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There is something very offensive about the idea that a ‘bachelor of science’ degree can be awarded by a university, as a prize for memorising gobbledygook.

Once the contents of the ‘degrees’ has been exposed to public ridicule, many universities have stopped doing it. All (or nearly all) of these pseudo-degrees have closed at the University of Salford, the University of Central Lancashire, Robert Gordon University, the University of Buckingham, and even at the University of Westminster (the worst offender), one course has closed (with rumours of more to follow).

 I’ve already written about the course in Traditional Chinese Medicine at the University of Salford (Chinese medicine -acupuncture gobbledygook revealed) and at the University of Westminster: see Why degrees in Chinese medicine are a danger to patients. The former has closed, but not the latter. Here is another one. One place that has yet to come under close scrutiny is Middlesex University. Michael Driscoll, VC of Middlesex University. The buck stops with him.

Their “Complementary Health” courses are as follows (April 2010).

I asked Middlesex University for samples of their teaching materials under the Freedom of Information Act, and, as usual, the request was refused. As usual, I then asked for the mandatory internal review of the decision, and this time, most unusually, the internal review did not confirm the initial refusal and I was sent a bundle of teaching materials about Chinese Herbal Medicine, It was not all I asked for, but it is quite enough to show the absurd ideas that are still being taught as part of bachelor of Science degree in a UK University.

Not only are the ideas absurd, pre-scientific, indeed antiscientific.  They are also dangerous. People who have been taught this nonsense are going out and being let loose on sick people.

The vice-chancellor of Middlesex University, Professor Michael Driscoll, is an economist, not a biologist. Surely you don’t need to be a scientist to feel a bit suspicious when you read on the Middlesex web site about

Traditional Chinese Acupuncture and Moxibustion including distribution of meridians-collaterals and location of acupoints; needling and moxibustion techniques;

Have any of the members of the Executive ever thought to ask about what goes on in these courses?  Even if it is beyond an economist to see through the nonsense, surely it should be possible for Professor Margaret House, Deputy Vice-Chancellor Academic, whose interests lie in water quality, should be able to, though as Dean of the School of Health and Social Sciences she appears to sponsor the nonsense. And Professor Waqar Ahmad, Deputy Vice-Chancellor Research and Enterprise, who has written a s book on Ethnicity, Health and Health Care, should surely be able to distinguish sense from nonsense in health care? In that respect, I’d have less confidence in Katie Bell, Chief Marketing Officer, who joined Middlesex University in 2009 following a career in brand marketing for Nestlé UK and GlaxoSmithKline Consumer Healthcare. Marketing people seldom have much regard for truth.

Have any of the University’s Governors ever asked what is going on in their name? It’s true that none of the long list of distinguished-sounding governors is a scientist. Surely you don’t need to be to question whether or not what follows can be described as ‘science’.

My guess is that none of these distinguished people has ever bothered to look at the dangerous nonsense that is being taught in their University.  It is not in the nature of ‘managers’ to look far beyond ticked-boxes and profit,  They should have done of course, but to make it easier for them, here is a small selection of the slides that I was sent (the copyright for them lies with the university: these few slides come under the heading ‘ ‘fair quotation’ and it is undoubtedly in the public interest to show them).

Course CMH 1211

e

Uhuh, my spleen qi is well and truly knotted already though when I learned physiology it was not thought that the spleen had much to do with emotions.

Ah so at least the problem of heavy breathers is solved. But high temperature, abdominal pain and abnormal pulse can be signs of serious illness. If your only explanation for them is “preponderant evil Qi”, you are a menace to public health.

All these symptoms could be the result of a serious disease. It is not only antiquated nonsense to talk about them in terms of Yin, Yang and Qi.  It endangers people,

Course CMH 2212

Chinese materia medica.  Some of the herbs are likely to contain active ingredients (indeed some are very dangerous). It would be quite possible to study the ingredients of these herbs and to investigate how they work in the light of what has been learned about physiology and pharmacology in the last 200 years.  Pharmacology has a long history of doing that,  But is seems to play no part in this course.  Herbs are “cold” or “hot” and may “check the exuberance of yang”.

and so on, just preposterous, made-up nonsense from another era.

If it were taught as cultural history, it might be interesting. But it is being taught as though it were true, and an appropriate way to treat sick people.

Course CMH 3214

Would you trust your child to someone who’d been taught that “causes of paediatric diseases are relatively simple”, and “children are pure yang”?

Now some Chinese recipes

Course CMH 3100

This may or may not taste good, but to recommend it for diabetes is seriously irresponsible.

The programme specification for the “BSc (Hons) Traditonal Chinese medicine” can be found here. [local copy download]

It is written with all the official trappings, just as though the degree was about science.  It isn’t. It is a danger to public health.

I have asked the vice-chancellor, Michael Driscoll, to express his view of these comments

### Follow-up

A rather unexpected comment from a London acupuncturist.

“At least,I knew that Professor David Colquhoun is very skeptical about Chinese medicine. he comment Chinese medicine study”not only are the ideas absurd, pre-scientific, indeed antiscientific. They are also dangerous. People who have been taught this nonsense are going out and being let loose on sick people.” “

“But,I still like to read his blog as His article very is respectable. I think. Look this…”

The skeptic blog featured this post in its weekly roundup.

27 May 2010.  Times Higher Education reported the decision of Middlesex University to close its philosophy department. This department seems to have a remarkable reputation, not least for a post-1992 university. Three academics and four students have been suspended and gagged in classical bullying style.

This has happened while they continue to teach dangerous rubbish like that described above.

I left a comment at Times Higher, as follows.

It is a reflection on the quality of university management that Middlesex has chosen to shut its philosophy department while continuing to run degrees in quackery. These courses not only offer an Hons BSc for memorising chunks of anti-scientific nonsense. They also pose a real danger to patients. See http://www.dcscience.net/?p=2923

I can think of no better illustration than this of the crass nature of the judgements made by Middlesex’s management. They are either ignorant of what constitutes science, or they are corrupt. I see no other possibilities. In either case they should not be running a university.

I think Prof Michael Driscoll owes the world an explanation.

## 114 Responses to More quackedemia. Dangerous Chinese medicine taught at Middlesex University

• Eric the half says:

@DC

Marketing people seldom have much regard for truth.

I’m looking forward to seeing the evidence base for that odd remark.

• jaffathecake says:

Excellent work exposing this stuff

• Allo V Psycho says:

@Eric the half: some useful info on health marketing at http://www.quackwatch.org/

• Teige says:

Well Eric, I surveyed 250 of my father’s finest horses for signs of agreement with the statement: “Marketing people seldom have much regard for truth.”

My results were 53% in agreement with a standard deviation of ±2.4 bushy tails.
And we all know that horses are not succeptible to the placebo effect.

http://www.prwatch.org/ <- That might be a good place to start if you want to see whether the comment was reasonable.

• phayes says:

A BSc course! Blimey! It’s not even high quality pseudoscience like the homeopaths sometimes come up with. It’s more like some of the looniest, most imbecilic stuff you can find in e.g. the web pages catalogued by crank.net.

• Sili says:

I wonder how many Jewish vegetarians are fans of ‘TCM’.

• neoconnell says:

This academic school contributed to a recent trial of electro-acupuncture for OA knee that was published in the rather prestigious journal “Pain”: http://www.painjournalonline.com/article/S0304-3959(09)00451-5/fulltext

The trial is remarkable in that it fails to meet almost any quality or risk of bias criteria but draws some bold conclusions such as electro-acupuncture provides pain relief “clearly beyond that of placebo effects” (see our letter on it here: http://www.painjournalonline.com/article/S0304-3959(10)00071-0/fulltext ).

It is well worth reading the authors response to the letter with the grandiose title “in defense of science” http://www.painjournalonline.com/article/S0304-3959(10)00070-9/fulltext

So it may not just be the teaching that is questionable. Of course I may just have knotted spleen Qi that makes me pensive/ overthinking etc.

• CdrFuzz says:

All sounds totally legit to me. I suppose next thing you’re going to tell me is that affixing a set of ram’s bollocks to my forehead for 2 or 3 days is not an effective treatment for migraine.

Seriously though, a bachelor of science degree? Do they also sign your degree certificate in crayon?

• jstreetley says:

While it isn’t quoted on the Middlesex University website, they also use their degree awarding powers to validate a “BSc (Hons) Homeopathy” course at the Centre for Homeopathy. http://www.homeopathycollege.org/

Middlesex really need to pull their finger out and stop these degrees and the legitimacy that a BSc degree gives them.

• DMcILROY says:

I would have thought the bit about channel tropism would have been right up your street DC.

• @DMcILROY
Haha yes, I was tickled by channel tropism. Perhaps they should be invited to do our course http://www.ucl.ac.uk/Pharmacology/matrix.htm

• redjsteel says:

Mdx also offers Msci in Ayurvedic medicine and also in Chnese medicine (both are outpost collaborative degrees). Both involve practical placement, the former one in India or Sri Lanka (so, NHS patients, for the time being, are safe).

However, what I found the most fascinating was that both courses include compulsory “Social Research Methods” modules (one wonders if it is for ESRC recognition and if so, how could ESRC recognise it). One could argue that a Social Research Methods module perhaps (definitely?) is not the most appropriate for medically oriented (well…) courses (except if the body of the patient is perceived as socially constructed). It really fascinates me, because I use the example of Chinese medicine in my research training course for Ph.D. students to demonstrate failures of establishing research problems, validity and reliability. So, my imagination becomes active and I wonder how the participants of the above two Msci courses feel, after forking out the tuition fee, when they arrive to the first Social Research Method class and they hear from the tutor that “now we are teaching you how you demonstrate in your dissertation the anti-scientific nature of Ayuvedic/Chinese medicine and the ethics of doing research in these. The outcome of these will show that practicing them is unethical. This is the main learning outcome of this module”

• dbaynard says:

“There is something very offensive about the idea that a ‘bachelor of science’ degree can be awarded by a university, as a prize for memorising gobbledygook.″

This story particularly annoys me because I’m currently studying for a BA. But I suppose TCM and homeopathy are more appropriate for a science degree than what I’m doing… errm… Natural Sciences (at Cambridge).

