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 “In causing NHS Choices to publish content that is less than completely frank about the evidence on homeopathy, the DH have compromised the editorial standards of a website that they themselves established”. . . “. . . they have failed the general public, by putting special interests, politics, and the path of least resistance (as they saw it) before the truth about health and healthcare.” David Mattin, lately of NHS Choices

NHS Choices is usually a good source of information for the public. But there is one exception: the information they provide about alternative medicine is poor. A Freedom of Information Act request has revealed that the attempt of NHS Choices to rewrite their pages more accurately was censored by the Department of Health in conjunction with the late Prince’s Foundation for Integrated Health. The Department of Health (DH) has misled the public.

The earliest version of the homeopathy information page recorded by the Wayback Machine was November 12 2007. It was still there on December 5 2010. The comments were mostly critical. One said, quite correctly,

 I find it most regrettable that the way NHS has covered this subject is to give uncritical voice to the claims of homoeopathy without giving readers the information they need to evaluate those claims. To refer readers to the websites of the British Homeopathy Association is like settling the question of the shape of planet by a reference to the website of the Flat Earth Society

There were a lot of complaints, and to the credit of NHS Choices, the page vanished. Throughout 2011, and up to October 2012 the information page on homeopathy read

 Introduction Content on homeopathy has been removed from the website pending a review by the Department of Health policy team responsible for complementary and alternative medicines. Homeopathy is not part of mainstream medicine. Instead it is defined as a complementary or alternative medicine. If you are considering using homeopathy, talk to your GP first. For more information about homeopathy see the House of Commons Science and Technology Committee report on homeopathy published on 8 February 2010 and the Department of Health response to that report published in July 2010 (PDF, 69KB).

Then, at the end of 2012, the page reappeared. It was a bit better than the original, but not much. Many of the comments criticise the misleading nature of the information (as well as the usual “it worked for me” comments). The “useful links” still has six links to flat-earth organisations like the Society of Homeopaths, and only one to a sensible source, the excellent pamphlet from Sense about Science. They do link at the end to the 2010 Science and Technology Committee Report: Evidence Check 2: Homeopathy (PDF, 1.61Mb), and to the Government Response to the Science and Technology Committee Report, Evidence Check 2: Homeopathy (PDF, 69kb) but no comment is made on the findings.

Policy-based evidence

I wondered why the NHS Choices page, after an absence of almost two years, had returned in such an unsatisfactory form. So I asked them. After a reminder, I was told that my queries were being dealt with not by NHS Choices, but had been referred to Dr Sunjai Gupta “the DH official with responsibility for this area”. Dr Sunjai Gupta OBE is Deputy Director of Public Health Strategy and Social Marketing, Department of Health.

Dr Gupta is not obviously sympathetic to woo. It’s hard to tell since he doesn’t seem to have published much. But one is not reassured by an article that he wrote for the Journal of Holistic Healthcare. It appears straight after an article by fantasy herbalist, Simon Mills.

Despite assurances that I’d hear from Dr Gupta shortly, nothing happened. So I sent a request for the correspondence under the Freedom of Information Act (2000). Although the request was addressed to NHS Choices, a public body, strenuous efforts were made to divert it to the Department of Health. These were resisted. Nevertheless when, after a long delay, the material arrived, it came not from NHS Choices, but from DH, who had evidently vetted it,. The emails were rather shocking [download all].

A mail dated 1 December 2009 said

This is the most direct statement I’ve seen that, in the Department of Health, policy dictates evidence. NHS Choices is meant to provide evidence, but what they say has to be checked by DH to make sure they “don’t clash with any policy messages”.

The re-written page

The original version of the re-written page was sent to me by David Mattin, who worked for NHS Choices until September 2012. You can download the whole draft here. It is an enormous improvement on the original page. For example, it says

 “Does it work? Many independent experts would respond to this question ‘no, homeopathy does not work’ There is no good quality clinical evidence to show that homeopathy is more successful than placebo in the treatment of any type of condition. A placebo is the unusual but well-documented psychological effect that sometimes occurs when a person is given a ‘dummy’ medication, such as a sugar pill. They feel better after taking the pill because they think that they are being given real medication. Furthermore, if the principles of homeopath were true it would violate all the existing theories of science that we make use of today; not just our theory of medicine, but also chemistry, biology and physics.

This original draft was sent to Mattin on 29 January 2010. After editing it for length Mattin sent it to DH for approval. Over the next two years, DH removed much of the accurate content.  Mattin’s own comments on this evisceration are reproduced below.

The DH emails

All the names have been redacted. Needless to say, nobody is willing to take responsibility. But the number of people who support magic medicine is really quite small so the main players were easy to identify.

During the nearly 2 year absence of the homeopathy page, dozens of changes were made by DH. It seems that the policy message with which the NHS Choices draft failed to comply were those of the Prince’s Foundation for Integrated Health, and its successor (after April 2010), the College of Integrated Health, now known as the College of Medicine.

NHS Choices sought advice about their redrafted pages from the right person, Sir Iain Chalmers, one of the founders of the Cochrane Collaboration. On 3 Nov 2009, Chalmers advised

  The most reliable source in the country - and one of the most reliable in the world - is Professor Edzard Ernst, professor of Complementary Medicine at the Peninsular Medical School,

Ernst returned his suggestions in July 2010, but it seems that few of them survived the subsequent 18 months of revisions by DH.

On 2 December 2009, a mail from the NHS headquarters (Quarry House, Leeds) was sent to NHS Choices

This makes it perfectly clear that DH regards the Prince’s Foundation, and the equally flaky Complementary and Natural Healthcare Council (CNHC: known on the web as Ofquack) as appropriate guides for public health policy. The fact of the matter is that regulation of magic medicine by the government has been a total disaster, because, it seems, DH regards the Prince of Wales as a reliable source.

On 29 December 2009, the Prince’s Foundation went on the attack.

On 10th January 2010, two more letters were sent to DH by the Prince’s Foundation. At 13.48 they wrote

And at 22.14 on the same day, it was followed up with

The references to Devon and to Thought Field Therapy, make it very obvious that these letters were written by Dr Michael Dixon OBE, who was medical director of the Prince’s Foundation, and who is now a director of the “College of Medicine”. And the object of Dixon’s bile is obviously Edzard Ernst (the quotation is from his book, Trick or Treatment).

I find it fascinating to see just how venomous quacks become when the evidence contradicts their views. The cuddly “holistic” veneer quickly vanishes.

It gets worse. On 21 January 2010, a mail from NHS Choices to DH said

The only person in the country who fits this description is the (in)famous George Lewith. It is simply mind-boggling that DH regards him as an appropriate person to advise on anything.

After that, NHS Choices kept asking DH to sign off the documents, and changes continued to be made. Almost two years later, DH were still stalling.

The admission that “We are a bit short of doctors within DH these days” is interesting.

A bit short of anyone capable of critical thinking would be more accurate.

The most interesting document that I got from DH was an intermediate draft of the rewritten page on homeopathy (undated). Download the document. Here are a couple of extracts.

It’s a story of two years of meddling and procrastination. The end result misinforms the public.

Right at the start, the NHS Choices draft says, reasonably enough

A House of Commons Science and Technology Committee report said that homeopathic remedies perform no better than placebos and that the principles on which homeopathv is based are “scientifically implausible”.

But a comment, added apparently by DH, says

Can we remove this statement? This report is really quite contentious and we may well be subject to quite a lot of challenge from the Homeopathic community if published.

What on earth? The DH seems to think that that its job is not to present the evidence, but to avoid challenges from the homeopathic community! And true enough, this piece is missing from the final version.

A bit later, the NHS Choices draft was censored again

“A 2010 Science and Technology Committee report said that scientific tests had shown that homeopathic treatments don’t work”

But again this doesn’t appear in the final version. The comment, apparently from DH, says

“The DH response to this report (point 24) doesn’t support this statement though”

That’s a gross distortion of point 24, which actually concludes

“The Government Chief Scientific Adviser cannot envisage scientifically credible proposals for funding for research into homeopathy in the future”

NHS Choices was not happy with the result

Shortly before the revised page was published, Paul Nuki, Editor in Chief of NHS Choicea, sent an email to DH.

 Date: 7th September 2011 Time: 3:33:42 pm Hi I’ve been through the CAM articles and asked that we publish them asap as requested. XYZ has asked that we get a couple of points checked …. For the record, we will be publishing these pieces outside of the normal editorial process. Although originally signed off by a suitably qualified clinician, the time lapse and policy changes have been so substantial as to render that null and void. We also don’t have a formal written policy sign off from XYZ and you should be aware that the process followed is unlikely to satisfy the of the Information Standard were the file to be audited.

It doesn’t need much reading between the lines to see that he was unhappy with the result. It will be interesting to see whether the Information Standard people at the Royal Society for Public Health do anything about it.

The Department of Health has not just ignored evidence but actively opposed it.

That’s the only possible conclusion from the documents that I was sent. And it’s pretty shocking that the DH has preferred advice from the Prince’s Foundation and its handful of acolytes (in particular Michael Dixon and George Lewith) to the findings of the Science and Technology Select Committee and the views of the Chief Scientific Advisor.

In January this year, the Chief medical Officer, Dame Sally Davies, said, in a rare outburst of candour

 ‘I’m very concerned when homeopathic practitioners try to peddle this way of life to prevent malaria or other infectious disease,” she said. “I am perpetually surprised that homeopathy is available on the NHS.” Dame Sally, who is England’s most senior doctor, concluded by remarking that homeopathy “is rubbish”.

So one part of DH is working to contradict another part. the Chief Medical Officer. Perhaps Sally Davies should have a word with Dr Gupta.

This all predates the advent of Jeremy Hunt (and known defender of homeopathy) as health minister. But the sympathies of some DH people are made obvious by the presence on the DH web site of an article “Personal health budgets: A new way of accessing complementary therapies?”. This astonishing piece confirms the worst fears that quacks will see personal health budgets as a commercial opportunity to peddle their wares. The article is by Jim Rogers of Lincoln University. What his paper does not mention is Rogers’ conflict of interest. He’s a homeopath, and he has a paper in the International Journal of High Dilution Research (yes, there is a journal for every form of make-believe). You can download a reprint of this paper. It advocates more research into homeopathic provings, something that even George Lewith seems to have given up on.

It’s about time that the DH started to listen to the Chief Medical Officer. As it is, some people at DH seem to prefer the advice of the Prince’s Foundation, and to actively suppress employees who prefer evidence to anecdote.

One thing is clear. The DH is an unholy mess. Parts of it are intent on producing policy-based evidence.

Comment by David Mattin, who edited the first draft for NHS Choices

David Mattin left NHS Choices in September, 2012. He edited the new version and lived through the two years of wrangling with DH during which much of the best content was eviscerated. He sent me this statement about the affair.

### Follow-up

13 February 2013 The Guardian version of this story, written by Sarah Boseley, is Prince’s charity lobbied government to water down homeopathy criticism. It’s fine as far as it goes but it doesn’t name any names. There are some good comments though.

14 February 2013. The printed Guardian gave the story full 5 column-width coverage. [download print version]

And news has reached the USA: there’s an account of the affair on the Neurologica blog: Politics trumping science at the NHS.

On 14 February, the Guardian version was Editor’s Choice by lunchtime, and the Guardian web version already had 414 comments, mostly sensible (though this blog got far more referrals from twitter than from the Guardian)

And news has reached the USA: there’s an account of the affair on the Neurologica blog: Politics trumping science at the NHS.

15 February 2013. The Daily Mail had very fair coverage of the story.

The Guardian closed the comments on the story when it had got 642 comments, most of them very sensible. And this page got almost 6000 hits in 24 hours. The majority of the referrals came from Twitter rather than from the Guardian, despite the direct link to the page from the Guardian.

18 February 2013. The affair featured in BMJ News [download the reprint]. The item featured prominently on the BMJ news page.

19 February 2013 Only six days of this post, the NHS Choices page has been re-written again, in a much improved form. That looks like bloggers 1, DH 0. It is baffling that it’s left to bloggers, working for nothing, to extract a bit of sense from the highly-paid civil servants at the Department of Health. But at least they listened this time, which is a lot more than happens often. Paul Nuki, who runs NHS Choices, deserves congratulations. Of course the revised page still doesn’t call a spade a spade, but it gets close at times. I like the way it starts "Homeopathy is a ‘treatment’ based". Notice the quotation marks.

Reputation management?

Incidentally, NHS Choices is outsourced to the (in)famous company, Capita. And the moderation of the comments on their site is outsourced again to Tempero, which describes itself as a "reputation management" company. Each of them creams off money meant of patient care. This discovery might explain why I and others have had comments rejected by NHS Choices several times. "Reputation management" is the antithesis of evidence. It is public relations, i.e. paid lying. That is quite wrong for a site that is meant to provide dispassionate information.

