, and you can even calculate exactly how much C you're going to get. Human experiments are more complicated. Molecules of a chemical are all identical, but humans are a mixed bunch of individuals that can be very different from each other. And humans don't cooperate like chemicals do. They may not follow instructions. They may try to figure out if they're in the placebo group by opening the capsules to taste for sugar. They may report what they think the researcher wants to hear, and they may even misrepresent their symptoms in order to qualify for a study. Dr. House was right. Patients lie, either deliberately or inadvertently. People don't remember accurately, they forget significant information, and they try to hide information that might make them look bad. A study showed advocates of any CAM treatment can cite studies showing that it works, but consider this. There are 6,500 peer-reviewed scientific journals that publish 2 million papers every year. That works out to 4 new scientific papers every minute of every day. So it's not surprising that a study can be found to back up virtually any point of view. This is Dr. John Ioannidis. He wrote a landmark paper showing that most published research findings are false. I'll say that again. Most published research findings are false. He showed that they're particularly likely to be false if they're small studies, if the effect size is small, if there are multiple endpoints, if financial interests and bias are involved, and if more teams are in competition in the same area of research. And they're a lot more likely to be false if they're studies of improbable treatments like homeopathy. Now, that doesn't mean we can't trust science. After all, Ioannidis had to use science to know which research findings turned out to be wrong. The scientific process is self-correcting in the long run. Early studies with false findings are followed by better studies that are more reliable, and a scientific consensus gradually builds based on the entire body of evidence. So, if most published research findings are wrong, how can we decide whether to trust the results of a given study? What can we do to minimize the chances of being fooled? Well, in the first place, don't trust the media. Media reports are notoriously unreliable. You can't trust them to give you accurate scientific information. I'll come back to that in the next lecture. Learn what sorts of things can go wrong in research. Never believe one study in isolation. Have the findings been replicated? Do other studies support it or contradict it? Has there been a meta-analysis? Consider prior probability. Remember what Carl Sagan said about extraordinary claims. When you hear about a study, don't just accept it at face value. Ask questions. I'm going to give you a whole toolkit of questions you can ask. The first question to ask, perhaps the most important question, is did they study people or fruit flies? Was the study done in vitro, in animals, or in humans?  But you can't very well use a blowtorch to treat cancer in people. Well, I suppose you could. It would get rid of the cancer, but it might get rid of the whole patient in the process. Animals have a lot in common with humans, but they're not exactly the same. If a treatment works on animals, it still has to be tested on humans. So we can't treat patients on the basis of lab studies and animal studies. Those are only a starting point. All you can do is file them away, reserve judgment, and wait for human studies. The next thing you can do is to ask the four questions on this quick checklist proposed by R. Barker Basel. I mentioned his book before, Snake Oil Science, The Truth About Complimentary and Alternative Medicine. He's a research methodologist who designs research studies for a living, so he knows what to look for. He thinks these are the four most important questions to ask. I'll go over each one of them. One, is it randomized with a credible control group? We know that doing anything is usually better than doing nothing. So we need to compare the test treatment to an appropriate control group. For an acupuncture study, a good placebo control might be sham acupuncture. For a drug study, a good placebo control might be a sugar pill that looks exactly like the drug pill. Some examples of poor controls might be comparing the treatment group to a waiting group that gets no treatment, comparing the results of a new study to historical data or to a group that gets usual treatment, and comparing different modalities to each other like acupuncture and drugs. Lots of studies get published that don't even have a control group. Look for the words randomized control trial in placebo controlled. A control group should eliminate as many confounders as possible so that you can be reasonably sure that the results were due to the test treatment rather than to some other unrecognized variable. Number two on Bowcell's checklist, were there at least 50 subjects in each group? That would be 100 total for a study with a treatment group and a placebo group, or 150 for a study that also included a no treatment group. In general, the larger the sample size, the more likely you can trust the results. There's an old story about a chicken study where one-third of the chickens got better and one-third stayed the same. If you're paying attention to the math, you should ask, what about the other third? The answer is, that chicken ran away. Obviously, you can't draw any conclusions from a study that only had three chickens. Item three, is the dropout rate 25% or less? Here's why that's important. Say there are 10 subjects and six of them quit because the treatment wasn't working. Of the four who were left, three improved and one didn't. So it looks like the success rate was 75%. But if you include the failures of all the ones who had dropped out, the true success rate was only 30%. Item number four, was it published in a high quality, prestigious peer-reviewed journal? If it got published in the New England Journal of Medicine or the Lancet, you know it had to meet pretty high standards. If it only managed to get published in the Laura Slobovian Acupuncture Weekly, you should wonder why. If you've never heard of the journal or don't know if it's a high quality journal, you can look it up online on impact factor lists to get a numerical estimate of its relative importance in its field. Here are some examples from a list of the 40 top-ranked medical journals. The top four are the New England Journal of Medicine, the Lancet, the Journal of the American Medical Association, and the British Medical Journal. The Mount Sinai Journal of Medicine is near the bottom of the list, and some journals are not on the list at all. This list is for general medical journals, and there are individual lists for specific areas like cardiology. There are also page-ranked listings and other ways of scoring. If a study meets Basel's four criteria, that still isn't a guarantee that you can trust the results, but if it doesn't meet these four criteria, it's an indication that it might not be trustworthy. If a study passes Basel's checklist, there is still a lot of other questions you should ask. First, who are the subjects? Are they a representative sample? Do they include both sexes, all ages, people like you? The results of studies done on men might not apply to women and children. Results in Africans might not apply to Americans. Results in young adults might not apply to the elderly. People with other diseases or on other medications may not get the same results as the carefully selected study participants. Was it a study of blood pressure medications and diabetics? The results might not apply to people who don't have diabetes. Could the subjects be biased? If it was a study of acupuncture, who do you think is likely to volunteer? People who believe in acupuncture are more likely to sign up. If they don't believe it works, they're not as likely to volunteer to let people stick needles in them. I read one study where the researcher used his own students as subjects. They might have wanted to please the teacher and get a good grade, and that might have skewed their reporting. Next question, who's paying? Studies have shown that when a drug company is paying for the research, the results are more likely to be positive for the company's drug. That doesn't mean they're deliberately being dishonest. The researcher might subconsciously want to please the company so that they'll get funding for more research, and the company might exert subtle influence in various ways. But that doesn't mean you should dismiss a study just because it was funded by the manufacturer. Most researchers are far more concerned with maintaining the integrity of their scientific reputation than in pleasing their funding sources. And in most cases, the funds are simply handed over with no