I’m ashamed that people will leave Universities with what appear to be science degrees in pseudoscience, whereas I would only get what appears to be a Bachelor of Arts.

• @redjsteel
In fact the Middlesex students, like most others doing ‘degrees’ in magic medicine, also get a certain amount of conventional pathology and medicine. Since what they are told in these lectures contradicts directly what they are told in in the TCM lectures, one wonders how they cope.

It seems to be characteristic of magic medicine that people are brought up to believe simultaneously in mutually incompatibel ideas. They seem not to be worried by parallel universes.

One you have believed in one thing that isn’t true, the next half dozen come more easiy perhaps.

• Dangerous Conventional says:

Many thanks for the links David. I was wondering what courses to look at when I’ve finished my herbal medicine degree.

• Michael Kingsford Gray says:

If this were not so serious, it would be an hilarious joke.
I wonder what the recipients of REAL BSc’s in REAL science disciplines at MU think about their qualifications being rendered now worthless?

• Avoided Cranium says:

The kind of material you cite is bog standard TCM mythology used in China as the basis for diagnosis for treatment with both herbs and acupuncture. The clear lack of scientific rigour and misuse of the term “B.Sc” is bad enough, but there is another strand to the story of Middlesex. This course was set up originally as an offshoot of Beijing University. It has close associations with the Asante Academy of Chinese Medicine which is run by staff from mainland China.
You might wonder how staff are able to get exit visas from communist China to engage in these endeavours. The answer is that Europe is a rapidly developing export market for Traditional Chinese Medicinal herbs – both “patent” (pre-prepared) and raw herbs, and this is something the Chinese government is acutely aware of. China exports 240,000 tons of medicines annually, of which 200,000 tons are raw herbs. The exported raw herbs accounted for 20 percent of the country’s annual harvest. Herb plantation has become a new source of income for some Chinese farmers. Many provinces such as Hebei, Guizhou, Yunnan, Sichuan, Shaanxi and Shanxi have designated traditional medicine as a pillar industry.
Most of TCM exported to Europe every year are herbal extracts, worth $63.15 million. The next are TCM herbs, worth$44.04 million. About $13.96 million worth of patent TCM are exported to Europe annually, too. Ever playing the long-game, the Chinese see the promotion of TCM, and the consequent export of over 600 herb species growing exclusively in China, as a major part of their export drive to the west. If they manage to comply with the EU ruling on GMP (Good Manufacturing Practice), then TCM products pass from “food” to the “medicinal” designation, attracting many times the profit level. What better way to market and promote expansion of this economic drive than to first find ‘tame’ British universities as a vehicle, and then to gain further respectability by allowing students to practise their “integrative” hodge-podge of pseudo-science in NHS hospital clinics such as the Whittington and North Middlesex Hospitals. The clamour for graduates with these so-called science degrees to be awarded statutory regulation, or Royal Charter, is all part of the same process of legitimising practitioners within the burgeoning Chinese export drive. As they say “Follow the money”. • @avoided cranium Thanks for that fascinating background. it is pretty clear that money drives much of the alternative industry, just as it drives Big Pharma. The main difference seems to be that at least some of the products of Big Pharma actually work. There is something ironic about China making money by selling TCM to the West -part of the profit goes, no doubt to setting up Western medicine in China, I’d like to know a bit more about what goes on at the Whittington and North Middlesex Hospitals. • redjsteel says: @avoided cranium Yes, in all the provinces listed TCM is a preferred field of investment. However, we are talking about the largest exporter of the world and TCM’s proportion of exports (even in the named provinces), is tiny, negligible. For China it does not matter (the farmers even less important – distributing subsidy is cheaper). On the other hand, there is no doubt that there are individuals (both in the Chinese bureaucracy and in Chinese business) who push such an export (and also some British-Chinese businesses found it as an opportunity for importing). So it is down to individual profits. While there is a good margin in TCM products, in my experience, it is lower than let’s say on furniture or wires. The argument is also problematic – Ayurvedic medicine is also offered at Middlesex and also Western Herbal Medicine Bsci (while the modules seem to suggest that it’s something serious, apart from some minor stumbles, the “student profiles” give story away). These points weaken the argument for the Chinese push behind magic treatment (at least the course leader for TCM at Middlesex is a member of the staff). Now, Middlesex, among many other courses in different disciplines, also accredits some rather strangely put-together counselling and psychotherapy courses delivered by various institutions around the country. I think the “Follow the money” is a good instruction, but in this case it seems that it is the university that tries to get any money from anywhere at any cost. It is not simply a question to the VC, but also to the Senate: do they really make more money in this way than by reputation (after all, these courses are relatively cheap)? Haven’t we been here in the late 1990s (OK, not in magic medicine)? David, knowing something of Chinese public finance, I would say that it is unlikely that the central Chinese government would see a penny from the exports of TCM products. At provincial level – perhaps (!) there would be some tax income from this. • Avoided Cranium says: The relative size of the TCM export market compared with the vast Chinese economy is irrelevent. In a country of dire rural poverty, no dollar earned is “negligible”. This is an area the Chinese government is officially seeking to grow via the Ministry of Science and Technology through its “International Traditional Chinese Medicine Program for Cooperation in Science and Technology”. TCM has its roots in an eclectic mish-mash of Daoist and Confucian philosophy, but to open up lucrative foreign markets, it is pushing the integrated medicine idea which “scientizes” the subject in order to make it more attractive to the vast health industries of the west. http://ie.china-embassy.org/eng/ScienceTech/iccst/t427577.htm “In 2007, Wan Gang, Minister of Science and Technology of China, called for the establishment of a TCM-based international alliance, to act as a body whose mission would be accelerating the globalization of the TCM sector. In addition, conference attendees pushed for the set up of an international TCM information platform combining TCM-related patents, glossaries and formulation libraries, which will help shorten the R&D cycle and reduce development cost. ” (Asia-lifesciences.com) No trade in China exists without the sanction of a complex pyramid of local and provincial bureaucrats who work within the umbrella of strategic aims laid down, and financially supported by central government. Many of the larger Chinese pharmaceutical companies are investing in traditional medicine sales as something which is an inroad into conventional drug supply, but also an export where the raw material and expertise is uniquely Asian, and therefore less vulnerable to replication and competition from western business. Chinese ministry-level endorsement of co-operation with European universities and pharmaceutical companies proceeds apace. It’s all part of a process to make primitive folk remedies acceptable to western science for the purposes of trade. http://www.docstoc.com/docs/3905979/SINO-EUROPEAN-CONFERENCE-ON-TRADITIONAL-CHINESE-MEDICINE-TCM-International-Cooperation/ They have the “product” – how can they “sling” it? Yes, Middlesex also does Ayurvedic. As India’s economy grows, the prospects of aping China’s traditional medicine national export drive has already begun. http://ecam.oxfordjournals.org/cgi/content/full/2/4/465 • redjsteel says: A bit further on this subject (as it came up) even if it is slightly off topic. Avoided cranium’s data comes from Helmut Kaiser Consulting’s 2009 market study on TCM. It may be correct – it is a reputable company. The reason I mention this is that from the raw import data of the EU it is impossible to identify how much of the imported herbs, spices and other vegetable preparations end up as magic pills, food stuff, components of supplements, additives in processed food, components of pharmaceutical products, etc. So, what classified as TCM in the statistics and market analyses is not necessarily the quack stuff. Thus terminologies vary massively: under TCM you have got “snake oil” miracles as well shikimic acid. The implications are massive. It is correct that one of the objectives of the Chinese government is to gain GMP and GAP, but the purpose of this is not selling quack herbs, but to become a main supplier to the pharmaceutical industry (e.g. the hike in Tamiflu production helped the sales of star anise extracts immensely). Having said that, the main market of TCM is China itself, then the rest of Asia (about 70% of exports), followed by the EU. However, China is also an importer of herbs and other extracts. Currently China’s share in the world export of herbal and plant extracts is very small: 2%, while it is a major supplier of raw material – so they want to go up on the value chain (especially as unprocessed TCM exports seem to be rather sensitive to economic cycles – 25% drop in volume during the current recession) and the emphasis on the ideology of TCM would be simply a marketing ploy and “legitimacy” argument in becoming a major supplier of extracts. Eventually, no doubt, they want to become a main player in the pharmaceutical industry. For this one they almost certainly will have to reduce hazardous material in their produce and to do this, they will likely create large scale production of herbs rather than small plot (as it is currently) and the same applies for manufacturing and storing of extracts. They will likely create a standardised classification and specification of the products. So, it’s not all bleak, it is actually a quite meaningful industrial policy. Which leads back to the original point: it is MDX University that wants to make money on selling courses on quackery. • redjsteel says: Sorry crossed postings. • JamesM says: David, Have you received any details of the various herbalism courses, whether extant or extinct? I’m curious to see their reading lists to see what species of herbalism they preach. • isobelmat says: @redjsteel; DC Actually I AM a social scientist with an MSc in Social Science Research from Leicester University (BTW some say the body IS socially constructed; shame Foucault is dead as he’d love this debate). And a paediatric nurse (trained at GOS, specialised in Neonatal Intensive Care) and a Health Visitor. AND an acupuncturist. I am pretty sure I can manage to understand these disciplines, and my practice in either allopathic or alternative health is enhanced, not confused, because of my background. It’s called ‘having an enquiring mind and not rushing to make sweeping statements without gathering enough information’, I think. I don’t experience conflict trying to work with different paradigms. I just use my intellect. Easy. • @isobelmat Aha now you mention Foucault, I begin to understand. Postmodernism is not yet entirely dead. I guess that anyone who believes that the body is socially-constructed (whatever that means) is quite capable of ‘believing’ simultaneously several mutually inconsistent ideas, as you appear to do. I cannot myself believe that such fantasies are in the interests of sick people. • Dangerous Conventional says: Some excellent points Isobelmat. Working in both allopathic and alternative health is the way forward. The Chinese and Germans have been doing this for decades. Still, they still have economies as well as common sense. • @Dangerous @Isobelmet There is no such thing as alternative medicine and real medicine, All there is is medicines that work and medicines that don’t. It follows that “integrated medicine” is merely a rather dishonest euphemism for mixing things that work with things that don’t. @Isobelmet seems to ne a bit confused about vocabulary. “Allopathic” is a homeopaths’ word for anything that isn’t homeopathic. I suppose that includes acupuncture and any number of non-homeopathic delusions. • Avoided Cranium says: Post-modernist influences are usually found in the sloppy subjective thinking of magic medicine. There is no right and wrong, there is no point in attempting a rational and objective scrutiny of reality – anyone using rational evidence based on the authority of a body of scholars is simply resorting to hegemonistic authoritarianism. Bang goes the Age of Reason, bang goes all the progress since the Enlightenment – hell, we’re not even allowed to call it “progress”. I think Foucault can Foucorff, he’s done immeasurable damage to civilisation. But are universities really going to endorse a system of primitive folk- medicine that’s based on the idea of substances that look or feel like the something you are treating? I wonder how many people who go into Chinese herbalists know what they are getting in those paper bags which they have to boil up into foul-smelling brews? A lot are old twigs and dried leaves, but animal products are used too. These are some of the typical “materia medica”. For example – Quan xe – buthus martensi or Scorpions. Yes dried scorpions are used to treat seizures and toxic sores – pretty much like the effgects of being bitten by one. Di long – lumbricus or Earthworm is another. Because they are wet, cool and wriggly, they are used to treat fevers and also hot joints with a reduced range of motion. Yum yum. Wu gong – scolopendra – Centipede. They are also cold and wriggly and used to dissipate carbuncles and neck sores. She tui – Snake Skin slough – used to treat superficial visual obstruction – such as opaque cornea, as after all the snake skin is semi-opaque itself. E jiao – Donkey-skin gelatin – like a good stew it’s supposed to be a blood tonic. Sang piao xiao – Oootheca mantidis – The Preying mantis – dried and crusty to soak up dribbling urine in the case of enuresis. Hai gou