Archive for March, 2010

Talking to my GP father about homeopathy #2

Posted on March 23rd, 2010 in Skepticism | 3 Comments »

Part one is here…

TOM

Let’s start by enlarging the list of things we both agree on.

I agree that placebo pills cause no direct harm whereas absolutely any active chemical introduced into the body has at least the potential for harm, even those which have long been associated with health and well-being; there is, for example, some evidence that routinely taking vitamin supplements when not indicated may have negative health outcomes.

I also agree that homeopathy and other alternative modalities make some people feel better but regret that the only way to safeguard the efficacy of the intervention is to mislead patients as to what is going on. It is important that the patient believes that the pill, needle, shamanic ritual or whatever will be efficacious. When prescribing even (or especially) a very risky treatment like radiotherapy, a physician can explain the potential costs and benefits, based on a large body of evidence, in order that the patient can make an informed choice. Prescribing placebo treatments as if they are effective removes that informed choice, but telling the patient “this won’t work” is a self-fulfilling prophecy, so homeopaths – whether or not they are themselves deluded – are deceiving their patients.

Of course, if patients want it and are made to feel better, why should we worry about removing informed choice? I do have an answer to this question, but I don’t want to get ahead of myself. Let me finish responding to your points first.

You write that you think that homeopathy is an appropriate use of public funds to treat chronic conditions for which no effective evidence-based treatment exists, and it may be that the London Homeopathic Hospital does restrict itself to interventions in those cases. It may also be that all of the Homeopaths working there are medically qualified (I wasn’t aware of this – do you have a reference?).

But it is not true, despite the name, that within the tranquil environment of the LHH, homeopathy is the only evidence-free service available. A quick look at their website reveals that they are also happy to provide Reiki, Acupuncture, Reflexology and Iscador – a new one on me – which we learn is “a preparation of mistletoe, which enhances immune system responses.” Bearing in mind that this is on a page titled Complementary Cancer Care Programme, doesn’t this worry you at all? Do you really want your patients believing that mistletoe will cure their cancer? Who benefits from sustaining this belief, except those who have “Iscador” to sell?

Only one passage in your very thoughtful email stood out as something I would really take issue with – this one: “Every form of medical practice has its own philosophy, including evidence based medicine, which, by the way is not always as reproducible in an ordinary community setting as it is under strict experimental conditions.  Even EBM in most cases only offers a probability of a cure or improvement: a significant proportion of those treated will not benefit at all. Some will be harmed.” Let me begin with your last point. Yes, every active treatment has a risk, but as I’ve said EBM enables patients and physicians to make informed choices. It is possible to do great harm with the best intentions, which is way we must hold evidence in such high regard. Are you familiar with the on-going libel case which the British Chiropractic Association recently brought against the journalist Simon Singh? This case illustrates one of my chief reasons to want to see homeopathy and other sham treatments no longer flattered by government support.

You warn me that lab trials are not always replicated in the real world. But my definition of “evidence” is not so narrow as to only include clinical trials (although I still regard a large, prospective, double-blind, randomised trial as the gold standard for determining whether and to what extent a given intervention will be effective). We can certainly obtain data from retrospective analyses, and from seeing what actually happens in the real world. Sometimes these results are surprising, but EBM means we can’t ignore results which sound wrong to us or which go against long-cherished notions.

For example, the United States Preventative Services Task Force recently altered its recommendations regarding breast cancer screening. In their report was the rather surprising and controversial finding that self-examination appears to have no effect whatsoever on breast cancer death rates, but that it can create a lot of unnecessary fear and alarm. The emphasis (at least in the States) is now on breast awareness – has anything in your breasts changed recently? – rather than teaching women to perform rigorous and regular self-examinations. Many people object to this advice on the basis that they have a belief that breast self-exams are important, or that they have a story about someone who found a lump during such an exam, and whose life may have been saved thanks to the operation which swiftly followed. This doesn’t alter the evidence which is that such exams make no difference to health outcomes, and we take lives in our hands if we allow our preconceptions and biases to defeat the evidence.

