This letter appeared in the Times on Friday 30 January, 2009. It was prompted by the news from the University of Salford, but its main purpose was to try to point out to the Department of Health that you can’t hope to regulate alternative treatments in any sensible way while continuing to push under the carpet the crucial question of which ones work and which don’t.
We would like to congratulate the vice-chancellor of the University of Salford, Professor Michael Harloe for his principled decision to drop “all the University’s programmes associated with complementary medicine within the School of Community, Health Sciences & Social Care”. This includes their “Homeopathy in Practice” degree.
It is also encouraging that the University of Central Lancashire recently closed its BSc in Homeopathy to new students, and announced a review of all its activities in alternative medicine.
Although universities are now taking sensible actions, government policy in the area of regulation of alternative medicine is in urgent need of revision. In May 2008 the Steering Group chaired by Professor Pittilo recommended to the Department of Health that entry into acupuncture, herbal medicine and traditional Chinese medicine should “normally be through a bachelor degree with honours”. But, in the same month, new regulations on Unfair Trading came into effect. One of the 31 commercial practices which are in all circumstances considered unfair is “falsely claiming that a product is able to cure illnesses, dysfunction or malformations”. One part of government seeks to endorse unproven and disproved treatments, at the same time as another part makes them illegal.
The reason for this chaotic situation is simple. The Department of Health, and the Medicines and Healthcare products Regulatory Agency (MHRA), have consistently failed to grasp the nettle of deciding which treatments work and which don’t. That is the first thing you want to know about any treatment. Vice-chancellors seem now to be asking the question, and the government should do so too. The ideal mechanism already exists. The question should be referred to the National Institute for Health and Clinical Excellence (NICE). That was recommended by a House of Lords report in 2000, and it was recommended again by the Smallwood report (commissioned by the Prince of Wales) in 2005. Now it should be done.
Sir Walter Bodmer FRCPath, FRS, FMedSci, FRCP (hon) FRCS(hon)
Professor David Colquhoun, FRS
Dame Bridget Ogilvie , AC, DBE, FRS, FAA,
Professor Dame Nancy Rothwell, FRS, FMedSci, FRCP (hon)
(Actually, the Times removed the qualifications of the signatories, but left the titles!)
An earlier, longer, version of the letter tried to preempt the obvious criticism by including, as the second paragraph, this passage.
“It makes no sense to offer Bachelor of Science degrees in subjects that have no scientific basis. Not only is homeopathy scientifically absurd, but also the best quality clinical trials show that it is not distinguishable from placebo. From the point of view of the patient, there is nothing wrong with placebo effects. Conventional drugs benefit from them too. There is everything wrong with surrounding the placebo effect with mystical mumbo-jumbo and awarding degrees in it.”
Universities drop degree courses in alternative medicine
In the same issue, there was a related article by the Times’ education editor, Alexandra Frean: Universities drop degree courses in alternative medicine..
“Universities are increasingly turning their backs on homoeopathy and complementary medicine amid opposition from the scientific community to “pseudo-science” degrees.
The University of Salford has stopped offering undergraduate degrees in the subjects, and the University of Westminster announced yesterday that it plans to strengthen the “science base” content of its courses after an internal review which examined their scientific credibility.
Both universities are following the lead of the University of Central Lancashire, which last year stopped recruiting new students to its undergraduate degree in homoeopathic medicine.
The decisions by Salford and Westminster open a new chapter in the fierce debate about the place of awarding of Bachelor of Science degrees in subjects that are not science.”
The article ends thus.
“Other universities are more robust in their defence of their courses
Ian Appleyard, principal lecturer in acupuncture at London South Bank University, said that acupuncture should be studied for the very reason that it was not well understood from the standpoint of Western scientific medicine. Acupuncture had been used by a significant proportion of the world’s population for thousands of years.
“Recent large-scale clinical trials such Haake and meta-analysis from reputable institutions such as The Cochrane Collaboration, have shown that there is evidence to support the therapeutic benefits of acupuncture treatment for back pain and migraine,” he said.”
Uhuh, it seems that Ian Appleyard has been reading the misleading BBC report on the recent trials. In fact they show precisely the opposite of what he claims. The fact that advocates of alternative medicine can misinterpret the evidence so badly is, I guess, at the heart of the problem.