shen – Callorhius ursinus – Penis and testicles of the seal – for impotence, predictably. Wu ling zhi – Excrementum Trogopteri – Flying Squirrel Faeces. Used to alleviate pain and stop bleeding on the basis that when flying squirrels glide from one tree to another, they often smash into the tree-trunk causing pain and bleeding, and they say “Sh*t – missed again”. If can they survive this, the ‘reasoning’ goes, their crap must be good for you. There are many many more of these disgusting ingredients, all selected by primitive peasants for their magic properties. Why are these sort of superstitions being promoted by British Universities as a means by which to treat genuine illness? • Dangerous Conventional says: Or you could try the following; A recent meta-analysis of SSRIs found them to be no better than placebo for most forms of mild to moderate depression seen in clinical practice. JAMA 2010:303:47-53 So why the hell are we still using them when they are associated with GI bleeds.Still we could give them a PPI but then again there is now evidence of increased risk of fractures with these Safe Medication Use Regional Drug Therapeutics Centre. Wolfson Unit 2010. Plus the three fold increased risk of getting C. diff. Keeping taking the tablets folks! Do people really know what they’re taking when they open up the bag from the chemists? The crap must be good for you. • @dangerous I don’t think you’ll find many people defending SSRIs for mild depression, now we have some evidence. But your comment reminds me of the much-vaunted study that showed St John’s Wort is as good as an SSRI. In other words both are much like placebo. Science is hard because we aren’t allowed to make stuff up. • redjsteel says: I cannot agree more on the critical points on postmodernism and especially Foucault. His writings were attacks on Enlightenment purely for the benefit of intellectual comfort (instead of satisfaction). His “theory” is the laziness of the reasoning. And by the way isobelmat, the body cannot be socially constructed only our terms of the body can be. However, postmodernism is wrong about this too. The notion of socially constructed derives from the claim that there is no “proof of truth”. Indeed purely in theory there is not, but postmodernism abuses this basic point that has been known and discussed at least since Descartes. What it ignores that there is also practice (but it is too dirty for postmodernism), there is relationship between the practice and theory (that is there is truth out there) and all these are in the contexts of development of knowledge of the humankind (denied by postmodernism), which offers the truth in both relative and absolute sense. To achieve this, postmodernism deduces from history, from relationships, from causalities and it is contented in the perception of the unique in complete isolation (thus the attraction for the magic pills, which uses the same methodology). This is the denial of theory, knowledge, but representatives of postmodernism cannot say that – it would mean loosing the livelihood, their academic jobs. If they were honest, they would stop calling themselves intellectuals, academics – as this is the only logical outcome of their assumptions. Instead of this, they continue to claim that they are the “objective” scientist by denying the existence of science and scientific thinking, therefore the existence of the “objective”. They continue the poisoning of the well of knowledge. As to the subject of David’s post, Avoided Cranium is right and his/her examples are excellent. What seems to be taught at Mdx University is primitive supersitition in which there might some flower, but the weed grew over everthing. And we can grow those flowers without the weed. And Avoided Cranium’s last question is the real one. It is of course – for money and for satisfying academic complacency. But at the end we will learn that the downside cost is much bigger. • redjsteel says: @dangerous conventional To be quite honest, we should not give anything to moderate depression apart from empathy. The spontaneous recovery is pretty high (not to mention the problem of separating depression from anxiety and using BDI for screening instead of diagnosis). But the point is surely – sometimes with try and error, sometimes, hopefully, more systematically we disselect treatments. This is what does not happen in CAM – there is no basis for disselecting anything. Both selection and exclusion is purely arbitrary. • Dangerous Conventional says: Number of people taking seal penis is probably small beer in the UK compared to the 33,967,542 items for antidepressants issued in England last year (item growth of 8.2% so good to see that EBM is alive and well). Death on a stick diclofenac weighs in with 7,662,067. Had to wince today, had a patient on alendronate and a PPI (to stop the reflux from the alendronate). I could go on about the evidence base for alendronate but then again live is too short.Is alendronate the ying and the PPI the yang? The cause or the effect. • Wendy says: Hi DC. Are you investigating the Middlesex University validation of the B.Sc in Homeopathy available at the Centre for Homeopathic Education, Regents College, London? The B.Sc is not actually run by Middlesex University, but is listed within their website under UK partners here – http://www.mdx.ac.uk/search/index.aspx?q=Homeopathy Have you asked your usual questions about validation? This was the first homeopathy college set up in Britain in the new-age period. To the new-age homeopathic tradition it is very important. The B.Sc is advertised on the College website and on the SoH approved colleges listing. I did e-mail quackometer some time ago and asked him if you had done work on this, and, if not, to pass on my e-mail, please. I realize how busy you all are. Good luck in your work! • @Wendy Thanks for the reminder about that. I’ve now put in an FoI request to learn more about that too. The usual answer is to say that they don’t possess teaching materials. In other words they accredit courses without knowing what’s taught on them. I also sent a similar request to British Accreditation Council which appears also to be involved. On the face of it this appears to be yet another box-ticking quango that fails to do its job. We’ll see. • Teige says: Dangerous Conventional, stop me if I’ve assumed things about your position on the issue that aren’t true, it can be hard to tell with someone who enjoys the position of devil’s advocate. You clearly see problems with prescribing some medicines, and I think perhaps all of us here agree that prescribing SSRIs or similar drugs with little benefit and a measurable risk, should not be a careless act. Over-prescribing these drugs is worthy of real concern. You’ve alluded that you are a practitionner of some CAM practice. How does advocating treatments with minor benefit and minor risk help to ameliorate the situation of drugs with minor benefit and high risk being recklessly prescribed? How does attacking the evidence-based movement (you may not be but seem to) seek to ameliorate the situation? You seem to be working on arbitrary distinctions, between “paradigms”. Well, if the paradigm of evidence-based medicine is to determine what works, determine relative risk-benefit, and aim to give patients the appropriate treatment according to that, it should be working to fix the problems you identify. Assuming the system is in working order. Why not contribute to evidence-based medicine is you feel the system is broke? CAM advocacy and “anti-conventional” dosn’t seem a useful position from which to contribute to improving medicine. • Pedro Albuquerque says: Dear Professor David Colquhoun, Although I feel your approach towards Chinese medicine to be rather rude and based in ignorance, in the best interest of science I would like to propose a dialogue in which the Chinese medicine terms and concepts may be explained. I think you would agree that criticizing a subject without making any effort to understand it doesn’t sound very clever. Warm regards, Pedro Albuquerque. • @Pedro Albuquerque I don’t know what makes you think that I have made “no effort to understand”. By all means try to explain “Qi”, “Yin” and “Yang”. but you will have to explain them in words that are understandable, and in terms of concepts are falsifiable. I notice that you are in the business of promoting Chinese medicine at “Global Smile” so I hope you will be able to separate the science from the way you earn your living. • Dangerous Conventional says: Teige The point I’m making is that not everything in the world of EBM or cookbook medicine is rosy. Clinical studies don’t necessarily transpose to real life clinical practice. There is strong evidence from studies that PPIs are safe and effective. It is only with long term use in clinical practice that we now seeing issues with C. diff infections and increased levels of osteoporosis.Cookbook medicine can never replace the benefits of long term clinical experience. Something that both Chinese and Western herbal medicine offers. • JamesM says: Dangerous Conventional, “Cookbook medicine can never replace the benefits of long term clinical experience. Something that both Chinese and Western herbal medicine offers.” Are you suggesting that what has evolved into modern medicine lacks long-term clinical experience? Are you out of your mind? • Teige says: I had thought that clinical observations and case studies made a significant contribution in medical journals, completely unrelated to any matters of alternative medicine systems. Dangerous Conventional, your reply, although reasonable, does not persuade me any more that CAM advocacy helps evidence-based medicine in any way. Your message becomes immediately confused for most people, when valid criticisms of medicine are attributed to the “paradigm” of EBM and this is juxtaposed with CAM… However I think your role on this blog is perhaps to be valued, so long as it dosn’t only serve to polarise people against you; with the credulous and the sceptics either side of an arbitrary fence. Please do keep informing us of the un-rosy goings on; but don’t you think more can be fixed when discrimination is made on the basis of evidence (yes including clinical practice whilst understanding its limitations), rather than on the basis of paradigm and rhetoric? • Dangerous Conventional says: I think the problems with cookbook medicine were neatly highlighted by the problems we had with COX-2 inhibitors. Guidance by NICE was heavily influenced by “gold standard” RCTs such as VIGOR and CLASS. So how many people were harmed by these drugs? How many people are having strokes and MIs from taking diclofenac? Recent issues with PPIs, SSRIs, alendronate are leaving more and more people questioning the efficacy and safety of many forms of conventional medicines. Isn’t it time we spent our resources looking at safer and more effective natural therapies? The Chinese are. • @Dangerous Oh come on, why do we need to spend “our resources looking at safer and more effective natural therapies”. This suggests that you already seem to know that they are safer and more effective. But that is the whole problem. We know nothing of the sort. If any of them do turn out to be safer and more effective when tested properly, they will cease to be alternative and just become part of medicine, as has happened many times before, • JamesM says: Dangerous, When something in TCM works, it becomes part of medicine. Ephedrine is derived from a TCM herb. (It is is not particularly safe, and isn’t often prescribed.) The anti-malarial drug artemisinin is also derived from TCM (and has nasty side-effects). The methods of TCM have not changed, so why would their products be any safer? Just because their philosophy sounds cuddly? Most of the world’s mephedrone comes from China. A good number of TCM potions have been found to be spiked with dexamethasone. I think I know who I’d rather trust my health to. • Dangerous Conventional says: As I’ve pointed out on previous threads there are herbs which have been shown to be effective in RCTs such as ginger,agnus castus, hawthorn,boswellia, horsechestnut, ruscus etc. Even with evidence there is bugger all chance of finding them in the BNF. Note the trials were done of whole plant extracts and not single chemical constituents. Still I believe in looking at the individual rather than the cookbook as per NICE guidance. Treating blood pressure with a calcium channel blocker (induce heart failure or reflux due to relaxation of pylori sphincter) and a thiazide (precipitate gout and electrolyte disturbances) or treat someone with herbs which provide adrenal support and reduce visceral tension. I know which I would choose. Wonder what the public would choose? • JamesM says: DangerCon Why is this important?: “Note the trials were done of whole plant extracts and not single chemical constituents.” I’m interested in how ancient your herbalism philosophy is. • Lindy says: @Dangercon Perhaps you can explain precisely what is meant by “provide adrenal support “. An example of such claims of this ‘support’ is found in Boots blurb about its ‘Lactium’ anti-stress product: “Also contains B vitamins, magnesium and vitamin C, which help to support a healthy immune system and energy levels”. Lactium: more rubbish from Boots the Chemists. And a more serious problem This notion is so vague that I really don’t know what people are talking about. • phayes says: “Treating blood pressure with … Wonder what the public would choose?” I expect all but the graduates of courses such as the one described above would choose to keep their blood pressure. 