A momentous decision was promulgated (as lawyers say) by the Information Tribunal on December 8th 2009. It marks a step forward in Freedom of Information about how universities spend your money. It has taken 3.5 years to get to this point. Perhaps now there will be an end to the attempts of every single university that I’ve
approached to conceal what they teach.
"The Tribunal upholds the decision notice dated 30th. March, 2009, dismisses the appeal and directs that all the steps required by the Decision Notice be taken within 28 days of the date of this Decision"
Back story for this case
24th July 2006. I asked the University of Central Lancashire (UCLAN) for copies of teaching materials and validation documents for their "BSc" degree in homeopathy (this degree no longer exists: it was abolished in 2008). A year later, UCLAN shut the rest of its courses in alternative medicine, after an internal review.
21 August 2006. I was sent the validation documents but refused the teaching materials as UCLAN claimed they were exempt under section 43(2) of the Freedom of Information Act (FOIA)(commercial interests). Two days later I sent a request for the mandatory internal review of the refusal.
4th October 2006. The internal review confirmed the original decision (it always does), and cited, as well as section .43(2) of FOIA, section 21.
21 October 2006. I appealed to the Information Commissioner. The basis of the appeal was that the university might have financial interests in the outcome, but not commercial interests, because universities are not commercial organisations as defined in section 43(2) of the FOIA. In addition, even if the commercial argument was not allowed, the public interest in knowing what was taught was sufficient to justify release of the requested materials.
21 January 2008. The Information Commissioner finally got round to starting on the case.
29 September 2008 The vice-chancellor, Malcolm McVicar, raised an objection to complying with my request under s.36(2)(c) of FOIA. This states that “In the reasonable opinion of a qualified person, disclosure of the information under this Act” “(c) would otherwise prejudice, or would be likely otherwise to prejudice, the effective conduct of public affairs..”
30 March 2009. The decision of the Information Commissioner was published. It has already been described here. Apart from one trivial matter, my appeal was upheld, and UCLAN was ordered to release the requested material within 35 days. However UCLAN did not release the material, but rather launched an appeal against the Information Commissioner. The appeal was heard by an Information Tribunal.
The full text of the Freedom of Information Act is here.
The Information Tribunal
The Tribunal heard the case of University of Central Lancashire v Information Commissioner in Manchester on November 3, 4 and 5. I was an ‘additional party’ to the proceedings and attended in person for the first two days, with the aim of helping the Information Commissioner’s case. This is what the tribunal looked like.
I was amazed to find myself sitting next to the barrister for the Information Commisioner, and still more amazed to be invited to cross-question the witnesses, after she had questioned them.
The witnesses were Malcom McVicar (vice-chancellor of UCLAN), Peter Hyett, (executive director of finance at UCLAN) and David Phoenix (Deputy vice-chancellor, UCLAN).
The decision in full can be read here.
The Tribunal upholds the decision notice dated 30th. March, 2009, dismisses the appeal and directs that all the steps required by the Decision Notice be taken within 28 days of the date of this Decision.
So we won.
The details of the decision contain some matters of great interest for universities, in particular the dismissal of the idea that the public can be reassured by either internal or external (e.g. QAA) validation procedures. I’ll try to summarise them (paragraph numbering as in the decision
The one disappointing thing about the Tribunal’s decision was that it contradicted the Information Commissioner’s decision on the meaning of commercial interests.
31 "Therefore, whether on a broad or narrow construction of the statutory words, we are satisfied that UCLAN `s interests in teaching material produced for its degree courses are properly described as “commercial”.
However, that does not affect the outcome because the Tribunal decided that there was no reason to think that the course materials actually had the commercial value that UCLAN said they did. For
36 We were not impressed by the claim that third parties with copyright in the disclosed materials would be alienated by UCLAN `s compliance with a decision that this information must be provided. None gave evidence to that effect.
