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Lines on Homeopathy. Stir the mixture wellLest it prove inferior, Then put half a drop Into Lake Superior. Every other day Take a drop in water, You'll be better soon Or at least you oughter. Bishop William Croswell Doane (1832–1913), first Episcopal bishop of Albany (NY) |
Another 19th century view on Homeopathy. "Some of you will probably be more or less troubled by that parody of medieval theology which finds its dogma in the doctrine of homeopathy, its miracle of transubstantiation in the mystery of its dilutions, its church in the people who have mistaken their century, and its priests in those who have mistaken their calling." [Oliver Wendell Holmes, Medical Essays. The Young Practitioner, [A Valedictory Address delivered to the Graduating Class of the Bellevue Hospital College, March 2, 1871.] ” |
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“There is currently insufficient evidence of effectiveness either to recommend homeopathy as a treatment for any specific condition.”
NHS CENTRE FOR REVIEWS AND DISSEMINATION (University of York) [get pdf]
The dilemmas at the heart of 'alternative medicine'All forms of ineffective treatment, 'alternative' or otherwise, pose real dilemmas that are usually neglected. The definition dilemma
As if telling lies to patients were not enough, the dilemma has another aspect, which is also almost always overlooked. Who trains CAM practitioners? Are the trainers expected to tell their students the same lies? Certainly that is the normal practice at the moment. Consider some examples. The training dilemma
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More students apply for CAM courses: Celia Bell's defence
Sigh! The Times Higher Education Supplement (27 July 2007) reports an 31.5% increase in applications for 'university' courses in complementary medicine.
Compare this with 19 per cent fall in applications for places on anatomy, physiology and pathology courses, and a relatively low 6 per cent rise in applications for pharmacology, toxicology and pharmacy.
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David Colquhoun, professor of pharmacology at University College London, said he was "appalled" by the development. "These courses are basically anti science. Universities that run them should be ashamed of themselves," he said. "They are cashing in on people's wishful thinking when there is no evidence that complementary medicine works. They might as well offer degrees in astrology." Edzard Ernst, professor of complementary medicine research at the Peninsula College of Medicine and Dentistry, said most complementary medicine degrees were "scandalously unacademic". He said: "I am quite cross with British universities for teaching these subjects in such an uncritical way. We need to build up research evidence of what works and what doesn't before offering courses." But Celia Bell, head of Middlesex University's department of natural sciences, which runs courses in Western and Chinese herbal medicine, said the critics were "out of step with the times". She said: "There are now millions of people seeking complementary medicine treatments, and we have to ensure that the practitioners are safe and competent and properly trained." |
Hang on a moment. Something is missing surely, How can a practitioner be "competent and properly trained" if the whole basis of their practice is nonsense and anti-scientific?
And there are "millions of people" who read astrology columns. There are "millions of people" who believe they have been abducted by aliens. There are "millions of people" who don't believe in evolution. Can Dr Bell believe seriously that this is a good argument for providing degrees in astrology, the physics of flying saucers and Creationism?
Dr Celia Bell is Chair, Human and Healthcare Sciences Academic Group at Middlesex University (soon to become “Natural Sciences”). She is not a herbalist by training. She has a B.Sc. in Human Sciences from University College London, a Masters Degree in Human Nutrition at the London School of Hygiene and Tropical Medicine and a PhD in Biochemistry at the Royal Postgraduate Medical School.
So what happened to her critical faculties? I can find in Medline only two recent publications, and they are only short abstracts of the proceedings of a conference in 2003. Before that you have to go back to 1991 See here and here. The second abstract has the title "Herbal treatment for osteoarthritis: a pilot study investigating outcomes". The conclusion is "These preliminary results suggest that the herbal treatment for osteoarthritis provided during this study does appear to benefit patients.". But there appears that there is no control group whatsoever!. If that is really the case (Dr Bell declined to confirm or deny this), the results are absolutely worthless. No better than the infamous Spence (2005).
The only other publication I can find is back in 1991, Chocolate is a migraine-provoking agent. This was a very small study (12 patients on chocolate, 8 on placebo) but a least it did have a control group.
Reports on this item in the Daily Mail, and Daily Telegraph.
BBC makes good on MMR
After the fuss about the BBC Alternative Medicine series (see next item), it was good to see the excellent report on the news last night (16th July 2007) about the appearence of the notorious Andrew Wakefield to face charges of professional misconduct. They showed graphs of the increase in the incidence of measles which has followed the fall in MMR vaccination. They reported on the many studies that have shown no link between MMR and autism. And most fascinatingly, they showed a movie of Wakefield's speech at the Mind Institute.
The movie has now appeared on youtube. Here it is.
And here is a transcript taken from the excellent account at Brian Dear's site (see also Autismdiva). Wakefield jokes about the unethical taking of blood samples at his son's birthday party
“ They all get paid £5, which doesn’t translate into many dollars I’m afraid.
"But, and, they put their arms out and they have the blood taken. All entirely voluntary. [laughter]. "And when we did this at that party, two children fainted, one threw up over his mother [laughter].
"One child, who’s my son’s best friend, Ollie, he put his arm out, very bold, had the tourniquet put on, and then went very pale and sort of … wait till next year. He was nine at the time, and his four year old sister came up, stuck her arm out, had the blood taken, took her five pounds and went off.
"And (NAME) burst into tears. Ruined his birthday party. But people said to me, Andrew, look, you know, you can’t do this, people, children won’t come back to you. [laughter]. I said you’re wrong, I said: 'Listen, we live in a market economy. Next year they’ll want ten pounds!'"
The BBC admits some bad science reporting (at last)
Remember that BBC2 series on Alternative Medicine, shown in February 2006?
Given the superb standards of many BBC science programmes, this series was certainly very disappointing, for the reasons, for the reasons listed in detail below. At the time, my own complaints to the BBC got nowhere at all. The series producer came to see me, but remained adamant that the presentation of evidence had been fair.
Simon Singh's excellent critiques in the Telegraph and the Guardian got some good publicity, but no retraction from the BBC. On the contrary, a letter was sent to the Guardian, apparently signed by scientists who were involved in making the programme. I discovered that this letter had been written by the BBC itself, and had not even been seen by some of the people whose names appeared at the bottom. Simon Singh also lodged a complaint to the BBC, which was rejected. But he is made of sterner stuff than most people. He appealed, but again the complaint was rejected. Singh then appealed to the highest level (Board of Trustees) and at last the complaint was upheld. At least two of the most serious complaints were upheld. |
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Singh says
“First, the BBC agreed that the acupuncture open heart surgery sequence "could have misled the audience". Second, the BBC agreed that their attempts to discredit my criticism of the series "was a breach of trust with the audience" because the BBC had not disclosed its role in organising critical letters ”
This is good news and we should all be grateful to Simon Singh for his persistence. Two of his three serious complaints were upheld, though seven "less serious" ones were not (but should have been). Read the full judgement of the BBC Trustees. Let's hope lessons have been learned.
Westminster Health Forum discusses "Integrative medicine"
The Westminster Diet and Health Forum "aims to provide the premier environment where parliamentarians, senior policy advisors, regulators and other decision makers can discuss critical issues, and exchange ideas and information with leaders from industry, responsible interest groups, analysts, academics, journalists and others".
Their meeting on Thursday 5 July 2007 had the title "Integrating Complementary and Conventional Approaches to Health Care". Despite some good contributions by Edzard Ernst and Simon Singh, the meeting failed to live up to the aims of the forum, partly because the representatives from the Department of Health failed to turn up (because of the changes following the accession of Gordon Brown), and partly because of the choice of speakers. For a start the audience consisted almost entirely of advocates of various forms of alternative medicine. And the meeting was chaired by David Tredinnick MP (Cons, Bosworth). This is what the BBC News profile says about him.
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David Tredinnick is an old style Conservative MP, being an Eton-educated former Guards officer, who has sat in the Commons since 1987. However, his ambition for high office was thwarted by his role in one of the sleaze stories which helped to sink the Major government. He accepted £1,000 from an undercover reporter to ask parliamentary questions about a fictitious drug. He was obliged to resign from his role as a PPS and was suspended from the Commons for 20 sitting days. He has not sat on the frontbench since. He is an orthodox Conservative loyalist, though he is more supportive of the European Union than many of his colleagues. He has, however, carved himself a niche as the Commons' most enthusiastic supporter of complementary medicine. He has wearied successive health secretaries with his persistent advocacy of any and all homeopathic remedies. He has also supported their use in prisons and even suggested them as an aid in alleviating the foot and mouth crisis. |
The chairmanship was punctuated by party political speeches, and, more remarkably, by the apparently serious assertion that he was aware of a psychiatric hospital that doubled its staff at full moon (this is an old urban myth, and is, of course, quite untrue). His advocacy of homeopathic borax as a way to control the 2001 epidemic of foot and mouth diease can be read here.