attempt to influence how the study is designed or carried out. But it's something to keep in mind, and you might want to give more weight to a study that was funded by an unbiased source. Next question, who are the authors? Could the researchers be biased? Is there a conflict of interest? Financial conflicts of interest are usually divulged in a statement at the end of the article. Do the authors have stock in the company or get lecture fees from them? Other conflicts of interest may be subtle and undeclared. If the researchers have strong beliefs about what they're testing, or if they have a vested interest in proving the truth of a claim, it's more likely that they'll get positive results. Do they make a living based on the treatment they're studying? Are they acupunctures? Studying acupuncture? Homeopaths studying a homeopathic remedy? Chiropractors studying chiropractic treatment? Is the subject a pet project of the researcher, one that he has staked his reputation on? Would his career be ruined if the claim were proven false? Was randomization adequate? Did they use proper procedures? If randomization isn't strictly controlled, researchers might be tempted to assign sicker people to the control group to make the treatment look better. Or they might feel sorry for a sicker patient and want to get him in the treatment group so that he'll have a chance. Even if proper randomization procedures are followed, the groups might end up with significant differences just by chance. For instance, did a lot more men than women end up in one group? Did the group getting the treatment have a lower blood pressure than the control group? Good studies usually publish a table of comparisons showing the age, sex, and other characteristics of subjects in both groups. So you can see at a glance if too many people with that characteristic ended up in one group. Was blinding effective? Was there any way the researchers might have guessed which group a subject was in? Could the subject have guessed? The best studies do an exit poll. After the study, they asked subjects whether they thought they got the active treatment or the placebo. Maybe they could tell because they got side effects from the active treatment. Maybe the researchers inadvertently gave the subject some clues to which group they were in. If they can guess better than chance, you didn't have an adequate placebo control and you should go back to the drawing board. Were there multiple endpoints? For instance, in a study of heart disease, you might have a single endpoint like death from heart attacks. Or you might also look at a lot of other outcomes like non-fatal heart attacks, chest pain, the need for interventions like bypass surgery, time in the coronary care unit, exercise tolerance, length of hospitalization, quality of life, blood pressure, the need for pain medication, etc. If you measure enough things, one is almost guaranteed to show a positive correlation just by chance, even if the treatment doesn't work. They might have gotten 14 negative results and chosen to declare the treatment a success by reporting the 15th one that was positive. It's like the Texas sharpshooter fallacy, where a Texan fired at the side of a barn and then drew a target where the bullets hit and claimed to be an expert marksman. There are statistical methods to correct for the problem of multiple endpoints. Were they used? Was there inappropriate data mining? Sometimes when researchers don't get the results they want, they mine the data. They go back and look at different segments of the data and twist the numbers every which way and torture the data until they get something that agrees with their expectations, and then they report that. It's a way of deceptively turning negative results into positive results. Where was the study done? The percentage of published trials with positive results varies widely from country to country. In Canada, 30% of acupuncture trials have positive results. In the U.S. it's 53%. In Asia, 98% of acupuncture studies are positive. That's not just for acupuncture studies, but the results of all clinical studies vary according to where the study was done. That should make you suspicious because science should be the same everywhere. In China, negative results are almost never published. The culture sees negative results as failures, and the researcher loses face and may lose his job. Russia is another big offender. I'm reluctant to believe any research out of China or Russia until the findings are replicated in a country with a better track record of publishing negative results. Failure to publish negative results is called the file drawer effect. You might have ten negative studies and only one positive study. If only the positive study gets published, people will believe that the evidence shows that the treatment works, even though the majority of the evidence was actually negative. In addition to the file drawer effect where the researchers don't submit negative studies for publication, there's also publication bias where journal editors are less likely to publish studies with negative results. Were the studies clinically meaningful? What was the effect size? If a drug lowers the blood pressure by 40 millimeters, it might be able to prevent a lot of strokes. If it only lowers it by one to two millimeters, that's probably not enough to make much difference. Was the endpoint a lab value or a clinically meaningful event? We don't just want to know if cholesterol levels went down on blood tests, we want to know if patients had fewer heart attacks. We're not treating lab tests, we're treating people. We don't want to have to say the surgery was a success, but the patient died. We're looking for what we call poems, patient-oriented evidence that matters. What does statistical significance really mean? Statistical significance is very commonly misunderstood. P values lower than 0.05 are said to be statistically significant. That cut-off is just an arbitrary convention. Some people think it means there's a 95% probability that the results of the study are true, but that's not what it means at all. A value of P equals 001 does not mean that the findings are more true than if it equals 0.05. The P value only measures the probability that you would get the same results you did if there was really no difference between the two groups, in other words, if the null hypothesis was true.  It doesn't necessarily prove the experimental hypothesis is true that A is better than B. Now, this is important. Remember this. Statistical significance is not the same as truth. And truth is not the same as clinically significant. Another question. What are the confidence intervals? If you repeat a study, you won't get exactly the same numbers every time. Look at the set of bars on the left. On this particular trial, they got a value of 18 for the brown bar. The red lines show the confidence interval. For the brown bar on the left, they calculated that if they did repeated trials, they could be 95% confident that the results would fall somewhere between 16 and 20. In other words, there's a 95% chance that the true value falls somewhere on that red line. In the set of bars on the left, the red lines don't overlap. The lowest red value in the brown bar is still higher than the highest point for the white bar. Brown clearly wins. On the right, some of the higher red values for the brown bar are higher than some of the lower red values for the white bar. So even though it looks like white is the winner, it's possible that brown might actually be the winner. And it just didn't happen to show up that way in this particular trial. Here's an example of how it might be reported in a scientific article. The reduction in mortality was 35% with a 95% confidence interval of 21% to 58%. Did they report relative or absolute risk? They might report that people who eat kumquats are twice as likely to have the disease very cyclitis. The relative risk is twice as much or 200%. But if only one person and a million people has the disease very cyclitis, twice as much would only mean that two out of a million people who eat kumquats will have the disease. The absolute risk is actually just one more person out of every million. 