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managerialism – DC's Improbable Science

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Stop press. Financial report casts doubt on Trainor’s claims

Science has a big problem. Most jobs are desperately insecure. It’s hard to do long term thorough work when you don’t know whether you’ll be able to pay your mortgage in a year’s time. The appalling career structure for young scientists has been the subject of much writing by the young (e.g. Jenny Rohn) and the old, e.g Bruce Alberts. Peter Lawrence (see also Real Lives and White Lies in the Funding of Scientific Research, and by me.

Until recently, this problem was largely restricted to post-doctoral fellows (postdocs). They already have PhDs and they are the people who do most of the experiments. Often large numbers of them work for a single principle investigator (PI). The PI spends most of his her time writing grant applications and traveling the world to hawk the wares of his lab. They also (to variable extents) teach students and deal with endless hassle from HR.

The salaries of most postdocs are paid from grants that last for three or sometimes five years. If that grant doesn’t get renewed. they are on the streets.

Universities have come to exploit their employees almost as badly as Amazon does.

The periodical research assessments not only waste large amounts of time and money, but they have distorted behaviour. In the hope of scoring highly, they recruit a lot of people before the submission, but as soon as that’s done with, they find that they can’t afford all of them, so some get cast aside like worn out old boots. Universities have allowed themselves to become dependent on "soft money" from grant-giving bodies. That strikes me as bad management.

The situation is even worse in the USA where most teaching staff rely on research grants to pay their salaries.

I have written three times about the insane methods that are being used to fire staff at Queen Mary College London (QMUL).
Is Queen Mary University of London trying to commit scientific suicide? (June 2012)
Queen Mary, University of London in The Times. Does Simon Gaskell care? (July 2012) and a version of it appeared th The Times (Thunderer column)
In which Simon Gaskell, of Queen Mary, University of London, makes a cock-up (August 2012)

The ostensible reason given there was to boost its ratings in university rankings. Their vice-chancellor, Simon Gaskell, seems to think that by firing people he can produce a university that’s full of Nobel prize-winners. The effect, of course, is just the opposite. Treating people like pawns in a game makes the good people leave and only those who can’t get a job with a better employer remain. That’s what I call bad management.

At QMUL people were chosen to be fired on the basis of a plain silly measure of their publication record, and by their grant income. That was combined with terrorisation of any staff who spoke out about the process (more on that coming soon).

Kings College London is now doing the same sort of thing. They have announced that they’ll fire 120 of the 777 staff in the schools of medicine and biomedical sciences, and the Institute of Psychiatry. These are humans, with children and mortgages to pay. One might ask why they were taken on the first place, if the university can’t afford them. That’s simply bad financial planning (or was it done in order to boost their Research Excellence submission?).

Surely it’s been obvious, at least since 2007, that hard financial times were coming, but that didn’t dent the hubris of the people who took an so many staff. HEFCE has failed to find a sensible way to fund universities. The attempt to separate the funding of teaching and research has just led to corruption.

The way in which people are to be chosen for the firing squad at Kings is crude in the extreme. If you are a professor at the Institute of Psychiatry then, unless you do a lot of teaching, you must have a grant income of at least £200,000 per year. You can read all the details in the Kings’ “Consultation document” that was sent to all employees. It’s headed "CONFIDENTIAL – Not for further circulation". Vice-chancellors still don’t seem to have realised that it’s no longer possible to keep things like this secret. In releasing it, I take ny cue from George Orwell.

"Journalism is printing what someone else does not want printed: everything else is public relations.”

There is no mention of the quality of your research, just income. Since in most sorts of research, the major cost is salaries, this rewards people who take on too many employees. Only too frequently, large groups are the ones in which students and research staff get the least supervision, and which bangs per buck are lowest. The university should be rewarding people who are deeply involved in research themselves -those with small groups. Instead, they are doing exactly the opposite.

Women are, I’d guess, less susceptible to the grandiosity of the enormous research group, so no doubt they will suffer disproportionately. PhD students will also suffer if their supervisor is fired while they are halfway through their projects.

An article in Times Higher Education pointed out

"According to the Royal Society’s 2010 report The Scientific Century: Securing our Future Prosperity, in the UK, 30 per cent of science PhD graduates go on to postdoctoral positions, but only around 4 per cent find permanent academic research posts. Less than half of 1 per cent of those with science doctorates end up as professors."

The panel that decides whether you’ll be fired consists of Professor Sir Robert Lechler, Professor Anne Greenough, Professor Simon Howell, Professor Shitij Kapur, Professor Karen O’Brien, Chris Mottershead, Rachel Parr & Carol Ford. If they had the slightest integrity, they’d refuse to implement such obviously silly criteria.

Universities in general. not only Kings and QMUL have become over-reliant on research funders to enhance their own reputations. PhD students and research staff are employed for the benefit of the university (and of the principle investigator), not for the benefit of the students or research staff, who are treated as expendable cost units, not as humans.

One thing that we expect of vice-chancellors is sensible financial planning. That seems to have failed at Kings. One would also hope that they would understand how to get good science. My only previous encounter with Kings’ vice chancellor, Rick Trainor, suggests that this is not where his talents lie. While he was president of the Universities UK (UUK), I suggested to him that degrees in homeopathy were not a good idea. His response was that of the true apparatchik.

“. . . degree courses change over time, are independently assessed for academic rigour and quality and provide a wider education than the simple description of the course might suggest”

That is hardly a response that suggests high academic integrity.

The students’ petition is on Change.org.

Follow-up

The problems that are faced in the UK are very similar to those in the USA. They have been described with superb clarity in “Rescuing US biomedical research from its systemic flaws“, This article, by Bruce Alberts, Marc W. Kirschner, Shirley Tilghman, and Harold Varmus, should be read by everyone. They observe that ” . . . little has been done to reform the system, primarily because it continues to benefit more established and hence more influential scientists”. I’d be more impressed by the senior people at Kings if they spent time trying to improve the system rather than firing people because their research is not sufficiently expensive.

10 June 2014

Progress on the cull, according to an anonymous correspondent

“The omnishambles that is KCL management

1) We were told we would receive our orange (at risk) or green letters (not at risk, this time) on Thursday PM 5th June as HR said that it’s not good to get bad news on a Friday!

2) We all got a letter on Friday that we would not be receiving our letters until Monday, so we all had a tense weekend

3) I finally got my letter on Monday, in my case it was “green” however a number of staff who work very hard at KCL doing teaching and research are “orange”, un bloody believable

As you can imagine the moral at King’s has dropped through the floor”

18 June 2014

Dorothy Bishop has written about the Trainor problem. Her post ends “One feels that if KCL were falling behind in a boat race, they’d respond by throwing out some of the rowers”.

The students’ petition can be found on the #KCLHealthSOS site. There is a reply to the petition, from Professor Sir Robert Lechler, and a rather better written response to it from students. Lechler’s response merely repeats the weasel words, and it attacks a few straw men without providing the slightest justification for the criteria that are being used to fire people. One can’t help noticing how often knighthoods go too the best apparatchiks rather than the best scientists.

14 July 2014

A 2013 report on Kings from Standard & Poor’s casts doubt on Trainor’s claims

Download the report from Standard and Poor’s Rating Service

A few things stand out.

  • KCL is in a strong financial position with lower debt than other similar Universities and cash reserves of £194 million.
  • The report says that KCL does carry some risk into the future especially that related to its large capital expansion program.
  • The report specifically warns KCL over the consequences of any staff cuts. Particularly relevant are the following quotations
  • Page p3 “Further staff-cost curtailment will be quite difficult …pressure to maintain its academic and non-academic service standards will weigh on its ability to cut costs further.”
  • page 4 The report goes on to say (see the section headed outlook, especially the final paragraph) that any decrease in KCL’s academic reputation (e.g. consequent on staff cuts) would be likely to impair its ability to attract overseas students and therefore adversely affect its financial position.
  • page 10 makes clear that KCL managers are privately aiming at 10% surplus, above the 6% operating surplus they talk about with us. However, S&P considers that ‘ambitious’. In other words KCL are shooting for double what a credit rating agency considers realistic.

One can infer from this that

  1. what staff have been told about the cuts being an immediate necessity is absolute nonsense
  2. KCL was warned against staff cuts by a credit agency
  3. the main problem KCL has is its overambitious building policy
  4. KCL is implementing a policy (staff cuts) which S & P warned against as they predict it may result in diminishing income.

What on earth is going on?

16 July 2014

I’ve been sent yet another damning document. The BMA’s response to Kings contains some numbers that seem to have escaped the attention of managers at Kings.

10 April 2015

King’s draft performance management plan for 2015

This document has just come to light (the highlighting is mine).

It’s labelled as "released for internal consultation". It seems that managers are slow to realise that it’s futile to try to keep secrets.

The document applies only to Institute of Psychiatry, Psychology and Neuroscience at King’s College London: "one of the global leaders in the fields" -the usual tedious blah that prefaces every document from every university.

It’s fascinating to me that the most cruel treatment of staff so often seems to arise in medical-related areas. I thought psychiatrists, of all people, were meant to understand people, not to kill them.

This document is not quite as crude as Imperial’s assessment, but it’s quite bad enough. Like other such documents, it pretends that it’s for the benefit of its victims. In fact it’s for the benefit of willy-waving managers who are obsessed by silly rankings.

Here are some of the sillier bits.

"The Head of Department is also responsible for ensuring that aspects of reward/recognition and additional support that are identified are appropriately followed through"

And, presumably, for firing people, but let’s not mention that.

"Academics are expected to produce original scientific publications of the highest quality that will significantly advance their field."

That’s what everyone has always tried to do. It can’t be compelled by performance managers. A large element of success is pure luck. That’s why they’re called experiments.

" However, it may take publications 12-18 months to reach a stable trajectory of citations, therefore, the quality of a journal (impact factor) and the judgment of knowledgeable peers can be alternative indicators of excellence."

It can also take 40 years for work to be cited. And there is little reason to believe that citations, especially those within 12-18 months, measure quality. And it is known for sure that "the quality of a journal (impact factor)" does not correlate with quality (or indeed with citations).

Later we read

"H Index and Citation Impact: These are good objective measures of the scientific impact of
publications"

NO, they are simply not a measure of quality (though this time they say “impact” rather than “excellence”).

The people who wrote that seem to be unaware of the most basic facts about science.

Then

"Carrying out high quality scientific work requires research teams"

Sometimes it does, sometimes it doesn’t. In the past the best work has been done by one or two people. In my field, think of Hodgkin & Huxley, Katz & Miledi or Neher & Sakmann. All got Nobel prizes. All did the work themselves. Performance managers might well have fired them before they got started.

By specifying minimum acceptable group sizes, King’s are really specifying minimum acceptable grant income, just like Imperial and Warwick. Nobody will be taken in by the thin attempt to disguise it.

The specification that a professor should have "Primary supervision of three or more PhD students, with additional secondary supervision." is particularly iniquitous. Everyone knows that far too many PhDs are being produced for the number of jobs that are available. This stipulation is not for the benefit of the young. It’s to ensure a supply of cheap labour to churn out more papers and help to lift the university’s ranking.

The document is not signed, but the document properties name its author. But she’s not a scientist and is presumably acting under orders, so please don’t blame her for this dire document. Blame the vice-chancellor.

Performance management is a direct incentive to do shoddy short-cut science.

No wonder that The Economist says "scientists are doing too much trusting and not enough verifying—to the detriment of the whole of science, and of humanity".

Feel ashamed.

Nobody could have been more surprised than I when I found myself nominated as an academic role model at UCL. I had to answer a few questions. It is not obvious to me what the object of the stunt is, but the person who asked me to do it seemed to find the answers amusing, so I’ll reproduce here what I said. I apologise for the temporary lapse into narcissism.

The final version has now been printed [download a copy]. Sadly the printed edition was “corrected” by someone who replaced “whom I asked to submit the first theoretical paper by Hawkes and me to the Royal Society” (as written below), with “paper by Hawkes and I”. Aaargh.

DC 2013

Your nomination – Why you were nominated as an Academic Role Model?

"David Colquhoun has made major contributions to our understanding of how ion channels (proteins which allow charged ions to pass across cell membranes) function to mediate electrical signalling in nerve and muscle cells. This work elegantly combines experimental and theoretical aspects, and resulted in David being made a Fellow of the Royal Society. David Colquhoun played a key role in resisting the notion that UCL should merge with Imperial College in 2002, by running a website opposed to the merger. He thus facilitated the continued existence of an independent UCL. He is also well-known for his principled opposition to therapies that are not based on scientific evidence, and for his blog which comments on this issue as well as on university bureaucracy and politics."

Role models’ questions

1.  What is your response to being nominated?

Astounded.

We are interested in giving people a very brief ‘snapshot’ description of their career trajectory, to help a broad range of people see how you got to where you are:

2.   What has your career path been?

My first job (in 1950s) was as an apprentice pharmacist in Timothy Whites & Taylors (Homeopathic Chemists) in Grange Road, Birkenhead.  You can’t get a more humble start than that.  But it got me interested in drugs, and thanks to my schoolmaster father, I got to the University of Leeds. 

pa 1955
My father (1907 – 2001), in 1955

One of the courses involved some statistics, and that interested me.  I think I made a semi-conscious decision that it would be sensible to be good at something that others were bad at, so I learned quite a lot of statistics and mathematics. I recall buying a Methuen’s Monograph on Determinants and Matrices in my final year, and, with the help of an Argentinian PhD student in physical chemistry (not my lecturers) I began to make sense of it. 

aitken

I purposely went into my final viva with it sticking out of my pocket. The examiner was Walter Perry, then professor of Pharmacology in Edinburgh (he later did a great job setting up the Open University).  That’s how I came to be a PhD student in Edinburgh. 

Although Perry was one of my supervisors, the only time I saw him was when he came into my lab between committee meetings for a cigarette.  But he did make me an honorary lecturer so I could join the Staff Club, where I made many friends, including a young physics lecturer called Peter Higgs. The  staff club exists no longer, having been destroyed in one of those acts of short-sighted academic vandalism that vice-chancellors seem so fond of.

The great university expansion in the 1960s made it easy to get a job.  The most famous pharmacology department in the world was at UCL so I asked someone to introduce me to its then head, Heinz Schild, and asked him if he had a job.  While interned during WW2 he had written a paper on the statistics of biological assay and wanted someone to teach it to students, so I got a job (in 1964), and have been at UCL ever since apart from 9 years.  Between 1964 and 1970 I published little, but learned a great deal by writing a textbook on statistics.

That sort of statistics is now thought too difficult for undergraduates, and the famous department that attracted me was itself destroyed in another act of academic vandalism, in 2007.

I have spent my life doing things that I enjoy.  Such success as I’ve had, I attribute to a liking for spending time with people cleverer than I am, and wasting time drinking coffee.  I found a very clever statistician, Alan Hawkes, in the Housman Room in the late 1960s, and we began to collaborate on the theory of single ion channel analysis in a series of papers that still isn’t quite finished.  He did the hard mathematics, but I knew enough about it to write it up in a more or less comprehensible form and to write computer programs to evaluate the algebra.  When I got stuck, I would often ask Hyman Kestelman (co-author of the famous mathematics textbook, Massie & Kestelman) to explain, usually in what was then the Joint Staff Common Room at lunch time (it is now the Haldane room, the common room having been confiscated by unenlightened management).  Before leaving for the USA in 1970, I, in league with the then professor of French, Brian Woledge, eventually got through a motion that allowed women into the Housman room.

I’d also talk as much as I could to Bernard Katz, whom I asked to submit the first theoretical paper by Hawkes and me to the Royal Society. His comments on the first draft led to the published version making a prediction about single ion channel behaviour before channels could be observed. 

The next step was sheer luck.  As this was going on, two young Germans, Neher & Sakmann, succeeded in observing the tiny currents that flow through single ion channel molecules, so it became possible to test the theory.  In series of visits to Göttingen, Sakmann and I did experiments late into the night.  Neher & Sakmann got a well-deserved Nobel Prize in 1991, and I expect I benefitted from a bit of reflected glory

The work that I have done is nothing if not basic.  It doesn’t fit in with the current vogue for translational research (most of which will fail), although I would regard it as laying the basis for rational drug design. My only regret is that rational drug design has proved to be so difficult that it won’t be achieved in my lifetime (please don’t believe the hype).

We’d also like you to take a slightly more personal view:

3.  What have been the highs (and the lows?) of your career so far?

The highs have been the chance to work with brilliant people and write a handful of papers that have a chance of having a lasting influence.  Because I have been able to take my time on those projects there haven’t been too many lows, apart from observing the continuous loss of academic integrity caused by the intense pressure to publish or perish, and the progressive decline in collegiality in universities caused by that pressure combined with the rise in power of managerialism.  Luckily the advent of blogs has allowed me to do a little about that. 

I’m saddened by the fact that the innumeracy of biologists that I noticed as an undergraduate has not really improved at all (though I don’t believe it is worse).  Most biologists still have difficulty with even the simplest equations.  Worse still, they don’t know enough maths to communicate their problem to a mathematician, so only too often one sees collaborations with mathematicians produce useless results.

The only real failure I’ve had was when, in a fit of vanity, I applied for the chair of Pharmacology in Oxford, in 1984, and failed to get it.  But in retrospect that was really a success too.  I would have hated the flummery of Oxford, and as head of department (an increasingly unattractive job) I would have spent my time on pushing paper, not ion channels.  In retrospect, it was a lucky escape.  UCL is my sort of place (most of the time).

We would like to hear what our role models have to say about the next generation:

4.  What advice would you give to people finishing off their PhD?  

My career course would be almost impossible now.  In fact it is very likely that I would have been fired before I got going in the present climate.  There were quite long periods when I didn’t publish much.  I was learning the tools of my trade, both mathematical and experimental.  Now there is no time to do that.  You are under pressure to publish a paper a week (for the glory of your PI and your university) and probably rarely find time to leave the lab to talk to inspiring people. If you are given any courses they’ll probably be in some inane HR nonsense, not in algebra.  That is one reason we started our summer workshop, though bizarrely that has now been dropped by the graduate school in favour of Advanced Powerpoint.

The plight of recent PhDs is dire.  Too many are taken on (for the benefit of the university, not of the student) and there aren’t many academic jobs.  If you want to stay in academia, all I can suggest is that you get good at doing something that other people can’t do, and to resist the pressure to publish dozens of trivial papers. 

Try to maintain some academic integrity despite the many pressures to do the opposite that are imposed on you by your elders (but not always betters).  That may or may not be enough to get you the job that you want, but at least you’ll be able to hold your head high. 

Finally, we want to give a balanced impression of our role models because many were nominated for their ability to motivate others, and to balance life and work:

5.  How do you keep motivated?

Work-life balance is much talked about by HR, though they are one of the reasons why it is now almost impossible, In the past it wasn’t a great problem.  I’m fascinated by the problems that I’m trying to puzzle out.  I’ve had periods of a year or two when things haven’t gone well and I’ve felt as though I was a failure, but luckily they haven’t lasted too long, and they occurred in a time before some idiotic performance manager would harass you for failing to publish for a year or two.  The climate of “performance management” is doing a lot to kill innovation and creativity.

6.  What do you do when are not working in SLMS?                                                               

I’ve had various phases. For a while I carried on boxing (which had been compulsory at school). When I was first at UCL in 1964 I bought a 21 foot sloop (and as a consequence could barely afford to eat), and in 1970 (at Yale) I learned to fly. I had a lot of fun sailing right up to the early 1980s, when I found I could not afford a son as well as a boat. That was when running came into fashion and that could be done for the price of a pair of shoes.  I did marathons and half marathons for fun (the London in 1988 was great fun).  And that was supplanted by walking country trails in the early 2000s.  

There is never a clear division between work and play, especially with algebra. You can continue to struggle with a derivation on a boat, or even get a new angle on it while running.  That, of course, is why the transparency review is such total nonsense.

The main cause of stress has never been work for me. Stress comes mainly from the imposition of dim-witted managerialism and incompetent HR policies.  And that has become progressively worse.  I doubt that if I were a young academic now I’d have the time to spend the weekend sailing.

I’m not sure whether the blogging that has taken up something like half my time since my nominal retirement in 2004 counts as work or not.  It certainly depends on things that I have learned in my academic work.  And it’s fun to have effects in the real world after a life spent on problems that many would regard as esoteric. 

If you want a hobby that costs very little, and allows you to say what you want, start a blog.

Follow-up

Jump to follow-up

The Scottish Universities Medical Journal asked me to write about the regulation of alternative medicine. It’s an interesting topic and not easy to follow because of the veritable maze of more than twenty overlapping regulators and quangos which fail utterly to protect the public against health fraud. In fact they mostly promote health fraud. The paper is now published, and here is a version with embedded links (and some small updates).

