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The extent to which irrationality has become established in US Medicine is truly alarming I wrote about Quackademics in the USA and Canada on my last trip to the USA, and on my May trip I visited Yale, where I decided to try a full frontal attack. [download the poster]

Several US blogs have written about this phenomenon. For example the incomparable Orac at the The Academic Woo Aggregator , and Dr RW (R.W. Donnell) , see particularly his articles on How did pseudoscience get admitted to medical school? and What is happening to our medical schools? Abraham Flexner is turning over in his grave. Excellent US stuff too at Science-based Medicine (try this and this). There is also a good analysis of what’s happening at Yale by Sandy Szwarc at Junkfood Science.

Remember that the terms ‘integrative’ and ‘complementary’ are euphemisms coined by quacks to make their wares sound more respectable, There is no point integrating treatments that don’t work with treatments that do work.

‘Integrative Medicine’ at Yale says, like all the others on the roll of shame, says “we aim to improve awareness and access to the best in evidence-based, comprehensive medical care available worldwide”. They all pay lip service to being “evidence based”, but there is just one snag. It is untrue. In almost all cases, the evidence is either negative or absent. But this does not put them off for a moment. The whole process is simply dishonest.

The evidence

The evidence has been summarised in several books recently, The following books are particularly interesting because they are all ‘views from the inside. Edzard Ernst is the UK’s first Professor of Complementary Medicine. Barker Bausell was research director of an NIH funded Complementary and Alternative Medicine Specialized Research Center at the University of Maryland.

The first two books go through the evidence fairly and carefully. They show no bias against alternative treatments (if anything, I’d say they are rather generous in cases of doubt).

For a first class US account try Barker Bausell’s Snake Oil Science

 Bausell’s book gives an excellent account of how to test treatments properly, and of all the ways you can be fooled into thinking something works when it doesn’t. Bausell concludes “There is no compelling, credible scientific evidence to suggest that any CAM therapy benefits any medical condition or reduces any medical symptom (pain or otherwise) better than a placebo”.
 For an excellent account of how to find the truth, try Testing Treatments (Evans. Thornton and Chalmers). One of the authors, Iain Chalmers, is a founder of the Cochrane library and a world authotity on how to separate medical fact from medical myth.

It can now be said with some certainty that the number of alternative treatments that have been shown to work better than placebo is very small, and quite possibly zero,

With that settled, what’s going on at Yale (and many others on the roll of shame)?

David L. Katz, MD, MPH, FACPM, FACP, is founder and director of the Integrative Medicine Center (IMC) at Griffin Hospital in Derby, Connecticut. He is also an associate professor, adjunct, of Public Health and director of the Prevention Research Center (PRC) at the Yale University School of Medicine in New Haven, Connecticut.

That sounds pretty respectable. But he is into not just good nutrition, exercise, relaxation and massage, but also utterly barmy and disproved things like homeopathy and ‘therapeutic touch’.

 Watch the movie It so happens that Yale recently held an “Integrative Medicine Scientific Symposium”. Can we find the much vaunted evidence base there? That is easy to answer because three hours of this symposium have appeared on YouTube. So this is the public face of Yale medical school. There’s some interesting history and a great deal of bunkum and double-speak. To save you time, I’ve cut out about 6 minutes from the movies.

Dean of education Richard Belitsky and Dr David Katz

Pretty remarble uh? Dr Katz goes through several different trials, all of which come out negative. And what is his conclusion? You guessed.
His conclusion is not that the treatments don’t work but that we need a “more fluid concept of evidence” .

It’s equally bizarre to hear Richard Belitsky, Dean of Medical Education at Yale saying he is “very proud” of this betrayal of enlightenment values. If this is what Yale now considers to be education, it might be better to go somewhere else.