21 February 2013. Sadly a step backwards. Part of the improved page was removed. This bit.

The Chief Medical Officer, Professor Dame Sally Davies, has said there is no scientifically plausible way that homeopathy can prevent or cure diseases. She has made it clear she is particularly concerned about the use of homeopathy in developing countries as a so-called cure for malaria.

We can only speculate why this was removed, because it was true. In fact she accurately described homeopathy as "rubbish". Why she should not be quoted beats me.

The College of Medicine is well known to be the reincarnation of the late unlamented Prince of Wales Foundation for Integrated Health. I labelled it as a Fraud and Delusion, but that was perhaps over-generous. It seems to be morphing into a major operator in the destruction of the National Health Service through its close associations with the private health industry.

Their 2012 Conference was held on 3rd May. It has a mixture of speakers, some quite sound, some outright quacks. It’s a typical bait and switch event. You can judge its quality by the fact that the picture at the top of the page that advertises the conference shows Christine Glover, a homeopathic pharmacist who makes a living by selling sugar pills to sick people (and a Trustee of the College of Medicine).

Her own company’s web site says

 "Worried about beating colds and flu this winter? We have several approaches to help you build your immune system." The approaches are, of course, based on sugar pills. The claim is untrue and dangerous. My name for that is fraud.

When the "College of Medicine" started it was a company, but on January 30th 2012, it was converted to being a charity. But the Trustees of the charity are the same people as the directors of the company. They are all advocates of ineffective quack medicine. The contact is named as Linda Leung, who was Operations Director of the Prince’s Foundation until it closed, and then became Company Secretary for the “College of Medicine”.

The trustees of the charity are the same people who were directors of the company

• Dr Michael Dixon, general practitioner. Michael Dixon was Medical Director of the Prince’s Foundation until it closed down.
• Professor George Lewith, is Professor of Health Research in the Complementary Medicine Research Unit, University of Southampton. He was a Foundation Fellow of the Prince’s Foundation until it closed down. Much has been written about him here.
• Professor David Peters. is Professor of Integrated Healthcare and Clinical Director at the University of Westminster’s School of Integrated Health; He’s famous for allowing dowsing with a pendulum as a method of diagnosis for treatment with unproven herbal medicines,
He was a Foundation Fellow of the Prince’s Foundation until it closed down.
• Mrs Christine Glover is a pharmacist who sells homeopathic pills. She was a Foundation Fellow of the Prince’s Foundation until it closed down.

### The involvement of Capita

According to their web site

"A Founder of the College of Medicine is Capita."

Still more amazingly, the CEO of the College of Medicine is actually an employee of Capita too.

"Mark Ratnarajah is interim CEO of the College of Medicine as well as Business Director at Capita Health and Wellbeing."

 That isn’t the end of it. The vice-president of the College of Medicine is Dr Harry Brunjes. There is an article about him in the May 2012 issue of Director Magazine. It has to be said that he doesn’t sound like a man with much interest in the National Health Service..

Within 9 years of graduating he set up in private practice in Harley Street. Five years later he set up Premier Medical, which, after swallowing a couple of rivals, he sold to Capita for £60 million. He is now recorded in a Companies House document as Dr Henry Otto Brunjes, a director of Capita Health Holdings Limited. This company owns all the shares in Capita Health and Wellbeing Limited, and it is, in turn, owned by Capita Business Services Limited. And they are owned by Capita Holdings Limited. I do hope that this baroquely complicated array of companies with no employees has nothing to do with tax avoidance.

Capita is, of course, a company with a huge interest in the privatisation of health care. It also has a pretty appalling record for ripping off the taxpayer.

It has long been known in Private Eye, as “Crapita” and “the world’s worst outsourcing firm”.

Capita were responsible for of the multimillion pound failed/delayed IT project for the NHS and HMRC. They messed up on staff administration services at Leicester Hospitals NHS Trust and the BBC where staff details were lost.  They failed to provide sufficient computing systems for the Criminal Records Bureau, which caused lengthy delays.  Capita were also involved in the failure of the Individual Learning Accounts following a £60M over-spend. And most recently, they have caused the near collapse of court translation services after their acquisition of Applied Language Services.

With allies like that, perhaps the College of Medicine hardly needs enemies. No doubt Capita will be happy to provide the public with quackery for an enormous fee from the taxpayer.

 One shouldn’t be surprised that the College is involved in Andrew Lansley’s attempts to privatise healthcare. Michael Dixon, Chair of the College of Medicine, also runs the "NHS Alliance", almost the only organisation that supported the NHS Bill. The quackery at his own practice defies belief (some it is described here).

One would have thought that such a close association with a company with huge vested interests would not be compatible with charitable status. I’ve asked the Charity Commission about that. The Charity commission, sadly, makes no judgements about the worthiness of the objects of the charities it endorses. All sorts of dangerous quack organisations are registered charities, like, for example, Yes to Life.

### Secrecy at the College of Medicine

One of the big problems about the privatisation of medicine and education is that you can’t use the Freedom of Information Act to discover what they are up to. A few private companies try to abide by that act, despite not being obliged to do so. But the College of Medicine is not one of them.

Capita They refuse to disclose anything about their relationship with Capita. I asked I asked Graeme Catto, who is a friend (despite the fact that I think he’s wrong). I got nothing.

"Critical appraisal" I also asked Catto for the teaching materials used on a course that they ran about "critical appraisal". Any university is obliged, by the decision of the Information Tribunal, to produce such material on request. The College of Medicine refused, point blank. What, one wonders, have they got to hide? Their refusal strikes me as deeply unethical.

The course (costing £100) on Critical Appraisal, ran on February 2nd 2012. The aims are "To develop introductory skills in the critical appraisal of randomised controlled trials (RCTs) and systematic reviews (SRs)". That sounds good. Have they had a change of heart about testing treatments?

But, as always, you have to look at who is running the course. Is it perhaps a statistician with expertise in clinical trials? Or is it a clinician with experience in running trials? There are plenty of people with this sort of expertise. But no, It is being run by a pharmacist, Karen Pilkington, from that hotbed of unscientific medicine, the University of Westminster.

Pilkington originally joined the University of Westminster as manager for a 4-year project to review the evidence on complementary therapies (funded by the Department of Health). All of her current activities centre round alternative medicine and most of her publications are in journals that are dedicated to alternative medicine. She teaches "Critical Appraisal" at Westminster too, so I should soon have the teaching materials, despite the College’s attempts to conceal them.

### Three people who ought to know better

Ore has to admire, however grudgingly, the way that the quacks who run the College of Medicine have managed to enlist the support of several people who really should know better. I suppose they have been duped by that most irritating characteristic of quacks, the tendency to pretend they have the monopoly on empathetic treatment of patients. We all agree that empathy is good, but every good doctor has it. One problem seems to be that senior medical people are not very good at using Google. They don’t do their homework.

 Professor Sir Graeme Catto MD DSc FRCP FMedSci FRSE is president of the College of Medicine. He’s Emeritus Professor of Medicine at the University of Aberdeen. He was President of the General Medical Council from 2002 to 2009, Pro Vice-Chancellor, University of London and Dean of Guy’s, King’s and St Thomas’ medical school between 2000 and 2005. He’s nice and well-meaning chap, but he doesn’t seem to know much about what’s going on in the College.

 Professor Sir Ian Kennedy LLD, FBA, FKC, FUCL, Hon.DSc(Glasgow), Hon.FRCP is vice-president of the College. Among many other things he is Emeritus Professor of Health Law, Ethics and Policy at University College London. He was Chair of the Healthcare Commission until 2003, when it merged with other regulators to form the Care Quality Commission. No doubt he can’t be blamed for the recent parlous performence of the CQC.

 Professor Aidan Halligan MA, MD, FRCOG, FFPHM, MRCPI Since March 200y he has been Director of Education at University College London Hospitals. From 2003 until 2005, he was Deputy Chief Medical Officer for England, with responsibility for issues of clinical governance, patient safety and quality of care. He’s undoubtedly a well-meaning man, but so focussed on his (excellent) homelessness project that he seems immune to the company he keeps. Perhaps the clue lies in the fact that when I asked him what he thought of Lansely’s health bill, he seemed to quite like it.

It seems to me to be incomprehensible that these three people should be willing to sign a letter in the British Medical Journal in defence of the College, with co-signatories George Lewith (about whom much has been written here) and the homeopath Christine Glover. In so doing, they betray medicine, they betray reason, and most important of all, they betray patients. Perhaps they have spent too much time sitting on very important committees and not enough time with patients.

The stated aims of the College sound good.

"A force that combines scientific knowledge, clinical expertise and the patient’s own perspective. A force that will re-define what good medicine means − renewing the traditional values of service, commitment and compassion and creating a more holistic, patient-centred, preventative approach to healthcare."

But what they propose to do about it is, with a few exceptions, bad. They try to whip up panic by exaggerating the crisis in the NHS. There are problems of course, but they result largely from under-funding (we still spend less on healthcare than most developed countries), and from the progressive involvement of for-profit commercial companies, like Capita. The College has the wrong diagnosis and the wrong solution. How do they propose to take care of an aging population? Self-care and herbal medicines seem to be their solution.

 The programme for the College’s workshop shows it was run by herbalist Simon Mills and by Dick Middleton an employee of the giant herbal company, Schwabe. You can see Middleton attempting to defend misleading labelling of herbal products on YouTube, opposed by me.

It seems that the College of Medicine are aiding and abetting the destruction of the National Health Service. That makes me angry.(here’s why)

I can end only with the most poignant tweet in the run up to the passing of the Health and Social Care Act. It was from someone known as @HeardInLondon, on March 15th

"For a brief period during 20th century, people gave a fuck and looked after each other. Unfortunately this proved unprofitable."

Unprofitable for Crapita, that is.

### Follow-up

5 May 2012. Well well, if there were any doubt about the endarkenment values of the College, I see that the Prince of Wales, the Quacktitioner Royal himself, gave a speech at the College’s conference.

"”I have been saying for what seems a very long time that until we develop truly integrated systems – not simply treating the symptoms of disease, but actively creating health, putting the patient at the heart of the process by incorporating our core human elements of mind, body and spirit – we shall always struggle, in my view, with an over-emphasis on mechanistic, technological approaches.”

Of course we all want empathy. The speech, as usual, contributes precisely nothing.

12 June 2012. Oh my, how did I manage to miss the fact the the College’s president, Professor Sir Graeme Catto, is also a Crapita eployee. It’s over a year since he was apponted to Capita’s clinical governance board he says "  In a rapidly growing health and wellbeing marketplace, delivering best practice in clinical governance is of utmost importance. I look forward to working with the team at Capita to assist them with continuing to adopt a best in class approach.". The operative word is "marketplace".

Since writing about anti-scientific degrees in Nature (March 2007), much has been revealed about the nonsense that is taught on these degrees. New Year’s day seems like a good time to assess how far we’ve got, five years on.

At the beginning of 2007 UCAS (the universities central admission service) offered 45 different BSc degrees in quackery, at 16 universities.

Now there are only 24 such degrees.

If you exclude chiropractic and osteopathy, which all run at private colleges, with some sort of "validation" from a university, there are now only 18 BSc/MSc courses being offered in eight universities.

Degrees in homeopathy, naturopathy and "nutritional therapy", reflexology and aromatherapy have vanished altogether from UCAS.

In the race to provide BScs in anti-science, Middlesex University has now overhauled the long-standing leader, Westminster, by a short head.

 Michael Driscoll, vice-chancellor of Middlesex Geoffrey Petts, vice-chancellor of Westminster

Let’s see what’s gone.

The University of Central Lancashire (UCLAN) was the first to see sense. In August 2008 they announced closure of their “BSc” degree in homeopathy. On September 2008 they announced an internal review of their courses in homeopathy. herbalism and acupuncture. The report of this review closed down all of them in July 2009. I first asked for their teaching materials in July 2006. I finally got them in December 2010, after winning an appeal to the Information Commissioner, and then winning an appeal against that decision at an Information tribunal . By the time I got them, the course had been closed for over two years. That is just as well, because it turned out that UCLAN’s students were being taught dangerous nonsense. No wonder they tried so hard to conceal it.

Salford University was the next to go. They shut down their courses in complementary medicine, homeopathy and acupuncture. In January 2009 they announced " they are no longer considered “a sound academic fit” ". Shortly afterwards. a letter appeared in The Times from three heavyweights (plus me) congratulating the vice-chancellor on his decision.

