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The Prince of Wales’ Foundation for Integrated Health (FiH) is a propaganda organisation that aims to persuade people, and politicians, that the Prince’s somewhat bizarre views about alternative medicine should form the basis of government health policy.

His attempts are often successful, but they are regarded by many people as being clearly unconstitutional.



The FiH’s 2009 AnnualConferen ce conference was held at The King’s Fund, London 13 – 14 May 2009. It was, as always, an almost totally one-sided affair devoted to misrepresentation of evidence and the promotion of magic medicine.  But according to the FiH, at least, it was a great success.  The opening speech by the Quacktitioner Royal can be read here. It has already been analysed by somebody who knows rather more about medicine than HRH.    He concludes

“It is a shocking perversion of the real issues driven by one man; unelected, unqualified and utterly misguided”.

We are promised some movie clips of the meeting. They might even make a nice UK equivalent of “Integrative baloney @ Yale“.

This post is intended to provide some background information about the speakers at the symposium. But let’s start with what seems to me to be the real problem. The duplicitous use of the word “integrated” to mean two quite different things.

The problem of euphemisms: spin and obfuscation

One of the problems of meetings like this is the harm done by use of euphemisms.   After looking at the programme, it becomes obvious that there is a rather ingenious bit of PR trickery going on.  It confuses (purposely?) the many different definitions of the word “integrative”  . One definition of “Integrative medicine” is this (my emphasis).

” . . . orienting the health care process to engage patients and caregivers in the full range of physical, psychological, social, preventive, and therapeutic factors known to be effective and necessary for the achievement of optimal health.”

That is a thoroughly admirable aim. And that, I imagine, is the sense in which several of the speakers (Marmot, Chantler etc) used the term.  Of course the definition is rather too vague to be very helpful in practice, but nobody would dream of objecting to it.

But another definition of the same term ‘integrative medicine’ is as a PR-friendly synonym for ‘alternative medicine’, and that is clearly the sense in which it is used by the Prince of Wales’ Foundation for Integrated Health (FIH), as is immediately obvious from their web site.
The guide to the main therapies supports everything from homeopathy to chiropractic to naturopathy, in a totally uncritical way. Integrated service refers explicitly to integration of ‘complementary’ medicine, and that itself is largely a euphemism for alternative medicine. For example, the FIH’s guide to homeopathy says

“What is homeopathy commonly used for?

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

But there is not a word about the evidence, and perhaps that isn’t surprising because the evidence that it works in any of these conditions is essentially zero.

The FIH document Complementary Health Care: A Guide for Patients appears to have vanished from the web after its inaccuracy received a very bad press, e.g. in the Times, and also here.   It is also interesting that the equally widely criticised Smallwood report (also sponsored by the Prince of Wales) seems to have vanished too).

The programme for the meeting can be seen here, for Day 1, and Day 2

Conference chair Dr Phil Hammond, GP, comedian and health service writer. Hammond asked the FIH if I could speak at the meeting to provide a bit of balance. Guess what? They didn’t want balance.

09:30 Opening session

Dr Michael Dixon OBE

09:30   Introduction: a new direction for The Prince’s Foundation for Integrated Health and new opportunities in integrated health and care. Dr Michael Dixon, Medical Director, FIH

Michael Dixon is devoted to just about every form of alternative medicine. As well as being medical director of the Prince’s Foundation he also runs the NHS Alliance. Despite its name, the NHS Alliance is nothing to do with the NHS and acts, among other things, as an advocate of alternative medicine on the NHS, about which it has published a lot.

Dr Dixon is also a GP at College Surgery, Cullompton, Devon, where his “integrated practice” includes dozens of alternative practitioners. They include not only disproven things like homeopathy and acupuncture, but also even more bizarre practitioners in ‘Thought Field Therapy‘ and ‘Frequencies of Brilliance‘.

To take only one of these, ‘Frequencies of Brilliance’ is bizarre beyond belief. One need only quote its founder and chief salesperson.

“Frequencies of Brilliance is a unique energy healing technique that involves the activation of energetic doorways on both the front and back of the body.”

“These doorways are opened through a series of light touches. This activation introduces high-level Frequencies into the emotional and physical bodies.  It works within all the cells and with the entire nervous system which activates new areas of the brain.”

Or here one reads

“Frequencies of Brilliance is a 4th /5th dimensional work.   The process is that of activating doorways by lightly touching the body or working just above the body.”

“Each doorway holds the highest aspect of the human being and is complete in itself. This means that there is a perfect potential to be accessed and activated throughout the doorways in the body.”

Best of all, it can all be done at a distance (that must help sales a lot). One is reminded of the Skills for Health “competence” in distant healing (inserted on a government web site at the behest (you guessed it) of the Prince’s Foundation, as related here)

“The intent of a long distance Frequencies of Brilliance (FOB) session is to enable a practitioner to facilitate a session in one geographical location while the client is in another.

A practitioner of FOB that has successfully completed a Stage 5 Frequency workshop has the ability to create and hold a stable energetic space in order to work with a person that is not physically present in the same room.

The space that is consciously created in the Frequencies of Brilliance work is known as the “Gap”. It is a space of nonlinear time. It contains ”no time and no space” or  respectively “all time and all space”. Within this “Gap” a clear transfer of the energies takes place and is transmitted to an individual at a time and location consciously intended. Since this dimensional space is in non-linear time the work can be performed and sent backward or forward in time as well as to any location.

The Frequencies of Brilliance work cuts through the limitations of our physical existence and allows us to experience ourselves in other dimensional spaces. Therefore people living in other geographic locations than a practitioner have an opportunity to receive and experience the work.

The awareness of this dimensional space is spoken about in many indigenous traditions, meditation practices, and in the world of quantum physics. It is referred to by other names such as the void, or vacuum space, etc.”

This is, of course, preposterous gobbledygook.  It, and other things in Dr Dixon’s treatment guide, seem to be very curious things to impose on patients in the 21st century.