200% or one in a million. These sound very different, but they're actually the exact same statistics just expressed in a different way. So when you read a study, look for actual numbers rather than percentages or proportions. Did they report NNT and NNH? NNT is the number needed to treat and NNH is the number needed to harm. In the early days of Lipitor, one study found a 19% reduction in the risk of heart attacks. Now, you might think that if you took the drug, it would reduce your personal risk of a heart attack by 19%, but that's not how it works. The numbers are for populations, not individuals. The study found that in order to prevent one heart attack, you would have to treat 250 patients. If you're not that one patient out of 250, the drug won't prevent you from having a heart attack. It won't do you any good, and it might cause side effects. And NNH of 200 means that out of every 200 patients who took the drug, one had a significant adverse effect. Those things are nice to know. Did they mistake correlation for causation? This is one of the biggest mistakes people make. Correlation does not equal causation. Remember this graph from lecture one? The rise in the number of diagnoses of autism correlates almost perfectly with the sales of organic food, but that doesn't mean organic food causes autism.  They've shown a correlation, but they haven't proven causation. It could be that kids who are likely to behave violently are also more likely to want to play video games. Or it could be that some other factor predisposes kids to both violent behavior and playing video games.  It might even make them angry and more likely to act out. Did they tell you the base rate of the disease? A news report says, Breaking news, new blood test, 87% accurate in detecting Alzheimer's with an 85% specificity rate. That sounds really good, but it may not be. You can't tell what it means unless you know the base rate of Alzheimer's and the population they studied. 87% accurate means that the test is positive and 87% of those who have Alzheimer's. We call that the sensitivity of the test. 85% specificity means the test is negative and 85% of those who don't have Alzheimer's. But sensitivity and specificity don't give you any useful information until you know the prevalence of Alzheimer's in the population. Let's say a population consists of 10,000 people and 5% of them have Alzheimer's. That means 500 people in this population have Alzheimer's. A sensitivity of 87% means that 87% of them will test positive. That's 435 people. And 65 of them will test negative and will be led to believe they don't have Alzheimer's when they really do. There are 9,500 people in this population who don't have Alzheimer's. A specificity of 85% means that 85% of 9,500 or 8,075 people will test negative and the other 1,425 will test positive and will be led to believe they have Alzheimer's when they really don't. What you really want to know is if you test positive, what's the likelihood that you actually have the disease? To get that, you divide the true positives, 435 by the total positives, 1,860 and you get a positive predictive value of 24%. And if you test negative, what's the likelihood that you really don't have the disease? Out of 8,140 people who test negative, all but 65 of them really don't have the disease. So the negative predictive value is 99%. So this test would be very good at ruling out the disease, but it would be useless for ruling it in since only about a quarter of those who test positive actually have the disease. Remember that the rarer the disease, the less likely that a positive test result is true. Lots of other things can go wrong in research. Here are just a few of them. Errors of math, using the wrong statistical test, contaminants in the lab, poor compliance, patients didn't take all the pills, technicians may have manipulated the data either consciously or unconsciously to please the boss. Procedures may not have been carried out properly. The data may be good, but the conclusion may be wrong. And there could have been fraud. Sometimes researchers deliberately fudge the data or even fake a study completely. In 2001, the Journal of Reproductive Medicine published a study by three researchers from Columbia University. They found that praying for women undergoing infertility treatments doubled the rate of pregnancy. Being prayed for can make you pregnant. That sounds like what Carl Sagan would call an extraordinary claim requiring extraordinary evidence. And this was one study not corroborated by anything else. Bruce Flam, a professor of OBGYN, was skeptical. He evaluated the study and he found that the experimental methods were seriously flawed. Then he investigated the authors and he became really alarmed. The lead author, Rogerio Lobo, didn't even know the study had been done until six to twelve months after it was completed and they asked him to provide editorial assistance with the write-up. The second author, Quang Cha, refused to respond to any inquiries. The third author, Daniel Worth, turned out to be a parapsychologist with no medical training who was also a con man and a convicted felon and who was strongly suspected of having faked data in other studies. So at this point we aren't sure any study was actually done. It may have been entirely fabricated or at least the data may have been altered or misreported. The journal never retracted it and it's still cited in the literature as proof of the efficacy of prayer. No, it isn't proof of anything. You may not have any way of knowing about fraud until it's revealed several years later or it may never be revealed. But at least you can keep the possibility of fraud in the back of your mind, especially if the reported findings are unexpected or if the authors have been involved in questionable behavior in the past. Two kinds of study are particularly likely to be wrong. Tooth fairy science and pragmatic studies of implausible treatments. Tooth fairy science is where you try to study things that don't exist like the tooth fairy or the human energy field. I've covered that in lecture 7. And pragmatic studies of implausible treatments are also likely to get false positive results. The setting of clinical trials is artificial with a select group of subjects and careful monitoring in a research environment. When the treatment is used in real world settings like a doctor's office with a broader mix of patients it may turn out to be less effective. That's where pragmatic trials come in. For example, clot buster drugs worked very well for strokes in clinical trials. But when doctors started using them in emergency rooms some of the patients weren't ideal candidates. Some of them had other diseases or were on other drugs. Sometimes doctors were district about treatment guidelines. There were delays in treatment and other factors interfered. In actual practice the drugs were less effective in the clinical trials and they were more likely to cause complications like bleeding. The pragmatic studies showed that in real world settings the benefit to harm ratio was much lower than in the clinical trials. So pragmatic studies give us valuable information and real world comparative effectiveness studies can help determine treatment policies. But pragmatic studies are not designed to prove that a treatment works. They were meant to be done on treatments that had already been proven to work. Things start to go wrong when you do a pragmatic study on an improbable treatment. For instance, you might compare acupuncture to conventional treatment for back pain. Acupuncture may appear to outperform conventional treatment in pragmatic studies because acupuncture is a theatrical placebo and patients are suggestible. But that doesn't mean acupuncture works. If the same theatrics could be added to the conventional treatment it would appear to work even better. Cam advocates love doing pragmatic studies because it makes their ineffective treatments look better than they are and it allows them to skip the essential step of proving that their treatment works better than placebo. I have a rule, the skeptox rule. Before you accept any claim make sure that you understand who disagrees with it and why. When you understand the arguments on each side it's usually obvious which side makes more sense. If Jenny McCarthy had followed that rule when she first heard the myth that vaccines cause autism she might have found solid refutations of all the anti-vaccine arguments and she might not have been so easily misled. You can ask whether other studies have been done on the same subject and whether they confirmed or contradicted the results of this study. You can check PubMed to find out. And you can check the science blogs to see if anyone has ever written about it and found serious flaws in the study. Steven Novella has pointed out that there's a double standard. Science-based medicine and CAM have different thresholds for establishing proof. Science-based medicine requires scientifically plausible interventions and rigorous trials showing replicable, statistically significant and clinically significant benefits. CAM puts the threshold of proof much lower. It softens standards and makes excuses. It often suggests that randomized control trials are inappropriate for CAM. It uses pragmatic studies as if they were efficacy trials. It interprets placebo effects as if they were proof of efficacy. It has a much more flexible concept of evidence. The last question and an important one is