Acupuncture has been in the news since, in a moment of madness, NICE gave it some credence,
Some people still seem to think that acupuncture is somehow more respectable than, say, homeopathy and crystal healing. If you think that, read Barker Bausell’s book ot Trick or Treatment. It is now absolutely clear that ‘real’ acupuncture is indistinguishable from sham, whether the sham control uses retractable needles, or real needles in the ‘wrong’ places. There has been no clear demonstration of long-lived benefits in any condition, and it is likely that it is no more than a theatrical placebo.
In particular, the indistinguishability of ‘real’ and sham acupuncture shows, beyond reasonable doubt that all the stuff about “energy flow in meridians” is so much hokum.
There is a small group of ‘medical acupuncturists‘ that believes that it is hokum. but who nonetheless maintain that acupuncture works, despite the evidence to the contrary. But most acupuncturists go for the wholesale gobbledygook.
If you don’t believe that, take a look at the exam paper that has come into my possession. It is this year’s exam from the University of Salford. Salford has, very sensibly, now decided to stop all its degrees in alternative medicine, so don’t hold this against the university too much.
You can download the entire exam paper. Here are a few highlights.
So students, in 2009, are being taught the crudest form of vitalism.
Oh really. Perhaps protons neutrons and electrons?
OK I’d fail that one because the words have no obvious meaning at all.
Perhaps an elementary textbook of embryology would help?
How one would love to see a set of model answers for these questions.
All this is ancient hokum being taugh to hapless students in the 21st century as though it were fact. The University of Salford has understood that and closed the course. All we need now is for NICE and the Department of Health to understand what it is that they are promoting.
NICE neglected the cultural cost of their guidance
When National Institute for Health and Clinical Excellence (NICE) included an acupuncture option on their low back pain guidance, they quite forget that one effect of their decision would be to ensure that new generations of students would have their minds poisoned with intellectual junk like this. That is why NICE really must think again. . See also
NICE falls for bait and switch by acupuncturists and chiropractors
NICE fiasco part 2 Rawlins should withdraw guidance and start again
NICE fiasco Part 3. Too many vested interests, not enough honesty
Pittilo and statutory regulation
Public consultation is due to open shortly on the appalling report of the Department of Health Steering Group on the Statutory Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and Other Traditional Medicine Systems Practised in the UK (see also, The Times)
One of the recommendations is that acupuncture and Chinese herbal medicine should have statutory regulation by the Health Professions Council (HPC), despite the fact that that would involve the HPC breaking its own rules. Another recommendation of Pittilo is that entry to the “profession” (his word, not mine) should be by means of honours degree only. So he wants to impose on students exams like this one in order to “protect the public”? The absurdity of that proposal should be obvious now. This exam paper will form part of my evidence to the consultation.
And there is one other small problem. Universities are busy shutting down their degrees in alternative medicine, now that the ridiculousness of what is taught has been exposed. They have shut down entirely at the University of Salford and at the University of Central Lancashire, And even the University of Westminster is working on closing them.
All we need now is for the common sense and integrity that has been shown by these universities to spread to the Department of Health (and NICE).
Following the results in CHerkin’s paper ( my blog on it), I’ve written to NICE to ask for a reappraisal of the evidence.
It will be interesting to see the response.
That’s great. Me too. I hope a lot of people will write to NICE to point out their uncharacteristic retreat from evidence
Re writing to NICE and making them think again, I wouldn’t hold your breath chaps. I worked on projects commissioned by them for several years and about a third of their own workforce (which didn’t include me!) was comms people. We never knew exactly why they needed so many of them, but they shield the number-crunchers, bean-counters and pulse-takers from your letters. You will be get a response from some fast-track civil service adolescent saying that NICE will review the guideline in 2013 and there will be a public consultation you can take part in then. In other words, sod off. If you want dialogue you might consider speaking to the chairman of the committee who is somewhat more of a loose cannon, or inclined to be off-message, as they might say at Midcity Place. But even he won’t get listened to by the real eminence gris, the PR bods. Their job is now to defend the acupuncture recommendation with every tool at their disposal.
That exam paper would be hilarious if it were not part of the wider trend towards acceptance of nonsense in all fields.