Latest news.  The Mid-Devon Star announces yet more homeopathy in Dr Dixon’s Cullompton practice.  This time it comes in the form of a clinic run from the Bristol Homeopathic Hospital.  I guess they must be suffering from reduced commissioning like all the other homeopathic hospitals, but Dr Dixon seems to have come to their rescue. The connection seems to be with Bristol’s homeopathic consultant, Dr Elizabeth A Thompson.   On 11 December 2007 I wrote to Dr Thompson, thus

In March 2006, a press release http://www.ubht.nhs.uk/press/view.asp?257 announced a randomised trial for homeopathic treatment of asthma in children.

This was reported also on the BBC http://news.bbc.co.uk/1/hi/england/bristol/4971050.stm .

I’d be very grateful if you could let me know when results from this trial will become available.

Yours sincerely

David Colquhoun


The reply, dated 11 December 2007, was unsympathetic

I have just submitted the funders report today and we have set ourselves the deadline to publish two inter-related papers by March 1st 2007.

Can I ask why you are asking and what authority you have to gain this information. I shall expect a reply to my questions,

I answered this question politely on the same day but nevertheless my innocent enquiry drew forth a rather vitriolic complaint from Dr Thompson to the Provost of UCL (dated 14 December 2007).  In this case, the Provost came up trumps. On 14 January 2008 he replied to Thompson: “I have looked at the email that you copied to me, and I must say that it seems an entirely proper and reasonable request. It is not clear to me why Professor Colquhoun should require some special authority to make such direct enquiries”.  Dr Thompson seems to be very sensitive. We have yet to see the results of her trial in which I’m still interested.

Not surprisingly, Dr Dixon has had some severe criticism for his views, not least from the UK’s foremost expert on the evidence for efficacy,  Prof Edzard Ernst.   Accounts of this can be found in Pulse,
and on Andrew Lewis’s blog.

Dixon is now (in)famous in the USA too.  The excellent Yale neurologist,  Steven Novella, has written an analysis of his views on Science Based Medicine. He  describes Dr. Michael Dixon as  “A Pyromaniac In a Field of (Integrative) Straw Men

Peter Hain

09:40 Politics and people: can integrated health and care take centre stage in 2009/2010? Rt Hon Peter Hain MP

It seems that Peter Hain was converted to alternative medicine when his first baby, Sam, was born with eczema. After (though possibly not because of) homeopathic treatment and a change in diet, the eczema got better. This caused Hain, while Northern Ireland Secretary to spend £200,000 of taxpayers’ money to set up a totally uninformative customer satisfaction survey, which is being touted elsewhere in this meeting as though it were evidence (see below). I have written about this episode before:  see Peter Hain and Get Well UK: pseudoscience and privatisation in Northern Ireland.

I find it very sad that a hero of my youth (for his work in the anti-apartheid movement) should have sunk to promoting junk science, and even sadder that he does so at my expense.

There has been a report on Hain’s contribution in Wales Online.

09:55 Why does the Health Service need a new perspective on health and healing? Sir Cyril Chantler, Chair, King’s Fund, previous Dean, Guy’s Hospital and Great Ormond Street

Cyril Chantler is a distinguished medical administrator. He also likes to talk and we have discussed the quackery problem several times. He kindly sent me the slides that he used.   Slide 18 says that in order to do some good we “need to demonstrate that the treatment is clinically effective and cost effective for NHS use”.  That’s impeccable, but throughout the rest of the slides he talks of integrating with  complementary” therapies, the effectiveness of which is either already disproved or simply not known.

I remain utterly baffled by the reluctance of some quite sensible people to grasp the nettle of deciding what works. Chantler fails to grasp the nettle, as does the Department of Health. Until they do so, I don’t see how they can be taken seriously.

10.05 Panel discussion

The Awards

10:20 Integrated Health Awards 2009 Introduction: a review of the short-listed applications

10:45 Presentations to the Award winners by the special guest speaker

11:00 Keynote address by special guest speaker

Getting integrated

Dr David Peters

12:00 Integration, long term disease and creating a sustainable NHS. Professor David Peters, Clinical Director and Professor of Integrated Healthcare, University of Westminster

I first met David Peters after Nature ran my article, Science Degrees without the Science. .One of the many media follow-ups of that article was on Material World (BBC Radio 4). This excellent science programme, presented by Quentin Cooper, had a discussion between me and David Peters ( listen to the mp3 file).


There was helpful intervention from Michael Marmot who had talked, in the first half of the programme, about his longitudinal population studies.

Marmot stressed the need for proper testing.  In the case of
homeopathy and acupuncture, that proper testing has largely been done.  The tests were failed.

The University of Westminster has, of course, gained considerable notoriety as the university that runs more degree programmes in anti-scientific forms of medicine than any other.  Their lecture on vibrational medicine teaches students that amethysts “emit high Yin energy so transmuting lower energies and clearing and aligning energy disturbances at all levels of being”.   So far their vice-chancellor, Professor Geoffrey Petts, has declined to answer enquiries about whether he thinks such gobbledygook is appropriate for a BSc degree.

But he did set up an internal enquiry into the future of their alternative activities. Sadly that enquiry seems to have come to the nonsensical conclusion that the problem can be solved by injection of good science into the courses, as reported here and in the Guardian.
It seems obvious that if you inject good science into their BSc in homeopathy the subject will simply vanish in a puff of smoke.

In 2007, the University of Westminster did respond to earlier criticism in Times Higher Education, but their response seemed to me to serve only to dig themselves deeper into a hole.

Nevertheless, Westminster has now closed down its homeopathy degree (the last in the country to go) and there is intense internal discussion going on there. I have the impression that Dr Peters’ job is in danger.  The revelation of more slides from their courses on homeopathy, naturopathy and Chinese herbal medicine shows that these courses are not only barmy, but also sometimes dangerous.