This is not science. It isn’t even common sense. It is a retreat to the dark ages of medicine when a physician felt free to guess the answer. In fact it’s worse. In the old days there was no evidence to assess. Now there is a fair amount of evidence, but Dr Katz feels free to ignore it and guess anyway. He refers to teaching about evidence as ‘indoctrination’, a pretty graphic illustration of his deeply anti-scientific approach to knowledge. And he makes a joke about having diverted a $1m grant from CDC, for much needed systematic reviews, into something that fits his aims better. Katz asks, as one must, what should we do if there is no treatment that is known to help a patient. That is only too frequent a problem. The reasonable thing to say is “there is no treatment that is known to help”. But Dr Katz thinks it’s better to guess an answer. There is nothing wrong with placebo effects but there is everything wrong with trying to pretend that you are doing more than give placebos. Perhaps he should consider the dilemmas of alternative medicine. You can read about more about Yale’s activities here and in interviews here. Dr Katz says “The founding approach—and I think Andrew Weil, MD, gets the lion’s share of credit for establishing the concept —is training conventional practitioners in complementary disciplines”. Let’s take a look at this hero. Try, for example, Arnold Relman’s “A trip to Stonesville“. “According to Weil, many of his basic insights about the causes of disease and the nature of healing come from what he calls “stoned thinking,” that is, thoughts experienced while under the influence of psychedelic agents or during other states of “altered consciousness” induced by trances, ritual, magic, hypnosis, meditation, and the like.” “To the best of my knowledge, Weil himself has published nothing in the peer-reviewed medical literature to document objectively his personal experiences with allegedly cured patients or to verify his claims for the effectiveness of any of the unorthodox remedies he uses.” Here is the advertisment for Andrew Weil’s nutrition symposium. Not only does this yet again propagate the great antioxidant myth, but a few moments with Google show that it is riddled with vested interests, as already pointed out on Quackademics in USA and Canada. What has brought medical schools down to this level? That isn’t hard to see, The main thing is simply money. Very few university administrators have the intellectual integrity to turn down money, whatever the level of dishonesty that is required by its acceptance. You can buy a lot of silence for$100m

The US Taxpayer has given almost a billion dollars, via NIH.

Wallace Sampson, MD says of NCCAM

“. . it has not proved effectiveness for any ‘alternative’ method. It has added evidence of ineffectiveness of some methods that we knew did not work before NCCAM was formed”

“Its major accomplishment has been to ensure the positions of medical school faculty who might become otherwise employed in more productive pursuits.”

“Special commercial interests and irrational, wishful thinking created NCCAM. It is the only entity in the NIH devoted to an ideological approach to health.”

NCCAM has given money from some very dubious trials too, Both Orac on Respectful Insolence and Dr RW (R.W. Donnell) have written recently about the NCCAM-funded trial of “chelation therapy”, as first exposed in a devastating article by Kimball C. Atwood IV, MD; Elizabeth Woeckner, AB, MA; Robert S. Baratz, MD, DDS, PhD; Wallace I. Sampson, MD on Medscape Today. This is a $30 million, 5-year, phase 3 Trial to Assess Chelation Therapy (TACT) for coronary artery disease. “But how did such a crappy study ever come to be, much less be funded by the NIH to the tune of$30 million? The answer, not surprisingly, involves one of the foremost promoters of quackery in the federal government, Representative Dan Burton (R-IN).”

We conclude that the TACT is unethical, dangerous, pointless, and wasteful. It should be abandoned.”

“TACT is not the only example of an unethical and scientifically worthless trial being funded not because the science is compelling but because powerful lobbies and legislators who are true believers in woo applied pressure to the NIH to do them”

The Bravewell Collaboration is the other major source of money. Forbes Business says “Bravewell is not some flaky New Age group”. Well dead wrong there, That is precisely what it is.

 This group of ultra-rich people, according to its boss, Christy Mack, has a ” . . common goal —fast-tracking integrative medicine into mainstream medicine” So Bravewell is corrupting the search for real knowledge and real cures with big bucks. You can buy a lot of hokum for $100m. The money comes from Morgan Stanley,  “John Mack earned the nickname “Mack the Knife” during his ascension to the top of the company [Morgan Stanley] ladder, known for his aggressive cost cutting and consolidation, managerial efficiency, yelling matches, and brutal treatment of others.” “From 2002 until July 2004, Mack was Co-CEO of Credit Suisse, where he eliminated about 10,000 jobs, cut costs by about$3 billion, and turned the company around to post a huge profit. Accused by SEC of insider trading in 2001, but escaped despite pressure from Senate Finance Committee Chairman Charles Grassley in 2006. Returned as CEO of Morgan Stanley in 2005.”

