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herbalism

‘We know little about the effect of diet on health. That’s why so much is written about it’. That is the title of a post in which I advocate the view put by John Ioannidis that remarkably little is known about the health effects if individual nutrients. That ignorance has given rise to a vast industry selling advice that has little evidence to support it.

The 2016 Conference of the so-called "College of Medicine" had the title "Food, the Forgotten Medicine". This post gives some background information about some of the speakers at this event. I’m sorry it appears to be too ad hominem, but the only way to judge the meeting is via the track record of the speakers.

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Quite a lot has been written here about the "College of Medicine". It is the direct successor of the Prince of Wales’ late, unlamented, Foundation for Integrated Health. But unlike the latter, its name is disguises its promotion of quackery. Originally it was going to be called the “College of Integrated Health”, but that wasn’t sufficently deceptive so the name was dropped.

For the history of the organisation, see

The new “College of Medicine” arising from the ashes of the Prince’s Foundation for Integrated Health

Don’t be deceived. The new “College of Medicine” is a fraud and delusion

The College of Medicine is in the pocket of Crapita Capita. Is Graeme Catto selling out?

The conference programme (download pdf) is a masterpiece of bait and switch. It is a mixture of very respectable people, and outright quacks. The former are invited to give legitimacy to the latter. The names may not be familiar to those who don’t follow the antics of the magic medicine community, so here is a bit of information about some of them.

The introduction to the meeting was by Michael Dixon and Catherine Zollman, both veterans of the Prince of Wales Foundation, and both devoted enthusiasts for magic medicne. Zollman even believes in the battiest of all forms of magic medicine, homeopathy (download pdf), for which she totally misrepresents the evidence. Zollman works now at the Penny Brohn centre in Bristol. She’s also linked to the "Portland Centre for integrative medicine" which is run by Elizabeth Thompson, another advocate of homeopathy. It came into being after NHS Bristol shut down the Bristol Homeopathic Hospital, on the very good grounds that it doesn’t work.

Now, like most magic medicine it is privatised. The Penny Brohn shop will sell you a wide range of expensive and useless "supplements". For example, Biocare Antioxidant capsules at £37 for 90. Biocare make several unjustified claims for their benefits. Among other unnecessary ingredients, they contain a very small amount of green tea. That’s a favourite of "health food addicts", and it was the subject of a recent paper that contains one of the daftest statistical solecisms I’ve ever encountered

"To protect against type II errors, no corrections were applied for multiple comparisons".

If you don’t understand that, try this paper.
The results are almost certainly false positives, despite the fact that it appeared in Lancet Neurology. It’s yet another example of broken peer review.

It’s been know for decades now that “antioxidant” is no more than a marketing term, There is no evidence of benefit and large doses can be harmful. This obviously doesn’t worry the College of Medicine.

Margaret Rayman was the next speaker. She’s a real nutritionist. Mixing the real with the crackpots is a standard bait and switch tactic.

Eleni Tsiompanou, came next. She runs yet another private "wellness" clinic, which makes all the usual exaggerated claims. She seems to have an obsession with Hippocrates (hint: medicine has moved on since then). Dr Eleni’s Joy Biscuits may or may not taste good, but their health-giving properties are make-believe.

Andrew Weil, from the University of Arizona
gave the keynote address. He’s described as "one of the world’s leading authorities on Nutrition and Health". That description alone is sufficient to show the fantasy land in which the College of Medicine exists. He’s a typical supplement salesman, presumably very rich. There is no excuse for not knowing about him. It was 1988 when Arnold Relman (who was editor of the New England Journal of Medicine) wrote A Trip to Stonesville: Some Notes on Andrew Weil, M.D..

“Like so many of the other gurus of alternative medicine, Weil is not bothered by logical contradictions in his argument, or encumbered by a need to search for objective evidence.”

This blog has mentioned his more recent activities, many times.

Alex Richardson, of Oxford Food and Behaviour Research (a charity, not part of the university) is an enthusiast for omega-3, a favourite of the supplement industry, She has published several papers that show little evidence of effectiveness. That looks entirely honest. On the other hand, their News section contains many links to the notorious supplement industry lobby site, Nutraingredients, one of the least reliable sources of information on the web (I get their newsletter, a constant source of hilarity and raised eyebrows). I find this worrying for someone who claims to be evidence-based. I’m told that her charity is funded largely by the supplement industry (though I can’t find any mention of that on the web site).