Picture of David Tredinnick MP from the Conservative Party |
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Kim Lavely, chief executive of the Prince's Foundation for Integrated Health (FIH), was chosen as the keynote speaker. She made (several times) the quite remarkable assertion that Prince's Foundation did not advocate complementary medicine. That's not quite the impression given by their web site, and I have to say I find the dissimulation of speeches like this hard to take. Just as with her boss, the Prince of Wales, the message seems to be tailored to the audience.
Kim Lavely, and Boo Armstrong (of GetWell UK), tried to persuade me that the 'audit' of the effects of Pater Hain's infliction of privatised alternative medicine in Northern Ireland would tell us something useful. Of course it won't provide any useful information. The efforts of Ben Goldacre to explain to the public what constitutes a trial and what doesn't have not made much progress here. Edzard Ernst's request for an example of a treatment that could not be tested in a randomised controlled trial produced no response.
Regulation of complementary medicine is the topic that occupied much of the time. The obvious question is 'how can one have a professional body for a therapy that doesn't work?'. This crucial question was consistently ignored. Alternative medicine advocates are mostly desparate to gain respectability by becoming regulated professionals, though only, of course, as along as the regulations do not require them to demonstrate that they can actually benefit patients (see letter, below).
The Council for Healthcare Regulatory Excellence (CHRE) is yet another quango. I was unaware of its existence until their "head of Fitness to practice" gave a talk. This organisation gets over £2 million per year of taxpayer's money. What does it do? Well "CHRE is a statutory overarching body, covering all of the United Kingdom and separate from Government, established from April 2003. It promotes best practice and consistency in the regulation of healthcare professionals by the following nine regulatory bodies". But these bodies include not only the General Medical Council and the General Dental Council, but also the two forms of alternative medicine that have so far succeeded in getting 'regulated' status, the General Chiropractic Council and the General Osteopathic Council (for information on Chiropractic see below and here).
H.L. Mencken (1924) on chiropractic "This preposterous quackery flourishes lushly in the back reaches of the Republic, and begins to conquer the less civilized folk of the big cities." (source)
I asked the CHRE representative, Mike Andrews, what would happen if a question of fitness to practice in medicine arose that involved inappropriate use of form of alternative medicine that was also represented by CHRE, but of course I got no answer. Such cases have happened in the UK, for example Dr Marisa Viegas was suspended by the GMC advising a patient to stop heart medication which led to her death. And a Dutch doctor was struck off the register after the death of Sylvia Millecam.
The CHRE seems to be yet another expensive form of 'box-ticking' bureaucratic regulation that ends up doing more harm than good. We have become very familiar with such things in universities, where "quality assurance regulators" approve people like Patrick Holford, and pursue policies that end up harming good science, not helping it.
Homeopathy in Intensive Care
Using potassium dichromate to treat patients in intensive care (rather than to clean the glassware)?
No, that isn't a joke. The respectable journal, Chest, official journal of the American College of Chest Physicians, published an article that purported to show that homeopathic potassium dichromate (i.e. water) was a useful way to treat patients in intensive care. [Frass M, Dielacher C, Linkesch M, et al. Influence of potassium dichromate on tracheal secretions in critically ill patients. Chest 2005; 27:936–941].
The title and abstract don't mention the word 'homeopathy' at all. Potassium dichromate, like all hexavalent chromium compounds, is very toxic, but luckily for the patients there was no potassium dichromate present whatsoever in the treatment (it was a 30C dilution). The editor of Chest didn't seem to think that there was anything very odd about this, but he did publish a response from me: Treating Critically Ill Patients With Sugar Pills, Chest, 131 , 645, 2007 [Get pdf ].
“It is one thing to tolerate homeopathy as a harmless 19th century eccentricity for its placebo effect in minor self-limiting conditions like colds. It is quite another to have it recommended for seriously ill patients. That is downright dangerous.”
This was accompanied by an unrepentant response from Frass.
The Frass paper has now received some close attention on the Respectful Insolence blog. Someone posting under the name 'getzal' has done a nice analysis which shows that the control group must have contained patients who were were more seriously ill than the homeopathically-treated group.
So what is a “blood cleanser”? Quinion speaks.
The saga of the excommunication of this page, and its de-excommunication, is described here, and here, and here.
I am supposed to be on holiday, but the Red Lion in Grasmere has a wireless network, and this is just too good not to post at once. So, after a distinctly moist walk over Loughrigg Fell, and an excellent dinner, here goes.
Panorama from half way up Loughrigg Fell, with Grasmere on left and Rydal Water on write, taken just before the downpour started.
Loughrigg Fell and Rydal Water on left. Grasmere Lake above and Grasmere village (right) with GPS track.
The main trigger for the allegations of defamation seems to have been the fact that I said (and still say), apropos of Dr Ann Walker's description of red clover, “What on earth is a "blood cleanser" or a "cleanser of the lymphatic system". This is so much meaningless gobbledygook”.
This set me wondering about the origin of the term "blood cleanser", and who better to ask than the erudite Micheal Quinion of the wonderful World Wide Words site. His weekly newsletter is invariably fascinating. And buy his books.
Michael Quinion has kindly given permission for me to reproduce his "non-definitive" investigation into the use of the term "blood cleanser". It seems to have been a favourite of snake oil salesmen in thw 19th century. Of course, none of them defined what it means. You are just meant to know that it's something good.
Quinion on “Blood Cleanser"“The exact phrase “blood cleanser” is known no later than the nineteenth century. The earliest I've found is from an advertisement in the Ohio Democrat for 30 June 1871 (it ran regularly from then on) “D.B. FAHRNEY'S Blood Cleanser or Panacea, for sale by Miller & O'Donnel, is becoming a popular family medicine." There was also Prof. Chapins' Blood Cleanser, advertised the following year. But the concept of cleansing the blood is very much older, of course. I have found another advertisement, in the Milwaukee Evening Courier of Wisconsin, dated 22 March 1847: “As a SPRING and FALL PURIFIER it cannot be surpassed, working its way through the system with a silent and effective force,--Cleansing the BLOOD; Removing DYSPEPTIC INFLUENCES; Soothing the NERVES; Removing INTERNAL Obstructions and diseases that would otherwise cause injury to the LIVER and LUNGS.” Variations on the phrase also occur several times in Culpeper's Herbal (1653 edition) in the section on hops: “In cleansing the blood they help to cure the French diseases, and all manner of scabs, itch, and other breakings-out of the body; as also all tetters, ringworms, and spreading sores, the morphew and all discolouring of the skin.” Another example is: “The roots of this Bastard Rhubarb are used in opening and purging diet- drinks, with other things, to open the liver, and to cleanse and cool the blood.” It also appears earlier still in The Anatomy of Melancholy by Richard Burton (1621): “And because the spleen and blood are often misaffected in melancholy, I may not omit endive, succory, dandelion, fumitory, &c., which cleanse the blood, Scolopendria, cuscuta, ceterache, mugwort, liverwort, ash, tamarisk, genist, maidenhair, &c., which must help and ease the spleen.” No doubt a more thorough search will turn up still earlier examples. (My sources are poor before the eighteenth century.)” |
Updates on the fallout . . .
The reversal of UCL's request to remove this page from UCL's server was, in large part, the result of the power of the blogosphere (see here and here). Here are some of the things that did the trick.
“Moved to tears by the beauty of blogs”. Goldacre wraps up the affair in the Guardian, and on badscience.net ("Stifling Debate - When Bloggers Attack"). He gives links to the close examination of the work of Dr Ann Walker that that is now appearing.
“UCL have just issued a smashing statement on Prof Colquhoun’s de-excommunication.” Comment from badscience.
This episode seems to have sparked a close inspection of some of the claims made by Ann Walker, Here are some examples.
“Dr Ann Walker and Her Neanderthal Theories”. An analysis of Walker's theory about the Neanderthal diet, on the quackometer blog. Goldacre comments
“In one piece, Walker promotes the idea that neanderthals were not a distinct kind of human, but degenerate and malnourished versions of ordinary humans: buy pills or regress to a sub-human state, seems to be Walker’s message. Yikes.”
“Ann Walker festival: "There is no convincing evidence that Ginkgo biloba is efficacious for dementia and cognitive impairment" ” Holfordwatch takes a cool look at more claims by Ann Walker.