We are witnessing an increasing commercialisation of medicine. It’s really taken off since the passage of the Health and Social Security Bill into law. Not only does that mean having NHS hospitals run by private companies, but it means that “any qualified provider” can bid for just about any service.  The problem lies, of course, in what you consider “qualified” to mean.  Any qualified homeopath or herbalist will, no doubt, be eligible.  University College London Hospital advertised for a spiritual healer. The "person specification" specified a "quallfication", but only HR people think that a paper qualification means that spiritual healing is anything but a delusion.

uclh-spirit

The vocabulary of bait and switch

First, a bit of vocabulary.  Alternative medicine is a term that is used for medical treatments that don’t work (or at least haven’t been shown to work).  If they worked, they’d be called “medicine”.  The anti-malarial, artemesinin, came originally from a Chinese herb, but once it had been purified and properly tested, it was no longer alternative.  But the word alternative is not favoured by quacks.  They prefer their nostrums to be described as “complementary” –it sounds more respectable.  So CAM (complementary and alternative medicine became the politically-correct euphemism.  Now it has gone a stage further, and the euphemism in vogue with quacks at the moment is “integrated” or “integrative” medicine.  That means, very often, integrating things that don’t work with things that do.  But it sounds fashionable.  In reality it is designed to confuse politicians who ask for, say, integrated services for old people.

Put another way, the salespeople of quackery have become rather good at bait and switch. The wikepedia definition is as good as any.

Bait-and-switch is a form of fraud, most commonly used in retail sales but also applicable to other contexts. First, customers are “baited” by advertising for a product or service at a low price; second, the customers discover that the advertised good is not available and are “switched” to a costlier product.

As applied to the alternative medicine industry, the bait is usually in the form of some nice touchy-feely stuff which barely mentions the mystical nonsense. But when you’ve bought into it you get the whole panoply of nonsense. Steven Novella has written eloquently about the use of bait and switch in the USA to sell chiropractic, acupuncture, homeopathy and herbal medicine: "The bait is that CAM offers legitimate alternatives, the switch is that it primarily promotes treatments that don’t work or are at best untested and highly implausible.".

The "College of Medicine" provides a near-perfect example of bait and switch. It is the direct successor of the Prince of Wales’ Foundation for Integrated Health. The Prince’s Foundation was a consistent purveyor of dangerous medical myths. When it collapsed in 2010 because of a financial scandal, a company was formed called "The College for Integrated Health". A slide show, not meant for public consumption, said "The College represents a new strategy to take forward the vision of HRH Prince Charles". But it seems that too many people have now tumbled to the idea that "integrated", in this context, means barmpottery. Within less than a month, the new institution was renamed "The College of Medicine". That might be a deceptive name, but it’s a much better bait. That’s why I described the College as a fraud and delusion.

Not only did the directors, all of them quacks, devise a respectable sounding name, but they also succeeded in recruiting some respectable-sounding people to act as figureheads for the new organisation. The president of the College is Professor Sir Graham Catto, emeritus professor of medicine at the University of Aberdeen. Names like his make the bait sound even more plausible. He claims not to believe that homeopathy works, but seems quite happy to have a homeopathic pharmacist, Christine Glover, on the governing council of his college. At least half of the governing Council can safely be classified as quacks.

So the bait is clear. What about the switch? The first thing to notice is that the whole outfit is skewed towards private medicine: see The College of Medicine is in the pocket of Crapita Capita. The founder, and presumably the main provider of funds (they won’t say how much) is the huge outsourcing company, Capita. This is company known in Private Eye as Crapita. Their inefficiency is legendary. They are the folks who messed up the NHS computer system and the courts computer system. After swallowing large amounts of taxpayers’ money, they failed to deliver anything that worked. Their latest failure is the court translation service.. The president (Catto), the vice president (Harry Brunjes) and the CEO (Mark Ratnarajah) are all employees of Capita.

The second thing to notice is that their conferences and courses are a bizarre mixture of real medicine and pure quackery. Their 2012 conference had some very good speakers, but then it had a "herbal workshop" with Simon Mills (see a video) and David Peters (the man who tolerates dowsing as a way to diagnose which herb to give you). The other speaker was Dick Middleton, who represents the huge herbal company, Schwabe (I debated with him on BBC Breakfast), In fact the College’s Faculty of Self-care appears to resemble a marketing device for Schwabe.

Why regulation isn’t working, and can’t work

There are various levels of regulation. The "highest" level is the statutory regulation of osteopathy and chiropractic. The General Chiropractic Council (GCC) has exactly the same legal status as the General Medical Council (GMC). This ludicrous state of affairs arose because nobody in John Major’s government had enough scientific knowledge to realise that chiropractic, and some parts of osteopathy, are pure quackery,

The problem is that organisations like the GCC function more to promote chiropractic than to regulate them. This became very obvious when the British Chiropractic Association (BCA) decided to sue Simon Singh for defamation, after he described some of their treatments as “bogus”, “without a jot of evidence”.

In order to support Singh, several bloggers assessed the "plethora of evidence" which the BCA said could be used to justify their claims. When, 15 months later, the BCA produced its "plethora" it was shown within 24 hours that the evidence was pathetic. The demolition was summarised by lawyer, David Allen Green, in The BCA’s Worst Day.

In the wake of this, over 600 complaints were made to the GCC about unjustified claims made by chiropractors, thanks in large part to heroic work by two people, Simon Perry and Allan Henness. Simon Perry’s Fishbarrel (browser plugin) allows complaints to be made quickly and easily -try it). The majority of these complaints were rejected by the GCC, apparently on the grounds that chiropractors could not be blamed because the false claims had been endorsed by the GCC itself.

My own complaint was based on phone calls to two chiropractors, I was told such nonsense as "colic is down to, er um, faulty movement patterns in the spine". But my complaint  never reached the Conduct and Competence committee because it had been judged by a preliminary investigating committee that there was no case to answer. The impression one got from this (very costly) exercise was that the GCC was there to protect chiropractors, not to protect the public.

The outcome was a disaster for chiropractors, wno emerged totally discredited. It was also a disaster for the GCC which was forced to admit that it hadn’t properly advised chiropractors about what they could and couldn’t claim. The recantation culminated in the GCC declaring, in August 2010, that the mythical "subluxation" is a "historical concept " "It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease.". Subluxation was a product of the fevered imagination of the founder of the chiropractic cult, D.D. Palmer. It referred to an imaginary spinal lesion that he claimed to be the cause of most diseases. .Since ‘subluxation’ is the only thing that’s distinguished chiropractic from any other sort of manipulation, the admission by the GCC that it does not exist, after a century of pretending that it does, is quite an admission.

The President of the BCA himself admitted in November 2011

“The BCA sued Simon Singh personally for libel. In doing so, the BCA began one of the darkest periods in its history; one that was ultimately to cost it financially,”

As a result of all this, the deficiencies of chiropractic, and the deficiencies of its regulator were revealed, and advertisements for chiropractic are somewhat less misleading. But this change for the better was brought about entirely by the unpaid efforts of bloggers and a few journalists, and not at all by the official regulator, the GCC. which was part of the problem. not the solution. And it was certainly not helped by the organisation that is meant to regulate the GCC, the Council for Health Regulatory Excellence (CHRE) which did nothing whatsoever to stop the farce.

At the other end of the regulatory spectrum, voluntary self-regulation, is an even worse farce than the GCC. They all have grand sounding "Codes of Practice" which, in practice, the ignore totally.

The Society of Homeopaths is just a joke. When homeopaths were caught out recommending sugar pills for prevention of malaria, they did nothing (arguably such homicidal advice deserves a jail sentence).

The Complementary and Natural Healthcare Council (CNHC) is widely know in the blogosphere as Ofquack. I know about them from the inside, having been a member of their Conduct and Competence Committee, It was set up with the help of a £900,000 grant from the Department of Health to the Prince of Wales, to oversee voluntary self-regulation. It fails utterly to do anything useful.. The CNHC code of practice, paragraph 15 , states

“Any advertising you undertake in relation to your professional activities must be accurate. Advertisements must not be misleading, false, unfair or exaggerated”. 

When Simon Perry made a complaint to the CNHC about claims being made by a CNHC-registered reflexologist, the Investigating Committee upheld all 15 complaints.  But it then went on to say that there was no case to answer because the unjustified claims were what the person had been taught, and were made in good faith. 
This is precisely the ludicrous situation which will occur again and again if reflexologists (and many other alternative therapies) are “accredited”.  The CNHC said, correctly, that the reflexologist had been taught things that were not true, but then did nothing whatsoever about it apart from toning down the advertisements a bit. They still register reflexologists who make outrageously false claims.

Once again we see that no sensible regulation is possible for subjects that are pure make-believe.

The first two examples deal (or rather, fail to deal) with regulation of outright quackery. But there are dozens of other quangos that sound a lot more respectable.

European Food Standards Agency (EFSA). One of the common scams is to have have your favourite quack treatment classified as a food not as a medicine. The laws about what you can claim have been a lot laxer for foods. But the EFSA has done a pretty good job in stopping unjustified claims for health benefits from foods. Dozens of claims made by makers of probiotics have been banned. The food industry, needless to say, objects very strongly to be being forced to tell the truth. In my view, the ESFA has not gone far enough. They recently issued a directive about claims that could legally be made. Some of these betray the previously high standards of the EFSA. For example you are allowed to say that "Vitamin C contributes to the reduction of tiredness and fatigue" (as long as the product contains above a specified amount of Vitamin C. I’m not aware of any trials that show vitamin C has the slightest effect on tiredness or fatigue, Although these laws do not come into effect until December 2012, they have already been invoked by the ASA has a reason not to uphold a complaint about a multivitamin pill which claimed that it “Includes 8 nutrients that can contribute to the reduction in tiredness and fatigue”

The Advertising Standards Authority (ASA). This is almost the only organisation that has done a good job on false health claims. Their Guidance on Health Therapies & Evidence says

"Whether you use the words ‘treatment’, ‘treat’ or ‘cure’, all are likely to be seen by members of the public as claims to alleviate effectively a condition or symptom. We would advise that they are not used"

"Before and after’ studies with little or no control, studies without human subjects, self-assessment studies and anecdotal evidence are unlikely to be considered acceptable"

"Before and after’ studies with little or no control, studies without human subjects, self-assessment studies and anecdotal evidence are unlikely to be considered acceptable"

They are spot on.

The ASA’s Guidance for Advertisers of Homeopathic Services is wonderful.

"In the simplest terms, you should avoid using efficacy claims, whether implied or direct,"

"To date, the ASA has have not seen persuasive evidence to support claims that homeopathy can treat, cure or relieve specific conditions or symptoms."

That seems to condemn the (mis)labelling allowed by the MHRA as breaking the rules.. Sadly, though, the ASA has no powers to enforce its decisions and only too often they are ignored. The Nightingale collaboration has produced an excellent letter that you can hand to any pharmacist who breaks the rules

The ASA has also judged against claims made by "Craniosacral therapists" (that’s the lunatic fringe of osteopathy). They will presumably uphold complaints about similar claims made (I’m ashamed to say) by UCLH Hospitals.

The private examination company Edexcel sets exams in antiscientific subjects, so miseducating children. The teaching of quackery to 16 year-olds has been approved by a maze of quangos, none  of which will take responsibility, or justify their actions. So far I’ve located no fewer than eight of them. The Office of the Qualifications and Examinations Regulator (OfQual), Edexcel, the Qualifications and Curriculum Authority (QCA), Skills for Health, Skills for Care, National Occupational Standards (NOS), private exam company VTCT and the schools inspectorate, Ofsted.. Asking any of these people why they approve of examinations in imaginary subjects meets with blank incomprehension. They fail totally to protect tha public from utter nonsense.

The Department of Education has failed to do anything about the miseducation of children in quackery. In fact it has encouraged it by, for the first time, giving taxpayers’ money to a Steiner (Waldorf) school (at Frome, in Somerset). Steiner schools are run by a secretive and cult-like body of people (read about it). They teach about reincarnation, karma, gnomes, and all manner of nonsense, sometimes with unpleasant racial overtones. The teachers are trained in Steiner’s Anthroposophy, so if your child gets ill at school they’ll probably get homeopathic sugar pills. They might well get measles or mumps too, since Steiner people don’t believe in vaccination.

Incredibly, the University of Aberdeen came perilously close to appointing a chair in anthroposophical medicine. This disaster was aborted by bloggers, and a last minute intervention from journalists. Neither the university’s regulatory mechanisms. nor any others, seemed to realise that a chair in mystical barmpottery was a bad idea.

Trading Standards offices and the Office of Fair Trading.

It is the statutory duty of Trading Standards to enforce the Consumer Protection Regulations (2008) This European legislation is pretty good. it caused a lawyer to write " Has The UK Quietly Outlawed “Alternative” Medicine?". Unfortunately Trading Standards people have consistently refused to enforce these laws. The whole organisation is a mess. Its local office arrangement fails totally to deal with the age of the internet. The situation is so bad that a group of us decided to put them to the test. The results were published in the Medico-Legal Journal, Rose et al., 2012. "Spurious Claims for Health-care Products: An Experimental Approach to Evaluating Current UK Legislation and its Implementation". They concluded "EU directive 2005/29/EC is
largely ineffective in preventing misleading health claims for consumer products in
the UK"

Skills for Health is an enormous quango which produces HR style "competences" for everything under the son. They are mostly quite useless. But those concerned with alternative medicine are not just useless. They are positively harmful. Totally barmy. There are competences and National Occupational Standards for every lunatic made-up therapy under the sun. When I phoned them to discover who’d written them, I learned that the had been drafted by the Prince of Wales’ Foundation for Magic Medicine. And when I joked by asking if they had a competence for talking to trees, I was told, perfectly seriously, “You’d have to talk to LANTRA, the land-based organisation for that.”

That was in January 2008. A lot of correspondence with the head of Skills for Health got nowhere at all. She understood nothing and it hasn’t improved a jot.

This organisation costs a lot of taxpayers’ money and it should have been consigned to the "bonfire of the quangos" (but of course there was no such bonfire in reality). It is a disgrace.

The Quality Assurance Agency (QAA) is supposed to ensure the quality of university courses. In fact it endorses courses in nonsense alternative medicine and so does more harm than good. The worst recent failure of the QAA was in the case of the University of Wales: see Scandal of the University of Wales and the Quality Assurance Agency. The university was making money by validating thousands of external degrees in everything from fundamentalist theology to Chinese Medicine. These validations were revealed as utterly incompetent by bloggers, and later by BBC Wales journalist Ciaran Jenkins (now working for Channel 4).

The mainstream media eventually caught up with bloggers. In 2010, BBC1 TV (Wales) produced an excellent TV programme that exposed the enormous degree validation scam run by the University of Wales. The programme can be seen on YouTube (Part 1, and Part 2). The programme also exposed, incidentally, the uselessness of the Quality Assurance Agency (QAA) which did nothing until the scam was exposed by TV and blogs. Eventually the QAA sent nine people to Malaysia to investigate a dodgy college that had been revealed by the BBC. The trip cost £91,000. It could have been done for nothing if anyone at the QAA knew how to use Google.

The outcome was that the University of Wales stopped endorsing external courses, and it was soon shut down altogether (though bafflingly, its vice-chancellor, Marc Clement was promoted). The credit for this lies entirely with bloggers and the BBC. The QAA did nothing to help until the very last moment.

Throughout this saga Universities UK (UUK), has maintained its usual total passivity. They have done nothing whatsoever about their members who give BSc degrees in anti-scientific subjects. (UUK used to known as the Committee of Vice-Chancellors and Principals).

Council for Health Regulatory Excellence (CHRE), soon to become the PSAHSC,

Back now to the CHRE, the people who failed so signally to sort out the GCC. They are being reorganised. Their consultation document says

"The Health and Social Care Act 20122 confers a new function on the Professional Standards Authority for Health and Social Care (the renamed Council for Healthcare Regulatory Excellence). From November 2012 we will set standards for organisations that hold voluntary registers for people working in health and social care occupations and we will accredit the register if they meet those standards. It will then be known as an ‘Accredited Register’. "

They are trying to decide what the criteria should be for "accreditation" of a regulatory body. The list of those interested has some perfectly respectable organisations, like the British Psychological Society. It also contains a large number of crackpot organisations, like Crystal and Healing International, as well as joke regulators like the CNHC.

They already oversee the Health Professions Council (HPC) which is due to take over Herbal medicine and Traditional Chinese Medicine, with predictably disastrous consequences.

Two of the proposed criteria for "accreditation" appear to be directly contradictory.

Para 2.5 makes the whole accreditation pointless from the point of view of patients

2.5 It will not be an endorsement of the therapeutic validity or effectiveness of any particular discipline or treatment.

Since the only thing that matters to the patient is whether the therapy works (and is safe), accrediting of organisations that ignore this will merely give the appearance of official approval of crystal healing etc etc. This appears to contradict directly

A.7 The organisation can demonstrate that there either is a sound knowledge base underpinning the profession or it is developing one and makes that explicit to the public.

A "sound knowledge base", if it is to mean anything useful at all, means knowledge that the treatment is effective. If it doesn’t mean that, what does it mean?

It seems that the official mind has still not grasped the obvious fact that there can be no sensible regulation of subjects that are untrue nonsense. If it is nonsense, the only form of regulation that makes any sense is the law.

Please fill in the consultation. My completed return can be downloaded as an example, if you wish.

Medicines and Healthcare products Regulatory Agency (MHRA) should be a top level defender of truth. Its strapline is

"We enhance and safeguard the health of the public by ensuring that medicines and medical devices work and are acceptably safe."

The MHRA did something (they won’t tell me exactly what) about one of the most cruel scams that I’ve ever encountered, Esperanza Homeopathic Neuropeptide, peddled for multiple sclerosis, at an outrageous price ( £6,759 for 12 month’s supply). Needless to say there was not a jot of evidence that it worked (and it wasn’t actually homeopathic).

Astoundingly, Trading Standards officers refused to do anything about it.

The MHRA admit (when pushed really hard) that there is precious little evidence that any of the herbs work, and that homeopathy is nothing more than sugar pills. Their answer to that is to forget that bit about "ensuring that medicines … work"

Here’s the MHRA’s Traditional Herbal Registration Certificate for devils claw tablets.

vitabiotics

The wording "based on traditional use only" has to be included because of European legislation. Shockingly, the MHRA have allowed them to relegate that to small print, with all the emphasis on the alleged indications. The pro-CAM agency NCCAM rates devil’s claw as "possibly effective" or "insufficient evidence" for all these indications, but that doesn’t matter because the MHRA requires no evidence whatsoever that the tablets do anything. They should, of course, added a statement to this effect to the label. They have failed in their duty to protect and inform the public by allowing this labelling.

But it gets worse. Here is the MHRA’s homeopathic marketing authorisation for the homeopathic medicinal product Arnicare Arnica 30c pillules

It is nothing short of surreal.

hom1
hom2

Since the pills contain nothing at all, they don’t have the slightest effect on sprains, muscular aches or bruising. The wording on the label is exceedingly misleading.

If you "pregnant or breastfeeding" there is no need to waste you doctor’s time before swallowing a few sugar pills.

"Do not take a double dose to make up for a missed one". Since the pills contain nothing, it doesn’t matter a damn.

"If you overdose . . " it won’t have the slightest effect because there is nothing in them

And it gets worse. The MHRA-approved label specifies ACTIVE INGREDIENT. Each pillule contains 30c Arnica Montana

No, they contain no arnica whatsoever.

hom3
hom4

It truly boggles the mind that men with dark suits and lots of letters after their names have sat for hours only to produce dishonest and misleading labels like these.

When this mislabeling was first allowed, it was condemned by just about every scientific society, but the MHRA did nothing.

The Nightingale Collaboration.

This is an excellent organisation, set up by two very smart skeptics, Alan Henness and Maria MacLachlan. Visit their site regularly, sign up for their newsletter Help with their campaigns. Make a difference.

Conclusions

The regulation of alternative medicine in the UK is a farce. It is utterly ineffective in preventing deception of patients.

Such improvements as have occurred have resulted from the activity of bloggers, and sometime the mainstream media. All the official regulators have, to varying extents, made things worse.

The CHRE proposals promise to make matters still worse by offering "accreditation" to organisations that promote nonsensical quackery. None of the official regulators seem to be able to grasp the obvious fact that is impossible to have any sensible regulation of people who promote nonsensical untruths. One gets the impression that politicians are more concerned to protect the homeopathic (etc, etc) industry than they are to protect patients.

Deception by advocates of alternative medicine harms patients. There are adequate laws that make such deception illegal, but they are not being enforced. The CHRE and its successor should restrict themselves to real medicine. The money that they spend on pseudo-regulation of quacks should be transferred to the MHRA or a reformed Trading Standards organisation so they can afford to investigate and prosecute breaches of the law. That is the only form of regulation that makes sense.

 

Follow-up

The shocking case of the continuing sale of “homeopathic vaccines” for meningitis, rubella, pertussis etc was highlighted in an excellent TV programme by BBC South West. The failure of the MHRA and the GPC do take any effective action is a yet another illustration of the failure of regulators to do their job. I have to agree with Andy Lewis when he concludes

“Children will die. And the fault must lie with Professor Sir Kent Woods, chairman of the regulator.”

Jump to follow-up

Academic staff are going to be fired at Queen Mary University of London (QMUL). It’s possible that universities may have to contract a bit in hard times, so what’s wrong?