Stephen Devries was a new name to me. You can infer what he’s like from the fact that he has been endorsed byt Andrew Weil, and that his address is "Institute for Integrative Cardiology" ("Integrative" is the latest euphemism for quackery). Never trust any talk with a title that contains "The truth about". His was called "The scientific truth about fats and sugars," In a video, he claims that diet has been shown to reduce heart disease by 70%. which gives you a good idea of his ability to assess evidence. But the claim doubtless helps to sell his books.

Prof Tim Spector, of Kings College London, was next. As far as I know he’s a perfectly respectable scientist, albeit one with books to sell, But his talk is now online, and it was a bit like a born-again microbiome enthusiast. He seemed to be too impressed by the PREDIMED study, despite it’s statistical unsoundness, which was pointed out by Ioannidis. Little evidence was presented, though at least he was more sensible than the audience about the uselessness of multivitamin tablets.

Simon Mills talked on “Herbs and spices. Using Mother Nature’s pharmacy to maintain health and cure illness”. He’s a herbalist who has featured here many times. I can recommend especially his video about Hot and Cold herbs as a superb example of fantasy science.

Annie Anderson, is Professor of Public Health Nutrition and
Founder of the Scottish Cancer Prevention Network. She’s a respectable nutritionist and public health person, albeit with their customary disregard of problems of causality.

Patrick Holden is chair of the Sustainable Food Trust. He promotes "organic farming". Much though I dislike the cruelty of factory farms, the "organic" industry is largely a way of making food more expensive with no health benefits.

The Michael Pittilo 2016 Student Essay Prize was awarded after lunch. Pittilo has featured frequently on this blog as a result of his execrable promotion of quackery -see, in particular, A very bad report: gamma minus for the vice-chancellor.

Nutritional advice for patients with cancer. This discussion involved three people.
Professor Robert Thomas, Consultant Oncologist, Addenbrookes and Bedford Hospitals, Dr Clare Shaw, Consultant Dietitian, Royal Marsden Hospital and Dr Catherine Zollman, GP and Clinical Lead, Penny Brohn UK.

Robert Thomas came to my attention when I noticed that he, as a regular cancer consultant had spoken at a meeting of the quack charity, “YestoLife”. When I saw he was scheduled tp speak at another quack conference. After I’d written to him to point out the track records of some of the people at the meeting, he withdrew from one of them. See The exploitation of cancer patients is wicked. Carrot juice for lunch, then die destitute. The influence seems to have been temporary though. He continues to lend respectability to many dodgy meetings. He edits the Cancernet web site. This site lends credence to bizarre treatments like homeopathy and crystal healing. It used to sell hair mineral analysis, a well-known phony diagnostic method the main purpose of which is to sell you expensive “supplements”. They still sell the “Cancer Risk Nutritional Profile”. for £295.00, despite the fact that it provides no proven benefits.

Robert Thomas designed a food "supplement", Pomi-T: capsules that contain Pomegranate, Green tea, Broccoli and Curcumin. Oddly, he seems still to subscribe to the antioxidant myth. Even the supplement industry admits that that’s a lost cause, but that doesn’t stop its use in marketing. The one randomised trial of these pills for prostate cancer was inconclusive. Prostate Cancer UK says "We would not encourage any man with prostate cancer to start taking Pomi-T food supplements on the basis of this research". Nevertheless it’s promoted on Cancernet.co.uk and widely sold. The Pomi-T site boasts about the (inconclusive) trial, but says "Pomi-T® is not a medicinal product".

There was a cookery demonstration by Dale Pinnock "The medicinal chef" The programme does not tell us whether he made is signature dish "the Famous Flu Fighting Soup". Needless to say, there isn’t the slightest reason to believe that his soup has the slightest effect on flu.

In summary, the whole meeting was devoted to exaggerating vastly the effect of particular foods. It also acted as advertising for people with something to sell. Much of it was outright quackery, with a leavening of more respectable people, a standard part of the bait-and-switch methods used by all quacks in their attempts to make themselves sound respectable. I find it impossible to tell how much the participants actually believe what they say, and how much it’s a simple commercial drive.