whether you might be tempted to accept or reject the study because of your own prior bias. Did you have an opinion about the subject or about the researcher before you read the study? You should examine your own thinking as carefully as you examine the study. You can learn a lot from bad examples. It might be useful to go through a lot of junk science. This was a study about homeopathy. It looked at children who had a cough from a viral URI, upper respiratory infection. In other words, a common cold. It had asked whether adding antibiotics to a homeopathic cough remedy would improve the resolution of the cough in children with URIs. Every published study starts with an introduction, covering the background of the subject and describing previous research in the area to demonstrate the reason for the new study. In this study, the background research for the homeopathic remedy consisted of only one study in adults showing that the homeopathic remedy worked, a study that had never been replicated. For antibiotics, they cited numerous studies showing that antibiotics don't work for cough in URIs. There had never been a single study showing that antibiotics did work to treat a cough. They were assuming, on the basis of a single, unreplicated study, that since the homeopathic remedy worked for adults, it would work the same way for children. And that's an unjustified assumption. And they knew the evidence showed that there was no rationale for using antibiotics. So why on earth would they use them in this study? All the children in the study got the homeopathic cough remedy, and half of them also got an antibiotic. Here is what was in the homeopathic cough syrup. There were 10 ingredients at all. According to homeopathic philosophy, you ought to treat a cough with a dilute solution of something that caused healthy people to cough. None of these ingredients would qualify. None of these ingredients has been shown to be effective for cough. The Natural Medicine's Comprehensive Database says there is insufficient information to assess their effectiveness, and it rates some of them as likely unsafe. Bryonia is rated as likely unsafe, as few as 15 berries can be fatal in children. Ipacac is one of the ingredients it's used to make people vomit after they've swallowed a poison. Some of these ingredients are not even real ingredients, but they're proprietary mixtures sold by the Boyron Company that were already in a dilute form. A solution of 3C equals one part per million. A solution of 6C means one part per trillion. Drosera is provided as a mother tincture rather than as a homeopathic dilution, so it's strong enough that it might possibly have a direct effect. It has been claimed to work for coughs, but the Natural Medicine's Comprehensive Database says there's insufficient reliable information to assess its effectiveness, and it rates it as only possibly safe. How do you suppose they came up with this particular combination of 10 remedies? I can't see any rationale for mixing these particular ingredients. Even if they had proved it worked, they wouldn't know whether one of the ingredients did the job or whether all 10 were really required to get the effect. So what did the study find? After a week, half of the subjects in each group were symptom-free. That's no surprise. Most cold symptoms resolve in a week or so without any treatment. They didn't compare children treated with homeopathic syrup to children who got no treatment, but we can assume that the untreated children improved just as much. There was no difference between those who got cough syrup and those who also got antibiotics. And that's also no surprise since we already knew that antibiotics don't make a difference in viral infections. Their conclusion? The homeopathic treatment worked and adding antibiotics didn't help. Their data don't support their conclusion. We can't tell from this study whether the homeopathic remedy worked. We have no way of knowing whether the subjects who got the homeopathic remedy did any better than they would have if they'd been given a placebo or if they'd been left untreated. Without treatment, they might have improved just as much from the natural course of the disease. And we already know that antibiotics don't work. They call the homeopathic treatment symptomatic treatment, which is pretty ironic because CAM claims to treat certain causes rather than the symptoms. Where was the study published? In an obscure journal. Who paid for it? It was financed by Boiron, the company that manufactured the homeopathic remedies. No meaningful information could be learned from this study, and it was unethical. That study violated the principles of ethical research on human subjects. Ethics require that a study have scientific validity. It should be designed to answer a meaningful question, and it should be done by good scientific methods. Ethics require protection of subjects to prevent harm from treatments already known to be ineffective. Like antibiotics for URIs. The potential benefits to subjects should be greater than risks. In this case, there was no reason to expect benefits from antibiotics, and we know that antibiotics can cause side effects. And there should have been proper informed consent. What do you suppose those subjects were told about antibiotics? This study was a travesty. Nothing meaningful could be learned from it, and the subjects were exposed to risk. It should never have been done. Peer reviewers should have spotted the flaws. But in this case, the peer reviewers were probably other homeopaths who were happy to believe anything and no reputable journal editor should have accepted this for publication. According to an article in the Journal of the American Medical Association, there seems to be no study too fragmented, no hypothesis too trivial, no literature citation too biased or too egotistical, no design too warped, no methodology too bungled, no presentation of results too inaccurate or too obscure and too contradictory, no analysis too self-serving, no argument too circular, no conclusions too trifling or too unjustified, and no grammar and syntax too offensive for a paper to end up in print. A lot of good studies get published, particularly in the most prestigious medical journals like the New England Journal of Medicine. But a lot of really awful studies get published too. In fact, researchers can even pay to get their study published in an online journal when they wouldn't be able to get it published anywhere else. Here's a list of some of the problems with research. Poor quality studies get published. The publish or perish climate in academia encourages scientists to do ill-advised research. Publication bias, negative studies are less likely to be published. Lack of replication, studies are seldom repeated and the replications are not likely to be accepted for publication. Mistakes are missed by peer reviewers who are sloppy or biased. Terrible studies get published and pay to publish journals. There have been examples of big pharma malfeasance with suppression or distortion of data. The scientific community recognizes those problems and is seeking solutions. Here are some of the solutions that have been proposed. Education of researchers Better quality control at journals Publishing replications in negative studies Registering all studies so the negative ones can't be forgotten or swept under the rug and there should be full disclosure and media reporting should be improved. Someone proposed that every research study should carry this label. Warning, taking any action on the basis of this research could result in injury or death. The results described in this study have not been replicated and the long-term effects of this treatment are unknown. Past performance is no guarantee of future results. When subjected to further investigation most published research findings turn out to be false. I hope when you read in the newspaper that eating kumquats prevents heart disease you will remember this warning and won't rush it. All of this is very discouraging but it's not hopeless. So many things can go wrong with research. You can never trust one study in isolation. But scientists eventually evaluate the whole body of evidence, sort out the wheat from the chaff and reach a consensus that we can rely on. Science isn't perfect but no other way of knowing even comes close. As described it as the slow lumbering beast we call science. The behemoth is clumsy, it stumbles and it meanders in its quest but its course is ultimately self-correcting and it inexorably trudges towards its final goal, the truth. Richard Dawkins said science, it works bitches. He didn't invent that saying but it's particularly delightful to hear him say it in his cultured British accent. In the next lecture I'll talk about the behem that often ensues when science meets the media and politics.