Professor Chris Fowler

12:10 Educating tomorrow’s integrated doctors. Professor Chris Fowler, Dean for Education, Barts and The London School of Medicine and Dentistry

I first came across Dr Fowler when I noticed him being praised for his teaching of alternative medicine to students at Barts and the London Medical School on the web site of the Prince’s Foundation. I wrote him a polite letter to ask if he really thought that the Prince of Wales was the right person to consult about the education of medical students.  The response I got was, ahem, unsympathetic. But a little while later I noticed that two different Barts students had set up public blogs that criticised strongly the nonsense that was being inflicted on them.

At that point, I felt it was necessary to support the students who, it seemed to me, knew more about medical education than Professor Fowler. It didn’t take long to uncover the nonsense that was being inflicted on the students: read about it here.

There is a follow-up to this story here.  Fortunately, Barts’ Director of Research, and, I’m told, the Warden of Barts, appear to agree with my view of the harm that this sort of thing can do to the reputation of Barts, so things may change soon,

Dame Donna Kinnair

12:30 Educating tomorrow’s integrated nurses.
Dame Donna Kinnair, Director of Nursing, Southwark PCT

As far as I can see, Donna Kinnair has no interest in alternative medicine. She is director of nursing at Southwark primary care trust and was an adviser to Lord Laming throughout his inquiry into the death of Victoria Climbié.  I  suspect that her interest is in integrating child care services (they need it, judging by the recent death of ‘Baby P’).  Perhaps her presence shows the danger of using euphemisms like ‘integrated medicine’ when what you really mean is the introduction of unproven or disproved forms of medicine.

Michael Dooley

12:40 Integrating the care of women: an example of the new paradigm. Michael Dooley, Consultant Obstetrician and Gynecologist

DC’s rule 2. Never trust anyone who uses the word ‘paradigm’.   It is a sure-fire sign of pseudoscience.  In this case, the ‘new paradigm’ seems to be the introduction of disproven treatment.  Dooley is a gynaecologist and Medical Director of the Poundbury Clinic.  His clinic offers a whole range of unproven and disproved treatments.  These include acupuncture  as an aid to conception in IVF. This is not recommended by the Cochrane review, and one report suggests that it hinders conception rather than helps.

12.40   Discussion

13.00 – 14.00  Lunch and Exhibition

15.30    Tea

Boo Armstrong and Get Well UK

16.00   Integrated services in action: The Northern
Ireland experience: what has it shown us and what are its implications?
Boo Armstrong of Get Well UK with a team from the NI study

I expect that much will be made of this “study”, which, of course, tells you absolutely nothing whatsoever about the effectiveness of the alternative treatments that were used in it. This does not appear to be the view of Boo Armstrong,   On the basis of the “study”, her company’s web site proclaims boldly

“Complementary Medicine Works

Get Well UK ran the first government-backed complementary therapy project in the UK, from February 2007 to February 2008″

This claim appears, prima facie, to breach the Unfair Trading Regulations of May 2008.   The legality of the claim is, at the moment, being judged by a Trading Standards Officer.  In any case, the “study” was not backed by the government as a whole, but just by Peter Hain’s office.  It is not even clear that it had ethical approval.

The study consisted merely of asking people who had seen an alternative medicine practitioner whether they felt better or worse.  There was no control group; no sort of comparison was made.  It is surely obvious to the most naive person that a study like this cannot even tell you if the treatment has a placebo effect, never mind that it has any genuine effects of its own.  To claim that it does so seems to be simply dishonest.  There is no reason at all to think that the patients would not have got better anyway.

It is not only Get Well UK who misrepresent the evidence.  The Prince’s
Foundation itself
says

“Now a new, year long trial supported by the Northern Ireland health service has . . . demonstrated that integrating complementary and conventional medicine brings measurable benefits to patients’ health.”

That is simply not true. It is either dishonest or stupid. Don’t ask me which, I have no idea.

This study is no more informative than the infamous Spence (2005) ‘study’ of the same type, which seems to be the only thing that homeopaths can produce to support their case.

There is an excellent analysis of the Northern Ireland ‘study’ by Andy Lewis, The Northern Ireland NHS Alternative Medicine ‘Trial’.  He explains patiently, yet again, what constitutes evidence and why studies like this are useless.

His analogy starts

” . . . the Apple Marketing Board approach the NHS and ask for £200,000 to do a study to show the truth behind the statement ‘An apple a day keeps the doctor away’. The Minister, being particularly fond of apples, agrees and the study begins.”

16.30 Social enterprise and whole systems integrated care.  Dee Kyne, Sandwell PCT and a GP.  Developing an integrated service in secondary care

Dee Kyne appears to be CEO of KeepmWell Ltd (a financial interest that is not mentioned).

Peter Mackereth, Clinical Lead, Supportive Services, Christie Hospital NHS Foundation Trust

I had some correspondence with Mackereth when the Times (7 Feb 2007) published a picture of the Prince of Wales inspecting an “anti-MRSA aromatherapy inhaler” in his department at the Christie. It turned out that the trial they were doing was not blind   No result has been announced anyway, and on enquiry, I find that the trial has not even started yet.  Surprising, then to find that the FIH is running the First Clinical Aromatherapy Conference at the Christie Hospital,  What will there be to talk about?

Much of what they do at the Christie is straightforward massage, but they also promote the nonsensical principles of “reflexology” and acupuncture.

The former is untested.  The latter is disproven.

Parallel Sessions

Developing a PCT funded musculoskeletal service Dr Roy Welford, Glastonbury Health Centre

Roy Welford is a Fellow of the Faculty of Homeopathy, and so promotes disproven therapies. The Glastonbury practice also advertises acupuncture (disproven), osteopathy and herbal medicine (largely untested so most of it consists of giving patients an unknown dose of an ill-defined drug, of unknown effectiveness and unknown safety).