Bravewell is run by his wife, Christy Mack (Mack-the-wife?) Vice-President, The C.J. Mack Foundation, Member, Board of Directors, The Bravewell Collaborative.

The Flexner report.

The story of Bravewell stands in chilling contrast to another case of philanthropy. Andrew Carnegie’s foundation financed the report by Abraham Flexner, “Medical Education in the United States and Canada” (1910) [download, 15 Mb] . That report was responsible for dragging medical education out of the dark ages
almost a century ago. It resulted in creation of some of the best medical schools anywhere (including Yale).

“By educational patriotism I mean this: a university has a mission greater than the formation of a large student body or the attainment of institutional completeness, namely, the duty of loyalty to the standards of common honesty, of intellectual sincerity, of scientific accuracy.”

“The tendency to build a system out of a few partially apprehended facts, deductive inference filling in the rest, has not indeed been limited to medicine, but it has nowhere else had more calamitous consequences.”

Flexner (1910).

Now another philanthropist is using big bucks to reverse the process and push medicine back into the 19th century.

Flexner would have thought it quite inconceivable that in 2007 medical schools would be offering Continuing Medical Education in homeopathy.

Perhaps they don’t even know it’s happening. If they say firmly that they don’t want it, it will go,

It’s been done before

Florida State University, allegedly under political pressure, proposed to set up a school of Chiropractic. That would have made it Florida State school of snake-oil salesmanship. What a sad fate. [ Science magazine comment] [comment form Paul Lee] [Comment in St Petersburg Times]

But the academics stopped it. An FSU professor, Albert Stiegman, predicted the future campus map.

According to FSUnews

“The Florida Board of Governors voted 10-3 Thursday to deny Florida State University’s request to build a chiropractic school.”

“However, the passage of the bill for the chiropractic school by the Legislature seemingly bypassed the Board of Governors.”

In the end, reason won. Let’s hope that Yale follows their example.

The problem of Yale has been taken up with great eloquence by some US commentators

Dr RW (R.W, Donnell): “Quackademic Medicine at Yale

“By the way, where’s the AAMC in all this? Aren’t they supposed to be guardians of integrity and professionalism in medical education? Are they asleep at the switch or is money silencing them too?”

Orac (Respectful Insolence): “Integrative” medicine at Yale: A more “fluid” concept of evidence?

“after the Dean of the Yale School Medicine embarrassed himself in the introduction by saying he’s proud of how far this nonsense has come, Dr. Katz takes the stage and demonstrates the sort of hostile attitude towards science that, if allowed to take root will be the death of scientific medicine in any meaningful form at U.S. medical schools”

Junkfood Science. Sandy Szwarc on “Quote of the day: ;We need a more fluid concept of evidence’

“Will healthcare professionals and consumers . . . . speak out against these wellness programs being enacted by government agencies, insurers and employers? Or is the money too good?”

Science-based Medicine. Steven Novella writes on “Changing the rules of evidence“. When alternative medicine people do not like the evidence, they change the rules to get the outcome that they want, as seen so graphically in this post. They have always done this, but it is only recently that this sort of behaviour has been endorsed by places like Yale.

The Macho Response, another US blog, comments bluntly, in “Yale wants a more fluid concept of evidence

This is beyond embarrassing – it’s a fucking crime – and it’s happening at Yale University and many others.

If you’re in the medical profession (and I know many of my readers are) you need to go here – now.

Kiosque Médias writes as follows

Pour ceux qui s’intéressent à la médecine et à la santé, le blog de David Colquhoun vaut probablement le détour. Ce professeur-chercheur au département de neurosciences, de physiologie et de pharmacologie de l’University College London y décrypte les résultats d’études médicales, en mettant l’accent sur les médecines alternatives. Et il est rarement tendre!

James Randi Newsletter. The hit rate soars after a recommendation this piece by the amazing Randi.

Hokum-Balderdash Assay. Edwardson writes

“Yale University is going to the ducks. It now has an Integrative Medicine program and in April held its first annual Integrative Medicine Scientific Symposium. I think there must’ve been a typo there. They must’ve meant “Ist Annual I.M. Pseudoscientific Symposium.” There! Now we’ve done away with the oxymoron.”

