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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

poll #1
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).

poll 2
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

Jump to follow-up

Balance in reporting | Call You and Yours | Report on regulation | Cancer video

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.

you and yours

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.

Jump to follow-up

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?

Eames
DC

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.

Jump to follow-up

What follows is mostly from the press release for the report of the Science and Technology Select Committee’s report on homeopathy.

Comments on their hearings can be found in Comedy gold in parliament and tragedy from Prince of Wales: editorial in British Medical Journal (Although published before Christmas, the comments on this editorial are still going strong in the BMJ).

scitec report

It seems that the attempts of the British Homeopathic Association to misrepresent the evidence (as documented by Martin Robbins in the Guardian) were not sufficient to fool the MPs.

Committee chairman. Phil; Willis, said

"We were seeking to determine whether the Government’s policies on homeopathy are evidence based on current evidence. They are not."

The NHS As well as recommending, as expected, that NHS funding of homeopathy should end. the report also recommends that no more money should be spent on clinical trials of homeoapthy. The evidence is in and it doesn’t work

The MHRA The Medicines and Health Regulatory Authority (the MHRA) came in for strong criticism when it allowed registering of homeopathic products, and allowed highly misleading labelling of them (see for example, The MHRA breaks its founding principle: it is an intellectual disgrace, and The MHRA loses the plot, and Learned Societies speak out against CAM, and the MHRA). During the committee’s hearings, the CEO of the MHRA, Kent Woods, seemed to say that the labelling of Arnica 30C had been tested to ensure that it did not mislead the public. However evidence subsequently submitted by the MHRA showed that this was not the case. This, rightly. elicited strong criticism in the report

"The MHRA’s user-testing of the label for Arnica Montana 30C—the only product currently licensed under the NRS—was poorly designed, with some parts of the test little more than a superficial comprehension test of the label and other parts actively misleading participants to believe that the product contains an active ingredient.”

With scientific papers it is not acceptable to cut and paste the press release, but for a report of this sort, it summarises the main points succinctly.

The summary of the report

In a report published today, the Science and Technology Committee concludes that the NHS should cease funding homeopathy. It also concludes that the Medicines and Healthcare products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims without evidence of efficacy. As they are not medicines, homeopathic products should no longer be licensed by the MHRA. 

The Committee carried out an evidence check to test if the Government’s policies on homeopathy were based on sound evidence. The Committee found a mismatch between the evidence and policy. While the Government acknowledges there is no evidence that homeopathy works beyond the placebo effect (where a patient gets better because of their belief in the treatment), it does not intend to change or review its policies on NHS funding of homeopathy. 

The Committee concurred with the Government that the evidence base shows that homeopathy is not efficacious (that is, it does not work beyond the placebo effect) and that explanations for why homeopathy would work are scientifically implausible.

The Committee concluded—given that the existing scientific literature showed no good evidence of efficacy—that further clinical trials of homeopathy could not be justified.

In the Committee’s view, homeopathy is a placebo treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception. Prescribing of placebos is not consistent with informed patient choice—which the Government claims is very important—as it means patients do not have all the information needed to make choice meaningful.

Beyond ethical issues and the integrity of the doctor-patient relationship, prescribing pure placebos is bad medicine. Their effect is unreliable and unpredictable and cannot form the sole basis of any treatment on the NHS.

The report also examines the MHRA licensing regime for homeopathic products. The Committee is particularly concerned over the introduction of the National Rules Scheme (NRS) in 2006, as it allows medical indications on the basis of study reports, literature and homeopathic provings and not on the basis of randomised controlled trials (RCTs) – the normal requirement for medicines that make medical claims.

The MHRA’s user-testing of the label for Arnica Montana 30C—the only product currently licensed under the NRS—was poorly designed, with some parts of the test little more than a superficial comprehension test of the label and other parts actively misleading participants to believe that the product contains an active ingredient.

The product labelling for homeopathic products under all current licensing schemes fails to inform the public that homeopathic products are sugar pills containing no active ingredients. The licensing regimes and deficient labelling lend a spurious medical legitimacy to homeopathic products.

The Chairman of the Committee, Phil Willis MP, said:

“This was a challenging inquiry which provoked strong reactions. We were seeking to determine whether the Government’s policies on homeopathy are evidence based on current evidence. They are not.

“It sets an unfortunate precedent for the Department of Health to consider that the existence of a community which believes that homeopathy works is ‘evidence’ enough to continue spending public money on it. This also sends out a confused message, and has potentially harmful consequences. We await the Government’s response to our report with interest.”

Follow-up

A lot of people gave written about the SciTech report. The report of the Parliamentary Select Committee appeared. Evidence check homeopathy damned the policy of both the Department of Health and of the MHRA. The main job, apart from a few talk shows, was a visit to the BBC News Channel for an interview about it. Here it is.  The comment about  Chanel Number 5 seemed to go down well on Twitter.

My ,main

Jump to follow-up

.The University of Central Lancashire (UCLAN) is the first place I asked to see teaching materials that were used on its homeopathy “BSc” course. The request was refused, and subsequent internal appeals were refused too, Clearly UCLAN had something to hide.

UClan-logo

An appeal to the information commissioner took almost two years to be judged, but the case was won. The eventual decision by the Information
Commissioner rejected all the grounds that UClan had used to evade the Freedom of Information Act.

UClan appealed against the judgement and I still haven’t got the stuff but that hardly matters now, because the course in question shut its doors. In any case, plenty of stuff from similar courses has leaked out already.

Meanwhile, in September 2008, UCLAN announced an internal review of all its courses in magic medicine, The review seemed to be genuine. For a start they asked me to give evidence to the review (something that no other university has done). They also asked Michael Eslea to give evidence. He is the UCLAN psychologist, whose magnificent open letter probably tipped the authorities into holding the review.

Just in case it is useful to anyone, here is a copy of the written evidence that I sent [download pdf],

Report of the Working Party on the Review of issues associated with Homeopathy, Acupuncture and Chinese Herbal Medicine

1. Introduction

As a consequence of concerns expressed by some colleagues within the University of Central Lancashire (UCLan) Dr Malcolm McVicar, Vice Chancellor appointed a working party to review the issues associated with the University offering courses in Homeopathy, Acupuncture and Chinese Herbal Medicine.

MEMBERSHIP:

Eileen Martin (Chair)                Pro-Vice Chancellor and Dean of Faculty of Health and Social Care 
Professor Gordon Bromage      Head of Centre for Astrophysics
Professor Malcolm Edmunds    Emeritus; Built and Natural Environment
Professor Doris Schroeder        Director of Centre for Professional Ethics
Elaine Austin                               Project Manager, Faculty of Health and Social Care


The report was the subject of a special meeting of UCLAN’s Academic Board on 9th July 2009. The following resolutions were passed.

Resolutions

R1    That further minor revisions be made to the report prior to publication on the University’s website;

R2   That the University refrain from offering any practitioner-qualifying courses in Homeopathy, Acupuncture and Chinese Herbal Medicine until such disciplines have achieved statutory regulation status;

R3    That the University consider offering a limited number of postgraduate research studentships (leading to Masters by Research of PhD) to suitably qualified UCLan students and staff in these disciplines. They should have interdisciplinary supervisory teams to facilitate development of a broad range of research skills and to contribute to the generation of knowledge in CAM;

R4   That the University consider how more interdisciplinary teaching can be achieved, where appropriate, within both undergraduate and postgraduate teaching to facilitate greater exposure to subject expertise and different paradigms.

Resolutions 1, 3 and 4 say very little. Resolution 4 sounds thoroughly relativist. We are talking about medicine, about treating sick patients. There is only one “paradigm”. That is to find treatments that are as effective and safe as possible. There aren’t two sorts of medicine, regular and alternative. There is just medicine that works and medicine that doesn’t work. It’s a good illustration of DC’s rule number 2, “never trust anyone who uses the word paradigm”.

Resolution 2 is the really interesting one, because none if the topics, Homeopathy, Acupuncture and Chinese Herbal Medicine, is subject to statutory regulation.

If taken literally, resolution 2 means that all the UCLan courses in alternative medicine will close their doors. Bafflingly, this inevitable conclusion is not stated explicitly.

At least resolution 2 means that homeopathy, already closed, will stay closed. It is never likely to get statutory regulation.

For practical purposes, we can ignore for the moment the obvious fact that statutory regulation of nonsense subjects results only in nonsense. The only forms of alternative medicine that have got “statutory regulation” at the moment are chiropractic and osteopathy. The public has not been safeguarded by the General Chiropractic Council (GCC). The GCC, on the contrary, has endangered the public by allowing false health claims to be made with impunity. Perhaps the members of the review committee had not noticed that the Simon SIngh affair has resulted in almost 600 complaints being made to the GCC? The faith of the review in statutory regulation is clearly misplaced.

The Pittilo report is critical for what happens next

Acupuncture and Chinese Herbal Medicine are not subject to statutory regulation at present, so one would suppose that these degrees will close their doors too. However the infamous Pittilo report has proposed that they should become regulated by the Health Professions Council (HPC). The many problems of the Pittilo report have been documented here, in “A very bad report: gamma minus for the vice-chancellor“. There was also a high-profile critique of the report in The Times (and on this blog).