University of Westminster

For many years, Westminster was the biggest supplier of BSc degrees in quackery. At the beginning of 2007 they offered 14 different BSc degrees in homeopathy, naturopathy, nutritional therapy, "complementary therapies", (western) herbal medicine and traditional Chinese medicine with acupuncture. Some of their courses were so bizarre that some of the students and even staff sent me slides which taught things like "amethysts emit high Yin energy". Like UCLAN, Westminster also held an internal review. Unlike UCLAN it came to the absurd conclusion that all would be well if they injected more science into the courses. The incompetence of the review meant that those who wrote it hadn’t noticed that if you try to put science into homeopathy or naturopathy, the whole subject vanishes in a puff of smoke. Nevertheless Westminster closed down entry to BSc homeopathy in March 2009 (though the subject remained as part of other courses).

Three years after the Nature article, all five BSc homeopathy degrees had shut their doors.

During 2011, Westminster shut down Naturopathy, Nutritional therapy, Therapeutic bodywork and Complementary Medicine. See, for example,
More dangerous nonsense from the University of Westminster: when will Professor Geoffrey Petts do something about it?

University of Westminster shuts down naturopathy, nutritional therapy, but keeps Acupuncture and Herbal Medicine

Now Westminster has only four courses in two subjects. They still teach some dangerous and untrue things, but I suspect the writing is on the wall for these too.

I have seen a document, dated 11 April 2011, which states

“The following courses have been identified as ‘at risk’ (School definition) and will be discussed at the APRG and University Review Group2, due to poor recruitment and high cost of delivery:
 Integrated Health Scheme: BSc Complementary Medicine, Naturopathy; BSc Chinese Medicine; BSc Nutritional Therapy; BSc Herbal Medicine”

All but Chinese medicine and Herbal medicine have already gone. Almost there.

University of Wales

Since my first post in 2008 about the validation scam operated by the University of Wales, and some good investigations by BBC Wales TV, the outcome was the most spectacular so far. The entire institution collapsed. They no longer "validate" external degrees at dodgy business colleges, loony religious colleges or magic medicine colleges.

Another worthless validation: the University of Wales and nutritional therapy (October 2008) This is a ‘degree’ in nutrtional therapy. It is even more hilarious than usual, but it passed the validation anyway.

Scandal of the University of Wales and the Quality Assurance Agency (November 2010). This post followed the BBC Wales TV programme. At last the QAA began to notice, yet further confirmation of its utter ineptitude.

The University of Wales disgraced (but its vice chancellor is promoted) (October, 2011) The eventual collapse of the university was well-deserved. But it is very weird that the people who were responsible for it have still got their jobs. In fact the vice-chancellor, Marc Clement, was promoted despite his mendacious claim to be unaware of what was going on.

It remains to be seen how many of the many quack courses that were validated by the University of Wales will be taken on by other universities. The McTimoney College of Chiropractic is owned by BPP University (so much for their quality control, as explained in Private Eye). but still claims to be validated by Wales until 2017.

Some of the more minor players

Edinburgh Napier University. After an FOI request (rejected), Napier closed their herbal medicine degree in 2010.

As expected, the Scottish Information Commissioner agreed with that for England and Wales and ordered material to be sent. Edinburgh Napier University teaches reflexology, aromatherapy and therapeutic touch. Scottish Information Commissioner says you should know. Some of the horrors so discovered appeared in Yet more dangerous nonsense inflicted on students by Edinburgh Napier University. The embarrassment seems to have worked. Their remaining degrees in aromatherapy and reflexology have now vanished from UCAS too. All that remains is a couple of part time “Certificates of Credit” for aromatherapy and reflexology

Anglia Ruskin Univerity Not only have BSc degrees gone in aromatherapy and reflexology, but their midwifery degree now states "We are unable to accept qualifications in aromatherapy, massage and reflexology."

University of Derby Reflexology and aromatherapy have gone, though doubtless Spa management therapies have much nonsense left

University of Greenwich. BSc in Complementary Therapies (Nutritional Health) and BSc in Complementary Therapies (Nutritional Health) have been shut. The BSc Acupuncture is listed on their web site but it is under review, and is not listed in UCAS for 2012. (Acupuncture is run at International College of Oriental medicine, validated by Greenwich.). Only osteopathy (MOst) is still running, and that is a validation of an external course run at The European School of Osteopathy, in Maidstone

Thames Valley University was renamed the University of West London in 2010. The nonsense that was run there (e.g. Nutritional Fairy Tales from Thames Valley University) seems to have vanished. Their previous alt med guru, Nicola Robinson, appears now to be at London South Bank University (ranked 116 out of the 116 UK universities)

### What’s left?

Chiropractic Surprisingly, given the total discreditation of chiropractic in the wake of the Simon Singh affair, and the internecine warfare that followed it, none of the chiropractic courses have shut yet. Some are clearly in trouble, so watch this space.

Osteopathy has also had no course closures since 2007. Like chiropractic it also suffers from internecine warfare. The General Osteopathic Council refuses to disown the utter nonsense of "craniosacral" osteopathy. But the more sensible practitioners do so and are roughly as effective as physiotherapists (though there are real doubts about how effective that is).

Excluding chiropractic and osteopathy, this is all that’s left. It now consists almost entirely of Chinese medicine and a bit of herbal.

Glyndwr university (Known as North East Wales Institute until 2008)   Ranked 104 out of 116 UK universities

BSc Acupuncture (B341) BSc
BSc Complementary Therapies for Healthcare (B343)

Cardiff Metropolitan University (UWIC) (Known as University of Wales Institute Cardiff (UWIC) until Nov 2011.)   The vice-chancellor of Cardiff Metropolitan, Antony Chapman, is in the QAA’s board of directors, so perhaps it isn’t surprising that the QAA has done nothing.

BSc Complementary Therapies (3 years) (B390)
BSc Complementary Therapies (4 yrs inc Foundation) (B300)

University of Lincoln

Acupuncture (B343) 3FT Hon BSc
Herbal Medicine (B342) 3FT Hon BSc

University of East London   Ranked 113 out of 116 UK universities

Acupuncture (B343) 3FT Hon BSc

London South Bank University   Ranked 116 out of 116 UK universities

Acupuncture (B343) 4FT Deg MCM

The Manchester Metropolitan University   Ranked 93 out of 116 UK universities

Acupuncture (B343) 3FT Hon BSc

Middlesex University

Acupuncture (B348) 3FT Hon BSc
Ayurvedic Medicine (A900) 4FT Oth MCM
Herbal Medicine (B347) 3FT Hon BSc
Traditional Chinese Medicine (BT31) 4FT Hon BSc

University of Westminster

Chinese Medicine: Acupuncture (B343) 3FT Hon BSc
Chinese Medicine: Acupuncture with Foundation (B341) 4FT/5FT Hon BSc/MSci
Herbal Medicine (B342) 3FT Hon BSc
Herbal Medicine with Foundation Year (B340) 4FT/5FT Hon BSc/MSci

It seems that acupuncture hangs on in universities that are right at the bottom of the rankings.

Manchester Metropolitan gets the booby prize for actually starting a new course, just as all around are closing theirs. Dr Peter Banister, who was on the committee that approved the course (but now retired), has told me ” I am sceptical in the current economic climate whether it will prove to be successful”. Let’s hope he’s right.

But well done Westminster. Your position as the leader in antiscientific degrees has now been claimed by Middlesex University. Their "degrees" in Ayurveda mark out Middlesex University as the new King of Woo.

Over to you, Professor Driscoll. As vice-chancellor of Middlesex University, the buck stops with you.

Both still teach Chinese and herbal medicine, which are potentially dangerous. There is not a single product from either that has marketing authorisation from the MHRA, though the MHRA has betrayed its trust by allowing misleading labelling of herbal medicines without requiring any evidence whatsoever that they work, see, for example

Sub-degree courses

In contrast to the large reduction in the number of BSc and MSc degrees, there has actually been an increase in two year foundation degrees and HND courses in complementary medicine, at places right near the bottom of the academic heap. The subject is sinking to the bottom. With luck it will vanish entirely from universities before too long.

Research-intensive Universities

Although all of the degrees in magic medicine are from post-1992 universities, the subject has crept into more prestigious universities. Of these, the University of Southampton is perhaps the worst, because of the presence of George Lewith, and his defender, Stephen Holgate. Others have staunch defenders of quackery, including the University of Warwick, University of Edinburgh and St Batholomew’s.

### Why have all these courses closed?

One reason is certainly the embarrassment caused by exposure of what’s taught on the courses. Professors Petts (Westminster) and Driscoll (Middlesex) must be aware that googling their names produces references to this and other skeptical blogs on the front page. Thanks to some plain brown emails, and, after a three year battle, the Freedom of Information Act, it has been possible to show here the nonsense that has been foisted on students by some universities. Not only is this a burden on the taxpayer, but, more importantly, some of it is a danger to patients.

When a course closes, it is often said that it is because of falling student numbers (though UCLAN and Salford did not use that excuse). Insofar as that is true, the credit must go to the whole of the skeptical movement that has grown so remarkably in the last few years. Ben Goldacre’s "ragged band of bloggers" have produced a real change in universities and in society as a whole.

The people who should have done the job have either been passive or an active hindrance. The list is long. Vice-chancellors and Universities UK (UUK), the Quality Assurance Agency (QAA), the Hiigher Education Funding Council England (HEFCE), Skills for Health, the Medicines and Health Regulatory Authority ( MHRA) , the Health Professions Council (HPC), the Department of Health, the Prince of Wales and his reincarnated propaganda organisation, the "College of Medicine", the King’s Fund, the Universities and Colleges Union (UCU), OfQual, Edexcel, National Occupational Standards and Qualifications and the Curriculum Authority (QCA).

Whatever happened to that "bonfire of the quangos"?

### Follow-up

2 January 2012 The McTimoney College of Chiropractic (owned by BPP University) claims that its “validation” by the University of Wales will continue until 2017. This contradicts the statement from UoW. Watch this space.

3 January 2012. Thanks to Neil O’Connell for drawing my attention to a paper in Pain. The paper is particularly interesting because it comes from the Southampton group which has previously been sympathetic to acupuncture. Its authors include George Lewith. It shows, yet again that there is no detectable difference between real and sham acupuncture treatment. It also shows that the empathy of the practitioner has little effect: in fact the stern authoritarian practitioner may have been more effective.

Patients receiving acupuncture demonstrated clinically important improvements from baseline (i.e., a 29.5% reduction in pain), but despite this, acupuncture has no specific efficacy over placebo for this group of patients. The clinical effect of acupuncture treatment and associated controls is not related to the use of an acupuncture needle, nor mediated by empathy, but is practitioner related and may be linked to the perceived authority of the practitioner.”

Sadly. the trial didn’t include a no-treatment group, so it is impossible to say how much of the improvement is regression to the mean and how much is a placebo effect. The authors admit that it could be mostly the former.

Surely now the misplaced confidence in acupuncture shown by some medical and university people must be in tatters.

In yet another sign that even acupuncture advovates are beginning to notice that it doesn’t work, a recent article Paradoxes in Acupuncture Research: Strategies for Moving Forward, shows some fascinating squirming.

3 January 2012.  The Daily Telegraph has carried a piece about closure of university courses, written by Michael Hanlon. On 31 January they carried a much longer piece.

3 January 2012.  It is a great pity that some physiotherapists seem to have fallen hook, line and sinker for the myths of acupuncture. Physiotherapists are, by and large, the respectable face of manipulative therapy. Their evidence base is certainly not all one would wish, but at least they are free of the outrageous mumbo humbo of chiropractors. Well, most of them are, but not the Acupuncture Association of Chartered Physiotherapists (AACP), or, still worse, The Association of Chartered Physiotherapists in Energy Medicine, a group that is truly away with the fairies. These organisations are bringing a very respectable job into disrepute. And the Health Professions Council, which is meant to be their regulator, has, like most regulators, done nothing whatsoever to stop it.

5 January 2012. Times Higher Education gives a history of the demise of the University of Wales, Boom or Bust. It’s a useful timeline, but like so many journalists, it’s unwilling to admit that bloggers were on to the problem long before the BBC, never mind the QAA.

There was also a leader on the same topic, Perils of the export business. It again fails to take the QAA to task for its failures.

Interviews for Deutsche Welle and Middle East Broadcasting Center TV.

17 January 2012 Another question answered. I just learned that the ludicrous course in Nutritional Therapy, previously validated by the University of Wales (and a contributor to its downfall), is now being validated by, yes, you guessed, Middlesex University. Professor Driscoll seems determined to lead his univerity to the bottom of the academic heap. His new partnership with the Northern college of Acupuncture is just one of a long list of validations that almost rivals that of the late University of Wales. The course has, of course, an enthusiastic testimonial, from a student. It starts

I work full time as a team leader for a pension company but I am also a kinesiologist and work in my spare time doing kinesiology, reiki and Indian head massage.

