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trust – DC's Improbable Science

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We have often had cause to criticise Boots Alliance, the biggest retail pharmacist in the UK, because of its deeply unethical approach to junk medicine. Click here to read the shameful litany. The problem of Boots was raised recently also by Edzard Ernst at the Hay Literary Festival. He said

“The population at large trusts Boots more than any other pharmacy, but when you look behind the smokescreen, when it comes to alternative medicines, that trust is not justified.”

Ernst accused Boots of breaching ethical guidelines drawn up by the Royal Pharmaceutical Society of Great Britain, by failing to tell customers that its homeopathic medicines contain no active ingredients and are ineffective in clinical trials.

Another chain, Lloyds Pharmacy, are just as bad. Many smaller pharmacies are no more honest when it comes to selling medicines that are known to be ineffective.

Pharmacists are fond of referring to themselves as “professionals” who are regulated by a professional body, the Royal Pharmaceutical Society of Great Britain (RPSGB). It’s natural to ask where their regulatory body stands on the question of junk medicine. So I asked them, and this is what I found.

17 April, 2008

I am writing an article about the role of pharmacists in giving advice about (a) alternative medicines and (b) nutritional supplements.

I can find no clear statements about these topics on the RPSGB web site.

Please can you give me a statement on the position of the Royal Pharmaceutical Society on these two topics.

In particular, have you offered guidance to pharmacists about how to deal with the conflict of interest that arises when they can make money by selling something that they know to have no good evidence for efficacy? This question has had some publicity recently in connection with Boots’ promotion of CCoQ10 to give you “energy”, and only yesterday when the bad effects of some nutritional supplements were in the news.

Here are some extracts from the first reply that I got from the RPSGB’s Legal and Ethical Advisory Service (emphasis is mine).

28 April 2008

Pharmacists must comply with the Code of Ethics and its supporting documents. Principle 5 of the Code of Ethics requires pharmacists to develop their professional knowledge and competence whilst Principle 6 requires pharmacists to be honest and trustworthy.

The Code states:

5. DEVELOP YOUR PROFESSIONAL KNOWLEDGE AND COMPETENCE

At all stages of your professional working life you must ensure that your knowledge, skills and performance are of a high quality, up to date and relevant to your field of practice. You must:

5.1 Maintain and improve the quality of your work by keeping your knowledge and skills up to date, evidence-based and relevant to your role and responsibilities.

5.2 Apply your knowledge and skills appropriately to your professional responsibilities.

5.3 Recognise the limits of your professional competence; practise only in those areas in which you are competent to do so and refer to others where necessary.

5.4 Undertake and maintain up-to-date evidence of continuing professional development relevant to your field of practice.

6. BE HONEST AND TRUSTWORTHY

Patients, colleagues and the public at large place their trust in you as a pharmacy professional. You must behave in a way that justifies this trust and maintains the reputation of your profession. You must:
6.1 Uphold public trust and confidence in your profession by acting with honesty and integrity.

6.2 Ensure you do not abuse your professional position or exploit the vulnerability or lack of knowledge of others.

6.3 Avoid conflicts of interest and declare any personal or professional interests to those who may be affected. Do not ask for or accept gifts, inducements, hospitality or referrals that may affect, or be perceived to affect, your professional judgement.

6.4 Be accurate and impartial when teaching others and when providing or publishing information to ensure that you do not mislead others or make claims that cannot be justified.

And, on over-the counter prescribing

In addition the “Professional Standards and Guidance for the Sale and Supply of Medicines” document which supports the Code of Ethics states:

“2. SUPPLY OF OVER THE COUNTER (OTC) MEDICINES

STANDARDS

When purchasing medicines from pharmacies patients expect to be provided with high quality, relevant information in a manner they can easily understand. You must ensure that:

2.1 procedures for sales of OTC medicines enable intervention and professional advice to be given whenever this can assist the safe and effective use of medicines. Pharmacy medicines must not be accessible to the public by self-selection.

Evidence-based? Accurate and impartial? High quality information? Effective use?

These words don’t seem to accord with Boots’ mendacious advertisements for CoQ10 (which were condemned by the ASA).

Neither does it accord with the appalling advice that I got from a Boots pharmacist about Vitamin B for vitality.

Or their bad advice on childhood diarrhoea.

Or the unspeakable nonsense of the Boots (mis)-education web site.

Then we get to the nub. This is what I was told by the RPSGB about alternative medicine (the emphasis is mine).

8. COMPLEMENTARY THERAPIES AND MEDICINES

STANDARDS

You must ensure that you are competent in any area in which you offer advice on treatment or medicines. If you sell or supply homoeopathic or herbal medicines, or other complementary therapies, you must:

8.1 assist patients in making informed decisions by providing them with necessary and relevant information.

8.2 ensure any stock is obtained from a reputable source.

8.3 recommend a remedy only where you can be satisfied of its safety and quality, taking into account the Medicines and Healthcare products Regulatory Agency registration schemes for homoeopathic and herbal remedies.”

Therefore pharmacists are required to keep their knowledge and skills up to date and provide accurate and impartial information to ensure that you do not mislead others or make claims that cannot be justified.

It does seem very odd that “accurate and impartial information” about homeopathic pills does not include mentioning that they contain no trace of the ingredient on the label. and have been shown in clinical trials to be ineffective. These rather important bits of information are missing from both advertisements and from (in my experience) the advice given by pharmacists in the shop.

If you look carefully, though, the wording is a bit sneaky. Referring to over-the-counter medicines, the code refers to “safe and effective use of medicines”, but when it comes to alternative medicines, all mention of ‘effectiveness’ has mysteriously vanished.