Why is Yale so secretive about its quackery department?,

Most universities are only to keen to boast about their grant income. Not in this case though. When I asked how they funded their quackery, all I got was a letter that had very obviously been drafted by a lawyer.

“As a private institution, Yale University is not generally subject to the U.S. Freedom of Information Act. We therefore respectfully decline to compile and provide the information you have requested.”

So pretty clear signs of guiltiness there.

Dr David Katz, yes, he of the “fluid concept of evidence”, has posted an article, Health Hazards of rhe Blogoshere. If it quacks like a duck . . .

It seems that he has been a bit alarmed by the reaction of the bloggers. It starts, rather pompously, thus.

“Being well educated does not guarantee you’ll always be right, and it certainly doesn’t guarantee everyone will agree with you. But it still matters. Or at least it used to “

But the rest if it reads less like a defence than as an admission of guilt, thus prompting the next item.

Paul Hutchinson’s blog

 A quack who admits it picks out a quotation from Dr Katz’s response and turned into a cartoon, released to the public domain, So here it is.

Respectful Insolence.

Orac comments too, in “Fluid evidence” strikes back: Dr. Katz versus the skeptical blogsophere”. He does a terrific job in taking apart the response from the hapless Dr Katz.

“No, Dr. Katz does not like his first encounter with the medical blogosphere at all. Indeed, he is so unhappy that apparently a few weeks ago he tried t answer the bloggers who had raked him over the coals for blatantly advocating “integrating” unscientific woo like homeopathy with scientific medicine. Unfortunately for him, he did not do a particularly good job of it. Indeed, what most stood out as I read his rejoinder was that he does not answer a single substantive criticism leveled at his comments. Not one. Instead, he does what pretty much all woo-meisters do when criticized for shifting goalposts and appealing to other ways of knowing besides science as a means of “proving” that their preferred fairy dust works; he wraps himself in the mantle of the brave iconoclast willing to challenge accepted dogma and whines about the peons who criticized him, heaping contempt on the bloggers who had the temerity to criticize his advocacy for pseudoscience because to him they have not earned the right to criticize his (at least in his opinion, apparently) greatness in comparison to him.”

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

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

Then on 1 May, the ASA said

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

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

This advertisement has to be one of the sneakiest bits of spin that I’ve seen in a while. It appeared in today’s Guardian. And a lot more people will see it than will look at the homeopathic nonsense on the Boots ‘education’ site.

What on earth does it mean? One interpretation could be this. We can’t make false claims for Vitamin(s) B in print, but your Boots Pharmacy Team will be happy to do so in private. OK gang, let’s find out. Get out there and ask them. I’ll be happy to post the answers you get (one of those little mp3 recorders is useful).

The Boots web site isn’t much better. Their Vitality Overview says

“The following vitamins and supplements are important for vitality..
B Vitamins
Ginkgo biloba
Ginseng
Iron
Magnesium
Vitamin C”

Needless to say “vitality” isn’t defined and there is the slightest reason to think that any of these things help the “energy level” of any person on a normal diet.

Sting number 1

I went into a large branch of Boots and asked to speak to a pharmacist. This what ensued (BP= Boots Pharmacist).

DC. My eye was caught by your advertisement. I’m pretty healthy for my age but I do get very tired sometimes and it says “ask your Boots pharmacy team, so what can you recommend?”

BP. “Well basically it helps release energy from your cells so you’ll feel more energetic if you have enough vitamin B in your, eh, blood system”

DC. “Ah, I see, I’ll feel more energetic?”

BP. “yes you’ll feel more energetic because it releases the energy from the cells ”

DC. “which vitamin B does that?”

BP. “It’s a complex. it has all the vitamins in it.”

DC. “So which one is it that makes you feel more energetic?”

BP. “Vitamin B”

DC. “All of them? ”

BP. “All of them. It’s mainly vitamin B12”

DC. “Vitamin B12. That makes you feel more energetic?”

BP. “Yes. B12 and B6.”

DC. “hmm B12 and B6. I wasn’t aware of that before so I’m a bit puzzled. I mean, vitamin B12. I thought that was for pernicious anaemia.”

