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On Sunday 23 September, we recorded an interview with Rosi Sexton. Ever since I got to know her, I’ve been impressed by her polymathy. She’s a musician, a mathematician and a champion athlete, and now an osteopath: certainly an unusual combination. You can read about her on her Wikipedia page: https://en.wikipedia.org/wiki/Rosi_Sexton.

The video is long and wide-ranging, so I’ll give some bookmarks, in case you don’t want to watch it all. (And please excuse my garish London marathon track suit.)

Rosi recently started to take piano lessons again, after a 20 year break. She plays Chopin in the introduction, and Prokofiev and Schubert at 17:37 – 20:08. They are astonishingly good, given the time that’s elapsed since she last played seriously.

We started corresponding in 2011, about questions concerning evidence and alternative medicine as well as sports. Later we talked about statistics too: her help is acknowledged in my 2017 paper about p values. And discussions with her gave rise to the slide at 26:00 in my video on that topic.

Rosi’s accomplishments in MMA have been very well-documented and my aim was to concentrate on her other achievements. Nonetheless we inevitably had to explore the reasons why a first class mathematician chose to spend 14 years of her life in such a hard sport. I’m all for people taking risks if they want to. I have more sympathy for her choice than many of my friends, having myself spent time doing boxing, rugby, flying, sailing, long distance running, and mountain walking. I know how they can provide a real relief from the pressures of work.

The interview starts by discussing when she started music (piano, age 6) and how she became interested in maths. In her teens, she was doing some quite advanced maths: she relates later (at 1:22:50) how she took on holiday some of Raymond Smullyan’s books on mathematical logic at the age of 15 or 16. She was also playing the piano and the cello in the Reading Youth Orchestra, and became an Associate of the London College of music at 17. And at 14 she started Taekwondo, which she found helpful in dealing with teenage demons.

She was so good at maths that she was accepted at Trinity College, Cambridge where she graduated with 1st class hons. And then went on to a PhD, at Manchester. It was during her PhD that she became interested in MMA. We talk at 23:50 about why she abandoned maths (there’s a glimpse of some of her maths at 24:31), and devoted herself to MMA until she retired from that in 2014. In the meantime she took her fifth degree, in osteopathy, in 2010. She talks about some of her teenage demons at 28:00.

Many of my sceptical friends regard all osteopaths as quacks. Some certainly are. I asked Rosi about this at 38:40 and her responses can’t be faulted. She agrees that it’s rarely possible to know whether the treatments she uses are effective or whether the patient would have improved anyway. She understands regression to the mean. We discussed the problem of responders and non-responders. She appreciates that it’s generally not possible to tell whether or not they exist (for more on this, see Stephen Senn’s work. . Even the best RCT tells us only about the average response. Not all osteopath’s are the same.

We talk about the problems of doping and of trans competitors in sports at 49:30, and about the perception of contact sports at 59:32. Personally I have no problem with people competing in MMA, boxing or rugby, if that’s what they want to do. Combat sports are the civilised alternative to war. It isn’t the competitors that I worry about, it’s the fans.

At 1:14:28 we discussed how little is known about the long-term dangers of contact sports. The possible dangers of concussion led to a discussion of Russell’s paradox at 1:20:40.

I asked why she’s reluctant to criticise publicly things like acupuncture or “craniosacral therapy” (at 1:25:00). I found her answers quite convincing.

At 1:43:50, there’s a clip taken from a BBC documentary of Rosi’s father speaking about his daughter’s accomplishments, her perfectionism and her search for happiness.

Lastly, at 1:45:27, there’s a section headed “A happy new beginning”. It documents Rosi’s 40th birthday treat, when she with her new partner, Stephen Caudwell, climbed the highest climbing wall in the world, the Luzzone dam. After they walked down at the end of the climb, they got engaged.

I wish them both a very happy future.

Postcript. Rosi now runs the Combat Sports Clinic. The have recently produced a video about neck strength training, designed to help people who do contact sports -things like rugby, boxing, muay thai and MMA. I’ve seen only the preview, but there is certainly nothing quackish about it. It’s about strength training.

If you are not a pharmacologist or physiologist, you may never have heard of Bernard Ginsborg. I first met him in 1960. He was a huge influence on me and a great friend. I’m publishing this here because the Physiological Society has published only a brief obituary.

Bernard with his wife, Andy (Andrina).

I’ll post here my own recollections of Bernard here.

Bernard Ginsborg was a lecturer in the Pharmacology department in Edinburgh when I joined that department in 1960, as a PhD student.

I recall vividly our first meeting in the communal tea room: smallish in stature, large beard and umbrella, My first reaction was ‘is this chap ever going to stop talking?’. My second reaction followed quickly: this chap has an intellect like nobody I’d encountered before.

I’d been invited to Edinburgh by Walter Perry, who had been external examiner for my first degrees in Leeds. In my 3rd year  viva, he’d asked me to explain the difference between confidence limits and fiducial limits. Of course I couldn’t answer, and spent much of my 4th year trying to find out.  I didn’t succeed but produced a paper that most have impressed him.  He, together with W.E. Brocklehurst, were my PhD supervisors. I saw Perry only when he dropped into my lab for a cigarette between committee meetings., but he treated me very well. He got me a Scottish Hospitals Endowment Trust scholarship which paid twice the usual MRC salary for a PhD student, and he made me an honorary lecturer so that I could join the magnificent staff club on Chambers Street (now gone), where I met, among many others, Peter Higgs, of boson fame.

I very soon came to wish that Bernard was my supervisor rather than Perry. I loved his quantitative approach. A physicist was more appealing to me than a medic.  We spent a lot of time talking and I learnt a huge amount from him.  I had encountered some of Bernard Katz’s papers in my 4th undergraduate year, and realised they were something special, but I didn’t know enough about electrophysiology to appreciate them fully. Bernard explained it all to me.  His 1967 review, Ion movements in junctional transmission, is a classic: still worth reading by anyone interested in electrophysiology. Bernard’s mathematical ability was invaluable to me when, during my PhD, I was wrestling with the equations for diffusion in a cylinder with binding (see appendix here).

The discussions in the communal tea room were hugely educational. Dick Barlow and R.P. Stephenson were especially interesting, I soon came to realise that Bernard had a better grasp on quantitative ideas about receptors than either of them. His use of Laplace transforms to solve simultaneous differential equations in a 1974 paper was my first introduction to them, and that proved very useful to me later. Those discussions laid the ground for a life-long interest in the topic for me.

After I left the pharmacology department in 1964, contact became more intermittent for a while. I recall vividly a meeting held in Crans sur Sierre, Switzerland in 1977,  The meetings there were good, despite have started as golfing holidays for J. Murdoch Ritchie and Joe Hoffman.  There was a certain amount of tension between Bernard and Charles F Stevens, the famous US electrophysiologist. Alan Hawkes and I had just postulated that the unitary event in ion channel opening at the neuromuscular junction was a short burst of openings rather than single openings.  This contradicted the postulate by  Anderson & Stevens (1973) that binding of the agonist was very fast compared with the channel opening and shutting. At the time our argument was theoretical –it wasn’t confirmed experimentally until the early 80s.  Bernard was chairing a session and he tried repeatedly to get Stevens to express an opinion on our ideas, but failed.

At dinner, Stevens was holding court: he expressed the view that rich people shouldn’t pay tax because there were too few of them and it cost more to get them pay up than it was worth.  He sat back to wait for the angry protestations of the rest of the people at the table,  He hadn’t reckoned with Bernard. He said how much he agreed, and by the same token, the police shouldn’t waste time trying to catch murderers. There were too few of them and it wasted too much police time.  The argument was put eloquently as only Bernard could do.  Stevens, who I suspect had not met Bernard before, was uncharacteristically speechless. He had no idea what hit him.  It was a moment to savour.

May 1977, Crans sur Sierre, Switzerland.

For those who knew Bernard, it was another example of his ability to argue eloquently for any proposition whatsoever. I’d been impressed by his speech on how the best way to teach about drugs was to teach them in alphabetical order: it would make as much sense as any other way of categorising them.  Usually there was just enough truth in these propositions to make the listener who hadn’t heard him in action before, wonder, for a moment, if he was serious.  The picture shows him with my wife, Margaret, at the top of a mountain during a break in the meeting.  He’d walked up, putting those of us who’d taken the train to shame.

In 1982, Alan Hawkes and I published a paper with the title “On the stochastic properties of bursts of single ion channel openings and of clusters of bursts.”  It was 59 pages long with over 400 equations, most of which used matrix notation. After it had been accepted, I discovered that Bernard had taken on the heroic job of reviewing itl  This came to light when I got a letter from him that consisted of two matrices which, when multiplied out, revealed his role.

For many years Bernard invited me to Edinburgh to talk to undergraduates about receptors and electrophysiology. (I’ve often wondered if that’s why most of our postdocs came from Glasgow than from Edinburgh during that time.)  It was on one such visit in 1984 that I got a phone call to say that my wife, Margaret, had collapsed on the railway station at Walton-on-Thames while 6 months pregnant, and had been taken to St Peter’s Hospital in Chertsey.  The psychodrama of our son’s birth has been documented elsewhere,  A year later we came to Edinburgh once again. The pictures taken then show Bernard looking impishly happy, as he very often did, in his Edinburgh house in Magdala Crescent. The high rooms were lined with books, all of which he seemed to have read.  His intellect was simply dazzling.

December 19th 1985. Magdala Crescent, Edinburgh

The following spring we visited again, this time with our son Andrew, aged around 15 months. We went with Bernard and Andy to the Edinburgh Botanic gardens. Andrew who was still not walking, crawled away rapidly up a grassy slope. Andy said don’t worry, when he gets to the tope he’ll stop and look back for you.  She was a child psychologist so we believed her. Andrew, however, disappeared from sight over the brow of the hill.

During these visits, we stayed with Bernard and Andy at their Edinburgh house.

The experience of staying with them was like being exposed to an effervescent intellectual fountain. It’s hard to think of a better matched couple.

After Bernard retired in 1985, he took no further interest in science.  For him, it was a chance to spend time on his many other interests.  After he went to live in France, contact became more intermittent. Occasional emails were exchanged.  It was devastating to hear about the death of Andy in 2013.  The last time that I saw both of them was in 2008, at John Kelly’s house.  He was barely changed from the day that I met him in 1960.

Bernard was a legend.  It’s hard to believe that he’s no longer here.

Bernard in 2008 at John Kelly’s house.

Lastly, here is a picture taken at the 2009 meeting of the British Pharmacological Society, held in Edinburgh.

At the British Pharm. Soc meeting, 2009.Left to right: DC, BLG, John Kelly, Mark Evans, Anthony Harmer

### Follow-up

On Monday evening (8th January 2018), I got an email from Ben van der Merwe, a UCL student who works as a reporter for the student newspaper, London Student.  He said

“Our investigation has found a ring of academic psychologists associated with Richard Lynn’s journal Mankind Quarterly to be holding annual conferences at UCL. This includes the UCL psychologist professor James Thompson”.

He asked me for comment about the “London Conference on Intelligence”. His piece came out on Wednesday 10th January. It was a superb piece of investigative journalism.  On the same day, Private Eye published a report on the same topic.

I had never heard about this conference, but it quickly became apparent that it was a forum for old-fashioned eugenicists of the worst kind.  Perhaps it isn’t surprising that neither I, nor anyone else at UCL that I’ve spoken to had heard of these conferences because they were surrounded by secrecy.  According to the Private Eye report:

“Attendees were only told the venue at the last minute and asked not to share the information"

The conference appears to have been held at least twice before. The programmes for the 2015 conference [download pdf] and the 2016 conference [download pdf] are now available, but weren’t public at the time.   They have the official UCL logo across the top despite the fact that Thompson has been only an honorary lecturer since 2007.

A room was booked for the conference through UCL’s external room booking service. The abstracts are written in the style of a regular conference. It’s possible that someone with no knowledge of genetics (as is likely to be the case for room-booking staff) might have not spotted the problem.

The huge problems are illustrated by the London Student piece, which identifies many close connections between conference speakers and far-right, and neo-nazi hate groups.

"[James Thompson’s] political leanings are betrayed by his public Twitter account, where he follows prominent white supremacists including Richard Spencer (who follows him back), Virginia Dare, American Renaissance, Brett Stevens, the Traditional Britain Group, Charles Murray and Jared Taylor.”

“Thompson is a frequent contributor to the Unz Review, which has been described as “a mix of far-right and far-left anti-Semitic crackpottery,” and features articles such as ‘America’s Jews are Driving America’s Wars’ and ‘What to do with Latinos?’.

His own articles include frequent defences of the idea that women are innately less intelligent than men (1, 2, 3,and 4), and an analysis of the racial wage gap which concludes that “some ethnicities contribute relatively little,” namely “blacks.”

“By far the most disturbing of part of Kirkegaard’s internet presence, however, is a blog-post in which he justifies child rape. He states that a ‘compromise’ with paedophiles could be:

“having sex with a sleeping child without them knowing it (so, using sleeping medicine. If they don’t notice it is difficult to see how they cud be harmed, even if it is rape. One must distinguish between rape becus the other was disconsenting (wanting to not have sex), and rape becus the other is not consenting, but not disconsenting either.”

The UCL Students’ Union paper, Cheesegrater, lists some of James Thompson’s tweets,including some about brain size in women

It’s interesting that these came to light on the same day that I learned that the first person to show that there was NO correlation  between brain size and intelligence was Dr Alice Lee, in 1901 [download pdf].
Alice Lee was the first woman to get a PhD in mathematics from UCL and she was working in the Galton laboratory, under Karl Pearson. Pearson was a great statistician but also a eugenicist.  It was good to learn that he supported women in science at a time when that was almost unknown.

### What’s been done so far?

After I’d warned UCL of the impending scandal, they had time to do some preliminary investigation. An official UCL announcement appeared on the same day (10 Jan, 2018) as the articles were published.

“Our records indicate the university was not informed in advance about the speakers and content of the conference series, as it should have been for the event to be allowed to go ahead”

“We are an institution that is committed to free speech but also to combatting racism and sexism in all forms.”

"We have suspended approval for any further conferences of this nature by the honorary lecturer and speakers pending our investigation into the case."

That is about as good as can be expected. It remains to be seen why the true nature of the conferences was not spotted, and it remains to be seen why someone like James Thompson was an honorary senior lecturer at UCL. Watch this space.

### How did it happen

Two videos that feature Thompson are easily found. One, from 2010, is on the UCLTV channel. And in March 2011, a BBC World News video featured Thompson.