So I wrote again to get clarification.

29 April, 2008

Thanks for that information. I’d appreciate clarification of two matters in what you sent.

(1) Apropros of complementary and alternative medicine, the code says

8.3 recommend a remedy only where you can be satisfied of its safety and quality

I notice that this paragraph mentions safety and quality but does not mention efficacy. Does this mean that it is considered ethical to recommend a medicine when there is no evidence of its efficacy? Apparently it does. This gets to the heart of my question and I’d appreciate a clear answer.

This enquiry was followed by a long silence. Despite several reminders by email and by telephone nothing happened until eventually got a phone call over a month later (May 3) from David Pruce, Director of Practice & Quality Improvement, Royal Pharmaceutical Society of Great Britain. The question may be simple, but the RPSGB evidently it hard, or more likely embarrassing, to answer.

When I asked Pruce why para 8.3 does not mention effectiveness, his reply, after some circumlocution, was as follows.

Pruce: “You must assist patients in making informed decisions by providing necessary and relevant information . . . we would apply this to any medicine, the pharmacist needs to help the patient assess the risks and benefits.”

DC: “and would that include saying it doesn’t work better than placebo?”

Pruce “if there is good evidence to show that it ???????? ????? ????????may, but it depends on what the evidence is, what the level of evidence is, and the pharmacist’s assessment of the evidence”

DC “What’s your assessment of the evidence?”

Pruce, “I don’t think my personal assessment is relevant. I wouldn’t want to be drawn on my personal assessment”. “If a pharmacist is selling homeopathic medicines they have to assist the patient in making informed decisions”

“I don’t think we specifically talk about the efficacy of any other medicine” [DC: not true, see para 2.1, above]

We would expect pharmacists to be making sure that what they are providing to a patient is safe and efficacious

DC “So why doesn’t it mention efficacious in para 8.3”

Pruce “What we are trying to do with the Code of Ethics is not go down to the nth degree of detail ” . . . “there are large areas of medicine where there is an absence of data”

DC “Yes, actually homeopathy isn’t one of them. It used to be.”

Pruce. “uh, that’s again a debatable point”

DC I don’t think it’s debatable at all, if you’ve read the literature

Pruce. “well many people would debate that point” “This [homeopathy] is a controversial area where opinions are divided on it”

DC “Not informed opinions”

Pruce “Well . . . there are also a large number of people that do believe in it. We haven’t come out with a categorical statement either way.”

I came away from this deeply unsatisfactory conversation with a strong impression that the RPSGB’s Director of Practice & Quality Improvement was either not familiar with the evidence, or had been told not to say anything about it, in the absence of any official statement about alternative medicine.

I do hope that the RPSGB does not really believe that “there are also a large number of people that do believe in it” constitutes any sort of evidence.

It is high time that the RPSGB followed its own code of ethics and required, as it does for over-the-counter sales, that accurate advice should be given about “the safe and effective use of medicines”.

“The scientist on the High Street”

The RPS publishes a series of factsheets for their “Scientist in the High Street” campaign. One of these “factsheets” concerns homeopathy, [download pdf from the RPSGB]. Perhaps we can get an answer there?

Well not much. For the most part the “factsheet” just mouths the vacuous gobbledygook of homeopaths. It does recover a bit towards the end, when it says

“The methodologically “best” trials showed no effect greater than that of placebo”.

But there is no hint that this means pharmacists should not be selling homeopathic pills to sick people..

That is perhaps not surprising, because the Science Committee of the RPSGB copped out of their responsibility by getting the factsheet written by a Glasgow veterinary homeopath, Steven Kayne. You can judge his critical attitude by a paper (Isbell & Kayne, 1997) which asks whether the idea that shaking a solution increases its potency. The paper is a masterpiece of prevarication, it quotes only homeopaths and fails to come to the obvious conclusion. And it is the same Steven Kayne who wrote in Health and Homeopathy (2001)

“Homeopathy is not very good for treating bacterial infections directly, apart from cystitis that often responds to a number of medicines, including Berberis or Cantharis”.

So there is a bacterial infection that can be cured by pills that contain no medicine? Is this dangerous nonsense what the RPSGB really believes?

More unreliable advice

While waiting for the train to Cardiff on April 16th (to give a seminar at the Welsh School of Pharmacy), I amused myself by dropping into the Boots store on Paddington station.

DC I’ve seen your advertisements for CoQ10. Can you tell me more? Will they really make me more energetic?

Boots: Yes they will, but you may have to take them for several weeks.

DC. Several weeks? Boots: yes the effect develops only slowly

Peers at the label and reads it out to me

DC I see. Can you tell me whether there have been any trials that show it works?

Boots. I don’t know. I’d have to ask. But there must be or they wouldn’t be allowed to sell it.

DC. Actually there are no trials, you know

Boots. Really? I didn’t think that was allowed. But people have told me that they feel better after taking it.

DC You are a pharmacist?

Boots. Yes

Sadly, this abysmal performance is only too typical in my experience, Try it yourself.

The malaria question

After it was revealed that pharmacists were recommending, or tolerating recommendations, of homeopathic treatment of malaria, the RPSGB did, at last. speak out. It was this episode that caused Quackometer to write his now famous piece on ‘The gentle art of homeopathic killing‘ (it shot to fame when the Society of Homeopaths tried to take legal action to ban it) Recommending pills that contain no medicine for the treatment or prevention or treatment of malaria is dangerous. If it is not criminal it ought to be [watch the Neals Yard video]. .

The RPSGB says it is investigating the role of pharmacists in the Newsnight sting (see the follow-up here). That was in July 2006, but they are stlll unwilling to say if any action will be taken. Anyone want to bet that it will be swept under the carpet?