37 It was not clear to us how a competitor could significantly exploit access to this material, without infringing UCLAN `s copyright or brazenly aping the content of a course, which would surely attract the scorn of the wider academic community. Moreover, it seemed to us likely that most potential students would be attracted to a particular course by the reputation of the teaching staff and a range of extra – curricular factors at least as much as by a comparative study of the powerpoint presentations and notes provided to current students.
39 Finally, in this particular case, we doubt whether this course had a significant commercial value, given the limited enrolment and the virtual absence of overseas interest.
At this point, the appeal is essentially dismissed. Nevetheless, the Tribunal went on to discuss the other defences offered by UCLAN, and some of their conclusions are more interesting than the subtle distinction between ‘financial interests’ and ‘commercial interests’.
40 In the light of this finding, it is not strictly necessary to decide the balance of public interest as to disclosure. Nevertheless, since the issue has been carefully and very fully argued, we shall shortly indicate our view, had the likelihood of prejudice been established.
The commercial interest defence is subject to the public interest argument in s.1(2((b) of the FOIA’
(b) in all the circumstances of the case, the public interest in maintaining the exclusion of the duty to confirm or deny outweighs the public interest in disclosing whether the public authority
holds the information.
Hence, the decision notice says
41 As ever, the question is whether the public interest in maintaining the exemption outweighs the interest in disclosure.
On the question of public interest, the Tribunal comes down strongly on the side of the Commissioner and me.
46 The public interest in disclosure seems to us appreciably stronger. Apart from the universal arguments about transparency and the improvement of public awareness, we find that there are particular interests here, arising from the nature of a university and the way it is funded.
It is particularly interesting that the Tribunal dismissed the role of internal and external validation as a substitute for transparency. As part of their case (para 18) UCLAN had argued
"Moreover, standards were ensured by the validation procedures which were required before a course was launched and which involved independent expert external monitors and by quality assurance (Q.A.A.) which demands a continuing compliance with national standards."
This cut no ice with the Tribunal. In one of his few direct interjections the Tribunal Chairman, David Farrar Q.C., questioned a witness directly about the internal validation processes, Evidently he was not impressed by the answers. During my own cross questioning of the deputy vice-chancellor, I put to him the view that since the QAA [Quality Assurance Agency] was not allowed to take any notice of the content of courses, that getting a high mark from the QAA was not a substitute for seeing what was actually taught. The deputy vice-chancellor did not seem to disagree strongly with that view.
47 First, the public has a legitimate interest in monitoring the content and the academic quality of a course, particularly a relatively new course in a new area of study, funded, to a very significant extent, by the taxpayer. It is no answer, we consider, to say that this function is performed by the process of validation or the continuing monitoring of standards with external input. Whether or not these processes are conducted with critical rigour, it must be open to those outside the academic community to question what is being taught and to what level in our universities. The apparent perception in some quarters that the intellectual demands of some or many degree courses have been relaxed, that higher classes of degree are too lightly earned, may be largely or entirely unfounded. But it is highly important that the material necessary to a fair judgement be available. That material will often, if not always, include the basic content of the course, such as is requested here.
48 Secondly, this is especially the case where, as with the BSc. (Homeopathy), there is significant public controversy as to the value of such study within a university. In this case, that factor standing alone would have persuaded us that the balance of public interest favoured disclosure.
49 We are not attracted by the somewhat patrician argument that the general public, uninstructed in the specialist subject under scrutiny, would be incapable of forming a proper judgement. That might be so, were it impossible to seek independent expertise to assist in making an assessment. Happily, it is not.
50 Finally, there is a public interest in opening up new methods of teaching and new insights as to the content of courses, so as to stimulate the spread of good practice.
So, a hands down win on the public interest argument.
Prejudice to effective conduct of public affairs
I found incomprehensible the argument that disclosure would ‘prejudice the effective conduct of public affairs’. But it was raised (at the last minute) by UCLAN, and it was considered by the Tribunal. This defence refers to s.36(2)(c) of FOIA. It states that “In the reasonable opinion of a qualified person, disclosure of the information under this Act” “(c) would otherwise prejudice, or would be likely otherwise to prejudice, the effective conduct of public affairs..”