Thanks for checking out this unboxing video. This is the May original BAM box Yeah, two days ago. Actually, I ended up doing the horror BAM box. Hopefully people enjoyed that video. Sorry the lighting might not be the best and see if I can fix it and when I'm editing, but Yeah, May box this should have the third print in the series of three for the infinity war stuff Pretty excited about that. I have an idea of you know, what characters are left Actually just got done at the theater saw them saw solo star wars story and No spoilers. I won't say any spoilers, but gotta be honest. I didn't really like it I know it's uh, I've heard I've heard good and bad about it. I've heard people were like, oh, I love it It's awesome. It's awesome. I've heard people like I thought it was terrible. So and and in between so, you know, whatever I wasn't a big fan, but I have a big fan of BAM box and I am a big fan of seeing what they put in here I don't remember any of the properties for the May one Well, I dropped something because it was wrapped up in here oops That'll be the first thing that I reveal two pieces of tissue paper cat will be happy And this is I don't On the house What is this? I don't know what this is from. Oh, this might be from I think They're supposed to be like a fallout item and this might have something to do a fallout. Maybe It says uh lucky 38 On this side You can see And it's like a roulette wheel kind of and then on the other side says 200 and then it says on the house Um Yeah, I don't know what that's referring to tebby once again, you know, they do metal stuff Not metal stuff, but metal stuff Although sometimes BAM boxes metal, especially the horror box anyway, um Did I get a one off? I did Got a one up. I got a one up in my horror one too. So pretty excited about that I don't remember what the colors have to do with And it doesn't say Because the horror one I got was yellow. This one's green I'll find out So pin next, you know, I love the pins This one's done by brian romero is the designer. Oh, and it's I have a feeling I know what it's gonna be Oh, nice. That's cool. Um This is from gi joe. I forgot that was one of the properties So like well, like I said, I forgot like all the properties in it and it's uh, looks like it's snake eyes Is that It's hard to see because of the lighting and it's purple. It just kind of like ends up looking black. Maybe I can fix it I see it Pretty good design Sorry, it's not showing up all that great just because of how dark it is. Um, but it's good I'm down with that. It's a good pin it's on the larger side, which Usually they're a lot smaller All right, so Yep, this is the third of the series of logan pack infinity war prints And looks just as good as the first two Okay, that's nice I'm gonna put this box down so I can go over everything with people here um Hopefully everyone's seen infinity war because there is like something a little Spoilery on here. It's not like a huge thing. So Spoiler alert. I got number 115 out of 2000. Here you go. Uh, this is a spoilery thing. There's red skull Uh, war machine falcon and loki vision scarlet witch winter soldier slash pucky barns Uh, black panther dr. Strange and spider man Yeah, looks good, right? I like how he's got uh, dr. Strange has his little like Energy things out or magic things It's cool. Looks good I expected it would because the other ones looked good. Good job logan pack. It's nice and then The autograph That says Oh, okay. I had a feeling this is this is what this was going to be Oh, and now I remember what what one of the properties was dead pool too That was a huge thing because everyone's going to get an autograph from someone in dead pool too and this is the It's signed by stefan capis cap capis six I'm sorry K. A. P. I. C. I. C Capicic I don't know Sorry, dude, uh, but he played colossus.  I haven't seen dead pool two yet I really really want to but Unfortunately, just I haven't had time. I will I will don't worry. Well, it's in the theater. I'll still I will see it So, um, yeah, I mean this is actually oh it is a piece of artwork It's not like an actual picture and the artworks by yohan britz He's the one who did this Because at first I was like it actually kind of did look like it was a picture But if you look closer, you can see that it's not actually a picture It looks it looks kind of air brushy I think it's done with airbrush. That's pretty cool Looks good. Oh, wow. Okay This must be the upgrade item because it says if you can see Right in here 74 out of 99 That's nice and limited 99 of these it looks good. Like that artwork is really cool Now i'm even more interested to see what the what the other ones were Which we will right now the spoiler sheet Okay, um All of these were were Yes, all of these were good options, honestly So with the autographs you could have gotten these You could see just a picture from the movie. It looks like With him signing as Colossus. This one's really cool. If you can get it Sorry the lighting like I said, not that great You can see he's like, uh, animated like Deadpool on a unicorn on a rainbow and then the One that we got it was only 99 done. That's cool. Those are all good options though With the art print there was just one variant And it was gray black white and gray for the most part Um, honestly, I'm glad that since I got like in the first one Well, if I would in any of them got the color version I'm glad I didn't get any of the gray scale like black and white ones in any of them because I would want them all to match up When I put them all side by side So glad that didn't happen to me Okay, I was right. Uh, the coin is from fallout new vegas lucky 38 platinum chip. Is what it's called That's by dark matter props Let me see on there. All right Then the pins we got the common. Well, I got the common for the pins Which was snake eyes like I said, uh, there's out of 250. There's destro and one out of 99 scarlet So people remember their gi joe See They look good. They look nice. Um, I'm good with getting snake eyes. I think snake eyes was one of my favorite characters. Anyway, so Definitely cool And then there was they were doing a giveaway For a signed Funko pop Inscribed yo joe snake eyes done by ray park Which is really cool because people don't know ray park also played, um Darth Maul in Phantom menace Lost it for a second. I was just at the star wars movie. So geez All right, so overall with this box. Um, I like it Typically like their stuff. Um Don't really care all that much about the coin But that's mainly because I haven't played fallout I actually like just briefly played fallout 3 before and that's pretty much it for any fallout game So don't really care about this one that much, but I do know I was actually just talking to some people recently who were saying they really like fallout, um new vegas So I'm gonna give that to them That's cool. Obviously always excited about the pins. They always look pretty good. So that is nice Obviously really like the print. I like the last two in this series did a really good job And very very very excited to have gotten this The most rare version of the autograph because it really does look good. It really does like it definitely Definitely looks like really nicely executed airbrush if you guys go Just like pause and just get a good look in there You can see Anyway, yeah good stuff once again, um the original box for oh, yeah, okay So for june, I already know there's one property in the june box and I'm very very very excited for Also with the horror one. It's the same situation. There's one property. I'm really excited for so both those boxes should be really worth it for me um, especially If those items are good Honestly, if just those items are good in each of the box, I'm gonna be totally good with the boxes overall But anyway, uh once again, bambox does it people if you could help me out, uh, please hit the subscribe button If you want to post put some comments down there. I will interact with you everyone We can interact together talk about geeky nerdy stuff and I'm good with that. I almost said another word Try to keep it clean And then uh, if you could go ahead and just let people know About the about the um the channel if they want to see some unboxings Give me some thumbs up for some likes not like it really means anything But you know, it's just nice for people to just be like hey thumbs up. I like you But anyway until next time. Thank you so much for checking this out and keep it brutal


