Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
Anti-science
In the discussion of magnets on the Badscience site, a Michael King says that 4ulcercare will be included in Part IX of the Drug Tariff because it meets the criteria of the Prescription Pricing Authority (PPA)
.
I presume this Michael King is Director of Planning and Corporate Affairs at the PPA, though he does not say so.
Michael King says
?There is no judgement offered about whether a product in the Drug Tariff
is more (or less) efficacious than any other, or the placebo effect.?
The criteria for inclusion in
Part IX of the Drug Tariff () include, in section 10 iii, ?They are cost
effective?
Will he please explain how a device can be cost-effective, if it is ineffective (relative to placebo)?
What the PPA says
Michael King has replied to my question by email (1 Mar 2006). He says
“The cost-effectiveness threshold for inclusion in the Drug Tariff is met if the ‘effectiveness’ of the device, as seen in data submitted by the manufacturer in support of the application, exceeds its cost to the NHS. ”
Sadly this is still ambiguous. It seems to suggest that that whatever data
are submitted by the manufacturer are taken at face value, without any attempt
to evaluate their quality. So I phoned King to ask if this was the case. He
was helpful, but he said that it was not the case. He told me that
the data were subject
to some sort of low level evaluation, short of the sort of evaluation that
NICE would do. This seems to contradict his earlier statement (above) that
inclusion in the Tariff implies no judgement about whether a device is better
than a placebo.
King said also that listing in the Tariff
“. . . is not a licensing decision nor a recommendation akin to the outcome of a NICE review”
The problem is, of course, that listing is seen as a recommendation by the public, by the Daily
Mail, and certainly by the manufacturer.
One thing, at least, is clear in this case. Whatever evaluation was done,
it was done very badly. But in order to try to find out exactly what evaluation
was done, and by whom, I’m having to resort to the Freedom of Information Act.
Watch this space.
What NICE says
Fraser Woodward (Communications Manager, National Institute for Health and Clinical Excellence (NICE)) writes as follows.
“The test of “cost effectiveness” applied by the PPA when determining whether or not a device should go on the tariff is very different to the way cost effectiviness is assessed by NICE”
That is pretty obvious, but how is the public meant to know that, when they hear that the NHS has declared a treatment to be ‘cost-effective’, that statement can mean two entirely different things according to which part of the bureaucracy the statement comes from?
Emails in my possession show that the Chiron Clinic is able to decide that nutritional supplements are needed for leg ulcers on the basis of an email (as well as magnets of course).
Read full entry on the original IMPROBABLE SCIENCE page.
Nobody knows the cost! But here is some information that I found by use of the Freedom of Information Act 2000…
Read full entry on the original IMPROBABLE SCIENCE page.
[This post was transferred from the old Improbable Science page]
It’s not just homeopathy. The Sunday Times, (26 February, 2006) reports that the National Health Service has fallen for another scam.
“IT COULD be called the Cleopatra Effect. Magnetic therapy, which has held the rich and powerful in thrall from ancient Egypt to modern Downing Street, is about to be made available on the National Health Service.
NHS accountants are so impressed by the cost-effectiveness of a “magnetic leg wrap” called 4UlcerCare that from Wednesday doctors will be allowed to prescribe it to patients.”
This is nicely timed to coincide with an Editorial in the British Medical Journal, by Finegold & Flamm (2006) (click to download pdf file). The editorial title was “Magnet therapy. Extraordinary claims, but no proved benefits“. They conclude
“Patients should be advised that magnet therapy has no proven benefits. If they insist on using a magnetic device, they could be advised to buy the cheapest – this will alleviate the pain in their wallet,”
For example, Carter et al,, 2002 found no detectable effect of magnet therapy for treatment of wrist pain Attributed to Carpal Tunnel Syndrome (30 patients,double blind, careful controls). Winemiller et al., 2003 (Journal of American Medical Association, 290, 1474–78), found no benefit of magnets vs sham-magnets in treatment of plantar heel pain in 101 patients.
Magnets are said to be one of Cherie Blair’s several curious and irrational beliefs. It is alleged, according to the Daily Telegraph, that “Cherie Blair did not allow her youngest child, Leo, to have the controversial MMR vaccine and instead asked a New Age healer to wave a “magic” pendulum over him”. A few more examples are documented here and here.
The accountants at the Prescription Pricing Authority have decided that the “the magnets will save money on bandages and nurses’ time by healing the wounds.” I dare say they could save even more money by removing all effective treatments.
The evidence in favour of the magnetic treatment all seems to come from a Dr Nyjon Eccles. The Sunday Times describes him as an “NHS GP in north London”, but elsewhere he is described as "Founder, CEO and Medical Director of the Chiron Clinic" in Harley Street. A look at their web site shows that they offer a full range of alternative scams. Cancer patients can get
“LYMPH DETOXIFICATION – This is achieved by non-invasive scalar, oxygen-fed light beam therapy. This helps to detoxify the tissues by assisting the body in dissolving lymph blockages and restoring normal lymph flow using the Nobel quantum scalar technology coupled with oxygen for remarkable healing potential.”