“Red Clover comments leave a bitter aftertaste” Click here
“The War Against Gobbledygook” Comment from Astrophysicists.
"UCL Makes good" Comment from the University of Minnesota
University Diaries. A US Professor of English reproduced Ben Goldacre's first article.
"Science bloggers unite" Comment from a Yale neurologist
"The Guardian: a quackbuster . . . " Comment from MIT (and it's on the MIT server).
"UCL change tack: Colquhoun is back" The Sceptical Preacher speaks
Freedom of speech and litigious herbalists
Announcement 13 June 2007. UCL restores DC's IMPROBABLE SCIENCE page.
After taking legal advice, the provost and I have agreed a joint statememt. Read it on the UCL web site.
“ . . . the Provost and Professor Colquhoun have taken advice from a senior defamation Queen’s Counsel, and we are pleased to announce that Professor Colquhoun’s website – with some modifications effected by him on counsel’s advice - will shortly be restored to UCL’s servers.”
I am grateful to UCL for its legal support, and I'm very grateful too for the enormous support I've had from many people, especially since Ben Goldacre mentioned the site move. Now all I need is a bit of help to get it into a more convenient format. The page will stay at its present address until there is time to sort things out. For some of the fallout from these events, click here. The name of the page has been changed from quack.html to improbable.html on tha advice of lawyers, but the old addresses still work.
Announcement 30 May 2007.
My item about claims made for alleged benefits of the red clover and other herbs has resulted in complaints being made to the provost of UCL (Malcolm Grant), and to Chair of Council (Lord Woolf). The complaints have come from Alan Lakin, husband of Ann Walker. I have received no complaints from them myself.
In the six or so years that I have been running this attempt to improve public understanding of science, I am aware of only two serious complaints being made, and as far as I know, this is the first to reach the level of the provost. This one resulted in a request to remove of this page from the UCL server, but that is now reversed.
Laying on of hands: just tick the box
The Islington Tribune (11 May 2007) revealed that spiritual healers are being paid by the NHS. The National Secular Society commented
“Spiritual healers” using up scarce NHS resourcesThe University College London Hospital is to spend £80,000 on testing whether "spiritual healers" can have an effect on cancer. “Healers” – who wave their hands over the patient and claim to transmit some kind of undefined 'energy' – want to find out whether their efforts increase the number of white blood cells in cancer sufferers. Astonishingly, UCLH has a dedicated team of 10 "healers", who cost the hospital around £80,000 a year to maintain. They are the idea of department manager Angela Buxton who first became interested in “spiritual healing” after the death of her seven-year-old son from leukaemia. She told the local paper: “Science has not caught up with how it works. Anecdotal evidence shows it works but we need hard evidence.”
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A defence of this procedure was offered in an email from Martin Lerner (Divisional Manager, Cancer Services)' He cites cancertherapies.org.uk as saying.
"Today we are also entering the era where appropriate scientific studies of complementary therapy will begin to show specific improvements in outcome for some patients."
Hang on. Aren't you meant to get the scientific studies before you start treating patients?
Lerner goes on to say
“UCLH does employ the staff and provide some of the budget (about £90,000 this year) towards the cost of this service, with a similar amount raised through charitable fundraising. By making these complementary therapy services an integral part of the clinical service, we show that we take responsibility for the whole of the patient's wellbeing, . . . ”
Spiritual healing clearly comes under the heading of “dishonest” placebo effects. Nobody is disputing the value to some patients of palliative treatments. The placebo effect can be quite powerful. But is seems the proponents of laying-on-of hands have not considered adequately the lying dilemma
The laying-on-of hands also gives rise to the training dilemma. What does it mean to be "trained", In something that is essentially mumbo-jumbo?. Well this poses no problem for the box-ticking mentality of the corporate administrator, Just tick the box. Here is the application form. It seems that if you can produce a piece of paper saying you are well-qualified in mumbo-jumbo, then everything is fine.
There is more on the box-ticker mentality elsewhere. It is only too typical of the "efficient administration" that results from corporatisation of the health service, and universities, and the removal of power from those who know what they are talking about.
What is the evidence about “spiritual healing” ?
Very little it seems. There is an interesting paper with the title “Psychotherapy and Survival in Cancer: The Conflict Between Hope and Evidence”, by Coyne, Stefanek & Palmer (2007) [download the paper]. They conclude that, despite the popular belief to the contrary, there is little reason to believe that psychotherapy can prolong life in cancer patients. Insofar as complementary treatments are placebos, they count as a form of psychotherapy.
No doubt, mumbo-jumbo can make some people feel better, and to that extent it is justified. But it can and should done be honestly (for example, foot massage is fine, 'reflexology' isn't). Lies to patients should be minimised and universities should not be tempted to hand out certificates in mumbo jumbo.Tomatso therapy
Well actually it is Amatsu therapy, another of the near-infinite number of sects of the laying-on-of-hands folks. There is a beautiful spoof here.“It takes a holistic approach to a client's financial affairs, seeking to rebalance them in the therapist's favour.”
The Goldacre effect
Saturday 9 June 2007. The wires (and my hit counter) are melting after Ben Goldacre's comments on the move of this web site from UCL's servers. That's understandable: his excellent badscience.net site gets 12,000 hits a day and 95,000 unique visitors per month.
Like all the other comments, his badscience column in today's Guardian, was not solicited by me, but it's wonderful to know that somebody cares. His badscience.net version ("The Mighty David Colquhoun"!) was even more over-the-top. I can't say I'm feeling very "mighty" at the moment.
Goldacre's piece starts "I've always said you'd get a lot more kids interested in science if you told them it involves fighting - which of course it does." A correspondent today enlarged on the theme "you have got me thinking and yes my kids would be far more interested in science if a playstation game was created whereby Prof. Colquhoun was zapping disgruntled alternative therapists". The mind boggles. Making money out of selling mindless violence (in the news again today) must be even worse than making money out of selling useless pills. A university should be one of the few places left where one cannot be accused of knowing the price
of everything, and the value of nothing.
Contrary to what some people seem to think, I don't enjoy rows. They keep me awake at night. But some things are just too important to duck out of them.
Read the provost's reply.
Goldacre has posted the complete text of the provost's reply to one of the many people who have written to him. You should read the other side of the story too (click here and search for "letter from provost"). Grant has a real problem. He shouldn't have to spend time fending off herbalists. Yet if they aren't fended off, more attacks will occur. Who'd be a provost? That is all sorted out now.
The moving of DC's Improbable Science page
UCL felled by a herbalist?
OK this isn't really bad science, but it's caused inconvenience to me and to readers. It still puzzles me that UCL has not got the resources to deal with a herbalist (the reason that I was given for the move).
On Friday 1 June, when it was announced that the IMPROBABLE SCIENCE page had been moved from the UCL server, several people sent letters to the provost. Here is one of them. I have never met Prof Shafer, but his letter, and other similar ones, lightened an otherwise bad day.
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Dear Dr. Grant: I am very sorry to learn that you have requested Dr. Colquhoun to remove his "Improbable Science" web page from the computer system at University College London. It is particularly disheartening to learn that you made this request after receiving a complaint from a practitioner of nonscientific medicine. I don't know how many of your faculty publish in Nature (Colquhoun D. Science degrees without the science. Nature. 2007;446:373-4). However, based on my experience at Stanford, I would guess precious few. You now appear to be attempting to squelch his academic freedom, or at least disassociate UCL from his efforts to educate the public about quack science. Perhaps you were put off by the "unprofessional appearance" of the web page. If so then you have misunderstood its purpose. The public is inundated by junk science, A large portion come from the Internet. There are almost no Internet resources where a lay reader can find a counterweight to the extensive claims of pseudoscientists. Dr. Colquhoun's blog is a unique resource. The format may put off a scientific reader, but it is exactly the format required to get the message to the web surfer with a 10 second attention span. In my view the Improbable Science web page was among the most important public services made available by the University College London. I don't know the facts of your decision. Perhaps there are policies, procedures, and regulations that Dr. Colquhoun has violated in creating the Improbable Science web page. However, I do know that any request to remove the page that follows a complaint from an individual offended by the page is entirely inappropriate. Even were your request otherwise reasonable, the mere appearance of academic censorship should have been absolutely unacceptable to you. (Think of it like conflict of interest - there is a need to avoid not only true conflict of interest, but the mere appearance of conflict of interest. Requesting removal of these pages may not represent censorship, but it certainly appears to be censorship, which is anathema to the academic credo.) It is thus with shock, sadness, and disappointment that I have learned of this decision by the University College London. I hope that you will reconsider. The present course makes it appear that UCL has caved in to pseudoscientists and is engaged in academic censorship of possibly the most important public service offered by the UCL. Sincerely, Steve Shafer Steven L. Shafer, MD |
No doubt it is an exaggeration to say "the Improbable Science web page was among the most important public services made available by the University College London". But thanks anyway.
