I’m baffled. Why is it that beautiful, high quality blogs like Orac’s Respectful Insolence, wanted to be on a commercially-run site in the first place?
Scienceblogs is such a site and it recently caused a crisis when it accepted a paid PR piece by Pepsico (without warning its bloggers first). This was not to be with the obvious advertisements in the side bars, but published like any other blog, Scienceblogs is a commercial organisation, owned and operated by the Seed Media group. The response to the crisis by Adam Bly was leaked and can be read here. It is, in my view, not anything like good enough. One of the great beauties of the internet is that it is really quite hard to keep things secret.
ScienceBlogs was offensive enough even before Pepsigeddon. I go there to read Orac, not to be bombarded with adverts for phone companies and the very sort of quackery that Orac so eloquently exposes. Perhaps Americans are more inured to constant mendacious advertising through their TV and radio. Thank heavens for the BBC which makes (some) good programmes and never has advertisements.
Should people be paid to blog?
I have no objection to people being paid for work that they do. I have had occasional payments from newspapers (and the BMJ) for articles that they have commissioned. This makes a nice change. Scientists usually work for nothing but their salary, and that is how it should be. We write up our results in papers, and then, quite often, we pay the journal to publish our work, and then pay again to buy the journal in which it appears. [That, together with the crisis in peer review, is what persuades me that the current publishing system is broken, but that is a different story.].
We travel the world to give talks for nothing (well just occasionally a small honorarium). Not infrequently we don’t even get paid the full cost of travel.
And those of us who blog, mostly do that for free too. This site costs nothing but a few pounds a year for the domain name, and that comes from my own pocket [and a lot more of my time than I could have afforded when I was doing full time science).
I’m not grumbling about any of this. On the contrary, I enjoy the science and I enjoy the blogging. I am (or was) adequately paid. What more can one ask? The great virtue of not being paid is that you are behoven to nobody. The whole point of science, and the whole point of blogging, is to provide an independent opinion, your own opinion, on matters of science.
I’m only grateful that so many people seem to feel that some of the things I say are worth reading. I do it because it is interesting, it is fun, and it might even do a bit of public good.
Any hint that you may be selling a story on behalf of someone else is the kiss of death, both in real science and in blogging. It doesn’t have to be real, just the perception is enough to ruin your credibility.
To expect independent scientific views from Pepsi is whistling in the wind. Everyone knows about the hugely powerful lobbying by the food industry. The ruthlessness of the industry is, one might argue, counter-productive, because even if they were to produce a totally honest assessment of the evidence, nobody would believe it.
Anyone who has been involved in the battle against junk medicine knows that one is always accused of being a shill for Big Pharma. Of course the purveyors of junk medicine are not very good at checking their facts. If they were, they’d be in a more honest job.
Bhopal report blocked by Seed Magazine
The interesting thing about this sort of kerfuffle is that it brings new facts out of the woodwork. In today’s Guardian, Gala Vince wrote ‘This isn’t the first time Seed has sacrificed editorial independence‘ A piece she wrote about one of the major shameful disasters of the 20th century, the Bhopal catastrophe, was not published by Seed, because it might have endangered advertising income from the Dow Chemical Company (they are the nice folk who made Agent Orange and Napalm). There is no doubt about this, because Vince quotes an email from Seed that told her.
“As for Bhopal, it’s a cautionary call on our part as we’re in the midst of advertising negotiations with Dow”
This sort of behaviour is much scarier than taking paid blogs from Pepsico, if only because it was secret at the time. The wonderful thing about blogs is that it isn’t secret now. It shows that, notwithstanding their fine words, Seed is not serious about scientific independence if it endangers their income.
Science and commerce don’t mix
Seed pay their contributors per page view, though I haven’t yet been able to discover how much (will anyone tell me?)
Most of the people who write for Scienceblogs do not rely on what they get paid by Seed for their bread and butter. Many of those I like best are practising physicians and surgeons. No doubt they are far richer than I have ever been. In my view they should leave Scienceblogs right now, before they lose any more credibility. Several already have.
If anyone doubts the corrupting effects of commercial interests in medicine, listen to this year’s Sense about Science lecture by Fiona Godlee (editor of the BMJ). The podcast has appeared on The Guardian’s web site. And if you are interested in the corrupting effects of commercial pressures in the alternative medicine industry there are plenty of sources in the links at the bottom of the right hand sidebar.