As noted at paragraph 17, it is common ground, established as to (iii), by the jurisprudence of the Tribunal, that this exemption is engaged if three requirements are met. They can be shortly labelled
(i) qualified person
(ii) reasonable opinion
(iii) reasonably arrived at.
The Tribunal seemed to be distinctly unimpressed by the arguments presented by UCLAN.
56 A reasonable opinion may be one with which the Tribunal emphatically disagrees, provided it is based on sound argument and evidence. With great respect to Professor McVicar, whose sincerity is not in question, we can find no adequate evidential basis for this opinion and consider that it rests on two misconceptions as to the application of FOIA. We do not find that it passes the required test of objective reasonableness.
57 We considered separately whether the opinion was reasonably arrived at. Again, our answer is no.
58 Section 36 provides for an exceptional exemption which the public authority creates by its own action, albeit subject to scrutiny of its reasonableness, the likelihood of prejudice and the question of the public interest. That factor of itself justifies a requirement that the authority provide substantial evidence as to the advice (other than legal advice) and the arguments presented to the qualified person upon which his opinion was founded. We emphasise that no set formula is required, just a simple clear record of the process.
59 The need for such evidence is all the greater where, as here, the authority invokes s.36 for the first time after the complaint to the IC [Information Commissioner].
60 The evidence consists of a briefly argued email from Dr. Bostock suggesting that s.36(2)(c) be invoked on the very broadly argued grounds already reviewed. The tone implicitly acknowledges that the claim is rather speculative. We are not concerned with the slightly uncertain use of possibility and likely but the impression left is of a last minute idea, not really thought through or investigated
but merely discussed with solicitors to tie it in to the FOIA. It was sent to the Vice Chancellor at 3.20pm. on a Friday afternoon, 26th. September, 2008, asking for the Vice Chancellor’s agreement. That agreement was forthcoming in a single sentence without further comment in an email reply timed at 12.05pm.on the following Monday.
61 We find that the process of forming the necessary opinion was, to say the least, perfunctory, indeed far short of the careful assessment and investigation that normally supports a qualified opinion for the purposes of s.36.
62 Accordingly, we do not find that it was reasonably arrived at.
62 It is for these reasons that we uphold the Decision Notice. We record our gratitude for the helpful and succinct submissions of counsel on both sides and the incisive contribution of Professor Colquhoun. We wish to add that, whilst we have not accepted the great majority of the arguments advanced by UCLAN, we do not in any way seek to cast doubt on the veracity of the evidence of its witnesses, nor the honesty and loyalty with which they have sought to serve its interests.
63 Our decision is unanimous.
Signed David Farrar Q.C.
Watch this space to see what can now be revealed.
[…] This post was mentioned on Twitter by David Colquhoun, Alan Henness. Alan Henness said: RT @david_colquhoun: Great win for Freedom of Information (after 3.5 years) http://bit.ly/4NW42v […]
This is indeed a fantastic win! Well done!
I can’t wait to see what they come up with now – or do you have the material already, I wonder?
Awesome. Brilliant win and I’m looking forward to you posting the course content.
I look forward to your discussion of the course material.
Congrats, David. A great win.
Dare one opine that UC Lancs’ reticence, even after they had shut the course, might have been prompted by the worry that revealing the content was/is likely to make them into a public laughing stock?
Now, of course, they are likely to be both a laughing stock, and a great deal of lawyers’ fees to the bad.
I am not sympathetic.
Well done for your patience and the great outcome! Is this going to create some sort of precedence now??
Can’t wait to see the contents of the course hehehe
That “Prejudice to effective conduct of public affairs” ruling is, in legal tribunal terms, a real bollocking on the s.36(2)(c) – Not a reasonable opinion “no adequate evidential basis for this opinion and consider that it rests on two misconceptions as to the application of FOIA”, not reasonably arrived at “far short of the careful assessment and investigation that normally supports a qualified opinion for the purposes of s.36”
And quite right too!