After an unrepentent response, Professor Shafer replied thus.
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Dear Provost Grant: I appreciate your taking the time to respond. I'm sure that as provost you live on the receiving end of a firehose of correspondence, as do I as a professor and a journal Editor-in-Chief. I'm sorry to have added to the e-mail overload. I appreciate your finding time to respond. It would be my hope that Stanford University would shoulder the responsibility of dealing with whatever harassment would come my way by virtue of my scientific and academic pursuits. Yes, when legal action is threatened, and staff are consumed with processing paperwork, I'm sure my Dean, Provost, and President would prefer to transfer everything to me. However, the effect would be chilling. Universities are supposed to provide a haven to insulate scientists from harassment. I've looked at Dr. Colquhoun's publications via PubMed. He is a top drawer investigator. He is also a very public advocate for critical thinking. You note that Dr. Colquhoun "accepts that he needs to be in a position where he shoulders directly the burden of responding to Dr Lakin." I applaud his fortitude, but note that are only 24 hours in a day. If the administrative resources of University College London are inadequate to respond to Dr. Lakin, how is Dr. Colquhoun, on his own, without the resources of UCL, expected to survive the harassment, legal challenges, and other pressures to silence him? As a counter example, the University of California at San Francisco stood solidly behind Stanton Glantz when the cigarette industry tried to destroy him for his efforts to expose their activities. Had he agreed to "shoulder directly the burden", we would never have known of the extensive research conducted by the cigarette industry over two decades that identified the health risks, and guided their extensive disinformation campaign. I would hope that Stanford University would following the UCSF example, and devote the necessary resources to defend my academic freedom, rather than the UCL example, and ask me to "shoulder the burden." Again, I appreciate your responding to my e-mail. I hope that my perspective is a least thought provoking on the complex mutual responsibilities between a prestigious University and an equally prominent faculty member with outspoken views. Thank you for your consideration, Sincerely, Steve Shafer |
Hmmm. Anybody know a good lawyer?
How to get good science
A different sort of bad science: the use of silly numerical indices for the assessment of the worth of people.
An essay that illustrates the numbskulled nature of assessment metrics (as used at Imperial College Medical School) is on a new site, http://goodscience.org.uk. This is an extended version of comments made in the Times Higher Education Supplement, June 1 2007.
Homeopathy on the NHS: one year on
May 23, 2007. A year ago, our letter to NHS Trusts urged them to stop paying for "unproven and disproved treatments". A year on, we sent a second letter. Read it here. On May 23 2007, John Humphrys introduced coverage of this on the Radio 4 Today Programme with the words
"Doctors who think homeopathy is a waste of time and money seem to be winning the argument"
To listen to his interview with Raymond Tallis and Peter Fisher click here. In the interview, Peter Fisher not only misrepresented the evidence, as usual, but also he said
“We are integrating it [homeopathy] within NHS services in University College London which is one of the leading, you know, biomedical centres in the country”
Hang on a moment! I'm glad that Fisher thinks that UCL is a "leading biomedical centre", but he does not work for UCL (which is a university), but for the UCLH Trust, which is an NHS Trust. This shameless attempt to use the reputation of a quite different institution to bolster his case smacks of desperation (not to mention mendacity).
After Fisher's emphasis on "integration", Tallis commented
“The use of the word integrate is interesting. I mean I suppose you can regard combining medicines that don’t work with medicines that do work as a kind of integrative approach . . . .”
The evidence
Our second letter to NHS Trusts said "If you have not already reviewed your own trust’s provision, you might find it useful to consider, in conjunction with your Director of Public Health, the paper that we have enclosed which, while not a full review of the scientific position, has been used by other trusts to promote evidence based commissioning.". This letter has a summary of the evidence,
Download the evidence hereGood reports in the newspapers include
"Hard-up NHS trusts cut back on unproven homoeopathy treatment": Mark Henderson in The Times
"Doctors renew drive to ban NHS homeopathy": James Randerson, in the GuardianFish oils: what NICE actually said
Much has been written here (and here), and especially by Ben Goldacre, about the irresponsible promotion of omega-3 fatty acids and fish oil on the basis of next-to-no evidence. Now the National Insitute for Clinical Excellence (NICE) is reported as recommending fish oil (e.g. BBC).
Before the supplement hucksters get too excited, try looking at their report.
The report concerns only the question of how to minimise the chances of another heart attack (myocardial infarction, MI) after you have had one. One section of the advice (among many) concerns diet.
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Later, on page 27, the evidence is assessed.
| What is the clinical and cost effectiveness of omega-3-acid ethyl esters treatment in all patients after an MI?
One trial has shown a benefit of treatment with omega-3-acid ethyl esters in patients within 3 months of an MI. However, other secondary prevention treatment had not been optimised in this trial and the majority of patients had preserved left ventricular function. There is some uncertainty about how much additional benefit patients after acute MI optimally managed for secondary prevention, including those with left ventricular systolic dysfunction, will obtain from the addition of omega-3-acid ethyl esters treatment. There is also a paucity of evidence for the effectiveness of treating patients who have had an MI in the past, at least 3 months earlier. The efficacy of omega-3-acid ethyl esters treatment in patients both early and later after MI deserves further research. |
Lord Hunt thinks “psychic surgery” is a “profession”
A colleague wrote to his MP to ask if anything could be done about the defrauding of the public by "psychic surgeons". He wrote, in particular, about Stephen Turoff. Turoff was the subject of the first episode of "Trust me I'm a Healer", a programme that looked at "fake psychic healers". They are the BBC's own words (see badpsychics.com). |
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“Psychic surgery is nothing but a total hoax.”
“Psychic surgery was discredited by the U.S. Federal Trade Commission in 1975. In a unanimous opinion, the commission declared that "'psychic surgery' is nothing but a total hoax." Judge Daniel H. Hanscom, in granting the FTC an injunction against travel agencies promoting psychic surgery tours, said: "Psychic surgery is pure and unmitigated fakery. The 'surgical operations' of psychic surgeons ... with their bare hands are simply phony." (see here) ”
Eventually my colleague got an answer from Lord Hunt, junior minister at the Department of Health (generally loyal Blairite, but he did resign over Iraq). The response makes one wonder what planet the minister is living on Psychic fraud a "profession"? And capable of self-regulation? This letter is just surreal. |
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Clearly misunderstanding the nature of science is not restricted to any political party. In any case, regulation of crackpot medicine arguably does more harm than good (see letter, below).
Most sorts of crackpot medicine are desparate to be "regulated" by the government. They know that the regulation is ineffective, and they know that it gives them a stamp of governnment approval with few obligations on their part. They can then claim to be "professional" psychic surgeons (or whatever) and pretend to be proper doctors. And foremost among those pressing for this sort of phony respectability has been the Prince of Wales Foundation for Integrated Health (see here and here)
Conservative party supports homeopathy: official(!)
The list of NHS Trusts that are cutting funding for homeopathy keeps growing (they are listed in a letter from Peter Fisher, no less). There is real hope that reason will prevail. Part of the backlash has been the tabling of an early day motion (1240) in parliament (these aren't voted on, but are just a sort of publicity stunt). EDM1240 opposes closure of homeopathic hospitals, though it is curiosly ambiguous“complementary medicine has the potential to offer clinically-effective and cost-effective solutions” (my italics)
The list if signatories is pretty depressing. It includes some MPs whom, in other ways. I particularly admire, for example Glenda Jackson and Robert Marhsall-Andrews, as well as quite a lot whom I don't admire a bit. Ignorance of science is, sadly, pretty common in all parties. The signatories include my own MP, Mike Penning (a rather right wing conservative). I wrote to him, and was surprised to hear that support for homeopathy is official Conservative policy. I quote from his reply.
“As you can see from the enclosed standard letter the Conservative Party's view is that there should be a small amount of money made available for homeopathic hospitals.”
OK, it is pretty half-hearted support, presumably based as much on the fact that believers in magic have more votes than scientists. The acccompanying statement says, with fine disregard for the facts,
“Homeopathy and alternative treatments are a valuable resource for doctors to be able to draw upon when offering treatments.”
Well, I guess the Conservatives' belief in the irrational magic is no worse that that of the Blairs.