But both of these videos are about his views on disaster psychology (Chilean miners, and Japanese earthquake, respectively). Neither gives any hint of his extremist political views. To discover them you’d have to delve into his twitter account (@JamesPsychol) or his writings on the unz site.  It’s not surprising that they were missed.

I hope we’ll know more soon about how these meetings slipped under the radar.  Until recently, they were very secret.  But then six videos of talks at the 2017 meeting were posted on the web, by the organisers themselves. Perhaps they were emboldened by the presence of an apologist for neo-nazis in the White House, and by the government’s support for Toby Young, who wrote in support of eugenics. The swing towards far-right views in the UK, in the USA and in Poland, Hungary and Turkey, has seen a return to public discussions of views that have been thought unspeakable since the 1930s. See, for example, this discussion of eugenics by Spectator editor Fraser Nelson with Toby Young, under the alarming heading "Eugenics is back".

The London Conference on Intelligence channel used the UCL logo, and it was still public on 10th January. It had only 49 subscribers. By 13th January it had been taken down (apparently by its authors). But it still has a private playlist with four videos which have been viewed only 36 times (some of which were me). Before it vanished, I made a copy of Emil Kirkegard’s talk, for the record.

### Freedom of speech

Incidents like this pose difficult problems, especially given UCL’s past history. Galton and Pearson supported the idea of eugenics at the beginning of the 20th century, as did George Bernard Shaw. But modern geneticists at the Galton lab have been at the forefront in showing that these early ideas were simply wrong.

UCL has, in the past, rented rooms for conferences of homeopaths. Their ideas are deluded and sometimes dangerous, but not illegal. I don’t think they should be arrested, but I’d much prefer that their conferences were not at UCL.

A more serious case occurred on 26 February 2008. The student Islamic Society invited  representatives of the radical Islamic creationist, Adnan Oktar, to speak at UCL. They were crowing that the talk would be held in the Darwin lecture theatre (built in the place formerly occupied by Charles Darwin’s house on Gower Street). In the end, the talk was allowed to go ahead, but it was moved by the then provost to the Gustave Tuck lecture theatre, which is much smaller, and which was built from a donation by the former president of the Jewish Historical Society. See more accounts here, here and here. It isn’t known what was said, so there is no way to tell whether it was illegal, or just batty.

It is very hard to draw the line between hate talk and freedom of speech.  There was probably nothing illegal about what was said at the Intelligence Conferences.  It was just bad science, used to promote deeply distasteful ideas..

Although, in principle, renting a room doesn’t imply any endorsement, in practice all crackpot organisations love to use the name of UCL to promote their cause. That alone is sufficient reason to tell these people to find somewhere else to promote their ideas.

### Follow up in the media

For a day or two the media were full of the story. It was reported, for example, in the Guardian and in the Click to play the interview.

### The real story

Recently some peope have demanded that the names of Galton and Pearson should be expunged from UCL.

There would be a case for that if their 19th century ideas were still celebrated, just as there is a case for removing statues that celebrate confederate generals in the southern USA.  Their ideas about measurement and statistics are justly celebrated. But their ideas about eugenics are not celebrated.

On the contrary, it is modern genetics, done in part by people in the Galton lab, that has shown the wrongness of 19th century views on race. If you want to know the current views of the Galton lab, try these.  They could not be further from Thompson’s secretive pseudoscience.

Steve Jones’ 2015 lecture “Nature, nurture or neither: the view from the genes”,

Or check the writing of UCL alumnus, Adam Rutherford: “Why race is not a thing, according to genetics”,

or, from Rutherford’s 2017 article

“We’ve known for many years that genetics has profoundly undermined the concept of race”

“more and more these days, racists and neo-Nazis are turning to consumer genetics to attempt to prove their racial purity and superiority. They fail, and will always fail, because no one is pure anything.”

“the science that Galton founded in order to demonstrate racial hierarchies had done precisely the opposite”

Or read this terrific account of current views by Jacob A Tennessen “Consider the armadillos".

These are accounts of what geneticists now think. Science has shown that views expressed at the London Intelligence Conference are those of a very small lunatic fringe of pseudo-scientists. But they are already being exploited by far-right politicians.

It would not be safe to ignore them.

### Follow-up

15 January 2018. The involvement of Toby Young

The day after this was posted, my attention was drawn to a 2018 article by the notorious Toby Young. In it he confirms the secretiveness of the conference organisers.

“I discovered just how cautious scholars in this ﬁeld can be when I was invited to attend a two-day conference on intelligence at University College London by the academic and journalist James Thompson earlier this year. Attendees were only told the venue at the last minute – an anonymous antechamber at the end of a long corridor called ‘Lecture
Room 22’ – and asked not to share the information with anyone else.”

More importantly,it shows that Toby Young has failed utterly to grasp the science.

“You really have to be pretty stubborn to dispute that general cognitive ability is at least partly genetically based.”

There is nobody who denies this.
The point is that the interaction of nature and nurture is far more subtle than Young believes, and that makes attempts to separate them quantitatively futile. He really should educate himself by looking at the accounts listed above (The real story)

16 January 2018. How UCL has faced its history

Before the current row about the “London Intelligence Conference”, UCL has faced up frankly to its role in the development of eugenics. It started at the height of Empire, in the 19th century and continued into the early part of the 20th century. The word “eugenics” has not been used at UCL since it fell into the gravest disrepute in the 1930s, and has never been used since WW2. Not, that is, until Robert Thompson and Toby Young brought it back. The history has been related by curator and science historian, Subhadra Das. You can read about it, and listen to episodes of her podcast, at “Bricks + Mortals, A history of eugenics told through buildings“. Or you can listen to her whole podcast.

Although Subhadra Das describes Galton as the Victorian scientist that you’ve never heard of. I was certainly well aware of his ideas before I first came to UCL (in 1964). But at that time. I thought of Karl Pearson only as a statistician, and I doubt if I’d even heard of Flinders Petrie. Learning about their roles was a revelation.

17 January 2018.

Prof Semir Zeki has been pointed out to me that it’s not strictly to say “the word “eugenics” has not been used at UCL since it fell into the gravest disrepute in the 1930s”. It’s true to say that nobody advocated it but the chair of Eugenics was not renamed the chair of Human Genetics until 1963. This certainly didn’t imply approval. Zeki tells me that it’s holder “Lionel Penrose, when he mentioned his distaste for the title, saying that it was a hangover from the past, and should be changed”.

Sarah Ferguson, ex-wife of Prince Andrew, Duke of York, seems to need a lot of money. Some of her wheezes are listed in today’s Times. That’s behind a paywall, as is the version reproduced in The Australian (Murdoch connection presumably). You can read it (free) here, with more details below the article.

 Thomas Ough and David Brown Published at 12:01AM, January 15 2015 In her seemingly endless quest to make money, Sarah, Duchess of York, has had little hesitation using her title to generate sales. This week, though, she landed herself in trouble after appearing to use the name of Britain’s foremost scientific university to lend credibility to a promotion for her new diet system. The duchess told NBC’s Today show during an interview to promote her “emulsifier” programme that she was aware of the dangers of obesity through her work as an ambassador for the Institute of Global Health Improvement at Imperial College London. Last night she apologised for “any misunderstanding” after Imperial College, ranked the joint second-best university in the world, sought to distance itself from the duchess’s promotion. A spokesman said: “The commercial activities promoted by Sarah Ferguson in the interview with Today are not connected in any way to Imperial’s staff or research activities, and the college does not endorse the suggestion of any possible link.” The institute, which has more than 160 specialists, including clinicians, engineers, scientists and psychologists, is headed by Lord Darzi of Denham, a former Labour health minister. The duchess told the Today presenter Matt Lauer that she had been a comfort eater since the age of 12 but the “turning point” was when she realised that she was the same weight as when pregnant with Princess Beatrice, now 25. “I couldn’t bear looking at myself any minute longer,” she confided. “In fact, the size of my ass probably saved my life.” She said she discovered that the “emulsifier” was “a solution for behavioural change” and helped her to lose 55lbs. The $99 kit, which includes a blender, a couple of recipe books and some workout DVDs, is produced by Tristar Products, a direct marketing company for home and health items. The duchess told the breakfast show: “I have just found out on my discoveries with Imperial College London . . . I’m an ambassador for the Institute for Global Health Innovation, and I found out that children, little children, are going to die before their parents because of obesity.” The benefits of the kit were questioned yesterday by Ayela Spiro, a senior scientist at the British Nutrition Foundation. She said: “In terms of the particular product, no juicer or blender on their own can enhance how much nutrition your body will absorb. Any claims made about such products such that it accelerates weight loss, boosts energy and strengthens the immune system need to be treated with caution.” Professor David Colquhoun of University College London, said: “I find it pretty amazing that Imperial chose someone like her to be an ‘ambassador’. Imperial does have an interest in appetite suppression but hasn’t come up with any usable product yet and this research has nothing to do with blenders. “[Her television appearance] was sheer name-dropping, something she’s quite good at. The only ‘discovery’ she seems to have made is that if you eat less you’ll lose weight. The$100 blender has nothing to do with it.” A spokesman for the duchess said: “She is not trying to use her association with the institute to promote her personal interests. She was talking about ‘behavioural change’, which is endorsed by the institute, and her own behavioural change.”

With the article there’s an inset that gives details of other ways in which Sarah Ferguson has exploited her title to make money.

Fergie’s latest wheeze, Duchess Discoveries is being promoted heavily on US television. It bears a close resemblance to those ghastly daytime TV advertising channels. Watch her interview on a US TV programme, "Today".

It’s partly promoting her latest diet scam, and partly a vigorous defence of her ex-husbands innocence in the face of allegations of sexual shenanigans. Of course she doesn’t know whether the allegations are true. The Queen doesn’t know (so why bother with the denial from Buckingham Palace?). And I don’t know. We know plenty about Prince Andrew’s bad behaviour, but we don’t know whether he’s had sex with minors.

Worse still is the promotional video on the “Duchess Discoveries” site itself.

I quote:

“I’m SO excited about my fusion accelerator system, accelerates weight loss, accelerates your energy, accelerates and strengthens your immune system.”

"accelerates weight loss" is certainly unproven. Mere hype

"accelerates your energy" is totally meaningless. It’s the sort of sciencey-sounding words that are loved by all quacks.

"accelerates and strengthens your immune system". Sigh. "strengthening the immune system is the perpetual mantra of just about every quack. It’s totally meaningless. Just made-up nutribollocks.

The promotional video is fraudulent nonsense. If it were based in the UK I have no doubt that it would be quickly slapped down by the Advertising Standards Authority. But in the USA the first amendment allows people to lie freely about nutrition, which is why it’s such big business.

It bothers me that the most that the best that the British Nutrition Foundation could manage was to say that such claims "need to be treated with caution". They are mendacious nonsense. Why not just say so?

### Follow-up

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

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

Her own company’s web site says

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

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

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

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

### The involvement of Capita

According to their web site

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

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

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

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

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

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

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

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

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

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

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

### Secrecy at the College of Medicine

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

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

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

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

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

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

### Three people who ought to know better

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

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

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

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

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

The stated aims of the College sound good.

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

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

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

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

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

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

Unprofitable for Crapita, that is.

### Follow-up

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

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

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

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

Open access is in the news again.

Index on Censorship held a debate on open data on December 6th.

 The video of of the meeting is now on YouTube. A couple of dramatic moments in the video: At 48 min O’Neill & Monbiot face off about "competent persons" (and at 58 min Walport makes fun of my contention that it’s better to have more small grants rather than few big ones, on the grounds that it’s impossible to select the stars).

The meeting has been written up on the Bishop Hill Blog, with some very fine cartoon minutes.

(I love the Josh cartoons -pity he seems to be a climate denier, spoken of approvingly by the unspeakable James Delingpole.)

It was gratifying that my remarks seemed to be better received by the scientists in the audience than they were by some other panel members. The Bishop Hill blog comments "As David Colquhoun, the only real scientist there and brilliant throughout, said “Give them everything!” " Here’s a subsection of the brilliant cartoon minutes

The bit about "I just lied -but he kept his job" referred to the notorious case of Richard Eastell and the University of Sheffield.

We all agreed that papers should be open for anyone to read, free. Monbiot and I both thought that raw data should be available on request, though O’Neill and Walport had a few reservations about that.

A great deal of time and money would be saved if data were provided on request. It shouldn’t need a Freedom of Information Act (FOIA) request, and the time and energy spent on refusing FOIA requests is silly. It simply gives the impression that there is something to hide (Climate scientists must be ruthlessly honest about data). The University of Central Lancashire spent £80,000 of taxpayers’ money trying (unsuccessfully) to appeal against the judgment of the Information Commissioner that they must release course material to me. It’s hard to think of a worse way to spend money.

A few days ago, the Department for Business, Innovation and Skills (BIS) published a report which says (para 6.6)

“The Government . . . is committed to ensuring that publicly-funded research should be accessible
free of charge.”

That’s good, but how it can be achieved is less obvious. Scientific publishing is, at the moment, an unholy mess. It’s a playground for profiteers. It runs on the unpaid labour of academics, who work to generate large profits for publishers. That’s often been said before, recently by both George Monbiot (Academic publishers make Murdoch look like a socialist) and by me (Publish-or-perish: Peer review and the corruption of science). Here are a few details.

Extortionate cost of publishing

Mark Walport has told me that

The Wellcome Trust is currently spending around £3m pa on OA publishing costs and, looking at the Wellcome papers that find their way to UKPMC, we see that around 50% of this content is routed via the “hybrid option”; 40% via the “pure” OA journals (e.g. PLoS, BMC etc), and the remaining 10% through researchers self-archiving their author manuscripts.

I’ve found some interesting numbers, with help from librarians, and through access to The Journal Usage Statistics Portal (JUSP).

Elsevier

UCL pays Elsevier the astonishing sum of €1.25 million, for access to its journals. And that’s just one university. That price doesn’t include any print editions at all, just web access and there is no open access. You have to have a UCL password to see the results. Elsevier has, of course, been criticised before, and not just for its prices.

Elsevier publish around 2700 scientific journals. UCL has bought a package of around 2100 journals. There is no possibility to pick the journals that you want. Some of the journals are used heavily ("use" means access of full text on the web). In 2010, the most heavily used journal was The Lancet, followed by four Cell Press journals

But notice the last bin. Most of the journals are hardly used at all. Among all Elsevier journals, 251 were not accessed even once in 2010. Among the 2068 journals bought by UCL, 56 were never accessed in 2010 and the most frequent number of accesses per year is between 1 and 10 (the second bin in the histogram, below). 60 percent of journals have 300 or fewer usages in 2010, Above 300, the histogram tails on up to 51878 accesses for The Lancet. The remaining 40 percent of journals are represented by the last bin (in red). The distribution is exceedingly skewed. The median is 187, i.e. half of the journals had fewer than 187 usages in 2010), but the mean number of usages (which is misleading for such a skewed distribution, was 662 usages).