😉 • Avoided Cranium says: “Isn’t it time we spent our resources looking at safer and more effective natural therapies? The Chinese are. “ This is the usual fallacy- that ‘natural’ = safer. There’s also nothing “natural” about sticking needles in people. The Chinese are not looking for safer herb based remedies – they are not adding to the traditional herbal materia medica which is well documented. What their pharmaceutical companies are doing is trying to flog TCM products to the west, alongside pharmaceuticals, to try to exploit the western New-Age concerns about big Pharma. In truth, the Chinese population are increasingly losing faith in traditional remedies. Chinese are flocking in increasing numbers to Western hospitals. Western medical doctors total about two million, while, in contrast, the number of Chinese practitioners has halved since the 1949 Communist takeover to fewer than 220,000. Traditional practices are increasingly being marginalised and regarded as an alternative therapy. Despite the potential for growth in exports of TCM products, there is a significant movement in China which is opposed to state endorsement of herbalism and acupuncture. One of these is Professor Zhang Gongyao, who describes TCM as “untrustworthy” and “pseudo-science”. “TCM doesn’t match the key elements of what we call science. There’s no reasonable logic to it, no solid evidence for it and it has no consistent effects,” he said. “TCM has no clear understanding of the human body, of the functions of medicines and their links to disease. It’s like a boat without a compass: it may reach the shore but it’s all up to luck.” Strange that, as the Chinese are bringing their medicine into line with the 21st century, people here in the UK are advocating swimming in the opposite direction. • Tom Morris says: I do enjoy these take-downs of universities teaching this kind of nonsense, but you always seem to ask somewhat rhetorically about non-scientists being responsible for these things. You’ll find that in any fight to rid the universities of bullshit quackery, there’ll be plenty of people who are outside of the science departments who’ll be willing to stand up and fight against the charlatans. Because the Bullshit Medicine crowd devalues the work of people in all real disciplines in the universities. People work hard to earn degrees both in science and in the arts and humanities, and then you get universities which offer B.Sc and M.Sc degrees in bullshit like homeopathy, Ayurvedic crap and traditional Chinese medicine – this devalues everyone’s qualifications, it devalues the universities that issue them, and devalues the university system as a whole. Plenty of people in the arts and humanities and in social science will be happy to rally to the call of the scientists in opposing medical quackery in academia – because they devalue our departments and qualifications too. The vast majority of the people I know in my discipline (philosophy) are dead set against bullshit and pseudoscience and would be perfectly happy to take part in organised campaigns against this kind of bullshit. I found out about this post because a philosophy Ph.D student pointed to it and compared it to how Middlesex have shut down their philosophy department but continue to fund crap like this. I think you are right about the business and marketing people: the managers are the ones who will let anything go so long as it turns a profit for the university, even if it is total bullshit. Preach on! There are plenty of us outside of science who agree with you and support closing down these quacks. • Dangerous Conventional says: Philosophy, now we are talking bullshit and a waste of tax payers money. As I’ve mentioned in previous posts the quality of the herbal medicine degree has been far, far more demanding and useful than the degree and post grad I did in pharmacy. I hope that arts courses like philosophy are the first to get the chop post IMF. With herbs it is better to give the whole plant and not just extract the \active\ ingredient. Herbs are a mixture of chemical entities which work synergistically in treating the individual.One such group of herbs are the adaptogens which are widely used in western, Ayurvedic and Chinese medicine.These are the herbs which provide adrenal support.I could go into the evidence but then again I think I’d be wasting my time. • @Dangerous I do wish you’d stick to the facts. You say “Herbs are a mixture of chemical entities which work synergistically”, but there isn’t a happorth of real evidence that the Synergistic effects” that are always cited by herbalists actually occur. You really must stop making stuff up. • Dr Aust says: \Herbs are a mixture of chemical entities which work synergistically in treating the individual.\ Snore. The first part of this statement is a fact. The second part is an article of faith, attested to by no evidence whatsoever. Or \not a jot\, if you prefer. (Well, save for the personal testimonials of determinedly one-eyed enthusiasts like DangerCon.) Sixty or seventy years ago conventional doctors often used herbs and the active ingredients derived from them side-by-side, or as alternatives. An example is Rauwolfia plant extracts and the alkaloid reserpine (a major component of the plant) for treating hypertension. The herb extracts quickly fell out of use because it was so difficult to get standardised preparations, and thus difficult to give patients reliable doses, and because the isolated alkaloid worked at least and well and was far, far easier to use. For some reason (largely a kind of religious fervour, as far as I can see) some people would like to take us back to the early 50s, or even the beginning of the 20th century, by going back to extracts of root and bark. As DC has put it: \Herbal medicine: giving people an unknown dose of an unknown mixture of substances of unknown effectiveness\ Now, some people’s revulsion at the modern world, and modern medicine, may be such that they prefer chewing on bark and leaves dished out by DangerCon and his/her mates to actual, er, medicine. But the idea that this is somehow better because it is, quote, \natural\, unquote, deserves to be laughed out of the building. • JamesM says: Dr Aust, Back to the 1950’s? Turn of the 20th century? DangerCon is *clearly* a remnant Coffinite from the 1840’s; a fad from the US that never quite burnt out. They were laughed out of court – and parliament – the last time they tried to establish themselves as serious practitioners. Back in the good old days, judges and MPs thought their astrological crutch was a bit dopey… Nothing changes with these plonkers. After all, it is “ancient wisdom”, like trepanning. • isobelmat says: Yes, OK, I accept that the term ‘allopathic’ is rooted in homeopathy and, therefore, anathema to many of your readers. I am guilty of using it as a cover-all term to describe a medical model perhaps different from the one I employ as an acupuncturist. In truth, I am uncomfortable with any of the terms in common use (conventional, western, alternative etc). I don’t know how to make distinctions. That is why I seek similarities, try to find where the common ground is. In doing so, I am aware of the potential for harm in ANY ‘medical’ intervention. I am also aware of the varied social and cultural settings health care (and symptomatology) takes place. The basic principles of Chinese medicine were formed in China. China is socially, politically, geographically, historically different from the UK so the response is different. But, I don’t think this is a country that is falling apart, the communist regime notwithstanding. Chinese people are not all naiive idiots. Neither do I believe the whole post-modern social constructionist stance, certainly where our physical form is concerned but, Foucault and his ilk made significant strides forward to help us understand how we see ourselves. The Birth Of The Clinic should be standard reading for anyone embarking on a medicine or claiming-to-be-medicine based career. The Chinese would say its b****cks. Experienced practitioners of Chinese medicine snicker at our pathetic attempts to understand humanity and the crude systems we employ. I bet there is an equivalent website (in theory if not reality, thanks to the repressive regime in China) going ‘fnar fnar’ at our science. It IS possible to be a safe, effective practitioner working with different paradigms. I do it every day; in my NHS practice, in my private practice. I see wonderful doctors and other – ahem – allopathic practitioners (after all, I am one) as well as shit ones. I see ‘alternative’ practitioners who should not be allowed to even breathe in the same air space as their clients, as well as people who have made huge changes to their clients lives. Why can’t we stop arguing? The fool believes himself wise; the wise man knows he is a fool. • isobelmat says: BTW @dangerous. Whilst it seems I might agree with the broad terms of your stance, there are anomalies. WTF? with philosophy? Please. It is because philosophy has been dropped as a discrete discipline in HE that arguments like the one on this blog are so bloody scattered! And if you make more derogatory comments about nurses…you need to account for them. Examples. Please. As said before, I know some serious numptys out there (o, someone may be saying the same about me in a parallel universe) but, come out and tell it like it is. • Dangerous Conventional says: Your comments, as usual, show a distinct lack of knowledge of natural medicine. Take an evidenced base herb like Vitex agnus castus. RCTs have shown the whole herb to be effective in treating PMS, unlike conventional rubbish (MeReC, 2003) yet when the “actives” are extracted eg. flavones and flavonoids they no longer work. MeReC Bulletin (February 2003) “Tackling Premenstrual Syndrome,”Volume 13, Number 3. NHS National Prescribing Centre Schellenberg R. for the study group (2001) “Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study.” BMJ;322:134-7 • redjsteel says: @Tom Morris You are perfectly right, there is a potential for a common ground against quackery – however, it should be against all kinds, not only medical quackery. So, there is a need to do so in social science (research question: if Britain was an animal what animal would it be – using beautiful structural equation modelling). Unfortunately, the pressure to increase revenue and the cuts undermine solidarity – accusations are flying: private (pharma) research funding in live science that does not cover any of the overhead, offer to any applicant who can pay the tuition fee and the airfare for “social science” Mscis. Both are true. And not only university managers, but unfortunately academics are busy parties in it. But – as you said, there is a common interest and it is strong. For the time being – the ethical stance of the individuals remains. @dangerous conventional Since TCM is purely speculative philosophy and as Avoided Cranium pointed out, TCM is today a business model – I cannot comprehend your argument against philosophy and arts (your intention is clear). Why don’t you just state: I believe in this for whatever personal/group/class reason, I am ready to obfuscate any of my arguments if necessary, I’m ready to be biased in selecting “evidence” and I’m willing to move the meaning of the discussion until any discussion becomes impossible and I will be vindicated. I would comprehend that. Oh, and the IMF will not be called in. We are not in the 1976 (among other things because in spite of the appearance, the economy is responsive to policy measures), the US does not need to force the UK to reduce the importance of the state in the economy (as in 1976), the government debt is mainly held in pound, so depreciation can easily reduce the debt and the world is more familiar with flexible exchange rates that it was then. The cuts in universities will be deep, but it has nothing to do with the IMF or, for that matter, with the state of public finance. The main issue here is that university financing needed a review, how it will not happen – the chopper replaces it. • Dangerous Conventional says: redjsteel the economy is responsive to policy measures err no. We have 0.3% growth with 0.5% base rates and £200 billion of QE. How many foreign bond holders will hold non index linked gilts in a depreciating currency with a yield of only 3.8%.Real long term yields will rise sharply once QE is reversed to stave off hyperinflation. This is going to be worse than the 1930s when we had the discipline of gold. • redjsteel says: @dangerous conventional This really goes far off from the post, but anyway, it is an important issue. I actually think that the best solution of the current situation is inflation, providing that there is sufficient time lag between inflation and interest rates. It would distribute the debt to most of the population and with a decent welfare policy, the most vulnerable can be compensated. Savers would loose (but the pension holders can be saved from this again with appropriate measures). Of these, I cannot care with foreign bondholders (and nobody should – if they did not hedge their bet, well, tough. In any case, they don’t represent a united front against the UK.). But it is fantasy. The UK is not in such a problem – all the recent bond issuances were oversubscribed. In any case you can continue QE to finance temporal shortage of liquidity for much longer than most people think (providing that the extra money is sucked back once the economy returns to stable growth). The economy does respond to policy measures: 1) we do not have a liquidity trap unlike the 1920s (crucial, because it shows that the government does not have a borrowing problem); 2) unemployment fell very little considering what happened to the private economy – the question is what would happen in the future: with Tories, the effort that went into maintaining the economic activity in the last two years would be wiped out and we would have to pay for it without getting the dividends, with other parties – I’m afraid we cannot know. 3) The disciple of gold existed only in textbooks – once it was tried, it ceased to work. It made more damage to the UK economy than any party: 1848, 1857, 1870, the Depression years. Since we don’t have supertitious belief (just to return to the post) in market clearing prices hopefully, we know that if there is saving in the economy, there has to be an overspending in other parts of the economy. So, if the private sector keeps on, logically, saving to recuperate asset value losses, the public sector has to overspend. It is this simple. But all these will not save many departments in many universities. • Dangerous Conventional says: I would agree this is a vital issue that needs to be discussed (something politicos aren’t doing) and it breaks up revising. There is no means of avoiding a final collapse of a boom brought about by credit expansion. The alternative is only whether the crisis should come sooner as a result of the abandonment of violent credit expansion or later as a final total catastrophe of the currency system involved. Ludwig von Mises. For those who don’t recognise the signs of inflation then look at the price of gold.From$240 an ounce when Gordon Clown sold our reserves to the current $1170 per ounce. The markets are starting to loose faith in the fait paper system. I think gold will hit$5000 an ounce when the dollar collapses due to the massive expansion of the Fed’s balance sheet (same as the BoE). It was this kind of expansion that led to the rise of inflation in the Weimar Republic with savers and bond holders being wiped out. This was later exploited by Hitler.

