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One year from our first letter to NHS Trusts, we sent another. Listen to the interview by John Humphrys on the Radio 4 Today Programme, with Raymond Tallis and Peter Fisher. :And hear Fisher suggest that he works for UCL (not true). You can also download a summary of the current evidence in the form of an example commissioning document which accompanied our letter.

May 23, 2007. A year ago, our letter to NHS Trusts urged them to stop paying for “unproven and disproved treatments”. A year on, we sent a second letter. Read it here.

On May 23 2007, John Humphrys introduced coverage of this on the Radio 4 Today Programme with the words

“Doctors who think homeopathy is a waste of time and money seem to be winning the argument”

To listen to his interview with Raymond Tallis and Peter Fisher click here. In the interview, Peter Fisher not only misrepresented the evidence, as usual, but also he said

“We are integrating it [homeopathy] within NHS services in University College London which is one of the leading, you know, biomedical centres in the country.”

Hang on a moment! I’m glad that Fisher thinks that UCL is a “leading biomedical centre”, but he does not work for UCL (which is a university), but for the UCLH Trust, which is an NHS Trust. This shameless attempt to use the reputation of a quite different institution to bolster his case smacks of desperation (not to mention mendacity).

After Fisher’s emphasis on “integration”, Tallis commented

“The use of the word integrate is interesting. I mean I suppose you can regard combining medicines that don’t work with medicines that do work as a kind of integrative approach . . “;

The evidence

Our second letter to NHS Trusts said “If you have not already reviewed your own trust’s provision, you might find it useful to consider, in conjunction with your Director of Public Health, the paper that we have enclosed which, while not a full review of the scientific position, has been used by other trusts to promote evidence based commissioning.”. This letter has a summary of the evidence,

Download the evidence here

Good reports in the newspapers include

“Hard-up NHS trusts cut back on unproven homoeopathy treatment”: Mark Henderson in The Times

“Doctors renew drive to ban NHS homeopathy”: James Randerson, in the Guardian

[This post has been transferred from my old IMPROBABLE SCIENCE page]

Follow-up

Homeopaths have been harping on about our alleged misuse of the NHS logo, ever since this second letter was sent.  It is often said that the letter was sent under the NHS letterhead.  As so often, they don’t bother to check.  There was no NHS logo on the letter.  The only place the logo occurred was on the sample template fo commissioners that was sent with the letter. That template has always been available for download from this post. It is very obviously intended to be a template, with sections that are to be completed by commissioners highlighted.  There is no way it could be taken to be representing itself as a letter from the NHS.  This is how it starts.

template letter

Twenty-five hospitals from London and southern and eastern England have already either stopped sending any patients to the Royal London Homeopathic Hospital or agreed to fund only a handful A campaign has started o save it, but the arguments are far from convincing.

This is reposted from the original IMPROBABLE SCIENCE page

The news is out. It was in February this year when I first saw some “Commissioning Intentions 2007-08” documents from several London NHS Primary Care Trusts (PCT), indicating their intention to break their contracts with the RLHH on the very reasonable grounds that homeopathy doesn’t work. It seemed better to wait for the intentions to be implemented before saying much, because of the inevitable outcry from those who want sugar pills at the taxpayers’ expense.

Then, in March 2007, the Health Services Journal carried a story “PCTs consider alternative to homeopathic hospitals” (free registration, or read it here).

On 8 April 2007, The Observer carried a special report, prominently featured on page 3.

Royals’ favoured hospital at risk as homeopathy backlash gathers pace
The Queen loves it. But alternative medicine centre’s future looks uncertain as more NHS trusts axe funding”

Fisher and Queen
Fisher and Queen,
Observer 8 April 2007

Peter Fisher, clinical director of the RLHH, is quoted as saying

“Twenty-five hospitals from London and southern and eastern England have already either stopped sending any patients to the RLHH or agreed to fund only a handful.”

“Prince Charles is sympathetic, supportive and concerned. But he doesn’t feel it’s appropriate to intervene in any way because there’s been some adverse publicity before about him ‘meddling’. ”

Fisher attributes this to the letter sent to PCTs by 13 of us, last May, in which we advocated that the NHS should not be paying for “unproven or disproved treatments”. The leading signatory on this letter, Professor Michael Baum, is quoted in the Observer thus.

“If the Royal London were to close because of PCT deficits we would scarcely miss it”.

“Homeopathy is no better than witchcraft. It’s no better than a placebo effect. It’s patronising and insulting for adults.”

“Instead you could have a centre for palliative and supportive care, which would be of greater benefit and involve half the cost. Rather than losing something, we would gain something.”

The backlash

The reaction seems to have started with a letter from homeopath Carol Boyce. Her letter starts thus.

ROYAL LONDON HOMEOPATHIC HOSPITAL UNDER SIEGE
Death by stealth. The Royal London Homeopathic Hospital (RLHH) – the visible presence of homeopathy within Britain’s NHS – an institution putting homeopathy in the public mind for the last 150 years – the place where homeopathy was seen to perform so well in the cholera epidemic of the 1840s – is being dealt a DEATH BLOW”

I’d guess the very first sentence must be something of an embarrassment to the RLHH’s clinical director, who is far too sensible to believe that cholera can be cured by homeopathic sugar pills.