The first item of business this afternoon is Scottish Parliamentary Corporate Body question time. I would invite members who are wishing to ask a supplementary question to press their question speak buttons during the relevant question. The time for this item of business has been extended, but there is an awful lot of interest. The usual plea for brevity in questions and responses, as far as possible. Question number one, Rhaetol Hamill. Ysgolwys Ffg ddechrau'r gweithio'r gwestfadau a'r ddyntgen o'r gweithio'r gwestfadau sgolwys Ffg ddechrau'r gwestfadau sy'n ddechrau'r gwestfadau. Jec Éan Carlawd. I can confirm, Presiding Officer, that the extension was not at the request of the members of the corporate body. I thank Rachel Hamilton for her question. I know that this is an issue that is of interest to a number of MSPs. The member sponsored events and exhibitions programme is very popular, with that in mind, the corporate body previously agreed that that event organisers could book up to 12 months in advance, which means the events and exhibition team are currently taking bookings from event organizers sponsoring members for events up to March 2025.級W that we pride ourselves in being a people's parliament, what is being done to ensure that stakeholders and citizens have the opportunity to engage with parliamentarians? Is this an issue of bureaucracy, or do we need to offer more flexibility of spaces to be used for events? First of all, I say that in order to manage resources across the parliamentary teams as well as the parliamentary campus on busy business nights, an agreement was given by the corporate body to limit the number of events accordingly. We currently deliver and support between nine and ten member-sponsored events and two member-sponsored exhibitions weekly. The events and exhibitions team will lead on the delivery and programming of the member-sponsored events and the exhibition programme, and also design and deliver the corporate body's agreed major events and exhibitions programme that supports the goals of the Scottish Parliament's public engagement strategy. It is, however, open to members out with that to organise events that are consistent with the meeting room booking policy should they wish to do so, but, of course, they then would have to provide the infrastructural support to allow that meeting to take place, which I suppose reasonably is not practical for a large gathering, but would be practical for a smaller gathering. In terms of the wider point, the corporate body will look to see whether, as part of, I think, the legacy report of this Parliament to the next. If we reflect and find that there has been a significant increase in the whole demand for member-sponsored events, whether it would, at that point, be appropriate to suggest that that particular part of the corporate body infrastructure received additional resource? You may not have asked for the extension in time, Mr Carlaw, but with answers that long, we are going to need a further extension. I call question number two, Murdo Fraser. Thank you, Presiding Officer. To ask the Scottish Parliament the corporate body what plans it has to commission a portrait of King Charles as head of state. I thank the member for his question. The SPCB is happy to consider suggestions from new commissions. We have asked parliamentary officials to explore options with a view to providing advice and recommendation to the SPCB in due course. We will keep you fully informed of those decisions, Deputy Presiding Officer. Murdo Fraser. I thank Christine Grahame for that answer, and I am sure that she is as enthusiastic as I am about the prospect of having a portrait of our head of state displayed in the building, as would be appropriate in a national parliament. We already have a photographic portrait of the late Her Majesty the Queen opposite the public entrance. It is much admired by visitors. I am sure that we would not want that to be removed but complemented by a portrait of our new head of state. Can the member tell me whether there are any plans to relocate the existing portrait of Her Majesty the Queen and ensure that it continues to be displayed in the building? I thank the member for his questions, which I am delighted to answer. The position about whether we keep the portrait of the late Queen will be considered by the SPCB in due course when considering the new commission for King Charles. To ask the Scottish Parliament corporate body what steps it is taking to address any ethnicity-related pay gap among Scottish Parliamentary corporate body staff. It is a complicated response, but the corporate body is proud of the steps that it has taken to develop our minority ethnic staff, including an award-winning emerging leaders development programme, which was jointly developed by the Scottish Parliamentary Service, Edinburgh College and the Scottish Association of Minority Ethnic Educators. That programme supported 13 staff to develop their leadership skills and prepare them for career development and advancement. The corporate body has also implemented a positive action approach to recruitment, which has significantly increased the numbers of applications received from people who identify as being minority ethnic and the successful appointment of such applicants. While progress has been made, we recognise that more needs to be done to reduce our ethnicity pay gap further, which is why we have made a commitment to develop a race strategy to tackle barriers in the workplace. Recent reports on diversity monitoring and pay gaps for 2021-22 show that ethnicity pay gap for all staff has increased from 27.6 per cent to 21 to 30.1 per cent to 22. Further to that, just 18 per cent of applications for jobs in the Scottish Parliament were from minority ethnic candidates in 2022 compared to 78 per cent from white candidates, with gaps existing in the success rates from those applications. Can the corporate body be clearer on what actual steps it is taking in the coming financial year to ensure that not only are staff from ethnic minority backgrounds paid fairly but that those vacancies are adequately promoted to ensure accessibility for those candidates? The Scottish Parliamentary Corporate Body began reporting on its ethnicity pay gap in 2018-2019. The media and ethnicity pay gap for 2022-23 stood at 20.1 per cent, which I think is a more up-to-date figure than the one Carol Mocken had, which was obviously down from the 30.1 per cent in the previous year. In large part, that reduction has been achieved through concerted positive action in our recruitment approach, which has successfully increased our proportion of applicants and successful appointments for people who identify as minority ethnic. We have also reviewed our pay arrangements to ensure that they are transparent, equitable, consistent, flexible and fair. To ask the SPCB whether it will provide an update on its plans to increase access to child care in the creche beyond three hours per day. After considerable engagement with the care inspectorate and our service provider, Ohana, we successfully achieved a variation to our registration December last year, increasing the hours from four hours a week to three hours a day, more than doubling the hours of childcare that can be provided. Alternatively, four hours can be taken in a single session if that is the only visit in a week. Since then, we have looked at further improving access of the creche to outdoor space, so children would have a free-flowing access to an outdoor space, and that might give us more flexibility with the care commission. However, to be clear, the Parliament design was always for a creche, and a nursery has very different requirements which our facilities cannot meet. We want to deliver the best facilities for children that we can and to meet the most up-to-date guidance and criteria. Can I put on record my immense thanks to the SPCB, the care inspectorate and the parliamentary authorities for pursuing this, especially getting the changes that Clare Baker has outlined in such a timely manner? I know that a huge amount of work went into it, and I am enormously grateful. Since the last time I asked this question, I think that there have been two, although others might be able to correct me, reports of MSPs having children this summer. They will also need childcare when it comes to returning to work. I am sure that the SPCB would agree with me that MSPs work more than three hours per day, so it is quite likely that there will continue to be demand for a facility that delivers what parents need in the Parliament, rather than based on guidance that does not meet the need. I appreciate Kate Forbes' welcome for the work that has been done by the corporate body and the care inspectorate that has improved offer that we have. We recognise that members have a particular challenge with childcare that they need to care both in Edinburgh and in their constituencies, and the creche is a service that can offer some support. As I said, the design of the Parliament was to include a creche for occasional use. It is unfortunately not possible to convert this facility into a nursery and also meet the requirements of the care inspectorate. The Parliament is trying to be more family friendly. I think that our on-going investment in remote working for MSPs can provide some flexibility in managing care and responsibilities. We are continuing to speak to the Scottish Government about the nursery at Victoria Quay. We do recognise that late business can have an impact on unpredictable hours. It can be difficult for parents and care and responsibilities, and we have made representation to the bureau regarding that. How many visitors to the Scottish Parliament have been asked by security and other SPCB staff to remove badges and other apparels since May 2021? We do not hold data on the number of visitors whose items were retained, just the item details. Since reopening to the public in March 2022, security staff have retained 26 items at the main public entrance, which meet the criteria in the member's question, including five badges. The reasons for retaining the items are not currently held. From badges to suffrage colours, it seems that parliamentary staff are with growing frequency subjectively enforcing the visitor code of conduct. It has become one rule for some, but not others. In the seat of Scottish democracy, policies of so-called inclusion are leading to the exclusion of women. This is a worrying and dangerous precedent, and it is unacceptable, and it must not continue. Will the SPCB commit to review not just the visitor behaviour policy in the Scottish Parliament, but all guidance and policies in relation to banners, flags, political slogans, to ensure clarity, fairness and public participation? I thank the member for the supplementary. The Scottish and the corporate body have commissioned a review of the protest policy that will include