Making the best of herbal self-prescription in integrated practice: key remedies and principles. Simon Mills, Project Lead: Integrated Self Care in Family Practice, Culm Valley Integrated Centre for Health, Devon

Simon Mills is a herbalist who now describes himself as a “phytotherapist” (it sounds posher, but the evidence, or lack of it, is not changed by the fancy name). Mills likes to say things like “there are herbs for heating and drying”, “hot and cold” remedies, and to use meaningless terms like “blood cleanser”, but he appears to be immune to the need for good evidence that herbs work before you give them to sick people. He says, at the end of a talk, “The hot and the cold remain the trade secret of traditional medicine”.  And this is the 21st Century.

Practical ways in which complementary approaches can improve the treatment of cancer. Professor Jane Plant, Author of “Your life in your hands” and Chief Scientist, British Geological Society and Professor Karol Sikora, Medical Director, Cancer Partners UK

Jane Plant is a geologist who, through her own unfortunate encounter with breast cancer, became obsessed with the idea that a dairy-free diet cured her.  Sadly there is no good evidence for that idea, according to the World Cancer Research Fund Report, led by Professor Sir Michael Marmot.   No doubt her book on the subject sells well, but it could be held that it is irresponsible to hold out false hopes to desperate people.   She is a supporter of the very dubious CancerActive organisation (also supported by Michael Dixon OBE –see above) as well as the notorious pill salesman, Patrick Holford (see also here).

Karol Sikora, formerly an oncologist at the Hammersmith Hospital, is now Dean of Medicine at the University of Buckingham (the UK’s only private university).  He is also medical director at CancerPartners UK, a private cancer company.

He recently shot to fame when he appeared in a commercial in the USA sponsored by “Conservatives for Patients’ Rights”, to pour scorn on the NHS, and to act as an advocate for the USA’s present health system. A very curious performance.  Very curious indeed.

His attitude to quackery is a mystery wrapped in an enigma.  One was somewhat alarmed to see him sponsoring a course at what was, at first, called the British College of Integrated Medicine, and has now been renamed the Faculty of Integrated Medicine That grand title makes it sound like part of a university.  It isn’t.




The alarm was as result of the alliance with Dr Rosy Daniel (who promotes an untested herbal conconction, Carctol, for ‘healing’ cancer) and Dr Mark Atkinson (a supplement salesman who has also promoted the Qlink pendant.  The Qlink pendant is a simple and obvious fraud designed to exploit paranoia about WiFi killing you.

The first list of speakers on the proposed diploma in Integrated Medicine was an unholy alliance of outright quacks and commercial interests.  It turned out that, although Karol Sikora is sponsoring the course, he knew nothing about the speakers.  I did and when I pointed this out to Terence Kealey, vice-chancellor of Buckingham, he immediately removed Rosy Daniel from directing the Diploma.  At the moment the course is being revamped entirely by Andrew Miles.  There is hope that he’ll do a better job.  It has not yet been validated by the University of Buckingham. Watch this space for developments.

Stop press It is reported in the Guardian that Professor Sikora has been describing his previous job at Imperial College with less than perfect accuracy. Oh dear. More developments in the follow-up.

The role of happy chickens in healing: farms as producers of health as well as food – the Care Farm Initiative Jonathan Dover, Project Manager, Care Farming, West Midlands.

Apparently,

“Care farming is a partnership between farmers, participants and health & social care providers. It combines the care of the land with the care of people, reconnecting people with nature and their communities.”

Sounds lovely, I wonder how well it works?

What can the Brits learn from the Yanks when it comes to integrated health? Jack Lord, Chief Executive Humana Europe

It is worth noticing that the advisory board of Humana Europe includes Micheal Dixon OBE, a well known advocate of alternative medicine (see
above
).  Humana Europe is a private company, a wholly owned subsidiary of Humana Inc., a health benefits company with 11 million members and 22,000 employees and headquarters in Louisville, Kentucky.  In 2005 it entered into a business partnership with Virgin Group. Humana was mentioned in the BBC Panorama programme “NHS for Sale”. The company later asked that it be pointed out that they provide commissioning services, not clinical services [Ed. well not yet anyway].

Humana’s document “Humana uses computer games to help people lead healthier lives” is decidedly bizarre.  Hang on, it was only a moment ago that we were being told that computer games rewired your brain.

Day 2 Integrated health in action

09.00 Health, epidemics and the search for new solutions. Sir Michael Marmot, Professor of Epidemiology and Public Health, Royal Free and University College Medical School

It is a mystery to me that a distinguished epidemiologist should be willing to keep such dubious company. Sadly I don’t know what he said, but judging my his publications and his appearence on Natural World, I can’t imagine he’d have much time for homeopaths.

9.25 Improving health in the workplace. Dame Carol Black, National Director, Health and Work, Department of Health

This is not the first time that Dame Carol has been comtroversial.

9.45 Integrated health in focus: defeating obesity. Professor Chris Drinkwater, President, NHS Alliance.

The NHS Alliance was mentioned above.   Enough said.

10.00 Integrated healthcare in focus: new approaches to managing asthma, eczema and allergy. Professor Stephen Holgate, Professor of Immunopharmacology, University of Southampton

10.15 Using the natural environment to increase activity. The Natural England Project: the results from year one. Dr William Bird and Ruth Tucker, Natural England.

10.30 Panel discussion

10.45 Coffee

Self help in action

11.10    Your health, your way: supporting self care through care planning and the use of personal budgets. Angela Hawley, Self Care Lead, Department of Health

11.25    NHS Life Check: providing the signposts to
integrated health. Roy Lambley, Project Director, NHS LifeCheck Programme

This programme was developed with the University of Westminster’s “Health and Well-being Network”. This group, with one exception, is separate from Westminster’s extensive alternative medicine branch (it’s mostly psychologists).