The statement issued by the RPSGB, 5 months after the malaria sting is just about the only example that I can find of them speaking out against dangerous and fraudulent homeopathic practices. Even in this case, it is pretty mild and restricted narrowly to malaria prevention.

The RPSGB and the Quacktioner Royal

The RPSGB submitted a response to the ‘consultation’ held by the Prince’s Foundation for Integrated Health, about their Complementary Healthcare; a guide for patients.

Response by the Royal Pharmaceutical Society of Great Britain
Dr John Clements, Science Secretary

“We believe that more emphasis should be given to the need for members of the public who are purchasing products (as opposed to services) to ask for advice about the product. Pharmacists are trained as experts on medicines and the public, when making purchases in pharmacies, would expect to seek advice from pharmacists”

So plenty of puffery for the role of pharmacists. But there is not a word of criticism about the many barmy treatments that are included in the “Guide for Patients”. Not just homeopathy and herbalism, but also Craniosacral therapy, Laying on of Hands, chiropractic, Reiki, Shiatsu –every form of barminess under the sun drew no comment from the RPS.

I can’t see how a response like this is consistent with the RPS’s own code of ethics.

A recent president of the RPSGB was a homeopath

Christine Glover provides perhaps the most dramatic reason of all for thinking thst, despite all the fine words, the RPSGB cares little for evidence and truth The NHS Blogdoctor published “Letter from an angry pharmacist”.

Mrs Glover was president of the RPSGB from 1999 to 2001, vice-president in 1997-98, and a member of the RPSGB Council until May 2005. She is not just a member, but a Fellow. (Oddly, her own web site says President from 1998 – 2001.)

So it is relevant to ask how the RPSGB’s own ex-president obeys their code of ethics. Here are some examples on how Ms Glover helps to assist the safe and effective use of medicines. . Much of her own web site seems to have vanished (I wonder why) so I’ll have to quote the “Letter from an angry pharmacist”., as revealed by NHS Blogdoctor,

“What has Christine got to offer?

  • “We offer a wide range of Homeopathic remedies (over 3000 different remedies and potencies) as well as Bach flower remedies, Vitamins, Supplements, some herbal products and Essential Oils.”
  • Jetlag Tablets highly recommended in ‘Wanderlust’ travel magazine. Suitable for all ages.
  • Wind Remedy useful for wind particularly in babies. In can be supplied in powder form for very small babies. Granules or as liquid potency.
  • Udder Care 100ml £80.00 One capful in sprayer filled with water. Two jets to be squirted on inner vulva twice daily for up to 4 days until clots reduced. Discard remainder. Same dose for high cell-counting cows detected.

Udder Care? Oh! I forgot to say, “Glover’s Integrated Healthcare” does cows as well as people. Dr Crippen would not suggest to a woman with sore breasts that she sprayed something on her inner vulva. But women are women and cows are cows and Dr Crippen is not an expert on bovine anatomy and physiology. But, were he a farmer, he would need some persuasion to spend £80.00 on 100 mls of a liquid to squirt on a cow’s vulva. Sorry, inner vulva.”

Nothing shows more clearly that the RPSGB will tolerate almost any quackery than the fact that they think Glover is an appropriate person to be president. Every item on the quotation above seems to me to be in flagrant breach of the RPSGB’s Code of Ethics. Just like the Society of Homeopaths, the code seems to be there merely for show, at least in the case of advice about junk medicine..

A greater role for pharmacists?

This problem has become more important now that the government proposes to give pharmacists a greater role in prescribing. Needless to say the RPSGB is gloating about their proposed new role. Other people are much less sure it is anything but a money–saving gimmick and crypto-privatisation.

I have known pharmacists who have a detailed knowledge of the actions of drugs, and I have met many more who haven’t. The main objection, though, is that pharmacists have a direct financial interest in their prescribing. Conflicts of interest are already rife in medicine, and we can’t afford them.

Conclusion

The Royal Pharmaceutical Society is desperately evasive about a matter that is central to their very existence, giving good advice to patients about which medicines work and which don’t. Pharmacists should be in the front line in education of the public, about medicines, the ‘scientist on the High Street’. Some of them are, but their professional organisation is letting them down badly.

Until such time as the RPSGB decides to take notice of evidence, and clears up some of the things described here, it is hard to see how they can earn the respect of pharmacists, or of anyone else.

Follow-up

Stavros Isaiadis’ blog, Burning Mind, has done a good piece on “More on Quack Medicine in High Street Shops“.

The Chemist and Druggist reports that the RPSGB is worried about the marketing of placebo pills (‘obecalp’ -geddit?). It does seem very odd that the RPSGB should condemn honest placebos, but be so very tolerant about dishonest placebos. You couldn’t make it up.

A complaint to the RPSGB is rejected

Just to see what happened, I made a complaint to thr RPSGB about branches of their own Code of Ethics at Boots in Hexham and in Evesham. Both of them supported Homeopathy Awareness Week These events had been publicised in those particularly unpleasent local ‘newspapers’ that carry paid advertising disguised as editorial material. In this case it was the Evesham Journal and the Hexham Courant.

Guess what? The RPSGB replied thus

“Your complaint has been reviewed bt Mrs Jill Williams and Mr David Slater who are both Regional Lead Inspectors. Having carried out a review they have concluded that support of homeopathic awareness week does not constitute a breach of the Society’s Code of Ethics or Professional Standards.”

In case you have forgotten, the Professional Standards say

2.1 procedures for sales of OTC medicines enable intervention and professional advice to be given whenever this can assist the safe and effective use of medicines.