The thing that really worries me is why someone like Phil Hammond supports this sort of thing by chairing their meetings (as he did for the "College of Medicine’s" direct predecessor, the Prince’s Foundation for Integrated Health. His defence of the NHS has made him something of a hero to me. He assured me that he’d asked people to stick to evidence. In that he clearly failed. I guess they must pay well.

Follow-up

Jump to follow-up

This post was written for the Spectator Health section, at short notice after the release of the spider letters. The following version is almost the same as appeared there, with a few updates. Some of the later sections are self-plagiarised from earlier posts.


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Picture: Getty

The age of enlightenment was a beautiful thing. People cast aside dogma and authority. They started to think for themselves. Natural science flourished. Understanding of the natural world increased. The hegemony of religion slowly declined. Eventually real universities were created and real democracy developed. The modern world was born.

People like Francis Bacon, Voltaire and Isaac Newton changed the world for the better. Well, that’s what most people think. But not Charles, Prince of Wales and Duke of Cornwall.

In 2010 he said

"I was accused once of being the enemy of the Enlightenment,” he told a conference at St James’s Palace. “I felt proud of that.” “I thought, ‘Hang on a moment’. The Enlightenment started over 200 years ago. It might be time to think again and review it and question whether it is really effective in today’s conditions."

It seems that the Prince preferred things as they were before 1650. That’s a remarkable point of view for someone who, if he succeeds, will become the patron of that product of the age of enlightenment, the Royal Society, a venture that got its Royal Charter from King Charles II in1622.

I suppose that the Prince cannot be blamed for his poor education. He may have been at Trinity College Cambridge, his 2.2 degree is the current euphemism for a fail (it seems that he even failed to learn the dates of the enlightenment).

His behaviour has brought to the fore the question of the role of the monarchy.

A constitutional monarch is purely ceremonial and plays no part in politics. Well actually in the UK it isn’t quite as simple as that. The first problem is that we have no constitution. Things haven’t changed much since the 19th century when Walter Bagehot said “the Sovereign has, under a constitutional monarchy… three rights—the right to be consulted, the right to encourage, the right to warn.”.

These are real powers in a country which is meant to be run by elected representatives. But nobody knows how these powers are used: it is all done in secret. Well, almost all. The Prince of Wales has been unusually public in expressing his views. His views bear directly on government policy in many areas: medicine, architecture, agriculture and the environment. These are mostly areas that involve at least an elementary knowledge of science. But that is something that he lacks. Worse still, he seems to have no consciousness of his ignorance.

The Royal family should clearly have no influence whatsoever on government policies in a democracy. And they should be seen to have no influence. The Queen is often praised for her neutrality, but the fact is that nobody has the slightest idea what happens at the weekly meetings between the Prime Minister and the Queen. I doubt that she advises the prime minister to create a National Health Service, or to tax the rich. We shall never know that. We should do.

Almost the only light that has been thrown on the secret activities of Charles was the release, on 13 May, of 27 letters that the Prince wrote to government ministers in the Blair government between 2004 and 2005. It has take 10 years of effort by the Guardian to get hold of the letters. It was ike getting blood from a stone. When the Information Commissioner ruled that the letters should be made public, the decision was vetoed by the Conservative attorney general, Dominic Grieve. He said. of the "particularly frank" letters,

" Disclosure of the correspondence could damage The Prince of Wales’ ability to perform his duties when he becomes King."

That, of course, is precisely why the documents should be revealed.

If Charles’ ability to perform his duty as King is damaged, should his subjects be kept unaware of that fact? Of course not.

In this case, the law prevailed over the attorney general. After passing through the hands of 16 different judges, the Supreme Court eventually ruled, in March, that the government’s attempts to block release were unlawful. The government spent over £400,000 in trying, and failing, to conceal what we should know. The Freedom of Information Act (2000) is the best thing that Tony Blair did, though he, and Jack Straw, thought it was the worst. I expect they are afraid of what it might reveal about their own records. Transparency is not favoured by governments of any hue.

What do the letters say?

You can read all the letters on the Guardian web site. They give the impression of being written by a rather cranky old man with bees in his bonnet and too much time on his hands. The problem is that not all cranky old men can write directly to the prime minister, and get an answer.

Not all the letters are wrong headed. But all attempt to change government policy. They represent a direct interference in the political process by the heir to the throne. That is unacceptable in a democracy. It disqualifies him from becoming king.