The red herring about cholera is repeated ad nauseam on hundreds of homeopathy sites (though most are curiously silent about whether they really believe that sugar pills can cure cholera). It is based on the report that during the London Cholera epidemic of 1854, of the 61 cases of cholera treated at the London Homeopathic Hospital, 10 died (16.4%), whereas the neighbouring Middlesex Hospital reported 123 deaths out of 231 cases of cholera (53.2%). Apart from the lack of any knowledge of the state of the patients on entry to hospital, it was also the case at the time that conventional medicine was no more based on evidence than homeopathy. Indeed the initial popularity of homeopathy could well have resulted not only from wishful thinking, but also because doing nothing at all (i.e. homeopathy) was less harmful than blood letting. The fallacy of the argument was spotted very early on by Oliver Wendell Holmes (senior) in his famous essay, Homeopathy and its Kindred Delusions.

But medicine moved on and homeopathy didn’t. The history of cholera, like that of tuberculosis, contrary to what is suggested by homeopaths, is a triumph for evidence based medicine. The epidemic was halted not by homeopaths but by the careful observations of John Snow that led to his removing the handle of the Broad Street pump. If medicine had been left to homeopaths, people would still be dying of these diseases.

Carol Boyce invites you to write directly to Queen Elizabeth II, to save the RLHH. She has also started an e-petition on the UK government site. The petition includes the words

ROYAL LONDON HOMEOPATHIC HOSPITAL UNDER SIEGE

“The RLHH has been part of the Health Service for 150 years. ”

“In 2005, 67% of GPs and 85% of practices in it’s [sic] Primary Care Trust, referred patients to the hospital. The hospital provides effective and most importantly, COST-EFFECTIVE treatments.”

Ms Boyce seems not to have noticed that the Prince of Wales’ own Smallwood report decided that there was not enough evidence to come to firm conclusions about cost-effectiveness.

Peter Fisher himself has appealed for the survival of the RLHH in a letter dated 9 March 2007 [download copy of letter].

“The Royal London Homoeopathic Hospital needs your support
09/03/2007

By Dr. Peter Fisher, Homeopath to Her Majesty, the Queen.

There is no silly talk about cholera here, but there is a useful list of Trusts who have decided to abandon "unproven and disproved treatments". Fisher recommends you to read Marcia Angell’s book to learn about the deficiencies of the drug industry. I recommend that too. I also recommend Dan Hurley’s book on the even greater deficiencies of the quackery industry.

Fisher suggests you write to your MP to prevent closure of the RLHH.
I suggest you write to your MP to support closure of the RLHH.

Channel 4 TV, Monday 12th March. This is the title of the Channel 4 TV documentary, Dispatches.

Lord Wedderburn, QC, a life peer and Emeritus Professor of Law at the London School of Economics, tells the programme:

“If, in fact, nothing changed and he became King, then there would be a most almighty fuss and controversy, and eventually the whole fabric of the constitutional monarchy could be threatened.”

The Prince’s Foundation for Integrated Health (FIH) is the Prince’s lobby group which attempts to make the hard-pressed NHS spend more money on unproven and disproved treatments. The FIH publishes “Complementary Healthcare: a Guide for Patients”.  This document is not just barmy, but positively dangerous.  In the rebuttal of the programme on the FIH web site, they claim that they do not promote alternative medicine, but elsewhere on the site they state their aim as “makes safe and effective complementary therapies available to patients in conjunction with conventional healthcare”.
Which would be all very well if they didn’t consistently ignore the evidence for effectiveness.

The MHRA recently, for the first time, betrayed its brief to nake sure that medicines work and are safe. This action has been condemned by just about every professional organisation. Nobody knows exactly what caused them to lose their heads in this way, but it is clear that they were under pressure from both the Department of Health and from the Prince of Wales. The Department of Health is clearly sympathetic to quackery, as shown by the letter below, and by their refusal to allow alternative medicine to be referred to NICE for assessment.

The MHRA admit to having had at least seven letters form the Prince of Wales, and we know that an MHRA member has met the Prince at Clarence House at least once.  But all the contents are secret from the public.  The Chairman of the MHRA Agency Board, Prof Alasdair Breckenridge, and chairman of their Herbal Medicines committee, Prof Philip Routledge, have both admitted to me to having had pressure from the Prince of Wales, but neither will give any details, despite having been condemned by their own professional organisation, the British Pharmacological Society.


The Pharmacological Society’s statement read thus.

The British Pharmacological Society believes that any claim made for a medicine must be based on evidence, and that it is the duty of the regulatory authorities, in particular the MHRA, to ensure that no claims can be made for the efficacy of any form of medicine unless there is good evidence that the claim is true. Despite many years of investigation, we have no convincing scientific evidence that homeopathic remedies work any better than placebo. Pharmacologists have noted frequently that most homeopathic products are diluted to the extent that they contain no molecule of active ingredient, that is, no medicine, which is highly misleading to consumers who are unlikely to recognise the expression “30C” for example. Furthermore, there are serious concerns, even in cases where they are used for minor ailments, that officially endorsed use of such remedies may put patients at risk of delayed diagnosis. The Society is therefore surprised that the national rules scheme for licensing homeopathic products, which came into force on 1 September (Statutory Instrument 2006 1952), will regard non-scientific data as evidence of efficacy.