What’s wrong is that the victims are being selected in a way that I can describe only as insane. The criteria they use are guaranteed to produce a generation of second-rate spiv scientists, with a consequent progressive decline in QMUL’s reputation.

The firings, it seems, are nothing to do with hard financial times, but are a result of QMUL’s aim to raise its ranking in university league tables.

In the UK university league table, a university’s position is directly related to its government research funding. So they need to do well in the 2014 ‘Research Excellence Framework’ (REF). To achieve that they plan to recruit new staff with high research profiles, take on more PhD students and post-docs, obtain more research funding from grants, and get rid of staff who are not doing ‘good’ enough research.

So far, that’s exactly what every other university is trying to do. This sort of distortion is one of the harmful side-effects of the REF. But what’s particularly stupid about QMUL’s behaviour is the way they are going about it. You can assess your own chances of survival at QMUL’s School of Biological and Chemical Sciences from the following table, which is taken from an article by Jeremy Garwood (Lab Times Online. July 4, 2012). The numbers refer to the four year period from 2008 to 2011.

Category of staff

Research Output ­ Quantity
(No. of  Papers)

Research Output ­
Quality
(No. of  high quality papers)

Research Income (£)
(Total)

Research Income (£)
As Principal Investigator

Professor

11

2

400,000

 at least 200,000

Reader

9

2

320,000

at least 150,000

Senior Lecturer

7

1

260,000

 at least 120,000

Lecturer

5

1

200,000

 at least 100,000

In addition to the three criteria, ‘Research Output ‐ quality’, ‘Research Output – quantity’, and ‘Research Income’, there is a minimum threshold of 1 PhD completion for staff at each academic level. All this data is “evidenced by objective metrics; publications cited in Web of Science, plus official QMUL metrics on grant income and PhD completion.”

To survive, staff must meet the minimum threshold in three out of the four categories, except as follows:

Demonstration of activity at an exceptional level in either ‘research outputs’ or ‘research income’, termed an ‘enhanced threshold’, is “sufficient” to justify selection regardless of levels of activity in the other two categories. And what are these enhanced thresholds?
For research quantity: a mere 26 published items with at least 11 as significant author (no distinction between academic level); research quality: a modest 6 items published in numerically-favoured journals (e.g. impact factor > 7). Alternatively you can buy your survival with a total ‘Research Income’ of £1,000,000 as PI.

The university notes that the above criteria “are useful as entry standards into the new school, but they fall short of the levels of activity that will be expected from staff in the future. These metrics should not, therefore, be regarded as targets for future performance.”

This means that those who survived the redundancy criteria will simply have to do better. But what is to reassure them that it won’t be their turn next time should they fail to match the numbers? 

To help them, Queen Mary is proposing to introduce ‘D3’ performance management (www.unions.qmul.ac.uk/ucu/docs/d3-part-one.doc). Based on more ‘administrative physics’, D3 is shorthand for ‘Direction × Delivery × Development.’ Apparently “all three are essential to a successful team or organisation. The multiplication indicates that where one is absent/zero, then the sum is zero!”

D3 is based on principles of accountability: “A sign of a mature organisation is where its members acknowledge that they face choices, they make commitments and are ready to be held to account for discharging these commitments, accepting the consequences rather than seeking to pass responsibility.” Inspired?

I presume the D3 document must have been written by an HR person. It has all the incoherent use of buzzwords so typical of HR. And it says "sum" when it means "product" (oh dear, innumeracy is rife).

The criteria are utterly brainless. The use of impact factors for assessing people has been discredited at least since Seglen (1997) showed that the number of citations that a paper gets is not perceptibly correlated with the impact factor of the journal in which it’s published. The reason for this is the distribution of the number of citations for papers in a particular journal is enormously skewed. This means that high-impact journals get most of their citations from a few articles.

The distribution for Nature is shown in Fig. 1. Far from being gaussian, it is even more skewed than a geometric distribution; the mean number of citations is 114, but 69% of papers have fewer than the mean, and 24% have fewer than 30 citations. One paper has 2,364 citations but 35 have 10 or fewer. ISI data for citations in 2001 of the 858 papers published in Nature in 1999 show that the 80 most-cited papers (16% of all papers) account for half of all the citations (from Colquhoun, 2003)

impact

The Institute of Scientific Information, ISI, is guilty of the unsound statistical practice of characterizing a distribution by its mean only, with no indication of its shape or even its spread. School of Biological and Chemical Sciences-QMUL is expecting everyone has to be above average in the new regime. Anomalously, the thresholds for psychologists are lower because it is said that it’s more difficult for them to get grants. This undermines even the twisted logic applied at the outset.  

All this stuff about skewed distributions is, no doubt, a bit too technical for HR people to understand. Which, of course, is precisely why they should have nothing to do with assessing people.

At a time when so may PhDs fail to get academic jobs we should be limiting the numbers. But QMUL requires everyone to have a PhD student, not for the benefit of the student, but to increase its standing in league tables. That is deeply unethical.

The demand to have two papers in journals with impact factor greater than seven is nonsense. In physiology, for example, there are only four journals with an impact factor greater that seven and three of them are review journals that don’t publish original research. The two best journals for electrophysiology are Journal of Physiology (impact factor 4.98, in 2010) and Journal of General Physiology (IF 4.71). These are the journals that publish papers that get you into the Royal Society or even Nobel prizes. But for QMUL, they don’t count.

I have been lucky to know well three Nobel prize winners. Andrew Huxley. Bernard Katz, and Bert Sakmann. I doubt that any of them would pass the criteria laid down for a professor by QMUL. They would have been fired.

The case of Sakmann is analysed in How to Get Good Science, [pdf version]. In the 10 years from 1976 to 1985, when Sakmann rose to fame, he published an average of 2.6 papers per year (range 0 to 6). In two of these 10 years he had no publications at all. In the 4 year period (1976 – 1979 ) that started with the paper that brought him to fame (Neher & Sakmann, 1976) he published 9 papers, just enough for the Reader grade, but in the four years from 1979 – 1982 he had 6 papers, in 2 of which he was neither first nor last author. His job would have been in danger if he’d worked at QMUL. In 1991 Sakmann, with Erwin Neher, got the Nobel Prize for Physiology or Medicine.

The most offensive thing of the lot is the way you can buy yourself out if you publish 26 papers in the 4 year period. Sakmann came nowhere near this. And my own total, for the entire time from my first paper (1963) until I was elected to the Royal Society (May 1985) was 27 papers (and 7 book chapters). I would have been fired.

Peter Higgs had no papers at all from the time he moved to Edinburgh in 1960, until 1964 when his two paper’s on what’s now called the Higgs’ Boson were published in Physics Letters. That journal now has an impact factor less than 7 so Queen Mary would not have counted them as “high quality” papers, and he would not have been returnable for the REF. He too would have been fired.

The encouragement to publish large numbers of papers is daft. I have seen people rejected from the Royal Society for publishing too much. If you are publishing a paper every six weeks, you certainly aren’t writing them, and possibly not even reading them. Most likely you are appending your name to somebody else’s work with little or no checking of the data. Such numbers can be reached only by unethical behaviour, as described by Peter Lawrence in The Mismeasurement of Science. Like so much managerialism, the rules provide an active encouragement to dishonesty.

In the face of such a boneheaded approach to assessment of your worth, it’s the duty of any responsible academic to point out the harm that’s being done to the College. Richard Horton, in the Lancet, did so in Bullying at Barts. There followed quickly letters from Stuart McDonald and Nick Wright, who used the Nuremburg defence, pointing out that the Dean (Tom Macdonald) was just obeying orders from above. That has never been as acceptable defence. If Macdonald agreed with the procedure, he should be fired for incompetence. If he did not agree with it he should have resigned.

It’s a pity, because Tom Macdonald was one of the people with whom I corresponded in support of Barts’ students who, very reasonably, objected to having course work marked by homeopaths (see St Bartholomew’s teaches antiscience, but students revolt, and, later, Bad medicine. Barts sinks further into the endarkenment). In that case he was not unreasonable, and, a mere two years later I heard that he’d taken action.

To cap it all, two academics did their job by applying a critical eye to what’s going on at Queen Mary. They wrote to the Lancet under the title Queen Mary: nobody expects the Spanish Inquisition

"For example, one of the “metrics” for research output at professorial level is to have published at least two papers in journals with impact factors of 7 or more. This is ludicrous, of course—a triumph of vanity as sensible as selecting athletes on the basis of their brand of track suit. But let us follow this “metric” for a moment. How does the Head of School fair? Zero, actually. He fails. Just consult Web of Science. Take care though, the result is classified information. HR’s “data” are marked Private and Confidential. Some things must be believed. To question them is heresy."

Astoundingly, the people who wrote this piece are now under investigation for “gross misconduct”. This is behaviour worthy of the University of Poppleton, as pointed out by the inimitable Laurie Taylor, in Times Higher Education (June 7)

The rustle of censorship

It appears that last week’s edition of our sister paper, The Poppleton Evening News, carried a letter from Dr Gene Ohm of our Biology Department criticising this university’s metrics-based redundancy programme.

We now learn that, following the precedent set by Queen Mary, University of London, Dr Ohm could be found guilty of “gross misconduct” and face “disciplinary proceedings leading to dismissal” for having the effrontery to raise such issues in a public place.

Louise Bimpson, the corporate director of our ever-expanding human resources team, admitted that this response might appear “severe” but pointed out that Poppleton was eager to follow the disciplinary practices set by such soon-to-be members of the prestigious Russell Group as Queen Mary. Thus it was only to be expected that we would seek to emulate its espousal of draconian censorship. She hoped this clarified the situation.

David Bignell, emeritus professor of zoology at Queen Mary hit the nail on the head.

"These managers worry me. Too many are modest achievers, retired from their own studies, intoxicated with jargon, delusional about corporate status and forever banging the metrics gong. Crucially, they don’t lead by example."

What the managers at Queen Mary have failed to notice is that the best academics can choose where to go.

People are being told to pack their bags and move out with one day’s notice. Access to journals stopped, email address removed, and you may need to be accompanied to your (ex)-office. Good scientists are being treated like criminals.

What scientist in their right mind would want to work at QMUL, now that their dimwitted assessment methods, and their bullying tactics, are public knowledge?

The responsibility must lie with the principal, Simon Gaskell. And we know what the punishment is for bringing your university into disrepute.

Follow-up

Send an email. You may want to join the many people who have already written to QMUL’s principal, Simon Gaskell (principal@qmul.ac.uk), and/or to Sir Nicholas Montagu, Chairman of Council, n.montagu@qmul.ac.uk.

Sunday 1 July 2012. Since this blog was posted after lunch on Friday 29th June, it has had around 9000 visits from 72 countries. Here is one of 17 maps showing the origins of 200 of the hits in the last two days

map

The tweets about QMUL are collected in a Storify timeline.

I’m reminded of a 2008 comment, on a post about the problems imposed by HR, In-human resources, science and pizza.

Thanks for that – I LOVED IT. It’s fantastic that the truth of HR (I truly hate that phrase) has been so ruthlessly exposed. Should be part of the School Handbook. Any VC who stripped out all the BS would immediately retain and attract good people and see their productivity soar.

That’s advice that Queen Mary should heed.

Part of the reason for that popularity was Ben Goldacre’s tweet, to his 201,000 followers

“destructive, unethical and crude metric incentives in academia (spotlight QMUL) bit.ly/MFHk2H by @david_colquhoun

3 July 2012. I have come by a copy of this email, which was sent to Queen Mary by a senior professor from the USA (word travels fast on the web). It shows just how easy it is to destroy the reputation of an institution.

Sir Nicholas Montagu, Chairman of Council, and Principal Gaskell,

I was appalled to read the criteria devised by your University to evaluate its faculty.   There are so flawed it is hard to know where to begin. 

Your criteria are antithetical to good scientific research.  The journals are littered with weak publications, which are generated mainly by scientists who feel the pressure to publish, no matter whether the results are interesting, valid, or meaningful.  The literature is flooded by sheer volume of these publications.

Your attempt to require “quality” research is provided by the requirement for publications in “high Impact Factor” journals.  IF has been discredited among scientists for many reasons:  it is inaccurate in not actually reflecting the merit of the specific paper, it is biased toward fields with lots of scientists, etc.  The demand for publications in absurdly high IF journals encourages, and practically enforces scientific fraud.  I have personally experienced those reviews from Nature demanding one or two more “final” experiments that will clinch the publication.  The authors KNOW how these experiments MUST turn out.  If they want their Nature paper (and their very academic survival if they are  at a brutal, anti-scientific university like QMUL), they must get the “right” answer.  The temptation to fudge the data to get this answer is extreme.  Some scientists may even be able to convince themselves that each contrary piece of data that they discard to ensure the “correct” answer is being discarded for a valid reason.  But the result is that scientific misconduct occurs.  I did not see in your criteria for “success” at QMUL whether you discount retracted papers from the tally of high IF publications, or perhaps the retraction itself counts as yet another high IF publication!

Your requirement for each faculty to have one or more postdocs or students promotes the abusive exploitation of these individuals for their cheap labor, and ignores the fact that they are being “trained” for jobs that do not exist. 

The “standards” you set are fantastically unrealistic.  For example, funding is not graded, but a sharp step function – we have 1 or 2 or 0 grants and even if the average is above your limits, no one could sustain this continuously. Once you have fired every one of your faculty, which will almost certainly happen within 1-2 rounds of pogroms, where will you find legitimate scientists who are willing to join such a ludicrous University?

4 July 2012.

Professor John F. Allen is Professor of Biochemistry at Queen Mary, University of London, and distinguished in the fields of Photosynthesis, Chloroplasts, Mitochondria, Genome function and evolution and Redox signalling. He, with a younger colleague, wrote a letter to the Lancet, Queen Mary: nobody expects the Spanish Inquisition. It is an admirable letter, the sort of thing any self-respecting academic should write. But not according to HR. On 14 May, Allen got a letter from HR, which starts thus.

14th May 2012

Dear Professor Allen

I am writing to inform you that the College had decided to commence a factfinding investigation into the below allegation: That in writing and/or signing your name to a letter entitled "Queen Mary: nobody expects the Spanish Inquisition," (enclosed) which was published in the Lancet online on 4th May 2012, you sought to bring the Head of School of Biological and Chemical Sciences and the Dean for Research in the School of Medicine and Dentistry into disrepute.

. . . .

Sam Holborn
HR Consultant- Science & Engineering

Download the entire letter. It is utterly disgraceful bullying. If anyone is bringing Queen Mary into disrepute, it is Sam Holborn and the principal, Simon Gaskell.

Here’s another letter, from the many that have been sent. This is from a researcher in the Netherlands.

Dear Sir Nicholas,

I am addressing this to you in the hope that you were not directly involved in creating this extremely stupid set of measures that have been thought up, not to improve the conduct of science at QMUL, but to cheat QMUL’s way up the league tables over the heads of the existing academic staff.

Others have written more succinctly about the crass stupidity of your Human Resources department than I could, and their apparent ignorance of how science actually works. As your principal must bear full responsibility for the introduction of these measures, I am not sending him a copy of this mail. I am pretty sure that his “principal” mail address will no longer be operative.

We have had a recent scandal in the Netherlands where a social psychology professor, who even won a national “Man of the Year” award, as well as as a very large amount of research money, was recently exposed as having faked all the data that went into a total number of articles running into three figures. This is not the sort of thing one wants to happen to one’s own university. He would have done well according to your REF .. before he was found out.

Human Resources departments have gained too much power, and are completely incompetent when it comes to judging academic standards. Let them get on with the old dull, and gobbledigook-free, tasks that personnel departments should be carrying out.


Yours,

5 July 2012.

Here’s another letter. It’s from a member of academic staff at QMUL, someone who is not himself threatened with being fired. It certainly shows that I’m not making a fuss about nothing. Rather, I’m the only person old enough to say what needs to be said without fear of losing my job and my house.

Dear Prof. Colquhoun,

I am an academic staff member in SBCS, QMUL.  I am writing from my personal email account because the risks of using my work account to send this email are too great.

I would like to thank you for highlighting our problems and how we have been treated by our employer (Queen Mary University of London), in your blog. I would please urge you to continue to tweet and blog about our plight, and staff in other universities experiencing similarly horrific working conditions.

I am not threatened with redundancy by QMUL, and in fact my research is quite successful. Nevertheless, the last nine months have been the most stressful of all my years of academic life. The best of my colleagues in SBCS, QMUL are leaving already and I hope to leave, if I can find another job in London. 

Staff do indeed feel very unfairly treated, intimidated and bullied. I never thought a job at a university could come to this.
Thank you again for your support. It really does matter to the many of us who cannot really speak out openly at present.
Best regards,

 

In a later letter, the same person pointed out

"There are many of us who would like to speak more openly, but we simply cannot."

"I have mortgage . . . . Losing my job would probably mean losing my home too at this point."

"The plight of our female staff has not even been mentioned. We already had very few female staff. And with restructuring, female staff are more likely to be forced into teaching-only contracts or indeed fired"."

"total madness in the current climate – who would want to join us unless desperate for a job!"

“fuss about nothing” – absolutely not. It is potentially a perfect storm leading to teaching and research disaster for a university!  Already the reputation of our university has been greatly damaged. And senior staff keep blaming and targeting the “messengers"."

6 July 2012.

Througn the miracle of WiFi, this is coming from Newton, MA. The Lancet today has another editorial on the Queen Mary scandal.

"As hopeful scientists prepare their applications to QMUL, they should be aware that, behind the glossy advertising, a sometimes harsh, at times repressive, and disturbingly unforgiving culture awaits them."

That sums it up nicely.

24 July 2012. I’m reminded by Nature writer, Richard van Noorden (@Richvn) that Nature itself has wriiten at least twice about the iniquity of judging people by impact factors. In 2005 Not-so-deep impact said

"Only 50 out of the roughly 1,800 citable items published in those two years received more than 100 citations in 2004. The great majority of our papers received fewer than 20 citations."

"None of this would really matter very much, were it not for the unhealthy reliance on impact factors by administrators and researchers’ employers worldwide to assess the scientific quality of nations and institutions, and often even to judge individuals."

And, more recently, in Assessing assessment” (2010).

29 July 2012. Jonathan L Rees. of the University of Edinburgh, ends his blog:

"I wonder what career advice I should offer to a young doctor circa 2012. Apart from not taking a job at Queen Mary of course. "

How to select candidates

I have, at various times, been asked how I would select candidates for a job, if not by counting papers and impact factors. This is a slightly modified version of a comment that I left on a blog, which describes roughly what I’d advocate

After a pilot study the entire Research Excellence Framework (which attempts to assess the quality of research in every UK university) made the following statement.

“No sub-panel will make any use of journal impact factors, rankings, lists or the perceived standing of publishers in assessing the quality of research outputs”

It seems that the REF is paying attention to the science not to bibliometricians.

It has been the practice at UCL to ask people to nominate their best papers (2 -4 papers depending on age). We then read the papers and asked candidates hard questions about them (not least about the methods section). It’s a method that I learned a long time ago from Stephen Heinemann, a senior scientist at the Salk Institute. It’s often been surprising to learn how little some candidates know about the contents of papers which they themselves select as their best. One aim of this is to find out how much the candidate understands the principles of what they are doing, as opposed to following a recipe.

Of course we also seek the opinions of people who know the work, and preferably know the person. Written references have suffered so much from ‘grade inflation’ that they are often worthless, but a talk on the telephone to someone that knows both the work, and the candidate, can be useful, That, however, is now banned by HR who seem to feel that any knowledge of the candidate’s ability would lead to bias.

It is not true that use of metrics is universal and thank heavens for that. There are alternatives and we use them.

Incidentally, the reason that I have described the Queen Mary procedures as insane, brainless and dimwitted is because their aim to increase their ratings is likely to be frustrated. No person in their right mind would want to work for a place that treats its employees like that, if they had any other option. And it is very odd that their attempt to improve their REF rating uses criteria that have been explicitly ruled out by the REF. You can’t get more brainless than that.

This discussion has been interesting to me, if only because it shows how little bibliometricians understand how to get good science.

I was asked recently to write a reply to an article about "research managers" for the magazine Research Fortnight. This is a magazine that carries news of research and has a very useful list of potential research funding agencies.

The article to which I was asked to respond originally had the title “Researchers and Research Managers, a match made in heaven?“, before the subeditors got hold of it. It was written by Simon Kerridge, who is secretary of the Association for Research Managers and Administrators The printed version of his article can be downloaded here, and the printed version of my response here. My response, as submitted, is below with live links.

This invitation came at a strangely appropriate time, just at the moment that every university is having serious budget cuts, Well, here is a chance to make a good start on cutting out non-jobs..

Researchers and Research Managers: an imminent divorce?

David Colquhoun, UCL.