What’s happening at the University of Westminster?
Westminster has regularly been labelled as the University that has more quackery courses than any other.
It is also the only university for which we have much idea about what is taught. The university, like all others, has tried to keep secret what they teach. That itself shows that they aren’t very proud of it. But a surprising amount has leaked out from Westminster, nonetheless. The set of “vibrational medicine” slides, including “Amethysts emit high Yin energy”, have caused much hilarity. The Westminster “miasmatic” examination question gets some laughs too, after it was published in Nature. The set of homeopathic materia medica notes that have come into my possession are pretty good too (coming on line soon).
Recently it emerged that the University of Westminster had followed the example of the University of Central Lancashire (UCLAN), and set up a review of its activities in alternative medicine. But unlike UCLAN it was kept secret, and as far as one can tell, it asked for no input from critics.
Well the outcome of this review turned up in my mail recently. Click the picture to read the whole letter from the Vice-Chancellor.
There is no doubt that the outcome, so far, is rather disappointing. Here are some quotations from this letter, with my comments interleaved.
“The Audit was Chaired by Professor Alan Jago and carried out its review using a comprehensive evidence base”
Alan Jago is a pro- vice chancellor, and formerly from Westminster’s School of Architecture and the Built Environment, so no specialist knowledge there.
“The panel made a number of recommendations to me as a result of their Audit. Many of these recommendations concern the University’s processes for review and validation of courses and these will be passed to the Pro Vice Chancellor responsible for Quality to consider.”
Uhuh, sounds like box-ticking again When will universities learn that validation procedures are, on the whole, not worth the paper they are written on.
“The overarching aim of these actions then is to strengthen and make more explicit the ‘scientific’ nature of the Integrated Health undergraduate degrees.
In order to do this we will:
Strengthen learning outcomes particularly in discipline and clinical modules to reflect the science outcomes embedded in the courses.
Revise course specific regulations to explicitly identify that the core health sciences modules have to be passed to complete a degree of the BSc Scheme.
Strengthen the final year project offer to provide more scientific projects through working with Biosciences staff.
Strengthen the scientific/academic qualifications of staff through development
of existing staff and appointments where they become available.”
This seems to me to be whistling in the wind. Remember, we are talking about “bachelor of science” degrees in things like homeopathy and naturotherapy. These are things that are not science at all. In fact they are antiscience to their core.
If you were successful in raising the increasing the scientific level of the staff, many of the subjects they are meant to be teaching would vanish in a puff of smoke.
Certainly the responses of the Westminster staff to earlier enquiries (here, and here) showed little sign of scientific thinking.
And I wonder what Westminster’s admirable biomedical scientists think about taking on homeopathy students for projects?
“I am certain that this work will place Complementary therapies courses in an extremely strong position to meet the external challenges of the future.
I’m sorry to say, Professor Petts, that the scientific community is not likely to share your certainty.
Remember, Peter Fisher is on record as saying that there is not enough science in homeopathy to justifiy offering a BSc degree in it (watch the movie). He is the Queen’s Homeopathic Physician, and Clinical Director of the Royal London Homeopathic Hospital But Westminster still seems to know better.
It seems, so far, that Westminster has missed a chance to change for the better.
Times Higher Education published a pretty pathetic report on the Westminster audit. They did ask me for comments but then failed to publish most of them. I suppose a magazine like that is so dependent on advertising that they can’t afford to upset the authorities. Nevertheless, do they really have to be quite so bland?
I hear that the internal audit has made everyone at the University of Woominster Westminster more nervous and that staff and students have been advised not to share teaching material with people outside the university. Having seen some of them, I’m not surprised they are ashamed of them.
[…] unknown wrote an interesting post today onHere’s a quick excerptIt is also encouraging that the University of Central Lancashire recently closed its BSc in Homeopathy to new students, and announced a review of all its activities in alternative medicine. Although universities are now taking sensible … […]
From the letter:
“Underpin development of high quality MSc programmes in selected areas of strength with research active staff.”