The RPSGB has some very quaint ideas on how to interpret their own code of ethics

This blog, along with many others, has had plenty to say about the Prince of Wales’ unconstitutional meddling in public affairs. The lovely description, Quacktitioner Royal, was coined by NHS Blog doctor.

The Times published a letter from Edzard Ernst and Simon Singh on April 16th. In their forthcoming book, Trick or Treatment? Alternative Medicine on Trial, they go carefully through all the evidence for all sorts of ‘alternative’ treatments. They find some evidence that a handful of them work. For most the answer is ‘not enough evidence’, and for a number there is good evidence that many of them don’t work to any useful extent.

“Sir, For over two decades the Prince of Wales has been actively promoting alternative medicine and his Foundation for Integrated Health continues to encourage the use of treatments such as homoeopathy or reflexology.””In light of this “rigorous scientific evidence”, we strongly advise that the Prince of Wales and the Foundation for Integrated Health withdraw the publications Complementary Health Care: A Guide for Patients and the Smallwood report. They both contain numerous misleading and inaccurate claims concerning the supposed benefits of alternative medicine. The nation cannot be served by promoting ineffective and sometimes dangerous alternative treatments.”

Thank heavens that someone has the courage to say it as it is.

If only the ineffectual and ill-educated people in the Department of Health wouold do the same. But no, instead they gave £37 000 to the Prince of Wales Foundation to write their make-believe guides. And £900 000 to write nonsense for the Complementary and Natural Healthcare Council (also known as Ofquack), and Skills for Health,

The next day The Times ran an article by their science editor, Mark Henderson, Prince of Wales’s guide to alternative medicine ‘inaccurate’. Natasha Finlayson, of the Prince’s Foundation for Integrated Health, is quoted as saying “The foundation does not promote complementary therapies.”. That takes some beating for sheer bare-faced dishonesty.

Edzard Ernst appeared on the Today Program on 18th April. He was interveiwed by the formidable John Humphrys, along with Kim Lavely, Chief Executive, The Prince’s Foundation for Integrated Health (FIH). Ernst points out that the FIH guide suggests that chiropractic is effective in asthma, and that acupuncture is good for addiction, whereas the evidence says the opposite. Lavely retorts, rather lamely (OK I’m biassed).

Lavely: ” . . . we didn’t attempt to give detailed evidence on every therapy”. “We think they [the public] have the right to know and what doesn’t”

Humphrys: “Well isn’t that the whole point? the professor is saying here is that these things do not work, at least in terms of the claims that are made for them, such as homeopathy and chiropractic . . . ”


Lavely: “There are no claims made in this guide for what works and what doesn’t. What we have said is that some therapies are used for some things but we aren’t saying they are effective for those things . . . “

So, one might ask, what on earth is the use of a guide is it that offers no indication of effectiveness? Lavely’s second quotation contradicts directly her first. A pretty pathetic performance.
Listen to the interview [mp3 file]


The Sunday Times, on April 20th, pblished a pretty good review of Trick of Treatment?. “Their case against the folly, vanity and damage of HRH et al. is hard to argue with.”

Of course, the letters column drew the expected response from the quacks, most verging on the hilarious.

Another blow for the alternative industry came in the same week, The authoratitve Cochrane review confirmed earlier reports that vitamin supplements not only do not help you but some actually increase mortality. The antioxidant myth nevertheless rumbles on, and on, and on. There is too much money in it for it to die easily.

Predictably enough, the conclusions were denied by the Health Food Manufacturers’ Association (HFMA). They wheeled out several pop singers to say how wonderful their products are. Read about that pathetic defence on Holfordwatch.

Who is behind HFMA? Incidentally, HFMA are strangely reticent about the identity of their 120 members. They will not reveal who they are. Does anybody out there know the answer? I’ll buy a good dinner for anyone who can root this out.  If it is anything like the ‘Health Supplements Information Service‘ it is likely to be backedby the very big pharmaceutical companies that the alternative industry loves to hate.

Take the test

Prince of Wales Guide

“Reflexologists work with a wide range of conditions including certain types of pain, particularly back and neck pain, migraine and headaches, chronic fatigue, sinusitis, arthritis, insomnia, digestive problems such as irritable bowel syndrome, and constipation, stress-related disorders and menopausal symptoms.”

Singh & Ernst

“The notion that reflexology can be used to diagnose health problems has been disproved and there is no convincing evidence that it is effective for any condition.”

The Times Higher Education Supplement (THES) last week had a headline “Staff loyalty key to Hefce report”.

Staff loyalty is something I’m interested in, so I read on eagerly.

The article was about report from the Higher Education Funding Council for England (HEFCE). It came from their Leadership, Governance and Management Strategic Advisory Committee (dated 2-3 July 2007). [Download the report: Word format]

Well there is the first cringe already. Whenever you see the word ‘leadership’ you can bet that it means that you are going to be lectured on how to do your job by somebody who has never done it themselves. (probably somebody suffering from Siegfried delusions -in the words of Ernest Newman. an overgrown boy scout).

No disappointment on that score. This particular sermon is being delivered not by a successful researcher. Not even by an unsuccessful researcher who has been moved up to manage the successful ones. It is being given by Ed Smith, Global Chief Operating Officer and Strategy Leader for Assurance, PricewaterhouseCoopers.

PricewaterhouseCoopers, remember, has not been entirely free of accounting scandals (and BBC report).

Their web site says of Ed Smith:

“He is a leading advocate of, and external speaker on People management in organisations, in particular diversity and work/life having led PwC’s own enlightenment in this area “

“PwC’s own enlightenment” ? Cringe!. Who writes this stuff, one wonders,


Here are the main points.