Nature Publishing Group

UCL bought 65 journals from NPG in 2010. They get more use than Elsevier, though surprisingly three of them were never accessed in 2010, and 17 had fewer than 1000 accesses in that year. The median usage was 2412, better than most. The leader, needless to say, was Nature itself, with 153,321.

Oxford University Press

The situation is even more extreme for 248 OUP journals, perhaps because many of the journals are arts or law rather than science.

The most frequent (modal) usage of was zero (54 journals), followed by 1 to 10 accesses (42 journals) 64 percent of journals had fewer than 200 usages, and the 36 percent with over 200 are pooled in the last (red) bin. The histogram extends right up to 16060 accesses for Brain. The median number of usages in 2010 was 66.

So far I haven’t been able to discover the costs of the contracts with OUP or Nature Publishing group. It seems that the university has agreed to confidentiality clauses. This itself is a shocking lack of transparency. If I can find the numbers I shall -watch this space.

Almost all of these journals are not open access. The academics do the experiments, most often paid for by the taxpayer. They write the paper (and now it has to be in a form that is almost ready for publication without further work), they send it to the journal, where it is sent for peer review, which is also unpaid. The journal sells the product back to the universities for a high price, where the results of the work are hidden from the people who paid for it.

It’s even worse than that, because often the people who did the work and wrote the paper, have to pay "page charges". These vary, but can be quite high. If you send a paper to the Journal of Neuroscience, it will probably cost you about $1000. Other journals, like the excellent Journal of Physiology, don’t charge you to submit a paper (unless you want a colour figure in the print edition, £200), but the paper is hidden from the public for 12 months unless you pay$3000.

The major medical charity, the Wellcome Trust, requires that the work it funds should be available to the public within 6 months of publication. That’s nothing like good enough to allow the public to judge the claims of a paper which hits the newspapers the day that it’s published. Nevertheless it can cost the authors a lot. Elsevier journals charge $3000 except for their most-used journals. The Lancet charges £400 per page and Cell Press journals charge$5000 for this unsatisfactory form of open access.

Open access journals

The outcry about hidden results has resulted in a new generation of truly open access journals that are open to everyone from day one. But if you want to publish in them you have to pay quite a lot.

Furthermore, although all these journals are free to read, most of them do not allow free use of the material they publish. Most are operating under all-rights-reserved copyrights. In 2009 under 10 percent of open access journals had true Creative Commons licence.

Nature Publishing Group has a true open access journal, Nature Communications, but it costs the author $5000 to publish there. The Public Library of Science journals are truly open access but the author is charged$2900 for PLoS Medicine though PLoS One costs the author only $1350 A 2011 report considered the transition to open access publishing but it doesn’t even consider radical solutions, and makes unreasonably low estimates of the costs of open access publishing. Scam journals have flourished under the open access flag Open access publishing has, so far, almost always involved paying a hefty fee. That has brought the rats out of the woodwork and one gets bombarded daily with offers to publish in yet another open access journal. Many of these are simply scams. You pay, we put it on the web and we won’t fuss about quality. Luckily there is now a guide to these crooks: Jeffrey Beall’s List of Predatory, Open-Access Publishers. One that I hear from regularly is Bentham Open Journals (a name that is particularly inappropriate for anyone at UCL). Jeffery Beall comments "Among the first, large-scale gold OA publishers, Bentham Open continues to expand its fleet of journals, now numbering over 230. Bentham essentially operates as a scholarly vanity press." They undercut real journals. A research article in The Open Neuroscience Journal will cost you a mere$800. Although these journals claim to be peer-reviewed, their standards are suspect. In 2009, a nonsensical computer-generated spoof paper was accepted by a Bentham Journal (for $800), What can be done about publication, and what can be done about grants? Both grants and publications are peer-reviewed, but the problems need to be discussed separately. Peer review of papers by journals One option is clearly to follow the example of the best open access journals, such as PLoS. The cost of$3000 to 5000 per paper would have to be paid by the research funder, often the taxpayer. It would be money subtracted from the research budget, but it would retain the present peer review system and should cost no more if the money that were saved on extortionate journal subscriptions were transferred to research budgets to pay the bills, though there is little chance of this happening.

The cost of publication would, in any case, be minimised if fewer papers were published, which is highly desirable anyway.

But there are real problems with the present peer review system. It works quite well for journals that are high in the hierarchy. I have few grumbles myself about the quality of reviews, and sometimes I’ve benefitted a lot from good suggestions made by reviewers. But for the user, the process is much less satisfactory because peer review has next to no effect on what gets published in journals. All it influences is which journal the paper appears in. The only effect of the vast amount of unpaid time and effort put into reviewing is to maintain a hierarchy of journals, It has next to no effect on what appears in Pubmed.

For authors, peer review can work quite well, but

from the point of view of the consumer, peer review is useless.

It is a myth that peer review ensures the quality of what appears in the literature.

I made some more radical suggestions in Publish-or-perish: Peer review and the corruption of science.

It seems to me that there would be many advantages if people simply published their own work on the web, and then opened the comments. For a start, it would cost next to nothing. The huge amount of money that goes to publishers could be put to better uses.

Another advantage would be that negative results could be published. And proper full descriptions of methods could be provided because there would be no restrictions on length.

Under that system, I would certainly send a draft paper to a few people I respected for comments before publishing it. Informal consortia might form for that purpose.

The publication bias that results from non-publication of negative results is a serious problem, mainly, but not exclusively, for clinical trials. It is mandatory to register a clinical trial before it starts, but many of the results never appear. (see, for example, Deborah Cohen’s report for Index on Censorship). Although trials now have to be registered before they start, there is no check on whether or not the results are published. A large number of registered trials do not result in any publication, and this publication bias can costs thousands of lives. It is really important to ensure that all results get published,

The ArXiv model

There are many problems that would have to be solved before we could move to self-publication on the web. Some have already been solved by physicists and mathematicians. Their archive, ArXiv.org provides an example of where we should be heading. Papers are published on the web at no cost to either user or reader, and comments can be left. It is an excellent example of post-publication peer review. Flame wars are minimised by requiring users to register, and to show they are bona fide scientists before they can upload papers or comments. You may need endorsement if you haven’t submitted before.

Peer review of grants

The problems for grants are quite different from those for papers. There is no possibility of doing away with peer review for the award of grants, however imperfect the process may be. In fact candidates for the new Wellcome Trust investigator awards were alarmed to find that the short listing of candidates for their new Investigator Awards was done without peer review.

The Wellcome Trust has been enormously important for the support of medical and biological support, and never more than now, when the MRC has become rather chaotic (let’s hope the new CEO can sort it out). There was, therefore, real consternation when Wellcome announced a while ago its intention to stop giving project and programme grants altogether. Instead it would give a few Wellcome Trust Investigator Awards to prominent people. That sounds like the Howard Hughes approach, and runs a big risk of “to them that hath shall be given”.

The awards have just been announced, and there is a good account by Colin Macilwain in Science [pdf]. UCL did reasonable well with four awards, but four is not many for a place the size of UCL. Colin Macilwain hits the nail on the head.

"While this is great news for the 27 new Wellcome Investigators who will share £57 million, hundreds of university-based researchers stand to lose Wellcome funds as the trust phases out some existing programs to pay for the new category of investigators".

There were 750 applications, but on the basis of CV alone, they were pared down to a long-list if 173. The panels then cut this down to a short-list of 55. Up to this point no external referees were used, quite unlike the normal process for award of grants. This seems to me to have been an enormous mistake. No panel, however distinguished, can have the knowledge to distinguish the good from the bad in areas outside their own work, It is only human nature to favour the sort of work you do yourself. The 55 shortlisted people were interviewed, but again by a panel with an even narrower range of expertise, Macilwain again:

"Applications for MRC grants have gone up “markedly” since the Wellcome ones closed, he says: “We still see that as unresolved.” Leszek Borysiewicz, vice-chancellor of the University of Cambridge, which won four awards, believes the impact will be positive: “Universities will adapt to this way of funding research."

It certainly isn’t obvious to most people how Cambridge or UCL will "adapt" to funding of only four people.

The Cancer Research Campaign UK has recently made the same mistake.

One problem is that any scheme of this sort will inevitably favour big groups, most of whom are well-funded already. Since there is some reason to believe that small groups are more productive (see also University Alliance report), it isn’t obvious that this is a good way to go. I was lucky enough to get 45 minutes with the director of the Wellcome Trust, Mark Walport, to put these views. He didn’t agree with all I said, but he did listen.

One of the things that I put to him was a small statistical calculation to illustrate the great danger of a plan that funds very few people. The funding rate was 3.6% of the original applications, and 15.6% of the long-listed applications. Let’s suppose, as a rough approximation, that the 173 long-listed applications were all of roughly equal merit. No doubt that won’t be exactly true, but I suspect it might be more nearly true than the expert panels will admit. A quick calculation in Mathcad gives this, if we assume a 1 in 8 chance of success for each application.

Distribution of the number of successful applications

Suppose $n$ grant applications are submitted. For example, the same grant submitted $n$ times to selection boards of equal quality, OR $n$ different grants of equal merit are submitted to the same board.

Define $p$ = probability of success at each application

Under these assumptions, it is a simple binomial distribution problem.

According to the binomial distribution, the probability of getting $r$ successful applications in $n$ attempts is

$P(r)=\frac{n!}{r!\left(n-r\right)! }\; {p}^{r} \left(1-p \right)^{n-r}$

For a success rate of 1 in 8, $p = 0.125$, so if you make $n = 8$ applications, the probability that $r$ of them will succeed is shown in the graph.

Despite equal merit, almost as many people end up with no grant at all as almost as many people end up with no grant at all as get one grant. And 26% of people will get two or more grants.

Of course it would take an entire year to write 8 applications. If we take a more realistic case of making four applications we have $n = 4$ (and $p = 0.125$, as before). In this case the graph comes out as below. You have a nearly 60% chance of getting nothing at all, and only a 1 in 3 chance of getting one grant.

These results arise regardless of merit, purely as consequence of random chance. They are disastrous, and especially disastrous for the smaller, better-value, groups for which a gap in funding can mean loss of vital expertise. It also has the consequence that scientists have to spend most of their time not doing science, but writing grant applications. The mean number of applications before a success is 8, and a third of people will have to write 9 or more applications before they get funding. This makes very little sense.

Grant-awarding panels are faced with the near-impossible task of ranking many similar grants. The peer review system is breaking down, just as it has already broken down for journal publications.

I think these considerations demolish the argument for funding a small number of ‘stars’. The public might expect that the person making the application would take an active part in the research. Too often, now, they spend most of their time writing grant applications. What we need is more responsive-mode smallish programme grants and a maximum on the size of groups.

Conclusions

We should be thinking about the following changes,

• Limit the number of papers that an individual can publish. This would increase quality, it would reduce the impossible load on peer reviewers and it would reduce costs.
• Limit the size of labs so that more small groups are encouraged. This would increase both quality and value for money.
• More (and so smaller) grants are essential for innovation and productivity.
• Move towards self-publishing on the web so the cost of publishing becomes very low rather than the present extortionate costs. It would also mean that negative results could be published easily and that methods could be described in proper detail.

The entire debate is now on YouTube.

### Follow-up

24 January 2012. The eminent mathematician, Tim Gowers, has a rather hard-hitting blog on open access and scientific publishing, Elsevier – my part in its downfall. I’m right with him. Although his post lacks the detailed numbers of mine, it shows that mathematicians has exactly the same problems of the rest of us.

11 April 2012. Thanks to Twitter, I came across a remarkably prescient article, in the Guardian, in 2001.
Science world in revolt at power of the journal owners, by James Meek. Elsevier have been getting away with murder for quite a while.

19 April 2012.

 I got invited to give after-dinner talk on open access at Cumberland Lodge. It was for the retreat of out GEE Department (that is the catchy brand name we’ve had since 2007: I’m in the equally memorable NPP). I think it stands for Genetics, Evolution and Environment. The talk seemed to stiir up a lot of interest: the discussions ran on to the next day.

It was clear that younger people are still as infatuated with Nature and Science as ever. And that, of course is the fault of their elders.

The only way that I can see, is to abandon impact factor as a way of judging people. It should have gone years ago,and good people have never used it. They read the papers. Access to research will never be free until we think oi a way to break the hegemony of Nature, Science and a handful of others. Stephen Curry has made some suggestions

Probably it will take action from above. The Wellcome Trust has made a good start. And so has Harvard. We should follow their lead (see also, Stephen Curry’s take on Harvard)

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

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

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

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

27 April 2014

The brilliant mathematician,Tim Gowers, started a real revolt against old-fashioned publishers who are desperately trying to maintain extortionate profits in a world that has changed entirely. In his 2012 post, Elsevier: my part in its downfall, he declared that he would no longer publish in, or act as referee for, any journal published by Elsevier. Please follow his lead and sign an undertaking to that effect: 14,614 people have already signed.

Gowers has now gone further. He’s made substantial progress in penetrating the wall of secrecy with which predatory publishers (of which Elsevier is not the only example) seek to prevent anyone knowing about the profitable racket they are operating. Even the confidentiality agreements, which they force universities to sign, are themselves confidential.

In a new post, Tim Gowers has provided more shocking facts about the prices paid by universities. Please look at Elsevier journals — some facts. The jaw-dropping 2011 sum of €1.25 million paid by UCL alone, is now already well out-of-date. It’s now £1,381,380. He gives figures for many other Russell Group universities too. He also publishes some of the obstructive letters that he got in the process of trying to get hold of the numbers. It’s a wonderful aspect of the web that it’s easy to shame those who deserve to be shamed.

I very much hope the matter is taken to the Information Commissioner, and that a precedent is set that it’s totally unacceptable to keep secret what a university pays for services.

The University of Wales is to stop validating all external degrees at home and abroad. and it has a new vice chancellor, Professor Medwin Hughes. This has happened eventually, after years of pressure, first from bloggers, and then from BBC Wales. That is a tacit admission that their validation procedures were useless, and bordering on the corrupt.

But the news doesn’t appear on the University of Wales front page. It is hidden away in a news item. With the incredible spin it is billed as “University of Wales launches bold new academic strategy“. No admission of the bad mistakes appears anywhere. Still worse, the vice-chancellor who was responsible for years of malpractice, Marc Clement, has not vanished, but has been promoted to be president of the University of Wales. It was Professor Clement who claimed, in November 2010, to be taken by “complete and total surprise“, when Welsh education minister accused him of bring the University of Wales into disrepute. This, sadly, cannot be true. I know that Clement was well aware of my 2008 blog, and of the opinion of Polly Toynbee. He’d corresponded with both of us in 2008.