An excellent article on this topic was published by Rose in The Biologist, British health care regulation moves away from science.

The appalling treatment of Professor Edzard Ernst

Edzard Ernst was the UK’s first professor of complementary medicine, and he is rather unusual in that field because he is totally honest, and very careful about evidence (something that has not always endeared him to the alternative medicine industry).

A letter was sent from Clarence House to the vice-chancellor of Exeter University, Steve Smith. The letter alleged a breach of confidence by Ernst. Having been sent a draft of the Smallwood report, Ernst was so horrified by the scientific standards in that document, he felt obliged, in the public interest, to speak out about it. Ernst was contacted by a newspaper, which had a copy of the draft, and described the initial findings as “outrageous and deeply flawed”. He added: “It is based on such poor science, it’s just hair-raising. The Prince … also seems to have overstepped his constitutional role”

Prof Edzard Ernst.

Prof Ernst was doing exactly what academics are meant to do. As a result he was subjected to a very prolonged disciplinary procedure, and for a year it was not obvious whether he’d keep his job. For a Prince, in a constitutional monarchy, to put pressure on a university to silence a conspicuously honest academic is just not acceptable.

The Prince of Wales behaviour was bad enough, but, to be generous, he is perhaps, a well-meaning but poorly educated man, filling in his time as best he can.

In the story of Edzard Ernst, the behaviour of the Vice-Chancellor of Exeter University, Prof Steve Smith seems to me to be unforgivable. Instead of supporting his staff, and supporting academic freedom, he appeared to cower before the Clarence House letterhead. After keeping Prof Ernst on tenterhooks for an entire year he eventually deigned not to fire him in the most grudging and unpleasant way imaginable.

Prof. Steve Smith, Vice chancellor.


That is illustrated by the end of Smith’s letter to Professor Ernst on 13th October 2006. It was shown on the TV programme, and is reproduced below.

Click to enlarge


The Daily Mail also has features on the healthiness of HRH’s own food lines, after his criticism of MacDonalds, Dutchy Original Sins, and here.
They are worth reading because the advice comes from Catherine Collins, a real dietician, not a nutribollocks guru.

Some responses The story was reported round the world.

Max Hastings (Guardian)

“To make good use of evidence, it is essential to possess not only intelligence, but a capacity for disciplined analysis. The prince has considerable virtues, a good heart notable among them. But he has always lacked discipline in his life and in his treatment of issues. Again and again, he gets himself into trouble by seeking to address matters that are, frankly, beyond his intellectual reach.”

This post has been transferred from the old IMPROBABLE SCIENCE page.

Misleading advertising of magnets. Office of Fair Trading acts

A major problem in stopping CAM fraud is the generally toothless attitude of the Advertising Standards Authority and of the Office of Fair Trading. Not this time though. The OFT Press Release reads thus.

“The OFT is seeking an injunction preventing publication of advertisements making the following claims about the company’s products:

  • the products have a therapeutic effect, caused by a specified physiological mechanism, due to the magnets they contain
  • the therapeutic effect of the products, due to the magnets they contain, is clinically proven or established by scientific trials, or is widely accepted in the scientific or medical communities
  • unqualified claims the products have a therapeutic effect and/or that wearing products containing magnets will always produce such an effect, due to their magnets
  • that products magnetise or ionise water as a result of the magnets they contain. 

Magno-Pulse Limited contends that the advertisements are not misleading and has refused to stop publishing adverts making these kinds of claims. Accordingly, the OFT has issued proceedings so the courts can decide the matter. Magno-Pulse Limited has indicated it intends to defend the proceedings.

Christine Wade, Director of Consumer Regulation Enforcement said:

“Where advertisements claim products have therapeutic effects it is important they do not mislead consumers. The OFT is asking the High Court to decide if Magno-Pulse Limited?s advertisements are misleading.”

It cannot have escaped the attention of the PPA (above) that this action makes them look pretty foolish.

Let’s hope the High Court is not fooled.

Magnets: ruling against false advertising

The amazing decision of the Prescription Pricing Authority to allow the NHS to pay for magnetic bandages has been covered in detail here (part 1, part 2, part 3), as has the extreme reluctance of the PPA and the Department of Health to give any useful information (here, and here). More on this topic elsewhere. Eventually the decision was referred to the Office of Fair Trading has delivered its judgement. MagnoPulse Limited was told to remove most of its absurd claims from its advertising.

It remains to be seen whether the PPA admit their mistake and reverse their decision.

The regulations that allow unjustified claims to be made for homeopathic pills were the subject of an annulment debate in the House of Lords on 26 October 2006.  The regulations were introduced as a statutory instrument.

“Statutory Instruments (SIs) are a form of legislation which allow the provisions of an Act of Parliament to be subsequently brought into force or altered without Parliament having to pass a new Act.”