Multivitamins linked to increased death rate from prostate cancer (?)
Another blow for the "Nutritional therapy" scam has appeared in the Journal of the National Cancer Institute. Men who take large doses of multivitamin (and other) supplements had a relative risk of fatal prostate cancer almost twice as big as those who don't.
Does this mean that taking vitamin supplements increases you risk of death? The BBC report says "Taking lots of multivitamins may increase the risk of deadly prostate cancer, say US researchers". Somebody (does anyone know who?) said never bother to read a report with 'may' in the title. The result was reported widely in the papers, but none of the reports bothered to explain why the ubiquitous 'may' appeared. To find out more you have to read the original paper (download it here).
The study was a big one. It involved 294 344 men (age 50 - 71) selected from 3.5 million people who had been recruited for a long term study of diet and health. They filled in questionnaires in 1995 - 6 and in 1996 - 7, to establish their (reported) intake of vitamin supplements and other relevant data.
This is good because it is a prospective study: the people who take part are selected before the outcome is known, On the other hand, it is bad because it was not a randomised study. This may sound a bit recondite, but it is very fundamental. If we want to know whether vitamin supplements cause fatal prostate cancer the study would have to be done differently. We would have to select a sample of men and allocate them randomly to two groups, one group taking the vitamins, the other taking similar dummy tablets. This is the famous randomised controlled trial and it has been well-understood since the 1930s. If people choose for themselves whether or not to take vitamins, as in this (and most other) studies, the evidence is necessarily much weaker, because the sort of people who decide to stuff vitamins are likely to differ in all sorts of other ways from those who don't.
All this is explained openly and clearly in the DIscussion section of the original paper (but not by the reports in newspapers). For example
“The increased risk of advanced prostate cancer and prostate cancer mortality with heavy use of multivitamins among men with a positive family history of prostate cancer could be due to men with a positive family history taking additional, unspecified supplements as part of a “prostate health” package to prevent the future development of prostate cancer.”
Also, the observations could not distinguish between effects of vitamins and effects of other things like iron, zinc, selenium, folic acid, beta-carotene and saw palmetto which are also often taken by invetarate pill-poppers. Other recent observations have suggested that supplements make actually do harm (see here and here).
So what are we meant to believe? The evidence, at a minimum, does not support the idea that any of these supplements do you any good, so just don't take them. That will save you money and it may even be better for your health.
It's a bit like the food-colouring debate. The evidence that the green dye in you frozen peas does you any harm is ambiguous, but you just don't need it, so why eat it?
The bizarre case of CarcinPLUS
Interesting name uh? What could it be meant for? Any resemblance to 'carcinoma' is just coincidental of course. After all it is illegal both in the USA and the UK to sell something as a cancer cure.
Well it seems to be good stuff. The producers's web site, says
“Introducing CarcinPLUS a brand new concept in homeopathic medicine with multiple applications for both humans and animals ”
but it is strangely coy about what these "multiple applications" are.
You are referred to a publication in "The International Journal of Healing and Caring – On Line". This is not a journal that appears in the National Library of Medicine. The article is by M Sue Benford, president of PHISinc, and it is nothing if not bizarre. Here is the abstract.
“This paper reports a potentially novel discovery pertaining to a method of transferring adaptive genetic
traits from one organism to another via a homeopathic process. Two anti-cancer homeopathic
nosode remedies were created representing different adaptive mutations. These remedies were used
and evaluated independently in both humans and animals. Anecdotal and case study reports are
provided for a remedy developed from the blood of a human donor with genes with a known familial
predisposition to long life and anti-cancer mutation mtDNA C150.” “This first remedy was created from the blood of a human donor with breast cancer (DCIS with microinvasive ductal carcinoma, comedo, high-grade) who showed improvement in her disease through the exclusive use of complementary and alternative medicine (CAM) therapies. The donor refused all traditional treatments, e.g., surgery, chemotherapy, hormone therapy and radiation, and began using CAM therapies involving both bioenergy treatments and nutritional supplements. The ’bioenergy’ treatments included both generalized ’laying-on-of hands’ and Reiki. The anti-cancer supplements consisted of the intermittent use of proteolytic enzymes, Quercetin, Turmeric, Coenzyme Q-10, Folic Acid, and Omega-3 fatty acids.” |
| So Sue Benford seems to be suggesting that the blood of a patient who was, allegedly, cured by laying-on-of-hands, has some characteristic that can be passed on to somebody else via a pill that contains nothing whatsoever (a 200C pill, as recommended by Benford, would contain one molecule from the patient's blood in a sphere of radius equal to the distance between the sun and the earth). And if a single pill doesn't work, “the dose should be increased one pill per day, up to three 200C per day” (hang on a moment, I thought that more meant less). |  M. Sue Benford |
You can't get much more bizarre than that.
Benford has tried to recruit patients though. You can see the appeal on a web site that certainly does claim to cure cancer ("Cancer Is Easy To Overcome -I'll Show You How" )
”Here is the appeal Jonathan sent me yesterday for the study participants. He says he knows nothing more about "Sue" (the researcher) except that she is "totally on top of her subject and that she is involved in bona fide research." She does not want to attract FDA attention at this stage of the study.” [My emphasis]
An enquiry by a friend got this reply from Benford.
“One thing we have observed with nearly all the cancer patients using C+ is an improvement in quality of life. In some instances, the cancer also goes into remission but this isn't a guarantee.”
These pills, which contain no active ingredient, will, I am told, cost the patient $110.45 for 100 doses.
How did I come across these amazing claims? Benford was foolish enough to try a get a bit of free advertising by sending a response to the debate in the British Medical Journal about assessment of homeopathy. See it here.
That wasn't smart, given her wish to avoid the attention of the FDA. And it got me looking too. This was my response in the BMJ.
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Thanks to Ms Benford for drawing the attention of BMJ readers to her web site http://www.phisinc.com/. The company comes very close indeed to offering to cure cancer with homeopathy. Of course it contains the usual disclaimer which amounts to saying 'anything you read here may be untrue'. Nonetheless, the message is clear. Claims to be able to cure cancer, without good evidence, are illegal both in the USA and in the UK. I have heard that phisinc.com has been referred to the FDA, so visit their site quickly. It may not be there much longer. You'd then miss the chance to "View an extraordinary video that demonstrates a novel new technology that images the bioholographic field of living organisms and detects very early stage cancers." Regardless of legality, claims to be able to cure cancer of this sort are, in my view, plain wicked. |
Can't get more bizarre than that?
Well perhaps you can. The same Sue Benford has a publication, listed in Medline. It purports to “demystify unexplained anomalies such as idiopathic thermogenesis, halos and auras, and incorruptibility of human corpses”. Beat that.
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Medical Hypotheses (2001) 56(1), 33–39 Radiogenic metabolism: an alternative cellular energy source M. S. Benford PreComp Inc. and Public Health Information Services Inc., Dublin, Ohio,USA Summary The concept of ‘healing energy’ is commonly used in complementary and alternative medicine; however, efforts to define this concept using contemporary scientific theory, and measure it using modern scientific methods, have been limited to date. Recent experimental testing by Benford et al. observed a uniform, substantial, and consistent decrease in gamma radiation during alternative healing sessions, thus supporting a new energy-balance paradigm hypothesizing ionizing radiation as an alternative cellular energy source. This hypothesis extends the known elements of radiogenic metabolism to potentially explain a number of presumably biopositive energy-related phenomena, including fasting and radiation hormesis, as well as to demystify unexplained anomalies such as idiopathic thermogenesis, halos and auras, and incorruptibility of human corpses. |
Precomp Inc, of Dublin Ohio, the biotechnology start-up company mentioned in the address, is something of a mystery. Benford was its president and CEO. In 1996 it received two NIH Small Business Innovative Research (SBIR) awards ($281,811), but these were apparently for perfectly good science, done not by Benford, but by Ohio University Scientists.
Exploring New Vistas of Science and Spirit is yet another Benford web site, this one run in collaboration with Joseph Marino, a catholic priest. That, I suppose, might explain the arcane interest in spontaneous human combustion and the incorruptibility of human corpses.
And if you believe all this, you'll believe anything.
Good sense in the Daily Mail
Yes, you read that correctly. The Mail published a powerful piece by Michael Baum "Homeopathy is worse than witchcraft - and the NHS must stop paying for it". Read it here.