At this point I think the pharmacist was getting a bit suspicious about all my questions (and spotted the recorder) and began to back off.

BP. “Not necessarily. You know its got [pause], basically what its [pause], if you have enough in your diet there’s no need to take an extra vitamin B.” . . .”This is really for people who are on the go and are, you know, unable to get fresh meals.”

Then the senior pharmacist (SP) was called and I repeated the question.

DC. “Will it give me extra energy? It says I should ask my Boots Pharmacy team about that.”

SP. “It may do, yes. It depends on your own body’s individual reaction to it.” . . . “To be honest I’m not the best person to ask about clinical data on it. If you have more detailed questions I can send them to head office”

At this point. I gave up. The first pharmacist ended up with reasonable advice, but only after she’d obviously become suspicious about all my questions (and spotted the recorder). The senior pharmacist just fudged it when asked a direct question. Initially, the ‘expert advice’ was pure gobbledygook. What does one make of it? The fact that I got the right answer in the end, one could argue, makes the first part worse rather than better. She knew the right answer, but didn’t give it straight away. Instead she talked a lot of nonsense in which two quite different meanings of the word ‘energy’ were confused in a way that is only too familiar in the supplement huckster business. I’m not impressed.

Sting number 2

An email enquiry to Boots customer service asked whether Vitamin B really helped ‘vitality’. It elicited this hilarious non-response (original spelling retained).

 Dear Mrs M*** Thank you for contacting us regarding an advertisement you have seen in relation to the benifits to vitamin C. Unfortunately as I am not medically trained I would be unable to provide you with advice on this particular product. I would however, advise that you contact our pharmacy team at your local store via the telephone directly. You’ll find that they will be more than happy to help you further.

Aha, so the Pharmacy Team are medically-trained?

The Nature title picture was ‘Taken from The Complete Guide to Homeopathy, © Dorling Kindersley Ltd’ (not a recommended 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].

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.

 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.”

Download the movie (5.9 Mb .wmv file: (quotation is at the end)
]

A shorter version of the movie, showing only the quotation at the end has appeared on YouTube.

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 yndromes”. 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

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.

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.” . . .”I suggest you make a formal complaint to your Provost, the Dean of the Medical School, and the committee of UK Vice-Chancellors of Medical Schools. You must know that you are completely out of sync but perhaps you don’t? 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.

### Trust Boots

Boots the Chemists (now Alliance Boots) is a very big business in the UK. There have 1,450 pharmacies in the UK and employ over 100,000 people.

I posted the item below a while ago, on the old Improbable Science page. I thought it deserved a bit more publicity, for the following reason.  The quackometer has posted about Boots too,

I mentioned it during the debate with Felicity Lee at the British Pharmaceutical Conference (2007) (Ben Goldacre’s interview with Felicity Lee is a gem). After the talk I was approached by two heavies. Well, two men in dark suits anyway. It turned out that one was from Boots and the other from Alliance Pharmacies, now merged to form Boots Alliance. They seemed rather bothered by the fact that I’d criticised Boots, but were not entirely unreasonable. They claimed to be on the scientific side and said they’d investigate the matter. I wrote to the Boots man on 10 September, but got no reply, After a reminder on 29 October, I got this.

 Dear David Thank you for your email and reminder. We have investigated the points you raised in your blog. I was informed that it was an old leaflet and has not been reprinted (to my knowledge). However on a point of principle, I have raised the wider issue of clinical validity in my department. This will take its course through to the commercial/buying team.

I wrote back to point out that is wasn’t an old leaflet, but was still on their web site, labelled as ‘education’.

 Dear David Thank you for pointing this out. I’ve had a quick look and it is an educational website looking at all aspects of medicine and therapy, including alternative medicine. It is not a direct sales message to the public. I hope this helps

So not much sign of concern for honesty there. Nothing has happened. Do they really care?

### Corporate Social Responsibility

Boots web site makes a big point about Corporate Social Responsibility (CSR)

“TRUST BOOTS

As you may have noticed, that’s the tagline which in 2005 we adopted as the sign-off to all our advertising. But it’s much more than just a slogan. It’s a concise statement of our entire corporate strategy. Our aim is to make Boots the world’s best health and beauty retailer, and we’re 100% clear that the unique trust in which we are held provides the key to achieving this. Which means, of course, that those two words are also the rationale for all our CSR activities. Everything we do that builds trust is good for our business; anything which could compromise it, a risk we can’t afford to take.”