In other words a minister just decides to do it without any debate or parliamentary approval

“The instrument is laid after making, subject to annulment if a motion to annul (known as a ‘prayer’) is passed within 40 days.”

The BBC Today programme covered the event before the debate. Lord (Dick) Taverne put the view of reason and common sense superbly, against some totally evasive fantasies from Imogen Spencer of the Society of Homeopaths. He is the author of “The March of Unreason: Science, Democracy, and the New Fundamentalism“). [Listen to the interview: mp3 file, 5.6 Mb]

Read the debate

The debate can be read in Hansard. In the archaic language of the House.

“Lord Taverne rose to move, That an humble Address be presented to Her Majesty praying that the regulations, laid before the House on 21 July, be annulled (S.I. 2006/1952). [44th Report from the Merits Committee].”.   Here are a few quotations.

Lord Taverne

“There is one very important, absolutely fundamental objection to this regulation. For the first time in the history of the regulation of medical products, it allows claims of efficacy to be made without scientific evidence. It is an abandonment of science and the evidence-based approach. Under this new regulation, the sole basis on which claims of efficacy can be made for homeopathic products quite legally is "homeopathic provings". There is no need for clinical or scientific tests. Homeopathy is not based on science and is not a science in any sense whatever.”
.

Let me read just three of the comments, the first from the British Pharmacological Society. I quote it first because two members of the MHRA, including the chairman, have pharmacological qualifications. The society says:

“The British Pharmacological Society believes that any claim for a medicine must be based on evidence, and that it is the duty of the regulatory authorities, in particular the MHRA, to ensure that no claims can be made for the efficacy of any form of medicine unless there is good evidence that the claim is true. Despite many years of investigation, we have no convincing scientific evidence that homeopathic remedies work any better than placebo”.

.
“What it has done is to promote what is in effect the selling of snake oil. This statutory instrument should be withdrawn;it is a disgrace. I beg to move.”

Lord Rees of Ludlow (Martin Rees, President of the Royal Society)

“ My Lords, the Royal Society, of which I have the honour to be president, believes that all complementary and alternative medicines should be subject to careful evaluation of their efficacy and their safety. All treatments so labelled should be properly tested and patients should not receive misleading information.

There are no great concerns about the safety of homeopathic treatments. What is at issue is their effectiveness. Obviously placebo effects can be powerful, nobody denies that. It is, however, quite different to assert that homeopathic treatments offer benefits beyond a placebo. Indeed, if medicines can really work even when so diluted that barely a single molecule is left, this would entail some fundamentally new scientific principle with amazingly broad ramifications. It would mean that materials like water carry imprints of their past and can remember their history, as it were, in some quite novel and mysterious way. If that were the case, it would have fundamental implications for precise experiments over the whole of science.

So it seems to me that the burden of proof on homeopathic remedies should actually be higher, not lower, than for conventional ones. Extraordinary claims demand extraordinary evidence. To put it mildly, so-called “homeopathic provings”; seem to fall far short of that. That is why I wholeheartedly support what the noble Lord, Lord Taverne, is saying on this issue.

Excellent speeches were made on the side of reason by Lord Turnberg (ex-professor of medicine and ex-president of the Royal College of Physicians) and Lord Jenkin of Roding . (who, as Patrick Jenkin, was a member of Margaret Thatcher’s government).

The 30th Countess of Mar

All of this counted for little with the Countess of Mar, a heriditary peer and organic farmer who opposed the annulment. She was, I fear, rather selective with the evidence. She quotes, for example,

“Professor Madeleine Ennis of Queen’s University, Belfast, with a large pan-European research team led by Professor Roberfroid of the Catholic University, Louvain, set out to show that homeopathy and water memory were utter nonsense. This was an exercise conducted with extreme scientific rigour.” . . . “In the end, she had to concede that high dilutions of the active ingredients in homeopathic solutions worked, whether or not the active ingredient was present in the water”

Bits of Lady Mar’s speech bear an extraordinary resemblence to an article written in the Guardian in 2001, by Lionel Milgrom (maverick chemist and apologist for homeopathy). I wonder who wrote it for her?

The Noble Countess appears not to have noticed that the first author on both of Ennis’s papers was Philippe Belon. who is a director of the huge French homeopathic company, Boiron.  In fact the address on the papers is not the University of Belfast (or Louvain), but it is “Boiron, 20 rue de la Liberation, 69110 Sainte-Foy-Les-Lyon, France.”

Boiron makes profits from homeopathy of about 20 miilion euros a year, on net operating revenues of about 300 million euros. It is big business. Philippe Belon has an interesting record.

He was one of the authors of the notorious Benveniste paper which lead to Beneveniste’s dismissal form INSERM in disgrace. The Countess also seems to have missed the careful refutation of Benveniste’s results by Hirst, Hayes, Burridge, Pearce and Foreman (1993, Nature.366, 525-7.