looking at items and dress. I recognise the need for policy to be consistent and to provide clarity. Corporate body staff must conduct themselves in an impartial manner. As an update, corporate body staff have until recently been allowed to wear personalised lanyards. That was introduced in 2017 as part of diversity inclusion strategy. However, a review of the code of conduct has just been completed and a decision has been taken that all staff must wear the Parliament-issued purple lanyard staff who are employed by corporate body. That decision will help to minimise the risk of perceived bias and avoid any perception that wearing such items may be influencing our own decision making. As the Scottish Parliamentary Corporate Body, will it give further consideration to allowing events to start in the Parliament building while members' business debates are on-going? I thank the member for his question. As my written answer to the member's question in November on this said, to enable all members to take part in events and recognising that parliamentary business needs to take precedence, events do not take place at the same time as parliamentary business in the chamber. However, when business runs late, parliamentary officials will, where appropriate, work with the event organisers to ensure that refreshments are served to event guests and they can go to the room where the event is taking place and meet members, where possible. Speeches should only take place once parliamentary business is concluded, so all members have the opportunity to hear them. The pragmatic approach appears to be working, but, as I said to the member on November, we continually keep this under review. I have a written response because I was not able to ask my question verbally at that time. I am asking for a review of the policy. I did not want to know what the policy is, I know that, but people look forward to visiting this Parliament. They can go to a lot of time and expense to be here. I think that we should do better by them. Some events have to be cancelled. The worst example was one that was sponsored by Michael Marr on colleges when people were actually on their way to the Parliament and it got cancelled. People are kept waiting in the lobby and events have to be curtailed. I would just plead to the corporate body that they have a review of the policy, which seems devoid of any common sense to me. As the member will appreciate, late sittings are not a matter for the bureau, that is not a matter for the corporate body, but a matter for the bureau for which we have no control. I put some context into this. Between January and June 23, there were six events cancelled due to Parliament sitting late. However, from September 2023 until this week, only one event had to be cancelled. That is a total of seven out of three hundred and twenty-four events. Of the seven that were cancelled since January 2023, three have been rescheduled. We have always tried to give priority to events that we have had to reschedule, but I hear what the member is saying that if there can be improvements, I am sure that the corporate body will consider it. To ask the Scottish Parliamentary Corporate Body whether it will look into rolling out accessibility options such as BSL and easy read as standard across all forms of public participation. When planning what participation support is needed for parliamentary activities, including committees, staff generally recommend a targeted approach based on the audiences identified as priority groups for each piece of work and taking into account the barriers to their participation. Accessibility options relevant to the audience are developed with partners. For example, the healthcare in remote and rural areas inquiry was developed in easy read as we knew adults with learning disabilities would face additional barriers. Work plan for the disability commissioner Scotland Bill will include BSL and easy read versions of the call for views. Lastly, Karen Adam will be interested to know that a public consultation for our new BSL plan, due to run from 2024 to 2030, is scheduled to take place this summer, and it will involve the use of citizen space and will be made fully BSL accessible. I am delighted and thankful for the member for that answer. I am particularly proud that, for the first time in the history of the Scottish Parliament, the Quality, Human Rights and Civil Justice Committee, which I convene, will be the first committee to trial the use of WhatsApp to allow the BSL users to respond to our call for views on Jeremy Balfour's disability commissioner bill. We have also ensured that easy read and other accessible versions of our call for views are ready at the time of launch to ensure parity. Will the SPCB join me in encouraging other committees and the Scottish Parliament more widely to promote equality and inclusion by adopting those practices? I thank Karen Adam for that supplementary. The WhatsApp trial will give us really good experience on how to receive evidence by video, and we are hoping that this will be of use not only to our BSL communities but to others too. Of course, it is not for corporate body to dictate committees how to do their business, but if the pilot works, then other committees may wish to use this method, and it is perhaps something that the convener's group can discuss further. Of course, we want to make sure that we are promoting different practices, alternative ways of getting unwidening participation. Given that this is British Sign Language week, I find that response slightly disappointing, as I am sure many BSL users will. It is not for us or the body to decide editorially what BSL users may or may not be interested in from a committee point of view. Surely in this modern day and age we could make you better use of technologies to ensure a wider participation in parliamentary activity. I thank Jamie Greene for that supplementary. I think that we recognise that people with accessibility requirements are interested in many issues, as you outline, not just specific those linked to their access needs. By focusing on barrier removal, we think that we have the balance of interest levels right in terms of access costs to the public purse and so on. The Citizen Participation and Public Petitions Committee's recent report welcomed our work to develop systematic and cost effective approaches to the use of different languages and formats to increase accessibility in our consultation and participation work. Of course, we are always eager to do more and would welcome further conversations and ideas and suggestions that the member may have. To ask the corporate body what consideration it is giving to the establishment of a permanent memorial to Michael Mick Magahy in this Parliament. I thank the member for his question. We are due to consider the request that the member has made to the SPCB at her next meeting on Thursday 18 April, and we will update the member as soon as we can. The SPCB notes the support expressed during the recent member's debate, and we will take that into consideration. I thank Christine Grahame for that answer. The National Union of Mine workers, the Magahy family, green MSPs, Labour MSPs, Liberal MSPs, SNP Government ministers, journalists past and present, and just this week the STUC all support a memorial. Will the corporate body meet the NUM, the family and me to work out how a fitting legacy to this working class hero can be delivered in time for the centenary of his birth next year? It is a very kind invitation but it is not the practice of the corporate body to meet with any one individual. With regard to the point being made because we are holding our meeting, those decisions are not taken on a blank canvas. The SPCB has a number of related policies, including the memorial policy and the Scottish Parliament's art collection development policy, which we will all take into account when we come to a decision whether or not there is a memorial to Michael Mick Magahy. On the topic of permanent memorials, one of my constituents, who approached me as one of my first constituency cases 27 years ago, was affected by the contaminated blood scandal. He is keen to establish some form of memorial in this Parliament to recognise those who have lost their lives in this scandal. As the United Kingdom inquiry is expected to report shortly, would the corporate body give consideration to the question of whether or not the Parliament may be a suitable venue for a memorial to those who have lost their lives in the contaminated blood scandal? I will duplicate the answer that I gave to Mr Leonard. If he makes an application to the corporate body, we will consider it against the backcloth of the memorial policy, the Parliament's art collection and other representations. To ask the Scottish Parliamentary Corporate Body what systems are in place to ensure that changes to IT systems and processes in the Parliament that will impact on the daily working practices of MSPs and their staff are consulted upon, tested, introduced, explained and evaluated? Where projects are changing the way that members and their staff work, officials will build in opportunities for consultation and feedback and often roll out the change to a smaller pilot group to gather feedback, tweak implementation and prepare appropriate training and communications. There are times when it is necessary to introduce certain changes at short notice. For example, to protect against emerging cyber security threats. The corporate body is keen to hear from members if and when they feel that we can collectively do better to keep them and their staff informed of any changes or developments. My question is prompted by introduction of system