“The majority of homeopathic physicians are nice, kind people and they're not stupid. They will claim homeopathy is a complementary therapy, not an alternative to medicine. But how does homeopathy complement other medicine? Bogus potions aren't complementary, they are a deception and provide false hope. What we don't have in the NHS is adequate palliative and supportive care that really does complement what people like me do. So I have a solution for the ailing Homeopathic Hospital and the £5million a year it receives from our NHS trust. Stop peddling placebos and turn the hospital into a centre for evidence-based, supportive care for people with life-threatening or terminal illnesses. A centre with psychologists, masseurs, counsellors, art and music therapists.” |
Tunbridge Wells Homeopathic Hospital: please help to make sure it shuts
The BBC News reports the expected resistance to the closure of the Tunbridge Wells Homeopathic Hospital, which was announced last year.
“Members of the public are being invited to five discussion events in May. The consultation is due to end in July.
The events are being held at Preston Hall, Maidstone, on 8 May, and Gravesham Community Hospital on 11 May, while three sessions are taking place at the Camden Centre, Tunbridge Wells, on 16 and 21 May.
A public consultation document entitled "Should the NHS pay for homeopathy?", which will be the focus of discussion, is due to be published on Thursday. ”
The West Kent PCT has a report from their "Directorate of Civic Engagement". This lists "underlying basic principles that the PCT is committed to". This list contains, inter alia, “The pursuit and performance of evidence based clinical practise”
The West Kent PCT consultation announcement is now public. The consultation document can be downloaded as can the feedback form.
The bad news is thay you can send in the feedback form only if you live in West Kent. As someone has already pointed out on Badscience, it isn't a good idea to falsify the form, But I see no reason why one shouldn't write to the PCT to express and opinion, while declaring that you aren't in the local area. The address is
“FREEPOST RRJX JYUR UYAC, West Kent PCT,
Wharf House, Medway Wharf Road, Tonbridge TN9 1RE or email jonathan.barnes@swkentpct.nhs.uk
We need your response by 2 July 2007.”
And just to keep your conscience clear, better put a stamp on it.
Red Clover and herbal spin
The Health Supplements Information Service (HSIS) is a spin organisation for the supplements industry. It was mentioned below, when they attempted to discredit a report that suppplements could actually increase mortality. In that case Ann Walker spoke for HSIS.
The same Ann Walker wrote an editorial for the British Journal of General Practice (January 2007), "Potential micronutrient deficiency lacks recognition in diabetes". The conclusion is "Although still considered to be controversial by some, taking a daily multinutrient supplement would bridge the gap between intake and requirements and ensure that nutrient target intakes are met". The affiliation given is senior lecturer in nutrition at the University of Reading, where she has a one-tenth full time appointment. No competing interests are declared. The University of Reading tells me that she has "consultancies for two supplement companies and for the Health Supplement Information Service. Dr Walker has also declared a private patients clinic".
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Ann Walker is also course director for an organisation called New Vitality. And she "operates a Clinic from her home on two days a week, using a combination of nutritional therapy and herbal medicine to treat patients with a wide variety of conditions." All this sounds rather less academic. And so it is. Take red clover. New Vitality's view is shown on the right What on earth is a "blood cleanser" or a "cleanser of the lymphatic system". This is so much meaningless gobbledygook. The term "blood cleanser" means nothing whatsoever. An enquiry about what "blood cleanser" means has yet to produce a reply. |
 The description of red clover on the New Vitality site |
And is red clover really good for "symptoms of the menopause"? There is quite a different view on Medline Plus. This is an information service run by the US National Librery of Medicine and National Institutes of Health. They say, of red clover for menopausal symptoms,
“most of the available human studies are poorly designed and short in duration (less than 12 weeks of treatment).As results of published studies conflict with each other, more research is needed before a clear conclusion can be drawn.”Medline Plus lists six other indications for red clover that have been suggested by herbalists. The conclusion in all seven cases is "Unclear scientific evidence for this use"
Likewise, New Vitality says of elderflower
“The primary use of elderflowers is for colds and influenze where its anti-viral properties come into play.”
But Medline Plus says
“it remains unclear whether there is truly any benefit from elder for this condition. Additional research is needed in this area before a firm conclusion can be reached. Elder should not be used in the place of other more proven therapies, and patients are advised to discuss influenza vaccination with their primary healthcare provider. It should be noted that the berries must be cooked to prevent nausea or cyanide toxicity.”
Complaints about this item
I have had no complaints myself, but Ann Walker's husband has written directly to the Provost of UCL and even to the chair of UCL's Council. The provost made it clear that he has no legal grounds for complaint (see above). I also heard indirectly of a complaint from the University of Reading's marketing director (yes, marketing dirrector!), Ann Wilstead. The main objection seemed to be to my use of the word "gobbledygook". On 22nd May, I replied to Ms Wilstead as follows.
“I'd also be grateful if you could provide me with definitions of the terms "blood cleanser" or a "cleanser of the lymphatic system". It is true that I describe these terms as gobbledygook, because they are terms unknown to science. If you can persuade me otherwise I'll happily change the description.”
Thus far I have had no reply.
Lakin's complaint was, no doubt, technically correct when he said that I had breached copyright by reproducing a graphic from the New Vitality web site. This free advertising was evidently not appreciated. I apologise for that, and the offending graphic has now been replaced with another one that quotes their words.
Acupuncture doesn't work to stop smoking
The latest if the highly-respected Cochrane reviews concludes
“There is no consistent evidence that acupuncture, acupressure, laser therapy or electrostimulation are effective for smoking cessation, but methodological problems mean that no firm conclusions can be drawn.”
And how many times have you read that? One inconclusive trial after another. More on acupuncture below
Two gross scams
These two, brought to my attention by correspondents, are unusually outrageous in that the advertised ingredients don't even exist!
Pherlure Cologne for men
This wonder product "will help you attract sexual attention instantly from the opposite sex". Or so it says at http://www.pherlure.com/. And what's the evidence?“A recent study conducted at The University of Chicago reports that the "Novel human pheromone formulation (Di-Dehydroepiandrosterone) increases sexual attractiveness." ”
“ Results indicated that Pherlure users "sexual intercourse activity levels increased by 62.4%" while the forty-one placebo controls increased by only 2.8%, respectively. ”
But guess what? The alleged ingredient, "Di-Dehydroepiandrosterone", is not any known chemical. And nobody can trace the alleged study. There is a very thorough debunking at http://www.pherlure.info/
Anatrim.
There has been a barrage of spam email advertising this wonder slimming treatment. Much of the advertising says it contains "Anatrim gordonii", a non-existent plant. It is widely supposed that this is Hoodia gordinii cactus from Southern Africa. Nobody knows who makes the stuff. The origin of some of the advertising has been traced to China. The good thing is that several web sites have sprung up to debunk this scam, e.g. Consumer Health Digest and http://www.anatrim.org/.
Chondroitin does not work for osteoarthritis (and probably glucosamine doesn't work either)
Sales of chondroitin and glucosamine are a worth billions of dollars, but the evidence that they work has never been good.
A new meta-analysis of clinical trials now shows that chondroitin on the symptoms of osteoarthritis is "minimal or nonexistent". (Reichenbach S and others. Meta-analysis: Chondroitin for osteoarthritis of the knee or hip. Annals of Internal Medicine 146:580-590, 2007: download the paper]
It is the same old story. Early trials were small and badly-designed. They seemed to show some effect, which was wildly exaggerated by the supplement hucksters to push sales. Eventually somebody does the trials properly, and it is found that there is little or no benefit. Look at Figure 6 from the paper (right). It shows the size of the beneficial effect plotted against the year of publication. The black circles represent trials with a large number (over 200) patients, the white circles are smaller (and mostly badly-designed) trials. As soon as the trials are done properly, the alleged benefits vanish. The authors conclude "Use of chondroitin in routine clinical practice should therefore be discouraged." |
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Analyses by ConsumerLab.com has reported that 8 out of 20 products said to contain chondroitin failed its quality tests, with four containing between 0% and 8% of amount stated on the label.
Glucosamine shows a similar trend. Glucosamine is a synthetic chemical, but it is not a licensed medicine in the UK. It is marketed as a "food supplement", not as a drug. It is not approved for precription on the NHS. The latest Cochrane review does not entirely rule out some benefit, but again the effects seem to get smaller as the trials get better.
Thanks to Quackwatch for the alert about the Reichenbach paper.