Or just read the admirable Orac, lately (I hope) of Scienceblogs.
Interesting. I got a direct message from one blogger on Twitter, in answer to my question about how much Seed pays bloggers.
“Seed pays peanuts: I usually get $100 – $200/ month, depending on # of page views. It goes up in increments of $25 per 10,000 extra visitors”
That’s a bit more than I’d guessed, but hardly a significant contribution to the pay of most people who write for them.
This week’s edition of Nature Neuroscience carried a paper with the title “Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture“. The paper was not without interest, but it tells one nothing about acupuncture in humans.
The mice had their paws injected with rather unpleasant stuff called Complete Freund’s Adjuvant. This makes them inflamed and sore, so they are unusually sensitive to pain. When the mice were pierced with human-sized needles, and the needles rotated, they responded a bit less to painful stimuli.
The newspaper reports of this paper were even worse than usual.
The worst of the lot was Richard Alleyne, in the Daily Telegraph: “Acupuncture does work as it stimulates a natural pain killer, scientists find“.
Fiona McCrae in the Daily Mail was marginally better, with “Let’s get straight to the point, acupuncture DOES ease pain“. At least she manages to include a brief critical comment from Edzard Ernst.
Even the usually-excellent Ian Sample in the Guardian was unusually gullible with “Acupuncture may ease pain by triggering release of natural painkiller“. The subheading did say the study was done in mice not man, but there was no critical comment and, as in the other reports, no attempt to summarise what’s known already about acupuncture.
When this sort of misreporting occurs, it often seems to come from the press release (another case documented here). Many journalists never get any further than the press release, Here is Nature‘s press release.
How needles pierce pain
Acupuncture can relieve many kinds of pain, but it remains unclear how it might work, beyond the possibility of a strong placebo effect. A study published online in Nature Neuroscience now shows that acupuncture locally activates pain-suppressing receptors which could be the key to the treatment’s ability to relieve pain.
Maiken Nedergaard and colleagues inserted fine needles into the mouse equivalent of a traditional acupuncture point near the knee, and rotated these needles intermittently as is practiced by acupuncturists. This alleviated the pain reactions of mice with an inflamed paw, and it also strongly increased the local tissue concentration of the neurotransmitter adenosine. Pain relief required the presence of a particular adenosine receptor. It is known that this receptor resides on pain-transmitting nerve fibers and can reduce the activity of these fibers. The authors found that no pain relief or adenosine elevation was observed when the needles were simply inserted into the acupuncture point without rotation. They also noted that a drug that prolongs the lifetime of adenosine in live tissue helped to prolong the pain-attenuating effect of mouse acupuncture.
It should be noted that while this work suggests a mechanism for local pain relief by acupuncture, it does not in any way endorse the ancient mystical idea that the needles work by correcting some aberrant “qi” energy flow along “meridians”. Instead, the authors propose a model whereby the minor tissue injury caused by rotated needles triggers adenosine release, which, if close enough to pain-transmitting nerves, can lead to the suppression of local pain.
The title, and the first sentence, are tendentious, to put it mildly. The false assertion that "Acupuncture can relieve many kinds of pain" misrepresents entirely the current state of the evidence. A lot has been written about acupuncture, not least on this blog, but the current position can be summed up roughly as follows.
- It has been found time and time again that no difference can be detected between real and sham acupuncture in blind comparisons, and
- a non-blind comparison between acupuncture and no-acupuncture usually shows some advantage for the acupuncture, but the effect is small, transient and very variable. A recent review from the Nordic Cochrane group concluded the effect was barely big enough to be clinically significant.
The odds are that acupuncture is no more than a theatrical placebo.
The press release should have made all this clear, but failed to do so. But then the paper itself also failed to make the context clear.
The abstract of the paper starts "Acupuncture is an invasive procedure commonly used to relieve pain." The second paragraph starts "Although the analgesic effect of acupuncture is well documented, little is understood about its biological basis". It is simply not true that "analgesic effect of acupuncture is well documented". It is not. Try reading Barker Bausell’s excellent book, “Snake Oil Science” if you want to know about the strength of the evidence.