all the recent bond issuances were oversubscribed

Not surprising when the BoE is buying them. The trouble starts when QE is stopped by the major economies. The sudden tsunami of debt on the market will led to a sharp rise in global interest rates and also reduce the amount of available credit for the private sector. Still, they can always keep firing up the printing presses!
A guy worth listening to is Peter Schiff (who predicted the US sub-prime collapse).His predictions for 2012 are sobering.

• Pedro Albuquerque says:

Dear Professor David Colquhoun,

Sorry for the late reply, too much work at the moment. Please let me introduce myself. I’m a Chinese medicine clinician with 15 years of experience and CEO of global-smile.com. I’m also studying for an MSc degree in a Chinese herbal medicine programme from Westminster University, and recently I was invited to be the programme leader of a Chinese medicine post-graduation in a Portuguese University.

Let me thank you for accepting my invitation. When you say “try to explain “Qi”, “Yin” and “Yang”. but you will have to explain them in words that are understandable” you revealed the main issue of this discussion… How can you understand concepts that you never studied? Could you tell us in what did your effort to understand Chinese medicine consisted? Which books and Teachers have you consulted? Which courses have you attended?

By the way, due to the Polysemic characteristic of Chinese language you must tell me the context so I can provide an accurate translation of “Qi”, “Yin” and “Yang”. Generally speaking they are a classification methodology of the phenomena observed in clinic practice.

For example in your sentence: “Would you trust your child to someone who’d been taught that… “children are pure yang”?”. 纯阳之体 ChúnYángZhīTǐ Pure-Yang constitution refers to the infantile physiological features, marked by vigour, rapid growth and fast metabolism (especially if compared with the elderly). Does this explanation meet your requirements? And yes, in my practice is quite common for parents to trust their children’s to Chinese medicine.

To be continued…

• Pedro Albuquerque says:

(Cont. II)
But let’s check some other notions you have:
1)” More quackedemia. Dangerous Chinese medicine taught at Middlesex University”, “even at the University of Westminster (the worst offender), one course has closed”, and “It is written with all the official trappings, just as though the degree was about science. It isn’t. It is a danger to public health.”
a) In your opinion what is the problem of post-graduation courses about non-scientific subjects? For example, are you against an MSc about religion?
b) How can we improve the methodology applied in Chinese medicine research papers and show the existence, or not, of evidence? By closing the degrees on Westminster, Middlesex, and Southampton Universities, etc? Is that your solution? Instead of providing the proper scientific background, your idea is to close all programmes? Could you please explain this in detail?