Fitting into this is the fact that the forthcoming public consultation on the Pittillo report is likely to be the usual sham.
The interim ‘Report of the Working Group on Extending Professional Regulation’, published on July 16th, states in para 1.15
‘Government has also agreed to extend regulation to practitioners of acupuncture, herbal medicine, and traditional Chinese medicine practised in the UK. Much work has taken place concerning regulation of these practitioners over the last decade including a report from the House of Lords’ Committee on Science and technology and three Working Groups and a public consultation. The most recent Steering Group on Statutory Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and Other Traditional Medicine Systems Practised in the UK, who delivered their report to Ministers in the UK in June 2008 *, strongly recommended regulation of these groups in order to provide the public seeking such treatment with assurance of safe and competent practice. The Working Group understands that a public consultation on the issues raised by the Steering Group is imminent.’
So it has already been decided. In addition the whole report is full of the usual HR rubbish with large numbers of references to stakeholders….
The House of Lords Science and Technology committee report (2000) recommended regulation, (based in part on another report from a CAM person at Exeter)
This makes it all the more important that as many scientists as possible respond to it. Also we should make sure that, as is usual, all responses are ultimately available on the website.
Sadly I have to agree with everything you say. Nonetheless I think it is worth writing. No doubt the initial response will be the usual PR pap, but if they get enough letters, the effect may permeate higher.
I have virtually never had any reply at all from vice-chancellors to whom I’ve written about quack degrees, but nevertheless they’ve closed the degrees down. They may not have replied, but it seems they have read the letters.
I hope you’re right DC. Medicine does not evolve in 4-year jumps. But one thing that might be promising is that once NICE have written the all-encompassing guideline on a topic, they only go back and update the sexy new bits. Viz heart failure guideline where only the newer drugs and cardiac rehab programmes are getting updated. The original review included CAM (including crystal therapy!) but that has now been quietly dropped. Perhaps we are moving on at last.
I could provide model answers to those questions, but neither of us would be able to make any sense of them…
For the multiple choice questions, would it be cheating to use a divining crystal?
No doubt those sitting the exam were frisked at the door to make sure they didn’t smuggle in crystals, dowsing rods or diagnostic pendululims. You can’t be too careful.
Hmm. While one could frisk the students, and tell invigilators to watch out for unauthorised use of diagnostic pendulums, what about students who were making use of remote cheating? (i.e. psychic communication with a friend sat outside the exam hall with a pile of Grimoires, sorry, textbooks?)
Anyway, I hadn’t thought before of the special problems of spotting cheating in magic exams… but perhaps the Harry Potter series might offer some hints?
Mrs Muscleman told me that a student at her Uni (name redacted) had handed in their cheat notes along with the exam script, so maybe if the script were wrapped around a pendulum that would be a giveaway.
I agree that many of the questions are not even wrong. It’s as though they want to surgically excise any scientific knowledge the students may come in with.
Leaving aside the subject matter, I’d like to express my horror at the appallingly low quality of the examination paper itself. The grammar is poor in many places, and question marks are used very inconsistently. Did anyone see this paper apart from the person who set it (and the students)?
Next, two hours for a paper that is almost entirely multiple choice (with three very short written answers at the end) is incredibly generous. I don’t generally approve of time pressure being applied in examinations, but this is going to the other extreme!
Finally, the questions aren’t really very hard, are they? It’s true that I don’t know any of the answers, but very few require more than simple recall. Is this typical of BSc papers in other subjects?
I thought that OCR had problems with its “21st century Science” GCSE papers (although in fairness I love the course), but compared to this paper they are exemplary in every way! I cannot believe that this paper was set as part of a formal assessment at a university in this country. Obviously I am very out of touch!
beat me to it, PhysicsTeacher! Normally one would allow 1 minute per MCQ question or EMQ stem. This leaves 1 hour 40 minutes for 4 short answer question.You know they are short because 1 question only equals just over 3 MCQs in weighting. In addition, the numbers don’t add up (27 marks for 10 EMQ stems at 3 marks each?), and it doesn’t specify the negative marks scheme (how many marks are lost for an incorrect answer).