I’m looking forward to seeing the material that can now be mined from what is undoubtedly a rich seam of comedy gold.
Truly monumental DC. This is a landmark victory.
Kudos to you for your persistence.
Exellent, David. Well done. I did get the feeling that even UCLAN was embarassed by its actions at times.
I wonder if it might be an idea to construct a ‘Looniversity League Table’, on the lines of those we are currently oppresssed by? Of course, league tables are arbitrary, unscientific, misleading, even deceptive – so just perfect for alternative medicine.
Criteria could include number of undergraduate courses, number of PG courses, number of students enrolled on each course, differential between entry qualifications and those for a rational health care course, proportion of graduates finding employment in alt med, and time delay in respnding to FOIA requests. Then a Press Release to launch it….anyone got some free time?!
Absolutely brilliant! Well done. This is truly a landmark and in the long run will go a long way towards improving standards – both of the integrity of course content and teaching quality. Probably more so than the quangocracy.
There is a parallel with cryptography algorithms and software, and with open-source software. Quality is assured not by secrecy and private management but by exposure to public inspection and testing.
The idea that UCLAN needs to protect standards by hiding its materials (oops, I nearly wrote “its dark materials”) whereas say, MIT publish theirs on the web is delicious comedy.
@Allo v Psycho: ‘Looniversity League Table’
I like that idea. It could fit nicely alongside the Golden Bull awards and the Ignobel prozes. Care would need to be taken to avoid falling into a “disgusted of Tunbridge Wells” sort of trap and not sure about the name but can’t think of a better one offhand.
Excellent news! I can’t wait to see the materials. Well done for persevering David.
I also quite liked ‘Wooniversity of the Year’! is that any better?
@cgr & @Allo v Psycho
Keep it Loony, it’s much more positive.
Sounds like a terrific waste of taxpayers money. Still, we’ve had 12 years of that. Talking of comedy gold I remember how useless and pointless my pharmacy degree was at a top 10 university. The pharmacology degree was even worse.
I few years back the national body for pharmacy students voted to have natural medicine included in their course. Not much response from the universities on that one. At least one group get to listen to me for two hours on the subject. The phrase lip service springs to mind.
Still, I’m glad you’ve all come to a conclusion before you’ve seen the course material from UCLAN.For the sake of the students I hope the course was written by teacher practitioners and not academics who won’t last ten minutes without the iron rice bowl of the public purse.
Talking of loonies…
[…] Filed under: Pseudoscience Finally some good news on the front of freedom of information: Prof. Colquhoun has achieved an important victory in this domain! For years now (literally!) he has been asking the University […]
a) Taxpayer’s money? I proposed a scheme for someone’s free time
b) You have degrees in both pharmacy and pharmacology? That’s unusual….but then, the internet is a wonderful place.
c) Pharmacy useless and pointless? Yet from my experience of hospital pharmacists, they seem to me to have high professional standards and show excellent evidence based practice. Are they useless and pointless too?
d) And in addition, you presumably have an alt med degree? So, between 6 and 8 years for the science degrees plus 3 years for your alt med degree? Sounds pretty academic to me.
e) Comments about alt med courses were based on material David published so far from elsewhere – no doubt there will be comments on UCLAN when it becomes available. Of course, we do know that they were so ashamed of it they tried to hide it.
f) Are you getting a little desperate? You don’t seem to be reading the contributions very carefully.
g) Do you have an interest to declare? Are you a ‘teacher practitioner’ contributing to one of these courses? Can we see your course material?
Great news. Thanks for all your efforts in pursuing this. I look forward to seeing what they have been teaching.
Along these lines, I recently had a conversation with a doctor who I later discovered is a doctor of naturopathy not a doctor of medicine. Depending on your view, these people have done all the training of a medical doctor as well as specialities in traditional medicines; or they have done considerably less medical training along with some complete nonsense.
But it made me realise what is going on here. In some ways such people are worse than total nutters because they have some real medical training. They establish their legitimacy by saying that they have trained like proper doctors then, when it suits them, they dispense with the evidence-based medicine on which their legitimacy is based and practice stuff which may include homeopathy.