This is total gobbledygook, designed to take advantage of the desperate.
The only real evidence to be provided by Dr Eccles that the device works is a small (26 patients) double blind trial that has not yet been published in a peer-reviewed journal, and which suffered from a number of problems (dropouts, outliers). What, I wonder, does NICE think of evidence like this?
More on magnets and the PPA
In the discussion of magnets on the Badscience site, a Michael King says that 4ulcercare will be included in Part IX of the Drug Tariff because it meets the criteria of the Prescription Pricing Authority (PPA).
I presume this Michael King is Director of Planning and Corporate Affairs at the PPA, though he does not say so.
Michael King says
“There is no judgement offered about whether a product in the Drug Tariff
is more (or less) efficacious than any other, or the placebo effect.”
The criteria for inclusion in
Part IX of the Drug Tariff () include, in section 10 iii, “They are cost effective”
Will he please explain how a device can be cost-effective, if it is ineffective (relative to placebo)?
What the PPA says
Michael King has replied to my question by email (1 Mar 2006). He says
“The cost-effectiveness threshold for inclusion in the Drug Tariff is met if the ‘effectiveness’ of the device, as seen in data submitted by the manufacturer in support of the application, exceeds its cost to the NHS. ”
Sadly this is still ambiguous. It seems to suggest that that whatever data are submitted by the manufacturer are taken at face value, without any attempt to evaluate their quality. So I phoned King to ask if this was the case. He was helpful, but he said that it was not the case. He told me that the data were subject to some sort of low level evaluation, short of the sort of evaluation that NICE would do. This seems to contradict his earlier statement (above) that inclusion in the Tariff implies no judgement about whether a device is better than a placebo.
King said also that listing in the Tariff
“. . . is not a licensing decision nor a recommendation akin to the outcome of a NICE review”
The problem is, of course, that listing is seen as a recommendation by the public, by the Daily
Mail, and certainly by the manufacturer.
One thing, at least, is clear in this case. Whatever evaluation was done, it was done very badly. But in order to try to find out exactly what evaluation was done, and by whom, I’m having to resort to the Freedom of Information Act.
The results are here and here..
What NICE says
Fraser Woodward (Communications Manager, National Institute for Health and Clinical Excellence (NICE)) writes as follows.
“The test of “cost effectiveness” applied by the PPA when determining whether or not a device should go on the tariff is very different to the way cost effectiviness is assessed by NICE”
That is pretty obvious, but how is the public meant to know that, when they hear that the NHS has declared a treatment to be ‘cost-effective’, that statement can mean two entirely different things according to which part of the bureaucracy the statement comes from?
A good chance was missed to convey the facts and the science. Well below the BBC’s usual standard for science programmes.
Read full entry on the original IMPROBABLE SCIENCE page.
This entry has been transferred from the old IMPROBABLE SCIENCE page..
The Open University is a great institution. Its first vice-chancellor was Walter Laing Macdonald Perry . Before he took that job, he was professor of Pharmacology in Edinburgh (and one of my Ph.D. supervisors). He must be turning in his grave at the new OU course, K221 – Perspectives on Complementary and Alternative Medicine .
The course description sounds harmless enough, ” This course provides an accessible but rigorous introduction to complementary and alternative approaches to health.”. But just how rigorous is it? The game is given away when you see that the “experts” seem mostly to be true believers, people who make their living from alternative medicine. How can such people be expected to the merits of the systems of beliefs
that are the basis of their livelihood? It is rather like having a rigorous discussion about the existence of god in which all the course tutors are priests. Take some examples.
The bit about Testing Therapies is by Elaine Weatherley-Jones, She is in clinical practice as a homeopath. And as you might expect the three pages on the web about ‘testing therapies’ are highly partisan and selective. Try these quotations.
“In homeopathy, the vital force is said to be responsible for maintaining health, combating disease by recruiting the body’s natural tendency to cure itself. In the homeopathy model, disease occurs when the vital force is not working efficiently to keep the balance of health.”
“. . . in The Manual of Conventional Medicine for Alternative Practitioners : “The essence of alternative medical thought is that there is a vitalistic principle behind and encompassing any physical object”, explaining that “vitalistic” means that there are “objects which are non-physical in part or whole”. The vital
force of homeopathy and qi of TCM are non-physical – it’s impossible to see them, no matter how powerful an electron microscope was used. Qi and the vital force are ideas that are put forward to explain how the body heals itself.”
“Vital forces”? Which century are we living in? If this were offered as social studies, perhaps it would not matter, but the Open University is offering this course as part of a B.Sc. degree. Then we get the usual weasel words about the impossiblity of testing empirically whether alternative medicines (CAM) produce an effect, regardless of how they work. That is the important question. After all we are pretty vague about how some conventional drugs work. In a mind-boggling passage we are told that it is impossible to test CAM against a placebo, but quite possible to test CAM against an orthodox treatment.