Some letters verged on the bizarre.

21 October 2004
To Elliot Morley (Minister for the Environment)

I particularly hope that the illegal fishing of the Patagonian Toothfish will be high on your list of priorities because until the trade is stopped, there is little hope for the poor old albatross.

No doubt illegal fishing is a problem, but not many people would write directly to a minister about the Patagonian Toothfish.

Others I agree with. But they are still attempts to influence the policies of the elected government. This one was about the fact that supermarkets pay so little to dairy farmers for milk that sometimes it’s cheaper than bottled water.

To Tony Blair 8 September 2004

". . . unless United Kingdom co-operatives can grow sufficiently the processors and retailers will continue to have the farmers in an arm lock and we will continue to shoot ourselves in the foot! You did kindly say that you would look at this . . . ".

Yours ever,

Charles

He wrote to the minister of education to try to influence education policy.

22 February 2005
Ruth Kelly

"I understand from your predecessor, Charles Clarke, that he has spoken to you about my most recent letter of 24th November, and specifically about the impact of my Education Summer School for teachers of English and History. This Programme, which involves up to ninety state school teachers each year, has been held over the past three years in Dartington, Devon, at Dunston, in Norfolk and at Buxton, in Derbyshire. I believe that they have added fresh inspiration to the national debate about the importance of English Literature and History in schools."

Despite having made substantial progress, as you may be aware I remain convinced that the correct approaches to teaching and learning need to be challenged

It’s interesting that the meeting was in Dartington. That’s near Totnes ("twinned with Narnia") and it’s a centre for the bizarre educational cult promoted by the mystic and racist, Rudolf Steiner.

Then we get a reference to one of Charles’ most bizarre beliefs, alternative medicine.

24 February 2005
Tony Blair

Dear Prime Minister, 

We briefly mentioned the European Union Directive on Herbal Medicines, which is having such a deleterious effect on complementary medicine sector in this country by effectively outlawing the use of certain herbal extracts. I think we both agreed this was using a sledgehammer to crack a nut. You rightly asked me what could be done about it and I am asking the Chief Executive of my Foundation for Integrated Health to provide a more detailed briefing which I hope to be able to send shortly so that your advisers can look at it. Meanwhile, I have given Martin Hurst a note suggesting someone he could talk to who runs the Herbal Practitioner’s Association.

Yours ever, Charles

In this he opposes the EU Directive on Herbal Medicines. All this directive did was to insist that there was some anecdotal evidence for the safety of things that are sold to you. It asked for no evidence at all that they work, and it allowed very misleading labels. It provided the weakest form of protection from the deluded and charlatans. It was put into effect in the UK by the Medicines and Healthcare Products Regulatory Authority (MHRA). They even allowed products that were registered under this scheme to display an impressive-looking “kite-mark”. Most people would interpret this as a government endorsement of herbal medicines.

This got a sympathetic response from Tony Blair, someone who, along with his wife, was notoriously sympathetic to magic medicine.

30 March 2005
Response from Tony Blair

Dear Prince Charles

Thanks too for your contacts on herbal medicines who have been sensible and constructive. They feel that the directive itself is sound and the UK regulators excellent, but are absolutely correct in saying that the implementation as it is currently planned is crazy. We can do quite a lot here: we will delay implementation for all existing products to 2011; we will take more of the implementation upon ourselves; and I think we can sort out the problems in the technical committee – where my European experts have some very good ideas. We will be consulting with your contacts and others on the best way to do this we simply cannot have burdensome regulation here.

Yours ever, Tony

Note "absolutely correct in saying that the implementation as it is currently planned is crazy. We can do quite a lot here: we will delay implementation for all existing products to 2011".

Government support for acupuncture and herbal medicine was made explicit in a letter from Health Secretary, John Reid (February 2005). He assures the prince that government is taking action to "enhance the status of the herbal medicine and acupuncture professions".

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Nothing could reveal more clearly the clueless attitude of the then government to quackery. In fact, after 15 years of wrangling, the promised recognition of herbalism by statutory regulation never happened. One is reminded of the time that an equally-clueless minister, Lord (Phillip) Hunt, referred to ‘psychic surgery’ as a “profession”.