This may not be the biggest con in town but it is surely the most cynical.
Allo I was referring to the quality of the pharmacy course and not pharmacists.Many start their real training once they’ve left university. I was also comparing the pharmacology course colleagues did at the same time as my pharmacy degree. My post grad is in clinical pharmacy. I’m in the 3rd year of a herbal medicine degree and I have showed some of my course material to pharmacists. One stated that “it puts the pharmacy course to shame”. Unlike many on this site I have opened my mind and looked at many different types of medicine.
Dr Aust, I find you rather sad.
Well, everyone’s got an opinion, Dangerous. I find you alternately hilarious and depressing.
Out of interest, how much do practioners of herbal medicine earn in private practice? As a postdoc at leading US institute my share of the iron rice bowl of the public purse ( as Dangerous Conventional puts it) was less than $20 an hour after 6 years.
The trouble with opening your mind too far is that sometimes, your brain may fall out.
Thanks for the clarification. I apologise for assuming you were claiming a pharmacology qualification (although your wording in your previous post was perhaps a little unclear).
It’s helpful to understand where you are in your programme. Do you think it is possible that having invested heavily in time and money in a herbal medicine course may affect your ability/willingness to detect/admit flaws in it? For my part, I’m happy to accept that herbal substances are bioactive (unlike homoeopathic remedies). What I’d propose is that herbal remedies have to demonstrate the same standards of safety and efficacy as other medicines. Do you disagree with that?
However, there are different issues about diagnosis. Doctors have long and arduous training in diagnosis. They work in teams with massive combined expertise. They have access to extremely sophisticated equipment and laboratory tests. Yet they still make mistakes, because it is difficult and they are human. To be blunt, I do not think that any alternative medicine practitioner should ever offer to diagnose conditions. They are human too, but also lack the expertise, team support and equipment to make a diagnosis. They also generally lack a credible intellectual framework. For instance, the underlying intellectual framework for homoeopathy is absurd to the point of being surreal. (On my desk here, I have a homoeopathic remedy made from starlight). Misdiagnosis can lead to unnecessary mortality and morbidity.
Your comment that pharmacists “start their real training once they’ve left university” echoes a common perception among all health professionals. However, evidence shows that it is not quite true: that advance training does indeed improve performance in practice, when it is evidence based.
I’m not surprised that you should be able to find ‘some’ materials which pharmacists like. Given that your course will include some evidence based subjects, and course materials vary in quality, it would be astonishing if you couldn’t! However, it is the totality that matters. What, for instance, are you taught about diagnosis? What are the underlying philosophies of a course in herbal medicine (as opposed to pharmacology in a medical course, for instance?). What are you taught about ‘conventional’ medicine, and about evidence based approaches? You are happy to share course materials with colleagues – will you share such material with Professor Colquhoun – or with me? If the content is justifiable, what would you have to hide? This is after all the subject of the original post.
Good to see a well thought out response.
I have invested heavily in terms of time and reduced earnings. Would I have done such a thing if the course was “away with the fairies”?
Looking at the modules in my course I have done research methods, differential diagnosis, diagnostic skills, nutrition, pathophysiology, business studies etc. No pendulum diagnosis I’m afraid.
I would agree that this is in no way compares with the training that doctors receive in diagnosis. No one would pretend that the case but where it is superior is the training that professions that are allied to medicine receive at universities. These professions are now independent prescribers with the power to give toxic conventional therapies like NSAIDS and that really worries me.Do they have the appropriate diagnostic skills? Perhaps they would be much safer if they could only prescribe sol 30c!
Are you serious?
A homeopathic remedy made from sun energy that’s said to prevent conditions caused, or exacerbated by, the sun.”
Sun energy? What the crap is sun energy? And how do you collect it and water it down?
The idea that we would be safer if doctors only gave us that crap is ludicrous. Do you really actually think that real medicine does more harm than good? Look at the effect medicine has had on life expectancy. Oh well this wont convince you if a degree didn’t.