It seems, incidentally, that the author’s grasp of pharmacology, and of the literature, is a bit weak. “. . . when Belon and his colleagues reported research in 2004 in the journal Inflammation Research , they showed that ultra-high dilutions of histamines (which are proteins involved in allergic reactions and causes, for example, inflammation of the breathing tubes in asthma) are active in influencing human cell activity. ”
Histamine (there is only one), is not a protein? This is meant to be a university course! Belon, of course, is a committed homeopath. This passage conveniently ignores the fact that his experiments have been repeated at least twice by respectable scientists, and they find no such effect. Surprisingly enough, they find that no drug gives no response. Amazingly, it seems that the OU would have us think otherwise.
The rest of the course seems to be much the same. The dispassionate expert on Herbal medicine is a herbal practitioner who makes his living from it, and is just as uncritical as one might expect in that circumstance. Unlike Weatherley–Jones, though, he does come clean (more or less) about the lack of evidence as to efficacy of herbal remedies (though that evidently does not deter him from practising the subject).
The “expert” on acupuncture , Rosey Grandage, is a bit more interesting on the history of her subject, but is every bit as committed to CAM as the others. She works at the University of Westminster as course leader of the Diploma in Qi Gong Tuina and also lectures on the BSc Acupuncture course. ” Rosey practices as a physiotherapist, acupuncturist and tuina practitioner in West London”. Hardly an unbiased observer. “ . . . it is this growing popularity which answers the question of whether acupuncture has a place in the modern world.”
Is it not obvious that the long persistence, and popularity, of an idea cannot possibly be used as an index of truth? One merely has to think of the long-persistent and popular ideas about the ‘one true god’. Clearly at most one of these can be true. The history of medicine is replete with popular and persistent ideas that turned out to be untrue. Take nux vomica . For hundreds of years conventional medicine regarded strychnine as a ‘tonic’. That persisted right up to the 1950s. But it became apparent that it just did not work, and strychnine, and the very word ‘tonic’, vanished from the vocabulary of rational medical people. You
won’t be surprised to find, though, that is still widely touted by fraudulent herbalists.
It could be argued that the course is intended as sociology rather than science, though the course description does not say so, and the course can count towards a BSc. Even as sociology though, it would seem better if the viewpoint of the tutors was rather broader.
The course books
I have now obtained copies of the three course books that were used for K221last year. They are indeed written largely as sociology not as science. But it is a highly biased sort of sociology, as one might have expected from the commitments of the authors. Although there are occasional references to lack of evidence, this does not seem to deter the authors from their relentless pursuit of the ‘integration’ of CAM into medical practice.
A superficial reading by a naive student might give an impression that the books are a “rigorous introduction to CAM”. The more sophisticated student is likely to see them as subtle, even insidious, propaganda. I won’t claim to have read all three books. Opening almost any page makes obvious their not-very-hidden agenda.
Here are a few examples from CAM: Structures and Safeguards (eds. Geraldine Lee–Treweek, Tom Heller, Hilary MacQueen, Julie Stone and Sue Spurr).
Chapter 5 (Homeopathy: principles practice and controversies) contains a ludicrously biased account ot the affair of Jacques Benveniste (see here and here ). There is no mention of the fact that his results were disproved at the time, and at least twice since, I know of only one group that has claimed similar results, and that group, like Benveniste’s, contained committed homeopaths. There is no mention of Beneveniste’s two Ignobel prizes. There is no mention of the fact that after he left France in disgrace, he went on to claim that the properties of the alleged memory of water could be sent by email, a claim so absurd that it has not persisted even within CAM.
This chapter uses the standard CAM trick of redefining the word efficacy. Rather than its usual meaning of having an effect greater than placebo, it is conveniently redefined to mean, roughly, ‘patients say they feel better’,
“Although the issue of whether or how homeopathic remedies ‘work’ is a major bone of contention for medical scientists, the fact that they perceive that the remedies do work makes it attractive to many orthodox medical practitioners.”
So that’s OK then. Don’t trouble yourself with what’s true.
Chapter 1 of ‘CAM: Structures and Safeguards’ has the title “Knowledge, names, fraud and trust”, and is by Geralidine Lee-Treweek. It is a fine example of relativism -almost post-modernist in style. This is a discussion of knowledge in which the words ‘true’ and ‘false’ barely appear. The student who lent me
the book has scribbled in the margin “If it is not true and right –then it is not knowledge”. Pass the student, fail the tutor . (in fairness, it has to be pointed out that the student passed with distinction, despite her scepticism.)
So does Open University course K221 really give you a “rigorous introduction to complementary and alternative approaches to health. ” No it seems that it does not. Here are some more reasons.
A student who has successfully completed course K221 has told me that
- “It was very anti-science and anti-orthodoxy in places”
- “I had several ‘discussions’ with her [OU tutor] in our online tutor group, some about her anti-vaccination stance and the fact that she was happy to give homeopathic anti-malarials to travellers.”
The argument that homeopaths at least do no harm ( see above ) seems to be destroyed by their advocacy of policies that will lead to more children getting measles, and which will contribute to the spread of malaria. There is an ultimate irony in OU tutors preaching against vaccination. Walter Perry, the first vice-chancellor of the OU, before he was my supervisor in Edinburgh, had been Director of Biological Standards at the Medical Research Council’s labs. In that job he had responsibility for introduction of polio vaccine in UK. That effectively eliminated the scourge of polio.