The HPC has, as one of its criteria for regulation, “evidence-based practice”. Disgracefully, the HPC has already shown its willingness to ignore its own rules and to act as statutory regulator for Acupuncture and Chinese Herbal medicine. This rather disgraceful behaviour is documented in “Health Professions Council ignores its own rules: the result is nonsense“.

The UCLAN report seems to assume that the recommendations of the Pittilo report will be accepted. But the long-awaited consultation has still not opened. We can be sure that when it does, the opposition to it will be very strong indeed.

The report in full

Here are a few comments on the report itself.    Download the full report (as of July 15th).

i have to say that when I visited Preston to give evidence, my views seem to be treated seriously, even sympathetically, so it was a great disappointment to see the outcome. So what’s wrong? The major disaster is declared early in the report.

Section 2, Context

The debate is centred on a number of key themes which relate to:-

1. The quality of and/or absence of an evidence base to support claims of the efficacy and benefits of such treatments, linked to issues of public safety/protection and professional regulation.

Sounds good. What matters about any sort of medicine is whether or not it works and whether it is safe. It therefore verges on the incredible that we read in section 4.1

“conclusions from research into the efficacy of the various CAM’s are outside the remit of this report.”

The whole point about CAM is that there is very little evidence that any of it works. So the review committee decided to ignore the most important problem of the lot.  I can’t see how any rational decision can be made without first deciding whether the treatment is better than placebo.  That, surely, is the main question, and it was dodged.

UCLAN has failed to grasp the nettle, just as the Department of Health has also consistently failed to do so.

Section 4,1  Efficacy   This section repeats the assertion, absurd to my mind, that it is possible to judge CAM courses while declining to assess whether they work or not.

Section 4.2 Role of Universities in Society.

There is universal agreement that critical thinking is crucial to the idea of a university, but the judgement of whether CAM teaches critical thinking is simply fudged. Again the report fails to grasp the nettle.

“Disagreements about critical thinking within CAMs arises because some will argue that such substantiation and assessment can occur within the discipline, whilst others will argue that the methodology for substantiation, that is evidence provision, is universal. As a result, the latter will demand that evidence is provided using methods from one field (e.g. randomised controlled trials) for use in another.”

Sadly, the report dodged the crucial judgement once again. The most obvious characteristic of every form of alternative medicine is their total lack of critical self-appraisal. It is very sad that the review committee could not bring itself to say so.

Section 4.4   Nomenclature of degrees

Recommendation
The nomenclature of courses, leading to a professional as well as an academic award, should reflect the professional route; for example Bachelor with Honours in Complementary Medicine, B Comp. Med.(Hons) or B Acupuncture (Hons).

This sounds to me like another truly pathetic fudge. What on earth is solved by changing the name of the degree? You’d still be teaching students the same load of gobbledygook and then letting them loose on sick people, whether you call it a Bachelor of Science, a Bachelor of Arts, or, as is recommended here, a Bachelor of nothing whatsoever.

Well, I suppose there is a (doubtless unintended) irony in calling CAM degrees “Bachelor of nothing whatsoever”.

Section 4.4   Ethical, non-harm and economic considerations

This section list a lot of reasons why teaching alternative medicine should be unethical. but nevertheless manages to conclude that

” . . . it is not unethical to offer courses in Homeopathy, Acupuncture and Chinese Herbal Medicine at a university.”

I find the logic by which this bizarre conclusion was reached quite impossible to follow. Like much of the rest of the report this conclusion seems to stem from a reluctance to grapple with the really important questions, like ‘does it work or not?’.

Despite this the recommendation is perhaps the most interesting of all.

Recommendation
• The University refrains from offering any CAM courses until such disciplines have achieved statutory regulation status.”

This recommendation was accepted, and passed as a resolution at Academic Board. If it is implemented now, than there will be no more alternative medicine degrees next year at the University of Central Lancashire. If and when this happens, the University must be congratulated on its return to rational medicine.

Follow-up

Michael Eslea, UCLAN’s hero in resisting nonsense from the inside, has posted on this topic.

17 July 2009. It seemed odd that that no announcement was made about the future if the remaining CAM courses at UCLAN. So I asked deputy Vice-Chancellor Patrick McGhee for clarification. After a couple of days, I got this response.

From: CTheobald@uclan.ac.uk

To: d.colquhoun@ucl.ac.uk
Subject: uclan clarification

Hi David,

I have been asked to respond to your question below on the running of acupuncture and Chinese herbal medicine at UCLan. It is correct to assume that UCLan will not be taking any new entrants onto these programmes until further notice.

Best Wishes

Chris

Chris Theobald
Corporate Communications
University of Central Lancashire

So the report may have been disappointing, but it has done the job. As several people have pointed out in comments, it would be asking too much to expect a university to say “sorry we just noticed that we have been running junk-science courses for years”. But they have done the right thing anyway.

Jump to follow-up

That isn’t my title. It is the title of a post by Richard Lanigan, with whom I’ve been corresponding. He has a major grudge against the General Chiropractic Council. And in particular he is disaffected about the GCC’s chair, Peter Dixon, about whom he has written a lot, I can’t judge the details of his complaints, but they are laid out in detail on his blog, http://chiropracticlive.com/

Particular interest attaches to his recent revelation of a letter that was sent on July 8th to its members by the McTimoney Chiropractic Association. The McTimoney sect of chiropractic are the ‘true believers’ in the most mystical codswallop aspects of the subject. Oddly enough their College has been validated by the University of Wales, I’ve put in a Freedom of Information Act reguest to the University of Wales to see how that happened. Watch this space.

My interpretation of this letter is that it is as near as you can get to an admission, by chiropractors themselves, that many chiropractors make claims that are against the law. And worse still, that the McTimoney Chiropractic Assocation is well aware of that.

News travels fasts in the blogosphere. This item has already appeared today on The Quackometer, The Lay Scientist and Gimpy and on Zeno’s blog. Let’s hope that the news spreads far and wide.

Date: 8 June 2009 09:12:18 BDT

Subject: FURTHER URGENT ACTION REQUIRED!

Dear Member

If you are reading this, we assume you have also read the urgent email we sent you last Friday.  If you did not read it, READ IT VERY CAREFULLY NOW and  – this is most important – ACT ON IT.  This is not scaremongering.  We judge this to be a real threat to you and your practice.

Because of what we consider to be a witch hunt against chiropractors, we are now issuing the following advice:

The target of the campaigners is now any claims for treatment that cannot be substantiated with chiropractic research.  The safest thing for everyone to do is as follows.

  1. If you have a website, take it down NOW.

When you have done that, please let us know preferably by email or by phone. This will save our valuable time chasing you to see whether it has been done.

  1. REMOVE all the blue MCA patient information leaflets, or any patient information leaflets of your own that state you treat whiplash, colic or other childhood problems in your clinic or at any other site where they might be displayed with your contact details on them.  DO NOT USE them until further notice. The MCA are working on an interim replacement leaflet which will be sent to you shortly.
  1. If you have not done so already, enter your name followed by the word ‘chiropractor’ into a search engine such as Google (e.g. Joe Bloggs chiropractor) and you will be able to ascertain what information about you is in the public domain e.g. where you might be listed using the Doctor title or where you might be linked with a website which might implicate you. We have found that even if you do not have a website yourself you may still have been linked inadvertently to a website listing you or your services.

CHECK ALL ENTRIES CAREFULLY AND IF IN DOUBT, CONTACT THE RELEVANT PROVIDER TO REMOVE YOUR INFORMATION.

CHECK OUR PREVIOUS EMAILS FOR SPECIFIC ADVICE AND KEY WORDS TO AVOID.

KEEP A LOG OF YOUR ACTIONS.  

  1. If you use business cards or other stationery using the ‘doctor’ title and it does not clearly state that you are a doctor of chiropractic or that you are not a registered medical practitioner, STOP USING THEM immediately.

5.   Be wary of ‘mystery shopper’ phone calls and ‘drop ins’ to your practice, especially if they start asking about your care of children, or whiplash, or your evidence base for practice.

IF YOU DO NOT FOLLOW THIS ADVICE, YOU MAY BE AT RISK FROM PROSECUTION.

IF YOU DO NOT FOLLOW THIS ADVICE, THE MCA MAY NOT BE ABLE TO ASSIST YOU WITH ANY PROCEEDINGS.

Although this advice may seem extreme or alarmist, its purpose is to protect you.  The campaigners have a target of making a complaint against every chiropractor in the UK who they perceive to be in breach of the GCC’s CoP, the Advertising Standards Code and/or Trading Standards.  We have discovered that complaints against more than 500 individual chiropractors have been sent to the GCC in the last 24 hours.

Whatever you do, do not ignore this email and make yourself one of the victims. Some of our members have not followed our earlier advice and now have complaints made against them.  We do not want that to happen to you.

Even if you do not have a website, you are still at risk. Our latest information suggests that this group are now going through Yellow Pages entries. Be in no doubt, their intention is to scrutinise every single chiropractor in the UK.