Until recently the University of Wales validated an astonishing 11,675 degree courses, including fundamantalist bible colleges in Russia, Chinese medicine in Barcelona and courses in quackery at the Scottish School of Herbal Medicine,  the Northern College of Acupuncture and the Mctimoney College of Chiropractic.

In October 2008 I posted Another worthless validation: the University of Wales and nutritional therapy. With the help of the Freedom of Information Act, it was possible to reveal the mind-boggling incompetence of the validation process used by the University of Wales. The vice chancellors organisation, UUK, did nothing whatsoever, as usual.

The mainstream media eventually caught up with bloggers. In 2010, BBC1 TV (Wales) produced an excellent TV programme that exposed the enormous degree validation scam run by the University of Wales. The programme can be seen on YouTube (Part 1, and Part 2). The programme also exposed, incidentally, the uselessness of the Quality Assurance Agency (QAA) which did nothing until the scam was exposed by TV and blogs.

One of the potty courses "validated" by the University of Wales was a "BSc" in Nutrional Therapy, run by Jacqueline Young at the Northern College of Acupuncture. The problem of Jacqueline Young’s fantasy approach to facts was pointed out at least as far back as 2004, by Ray Girvan., who wrote about it again in May 2005. The problems were brought to wider attention when Ben Goldacre wrote two articles in his Badscience column, Imploding Researchers (September 2005), and the following week, Tangled Webs.

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

I wrote to Clement in 2008 to ask for his opinion, as a one-time electrical engineer, of this statement. Naturally I got no reply. It seems to be a characteristic of people who are very well paid that failure to do their job results in promotion, not firing.

Furthermore, the people who were primarily responsible for validating crackpot degrees are still there. It seems that Professor Nigel Palastanga (a physiotherapist) is still  Pro Vice-Chancellor (Learning, Teaching and Enhancement). He was the person who totally failed to notice that Jacqueline Young had been a laughing stock for years before his committee solemnly approved her degree. And as late as 2010, Jacqueline Young was made a senior lecturer.

Among the courses "validated" by Palastanga were the McTimoney College of Chiropractic. They are presumably now in deep trouble. The College was, incidentally, owned by the BPP University, as recently promoted by David Willetts, so this is yet another sign of Willetts’ bad judgment. It’s private so it must be good, OK? The matter was recently given some well-deserved bad publicity in Private Eye.

It is a sorry story of pathetic quality control procedures and snail-like response from regulatory authorites. But something has been done and we should be grateful for that. Patients will be a bit safer now.

### Follow-up

Quackometer also posted on October 3rd: McTimoney Chiropractic College in Deep Trouble.

October 4th More from BBC Wales, The new vice chancellor speaks. He admits nothing about malpractice.

October 5th “University of Wales degree and visa scam exposed by BBC”. More BBC Wales from Ciaran Jenkins.

October 5th (20.31) “Scrap University of Wales call by vice-chancellors” “Five universities want the University of Wales (UoW) title scrapped because they are appalled by claims about the validation of its qualifications.” So they noticed at last, 3 years after the first revelations, on this blog and by the BBC.

October 12. “University of Wales helps 650 stranded Tasmac students“. More than 650 overseas students may lose £7,850 fees paid to the Tasmac London School of Business, for a degree formerly validated by University of Wales. Tasmac has gone into liquidation, That’s what happens when validations are handed out like sweeties. The fact that the QAA approved the course means, as this case among others has shown, absolutely nothing. The University of Wales should be sufficiently ashamed of its past behaviour to refund the fees.

October 18. Bob Croydon, Welsh representative of the Prince of Wales’ Foundation for the Built Environment, is rather cross with Leighton Andrews, the Welsh minister of education who must get much of the credit for winding up the scams. He may also be in trouble with the quacktitioner royal after writing in an email " “Whilst the Minister could doubtless give the Prince of Wales a good run for his money in the Self Importancy Sweepstakes it would be. . ."

October 21 It now seems that the University of Wales will essentially vanish (and BBC report). . The chair of Council, Huw Thomas, has resigned. The closure is a pity for those who have real degrees awarded by the university, but it is a fate well-earned, The remaining mystery is the fate of Prof Clement and Prof Palastanga, who presided over the validation fiasco. It is they who are responsible for the students who have now been abandoned (read an account of Tasmac)

October 22 The Daily Telegraph reports University of Wales abolished after visa scandal. This misses the whole back story about validation scams.

Although the chair of Council has resigned, there is no information yet about Professors Clement and Palastanga, who presided over the fiasco. I was told on 24 October that “This information is yet to be determined”.

October 28. The university has produced two statements. one for students, and one for alumni. Both documents say

"Why is the merger happening?
Recent developments in Welsh Higher Education policy have been driven by a desire for there to be fewer universities in Wales. The Welsh Government is putting policies in place to have only six or seven universities (there are currently eleven). Our merger is in response to this challenge from the Government."

This, sadly, is a straighforward lie. The closure is a result of a long-running saga of phony and incompetent validations, sold for money. They have been aware of this at least since my first post in 2008, but nothing happened until the BBC gave it wide publicity. You don’t have to take my word that it’s a lie. Geraint Talfan Davies, a member of the Welsh government-commissioned McCormick review, said:

“I think that everybody has been aware of some of the risks involved in the University of Wales’ overseas activities.

“Validating at distance provides some real challenges, governance challenges, and that goes for everybody.

“The difficulty with the University of Wales was that it was on a pretty big scale and doing it on that scale makes it more difficult.”

It seems the University has lost touch with the idea of telling the truth.

One wonders about the standards of peer review at the British Journal of General Practice. The June issue has a paper, "Acupuncture for ‘frequent attenders’ with medically unexplained symptoms: a randomised controlled trial (CACTUS study)". It has lots of numbers, but the result is very easy to see. Just look at their Figure.

There is no need to wade through all the statistics; it’s perfectly obvious at a glance that acupuncture has at best a tiny and erratic effect on any of the outcomes that were measured.

But this is not what the paper said. On the contrary, the conclusions of the paper said

 Conclusion The addition of 12 sessions of five-element acupuncture to usual care resulted in improved health status and wellbeing that was sustained for 12 months.

How on earth did the authors manage to reach a conclusion like that?

The first thing to note is that many of the authors are people who make their living largely from sticking needles in people, or advocating alternative medicine. The authors are Charlotte Paterson, Rod S Taylor, Peter Griffiths, Nicky Britten, Sue Rugg, Jackie Bridges, Bruce McCallum and Gerad Kite, on behalf of the CACTUS study team. The senior author, Gerad Kite MAc , is principal of the London Institute of Five-Element Acupuncture London. The first author, Charlotte Paterson, is a well known advocate of acupuncture. as is Nicky Britten.

The conflicts of interest are obvious, but nonetheless one should welcome a “randomised controlled trial” done by advocates of alternative medicine. In fact the results shown in the Figure are both interesting and useful. They show that acupuncture does not even produce any substantial placebo effect. It’s the authors’ conclusions that are bizarre and partisan. Peer review is indeed a broken process.

That’s really all that needs to be said, but for nerds, here are some more details.

How was the trial done?

The description "randomised" is fair enough, but there were no proper controls and the trial was not blinded. It was what has come to be called a "pragmatic" trial, which means a trial done without proper controls. They are, of course, much loved by alternative therapists because their therapies usually fail in proper trials. It’s much easier to get an (apparently) positive result if you omit the controls. But the fascinating thing about this study is that, despite the deficiencies in design, the result is essentially negative.

The authors themselves spell out the problems.

“Group allocation was known by trial researchers, practitioners, and patients”

So everybody (apart from the statistician) knew what treatment a patient was getting. This is an arrangement that is guaranteed to maximise bias and placebo effects.

"Patients were randomised on a 1:1 basis to receive 12 sessions of acupuncture starting immediately (acupuncture group) or starting in 6 months’ time (control group), with both groups continuing to receive usual care."

So it is impossible to compare acupuncture and control groups at 12 months, contrary to what’s stated in Conclusions.

"Twelve sessions, on average 60 minutes in length, were provided over a 6-month period at approximately weekly, then fortnightly and monthly intervals"

That sounds like a pretty expensive way of getting next to no effect.

"All aspects of treatment, including discussion and advice, were individualised as per normal five-element acupuncture practice. In this approach, the acupuncturist takes an in-depth account of the patient’s current symptoms and medical history, as well as general health and lifestyle issues. The patient’s condition is explained in terms of an imbalance in one of the five elements, which then causes an imbalance in the whole person. Based on this elemental diagnosis, appropriate points are used to rebalance this element and address not only the presenting conditions, but the person as a whole".

Does this mean that the patients were told a lot of mumbo jumbo about “five elements” (fire earth, metal, water, wood)? If so, anyone with any sense would probably have run a mile from the trial.

"Hypotheses directed at the effect of the needling component of acupuncture consultations require sham-acupuncture controls which while appropriate for formulaic needling for single well-defined conditions, have been shown to be problematic when dealing with multiple or complex conditions, because they interfere with the participative patient–therapist interaction on which the individualised treatment plan is developed. 37–39 Pragmatic trials, on the other hand, are appropriate for testing hypotheses that are directed at the effect of the complex intervention as a whole, while providing no information about the relative effect of different components."

Put simply that means: we don’t use sham acupuncture controls so we can’t distinguish an effect of the needles from placebo effects, or get-better-anyway effects.

"Strengths and limitations: The ‘black box’ study design precludes assigning the benefits of this complex intervention to any one component of the acupuncture consultations, such as the needling or the amount of time spent with a healthcare professional."

"This design was chosen because, without a promise of accessing the acupuncture treatment, major practical and ethical problems with recruitment and retention of participants were anticipated. This is because these patients have very poor self-reported health (Table 3), have not been helped by conventional treatment, and are particularly desperate for alternative treatment options.".

It’s interesting that the patients were “desperate for alternative treatment”. Again it seems that every opportunity has been given to maximise non-specific placebo, and get-well-anyway effects.

There is a lot of statistical analysis and, unsurprisingly, many of the differences don’t reach statistical significance. Some do (just) but that is really quite irrelevant. Even if some of the differences are real (not a result of random variability), a glance at the figures shows that their size is trivial.

My conclusions

(1) This paper, though designed to be susceptible to almost every form of bias, shows staggeringly small effects. It is the best evidence I’ve ever seen that not only are needles ineffective, but that placebo effects, if they are there at all, are trivial in size and have no useful benefit to the patient in this case..

(2) The fact that this paper was published with conclusions that appear to contradict directly what the data show, is as good an illustration as any I’ve seen that peer review is utterly ineffective as a method of guaranteeing quality. Of course the editor should have spotted this. It appears that quality control failed on all fronts.

### Follow-up

In the first four days of this post, it got over 10,000 hits (almost 6,000 unique visitors).

The Daily Mail exceeds itself in an article by Jenny Hope whch says “Millions of patients with ‘unexplained symptoms’ could benefit from acupuncture on the NHS, it is claimed”. I presume she didn’t read the paper.

The Daily Telegraph scarcely did better in Acupuncture has significant impact on mystery illnesses. The author if this, very sensibly, remains anonymous.

Many “medical information” sites churn out the press release without engaging the brain, but most of the other newspapers appear, very sensibly, to have ignored ther hyped up press release. Among the worst was Pulse, an online magazine for GPs. At least they’ve publish the comments that show their report was nonsense.

The Daily Mash has given this paper a well-deserved spoofing in Made-up medicine works on made-up illnesses.

“Professor Henry Brubaker, of the Institute for Studies, said: “To truly assess the efficacy of acupuncture a widespread double-blind test needs to be conducted over a series of years but to be honest it’s the equivalent of mapping the DNA of pixies or conducting a geological study of Narnia.” ”

There is no truth whatsoever in the rumour being spread on Twitter that I’m Professor Brubaker.

Euan Lawson, also known as Northern Doctor, has done another excellent job on the Paterson paper: BJGP and acupuncture – tabloid medical journalism. Most tellingly, he reproduces the press release from the editor of the BJGP, Professor Roger Jones DM, FRCP, FRCGP, FMedSci.

"Although there are countless reports of the benefits of acupuncture for a range of medical problems, there have been very few well-conducted, randomised controlled trials. Charlotte Paterson’s work considerably strengthens the evidence base for using acupuncture to help patients who are troubled by symptoms that we find difficult both to diagnose and to treat."

Oooh dear. The journal may have a new look, but it would be better if the editor read the papers before writing press releases. Tabloid journalism seems an appropriate description.

Andy Lewis at Quackometer, has written about this paper too, and put it into historical context. In Of the Imagination, as a Cause and as a Cure of Disorders of the Body. “In 1800, John Haygarth warned doctors how we may succumb to belief in illusory cures. Some modern doctors have still not learnt that lesson”. It’s sad that, in 2011, a medical journal should fall into a trap that was pointed out so clearly in 1800. He also points out the disgracefully inaccurate Press release issued by the Peninsula medical school.

Some tweets

Twitter info 426 clicks on http://bit.ly/mgIQ6e alone at 15.30 on 1 June (and that’s only the hits via twitter). By July 8th this had risen to 1,655 hits via Twitter, from 62 different countries,

@followthelemur Selina
MASSIVE peer review fail by the British Journal of General Practice http://bit.ly/mgIQ6e (via @david_colquhoun)

@david_colquhoun David Colquhoun
Appalling paper in Brit J Gen Practice: Acupuncturists show that acupuncture doesn’t work, but conclude the opposite http://bit.ly/mgIQ6e
Retweeted by gentley1300 and 36 others

@david_colquhoun David Colquhoun.
I deny the Twitter rumour that I’m Professor Henry Brubaker as in Daily Mash http://bit.ly/mt1xhX (just because of http://bit.ly/mgIQ6e )

@brunopichler Bruno Pichler
http://tinyurl.com/3hmvan4
Made-up medicine works on made-up illnesses (me thinks Henry Brubaker is actually @david_colquhoun)

@david_colquhoun David Colquhoun,

@psweetman Pauline Sweetman
Read @david_colquhoun’s take on the recent ‘acupuncture effective for unexplained symptoms’ nonsense: bit.ly/mgIQ6e

@bodyinmind Body In Mind
RT @david_colquhoun: ‘Margaret McCartney (GP) also blogged acupuncture nonsense http://bit.ly/j6yP4j My take http://bit.ly/mgIQ6e’

@abritosa ABS
Br J Gen Practice mete a pata na poça: RT @david_colquhoun […] appalling acupuncture nonsense http://bit.ly/j6yP4j http://bit.ly/mgIQ6e

amusing!RT @david_colquhoun: paper in Brit J Gen Practice shows that acupuncture doesn’t work,but conclude the opposite http://bit.ly/mgIQ6e

@kashfarooq Kash Farooq
Unbelievable: acupuncturists show that acupuncture doesn’t work, but conclude the opposite. http://j.mp/ilUALC by @david_colquhoun

@NeilOConnell Neil O’Connell
Gobsmacking spin RT @david_colquhoun: Acupuncturists show that acupuncture doesn’t work, but conclude the opposite http://bit.ly/mgIQ6e

@euan_lawson Euan Lawson (aka Northern Doctor)
Aye too right RT @david_colquhoun @iansample @BenGoldacre Guardian should cover dreadful acupuncture paper http://bit.ly/mgIQ6e

@noahWG Noah Gray
Acupuncturists show that acupuncture doesn’t work, but conclude the opposite, from @david_colquhoun: http://bit.ly/l9KHLv

8 June 2011 I drew the attention of the editor of BJGP to the many comments that have been made on this paper. He assured me that the matter would be discussed at a meeting of the editorial board of the journal. Tonight he sent me the result of this meeting.