“3. There are high level activities to be undertaken of reconceptualising the university and rethinking the business model.”

Reconceptualise? Is it a condition of essential condition of working for PricewaterhouseCoopers to be unable to write plain English?

More to the point, one would be interested to know what concept of a university he has in mind? The statement as it stands has roughly zero content.

“4. To implement the outcome of this rethinking, there will need to be significant culture change. HEIs’ staff will need to be more aware of and aligned to the strategic needs of the HEI.

Academics’ goals are often related to their discipline rather than their institution and they will need to develop institutional loyalties in addition to discipline loyalties. Corporate planning processes will need to be communicated more effectively for those processes to be more successful. “

This statement fails to make the important distinction between the Institution itself, and the people who, for the time being, are running it (see Letters). The first thought that comes to mind after reading this is that it is a statement that is likely to have exactly the opposite effect from that intended by the writer. The more statements like this that come from on high, the less inclined people are to feel allegiance to the institution that issues them, or, to be more precise, the people who are running the institution for the time being.


Respect has to be earned.

“5. HE staff can find themselves uncertain about their role, typically
because it has never been fully made clear. Research has often become too prominent as an indicator of performance, because it has been measured in the RAE, and other activity has not been equally recognised and rewarded. “

Aha, now does that mean that our role is not to do research and teaching after all? Perhaps it has now been redefined somehow? Perhaps our role now is to waste time on sham consultations, read reams of world-class policy bollocks, and do what one is told by some official in HR? I don’t think so. The second sentence has some justice, but I guess Mr Smith has not had to suffer floods of contradictory instructions from the endlessly-multiplying ‘managers’.

One day a ‘manager’ says we must all publish three papers a year, and they must all be in the same handful of journals (though there has not, as far as I know, been
the sort of crude bullying about this at UCL that I have heard about in, say Imperial and a few other places). Furthermore we mustn’t collaborate with anyone in the same place because the same paper must not appear to the RAE to come from two groups.


The next day we will be told that the entire place must be turned upside down because of the absolute necessity for collaborations. Of course the measures that are proposed never have the slightest effect on collaboration, because they come from people who talk about it, not from people who do it.


And the next day we are told by a third person that all of the above is secondary and that teaching matters more than anything else.


Of course all these contradictory instructions do nothing but prevent us doing the research and teaching that we had supposed to be our job.

“7. HEIs will need to develop their business process and become more efficient, so that they can re-invest. The Committee advises that HEIs should not be afraid of the language and culture of business. “


The language of business, at least of the sort that now permeates universities, is usually both vacuous and pretentious. The culture of business is what produces BSc degrees in anti-science (not to mention accounting scandals).


The use of the word “afraid” in this context is sheer overweening arrogance. I have spent a lifetime trying to express complicated ideas in simple language. That seems to me to be as desirable in real science as it is in my attempts to improve public understanding of science. The aim of managers seems often to be to express
simple ideas in complicated language. I’m never quite sure whether the reason for this is illiteracy. or a conscious effort to disguise the emptiness of the ideas. A bit of both, I expect.


What do we conclude from this?

The interesting thing about this document is that it is written by a businessman but appears to me to ignore two basic business principles that can be put in perfectly simple language.

(1) Supply and demand. There will always be an endless supply of managers and pensioned-off researchers who are willing to accept professorial salaries for producing reams of policy bollocks. There isn’t even much shortage of people who can do a tolerable job of teaching at least at first or second year level. The really scarce people are the top flight original researchers, the ones who will make a difference to the future. It follows that these people have enormous power (though often they are too busy to use it). If the place that they works adopts the culture of managerialism, they will just leave Highly original minds have a low tolerance for policy bollocks. Of course this is a slow process. It might take a decade or more to destroy a good research outfit in this way, and by the time managers notice the consequences of their actions it would already be too late. It is much easier to destroy than to build.


(2) The value of brand names . This is where it gets personal, though I imagine many other people have had similar experiences in recent years. The Pharmacology Department at UCL has had a distinguished history for 100 years. I can’t count the number of times that I’ve been at meetings and heard people say “gosh you are from Pharmacology at UCL -that’s impressive”. People in the department got a glow from comments like that. That is what generated loyalty to the department and to the College that houses it. Now we are told that we are to be part of an over sized monstrosity called the “Research department of Neuroscience, Physiology and Pharmacology”. That really trips off the tongue, right? One can’t imagine something with an utterly unmemorable name like that ever getting an international reputation. In any case, I expect that another policy wonk will come along and change the name again in 5 year’s time,

How does this sort of vandalism happen? I guess one reason is that the sort of people who get to be managers just aren’t sufficiently in contact with science to be aware of the reputation that we used to have. They seem to be unaware that the reputation of an institution is no more than the sum of the reputations of the researchers and teachers who work in it (not the administrators). And if a department has a few good people in it over a long period, the department as a whole contributes too. The College reputation barely exists in isolation, just the sume of individuals. Take an example. At UCL we have an excellent department of German, a department that contributes to the reputation of UCL. But of course not one pharmacologist in a million has heard of it, just as I imagine not one German historian in a million has heard of our (late) pharmacology department.

Let’s get a few things clear.

  • The job of universities is to do teaching and research.
  • The teaching is enormously important but the external reputation of the establishment will inevitably depend almost entirely on its research.
  • The success of the place therefore depends entirely on the people who do the research and teaching. Everybody else, from junior technician to vice chancellor is there only to support them.
  • The people who do the research and teaching are the only ones who know how to make a success of those jobs The HR department, for example, know nothing about either either teaching or research. How could they? They have never done either. Their job is to make sure people get paid, not to bully and harass the people doing the real work of the university.
  • The aims of business are, in some ways, precisely the opposite of those of universities. Business aims to sell things. Spin and mendacious advertising are an accepted part of the game. The tendency for them to become part of the game in universities too can do nothing but harm. Are universities mean to admire the mentality that gave rise to Enron and Worldcom?
  • Remember the words of Robert May (President of the Royal Society, 2000 – 2005).