The MCA Executive has worked tirelessly over the last week keeping abreast of development and contacting at risk members.  We have decided that this is our best course of action to protect you and the Association at this time of heightened tension.  This advice is given to you solely to protect you from what we believe is a concerted campaign, and does not imply any wrongdoing on your part or the part of the Association.  We believe that our best course of action is simply to withdraw from the battleground until this latest wave of targeting is over.

Finally, we strongly suggest you do NOT discuss this with others, especially patients, Firstly it would not be ethical to burden patients with this, though if they ask we hope you now have information with which you can respond.

Most importantly, this email and all correspondence from the MCA is confidential advice to MCA members alone, and should not be shared with anyone else.    

Please be aware that the office phone lines are likely to be busy, so, if you need our help, please send an email to the office and we will get back to you as soon as we can.

Yours,

Berni Martin

MCA Chair.

Best wishes,

Nicki

Nicki Choules-Rowe

Administrative Officer – Executive Liaison

McTimoney Chiropractic Association

Crowmarsh Gifford

Wallingford OX10 8DJ

Tel : 01491 829494

www.mctimoney-chiropractic.org

free debate

Follow-up

The deleted pages are here. Thanks again to quackometer, here is where you can see the pages that might have been taken down as a result of McTimoney’s letter. I hope they won’t grumble. Really, they sjould never have put them up if they weren’t true, should they?.

Jump to follow-up

Today brings a small setback for those  of us interested in spreading sensible ideas about science.  According to a press release

“The BMJ Group is to begin publishing a medical journal on acupuncture from next year, it was announced today (Tuesday 11 November 2008).

This will be the first complementary medicine title that the BMJ Group has published.”

And they are proud of that? What one earth is going on?   The BMJ group is a publishing company which says, of itself,

“Our brand stands for medical credibility.   We are one of the world’s best known and most respected medical publishers.”

Well perhaps it used to be.

They have certainly picked a very bad moment for this venture.  In the last year there have been at least five good books that assess the evidence carefully and honestly.  Of these, the ones that are perhaps the best on the subject of acupuncture are Singh & Ernst’s Trick or Treatment and Barker Bausell’s Snake Oil Science.  Both Ernst and Bausell have first hand experience of acupuncture research.  And crucially, none of these authors has any financial interest in whether the judgement goes for acupuncture or against it.

Here are quotations from Singh & Ernst’s conclusions

“Reliable conclusions from systematic reviews make it clear that acupuncture does not work for a whole range of conditions, except as a placebo.”

“There are some high quality trials that support the use of acupuncture for some types of pain and nausea, but there are also high quality trials that contradict this conclusion.  In short, the evidence is neither consistent nor convincing – it is borderline.”

The House of Lords’ report in 2000 tended to give acupuncture the benefit of the (very considerable) doubt that existed at the time the report was written.  Since that time there have been a lot of very well-designed trials of acupuncture.

Now it is quite clear that,  for most (and quite possibly all) conditions, acupuncture is no more than a particularly theatrical placebo.  Perhaps that is not surprising insofar as the modern western practice of acupuncture owes more to Chinese nationalistic propaganda that started in the time of Mao-Tse Tung than it owes to ancient wisdom (which often turns out to be bunk anyway).

The BMJ Group has decided to endorse acupuncture at a time when it is emerging that the evidence for any specific effect is very thin indeed.  Well done.

The journal in question is this.

Acupuncture in Medicine is a quarterly title, which aims to build the evidence base for acupuncture. It is currently self-published by the British Medical Acupuncture Society (BMAS).

One good thing can be said about the Society and the Journal. That is that they don’t espouse all the mumbo-jumbo about ‘meridians’ and ‘Qi’. This, of course, puts them at odds with the vast majority of acupuncture teaching.  This sort of internecine warfare between competing sects is characteristic of all sorts of alternative medicine.  But that is just ideology.  What matters is whether or not sticking needles in you is actually anything more than a placebo.

British Medical Acupuncture Society (BMAS)

The British Medical Acupuncture Society (BMAS). is “a registered charity established to encourage the use and scientific understanding of acupuncture within medicine for the public benefit.”.   The phrase “encourage the use” suggests that they do not even envisage the possibility that it might not work.  Their web site includes these claims.

Acupuncture can help in a variety of conditions:

  • Pain relief for a wide range of painful conditions
  • Nausea, especially postoperative nausea and vomiting
  • Overactive bladder, also known as bladder detrusor instability
  • Menstrual and menopausal problems, eg period pains and hot flushes
  • Allergies such as hay fever and some types of allergic rashes
  • Some other skin problems such as ulcers, itching and localised rashes
  • Sinus problems and more

Presumably the word “help” is chosen carefully to fall just short of “cure”.  The claims are vaguely worded, but let’s see what we can find about them from systematic reviews.  It appears that the BMAS is being rather optimistic about the evidence.

BMJ Clinical Evidence is considered reliable and is particular interesting because it is owned by the BMJ Publishing Group.

Low Back Pain (chronic) Acupuncture is listed as being of “unknown effectiveness”.

Dysmenorrhoea Acupuncture is listed as being of “unknown effectiveness”.

Osteoarthritis of the knee.  Acupuncture is listed as being of “unknown effectiveness”.

Psoriasis (chronic plaque) Acupuncture is listed as being of “unknown effectiveness”.

Neck pain “Acupuncture may be more effective than some types of sham treatment (not further defined) or inactive treatment (not further defined) at improving pain relief at the end of treatment or in the short term (less than 3 months), but not in the intermediate term (not defined) or in the long term (not defined)”

Headache (chronic tension-type) Acupuncture is listed as being of “unknown effectiveness”.

What about the greatest authority, the Cochrane Reviews?

Cochrane Reviews

Low back pain The data do not allow firm conclusions about the effectiveness of acupuncture for acute low-back pain. For chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and “alternative” treatments. The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low-back pain. Because most of the studies were of lower methodological quality, there certainly is a further need for higher quality trials in this area.

Chronic asthma.  There is not enough evidence to make recommendations about the value of acupuncture in asthma treatment. Further research needs to consider the complexities and different types of acupuncture.

But most of the vaguely-worded claims made by BMAS have not been the subject of Cochrane reviews.  The obvious interpretation of that is that there is not enough evidence to make it worth writing a review.  In which case, why does BMAS claim that acupuncture can “help”?

Bandolier is another excellent source of high quality information, This was their view in September 2006

“Large, high-quality randomised trials of acupuncture have been published since the reviews. In fibromyalgia, chemotherapy-induced nausea and vomiting, breech presentation, tension headache, and migraine, all were negative compared with sham acupuncture. One in osteoarthritis of the knee, had statistical improvement over sham acupuncture at three months, but not later. Both large trials and this review of reviews come to the same general conclusion; that over a whole range of conditions and outcomes acupuncture cannot yet be shown to be effective.”

After thousands of years of acupuncture (or at least almost 40 years in the West) there seems to be very little to show for it.

The journal: Acupuncture in Medicine

What about the journal in question?  Like all journals devoted to alternative medicine, it claims to be evidence-based.  And like all journals devoted to alternative medicine it suffers from a fatal conflict of interest.  If this journal were ever to conclude that acupuncture is a placebo, it would destroy the journal and the livelihoods of many of the people who write for it.

Scanning the first three issues of 2008 shows that it is very much like other alternative medicine journals.  Most of the papers don’t address the critical question, is it a placebo.  And most papers end up rather limply, with a statement along the lines “acupuncture may be useful for ***.  More research is needed.”

The editor in chief of the journal is Dr Adrian White, and its editor  is Michael Cummings.  White is quoted by Ernst in the Guardian in 2004.

“We need to provide hard evidence to support what we all see in our clinics every day: that the modern approach to acupuncture works, and is highly relevant to the new,  patient-centred NHS.” .

That means the answer is assumed in advance. That just isn’t science.. ‘We know the answer, all we have to do now is get some evidence’.

Why should the BMJ Group want to do a thing like this?

The press release says

Commenting on the move, BMJ and BMJ Journals Publishing Director, Peter Ashman, said “The journal is a good complement for our existing portfolio of journals and we’re certain that the Society’s members and other subscribers will appreciate the benefits of the decision the BMAS has made on their behalf.”

He continued: “The BMAS is ambitious for its journal to grow and flourish and we’re looking forward to working with the Society to develop an editorial and commercial strategy which will achieve the aims of BMAS and those of its members, while reaching out to the wider global community interested in this fascinating area of medicine.”

Yes, you got it.  Money.  The same motive that causes some vice-chancellors to bring their university into disrepute by awarding BSc degrees in subjects that are not only not science, but which are oftenly openly anti-science.

Conscience doesn’t seem to bother these people, so let’s put the problem in purely cash terms.

Both the BMJ Group and the vice-chancellors will have to decide whether the cash they gain is sufficient to counterbalance the corrosive effects of their actions on their own reputations.

Follow-up

Only a couple of days later, two new trials show acupuncture is no different from sham controls for helping IVF pregnancy rates. James Randerson in the Guardian writes thus.