The web site of the Association of Research Managers and Administrators says it has 1600 individual members [1], but every scientist I have met is baffled about why they have suddenly sprung into existence.  The web site says “Our mission is to facilitate excellence in research by identifying and establishing best practice in research management and administration”.  I had to read that several times in an attempt to extract a meaning from the mangled bureaucratic prose.  “Our mission is to promote excellence in research”.  How can non-scientists with no experience of research possibly “promote excellence in research”?  They can’t, and that’s pretty obvious when you read the second half of the sentence.  They propose to improve science by promoting research management, i.e.  themselves.

res fortnight

Kerridge’s article didn’t help much either.  He seems to think that research managers are there to make that scientists fulfil “overall strategic aims of the University”.  In other words they are there to make sure that scientists obey the orders of non-scientists (or elderly ex-scientists) who claim to know what the future holds.  I can think of no better way to ruin the scientific reputation of a university and to stifle creativity.

We all appreciate good support.  We used to have a very helpful person in the department (not a ‘manager’) who could advise on some of the financial intricacies, but now it is run by a ‘manager’ it has been centralised, depersonalised and it is far less efficient.

The fact of the matter seems to be that “research managers” are just one more layer of hangers-on that have been inflicted on the academic enterprise during the time new labour was in power.  They are certainly not alone.  We have now have “research facilitators” and offshoots of HR running nonsense courses in things like Brain Gym [2].  All of these people claim they are there to support research.  They do no such thing.  They merely generate more paper work and more distraction from the job in hand.  Take a simple example.  At a time when there was a redundancy committee in existence to decide which academics should be fired in my own faculty, the HR department advertised two jobs (on near professorial salaries) for people trained in neurolinguistic programming (that is a well-known sort of pseudo-scientific psychobabble, but it’s big business [3]).

A quick look at what research managers actually do (in two research-intensive universities) shows that mostly they send emails that list funding agencies, and to forward emails you already had from someone else.  Almost all of it can be found more conveniently by a couple of minutes with Google.  Although they claim to reduce administrative work for scientists, it is usually quicker to do it yourself than to try to explain things to people who don’t understand the science.  They don’t save work, they make it.

One might well ask how it is that so much money has come to be spent on pseudo-jobs like “research managers”.  I can only guess that it is part of the ever-expanding tide of administrative junk that encumbers the work of people who are trying to do good creative science.  It also arises from the misapprehension, widespread among vice-chancellors, that you can get creative science by top down management of research by people who know little about it.

I’m reminded of the words of the “unrepentant capitalist”, Luke Johnson [4] (he was talking about HR but the words apply equally here).

“HR is like many parts of modern businesses: a simple expense, and a burden on the backs of the productive workers”,

“They don’t sell or produce: they consume. They are the amorphous support services”.

“I have radically downsized HR in several companies I have run, and business has gone all the better for it.”

The dangers are illustrated by the report [5] of a paper by the professor of higher education management at Royal Holloway (yes, we already have a chair in this non-subject).  It seems that “Research "can no longer be left to the whims and fortunes of individual academics" “.  It must be left to people who don’t do research or understand it.  It’s hard to imagine any greater corruption of the academic enterprise.

Oddly enough, the dire financial situation brought about by incompetent and greedy bankers provides an opportunity for universities to shed the myriad hangers-on that have accreted round the business of research.  Savings will have to be made, and it’s obvious that they shouldn’t start with the people who do the teaching and research on which the reputation of the university depends.  With luck, it may not be too late to choke off the this new phenomenon before it chokes us. If you want research, spend money on people who do it, not those who talk about it.

 [1] Association of Research Managers and Administrators http://www.arma.ac.uk/about/

[2] When HR gets hold of academe, quackery and gobbledegook run riot. Times Higher Education 10 April 2008, http://www.timeshighereducation.co.uk/story.asp?sectioncode=26&storycode=401385  and expanded version at http://www.dcscience.net/?p=226

[3] What universities can do without. http://ucllifesciences.wordpress.com/2010/04/25/what-universities-can-do-without/

[4] Luke Johnson The Truth About the HR Department, Financial Times, Jnauary 30 2008 http://www.ft.com/cms/s/0/9e10714c-ced7-11dc-877a-000077b07658.html  and http://www.dcscience.net/?p=226

[5] Managers must be qualified to herd the academic cats. Times Higher Education 20 May 2010 http://www.timeshighereducation.co.uk/story.asp?sectioncode=26&storycode=411643

 

Follow-up

It seems very reasonable to suggest that taxpayers have an interest in knowing what is taught in universities.  The recent Pittilo report suggested that degrees should be mandatory in Acupuncture, Herbal Medicine and Traditional Chinese Medicine. So it seems natural to ask to see what is actually taught in these degrees, so one can judge whether it protects the public or endangers them.

Since universities in the UK receive a great deal of public money, it’s easy.  Just request the material under the Freedom of Information Act.

Well, uh, it isn’t as simple as that. 

Every single application that I have made has been refused.  After three years of trying, the Information Commissioner eventually supported my appeal to see teaching materials from the Homeopathy "BSc" at the University of Central Lancashire.  He ruled that every single objection (apart from one trivial one) offered by the universities was invalid.  In particular, it was ruled that univerities were not "commercial" organisations for the purposes of the Act.

So problem solved?  Not a bit of it.  I still haven’t seen any of the materials from the original request because the University of Central Lancashire appealed against the decision and the case of University of Central Lancashire v Information Commissioner is due to be heard on November 3rd, 4th and 5th in Manchester. I’m joined (as lawyers say) as a witness. Watch this space.

UCLan  is not the exception.  It is the rule.  I have sought under the Freedom of Information Act, teaching materials from UClan (homeopathy), University of Salford (homeopathy, reflexology and nutritional therapy), University of Westminster (homeopathy, reflexology and nutritional therapy), University of West of England, University of Plymouth and University of East London, University of Wales (chiropractic and nutritional therapy), Robert Gordon University Aberdeen (homeopathy), Napier University  Edinburgh (herbalism).

In every single case, the request for teaching materials has been refused. And that includes the last three, which were submitted after the decision of the Information Commissioner.  They will send things like course validation documents, but these are utterly uninformative box-ticking documents.  They say nothing whatsoever about what is actually taught.

The fact that I have been able to discover quite a lot about what’s being taught owes nothing whatsoever to the Freedom of Information Act. It is due entirely to the many honest individuals who have sent me teaching materials, often anonymously. We should be grateful to them. Their principles are rather more impressive than those of their principals.

Since this started about three years ago, two of the universities, UCLan and Salford, have shut down entry to all of their CAM courses. And Westminster has shut two of them, with more rumoured to be closing soon. They are to be congratulated for that, but is far from being the end of the matter. The Department of Health, and some of the Royal Colleges, have yet to catch up with the universities, The Pittolo report, which recommends making degrees compulsory, is being considered by the Department of Health. The consultation ends on November 2nd:  if you haven’t yet responded, please do so now (see how here, and here).

A common excuse: the university does not possess teaching materials (yes, really)

Several of the universities claim that they cannot send teaching materials, because they have no access to them. This happens when the university has accredited a course that is run by another, privately run, institution. The place that does the actual teaching, being private, is exempt from the Freedom of Information Act.

The ludicrous corollary of this excuse is that the university has accredited the course without checking on what is taught, and in some cases without even having seen a timetable.

The University of Wales

In fact the University of Wales doesn’t run courses at all. Like the (near moribund) University of London, it acts as a degree-awarding authority for a lot of Welsh Universities. It also validates a lot of courses in non-university institutions, 34 or so of them in the UK, and others scattered round the world. 

Many of them are theological colleges. It does seem a bit odd that St Petersburg Christian University, Russia, and International Baptist Theological Seminary, Prague, should be accredited by the University of Wales.

They also validate the International Academy of Osteopathy, Ghent (Belgium), Osteopathie Schule Deutschland,  the Istituto Superiore Di Osteopatia, Milan,  the Instituto Superior De Medicinas Tradicionales, Barcelona, the Skandinaviska Osteopathögskolan (SKOS) Gothenburg, Sweden and the College D’Etudes Osteopathiques, Canada.

The 34 UK institutions include the Scottish School of Herbal Medicine,  the Northern College of Acupuncture and the Mctimoney College of Chiropractic.

The case of the Nutritional Therapy course has been described already in Another worthless validation: the University of Wales and nutritional therapy. It emerged that the course was run by a grade 1 new-age fantasist. It is worth recapitulating the follow up.

What does the University of Wales say? So far, nothing. Last week I sent brief and polite emails to Professor Palastanga and to

Professor Clement to try to discover whether it is true that the validation process had indeed missed the fact that the course organiser’s writings had been described as “preposterous, made-up, pseudoscientific nonsense” in the Guardian.

So far I have had no reply from the vice-chancellor, but on 26 October I did get an answer from Prof Palastanga.

As regards the two people you asked questions about – J.Young – I personally am not familiar with her book and nobody on the validation panel raised any concerns about it. As for P.Holford similarly there were no concerns expressed about him or his work. In both cases we would have considered their CV’s as presented in the documentation as part of the teaching team. In my experience of conducting degree validations at over 16 UK Universities this is the normal practice of a validation panel.



I have to say this reply confirms my worst fears. Validation committees such as this one simply don’t do their duty. They don’t show the curiosity that is needed to discover the facts about the things that they are meant to be judging. How could they not have looked at the book by the very person that they are validating? After all that has been written about Patrick Holford, it is simply mind-boggling that the committee seems to have been quite unaware of any of it.

It is yet another example of the harm done to science by an unthinking, box-ticking approach.

Incidentally, Professor Nigel Palastanga has now been made Pro Vice-Chancellor (Quality) at the University of Wales and publishes bulletins on quality control. Well well.

The McTimoney College of Chiropractic was the subject of my next  Freedom of Information request to the University of Wales. The reasons for that are, I guess, obvious. They sent me hundreds of pages of validation documents, Student Handbooks (approx 50 pages), BSc (Hons) Chiropractic Course Document. And so on. Reams of it. The documents mostly are in the range of 40 to 100 pages. Tons of paper, but none of it tells you anyhing whatsover of interest about what’s being taught. They are a testament to the ability of universities to produce endless vacuous prose with
very litlle content.

They did give me enough information to ask for a sample of the teaching materials on particular topics. But I gor blank refusal, on the grounds that they didn’t possess them. Only McTimoney had them. Their (unusually helpful) Freedom of Information officer replied thus.

“The University is entirely clear about the content of the course but the day to day timetabling of teaching sessions is a matter for the institution rather than the University and we do not require or possess timetable information. The Act does not oblige us to request the information but there is no reason you should not approach McTimoney directly on this.”

So the university doesn’t know the timetable. It doesn’t know what is taught in lectures, but it is " entirely clear about the content of the course".

This response can be described only as truly pathetic.

Either this is a laughably crude form of obstruction of my request, or perhaps, even more frighteningly, the university really believes that its endless box-ticking documents actually provide some useful control of quality. Perhaps the latter interpretation is more charitable. After all, the QAA, CHRE, UUK and every HR department share similar delusions about what constitutes quality.

Perhaps it is just yet another consequence of having science run largely by people who have never done it and don’t understand it.

Validation is a business. The University of Wales validates no fewer than 11,675 courses altogether. Many of these are perfectly ordinary courses in universities in Wales, but they validate 594 courses at non-Welsh accredited institutions, an activity that earned them £5,440,765 in the financial year 2007/8. There’s nothing wrong with that if they did the job properly. In the two cases I’ve looked at, they haven’t done the job properly. They have ticked boxes but they have not looked at what’s being taught or who is teaching it.

The University of Kingston

The University of Kingston offers a “BSc (Hons)” in acupuncture. In view of the fact that the Pittilo group has recommended degrees in acupuncture, there is enormous public interest in what is taught in such degrees, so I asked.

They sent the usual boring validation documents and a couple of sample exam papers . The questions were very clinical, and quite beyond the training of acupuncturists.  The validation was done by a panel of three, Dr Larry Roberts (Chair, Director of Academic Development, Kingston University), Mr Roger Hill (Accreditation Officer, British Acupuncture Accreditation Board) and Ms Celia Tudor-Evans (Acupuncturist, College of Traditional Acupuncture, Leamington Spa).   So nobody with any scientific expertise, and not a word of criticism.

Further to your recent request for information I am writing to advise that the University does not hold the following requested information:

(1) Lecture handouts/notes and powerpoint presentations for the following sessions, mentioned in Template 3rd year weekend and weekday course v26Aug2009_LRE1.pdf

(a) Skills 17: Representational systems + Colour & Sound ex. Tongue feedback 11

(b) Mental Disease + Epilepsy Pulse feedback 21

(c) 18 Auricular Acupuncture

(d) Intro. to Guasha + practice Cupping, moxa practice Tongue feedback 14

(2) I cannot see where the students are taught about research methods and statistics. I would like to see Lecture handouts/notes and PowerPoint presentations for teaching in this area, but the ‘timetables’ that you sent don’t make clear when or if it is taught.

The BSc Acupuncture is delivered by a partner college, the College of Integrated Chinese Medicine (CICM), with Kingston University providing validation only. As such, the University does not hold copies of the teaching materials used on this course. In order to obtain copies of the teaching materials required you may wish to contact the College of Integrated Chinese Medicine directly.

This completes the University’s response to your information request.

So again we see that Kingston has validated the course but has not seen a timetable, far less what is taught.  My reply was thus

Yes I am exceedingly unhappy about it.  The university attaches its name to the course so it must obviously be able to get the material simply by asking for it (I’m surprised that the university should endorse a course without knowing what is taught on it, but that’s another matter).

I request formally that you obtain this material.  If necessary please read this as a formal appeal.

I await with interest. In every single case so far, the internal review has merely confirmed the initial refusal.  It means a bit of a delay before the case goes to the Information Commisssioner’s Office.

Napier University Edinburgh

Napier University runs a "BSc (Hons) Herbal medicine". (brochure here).  Since herbal medicine is a subject of the Pittilo recommendations, there is enormous public interest in what they teach. So I asked, under the Freedom of Information (Scotland) Act (2002).  They sent quite quickly validation and accreditation documents, some examination papers, timetables and lecture lists.

The validation was the usual vacuous box-ticking stuff though it did reveal that the course “made extensive use of techniques such as tongue and pulse diagnosis”, which are well known phoney diagnosis methods, about as much use as a pendulum (as used at Westminster University).

As at Kingston University, the exam papers they chose to send were mostly "pretend doctor" stuff. One of them was

Discuss the herbal practitioner’s role in the management of IHD [ischaemic heart disease)

How one would like to see what the students said, and, even more one would like to see the model answer.  Amateurs who try to treat potentially serious conditions are a danger to the public.

So then we got to the interesting bit, the request for actual teaching materials.

I have looked at the material that you sent and I’d now like to make the following supplementary request

(A) Lecture notes/handouts and powerpoint slides for the following small smaple of lectures

HRB09102 Materia Medica 4
(1) Zingiber officinalis, Eleutherococcus senticosus, Valeriana officinalis
(2) Gelsemium sempervirens, Cimicifuga racemosa, Datura stramonium, Piscidia erythrina
(3) Betula pendula, Capsella bursa-pastoris, Ephedra sinica, Solidago virgaurea

Materia Medica 3 HRB08103
(1) Cardiovascular system
(2) Nervous system

Clinical Medicine and Diagnosis 4 (HRB09104)
(1) Neuro-sensory deficits, paraesthesiae, head pain

HRB09100 Materia Medica & Herbal Practice
Week 7  Compiling a therapeutic plan and prescription building

BSc Herbal Medicine : Materia Medica HRB07102
Week 3   History of Herbal Medicine Gothean tasting session
Week 10  Energetics  the basic concepts Ayurveda

Lastly, I can see nowhere in the timetable, lectures that deal with

Research methods, clinical trial design and statistics.
If such lectures exist, please send notes and powerpoints for them too

No prizes for guessing the result   Total refusal to send any of them.  To make matters worse, the main grounds for refusal were the very "commercial interests" which, after careful legal examination, the Information Commissioner (for England and Wales) had decided were invalid.  They say too that "The public interest in withholding the information is greater than the public interest in its release".. It is hard to see how the public interest is served by concealing from the people who pay for the degrees what is taught on degrees that Pittilo wants to make compulsory. [Download the whole response]

The matter is now under internal appeal (read the appeal) and eventually we shall find out whether the Scottish Information Commissioner backs the judgement.

Robert Gordon University Aberdeen

This case has particular interest because the Vice-Chancellor of Robert Gordon University is Professor Michael Pittilo, chair of the highly contentious steering group that recommended degress in CAM.  Robert Gordon University (RGU) does not teach herbal medicine or acupuncture. But they do run An Introduction to Homeopathy. All the degrees in homeopathy have closed. It is perhaps the daftest and most discredited of all the popular forms of Magic Medicine.  But Professor Pittilo thinks it is an appropriate subject to teach in his university.

So again I asked for information under the Freedom of Information (Scotland) Act 2002. They sent me quite quckly a list of the powerpoint presentations used on the courses [download it]. I asked for a small sample of the powerpoints.  And again the university did not possess them!

I should like to see only the following three powerpoint presentations in the first instance, please.

Please can you let me know also who produced the powerpoints.

(1) Evidence for homeopathy
(2) First aid remedies
(3) Allergies

I note that you will have to request them but since they are being offered as part of a course offered by RGU, so RGU is responsible for their quality, I presume that this should cause no problem.

The request was refused on much the same grounds as used by Napier University.  As usual, the internal review just confirmed the initial proposal (but dropped the obviously ludicrous public interest defence).  The internal review said

“it is mainly the quality of our courses (including course material) and teaching which has given us the position of "the best modern university in Scotland"

I am bound to ask, if the university is so proud of its course material, why is it expending so much time and money to prevent anyone from seeing a small sample of it?

My appeal has been sent to the Scottish Information Commissioner [download the appeal].

What are vice-chancellors thinking about?

I find it very difficult to imagine what is going through the heads of vice-chancellors who run courses in mumbo-jumbo.   Most of them don’t believe a word of it (though Michael Pittilo might be an exception) yet they foist it on their students. How do they sleep at night?

Recently the excellent Joe Collier wrote a nice BMJ blog which applauded the lack of respect for authority in today’s students, Joe Collier says good riddance to old-fashioned respect. I couldn’t resist leaving a comment.

I couldn’t agree more. There is nothing quite so unnerving as being addressed as “Sir”.

It is an advantage of age that you realise what second-rate people come to occupy very grand positions. Still odder since, if occasionally they are removed for incompetence, they usually move to an even grander position.

I guess that when I was an undergraduate, I found vice-chancellors somewhat imposing. That is, by and large, not a view that survives closer acquaintance.

Should teaching materials be open to the public?

There is only one university in the world that has, as a matter of policy, made all of its teaching material open to the public,  that is the Massachusetts Institute of Technology (MIT).  I can recommend strongly course 18.06, a wonderful set of lectures on Linear Algebra by Gilbert Strang.  (It is also a wonderful demonstration of why blackboards may be better than Powerpoint for subjects like this). Now they are on YouTube too.

A lot of other places have made small moves in the same direction, as discussed recently in Times Higher Education, Get it Out in the Open

Now the OU is working with other British universities to help them develop and share open course materials. In June, at the celebrations for the 40th anniversary of the OU, Gordon Brown announced funding to establish the Support Centre for Open Resources in Education at the OU, as part of a £7.8 million grant designed to enhance the university’s national role.

The funding follows a separate grant of £5.7 million from the Higher Education Funding Council for England for universities across the sector to make thousands of hours of free learning materials available. 

Much material is available on the web, when individual teachers choose to place it there, but at the same time there is a move in the other direction. In particular, the widespread adoption of Moodle has resulted in a big decrease in openness. Usually you have to be registered on a course to see the material. Even other people in the university can’t see it. I think that is a deplorable development (so, presumably, does HEFCE).

Conclusion

I was told by the Univerity of Kingston that

“The course is one which the University has validated and continues to be subject to the University’s quality assurance procedures, such as internal subject reviews, annual monitoring and external examining”

The only conclusion to be drawn from this is that “quality arrurance procedures” work about as well in universities as they did in the case of baby Peter. No doubt they were introduced with worthy aims. But in practice they occupy vast amounts of time for armies of bureaucrats, and because the brain does not need to be engaged they end up endorsing utter nonsenes. The system is broken.

Resistance is futile.  You can see a lot of the stuff here

It is hard to keep secrets in the internet age. Thanks to many wonderful people who have sent me material. you can see plenty of what is taught, despite the desperate attempts of vice-chancellors to conceal it.  Try these links.

What is actually taught

Chinese medicine -acupuncture gobbledygook revealed
http://www.dcscience.net/?p=1950

Consultation opens on the Pittilo report: help top stop the Department of Health making a fool of itself 
http://www.dcscience.net/?p=2007

Why degrees in Chinese medicine are a danger to patients 
http://www.dcscience.net/?p=2043

More make-believe from the University of Westminster. This time its Naturopathy
http://www.dcscience.net/?p=1812
 
The last BSc (Hons) Homeopathy closes! But look at what they still teach at Westminster University.
http://www.dcscience.net/?p=1329
 
The opposite of science
http://www.dcscience.net/?p=1191
 
Bad medicine. Barts sinks further into the endarkenment.
http://www.dcscience.net/?p=1143
 
A letter to the Times, and progress at Westminster
http://www.dcscience.net/?p=984
 
Nutritional Fairy Tales from Thames Valley University
http://www.dcscience.net/?p=260
 
Westminster University BSc: amethysts emit high yin energy
http://www.dcscience.net/?p=227
 

References for Pittilo report consultation
 
A very bad report: gamma minus for the vice-chancellor
http://www.dcscience.net/?p=235

The Times (blame subeditor for the horrid title)
http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article4628938.ece

Some follow up on the Times piece
http://www.dcscience.net/?p=251

The Health Professions Council breaks its own rules: the result is nonsense
http://www.dcscience.net/?p=1284

One month to stop the Department of Health endorsing quackery.  The Pittilo questionnaire,
http://www.dcscience.net/?p=2310

An excellent submission to the consultation on statutory regulation of alternative medicine (Pittilo report) 
http://www.dcscience.net/?p=2329

Follow-up

Jump to follow-up

i love nhs logo

Conservatives in the USA have been lying about the NHS on a massive scale. As Simon Hoggart comments today “There are few tribes more loathsome than the American right”.