    “A rather different issue that has emerged during the Blair decade is the tendency to invite people from the world of business to advise on the management of universities, or to head them. Given that UK universities still stand significantly higher on international league tables than does most of the UK business sector, this seems odd.”

On ‘leadership’ and ‘vision’.

The two most overworked words in management-speak remind me inexorably of the rhetoric used by those who advocated the merger of UCL and Imperial. And of two comments that appeared in the financial (not the academic) press after the attempt crumbled.


Lessons of a failed merger (Matthew Lynn, Bloomberg News. 20-Nov-02). “: [get the pdf].

“Unfortunately for Sykes, the professors of Imperial and University College London were smarter than the last recipients of his strategic wisdom, the shareholders in the formerly independent drug companies Glaxo Wellcome and SmithKline Beecham.



The biggest universities in the world are clearly not the best. So why do some British universities think that mergers will make them world class? (John Kay, 21-Nov-02 Financial Times).

” The same empty phrases that were used in the 1990s to justify corporate mergers are today used to justify university mergers – the aspiration to be a “global player”, the need to achieve “critical mass”. But greater size is always the aspiration of those with no better strategic vision.”



Two letters

These two responses appeared in THES the following week (Dec 7th), from opposite ends of the age spectrum. Notice that the younger one does not dare to give a name. I don’t blame him or her. That is the rule rather than the exception, when people feel intimidated. Exactly the same thing happened when the crazy “vision” of merging Imperial and UCL was on the cards. Anyone with half a brain could see it was nuts (with the exception of the senior management team at the time), but not everyone dared to say so.

Loyalty, but not blind allegiance 1


Research associate, Russell Group university

Published: 07 December 2007


Loyalty cuts both ways (“Staff loyalty key to Hefce report”, November 30).

Look at contract research staff such as myself who are forced to seek employment in other institutions and environments.


I cannot say that I have had an experience in my institution that inspires anything like loyalty. People there want it to go only one way. When are we going to get loyalty from our employing institutions rather than being treated as disposable drones?



Research associate, Russell Group university.




Loyalty, but not blind allegiance 3


Geoffrey Alderman
Published: 07 December 2007




Many years ago, it fell to me to chair Higher Education Funding Council for England teaching-quality inspections of academic departments.
At one such event, the head of department confided to me and my team that he and his team completely disagreed with the strategic direction in which their vice-chancellor was taking them and were doing all they could to undermine it, in the interests of the discipline they taught.



We agreed, and gave the department top marks.



Geoffrey Alderman, Michael Gross professor of politics and contemporary history Buckingham University.


Postscript

How very nice to get an endorsement from a Nobel prizewinner. Why, I wonder, was he not asked for his opinion about how to get good science. Perhaps PricewaterhouseCooper know better

Thanks to a correspondent for alerting me to a medical emergency in France.

You can read the press release here, from Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSAPS, the French equivalent of the MHRA or FDA).



Withdrawal of batches of Gingko biloba and Equisetum arvense


AFSSAPS has been informed by Laboratoires Boiron of an inversion of the labelling of two homeopathic medicaments, The bottles labelled “mother tincture of Gingko biloba” contain mother tincture of Equisetum arvense and vice versa

;. . .

“AFSSAPS has said that this mix-up does not pose any particular risk . . .”
. . .
“Laboratoires Boiron has asked pharmacists who stock these homeopathic medicaments to report, as far as possible, the inversion of labelling to any doctors in their neighbourhood who may have prescribed these items between May and October 2007.”

How would they know, given that the final diluted products are identical, whatever the label? No doubt AFSSAPS are just following the rules. This just shows the absurdities that can occur when you start to allow official ‘regulation’ of witchcraft.

This gem brings to mind the interchange between Lord Broers and Ms Kate Chatfield of the Society of Homeopaths, as recorded in the minutes of evidence to the Select Committee on Science and Technology .

Q538 Lord Broers: I have a simple, technical question about homeopathy and drugs. Is it possible to distinguish between homeopathic drugs after they have been diluted? Is there any means of distinguishing one from the other?

Ms Chatfield: Only by the label.


You can read a lovely analysis of the views of Kate Chatfield here. She works at the University of Central Lancashire, where she is module leader for what the university, disgracefully, calls a “Bachelor of Science Degree” in Homeopathic Medicine. That is the university that refuses to reveal to the public what it is that they are teaching in these courses. I’m still waiting for the result of my appeal to the Information Commisioner: watch this space.

In contrast, Mike Eslea’s pages on pseudoscience are also from the University of Central Lancashire. They are very well worth reading.

Tnanks to the Breath Spa blog for drawing attention to the Broers – Chatfield interchange, in an excellent posting: ” Discouraging News from the Review of Allergy and Intolerance: Homeopathy Means We Need to Rewrite Textbooks”.

No longer are we just told what to do from the top. Important decisions are preceded by a long period of consultation. That is a wonderful contribution to democracy. Sometimes. But in truth, these consultations are only too often totally sham public relations exercises. Here are a couple of examples. The first is a government consultation, followed by consultations within universities.

Consultations on nuclear power stations

I am not using this example to propose a particular view on muclear power stations, but rather as an example of sham consultation.

The background is this.