11.45    The agony and the ecstasy of helping patients to help themselves: tips for clinicians, practices and PCTs. Professor
Ruth Chambers, FIH Foundation Fellow.

11.55    Providing self help in practice: Department of Health Integrated Self Help Information Project. Simon Mills, Project Lead: Integrated Self Care in Family Practice, Culm Valley Integrated Centre for Health, Devon and Dr Sam Everington, GP, Bromley by Bow.

The Culm  Valley Integrated Centre for health is part of the College Surgery Partnership, associated with Michael Dixon OBE (yes, again!).

Simon Mills is the herbalist who says “The hot and the cold remain the trade secret of traditional medicine” .

Sam Everington, in contrast, seems to be interested in ‘integration’ in the real sense of the word, rather than quackery.

Integrated health in action


How to make sense of the evidence on complementary approaches: what works? What might work? What doesn’t work?
Dr Hugh MacPherson, Senior Research Fellow in Health Sciences, York University and Dr Catherine Zollman, Bravewell Fellow

Hugh MacPherson‘s main interest is in acupuncture and he publishes in alternative medicine journals. Since the recent analysis in the BMJ from the Nordic Cochrane Centre (Madsen et al.,  2009) it seems that  acupuncture is finally dead. Even its placebo effect is too small to be useful. Catherine Zollman is a Bristol GP who is into homeopathy as well as acupuncture.  She is closely connected with the Prince’s Foundation via the Bravewell Fellowship. That fellowship is funded by the Bravewell Collaboration, which is run by Christie Mack, wife of John Mack (‘Mack the Knife’), head of Morgan Stanley (amazingly, they still seem to have money). This is the group which, by sheer wealth, has persuaded so many otherwise respectable US universities to embrace every sort of quackery (see, for example, Integrative baloney @ Yale)

The funding of integrated services

14.15 How to get a PCT or practice- based commissioner to fund your integrated service. A PCT Chief Executive and a Practice-Based Commissioning lead.

14.30 How I succeeded: funding an integrated service. Dr John Ribchester, Whitstable

14.45 How we created an acupuncture service in St Albans and Harpenden PBC group. Mo Girach, Chief Executive, STAHCOM

Uhuh Acupunture again. Have these people never read Bausell’s
book
?  Have they not read the BMJ?  Acupuncture is now ell-established to be based on fraudulent principles, and not even to have a worthwhile placeobo effect.  STAHCOM seem to be more interested in money than in what works.

Dragon’s Den. Four pitchers lay out their stall for the commissioning dragons

And at this stage there is no prize for guessing that all four are devoted to trying to get funds for discredited treatments

  • An acupuncture service for long-term pain. Mike Cummings Chair, Medical Acupuncture Association
  • Manipulation for the treatment of back pain Simon Fielding, Founder Chairman of the General Osteopathic Council
  • Nigel Clarke, Senior Partner, Learned Lion Partners Homeopathy for long term conditions
  • Peter Fisher, Director, Royal Homeopathic Hospital

Sadly it is not stated who the dragons are. One hopes they will be more interested in evidence than the supplicants.

Mike Cummings at least doesn’t believe the nonsense about meridians and Qi. It’s a pity he doesn’t look at the real evidence though.
You can read something about him and his journal at BMJ Group promotes acupuncture: pure greed.

Osteopathy sounds a bit more respectable than the others, but in fact it has never shaken off its cult-like origins. Still many osteopaths make absurd claims to cure all sorts of diseases. Offshoots of osteopathy like ‘cranial osteopathy’ are obvious nonsense. There is no reason to think that osteopathy is any better than any other manipulative therapy and it is clear that all manipulative therapies should be grouped into one.

Osteopathy and chiropractic provide the best ever examples of the folly of giving official government recognition to a branch of alternative medicine before the evidence is in.

Learned Lion Partners is a new one on me. It seems it is
part of Madsen Gornall Ashe Chambers (‘MGA Chambers’) “a grouping of top level, independent specialists who provide a broad range of management consultancy advice to the marketing community”.  It’s a management consultant and marketing outfit.    So don’t expect too much when it comes to truth and evidence. The company web site says nothing about alternative medicine, but only that Nigel Clarke

“. . . has very wide experience of public affairs issues and campaigns, having worked with clients in many sectors in Europe, North America and the Far East. He has particular expertise in financial, competition and healthcare issues. “

However, all is revealed when we see that he is a Trustee of the Prince’s Foundation where his entry says

“Nigel Clarke is senior partner of Learned Lion Partners. He is a director of Vidapulse Ltd, Really Easy Ltd, Newscounter Ltd and Advanced Transport Systems Ltd. He has worked on the interfaces of public policy for 25 years. He has been chair of the General Osteopathic Council since May 2001, having been a lay member since it was formed. He is now a member of the Council for Healthcare Regulatory Excellence”

The Council for Healthcare Regulatory Excellence is yet another quango that ticks boxes and fails absolutely to grasp the one important point, does it work?.  I came across them at the Westminster Forum, and they seemed a pretty pathetic way to spend £2m per year.

Peter Fisher is the last supplicant to the Dragons.  He is clinical director of the Royal London Homeopathic Hospital (RLHH), and Queen’s homeopathic physician,  It was through him that I got an active interest in quackery. The TV programme QED asked me to check the statistics in a paper of his that claimed that homeopathy was good for fibrositis (there was an elementary mistake and no evidence for an effect).  Peter Fisher is also remarkable because he agreed with me that BSc degrees in homeopathy were not justified (on TV –see the movie).   And he condemned homeopaths who were caught out recommending their sugar pills for malaria.  To that extent Fisher represents the saner end of the homeopathic spectrum.  Nevertheless he still maintains that sugar pills work and have effects of their own, and tries to justify the ‘memory of water’ by making analogies with a memory stick or CD.  This is so obviously silly that no more comment is needed.