Belon was also senior author in Fisher, P., Greenwood, A., Huskisson, E. C., Turner, P., & Belon, P. (1989). (Effect of homoeopathic treatment on fibrositis (primary fibromyalgia) British Medical Journal 299, 365-366.). That is the paper which I was asked to check (by a TV programme). After Peter Fisher gave me the raw data I found that a naive mistake had been made in the statistical analyis. There was NO evidence for the effect of the treament at all, as described below. This correction was published (Colquhoun, D. (1990). Reanalysis of a clinical trial of a homoeopathic treatment of fibrositis. Lancet 336, 441-442.), though the correction is usually ignored by homeopaths (see below). [Get pdf].

How odd that all Belon’s papers seem to favour homeopathy.

 

Lord Colwyn

(The Rt Hon Lord Colwyn, CBE, a Conservative peer) also supported mumbo jumbo. Don’t you love this bit?

“I went on a course about 15 years ago on the relationship between quantum physics and homeopathy. I probably did not understand a word I was told at the time, but at least there was evidence that the two were linked.”

But he shouldn’t worry if he didn’t understand a word: it was just gobbledygook.

Lord Colwyn finished his speech thus.

“It is interesting to consider why homeopathy, which of all complementary therapies is probably at most variance with orthodox medicine, should have received sufficient support from the Government to be able to maintain a number of specialised hospitals.”

Well, agreed again, it is interesting -in fact it’s quite incredible.

What a pity, though, that Lord Colwyn quite forgot to declare his interests. He is vice-president of the Blackie Foundation Trust. This trust was “founded by Dr Margery Blackie in 1971, at that time homoeopathic physician to Her Majesty, the Queen. Dr Blackie saw the need to promote homoeopathic remedies to the wider community and to educate the public about the success of homoeopathy in treating illness.”. 
He also forgot to mention that he is a patron of the National Federation of Spiritual Healers.

Lord Warner

(Lord Warner of Brockley, Minister of State at the Department of Health) defended quackery on behalf of the government. He says the legislation

“will, for the first time since the PLR scheme in 1971, allow homeopathic products to be marketed with information to the consumer about what they can be used for. This will provide better information to the consumer and reduce the risk of confusion. “

Lord Warner makes no comments about how claims made for efficacy in the absence of evidence can be called “better information” for the consumer

“We have done much as a Government to support science and research, and will continue to do so. Homeopathic products are, however, in a different category. Provided that such products are safe, properly manufactured and clearly labelled without making false claims, which they will be under the new national rules scheme, patients should not be denied access to them for the conditions to which they relate. “

What, one wonders, does “a different category” mean? The magic category? And since the manufacturers have just been excused from producing any evidence of efficacy, who is to judge what are “false claims”.

Some reports

The BBC report before the debate

The Daily Mail -pretty good stuff.

Wearing magnets in the hope of benefit is one of the best know delusions (see below). It was therefore a shock when the NHS said it would pay for magnetic bandages. Using the Freedom of Information Act (FoI) II asked the Prescription Pricing Authority (PPA), and then the Department of Health (DoH), for documents that referred to this bizarre decision. Both refused, as related below.

When the Department of Health refused my FoI request, I asked for an internal review. Nothing happened for months, but on 10th Oct 2006, a parcel of papers arrived.

Michael King is Director of Planning and Corporate Affairs at the PPA He said (see below)

“There is no judgement offered about whether a product in the Drug Tariff is more (or less) efficacious than any other, or the placebo effect.”

This is not true, The papers from the DoH show that the PPA considered at length the evidence provided by the manufacturer, Magnopulse Ltd. 

 
 

And in an email dated 19 Dec 2005

 
 
 
 

So the ‘efficacy’ of the product was assessed. It was just assessed incompetently.  

The PPA do not seem to have noticed that a quite different conclusion about the paper in the Journal of Wound Care was reached by a different bit of the NHS. The NHS National Electronic Library for Health concludes (and also the NHS Clinical Answers Service)

“Therefore, no firm conclusions can be made on the basis of this study alone.”

The PPA do not seem to have noticed the endless evidence from other sources that magnets are boloney (see below)

And the the PPA do not seem to have noticed that the author of this paper is the is the Founder, CEO and Medical Director of one of the wackiest alternative medicine clinics, the Chiron Clinic (see below). He will charge you £135 for a consultation for which you’ll get magnets and phony nutrient treatment.

 

Follow-up

The Royal Society , the UK’s national academy of science, has put a statement about alternative medicine on its “science issues” web site.

 The Royal Society believes that complementary and alternative medicines, like conventional medicines, should be subject to careful evaluation of their effectiveness and safety. It is important that treatments labelled as complementary and alternative medicines are properly tested and that patients do not receive misleading information about the effectiveness of complementary medicine. Furthermore, NHS provision for complementary and alternative medicines, as for conventional medicines, should be confined to treatments that are supported by adequate diagnosis together with evidence of both effectiveness and safety.

Notice the very proper insistence that patents are not deceived about whether the “medicine” works or not. This is in stark contrast to the attitude of the MHRA, which has just endorsed misleading labelling.

The Independent has a good medical column br Dr Fred Kavalier. The column has an insert for readers’ letters. On 1st August 2006 the ‘readers write’ section had this letter “I know homeopathy has taken a bit of a bashing recently but homeopathic remedies for travel sickness have a long and excellent reputation for working. The most important ones are cocculus, petroleum and tabacum.”.
Dr Kavalier was appropriately apologetic about this, and published my response on 15th August.