This is not what a real university should be doing, as part of a B.Sc. degree.
On 21 November, 2005, Dr David Spence appeared on the BBC’s Today Programme. He was being interviewed about a report that, he said, provided evidence for the effectiveness of homeopathy. In fact it does nothing of the sort.
Dr Spence’s paper was published in the Journal of Alternative and Complementary Medicine. It is not really research at all. They simply asked 6544 patients who had had homeopathic treatment whether they felt better or not. Half the patients (50.7%) said they were ‘better’ ot ‘much better’. A further 20% said they were ‘slightly better’. The patients who had homeopathic treatment were not compared with anything whatsoever!
This is reported in a straighforward way. What is quite ludicrous is the stated conclusion of the paper:
“The study results show that homeopathic treatment is a valuable intervention”.
It is obvious that there is not the slightest reason to attribute the answers given by patients to the fact that they had been given homeopathic treatment. That would be the crudest form of post hoc ergo propter hoc error. It does not even show that the homeopathic treatment was producing a placebo effect.
Papers like this do not add to human knowledge, they detract from it. By reverting to pre-enlightment forms of argument, they mislead rather than enlighten. To make matters worse, this work was done at public expense, by the Directorate of Homeopathic Medicine, United Bristol Healthcare, National Health Service Trust, Bristol, United Kingdom.
What on earth is a respectable hospital and medical school, like those in Bristol, wasting money with this sort of mediaeval hindrance to medical knowledge? We are truly living in an age of delusions.
Download the paper and see for yourself [ Spence DS, Thompson EA, Barron SJ. J Altern Complement Med. 2005, 11, 793-8. pdf file, 74 kb].
The Daily Telegraph recently published two reports about acupuncture. One said it worked. The other said it didn’t work. Needle cure effect ‘is not all in the mind’ By Catriona Davies, starts
Acupuncture has a genuine ability to relieve pain, scientists have found.
The other report was
Doubt cast on needle therapy for migraine By Nic Fleming, Health Correspondent, starts
Acupuncture is no better at reducing migraines than fake treatment, researchers say today.
A study involving more than 300 patients found the healing method did reduce headaches, but only by the same amount as placing needles at non-acupuncture points.
Unfortunately the Daily Telegraph‘s reporters did nothing to help the confused reader. No comment was made on the apparent contradiction. In this particular case, there is an obvious explanation.
The first (favourable) article was said to be published in Nature, though in fact it was published in Neuroimage (Pariente J., White P., Frackowiak , Richard S. J. & Lewith G. Neuroimage, 25. 1161 – 1167, 2005). Presumably the reporter had picked it up from a rather uncritical synopsis on the news site, nature.com. It was conducted on 14 patients with painful osteoarthritis. Contrary to the first line of the Telegraph‘s report (“Acupuncture has a genuine ability to relieve pain”), the work did not measure pain at all. In fact the summary of the paper says
“The three interventions, all of which were sub-optimal acupuncture treatment, did not modify the patient’s pain.”
What the paper actually did was to use positron emission tomography (PET) to measure ‘activation’ of certain parts of the brain when needles were inserted. Some parts were activated more by having acupuncture needles piercing ths body than by ‘stage-dagger’ needles which retracted and did not pierce the body. I have no criticism of these findings: my purpose here is to explore the apparent contradiction between this trial and another.
The second, unfavourable, report was of a much bigger study, 302 patients with migraine headaches. It was published by Linde et al. (Journal of the American Medical Association. 2005 293(17):2118-25). This study concluded
“Acupuncture was no more effective than sham acupuncture in reducing migraine headaches although both interventions were more effective than a waiting list control. ”
These two studies were on quite different conditions, used different methods, and very different numbers of patients. But suppose we take them at face value, are they not contradictory? No, not necessarily, because they used quite different sorts of control group.
The study that was reported as showing that acupuncture worked compared patients that had real acupuncture with patients who had treatment with “stage dagger” needles that appeared to pierce the skin but did not.
The study that was reported as showing that acupuncture did not work (Linde et al.) used a different sort of control group, acupuncture needles that pierced the skin but were inserted in the wrong places (as defined by the ‘principles’ of acupuncturists). No difference was found between ‘real acupuncture’ and control.
There is nothing incompatible about these two studies if one adopts the view that piercing the skin with a needle can produce a physiological response that makes the patient feel that other sorts of pain are less painful, but that it does not matter where the skin is pierced. The latter hypothesis means, of course, that all talk about “meridians”` and “energy flow” that acupuncturists use, is no more than mumbo jumbo.
Dr Lewith is quoted as saying, of the negative study, “This is a badly conceived study that just adds more confusion to the debate because it uses non-site specific acupuncture as a control.” Quite on the contrary, the Linde study seems more interesting to me, because it unveils the mumbo jumbo of meridians (at least for the particular points used in this study). Dr Lewith may find this conclusion unpalatable, but it is the obvious implication of this pair of studies.