Given Fisher’s sensible condemnation of the malaria fiasco, I was rather surprised to see that he appeared on the programme of a conference at the University of Middlesex, talking about “A Strategy To Research The Potential Of Homeopathy In Pandemic Flu”.   The title of the conference was Developing Research Strategies in CAM.   A colleague, after seeing the programme, thought it was more like “a right tossers’ ball”.

Much of the homeopathy has now vanished from the RLHH as a result of greatly reduced commissioning by PCTs (read about it in Fisher’s own words). And the last homeopathy degree in the UK has closed down. It seems an odd moment for the FIH to be pushing it so hard.

Follow-up

Stop press It is reported in the Guardian (22 May 2009) that Professor Sikora has been describing his previous job at Imperial College with less than perfect accuracy. Oh dear, oh dear.

This fascinating fact seems to have been unearthed first by the admirable NHS Blog Doctor, in his post ‘Imperial College confirm that Karol Sikora does not work for them and does not speak on their behalf‘.

Notice

I heard, in January 2011, that Barts has a new Dean of Education, and no longer teaches about alternative medicine in the way that has caused so much criticism in the last two years. That’s good news.


What on earth has gone wrong at the Barts and The London School of Medicine and Dentistry (SMD)?

It is not so long ago that I discovered that the very sensible medical students at Barts were protesting vigourously about being forced to mix with various quacks.  A bit of investigation soon showed that the students were dead right: see St Bartholomew’s teaches antiscience, but students revolt.

Now it seems that these excellent students have not yet succeeded in educating their own  Dr Mark Carroll who, ironically, has the title Associate Dean (Education Quality) in the Centre for Medical Education (SMD), specialising in all aspects of quality assurance in the SMD,

Recently this letter was sent to all medical students.  They are so indignant at the way they are being treated, it didn’t take long for a copy of the letter to reach me via a plain brown email.

Does any medical student have a particular interest in Complementary Medicine?  If so, a group at Westminster University would like to contact you (see email message below) with a view to some collaborative work.  Further details from Dr Mark Carroll ( m.carroll@qmul.ac.uk ).



I am writing this email to put you in contact with **** ******, who is a Naturopathy student at Westminster University and who has set up a Society for Integrated Health, which is closely affiliated with the Society of Complementary Medicine at University College London Hospital.  **** is keen to create a network of connections between student complementary practitioners and medical students and, given Barts’ teaching commitment to integrated approaches, I wondered if you could have put **** in contact with any individual student or group of students that might be interested in joining her developing network of practitioners “crossing the divide”.  Given that Barts is “ahead of the game” I have suggested to **** that she should affiliate Barts among a number of other hospitals to her fast developing group.

Dr Mark Carroll

A student of naturopathy?  Does Mark Carroll have the slightest idea what naturopathy is (or pretends to be)?   If so, why is he promoting it? If not, he clearly hasn’t done his homework.

You can get a taste of naturopathy in Another worthless validation: the University of Wales and nutritional therapy, or in Nutritional Fairy Tales from Thames Valley University.

It is a branch of quackery that is so barmy that it’s actually banned in some US states. A pharmacist was fined $1 miilion for practising it. But Barts encourages it.

Or read here about the College of Natural Nutrition: bizarre teaching revealed. They claim to cure thyroid cancer with castor oil compresses, and a holder of their diploma was fined £800 000 for causing brain damage to a patient.

I removed the name of the hapless naturopathy student, I have no wish for her to get abusive mail.  It isn’t her fault that she has been misled by people who should know better.   If you feel angry about this sort of thing then that should be directed to the people who mislead them.  The poor student has been misled in to taking courses that teach amethysts emit high yin energy by the University of Westminster’s Vice-chancellor, Professor Geoffrey Petts,  But note that Professor Petts has recently set up a review of the teaching of what he must know to be nonsense (though it hasn’t got far yet).  In contrast, Dr Carroll appears to be quite unrepentant. He is the person you to whom you should write if you feel indignant.  

He claims Barts is "ahead of the game".  Which game? Apparently the game of leading medicine back to the dark ages and the High Street quack shop. But, Dr Carroll, it isn’t a game. Sick people are involved.

Dr Carroll is the Associate Dean (Education Quality) in the Centre for Medical Education (SMD), specialising in all aspects of quality assurance in the SMD.  This has to be the ultimate irony.  It’s true that the Prince of Wales approach to medicine has penetrated slightly into other, otherwise good, medical schools (for example, Edinburgh) but I’m not aware of any other that has gone so far down the road of irrationality as at Barts.

Dr Carroll, I suggest you listen to your students a bit more closely.

You might also listen to President Obama.  He has just allocated $1.1 billion “to compare drugs, medical devices, surgery and other ways of treating specific conditions“. This has infuriated the drug industry and far-right talk show host Rush Limbaugh. Doubtless it will infuriate quacks too, if any of it is spent on testing their treatments properly.

 

Follow-up

Jump to follow-up

It may be only post-1992 universities that run degrees in nonsense, but you can find plenty even in the highest places. Like St Bartholomew’s (founded in 1123).  That well known source of misleading medical advice, The Prince’s Foundation for Integrated Health (FiH), published last March, “Teaching integrated health at Barts and the London“. This consists of an interview with two members of staff from what is now known as the Barts and The London School of Medicine and Dentistry (SMD)..

Dr Mark Carroll BSc (Hons), PhD, FHEA is Associate Dean (Education Quality) in the Centre for Medical Education (SMD), specialising in all aspects of quality assurance in the SMD
Prof Chris Fowler BSc MA MS FRCP FRCS(Urol) FEBU is Dean of Education

They say they are dubious about alternative medicine, but rather keen on integrated medicine.  Seems odd, since the latter is really just a euphemism for the former.

After seeing the FiH posting, I wrote to Carroll and Fowler to get more information.