Where we really part company is when you describe different forms of medical practice as having their own philosophies. It sounds to me as if you are claiming that each of these philosophies is equally good, and the only real difference is in the philosophical starting point, EBM being no better and no worse than homeopathy. While that might be a useful diplomatic position to take, I simply can’t accept it, any more than I would accept Apartheid (or any one of a number of other atrocities) as a mere difference in political philosophy.

While it is true that there is a bewildering array of supposedly therapeutic modalities available, they all slot cleanly into one of two categories – based on evidence or not based on evidence. Anything not based on evidence is based to some extent on subjectivity and personal choice. A practitioner who accepts Reiki but rejects Iridology has no objective basis for making this choice. They simply prefer Reiki and allow confirmation bias to do the rest.

When the system is working (and god knows it doesn’t always) evidence-based medicine prevents even the most enthusiastic champion of a particular intervention from being able to claim that it works when it doesn’t. We know that Dimebon is ineffective for treating Alzheimer’s and so it will not be prescribed. We know that mistletoe will not cure cancer, but at the Royal London Homeopathic Hospital, they will apparently provide it to anyone who asks, and at the taxpayer’s expense.

This means that proponents of non-evidence based modalities have no choice but to duck the issue, or misleadingly cherry-pick from the data in order to create a false picture – which is exactly what the select committee experienced when it asked notable homeopaths to give evidence. Who benefits from this corruption of the scientific method? Isn’t this exactly the “denying the validity of science itself” which you hoped wouldn’t happen? Why does homeopathy get a pass? Because it does no harm? I’m not so sure that’s true.

You began by saying that you wanted to include in our discussion the whole context of treatment, and here again I agree enthusiastically. So, while we both know that a sugar pill in itself is guaranteed harmless, we also know that we are talking about a complicated cultural phenomenon which is not limited to a person taking a pill, and therefore nor is homeopathy’s reach confined to people suffering from chronic back pain. Nor is it always the case that homeopaths advise people who need conventional treatment to go and get it. In 2006, a survey performed by Sense about Science which was followed up by Newsnight found that every high street homeopath visited by a researcher about to travel to a malaria-infested country was given useless homeopathic quinine and none were told to visit a GP or a travel clinic or even to buy a mosquito net.

How are “responsible” homeopaths supposed to respond to this? The Royal Homeopathic Hospital did its best to smack down this irresponsible behaviour, but what are they really saying? “We all know the sugar pills don’t really work, so don’t for goodness sake go giving them to someone who actually needs medicine.” What would the True Believers make of that!? By beginning from a position which isn’t supported by evidence, “responsible” homeopaths are now in an impossible bind. They either have to defend the magic to the hilt, or admit that it’s all a load of imaginative nonsense. Not surprisingly, they hem and haw and waffle and evade, they dissemble in front of parliamentary select committees, and essentially they let the harm continue, such as in the horrifying case of the Australian couple who attempted to treat their baby daughter’s eczema with homeopathy until eventually she died after months of excruciating pain (they are now in prison).

So even if we are happy to divide quackery into good (prescribed by responsible physicians in tandem with evidence-based treatments where appropriate) and bad (prescribed willy-nilly by people with little or no medical training, and cheerfully offered as a substitute for evidence-based treatments, or non-medicalised interventions) – the question must still be asked can you have one without the other? This line of argument will eventually bring us back to vaccines, but I feel I should stop here, having written quite a lot already, and get another response from you.


JOHN

Can we aim for something a little more concise? I don’t have time for a discussion in this depth!

I am very pleased that you are taking such an interest in medicine and medical ethics. I note that you are a very much a postitivist in your approach and have no time for post-modernist ideas of different beliefs having equal validity! Well I don’t know that I have in extreme cases where it is clear that science has the best solution (e.g. antibiotic for pneumonia or angioplasty for blocked artery).