The government was obliged to run the “fullest public consultation” ( pdf ) before changing its policy on nuclear power. In 2006 they tried to run one but it was descibed by a high court judge described it as “unfair”, “misleading”, “very seriously flawed” and ” procedurally unfair ” and he ordered them to do the whole thing again. In May 2007 the government announced a new nuclear consultation that would remedy all the
judge’s concerns. It has recently finished.

The government (again) paid a large amount of public money to an organisation called Opinion Leader Research (OLR) to run the consultation. One does not need to go further than their own web site to discover that, as its name suggests, this organisation exists not to discover public opinion but to influence it in whatever direction it is paid (in this case by the government) to do. Here are some of OLR’s own words.

“Opinion Leader believe that research is an active part of the communications process enhancing the client’s reputation by positioning them as open, engaging, listening and responding.”

“We develop bespoke approaches to help our clients develop clear actionable insights.”
“Opinion Leader draws on the widest range of approaches to design research based solutions to address client challenges. Our work is tailor-made to suit the specific needs of our clients. We continually innovate and develop new approaches and thinking to help our clients achieve their ambitions.”



According to reports of what happened, that is exactly what OLR did. Here is what Channel 4 News said.

“In nine day-long meetings across Britain two weekends ago, nearly a thousand people were shown a series of videos, presentations and handouts – and their opinion on building new nuclear power stations canvassed.

The government got the result it wanted – 44 per cent said power companies should have option of building nuclear, 36 per cent said no. But day before, the environmental group, Greenpeace, along with other green groups, had pulled out, alleging the questions were loaded and the information biased, partial and factually inaccurate.

Greenpeace would say that, you could argue. But, independently, 20 senior academics too have come forward and will be writing to government with similar reservations.

They say the consultations were deliberately skewed by linking nuclear to fears about climate change – because the government knew past research had shown it’s the only way to get people to accept nuclear, albeit reluctantly.”

“In the videos – alternative viewpoints had doom-ridden music in the background. The government’s view was then given against calm, relaxing music. I feel I have been mugged.”

“Not at all a consultation, merely a sleek marketing ploy.”

“I went in with an open mind… myself and others felt we were being misled and manipulated.”

Channel 4 News also spoken to someone involved in the events. They want to remain anonymous but told us “…repeating the government view, on page after page, on videos and in handouts, acted to almost bludgeon it into their heads.”

You can see some of the slides that were used here. One of them reads thus.

“In the context of tackling climate change and ensuring energy security, do you agree or disagree that it would be in the public interest to give energy companies the option of investing in new nuclear power stations?”

One very apt comment on this was

“Guess what, a majority of people agreed, and when you count the “neither agree or disagree” (which will be tacitly taken to mean “go for it now, build build build!”) the figure goes well into an overall majority. You can’t beat a good loaded question to elicit the desired response.

It’s a bit like asking someone allergic to cats: Do you like fluffy kittens, or are you a Nazi?”

Opinion Leader Research. A family affair?

There’s some very interesting background about OLR here.

“According to this morning’s Independent the energy giant EDF has gone on a public relations offensive to promote it’s new reactors in conjunction with another supplier, Areva . They have launched a website with a generic design assessment called EPR Reactor , which is of course perfectly timed with the consultation upon which the Government appears to have already made up it’s mind.

What’s odd (given what you’d exepct the Indy line to be on things like nuclear) is that they don’t mention that Gordon Brown’s brother, Andrew, is the Head of Media Relations at EDF. Unbelievably good timing for a web site though, don’t you think? The Government makes an announcement of a nuclear consultation on Friday and in the space of two days the big boys have designed and completed
a new website to tell everyone all about the wonders of nuclear? They must have been whipping those Indian developers in Bangalore good this weekend.

It’s worth noting as well that they also don’t mention that Brown’s protege, the Secretary of State for Children, Schools and Families, Ed Balls, has a father-in-law, who just happens to be the former Chairman of the Nuclear Industry Association, and is now a non-executive director of the Government quango known as the Nuclear Decommissiong Authority .

If you’re thinking right now “father-in-law?” and “Cooper?” the answer is yes. He is the father of the Minister of State for Housing (attending Cabinet) at the Department for Communities and Local Government, Yvette Cooper. Purely as an aside, you have to love the doublespeak style in the name of the NDA don’t you? It makes it sound like its interests are somehow opposite to the interests of the nuclear industry. “

There is more on this at the Guido Fawkes blog

“Gordon’s pollster Deborah Mattinson sits on the board of Gordon’s think-tank, the Smith Institute. Her relationship with Gordon has been very profitable for her firm, OLR. According to today’s Sunday Telegraph , government contracts totalling some £3 milllion have
come her way. ”

“the taxpayer is paying OLR £153,484.38 for one-day seminars

The Involve organisation sent a reporter to one of the public meetings, and commented thus.

“On Saturday 8 events were run across the UK to consult 1,100 people on the future of nuclear power. This was the second time the government had run the consultation. The previous being judged to be “seriously flawed” and “manifestly inadequate and unfair” by the high court. The inadequacies stemmed partly from poor management and a lack of time for people to state their views, but also because leading politicians had publicly made up their mind to support nuclear which critically undermined the consultation.

The same problem rose its head again on Friday when Britain’s leading environmental groups formally withdrew from the second nuclear consultation, citing serious concerns with our new Prime Minister, Gordon Brown telling parliament that a decision to continue with nuclear power had been taken “and that is why the security of our energy supply is best safeguarded by building a new generation of nuclear power stations”. The prime minister qualified his remarks a week later after a warning letter from Greenpeace’s lawyers.
The green groups were also concerned that the “ [consultation] document was full of pro-nuclear opinion masquerading as fact …
This document is fundamentally flawed and cannot form the basis for a full public consultation.” “



Sham consultations in universities

In universities one might hope things would be done better. But sadly, it is not so. We too have become accustomed to sham consultations. In many places, for example Edinburgh, staff have been consulted, but what they say has had little effect. The same has happened at UCL. As a matter of historical record, it is worth giving a very abbreviated account of our own sham consultation.