(There are 4 free text answers for 10 marks each, incidentally, not 3). I would question their assessment skills, and those of their external examiner, even without the nonsense!
For acceptable reliability, I would look for about 100 MCQs. Low reliability here means the standard error of measurement (the error bars) will be very large. Finally, I wouldn’t recommend mixing free text questions with MCQs and EMQs in one paper. They have different score distributions, and it distorts the outcome to combine them by simple arithmetic. But lots of Higher Education depts gets this latter part wrong.
It is currently possible to download a document containing a brief syllabus, course aims, and recommended reading etc for this unit from the 2006/7 session here. It was a first year/level unit in the TCM “B.Sc.”.
The document tells you that the overall course mark was made up as 70% from the score in the end-of-course exam, and 30% on three in-course progress tests (likely MCQ as well) – i.e. 70% exam, 30% semi-formative assessment coursework (if you will forgive the edu-jargon).
I can’t recall now whether the students doing Salford’s CAM B.Sc.s had to take a first yr unit in “mainstream” anatomy / physiology, but they probably did. As DC has often commented, it must have been a bit of a brain-ache trying to keep reality and unreality simultaneously percolating round the brain.
Oops. link didn’t paste properly. Try again:
intranet.chssc.salford.ac.uk/open/handbooks/module/200809/Mod Hbook 2008 entry.doc
..or just Google for “salford TCM BSc” and it appears in the first half-dozen hits (NB Word doc)
Just to back up what Allo V says, for first year bioscience courses at my within-fifty-miles-of-Salford “trad” University, we would typically have 80-100 MCQs for an exam of 90-120 minutes duration.
Slight variations tend to exist between courses, e.g. medical students may get more questions in less time than bioscience degree students. But twenty MCQs and four short essay answers (each only worth as much as three correct MCQ answers, as Allo V points out) in two hrs sounds like “money for jam”, to use a technical scientific term.
Add to that the probable 30% of the overall course mark for in-course testing (where marks typically tend to be slightly higher than for end-of-course exams) and you are left with the feeling that it must be, erm, quite difficult not to pass the course.
The CAM anatomy module
The toe bone connected to the heel bone,
The heel bone connected to the foot bone,
The foot bone connected to the leg bone,
The leg bone connected to the knee bone,
The knee bone connected to the thigh bone,
The thigh bone connected to the back bone,
The back bone connected to the neck bone,
The neck bone connected to the head bone,
Oh, hear the word of the Lord!
Dem bones, dem bones gonna walk aroun’
Dem bones, dem bones, gonna walk aroun’
Dem bones, dem bones, gonna walk aroun’
Oh, hear the word of the Lord.
The head bone connected to the neck bone,
The neck bone connected to the back bone,
The back bone connected to the thigh bone,
The thigh bone connected to the knee bone,
The knee bone connected to the leg bone,
The leg bone connected to the foot bone,
The foot bone connected to the heel bone,
The heel bone connected to the toe bone,
Oh, hear the word of the Lord!
Surely the CAM anatomy module would be along the lines of :-
The head bone connected to the thigh bone
The thigh bone connected to the toe bone
The toe bone connected to knee bone
Oh hear the woo of the Word.
Dr. Aust – I don’t think it matters how many MCQ’s a minute these students do – its all such nonsense. There’s surely no need to distinguish between high velocity clap-trap, and low velocity clap trap?
I quite agree that it’s all nonsense – but remember that Pittilo recommended “degree level education for CAM therapists” and that the results of his dire report are still up for national discussion. And now we hear the homeopaths are apparently trying to join the Health Professions Council.
Given this, it is important to set out for the record that these “CAM B.Sc.” s – which, I repeat, were very much the kind of model Pittilo et al were looking to for CAM therapist training – were a farce, including in terms of what one would normally regard as “suitably rigorous University level assessment”. The combination of nonsense content, PLUS a course assessment meaning it would be difficult to impossible to fail, is damning. But it needs to be there for the world to look at, or the question will be back.
Incidentally, I wonder what a course unit exam in “TCM” would look like if the course was taught and assessed from an anthropological perspective? I rather doubt the exam would look like this, but if any social scientist is reading I would be interested to hear what they think.
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