Another study confirms that the principles of acupuncture are nonsense
A trial by Melchart and colleagues on 270 patients shows conclusively that acupuncture can indeed produce amelioration of tension-type headache when compared with no treatment, BUT the relief is produced whether or not needles are inserted at ‘acupuncture points’. Very similar results were found with ‘superficial needling at non-acupuncture points’. British Medical Journal, 15 August 2005. Yet again it is shown that the mumbo-jumbo of meridians and magic points is nonsense. Yet again, that is a good reason why universities cannot be expected to train acupuncturists. Our business is to minimise mumbo-jumbo, not to propagate it.
This letter to The Times points out the folly of making regulations that do not require any demonstration that the product works. Can you imagine a regulation for television sets that required only that they do no harm, but did not specify that they should show a picture?
| From Professor D. Colquhoun, FRS Sir, Congratulations on your report on the deficiencies found in complementary medicine practitioners (Body & Soul, January 10). In the face of such evidence it is natural to ask for more effective regulation of this very profitable industry. But the question is quis custodiet ipsos custodes? This question has serious implications for the universities as well as for the public (and the industry).The House of Lords report and the Government’s response to it, pointed out that the first step was to find out whether the complementary treatment worked (better than a placebo). They recommended that the Department of Health should fund research on complementary medicine, the first priority being to find out whether each therapy worked. The problem is that you cannot regulate properly an area when it is not, in most cases, known whether the product being offered has no effect above that of wishful thinking. This raises a serious question for universities, because it leads, naturally enough, to demands for better training. But how can a university run a course on a subject about which there is so little hard evidence? Tragically (for their own reputation), some of the new universities are running three-year BSc courses in such subjects as complementary therapies. I’m quite happy to believe that nice smells produce good placebo effects, but aromatherapy is not, by any stretch of the imagination, science, and in my view it is not honest to award Bachelor of Science degrees in it.The effect of such courses will be not to promote better regulation, but to give spurious respectability to an industry that, according to the Government, should (but does not) have, as its first priority, to find out what works and what doesn’t. Yours faithfully, DAVID COLQUHOUN, A. J. Clark Professor of Pharmacology, |
This is the story of my first incursion in to the fantasy world of alternative medicine.
I was asked by the producer of a television programme (QED) to look at a paper that claimed a beneficial effect of homeopathic treatment of fibrositis (Fisher, P., Greenwood, A., Huskisson, E. C., Turner, P., & Belon, P. (1989). Effect of homoeopathic treatment on fibrositis (primary fibromyalgia) British Medical Journal 299, 365-366.) [download pdf].
The homeopath, Peter Fisher, was kind enough to give me the raw data for re-analysis. Curiously. the two medical co-authors (apparently guest authors), neither of them homeopath, were reluctant to hand over the raw data.
It appeared from the paper that the crossover trial had been analysed incorrectly (each patient had been counted twice). When the results were analysed correctly, no significant effects were found.
Astonishingly, the British Medical Journal declined to publish the correction, but their rival, the Lancet, did so with alacrity (Colquhoun, D. (1990). Reanalysis of a clinical trial of a homoeopathic treatment of fibrositis. Lancet 336, 441-442.).[ download pdf ].
Incidentally, the result of this exercise, despite the fact that it had been commissioned by the television producer, was entirely misrepresented in the final TV programme. The producer was evidently less interested in discovering the truth, than in giving the public what he thought they wanted, i.e. wishful thinking. In this he must have been successful, because the first letter that I received after the programme was from a lady in Fulham, who asked me to recommend a source of homeopathic flu jabs for her cat.
It’s interesting, but not surprising that this correction has been universally ignored by advocates of homeopathy. Whether this is incompetence or dishonesty is impossible to say.
Both the House of Lords report on Complementary and Alternative Medicine, and the Government’s response to it, state clearly “. . . we recommend that three important questions should be addressed in the following order:”. (1) does the treatment offer therapeutic benefits greater than placebo? (2) the treatment safe? (3) how does it compare, in medical outcome and cost-effectiveness, with other forms of treatment?
These recommendations seem admirable, but they have not been followed. The money has gone, almost (if not completely) to projects that address the second and third questions, before it has been established that the treatments have anything other than a placebo effect. This interesting case is debated in Debate: UK government funds CAM research (Focus on Alternative and Complementary Therapies , 8, 397-401 (DC’s bit, pp 400-401)).
[Get PDF of whole debate]
|
Both the House of Lords report and the Government response to it, state clearly “… we recommend that three important questions should be addressed in the following order: . . .