In the forefront has been a far-right lobby group, Conservatives for Patients’ Rights (CPR).  Even I was surprised to read in the Washington Post

“The campaign is being coordinated by CRC Public Relations, the group that masterminded the “Swift boat” attacks against 2004 Democratic presidential candidate, John F. Kerry”

CRC Public Relations is a conservative PR firm previously known as Creative Response Concepts. ‘Creative’ appears to mean ‘lying’, but I guess that is what PR is all about.

The founder of CPR, Rick Scott, has an interesting background. According to Stephen Barrett

“In 1987, he founded and became chief operating officer of a hospital chain that grew into the 23 billion-dollars-a-year Columbia/HCA. In 1997, a few weeks after the FBI raided HCA hospitals in five states, Scott was ousted as CEO and three executives were indicted on charges of Medicare fraud. The FBI’s investigation found that the hospital chain had been overbilling Medicare and giving kickbacks to doctors who steered patients to its hospitals. The overbilling included upcoding lesser procedures to get higher reimbursements and billing for lab tests that were not medically necessary and were not ordered by physicians. The situation was settled with a set of guilty pleas and criminal and civil fines totalling $1.7 billion. The U.S. Department of Justice referred to the matter as the “largest health care fraud case in U.S. history.”

Disgracefully, Karol Sikora, a former oncologist at the Hammersmith Hospital, supported CPR on US television. See Karol Sikora makes a fool of himself at NHSblogdoctor. I quote

“Karol Sikora had been duped by a slick American businessman into providing a “rent-a-quote” service for a notorious right-wing American organisation”

This post was reproduced on the US site, Trusted.MD

Sikora now works for the UK’s only private university and a private cancer treatment company. He is also famous for claiming,
falsely,
to be a professor at Imperial College (he has an honorary contract with the Imperial College Hospital Trust but nothing with the University).  And for promoting a load of nonsense about
alternative medicine (a lot more on that coming up shortly).

This is why love the NHS

Europe as a whole gets better health care for less money than in the USA.  The fact that every US doctor has a financial interest in ordering expensive treatments whether they are needed or not,
is an obscenity.  The fact that over 40 million Americans have no insurance is an obscenity (see The brutal truth about America’s healthcare).

Just look at the numbers (Source: WHO/OECD Health Data 2009)

Health spending as a share of GDP.
US 16%     UK 8.4%

Public spending on healthcare (% of total spending on healthcare)
US 45%   UK 82%

Health spending per head
US $7,290    UK $2,992

Practising physicians (per 1,000 people)
US 2.4   UK 2.5

Nurses (per 1,000 people)
US 10.6   UK 10.0

Acute care hospital beds (per 1,000 people)
US 2.7   UK 2.6

Life expectancy:
US 78   UK 80

Infant mortality (per 1,000 live births)
US 6.7   UK 4.8

My experience

Yes I know this is anecdote, but it matters a lot to me. I already posted a version of this story, but this seems like the time to repeat it.

On December 13th 1984, my wife had a subarachnoid haemorrhage when she was seven months pregnant.  After an initial misdiagnosis by an obstetrician at St Peter’s Hospital, Chertsey, she was moved to UCH and diagnosed very quickly.  The next morning I was called to see the neurourgeon, the great Alan Crockard. He was sitting surrounded by medical students some of whom I’d taught the previous year. He told me my wife had had a subarachnoid haemorrhage (at 33!) and they would operate straight away. And “I have to ask you, if we can save only the mother or the baby, which shall it be”. It’s as well to write that down because even 24 years later I can’t say it without a lump rising in my throat.

That same day she had neurosurgery to pin an aneurysm at the Maida Vale Neurosurgical Hospital, part of the UCLH group (it no longer exists).  The surgeon, Alan Crockard, came out of theatre after five hours, looking rather tired and said “it was adhered to the optic chiasma on one side and about a millimetre from the pituitary on the other.  It was a bit tricky but I think we got it”.  Obstetricians were in theatre too because all this was done with the baby still in situ

After a week in intensive care, under heavy sedation, Margaret’s blood pressure was not low enough and they decided to deliver the baby.  At about 4 pm on a snowy Christmas Eve, a team of neurosurgeons and a team of obstetricians gathered and soon after, Andrew Stuart Colquhoun emerged in a small incubator to be whisked off in an ambulance to the Special Care Baby Unit at UCH (run, at that time, by Osmund Reynolds). Christmas day was spent in the hospital, with Margaret’s mother.  Andrew weighed 1.4 kg at birth, but by Christmas day he had pulled out his ventilator himself, and was doing fine. He was so tiny that it was a couple of days before I dared to hold him. The Unit had racks of doll-sized clothes, knitted by volunteers. The care was superb. Andrew's birth

Andrew (at 9 days) and Dad. Jan 2, 1985. Click for album.

Once Margaret was well enough, she was given a side room in a neurosurgical ward with a cot for Andrew by her bed, an arrangement that gave the neurosurgical nurses some fun. They were in UCLH continuously until 27th April before Margaret had recovered enough to go home, [Full photo album here]

Now they are both fine.and Andrew is 6′ 7″ (200.5 cm)..

It is episodes like this that make one very proud of the NHS.  She and Andrew were in hospital continuously for more than four months.  Not a penny changed hands.  Heaven knows what it would have cost in the USA, or even of insurance would have covered such a gargantuan bill.

Margaret & Andrew, with carer, Anna, June 2, 1985

Andrew (left) playing cricket in Bangladesh, Feb 2005.

My own experience is trivial compared with that of Margaret and Andrew, but it has been as near perfect as anyone could wish.  I had a lumbar spinal fusion (L3 – L4) in 1995, after several attempts at less drastic solutions.  I’ve had two artificial hips.  They allowed me to walk across the Alps for my 65th birthday. Then a few trivial things like bilateral hernia and DVT (I had been scanned and was on anticoagulant therapy within 4 hours of walking into UCLH’s Accident and Emergency).  And now it looks as though I’ll be getting a partial or total nephrectomy too.

And not a penny has changed hands.

The NHS is a beautiful thing.  OK it has has the usual excessive number of managers and HR-bollocks, like most big companies.  It isn’t perfect but it is a great deal closer to perfection
than the US system.

 

Crossing the Alps
Approaching Seescharte (2600 m) at 08.20, 21 August 2001. Memminger Hütte visible below. With fused vertebrae and right prosthetic hip, thanks to the NHS. (Click for bigger picture.)

Bush may have gone, but a large fraction of Americans seem to be unrepentant Bush-ites. Almost all of my many friends in the USA think more or less like I do. Even Obama is to the right of most European conservatives, The other 48% are to the right of Attila the Hun. The extent of the polarisation that still exists is nothing short of terrifying. 

Thanks to the great Aneurin Bevan who established the NHS in 1948 for ordinary people like me, in the face of fierce opposition from the medical establishment.

” . . . no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”
—Aneurin Bevan, In Place of Fear, p100

 

Bevan statue
Statue of Bevan in Cardiff

 

Ah well, The Daily Mash. is always there when you need a (wry) laugh

Follow-up

Paul Krugman in the New York Times is magnificent as always. In The Swiss Menace he points out that Obama’s scheme is nothing like the NHS anyway, but more like that in Switzerland.

“The plans on the table would, roughly speaking, turn America into Switzerland — which may be occupied by lederhosen-wearing holey-cheese eaters, but wasn’t a socialist hellhole the last time I looked.”

“In Britain, the government itself runs the hospitals and employs the doctors. We’ve all heard scare stories about how that works in practice; these stories are false.”

“So we can do this. At this point, all that stands in the way of universal health care in America are the greed of the medical-industrial complex, the lies of the right-wing propaganda machine, and the gullibility of voters who believe those lies.”

Comparing US and UK cancer statistics . As Ben Goldacre says, “I think you’ll find it’s a bit more complicated than that”.   There’s an interesting analysis at Cancer Research UK

The US uses the PSA blood test far more widely than we do in the UK – despite questions over how effective it is at spotting cancers that would actually kill, as opposed to those that cause no symptoms.  As a result, the USA has one of the highest recorded rates of prostate cancer in the world.

So although it’s undoubtedly ‘better’ at spotting prostate cancers, it’s also fair to say that some of these Americans will never die from their disease.  This ‘overdiagnosis‘ inflates the survival statistics, at the expense of ‘overtreating‘ men – which is expensive and can cause long-term side effects (which can need further treatment).

In fact the age-standardised death rates per 100,000 people are almost the same in the UK (all races) when compared with the USA (whites only). What is different is that far more cases of prostate cancer are diagnosed in the USA. If the rate of ‘real’ (potentially fatal) prostate cancer were similar in both countries then both countries have much the same success in treating it, If, on the other hand, US men had a genuinely higher incidence of real prostate cancer, the US would be doing better, There is no way to distinguish between these two interpretations,

Shibata Fig 1

Jump to follow-up

Now back to the Ed Biz, for a moment.  An article in Times Higher Education last week caused something of a stir.

V-cs’ candid views slip out online. 2 July 2009 By Zöe Corbyn
Prematurely released paper reveals fears of staff revolution and desire to cash in, writes Zöe Corbyn

The article refers to a paper that appeared on the web site of the journal Higher Education Quarterly. It is Perspectives of UK Vice-Chancellors on Leading Universities in a Knowledge-Based Economy by Lynn Bosetti, University of Calgary, and Keith Walker, University of Saskatchewan. The paper quotes ten different university vice-chancellors (presidents) of UK universities. Some of the comments caused quite a stir when they were quoted anonymously in an article in Times Higher Education. But the paper soon vanished and still has not reappeared. A version that lacks some of the names is expected to appear soon. The original uncensored version has now appeared on Wikileaks. Its source is no great mystery since it was available to the public for a short time.  It seems a pity if vice-chancellors want to hide their views, so here are a few quotations from the original version.

The Vice-Chancellor of Oxford, Colin Lucas, cautions:

“One of the greatest distortions is this sense that the only thing that universities are for, is to drive the economy. The core mission of universities is threatened by a narrow value system.”

Steven Schwartz was vice-chancellor of Brunel University until February 2006 when he became Vice Chancellor of Macquarie University in Sydney, Australia. He’s quoted as saying

We all know that education is a commodity that can be bought and sold, often at a very high price. So universities are busy doing that – charging students a large amount of money to study in England because it is a popular destination. Branding and marketing take the font seat and education is in the back. (S. Schwartz, Brunel University)

Reflecting on the traditional role of the university, the Vice-Chancellor of University of Oxford, Colin Lucas, is concerned that

“commodification threatens to destroy not only scholarly democracy but civilisation itself.”

“The vice-chancellor needs to have a network of people involved in ‘intelligence gathering’ to be able to swiftly deal with ‘even the faintest hint of a revolution’ (S. Schwartz, Brunel University)”

That sounds a bit like the secret police and their network of informers. Hardly a good way to get the loyalty of your staff.

“you have to lead with flow and authority.You can never be out of touch with what faculty are thinking . . . if in the end faculty don’t follow you, it isn’t because they are stupid, it’s because you are out of touch’ (S. Schwartz)”

And that seems to say that you need to know how faculty think, not in order to listen to their views, but only to know how to beat them. Perhaps it has never occurred to Steven Schwartz that he might, just occasionally, be wrong?

Drummond Bone succeeded Howard Newby (of whom more here) as vice-chancellor of the University of Liverpool. he also seems to regard the drive to corporatisation of univeristies as a war against his own staff.

“You need to start by setting the agenda for change, then you have to look at who is going to be a driver or champion of that change, who is going to be a passenger and who, quite frankly, is going to stand against it’ (J. Drummond Bone)”.

Steven Schwartz again.

“we filled our senior management positions with people who had never worked in universities before. The HR [human relations] person came from mining, another from banking. It’s probably made a big difference to Brunel and its ability to move, in that people aren’t weighted down with a lot of public service type history.”

This attitude seems to me to be at the heart of the problem. it is based on a mistaken idea of what it is that gives a university a good reputation. The reputation, at least in academia, is the sum of the reputations of eminent people who work there, Physiologists will think of Bernard Katz and Andrew Huxley. Pharmacologists will think of Heinz Schild and James Black, People in English literature may never have heard of them, but they will think of John Sutherland and Rosemary Ashton, Each of them gives UCL a bit of reflected glory..But nobody will think about our Public Relations attempts at corporate image building. The only way to have a great university is to have great people doing the research and teaching. Anything that makes a university unattractive to them will, in the long run, harm the place. And one thing that makes a university unattractive is the perception that it is run by people who view it as a business, and who know nothing about what makes the place great. The sort of people whom Steven Schwartz seems to have gone out of his way to employ.

I was asked recently by the head of media relations to answer some questions about UCL’s attempts to build its “corporate identity” (nice to be asked, for a change). My answer was that I though they probably did more harm than good. The reason for saying that is that they are, only too often, downright embarrassing. I’ve mentioned the examples of ‘sustainable degrees‘, the concordat fiasco and ‘research days‘. And the new-age junk forced on our research staff by Human Resources is acutely embarrassing. Luckily for UCL, all universities have pursued this corporate path, so there is nowhere to run to,

The general public, having lived through the Blair era, is able to detect vacuous spin when it hears it. And there is no shortage of that in universities now. The aim of science is to discover truth. The aim of PR is to disguise truth, They are utterly incompatible. In the words of the “unrepentant capitalist” Luke Johnson, in the Financial Times,

“I have radically downsized HR in several companies I have run, and business has gone all the better for it.”

Another way to dismepower academics Steven Schwartz, with his spy network, is quite excessively conspiritorial. There is a much easier way to do it, You have a consultation. You hold open “town meetings”. The opposition then reveal themselves. Having taken the precaution of neutering the academic board, you are under no obligation to take the slightest notice of what anyone else says, and public humiliation of opponents will ensure there aren’t too many of them. I have seen this plan in action. It works rather well, in the short run.   In the long run, though, academics lose morale, loyalty and altruism when treated in that way. Vice-chancellors who behave like that are bringing their institution into disrepute.

This was poeted from the train to Edinburgh,where I’ll be giving the Paton lecture, on a related topics.

Follow-up

The modified paper has now been published in Higher Education Quarterly. And, guess what, Steven Schwartz’s name is not mentioned in it.

Des Spence, a general practitioner in Glasgow, has revealed a memorandum that was allegedly leaked from the Department of Health. It was published in the Britsh Medical Journal (17 June 2009, doi:10.1136/bmj.b2466, BMJ 2009;338:b2466). It seemed to me to deserve wider publicity, so with the author’s permission, I reproduce it here. It may also provide a suitable introduction to a forthcoming analysis of a staff survey.

Re: The use of ‘note pads’ in the NHS and allied service based agencies.

Hi, all care providers, managers of care, care managers, professions allied to care providers, carers’ carers, and stakeholders whose care is in our care. (And a big shout to all those service users who know me.)

We report the findings from a quality based review, with a strong strategic overview, on the use of “note pads” across all service user interfaces. This involved extensive consultation with focus groups and key stakeholders at blue sky thinking events (previously erroneously known as brain storming). This quality assured activity has precipitated some heavy idea showers, allowing opinion leaders to generate a national framework of joined-up thinking. This will take this important quality agenda forward. A 1000 page report is available to cascade to all relevant stakeholders.

The concentric themes underpinning this review are of confidentiality. Notes have been found on the visual interface devices on computers and writing workstations throughout the NHS work space. Although no actual breach of confidentiality has been reported, the independent external consultants reported that note pads “present a clear and present danger” to the NHS, and therefore there is an overarching responsibility to protect service users from scribbled messages in felt tip pen. Accordingly all types of note pads will be phased out in the near time continuum. A validated algorithm is also attached to aid this process going forward.

This modernising framework must deliver a paradigm shift in the use of note pads. Care provider leaders must employ all their influencing and leverage talents to win the hearts and minds of the early adopter. A holistic cradle to grave approach is needed, with ownership being key, and with a 360 degree rethink of the old think. All remaining note pads must be handed over in the next four week ” note pad armistice” to be shredded by a facilitator (who is currently undergoing specialist training) and who will sign off and complete the audit trail.

(Please note that the NHS’s email system blocks all attachments, so glossy, sustainable, wood based hard copies will be sent directly to everyone’s waste recycling receptacles.)

Cite this as: BMJ 2009;338:b2466


Spence added a footnote, Note: The BMJ’s lawyers have insisted that I make it clear that this is a spoof, just in case you were wondering.

 

Here are a few more

There is an initiative underway to determine what we do as an organisation in the realms of drug discovery. The intention is to identify internal and appropriate external capabilities to foster a pipeline of competencies that enable some of our basic research outputs to better impact healthcare.

Follow-up

The Health Professions Council (HPC) is yet another regulatory quango.

The HPC’s strapline is

“Working with health professionals to protect the public”

At present the HPC regulates; Arts therapists, biomedical scientists, chiropodists/podiatrists, clinical scientists, dietitians, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, prosthetists/orthotists, radiographers and speech & language therapists.

These are thirteen very respectable jobs. With the possible exception of art therapists, nobody would doubt for a moment that they are scientific jobs, based on evidence. Dietitians, for example, are the real experts on nutrition (in contrast to “nutritional therapists” and the like, who are part of the alternative industry).  That is just as well because the ten criteria for registration with the HPC say that aspirant groups must have

“Practise based on evidence of efficacy”

But then came the Pittilo report, about which I wrote a commentary in the Times, and here, A very bad report: gamma minus for the vice-chancellor, and here.

Both the Pittilo report, the HPC, and indeed the Department of Health itself (watch this space), seem quite unable to grasp the obvious fact that you cannot come up with any sensible form of regulation until after you have decided whether the ‘therapy’ works or whether it is so much nonsense.

In no sense can “the public be protected” by setting educational standards for nonsense.  But this obvioua fact seems to be beyond the intellectual grasp of the quangoid box-ticking mentality.

That report recommended that the HPC should regulate also Medical Herbalists, Acupuncturists and Traditional Chinese Medicine Practitioners. Even more absurdly, it recommended degrees in these subjects, just at the moment that those universities who run them are beginning to realise that they are anti-scientific subjects and closing down degrees in them.

How could these three branches of the alternative medicine industry possibly be eligible to register with the HPC when one of the criteria for registration is that there must be “practise based on evidence of efficacy”?

Impossible, I hear you say.  But if you said that, I fear you may have underestimated the capacity of the official mind for pure double-speak.

The HPC published a report on 11 September 2008, Regulation of Medical Herbalists, Acupuncturists and Traditional Chinese Medicine Practitioners.

The report says

1. Medical herbalists, acupuncturists and traditional Chinese medicine practitioners should be statutorily regulated in the public interest and for public safety reasons.

2. The Health Professions Council is appropriate as the regulator for these professions.

3. The accepted evidence of efficacy overall for these professions is limited, but regulation should proceed because it is in the public interest.

But the last conclusion contradicts directly the requirement for “practise based on evidence of efficacy”.  I was curious about how this contradiction
could be resolved so I sent a list of questions.  The full letter is here.

The letter was addressed to the president of the HPC, Anna van der Gaag, but with the customary discourtesy of such organisations, it was not answered by her but by Michael Guthrie, Head of Policy and Standards   He said

“Our Council considered the report at its meeting in July 2008 and decided that the regulation of these groups was necessary on the grounds of public protection. The Council decided to make a recommendation to the Secretary of State for Health that these groups be regulated.
http://www.hpc-uk.org/assets/documents/100023FEcouncil_20080911_enclosure07.pdf
“.

This, of course, doesn’t answer any of my questions. It does not explain how the public is protected by insisting on formal qualifications, if the qualifications
happen to teach mythical nonsense. Later the reply got into deeper water.

“I would additionally add that the new professions criteria are more focused on the process and structures of regulation, rather than the underlying rationale for regulation – the protection of members of the public. The Council considered the group’s report in light of a scoring against the criteria. The criteria on efficacy was one that was scored part met. As you have outlined in your email (and as discussed in the report itself) the evidence of efficacy (at least to western standards) is limited overall, particularly in the areas of herbal medicines and traditional Chinese medicine. However, the evidence base is growing and there was a recognition in the report that the individualised approach to practice in these areas did not lend themselves to traditional RCT research designs.”