Readers write

DC, a scientist from London, replies to last week’s homeopath:
“The homeopath from Devon commented last week that ‘homeopathy has taken a bit of a bashing recently’. So it should. Selling pills that contain nothing whatsoever but sugar as medicines isn’t just delusional, it’s fraud. One of the recommendations for travel sickness was for cocculus. That is a plant that contains the poisonous alkaloid, picrotoxin. Luckily, the label on the bottle is untrue and the pills contain none. Travel sickness is known to be influenced by expectations. That makes it a good candidate for placebo effects. And also good for the income of charlatans.”

The question of where delusion ends and fraud begins is an interesting one. A book by Robert Park of the American Physical Society discusses the question particularly well.

Voodoo Science: the road from foolishness to fraud (Oxford
University Press) is an excellent read. [Amazon].

Robert Park deals with everything from perpetual motion macines to homeopathy. His thesis is that those who propagate these ideas often start with a genuine belief that what they say is true. Rejection of the ideas by sensible people just makes them more determined. Eventually, though, it probably dawns on many of them that they have made a terrible mistake. At this point, some recant, but more often they have so much reputation to defend, and frequently too much income to protect, that they will continue to propagate their ideas even after they have realised that they are wrong.

That is when foolishness becomes fraud.  I have often wondered how many middle-aged homeopaths still really believe their own nonsense?

“Alas, to wear the mantle of Galileo it is not enough that you be persecuted by an unkind establishment; you must also be right.” (Robert Park)

This letter was sent to the chief executives of 476 NHS Trusts (acute and primary care trusts). It was the main headline in The Times, and the lead item on the BBC’s Today Programme.

From Professor Michael Baum and others 19th May 2006


Dear

Re Use of ‘alternative’ medicine in the NHS


We are a group of physicians and scientists who are concerned about ways in which nproven or disproved treatments are being encouraged for general use in the NHS. We would ask you to review practices in your own trust, and to join us in representing our concerns to the Department of Health because we want patients to benefit from the best treatments available.


There are two particular developments to which we would like to draw your attention. First, there is now overt promotion of homeopathy in parts of the NHS (including the NHS Direct website). It is an implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness. Despite this, a recently-published patient guide, promoting use of homeopathy without making the lack of proven efficacy clear to patients, is being made available through government funding. Further suggestions about benefits of homeopathy in the treatment of asthma have been made in the ‘Smallwood Report’ and in another publication by the Department of Health designed to give primary care groups “a basic source of reference on complementary and alternative therapies.” A Cochrane review of all relevant studies, however, failed to confirm any benefits for asthma treatment.


Secondly, as you may know, there has been a concerted campaign to promote complementary and alternative medicine as a component of healthcare provision. Treatments covered by this definition include some which have not been tested as pharmaceutical products, but which are known to cause adverse effects, and others that have no demonstrable benefits. While medical practice must remain open to new discoveries for which there is convincing evidence, including any branded as ‘alternative’, it would be highly irresponsible to embrace any medicine as though it were a matter of principle.


At a time when the NHS is under intense pressure, patients, the public and the NHS are best served by using the available funds for treatments that are based on solid evidence. Furthermore, as someone in a position of accountability for resource distribution, you will be familiar with just how publicly emotive the decisions concerning which therapies to provide under the NHS can be; our ability to explain and justify to patients the selection of treatments, and to account for expenditure on them more widely, is compromised if we abandon our reference to evidence. We are sensitive to the needs of patients for complementary care to enhance well-being and for spiritual support to deal with the fear of death at a time of critical illness, all of which can be supported through services already available within the NHS without resorting to false claims.


These are not trivial matters. We urge you to take an early opportunity to review practice in your own trust with a view to ensuring that patients do not receive misleading information about the effectiveness of alternative medicines. We would also ask you to write to the Department of Health requesting evidence-based information for trusts and for patients with respect to alternative medicine.


Yours sincerely


Text Box: Professor Michael Baum   Emeritus Professor of Surgery, University College London  and Professor Frances Ashcroft FRS
University Laboratory of Physiology, Oxford

Professor Sir Colin Berry
Emeritus Professor of Pathology, Queen Mary, London

Professor Gustav Born FRS
Emeritus Professor of Pharmacology, Kings College London

Professor Sir James Black FRS
Kings College London

Professor David Colquhoun FRS
University College London

Professor Peter Dawson
Clinical Director of Imaging, University College London

Professor Edzard Ernst
Peninsula Medical School , Exeter

Professor John Garrow
Emeritus Professor of Human Nutrition, London

Professor Sir Keith Peters FRS
President, The Academy of Medical Sciences

Mr Leslie Rose
Consultant Clinical Scientist

Professor Raymond Tallis
Emeritus Professor of Geriatric Medicine, University of Manchester

Professor Lewis Wolpert CBE FRS
University College London


As soon as this appeared the phone started ringing.