“Acupuncture aimed at improving IVF success rates is widely offered by fertility clinics in the UK. In the first of the studies, researchers in Hong Kong split 370 women receiving IVF into two groups. One group received real acupuncture before and after having an IVF embryo implanted into their uterus. The other had the same procedure, except the treatment used retractable needles that did not penetrate the skin.”

“Of the 185 who received the sham treatment, 91 achieved a clinical pregnancy (foetal heartbeat identified using ultrasound) and 71 had a successful delivery. This compared with 72 clinical pregnancies in the true acupuncture group and 55 live births. The differences between the groups were not statistically significant.”

“In a second study, researchers in Chicago used a similar design in which 124 women received true or sham acupuncture. The control group had their skin punctured by real acupuncture needles, but not at genuine “Qi-lines” on the body.   In the true acupuncture group, 43.9% achieved a clinical pregnancy, compared with 55.2% of the women given the sham treatment. “

The original paper for the first study can be seen here.

Jump to follow-up

Latest: Michael Reiss resigns 16 September 2008: see below

There has been something of a rumpus in the media today when the education secretary of the Royal Society, Michael Reiss, appeared to endorse the teaching of creationism in science classes,  The BBC’s report was only too typical.

“Call for creationism in science”

“Creationism should be discussed in school science lessons, rather than excluded, says the director  of education at the Royal Society.”

The Guardian’s report, perhaps also not entirely accurate, started with the words

“Creationism and intelligent design should be taught in school science lessons, according to a leading expert in science education.”

After lunch today the email below was sent out to Fellows

Dear Fellow/Foreign Member

Royal Society’s position on the teaching of creationism in schools

You may have seen in the today’s media coverage of the Royal Society’s position on the teaching of creationism in schools, following a speech by the Society’s Director of Education.  Unfortunately, much of the coverage has given a misleading impression of the Society’s policy.

To prevent further confusion, a statement clarifying the Society’s position has been issued today and the text is given below:

“The Royal Society is opposed to creationism being taught as science.  Some media reports have misrepresented the views of Professor Michael Reiss, Director of Education at the Society expressed in a speech yesterday.

Professor Reiss has issued the following clarification. “Some of my comments about the teaching of creationism have been misinterpreted as suggesting that creationism should be taught in science classes. Creationism has no scientific basis. However, when young people ask questions about creationism in science classes, teachers need to be able to explain to them why evolution and the Big Bang are scientific theories but they should also take the time to explain how science works and why creationism has no scientific basis.”

In addition, we are working actively to correct the misunderstanding by dealing directly with individual newspapers and broadcast media.



So that seems clear “The Royal Society is opposed to creationism being taught as science.”.  So I shan’t have to resign.

You can be sure that proponents of creationism, and its dishonestly disguised version, “intelligent design” will exploit this misunderstanding ruthlessly.

Much more of this and I’ll have to revive my old religion page. I thought for a moment that we were going back to the dark ages of Sarah Palin.

Watch this space for developments.

Follow-up

Perhaps this matter is not so trivial after all. The Guardian report Reiss as saying

“science teachers should not see creationism as a “misconception” but as an alternative “world view” “

The BBC says

“Rather than dismissing creationism as a “misconception”, he says it should be seen as a cultural “world view”. “

Most importantly, Reiss himself said, in a Guardian blog (not the original speech), on September 11th,

“I feel that creationism is best seen by science teachers not as a misconception but as a world view.”

None of those versions sounds at all acceptable to me.

Creationism is a misconception.

The original speech can be heard on a Guardian Play the mp3 file.

It seems to me all to turn on what Reiss means by “showing respect” for ‘alternative world views’, which you believe to be pernicious bunkum. The term ‘alternative world view’ is itself cause for concern. It smacks of alternative medicine.  In what sense is a piece of nonsensical bunkum an ‘alternative’ as opposed to being simply bunkum?. I don’t envy teachers who have to deal with young children, who have been brainwashed by religious parents, on matters like this, but older ones should not be encouraged to think that religious nonsense is a proper alternative to sensible thought and observation.

The Observer on Sunday 14 September reports

Creationism call divides Royal Society

Two Nobel prize winners – Sir Harry Kroto and Sir Richard Roberts – have demanded that the Royal Society sack its education director, Professor Michael Reiss. The call, backed by other senior Royal Society fellows, follows Reiss’s controversial claim last week that creationism be taught in schools’ science classes.

Reiss, an ordained Church of England minister, has since alleged he was misquoted. Nevertheless, several Royal Society fellows say his religious views make him an inappropriate choice for the post.

The Reverend Professor Reiss presumably believes the Nicene Creed. That creed seems to make about as much sense as homeopathy (with the same reservation that some of the words have no discernible meaning at all). I’m inclined to agree that it makes no sense to ask someone who believes that stuff to take charge of science education.

Steve Jones, the UCL geneticist, has his say in the Sun

Latest: Michael Reiss resigns

On 16th September, the following statement was made by the Royal Society.

Some of Professor Michael Reiss’s recent comments, on the issue of creationism in schools, while speaking as the Royal Society’s Director of Education, were open to misinterpretation. While it was not his intention, this has led to damage to the Society’s reputation. As a result, Professor Reiss and the Royal Society have agreed that, in the best interests of the Society, he will step down immediately as Director of Education a part time post he held on secondment. He is to return, full time, to his position as Professor of Science Education at the Institute of Education.

The Royal Society’s position is that creationism has no scientific basis and should not be part of the science curriculum. However, if a young person raises creationism in a science class, teachers should be in a position to explain why evolution is a sound scientific theory and why creationism is not, in any way, scientific.

The Royal Society greatly appreciates Professor Reiss’s efforts in furthering the Society’s work in the important field of science education over the past two years. The Society wishes him well for the future.

Sadly, I’m inclined to believe that this is the best solution. Reiss’s soundness on evolution is not in doubt. but there was sufficient ambiguity in his statements that he should perhaps have anticipated the furore that would, and did, ensue.

Now the trivial stuff.

This video about Sarah Palin’s church was pulled from YouTube for “inappropriate content” -found it on richarddawkins.net



Sarah Palin’s Churches and The Third Wave from Bruce Wilson on Vimeo.

And this hilarious one from CNN


OK this is not very serious (or is it?). A computer game: players of PolarPalin must help a polar bear to navigate its way across Alaska to blow up oil wells, all the while avoiding Palin, the governor of the state, in her campaign tank.



Jump to follow-up

After the announcement that the University of Central Lancashire (Uclan) was suspending its homeopathy “BSc” course, it seems that their vice chancellor has listened to the pressure, both internal and external, to stop bringing his university into disrepute.

An internal review of all their courses in alternative medicine was announced shortly after the course  closure.   Congratulations to Malcolm McVicar for grasping the nettle at last.  Let’s hope other universities follow his example soon.

I have acquired, indirectly, a copy of the announcement of the welcome news.

Homeopathy, Herbalism and cupuncture


Concern has been expressed by some colleagues as to whether the University should offer courses in homeopathy, Herbalism and Acupuncture. Therefore, to facilitate proper discussion on this matter I have set up a working party to review the issues.



I have asked Eileen Martin, Pro Vice-Chancellor and Dean of the Faculty of Health, to lead this working party and report to me as soon as possible. Whilst the review is taking place, we need to recognise that there are students and staff studying and teaching on these courses which have satisfied the University’s quality assurance procedures and been duly validated. I would therefore ask that colleagues would refrain from comment or speculation which would cause concern to these students and staff. Staff who wish to express their views on this issue should direct these to Eileen Martin, by the end of September.


Regards

Malcolm McVicar

Vice-Chancellor



Times Higher Education today reports

“The University of Central Lancashire is to review all its courses in homoeopathy, herbalism and acupuncture after some staff said it should not be offering degrees in “quackery”, Times Higher Education has learnt.

A university spokesman said: “As a university we value and practise transparency and tolerance and welcome all academic viewpoints.”

(Later, an almost identical version of the story ran on the Times Online.)

So far, so good.   But of course the outcome of a committee depends entirely on who is appointed to it.  Quite often such committees do no more than provide an internal whitewash.

It does seem a bit odd to appoint as chair the dean of the faculty where all these course are run, and presumably generate income.  Eileen Martin has often appeared to be proud of them in the past. Furthermore, the whole investigation will (or should) turn on the assessment of evidence.  It needs some knowledge of the design of clinical trials and their statistical analysis, As far as I can see, Ms Martin has essentially no research publications whatsoever.

I also worry about a bit about “satisfied the University’s quality assurance procedures and been duly validated”.  One point of the investigation should be recognise frankly that the validation process is entirely circular, and consequently worth next to nothing.  It must be hard for a vice-chancellor to admit that, but it will be an essential step in restoring confidence in Uclan.

Let’s not prejudge though. If there are enough good scientists on the committee, the result will be good.

I hope that transparency extends to letting us know who will be doing the judging.  Everything depends on that.

Follow-up

Well well, there’s a coincidence, Once again, the week after a there is an announcement about degrees in witchcraft, what should pop up again in the column of the inimitable Laurie Taylor in THE. The University of Poppleton’s own Department of Palmistry.