The whole paper is written with the underlying premise that acupuncture works, and all that needs to be done is to explain why. How the paper got past the referees in its present form beggars belief.
Journals like Nature Neuroscience, like it or not, have a certain prestige. Of course, the prestige is exaggerated, and like all journals, it has some good papers and some poor ones. With that prestige comes responsibility to ensure that press releases are accurate. But one often has the impression that press releases are written with the aim of getting wide press coverage, and prestige for the journal, rather that as critical evaluations of the science. This is one such case.
Martin Rees said today, in his first Reith lecture, that "science is organised scepticism". It should be, and in the long run, it is. This paper is an exception and sadly it isn’t alone.
Other commentaries on this paper
There have already been some excellent commentaries on blogs. As so often, the best bloggers are sharper than the scientific journals. If it were not for the fact that my comments on Twitter got some criticism from Nature, I wouldn’t have bothered to add to the following excellent analyses.
Ed Yong, in the Discover site was quick off the mark with A biological basis for acupuncture, or more evidence for a placebo effect?. This provides more detail than I’ve given here. It also has an intriguing postscript.
“PS: The paper notes that the authors have no competing financial interests that might have affected their work. However, it is worth noting that one of the co-authors, Jurgen Schnermann, is married to one Josephine Briggs. Briggs is the director of the National Center for Complementary and Alternative Medicine [NCCAM], an institute that has had its fair share of controversy in the past.”
NCCAM is, of course the branch of the US National Institutes of Health that has spent over a billion dollars of US taxpayers’ money without coming up with a single good treatment. This is rather fascinating, because the report in the Telegraph ends with a laudatory comment from, ahem. Dr Josephine Briggs.
Dr Josephine Briggs, director of the National Centre for Complementary and Alternative Medicine at the National Institutes of Health in the US, said: “It is clear that acupuncture may activate a number of different mechanisms.
“This carefully performed study identifies adenosine as a new player in the process. It is an interesting contribution to our growing understanding of the complex intervention which is acupuncture.”
James Cole at the Stuff and Nonsense blog has another take on the same work, under the ironic title Acupuncture Works, Say Scientists
At Respectful Insolence, Orac gives a superb and thorough account. Read it: When what an acupuncture study shows is much more interesting than what acupuncture believers think it shows.
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
(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).
Admittedly the first poll shows a pretty exaggerated idea of Clegg’s lead. That’s why on-line polls like this are worth next-to-nothing,
It seems that the Daily Mail. not liking the result of their first poll, simply trashed it and began again.
Even by the standards of the Daily Mail, that is cynical dishonesty.
You can vote yourself in the second version at http://www.dailymail.co.uk/debate/polls/poll.html?pollId=1017190
In the wake of the report by the Science and Technology Committee (STC) on the lack of evidence for homeopathy, and the Chinese medicine poisoning, the BBC carried at least three very bad reports. Being a strong supporter of the BBC that saddens me.
Nevertheless it has to be said that the BBC does not always do very well on science reporting. Too many of the reports are anonymous -you don’t know who to blame or who to write to. Worse still, the BBC’s reports on its web site usually fail to link to original sources. This is unforgiveable: the ability to link to sources is the huge advantage of the web over print media.
The problem of balance in media reports
The question of balance is important. Ofcom imposes an obligation that reporting should reflect the balance of viewpoints. Section 5 of Ofcom’s broadcasting code says (emphasis is mine).
“Section 5: Due Impartiality and Due Accuracy and Undue Prominence of Views and Opinions”
“To ensure that news, in whatever form, is reported with due accuracy and presented with due impartiality.”
“Meaning of “due impartiality”: “Due” is an important qualification to the concept of impartiality. Impartiality itself means not favouring one side over another. “Due” means adequate or appropriate to the subject and nature of the programme. So “due impartiality” does not mean an equal division of time has to be given to every view, or that every argument and every facet of every argument has to be represented.”
The BBC Trust has a very similar definition of "due impartiality".
It seems to me that in practice producers tend to use "equal time" too much, and that this often gives a quite misleading impression of the state of play of informed opinion. Nevertheless, inappropriate use of “equal time” is so common that it would not be worth a formal complaint. This post concerns cases of very unequal time,
Somebody said recently, it is as though after an air crash one gave equal time to the air accident investigator and a representative gravity-deniers association. That is scarcely an exaggeration of what happened on the BBC after the STC’s report.