Evidently she’s a believer in the barmiest and totally disproved forms of magic medicine. And Middlesex University will give her a Master of Science degree. I have to say I find it worrying that she’s a team leader for a pension company. Does she also believe in the value of worthless derivatives. I wonder?

18 January 2012. the story has gone international, with an interview that I did for Deutsche Welle, UK universities drop alternative medicine degree programs. I’m quoted as saying “They’re dishonest, they teach things that aren’t true, and things that are dangerous to patients in some cases”. That seems fair enough.

There is also an interesting item from July 2010 about pressure to drop payment for homeopathy by German health insurance

31 January 2012

The Daily Telegraph carried a prominent 1200 word account (the title wasn’t mine). The published version was edited slightly.

There’s been no official announcement, but four more of Westminster’s courses in junk medicine have quietly closed.

For entry in 2011 they offer

 University of Westminster (W50) qualification Chinese Medicine: Acupuncture (B343) 3FT Hon BSc Chinese Medicine: Acupuncture with Foundation (B341) 4FT/5FT Hon BSc/MSci Complementary Medicine (B255) 3FT Hon BSc Complementary Medicine (B301) 4FT Hon MHSci Complementary Medicine: Naturopathy (B391) 3FT Hon BSc Herbal Medicine (B342) 3FT Hon BSc Herbal Medicine with Foundation Year (B340) 4FT/5FT Hon BSc/MSci Nutritional Therapy (B400) 3FT Hon BSc

But for entry in 2012

 University of Westminster (W50) qualification Chinese Medicine: Acupuncture (B343) 3FT Hon BSc Chinese Medicine: Acupuncture with Foundation (B341) 4FT/5FT Hon BSc/MSci Herbal Medicine (B342) 3FT Hon BSc Herbal Medicine with Foundation Year (B340) 4FT/5FT Hon BSc/MSc

At the end of 2006, Westminster was offering 14 different BSc degrees in seven flavours of junk medicine. In October 2008, it was eleven. This year it’s eight, and next year only four degrees in two subjects. Since "Integrated Health" was ‘merged’ with Biological Sciences in May 2010, two of the original courses have been dropped each year. This September there will be a final intake for Nutrition Therapy and Naturopathy. That leaves only two, Chinese Medicine (acupuncture and (Western) Herbal Medicine.

The official reason given for the closures is always that the number of applications has fallen. I’m told that the number of applications has halved over the last five or six years. If that’s right, it counts as a big success for the attempts of skeptics to show the public the nonsense that’s taught on these degrees. Perhaps it is a sign that we are emerging from the endarkenment.

Rumour has it that the remaining degrees will eventually close too. Let’s hope so. Meanwhile, here is another helping hand.

There is already quite a bit here about the dangers of Chinese medicine, e.g. here and, especially, here. A submission to the Department of Health gives more detail. There has been a lot on acupuncture here too. There is now little doubt that it’s no more than a theatrical, and not very effective, placebo. So this time I’ll concentrate on Western herbal medicine.

### Western Herbal Medicine

Herbal medicine is just a branch of pharmacology and it could be taught as such. But it isn’t. It comes overlaid with much superstitious nonsense. Some of it can be seen in slides from Edinburgh Napier University (the difference being that Napier closed that course, and Westminster hasn’t)

Even if it were taught properly, it wouldn’t be appropriate for a BSc for several reasons.

First, there isn’t a single herbal that has full marketing authorisation from the MHRA. In other words, there isn’t a single herb for which there is good evidence that it works to a useful extent.

Second, the fact that the active principals in plants are virtually always given in an unknown dose makes them potentially dangerous. This isn’t 1950s pharmacology. It’s 1920s pharmacology, dating from a time before methods were worked out for standardising the potency of natural products (see Plants as Medicines).

Third, if you are going to treat illness with chemicals, why restrict yourself to chemicals that occur in plants?

It was the herbal medicine course that gave rise to the most virulent internal complaints at the University of Westminster. These complaints revealed the use of pendulum dowsing by some teachers on the course and the near-illegal, and certainly dangerous, teaching about herbs in cancer.

Here are a few slides from Principles of Herbal Medicine(3CT0 502). The vocabulary seems to be stuck in a time warp. When I first started in the late 1950s, words like tonic, carminative, demulcent and expectorant were common Over the last 40 years all these words have died out in pharmacology, for the simple reason that it became apparent that there were no such actions. But these imaginary categories are still alive and well in the herbal world.

There was a lecture on a categories of drugs so old-fashioned that I’ve never even heard the words: "nervines". and "adaptogens".

 The "tonics" listed here seem quite bizarre. In the 1950s, “tonics” containing nux vomica (a small dose of strychnine) and gentian (tastes nasty) were common, but they vanished years ago, because they don’t work. None of those named here even get a mention in NCCAM’s Herbs-at-a-glance. Oats? Come on!

 The only ‘relaxant’ here for which there is the slightest evidence is Valerian. I recall tincture of Valerian in a late 1950s pharmacy. It smells terrible, According to NCCAM Research suggests that valerian may be helpful for insomnia, but there is not enough evidence from well-designed studies to confirm this. There is not enough scientific evidence to determine whether valerian works for other conditions, such as anxiety or depression. Not much, for something that’s been around for centuries. Chamomile has not been well studied in people so there is little evidence to support its use for any condition. None of this near-total lack of evidence is mentioned on the slides.

What about the ‘stimulants‘? Rosemary? No evidence at all. Tea and coffee aren’t medicine (and not very good stimulants for me either).

 Ginseng, on the other hand, is big business. That doesn’t mean it works of course. NCCAM says of Asian ginseng (Panax Ginseng). Some studies have shown that Asian ginseng may lower blood glucose. Other studies indicate possible beneficial effects on immune function. Although Asian ginseng has been widely studied for a variety of uses, research results to date do not conclusively support health claims associated with the herb. Only a few large, high-quality clinical trials have been conducted. Most evidence is preliminary—i.e., based on laboratory research or small clinical trials.

Thymoleptics – antidepressants are defined as "herbs that engender a feeling of wellbeing. They uplift the spirit, improve the mood and counteract depression".

Oats, Lemon balm, Damiana, Vervain. Lavender and Rosemary are just old bits of folklore

 NCCAM says Some “sleep formula” products combine valerian with other herbs such as hops, lavender, lemon balm, and skullcap. Although many of these other herbs have sedative properties, there is no reliable evidence that they improve insomnia.

The only serious contender here is St John’s Wort. At one time this was the prize exhibit for herbalists. It has been shown to be as good as the conventional SSRIs for treatment of mild to moderate depression. Sadly it has turned out that the SSRIs are themselves barely better than placebos. NCCAM says

• There is scientific evidence that St. John’s wort may be useful for short-term treatment of mild to moderate depression. Although some studies have reported benefits for more severe depression, others have not; for example, a large study sponsored by NCCAM found that the herb was no more effective than placebo in treating major depression of moderate severity.

"Adaptogens" are another figment of the herbalists’ imaginations. They are defined in the lecture thus.

 Herbs that have a normalising or balancing effect. Mind and body are restored to optimum normal peak, Increase threshold to physical and mental trauma and damage Mental and physical activity and performance improved.

Well, it would be quite nice if such drugs existed. Sadly they don’t.

NCCAM says

• The evidence for using astragalus for any health condition is limited. High-quality clinical trials (studies in people) are generally lacking.

Another lecture dealt with "stimulating herbs". No shortage of them, it seems.

Well at least one of these has quite well-understood effects in pharmacology, ephedrine, a sympathomimetic amine. It isn’t used much because it can be quite dangerous, even with the controlled dose that’s used in real medicine. In the uncontrolled dose in herbal medicines it is downright dangerous.

This is what NCCAM says about Ephedra

• An NCCAM-funded study that analyzed phone calls to poison control centers found a higher rate of side effects from ephedra, compared with other herbal products.
• Other studies and systematic reviews have found an increased risk of heart, psychiatric, and gastrointestinal problems, as well as high blood pressure and stroke, with ephedra use.
• According to the U.S. Food and Drug Administration (FDA), there is little evidence of ephedra’s effectiveness, except for short-term weight loss. However, the increased risk of heart problems and stroke outweighs any benefits.

It seems that what is taught in the BSc Herbal Medicine degree consists largely of folk-lore and old wives’ tales. Some of it could be quite dangerous for patients.

### A problem for pharmacognosists

While talking about herbal medicine, it’s appropriate to mention a related problem, though it has nothing to do with the University of Westminster.

My guess is that not many people have even heard of pharmacognosy. If it were not for my humble origins as an apprentice pharmacist in Grange Road, Birkenhead (you can’t get much more humble than that) I might not know either.

Pharmacognosy is a branch of botany, the study of plant drugs. I recall inspecting powered digitalis leaves under a microscope. In Edinburgh, in the time of the great pharmacologist John Henry Gaddum, medical students might be presented in the oral exam with a jar of calabar beans and required to talk about their anticholinesterase effects of the physostigmine that they contain.

The need for pharmacognosy has now all but vanished, but it hangs on in the curriculum for pharmacy students. This has engendered a certain unease about the role of pharmacognists. They often try to justify their existence by rebranding themselves as "phytotherapists". There are even journals of phytotherapy. It sounds a lot more respectable that herbalism. At its best, it is more respectable, but the fact remains that there no herbs whatsoever that have well-documented medical uses.

The London School of Pharmacy is a case in point. Simon Gibbons (Professor of Phytochemistry, Department of Pharmaceutical and Biological Chemistry). The School of Pharmacy) has chosen, for reasons that baffle me, to throw in his lot with the reincarnated Prince of Wales Foundation known as the “College of Medicine“. That organisation exists largely (not entirely) to promote various forms of quackery under the euphemism “integrated medicine”. On their web site he says "Western science is now recognising the extremely high value of herbal medicinal products . . .", despite the fact that there isn’t a single herbal preparation with efficacy sufficient for it to get marketing authorisation in the UK. This is grasping at straws, not science.

The true nature of the "College of Medicine" is illustrated, yet again, by their "innovations network". Their idea of "innovation" includes the Bristol Homeopathic Hospital and the Royal London Hospital for Integrated medicine, both devoted to promoting the utterly discredited late-18th century practice of giving people pills that contain no medicine. Some "innovation".

It baffles me that Simon Gibbons is willing to appear on the same programme as Simon Mills and David Peters, and George Lewith. Mills’ ideas can be judged by watching a video of a talk he gave in which he ‘explains’ “hot and cold herbs”. It strikes me as pure gobbledygook. Make up your own mind. He too has rebranded himself as "phytotherapist" though in fact he’s an old-fashioned herbalist with no concern for good evidence. David Peters is the chap who, as Clinical Director of the University of Westminster’s ever-shrinking School of Quackery, tolerates dowsing as a way to select ‘remedies’.

The present chair of Pharmacognosy at the School of Pharmacy is Michael Heinrich. He, with Simon Gibbons, has written a book Fundamentals of pharmacognosy and phytotherapy. As well as much good chemistry, it contains this extraordinary statement

“TCM [traditional Chinese medicine] still contains very many remedies which were selected by their symbolic significance rather than their proven effects; however this does not mean that they are all ‘quack’remedies! There may even be some value in medicines such as tiger bone, bear gall, turtle shell, dried centipedes, bat dung and so on. The herbs, however, are well researched and are becoming increasingly popular as people become disillusioned with Western Medicine.”

It is irresponsible to give any solace at all to the wicked industries that kill tigers and torture bears to extract their bile. And it is simple untrue that “herbs are well-researched”. Try the test,

A simple test for herbalists. Next time you encounter a herbalist, ask them to name the herb for which there is the best evidence of benefit when given for any condition. Mostly they refuse to answer, as was the case with Michael McIntyre (but he is really an industry spokesman with few scientific pretensions). I asked Michael Heinrich, Professor of Pharmacognosy at the School of Pharmacy. Again I couldn’t get a straight answer. Usually, when pressed, the two things that come up are St John’s Wort and Echinacea. Let’s see what The National Center for Complementary and Alternative Medicine (NCCAM) has to say about them. NCCAM is the branch of the US National Institutes of Health which has spent around a billion dollars of US taxpayers’ money on research into alternative medicine, For all that effort they have failed to come up with a single useful treatment. Clearly they should be shut down. Nevertheless, as an organisation that is enthusiastic about alternative medicine, their view can only be overoptimistic.