Letter to the editor


Dear Sir

I was shocked to see yet another scurrilous attack upon the work of my department in The Poppletonian. Although Palmistry is in its early days as an academic discipline it cannot hope to progress while there are people like your correspondent who insist on referring to it as “a load of superstitious nonsense which doesn’t deserve a place on the end of the pier let alone in a university”.

A large number of people claim to have derived considerable benefit from learning about life lines, head lines and heart lines and the role of the six major mounts in predicting their future. All of us in the Palmistry Department believe it vitally important that these claims are rigorously examined. How else can science advance?

Yours sincerely,

Janet Petulengro (Doctor)


Jump to follow-up



The Times today has given s good showing for my comment piece. It gives the case against following the advice of the Pittilo report. It simply makes no sense to have government regulation of acupuncture, herbal medicine, traditional Chinese medicine until such time as there is evidence that they work. It makes even less sense to have BSc degrees in them. The Department of Health should have more sense that to use the Prince of Wales as its scientific advisor.

Let’s hope that the recent example set by the University of Central Lancashire is the start of trend for vice-chancellors to appreciate that running such degrees brings their universities into disrepute.

I can only apologise for the dreadful title that The Times’ sub-editors put on the piece, My original title was

A bad report for the vice chancellor

The Pittilo report to the Department of Health will endanger the public and corrupt universities. There is a better way.

I like that much better than “Regulate quack nedicine? I feel sick”.

But, oh dear, the picture that I sent them is on the left, but what appeared is on the right. Spot the difference.


Well now, at least, I can feel I have something in common with Isambard Kingdom Brunel.


Follow-up

It so happens that Professor Pittilo wrote a letter to Times Higher Education this week. I fear that it provided a yet more evidence that he hasn’t really quite got the hang of evidence.

The Lancashire Evening Post catches up with the UCLan story, two days after you read it here.

A reply from Professor Pittilo

This response to the op-ed of 29th August appeared as a letter
in the Times
on Sept 2.

Public health needs protection

Regulation of acupuncture and herbal medicine has been subject to much scrutiny

Sir, Professor Colquhoun’s campaign to discredit our report (“Regulate quack medicine? I feel sick,” Aug 29) is in danger of placing public health at risk. He is entitled to challenge existing evidence for the effectiveness of complementary and alternative medicine (CAM) but fails to acknowledge the key recommendation from the steering group on the essential need to demonstrate efficacy, safety and quality assurance as a prerequisite for NHS funding.

Professor Colquhoun dismisses CAM because of the absence of a rigorous scientific foundation and he asserts that to teach and practise it is unethical. Survey data consistently demonstrates very high demand for CAM with one report estimating that 22 million visits involving 10.6 per cent of the population in England alone occurred in 2008. This demand is one reason why his alternative model of trade law enforcement will not work. He may argue that these people are uncritical recipients of nonsense, but data from the Medicines and Healthcare products Regulatory Agency confirm that they are at significant risk from poor practice. It is essential that we protect the public by implementing statutory regulation alongside demanding evidence of efficacy. Professor Colquhoun’s resistance to the teaching of science to CAM practitioners will do little to help them to critically evaluate effectiveness.

Professor Michael Pittilo

Chair of the Department of Health Steering Group

And Pittilo wrote in similar vein to Times Higher Education.

Science vital to health study

28 August 2008

Your feature on some members of staff at the University of Central Lancashire attacking science degrees in complementary and alternative medicine (“Staff attack science degrees in alternative health”, 7 August) raises a number of concerns.

It is up to any university, taking account of the expert views of staff and external peer review, to determine the appropriate title and award for any degree. It is encouraging to note from the feature that new courses
in acupuncture and Chinese herbal medicine “contain significant elements of science”.

The recent report to Ministers from the Department of Health Steering Group on the Statutory Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and other Traditional Medicine
Systems Practised in the UK recognises the significant challenges in developing a strong research and evidence base for complementary and alternative medicine (CAM). It also states that the need to demonstrate
benefit is essential if National Health Service resources are to be made available to fund these therapies.

There is no doubt that courses that provide a solid scientific foundation will greatly assist CAM practitioners in establishing evidence-based practice. It would be most unfortunate if the reported resistance to degree titles led to those wishing to practise acupuncture or herbal medicine receiving less hard science than they might have.

To say that acupuncture and herbal medicine degrees have no academic justification appears arrogant in the extreme. Although it is certainly true that some content may not be scientific, this does not invalidate the legitimacy of these courses at degree level, a fact borne out by their successful validation in a number of universities.

R. Michael Pittilo, Principal and vice-chancellor, The Robert Gordon University.


This one got excellent responses from Kevin Smith (University of Abertay, Dundee), and from Peter J. Brophy (Professor of veterinary anatomy and cell biology University of Edinburgh). This was  my comment to THE

There are a few very obvious responses to Professor Pittilo’s letter

(1) “It is encouraging to note from the feature that new courses in acupuncture and Chinese Herbal medicine “contain significant elements of science”.

For many alternative therapies the “philosophy” is simply incompatible with science. One obvious example is homeopathy. On Mondays and Wednesdays (science days) the students will be required to learn that response increases with dose. On Tuesdays and Thursdays will be taught the opposite. But for the exam they must reproduce only the latter (nonsensical) idea because their aim is to get a job as a homeopath. That makes nonsense of the idea of a university.

(2) His report “recognises the significant challenges in developing a strong research and evidence base for complementary and alternative medicine (CAM)”.

This seems to constitute a recognition that the evidence is still very inadequate. The time to start degrees, and the time to give official government recognition, is after the evidence is in, not before. What happens if you start degrees and then find that the subject is so much nonsense? Well, that has already happened in several areas of course. But the people who accredit the course and who act as external examiners just happen to be fervent believers in that nonsense, so all appears to be well (to bean counters anyway).

(3) “It would be most unfortunate if the reported resistance to degree titles led to those wishing to practise acupuncture or herbal medicine receiving less hard science than they might have.”

There is, as it happens, a great deal of evidence now about acupuncture, but the authors of the report do not seem to be aware of it. I recommend Barker Bausell’s book on the topic. If students are educated science, like what constitutes evidence, and our current understanding of words like “energy”, they would have to disavow the subject that there are supposed to training to practise

(4) “To say that acupuncture and herbal medicine degrees have no academic justification appears arrogant in the extreme.”

No, it is not a matter of arrogance, just a matter of careful attention to the evidence. Attention to evidence was notably absent in Prof Pittilo’s report, perhaps because his committee consisted entirely of people who earn their living from the subjects they were supposed to be assessing.

(5) “ . . a fact borne out by their successful validation in a number of universities”.

I have had the misfortune to have waded through a mound of such validation documents. The one thing they never consider is whether the treatment works. Sad to say, these validations are not worth the paper they are written on.


Jump to follow-up

My original piece on Integrative Baloney@Yale was posted on May 16th, after I got back from a visit there. The talk I gave there included a short video. My movie, Integrative baloney@Yale, was made entirely from clips taken from Yale’s own YouTube movies which showed something approaching three hours of its “1st Annual Scientific [sic] symposium”, entitled “Complementary and Alternative Medicine: Evidence for Integration”. I had merely interspersed a few titles to show the worst scientific absurdities of that rather pathetic event. YouTube removed the movie last week.

You can download the movie here [15.8 Mb, wmv file].

It should soon reappear on YouTube (actually it took over a month and several reminders, but eventually  they kept their word in the end).

Yale’s lawyers had written to YouTube, to have my movie removed. I guess if you have no evidence, all you can do is resort to law to suppress the views of those who have the temerity to point out that the emperor is naked. Last week it was New Zealand Chiropractors’ Association Inc. This week the rather more substantial Yale University. We live in interesting times.

This is what I got on 15th August.

Dear Member

This is to notify you that we have removed or disabled access to the following material as a result of a third-party notification by Yale University, Yale School of Medicine (CME) claiming that this material is infringing:

Integrative baloney@Yale: http://uk.youtube.com/watch?v=HEl2fhfGBdI

Please Note: Repeated incidents of copyright infringement will result in the deletion of your account and all videos uploaded to that account. In order to prevent this from happening

If you clicked on the link you saw

“This video is no longer available due to a copyright claim by Yale University, Yale School of Medicine (CME)”

It seems that Yale’s Continuing Medical Education (CME) department was responsible.

Of course Yale is correct. I expect they own the copyright of their original movies, but they are not what I posted. I would argue that selecting 6 minutes from a 3 hour original amounts to “fair quotation”, no different from when one cites a short passage from somebody else’s book or paper. Perhaps Yale was just a bit jealous that my movie was getting viewed a lot more times than theirs. Or perhaps they were a bit peeved that a Google search for “Yale Integrative Medicine” produced my movie as #2 (add the word movie and I was #1).

My movie seems to me to be fair comment from someone who is a pharmacologist by trade. Apparently it didn’t seem that way to the apparatchiks of Yale Medical School, who seem to think that academic arguments should be settled by paying lawyers to suppress views they don’t like, rather than by rational discussion.