 Subject: BJGP From: “Roger Jones” To: Dear Prof Colquhoun We discussed your emails at yesterday’s meeting of the BJGP Editorial Board, attended by 12 Board members and the Deputy Editor The Board was unanimous in its support for the integrity of the Journal’s peer review process for the Paterson et al paper – which was accepted after revisions were made in response to two separate rounds of comments from two reviewers and myself – and could find no reason either to retract the paper or to release the reviewers’ comments Some Board members thought that the results were presented in an overly positive way; because the study raises questions about research methodology and the interpretation of data in pragmatic trials attempting to measure the effects of complex interventions, we will be commissioning a Debate and Analysis article on the topic. In the meantime we would encourage you to contribute to this debate throught the usual Journal channels Roger Jones Professor Roger Jones MA DM FRCP FRCGP FMedSci FHEA FRSA Editor, British Journal of General Practice Royal College of General Practitioners One Bow Churchyard London EC4M 9DQ Tel +44 203 188 7400

It is one thing to make a mistake, It is quite another thing to refuse to admit it. This reply seems to me to be quite disgraceful.

20 July 2011. The proper version of the story got wider publicity when Margaret McCartney wrote about it in the BMJ. The first rapid response to this article was a lengthy denial by the authors of the obvious conclusion to be drawn from the paper. They merely dig themselves deeper into a hole. The second response was much shorter (and more accurate).

 Thank you Dr McCartney Richard Watson, General Practitioner Glasgow The fact that none of the authors of the paper or the editor of BJGP have bothered to try and defend themselves speaks volumes. Like many people I glanced at the report before throwing it away with an incredulous guffaw. You bothered to look into it and refute it – in a real journal. That last comment shows part of the problem with them publishing, and promoting, such drivel. It makes you wonder whether anything they publish is any good, and that should be a worry for all GPs.

30 July 2011. The British Journal of General Practice has published nine letters that object to this study. Some of them concentrate on problems with the methods. others point out what I believe to be the main point, there us essentially no effect there to be explained. In the public interest, I am posting the responses here [download pdf file]

Thers is also a response from the editor and from the authors. Both are unapologetic. It seems that the editor sees nothing wrong with the peer review process.

I don’t recall ever having come across such incompetence in a journal’s editorial process.

Here’s all he has to say.

 The BJGP Editorial Board considered this correspondence recently. The Board endorsed the Journal’s peer review process and did not consider that there was a case for retraction of the paper or for releasing the peer reviews. The Board did, however, think that the results of the study were highlighted by the Journal in an overly-positive manner. However,many of the criticisms published above are addressed by the authors themselves in the full paper.

If you subscribe to the views of Paterson et al, you may want to buy a T-shirt that has a revised version of the periodic table.

5 August 2011. A meeting with the editor of BJGP

Yesterday I met a member of the editorial board of BJGP. We agreed that the data are fine and should not be retracted. It’s the conclusions that should be retracted. I was also told that the referees’ reports were "bland". In the circumstances that merely confirmed my feeling that the referees failed to do a good job.

Today I met the editor, Roger Jones, himself. He was clearly upset by my comment and I have now changed it to refer to the whole editorial process rather than to him personally. I was told, much to my surprise, that the referees were not acupuncturists but “statisticians”. That I find baffling. It soon became clear that my differences with Professor Jones turned on interpretations of statistics.

It’s true that there were a few comparisons that got below P = 0.05, but the smallest was P = 0.02. The warning signs are there in the Methods section: "all statistical tests were …. deemed to be statistically significant if P < 0.05". This is simply silly -perhaps they should have read Lectures on Biostatistics. Or for a more recent exposition, the XKCD cartoon in which it’s proved that green jelly beans are linked to acne (P = 0.05). They make lots of comparisons but make no allowance for this in the statistics. Figure 2 alone contains 15 different comparisons: it’s not surprising that a few come out "significant", even if you don’t take into account the likelihood of systematic (non-random) errors when comparing final values with baseline values.

Keen though I am on statistics, this is a case where I prefer the eyeball test. It’s so obvious from the Figure that there’s nothing worth talking about happening, it’s a waste of time and money to torture the numbers to get "significant" differences. You have to be a slavish believer in P values to treat a result like that as anything but mildly suggestive. A glance at the Figure shows the effects, if there are any at all, are trivial.

I still maintain that the results don’t come within a million miles of justifying the authors’ stated conclusion “The addition of 12 sessions of five-element acupuncture to usual care resulted in improved health status and wellbeing that was sustained for 12 months.” Therefore I still believe that a proper course would have been to issue a new and more accurate press release. A brief admission that the interpretation was “overly-positive”, in a journal that the public can’t see, simply isn’t enough.

I can’t understand either, why the editorial board did not insist on this being done. If they had done so, it would have been temporarily embarrassing, certainly, but people make mistakes, and it would have blown over. By not making a proper correction to the public, the episode has become a cause célèbre and the reputation oif the journal will suffer permanent harm. This paper is going to be cited for a long time, and not for the reasons the journal would wish.

Misinformation, like that sent to the press, has serious real-life consequences. You can be sure that the paper as it still stands, will be cited by every acupuncturist who’s trying to persuade the Department of Health that he’s a "qualified provider".

There was not much unanimity in the discussion up to this point, Things got better when we talked about what a GP should do when there are no effective options. Roger Jones seemed to think it was acceptable to refer them to an alternative practitioner if that patient wanted it. I maintained that it’s unethical to explain to a patient how medicine works in terms of pre-scientific myths.

I’d have love to have heard the "informed consent" during which "The patient’s condition is explained in terms of imbalance in the five elements which then causes an imbalance in the whole person". If anyone had tried to explain my conditions in terms of my imbalance in my Wood, Water, Fire, Earth and Metal. I’d think they were nuts. The last author. Gerad Kite, runs a private clinic that sells acupuncture for all manner of conditions. You can find his view of science on his web site. It’s condescending and insulting to talk to patients in these terms. It’s the ultimate sort of paternalism. And paternalism is something that’s supposed to be vanishing in medicine. I maintained that this was ethically unacceptable, and that led to a more amicable discussion about the possibility of more honest placebos.

It was good of the editor to meet me in the circumstances. I don’t cast doubt on the honesty of his opinions. I simply disagree with them, both at the statistical level and the ethical level.

30 March 2014

I only just noticed that one of the authors of the paper, Bruce McCallum (who worked as an acupuncturist at Kite’s clinic) appeared in a 2007 Channel 4 News piece. I was a report on the pressure to save money by stopping NHS funding for “unproven and disproved treatments”. McCallum said that scientific evidence was needed to show that acupuncture really worked. Clearly he failed, but to admit that would have affected his income.

Watch the video (McCallum appears near the end).

The British Medical Journal for 10 December 2010 carried a real classic, Integrative medicine and the point of credulity (it is no longer behind pay wall).

The subtitle was

"So called integrative medicine should not be used as a way of smuggling alternative practices into rational medicine by way of lowered standards of critical thinking. Failure to detect an obvious hoax is not an encouraging sign "

The use of the terms "integrated medicine" or "integrative medicine" as a form of bait and switch has been discussed quite a lot on this blog (e..g. here and here).

Two common reactions when reading about various sorts of magic medicine are "You couldn’t make it up" and "If you believe that you’ll believe anything". One way to test just how much a true believer will believe is the spoof paper. This was used to devastating effect by Alan Sokal, to demolish the pretentious nonsense of postmodernism.

John C. McLachlan of Durham University put the idea to the test, with hilarious results. He responded to one of those spam emails that invite you to speak at a conference, in this case “The Jerusalem Conference on Integrative Medicine.”.

"I have discovered a new version of reflexology, which identifies a homunculus represented in the human body, over the area of the buttocks. The homunculus is inverted, such that the head is represented in the inferior position, the left buttock corresponds to the right hand side of the body, and the lateral aspect is represented medially. As with reflexology, the “map” responds to needling, as in acupuncture"

"Unfortunately, this novel paradigm may meet with closed minds and automatic rejection. Patience and understanding of “closed” mindsets is essential in order to advance this new discovery in a way commensurate with its importance."

The helpful diagram (above) explained all. Unbelievably, he soon got an answer.

Dear Prof. John C. McLachlan,

You have sent a proposal to the The (sic) Jerusalem International Conference on Integrative Medicine. We are happy to inform you that the Scientific Committee has reached it’s (sic) decision and that your paper has been accepted and you will be able to present your lecture.

The scientific committee?

How did universities come to employ the sort of brain-dead people who could take something like this seriously? No doubt they have nice suits and ties, but lack something between the ears.

London South Bank University recently advertised at a salary £66,000 to £74,000 "London South Bank University is delighted to announce this new full time post of Professor of Integrated Health and Traditional Chinese Medicine". This makes a heartbreaking contrast to brilliant postdoctoral fellows on short insecure contracts, doing wondeful science for half that pay.

There is too much intellectual corruption in universities and vice-chancellors defend it rather than root it out, If the London South Bank school of quackery wants to save some money in the presnt financial crunch, it’s obvious where they should start. More details on this when they respond to my Freedom of Information requests.

### Follow-up

 Number 19 Buckingham Street, London WC2N 6EF.is to be the home of the proposed "College of Medicine" that has arisen from the ashes of the late unlamented Prince’s Foundation for Integrated Health (their last accounts can be seen at Quackometer). Naturally one must ask if the "College of Medicine" will propagate the same sort of barmy ideas as the Prince’s Foundation used to do,  A visit to Companies House shows the auguries are not good 19 Buckingham Street

For one thing, the name College of Medicine has existed only since May 2010.  The company was registered originally 19th November 2009 as The College of Integrated Health, but after a teleconference on 5th May 2010 it changed its name, presumably to make itself sound more like real medicine.  This happened immediately after the closure of the Prince’s Foundation on April 30th.

There is no doubt that the "College of Medicine" is the direct descendent of the Prince of Wales’ Foundation. In a powerpoint show dated 9th November 2009 (before the name change) this slide is to be found.

The author of the slide show is specified as "Linda". That, it is a fair bet, must be Linda Leung, who was Operations Director of the Prince’s Foundation until it closed, and is now Company Secretary for the "College of Medicine".

The final form of the "College" is still being argued about, but guess who will open it?

When ask about how Charles’ relationship with the College, The Office of TRH The Prince of Wales and The Duchess of Cornwall declined to make any comment, but simply referred me to Michael Dixon, who, in turn referred me to Pat Goodall.

Recently a statement from Clarence House to the Guardian said that "the Prince of Wales was aware of the college, but “has not been involved with setting-up the college, is not launching it and has no official role with it". That’s the official line anyway.

It is, of course, almost impossible to find out exactly what the relationship is between Prince Charles himself and the new "College". He operates largely out of sight, and the Freedom of Information Act, disgracefully, excludes his interference in the democratic process from public scrutiny.

### Who is paying?

Flat 5 at 19 Buckingham Street was recently valued at half a million pounds.  There is some serious money behind this venture. The rumour is that it’s from a ‘private donor’.  Small prize for anyone who finds out who it is.

### Aims of the College

The stated object of the College is "to advance health for the public benefit".  Sounds good, but what does it mean?  It doesn’t take long to find out. It is laid out in the document from Companies House.

To further its objects the Charity may:
7.1 engage with and develop communities of health professionals, health care providers and patients;
7.2 set standards and promote excellence in the fields of health and care;
7.3 lead, represent, train and support stakeholders so that they are better equipped to serve the public in improving the health ofthe public;
7.4 establish an evidence base for integrated health and for individual complementary modalities;
7.5 promote, foster and advance an integrated approach to health and care;
7.6 raise public, professional and political awareness and cultivate a sentiment in favour of an integrated approach to health and care by publishing and distributing books, pamphlets, reports, leaflets, journals, films, tapes and instructional matter on any media;

and so on, for 36 paragraphs. Already in paragraph 4 to 6 we see their interest is to promote “integrated health” and “complementary modalities. These of course are just what most of the rest of the world calls quackery. The objects don’t differ greatly from the Prince’s Foundation from which this outfit sprang.

### What will be taught at the College?

Some information about the preliminary plans can be gleaned from a letter that describes the new College (download the letter). The letter says

“The College is developing two groups of courses. The first is aimed at registered professionals such as doctors, nurses and physiotherapists. It will familiarise them with different aspects of CAM and develop skills they can use in their day to day practice – not least techniques they can pass on to patients to help them manage their own conditions.”

In other words, the only course for doctors will be to teach them about quackery. Final judgement on that must await information about who will teach it.

“The second group of courses is aimed at non-registered practitioners and will focus on developing their understanding of conventional medicine, including ‘red flag’ symptoms, familiarisation with conventional therapeutics and increased awareness of critical appraisal.”

The other course, it seems, will be for quacks, to try to teach them enough real medicine to prevent them from killing too many people. The bit about teaching them about “critical appraisal” is hard to believe. If that were really done the clients would mostly be out of business.

If you were in any doubt at all about the aims of the College, it is necessary only to look at the four directors of the Company

### Directors of the College of Medicine.

• Dr Michael Dixon, general practitioner. Michael Dixon was Medical Director of the Prince’s Foundation until it closed down.
• Professor George Lewith, is Professor of Health Research in the Complementary Medicine Research Unit, University of Southampton. He was a Foundation Fellow of the Prince’s Foundation until it closed down.
• Professor David Peters. is Professor of Integrated Healthcare and Clinical Director at the University of Westminster’s School of Integrated Health.
He was a Foundation Fellow of the Prince’s Foundation until it closed down.