Worse still, far more time was given (especially on ‘Call You and Yours’) to the viewpoint that any scientist, indeed any informed person, would regard as quackery.
This post gives details of three examples of highly partial reporting and it is the basis of complaints to the BBC. But since complaints to the BBC about science reporting rarely get far, a complaint
is being sent also to Ofcom.
(1) Call You and Yours: a platform for herbalists
You and Yours is often quite a good programme, They did an excellent job on a "snoring remedy" which I had unearthed. But on Tuesday 23 February they did a "Call You and Yours" phone-in programme which was badly researched and highly partial.
The presenter, Julian Worricker, didn’t know enough about the topic to ask the right questions, though I’d guess that the blame for the poor quality must lie more with the person who decided that the only "expert" on the programme was a herbalist, and with the people who screened the phone calls.
The programme was billed as being a reaction to the case of a Chinese medicine practitioner who poisoned a patient, and to the publication of the report of Science and Technology Select Committee which damned homeopathy.
The programme can be heard here (at you own risk of bursting a blood vessel) Download mp3 file (43.6 Mb)
The major mistake was that the only "expert" on the programme was Michael McIntyre who is chair of the European Herbal & Traditional Medicine Practitioners Association. McIntyre is a well known advocate of alternative medicine, who constantly fudges the need for proper evidence. He is very keen to increase the respectability of herbalists (like all alternative practitioners, he is desperate to be accepted as a real doctor). In fact McIntyre doesn’t even represent all herbalists. . He failed to mention, and the presenter apparently didn’t know, that 2553 herbalists (as of 24 Feb) signed a petition that opposes the sort of pseudo-regulation the McIntyre wants so desperately.
"We the undersigned strongly object to the Government’s proposals to statutorily regulate herbalists and change section 12(1) of the 1968 Medicines Act."
Not to mention this was a serious error on the part of the researchers for this programme.
This was a programme about alternative medicine in which the ONLY expert was a notorious alternative medicine advocate. It was one of the most highly biassed programmes I have ever heard from the BBC. McIntyre most certainly does not represent the views of science or medicine, as shown, for example, by the submission from Sense About Science, the Academy of Medical Royal Colleges, the Institute of Biomedical Science, the Medical Research Society, the Medical Schools Council, the Physiological Society and the Royal College of Pathologists. The opinion of these not insubstantial people was not mentioned anywhere in the programme.
Here is a summary of the main points in the programme. It shows the bias very clearly. Furthermore the people who selected the phone calls seemed to pick almost all people who advocated alternative medicine.
(1) A lengthy anecdote relating a miraculous “cure” of fibromyalgia with homeopathy. No challenge or alternative interpretation was offered.
(2) A pharmacist (for heavens sake) who said she’d "seen results" from homeopathy and didn’t care whether or not it was placebo. She wasn’t challenged on the problem of lying about whether or not is placebo. We’ve had cause before to worry about the quality of advice given my pharmacists.
(3) Another long anecdote from a nurse (!) claiming to have been "cured" if fibroids by acupressure and cupping. No challenge or alternative interpretation was offered.
(4) Then some emails read out, mostly pro-quack. Only one claiming no effect (in asthma) but that was an anecdote too. Mostly more miracle cures.
(5) Michael McIntyre has the first of several long speeches. advocating more research. There was an advertisement for his web site "promotes best practice" (allegedly). He talks quite seriously about "reflexology" and so on, as though it were real subject (it isn’t; its "principles" are made-up fantasies).
He said. "We need more research in how complementary medicine works". Notice the inbuilt assumption that it does work. This is directly contradicted by the fact that the USA has spent over a billion dollars on CAM research and come up with not a single useful treatment. Why did the researchers and the presenter not know about this, and challenge McIntyre? Once again, the programme researchers seem to be Incompetent.
(7) A caller was mildly critical of fact the Norwich council can’t to anything about claims made by TCM shops (actually Trading Standards could, but generally don’t, but this wasn’t pointed out to the caller).