However, there are many grey areas where all is not as certain as one would like. As I have already mentioned, the much venerated ‘gold standard’ trial doesn’t simply distinguish effective from ineffective interventions. When the effect is really clear you dont need a trial. What we usually get is a statistical result showing that the probability of an effect is greater than could be due to chance alone. This means that some patients will do well but others won’t. The NNT (number needed to treat) may be 4 or 5 for a good drug or 10 or more for many others. So we can’t promise our patients that even a gold standard treatment will do them any good (or no harm). It’s a game of roulette. No one can tell what will happen to any individual.

It is unfortunately not the case that everything slots neatly into two categories, evidence-based or not. Evidence can be strong or weak. Evidence is continually being modified or even contradicted. It doesn’t apply to all individuals. So I tell my patients who ask me if complementary treatments are any good, that some patients find them helpful but others don’t. Same difference.

I agree that it would be dishonest to say that ‘a sugar pill’ will have a biochemical effect. But you can say that, some practioners believe that the way this pill was made can make a difference to the ability of some people to cope with an illness that conventional medicine has not been able to help very much.

I agree, of course, that no one should make false claims about these remedies. The information for cancer patients from the Homeopathic Hospital seems to me to make it very clear that these treatments are to help you cope with the illness and its definitive treatment rather than to act alone. I dont know about the eczema girl who died, it is often difficult to tell from these accounts exactly what happened. But no responsible doctor would have advised the parents to ignore conventional medicine. I don’t think this would happen at the Homeopathic Hospital. I went on a visit to the place and met the medical director Dr Sara Eames who was very clear about this. She also told us that all the medical staff have medical qualifications.

Can you have good quackery without bad? Can you have medicine without quackery? I don’t think you can have medicine based on evidence alone. There isn’t enough evidence for one thing. And people are often have health beliefs that are so firm that no amount of statistical information will influence them. The placebo effect, if you want to call it that will often make something happen. If you prefer you can call it the effects of thoughts and feelings being processed by different brain areas resulting in changes in pain perception, sensation, reduced muscular stiffness, improved mood and reduced anxiety etc. etc.

Enough for now!

Talking to my GP father about homeopathy #1

Posted on March 22nd, 2010 in Skepticism | 1 Comment »

I recently invited my father to an exchange of views about homeopathy – me from the point of view of an ethusiastic skeptic, eagerly slashing down falsehood and flummery wherever I find it; he from the point of view of a physician with decades of experience actually helping people to get better. Here is the first of our exchanges…

TOM

As I understand it, you think that NHS should continue to provide homeopathic remedies under some circumstance, and you are surprised at the strength of my feeling that they should not. Through this exchange of emails, I hope to better understand your position (since you speak from experience of treating patients, which I can’t) and to get you to better understand mine.

I imagine there is quite a lot of common ground between us, so before we get to the fun of the debate, here are some statements I think we can both agree with.

–          Homeopathy doesn’t work. Reviewing the evidence base as a whole reveals that homeopathy works no better than placebo. While a number of studies do exist which apparently show a more significant effect, these are always smaller studies often with methodological flaws. The better the study, the smaller the effect. This finding is confirmed by the Cochrane Collaboration and the recent Select Committee report.

–          Homeopathy couldn’t possibly work. The notions that “like cures like” and that “dilution increases potency” are pre-scientific magical thinking. Many homeopathic remedies are so diluted that it is literally true that not a single molecule of the original substance can possibly remain. How the water used for the dilution “remembers” the substance (and none of the other substances it had previously been in contact with) is a mystery which homeopaths avoid tackling.

–          Evidence-based medicine is, in general, a good thing. Especially within a cash-strapped NHS, treatments should be provided to patients on the basis of the best evidence available, not on a patient’s demand, nor a physician’s whim, nor in order prop up a discredited theory.