Virginia Tech shootings
My twopennorth is on the politics page, click here.This is a corker
This fine bit of abuse is on glastoburyofthemind. Just for the record, my research has been funded by the MRC and the Wellcome Trust: it has never been funded by the pharmaceutical industry. Here is one reason why. I will admit, though, that I've never heard of Spank Rock. The power of Verdi's requiem is wonderful (especially because Verdi was a non-believer). Just don't pretend that use of the word "power" has anything to do with science. The amazing thing about quacks is that they love to use the language of science while at the same time despising it.
| Very annoyed that The Independent Thursday March 23rd 2007 page 5 gives Doctor David Colquhoun, a London based pharmacologist, free reign to spurt some of the medical lobby’s ongoing anti homeopathy drive. According to Colquhoun one of the problems with homeopathy is that it uses words “borrowed from science’. Such as? “Force and energy they are used in a way that has no scientific meaning whatsoever.” Well EXCUUUUUU-SSSSE ME! “Science” (Is that science PLC you vested interest protecting weasel?) owns words does it? When did it corral them up and put them in the science camp? What a load of hogwash. Haven’t you ears haven’t you heard Spank Rock, James Brown, Jimi Hendrix, The Clash, Public Enemy, ad infibloodynitum? Haven’t they all got as great a right to OWN the energy and power words as a self important self appointed lobby of pharmaceutically funded fucks? Just curious. |
The Royal London Homeopathic Hospital (RLHH) has problems
The news is out. It was in February this year when I first saw some "Commissioning Intentions 2007-08" documents from several London NHS Primary Care Trusts (PCT), indicating their intention to break their contracts with the RLHH on the very reasonable grounds that homeopathy doesn't work. It seemed better to wait for the intentions to be implemented before saying much, because of the inevitable outcry from those who want sugar pills at the taxpayers' expense.
Then, in March 2007, the Health Services Journal carried a story "PCTs consider alternative to homeopathic hospitals" (free registration, or read it here).
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On 8 April 2007, The Observer carried a special report, prominently featured on page 3. “Royals' favoured hospital at risk as homeopathy backlash gathers pace Peter Fisher, clinical director of the RLHH, is quoted as saying
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 Fisher and Queen, Observer 8 April 2007 |
“If the Royal London were to close because of PCT deficits we would scarcely miss it”.
“Homeopathy is no better than witchcraft. It's no better than a placebo effect. It's patronising and insulting for adults.”
“Instead you could have a centre for palliative and supportive care, which would be of greater benefit and involve half the cost. Rather than losing something, we would gain something.”
The backlash
The reaction seems to have started with a letter from homeopath Carol Boyce. Her letter starts thus.
| ROYAL LONDON HOMEOPATHIC HOSPITAL UNDER SIEGE “Death by stealth. The Royal London Homeopathic Hospital (RLHH) – the visible presence of homeopathy within Britain’s NHS - an institution putting homeopathy in the public mind for the last 150 years – the place where homeopathy was seen to perform so well in the cholera epidemic of the 1840s - is being dealt a DEATH BLOW” |
I'd guess the very first sentence must be something of an embarrassment to the RLHH's clinical director, who is far too sensible to believe that cholera can be cured by homeopathic sugar pills.
The red herring about cholera is repeated ad nauseam on hundreds of homeopathy sites (though most are curiously silent about whether they really believe that sugar pills can cure cholera). It is based on the report that during the London Cholera epidemic of 1854, of the 61 cases of cholera treated at the London Homeopathic Hospital, 10 died (16.4%), whereas the neighbouring Middlesex Hospital reported 123 deaths out of 231 cases of cholera (53.2%). Apart from the lack of any knowledge of the state of the patients on entry to hospital, it was also the case at the time that conventional medicine was no more based on evidence than homeopathy. Indeed the initial popularity of homeopathy could well have resulted not only from wishful thinking, but also because doing nothing at all (i.e. homeopathy) was less harmful than blood letting. The fallacy of the argument was spotted very early on by Oliver Wendell Holmes (senior) in his famous essay, Homeopathy and its Kindred Delusions.
But medicine moved on and homeopathy didn't. The history of cholera, like that of tuberculosis, contrary to what is suggested by homeopaths, is a triumph for evidence based medicine. The epidemic was halted not by homeopaths but by the careful observations of John Snow that led to his removing the handle of the Broad Street pump. If medicine had been left to homeopaths, people would still be dying of these diseases.
Carol Boyce invites you to write directly to Queen Elizabeth II, to save the RLHH. She has also started an e-petition on the UK government site. The petition includes the words
| ROYAL LONDON HOMEOPATHIC HOSPITAL UNDER SIEGE “The RLHH has been part of the Health Service for 150 years. ” “In 2005, 67% of GPs and 85% of practices in it’s [sic] Primary Care Trust, referred patients to the hospital. The hospital provides effective and most importantly, COST-EFFECTIVE treatments.” |
Ms Boyce seems not to have noticed that the Prince of Wales' own Smallwood report decided that there was not enough evidence to come to firm conclusions about cost-effectiveness.
Peter Fisher himself has appealed for the survival of the RLHH in a letter dated 9 March 2007.
“The Royal London Homoeopathic Hospital needs your support
09/03/2007
By Dr. Peter Fisher, Homeopath to Her Majesty, the Queen”
There is no silly talk about cholera here, but there is a useful list of Trusts who have decided to abandon "unproven and disproved treatments". Fisher recommends you to read Marcia Angell's book to learn about the deficiencies of the drug industry. I recommend that too. I also recommend Dan Hurley's book on the even greater deficiencies of the quackery industry.
Fisher suggests you write to your MP to prevent closure of the RLHH.
I suggest you write to your MP to support closure of the RLHH.
Times Higher Education Supplement (THES), and another response from Westminster
Following the kerfuffle caused by Nature, THES asked for 800 words on the same topic, Bachelor of Science degrees in subjects that are anti–science (read it here). Every time I read an official validation document I am reminded inexorably of the inimitable Laurie Taylor, which is why the article starts thus.
| The vice-chancellor of Poppleton University is pleased to announce that the university's finances have been transformed since the conversion of its old-fashioned department of physics and astronomy into the new department of alternative physics and astrology. Quality is ensured by the course validation and top Quality Assurance Agency rating, both awarded by a distinguished panel of academics with appropriate expertise in astrology. (Apologies to Laurie Taylor.) |
As it happens, Laurie Taylor's column in the same issue of THES is on "Maintaining Standards", and is as grimly hilarious as always. And his column in the following week (13th April) was about the report of the external examiner, Professor J.K.L. Anonymous, on the Universlity of Poppleton's BSc in palmistry ("There were 36 first-class papers, 22 upper seconds and only one marginal failure". Well, there's a coincidence.
My piece ends thus.
| If a few vice-chancellors appear to value bums on seats more than honest science they should justify their views in public. |
THES plans soon to bring us some responses from the hitherto elusive vice chancellors. That should be interesting.
| This was accompanied by an article by Brian Isbell, who is head of the department of complementary therapies at Westminster University. He presumably had a hand in the (unsigned) response of Westminster to the Nature article, but this time the response was rather different (could that be because he'd read my comments on the original response?). This time there was no quoting of bad evidence, or the Society of Homeopaths, but rather a defence based on the fact that BSc degrees in CAM include some real scientific content. Let's take a look at this new response. Isbell says |  Brian Isbell |
| “The shared philosophy across Westminster's range of complementary therapy degrees is that students need a compulsory core of health sciences. This includes anatomy, physiology, biochemistry, pathology and differential diagnosis. Phytochemistry and pharmacology are included for degrees in herbal medicine and nutritional therapy.” Brian Isbell |
In fact homeopaths at Westminster get two courses on Physiology and two on anatomy out of a total of 22 courses. They get no biochemistry and no pharmacology at all. The standard of these courses is quite unknown because the university refuses to disclose any of its teaching materials. Let’s suppose, for the sake of argument, that they are good. You can’t learn physiology without subscribing to the principles of chemistry and physics. These principles include Avogadro’s number and the very basic idea that response to a drug usually increases as you increase the dose. Both of these ideas are inconsistent with “homeopathic philosophy” (also the subject of four courses).
So on Mondays and Thursdays (for example) the students must believe that response increases with dose, but on Tuesdays and Fridays they are called upon to believe that response decreases with dose.
Isbell admits as much himself when he says “at times students have to work with conflicting scientific models that may not always fit with their clinical practice”. What he does not say is how this absurd conflict is resolved, or how it can be made compatible with science or simple common sense. The course evidently teaches you how to believe several mutually contradictory things at the same time, or at least on alternating days. You don't need to be a scientist to see that is plain daft.