(8) A caller from Somerset makes the good point that alternative medicine becomes just medicine once it is shown to work.
(9) Michael McIntyre is challenged about evidence, and gives a lengthy speech about why proper RCTs aren’t necessary. They are necessary, but he isn’t challenged. Plus the usual excuse about lack of money for trials. What about that billion dollars?
(10) The Somerset caller says why restrict yourself to herbs? Good point, but no response.
(11) McIntyre gives another long speech in which he propagates the myth that the impurities in herbal medicines are in some way helpful, or synergistic, This is the only justification that herbalists have for giving impure drugs, but there isn’t the slightest evidence to think it’s true. McIntyre should have been challenged about this, but wasn’t.
At no point was McIntyre challenged about the danger of giving drugs (herbal or otherwise) in unknown doses, as herbalists do. He should have been challenged.
(12) Worker (unspecified) in NHS psychiatry says placebos were used to get patients off drugs. The presenter misses the point by asking if the placebos should be paid for by the NHS. The question he should have asked is about ethics of deceiving patients, but presenter did not do this.
(13) A blatant advertisement from a "health food store" in Barnoldswick. The owners are "pharmacy technicians" (since most pharmacists seem to have difficulties about evidence,
this can’t be regarded as a high qualification). They plug the supplements (almost all unnecessary, a few dangerous) that they sell.
(14) McIntyre again. Says something more or less sensible about drug interactions.
(15) By this time I’d emailed and got in a quick bit about the valuelessness of anecdotes, but was .cut short before I could talk about regulation.
(16) McIntyre defends anecdotes, predictably enough. This time the presenter did raise a good point about how anecdotes should be verified by proper tests but McIntyre again evades the main point that most herbs have not been properly tested, and isn’t challenged.
(17) More emails. A man who takes sage for sore throats. One says "of course homeopathic remedies are placebos but placebos work"; "homeopathy is an extraordinary system for industrialising
the placebo effect, but used by responsible practitioners it has a valuable place". Once again the ethics of deceiving patients with hocus pocus in order to elicit a placebo effect was not raised.
And one caller raised the usual red herring about dogs responding. This, yet again, went unchallenged. Why wasn’t it pointed out that it is the human who reports the state of the dog who has the placebo response?
(18) Then on to regulation. The researchers and presenter seemed to be quite unaware of the near-unanimous opinion of scientists and also of the Royal College of Physicians, that regulation in the form
proposed by the Pittilo report will be ineffective, and will do more to harm patients than to safeguard them. There is more than one way to regulate, and this uninformed intervention was especially
unwelcome at a time when the government is considering the question.
(19) Lady with MS said that acupuncture didn’t do her any good at all, but she didn’t like to tell the acupuncturist. But the obvious conclusions were not drawn.
(20) Presenter asks McIntyre leading question "it does work for some and not for others ". No hint there that the ones it "works for" might be the ones who were going to get better anyway. McIntyre himself actual pointed out that some forms of MS (‘relapsing’) undergo spontaneous remissions but of course fails to draw the obvious conclusion that any. He apparent effect of acupuncture could well have been a spontaneous remission. He went on to say (without any evidence) that "acupuncture may help". He relied on the standard line that "more research needed", but failed to mention the vast amount of research that has already been done which shows that acupuncture is probably little more than a theatrical placebo. See, for example, the Nordic Cochrane Centre review and Barker Bausell’s book, Snake Oil Science.
(21) An email points out that anecdotes are no substitute for proper tests. McIntyre then misquotes Sir Michael Rawlins(chair of NICE). He claimed, as most quacks do, that Rawlins had endorsed anecdotes as an acceptable form of evidence in his lecture. This is not what he said at all. In fact Rawlins was referring to treatments that had already passed RCTs and saying that they should be followed up in the wider population of patients to see if they lived up to their initial promise. This interpretation of his words was published in the BMJ after I’d checked it was correct with Rawlins himself.
In the same lengthy speech McIntyre claimed "There really isn’t any dummy acupuncture". This is absolutely untrue, but was not challenged. Huge ingenuity has gone into devising retractable ‘stage dagger’ acupuncture needles, as well as trials that use real needles inserted in the "wrong" positions. One of the most consistent findings in CAM research is that sham acupuncture is not distinguishable from "real" acupuncture. McIntyre, needless to say, didn’t mention this, He should have been challenged but wasn’t.