Assuming that we agree on these three points, it seems that you wish to make an exception to the evidence-based rule for homeopathy. Is that right? If so, here are the questions that next spring to mind.

  1. Under what circumstances do you think it is appropriate for the NHS to provide homeopathic remedies? What are the possible negative consequences of doing this under these circumstances (if any)?
  2. Do you feel the same way about chiropractic, reflexology, acupuncture, iridology, reiki (to name a few)? Are some of these interventions more worthwhile than others in your opinion? Are they all equally beneficial placebos or are some more worthy of public funding than others?
  3. Are you concerned about the drop-off in vaccinations which has taken place in the UK and the USA recently? Do you see any connection between this and people’s fondness for alternative medicine?

JOHN

I think the first thing I’d like to say is that when considering the possible beneficial or harmful effects of any form of  treatment, I like to include not just the intrinsic chemical power of the substance prescribed, but the whole context of treatment.

The so-called placebo effect also includes the  treatment environment, the way the doctor approaches the patient, her kindness and consideration,  her ability to listen and to accept people’s distress. The faith of both doctor and patient in the theory, the method, the procedures, and in the personal relationship are all important too.  Every form of medical practice has its own philosophy, incuding evidence based medicine, which, by the way is not always as reproducible in an an ordinary community setting as it is under strict experimental conditions.  Even EBM  in most cases only offers a probability of a cure or improvement: a significant proprtion of those treated will not benefit at all. Some will be harmed.

You and I don’t believe that homeopathic remedies can have any chemical effect as such. But this is not chemotherapy. These patients are not being treated with agents that can kill cancer cells or eliminate antibodies. The patients who attend homeopathic practitioners and the homeopathic hospitals are suffering from chronic diseases for which conventional chemical medicine or surgery can do no more. The treatment is not and should not be a substitute for ‘proper’ medicine.  At the London Homeopathic hospital, where all the clinical staff are medically qualified, they examine people in the usual way and advise anyone who needs conventional treatment to go and get it.  The homeopathic treatment process  (including the empty tablets) has the effect of making patients feel better and feel cared for. It gives them some hope. The placebo effect can be incredibly powerful and can certainly  relieve pain and other symptoms such as nausea, giddiness, anorexia etc.

Are the remedies expensive?  No, compared with modern drugs, often unscrupulously promoted by pharmaceutical companies and overprescribed by doctors, they are cheap. Unlike most conventional drugs there is no risk of  serious adverse effects. The London Homeopathic Hospital has just had a fairly expensive refit. It looks beautiful, calm, tranquil and peaceful. It would be a pleasure to go there for treatment.  OK they don’t cure any cancers or kill any bacteria. But a large part of medical practice is about helping people to cope with  chronic illnesses that can’t (yet) be cured or with distressing symptoms that are not even understood.

There has always been a need for some sort of magic and mystery in medicine, going back to the ancient shamans. This has not gone away, despite the acievements of scientific medicine. If some patients are helped to feel better by what we see as pseudoscience, why should we be outraged? It doesn’t mean that we are denying the validity of science itself.

I think the money is well spent!   And, by the way, I have no  personal interest to declare.

Finally in answer to your last three points:

1) I have argued above that the remedies should be seen in the context of the treatment as a whole and the kind of ill-health for which homeopathic treatment is suited.

2) I think a similar case can be made for the other complementary therapies but I dont think any of these are publicly funded at present. I think some treatment ‘stories’  will  help some patients  but not others and there is no reason why those whom conventional medicine still cannot help adequately should not explore them. It’s important, if you have a chronic illness, to have a plan, to keep trying.

3) I think the drop-off in immunisations has been largely due to Dr Wakefield, a thoroughly conventional medical researcher who got carried away and did a lot of harm. I don’t think homeopathy has anything to do with refusing vaccines of proven effectiveness.