For two years meetings were held. It was made pretty clear at the outset, what the plans were. Few people had the courage to oppose them in a public meeting. Those who did were largely ignored. Most people didn’t even come to the meetings anyway. Most people cynically, or perhaps just realistically, presumed it would be a waste of time and effort. As a result, the voices of our top scientists were rarely heard, and had little influence.

The next stage was external review. Surely that should provide an independent voice? Four possible plans were put to the external review committee. It was made clear to the external review committee that plan 1 (the least disastrous one) was what “we” preferred, though in fact none of the plans had been agreed or even properly discussed by most of the people who do the research and the teaching. Plan 1 involved removal of all existing departments, with consequent destruction of brand names that, over a long period, have reflected well on the reputation of UCL. The external review obligingly said that plan 1 was OK, though they made one (very important) criticism. They said that the size of the research groups was too big. That criticism was rejected by UCL’s senior management team (SMT). We therefore ended up with precisely what the SMT had put to the external reviewers in the first place. With a fine bit of spin. this is represented as following the advice of the external reviewers.

So far, the whole procedure has born an eerie resemblance to the Blairite idea of what constitutes consultation. But the changes had, according to UCL’s statutes, to be recommended to Council by the Academic Board (which consists of all professors and many non-professorial representatives). That safeguard proved ineffective. At the Academic Board meeting of May 24 2007, the consultation stopped, with jaw-dropping speed. In an item that was not even marked for discussion, Academic Board was persuaded to relinquish its statutory powers, and to leave all future decisions about organisation of the Faculty of Life Sciences to the SMT. After three years of talking, it suddenly became apparent that no opposition would be tolerated. No wonder so few people turned up at the Academic Board meeting on November 7th. What point would there be in going, when all power had already been removed from them?

A report on the meeting of the Academic Board on May 24 was sent to a member of UCL Council (at his request). In the interests of completing the historical record I have now made it available to download (with names removed).

This may seem very odd to people outside the biosciences area, but in recent years a business has grown up that will write a paper for you, on the basis of data supplied by a pharmaceutical company. The person who actually did the writing will usually not appear as an author at all This practice is known as ghost writing.

It is obvious from the last two posts ( here and here ) that ghost writing of papers has became a major menace to science in the clinical world. The authors may have not even seen all of the data, and some “authors” may even not have seen the paper at all. Awareness of the size of the problem has increased, especially since the paper by Healy & Catell (2003) [ download the pdf ] (see also here ).
They say

“a process of changing scientific authorship that could conceivably culminate in a situation in which the dominant figures in therapeutics actually have comparatively little first-hand research experience and few raw data that they can share with others.”

See also “Declaration of Medical Writing Assistance in International Peer-Reviewed Publications”, Wooley et al ., 2006, JAMA, 296, 932 – 3 [get pdf ], and a Professional Ethics Report published by the American Association for the Advancement of Science.

The conversation

I recently had a conversation with a “medical writer” (don’t bother asking me who, I’m not saying). I’m very grateful that he spoke to me, because this is the sort of information that is usually concealed carefully from public view. He was clearly a person with integrity, but nonetheless what he had to say was quite disturbing. Here are some of the things that I learned.

  • So called ‘Medical education agencies’ are also marketing agencies. They give expert advice to industry on how to select information from large clinical studies and how to cut and slice it to generate numerous papers. They advise on ‘publication planning’ and on which journals are best to reinforce particular messages that the companies want to convey.
  • Medical writers who are acting as ‘ghost writers’ often interact with clients in the industry and don’t necessarily interact with the proposed academic authors. Opportunities to talk to the authors directly can be very limited and discussions are often mediated by a third party.
  • Medical writers often do not see evidence that all authors have approved the submitted manuscript. It is perceived that only the primary author has actually approved the manuscript.
  • Even if medical writers are aware of their responsibilities concerning ‘good publication practice’ and publication ethics it can be difficult to persuade clients to adopt all of these practices.
  • Often medical writers do not see all of the raw data for a study or publication, they can get pre-selected data or just tables and figures for inclusion in the paper. Medical writers who are relatively inexperienced do not realise that this is not ‘best practice and will prepare a paper without requesting further background data.
  • Medical writers can be pressurised by clients to include ambiguous data or marketing terms in manuscripts. When medical writers have problems with clients, support from their employers can be limited as clients are paying the bills. In this context, the ‘client’ is the company who produce the drug, not the people who eventually appear as authors.
  • Ghost written papers have a number of authors. Often the most important is the primary author; this can be a selected ‘key opinion leader’ whose reputation is relied on by the company for promotion of the product.

In defence he did say that 99% of those working in the pharmaceutical industry are a pretty decent bunch. They understand that the consequences of manipulating data or employing unethical publication practices, if discovered, can be disastrous for the company and their product.

He also said that unethical publication practices occur regularly in purely academic environments. And in that he is, unfortunately, absolutely right. After all, the business of “medical writing” would not exist at all if senior academics were not willing to attach their names to papers that they have not written, and may well not even have seen all of the data.

Still worse, having been caught out doing that, they may be defended by their vice chancellors rather than condemned. Indeed anyone who dares to mention that it is going on is taking the risk of being fired. There is a shocking example here.