I would like to ask a couple of questions though about your beliefs. Do you believe in:
# Avogadro’s number
# The ability to collect “sun energy” and then dilute it?
I am just trying to get a feel for what you really think about science.
I’m not a medic so I looked up NSAIDS on wiki, just to be sure I knew what they are. And I was right. I don’t need a prescription from anyone to get my hands on NSAIDS. I can buy them over the counter or even in the supermarket that has one of those self-check-out gadgets.
Are you so concerned that you are going to begin a campaign to have aspirin and ibuprofen, made available only after consultation with a GP who hands over a prescription if he sees a need? That is what wiki says NSAIDS are.
Congrats on two counts! – really good news that you’ve recovered successfully from your op. and it’s fantastic that you won against UCLAN.
The amount of tenacity that was needed against UCLAN is really mind-blowing – 3.5 years! I guess that’s how these institutions get away with many things; they were probably in shock that you didn’t let up after the 1st, then the 2nd, then the 3rd year! Congrats again!
Julian I was taking the proverbial with the Sol 30 comment. Homoeopathy is no more than a placebo.
Margaret in previous posts I’ve expressed my concern that diclofenac has a similar cardiovascular risk as Vioxx (Medal study etc.) To answer your question I would like to see NSAIDs banned completely. That includes OTC as well (apart from aspirin 75mg for secondary prevention only).
You say:”I have invested heavily in terms of time and reduced earnings. Would I have done such a thing if the course was “away with the fairies”?
No. It is the other way round. Because you ahve invested invested heavily – emotionally and financially – you dare not admit to yourself the profound flaws in your course.
You say of AHPs “These professions are now independent prescribers”. In general, this is not the case. For example, for nurses, only a very limited number have prescribing powers, they receive extensive further training, and their prescribing powers are tightly defined and confined to simple, non hazardous cases. They also practice under the general supervision of, and with reference to, qualified medical practitioners.
I find that, when a discussion with alternative medical practitioners begins to threaten their core beliefs, they frequently respond by changing the subject and starting irrelevant hares. Let me repeat my questions.
(a) Do you believe that all medicines, including herbal remedies, should be subject to the same standards of safety and efficacy?
(b) will you share your relevant course materials for independent study?
Allo V Psycho
Thanks for keeping the conversation on course. You have asked the right questions.
Now the ball is in the court of dangerous conventional. May we have the straight answers please?
Having descended into the mire UCLAN have well and truly had their faces rubbed in it. Quack degrees can now be subject to full public scrutiny. Wonderful work David.
There is a whiff of East Anglia, on the other hand, about this site.
That comment made me laugh so much I nearly reached for the oxybutynin.
For example, for nurses, only a very limited number have prescribing powers.
Hello…….How come I have just seen discharge letters making changes to patients meds from heart failure nurse specialists and neurology nurse specialists. You must work in a different NHS to the one I deal with.
a) Do you believe that all medicines, including herbal remedies, should be subject to the same standards of safety and efficacy?
Yes I do. I support the EU directives on traditional herbal medicines. All herbal medicines and conventional medicines should be subjected to studies that have primary end point data and not RCTs that chase pointless surrogate markers such as blood pressure and cholesterol levels. In previous discussions I have pointed out that many conventional medicines do not have primary end point data and therefore should not be prescribed.Those that do have such data and have been shown to be ineffective and down right dangerous (eg. doxazosin) are still being heavily prescribed in the UK.
Clearly, the Chinese government support this view judging by the fact they are pouring ten of millions into studies looking at Chinese herbal medicines. I wonder if our government will do the same? I can see the complaints from Norwich and Ipswich now. Would the people on this website support taxpayers money being used to support a primary end point study looking at say hawthorn in heart failure.O dear , those Germans have beaten us to it. They only spend 2 billion euros a year on herbal medicines. If your looking for evidence then compare our beloved NHS with their healthcare system.