Friday’s This Week In History

Posted on March 12th, 2010 in This Week in History | No Comments »

If history is paying attention, then surely the week ending 12 March 2010 will be noted as…

Liveblogging The 2010 Oscars

Posted on March 7th, 2010 in Culture | No Comments »

10:26:26 PM: Twitter, Facebook and my blog will all be mashed-up in Oscarland from midnight GMT onward… Join me. #oscars

11:26:11 PM: Freshly-popped popcorn ready, red carpet coverage about to begin. Here we go. #Oscars

11:43:52 PM: “Oh my god, Claudia, it’s The Oscars!” (It’s the sheer professionalism of the Sky One presenters I respect) #oscars

11:59:11 PM: I gather Nick Park’s homemade bowtie is up for Best Adapted Neckwear. #oscars

12:26:49 AM: This Sky One bimbette needs to stop saying “obviously” in every sentence. She really needs to stop. #oscars

12:38:39 AM: Is George Clooney drunk already? Or tired? Or just tired of talking to Sky One bimbettes? #Oscars

1:22:48 AM: You’re not a presenter. You’re a stalker with a microphone. #Oscars

1:34:12 AM: What!? #Oscars

1:34:43 AM: Here’s our big opening. First all the acting nominees stand around awkwardly for 120 seconds…

1:35:17 AM: Then Doogie Houser sings inaudibly while 70s TV dancers spiral around him. It’ll be a smash! #Oscars

1:39:26 AM: Either there’s something up with Alec Baldwin’s mic or he can clap *really* loud. #Oscars

1:45:35 AM: Creditable gags rather than a barnstorming performance from Baldwin and Martin. What was up with George Clooney? #Oscars

1:45:58 AM: Surely Christoph Waltz? #Oscars

1:49:06 AM: Exactly so! #Oscars

1:50:54 AM: Eloquent, concise and generous speech from Waltz. #Oscars

1:51:41 AM: First of ten – fuck me, ten! – Best Picture nominees. The Blind Side, which I haven’t seen yet. Is it any good? #Oscars

1:59:17 AM: Wonderful Best Animated Feature nominees. Funniest – Up. Second funniest – The Princess and the Frog. Good predictor? #Oscars

1:59:43 AM: Up wins. Beautiful movie and well deserved. #Oscars

2:01:24 AM: “Our next two presenters are two young actresses who have no idea who we are!” #Oscars

2:03:13 AM: No production numbers for the Best Song nominees?? Shame. That always used to break up the show a bit. #Oscars.

2:07:42 AM: Crazy Heart wins and the girls here are swooning over Colin Farrell. #Oscars

2:13:24 AM: What does a writer look for in an actor? Memorizing. #Oscars.

2:15:10 AM: Hurt Locker’s only chance for a win without Avatar breathing down its neck. #Oscars

2:16:55 AM: Hurt Locker does it. This could be its only gong all night if Kathryn Bigelow doesn’t make it. Well deserved though. #Oscars.

2:18:26 AM: What the rubbery fuck has happened to Molly Ringwold? #Oscars

2:18:56 AM: “Hey Ferris, is it your day off?” Apparently Matthew Broderick never gets tired of that one. #Oscars

2:23:42 AM: The Brat Pack reassembled – now the Middle Aged Spread Pack. #Oscars

2:25:15 AM: If you think Up has a chance in hell of winning Best Picture, put your hands up in the air (which only has a slightly better chance) #Oscars

2:29:41 AM: Short films. Ah, who cares. #Oscars

2:32:50 AM: Nick Park fumbles it! Disaster! #Oscars

2:34:42 AM: At least we’re sprinting through the shorts in one compact package. Good-o. #Oscars

2:39:00 AM: Ben Stiller dressed up as a Na’vi FTW! #Oscars

2:42:54 AM: Best Trek wins Star Make Up. Getting tired now. #Oscars.