(21) Declan Naughton (Kingston University) advocates greater "regulation". "If we have trained herbal practitioners" it will make it safer for everyone. Thw revelation of what is actually taught on these degrees shows that, on the contrary, they endanger patients, He claims that use of purified antibiotics leads to problems with drug resistance. There isn’t the slightest reason to think that resistance has anything to do with purification, This was a red herring but went unchallenged. I notice that Naughton has published in Medical Hypotheses, a journal for wild speculations that is not peer-reviewed
(22) Donald Kerr a TCM practitioner, supports McIntyre in looking for statutory regulation. "like the GMC". He is not challenged on the extent to which real medicine and TCM have a sound basis. Like most alternative medicine advocates, he goes for the usual diversionary tactic of criticising western medicine which he refers to as "prescriptive medicines" [sic]
(23) London herbalist Michael Simmons. His web site claims that "Medical Herbalists are trained in the same diagnostic skills as orthodox doctors b". This is simply not true, The fact that herbalists claim it is true mereyl shows how they endanger patients.
(24) Marc Seale, chair of the Health Professions Council (HPC) now appears. he says one very interesting thing "things like false advertising would be dealt with by the regulator". He also acknowledged that there is a strong feeling among scientists and physicians that statutory regulation would give a "false sense of legitimacy " to the area. This latter point was entirely missed by the programme and that seems like another example of incompetent research. But Seale still doesn’t seem to understand the problem, as outlined here and in a joint submission from Sense About Science, the
Academy of Medical Royal Colleges, the Institute of Biomedical Science, the Medical Research Society, the Medical Schools Council, the Physiological Society and the Royal College of Pathologists. This submission opposed regulation of the sort favoured by McIntyre and Seale, but wasn’t even mentioned. Once again, all the speakers were on the same side.
(25. Back once again to McIntyre, who lamented that after ten years of trying, he still hadn’t achieved statutory regulations for herbalists (to the joy of 2500 herbalists), That is simply because they have not fulfilled the requirements for statutory regulation, as laid out in the House of Lords report (2000). That was not mentioned either. Agani the researchers appear not to have done their job properly.
(26) The presenter, Julian Worricker, refers to Prof. Edzard Ernst as a “divisive figure in this field”. That is a highly partial way to refer to the person who has done more than any other individual to bring together objectively the evidence for the effectiveness of alternative medicine. Ernst has every scientist and every informed person behind him.
(27) McIntyre again. He misrepresents Ernst’s views and misrepresents the strength of the evidence for the efficacy of herbal medicines, which are mostly untested.. But he is not challenged.
McIntyre goes on to misrepresent the BMJ Clinical Evidence paper which, he says, shows that 46% of all treatments are not proven to be effective. It is hard to be believe that McIntyre is really unaware that a large proportion of those that were not shown to be effective are CAM treatments, herbal medicine and the like. Professor John Garrow has pointed this out (see, also Healthwatch)
“It is true they chortle, but they have got their facts wrong. The 46% of treatments which are not proven to be effective is 46% of all treatments for 240 common conditions – and very few are used in the NHS. The great majority are treatments used by alternative practitioners. “
If McIntyre was not aware of this he should have been, If he was aware of it he was being less than honest. In any case the programme’s researchers should have been aware of it and McIntyrere should have been challenged. He wasn’t.
(28) A bizarre phone call from someone who seems to think that real medicines are not labelled with their ingredients
(29) Seale is asked if alternative medicine can be regulated like real medicine He says they’ll check degrees. If the checking is done properly, he’ll find endless dangerous made-up material like that revealed here. No degrees on TCM would pass and the whole edifice would collapse.
(30) Another presenter says "it all depends on peoples’ experiences which side they are on".. No! That is simply not true. Well it may have been be true of the phone callers, but is both misleading and untrue in general, The divide is actually between those who are aware of, and care about, evidence and those who do not. Some people actually take the questions seriously, but this comment reduced the discussion to the level of the life style section in a downmarket women’s magazine. One expects more of the BBC.
(31) McIntyre pleads that herbal medicines must be all right because they are used widely on continental Europe. This non sequiter went unchallenged.