Trust Boots to provide straight answers.

At one time. Boots were sufficiently ethical not to deal in homeopathy. But no longer.

When asked for evidence that the things they sell actually work, the Boots help desk is astonishingly coy, as related here (thanks to ebm-first.com for giving publicity to this report).

When Boots were asked about their ‘Alternatives Hayfever Relief Tablets’, the answer came, after some delay, “This is a homeopathic product, further information on homeopathic products is available from the Nelson company who make this
particular product for Boots. ” This company has been making homeopathic products for many years and
may well be able to help you further. You may also find general
information about homeopathic medicines in reference books in the public
library”. The email address that they gave me for Nelson’s did not work, and writing to another Nelson’s address produced no reply at all. Clearly any letter that contains the word “evidence” arouses suspicion and is simply deflected.

Dangerous advice from Boots: a small sting.

I have been into several Boots stores, sought out the most senior pharmacist that I can find, and asked them the following question. “I have a 5 year old son who has had diarrhoea for three days now. Please can you recommend a natural remedy”. The response was interesting. In every case but one, the pharmacist reached for a copy of the Boots pamphlet on homeopathy, and thumbed through it, while desperately, but unsuccessfuly, trying to retain an air of professional authority. Then one or another homeopathic treatment from the booklet was recommended. In only one case out of six did the pharmacist even mention the right answer (GP and rehydration). One pharmacist, who turned out to have qualified in Germany, was very insistent that homeopathic treatment was inappropriate and that I should should start rehydration and take the child to the GP. The other five, including one who had an impressive-looking badge saying “consultant pharmacist”, did not even mention rehydration.
Conclusion The education of the pharmacists was clearly insufficient for them to give reliable advice. On the contrary, their advice was downright dangerous.

### Miseducation by Boots the chemists

 Boots also run an “educational” web site for children, the ‘Boots learning store’. Click on the section for ‘pupils’, and then ’16+’ and you find their education about alternative medicine (do their pharmacists do this course, I wonder?). The slide show that follows is an insult to human intelligence, “‘POTENCY‘ is the term used to describe the dilution of a remedy. The weaker the solution the more potent the medication.”

There is nothing wrong with the enzyme bit, but the analogy with homeopathy is baseless and misleading. Enzymes don’t work when there are no molecules present.

But in the next slide, enzymes and catalysts are forgotten anyway, This is how it works.

This meaningless mediaeval gobbledygook about ‘vital forces’ is being peddled as ‘education’ by the biggest retail pharmacy chain in the UK. What hope is there for kids?

But there is more. Now for the exam. If you click on the ‘teacher’ section you can download the students’ notes and the test. The ‘Student Notes’ include the following direct claim that homeopathy can cure diseases.

Now take the test, Here is question 1, and the answer.

I suppose that if the educators at Boots classify Hahnemann’s provings as a ‘clinical trial’ it goes a long way to explain the quality of their learning store, and the quality of the advice given by their pharmacists.

Boots Alternatives also sells a “snoring remedy”

The evidence for effectiveness of this herbal product is very dodgy, as described here earlier. This was an interesting saga that involved bad statistics, inappropriate controls and concealed financial interests. It eventually appeared on the BBC Radio 4 programme, You and Yours.

### Postcript: “Nurses and pharmacists are to be given greater powers to prescribe drugs”

The foregoing history does not give one much confidence in the government’s latest money-saving wheeze. [BBC]

“The latest measures mean nurses and pharmacists will be able to prescribe treatments for more serious conditions such as heart disease and diabetes – traditionally the domain of GPs.

Health Secretary Patricia Hewitt said: “Nurse and pharmacist independent prescribing is a huge step forward in improving patient accessibility to medicines from highly skilled and well trained staff.”

And Chief Pharmaceutical Officer Dr Keith Ridge added: “For pharmacists, this is the dawn of a new era. It will help transform the public’s perception of pharmacy and the services they deliver to patients.”

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