2:51:07 AM: Precious nicks its first statuette of the night. #Oscars

2:55:31 AM: Roger Corman and Lauren Bacall pick up their honorary awards. I’d love to see a film directed by him and starring her. #Oscars

2:56:56 AM: Everyone says its Mo’Nique for Best Supporting Actress. Even Penelope Cruz. #Oscars

3:00:08 AM: For once, everyone is right! #Oscars

3:07:09 AM: If Avatar doesn’t bag this, then we could be looking at a major upset. #Oscars

3:10:29 AM: Sarah Jessica Parker – a whore and a lightweight apparently! #Oscars

3:11:38 AM: Avatar not up for this one, so I don’t care. (I have a fiver on Avatar winning all nine Oscars it’s up for.) #Oscars

3:12:18 AM: “I already have two of these…” Just one step down from “Thank you for awarding me my first Oscar.” #Oscars

3:18:31 AM: Prefilmed Baldwin/Martin sketch. After the Morcambe and Wise-esque dance routine at the beginning, now they’re sharing a bed. #Oscars

3:21:53 AM: The Academy’s tribute to… movies in which scantily-clad women scream a lot. #Oscars

3:26:10 AM: That kills my 9/9 Avatar bet. Bollocks. Could be The Hurt Locker’s night though, which would be nice. #Oscar.

3:28:21 AM: And that kills my insurance bet on 8/9 for Avatar. Happy for the Hurt Locker, and I suppose for Paddy Power. #Oscars

3:35:45 AM: “Please welcome my dear friend – and by that I mean I’ve never met her – Sandra Bullock!” #Oscars

3:37:12 AM: Avatar finally gets its act together, but too late for it to even be exciting for me. #Oscars

3:38:56 AM: First the tribute to horror, now the role-call of the dead. Morbid much? #Oscars

3:39:24 AM: Sorry, that should have been “maudlin” – James Taylor is on stage. #Oscars

3:47:24 AM: Here’s our missing production number. Achievement in Irrelevant Dancing. #Oscars

3:48:44 AM: Is this the Los Angeles chapter of Diversity? #Oscars #Britainsgottalent

3:53:47 AM: Really, really tired now. Need some balloons to help me stay upright…. #Oscars

4:03:56 AM: Er, Food Inc probably? Don’t really care. Tired now. #oscars

4:11:00 AM: Hoo-ray for Hollywood! Boo for time differences! #Oscars

4:26:41 AM: The dude abides… #oscars

4:33:45 AM: Jeff Bridges, unless i’m having very predictable dreams. #oscars

4:46:13 AM: Somebody get Oprah a trowel so she can lay it on even thicker. #Oscars

4:47:58 AM: Why can we never hear Voice Over Announcer Woman properly? #Oscars

4:49:30 AM: Has Sandra Bullock come dressed as Anne Hathaway? #Oscars

4:56:40 AM: Bigelow’s done it! Yay! (zzz) #Oscars

4:59:27 AM: James Cameron = King of Nothing! #Oscars

5:01:20 AM: That’s it, folks. Analysis in the next few days. Night all.

Best Picture Nominees

Posted on March 7th, 2010 in Culture | 1 Comment »

This year, the Academy of Motion Picture Arts and Sciences attempted to up the excitement factor by giving us not just five nominees for Best Picture, but ten – divided neatly into five which are in with a shot (with two clear favourites) and five also-rans. Yay Academy of Motion Picture Arts and Sciences!

I’ve (almost) succeeded in my mission to watch all ten before the ceremony, and here are my thumbnail reviews. For my predictions as to the Oscar winners, see my earlier post here.

AVATAR (wd. James Cameron; starring Sam Worthington, Sigourney Weaver, Zoe Saldana)
Synopsis: Paraplegic marine Jake Sully is dropped on alien world Pandora and given an “avatar” to control so he can better mingle with the 10 foot tall, bright blue natives. If you know the story of Pocahontas, you pretty much know what comes next.
Review: James Cameron creates a jaw-droppingly, eye-poppingly convincing world, populated with not just the slender yet muscular Na’vi, but a whole da-glo managerie of hexapod creatures, sentient trees and much else besides. The story is pretty much by-the-numbers, with a somewhat static middle third, but everything does pay off and there are even some grace notes in the script, and some bright performances – hello Giovanni Ribisi!
Fun facts: James Cameron’s first film since 1997’s Titanic, but he’s been talking about it pretty much since then.
Oscars: Nominated for nine and could win them all. Big favourite for Best Picture.