They want to run MSc projects with research staff in woo? i can see it now, at conferences posters from the U of Westminster will be accorded a section of their own where attendees can go and laugh and snigger at what is supposed to be science research there.
Has the VC no idea of how that would lead his science staff into ridicule and his institution with them? If they tried to force homeopathy students on research active staff I can see people fleeing the place with alacrity. It can’t be easy doing research there in the first place without your VC actively undermining the quality of your science.
In response to a reader’s comment on the Alexandra Frean article saying “This decision goes against the spirit of academic inquiry which our universities should be nurturing, not destroying.” I replied:
“No Nick. Studying these ‘subjects’ is just like studying pixies or a course on Santa Clause. They are not appropriate academic subjects because there is no academic content in them.”
Comments are moderated, so it may not appear.
Can we assume that that means using unreliable evidence as well as the good stuff?
Whistling in the wind while aggravating the fraud and perversion of science they’ve apparently committed to.
UoW belongs in a gaily painted shack on the end of the pier or in a carnival booth.
Would you have cared about his qualification, if he had found for the side of reason and recommended the course be shut down? I understand what you mean, but it smacks of ad hominem.
If we could get you set up for a knighthood, would you accept?
No of course I would not have cared if the outcome has been more sensible, but it is hardly ad hominem. I don’t know and have nothing against Alan Jago personally. My point was that you need to involve someone who not only is capable of assessing evidence, but who is aware for what evidence exists. You need critical self-appraisal.
There is a tendency (sadly it is as common in universities as anywhere else) to think that questions of policy can be decided by ticking boxes, with little knowledge of what it is that is being assessed.
A good example might be the earnest army of people at Skills for Health writing “competences” in distant healing. Or the validation documents produced by the University of Wales. Correct “procedures” are followed, but the result is nonsense,.
From what little I know of the Westminster audit, I suspect that it might be in that category. How else could it have come to the conclusions we see here?
A couple of responses to the letter.
The first one is giving it the usual wibble about “iatrogenic harm”, and pretending that you want to “ban further discussion of the subject”, much as the first response to the Frean story linked to above invoked “the spirit of academic inquiry”.
They miss the point that these courses are aimed not at genuine inquiry, but at training future practitioners in therapies which have no real basis in fact. Anyone wanting to know what the alternative medicine industry’s attitude is to “the spirit of academic inquiry” should just take a look at their response to the work of Edzard Ernst: personal attacks, vilification, and in some cases attempts to get him sacked.
Here’s a letter by Colin Cowell (author of the first letter in today’s Times) in response to an article by Ernst in the BMJ. He starts by saying that Ernst’s article is “a welcome addition”, but eventually continues: “This is not a polemic against research and it would be tragic if research were to be stifled by over-regulation but…”
In the last paragraph he seems very keen on the idea of training and approved qualification in CAM.
That reminds me… Why write letters to The Times (or any other rag) in the first place? This is the 21st century – not the 19th – and writing letters to a moronic and slanted opinion dominated rag which declines to publish (IME) circa 50% of comments posted on its crummier-even-than-the-Guardian-CiF website is rather pointless, IMO.
The sooner these vanity publishing platforms that absurdly still call themselves “newspapers“ vanish, the better.
phayes. The reason is surely pretty obvious. It reaches an entirely different audience. In particular,, it reaches more people who disagree than a blog ever can, and quite possibly, in the case of the Times, more people with the power to do something about it. That’s the theory anyway.
Not obvious, no. Perhaps you are right, DC, but the disappointment of a post-Apollo society is hard enough to bear even without having to face such Trollopian anachronisms. 😛
Letters from Professor Karol Sikora and Michael Dixon today.
Apparently you’re a Stalinist.
Yesterday a Nazi, today a Stalinist! It really is quite surprising see the names you can get called, simply for trying to assess evidence as fairly as possible, and to advocate that as a basis for public policy.
Use of that sort of language, I can interpret only as a sign of panic. Some people get very distressed when evidence challenges their deeply-held beliefs. But it really can’t do their case much good, as we see from the comments at The Economist.