2) “Not only are the ideas absurd, pre-scientific, indeed antiscientific. They are also dangerous. People who have been taught this nonsense are going out and being let loose on sick people”, and “It is not only antiquated nonsense to talk about them in terms of Yin, Yang and Qi. It endangers people”.
a) You are right in saying that Chinese medicine rationale is pre-scientific, the scientific methodology has only a couple of centuries of existence, but could you explain why in your view is Chinese medicine antiscientific?
b) Could you please show some evidence of why will Chinese medicine clinicians become dangerous by mastering the terminology of their own metier? We all are aware of the iatrogenic related problems, but I ask you to provide some evidence about this specific aspect of Chinese medicine.

To be continued…

• Pedro Albuquerque says:

(Cont. III)
Please don’t be offended but your approach could be comparable to a Physics Professor, PhD in acoustics but without any music training. When unable to read a sheet of music this professor creates a blog saying that music is preposterous, based in made-up nonsense from another era. Instead of starting a music course, study the subject or discussing it with music teachers, this impassioned Professor emphasizes that not only Music makes no mention to the Doppler’s Effect but also has several gobbledygook-like terms like “allegretto vivace”, “peu à peu” or “getragen”… Sounds silly? Yes, I agree…

A clean and clear dialogue between Western and Chinese medicine can only benefit our patients, for that to happen you should be more aware about the subjects you are criticizing. Would it be too much to ask you to try to avoid this fallacious approach?

Sincerely,
Pedro Albuquerque.

• @Pedro Albuquerque

Actually my main response can be based on something that you say yourself.

You are right in saying that Chinese medicine rationale is pre-scientific, the scientific methodology has only a couple of centuries of existence, but could you explain why in your view is Chinese medicine antiscientific?

Since you agree that Chinese medicine is not scientific, you must surely agree with me that it is wrong to offer Bachelor of Science degrees in it.  The reason that I think it is antiscientific is because it is taught as though it were science (despite the fact that we both believe that it isn’t).  This corrupts science because it inhibits critical thinking and teaches people to use ‘sciencey’ words to describe non-science topics.

Your attempt to define Yin, Yang and Qi make no sense to me at all. They are essentially mystical concepts that come from another, irrational, age. Difficult concepts in science rest ultimately on experimental observations, and give rise to testable predictions. No amount of reading would make mystical concepts like these ‘understandable’.

I’m often asked if it would be OK if it were described as a Bachelor of Arts degree rather then a Bachelor of Science.  I don’t think this would help much. A BA would be fine if TCM were being taught as cultural history, but it is not. It is being taught as a way of treating sick people.

You ask what I think about postgraduate work in religion.  I’m not keen on that, being atheist myself, but if people want to do it, that’s fine.  There are two important ways in which it differs from TCM.  First, sick people are not being given treatments that haven’t been properly tested, so there is little potential to do harm.  Second, I believe that many religious studies don’t need you to believe irrational things anyway, but are more like the study of history, palaeography and ancient languages.

You ask why I think degrees should be closed. One reason is that I believe that they teach things that are not true, and that endangers people. I think that you are suggesting that research will not be done if the courses are closed. But the standards of the courses are so low that the people who teach them do virtually no serious research at all. In fact such as they do is often aimed at self-justification, and obscures truth rather than revealing it.

On the question of danger you ask " Could you please show some evidence of why will Chinese medicine clinicians become dangerous by mastering the terminology of their own metier? ". Danger does not come from learning terminology, it comes from giving treatments than do harm, or do nothing but prevent the patient getting more effective treatment. The problem with mystical terminology is that it blinds people to the need to have evidence for what they do to people. As you know, there have been very many reports of contaminated and dangerous Chinese herbs (one of the latest MHRA urgent safety warnings is here).

TCM also endangers species like rhinos and tigers, for no good reason. And it involves intolerable animal cruelty, as in production of bear bile. These things have no place in a civilised society.

• Dudeistan says:

It is interesting that many Born Again Christians refuse Traditional Chinese medicine as they see it as pre-Christian paganism, i.e. an animistic belief system or quasi-religion.

This is of course another gross misunderstanding of paganism (not something I have signed up to, but there is an awful lot of guff written about pagans).

My point is that I see TCM as a sort of religious movement. In fact with the demise of Christianity itself in the UK, it seems hardly surprising that TCM and other forms of quackery have quickly filled the void.

Add to that the pressure on GPs being such that they have very little time to properly consult with their patients, an hour with a sympathetic acupuncturist can seem like a good deal for the ‘worried well’ patient.

As a corollary to the above, it is also interesting how many modern religions (Scientology, Mormons, Moonies and Baptist churches up and own the mid-west of America) cost their followers a small fortune in tithes and donations.

It seems that if the confession box or Holy Communion is not your thing anymore, why not join a wacky religion or go for some expensive alternative medicine sessions.

• Dr Aust says:

Well put, Dudeistan. What’s that quotation:

“When a man ceases to believe in God, he does not believe in nothing. He believes in everything.”

……….G.K. Chesterton

A line which has always seemed to me to explain much of Alt.Med’s appeal.

The power of science is that it enables you to do the first bit – though it is not compulsory – without doing the second bit. So perhaps we should modernise Chesterton’s statement with the additional sentence:

“Unless he understands science

• isobelmat says:

TCM has nothing at all to do with religion. That much I can say with utter conviction. However, TCM (and 5 element) recognises the spirit and how our health is influenced by it… Have you stopped spluttering, yet? Have you caught your breath? If you do not understand the concept of spirit then that does not make us who do wrong. You are just innocently ignorant. To explain multi-dimensional thinking to a three-dimensionally orientated mind is like trying to explain to Tom and Jerry that they are, indeed, two-dimensional charicatures entertaining an audience this is capable of three-dimensional understanding. No matter how much T & J protest they do not accept or believe this, it is impossible to explain to them from a 3D perspective that they are only 2D and their is more to the universe than their view. “There are more things in heaven and earth than are dreamed of in your philosophy, Horatio”. BTW, welcome Mr Albuquerque. An ally.

• Dr Aust says:

I’m suffering from a touch of multidimensional loss of perspective, since my eyes are glazing over. I can’t decide whether it is the two bottles of beer I had with my supper, or the dizzying gibberish IsobelMat just trotted out.

And I find it hilarious when Alt.Med people deny there are any analogies between what they do and religion, whilst simultaneously deploying the exact same arguments as the religions do.

Obviously I’m missing something. Probably a few dimensions.

• Dudeistan says:

Spirit?

• isobelmat says:

Dudeistan. Yes. Spirit.
Dr Aust. I came to this site to be informed. To that end, could you tell me what you know about the arguments ‘the religions’ deploy? I am asking your opinion and would really like to know more. Seriously. Years of nursing sick and dying children have done nothing to convince me that there is some sort of benevolent/malevolent Being, responsible for the whole world. The idea that there is an old scrote with a beard sitting on a cloud somewhere is ridiculous, as far as I am concerned. As you are clearly more informed or aware than I, please can you give me your perspective, especially vis a vis health/disease/illness etc? Is science the new religion? I do, in all seriousness and with respect, look forward to your reply.

• Dudeistan says:

What do you mean by spirit?

You said this: “If you do not understand the concept of spirit then that does not make us who do wrong. You are just innocently ignorant.”

What is the concept of the spirit you refer to?

• phayes says:

“If you do not understand the concept of spirit then that does not make us who do wrong.”

I think your ability to elicit a response from Tom & Jerry, rather than your understanding of the concept of spirit, is a better clue to the nature of the differences between us, isobelmat.

• Dudeistan says:

I feel short changed. I was hoping for an explanation of spirit.

• Iain says:

Dudeistan said “I was hoping for an explanation of spirit.”

In what terms would you like it explained?

Here are some of the spiritual goods: truth, justice, beauty, goodness. They are not material things. A scientist cannot prove that they exist by some sort of trial. Nor could he give us a cup of beauty or a cup of justice to hold and look at.

But we all know they exist. We know it in our hearts (not in a small compartment of our brains), which is how we approach spiritual things. We could undergo a painstaking inquiry into the neuro-science of appreciating beauty, and I’m sure someone’s getting a grant for that somewhere, but spiritual knowledge is available to all, not just scientists.

• Iain says:

David Colquhoun returns to one of his favourite criticisms everyone else “‘believing’ simultaneously several mutually inconsistent ideas”

Here’s one;

‘Home sweet home’

The scientist is the person who tells us that our home is not in fact sweet. It is mainly bitter in taste and after that salty. If you include the furniture, it is also acrid and quite sour to taste. ‘Well it will always be sweet to me, Mr Science’..

Chinese medicine follows its own logical consistancy, a fact that is absent from Colquhoun’s critique. You cannot simultaneously have Spleen Qi deficiency and have Spleen Qi excess. You cannot have Stomach Heat and a Cold Stomach at the same time.

What you can, of course have is cold dampness and heat pathology simultaneously present. For example, in the case of someone suffering oedema below and insomnia above.

I have seen some excellent results treating chronic oedema in people that biomedicine hasn’t helped. Diuretics may be proven to ‘work’, but the way they work causes damage, and is often insufficient for any kind of long term cure.

You are wrong to think that, if this stuff works, we can just take it and make it part of medicine. There is not one herb or formula(to become one drug) that treats oedema. There is a complex differential diagnosis that leads to herb combination strategies that simply can’t be taken out of their own diagnositic structure. If we could, it would be easy to do so, and why would anyone be unwilling? But we can’t.

If what I’m saying is true, that Chinese medicine can treat conditions that modern medicine can’t, then I would hope that our natural desire to help people would make us want to work just a little harder to reconcile the difficulties we have with living alongside premodern ideas about health in our medical culture.