THE BLIND SIDE (w. Michael Lewis, John Lee Hancock; d. Hancock; starring Sandra Bullock, Tim McGraw, Quinton Aaron, Kathy Bates)
Synopsis: To follow
Review: To follow
Fun facts: To follow
Oscars: Also-ran, except for Sandra Bullock

DISTRICT 9 (w. Neill Blomkamp, Terri Tatchell; d. Blomkamp; starring Sharlto Copley, Jason Cope, David James)
Synopsis: In Jo’burg, a civil servant responsible for rounding up alien “prawns” eventually starts to see things from their point of view when he becomes accidentally infected.
Review: Probably my favourite film of the year – witty, fast-moving, exciting, satirical and intelligent. It gleefully steals from the very best to make something which feels entirely fresh, and the special effects are so good you forget they’re there.
Fun facts: First-time actor Copley improvised virtually all of his dialogue.
Oscars: Nominated for three more besides Best Picture, which it won’t win in a thousand years. In with a shot for Adapted Screenplay. Would have won for Effects in any field which didn’t include Avatar.

AN EDUCATION (w. Nick Hornby, book Lynn Barber; d. Lone Scherfig; starring Carey Mulligan, Emma Thompson, Peter Sarsgaard)
Synopsis: In 1961, 16 year old schoolgirl Jenny discovers that working hard to get into Oxford seems rather less glamorous next to her exciting new older boyfriend who whisks her off to Paris and pinches artworks from old ladies.
Review: Perfectly amusing, with a winning turn from Carey Mulligan, but entirely inessential and unextraordinary. A Channel 4 film which has been inexplicably nominated for an Oscar. Bizarre.
Fun facts: Screenplay by novellist Nick Hornby, based on Lynn Barner’s memoire.
Oscars: Also-ran. The kind of dull-but-worthy British film that won for Goldcrest in the 80s, but those days are over.

THE HURT LOCKER (w. Mark Boal; d. Kathryn Bigelow; starring Jeremy Renner, Anthony Mackie, Brian Geraghty)
Synopsis: Under the command of a new and apparently reckless team leader, a three man bomb disposal squad goes about its work in Iraq.
Review: For the first three quarters, Bigelow and Boal trust that their characters and the episodes of their working lives will be strong enough, and they’re right. When a more melodramatic plot arrives, late in the day, it seems irrelevant and upsets the tone so masterfully maintained up till then.
Fun facts: Bigelow is James Cameron’s ex-wife, so it’s not just that Bigelow is only the fourth woman ever nominated for Best Director – this time it’s personal.
Oscars: Nine nominations, same as Avatar, and competing head-to-head in every category.

INGLOURIOUS BASTERDS (wd. Quentin Tarantino; starring Brad Pitt, Christoph Waltz, Diane Kruger, Michael Fassbender)
Synopsis: Demented fairytale, set in something which looks an awful lot like World War II, but not quite enough like it to be mistaken for it.
Review: Far more about cinema than about warfare, Tarantino’s latest is also his most juvenile, but at the same time probably his most fun, mixing agonising suspense with bravura imagery and a shockingly devil-may-care attitude to history. Provided you aren’t looking for maturity, you are unlikely to leave the cinema disappointed, but let’s face it – Up has a better chance of winning Best Picture.
Fun facts: The soundtrack is compiled from other war movies, for which Jonathan Ross castigated Tarantino on his chat-show. Tarantino was forced to admit that because he doesn’t compose music himself he prefers to choose music from stock because otherwise he feels he’s handing over too much control to another artist.
Oscars: Will win exactly one, for Christoph Waltz.