(32) Seale says we must wait for Department of Health consultation on Pittilo recommendations. Quite right. For the sake of patient safety, one must hope that the Department of Health will listen to the evidence, and not implement them, despite McIntyre’s success in putting one side of the story on this programme.
(33) McIntyre laments the fact that Europe is bringing in some very sensible regulations about herbal medicine. Again he had free rein to air the views of some (not all) herbalists, with nobody there to support these sensible measures.
(2) Guilty plea in Chinese herbal ‘cancer’ case
This BBC web page gave a very unbalanced account of the case for and against statutory regulation< of traditional Chinese medicine. It simply echoed the (uninformed) view of the judge that "more regulation is necessary" but it was apparently quite unaware that the form of this regulation is at present under consideration by the Department of Health.
The vast majority of scientific and medical opinion is against the particular form of statutory regulation recommended by the Pittilo steering group, and the author of this anonymous report should have been aware of that. Why was there no reference to the submission from Sense About Science, the Academy of Medical Royal Colleges, the Institute of Biomedical Science, the Medical Research Society, the Medical Schools Council, the Physiological Society and the Royal College of Pathologists? These are bodies whose views should not have been ignored, as also the individual submissions here and here. It may be acceptable for a judge to be unaware of this powerful body of opinion. It is not acceptable for BBC reporters to ignorant of it.
The web page does now contain a short statement from Sense about Science which goes a small way to redress the imbalance, That was inserted only after a phone call to the BBC from a member of parliament.
(3) Woman claims that homeopathy cured her cancer
On February 23rd 2010m the BBC showed a an utterly irresponsible item. A homeopath, Gemma Hoefkens, claimed to have been cured of cancer by taking homeopathic sugar pills. There was nobody to point out the utter impossibility of this claim, just some not-very-probing questions fromt the presenter.
Hoefkens promoted her own web site during the interview. It is illegal under the Cancer ACt 1939 to claim to be able to cure cancer and this video must come very close to breaking that law. Some interesting inconsistencies in Hoefken’s account have been pointed out on the Ministry of Truth web site . This was a new low point in science reporting.
This complaint has been sent to the BBC. But the Ofcome web site says
“However, we cannot consider complaints about accuracy in BBC TV and radio news or complaints about impartiality in BBC TV and radio programmes. These complaints have to be dealt with by the BBC.”
This seems to preclude any independent outside adjudication. Not good.
Mark Henderson wrote a nice piece about impartiality in The Times (Feb 4 2010), “Science Matters: The BBC’s balancing act“. He expresses views that are, in many ways, similar to mine.
Yes, it’s that most boring of non-medicine topics, homeopathy, again. At lunchtime on Thursday I got a call from a Times journallst, Fay Schopen, to ask if I could do 500 words on the Science and Technology Committee’s Evidence Check report on homeopathy. Bang goes another evening. The (im)balance was provided by Sara Eames, President of the Faculty of Homeopathy. As always the media insist on treating the matter as though it were an even argument. It’s not. The version I bashed out was three times the length they wanted, and it was skilfully pruned to length by Fay Schopen for the published version. Here is the original. longer, version, for what it’s worth.
Should the NHS fund homeopathy?
The problem with parliament is that there aren’t enough doctors in the House. Or at least there are too many people who seem not to be able to make a critical distinction between what you’d like to be true and what actually is true (no, I’m not talking about Iraq but about something far less important). Perhaps the prime example is David Tredinnick (Cons. Bosworth) who claimed £700 on expenses for his efforts to link astrology and alternative medicine.
Luckily there are a few MPs who are not convinced that healthcare depends on the phase of the moon, and most of them are on the parliamentary Science and Technology Committee (STC). That committee has been conducting ‘evidence checks’ in an effort to find out the extent to which government policy is based on good evidence. Last Monday they published Evidence Check 2: Homeopathy. The report restores ones faith in reason. It concluded that there is no reason to think homeopathic pills have more effect than a placebo, therefore they should not be paid for by the NHS, and neither was more research justified. The report also criticised the Medicines and Health Regulatory Authority (MHRA) for allowing misleading labelling of homeopathic pills, and the Department of Health for failing the take notice of evidence.