For St John’s Wort . NCCAM says

• There is scientific evidence that St. John’s wort may be useful for short-term treatment of mild to moderate depression. Although some studies have reported benefits for more severe depression, others have not; for example, a large study sponsored by NCCAM found that the herb was no more effective than placebo in treating major depression of moderate severity.

For Echinacea NCCAM says

• Study results are mixed on whether echinacea can prevent or effectively treat upper respiratory tract infections such as the common cold. For example, two NCCAM-funded studies did not find a benefit from echinacea, either as Echinacea purpurea fresh-pressed juice for treating colds in children, or as an unrefined mixture of Echinacea angustifolia root and Echinacea purpurea root and herb in adults. However, other studies have shown that echinacea may be beneficial in treating upper respiratory infections.

If these are the best ones, heaven help the rest.

### Follow-up

An email yesterday alerted me to YesToLife. This outfit seemed to me to be so dangerous that a word of warning is in the public interest.

Their own description says “YES TO LIFE is a new charitable initiative to open up a positive future for people with cancer in the UK by supporting an integrative* approach to cancer care”. That sounds sort of cuddly but lets look below the surface.

As so often, the funding seems to have been raised as the result of the death of an unfortunate 23 year old woman. Instead of putting the money into real research, yet another small charity was formed. My correspondent pointed out that “I came across them at St Pancras Station on Friday afternoon — they had a live DJ to draw in the crowd and were raising funds through bucket collections”. No doubt many people just see the word ‘cancer’ and put money in the bucket, without realising that their money will be spent on promoting nonsensical and ineffective treatments.

The supporters list.

The list of supporters tells you all you need to know, if you are familiar with the magic medicine business, though it might look quite convincing if you don’t know about the people. Sadly the list starts with some celebrities (I didn’t know before that Maureen Lipman was an enthusiast foir quackery -how very sad). But never mind the air-head celebrities. The more interesting supporters come later.

• Dr Rosy Daniel of Health Creation is an old friend. After I complained about her promotion of some herbal concoction called Carctol to “heal cancer”, she was reprimanded by Trading Standards for breaching the Cancer Act 1939, and forced to change the claims (in my view she should have neen prosecuted but, luckily of her, Trading Standards people are notoriously ineffective). There is, of course not the slightest reason to to think that Carctol works (download Carctol: Profits before Patients?). Read also what Cancer Research UK say about carctol.
Dr Daniel is also well known because ran a course that was, for one year, accredited by the University of Buckingham. But once the university became aware of the nonsense that was being taught on the course, they first removed her as the course director, and then removed accreditation from the course altogether. She then tried to run the course under the aegis of the Prince’s Foundation for Integrated Health, but even they turned her down. Now it is running as a private venture, and is being advertised by YesToLife.
• Boo Armstrong, “Chief Executive of The Prince’s Foundation for Integrated Health and Founder and Executive Director GetWellUK”. The web site is out of date since the Prince’s Foundation shut its doors a year ago. She runs a private company, GetWellUK, that was responsible for a very poor study of alternative medicine in Northern Ireland. So she has a vested interest in promoting it. See Peter Hain and GetwellUK: pseudoscience and privatisation in Northern Ireland
• Professor George Lewith. This is beginning to look like the usual list of suspects. I’ve had cause to write twice about the curious activities of Dr Lewith. See Lewith’s private clinic has curious standards, in 2006, and this year George Lewith’s private practice. Another case study. The make up your own mind about whether you’d trust him.
• Dr Michael Dixon OBE, Chairman NHS Alliance and Medical Director The Prince’s Foundation for Integrated Health. Again the job description is a year out of date. You can read about Dr Dixon at Prince of Wales Foundation for magic medicine: spin on the meaning of ‘integrated’. He seems to be a well meaning man for whom no new-age idea is too barmy.

In fact both Dixon and Lewith have moved to a reincarnation of the Prince’s Foundation known as the “College of Medicine” (actually it’s a couple of offices in Buckingham Street). See Don’t be deceived. The new “College of Medicine” is a fraud and delusion.
It seems to me incomprehensible that people such as Sir Graeme Catto, Sir Cyril Chantler and Sir Muir Grey are willing to be associated with people who behave like this.
• Charlotte Grobien, Managing Director, Give it Away. This seems to be a fund-raising organisation that has supported YesToLife. The lesson seems to be, never give money to fundraisers unless you know exactly where your money is going.

The Help Centre

YesToLife has a help centre. But beware, There is no medical person there. Just Traditional Chinese medicine (rather dangerous), acupuncture, osteopath and naturopathy (which means, roughly, do nothing and hope for the best).

Patrick Holford,

There can be no better indication of the standard of advice to be expected from YesToLife than the fact they are advertising a lecture by Holford, with the enticing title "Say no to cancer"."Through learning about the effects of diet and nutrition, people with cancer or at risk of developing cancer can be empowered to say Yes to Life and No to Cancer". Would that it were so easy. It will cost you £15.00.

Just in case there is still nobody who has heard of Holford, he is the media nutritionist who has an entire chapter devoted to him in Ben Goldacre’s Bad Science book, He has a whole website that has exposed his dubious advice, the excellent HolfordWatch. And you can find quite a lot about him on this blog. Try, for example, Patrick Holford’s CV: the strange case of Dr John Marks, and Response to a threatening letter from Mr Holford, or Holford’s untruthful and unsubstantiated advertisement

The treatments directory

Now we get to the truly scary bit of YesToLife, their treatment directory. Try searching for ‘cancer type’ and then "breast (metastatic)".. We find no mention of the advances in understanding of the genetics of breast cancer, nor ot real therapies like tamoxifen. What we find are four "alternative treatments".

• Neuroimmunomodulation Therapy It sounds impressive until you learn that its only proponent is a an 82 year old Venezuelan doctor with a clinic in Caracas. Even YesToLife doesn’t pretend that there is any evidence that it works
• Vitamin C Therapy The old chestnut cure-all Vitamin C Again even YesToLife don’t pretend there is any good evidence but it is still offered; treatment cost £3140.00 (what? Vitamin C is very cheap indeed)
• Dendritic Cell Therapy Said by YesToLife to be "well-researched", though that isn’t so for breast cancer (metastatic). Although possibly not as barmy as the other things that are recommended, it is nevertheless not shown to be effective for any sort of cancer,
• Gerson Therapy It is a sign of the extreme unreliability of advice given by YesToLife that they should still recommend anything as totally discredited as Gerson Therapy.Although YesToLife describes it as "well-researched" that is simply not true: there are no proper clinical trials. Cancer Research UK say

"Overall, there is no evidence to show that Gerson therapy works as a cure for cancer. "
"Available scientific evidence does not support claims that Gerson therapy can treat cancer. It is not approved for use in the United States. Gerson therapy can be very harmful to your health. Coffee enemas have been linked to serious infections, dehydration, constipation, colitis (inflammation of the colon), and electrolyte imbalances. In some people, particular aspects of the diet such as coffee enemas have been thought to be responsible for their death."

Recommended reading: The (Not-So-)Beautiful (Un)Truth about the Gerson protocol and cancer quackery, by David Gorski (breast cancer surgeon, writing in Science-based Medicine.

Conclusion

The information supplied by YesToLife is more likely to kill you than to cure you.

The next time you see somebody collecting for a "cancer charity" be very careful before you give them money.

### Follow-up

November 2012. It gets worse.

I had an email from someone who was distressed because a friend was trying to raise £15,000 to cover the cost of treatments recommended by YesToLife. The treatment is high-dose intravenous Vitamin C infusion. This is pure quackery. There isn’t the slightest reason to think it will affect the course of cancer, or the wellbeing of the patient. It is exploitation of the desperate. My heart sinks at the thought that a “charity” can be quite so wicked.

 Professor George Lewith is perhaps the most prominent advocate of alternative medicine within quackademia, at least in Russell Group University. He claims to be a member of “The Complementary and Integrated Medicine Research Unit is within the School of Medicine at the University of Southampton.”.

The URL for this unit is actually http://www.cam-research-group.co.uk/. Strangely, though, a search of Southampton University’s own web site for “Complementary and Integrated Medicine Research Unit” yields very little information about this unit.

But Lewith does not spend all of his time on his academic duties. He also spends time in London at his private practice, at the Centre for Complementary and Integrated Medicine. This practice, I discovered in 2006, was selling to patients that well known method for misdiagnosing food intolerance, the Vega test. It was doing so despite the fact that Lewith himself had written a paper that concluded that the Vega machine does not work, The paper was in the British Medical Journal, 2001;322:131-4. It concludes “Electrodermal testing cannot be used to diagnose environmental allergies”. This history is recorded in Lewith’s private clinic has curious standards.

Dr Lewith was in the news again recently when he published a paper that showed (yet again) that homeopathic pills work no better than placebo. No surprise there of course. The paper has been described here, in Despite the spin, Lewith’s paper surely signals the end of homeopathy (again).

So we can congratulate Lewith for being one of the few members of the magic-medicine community to have published papers of reasonable quality that show that neither homeopathy nor the Vega test work. In fact there was nothing novel in the conclusions about the Vega machine. It has been debunked again and again.

The BBC’s Inside Out programme in 2003 found that when the Vega test was taken in three different branches of Holland and Barrett, the results were quite different every time. The reporter was advised to by a total of 20 different supplements, but got different advice from every store.

In 2006, the test was destroyed again in, of all places, the Daily Mail which published ‘The great allergy con‘.

In 2011, BBC’s Watchdog programme looked again at food intolerance tests, with results as crazy as before. Holland & Barrett said “In light of this report, however, we have instructed The UK Health Partnership to investigate the findings and review their current training practices”. That’s odd, because in 2001 they had said “”In light of the issues raised, we are already carrying out a full review of the services that HSL provide.” So not much progress there.

What is rather more surprising is to find that Dr Lewith, having himself shown that neither the Vega test nor homeopathy work, continues to sell both to patients in his private practice.

I recently heard from a young student about her experiences when she went to Prof Lewith’s private practice. If you want to read her letter in full, download the pdf. Some quotations from it suffice to tell the tale.

“I had suffered from CFS/ME for nearly 8 years when on March 18th 2009 I had my  first appointment with doctor Lewith”

“We talked for 7 to 10 minutes about my history and gave a very brief outline of my medical past. I did feel that this was a bit rushed”

“He said that he would treat me with a mixture of homeopathic medicine and conventional treatments and then hooked me up to a machine to determine any food intolerances.”

“He put me off all dairy products and said that he would send me some homeopathic remedies and food supplements”

“Having suffered with the illness for so long and having been involved with the conventional practices for treating ME with no relief I went to Dr Lewith desperate. I left this first consultation a little shocked at the rushed pace and a little wary of homeopathy but determined to carry on. ”

“I waited for my remedies in the post but only the food supplements and the blood test results arrived.”

“On April 8th 2009, I went back for my 30 minute follow up consultation. We talked briefly about how I was doing. Dr Lewith exclaimed that I looked so much better than last time and that the treatments that he had sent me had obviously worked. I assumed he meant the food supplements. It quickly transpired that he meant the homeopathic drops that I had never received. I suggested that I  was probably better than last time because I was not recently recovering from tonsillitis. My confidence was immediately lost as I felt I was being coerced into thinking that the drugs he had provided were the reason for my recovery. Someone with knowledge of ME should be aware that a sufferer is not in a permanent state of ill health but generally that they follow what is known as ‘Boom and Bust’. I was going through a good patch, which after 8 years of being ill was the normal pattern. This was a maximum 5 minute conversation.”

“He hooked me up to the machine again still without any real explanation. ”

“I cancelled my next appointment with Dr Lewith having completely lost faith in his methods. I subsequently received two packages of drugs by post which I have returned. Neither at the consultation nor with the packages of drugs was there any explanation of what each drug was prescribed to achieve.”

“It was soon after that Lewith was chasing me for payment of the cancelled appointment and the homeopathic drugs that I had sent back. This was a total of £230. I had already spent nearly £300. I refused to pay as I did not feel that I had received the proper medical care that is expected of a GP.”

“He threatened to lay a claim against me at the small claims court.”

“I submitted both a Defence and Counterclaim to his action against me.”

“We went to court yesterday [January 17 2011] where Dr Lewith did not attend. ”

“He failed to submit witness statements and a Defence to my Counterclaim. The judge struck the case off and my costs awarded against Dr Lewith.”

“Conventional medicine had not been successful in helping me with ME and at 20 years old and at university I was desperate for a cure. I feel that complementary medicine takes advantage of people in my situation – I witnessed extortionate fees, blatant coercion to believe that it was working and blasé professionalism”

In response to a subsequent enquiry, the student told me

“He never told me what the homeopathic drugs were or what they were meant to do. When I received them I sent them straight back.”