These aims seem admirable, but to what extent do the projects that have been funded match these recommendations? The answer, sad to say, is that they do not seem to follow the recommended order of priorities at all. None of the studies in the first initiative (Tovey, Corner and Shaw) appears to address the question that the recommendations specify should be done first. With the possible exception of White, none of those in the second phase (Shaw, Barry, Weatherley-}ones, White and MacPherson) do. (Dr White, like most other recipients, has declined to provide any information about his project so it is impossible to be sure.) None really addresses ,the second priority directly. The third recommendation is worded much more vaguely than the first two, but it is The rationalisation given by some of the applicants for uncontrolled, or ‘pragmatic’ trials is that they are conducted under real clinical conditions and tell you what the patient actually thinks. It is quite true that, from the point of view of the patient, it does not matter in the least whether they feel better because of a placebo effect or because of a specific effect of the treatment. That is an important consideration but it is not the only one. If the first priority had been addressed first (which it has not) it is quite possible that the outcome could be that the entire effect could be a placebo effect. Such a possibility has been envisaged by no less a luminary of the CAM world than Peter Fisher (ref 1). If that were to turn out to be the case it might matter little to the patient but it would matter a great deal to universities, which are under continual pressure from CAM people to run degree courses (though only a few have acquiesced). If the whole effect were placebo, it follows that the ‘principles’ of homoeopathy, reflexology, etc. are mere mambo jumbo and so not appropriate for teaching in universities (or, indeed, anywhere else). The question of courses and ‘training’ cannot be considered until the first question is answered because, until then, we do not know if there is anything real to train people about. That is why it is the first priority. There would however, be a dilemma for clinical practice. The placebo effect does appear to be useful, so the question would then become how best to produce a good. placebo effect without too much intellectual dishonesty. Perhaps that is a question that deserves more research. The fact of the matter is that the Department of Health has ended up spending £1.3 million of public money in a way that directly contravenes the recommendations of the House of Lords and of the government (with one possible exception). They claim that this happened because very few applications were received that addressed the government’s first priority. That alone says something about the extent to which the CAM world is interested in tests against placebo hardly surprising since a negative result would destroy their livelihood. But, arguably, if few applications were received that addressed the first priority, then the funding should have been postponed until appropriate applications were forthcoming. The reason that this did not happen is, I fear, only too obvious. The judging panel was dominated by CAM people who clearly share the lack of interest shown by the rest of the CAM community in answering the most important question first. If such research must be done, because of public demand for it, it should have been organised by the Medical Research Council using the same criteria they would use for any other treatment. References 1 Fisher P, Scott DL. A randomized controlled trial |
This item appeared originally on my old Religion and Education page. It has been moved here because of the discussion that followed my review in the BMJ of Unscientific America and the discussion that followed, on this blog and on P.Z. Myers Pharyngula blog.
Until recently, the idea that the earth was created 6000 years ago was largely restricted to right wing religious fundamentalists in the USA. Now we have a government in the UK which seems to be happy that such “fruit-cake” nonsense should be taught at the taxpayers’ expense.
The following article, Good God Almighty, was commissioned by Punch magazine, which folded before it could be published.
It refers to the fuss that followed the discovery that a state-funded school was being run by extreme ‘young earth’ creationists. If you want to see just how extreme, look at the speech made by Steven Layfield, the head of science at Emmanuel School. The views expressed are so extreme that the speech was actually deleted from the web site of the Christian Institute as soon as the fuss blew up. Luckily, thanks to the Google cache, this did not work and you can still read it at here.
Good God Almighty!
or Jurassic Theology
[This article was commissioned by Punch, but the magazine went out of business before it was published]
OK class, settle down. Here is your quiz. Compare and contrast the following.
(1) ” . . if the Bible really is the Word of God – and the internal evidence is overwhelming – true Science will always agree with it.”
(2)Science teachers should
“Note every occasion when an evolutionary/old-earth paradigm (millions or billions of years) is explicitly mentioned or implied by a text-book, examination question or visitor and courteously point out the fallibility of the statement and, wherever possible, give the alternative (always better) Biblical explanation of the same data”.
[Steven Layfield, Head of Science at Emmanuel School Gateshead, 2000]
(3) “There are those that argue that Science and Christianity can be harmoniously reconciled . . . We cannot subscribe to this view”
[John Burn & Nigel McQuoid; ex-head, and head, of Emmanuel School Gateshead, 2002]
(4) “Then there is science. Science is a God-given activity. Scientists are 5using their God-given minds and God-given creativity to explore and utilise God-given nature. Sadly, biblical literalism brings not only the bible but Christianity itself into disrepute.”
[The Bishop of Oxford. The Rt. Revd. Richard Harries, 2002]
(5) “God created the world and everything in it.” “It is about 6000 years old”
[Kate and Simon, pupils of Emmanuel School, Gateshead, interviewed by Mike Thomson, BBC]
(5) [Jenny Tonge, MP:] “Is the Prime Minister happy to allow the teaching of creationism alongside Darwin’s theory of evolution in state schools?”
[Tony Blair]. First I am very happy.”
“Secondly, I know that the honourable lady is referring to a school in the north-east, and I think that certain reports about what it has been teaching have been somewhat exaggerated”.
The prime minister is right. Something has been exaggerated:
The idea that teachers realise that the scientific method involves not declaring the outcome in advance.
Clearly, the head of science at Emmanuel doesn’t. To proclaim, before looking, that one view (the literal interpretation of the bible) is “always better” might be expected of an itinerant preacher in the deepest bible belt, but that is the view of the man in charge of educating children at a state-funded English school.