From Carroll 20 March

We are at an early stage in the planning process for the “Integrated Health & Wellbeing” strand in our new MBBS curriculum.  I can send you our ideas (attached).  Much will depend on whether we can make a new appointment of someone who can lead on the planning

From Fowler 25 March 2008

Our discussions with the PFIH [Prince’s Foundation for Integrated Health] have only progressed to the stage of indicating an indicative curriculum for integrated health.  We don’t have the sort of detail that you are asking for at present.  We are hoping that they will work with us to get someone to champion the development.

.  .  .

Your views would be welcome

So I sent them some views on 26 March (read them here). I also said   “I find it quite astonishing that a respectable medical school should feel it appropriate to have parts of its curriculum in the hands of the Prince of Wales.”.  It seems, though, that only one sort of view was wanted. On 27 March. Fowler wrote

“I find your insinuation unnecessary and insulting.  We have been working on a serious response to the GMC’s requirement that we teach medical students about the range of options available to patients. It is fatuous to suggest that the Prince of Wales is personally involved in any practical sense.  The Prince’s Foundation for Integrated Health is an important stakeholder and I think that it entirely reasonable both to talk to them and to seek funding to help us to develop an area that is deficient in our current provision.”

Uhuh, not a very nice response to a rather moderate letter.  Lesson 1: never trust anyone who uses the word “stakeholder”.

It does seem very odd that a medical school like Barts should turn to the Prince of Wales’ Foundation for advice on medicine.  After all, the bad advice given by the “Patients Guide” is rather well documented (see also here). If messrs Fowler and Carroll were really unaware of that, I’d argue that they aren’t doing their job properly.

It seems that Barts, like Edinburgh, has over-reacted to pressure from the General Medical Council (GMC).  Actually all that the GMC require is that

“They must be aware that many patients are interested in and choose to use a range of alternative and complementary therapies. Graduates must be aware of the existence and range of such therapies, why some patients use them, and how these might affect other types of treatment that patients are receiving.” (from Tomorrow’s Doctors, GMC)

There is nothing there about saying that they work.  Certainly medical students need to be familiar with alternative medicine, given the number of theit patients that use it. That is a job I have done myself, both at UCL and at Kings College London. I’d argue that I am marginally better qualified to assess the evidence than the Prince of Wales.

Oddly enough, the bad education in Edinburgh came also from a Professor of Medical Education and Director of Undergraduate Learning and Teaching,

The result is manifested in two ways.  Barts has a “Science in Medicine” course that has resulted in medical students being placed with homeopaths.  And it has a Special Studies Module in Ayurvedic Medicine.  Let’s take a look at them.

An Introduction to Ayurvedic Medicine

The aims of this Special Study Module are “To introduce the concepts and principles which underpin Ayurvedic medicine. To introduce Year 1 and 2 medical students to the Ayurvedic approach to patient assessment, diagnosis and treatment”, and to “Critically evaluate the evidence base for Ayurvedic treatments and yoga therapy”. Just one small snag there. There is next to no evidence base to be assessed.
Click to enlarge

The module is given by Professor Shrikala Warrier, who is Dean of MAYUR: The Ayurvedic University of Europe. That sounds quite grand.  But the web site of The Ayurvedic University of Europe is rather unusual for a university. It lists two courses but has no list of staff. Could it be that Professor Shrikala Warrier is the staff? Neither is it clear where Professor Warrier’s professorial title comes from. Her own private university perhaps?

The two courses it offers are B.Sc.(Hons) Ayurveda and B.Sc.(Hons) Yoga.  It says that the course the “BA(Hons)Ayurvedic Studies is a three year programme of study developed in collaboration with Thames Valley University in London”. That’s odd too, because there is no mention of it on the Thames Valley University web site (and TVU is not in London, it’s in Slough). Elsewhere it is stated that the “programme has been validated by MAHE, which is also the degree awarding body”. MAHE is not explained but it appears to refer to the Manipal Academy of Higher Education,  in Goa, India. That looks like a pretty good place. It does not offer degrees in Ayurveda, though there is a small Department of Ayurvedic medicine within the otherwise entirely conventional Kasturba Medical College-Manipal. Their first year physiology exam would tax our students.

Elsewhere we see the same address, 81 Wimpole Street, listed as The Manipal Ayurvedic University of Europe (a joint venture between The Manipal University and the Ayurvedic Company of Great Britain) Prof. S. Warrier, B.A.(Hons), M.A., Ph.D., MILT, Dean of Academic Planning.

If one checks Mayur Ltd at Companies House, one finds that it has two directors, Lady Sarah Morritt and Professor Shrikala Warrier. The company report shows that no accounts have been filed up to now and their 2008 accounts are overdue.

The business history of ayurveda is nothing if not tortuous.  The London Gazette (May 2008) notifies us that

AYURVEDA HOLDINGS LIMITED (chairman Lady Sarah Morritt) was passed a Special Resolution: “That the company be wound up voluntarily.”

If you email the Ayurvedic University of Europe, the reply comes not from a University address but from unififiedherbal.com. That seems to be some sort of marketing company, at the same address, 81 Wimpole Street. But efforts to find out more about it from Companies House show that UnifiedHerbal.com was dissolved on 3 October 2006.

Several of the links are broken on the web site of Ayurvedic University of Europe, but one that does work is ‘products’. That takes you to the sales pages of http://www.drwarrier.co.uk/.  That doesn’t look much like a university, but no prizes for guessing the address.  Yes, it’s 81 Wimpole Street again. They will sell you all sorts of cosmetics, though Companies House lists Dr Warrier Limited, and tells us

Last Accounts Made Up To : 31/08/2007 (DORMANT) and

Next Return Due : 26/09/2008 OVERDUE.  Their registered office is
at Harold House, Waltham Cross EN8 7AF.

From drwarrier.co.uk you can buy, for example,

Triphala

The most commonly prescribed Ayurvedic formula. Triphala is an effective blood purifier that detoxifies the liver, helps digestion and assimilation, and reduces serum cholesterol and lipid levels.