It’s interesting that the three hours of Yale’s own movie have also vanished from YouTube. Could that be because they realise that the remarks made at the meeting are so embarrassing intellectually that it would be better not to make them public? Actually, no.

What does Yale CME say?

Rather than publishing this straight away, I thought it better to delve a bit further into what had happened. I lodged an appeal with YouTube and I wrote to Ronald J. Vender, MD (Associate Dean, YSM Clinical Affairs, CMO, Yale Medical Group, Medical Director, Yale CME ). The outcome was rather interesting.

First, it turned out that the original posting of the three hours of the symposium proceedings on YouTube was itself unauthorised, which is why it suffered the same fate as my movie.

Dr Vender told me that he is new to the job, and didn’t know about the incident. What’s more surprising, he said he “did not know an Integrative Program even existed at Yale”. That does seem a bit odd indeed for an Associate Dean of Clinical Affairs.

However, Dr Vender turned out to be a very reasonable man,.After some amiable correspondence over the weekend, it took him only a day and a half to sort the matter out. After talking to Yale’s attorney, he wrote on 19th August, thus

“The University attorney believes that there is in fact a difference between the initial unauthorized filming of an entire conference as opposed to quoting from that conference. Therefore, she has agreed to withdraw the injunction that has been imposed on your use of the material. YouTube will be contacted.”

That’s good for me, but it isn’t the main thing. The movie would doubtless have been seen by more people if Yale had tried to maintain the ban. Much more impressively, Dr Vender also said

“As for this particular program, I will be speaking with Dr Belitsky and the program directors to encourage them to adopt a more critical view of the scientific basis for claims made by proponents of CAM. They will also be encouraged to develop a future program that includes faculty who have opposing points of view.”

It remains to be seen what actually happens, but so far, so good.

What next?

The removal of the original videos of the meeting is understandable because they were pretty embarrassing to Yale. But can that be the real reason? I was told that it is simply because their posting was “unauthorised”. But Yale Continuing Medical Education still boasts about the meeting on their own web site. They describe the meeting as “successful”, but if they are so proud of it, why remove the video from YouTube whether it was authorised or not? We are told

“The symposium, accredited for 7.5 AMA PRA Category 1 Credits, began what is hoped to be a long tradition at the Yale School of Medicine.”

They give credits for such miseducation?

Dr Katz’s phrase “we need a more fluid concept of evidence” now gets about 148 hits in Google, since I first helped him to publicise it.

Two of the six “learning objectives” that Yale CME lists for this symposium are particularly revealing.

  • Describe therapeutic benefits and recent scientific evidence supporting a wide range of safe and practical complementary treatments, including acupuncture, massage, yoga, meditation, nutrition and exercise
  • Identify and discuss barriers to CAM use, practice and research, as well as propose ways of overcoming these barriers

‘Describe the evidence supporting complementary treatments’? But don’t on any account describe the much more substantial evidence that does not support them? A question (or “learning objective”) put in this loaded way is the very antithesis of education.

Equally the second ‘learning objective’ carries with it the assumption that CAM works, otherwise why would anyone want to overcome the barriers to it?

This is indoctrination, not education. It betrays everything that a university should stand for.

Let’s hope the new head of CME, the admirable Dr Vender, succeeds in doing something about it

Follow-up

Success!. Well I think it is success. On 26 November 2008, the admirable Dr Vender wrote to me as follows.

“I do not know if another CAM/Integrative Medicine program is planned at Yale. However, based on the new ACCME standards, this program does not fulfil the standards for receiving CME accreditation (by my interpretation of the standards). At least one of last year’s program directors has been notified already.”

This post is written in part as a distraction from a plague of lawyers, in New Zealand, here in the UK, and now in the USA (my movie, Integratative baloney@Yale, has recently been removed from YouTube. More on that coming soon).

The duty of an advocate is to take fees, and in return for those fees to display to the utmost advantage whatsoever falshoods the solicitor has put into his brief.

[ Bentham, Jeremy , The Elements of the art of packing as applied to special juries , 1821]

The letter below comes from a much-copied piece of paper that I unearthed in my office during its decennial clearout. It was typed on a manual typewriter and I have no idea where it came from or whether it is genuine. Its origin has been discussed on the internet, with no firm conclusion. This post is a miscellany of thought that followed its rediscovery.

The alleged quotation shows that there is nothing new about the cult of managerialism, at least in Whitehall. It took longer to reach universities, which are now suffering an acute case of this sad condition,

MESSAGE FROM THE DUKE OF WELLINGTON TO THE BRITISH FOREIGN OFFICE IN LONDON–

written from Central Spain, August 1812

Gentlemen,

Whilst marching from Portugal to a position which commands the approach to Madrid and the French forces, my officers have been diligently complying with your requests which have been sent by H.M. ship from London to Lisbon and thence by dispatch to our headquarters.

We have enumerated our saddles, bridles, tents and tent poles, and all manner of sundry items for which His Majesty’s Government holds me accountable. I have dispatched reports on the character, wit, and spleen of
every officer. Each item and every farthing has been accounted for, with two regrettable exceptions for which I beg your indulgence.

Unfortunately the sum of one shilling and ninepence remains unaccounted for in one infantry battalion’s petty cash and there has been a hideous confusion as to the number of jars of raspberry jam issued to one cavalry
regiment during a sandstorm in western Spain. This reprehensible carelessness may be related to the pressure of circumstance, since we are at war with France, a fact which may come as a bit of a surprise to you gentlemen in Whitehall.

This brings me to my present purpose, which is to request elucidation of my instructions from His Majesty’s Government so that I may better understand why I am dragging an army over these barren plains. I construe that perforce it must be one of two alternative duties, as given below. I shall pursue either one with the best of my ability, but I cannot do both:

  1. To train an army of uniformed British clerks in Spain for the benefit of the accountants and copy-boys in London, or perchance.
  2. To see to it that the forces of Napoleon are driven out of Spain.

Your most obedient servant,

Wellington

Substitute the options

“I shall pursue either one with the best of my ability, but I cannot do both:

  1. To spend my days in endless meetings and form-filling for the benefit of the accountants and copy-boys in central administration, or perchance
  2. To do some original science.”

It seems a bit odd to be citing approvingly Arthur Wellesley, 1st Duke of Wellington. As a politician he was a high Tory and arch-opponent of parliamentary reform. He became prime minister in 1828, two years after
the foundation of UCL, the ‘godless institution of Gower Street”, and he was instrumental in the foundation of the traditionally religious rival to UCL, King’s College London.

Wellington’s government fell in 1830, and a Whig goverment was formed with Earl Grey as prime minister. In 1832, after many struggles, Lord John Russell managed to get the Great Reform Act passed (properly known as the Representation of the People Act 1832). This was an enormously important reform. It could be said to mark the beginning of true democracy in the UK.

The Whigs had been out of power for most of the time since the 1770s. But there were riots in the country and the Whigs advocated political reform as the best response to the unrest. Wellington, on the other hand, ignored the riots and continued with the Tory policy of opposition all reform and to any expansion of the franchise. He got the nickname “the iron duke” not because of his military prowess but because of the iron shutters he had to put on his London home, Apsley House, as protection against rioters. He lost a vote of no confidence on 15 November 1830, and was replaced as Prime Minister by Earl Grey, who put the passage of the Reform Bill in the hands of Lord John Russell

Lord John Russell was the grandfather of Bertrand Russell, whose 1935 essay, On the Value of Scepticism, had an enormous influence on me. This following quotation I find just beautiful, both the ideas, the wonderfully simple prose in which he conveys the ideas, and the Voltaire-like pure mischiefness.

I wish to propose for the reader’s favourable consideration a doctrine which may, I fear, appear wildly paradoxical and subversive. The doctrine in question is this: that it is undesirable to believe a proposition when there is no ground whatever for supposing it true. I must, of course, admit that if such an opinion became common it would completely transform our social life and our political system: since both are at present faultless, this must weigh against it. I am also aware (what is more serious) that it would tend to diminish the incomes of clairvoyants, bookmakers, bishops and others who live on the irrational hopes of those who have done nothing to deserve good fortune here or hereafter. In spite of these grave arguments, I maintain that a case can be made out for my paradox, and I shall try to set it forth.

Bertrand Russell, 1935. On the Value of Scepticism

Bertrand Russell was brought up by his grandfather, Lord John Russell in Pembroke Lodge at the edge of Richmond Park (I’ve been there often, but only because it became a tea room, a welcome break from marathon training in the park). I saw Russell in the distance, speaking in Trafalgar Square at a CND rally in about 1963. It is the most striking example I know of the the very short time than there has been any real democracy in the UK. I was one step away from the passing of the Reform Act, the founding of UCL and medical reforms.

The medical connections.

Adrian Desmond’s fascinating book, The Politics of Evolution. described what was happening in medicine and biology at around the same time as Wellington was deposed, and the Reform Bill was passed.  There was equal turmoil in the medical world. Radicals in London agitated for removal of the hegemony of the Royal Colleges and of Oxford and Cambridge, so proper medical schools could be established in London.  That is the atmosphere in which UCL’s medical school was born.