It is a view that offends the Bishop of Oxford, and it is contrary to the views expressed by Pope John Paul II. But don’t worry, our leader is “very happy” with it. To give equal time to a simple assertion (that the earth was created 6000 years ago), and to the wealth of hard-won reasons for thinking it to be untrue, is deeply offensive to every scientist who is trying to fumble towards the best approximation to the truth that can be found. Rarely can a couple of teachers and one prime minister have managed to offend so many people, everyone from bishops to professors, at a single sweep.
Of course neither the prime minister nor anybody else knows exactly what Emmanuel School has been teaching (though the reports from the children themselves give us a good idea). The glowing report from OFSTED was actually the result of a “short inspection” which does not look at such details. The school has not been given a full inspection since 1994, before the serious zealots took control. Views such as those in the first two quotations are so obviously relevant to the quality of science teaching that you may well ask how OFSTED managed not to notice that the views of the head of science were at the very extreme edge of fundamentalism.
Consider also the following amazing coincidence. The team of inspectors who found no fault with the unusual science (biblical is always best) teaching at Emmanuel was almost the same as the team that inspected the Huntington School, York. At that school they said that there was not enough teaching of religion (in the narrow sense, as opposed to spiritual values in general). The Huntington head teacher Chris Bridge lodged a complaint against that report, and it was partially upheld by OFSTED.
Does all this mean that extreme fundamentalism has infiltrated OFSTED, or does it simply mean that the inspectors did not do their homework?
The latter is the more charitable interpretation, but the inspectors are not going to get the chance to ‘try harder next time’. Instead Her Majesty’s Chief Inspector, wrote a letter to the chairman of the governors, asking for “clarification”. Unlike most schools, the Emmanuel School does not publish the names of its governors in the school prospectus, and neither OFSTED, nor the Department of Education, knows who they are. OFSTED does give the name of the chairman as “Dr `Peter Vardy” (as does the school if you phone). It turns out that the learned Dr Vardy is one and the same person as Sir Peter Vardy, the man who gave the government two million pounds to pay for the school. Don’t worry about the “Dr” bit though –it is perfectly genuine. The University of Sunderland was generous enough to give him an honorary doctorate in business administration (after he generously gave the University £1 million). The Chief Inspector (by then changed) recieved a suitably emollient letter from Sir Peter, but did no investigation whatsoever. Ofsted gives the firm impression of having born yesterday.
It is hard to appreciate the manic fervour of Mr Layfield’s notorious speech from only two quotations. It used to be on the web site of the Christian Institute (www.Christian.org.uk), and that site is still worth a visit. Mr McQuoid is a major contributor (see quotation no 2), but other bits are well worth reading too, like the vigorous defence of beating children (don’t get me wrong –I know there are lots of sites that deal with that sort of thing, but this is different; it is holy beating).
Mr Layfield’s speech suddenly vanished from this web site shortly after Tania Brannigan (of the Guardian) told us what was going on. Luckily, though, some kind folks thought it was such an outstanding piece of work that should still be available to everyone (just go to http://www.darwinwars.com/lunatic/liars/layfield.html).
Time’s up folks. Put down your pens and now go out and vote.
This item appeared originally on my old Religion and Education page. It has been moved here because of the discussion that followed my review in the BMJ of Unscientific America and the discussion that followed, on this blog and on P.Z. Myers Pharyngula blog. Evan Harris MP and I were up against the head of fundamentist school that had been started by wealthy used-car dealer, Peter Vardy. Being rather daunted by the Oxford Union, I actually wrote down my bit. The order of speaking because Evan Harris had to rush back to the House of Commons to vote against the Iraq war. The rest is history.
Oxford Union talk on ‘faith schools’ and creationism
This debate is meant to be about ‘faith schools’, but I suspect that the differences between the views of my two friends opposite are rather large. Mr Brady will, I presume, advocate schools that teach conventional religious views, and that I take to be the topic under discussion. First let’s get the issue of Mr McQuoid’s view on creation out of the way before coming to the serious matter of the debate. We have to be clear about one thing -there is a spectrum of religious views and Mr McQuoid is at the extreme fruit cake end of that spectrum. A true flat-earther.
An article by John Burn & Nigel McQuoid; (ex-head, and head, of Emmanuel School) stated:
“There are those that argue that Science and Christianity can be harmoniously reconciled . . . We cannot subscribe to this view”
This appeared on the web site of the Christian Institute, and that site is well worth a look. Apart from promoting ‘young-earth creationism’, it has two other obsessions, the evilness of homosexuality and the desirability of corporal punishment of small boys. It is truly bizarre. Well, at least Mr McQuoid’s job is not to teach science, but the head of science in his school, Steven Layfield, said in a speech published on the same web site (in 2000)
“…if the Bible really is the Word of God – and the internal evidence is overwhelming – true Science will always agree with it.”