“I am pretty sure that I was given general vitamins and minerals and some magnesium (if that makes sense?)”

 “From what I can gather from the internet it was the Vega machine. I was given something metal to hold in my hand whilst he applied a probe to my toe and added different vials into a slot in the machine. “ A Vega machine

The student also paid £85 for an ATP metabolism test, done by Acumen, a private company run by Dr John McLaren-Howard. This test allegedly found defects in ATP metabolism on the basis of which the student was charged £91.91 for CoQ10 tablets. Neither the test, nor CoQ10, have any verified usefulness for her condition.

Here’s the bill for the homeopathic pills prescribed by Lewith.

Click to enlarge

These are the facts. Make of them what you will. At a cost of over £500, no good was done.

It isn’t surprising that Lewith’s claim was dismissed by the court.

The College of Medicine

We notice that Professor Lewith plays is vice-chair of the “College of Medicine” that has arisen from the ashes of the Prince’s Foundation for Integrated Health (for more details see Don’t be deceived. The new “College of Medicine” is a fraud and delusion). That organisation is supposed to be devoted to “patient-centered medicine”. The reader can judge whether the case related here is a good example.

It is often said that one reason that people go to alternative practitioners is because real medicine can do nothing for them. That, only too often, is the case. People get desperate and clutch at straws. That is bad enough even in cases where the alternative practitioner believes sincerely, if wrongly, that their treatments work.

For the alternative practitioner to prescribe things which he knows full well don’t work, is, perhaps, rather worse.

### Follow-up

Just as this post was about to go up, George Lewith popped up again in a BCC piece about how expectations affect the perception of pain (something that has been known for years). Lewith is quoted as saying “It completely blows cold randomised clinical trials, which don’t take into account expectation.” This comment shows a total misunderstand of how a randomised trial works. It is all explained properly by Majikthyse, in The wrong end of the stick

Just for fun, here is a discussion that I had with Lewith on Channel 4 News, as edited (not by me) for YouTube.

I’m bored stiff with that barmiest of all the widespread forms of alternative medicine, homeopathy. It is clearly heading back to where it was in 1960, a small lunatic fringe of medicine. Nevertheless it’s worth looking at a recent development.

A paper has appeared by that arch defender of all things alternative, George Lewith.

The paper in question is “Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the
consultation process but not the homeopathic remedy: a randomized controlled clinical trial”, Sarah Brien, Laurie Lachance, Phil Prescott, Clare McDermott and George Lewith. [read it here]. It was published in Rheumatology.

Conclusion. Homeopathic consultations but not homeopathic remedies are associated with clinically relevant benefits for patients with active but relatively stable RA.

So yet another case where the homeopathic pills turn out the same as placebos, Hardly surprising since the pills are the same as the placebos, but it’s always good to hear it from someone whose private practice sells homeopathy for money.

The conclusion isn’t actually very novel, because Fisher & Scott (2001) had already found nine years ago that homeopathy was ineffective in reducing the symptoms if joint inflammation in RA. That is Peter Fisher, the Queens’ homeopathic physician, and Clinical Director of the Royal Hospital for Integrated Medicine (recently renamed to remove ‘homeopathy’ from its title). That paper ends with the remarkable statement [download the paper]

"Over these years we have come to believe that conventional RCTs [randomised controlled trials] are unlikely to capture the possible benefits of homeopathy . . . . It seems more important to define if homeopathists can genuinely control patients’ symptoms and less relevant to have concerns about whether this is due to a ‘genuine’ effect or to influencing the placebo response."

That seemed to me at the time to amount to an admission that it was all ‘placebo effect’, though Fisher continues to deny that this is the case.

"Homeopathy has clinical benefits in rheumatoid arthritis patients" -the title says. But does it?

In fact this is mere spin. What the paper actually shows is that an empathetic consultation has some benefit (and even this is inconsistent). This is hardly surprising, but there is really not the slightest reason to suppose that the benefit, such as it is, has anything whatsoever to do with homeopathy.

Homeopathy, non-specific effects and good medicine is the title of an excellent editorial, in the same issue of Rheumatology, by Edzard Ernst. He points out that "The recognition of the therapeutic value of an empathetic consultation is by no means a new insight". Any therapy that provides only non-specific effects is unacceptable. Any good doctor provides that and, when it exists, real effective treatments too.

### Lewith’s private clinic

The Centre for Complementary and Integrated Medicine is run by Drs Nick Avery and George Lewith. It is always a bit galling to real scientists, who often work 60 hours a week or more to get results, that people like Lewith get a professorial salary (in his case from the University of Southampton) but still have time to make more money by doing another job at the same time.

Avery is a homeopath. I wonder whether we can now look forward to the web site being changed in the near future so that there is a clear statement that the pills have no effect?

There is, at least, now no longer any mention of the Vega test on Lewith’s site. That is a test for food allergy that has been shown again and again to be fraudulent. The Environmental medicine page is brief, and avoids making any claims at all. It now contains the somewhat coy statement

“Specific food avoidance regimes are a controversial area and one in which there may be conflict between conventionally trained allergists and CAM practitioners.”

However the page about fibromyalgia still mentions homeopathy favourably. And it still fails to refer to my reanalysis of one of the positive trials which revealed a simple statistical mistake.

The front page of their web site boasts that "Dr George Lewith is now one of The Lifestyle 50!". " The Times, in an article on September 6th 2008, included George Lewith in The Lifestyle 50, this newspaper’s listing of the “top 50 people who influence the way we eat, exercise and think about ourselves”. Dr Lewith is included in the Alternatives category". It doesn’t mention that this is an honour he shares with such medical luminaries as Gillian ("I’m not a doctor") McKeith, Jennifer Ariston and the Pope,

But let’s end this on a happier note. There is one thing that I agree with wholeheartedly. Lewith says

"The use of bottled water seems to me to be a multi-billion pound industry, based on some of the cleverest marketing that I have ever encountered.  There is absolutely no evidence that bottled water is any safer, better, or more “energising” than the water you get from the tap."

No connection of course with the multi-million pound industry of selling homeopathic water by clever marketing.

### Some limitations of the paper by Brien et al.

Like any good trial, this one defined in advance a primary and secondary outcome.

The primary outcome was ACR20. which means the propertion of patients that showed an improvement of at least 20% of the number of tender and swollen joint counts and 20% improvement in 3 of the 5 remaining ACR core set measures (see Felsen 1995). Although it isn’t stressed in the paper, there was no detectable difference between consultation vs no consultation for this primary outcome.

The secondary outcome was 28-joint DAS (DAS-28), tender and swollen joint count, disease severity, pain, weekly patient
and physician GA and pain, and inflammatory markers (see, for example, Stucki. 1996). It was only on this outcome that an effect was seen between consultation and no consultation. The "effect size" (standardized mean score differences, adjusted for baseline differences) was an improvement of 0.7 in DAS-28 score, which runs on a scale from 0 – 10. Although this improvement is probably real (statistically significant), it is barely bigger than improvement of 0.6 which is said to be the smallest change that is clinically significant (Stucki. 1996).

Not only is the improvement by the consultation small in clinical terms. It is also rather inconsistent. for example Table 6 shows that the consultation seemded to result in a detectable effect on swollen joint count, but not on tender joint count. Neither was there any significant effect of the consultation on the response to “considering all the ways your arthritis affects you, please make a vertical line to show how well you are now”. There appeared to be an improvement on “negative mood score”, but not on “positive mood score”. Effects of the consultation on pain scores was marginal at best.

It seems to me that the conclusion that the consultation process helps patients, though not entirely implausible, gets marginal support from this study. It may be real, but if so it isn’t a large effect.

Like most alternative medicine advocates, the authors of this paper make the mistake of confusing caring and curing. Caring is good if there is nothing else that can be done (as is only too often the case). But what patients really want is cures and they’ll never get that from an empathetic consultation.

### The problem of Human Resources

What does all this mean for alternative medicine on the NHS? Nobody denies the desirability of empathy. In fact it is now talked about so much that there is a danger that scientific medical education will be marginalised. My own experience of the NHS is that most doctors are quite good at empathy, without any need to resort to hocus pocus like homeopathy and all the myriad forms of mythical medicine.

It must be said that Drs Avery and Lewith have had proper medical training. Their views on alternative medicine seem bizarre to me, but at least they should do no great harm. Sadly, the same can’t be said for the majority of homeopaths who have no medical training and who continue to andanger the public by recommending sugar pills for anything from malaria to Dengue fever. People like that have no place in the NHS. Indeed some are in jail.

Not long ago, I was invited to tour the oncology wards at UCL hospital with their chief spiritual healer, Angie Buxton-King. Although in her private practice she offers some pretty bizarre services like healing humans and animals at a distance, I had the impression that on the wards she did a pretty good job holding hands with people who were nervous about injections and chatting to people in for their third lot of chemotherapy. I asked if she would object to being called a "supportive health care worker" rather than a spiritual healer. Somewhat reluctantly she said that she wouldn’t mind that. But it can’t be done because of the absurd box-ticking mentality of HR departments. There is no job-description for someone who holds hands with patients, and no formal qualifications. On the other hand, if you are sufficiently brainless, you can tick a box for a healer. Once again I wish that HR departments would not hinder academic integrity.

### Follow-up

The Prince of Wales’ Foundation for Integrated Health shut down amidst scandal in April 2010. In July, we heard that a new “College of Medicine” was to arise from its ashes. It seemed clear from the people involved that the name “College of Medicine” would be deceptive.

Now the College of Medicine has materialised, and it is clear that one’s worst fears were well justified.

At first sight, it looks entirely plausible and well-meaning. Below the logo one reads

“There is a new force in medicine. A force that brings patients, doctors, nurses and other health professionals together, instead of separating them into tribes.”

"That force is the new College of Medicine. Uniquely, it brings doctors and other health professionals together with patients and scientists.”

It is apparent from the outset that the well-meaning words fall into the trap described so clearly by James May (see What ‘holistic’ really means). It fails to distinguish between curing and caring.

As always, the clue lies not in the words, but in the people who are running it.

### Who is involved?

After a bit of digging on the web site, you find the names of the people on the Science Council of the “College of Medicine”, The preamble says

“Good medicine must be grounded in good science as well as compassion. The College’s Science Council brings a depth of knowledge from many senior figures.”

But then come the names. With the odd exception the “science council” is like a roll-call of quacks, the dregs left over from the Prince’s Foundation. The link (attached to each name) gives the College’s bio, My links tell a rather different story.

It seems that the "Scientific Council" of the College of Medicine could more properly be called an "Antiscientific Council".

There are a few gaps in this table, to be filled in soon. One can guarantee that a great deal more will appear about the College on the web, very soon.

The Governing Council of the College is equally replete with quacks (plus a few surprising names). It has on it, for example, a spiritual healer (Angie-Buxton King), a homeopath (Christine Glover), a herbalist (Michael McIntyre). Westminster University’s king of woo (David Peters), not to mention the infamous Karol Sikora. Buxton-King offers a remarkable service to heal people or animals at a distance.

Meanwhile, it seemed worthwhile to provide a warning that the title of the College is very deceptive. It hides an agenda that could do much harm.

It is, quite simply, the Prince of Wales by stealth.

### Follow-up

28 October 2010

Professor Sir Graeme Catto, who has, disgracefully, allowed his name to be used as president of this “College” has said to me “There are real problems in knowing how to care for folk with chronic conditions and the extent of the evidence base for medicine is pretty limited”.

Yes of course that is quite true. There are many conditions for which medicine can still do little. There is a fascinating discussion to be had about how best to care for them. The answer to that is NOT to bring in spiritual healers and peddlers of sugar pills to deceive patients with their fairy stories. The “College of Medicine” will delay and pervert the sort of discussion that Catto says, rightly, is needed.

29 October 2010

I need a press card. I see that the BMJ also had a piece about the “College of Medicine” yesterday: Prince’s foundation metamorphoses into new College of Medicine, by Nigel Hawkes. He got the main point right there in the title.

As was clear since July, the driving force was Michael Dixon, Devon GP and ex medical director of the Prince’s Foundation. Hawkes goes easy on the homeopaths and spiritual healers, but did spot something that I can’t find on their web site. The “Faculties” will include

“in 2011, neuromusculoskeletal care. Two of the six strong faculty members for this specialty are from the British Chiropractic Association, which sued the author Simon Singh for libel for his disobliging remarks about the evidence base for their interventions.”

The College certainly picks its moment to endorse chiropractic, a subject that is in chaos and disgrace after they lost the Singh affair.