Many of the first staff there came from Scotland. Robert Grant, UCL’s first professor of comparative anatomy, came from Edinburgh and brought to UCL the new French ideas about evolution, especially those of Geoffroy. His influence was enormous, not least because Charles Darwin was one of his students.

The same period saw the foundation in 1823 of Thomas Wakley’s “ribald and radical” medical journal, The Lancet. The Wikipedia entry gives us a taste of Wakley’s style,

“[We deplore the] “state of society which allows various sets of mercenary, goose-brained monopolists and charlatans to usurp the highest privileges…. This is the canker-worm which eats into the heart of the medical body.” Wakley, The Lancet 1838-9, 1,

“The Council of the College of Surgeons remains an irresponsible, unreformed monstrosity in the midst of English institutions – an antediluvian relic of all… that is most despotic and revolting, iniquitous and insulting, on the face of the Earth.” Wakley, The Lancet 1841-2,
2, p246.

He was especially severe on whomever he regarded as quacks. The English Homeopathic Association were “an audacious set of quacks” and its supporters “noodles and knaves, the noodles forming the majority, and the knaves using them as tools”. [5]

Plus ça change, plus c’est la même chose.

Samuel Hahnemann (1755 – 1843) was the originator of homeopathy. He was clearly a well-intentioned man.. There is good reason to believe that he thought dilution could not go on for ever, but he died 22 years before it became possible to calculate that his favourite 30C dilution already contained nothing at all.

The bible of homeopaths is Hahnemann’s Organon der rationellen Heilkunde, “Organon of the Medical Art”. His views on dosage, as expressed in the six editions of this book are almost as self-contradictory as the other bible. Hahnemann’s writing about ‘vital spirits’ sounds very silly now, but it is language that was quite common at the end of the 18th century, before much was known about medicine or physiology. But his interest in chemistry was entirely sensible.

Before 1800 Hahnemann started out with the very high doses that were conventional at the time. Unlike most of his contemporaries, he was smart enough to realise that giving 50 g of antimony was killing people so he kept reducing the dose until it was no longer toxic. Unfortunately he (like almost everyone else at the time) didn’t know about controls so he mistook lack of toxicity (because the dose was zero) for a beneficial effect. Nonetheless, for most of his life he did not advocate the extreme dilutions that many modern homeopaths use routinely.

In The Life and Letters of Dr Samuel Hahnemann by Thomas Lindsley Bradford, M.D.(or see Google books edition of the Organon), there is an interesting passage. According to the edition here pp. 237 – 238), this was a note attached to para. #283 in the first edition of the Organon.

” The doctrine of the divisibility of matter teaches us that we cannot make a part so small that it shall cease to be something, and that it shall not share all the properties of the whole.”

Here Hahnemann refers to the doctrine of divisibility, but appears to be saying that dilution can go on for ever. But he also says something that directly contradicts this view (Organon, Dudgeon’s translation see also here, page 239 ). The emphasis is mine.

“I must say that these procedures seem to show chiefly how high one can go with the potentized attenuation of medicines without their action on the human health becoming nil.

Although this claims that you can dilute a lot, it also admits that if the dilution goes too far the effect would eventually vanish, contrary to the usual homeopathic “principle” that it should keep getting stronger and stronger. and contrary to Hahnemann’s suggestions in other places that he thought matter was infinitely divisible.

This passage shows quite clearly that Hahnemann did not believe that his medicines would work if they were diluted so much that that there were no molecules left. That he believed this is confirmed by a letter that Hahnemann wrote in a letter to a Dr Schreter dated September 13th, 1829. This letter reprimanded Schreter for advocating extremely high dilutions.

there must be some limit to the thing. It cannot go on to infinity


The original German version was

“Es muss ein Ende geben, es kann nicht bis ins Unendliche weitergehen”

This confirms that Hahnemann was aware of, and accepted, that matter was not infinitely divisible and his medicines would not work if they contained nothing of the original material.

This attitude is actually not at all surprising, because Hahnemann was an educated man and he had a particular interest in chemistry. He cannot have failed to be aware of Dalton’s atomic theory, which was published between 1805 – 1810, while Hahnemann was writing the first edition of the Organon.

Peter Morrell, in Hahnemann and Homeopathy, says

“These were obviously developments that Hahnemann could not have failed to know about and indeed, was thoroughly excited about, It is clear from many of his asides that he regarded chemistry as the most important science.”

What is astonishing is that I can find no example of Hahnemann ever having mentioned Dalton or Avogadro. Perhaps he was a bit scared by the implications of their suggestions that molecules could not be divided without changing their nature.

The first edition of the Organon was published in 1810. but in the 5th edition appeared 1833, ten years before his death, These dates turn out to be important.

John Dalton (1776 – 1844) was able to estimate relative atomic masses of various molecules, the smallest unit that a chemical can exist in without losing irs identity. His values were soon improved by Amadeo
Avogadro
(1776 – 1856), in 1811. Avogadro made the very important proposal that the volume of a gas (strictly, of an ideal gas ) is proportional to the number of atoms or molecules that are present. More precisely, the relationship between the masses of the same volume of different gases (at the same temperature and pressure) corresponds to the relationship between their respective molecular weights. Hence, the relative molecular mass of a gas can be calculated from the mass of a sample of known volume.

BUT neither Avogadro nor Dalton knew how many molecules there were in a given mass of a substance

This is absolutely crucial because it means that, although Hahnemann realised that there was a limit to the dilutions that could be used, he had no way of knowing what that limit was,

The answer to that question was discovered only in 1865, 22 years after the death of Hahnemann.  It was discovered not by Avogadro, but by Johann Josef Loschmidt (1821 – 1895). It is Loschmidt, not Avogadro, who discovered the crucial numerical value of ‘Avogadro’s number‘, and in the German literature it is known, properly, as Loschmidt’sche Zahl.

This number is 6.022 x 1023 molecules per mole. One mole of a pure compound is its molecular mass in grams. The molecular mass of carbon (relative to hydrogen) is 12, so 12 grams of carbon contain 6.022 x 1023 carbon atoms. The molecular mass of of strychnine is 334.4 so 334.4 grams of strychnine contain 6.022 x 1023 strychnine molecules.

Armed with the numerical value of Avogadro’s number, it is easy to calculate that a 30 C homeopathic dilution contains nothing whatsoever. More precisely, it would contain, on average, a single molecule in spherical pill with a diameter equal to the distance from the earth to the sun.

But Hahnemann could not have known that. If had lived another 25 years he would almost certainly have renounced the idea of using 30 C dilutions.

He had a good excuse for getting it wrong. He was dead before the knowledge existed to do the calculation

But modern homeopaths have no excuse whatsoever for believing the impossible.

Hahnemann would have thought they were nuts, I suspect. He was too intelligent to believe that medicines that contain no medicine could be effective. In his words, “It cannot go on to infinity”.

Acknowledgement

I very grateful to ‘ Lindy’ for help in checking the references that are cited here, and for helpful discussions.

The article below is an editorial that I was asked to write for the New Zealand Medical Journal, as a comment on article in today’s edition about the misuse of the title ‘doctor’ by chiropractors [download pdf]. Titles are not the only form of deception used by chiropractors, so the article looks at some of the others too.  For a good collection of articles that reveal chiropractic for what it is, look at Chirobase


THE NEW ZEALAND
MEDICAL JOURNAL

Journal of the New Zealand Medical Association

NZMJ 25 July 2008, Vol 121 No 1278; ISSN 1175 8716

URL: http://www.nzma.org.nz/journal/121-1278/3158/ ©NZMA

Doctor Who?
Inappropriate use of titles by some alternative “medicine” practitioners

David Colquhoun

Who should use the title ‘doctor’? The title is widely abused as shown by Gilbey1 in this issue of the NZMJ in an article entitled Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy. Meanwhile, Evans and colleagues 2, also in this issue, discuss usage and attitudes to alternative treatments.

Gilbey finds that the abuse of the title doctor is widespread and that chiropractors are the main culprits. An amazing 82% of 146 chiropractics used the title Doctor, andL most of them used the title to imply falsely that they were registered medical practitioners.

Although it is illegal in New Zealand to do that, it seems clear that the law is not being enforced and it is widely flouted. This is perhaps not surprising given the history of chiropractic. It has had a strong element of ruthless salesmanship since it was started in Davenport, Iowa by D.D. Palmer (1845–1913). His son, B.J. Palmer, said that their chiropractic school was founded on “a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell” (Shapiro 2008)3 It is the same now. You can buy advice on how to build “build high-volume, subluxation-based, cash-driven, lifetime family wellness practices”

In her recent book3 , Rose Shapiro comments on the founder of chiropractic as follows.

“By the 1890s Palmer had established a magnetic healing practice in Davenport, Iowa, and was styling himself “doctor”. Not everyone was convinced, as a piece about him in an 1894 edition of the local paper, the Davenport Leader, shows.

A crank on magnetism has a crazy notion hat he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious,those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method he has certainly profited by the ignorance of his victim. His increase in business shows what can be done in Davenport, even by a quack.”

D.D. Palmer was a curious mixture: grocer, spiritual healer, magnetic therapist, fairground huckster, religious cult leader—and above all, a salesman. He finally found a way to get rich by removing entirely imaginary “subluxations”.