Let’s get one thing straight. Homeopathy is very simple indeed. The medicine (in dilutions beyond 12C) contains no medicine. Zero, zilch, nothing. That’s why it is a placebo. Arnica 30C contains not a single molecule of Arnica. It is like selling strawberry jam that has never seen a strawberry. Yet Trading Standards officers can do nothing about this gross mislabelling because loopholes in the law allow advocates of magic medicine to get away with it. It also involves the preposterous idea that the more you dilute a remedy the stronger it gets. If you want to get drunk quickly, put a drop of whisky in the Atlantic Ocean and take a drop. It is nothing sort of surreal that the matter is still being discussed after 200 years.
How did these absurd ideas ever take hold? Around 1800, when homeopathy started, conventional medicine barely existed, and giving nothing was better than being bled and poisoned. Bleeding patients had been standard medicine for hundreds of years in 1800 despite the fact that it killed people. It went on so long because it depended on anecdotes, clinical authority and wishful thinking. These are still the forms of evidence favoured by homeopaths, but real medicine has changed entirely now whereas homeopathy has remained stuck in 1800.
The problem is that homeopaths routinely misrepresent the evidence (if they didn’t they’d be out of business). The report says
”We regret that advocates of homeopathy, including in their submissions to our inquiry, choose to rely on, and promulgate, selective approaches to the treatment of the evidence base”.
The Society of Homeopaths has the nerve to offer you “An overview of positive homeopathy research”. They quite blatantly omit the very much stronger negative evidence. The only word for that is dishonesty.
A favourite with homeopaths is a 2005 study in which 6544 consecutive patients were asked how they felt after homeopathic treatment and 50% said they felt better or much better. That seems a surprisingly small proportion given that most of them would have been treated for minor self-limiting conditions, but we’ll never know because there was no comparison group at all. As evidence, this is utterly worthless,
Two other defences are commonly offered by homeopaths. One is patient choice. The other is that it doesn’t really matter if it’s a placebo if it makes you happy. Choice is fine as long as it’s informed choice. If the homeopath said “these pills contain nothing, but you might feel better after taking them anyway”, that would be fine. But homeopaths never say that. In any case to deceive the patient into thinking they are being offered real medicine when they are not poses deep ethical problems, and the Department of Health has refused to grasp that nettle. You might as well say that Chanel No 5 should be available on the NHS because it makes some people feel better. At the moment we are in the absurd position in which a doctor is not supposed to give placebo knowingly and honestly, but can refer patient to a homeopath for a dishonest placebo. The fact that the homeopath may genuinely believe in the magic is not a sufficient excuse.
If homeopaths limited themselves to minor self-limiting conditions, they wouldn’t do too much harm. But non-medical homeopaths (the vast majority, in the Society of Homeopaths) mostly have no idea of their limitations. They believe they can prevent and treat treat malaria, AIDS, cholera, yellow fever, even cancer.. At this point homeopathy ceases to be a harmless joke but becomes more like culpable homicide.
Recently two homeopaths in Australia were jailed for manslaughter after their own daughter died for want of proper treatment. That is the sort of thing that happens you put your faith in magic medicine,
Homeopathy is on a par with talking to trees. No decent health service should pay for it.
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.
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).
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.”
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.
.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.
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
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.
Eileen Martin (Chair) Pro-Vice Chancellor and Dean of 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.
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
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.
• 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.
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.
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.
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.
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.
Date: 8 June 2009 09:12:18 BDT
Subject: FURTHER URGENT ACTION REQUIRED!
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.
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.
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.
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.
Administrative Officer – Executive Liaison
McTimoney Chiropractic Association
Wallingford OX10 8DJ
Tel : 01491 829494
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?.
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?
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.
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.
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.
Watch this space for developments.
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.
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.
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.
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.
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
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?
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.
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.
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
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
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
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.
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).
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
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.
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.
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.
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.
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
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
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
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
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:
Your most obedient servant,
Substitute the options
“I shall pursue either one with the best of my ability, but I cannot do both:
- To spend my days in endless meetings and form-filling for the benefit of the accountants and copy-boys in central administration, or perchance
- 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,
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”.  “
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”.
I very grateful to ‘ Lindy’ for help in checking the references that are cited here, and for helpful discussions.