One bit of good news emerges from Hawkes’ piece, There is at least one high profile doubter in the medical establishment, Lord (John) Walton (his 2000 report on CAM was less than blunt, and has been widely misquoted by quacks) is reported as saying, at the opening ceremony

“I’m here as a sceptic, and I’ve just told my former houseman that,” he said. The target of the remark was Donald Irvine, another former GMC president and a member of the new college’s advisory council.”

31 October 2010. I got an email that pointed out a remarkable service offered by a member of College’s Governing Council. Angie Buxton-King, a “spiritual healer” employed by UCLH seems to have another web site, The Beacon of Healing Light that is not mentioned in her biography on the College’s site. Perhaps it should have been because it makes some remarkable claims. The page about distant healing is the most bizarre.

Absent Healing/Distant Healing

"Absent healing is available when it is not possible to visit the patient or it is not possible for the patient to be brought to our healing room. This form of healing has proved to be very successful for humans and animals alike."

"We keep a healing book within our healing room and every night spend time sending healing to all those who have asked for it. We have found that if a picture of the patient is sent to us the healing is more beneficial, we also require a weekly update to monitor any progress or change in the patients situation. Donations are welcome for this service."

I wonder what the Advertising Standards people make of the claim that it is “very successful”? I wonder what the president of the College makes of it? I’ve asked him.

### Other blogs about the “College of Medicine”

30 October 2010. Margaret McCartney is always worth reading. As a GP she is at the forefront of medicine. She’s written about the College in The Crisis in Caring and dangerous inference. She’s also provided some information about a "professional member" of the College of Medicine, in ..and on Dr Sam Everington, at the Bromley by Bow Centre….

It is one of the more insulting things about alternative medicine addicts that they claim to be the guardians of caring (as opposed to curing), They are not, and people like McCartney and Michael Baum are excellent examples.

19 January 2011

Prince of Wales to become honorary president of the “College of Medicine?”

Last night I heard a rumour that the Prince of Wales is, despite all the earlier denials, to become Honorary President of the “College”. If this is true, it completes the wholesale transformation of the late, unlamented, Prince’s Foundation for Integrated Medicine into this new “College”. Can anybody take it seriously now?

Text messages to Graeme Catto and Michael Dixon, inviting them to deny the rumour, have met with silence.

### Herbal nonsense at the College

29 July 2011. I got an email from the College if Medicine [download it]. It contains a lot of fantasy about herbal medicines, sponsered by a company that manufactures them. It is dangeroous and corrupt.

In July 2008 I wrote an editorial in the New Zealand Medical Journal (NZMJ), at the request of its editor.

The title was  Dr Who? deception by chiropractors.  It was not very flattering and it resulted in a letter from lawyers representing the New Zealand Chiropractic Association.  Luckily the editor of the NZMJ, Frank Frizelle, is a man of principle, and the legal action was averted. It also resulted in some interesting discussions with disillusioned chiropractors that confirmed one’s worst fears.  Not to mention revealing the internecine warfare between one chiropractor and another.

This all occurred before the British Chiropractic Association sued Simon Singh for defamation.  The strength of the reaction to that foolhardy action now has chiropractors wondering if they can survive at all.  The baselessness of most of their claims has been exposed as never before.  No wonder they are running scared.  The whole basis of their business is imploding.

Needless to say chiropractors were very cross indeed.  Then in February 2009 I had a polite email from a New Zealand chiropractor, David Owen, asking for help to find one of the references in the editorial.  I’d quoted Preston Long as saying

"Long (2004)7 said “the public should be informed that chiropractic manipulation is the number one reason for people suffering stroke under the age of 45.

And I’d given the reference as

7. Long PH. Stroke and spinal manipulation. J Quality Health Care. 2004;3:8–10

I’d found the quotation, and the reference, in Ernst’s 2005 article, The value of Chiropractic, but at the time I couldn’t find the Journal of Quality Healthcare.  I did find the same article on the web. At least the article had the same title, the same author and the same quotation.  But after finding, and reading, the article, I neglected to change the reference from J Quality Health Care to http://skepticreport.com/sr/?p=88.  I should have done so and for that I apologise.

When I asked Ernst about the Journal of Quality Healthcare, he couldn’t find his copy of the Journal either, but he and his secretary embarked on a hunt for it, and eventually it was found.

 It turns out that Journal of Quality Healthcare shut down in 2004, without leaving a trace on the web, or even in the British Library.  It was replaced by a different journal, Patient Safety and Quality Healthcare (PSQH)  A reprint was obtained from them.   It is indeed the same as the web version that I’d read, and it highlighted the quotation in question. The reprint of the original article, which proved so hard to find, can be downloaded here.

The full quotation is this

"Sixty-two clinical neurologists from across Canada, all certified members of the Royal College of Physicians and Surgeons, issued a warning to the Canadian public, which was reported by Brad Stewart, MD. The warning was entitled Canadian Neurologists Warn Against Neck Manipulation. The final conclusion was that endless non-scientific claims are being made as to the uses of neck manipulation(Stewart, 2003). They need to be stopped. The public should be informed that chiropractic manipulation is the number one reason for people suffering stroke under the age of 45."

I have often condemned the practice of citing papers without reading them (it is, of course, distressingly common), so I feel bad about this, though I had in fact read the paper in question in its web version. I’m writing about it because I feel one should be open about mistakes, even small ones.

I’m also writing about it because one small section of the magic medicine community seems to think they have nailed me because of it.  David Owen, the New Zealand chiropractor, wrote to the editor of the NZMJ, thus.

 The quote [in question] is the public should be informed that chiropractic manipulation is the number one reason for people suffering stroke under the age of 45. Long PH. Stroke and Manipulation. J Quality Health Care. 2004:3:8-10 This quote actually comes from the following blog article http://www.skepticreport.com/medicalquackery/strokespinal.htm [DC the URL is now http://skepticreport.com/sr/?p=88] I have attached all my personal communications with Colquhoun. They demonstrate this is not a citation error. Prof Colquhoun believes the origin of the quote doesn’t matter because Long was quoting from a Canadian Neurologists’ report (this is also incorrect). As you can see he fails to provide any evidence at all to support the existance [sic] of the “J Quality Health Care.” This would not be an issue at all if he had admitted it came from a blog site— but I guess the link would have eroded the credibility of the quote. Colquhoun ‘s belief that my forwarding this complaint is me “resorting to threats” is the final nail in the coffin. If he had any leg to stand on where is the threat? This may seem pedantic but it surely reflects a serious ethical breach. Is it acceptable to make up a reference to try and slip any unsupported statement into a “scientific” argument and thereby give it some degree of credibility? Incidentally, at the end of the article, conflicts of interest are listed as none. As Colquhoun is a Professor of Pharmacology and much of his research funding no doubt comes from the pharmaceutical industry how can he have no conflict of interest with therapies that do not advocate the use of drugs and compete directly against the billions spent on pain medications each year? If I may quote Colquhoun himself in his defence of his article (Journal of the New Zealand Medical Association, 05-September-2008, Vol 121 No 1281) I’ll admit, though, that perhaps ‘intellect’ is not what’s deficient in this case, but rather honesty. David Owen

### Financial interests

Well, here is a threat: I’m exposed as a shill of Big Pharma.  ". . . much of his funding no doubt comes from the pharmaceutical industry".  I can’t count how many times this accusation has been thrown at me by advocates of magic medicine.  Oddly enough none of them has actually taken the trouble to find out where my research funding has come from.  None of them even knows enough about the business to realise the extreme improbability that the Pharmaceutical Industry would be interested in funding basic work on the stochastic properties of single molecules.  They fund only clinicians who can help to improve their profits,

The matter of funding is already on record, but I’ll repeat it now.   The media ‘nutritional therapist’, Patrick Holford, said, in the British Medical Journal

“I notice that Professor David Colquhoun has so far not felt it relevant to mention his own competing interests and financial involvements with the pharmaceutical industry “

” Oh dear, Patrick Holford really should check before saying things like “I notice that Professor David Colquhoun has so far not felt it relevant to mention his own competing interests and financial involvements with the pharmaceutical industry”. Unlike Holford, when I said “no competing interests”, I meant it. My research has never been funded by the drug industry, but always by the Medical Research Council or by the Wellcome Trust. Neither have I accepted hospitality or travel to conferences from them. That is because I would never want to run the risk of judgements being clouded by money. The only time I have ever taken money from industry is in the form of modest fees that I got for giving a series of lectures on the basic mathematical principles of drug-receptor interaction, a few years ago.”

I spend a lot of my spare time, and a bit of my own money, in an attempt to bring some sense into the arguments. The alternative medicine gurus make their livings (in some cases large fortunes) out of their wares.

So who has the vested interest?

### Does chiropractic actually cause stroke?

As in the case of drugs and diet, it is remarkably difficult to be sure about causality. A patient suffers a vertebral artery dissection shortly after visiting a chiropractor, but did the neck manipulation cause the stroke? Or did it precipitate the stroke in somebody predisposed to one? Or is the timing just coincidence and the stroke would have happened anyway? There has been a lot of discussion about this and a forthcoming analysis will tackle the problem of causality head-on,

My assessment at the moment, for what it’s worth, is that there are some pretty good reasons to suspect that neck manipulation can be dangerous, but it seems that serious damage is rare.

In a sense, it really doesn’t matter much anyway, because it is now apparent that chiropractic is pretty well discredited without having to resort to arguments about rare (though serious) effects. There is real doubt about whether it is even any good for back pain (see Cochrane review), and good reason to think that the very common claims of chiropractors to be able to cure infant colic, asthma and so on are entirely, ahem, bogus.  (See also Steven Novella, ebm-first, and innumerable other recent analyses.)

Chiropractic is entirely discredited, whether or not it may occasionally kill people.

### Complaint sent to UCL

I had an enquiry about this problem also from my old friend George Lewith.  I told him what had happened.  Soon after this, a complaint was sent to Tim Perry and Jason Clarke, UCL’s Director and Deputy Director of Academic Services. The letter came not from Lewith or Owen, but from Lionel Milgom.   Milgrom is well known in the magic medicine community for writing papers about how homeopathy can be “explained” by quantum entanglement.   Unfortunately for him, his papers have been read by some real physicists and they are no more than rather pretentious metaphors.  See, for example, Danny Chrastina’s analysis, and shpalman, here. Not to mention Lewis, AP Gaylard and Orac.

 Dear Mr Perry and Mr Clark, I would like to bring to your attention an editorial (below) that appeared in the most recent issue of the New Zealand Medical Journal. In it, one of your Emeritus Professors, David Colquhoun, is accused of a serious ethical breach, and I quote – “Is it acceptable to make up a reference to try and slip any unsupported statement into a “scientific” argument and thereby give it some degree of credibility?” Professor Colquhoun is well-known for writing extensively and publicly excoriating many forms of complementary and alternative medicine, particularly with regard to the alleged unscientific nature and unethical behaviour of its practitioners. Professor Colquhoun is also a voluble champion for keeping the libel laws out of science. While such activities are doubtlessly in accord with the venerable Benthamite liberal traditions of UCL, I am quite certain hypocrisy is not. And though Professor Colquhoun has owned up to his error, as the NZMJ’s editor implies, it leaves a question mark over his credibility. As custodians of the college’s academic quality therefore, you might care to consider the possible damage to UCL’s reputation of perceived professorial cant; emeritus or otherwise. Yours Sincerely Dr Lionel R Milgrom

So, as we have seen, the quotation was correct, the reference was correct, and I’d read the article from which it came   I made a mistake in citing the original paper rather than the web version of the same paper..

I leave it to the reader to judge whether this constitutes a "serious ethical breach", whether I’d slipped in an "unsupported statement", and whether it constitutes "hypocrisy"

### Follow-up

It so happens that no sooner was this posted than there appeared Part 2 of the devastating refutation of Lionel Milgrom’s attempt to defend homeopathy, written by AP Gaylard. Thanks to Mojo (comment #2) for pointing this out.

The King’s Fund recently published Assessing complementary practice Building consensus on appropriate research methods [or download pdf].

It is described as being the “Report of an independent advisory group”. I guess everyone knows by now that an “expert report” can be produced to back any view whatsoever simply by choosing the right “experts”, so the first things one does is to see who wrote it.  Here they are.