Over 100 years later, it seems that the “weak-minded, ignorant, and superstitious” include the UK’s Department of Health, who have given chiropractics a similar status to the General Medical Council.

The intellectual standards of a 19th Century Mid-Western provincial newspaper journalist are rather better than the intellectual standards of the UK’s Department of Health, and of several university vice-chancellors in 2007.

Do the treatments work?

Neither Gilbey nor Evans et al. really grasp the nettle of judging efficacy. The first thing one wants to know about any treatment —alternative or otherwise — is whether it works. Until that is decided, all talk of qualifications, regulation, and so on is just vacuous bureaucratese. No policy can be framed sensibly until the question of efficacy has been addressed honestly.

It is one good effect of the upsurge of interest in alternative treatments that there are now quite a lot of good trials of the most popular forms of treatments (as well as many more bad trials). Some good summaries of the results are now available too. Cochrane reviews set the standard for good assessment of evidence. New Zealand’s Ministry of Health commissioned the Complementary and Alternative Medicine
website to assess the evidence, and that seems to have done a good job too. Their assessment of chiropractic treatment of low back pain is as follows:

There appears to be some evidence from one systematic review and four other studies, although not conclusive, that chiropractic treatment is as effective as other therapies but this may be due to chance. There is very little evidence that chiropractic is more effective than other therapies.

And two excellent summaries have been published as books this year. Both are by people who have had direct experience of alternative treatments, but who have no financial interest in the outcome of their assessment of evidence. The book by Singh and Ernst4 summarises the evidence on all the major alternative treatments, and the book by Bausell5 concentrates particularly on acupuncture, because the author was for 5 years involved in research in that area, Both of these books come to much the same conclusion about chiropractic. It is now really very well-established that chiropractic is (at best) no more effective than conventional treatment. But it has the disadvantage of being surrounded by gobbledygook about “subluxations” and, more importantly, it kills the occasional patient.

Long (2004)7 said “the public should be informed that chiropractic manipulation is the number one reason for people suffering stroke under the age of 45.

The chiropractors of Alberta (Canada) and the Alberta Government are now facing a class-action lawsuit8. The lead plaintiff is Sandra Nette. Formerly she was a fit 41 year old. Now she is tetraplegic. Immediately
after neck manipulation by a chiropractor she had a massive stroke as a result of a torn vertebral artery.

Acupuncture comes out of the assessments equally badly. Bausell (2007) concludes that it is no more than a theatrical placebo.

Are the qualifications even real?

It is a curious aspect of the alternative medicine industry that they often are keen to reject conventional science, yet they long for academic respectability. One aspect of this is claiming academic titles on the flimsiest of grounds. You can still be held to have misled the public into thinking you are a medical
practitioner, even if you have a real doctorate. But often pays to look into where the qualifications come from.

A celebrated case in the UK concerned the ‘lifestyle nutritionist’, TV celebrity and multi-millionaire, Dr Gillian McKeith, PhD. A reader of Ben Goldacre’s excellent blog, badscience.net did a little investigation. The results appeared in Goldacre’s Bad Science column in the Guardian9.

She claimed that her PhD came from the American College of Nutrition, but it turned out to come from a correspondence course from a non-accredited US ‘college’. McKeith also boasted of having “professional membership” of the American Association of Nutritional Consultants, for which she provided proof of her degree and three professional references.

The value of this qualification can be judged by the fact that Goldacre sent an application and $60 and as a result “My dead cat Hettie is also a “certified professional member” of the AANC. I have the certificate hanging in my loo”.

Is the solution government regulation?

In New Zealand the law about misleading the public into believing you are a medical practitioner already exists. The immediate problem would be solved if that law were taken seriously, but it seems that it is not.

It is common in both the UK and in New Zealand to suggest that some sort of official government regulation is the answer. That solution is proposed in this issue of NZMJ by Evans et al2. A similar thing has been proposed recently in the UK by a committee headed by Michael Pittilo, vice-chancellor of Robert Gordon’s University, Aberdeen.

I have written about the latter under the heading A very bad report. The Pittilo report recommends both government regulation and more degrees in alternative medicine. Given that we now know that most alternative medicine doesn’t work, the idea of giving degrees in such subjects must be quite ludicrous to any thinking person.

The magazine Nature7 recently investigated the 16 UK universities who run such degrees. In the UK, first-year students at the University of Westminster are taught that “amethysts emit high yin energy” . Their vice chancellor, Professor Geoffrey Petts, describes himself a s a geomorphologist, but he cannot be tempted to express an opinion about the curative power of amethysts.

There has been a tendency to a form of grade inflation in universities—higher degrees for less work gets bums on seats. For most of us, getting a doctorate involves at least 3 years of hard experimental research in a university. But in the USA and Canada you can get a ‘doctor of chiropractic’ degree and most chiropractic (mis)education is not even in a university but in separate colleges.

Florida State University famously turned down a large donation to start a chiropractic school because they saw, quite rightly, that to do so would damage their intellectual reputation. This map, now widely distributed on the Internet, was produced by one of their chemistry professors, and it did the trick.

Other universities have been less principled. The New Zealand College of Chiropractic [whose President styles himself “Dr Brian Kelly”,though his only qualification is B. App Sci (chiro)] is accredited by the New Zealand Qualifications Authority (NZQA). Presumably they, like their UK equivalent (the QAA), are not allowed to take into account whether what is being taught is nonsense or not. Nonsense courses are accredited by experts in nonsense. That is why much accreditation is not worth the paper it’s written on.

Of course the public needs some protection from dangerous or fraudulent practices, but that can be done better (and more cheaply) by simply enforcing existing legislation on unfair trade practices, and on false advertising. Recent changes in the law on unfair trading in the UK have made it easier to take legal action against people who make health claims that cannot be justified by evidence, and that seems the best
way to regulate medical charlatans.

Conclusion

For most forms of alternative medicine—including chiropractic and acupuncture—the evidence is now in. There is now better reason than ever before to believe that they are mostly elaborate placebos and, at best, no better than conventional treatments. It is about time that universities and governments recognised the evidence and stopped talking about regulation and accreditation.

Indeed, “falsely claiming that a product is able to cure illnesses, dysfunction, or malformations” is illegal in Europe10.

Making unjustified health claims is a particularly cruel form of unfair trading practice. It calls for prosecutions, not accreditation.

Competing interests: None.
NZMJ 25 July 2008, Vol 121 No 1278; ISSN 1175 8716
URL: http://www.nzma.org.nz/journal/121-1278/3158/ ©NZMA

Author information: David Colquhoun, Research Fellow, Dept of Pharmacology, University College London, United Kingdom (http://www.ucl.ac.uk/Pharmacology/dc.html)

Correspondence: Professor D Colquhoun, Dept of Pharmacology, University College London, Gower Street, London WC1E 6BT, United Kingdom. Fax: +44(0)20 76797298; email: d.colquhoun@ucl.ac.uk

References:

1. Gilbey A. Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy. N Z Med J. 2008;121(1278). [pdf]

2. Evans A, Duncan B, McHugh P, et al. Inpatients’ use, understanding, and attitudes towards traditional, complementary and alternative therapies at a provincial New Zealand hospital. N Z Med J. 2008;121(1278).

3 Shapiro. Rose. Suckers. How Alternative Medicine Makes Fools of Us All Random House, London 2008. (reviewed here)

4. Singh S, Ernst E. Trick or Treatment. Bantam Press; 2008 (reviewed here)

5. Bausell RB. Snake Oil Science. The Truth about Complementary and Alternative Medicine. (reviewed here)
Oxford University Press; 2007

6. Colquhoun D. Science degrees without the Science, Nature 2007;446:373–4. See also here.

7. Long PH. Stroke and spinal manipulation. J Quality Health Care. 2004;3:8–10.

8. Libin K. Chiropractors called to court. Canadian National Post; June21, 2008.

9. Goldacre B. A menace to science. London: Guardian; February 12, 2007/

10. Department for Business Enterprise & Regulatory Reform (BERR). Consumer Protection from Unfair Trading Regulations 2008. UK: Office of Fair Trading.

After writing the recent post Boots reaches new level of dishonesty with CoQ10 promotion, I sent a complaint about the dishonesty of the advertisements to the Advertising Standards Authority. I got a surprsingly fast response. On April 22 I got

“it appears you have a valid point and, with a view to acting quickly, have asked Boots to change their ad. We have asked them to remove the claims that CoQ1 0 can create “a spring in your step” and “boost energy levels”. Provided we get an assurance from the advertisers that they will change their ad, we will close the case.”

Then on 1 May, the ASA said

“We have now received a response from Boots and they have given us an assurance that they will not repeat the problematic claims for this product. We have therefore closed our file on that basis.”

Boots agreed to this request, so no full investigation will appear. That’s a win for reason, up to a point, but it also shows how toothless the rules about advertising are. Boots launch a big promotion with advertisements that are simply not true. The promotion is over and they got clean away with it. All they get is a little publicised rap on the knuckles and no doubt they’ll do the same again next time.