Michael Baum did an excellent job on the Today Programme, and on BBC Birmingham, BBC55, BBC world service, ITN news (interviewed for 20 minutes outdoor in the rain), Sky News live, and as well as all that he saw patients, and missed lunch while in the operating theatre. Michael comments ” How was your day your Royal Highness? “.


Leslie Rose did BBC Breakfast TV interview and various radio stations.


I did interviews for BBC News24, BBC1 News, Chanel 5 News, Sky news, the Jeremy Vine Show (radio 2), BBC Radio Solent, and wrote something for the Scotsman. Today it’s Radio London at 10.35 pm and tomorrow, Radio Foyle (Derry).

Listen to the Today Programme 08.10 interview


John Humphrys, on the Today Programme, interviews Michael Baum (lead signatory on the letter), and Peter Fisher of the Royal London Homeopathic Hospital (For more on Peter Fisher, see here, and here, and here). Listen to the interview [mp3 file, 4.4 Mb]

Leslie Rose interviewed on BBC
Breakfast
TV. Watch the interview (Realplayer file).

Interview for Sky News.

The Jeremy Vine show interview (Radio 2)

The Late Show on BBC Radio London (24 May), host Stephen
Rhodes, DC versus Gary Trainer: click to listen

Radio Foyle (N. Irelend) Talk show with Mark Patterson. The local health
food shop manager told me that ‘arthritis is a build up of toxins in the body’,
and that glucosamine and chondroitin are herbal! Click to listen


Michael Baum’s 2004 Open letter. “An open letter to the Prince of Wales: with respect, your highness, you’ve got it wrong”. Download pdf file.

Coverage in The Times, 23 May 2006. The front page headline.

New International has forced me to remove the pictures of the front page, but the front page headline was

NHS told to abandon alternative medicine

Top doctors say money should go to conventional treatment

Here is Mark Henderson’s article.

NHS told to abandon alternative medicine

By Mark Henderson, Science Editor

Top doctors say money should go to conventional treatment

A GROUP of Britain’s leading doctors has urged every NHS trust to stop paying for alternative medicine and to use the money for conventional treatments.

Their appeal is a direct challenge to the Prince of Wales’s outspoken campaign to widen access to complementary therapies.

Public funding of “unproven or disproved treatments” such as homoeopathy and reflexology, which are promoted by the Prince, is unacceptable while huge NHS deficits are forcing trusts to sack nurses and limit access to life-saving drugs, the doctors say.

The 13 scientists, who include some of the most eminent names in British medicine, have written to the chief executives of all 476 acute and primary care trusts to demand that only evidence-based therapies are provided free to patients.

Their letter, seen by The Times, has been sent as the Prince today steps up his crusade for increased provision of alternative treatments with a controversial speech to the World Health Organisation assembly in Geneva.

The Prince, who was yesterday given a lesson in crystal therapy while touring a complementary health unit in Merthyr Tydfil, will ask the WHO to embrace alternative therapies in the fight against serious disease. His views have outraged clinicians and researchers, who claim that many of the therapies that he advocates have been shown to be ineffective in trials or have never been properly tested.

The letter criticises two of his flagship initiatives on complementary medicine: a government-funded patient guide prepared by his Foundation for Integrated Medicine, and the Smallwood report last year, which he commissioned to make a financial case for increasing NHS provision.

Both documents, it is claimed, give misleading information about scientific support for therapies such as homoeo-pathy, described as “an implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness”.

The letter’s signatories include Sir James Black, who won the Nobel Prize for Medicine in 1988, and Sir Keith Peters, president of the Academy of Medical Science, which represents Britain’s leading clinical researchers.

It was organised by Michael Baum, Emeritus Professor of Surgery at University College London, and other supporters include six Fellows of the Royal Society, Britain’s national academy of science, and Professor Edzard Ernst, of the Peninsula Medical School in Exeter, who holds the UK’s first chair in complementary medicine.

The doctors ask trust chief executives to review their policies so that patients are given accurate information, and not to waste scarce resources on therapies that have not been shown to work by rigorous clinical trials.

They conclude: “At a time when the NHS is under intense pressure, patients, the public and the NHS are best served by using the available funds for treatments that are based on solid evidence.”

Professor Baum, a cancer specialist, said that he had organised the letter because of his “utter despair” at growing NHS acceptance of alternative treatments while drugs of proven effectiveness are being withheld. “At a time when we are struggling to gain access for our patients to Herceptin, which is absolutely proven to extend survival in breast cancer, I find it appalling that the NHS should be funding a therapy like homoeopathy that is utterly bogus,” he said.

He said that he was happy for the NHS to offer the treatments once research has proven them effective, such as acupuncture for pain relief, but that very few had reached the required standards.

“If people want to spend their own money on it, fine, but it shouldn’t be NHS money.”

The Department of Health does not keep figures on the total NHS spending on alternative medicine, but Britain’s total market is estimated at £1.6 billion.

There’s no remedy for the Prince of Quacks

This is the title of a piece by Francis Wheen in the London Evening Standard, 16 May 2006. Francis Wheen is the author of the Top ten delusions.

“Prince Charles travels to Geneva next week to deliver the keynote speech at the annual assembly of the World Health Organisation. Some mistake, surely?”