Yes, based on process and structures (without engaging the brain it seems). Rather reminiscent of the great scandal in UK Social Services. It is right in one respect though.

The evidence base is indeed growing, But it is almost all negative evidence. Does the HPC not realise that? And what about “at least by Western standards”?   Surely the HPC is not suggesting that UK health policy should be determined by the standards of evidence of Chinese herbalists?  Actually it is doing exactly that since its assessment of evidence was based on the Pittilo report in which the evidence was assessed (very badly) by herbalists.

One despairs too about the statement that

“there was a recognition in the report that the individualised approach to practice in these areas did not lend themselves to traditional RCT research designs”

Yes of course the Pittilo report said that, because it was written by herbalists! Had the HPC bothered to read Ben Goldacre’s column in the Guardian they would have realised that there is no barrier at all to doing proper tests. It isn’t rocket science, though it seems that it is beyond the comprehension of the HPC.

So I followed the link to try again to find out why the HPC had reached the decision to breach its own rules. Page 10 of the HPC Council report says

3. The occupation must practise based on evidence of efficacy This criterion covers how a profession practises. The Council recognizes the centrality of evidence-based practice to modern health care and will assess applicant occupations for evidence that demonstrates that:

  • Their practice is subject to research into its effectiveness. Suitable evidence would include publication in journals that are accepted as
    learned by the health sciences and/or social care communities
  • There is an established scientific and measurable basis for measuring outcomes of their practice. This is a minimum—the Council welcomes
    evidence of there being a scientific basis for other aspects of practice and the body of knowledge of an applicant occupation
  • It subscribes to the ethos of evidence-based practice, including being open to changing treatment strategies when the evidence is in favour
    of doing so.

So that sounds fine. Except that research is rarely published in “journals that are accepted as learned by the health sciences”. And of course most of the good evidence is negative anyway. Nobody with the slightest knowledge of the literature could possibly think that these criteria are satisfied by Medical Herbalists, Acupuncturists and Traditional Chinese Medicine Practitioners.

So what does the HPC make of the evidence?  Appendix 2 tells us. It goes through the criteria for HPS registration.

“Defined body of knowledge:  There is a defined body of knowledge, although approaches to practice can vary within each area.”

There is no mention that the “body of knowledge” is, in many cases, nonsensical gobbledygook and, astonishingly this criterion was deemed to be “met”!.

This shows once again the sheer silliness of trying to apply a list of criteria without first judging whether the subject is based in reality,

Evidence of efficacy. There is limited widely accepted evidence of efficacy, although this could be partly explained by the nature of the professions in offering bespoke treatments to individual patients. This criterion is scored part met overall.

Sadly we are not told who deemed this criterion to be “part met”. But it does say that “This scoring has been undertaken based on the information outlined in the [Pittilo] report”. Since the assessment of evidence in that report was execrably bad (having been made by people who would lose their jobs if
they said anything negative). it is no wonder that the judgement is overoptimistic!
Did the HPC not notice the quality of the evidence presented in the Pittilo report?   Apparently not.  That is sheer incompetence.

Nevertheless the criterion was not “met”, so they can’t join HPC, right?   Not at all. The Council simply decided to ignore its own rules.

On page 5 of the Council’s report we see this.

The Steering Group [Pittilo] argues that a lack of evidence of efficacy should not prevent regulation but that the professions should be encouraged and funded to strengthen the evidence base (p.11, p. 32, p.34).

This question can be a controversial area and the evidence base of these professions was the focus of some press attention following the report’s publication. An often raised argument against regulation in such circumstances is that it would give credibility in the public’s eyes to treatments that are not proven to be safe or efficacious.

This second point is dead right, but it is ignored. The Council then goes on to say

In terms of the HPC’s existing processes, a lack of ‘accepted’ evidence of efficacy is not a barrier to producing standards of proficiency or making decisions about fitness to practise cases.

This strikes me as ludicrous, incompetent, and at heart, dishonest.

There will be no sense in policy in this area until the question of efficacy is referred to NICE.  Why didn’t the HPC recommend that?  Why has it not been done?

One possible reason is that I discovered recently that, although there are two scientific advisers in the Department of Health,. both of them claim that it is “not their role” to give scientific advice in this area.  So the questions get referred instead to the Prince of Wales Foundation. That is no way to run a ship.

The fact of the matter is that the HPC, like so many other regulatory agencies, fails utterly to protect the public from fraudulent and incompetent practitioners. In fact it actually protects them, in the same way that the financial ‘regulators’ protected fraudulent bankers.  They all seem to think that ticking boxes and passing exams is an effective process. Even if the exams require you to memorise that amethysts “emit high Yin energy so transmuting lower energies and clearing and aligning energy disturbance as all levels of being”.

From time to time, Private Eye Magazine takes a look at university vice-chancellors (aka presidents/rectors/principals) in its High Principals column.

The current issue (No, 1239, 20, Feb – 5 Mar, 2009) features Professor Geoffrey Petts, vice-chancellor of the University of Westminster,

Well well. Who’d have thought such things were possible?

Follow-up

Jump to follow-up

It’s hard enough to communicate basic ideas about how to assess evidence to adults without having the effort hindered by schools.

The teaching of quackery to 16 year-olds has been approved by a maze of quangos, none  of which will take responsibility, or justify their actions. So far I’ve located no fewer than eight of them.

[For non-UK readers, quango = Quasi-Autonomous Non-Governmental Organisation].


A lot of odd qualifications are accredited by OfQual (see here).  Consider, for example, Edexcel Level 3 BTEC Nationals in Health and Social Care (these exams are described here), Download the specifications here and check page 309.

Unit 23: Complementary Therapies for Health and Social Care
NQF Level 3: BTEC National
Guided learning hours: 60

Unit abstract

“In order to be able to take a holistic view towards medicine and health care, health and social care professionals need to understand the potential range of complementary therapies available and how they may be used in the support of conventional medicine.”

Well, Goldacre has always said that homeopathy makes the perfect vehicle for teaching how easy it is to be deceived by bad science, so what’s wrong?  But wait

“Learners will consider the benefits of complementary therapies to health and wellbeing, as well as identifying any contraindications and health and safety issues in relation to their use.”

Then later

“The holistic approach to illnesses such as cancer could be used as a focus here. For example, there could be some tutor input to introduce ideas about the role of complementary therapies in the treatment and management of cancer, this being followed up by individual or small group research by learners using both the internet and the services available locally/regionally. If available, a local homeopathic hospital, for example, would be an interesting place to visit.”

It’s true that to get a distinction, you have to “evaluate the evidence relating to the use of complementary therapies in contemporary society”, but it isn’t at all clear that this refers to evidence about whether the treatment works.

The really revealing bit comes when you get to the

“Indicative reading for learners
There are many resources available to support this unit.

Websites
www.acupuncture.org.uk British Acupuncture Council
www.bant.org.uk British Association for Nutritional Therapy
www.exeter.ac.uk/sshs/compmed Exeter University’s academic department of Complementary medicine
www.gcc-uk.org General Chiropractic Council
www.nimh.org.uk National Institute of Medical Herbalists
www.nursingtimes.net The Nursing Times
www.osteopathy.org.uk General Osteopathic Council
www.the-cma.org.uk The Complementary Medical Association”

This list is truly astonishing. Almost every one of them can be relied on to produce self-serving inaccurate information about the form of “therapy” it exists to promote. The one obvious exception is the reference to Exeter University’s academic department of complementary medicine (and the link to that one is wrong). The Nursing Times should be an exception too, but their articles about CAM are just about always written by people who are committed to it.

It is no consolation that the 2005 version was even worse.  In its classification of ‘therapies’ it said “Pharmaceutically mediated: eg herbalism, homeopathy “. Grotesque! And this is the examinng body!

The Teacher

This particular educational disaster came to my attention when I had a letter from a teacher.  She had been asked to teach this unit, and wanted to know if I could provide any resources for it.  She said that Edexcel hadn’t done so. She asked ” Do you know of any universities that teach CT’s [sic] so I could contact them about useful teaching resources?.” She seemed to think that reliable information about homeopathy could be found from a ‘university’ homeopathy teacher.  Not a good sign. It soon emerged why.
She said.

“My students are studying BTEC National Health Studies and the link is Edexcel BTEC National Complimentary [sic] studies.”

“I am a psychotherapist with an MA in Education and Psychology. I am also trained in massage and shiatsu and have plenty of personal experience of alternative therapy”

Shiatsu uh? It seems the teacher is already committed to placebo medicine.  Nevertheless I spent some time looking for some better teaching material for 16 year-old children.  There is good stuff at Planet
Science
, and in some of the pamphlets from Sense about Science, not least their latest, I’ve got nothing to lose by trying it – A guide to weighing up claims about cures and treatments.  I sent all this stuff to her, and prefaced the material by saying

“First of all, I should put my cards on the table and say that I am quite appalled by the specification of Unit 23. In particular, it has almost no emphasis at all on the one thing that you want to know about any therapy, namely does it work?  The reference list for reading consists almost entirely of organisations that are trying to sell you various sorts of quackery, There is no hint of balance; furthermore it is all quite incompatible with unit 22, which IS concerned with evidence.”

At this point the teacher the teacher came clean too, As always, anyone who disagrees with the assessment (if any) of the evidence by a true believer is unmeasured and inflammatory.

“I have found your responses very unmeasured and inflammatory and I am sorry to say that this prejudicial attitude has meant that I have not found your comments useful.”

shortly followed by

“I am not coming from a scientific background, neither is the course claiming to be scientific.”

That will teach me to spend a couple of hours trying to help a teacher.

What does Edexcel say?

I wrote to Edexcel’s science subject advisors with some questions about what was being taught. The response that I got was not from the science subject advisors but from the Head of Customer support, presumably a PR person.

From: (Bola Arabome) 12/11/2008 04.31 PM

Dear Professor Colquhoun

Thank you for email communication concerning the complementary therapies unit which is available in our BTEC National in Health and BTEC National in Health and Social Care qualifications. I have replied on behalf of Stephen Nugus, our science subject advisor, because your questions do not refer to a science qualification. I would like to answer your questions as directly as possible and then provide some background information relating to the qualifications.

The units and whole qualifications for all awarding bodies are accredited by the regulator, the Qualifications and Curriculum Authority. The resource reading list is also produced by us to help teachers and learners. The qualification as a whole is related to the National Occupational Standards for the vocational sectors of Health and Health and social care with consultation taken from the relevant sector skills councils . As you will be aware many of these complementary therapies are available in care centres and health centres under the NHS and in the private sector. The aim of BTEC qualifications is to prepare people for work in these particular sectors. Clearly a critical awareness is encouraged with reference to health and safety and regulation. There are other units, in some cases compulsory, within the qualification with a scientific approach.

‘  ‘  ‘  ‘  ‘

Stephen Harris

Head of Customer Support



Aha, so it seems that teaching people to treat sick patients is “not a science qualification”.  Just a business qualification perhaps?.  I haven’t yet managed to reach the people who make these decisions, so I persisted with the PR man. Here is part of the next letter (Edexcel’s reply in italic).

19 November

I find it quite fascinating that Edexcel regards the treatment of sick patients as not being part of science (“do not refer to a science qualification”).

Does that mean Edexcel regard the “Health” part of “Health and Social Care” as being nothing to do with science, and that it therefore doesn’t matter if Health Care is unscientific, or even actively anti-scientific?

I am sorry if my answer lacked clarity. My comment, that I had taken your enquiry on behalf of our Science Advisor because  this was not a science qualification, was intended to explain why I was replying. It was not intended as a comment on the relationship between Health and Social  Care and science. At Edexcel we use bureaucratic categories where we align our management of qualifications with officially recognised occupational sectors. Often we rely on sector bodies such as Sector Skills Councils to endorse or even approve the qualifications we offer. Those involved in production of our Science qualifications and our
Health and Social care qualifications are, as far as I can ascertain, neither anti-scientific nor non-scientific in their approach

(4) You say “The qualification as a whole is related to the National Occupational Standards for the vocational sectors of Health and Health and social care with consultation taken from the relevant sector skills councils”. Are you aware that the Skills for Health specifications for Alternative medicine were written essentially by the Prince of Wales Foundation?
When I asked them if they would be writing a competence in talking to trees, they took the question totally seriously!! (You can see the transcript of the conversation at http://dcscience.net/?p=215 ).

The qualification was approved by both ‘Skills for Health’ and ‘Skills for Care and Development’ prior to being accredited by QCA. It uses the NOS in Health and Social Care as the basis for many of the mandatory units. The ‘Complementary Therapies’ NOS were not used. This was not a requirement of a ‘Health and Social Care’ qualification.

“Are the NOS in Health and Social Care that you mention the ones listed here? http://www.ukstandards.org/Find_Occupational_Standards.aspx?NosFindID=1&ClassificationItemId=174 If so, I can see nothing there about ‘complementary therapies’. if I have missed it, I’d be very grateful if you could let me know where it is. If it is not there, I remain very puzzled about the provenance of Unit 23, since you say it is not based on Skills for Health.”



Now we are immediately at sea, struggling under a tidal wave of acronyms for endless overlapping quangos.  In this one short paragraph we have no fewer than four of them. ‘Skills for Health’, ‘Skills for Care and Development’ , ‘Quality and Curriculum Authority (QCA) and NOS.

It seems that the specification of unit 23 was written by Edexcel, but Harris (25 Nov) declines to name those responsible

“When I refer to our “Health and Social care team” I mean the mix of Edexcel Staff and the associates we employ on a contract basis as writers, examiners and  external verifiers.   The writers are generally recruited from those who are involved in teaching and assessment the subjects in schools and colleges. The editorial responsibility lies with the Edexcel Staff. I do not have access to the names of the writers and in any case would not be able to pass on this information. Specifications indicate the managers responsible for authorising publication”

“Edexcel takes full responsibility for its ethical position on this and other issues. However we can not accept responsibility for the opinions expressed in third party materials. There is a disclaimer to this effect at the beginning of the specification. ”
” You have the correct link to the Health NOS . These are the standards, which where appropriate, influence our qualifications. However in the case of Unit 23 I understand that there is no link with the Health NOS. I don’t know if the NOS cover the unit 23 content.”

So, contrary to what I was told at first, neither Skills for Health, nor NOS were involved  Or were they (see below)?

So who does take responsibility?  Aha that is secret.  And the approval by the QCA is also secret.

“I cannot provide you with copies of any correspondence between Skills for Health and  Edexcel. We regard this as confidential. “

What does the QCA say?

The strapline of the QCA is

“We are committed to building a world-class education and training framework. We develop and modernise the curriculum, assessments, examinations and qualifications.”

Referring school children to the Society of Homeopaths for advice seems to be world-class bollocks rather than world-class education.

When this matter was brought to light by Graeme Paton in the Daily Telegraph, he quoted Kathleen Tattersall, CEO of the QCA. She said

“The design of these diplomas has met Ofqual’s high standards. We will monitor them closely as they are delivered to make sure that learners get a fair deal and that standards are set appropriately.”

Just the usual vacuous bureaucratic defensive sound-bite there. So I wrote to Kathleen Tattersall  myself with some specific questions. The letter went on 2nd September 2008.  Up to today, 26 November, I had only letters saying

“Thank you for your email of 12 November addressed to Kathleen Tattersall, a response is being prepared which will be forwarded to you shortly.”

“Thank you for your email of 25th November addressed to Kathleen Tattersall. A more detailed response is being prepared which will be sent to you shortly.”

Here are some of the questions that I asked.

I wrote to Edexcel’s subject advisors about unit 23 and I was told “your questions do not refer to a science qualification”. This seems to mean that if it comes under the name “Health Care” then the care of sick patients is treated as though it were nothing to do with science, That seems to me to be both wrong and dangerous, and I should like to hear your view about that question.

Clearly the fundamental problem here is that the BTEC is intended as a vocational training for careers in alternative medicine, As a body concerned with education, surely you cannot ignore the view of 99% of scientists and doctors that almost all alternative medicine is fraud. That doesn’t mean that you can’t make a living from it, but it surely does create a dilemma for an educational organisation. What is your view of that dilemma?



Eventually, on 27th November, I get a reply (of sorts)  It came not from the Kathleen Tattersall of the QCA but from yet another regulatory body, OfQual, the office of the Qualifications and Examinations Regulator.  You’d think that they’d know the answers, but if they do they aren’t telling, [download whole letter.  It is very short.  The “more detailed response” says nothing.

Ofqual does not take a view on the detailed content of vocational qualifications as that responsibility sits with the relevant Sector Skills Council which represents employers and others involved in the sector. Ofqual accredits the specifications, submitted by sector-skilled professionals, after ensuring they meet National Occupational Standards.  Ofqual relies on the professional judgement of these sector-skilled professionals to include relevant subjects and develop and enhance the occupational standards in their profession.

The accreditation of this BTEC qualification was supported by both Skills for Health, and Skills for Care and Development, organisations which represent the emerging Sector Qualifications Strategies and comply with the relevant National Occupational Standards

Isabel Nisbet

Acting Chief Executive



So no further forward. Every time I ask a question, the buck gets passed to another quango (or two, or three). This letter, in any case, seems to contradict what Edexcel said about the involvement of Skills for Health (that’s the talking to trees outfit),

A nightmare maze of quangos

You may well be wondering what the relationship is between Ofqual and the QCA.  There is an ‘explanation’ here.

Ofqual will take over the regulatory responsibilities of the Qualifications and Curriculum Authority (QCA), with stronger powers in relation to safeguarding the standards of qualifications and assessment and an explicit remit as a market regulator. The QCA will evolve into the Qualifications and Curriculum Development Agency (QCDA): supporting Ministers with advice and undertaking certain design and delivery support functions in relation to the curriculum, qualifications, learning and development in the Early Years Foundation Stage, and National Curriculum and Early Years Foundation Stage assessments.

Notice tha QCA won’t be abolished. There will be yet another quango.

The result of all this regulatory bureaucracy seems to be worse regulation, Exactly the same thing happens with accreditiation of dodgy degrees in universities.

At one time, a proposal for something like Unit 23 would have been shown to any competent science teacher, who would have said”you must be joking” and binned it.  Now a few hundred bureaucrats tick their boxes and rubbish gets approved.

There seems to be nobody in any of these quangos with the education to realise that if you want to know the truth about homeopathy, the last person you ask is the Society of Homeopaths or the Prince of Wales.

What next?

So the mystery remains. I can’t find out who is responsible for the provenance of the appallingly anti-science Unit 23, and I can’t find out how it got approved.  Neither can I get a straight answer to the obvious question about whether it is OK to encourage vocational qualifications for jobs that are bordering on being fraudulent.

.All I can get is platitudes and bland assurances.  Everything that might be informative is clouded in secrecy.

The Freedom of Information requests are in.  Watch this space. But don’t hold your breath.

Follow-up

Here are some attempts to break through the wall of silence.

Edexcel. I sent them this request.

Freedom of Information Act

Hello

I should like to see please all documents from Edexcel and OfQual or QCA (and communications between then) that concern the formulation and approval of Unit 23 (Complementary Therapies) in the level3 BTEC (page 309 in attached document). In vew of the contentious nature of the subject matter, I believe that is is in the public interest that this information be provided

David Colquhoun

The answer was quite fast, and quite unequivocal, Buzz off.

Dear Mr Colquhoun,

Thank you of your e-mail of today’s date. I note your request for information pursuant to The Freedom of Information Act. As you may know this Act only applies to public bodies and not to the private sector. Edexcel Limited is privately owned and therefore not subject to this Act. Edexcel is therefore not obliged to provide information to you and is not prepared to give you the information you seek.

Please do not hesitate to contact me again if you have any further queries.

Kate Gregory
Director of Legal Services
Pearson Assessments & Testing
One90 High Holborn, London, WC1V 7BH
T: +44 (0)20 7190 5157 / F: +44 (0)207 190 5478
Email: kate.gregory@pearson. com



This lack of public accountability just compounds their appalling inability to distinguish education from miseducation.

International Therapy Examination Council (ITEC)

Mojo’s comment, below, draws attention to the Foundation degree in Complementary Therapies offered by Cornwall College, Camborne, Cornwall (as well as to the fact that the Royal National Lifeboat Institution has been wasting money on ‘research’ on homeopathy –write to them).

At least the courses are held on the Camborne campus of Cornwall College, not on the Duchy campus (do we detect the hand of the Quacktitioner Royal in all this nonsense?).

Cornwall College descends to a new level of barminess in its course Crystal Healing VTCT Level 3

“Who is this course for?

This course is designed to enhance the skills of the Holistic Therapist. Crystals may be used on their own in conjunction with other therapies such as Indian Head Massage, Aromatherapy and Reflexology. Due to the nature of the demands of the holistic programme this course is only suitable for students over the age of 18.”

“What will I be doing on the course?

Students will study the art of Crystal healing which is an energy based treatment where crystals and gemstones are used to channel and focus various energy frequencies.”

.VTCT stands for the Vocational Training Charitable Trust.

It is yet another organisation that runs vocational exams, and it is responsible for this particular horror

The crystals are here. I quote.