• Mrs Christine Glover is a pharmacist who sells homeopathic pills. She was a Foundation Fellow of the Prince’s Foundation until it closed down.

The company secretary is named as Linda Leung, who was Operations Director of the Prince’s Foundation until it closed.

A request to Michael Dixon for information was deflected to Mrs Pat Goodall She is yet another connection with PFIH. Mrs Goodall acted as a spokesperson for the Prince’s Foundation until it closed down. Now she is scheduled to become Director of Policy and Communications for the "College of Medicine". Mrs Goodall declined to say where the money came from. But she did say that the College was not the "equivalent of a further education college,. . . or higher education college", That being the case, it seems very odd to use the name "College of Medicine". It is a downright misleading name.

These people are all well know advocates of alternative medicine, It is very obvious that the "College of Medicine", despite its misleadingly innocuous name, is simply a reincarnation of the Prince’s Foundation for Integrated Health.

The term "integrated" is, of course, simply a euphemism for alternative medicine. That means those forms of medicine for which there is little or no evidence that they work. When evidence that something works is found, it is called simply medicine.

### Dr Michael Dixon OBE

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.”

“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.

You can read more about Michael Dixon at Dr Aust’s blog (Dr Michael Dixon is annoyed), and, from the USA, Steven Novella’s analysis in Dr. Michael Dixon – “A Pyromaniac In a Field of (Integrative) Straw Men”

### Professor George Lewith,

George Lewith has appeared quite often in this blog. He first came to my attention when I discovered in 2006 that his private clinic was offering a well-known form of fraudulent allergy diagnosis, the Vega test, despite the fact that Lewith himself had written a paper that said it didn’t work.

Lewith is particularly keen on acupuncture and that most discredited form of quackery, homeopathy. On More 4 News, he actually claimed that there was no good sham form of acupuncture. That is simply not true: great ingenuity has gone into devising controls for acupuncture trials and ‘real’ acupuncture always comes out the same as sham.

### Professor David Peters

David Peters comes from the University of Westminster, which is famous for offering more degrees than any other in anti-scientific nonsense.

Westminster is home of the quite remarkable teaching that "Amethysts emit high Yin energy". dowsing, aura photography and other such fairground frauds.

Westminster offers also a "BSc degree" in that quite remarkable branch of make-believe known as naturopathy, This teaches students about a totally insane form of psycho-babble called Emo-trance and they are taught (no. seriously) about diagnosis with dowsing and pendulums

Westminster also teaches about kinesiology.  Sounds sort of sciencey, but Applied Kinesiology is actually a fraudulent and totally ineffective diagnostic method invented by (you guessed) a chiropractor.   It has been widely used by alternative medicine to misdiagnose food allergies. It does not work (Garrow, 1988: download reprint).

Westminster offers “BSc degrees” in Chinese Medicine that are a menace to public health. Their unfortunate students are told "Legally, you cannot claim to cure cancer. This is not a problem because we treat people not diseases". It is hard to imagine anything more irresponsible,

David Peters, as Clinical Director at Westminster must bear responsibility for this load of irresponsible make-believe,  I have no doubt that he is well-intentioned but some of the stuff on these courses is a serious danger to public health.

### Mrs Christine Glover

Mrs Glover is an Edinburgh pharmacist. She claims

She believes symptoms rarely occur in isolation but are usually linked to a persons circumstancs [sic].

Illness occurs when there are imbalances in any of the physical, emotional and spiritual aspects of their life.

Well, yes and no, Would you really go to her if you had cancer, or tuberculosis, or even atrial flutter? Judging by her website, what you’d get is a bottle of her Liquid Iron & Vitamin Formula (for £16.25 !). Or any one of a range of homeopathic pills.

There is no branch of alternative medicine that is more totally discredited than homeopathy. Yet now it i being proposed to form a College of Medicine with four directors who are all part of the dwindling band that insists you can do magic with pills that contain no medicine.

### Who else supports the College?

There are some pretty surprising people who are listed in the letter as supporting the College of Medicine, though it remains to be seen how many are left once the true nature of the College is known.

Some of the supporters were already Foundation Fellows of the Prince’s Foundation, despite having no obvious sympathy with quackery. These include Professor Sir Cyril Chantler, Professor Adrian Eddleston and Professor Simon Gibbons. They also include the notorious Karol Sikora, and the geochemist Professor Jane Plant.

Professor Jane Plant is, apparently, a distinguished geochemist, but she developed an obsession with dairy-free diets, after her own experiences with breast cancer. She has written a lot of books and, no doubt, made a lot of money from the desperate. An extracr from one of her books is titled “Why I believe that giving up milk is the key to beating breast cancer”. If you want to see the ‘evidence’ for some of her wild claims, her web site invites to join -at a cost of £30. To get a bit closer to the truth it is only necessary to quote the World Cancer Research Fund (WCRF) Report on diet and cancer, ‘Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective‘. The WCRF is inclined, in my view, to exaggerate the strength of the evidence for a causal link between diet and cancer (see Diet and health. What can you believe: or does bacon kill you?) but nevertheless their assessment of dairy products is very different from Plant’s.

"The strongest evidence, corresponding to judgements of ‘convincing’ and ‘probable’, shows that milk probably protects against colorectal cancer, and that diets high in calcium are a probable cause of prostate cancer."

It seems that Jane Plant’s claims are thoroughly irresponsible.

I’m told that two people who were also Foundation Fellows, and who were originally listed as supporters of the College seem to have already jumped ship, namely Professor Stephen Holgate and Baroness Finlay.

Professor Sir Graeme Catto is to be president, and I’m told, Professor Sir Ian Kennedy has agreed to be vice president.

It is incomprehensible to me why people like this should be willing to lend their names to the Prince’s Foundation in the first place, or to its replacement now..

Other people listed as supporters include Sir Donald Irvine, Professor John Cox, and, on the "scientific advisory committee, Professor Mustafa Djamgoz and Professor Ajit Lalvani.

None of these people has an obvious belief in quackery. sp what are they doing mixed up with a venture like this?

Graeme Catto tells me he “knows very little about CAM”, and Cyril Chantler says the College should deal with evidence-based integrated medicine “but not alternative medicine or homeopathy”. Since, during his time as a Foundation Fellow of the Prince’s Foundation, Cyril Chantler failed totally to shake the advocacy of homeopathy by them, it seems unlikely yhat he’ll be any more successful with the College.

The only member of the "scientific advisory committee" who has answered by invitation to comment on a draft of this post is Professor Mustafa Djamgoz. It seems that he is more gullible that meets the eye He said, for example,

“There are many ‘eastern’ remedies (such as acupuncture that we witnessed dismissed 25 year ago) that work.”

“We ourselves have already shown that natural substances like omega-3 polyunsaturated fatty acids, reseveratrol [sic] etc can produce anti-cancer effects by blocking ion channels.”

Clearly Professor Djamgoz has not been keeping up with research in these areas. Has he never read Barker Bausell’s book on acupuncture, Snake Oil Science.? Apparently not. And there is, of course, not the slightest reason to think that omega-3 or resveratrol help cancer in humans.

It is often said that the reason that eminent people support quackery is that they live in hopes of a peerage. That is, perhaps, a bit uncharitable. I think it more likely that they don’t bother to investigate closely what it is they are signing up to, and that they are fooled by the weasel words of “integrated medicine”.

People like Catto and Chantler seem to think they are supporting caring, human centred, medicine. I fear they have been fooled, They are supporting sheer quackery.

### Patient centred medicine

One of the most infuriating characteristics of quacks is their attempt to hi-jack the ‘human side of medicine’. I suppose they have little else to offer, so it’s understandable. But there is nothing human about deceiving desperate patients and the human side of medicine is something that is emphasised in the education of every real doctor.

If you want to know more about it, there is no better exposition than Michael Baum’s Samuel Gee lecture. Baum has been at the forefront of thinking about supportive or spiritual care of cancer patients. His 2009 Samuel Gee lecture is available in video, Concepts of Holism in Orthodox and Alternative Medicine. It is a masterpiece. He ends the lecture thus.

“Alternative versions of “holistic medicine” that offer claims of miracle cures for cancer by impossible dietary regimens, homeopathy or metaphysical manipulation of non-existent energy fields, are cruel and fraudulent acts that deserve to be criminalized.”

A similar distinction has been made with beautiful clarity by Dr James May

“The use of the term ‘integrative medicine’ in your editorial seems to confuse more than clarify the problem of ‘holism’ in medicine. Complementary therapists for example often use the term ‘holistic’ to blur the boundaries between the therapies used and the practitioner’s interpersonal skills. It would be better, however, to keep these distinctions clear. Caring is different from curing.”

“‘Holism’ is not a multifaceted approach to curing, it is a multifaceted approach to caring”

“Effective medicine is best measured with RCTs. Caring is not. ‘Integrative medicine’ therefore risks both damaging how we measure effective medicines (RCTs), as well as reducing caring to measurables. A better term for this might be ‘disintegrative medicine’.Effective medicine is best measured with RCTs. Caring is not. ‘Integrative medicine’ therefore risks both damaging how we measure effective medicines (RCTs), as well as reducing caring to measurables. A better term for this might be ‘disintegrative medicine’.”

I hope that the various eminent people who have lent their name to this mis-named ‘College of Medicine’ will look very carefully at what it actually does. And that will probably mean withdrawing their support.

### Follow-up

The Guardian, 2nd August 2010, carried this story, written by their science correspondent, Ian Sample: College of Medicine born from ashes of Prince Charles’s holistic health charity. He quotes Tracey Brown of the Sense about Science charity as saying that the college’s emphasis on merging conventional medicine with unproven complementary therapies “would take society back a century”.

“Despite its mission to promote the integration of alternatives to medicine, this new body has chosen to call itself very grandly the College of Medicine. Perhaps someone thinks this will sound good with Royal in front of it? This wouldn’t be a surprise given the institution’s origins in the Prince of Wales’s efforts to integrate his favoured traditional remedies into medicine.”

Quotation from DC

I’m baffled. Why is it that beautiful, high quality blogs like Orac’s Respectful Insolence, wanted to be on a commercially-run site in the first place?

Scienceblogs is such a site and it recently caused a crisis when it accepted a paid PR piece by Pepsico (without warning its bloggers first). This was not to be with the obvious advertisements in the side bars, but published like any other blog, Scienceblogs is a commercial organisation, owned and operated by the Seed Media group. The response to the crisis by Adam Bly was leaked and can be read here. It is, in my view, not anything like good enough. One of the great beauties of the internet is that it is really quite hard to keep things secret.

ScienceBlogs was offensive enough even before Pepsigeddon. I go there to read Orac, not to be bombarded with adverts for phone companies and the very sort of quackery that Orac so eloquently exposes. Perhaps Americans are more inured to constant mendacious advertising through their TV and radio. Thank heavens for the BBC which makes (some) good programmes and never has advertisements.

### Should people be paid to blog?

I have no objection to people being paid for work that they do. I have had occasional payments from newspapers (and the BMJ) for articles that they have commissioned. This makes a nice change. Scientists usually work for nothing but their salary, and that is how it should be. We write up our results in papers, and then, quite often, we pay the journal to publish our work, and then pay again to buy the journal in which it appears. [That, together with the crisis in peer review, is what persuades me that the current publishing system is broken, but that is a different story.].

We travel the world to give talks for nothing (well just occasionally a small honorarium). Not infrequently we don’t even get paid the full cost of travel.

And those of us who blog, mostly do that for free too. This site costs nothing but a few pounds a year for the domain name, and that comes from my own pocket [and a lot more of my time than I could have afforded when I was doing full time science).

I’m not grumbling about any of this. On the contrary, I enjoy the science and I enjoy the blogging. I am (or was) adequately paid. What more can one ask? The great virtue of not being paid is that you are behoven to nobody. The whole point of science, and the whole point of blogging, is to provide an independent opinion, your own opinion, on matters of science.

I’m only grateful that so many people seem to feel that some of the things I say are worth reading. I do it because it is interesting, it is fun, and it might even do a bit of public good.

Any hint that you may be selling a story on behalf of someone else is the kiss of death, both in real science and in blogging. It doesn’t have to be real, just the perception is enough to ruin your credibility.

To expect independent scientific views from Pepsi is whistling in the wind. Everyone knows about the hugely powerful lobbying by the food industry. The ruthlessness of the industry is, one might argue, counter-productive, because even if they were to produce a totally honest assessment of the evidence, nobody would believe it.

Anyone who has been involved in the battle against junk medicine knows that one is always accused of being a shill for Big Pharma. Of course the purveyors of junk medicine are not very good at checking their facts. If they were, they’d be in a more honest job.

### Bhopal report blocked by Seed Magazine

“As for Bhopal, it’s a cautionary call on our part as we’re in the midst of advertising negotiations with Dow”

This sort of behaviour is much scarier than taking paid blogs from Pepsico, if only because it was secret at the time. The wonderful thing about blogs is that it isn’t secret now. It shows that, notwithstanding their fine words, Seed is not serious about scientific independence if it endangers their income.

### Science and commerce don’t mix

Seed pay their contributors per page view, though I haven’t yet been able to discover how much (will anyone tell me?)

Most of the people who write for Scienceblogs do not rely on what they get paid by Seed for their bread and butter. Many of those I like best are practising physicians and surgeons. No doubt they are far richer than I have ever been. In my view they should leave Scienceblogs right now, before they lose any more credibility. Several already have.

If anyone doubts the corrupting effects of commercial interests in medicine, listen to this year’s Sense about Science lecture by Fiona Godlee (editor of the BMJ). The podcast has appeared on The Guardian’s web site. And if you are interested in the corrupting effects of commercial pressures in the alternative medicine industry there are plenty of sources in the links at the bottom of the right hand sidebar.

### Follow-up

Interesting. I got a direct message from one blogger on Twitter, in answer to my question about how much Seed pays bloggers.

“Seed pays peanuts: I usually get $100 –$200/ month, depending on # of page views. It goes up in increments of \$25 per 10,000 extra visitors”

That’s a bit more than I’d guessed, but hardly a significant contribution to the pay of most people who write for them.

This week’s edition of Nature Neuroscience carried a paper with the title “Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture“.  The paper was not without interest, but it tells one nothing about acupuncture in humans.

The mice had their paws injected with rather unpleasant stuff called Complete Freund’s Adjuvant. This makes them inflamed and sore, so they are unusually sensitive to pain.  When the mice were pierced with human-sized needles, and the needles rotated, they responded a bit less to painful stimuli.