(b) will you share your relevant course materials for independent study
How about sending me the the pharmacology course material. Judging by the number of new entities coming out of UK Big Pharma it must be quality.
I’m afraid that the education of which are so proud (and several attempts here) you have still failed to understand the crucial problem of causality. Can you imagine the rubbish that Big Pharma would inflict on us if they were not required to do proper RCTs?
If that were allowed all pharmacology would become a morass of unproven claims, just as herbal medicine is now. [Yes, I know Big Pharma are not always honest about the results but that is a question of morals, not of the principle of causal inference]
It doesn’t help either that you conflate the two quite separate matters of randomisation and of surrogate endpoints.
I’ll be happy to send you any of my teaching material, but you evidently are still not happy to send yours. This post was about the enormous time, effort and expenxe that alt med people are willing to go to in order to conceal what they teach from the public. That, I think, speaks for itself.
I would be more thah happy to send you ALL of my teaching materials for human physiology, applied human physiology and environmental physiology that I have.
I will assume that will not make the same offer, then change the subject.
I work in a department that has recently had to undergo a merger with the Hogwarts department (soaking up the debt they were in in the process). I have “come across” some teaching material and a keynote lecture (on human biofields, 101 slides long) from the magic and medicine crew and it makes me sad to see what some of these young people are paying money to be “educated” in. Staff are also leaving and not being replaced to soak up the shortfall, which is effecting the eduaction and experience of many of the students here, something the dean of the school doesn’t seem to grasp. Although I suspect hands may be tied.
Just to reiterate:
I will send you ALL of my course material, David has said he will do the same. Will you, or like UCLAN, do you have something to hide. A simple yes no answer is all that we require.
Hello to you too, dangerous conventional! Or did you mean that sarcastically?
In which case, I’m puzzled by the example you choose, since it exactly confirms my point and disconfirms yours. Heart failure nurse specialists and neurology nurse specialists are examples of senior nurses who have received special prescribing training. The initial diagnosis was made by experienced senior clinicians who retain overall clinical responsibility. There are limits on nurses’ prescribing capabilities, and, most important of all, they are required to observe the principles of evidence based practice.
I’m also puzzled by your use of ‘primary end point data’ as if it was in some way incompatible with double blind randomised controlled trials. Do you misunderstand what it means? In designing a clinical trial, researchers always think first of the most desirable end point criteria. Sometimes you have to turn to interim surrogate measures, because the most desirable data are currently impossible to collect.
But I think I do understand the roots of your cognitive dissonance. As I’ve said before, medicine is an imperfect process. Drugs have side effects, because the universe did not design them for human benefit. Medicine has many successes, but there are many problems not yet fixable, and humans are both fallible, and, sometimes, influenced by non-rational factors (such as profit – or emotive belief systems). The way forward is through evidence based approaches, relying on the best science available, mediated (as evidence based medicine requires) by responsiveness to the individual and their situation. But in order to justify to yourself the investment you have made in your branch of alternative medicine, you resolve discrepancies between that and rational medicine by rejecting rational medicine. Your web name seems a clear sign of this.
Of course, there is another way. No one doubts that plants, while not magical, are a potential source of new medicines, as they have been in the past. If they pass the tests of rationality, of not fooling yourself about the outcomes, they become: – medicine. If they don’t, we go back and try again. There are individuals who have studied herbal medicine who don’t feel required to reject rational medicine – could you become one of them? Surely, exposing your course materials to study can only help? Where they are well founded, they can be commended. Where they make more contentious claims, these can only be strengthened by being exposed to comment and criticism. I look forward to your reply to David’s offer.
Allo V, your patience and restraint with our friend DangerCon are… well, “Olympian” is the word, I think.
I hope it is repaid with some humility, or at least an attempt at engagement. Though I know which way I’m betting.
I’m also puzzled by your use of ‘primary end point data’ as if it was in some way incompatible with double blind randomised controlled trials. Do you misunderstand what it means? In designing a clinical trial, researchers always think first of the most desirable end point criteria. Sometimes you have to turn to interim surrogate measures, because the most desirable data are currently impossible to collect.