“The WHO describes Charles as the president of the Prince’s Foundation for Integrated Health and “patron of a number of health charities”. It omits to add that his views on medicine are barmy – and pernicious. ”

“WHO delegates from 192 nations have plenty to discuss during their five-day meeting – HIV/Aids, sickle-cell anaemia, preparations for a flu pandemic, the eradication of polio and smallpox. Why waste precious time listening to the heir to the British throne, who has spent more than 20 years displaying his ignorance of medical science?”

“The prince has never met a snake oil vendor he didn’t like. A couple of years ago he urged doctors to prescribe coffee enemas to cancer patients, a suggestion which provoked this rebuke from Professor Michael Baum of University College London: “The power of my authority comes with a knowledge built on 40 years of study and 25 years of active involvement in cancer research. Your power and authority rest on an accident of birth.” ”

The Prince’s Foundation for Integrated Health publishes Complementary healthcare: a guide for patients which is full of wishful thinking. For example, it tells the unfortunate patient that

“Homeopathy is most often used to treat chronic conditions such as asthma; eczema; arthritis; fatigue disorders like ME; headache and migraine; menstrual and menopausal problems; irritable bowel syndrome; Crohn’s disease; allergies; repeated ear, nose, throat and chest infections or urine infections; depression and anxiety.”

but says nothing at all about whether or not they work. That is just irresponsible.  And to describe pills that contain no trace of the substance on the label as ”very diluted” is plain dishonest .

This item was transferred from the old IMPROBABLE SCIENCE page.

Well this beats everything. Following the advice of the PPA, I re-submitted my request under the Freedom of Information Act to the Department of Health (DoH), which is where the PPA claimed to to have sent very single bit of information concerning their decision to make magnetic ulcer treatment available on the NHS.

When I mananged to decode the result (the DoH seem incapable of sending legible emails) this is what they said.

As you are aware, the decision by the PPA to allow Magnopulse;s 4Ulcercare on Part IX of the Drug Tarriff is a recent one and the documentation that went along with the application are still very much restricted as “commercially sensitive”. We have therefore decided to withhold this information under the FOI Act.

Section 43: Commercial Interests
Section 43 exempts information whose disclosure would be likely to prejudice the commercial interests of any person. It also includes a specific exemption for trade secrets

Trade secrets in magnets? They are one of the oldest scams of the health fraud industry! Are the DoH really so enthusiastic to protect these non-existent trade secrets? (The company whose trade secrets the DoH are so eager to protect are under invesitgation by the Office of Fair Trading!) Or is the DoH merely colluding to cover up the cockup at the PPA?

Either way, the Freedom of Information Act 2000 has yet to prove it’s worth the paper it’s written on.

Why not write to your MP to ask them to approach the DoH about this absurd misuse of the Act?

I have requested an internal investigation by the DoH. Next the appeal goes to the Ombudsman.

In the discussion of magnets on the Badscience site, a Michael King says that 4ulcercare will be included in Part IX of the Drug Tariff because it meets the criteria of the Prescription Pricing Authority (PPA).
I presume this Michael King is Director of Planning and Corporate Affairs at the PPA, though he does not say so.

Michael King says

?There is no judgement offered about whether a product in the Drug Tariff
is more (or less) efficacious than any other, or the placebo effect.?

The criteria for inclusion in
Part IX of the Drug Tariff () include, in section 10 iii, ?They are cost
effective?

Will he please explain how a device can be cost-effective, if it is ineffective (relative to placebo)?

What the PPA says

Michael King has replied to my question by email (1 Mar 2006).  He says

“The cost-effectiveness threshold for inclusion in the Drug Tariff is met if the ‘effectiveness’ of the device, as seen in data submitted by the manufacturer in support of the application, exceeds its cost to the NHS. ”

Sadly this is still ambiguous. It seems to suggest that that whatever data
are submitted by the manufacturer are taken at face value, without any attempt
to evaluate their quality. So I phoned King to ask if this was the case. He
was helpful, but he said that it was not the case. He told me that
the data were subject
to some sort of low level evaluation, short of the sort of evaluation that
NICE would do. This seems to contradict his earlier statement (above) that
inclusion in the Tariff implies no judgement about whether a device is better
than a placebo.

King said also that listing in the Tariff

“. . . is not a licensing decision nor a recommendation akin to the outcome of a NICE review”

The problem is, of course, that listing is seen as a recommendation by the public, by the Daily
Mail
, and certainly by the manufacturer.

One thing, at least, is clear in this case. Whatever evaluation was done,
it was done very badly. But in order to try to find out exactly what evaluation
was done, and by whom, I’m having to resort to the Freedom of Information Act.

Watch this space.

What NICE says

Fraser Woodward (Communications Manager, National Institute for Health and Clinical Excellence (NICE)) writes as follows.

 “The test of “cost effectiveness” applied by the PPA when determining whether or not a device should go on the tariff is very different to the way cost effectiviness is assessed by NICE”

That is pretty obvious, but how is the public meant to know that, when they hear that the NHS has declared a treatment to be ‘cost-effective’, that statement can mean two entirely different things according to which part of the bureaucracy the statement comes from?