If only patients symptoms were consistent with their diagnosis we (doctors) could practice a clear, scientific objective medicine. Whilst some patients seek a diagnosis, many seek relief from suffering, which often doesn’t lend itself very well to a scientific medical model. That patients seek and find relief in CAM should not result in indignation, but prompt self-examination about where we are failing to provide the relief they seek. We could do a lot better. Its no surprise that Trisha Greenhalgh should write about evidence based medicine and narrative based medicine.
In my experience, only a few patients seek a mystical (CAM) diagnosis, most simply want to feel better. The darkside of CAM is mostly due to market economics. Patients are decieved and dumbed down (by advertising including advertising masquerading as journalism) and exploited (by fear mongering and by being parted from their cash) in much the same way in every market situation including allopatic medicine (where markets exist) hence if you want a MRI for your migraine you seek a private opinion or drugs of limited value are advertised directly to patients.
Competing interests: Barts and the London Medicine in Society Tutor (Badscience and dcscience are on my students reading list)
Sikkora also said: “Armchair physicians are welcome to their views, but clearly patients know better.” I hope you’re comfy, David!
I posted the following comment on The Times website (awaiting moderation):
“I would have thought that a professor of medicine would not have had to resort to ad hominems and would also know that ad populum fallacies are wholly insufficient in determining what treatments should be given to patients.
As for acupuncture, I suggest Dr Dixon reads the paper in the recent BMJ.”
Pity they restrict comments to 200 characters.
r/e teaching CAM in university. Surely they are social sciences and should be studied as branches of human behaviour, perhaps as part of medicine and anthropology? Some history and philosopy of science and medicine would have to be included so that students understand where CAM is in relation to allopathic medicine and science. It would make a valuable and fascinating MA course.
Yes, as a branch of anthropology or human behaviour they’d make a fascinating course. But remember these are vocational courses. Their aim is to train people to run a business. That is why they are so totally uncritical. You can’t cast any doubt on the premises of the subject if the students are to make their living by practising it.
Sometimes it is suggested that the problem could be solved by changing the name of the degree from “BSc” to BA. I don’t believe that would help at all. We are still talking about treating sick people, and who’d want to be treated by a BA, whose degree would be a tacit admission that logic had been abandoned?
I suspect that that makes you a “microfascist” as well!
Mojo: …and it calls itself a “Scholarly Article”!
Its no coincidence that the birth of the NHS coincided with the dawn of science based medicine at which point what worked was more important than making profits from patients. The governments obsession with forcing the market into the NHS is a greater risk to science based medicine than the leverage of CAM from social science to clinical science.
I wouldn’t bother reading the paper.
It’s the usual social sciences BS full of forelock tugging to the usual suspects: Deleuze, Guattari, Foucault, Derrida.
Apparently “The ossifying discourse that supports EBM” is something different to whatever it was that gave us antibiotics, immunisation, antiseptics, MRIs etc etc.
In any case you professors, doctors and associated medicos who contribute to this (and similar) sites are not “critical intellectuals”.
“””Critical intellectuals are at ‘war’ with those who have no regards other than for an evidence-based logic”””.
It must really sting being put in your place by a couple of Canadian buffoons.
Anecdotal evidence would appear to support the hypothesis that huge amounts of open space and bitter winters makes you stupid.
The legendary Holmes et al. PoMo bollocks-fest is an old Bad Science cause celebre, John. See here and here.
The saga became even more surreal when the same journal that had published it subsequently published an article by its editor consisting of his taking affront at the blog coverage of the Holmes et al. paper. He even quoted a bunch of bloggers (rather selectively) by our Noms de Blog.
You really, truly, couldn’t make it up.
To be perfectly honest I thought I had read that paper before. Probably when it was first dissected. If I wrote a paper and people could not remember whether they had read it before I would be remarkably unimpressed with myself and wonder if I had actually said anything of merit.
I did not read the remarks by the sorely affronted editor so that will be my lunchtime treat.
And I beg to differ on the “you couldn’t make it up” comment. You can do exactly that:
Thanks for the link to the Po-Mo essay generator and product thereof, John. I had heard about it but not seen the output. Cheered up a dull afternoon.
I was trying to remember the source of the remark that if the communists called you a fascist, and the fascists called you a communist, you were probably doing something right. Can anyone advise?