Objectives

  • the use of interpersonal skills with client
  • how to complement other therapies with crystals
  • the types and effects of different crystals
  • uses of crystals including cleansing, energising, configurations
  • concepts of auras and chakras

This is, of course, pure meaningless nonsense. Utter bollocks being offered as further education

Cornwall College has many courses run by ITEC.

The College says

“You will become a professional practitioner with the International Therapy Examination Council (ITEC), study a number of essential modules to give a vocational direction to your study that include: Homeopathy and its application,”

Who on earth, I hear you cry, are ITEC? That brings us to the seventh organisation in the maze of quangos and private companies involved in the miseducation of young people about science and medicine. It appears, like Edexcel, to be a private company though its web site is very coy about that.

After the foundation degree you can go on to “a brand new innovative BSc in Complementary Health Studies (from Sept 2009)”

The ITEC web site says

Oddly enough, there is no mention of accreditation by a University (not that that is worth much).  So a few more Freedom of Information requests are going off, in an attempt to find out why are kids are being miseducated about science and medicine.

Meanwhile you can judge the effect of all that education in physiology by one of the sample questions for ITEC Unit 4, reflexology.

The pancreas reflex:

A Extends across both feet
B Is on the right foot only
C Is on the left foot only
D Is between the toes on both feet

Uhuh, they seem to have forgotten the option ‘none of the above’.

Or how about a sample question from ITEC Unit 47 – Stone Therapy Massage

Which organ of the body is associated with the element fire?

A Heart
B Liver
C Spleen
D Pancreas


Or perhaps this?

Which incantation makes hot stones work best?

A Incarcerous
B Avada Kedavra,
C Dissendium
D Expelliarmus.

(OK I made the last one up, with help from Harry Potter, but it makes just about as much sense as the real ones).

And guess what? You can’t use the Freedom of Information Act to find out how this preposterous rubbish got into the educational system because ” ITEC is a private organisation therefore does not come under this legislation”. The ability to conduct business in secret is a side effect of the privatisation of public education is another reason why it’s a bad idea.

Ofsted

Ofsted has inspected Cornwall College. They say “We inspect and regulate to achieve excellence in the care of children and young people, and in education and skills for learners of all ages.”. I can find no mention of this nonsense in their report, so I’ve asked them.

Ofsted has admitted a spectacular failure in its inspection of child care in the London Borough of Haringey. Polly Curtis wrote in the Guardian (6 Dec 2008) “We failed over Haringey – Ofsted head”. It was the front page story. But of course Ofsted don’t take the blame, they say they were supplied with false information,

That is precisely what happens whenever a committee or quango endorses rubbish. They look only at the documents sent to them and they don’t investigate, don’t engage their brains.

In the case of these courses in utter preposterous rubbish, it seems rather likely that the ultimate source of the misinformation is the Princes’ Foundation for Integrated Health. Tha views of the Prince of Wales get passed on to the ludicrous Skills for Health and used as a criterion by all the other organisations, without a moment of critical appraisal intervening at any point.

2 December 2008 A link from James Randi has sent the hit rate for this post soaring.  Someone there left are rather nice comment.

“A quango seems to be a kind of job creation for the otherwise unemployable ‘educated ‘( degree in alternative navel contemplation) middle classes who can’t be expected to do anything useful like cleaning latines ( the only other thing they seem qualified for ). I really hate to think of my taxes paying for this codswollop.”


Jump to follow-up

Thames Valley University is one of those shameful institutions that offer Bachelor of Science degrees in homeopathy. They don’t stop there though. They’ll teach you several other forms of make-believe medicine. Among these is “nutritional medicine”. This is taught at the Plaskett Nutritional Medicine College which is now part of Thames Valley University.

Everyone is for good nutrition of course, but ‘nutritional medicine’, or ‘nutritional therapy’ pretends to be able to cure all sorts of diseases by changes in diet or by buying expensive nutritional supplement pills. It has no perceptible relationship to the very important subjects of ‘nutrition’ or ‘dietetics’.  Nutritional therapy is very firmly part of alternative medicine, in other words it is largely quackery. If you don’t believe that, read on.

The subject of nutritional therapy was in the news recently because of Matthias Rath. He is the person who is reponsible for the death of many Africans because of his advocacy of vitamin pills for the treatment of HIV/AIDS. He didn’t just (mis)treat people, but also played a role in persuading the recently departed Thabo Mbeki, and his health minister (“Mrs Beetroot”) to abandon effective therapies for AIDS sufferers. See reports in The Guardian, by Ben Goldacre, and here,

I’ve written a lot about the penetration of quackery into universities, and I thought I’d seen the worst with ‘amethysts emit high yin energy‘.  But, as Goldacre said, let me tell you how bad things have become. .

Recently I came into possession of a lengthy set of notes for a first year course on “The Holistic Model of Healthcare”.  The notes are from the 2005 course at Thames Valley University,  They are not signed, but appear to have been written by Dr Lawrence Plaskett himself. . You can download the whole set of notes here.

Here are a few choice quotations. The basis of them is pure vitalism. They read like a throwback to the dark ages.  Little comment is needed.  They speak for themselves.

1.3 What do Orthodox Dieticians know about Food and Health?

Dieticians working in the National Health Service and private clinics and hospitals are usually well trained in the basics of the subject, though they too have an entirely orthodox slant.  By and large they seem to accept the general view of most of the medical profession that nutrition does not affect illness much. Hence, they restrict themselves to designing diets required by the doctors for whom they work – usually for specified narrow purposes, such as low fat diets, low sodium diets etc. Such diets are, indeed, important in the hospital management of certain diseases (once these have become established) but they represent extremely limited horizons. Much that is in the basic and essential training of alternative nutritional practitioners is missing from the training of dieticians. As a result, most hospital diets are not very good for health judging from the parameters that will be set down in the following Sessions

Well, it is true that real dietitians prefer not to base their practice on mediaeval vitalism. That is what marks them out as professionals.

1.4 Relationship to Science and the Limitations of Orthodox Methods

However, the subject of Wholistic Nutrition transcends the area of human understanding for which science, alone, is appropriate. The reason is that it is ‘vitalistic’. It recognises the presence in all life forms including the human body, of subtle (or ‘etheric’) energy forces not easily measurable by the physicist’s equipment.  It shares that position with the ‘energy medicine’ disciplines such as homoeopathy, traditional acupuncture and spiritual healing. It follows an approach to those subtle energies that is embodied in the discipline and philosophy of naturopathy.

Vitalism is the notion that life in living organisms is sustained by a vital principle that cannot be explained in terms of physics and chemistry.   This vital principle, often called “the life force”, is something quite distinct from the physical body and is responsible for much that happens in health and disease.

Naturopathy is a relatively modem term for an ancient concept (dating back to 400 BC). This concept embraces the notion that the body is inherently self-healing and that it is the practitioner’s job to stimulate and support this process.  Each patient is recognised as having a unique life experience and a unique genetic inheritance. All diseases are seen as one and as attempts by the body to purify itself of toxins. Treatment focuses on causes rather than on symptoms and always addresses the whole person. The wise words of Hippocrates (often called the Father of Medicine) express some of the main tenants of naturopathic thought. He said:

  • It is only nature that heals and wherever and whenever possible nature should be given the opportunity to do so.
  • Disease is only an expression of purification.
  • All disease is one.
  • Let food be your medicine and medicine be your food.”

Hence, most ‘alternative’ nutritionists see conventional nutrition. as being rather rigid and unmoving. Hence, they also see it as very limited. This happens because orthodox nutritionists tend to be locked into science alone. They fail to grasp the significance (or the reality of) the subtle energies and they reject the philosophy of vitalism. It is generally the view of ‘alternative’ nutritionists that understanding these things is a major step to healing the patient.

“Understanding” vitalism sounds more like a way of harming patients than healing patients.

1.5 The Pressure of the Orthodox model

Almost everyone who takes steps towards ‘alternative’ medicine experiences a backlash from others around them who have not been able to make the same conceptual change. Patients wanting to settle into an ‘alternative’ approach can be subject to negativity from their doctors (and as a result many patients do not ask the doctor’s opinion). But students and practitioners alike are frequently subject to negative expressions and even frank hostility from relatives
who can understand only orthodox, symptomatic treatment. It is therefore best to be forewarned that your adherence to ‘alternative’ principles will be tested in these ways.

The “Life Force” gets capital letters, like God, But what is it? Pure fantasy.

2 THE LIFE FORCE

2.1 What does our Energy Consist of?

At the root of most hoIistic therapies lies the belief that all life is animated by a subtle force. We call this the Life Force. You either believe it or you do not. It cannot exactly be proved at the moment and the belief is not in accord with the yardsticks that we call ‘scientific’, The belief is a little akin to the belief in God or in spirits or ghosts, and yet at the same time it is not,
because the Life Force is by no means so remote from us. It is not necessarily difficult for an agnostic to accept the Life Force. The writer was once asked for a definition of the Life Force and wrote:

” The Life Force is that non-material. non-physical force that animates all life forms and distinguishes them from non-living matter. It Is seen as a determining Force, not as a mere accompaniment to the phenomenon of Life. That is, it determines whether Life can exist or not. It determines the physical form that a life form takes: by its quality and its strength it determines the health, vigour and vitality of the life form. Hence it determines our freedom from, or our  susceptibility to illnesses, and our general ability to come through and to recover from Life’s stresses and traumas.”

A bit later it gets even better, when we get to astral travel and even survival after death. Truly bonkers.

The postulate of a subtle Life Force makes a natural connection with such topics as out of body experiences, astral travel and even survival after death. This happens because the subtle Life Force appears by its very nature to be “life within a different medium” and if life can exist in
a different medium, then why should it not exist quite independently of the physical body?

So what’s the evidence?

2.2 Evidence Concerning the Life Force

Since our ‘usual’ human senses only work through the medium of the human body we can only expect to detect the Life Force or other subtle forces, through their interactions with matter. It is clear that these interactions are themselves subtle and sensitive because one level or state is impinging upon another. It is postulated that they are not entirely of our world, not physical, only detectable with physical apparatus under special conditions.
Often they are described as “that which science cannot see”. Not surprisingly, therefore, when investigators come forward convinced that they have a phenomenon that demonstrates the Life Force. the physicists, looking at it with a steely scientific eye, are not usually ready to accept the conclusions claimed. Hence, we have several delicate phenomena that are often claimed to be manifestations of the Life Force, yet not accepted as such scientifically.

• The experiments done by Harold Saxton Burr on the “Fields of Life”.

• The experimen1s performed on detecting and measuring “Electrodynamic fields”

• The phenomenon of “Capillary dynamolysis”

• Homoeopathic effects.

• The Chinese ‘energy pulses’ at the human wrists.

From experience it is clear that many students will simply accept the Life Force as ‘obvious’.  Some will say they have always known about it. Others are able to accept the concept now as a reasonable principle.  Others perhaps (though we have rarely come across it) will never accept the Life Force. If that occurs, it seems a shame, for it removes some of the excitement from wholistic nutrition, . . .

What’s said about the homeopathic evidence?

2.6 Homoeopathic Effects

It is not until Nutritional Medicine students have qualified and got into practice that they usually employ any homoeopathy as an adjunct to their therapy in anything other than a first-aid role. That is because homoeopathy is a complex training in its own right and a quite separate discipline. However, any demonstration of the effectiveness of homoeopathic medicines at potencies higher than 12C is evidence for the existence of the subtle etheric energies. Such remedies have been diluted beyond the point at which the last traces of material substance derived from the Mother tincture, have been removed, leaving only the residual energy associated with the original material.

Of course the notes go on to misrepresent the clinical trials which actually show that homeopathy is mere placebo.

2.9 Toxic Effects upon the Life Force

The Life Force is generally seen as an abundant ebullient and beautiful manifestation of Nature’s energy. Although some forms of acupuncture take in the concept of a form of polluted Life Force called Aggressive Energy”, that idea is not shared much by other whoIistic disciplines. We are left for the most part with the idea of a rather perfect form of energy.

In Western Naturopathic thought, the enemy of the Life Force is toxicity. The Life Force inhabits a potentially perfect physical body. The main threat to the integrity of that body consists of the body’s own metabolic wastes, if they are not properly cleared out. Plus environmental toxins that gain access to the body from outside, or that are generated in the bowel. In that way the bowel gains a high level of importance in Naturopathy and ‘”Nature Cure”.

The Life Force, then, with its almost holy purity, is in danger of being inhibited, dampened down and threatened by what amounts to some entirely physical dirt that gains access to that temple of the soul the human body. Whilst in Traditional Chinese Medicine impurities in the mind, emotions or spirit are just as important as physical impurity, it is naturopathy that focuses upon the actual physical sewers of the body.

Aha, that’s it. Holy water.

The inability of naturopaths in the past to identify specific toxins or to point with sufficient exactitude to the ways in which they can be removed, has been the Achilles Heel of the naturopaths in trying to represent their views in the past to orthodox doctors or medical scientists.

And it still is. The alleged toxins have never been identified, still less removed. Detoxification is a myth of downmarket women’s magazines and profiteering spas. And, of course, of some Bachelor of Science  degrees.

2.10 Nutritional Effects upon the Life Force

2.10.1 Bulk nutrients

Next comes the consideration of the bulk nutrients – the protein, carbohydrate and fat. These are our source of biochemical energy and we obviously starve without them. Their purity is crucial.  If they have been chemically modified or damaged by toxic interactions, then they will entrain toxicity and also be hard to break down. Even at best, their digestion and assimilation costs energy, which may well be both biochemical and subtle.

What “toxic interactions”? This is all sheer fantasy.

2.10.3 The micronutrients

When you practice [sic] nutritional therapy in a naturopathic setting, being aware at the same time of the on-going biochemistry, you become critically aware of the role of the  micronutrients in a way that the classical naturopaths were not.

Biochemical reactions will flow better when they are present in the correct balance. Therefore the minerals have a key interaction with the Life Force. Without the right minerals the Life Force can be conceived of as pushing forward to achieve high activity in the body, yet being blocked through the chemical composition not being correct. If you apply the minerals in this situation, there may, indeed. be a surge forward of the energy.

Whatever that may mean.

3 THE EBULLIENCE OF THE LIFE FORCE: STOPPING THE ROT AND STARTING TO RECOVER

3.1 The Horror of Deterioration: The Chronic State

All that has gone before has already shown that the grassroots of deterioration in the physical body are:

  • Weakened Life Force
  • Nutritional Deficiency and Imbalance
  • Toxic Attack

If nutritional error or deprivation are the more strongly implicated primary cause, then the Life Force struggles with an unbalanced physical body, getting the tissue biochemistry to work at full integrity is impossible; hence. the body’s detoxification system becomes incompetent and the body’s toxic burden may rise steeply. At the same time the Life Force ails.

So, focusing as we do now upon elimination of toxins (the very nub of classical naturopathy), we perceive that it is a process that depends upon a good strong Life Force and also upon adequate nutrient intake. Therapies that directly stimulate the Life Force (homoeopathy, acupuncture and spiritual healing) therefore make an indirect, though real, contribution to toxic elimination through increasing the Life Force or otherwise improving its health and balance.

So according to this, all CAM is much the same. That idea will provoke bitter internecine warfare.

3.5 The Law of Cure

We have above depicted the move from relative health to chronic illness as a downward path. Equally, the route back from the edge of the abyss of chronic illness is one of revitalisation and detoxification. The idea of the ‘route back’ was spotted years ago by the homoeopath, Constantine Hering, and has become known as ‘Hering’s Law of Cure’.

The Law further embodies the notion that toxins, and therefore symptoms, tend to move outward from within as recovery or cleansing occurs. This is fully in accord with the classical naturopath’s idea. Toxins close to the surface of the body are conceived to be most likely on their way out. The skin is an eliminatory organ and toxins at or near the skin level are not so much of a threat to well being. Naturally, the patient may well be horrified at the disfiguring
rash that may be seen by all. Nonetheless, the patient is seen to be far better off than when having these toxins deep within the body, held, perhaps within essential organs that are becoming progressively damaged.

This sounds increasingly like a ‘do-nothing’ approach (much like homeopathy then).

3.6 Suppression

Boils used to swell up into a red sore and then burst. Very bad ones, or carbuncles, might be lanced to cause the pus (morbid matter) to run out. These days, boils and carbuncles tend to occur much less than formerly, presumably because of the lower Life Force of the population and the generally suppressive medical culture. The chances are that they get treated with an antibiotic long before they get a chance to come to a head and burst. Such treatment is suppressive in the strictly naturopathic sense of the word. The same is absolutely true with regard to bringing down artificially the temperature during a fever, whereas ‘sweating it out’ is the natural thing to do.

More of the do-nothing approach.

4.2 How lridology Helps us to See Toxic Foci

As mentioned above, toxic foci (deposits) in the body show up in the iris of the eye. The iris is arranged so as to encompass a complete ‘map’ of the body. with all the organs and systems laid out upon it. Hence the location of a toxic deposit in the iris shows the iridologist its position within the body. The toxins may appear as colours, spots. blobs and smears in particular
places in the iris, or as darkened areas.

Now iridology, another sort of fantasy medicine, creeps in.

5.5 What Place for Immunisations?

Here we shall restrict ourselves to saying as little as possible. We shall. indeed, make no recommendations. However. the classical naturopaths and homoeopaths have all been of one voice in condemning the use of morbid diseased matter for injection into the human body to prevent disease. It was not, they said, a proper procedure. There has also been much disagreement about how effective such measures are. Of course, whenever there is danger of infection. it is wrong to do nothing. At least you should use the homoeopathic equivalent treatment. As to the effectiveness of those methods, that is beyond the scope of this course.

As to the personal view of the writer, it is that the natural therapists who have declared thernselves on this topic in the past are probably right. They have maintained that immunisation is just another form of toxin and an especially potent one capable, on its own, of sparking a downward spiral into ill health in susceptible people. As to what extent that effect might be balanced by benefit, that is an unresolved argument.  The writer does not use immunisations himself.

Well there is a surprise. Just like almost every other quack, the writer would endanger the whole population by opposing immunisation.

The quiz

The notes contain a number of questions, and, more interestingly, model answers are given at the end. Here is one example.

Question.    Why do some patients respond well to very little treatment?

Answer.  The size of the toxic burden, the strength of the Life Force and micro nutrient status strongly influence a person’s response to treatment. Therefore a person with a low toxic burden, high micro nutrient status and strong life force should respond well to very little treatment.

Or, to put it differently, echinacea cures your cold in seven days, when otherwise it would have taken a week.

Conclusion

We’ll always have crackpot ideas about medicine, at least until real medicine gets much more effective than it is now. For example, in low back pain, the cause is usually not known, the treatments are only palliative, and it isn’t very effective palliation either. The big difference between real medicine and crackpot medicine, is that in real medicine you aren’t allowed to invent the answer when you don’t know it.

No doubt the author of these fantasy notes was entirely sincere in his delusions.  But how can any self-respecting vice-chancellor tolerate having this sort of stuff as part of a Bachelor of Science degree?   Professor Peter John, vice-chancellor of Thames Valley University is not a scientist. His background is in education. But you don’t need to be a scientist to see what nonsense is being taught as science in his university.

Perhaps he didn’t know what is going on. Well, he does now.

Follow-up

Thanks to Ben Goldacre for the link from his miniblog.?

Thames Valley University and their degree in “Nutritional Medicine”

Why? Why do they pretend it’s science? Why don’t they just call it “some stuff we made up”


Jump to follow-up

It seems that validation committees often don’t look beyond the official documents. As a result, the validations may not be worth the paper they are written on. Try this one.

One of the best bits of news recently was the downfall of Matthias Rath.  He’s the man who peddled vitamin pills for AIDS in Africa, and encouraged the AIDS denialists in the South African government.  Thabo Mbeki and his Health Minister, Mrs Beetroot, have gone now, thank heavens.

Rath was one of the best illustrations of the murderous effect of selling ineffective treatments.  The fact that nobody in the “nutritional therapy” industry has uttered a word of condemnation for this man illustrates better than anything one can imagine the corrupt state of “nutritional therapy”.  The people who kept silent include the British Association of Nutritional Therapists (BANT).

It might be surprising, then, to find the Northern College of Acupuncture proudly adding a course in alternative nutrition to its courses in acupuncture (now known to be a theatrical placebo) and Chinese herbal medicine (largely untested and sometimes toxic).  It might be even more surprising to find the boast that the course is validated by the University of Wales.  It seemed a good idea to find out a bit more about how this came about.  Thanks to the Freedom of Information Act, some interesting things can be discovered.

Polly Toynbee’s superb article, Quackery and superstition – available soon on the NHS,  written in January 2008, mentioned diplomas and degrees in complementary therapies offered by, among others, the University of Wales.  This elicited a letter of protest to Toynbee from the Vice-Chancellor of the University of Wales, Professor Marc Clement BSc, PhD, MInstP, CEng,CPhys,FIET.   He invited her to visit the university to see their “validation and monitoring procedures (including the University’s very specific guidelines on health studies disciplines”.

So let’s take a look at these validation procedures and guidelines.

The validation process

The Northern College of Acupuncture submitted a 148 page proposal for the course in October 2007.   The document has all the usual edu-bollocks jargon, but of course doesn’t say much about clinical trials, though it does boast about an unblinded trial of acupuncture published in 2006 which, because of lack of appropriate controls, served only to muddy the waters.  : This submission was considered by the University’s validation committee last December.