PRECIOUS: BASED ON THE NOVEL “PUSH” BY SAPPHIRE (w. Geoffrey Fletch, novel Sapphire; d. Lee Daniels; starring Gabourey Sidibe, Mo’Nique, Paula Patton, Mariah Carey)
Synopsis: Barely-literate, abused, single teenage mother Clarice Precious Jones struggles to rebuild her life with the aid of a sympathetic teacher.
Review: Deeply moving drama which transcends its movie-of-the-week logline due not least in part to a series of bravura directoral flourishes.
Fun facts: Mariah Carey was a last-minute replacement for Helen Mirren.
Oscars: Up for a staggering six Oscars, but only likely to win for one of the lead actresses or just possibly its screenplay. A long-shot for Best Picture, but not an also-ran.

A SERIOUS MAN (wd. Joel and Ethan Coen; starring Michael Stuhlbarg, Richard Kind, Sari Wagner Lennick)
Synopsis: In 1967, physics professor Larry Gopnik becomes a latter-day Job weeks before the his son’s barmitzvah as he faces the collapse of his marriage, questions over his professional ethics and the bewildering advice of a variety of Rabbis, old and young.
Review: The Coen Brothers on doggedly quirky form, for much of its running time this is original, funny and moving stuff, but the what-the-hell ending is a huge disappointment, even if it is somewhat in keeping with the overall message.
Fun facts: Lead actor’s first film after a substantial stage career.
Oscars: The slimmest of chances for Best Picture.

UP (w. Pete Docter, Bob Peterson, Thomas McCarthy; d. Docter, Peterson; voices: Ed Asner, Jordan Nagai, Christopher Plummer)
Synopsis: Elderly Carl Fredricksen floats away from a grim retirement home in search of the adventures he and his late wife dreamed about.
Review: Beautiful stuff, as ever from Pixar, with humour, visual appeal, story and drama expertly balanced. The 3D is not instrusive and the characters beautifully rendered. Possibly not their very best – the narrative splits into three chunks fairly gracelessly (on the ground, travelling, fighting) – but the wordless opening sequence might be one of the best pieces of animation ever.
Fun facts: John Ratzenberger, Pixar’s lucky mascot, can be heard as a construction worker.
Oscars: Will scoop Best Animated, but that’s yer lot. An also-ran in the Best Picture stakes.

UP IN THE AIR (w. Sheldon Turner, Jason Reitman, book Walter Kirn; d. Reitman; starring George Clooney, Vera Farmiga, Anna Kendrick)
Synopsis: Ryan Bingham is happiest when flying across the United States and very good at his job – firing people who work for other companies. His life is upset by the presence of two women, one who admires his lifestyle and one who threatens to destroy it.
Review: A very near miss, full of smart touches and another breezy-yet-angsty performance from Clooney. It loses energy towards the end and the plot doesn’t quite serve the characters as strongly as it could.
Fun facts: Most of the firees were genuinely made redundant and asked to re-enact the moment on camera.
Oscars: Has a chance of picking up an acting or screenwriting award. Hardly an also-ran for Best Picture, but certainly not a favourite.

Friday’s This Week in History

Posted on March 5th, 2010 in This Week in History | No Comments »

History may well find it necessary to record the week ending 5 March 2010 as the week in which…

  • I was unexpectedly kicked out of the flat I’d been renting for almost a decade. This may impair the frequency of my blogging for a short while, although I shall endeavour to keep up my Oscar coverage with reviews of the best picture nominees hopefully by tomorrow, and a liveblog of the ceremony itself.

Thursday’s Random Link

Posted on March 4th, 2010 in Links | No Comments »

Years old now, but still one of my favourite pieces of physical comedy. David Armand still crops up in other people’s sketch shows, but this is his finest hour by far.

http://www.youtube.com/watch?v=glzkWmJgCgY