Blood purifier? Detox? Where have we seen this sort of utter gobbledygook before? Or perhaps she can sell you some

Guggul (Commiphora
mukul)

Traditionally used for obesity and overweight, and reducing and preventing accumulation of cholesterol (LDL). Its anti-inflammatory and detoxifying actions help reduce arthritic pain and swelling.

There isn’t the slightest evidence for these effects in man. Hence, no doubt, the usual weasel words. “traditionally used for . . . ”

The sales department alone casts rather a large doubt on Prof Warrier’s ability to teach medical students how to “critically evaluate the evidence base for Ayurvedic treatments”.

It does seem a bit surprising that a top flight medical school should think that this is an appropriate place to educate its students.

Medicine in Society

The syllabus at Barts includes something called Medicine and Society. Page 5 of the second year Tutor Guide mentions “complementary therapies” as part of the course. There is little hint about what that means in practice.

It turns out that the alt med placements are at the Greenwich Natural Health Centre. Nothing is too barmy for them Acupuncture. Cranial Osteopathy, Craniosacral Therapy, Herbal Therapy, Homeopathy, Hot Stone Therapy and Nutritional therapy to name but a few of the preposterous make-believe stuff that is on offer.

Medical students are having to spend their time listing to stuff like this, on ‘hot stone therapy’.

“Hot stone therapy / massage is a kind of massage that uses treated volcanic rocks such as basalt and basinite that are believed to promote relaxation as well as eliminating negative energy within the client’s body, mind and soul.”

“These stones are carefully gathered and handcrafted for various sizes, shapes and weights according to what part of the body it will be use on.”

Or this, on ‘nutritional therapy’.

“Many of us lack the basic raw materials (from food and drink) to function at our best. Intensive farming, pollution, stress, stimulants and an over-reliance on processed foods are just some of the reasons for us being deficient in vital nutrients. As a result, we may develop serious degenerative diseases like cancer or arthritis.”

“Some clients may experience reactions like headaches, skin eruptions or bad breath during the first stage of treatment. These are quite normal and are due to detoxification, which is usually followed by a sense of well-being and increased energy.”

That must be about as close as you can get to claiming you can prevent cancer by taking vitamin pills. It is wrong and it is dangerous,

Sigh. What century are we living in?

According to Barts’ second year Tutor Guide, “Placement tutors are responsible for student assessment”.

What sort of grade will the student get if they tell their tutor in homeopathy or ‘Nutritional therapy’ that they are talking nonsense?

What do the students think?

Could the Ayurvedic course be the very same course that is referred to by a second year medical student on the Unprotected Text blog?

“When I found out my friend had been attached to a “doctor” in Ayurvedic “medicine” for the year I was horrified, as was she, and the school would not allow her to change claiming that the point is not to learn the medicine but its role in the multidisciplinary healthcare team.

I don’t believe that there is such a role.

The very fact that a student is forced to put up with this as a part of their education is appalling.”

A comment left on Unprotected Text by someone writing as ‘Barts Medic’ said

“I was HORRIFIED to hear that some of my friends have their medsoc placements
at such RUBBISH places too!

last week, they were forced into a room one by room to be touched up (‘massaged’)
by the ‘doctor-person’ to HEAL them. she rubbed them all over, and CHANTED! WTF.

if i was given a CRAPPY placement like that, i wouldnt turn up either”.

And there is an excellent statement about “holistic medicine” on Unprotected Text. Better, perhaps, than you’d get from the GMC.

“Holistic medicine is in fact a world away from homeopathy, although the two are often confused predominantly by homeopaths trying to validate their branch of “medicine”. Much of what is taught in medical school is in fact, holistic, and so it should be. The importance of mentality, or spirituality in medicine should not be used to excuse homeopathy.”

“That doesn’t seem to add up” is another blog that relates the experiences of another student who has been exposed to “Enforced quackery Day 1, “, “Enforced quackery Day 2“, “Enforced quackery Days 3 and 4“. He says

“. . .by the end of day 3 the students *still* hadn’t seen any patients and that, when confronted with this fact the person in charge is reported to have said that this was because she was scared of what the students might say to the patients… Apart from this being a massive insult to the professionalism of the students, it is at least an encouraging sign that they have not been very effectively indoctrinated.”

It seems that we shall soon have some more documentary evidence.  It is truly impressive to find that Barts’ medical students are so bright and that they have the courage to speak up about it.

So there is one good thing. We have some very perspicacious medical students in London.

Pity that one can’t say the same thing of their teachers.

Follow-up

I have it on good authority that the unhappy students who were placed at the Greenwich Natural Health Centre were presented with one of the more absurd documents ever to be produced by homeopaths, “An Overview of positive homeopathy research and surveys“.

There is no need to argue about whether homeopaths cherry-pick the evidence.  The selective use of evidence is announced proudly, right there in the title.

What excuse can Bart’s have for exposing medical students to such profoundly anti-educational stuff as this?

Later there appeared on the That doesn’t seem to add up blog, Enforced
Quackery – the literature
. The unfortunate students who were pushed into a homeopathic placement were give a print out of a page from Sue Young’s homeopathic web site.  It is merely a bit of phony history that attempts to link Pasteur with homeopathy.

Sue Young, incidentally, is a homeopath who has consistently breached the Code of Ethicsof the Society of Homeopaths by claiming to treat serious diseases, though needless to say the Society did nothing about it.  She is also the person who wrote a wholly inaccurate account of the reasons why my blog left the UCL server (see alse here and here). She didn’t, needless to say, ask me, but luckily she was soon corrected on quackometer and in the Guardian.

Incidentally, the Unprotected Text blog continues to provide a fascinating student view on medical education.  Students show more sense than their teachers not only about alternative nonsense but also about other gimmicks like ‘problem based learning’.

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