Panel of Assessors:

Professor Nigel Palastanga (Chair), Cardiff University

Dr Celia Bell (School of Health and Social Sciences Middlesex University)

Dr John Fish (Moderator designate) (Institute of Biological Sciences University of Wales, Aberystwyth)

Ms Rhiannon Harris (Centre for Nutrition & Dietetics University of Wales Institute,
Cardiff (UWIC))

Ms Felicity Moir (School of Integrated Health University of Westminster)

The whole validation document is only four pages long [download it]. The most interesting thing about it is that the words ‘evidence’ or ‘critical’ do not occur in it a single time.  It has all the usual bureaucratic jargon of such documents but misses entirely the central point.

Does that mean that the University of Wales doesn’t care about evidence or critical thinking?  Well, not on paper. Two years previously a short document called Health Studies Guidelines had been written by Dr Brian Spriggs (Health Studies Validation Consultant, since retired) for the Health Studies Committee, and it was approved on 21 April 2005.  It starts well.

“Degrees in the Health Studies field are expected to promote an understanding of the  importance of the scientific method and an evidence-base to underpin therapeutic interventions and of research to expand that base.”

It even goes on to say that a BSc degree in homeopathy is “unacceptable”.  Don’t get too excited though, because it also says that acupuncture and Chinese herbal  stuff is quite OK.  How anyone can imagine they live up to the  opening sentence beats me.   And it gets worse. It says that all sorts of rather advanced forms of battiness are OK if they form only part of another degree.  They include Homeopathy, Crystal therapy. Dowsing, Iridology; Kinesiology, Radionics, Reflexology, Shiatsu, Healing, and Maharishi Ayurvedic Medicine.

Dowsing? Crystal therapy?  Just let me remind you. We are living in 2008. It is easy to forget that when ploughing through all this new age junk.

The Validation Handbook of Quality Assurance: Health Studies (2007) runs to an astonishing 256 pages [download the whole thing]. On page 12 we find the extent of the problem.

“The University of Wales validates a number of schemes in the Health Studies field. At the current time we have undergraduate and/or postgraduate degree schemes in Acupuncture, Animal Manipulation, Chiropractic, Herbal Medicine, Integrative Psychotherapy, Osteopathy, Osteopathic Studies, Traditional Chinese Medicine and Regulatory Affairs, both in the UK and overseas.”

That sounds pretty shocking.   Further down on page 12, though, we find this.

“Degrees in the Health Studies field are expected to promote an understanding of the importance of the scientific method and an evidence-base to underpin therapeutic interventions and of research to expand that base. The mission is to promote and require the critical evaluation of the practices, doctrines, beliefs, theories and hypotheses that underlie the taught therapeutic measures of the discipline.”

They are indeed fine words. The problem is that I can detect no sign in the submission, nor in its consideration by the validation committee, that any attempt whatsoever was made to ensure that the course complied with these requirements.

The only sign of concern I could detect of any concern about the quality of what was being taught came in a minute to a meeting of the Health Studies Committee meeting on 24th April 2008.

“Members received a copy of an article entitled Quackery and superstition available soon on the NHS which appeared in The Guardian newspaper in January 2008, and a copy of the Vice- Chancellors response. Members agreed that this article was now historical but felt that if/when the issue were to arise again; the key matter of scientific rigour should be stressed. The Committee agreed that this was the most critical element of all degree schemes in the University of Wales portfolio of health studies schemes. It was felt it would be timely to re-examine the schemes within the portfolio as well as the guidelines for consideration of Health Studies schemes at the next meeting. The Committee might also decide that Institutions would be required to include literature reviews (as part of their validation submission) to provide evidence for their particular profession/philosophy. It was agreed that the guidelines would be a vital document in the consideration of new schemes and during preliminary visits to prospective Institutions. “

The Press Office had passed Polly Toynbee’s article to them.  Curiously the Health Studies Committee dismissed it as “historical”, simply because it was written three months earlier.  That is presumably “historical” in the sense that the public will have forgotten about it, rather than in the sense that the facts of the matter have changed since January.  So, at least for the nutrition degree, Toynbee’s comments  were simply brushed under the carpet.

After a few cosmetic changes of wording the validation was completed on 16th January 2008. For example the word “diagnosis” was removed in 43 places and “rewritten in terms of evaluation and assessment”.  There was, needless to say, no indication that the change in wording would change anything in what was taught to students.

You may think that I am being a bit too harsh. Perhaps the course is just fine after all? The problem is that the submission and the reaction of the validation committee tell you next to nothing about what actually matters, and that is what is taught. There is only a vague outline of that in the submission (and part of it was redacted on the grounds that if it were made public somebody might copy ;it.  Heaven forbid).

That is why I have to say, yet again, that this sort of validation exercise is not worth the paper it’s written on.

How can we find out a bit more? Very easily as it happens. Just Google. What matters is not so much formal course outlines but who teaches them.

The nutrition course

The title of the course is just “Nutrition”, not ‘Nutritional Therapy’ or ‘Alternative Nutrition’.  That sounds quite respectable but a glance at the prospectus shows immediately that it is full-blown alternative medicine.

Already in July 2007, the glowing press releases for the course had attracted attention from the wonderfully investigative web site HolfordWatch.   I see no sign that the validation committee was aware of this. But if not, why not? I would describe is as dereliction of academic duty.

“This pioneering course is unique in that it is firmly rooted in both Western nutritional science and naturopathic medicine and also covers concepts of nutrition within traditional Chinese, Japanese, Tibetan and Ayurvedic medicine.

This means that graduates will gain comprehensive understanding of both modern scientific knowledge and ancient wisdom concerning nutrition and dietetics.”

Ancient wisdom, of course, means something that your are supposed to believe though there is no good reason to think it’s true.  In the end, though, almost the only thing that really matters about any course is who is running it.  The brochure shows that all of the people are heavily into every form of alternative nuttiness.

Course Director and Tutor: Jacqueline Young nutritionist, naturopath, clinical psychologist and Oriental medical practitioner

Nutrition Tutors:

Elaine Aldred  (qualified as a chiropractor with the Anglo European Chiropractic College, as an acupuncturist with the British College of Acupuncture and as a Western Medical Herbalist with the College of Phytotherapy. She recently also qualified in Chinese herbal medicine with the Northern College of Acupuncture.)

Sue Russell (3 year diploma in nutritional therapy at the Institute of Optimum Nutrition. She currently practises as a nutritional therapist and also works part-time as a manager at the Northern College of Homeopathic Medicine.)

Anuradha Sharma (graduated as a dietician from Leeds Metropolitan University in 2002 and subsequently completed a Naturopathy certificate and a post-graduate diploma in acupuncture).

Guest Lecturers include : Dr John Briffa, Professor Jane Plant, M.B.E. (a geochemist turned quack), and, most revealingly, none other than the UK’s most notorious media celebrity and pill peddler, Patrick Holford.

So much has been written about Holford’s appalling abuse of science, one would have thought that not even a validation committee could have missed it.

“The course has been created by Jacqueline Young“, so let’s look a bit further at her track record.

Jacqueline Young has written a book, ‘Complementary Medicine for Dummies’ [Ed: ahem shouldn’t that be Dummies for Complementary Medicine?].  You can see parts of it on Google Books. Did the validation committee bother to look at it?  As far as I can tell, the words ‘randomised’ or ‘clinical trial’ occur nowhere in the book.

The chapter on Tibetan medicine is not very helpful when it comes to evidence but for research we are referred to the Tibetan Medical and Astrology Institute.  Guess what? That site gives no evidence either. So far not a single university has endorsed Astrology (there is a profitable niche there for some vice-chancellor).

Here are few samples from the book. The advice seems to vary from the undocumented optimism of this

Well researched?  No. Safe? Nobody knows.  Or this

Mandarin peel prevents colds and flu?  Old wive’s tale.  Then there are things that verge on the weird, like this one

or the deeply bizarre like this

The problem of Jacqueline Young’s fantasy approach to facts was pointed out at least as far back as 2004, by Ray Girvan., who wrote about it again in May 2005. The problems were brought to wider attention when Ben Goldacre wrote two articles in his Badscience column, Imploding Researchers (September 2005), and the following week, Tangled Webs.

“we were pondering the ethics and wisdom of Jacqueline Young dishing out preposterous, made-up, pseudoscientific nonsense as if it was authoritative BBC fact, with phrases such as: “Implosion researchers have found that if water is put through a spiral its electrical field changes and it then appears to have a potent, restorative effect on cells.” “

and later

“Take this from her article on cranial osteopathy, riddled with half truths: “Sutherland found that the cranial bones (the skull bones encasing the brain) weren’t fused in adulthood, as was widely believed, but actually had a cycle of slight involuntary movement.” In fact the cranial bones do fuse in adulthood.

She goes on: “This movement was influenced by the rhythmic flow of cerebrospinal fluid (the nourishing and protective fluid that circulates through the spinal canal and brain) and could become blocked.” There have now been five studies on whether “cranial osteopaths” can indeed feel these movements, as they claim, and it’s an easy experiment to do: ask a couple of cranial osteopaths to write down the frequency of the rhythmic pulses on the same person’s skull, and see if they give the same answer. They don’t. A rather crucial well-replicated finding to leave out of your story.

That was in 2005 and since then all of Young’s “preposterous, made-up, pseudoscientific nonsense” (along with most of the other stuff about junk medicine) has vanished from the BBC’s web site, after some people with a bit of common sense pointed out what nonsense it was.  But now we see them resurfacing in a course validated by a serious university.  The BBC had some excuse (after all, it is run largely by arts graduates). I can see no excuses for the University of Wales.

Incidentally,  thanks to web archive you can still read Young’s nonsense,  long after the BBC removed it.  Here is a quotation.

“Implosion researchers have found that if water is put through a spiral its ,field changes and it then appears to have a potent, restorative effect on cells. In one study, seedlings watered with spiralised water grew significantly faster, higher and stronger than those given ordinary water.”

The vice-chancellor of the University of Wales, Marc Clement, is a physicist (Department of Electrical and Electronic Engineering), so can he perhaps explain the meaning of this?

Selection committees for jobs (especially senior jobs) and validation committees for courses, might make fewer mistakes if they didn’t rely so much on formal documents and did a little more investigation themselves. That sort of thing is why the managerial culture not only takes a lot more time, but also gives a worse result.

It would have taken 10 minutes with Google to find out about Young’s track record, but they didn’t bother. As a result they have spent a long time producing a validation that isn’t worth the paper it’s written on. That makes the University of Wales a bit of a laughing stock. Worse still, it brings science itself into disrepute.

Follow-up

What does the University of Wales say? So far, nothing.   Last week I sent brief and polite emails to Professor Palastanga and to Professor Clement to try to discover whether it is true that the validation process had indeed missed the fact that the course organiser’s writings had been described as “preposterous, made-up, pseudoscientific nonsense” in the Guardian.

So far I have had no reply from the vice-chancellor, but on .26 October I did get an answer from Prof Palastaga.

As regards the two people you asked questions about – J.Young – I personally am not familiar with her book and nobody on the validation panel raised any concerns about it. As for P.Holford similarly there were no concerns expressed about him or his work. In both cases we would have considered their CV’s as presented in the documentation as part of the teaching team. In my experience of conducting degree validations at over 16 UK Universities this is the normal practice of a validation panel.


I have to say this reply confirms my worst fears. Validation committees such as this one simply don’t do their duty. They don’t show the curiosity that is needed to discover the facts about the things that they are meant to be judging. How could they not have looked at the book by the very person that they are validating? After all that has been written about Patrick Holford, it is simply mind-boggling that the committee seems to have been quite unaware of any of it.

It is yet another example of the harm done to science by an unthinking, box-ticking approach.

Pharmacology. A Handbook for Complementary Healthcare Professionals

Elsevier were kind enough to send me an inspection copy of this book, which is written by one of the nutrition course tutors, Elaine Aldred. She admits that pharmacology is “considered by most students to be nothing more that a ‘hoop-jumping’ exercise in the process of becoming qualified”.  She also says. disarmingly. that “I was certainly not the most adept scientist at school and found my university course a trial”.

The book has all the feel of a cut and paste job. It is mostly very simple (if not simplistic). though for no obvious reason it starts with a long (and very amateur) discussion of chemical bonding  Then molecules are admitted to be indivisible (but, guess what, the subject of homeopathy is avoided).  There is a very short section on ion channels, though, bizarrely, it appears under the heading “How do drugs get into cells?”. Since the author is clearly not able to make the distinction between volts and coulombs, the discussion is more likely to confuse the reader than to help.

Then a long section on plants. It starts of by asserting that “approximately a quarter of prescription drugs contain at least one chemical that was originally isolated and extracted from a plant”.. This cannot be even remotely correct.  There are vast tables showing complicated chemical structures, but the usual inadequate
list of their alleged actions  This is followed by a quick gallop through some classes of conventional drugs, illustrated again mainly by chemical structures not data.  Hormone replacement therapy is mentioned, but the chance to point out that it is one of the best illustrations of the need for RCTs is missed.

The one thing that one would really like to see in such a book is a good account of how you tell whether or not a drug works in man. This is relegated to five pages at the end of the book, and it is, frankly, pathetic.  It
is utterly uncritical in the one area that matters more than any other for people who purport to treat patients. All you get is a list of unexplained bullet points.

If this book is the source of the “scientific content” of the nutrition course, things are as bad as we feared.




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Jump to follow-up

We know all about the sixteen or so universities that run “BSc” degrees in hokum. They are all “post-1992” universities, which used to be polytechnics. That is one reason why it saddens me to see them destroying their own attempts to achieve parity with older universities by running courses that I would regard as plain dishonest.

Older universities do not run degree courses in such nonsense. Academics (insofar as they still have any influence) certainly would not put up with it if they tried. But nevertheless you can find quackery in some of the most respected universities, and it gets there not via academics but (guess what) via Human Resources.  It creeps in through two routes.  One is the “training courses” that research staff now have to do (the “Roberts agenda”).  The other route is through occupational health services.

Quackery in training courses

It isn’t easy to find out what happens elsewhere, but I was certainly surprised to find out that UCL’s own HR department was offering a course that promised to teach you the “core principles” of Brain Gym and  Neurolinguistic Programming, both totally discredited bits of psycho-babble, more appropriate to the lifestyle section of a downmarket.women’s magazine than a university.  I gather that HR’s reaction after I brought this to light was not to ask what was wrong with it, but just to get angry.

In a spirit of collegiality I offered to run a transferable skills course myself.  I even offered to do it for nothing (rather than the rumoured £700 per day charged by the life style consultants).  I proposed a course in ‘How to read critically’ (subtitle ‘How to detect bullshit’).  This seems to me to be the ultimate transferable skill. Bullshit occurs in every walk of life. My proposal was moderately worded and perfectly serious.

Guess what?  Despite several reminders, I have never had any response to my suggestion.  Well, I suppose that HR people now regard themselves as senior to mere professors and there is really no need to reply to their
letters.

Quackery in occupational health. Leicester sets a good example

If you work at a university, why not search the university’s web site for “complementary medicice” or complementary therapies”. If it is a real university, you won’t find any degrees in homeopathy, or in amethysts
that emit high yin energy
.  But some quite surprising places are found to be recommending magic medicine through their Occupational Health service, which usually seems to be part of HR.  In fact at one time even UCL was doing it, but no soon had somebody sent me the link than it disappeared. As a matter of historical record, you can see it here (it had all the usual junk, as well as harmless stuff like yoga and pilates).

While looking for something else I stumbled recently some other cases.  One was at the University of Leicester, a very good university (and alma mater to the great David Attenborough who must have done more to point out the beauty of science than just about anyone).  But we find on their staff wellbeing site, alongside some perfectly sensible stuff, a link to complementary therapies.

The list of ‘therapies’ includes not only the usual placebos, acupuncture, reiki, reflexology, but, even more exotically, a fraudulent Russian device called SCENAR therapy. They have a nice leaflet that explains all these things in words that run the whole gamut from meaningless gobbledygook to plain wrong.  Here are some examples from the leaflet.

Reflexology

“In the feet, there are reflex areas corresponding to all the parts of the body and these areas are arranged in such a way as to form a map of the body in the feet”

Reflexology has been shown to be effective for:

  • Back Pain
  • Migraine
  • Infertility
  • Arthritis

Well no, there are no such areas in your feet. That is sheer imagination.  And reflexology has not “been shown to be effective” for any of those conditions.  These claims for therapeutic efficacy are not only lies.  They are also illegal.

Reiki

Each hand position is held for a few minutes, and during this time healing energy will flow into you, balancing your energy system, releasing stress, soothing pain, and promoting your body’s natural ability to heal itself.”

This is sheer idiotic mumbo-jumbo. The “flow of healing energy” is totally imaginary. Such talk is offensive to anyone with half a brain. Insofar as they claim to heal anything, it is also illegal.  The comes SCENAR.

What is SCENAR?

SCENAR is an acronym for Self Controlled Energo- Neuro Adaptive Regulator. It is a reflex biofeedback device which when used by a qualified practitioner, can help to alleviate acute and chronic pain. It is licensed in the UK for pain relief but experience has shown that it is helpful in a wide variety of conditions.”

This is even more seriously nuts than the others.  The term “licensed” means merely that it is electrically safe. It certainly does not mean that it works.  Pubmed shows only three publications about the SCENAR device, all in Russian,

One sales site (apparently Russian) makes the following modest claim.

“A prime goal of the Russian Space Program was to provide space travelers with a portable  medical device that would become their “universal medical assistant” in space. So from the beginning, the SCENAR was designed to replace an entire medical hospital, with all its staff, diagnostic and treatment facilities, even the pharmacy. A universal, non-invasive, portable regulator of body functions (among other things) was envisaged.”

The SCENAR device (right) looks like a TV remote control (perhaps it IS a TV remote control -we aren’t anywhere told in comprehensible terms what’s in the box.  The Russian site sells also the rather baffling accessory on the right. The mind boggles.

SCENAR device

Remote rectal-vaginal electrode for SCENAR

How does this rubbish get onto the web site of a good university?

I presume that it is just another sign of what happens when universities come to be run by non-academics.  No doubt the occupational health people are well meaning and kind, but just scientifically illiterate. What about the HR person in charge of them?  They are not known for scientific literacy either (which would not matter if they stuck to their job).  But perhaps they just didn’t notice.  There is only one way to find out. Ask.  So I sent this letter.on 10th September.

Hello

I am a pharmacologist and I have a side interest in public understanding of science, alternative medicine.and medical fraud

I was quite surprised when Google led me unexpectedly to your complementary therapies page at http://www.le.ac.uk/staffwellbeing/complementary_therapy.html

There is, sad to say, a great deal of information on these pages that is simply not true. For example it has NOT been shown that reflexology has been shown to be effective in any of the conditions which you list, as far as I know
(please send me references if you think I’m wrong) “Reflexology has been shown to be effective for: Back Pain Migraine Infertility Arthritis Sleep disorders Hormonal imbalances Sports injuries Digestive disorders Stress-related condition ”

To take only one more example from this page, the SCENAR device is an even more extreme example. It is well known to be fraudulent. and has been investigated by the Washington State Attorney General.

This sort of thing is not what one would expect from a very respectable university, and it must be a great embarrassment to your excellent medical scientists.

Apart from the many scientific inaccuracies (which greatly impede the efforts of those of us who try to improve public understanding of science), you are, I hope, aware that there is a legal aspect.

Since May this year, new regulations have made it illegal to make claims for health benefits if evidence cannot be produced to show that the claims are justified.  I would like to put it to you that many of the claims made on this page are not only immoral, but also illegal.

I wondered whether you , or your HR department, would like to make any comments

Best regards

David Colquhoun


I got an immediate and very sympathetic response from the Director of HR and a week later, on17th September, he wrote

“Hi David,

I have discussed the matter with my manager of Staff Counselling and Welfare and have agreed that it is probably safest that we remove the references to ‘complimentary’[sic] therapies from the site entirely.

Thank you for your helpful input and the recommendations for reading matter.”

So there is a lesson here.  If you find this sort or stuff on your own institution’s web site, all that may be needed is a simple letter that points out what nonsense it is.  Admittedly the HR man seemed rather more worried about whether the claims were illegal than whether they were true, but either way, it worked.

Only one little snag.  As of 6 October the pages still have not been removed.

On the assumption that they eventually will be removed, I have kept copies of the Wellbeing page, of the Complementary Therapies page, and of the ‘explanatory leaflet’. They stand as part of a historical record that
shows, once again, what can happen when scientific matters get into the hands of HR. Fortunately Leicester University has an HR director who is willing to listen to advice.

Follow-up

Something seems to have gone seriously wrong. Despite the rapid response, virtually all the nonsense is still there on 13th October. It seems not to be so simple after all.

And despite several reminders, the advertisement for SCENAR ‘therapy’ is still on  the University web site on December 14th.  I know that no decision by HR can be made with fewer than 25 meetings and an awayday in Majorca, but this is getting ridiculous.