• Chair: Professor Dame Carol Black
• Harry Cayton, Chief Executive, Council for Healthcare Regulatory Excellence
• Professor Adrian Eddleston, then Vice-Chairman, The King’s Fund
• Professor George Lewith, Professor of Health Research, Complementary and Integrated Medicine Research Unit, University of Southampton
• Professor Stephen Holgate, MRC Clinical Professor of Immunopharmacology, University of Southampton
• Professor Richard Lilford, Head of School of Health and Population Sciences, University of Birmingham

We see at once two of the best known apologists for alternative medicine, George Lewith (who has appeared here more than once) and Stephen Holgate

Harry Cayton is CEO of Council for Healthcare Regulatory Excellence (CHRE) which must be one of the most useless box-ticking quangos in existence. It was the CHRE that praised the General Chiropractic Council (GCC) for the quality of its work.  That is the same GCC that is at present trying to cope with 600 or so complaints about the people it is supposed to regulate (not to mention a vast number of complaints to Trading Standards Offices).  The GCC must be the prime example of the folly of giving government endorsement to things that don’t work. But the CHRE were not smart enough to spot that little problem.  No doubt Mr Cayton did good work for the Alzheimer’s Society.  His advocacy of patient’s choice may have helped me personally.  But it isn’t obvious to me that he is the least qualified to express an opinion on research methods in anything whatsoever. According to the Guardian he is “BA in English and linguistics from the University of Ulster; diploma in anthropology from the University of Durham; B Phil in philosophy of education from the University of Newcastle.”

Adrian Eddlestone is a retired Professor of Medicine. He has been in academic administration since 1983. His sympathy for alternative medicine is demonstrated by the fact that he is also Chair of the General Osteopathic Council, yet another “regulator” that has done nothing to protect the public
from false health claims (and which may, soon, find itself in the same sort of trouble as the GCC).

Richard Lilford is the only member of the group who has no bias towards alternative medicine and also the only member with expertise in clinical research methods  His credentials look impressive, and his publications show how he is the ideal person for this job. I rather liked also his article Stop meddling and let us get on.. He has written about the harm done by postmodernism and relativism, the fellow-travellers of alternative medicine.

Most damning of all, Lewith, Eddlestone and Holgate (along with Cyril Chantler, chair of the King’s Fund, and homeopaths, spiritual healers and Karol Sikora) are Foundation Fellows of the Prince of Wales Foundation for Magic Medicine, an organisation that is at the forefront of spreading medical misinformation.

I shall refer here to ‘alternative medicine’ rather than ‘complementary medicine’ which is used in the report. It is not right to refer to a treatment as ‘complementary’ until such time as it has been shown to work. The term ‘complementary’ is a euphemism that, like ‘integrative’, is standard among alternative medicine advocates whose greatest wish is to gain respectability.

### The Report

The recommendations

On page 10 we find a summary of the conclusions.

The report identifies five areas of consensus, which together set a framework for moving forward. These are:

• the primary importance of controlled trials to assess clinical and cost effectiveness.
• the importance of understanding how an intervention works
• the value of placebo or non-specific effects
• the need for investment and collaboration in creating a sound evidence base
• the potential for whole-system evaluation to guide decision-making and subsequent research.

The first recommendation is just great. The rest sound to me like the usual excuses for incorporating ineffective treatments into medical practice. Notice the implicit assumption in the fourth point
that spending money on research will establish “a sound evidence base". There is a precedent, but it is ignored. A huge omission from the report is that it fails to mention anywhere that a lot of research has already been done.

### Much research has already been done (and failed)

The report fails to mention at all the single most important fact in this area. The US National Institutes of Health has spent over a billion dollars on research on alternative medicines, over a period
of more than 10 years. It has failed to come up with any effective treatments whatsoever. See, for example Why the National Center for Complementary and Alternative Medicine (NCCAM) Should Be Defunded;   Should there be more alternative research?;   Integrative baloney @ Yale, and most recently, \$2.5B Spent, No Alternative Med Cures found. .

Why did the committee think this irrelevant? I can’t imagine. You guess.

The report says

“This report outlines areas of potential consensus to guide research funders, researchers, commissioners and complementary practitioners in developing and applying a robust evidence base for complementary practice.”

As happens so often, there is implicit in this sentence the assumption that if you spend enough money evidence will emerge. That is precisely contrary to the experence in the USA where spending a billion dollars produced nothing beyond showing that a lot of things we already thought didn’t work were indeed ineffective.

And inevitably, and tragically, NICE’s biggest mistake is invoked.

“It is noteworthy that the evidence is now sufficiently robust for NICE to include acupuncture as a treatment for low back pain.” [p ]

Did the advisory group not read the evidence used (and misinterpeted) by NICE? It seems not. Did the advisory group not read the outcome of NIH-funded studies on acupuncture as summarised by Barker Bausell in his book, Snake Oil Science? Apparently not. It’s hard to know because the report has no references.

George Lewith is quoted [p. 15] as saying “to starve the system of more knowledge means we will continue to make bad decisions”. No doubt he’d like more money for research, but if a billion dollars
in the USA gets no useful result, is Lewith really likely to do better?

### The usual weasel words of the alternative medicine industry are there in abundance

“First, complementary practice often encompasses an intervention (physical treatment or manipulation) as well as the context for that intervention. Context in this setting means both the physical setting for the delivery of care and the therapeutic relationship between practitioner and patient.” [p. 12]

Yes, but ALL medicine involves the context of the treatment. This is no different whether the medicine is alternative or real. The context (or placebo) effect comes as an extra bonus with any sort of treatment.

“We need to acknowledge that much of complementary practice seeks to integrate the positive aspects of placebo and that it needs to be viewed as an integral part of the treatment rather than an aspect that should be isolated and discounted.” [p. 13]

This is interesting. It comes very close (here and elsewhere) to admitting that all you get is a placebo effect, and that this doesn’t matter. This contradicts directly the first recommendation of the House of Lords report (2000).. 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)  is the treatment safe? (3) how does it compare, in medical outcome and cost-effectiveness, with other forms of treatment?.

The crunch comes when the report gets to what we should pay for.

“Should we be prepared to pay for the so-called placebo effect?

The view of the advisory group is that it is appropriate to pay for true placebo (rather than regression to the mean or temporal effects).” [p 24]

Perhaps so, but there is very little discussion of the emormous ethical questions:that this opinion raises:

• How much is one allowed to lie to patients in order to elicit a placebo effect?
• Is is OK if the practitioner believes it is a placebo but gives it anyway?
• Is it OK if the pratitioner believes that it is not a placebo when actually it is?
• Is it OK for practitioners to go degrees taught by people who believe that it is not a placebo when actually it is?

The report fails to face frankly these dilemmas.  The present rather absurd position in which it is considered unethical for a medical practitioner to give a patient a bottle of pink water, but
perfectly acceptable to refer them to a homeopath. There is no sign either of taking into account the cultural poison that is spread by telling people about yin, yang and meridians and such like preposterous made-up mumbo jumbo.  That is part of the cost of endorsing placebos. And just when one thought that believing things because you wished they were true was going out of fashion

Once again we hear a lot about the alleged difficulties posed by research on alternative medicine. These alleged difficulties are, in my view, mostly no more than excuses. There isn’t the slightest
difficulty in testing things like herbal medicine or homeopathy, in a way that preserves all the ‘context’ and the ways of working of homeopaths and herbalists. Anyone who reads the Guardian knows
how to do that.

In the case of acupuncture, great ingenuity has gone into divising controls. The sham and the ‘real’ acupuncture always come out the same. In a non-blind comparison between acupuncture and no acupuncture the latter usually does a bit worse, but the effects are small and transient and entirely compatible with the view that it is a theatrical placebo.

Despite these shortcomings, some of the conclusions [p. 22] are reasonable.

“The public needs more robust evidence to make informed decisions about the use of complementary practice.

Commissioners of public health care need more robust evidence on which to base decisions about expenditure of public money on complementary practice.”

What the report fails to do is to follow this with the obvious conclusion that such evidence is largely missing and that until such time as it is forthcoming there should be no question of the NHS paying for alternative treatments.

Neither should there be any question of giving them official government recognition in the form of ‘statutory regulation’. The folly of doing that is illustrated graphically by the case of chiropractic which is now in deep crisis after inspection of its claims in the wake of the Simon Singh defamation case. Osteopathy will, I expect, suffer the same fate soon.

In the summary on p.12 we see a classical case of the tension

Controlled trials of effectiveness and cost-effectiveness are of primary importance

We recognise that it is the assessment of effectiveness that is of primary importance in reaching a judgement of different practices. Producing robust evidence that something works in practice – that it is effective – should not be held up by the inevitably partial findings and challenged interpretations arising from inquiries into how the intervention works.

The headline sounds impeccable, but directly below it we see a clear statement that we should use treatments before we know whether they work.  “Effectiveness”, in the jargon of the alternative medicine business, simply means that uncontrolled trials are good enough. The bit about “how it works” is another very common red herring raised by alternative medicine people. Anyone who knows anything about pharmacology that knowledge about how any drug works is incomplete and often turns out to be wrong. That doesn’t matter a damn if it performs well in good double-blind randomised controlled trials.

One gets the impression that the whole thing would have been a lot worse without the dose of reality injected by Richard Lilford. He is quoted as a saying

“All the problems that you find in complementary medicine you will encounter in some other kind of treatment … when we stop and think about it… how different is it to any branch of health care – the answer to emerge from our debates is that it may only be a matter of degree.” [p. 17]

I take that to mean that alternative medicine poses problems that are no different from other sorts of treatment. They should be subjected to exactly the same criteria. If they fail (as is usually the case) they should be rejected.  That is exactly right.  The report was intended to produce consensus, but throughout the report, there is a scarcely hidden tension between believers on one side, and Richard Lilford’s impeccable logic on the other.

### Who are the King’s Fund?

The King’s Fund is an organisation that states its aims thus.

“The King’s Fund creates and develops ideas that help shape policy, transform services and bring about behaviour change which improve health care.”

It bills this report on its home page as “New research methods needed to build evidence for the effectiveness of popular complementary therapies”. But in fact the report doesn’t really recommend ‘new research methods’ at all, just that the treatments pass the same tests as any other treatment. And note the term ‘build evidence’.  It carries the suggestion that the evidence will be positive.   Experience in the USA (and to a smaller extent in the UK) suggests that every time some good research is done, the effect is not to ‘build evidence’ but for the evidence to crumble further

If the advice is followed, and the results are largely negative, as has already happened in the USA, the Department of Health would look pretty silly if it had insisted on degrees and on statutory regulation.

The King’s Fund chairman is Sir Cyril Chantler and its Chief Executive is Niall Dickson.  It produces reports, some of which are better than this one. I know it’s hard to take seriously an organisation that wants to “share its vision” withyou, but they are trying.

“The King’s Fund was formed in 1897 as an initiative of the then Prince of Wales to allow for the collection and distribution of funds in support of the hospitals of London. Its initial purpose was to raise money for London’s voluntary hospitals,”

It seems to me that the King’s Fund is far too much too influenced by the present Prince of Wales. He is, no doubt, well-meaning but he has become a major source of medical misinformation and his influence in the Department of Health is deeply unconstitutional.  I was really surprised to see thet Cyril Chantler spoke at the 2009 conference of the Prince of Wales Foundation for Integrated Health, despite having a preview of the sort of make-believe being propagated by other speakers. His talk there struck me as evading all the essential points. Warm, woolly but in the end, a danger to patients. Not only did he uncritically fall for the spin on the word “integrated”, but he also fell for the idea that “statutory regulation” will safeguard patients.

Revelation of what is actually taught on degrees in these subjects shows very clearly that they endanger the public.

But the official mind doesn’t seem ever to look that far. It is happy ticking boxes and writing vacuous managerialese. It lacks curiosity.

### Follow-up

The British Medical Journal published today an editorial which also recommends rebranding of ‘pragmatic’ trials.  No surprise there, because the editorial is written by Hugh MacPherson, senior research fellow, David Peters, professor of integrated healthcare and Catherine Zollman, general practitioner. I find it a liitle odd that the BMJ says “Competing Interests: none. David Peters interest is obvious from his job description. It is less obvious that Hugh MacPherson is an acupuncture enthusiast who publishes mostly in alternative medicine journals. He has written a book with the extraordinary title “Acupuncture Research, Strategies for Establishing an Evidence Base”. The title seems to assume that the evidence base will materialise eventually despite a great deal of work that suggests it won’t. Catherine Zollman is a GP who is into homeopathy as well as acupuncture. All three authors were speakers at the Prince of Wales conference, described at Prince of Wales Foundation for magic medicine: spin on the meaning of ‘integrated’.

The comments that follow the editorial start with an excellent contribution from James Matthew May. His distinction between ‘caring’ and ‘curing’ clarifies beautifully the muddled thinking of the editorial.

Then a comment from DC, If your treatments can’t pass the test, the test must be wrong. It concludes

“At some point a stop has to be put to this continual special pleading. The financial crisis (caused by a quite different group of people who were equally prone to wishful thinking) seems quite a good time to start.”