I was referring to the fact that drugs like simvastatin 40mg has primary end point data eg. reduction in numbers dying or significant MIs compared to a drug like rosuvastatin which came to market with just surrogate marker data eg. reduces cholesterol. Most QoF targets are based on surrogate markers eg. HbA1C and not evidence based targets eg. UKDPS showed that tight blood glucose control didn’t reduce macro and microvascular complications. So why do we chase surrogate markers in the NHS when there is no evidence to back them up.The argument against many conventional interventions is that they are not backed up by primary end point data. Even with this data would I want to take simvastatin 40mg with a NNT of 22 (in very high risk individuals) when a proper diet has a NNT of 8.
In answer to your thirst for herbal knowledge I did email David a dissertation I did (to help measure the standard, with the mark I received) and received no comment. I’m happy to send lecture material I do for pharmacy students. I would be unhappy to email other peoples lecture notes without their permission. For example, differential diagnosis was taught by a visiting GP. I must phone her up in the middle of surgery to ask if the good folks of Norwich can look at her lectures.
I note a get few replies when I throw EBM back at you. That’s the joys of having taken the trouble to study many different forms of medicine.I get the impression I’m the only one on this site who can say that.
To tell you the truth I can feel some sympathy with Danger Con, because his predicament is very human. He has a set of cognitive schema, in which he has invested time, money and belief. He can assimilate* new information which accords with these schema (essentially, rational medicine is only dangerous, and herbal medicine is only beneficent), but has difficulty in accommodating* new information which challenges them. My hoped-for role, therefore, is not that of ‘teacher’, giving new information, but ‘facilitator’, helping him (?her) to new schema. I think he resolves his evidentiary dilemma by evading it: by saying that one of the horns of the dilemma (the largely self evident statement that rational medicine is useful) does not exist. And no, I’m not optimistic about Danger Con ever admitting here that he will consider that he might possibly be mistaken. Still, I feel I have to try. Perhaps in the future….
Can you see that overstating your case does not help? No one but you has suggested that you phone a GP during her surgery. You wouldn’t get through, anyway. There would be no harm in phoning and leaving a message, or writing. Meanwhile, you could just tell us how many sessions on differential diagnosis you had, so we can compare that with a medical student.
With regard to EBM, I have already indicated that I think that rational medicine has risks (so we have to consider the risk/benefit ratio) and that primary end point data are desirable when feasible. (In my own research, the primary end point mortality and morbidity data would only be available after more than three decades, so I have to work with surrogate data – I’m not really as patient as the Olympians).
So, I don’t feel required to comment on your particular examples (other than to offer even better ones, like paracetamol!). However, I would be very happy to consider double blinded randomised controlled trials for herbal remedies compared to (a) placebo and (b) the best currently available rational treatment, with mortality and morbidity as the outcome measures. Please give me a reference list to studies of this kind – I would be most grateful.
As for studying alternative medicine, you make assumptions about the site contributors which I do not think are evidence based. In my case, I have taken an interest in homoeopathy over many years, and even submitted a preliminary research grant proposal and protocol to the Medical Research Council. But my homoeopathic research partner then pulled out of the study.
*technical terms from education theory, which David Colquhoun reckons is worse than homoeopathy!
Just wanted to wish everyone here a Merry Christmas and Happy New Year! That includes you, Danger Con, of course: but just wanted to advise that some OTC herbal remedies (the fermented or distilled juices of the grape and the barley, for instance) pose hazards when misused, and the risk/benefit ration has to be carefully considered. Cheers!
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Pedantry – only Parliament gets to “promulgate”. Everyone else just “publishes”.
You’d better correct David Farrar QC rather than me. The Information Tribunal’s document (the first link in this post) is headed “decision promulgated 8 December 2009”
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[…] The only thing that has worked was public derision. A combination of internal moles and Freedom of Information Act requests unearthed what was being taught on these courses. Like Westminster’s assertion that […]