Anyway, I reckon if DC is getting called a fascist (by the “health freedom of reality of our choice” lobby) AND simultaneously a Stalinist (by noted medical free-marketeer Karel Sikora), then the same principle applies.
Checking out the increasingly hilarious Economist thread, I see that the latest description of DC that the natural health loony lobby have come up with is “Jekyll and Hyde”. I am wondering which one smokes the pipe.
I promised myself a blog-free day so I could get on with some work but couldn’t resist following John’s link to elsewhere.
Superb! To begin with I really wasn’t sure whether or not it was ‘real’ (i.e. from the PoMo parallel universe) or the fabulous send-up that it is. I will save the Economist follow-up until later.
Meanwhile, alarmingly, I found this link about Hy and cancer. http://www.annieappleseedproject.org/homeopathy1.html Grim.
Apologies if everyone knows about it already, but I don’t remember seeing it recently.
I started reading the Economist article. The following quote jumped out at me before I even got to the comments:
“””the Medicines and Healthcare Regulatory Agency oversees homeopathy but no other alternative therapy. This agency, whose day job is to license conventional drugs, excuses homeopathy, unlike other treatments, from proving it is more effective than a placebo.”””
Do you (or does anyone else) know why this is the case. It mystifies me. I cannot for the life of me work out why HY should be excused oversight (I would have thought that with its claims to cure virtually every ailment known to man combined with a complete lack of scientific validity it would be first in the firing line for regulation).
As we were in po-mo mode above does anyone have any idea what this privileging signifies ?
(PS I followed the trail you referenced in post 23. I feel as if I have just drowned in a vat of treacle. I did like the article by the computer geek who played them at their own game. He made some very accurate observations following his immersion in the social sciences vat). Been there – agree with him all the way.
John -try putting MHRA in the search box here. The earlier posts that come up relate the saga.
I did that and am still none the wiser. I am not sure whether I just fell down a rabbit hole or through a looking glass.
According to a certain contributor of this parish “”To make such a claim, the manufacturers need only show that the product has been used to treat those particular conditions within the homeopathic industry””.
So in effect the argument is that there is a sort of legal precedent for sugar pills. We have been prescribing antimatter or dogs testes for year so we should be entitled to continue in the same vein.
Why not apply the same logic to the rest of the quacks portfolio (not that I want them to).
I think I preferred the contribution from the Royal Physiological Society.
On a seperate note you really ended up in a vipers nest of drivel on that Economist thread.
If the best the woosters can come up with is Mad Molly (her of the bogus credentials and the economy with the truth) and scepticsbane then woo is in a bad way. (I think the latter is in a bad way in any case. It would appear that a wholesale belief in quackery destroys your critical facilities and your capacity for spelling and grammar).
Full marks for considered responses and not stooping to thier level (is there somewhere lower than a gutter ? Sewer possibly).
John Hooper wrote:
I think you may have cause and effect the wrong way round there.
I am happy either way Mojo.
Re Me. It is always a risk criticising someones English when you screw up yourself. Hubris.
There was a letter in The Times today in response to DC’s letter from Earl Baldwin of Bewdley:
I managed to comment:
“It is not a question of the Government ‘seeking to endorse’ AltMed, but many will see registration with http://www.OfQuack.org.uk (aka CNHC) as a sign that the treatments are bone fide – OfQuack only ensures that they have insurance and have had some training with no evidence whatsoever that they work.”
Unfortunately, comments are restricted to 200 characters.
Alan -you are lucky to get even 200 characters on the Times comments. My comment on Karol Sikora’s letter never appeared, and the response to Bewdley is still in limbo. He appears not to know that the Medicines Control Agency was a predecessor of NICE.
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I thought the Holmes “Scholarly Article” @ 19 above complete rubbish – just a lod of nonsense jargon strung together. However I asked a bright young graduate of English Literature what she thought of it, expecting to hear a full condemnation. She thought it was “pedantic, but the underlying logic is ok”.
What that tells you, Andrew, is that the kind of linguistic stylings favoured by Holmes et al have become the lingua franca for a significant chunk of those working in the arts and social sciences.
…Which might in turn suggest a reason why some of those subjects are in a kind of academic crisis of purpose – they are busy disappearing up their own fundaments.
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