The newspaper reports of this paper were even worse than usual.

The worst of the lot was Richard Alleyne, in the Daily Telegraph: “Acupuncture does work as it stimulates a natural pain killer, scientists find“.

Fiona McCrae in the Daily Mail was marginally better, with “Let’s get straight to the point, acupuncture DOES ease pain“. At least she manages to include a brief critical comment from Edzard Ernst.

Even the usually-excellent Ian Sample in the Guardian was unusually gullible with “Acupuncture may ease pain by triggering release of natural painkiller“. The subheading did say the study was done in mice not man, but there was no critical comment and, as in the other reports, no attempt to summarise what’s known already about acupuncture.

Worse still, it wasn’t just the newspapers.  There were similar poor reports in Science magazine, in Scientific American, and even the Nature news blog left a lot to be desired.

When this sort of misreporting occurs, it often seems to come from the press release (another case documented here).  Many journalists never get any further than the press release, Here is Nature‘s press release.

 How needles pierce pain Embargoed until: 30-May-2010 13:00 US Eastern time | 18:00 London time 31-May-2010 02:00 Japanese time | 03:00 Australian Eastern time DOI: 10.1038/nn.2562 Acupuncture can relieve many kinds of pain, but it remains unclear how it might work, beyond the possibility of a strong placebo effect. A study published online in Nature Neuroscience now shows that acupuncture locally activates pain-suppressing receptors which could be the key to the treatment’s ability to relieve pain. Maiken Nedergaard and colleagues inserted fine needles into the mouse equivalent of a traditional acupuncture point near the knee, and rotated these needles intermittently as is practiced by acupuncturists. This alleviated the pain reactions of mice with an inflamed paw, and it also strongly increased the local tissue concentration of the neurotransmitter adenosine. Pain relief required the presence of a particular adenosine receptor. It is known that this receptor resides on pain-transmitting nerve fibers and can reduce the activity of these fibers. The authors found that no pain relief or adenosine elevation was observed when the needles were simply inserted into the acupuncture point without rotation. They also noted that a drug that prolongs the lifetime of adenosine in live tissue helped to prolong the pain-attenuating effect of mouse acupuncture. It should be noted that while this work suggests a mechanism for local pain relief by acupuncture, it does not in any way endorse the ancient mystical idea that the needles work by correcting some aberrant “qi” energy flow along “meridians”. Instead, the authors propose a model whereby the minor tissue injury caused by rotated needles triggers adenosine release, which, if close enough to pain-transmitting nerves, can lead to the suppression of local pain. Author contact: Maiken Nedergaard (University of Rochester Medical Center, Rochester, NY, USA) nedergaard@urmc.rochester.edu

The title, and the first sentence, are tendentious, to put it mildly.  The false assertion that "Acupuncture can relieve many kinds of pain" misrepresents entirely the current state of the evidence.  A lot has been written about acupuncture, not least on this blog, but the current position can be summed up roughly as follows.

1. It has been found time and time again that no difference can be detected between real and sham acupuncture in blind comparisons, and
2. a non-blind comparison between acupuncture and no-acupuncture usually shows some advantage for the acupuncture, but the effect is small, transient and very variable.  A recent review from the Nordic Cochrane group concluded the effect was barely big enough to be clinically significant.

The odds are that acupuncture is no more than a theatrical placebo.

The press release should have made all this clear, but failed to do so. But then the paper itself also failed to make the context clear.

The abstract of the paper starts "Acupuncture is an invasive procedure commonly used to relieve pain."  The second paragraph starts "Although the analgesic effect of acupuncture is well documented, little is understood about its biological basis".  It is simply not true that "analgesic effect of acupuncture is well documented".  It is not.  Try reading Barker Bausell’s excellent book, “Snake Oil Science” if you want to know about the strength of the evidence.

The whole paper is written with the underlying premise that acupuncture works, and all that needs to be done is to explain why.  How the paper got past the referees in its present form beggars belief.

Journals like Nature Neuroscience, like it or not, have a certain prestige. Of course, the prestige is exaggerated, and like all journals, it has some good papers and some poor ones. With that prestige comes responsibility to ensure that press releases are accurate. But one often has the impression that press releases are written with the aim of getting wide press coverage, and prestige for the journal, rather that as critical evaluations of the science.  This is one such case.

Martin Rees said today, in his first Reith lecture, that "science is organised scepticism".  It should be, and in the long run, it is.  This paper is an exception and sadly it isn’t alone.

### Other commentaries on this paper

There have already been some excellent commentaries on blogs.  As so often, the best bloggers are sharper than the scientific journals.  If it were not for the fact that my comments on Twitter got some criticism from Nature, I wouldn’t have bothered to add to the following excellent analyses.

Ed Yong, in the Discover site was quick off the mark with A biological basis for acupuncture, or more evidence for a placebo effect?. This provides more detail than I’ve given here. It also has an intriguing postscript.

“PS: The paper notes that the authors have no competing financial interests that might have affected their work. However, it is worth noting that one of the co-authors, Jurgen Schnermann, is married to one Josephine Briggs. Briggs is the director of the National Center for Complementary and Alternative Medicine [NCCAM], an institute that has had its fair share of controversy in the past.”

NCCAM is, of course the branch of the US National Institutes of Health that has spent over a billion dollars of US taxpayers’ money without coming up with a single good treatment.  This is rather fascinating, because the report in the Telegraph ends with a laudatory comment from, ahem. Dr Josephine Briggs.

Dr Josephine Briggs, director of the National Centre for Complementary and Alternative Medicine at the National Institutes of Health in the US, said: “It is clear that acupuncture may activate a number of different mechanisms.

“This carefully performed study identifies adenosine as a new player in the process. It is an interesting contribution to our growing understanding of the complex intervention which is acupuncture.”

James Cole at the Stuff and Nonsense blog has another take on the same work, under the ironic title Acupuncture Works, Say Scientists

At Respectful Insolence, Orac gives a superb and thorough account. Read it: When what an acupuncture study shows is much more interesting than what acupuncture believers think it shows.

### Follow-up

This morning I noticed a Daily Mail poll for the winner of last night’s leaders’ debate, so I cast my vote

The results looked like this

Click to enlarge

(This picture was recorded after lunch at 14.29, so it says I’d already voted.) At the time of writing it is still there, at http://www.dailymail.co.uk/debate/polls/poll.html?pollId=1017189, though not for much longer I suspect.

Then I saw on Twitter a link to the refpls web site. They had very smartly noticed that the URL for the poll, linked from the Mail’s front page, and from the article on the debate, had changed to http://www.dailymail.co.uk/debate/polls/poll.html?pollId=1017190, So I voted again there and this time I wasn’t told I’d already voted. The result was utterly different. At about 14.30 it showed Cameron ahead (just).

Click to enlarge

Admittedly the first poll shows a pretty exaggerated idea of Clegg’s lead. That’s why on-line polls like this are worth next-to-nothing,

It seems that the Daily Mail. not liking the result of their first poll, simply trashed it and began again.

Even by the standards of the Daily Mail, that is cynical dishonesty.

You can vote yourself in the second version at http://www.dailymail.co.uk/debate/polls/poll.html?pollId=1017190

In the wake of the report by the Science and Technology Committee (STC) on the lack of evidence for homeopathy, and the Chinese medicine poisoning, the BBC carried at least three very bad reports. Being a strong supporter of the BBC that saddens me.

Nevertheless it has to be said that the BBC does not always do very well on science reporting.  Too many of the reports are anonymous -you don’t know who to blame or who to write to.  Worse still, the BBC’s reports on its web site usually fail to link to original sources. This is unforgiveable: the ability to link to sources is the huge advantage of the web over print media.

### The problem of balance in media reports

The question of balance is important. Ofcom imposes an obligation that reporting should reflect  the balance of viewpoints. Section 5 of Ofcom’s broadcasting code says (emphasis is mine).

“Section 5: Due Impartiality and Due Accuracy and Undue Prominence of Views and Opinions”

“To ensure that news, in whatever form, is reported with due accuracy and presented with due impartiality.”

“Meaning of “due impartiality”: “Due” is an important qualification to the concept of impartiality. Impartiality itself means not favouring one side over another. “Due” means adequate or appropriate to the subject and nature of the programme. So “due impartiality” does not mean an equal division of time has to be given to every view, or that every argument and every facet of every argument has to be represented.”

The BBC Trust has a very similar definition of "due impartiality".

It seems to me that in practice producers tend to use "equal time"  too much, and that this often gives a quite misleading impression of the state of play of informed opinion.  Nevertheless, inappropriate use of “equal time” is so common that it would not be worth a formal complaint. This post concerns cases of very unequal time,

Somebody said recently, it is as though after an air crash one gave equal time to the air accident investigator and a representative gravity-deniers association.  That is scarcely an exaggeration of what happened on the BBC after the STC’s report.

Worse still, far more time was given (especially on ‘Call You and Yours’) to the viewpoint that any scientist, indeed any informed person, would regard as quackery.

This post gives details of three examples of highly partial reporting and it is the basis of complaints to the BBC. But since complaints to the BBC about science reporting rarely get far, a complaint
is being sent also to Ofcom.

### (1) Call You and Yours: a platform for herbalists

You and Yours is often quite a good programme, They did an excellent job on a "snoring remedy" which I had unearthed.  But on Tuesday 23 February they did a "Call You and Yours" phone-in programme which was badly researched and highly partial.

The presenter, Julian Worricker, didn’t know enough about the topic to ask the right questions, though I’d guess that the blame for the poor quality must lie more with the person who decided that the only "expert" on the programme was a herbalist, and with the people who screened the phone calls.

The programme was billed as being a reaction to the case of a Chinese medicine practitioner who poisoned a patient, and to the publication of the report of Science and Technology Select Committee which damned homeopathy.

The programme can be heard here (at you own risk of bursting a blood vessel) Download mp3 file (43.6 Mb)

The major mistake was that the only "expert" on the programme was Michael McIntyre who is chair of the European Herbal & Traditional Medicine Practitioners Association. McIntyre is a well known advocate of alternative medicine, who constantly fudges the need for proper evidence. He is very keen to increase the respectability of herbalists (like all alternative practitioners, he is desperate to be accepted as a real doctor). In fact McIntyre doesn’t even represent all herbalists. . He failed to mention, and the presenter apparently didn’t know, that 2553 herbalists (as of 24 Feb) signed a petition that opposes the sort of pseudo-regulation the McIntyre wants so desperately.

"We the undersigned strongly object to the Government’s proposals to statutorily regulate herbalists and change section 12(1) of the 1968 Medicines Act."

Not to mention this was a serious error on the part of the researchers for this programme.

This was a programme about alternative medicine in which the ONLY expert was a notorious alternative medicine advocate. It was one of the most highly biassed programmes I have ever heard from the BBC. McIntyre most certainly does not represent the views of science or medicine, as shown, for example, by the submission from Sense About Science, the Academy of Medical Royal Colleges, the Institute of Biomedical Science, the Medical Research Society, the Medical Schools Council, the Physiological Society and the Royal College of Pathologists. The opinion of these not insubstantial people was not mentioned anywhere in the programme.

Here is a summary of the main points in the programme. It shows the bias very clearly. Furthermore the people who selected the phone calls seemed to pick almost all people who advocated alternative medicine.

(1) A lengthy anecdote relating a miraculous “cure” of fibromyalgia with homeopathy. No challenge or alternative interpretation was offered.

(2) A pharmacist (for heavens sake) who said she’d "seen results" from homeopathy and didn’t care whether or not it was placebo. She wasn’t challenged on the problem of lying about whether or not is placebo.  We’ve had cause before to worry about the quality of advice given my pharmacists.

(3) Another long anecdote from a nurse (!) claiming to have been "cured" if fibroids by acupressure and cupping. No challenge or alternative interpretation was offered.

(4) Then some emails read out, mostly pro-quack. Only one claiming no effect (in asthma) but that was an anecdote too. Mostly more miracle cures.

(5) Michael McIntyre has the first of several long speeches. advocating more research. There was an advertisement for his web site "promotes best practice" (allegedly). He talks quite seriously about "reflexology" and so on, as though it were real subject (it isn’t; its "principles" are made-up fantasies).

He said. "We need more research in how complementary medicine works".  Notice the inbuilt assumption that it does work. This is directly contradicted by the fact that the USA has spent over a billion dollars on CAM research and come up with not a single useful treatment.  Why did the researchers and the presenter not know about this, and challenge McIntyre?  Once again, the programme researchers seem to be Incompetent.

(7) A caller was mildly critical of fact the Norwich council can’t to anything about claims made by TCM shops (actually Trading Standards could, but generally don’t, but this wasn’t pointed out to the caller).

(8) A caller from Somerset makes the good point that alternative medicine becomes just medicine once it is shown to work.

(9) Michael McIntyre is challenged about evidence, and gives a lengthy speech about why proper RCTs aren’t necessary. They are necessary, but he isn’t challenged. Plus the usual excuse about lack of money for trials.  What about that billion dollars?

(10) The Somerset caller says why restrict yourself to herbs? Good point, but no response.

(11) McIntyre gives another long speech in which he propagates the myth that the impurities in herbal medicines are in some way helpful, or synergistic, This is the only justification that herbalists have for giving impure drugs, but there isn’t the slightest evidence to think it’s true. McIntyre should have been challenged about this, but wasn’t.

At no point was McIntyre challenged about the danger of giving drugs (herbal or otherwise) in unknown doses, as herbalists do. He should have been challenged.

(12) Worker (unspecified) in NHS psychiatry says placebos were used to get patients off drugs. The presenter misses the point by asking if the placebos should be paid for by the NHS. The question he should have asked is about ethics of deceiving patients, but presenter did not do this.

(13) A blatant advertisement from a "health food store" in Barnoldswick. The owners are "pharmacy technicians" (since most pharmacists seem to have difficulties about evidence,
this can’t be regarded as a high qualification). They plug the supplements (almost all unnecessary, a few dangerous) that they sell.

(14) McIntyre again. Says something more or less sensible about drug interactions.

(15) By this time I’d emailed and got in a quick bit about the valuelessness of anecdotes, but was .cut short before I could talk about regulation.

(16) McIntyre defends anecdotes, predictably enough. This time the presenter did raise a good point about how anecdotes should be verified by proper tests but McIntyre again evades the main point that most herbs have not been properly tested, and isn’t challenged.