changes. For example, the recent quarantine system that has added another layer of complexity made it more difficult to find and, in some cases, has lost track of important communication from constituents and has added to MSP staff's workload. Prior to that, the introduction of the new reimbursement system in its early stages was cumbersome and difficult to operate. The point that I am making to the body is that, to what extent, it feels empowered to push back on the IT department that may come with new whiz buying systems introduced but has not been thought through and checked with MSP staff as to the implication on workload and whether, in fact, it is often necessary at all. The interesting issue that has come as a bit of a surprise to some in the chamber in the main corporate body access is software and cloud services on a subscription basis, including the Microsoft 365 applications for our email system and other office functions. Microsoft makes modifications and updates that are then available immediately to users, enhancing functions or addressing cyber vulnerabilities. Quarantine is one such update introduced to protect users from emails that are potentially harmful, such as phishing or malware. BIT recently introduced the new alerting system to let members know when email messages had been placed in quarantine. I think that that is the change that Ms McKee is referencing. The notification system was introduced by BIT because it would otherwise not be automatically obvious to users that messages had been quarantined, and that was in response to something that Microsoft had done behind the scenes. As far as the alerting system is being updated, members and staff were offered a range of training options during the roll-out of the system, with step-by-step instructional material available on the internet. Aluncers' offices and other parts of the parliamentary estate continue to provide support and advice to members. Of course, we always welcome feedback and challenge and pushback where members or their staff think that that will not work and that those views will be taken into consideration. To ask the Scottish Parliamentary Corporate Body whether it will consider stocking alcohol-free variants of spirits, wine and other alcoholic beverages in the Scottish Parliament gift shop. I thank the member for a question. I agree with him that this would be good for the shop to stock alcohol-free options. A retail manager regularly checks the market for such products most recently at the start of this year. Unfortunately, we have so far been unable to find a product that could be branded and meet our requirements for low-minimum quantity ordering. We will keep checking though and update the member if we are successful. I thank Christine Grahame for her answer. Many people now do not drink alcohol for all sorts of reasons, including health and religion, not that anyone ever needs a reason. A recent survey suggested that 44 per cent of 18 to 24-year-olds now regularly or occasionally drink alcohol alternatives. Alcohol alternatives now mean that they do not need to drink alcohol to be able to enjoy the taste of some of our nation's most famous drinks. What more can be done to encourage producers and suppliers to the part of the Parliament to offer alcohol-free alternatives, allowing our Parliament to move with the times and to stock a more inclusive range of gifts? I advise the member the difficulty is that branded items designed for us and available nowhere else remain popular to customers from the tartan scarves to malt whisky. We know our alcohol products are popular because the Parliament's branding and uniqueness to us. Our whisky range is currently supplied under contract by the own label company or based in Edinburgh. They do not, unfortunately, yet have alcohol-free drinks in their product portfolio, but we continue to investigate that. To ask the Scottish Parliamentary Corporate Body what steps it is considering to ensure the safety of the public, MSPs and staff entering or exiting the Scottish Parliament campus in light of a number of recent events of concern. The Corporate Body takes its security and safety responsibilities very seriously. There are a wide range of physical and personal security arrangements in place to ensure the safety of everyone visiting or working in the building. The security arrangements reflect height and response. That is the required stance for the UK threat level, which is presently set at substantial. While there have been recent incidents, the threat and subsequent response level have not changed since February 2022. I thank the member for that, but despite all of that, in recent weeks we have seen a spate of attempts to disrupt this democracy in this Parliament. We have had interference from the gallery during FMQs, members of the public, being harassed or even prevented from entering the building during protests. Members and even our staff accosted by those protesters upon exiting various points of the building. Of course, the building outside was dobbed in red paint just last week. Some might say that that was an improvement, but seriously, in the current feeble environment that politics is, this is more than unacceptable, and it could be potentially dangerous. Has there been any investigation into those specific protests? And if any of them were facilitated or aided by any MSP or MSP group? And secondly, why is exterior security in the Parliament clearly failing to keep all of us, the building, our staff and the public, safe? The member has raised a number of points. In terms of protests that have been outside the building, we do welcome peaceful protests outside the building, but I do recognise there have been some recent incidents that have been a cause for concern. The management of protests and the safety of the public are a matter for Police Scotland, and while we work very closely with Police Scotland, they are responsible for public safety. I can, however, confirm that a review of the protests that took place last month, its impact and lessons learned, was immediately commissioned by the security team and is currently under way. I can also confirm that we are looking into allegations that pass holders helped protesters block entrances by sharing information. I was going to come in as a supplementary to be helpful, but to ask the Scottish Parliamentary Corporate Body what steps it will take to ensure that any protests and demonstrations to disrupt the ability of MSPs, staff and the public to access the Scottish Parliament are fully investigated with any findings and lessons learned available to MSPs. As I said, we do welcome peaceful protests outside the building. We do recognise that there have been recent incidents and a review of the protests and its impact and lessons learned is currently under way. As I said, the safety of the public outside the building is an issue for Police Scotland. We are assured that the security office is progressing on the review. If there are any recommendations that require proper body approval, we will consider the findings in due course, and any approved recommendations will be notified to members. I heard the answer just given and the previous answers. It is clearly unacceptable that any group or individual attempt to disrupt the workings of this Parliament or bar people from either entering or leaving the building. However, we have had a number of instances that have just been described by Jamie Greene. It is clearly intolerable that any of those activities were aided and abetted by members of this Parliament. That has happened. We all know that it has happened. It has been boasted about on social media. When those reports that were described become available and their findings, can any breach of the MSP code of conduct be published and made available to members? Will the corporate body, as it is now established in precedent, make any reports that have in relation to MSP complicity in those activities subject to a referral to the standards committee of this Parliament? I assume that the member is aware of the mechanism for reporting any concerns over MSP's behaviour, and that that would not be a matter for the corporate body. As I said, it is not a matter for the corporate body. As I said earlier, we are looking into allegations that pastholders helped to protest our block entrances by sharing information, but at this point in time, that is allegations. That concludes the Scottish Parliamentary corporate body questions. There will be a brief pause till we move to the next item of business to allow the front benches to change.


Any kind of activity that gets you moving, if you compare to not moving at all, so long as it's appropriate, is way better than nothing. So if you like to dance, if you like to hike, if you like to row, or swim, or stretch, or lift weights, or whatever, all of that is exercise, and you can do any of that to become more accurate. A lot of the answer to this one is literally reframing how you look at it. Looking at the exercise portion, which most people look at as like this, the means to get this body fat off, the means to change this body I don't like, instead of thinking about, I want to get good at these movements, right? I want to get good at these exercises and going into it as if you're trying to practice them to be better at the movements. Learning a skill. Right, versus the outcome that's supposed to happen from the consistency of the training. Let's just pick one or two really good movements that I know are extremely beneficial and let's really focus on the form, the technique. This is a great strategy for someone who looks at the gym as a boring task that they have to do every single day.