Many doctors have no problem doing this. Either they are the irresponsible ones, as it seems this blog would have it, or they have seen the need that is out there and are in fact the ones doing the good thing – looking for answers in the right places.

Certainly, they are in a better position to criticise Chinese medicine that those who have not studied it in a serious way.

• @Iain
“If what I’m saying is true, that Chinese medicine can treat conditions that modern medicine can’t,”

Yes that would be lovely, but sadly what you are saying isn’t true. Or, more precisely, what you are saying is mystical mumbo jumbo that is so vague one can’t say what it means or devise any means of saying whether it is true or not.

But your statement that “Chinese medicine can treat conditions that modern medicine can’t” is easily tested with RCTs. You bring me the results and then I’ll believe you. But you know as well as I do that there are next to no such results.

I’m afraid you are just making stuff up, and that is dangerous for patients,

• Dudeistan says:

I still feel short changed. I was hoping for an explanation of spirit.

• Iain says:

I have no interest in bringing you RCTs, DC, because they so distort the practice of Chinese medicine in the process as to no longer be examining it. Same old circular argument. You’re asking something akin to setting up a RCT to measure ‘surgery’. But surgery doesn’t exist in the abstract – it’s the surgeon and his work that counts. You cannot double blind him – its absurd. There are definately ways of assessing Chinese medicine, but some common sense and good will is needed.

There is no ‘acupuncture’ that is seperate from the acupuncturist. There are herbs, and there are formulas, but to prescribe them blind is not Chinese medicine.

A sticking point in an argument is one thing, but this is more like talking to someone with bible-belt certainty in their own dogma (and consequent lack of interest in the other). The gospel of RCTs does not tend to all the problems in medicine. For your position to be respected, we’d have to hear more of your critique of RCTs and, dare I say it, science. But there is your blind spot.

• Avoided Cranium says:

@Iain

Okay, replace the “easily tested with RCTs” with “easily tested with statistically sound research” and your argument folds.

You assert that you can’t separate the acupuncturist from the acupuncture, or the surgeon from the surgery. Complete rubbish.
An intervention carried out in order to make a medical condition better can be tested for efficacy, whether it be an intervention involving filiform needles, or scapel and sutures. Take for example strictureplasty for treatment of Crohn’s Disease. Research shows that this procedure is relatively safe with statistically significant rates on non-recurrence of symptoms. We don’t hear arguments from surgeons that they should never have their work tested because the diagnostic and skill levels vary between individuals.

Most people will find it suspicious that, on the one hand you the Chinese TCM hospitals thinking it’s fine to do RCTs on both TCM and acupuncture, where strangely the results always seem to be “99.9% effective”. Or on the other hand you have the “mysteries of the East” argument invoked by the western practitioners to suggest that it’s all so profound and complicated that it can never be subject to rational objective analysis. A convenient cop-out, but it plays to the fee-paying customers of alternative medicine who want to feel that they are not only getting their aches and pains alleviated, but also having their chakras scrubbed clean too!

• Iain says:

@ AC

If you read my post, it says

“There are definately ways of assessing Chinese medicine, but some common sense and good will is needed.”

Its actually far more interesting than that, and there are new ways of assessing how mainstream medicine ‘works’ emerging too, which requires a bit of lateral thinking. But then I think what you refer to as objective and rational analysis, for all its successes, falls short on many counts, including the problems of bias. It leads to toxic interventions, which the public are increasingly informed about and wary of, and leaves large gaps in care.

Even what you call ‘statistically sound research’, which I think is a far more reasonable and achievable means of enquiry, needs to be thought through in a way that cannot be done with the often adopted hostile starting point (Professor Colquhoun’s) – lets see what we can take and turn into a biomedical intervention. But if your starting point is that exotic concepts about the body are obviously mumbo jumbo, you’ll never see beyond this position.

One of the things that concerns me, for example, is the difference between good quality Chinese medicine and poor quality Chinese medicine. I know what difference there is between the two. That’s why you don’t understand my point about surgery. The skill of the surgeon counts for a lot in terms of effectiveness in many situations – that’s not so hard to understand is it? You can’t go and buy some acupuncture from the chemist, like aspirin, you have to receive it from someone who is trying to do some good. Blinding it and placebo needling is the real nonsense.

• Avoided Cranium says:

The whole point of “objective and rational analysis” is to eliminate bias and subjectivity. I have heard so many alternative medicine people state, usually with a pseudo-medical pomposity, that such & such a treatment “had very good results”. As if their subjective opinion, often based on no representative sample size, no clinical investigations, was to be simply taken on trust because they said so. They “know” in a faith-based way. It’s strange how I never hear them say that a particular treatment was completely useless, had no benefit whatsoever, and so should be eliminated from their repertoire. We never hear this kind of talk, because so much of alternative medicine is based on the “positive affirmation” style of born-again Evangelists. After all, doubt and left-brainism are the works of the Devil.

If using “exotic concepts about the body” reliably got repeatable beneficial results beyond placebo, then I think any clinician would be interested enough to overlook the woo. But it is the TCM starting position that requires some leap of faith from the orthodox scientist that is at odds here. It reminds me of Harry Houdini who was desperate to contact the spirit of his dead mother, which many mediums he visited said they could. When he started to question the nonsense they were telling him, many said that they couldn’t get through to the other side because of bad energy being put out by “a disbeliever” at the séance table. Actually he wasn’t a disbeliever at all, to start with, but he was aware of the fallibility of humans to see and hear things which aren’t there. The starting position of the Houdini’s medium is very much like the TCM practitioner, because it creates a self-fulfilling prophecy.
Either (A) Houdini uses his rational mind to question whether the purported maternal messages were specific enough to not be accidentally accurate or fake.
Or (B) he closes down his powers of reason, observation and knowledge of mentalist techniques, and just accepts what he his told.
The first according to the medium, destroys the evidence. The only remaining approach is irrational subservience to the power of another individual, with an experience that has no meaning outside its own self-referencing reality.

“One of the things that concerns me, for example, is the difference between good quality Chinese medicine and poor quality Chinese medicine. I know what difference there is between the two. That’s why you don’t understand my point about surgery. “

So this is a roundabout way of saying that if Chinese medicine can’t be shown to work, then it’s because it was performed by a poor practitioner. But if someone’s disease goes into self-remission, as many do, then it’s all down to the skills and intention of their healer. If they don’t, it’s because the practitioner didn’t know what they were doing. Another circular argument that defies objective quantifiable analysis. Another convenient cop-out, again one that I don’t hear NHS surgeons using in the context of common surgical interventions. If you are saying that half the Chinese herbalists and acupuncturists in this country have insufficient training and experience, then perhaps everyone should stay well clear until they can start to get more consistent results as practitioners. The truth of the matter is that these are all lame excuses to cover up the fact that, despite the many colleges of Chinese medicine churning out graduates since the seventies, these practitioners have been unable to come up with any sound evidence of efficacy. Like Houdini, many people are getting a little tired with the prevarication, the pre-conditions, the excuses, when all they want is straightforward evidence to back up the endless claims.

• Dudeistan says:

Therapeutic Touch (TT) is another altmed practice like traditional acupuncture and homeopathy. TT practitioners try to identify an aura or Human Energy Field (HEF) that is claimed could be manipulated to diagnose disease and improve the well being of the patient. They do this by hovering their hands over the patient.

An American researcher called Emily Rose carried out a single-blind study to test the ability of TT practitioners to accurately ‘diagnose’ the HEF. Her study concluded that the null hypothesis cannot be rejected at the the subjects, with only 123 of 280 correct in the 2 trials, did not perform better than chance. In other words Rose demonstrated in a very simple study the nonsense of TT.

Pretty remarkable given that Emily Rose was only 11 at the time (the youngest person to ever have a paper published in a peer reviewed medical journal).

If an eleven year old can test an altmed practice, why can’t alternative practitioners do it themselves – or do they not want to?

• Lindy says:

Whilst not suggesting for a moment that this human energy field means anything I wonder if this the study you mean?

A Close Look at Therapeutic Touch
Linda Rosa, Emily Rosa, Larry Sarner, and Stephen Barrett JAMA. 1998;279(13):1005-1010. April 1, 1998

• Lindy says:

Plants that die if you use microwaved water on them anybody?

I googled Emily Rosa and microwaved water, you get this:
http://www.execonn.com/sf/

‘Below is a science fair project that my granddaughter did for 2006. In it she took filtered water and divided it into two parts. The first part she heated to boiling in a pan on the stove, and the second part she heated to boiling in a microwave. Then after cooling she used the water to water two identical plants to see if there would be any difference in the growth between the normal boiled water and the water boiled in a microwave. She was thinking that the structure or energy of the water may be compromised by microwave. As it turned out, even she was amazed at the difference’, and then somescepticism:

• Dudeistan says:

That’s the one.

http://en.wikipedia.org/wiki/Emily_Rosa

The date? April 1st? Fools day?

• Iain says:

Avoided Cranium says

“The whole point of “objective and rational analysis” is to eliminate bias and subjectivity.”

But it doesn’t, does it. This is an article of your own faith. It’s a nice theory, leading to some good results, but it falls very short of the truth. If you aren’t aware of the facts that back up my assertion, you haven’t been looking closely enough.

You also say

“So this is a roundabout way of saying that if Chinese medicine can’t be shown to work, then it’s because it was performed by a poor practitioner.”

No its not. But it points to some of the problems with trials performed by clunking scientists with a non-grasp of the culture acupuncture comes out of and what acupuncture, therefore, is. It also leads to many other important implications for understanding what it is we are assessing, guaranteed to be ignored by polemicists like DC.