(17) More emails. A man who takes sage for sore throats. One says "of course homeopathic remedies are placebos but placebos work"; "homeopathy is an extraordinary system for industrialising
the placebo effect, but used by responsible practitioners it has a valuable place". Once again the ethics of deceiving patients with hocus pocus in order to elicit a placebo effect was not raised.
And one caller raised the usual red herring about dogs responding. This, yet again, went unchallenged.  Why wasn’t it pointed out that it is the human who reports the state of the dog who has the placebo response?

(18) Then on to regulation. The researchers and presenter seemed to be quite unaware of the near-unanimous opinion of scientists and also of the Royal College of Physicians, that regulation in the form
proposed by the Pittilo report will be ineffective, and will do more to harm patients than to safeguard them.  There is more than one way to regulate, and this uninformed intervention was especially
unwelcome at a time when the government is considering the question.

(19) Lady with MS said that acupuncture didn’t do her any good at all, but she didn’t like to tell the acupuncturist. But the obvious conclusions were not drawn.

(20) Presenter asks McIntyre leading question "it does work for some and not for others ". No hint there that the ones it "works for" might be the ones who were going to get better anyway. McIntyre himself actual pointed out that some forms of MS (‘relapsing’) undergo spontaneous remissions but of course fails to draw the obvious conclusion that any. He apparent effect of acupuncture could well have been a spontaneous remission. He went on to say (without any evidence) that "acupuncture may help". He relied on the standard line that "more research needed", but failed to mention the vast amount of research that has already been done which shows that acupuncture is probably little more than a theatrical placebo. See, for example, the Nordic Cochrane Centre review and Barker Bausell’s book, Snake Oil Science.

(21) An email points out that anecdotes are no substitute for proper tests. McIntyre then misquotes Sir Michael Rawlins(chair of NICE). He claimed, as most quacks do, that Rawlins had endorsed anecdotes as an acceptable form of evidence in his lecture. This is not what he said at all. In fact Rawlins was referring to treatments that had already passed RCTs and saying that they should be followed up in the wider population of patients to see if they lived up to their initial promise. This interpretation of his words was published in the BMJ after I’d checked it was correct with Rawlins himself.

In the same lengthy speech McIntyre claimed "There really isn’t any dummy acupuncture". This is absolutely untrue, but was not challenged. Huge ingenuity has gone into devising retractable ‘stage dagger’ acupuncture needles, as well as trials that use real needles inserted in the "wrong" positions. One of the most consistent findings in CAM research is that sham acupuncture is not distinguishable from "real" acupuncture. McIntyre, needless to say, didn’t mention this, He should have been challenged but wasn’t.

(21) Declan Naughton (Kingston University) advocates greater "regulation". "If we have trained herbal practitioners" it will make it safer for everyone. Thw revelation of what is actually taught on these degrees shows that, on the contrary, they endanger patients, He claims that use of purified antibiotics leads to problems with drug resistance. There isn’t the slightest reason to think that resistance has anything to do with purification, This was a red herring but went unchallenged. I notice that Naughton has published in Medical Hypotheses, a journal for wild speculations that is not peer-reviewed

(22) Donald Kerr a TCM practitioner, supports McIntyre in looking for statutory regulation. "like the GMC". He is not challenged on the extent to which real medicine and TCM have a sound basis. Like most alternative medicine advocates, he goes for the usual diversionary tactic of criticising western medicine which he refers to as "prescriptive medicines" [sic]

(23) London herbalist Michael Simmons. His web site claims that "Medical Herbalists are trained in the same diagnostic skills as orthodox doctors b". This is simply not true, The fact that herbalists claim it is true mereyl shows how they endanger patients.

(24) Marc Seale, chair of the Health Professions Council (HPC) now appears. he says one very interesting thing "things like false advertising would be dealt with by the regulator". He also acknowledged that there is a strong feeling among scientists and physicians that statutory regulation would give a "false sense of legitimacy " to the area. This latter point was entirely missed by the programme and that seems like another example of incompetent research. But Seale still doesn’t seem to understand the problem, as outlined here and in a joint submission from Sense About Science, the
Academy of Medical Royal Colleges, the Institute of Biomedical Science, the Medical Research Society, the Medical Schools Council, the Physiological Society and the Royal College of Pathologists. This submission opposed regulation of the sort favoured by McIntyre and Seale, but wasn’t even mentioned. Once again, all the speakers were on the same side.

(25. Back once again to McIntyre, who lamented that after ten years of trying, he still hadn’t achieved statutory regulations for herbalists (to the joy of 2500 herbalists), That is simply because they have not fulfilled the requirements for statutory regulation, as laid out in the House of Lords report (2000). That was not mentioned either.  Agani the researchers appear not to have done their job properly.

(26) The presenter, Julian Worricker, refers to Prof. Edzard Ernst as a “divisive figure in this field”. That is a highly partial way to refer to the person who has done more than any other individual to bring together objectively the evidence for the effectiveness of alternative medicine.  Ernst has every scientist and every informed person behind him.

(27) McIntyre again. He misrepresents Ernst’s views and misrepresents the strength of the evidence for the efficacy of herbal medicines, which are mostly untested.. But he is not challenged.

McIntyre goes on to misrepresent the BMJ Clinical Evidence paper which, he says, shows that 46% of all treatments are not proven to be effective. It is hard to be believe that McIntyre is really unaware that a large proportion of those that were not shown to be effective are CAM treatments, herbal medicine and the like. Professor John Garrow has pointed this out (see, also Healthwatch)

“It is true they chortle, but they have got their facts wrong. The 46% of treatments which are not proven to be effective is 46% of all treatments for 240 common conditions – and very few are used in the NHS. The great majority are treatments used by alternative practitioners. “

If McIntyre was not aware of this he should have been, If he was aware of it he was being less than honest. In any case the programme’s researchers should have been aware of it and McIntyrere should have been challenged. He wasn’t.

(28) A bizarre phone call from someone who seems to think that real medicines are not labelled with their ingredients

(29) Seale is asked if alternative medicine can be regulated like real medicine   He says they’ll check degrees. If the checking is done properly, he’ll find endless dangerous made-up material like that revealed here. No degrees on TCM would pass and the whole edifice would collapse.

(30) Another presenter says "it all depends on peoples’ experiences which side they are on".. No!  That is simply not true. Well it may have been be true of the phone callers, but is both misleading and untrue in general, The divide is actually between those who are aware of, and care about, evidence and those who do not.  Some people actually take the questions seriously, but this comment reduced the discussion to the level of the life style section in a downmarket women’s magazine. One expects more of the BBC.

(31) McIntyre pleads that herbal medicines must be all right because they are used widely on continental Europe. This non sequiter went unchallenged.

(32) Seale says we must wait for Department of Health consultation on Pittilo recommendations. Quite right. For the sake of patient safety, one must hope that the Department of Health will listen to the evidence, and not implement them, despite McIntyre’s success in putting one side of the story on this programme.

(33) McIntyre laments the fact that Europe is bringing in some very sensible regulations about herbal medicine.  Again he had free rein to air the views of some (not all) herbalists, with nobody there to support these sensible measures.

### (2) Guilty plea in Chinese herbal ‘cancer’ case

This BBC web page gave a very unbalanced account of the case for and against statutory regulation< of traditional Chinese medicine. It simply echoed the (uninformed) view of the judge that "more regulation is necessary" but it was apparently quite unaware that the form of this regulation is at present under consideration by the Department of Health.

The vast majority of scientific and medical opinion is against the particular form of statutory regulation recommended by the Pittilo steering group, and the author of this anonymous report should have been aware of that.  Why was there no reference to the submission from Sense About Science, the Academy of Medical Royal Colleges, the Institute of Biomedical Science, the Medical Research Society, the Medical Schools Council, the Physiological Society and the Royal College of Pathologists? These are bodies whose views should not have been ignored, as also the individual submissions here and here. It may be acceptable for a judge to be unaware of this powerful body of opinion. It is not acceptable for BBC reporters to ignorant of it.

The web page does now contain a short statement from Sense about Science which goes a small way to redress the imbalance,  That was inserted only after a phone call to the BBC from a member of parliament.

### (3) Woman claims that homeopathy cured her cancer

On February 23rd 2010m the BBC showed a an utterly irresponsible item. A homeopath, Gemma Hoefkens, claimed to have been cured of cancer by taking homeopathic sugar pills. There was nobody to point out the utter impossibility of this claim, just some not-very-probing questions fromt the presenter.

Hoefkens promoted her own web site during the interview.  It is illegal under the Cancer ACt 1939 to claim to be able to cure cancer and this video must come very close to breaking that law.  Some interesting inconsistencies in Hoefken’s account have been pointed out on the Ministry of Truth web site . This was a new low point in science reporting.

### Follow-up

This complaint has been sent to the BBC. But the Ofcome web site says

“However, we cannot consider complaints about accuracy in BBC TV and radio news or complaints about impartiality in BBC TV and radio programmes. These complaints have to be dealt with by the BBC.”

This seems to preclude any independent outside adjudication. Not good.

Mark Henderson wrote a nice piece about impartiality in The Times (Feb 4 2010), “Science Matters: The BBC’s balancing act“. He expresses views that are, in many ways, similar to mine.

Yes, it’s that most boring of non-medicine topics, homeopathy, again.  At lunchtime on Thursday I got a call from a Times journallst, Fay Schopen, to ask if I could do 500 words on the Science and Technology Committee’s Evidence Check report on homeopathy. Bang goes another evening.  The (im)balance was provided by Sara Eames, President of the Faculty of Homeopathy.  As always the media insist on treating the matter as though it were an even argument.  It’s not.  The version I bashed out was three times the length they wanted, and it was skilfully pruned to length by Fay Schopen for the published version.  Here is the original. longer, version, for what it’s worth.

### Should the NHS fund homeopathy?

The problem with parliament is that there aren’t enough doctors in the House.  Or at least there are too many people who seem not to be able to make a critical distinction between what you’d like to be true and what actually is true (no, I’m not talking about Iraq but about something far less important). Perhaps the prime example is David Tredinnick (Cons. Bosworth) who claimed £700 on expenses for his efforts to link astrology and alternative medicine.

Luckily there are a few MPs who are not convinced that healthcare depends on the phase of the moon, and most of them are on the parliamentary Science and Technology Committee (STC).  That committee has been conducting ‘evidence checks’ in an effort to find out the extent to which government policy is based on good evidence.  Last Monday they published Evidence Check 2: Homeopathy.  The report restores ones faith in reason.  It concluded that there is no reason to think homeopathic pills have more effect than a placebo, therefore they should not be paid for by the NHS, and neither was more research justified. The report also criticised the Medicines and Health Regulatory Authority (MHRA) for allowing misleading labelling of homeopathic pills, and the Department of Health for failing the take notice of evidence.

Let’s get one thing straight. Homeopathy is very simple indeed.  The medicine (in dilutions beyond 12C) contains no medicine. Zero, zilch, nothing. That’s why it is a placebo.  Arnica 30C contains not a single molecule of Arnica.  It is like selling strawberry jam that has never seen a strawberry.  Yet Trading Standards officers can do nothing about this gross mislabelling because loopholes in the law allow advocates of magic medicine to get away with it.  It also involves the preposterous idea that the more you dilute a remedy the stronger it gets.  If you want to get drunk quickly, put a drop of whisky in the Atlantic Ocean and take a drop.  It is nothing sort of surreal that the matter is still being discussed after 200 years.

How did these absurd ideas ever take hold?  Around 1800, when homeopathy started, conventional medicine barely existed, and giving nothing was better than being bled and poisoned.  Bleeding patients had been standard medicine for hundreds of years in 1800 despite the fact that it killed people.  It went on so long because it depended on anecdotes, clinical authority and wishful thinking.  These are still the forms of evidence favoured by homeopaths, but real medicine has changed entirely now whereas homeopathy has remained stuck in 1800.

The problem is that homeopaths routinely misrepresent the evidence (if they didn’t they’d be out of business).  The report says

”We regret that advocates of homeopathy, including in their submissions to our inquiry, choose to rely on, and promulgate, selective approaches to the treatment of the evidence base”.

The Society of Homeopaths has the nerve to offer you “An overview of positive homeopathy research”. They quite blatantly omit the very much stronger negative evidence.  The only word for that is dishonesty.

A favourite with homeopaths is a 2005 study in which 6544 consecutive patients were asked how they felt after homeopathic treatment and 50% said they felt better or much better.  That seems a surprisingly small proportion given that most of them would have been treated for minor self-limiting conditions, but we’ll never know because there was no comparison group at all.  As evidence, this is utterly worthless,

Two other defences are commonly offered by homeopaths.  One is patient choice.  The other is that it doesn’t really matter if it’s a placebo if it makes you happy.  Choice is fine as long as it’s informed choice.  If the homeopath said “these pills contain nothing, but you might feel better after taking them anyway”, that would be fine.  But homeopaths never say that.  In any case to deceive the patient into thinking they are being offered real medicine when they are not poses deep ethical problems, and the Department of Health has refused to grasp that nettle.  You might as well say that Chanel No 5 should be available on the NHS because it makes some people feel better.  At the moment we are in the absurd position in which a doctor is not supposed to give placebo knowingly and honestly, but can refer patient to a homeopath for a dishonest placebo.  The fact that the homeopath may genuinely believe in the magic is not a sufficient excuse.

If homeopaths limited themselves to minor self-limiting conditions, they wouldn’t do too much harm.  But non-medical homeopaths (the vast majority, in the Society of Homeopaths) mostly have no idea of their limitations.  They believe they can prevent and treat treat malaria, AIDS, cholera, yellow fever, even cancer..  At this point homeopathy ceases to be a harmless joke but becomes more like culpable homicide.

Recently two homeopaths in Australia were jailed for manslaughter after their own daughter died for want of proper treatment.  That is the sort of thing that happens you put your faith in magic medicine,

Homeopathy is on a par with talking to trees. No decent health service should pay for it.

### Follow-up

Goldacre has lovely piece in the Guardian.

Homeopathy doesn’t work. But are the claims for other medicines any better?

Drug ads that don’t back up their claims show how dumb doctors can be about evidence and how lax regulation has become

After the Commons science and technology committee report this week, and the stupidity of “we bring you both sides” media coverage, you are bored with homeopathy. So am I, but it gives a simple window into the wider disasters in medicine.

He sounds as bored with homeopathy as I am. He points out that while 100% of claims made by homeopaths’ advertisements are untrue, it is also the case that 30 – 60% of advertisements by Big Pharma can’t be justified by evidence. Once again we see the similarity between the alternative industry and the regular industry (though the former still comes out worse).

Michael Grayer (2 march 2010) , at nontoxic.org.uk has some trenchant comments about what the mainstream media call “balance”. What constitutes balanced coverage worries me too, and gave rise to a complaint to the BBC recently.