Not only are some of the doctrines of CAM incompatible with science or common sense, but they are often also incompatible with each other. Homeopaths subscribe to the bizarre doctrine that the less you give the bigger the effect, but herbalists do not. Herbal medicine is nothing other than pharmacology, albeit pharmacology as practised at the beginning of the 20th century, before biological standardisation was introduced to assure constant potency of medicines. So they want to give a sensible dose, but don't know what it is. Nutritional therapists go to the opposite extreme and want to give huge (and sometimes toxic) doses.
I have been told that herbal medicine students at Westminster are instructed not to talk to the homeopaths in another part of Isbell’s school, because they talk rubbish. They even have separate sections on the university’s intranet, so that one sort of CAM can’t be polluted by the beliefs of a different sort of CAM. Likewise, students of reflexology are taught that a small area on the big toe is connected with the pituitary gland. Not only is this incompatible with physiology, but it is also incompatible with homeopathy, herbal medicine and nutritional therapy.
The department of complementary therapies seems to resemble a collection of religious sects at war with each other, rather than anything recognisable as science.
The second plank in Isbell's new defence is that students are taught to develop research skills. Homeopathy students get one course (out of 22) called "Methods of Research in Complementary Medicine", and a project, "Research in Practice". It is impossible to know what is taught on these courses because the university refuses to release any of the course materials. But I find it hard to imagine that the courses are very critical when the official response from the university cited the Spence (2005) study as though it provided evidence for the efficacy of homeopathy.
If that is the best the teachers can do, what hope is there for the students?
Th first response from the University of Westminster
The day after the Nature commentary, the University of Westminster issued a statement in response. Let's take a look at it.
| “The BSc (Hons) Health Sciences: Homeopathy is a fully validated degree that satisfies internal and external quality assurance standards.” |
Well, since the University has so far refused to release any of the documents, it is hard to judge what that validation is worth. The validation documents will, no doubt, appear eventually. Watch this space.
One mechanism that is intended to maintain the standard of degrees is the external examiner. Their identities, like almost everything else, are kept secret. In the case of the Westminster BSc in homeopathy, however, we are in luck. According to the Teaching Quality Information (TQI) site, their external examiner is the "Chair of the Society of Homoeopaths". Since April 2004, that has been Andy Kirk RSHom, a homeopath in private practice, with no degree and no scientific qualifications. He, I imagine, is not likely to question the bizarre homeopathic doctrine that the smaller the dose you give, the bigger effect you get.
Correction (4 April 2007). It seems that Westminster supplied wrong information to the TQI site, and the external examiner is not Kirk. They refuse to say who it is. But watch this space.
| “The University’s stance received the backing of the Society of Homeopaths, the UK’s largest register of professional homeopaths”. |
Yes, I'm sure it did. The Society of Homeopaths is an organisation for homeopaths who have no medical qualification. Their scientific credentials can be judged from this quotation from their web site.
“If they are so dilute, how can they work?
After each dilution the mixture is vigorously agitated in a machine that delivers a calibrated amount of shaking. This is called succussion. It is thought that this process imprints the healing energy of the medicinal substance throughout the body of water (the diluent) as if a message is passed on. The message contains the healing energy.”
This is pure gobbledygook. The word "energy" is being used in a way unknown to science. It is mere armwaving in an attempt to 'explain' a phenomenon that almost certainly doesn't occur anyway.
| “In fact there is considerable evidence demonstrating the clinical effectiveness of homeopathic treatment, including a large outcomes study published in 2005, of an analysis of over 23,000 outpatient consultations at the Bristol Homeopathic Hospital, in which more than 7 per cent reported clinical improvement,” |
(Notice the Freudian slip. That should be 70%)
The study to which they allude here has to be the worst paper ever published. It is the infamous Spence (2005) study, which is dealt with below. Oddly enough, this paper is one that Westminster students were asked to assess critically. Sadly, though, it hasn't been possible to see any marked answers.
The fact that this is the best evidence that the University can produce in response to criticisms is, perhaps, the best reason ever to think that the material being taught is not, in any sense, science, and is not appropriate for a BSc. It seems that they are hoist by their own petard.
The Nature title picture was 'Taken from The Complete Guide to Homeopathy, © Dorling Kindersley Ltd' (not a recommmended text book at UCL)
Nature (March 22 2007) ran this commentary, alongside a News item by Jim Giles:
“Degrees in homeopathy slated as unscientific”
and a Nature podcast [listen to podcast]. Here is some of the coverage of this commentary (more soon, including some of the abuse). A transcript pf the podcast is here.
Interview on the BBC's Today Programme, with Edward Stourton.
Listen to interview
Material World (BBC Radio 4). This excellent science programme, presented by Quentin Cooper, had a longer version of DC versus David Peters (Westminster University). There was helpful intervention from Michael Marmot who had talked, in the first half of the programme, about his longitudinal population studies. [listen to part 2].
Radio 5 Live interview.
BBC London News (BBC1 TV), An interview of DC and Peter Fisher by the News Presenter, Riz Lateef. Dr Fisher, who is clinical director of the Royal London Homeopathic Hospital, made a very interesting comment, at the end of a discussion about whether homeopathy was a suitable subject for a science degree. [watch the video]
|
Riz Lateef (presenter): “Dr Fisher, could you ever see it [homeopathy] as a science degree in the future? Dr Peter Fisher: “I would hope so. I wouldn't deny that a lot of scientific research needs to be done, and I would hope that in the future it would have a scientific basis. I have to say that at the moment that basis isn't comprehensive. To that extent I would agree with Professor Colquhoun.” [Play the movie (quotation is at the end)] |
|
Evidence? During the interview, Peter Fisher said
“. . .if you look in the Cochrane library, . . . you will find that there are two treatments for flu that appear to be effective, and one of them is homeopathic”
I presume this refers to the Cochrane review "Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes". What this actually says is
“Trials do not show that homoeopathic Oscillococcinum can prevent influenza. However, taking homoeopathic Oscillococcinum once you have influenza might shorten the illness, but more research is needed.”
Well, it might, but even if it did, the average length of the putative "shortening" of the illness was a mere 0.28 days, i.e. 6.7 hours. To call that "effective" seems to me to be just a tiny bit of an exaggeration.
The newspapers
“Faith-based degree ‘damages science’ ”
Mark Henderson, Science Editor, The
Times. I love that title: it says it all.
“Homeopathy science degrees 'gobbledygook' ”
Ian Sample, science correspondent, The Guardian.
“Alternative medicine degrees 'anti-scientific' ”
Roger Highfield, Science Editor, in the Daily Telegraph
“Universities 'are duping students with homeopathy science degrees' ”
Steve Connor, science correspondent The Independent
“Less than complementary?”
James Morgan in the Glasgow Herald
“Alternative therapy degree attack”
“UK universities are teaching "gobbledygook" following the explosion in
science degrees in complementary medicine, a leading expert says.”
BBC News web site
“University homoeopathy degrees 'gobbledygook', claims Professor”
Fiona McRae in the Daily Mail.
and the story even got into the free London papers, Metro and The London Paper
And some from abroad
“British health expert brands homeopathy 'gobbledygook'”
From 'our correspondent' at DailyIndia.com.
“Homeopathic Degree in Britain Puts Scientific Gloss on Nonscientific Dross, Critics Say”
Susan Brown in The Chronicle of Higher Education (USA)
UK Fight Over Anti-Science in Medicine
Dr Steven Novella comments in the NeuroLogica Blog, part of the New England Skeptical Society site.
Some follow up
“A matter of degree. Why the letters after a homoeopath’s name really do count”
Mark Henderson, 24th March, in The Times (Body and Soul section)
Ann Robinson, in the Guardian's Comment is Free (Sunday 25th March) gives me a bit of a slagging off. But her piece is followed by a flood of comments, almost all of them thoroughly sensible. One comment, from 'Midas' ends thus.
“So why not homeopathy alongside medicine?”
Right. Why not Levitation alongside Aeronautical Engineering?
And the blogs: quite a lot of blogs picked up the story.
Thanks to everyone who sent letters of support, not least the regular scientists from Westminster, and University of Central Lancashire who are clearly rather embarrassed by their homeopathic colleagues.
Inevitably there were a few bits of hate mail too, each answered politely, and some even resulting in a degree of agreement. The only one worth quoting is a rather mild one from George Lewith (see below).
“Do you realise that your own university (University College London) offers a BSc in architecture? I have yet to find that this particular course (from personal experience) involves a single piece of science. You might like to investigate at the Bartlett.” . . . Kind regards George” |
I guess one of us is out of sync anyway. Unlike George (it appears), I know little about architecture, but the idea of design for a tower block based on homeopathic principles sounds a bit scary to me.
Items
Celia Bell defends CAM degrees