The type of puritanical scientist position taken up by taken up critics on blogs like this are not generally held by those who actually practice medicine with close proximity to patients – there are reasons for this that have nothing to do with ignorance or stupidity, but come from understanding something about healing (which is virtually a dirty word, I realise).

• Dudeistan says:

I work with patients. I think sometimes acupuncture works, through a combination of subtle neurophysiological effects and placebo.

This is not unusual. All orthodox treatments in medicine work though a combination of biological effect and placebo, be it medication or surgery.

However, in terms of cost benefit analysis one hopes that the tax payer’s hard earned money pays for treatments heavily weighted in favour of any potential biological benefits over placebo effects.

The process of testing as alluded to by many contributors to this forum helps us identify actual biological changes as opposed to placebo effects alone.

You are right to suggest that such tests do not apply to Traditional Chinese Medicine, because TCM’s philosophy is based on belief, not science. Testing beliefs (e,g, TCM or religion) is impossible with an RCT.

That doesn’t mean to say acupuncture – stripped of TCM’s quasi-religous interpretations – cannot be tested as a simple pain reliever or anti-emetic.

If you are suggesting that TCM acupuncture is much more than that then you must be believe that it works at a spiritual level.

• Iain says:

I agree in a round about way with a lot of your post, Dudeistan. But I sense you are still trying to make life easy for yourself by equating TCM to a religion.

TCM’s philosophy is based on beliefs, yes, a fact that is much easier to see because it is, well, Chinese and ancient for the most part. But you imply that science is not based on belief, which is a position that can only be sustained if we think science is marching onwards unstoppably towards truth and will correct itself from any mistakes along the way, which is indeed what many people think (try defining why that is not a religion). We will perhaps only be able to judge how erroneous a belief that is in a couple of hundred years from now. But the RCT is born of a belief system – let’s admit that. Science is not the only human thing to ever extricate itself from the tyranny of belief.

The other main criticism your post requires is the question of ‘treatments heavily weighted in favour of any potential biological benefits’, which is obviously practical and straight-forward as an aim. However, there are still many problems emerging from the drug portfolio we already have and patients are only now starting to become savvy about this, picking and choosing when they take their doctors’ advice and therapy. Many doctors themselves would think twice about taking the drug they are prescribing to a patient for the very same condition.

Statistics about how ineffective many of these drugs are is coming to light, and their toxicity is the real reason why CAM therapies have made some inroads recently. Indeed, much of the evidence actually questions whether the biological benefits are being properly considered, even in the case of the near miraculous antibiotics. Until these questions are answered in a satisfactory way, I would say it is irresponsible to dismiss a radically different way of prescribing chemicals, Chinese herbalism, and question the motivations of those who would do that.

• @Iain
“But the RCT is born of a belief system ”

No, I think this is quite wrong. Have you never read R.A. Fisher’s Design of Experiments, and the huge statistical literature about how one can establish causality and minimise bias? RCTs are based on the soundest of mathematical/ logical/ statistical foundations. If you are not prepared to spend time learning about those foundations, perhaps you should be less vociferous,

• Dudeistan says:

@Iain
Herbs are herbs, Chinese or otherwise. If herbs have medicinal purposes that stand the test of RCTs then they should be used.

As to your perception that RCTs are born of a belief system, I suppose you are implying that orthodox medicine thinks it has all the answers. Well it doesn’t and never will. But at least it challenges assumptions, dogma and beliefs.

There are many examples of medical imperfections and dangers. But these have to to be taken in the context of huge improvements in morbidity and mortality rates. I cannot imagine for one minute these developments coming about because of TCM.

In fact TCM (or so its advocates claim) has been around for 3000 years. So why wasn’t smallpox eradicated with herbs at that time?

(P.S. I remember one of Benny Hill’s infamous recipes. “Take a mug of herb’s. Herb won’t mind!)

• Iain says:

No matter how beautiful or perfect the maths, there are still beliefs implicit within the RCT or statistical analysis in general. That’s the real sticking point in this non-debate. The very idea that we can be objective about human health, that we can take the human being out of calculations is a belief – noone’s proved that to be true have they?

If the information coming from RCTs is pure, unadulterated truth, then there is no reason to question it. The testimony of Andrew Wakefield is a fascinating tale of how statistical evidence gathering can miss vital facts (or potentially miss it). That he is currently on the receiving end of his own Inquisition says something about the uncomfortable conflict between truth, power and belief.

• @Iain
Since you sound so confident, am I right to think you’ve made a serious attempt to study the maths? Perhaps you’d care to explain exactly what the implicit beliefs are?

• Iain says:

I do have a background in maths, as it happens. I love maths and think statistics can be very helpful in medicine. But the application of maths in the field of medicine must be in response to enquiries that reflect beliefs.

I personally know two mothers who have seen their child receive the MMR vaccine one day and develop autism the next. Arguing from statistical analysis that the vaccine is safe overral is one response reflecting a belief in what the greater good represents in this situation. One step further would be to deduce that they are imagining the causal link and would indicate a belief in what the statistics can prove. Can anyone actually know that the causal link is not there for certain in these two cases (and the cases that came to Andrew Wakefield’s attention)?

If we show the success of the flu vaccine in any given year, the satisfaction we get from the results will reflect a number of our beliefs about the benefits of avoiding the flu as well as beliefs that cause us to overlook potential adverse effects. These kinds of considerations can be applied to any area of biomedicine. Some of the latest thinking in oncolgy is that cancer cell may be part of the body’s healing response – that may become a useful belief at some point and will represent a departure from the present beliefs about cancer.

Ultimately, answers to questions such as ‘what is health?’, ‘what is illness?’ and ‘what is a cure?’ underpin our medicine. The answers to these questions may appear blindingly obvious to you, but there are people who disagree with you fundamentally, and infact if we listen to how doctors talk to their patients about their illness we find all kinds of philosophy entering into the equation. Not only do individual doctors have different beliefs about what illness means, so do patients.

I find your attitude to be essentially totalitarian – you seem to think if everyone saw things as straightforwardly as you do (which is somehow belief-free), everything would be sorted out in time. The successes of biomedicine over the 60 years or so can engender a sense of faith in inevitable progress, but the critique of where biomedicine has failed to live up to its promise is missing from the equation. Your response is always to argue that we will only be able to overcome failures by plowing the same furrow, but that is a circular argument.

• Dudeistan says:

Quote from Iain: I personally know two mothers who have seen their child receive the MMR vaccine one day and develop autism the next.

Rubbish! I am the father of an autistic child so please don’t insult me with nonsense such as this.

• phayes says:

“I do have a background in maths, as it happens. I love maths…”

That’s just… Satanic. I think I’m going to need hypnotherapy to erase the memory of reading Iain’s posts in this thread. Feynman chasers just aren’t going to be enough this time.

• Avoided Cranium says:

Iain said:
“Some of the latest thinking in oncolgy (sic) is that cancer cell may be part of the body’s healing response – that may become a useful belief at some point and will represent a departure from the present beliefs about cancer. “

There is no thinking in oncology that suggests cancer is part of a healing response. The only rubbish fitting that description is by a medically unqualified author living in South Carolina with a book called “Cancer is not a Disease – It’s a Survival Mechanism”.
Little gems of new-age bilge include: “Cancer patients typically suffer from lack of self-respect or worthiness, and often have what I call an “unfinished business” in their life. Cancer can actually be a way of revealing the source of such inner conflict.”

This quack tries to silence critics by threatening lawsuits, but it’s worth looking at what Pharyngula said on his blog:

“Note that he has absolutely no credentials or expertise in medicine; he calls himself a “medical intuitive”. Yet he is dispensing dangerous, defeatist advice on how to manage cancer, such as recommending against chemotherapy. Have you had a loved one die of cancer? It was their fault. Do you have or have you had cancer? It’s your own damn fault for being so negative. “

http://scienceblogs.com/pharyngula/2010/02/andreas_moritz_is_a_cancer_qua.php

Iain, casually mentioning something as “latest oncological thinking” would suggest to anyone that respected experts (like UCL’s Professor Baum) might have published a new Lancet paper. It is nothing of the sort – just another American self-publicist and self-appointed guru – with another wacky trendy paperback to sell. If you genuinely believe this can be counted as serious oncological work, then you are barmy, and if you don’t, then you are dishonestly alluding to reference work that doesn’t exist. Either way, you cheapen your argument and lose what little credibility you had at the outset.

• Teige says:

“But the application of maths in the field of medicine must be in response to enquiries that reflect beliefs.”
You’re saying that there are some fundamental assumptions? You love maths so you’ll know all about conjecture and proof. You’ll know that science tries to base its conclusions on the most basic assumptions only, like that the world is real.
The application of mathematics in medicine is totally appropiate, are you suggesting otherwise? Or are you just saying that RCTs (etc.) don’t reflect reality? Or are you merely pointing out that the belief that RCTs do reflect reality, might be categorised as a belief?

“I personally know two mothers who have seen their child receive the MMR… Can anyone actually know that the causal link is not there for certain in these two cases”
Cautious knowledge has to accept a modicum of doubt, but clearly the evidence that MMR and autism are unliked is strong (perhaps other than a coinciding of the average manifestion of autism and the usual time MMR is administered). What makes these two cases different to every individual comprising the studies showing no link? Maybe you could do some lumbar punctures on the kids and try to infer something. You’d probably end up on the wrong side of the law.
“Beliefs” about how to determine causality are usually based on some substantial logic and evidence. What’s your belief based on?

• Teige says:

Oh P.S. I personally know an autistic person who did not develop their symptoms immediately after having the MMR jab.
I personally know a handful of people who’ve had the MMR jab and have not yet developed autism.

That kind of anecdote is just insulting here. Your earlier posts didn’t let on to your truly wacky ideas about medicine.

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