Science teachers should… “Note every occasion when an evolutionary/old-earth paradigm (millions or billions of years) is explicitly mentioned or implied by a text-book, examination question or visitor and courteously point out the fallibility of the statement and, wherever possible, give the alternative (always better) Biblical explanation of the same data”.
He is free to express that view, but it disqualifies him from teaching science. The speech from which this is quoted, incidentally, disappeared form the web site of christian.org as soon as the row became public -one does wonder why, but don’t worry you can still ready it at the quaintly named site http://www.darwinwars.com/lunatic/liars/layfield.html However offensive it may be that such extremism is subsidised by taxpayers money, however offensive it may be that no full inspection of his school has been carried out since he came to power, and however offensive it may be that the prime minister supported his views, it is an irrelevant issue for the purposes of serious discussion. The pope does not believe that the earth was created 6000 years ago, the Anglican church does not believe that the earth was created 6000 years ago, hardly anyone but Mr. McQuoid thinks that the earth was created 6000 years ago (except in some parts of the south USA). The number of people who have that capacity to deny the obvious will never be more than handful, and to that extent we need not bother any further about them, and we can get on with the real issue of religious schools. As the Bishop of Oxford (The Rt. Revd. Richard Harries) said (2002)
“Then there is science. Science is a God-given activity. Scientists are using their God-given minds and God-given creativity to explore and utilise God-given nature. Sadly, biblical literalism brings not only the bible but Christianity itself into disrepute.”
Now to the real question…
What is wrong with allowing parents to choose a school for their child that teaches the parents’ religious belief? At first sight this sounds quite innocent, apart from the fact that it is the parents’ religious belief, not the child’s. In any case there are not many parents in the country who have religious (well Christian) beliefs. No more than 7.5 % now go to church regularly, and recently, for the first time, the proportion who profess even a nominal attachment to the church fell below half (as did the proportion of parents who have children baptised).
Why, then, are religious schools quite popular? The reason appears to be that they are selective. The rules say that selection must be on religious grounds only, but it simply does not work out like that. It is bad enough that children’s access to education should depend on their parents’ religious views (or, not infrequently, on their parents’ skill at lying about their religious views). But of course, selection of some implies exclusion of others, and, it turns out, not only because of their religion. Religious selection leads inevitably to racial selection too. In Oldham, scene of the recent race riots, the christian schools are almost exclusively white. Selection by wealth occurs too. In Accrington a C of E school has 12.5% of special needs pupils, while its neighbouring non-religious school has 69.8%; eligibility for free school meals is and 5% in the C of E school and 33% in its neighbour (on average the factor is almost 2).
How could such a disgraceful state of affairs come about? I believe that, as so often, a look at history might help, so let’s go back to see how the world looked in 1820.
Apart from 9 years I have spent all my working life at University College London.
The relevance of that will be obvious if we recall that in 1820, there were only two universities in England, Oxford and Cambridge (though 3 in Scotland). Both Oxford and Cambridge restricted entry to members of the Church of England – not only did they exclude Jews, atheists and muslims, but they also excluded many christians -catholics, protestants and dissenters. They would, no doubt, have excluded Mr McQuoid from getting higher education. It was in this context that liberals and dissenters in London founded the University of London, soon to become known as University College London, with the specific aim of admitting good students regardless of their religious beliefs, and with providing them with non-sectarian education in science as well as humanities (there was little science in Oxford and Cambridge at that time). Despite prolonged opposition from Oxford and Cambridge, UCL opened its doors in 1828.
At that time the fiercely conservative Duke of Wellington had just, albeit reluctantly, made the transition from general to prime minister. Even his government passed measures to increase the rights of catholics and dissenters, but his implacable opposition to electoral reform led to his resignation two years later, to be replaced by the Whig administration of Earl Grey.
The country was in ferment and change was rapid -in 1830 the Liverpool-Manchester railway opened and Faraday’s work on electricity was well-developed. But the electoral system was still mediaeval. The ‘rotten borough’ of Old Sarum (an iron age fort and 7 inhabitants) had two MPs while Manchester, already busy with the cotton trade, had none at all. In 1831 three attempts at electoral reform failed in parliament, but Earl Grey had told William IV “it is the spirit of the age which is triumphing and that to resist it is certain destruction”. The next year, in 1832, Lord John Russell (grandfather of Bertrand Russell) successfully got parliament to pass the (first) Reform Act and the modern age of democracy had begun.
The political ferment was paralleled by scientific ferment -people were no longer constrained by dogma and authority and new ideas came into medicine and biology too.
After another 40 years, Oxford and Cambridge caught up, when the Universities Test Act of 1870 eliminated religious criteria for university entrance. After 1870 it became quite unthinkable that a selection for higher education should be dependent on what a person believed, or did not believe in their private lives about religion.
That was 1870. Now it is 2002.. Can you imagine Oxford reintroducing religious selection of undergraduates now? Yet my friends opposite, and the government, are supporting a view of education that started to vanish in 1828 with the foundation of UCL, and finally died in 1870 with the Test Acts. They are trying to set back progress not by 10 or 20 years but by 175 years.
What next? Bring back rotten boroughs?