We got a preview of the Prince’s letters a month before the release when Max Hastings wrote in the Spectator

I have beside me a copy of a letter allegedly written by him some years ago to a cultural institution, asserting the conviction that ‘there is a DIVINE Source which is ultimate TRUTH… that this Truth can be expressed by means of numbers… and that, if followed correctly, these principles can be expressed with infinite variety to produce Beauty’.

You can’t get much barmier than that.

Are the letters harmless?

That has been the reaction on the BBC. I can’t agree. In one sense they so trivial that it’s amazing that the government thought it was a good use of £400,000 to conceal them. But they are all the evidence that we’ll get of the Prince’s very direct attempts to influence the political process.

The Prince of Wales is more than just a crank. He has done real harm. Here are some examples.

When the generally admirable NHS Choices re-wrote their advice on homeopathy (the medicines that contain no medicine) the new advice took two years to appear. It was held up in the Department of Health while consultations were made with the Prince’s Foundation for Integrated Health. That’s Charles’ lobby organisation for crackpot medicine. (The word "integrated" is the euphemism for alternative medicine that’s in favour with its advocates.) If it were not for the fact that I used the Freedom of Information Act to find out what was going on, the public would have been given bad advice as a direct result of the Prince’s political interference.

The Prince’s Foundation for Integrated Health (FIH) folded in 2010 as a result of a financial scandal, but it was quickly reincarnated as the "College of Medicine". It was originally going to be named the College of Integrated Medicine, but it was soon decided that this sounded too much like quackery, so it was given the deceptive name, College of Medicine. It appears to be financed by well-known outsourcing company Capita. It’s closely connected with Dr Michael Dixon, who was medical advisor to the FIH, and who tried to derail the advice given by NHS Choices.

Perhaps the worst example of interference by the Prince of Wales, was his attempt to get an academic fired. Prof Edzard Ernst is the UK’s foremost expert on alternative medicine. He has examined with meticulous care the evidence for many sorts of alternative medicine.Unfortunately for its advocates, it turned out that there is very little evidence that any of it works. This attention to evidence annoyed the Prince, and a letter was sent from Clarence House to Ernst’s boss, the vice-chancellor of the University of Exeter, Steve Smith. Shamefully, Smith didn’t tell the prince to mind his ow business, but instead subjected Ernst to disciplinary proceedings, After subjecting him to a year of misery, he was let off with a condescending warning letter, but Ernst was forced to retire early. In 2011and the vice-chancellor was rewarded with a knighthood. His university has lost an honest scientist but continues to employ quacks.

Not just interfering but costing taxpayers’ money

The Prince’s influence seems to be big in the Department of Health (DH).  He was given £37,000 of taxpayers’ money to produce his Patients’ Guide (I produced a better version for nothing). And he was paid an astonishing £900,000 by DH to prepare the ground for the setting up of the hapless self-regulator, the Complementary and Natural Healthcare Council (CNHC, also known as Ofquack).

The Prince of Wales’ business, Duchy Originals, has been condemned by the Daily Mail, (of all places) for selling unhealthy foods. And when his business branched into selling quack “detox” and herbal nonsense he found himself censured by both the MHRA and the Advertising Standards Authority (ASA) for making unjustifiable medical claims for these products.

It runs in the family

The Prince of Wales is not the only member of the royal family to be obsessed with bizarre forms of medicine. The first homeopath to the British royal family, Frederick Quin, was a son of the Duchess of Devonshire (1765-1824).  Queen Mary (1865-1953), wife of King George V, headed the fundraising efforts to move and expand the London Homeopathic Hospital.  King George VI was so enthusiastic that in 1948 he conferred the royal title on the London Homeopathic Hospital.

The Queen Mother loved homeopathy too (there is no way to tell whether this contributed to her need for a colostomy in the 1960s).

The present Queen’s homeopathic physician is Peter Fisher, who is medical director of what, until recently was called the Royal London Homeopathic Hospital (RLHH).  In 2010 that hospital was rebranded as the Royal London Hospital for Integrated medicine (RLHIM) in another unsubtle bait and switch move. 

The RLHIM is a great embarrassment to the otherwise excellent UCLH Trust.  It has been repeatedly condemned by the Advertising Standards Authority for making false claims.  As a consequence, it has been forced to withdraw all of its patient information. 

The patron of the RLHIM is the Queen, not the Prince of Wales.  It is hard to imagine that this anachronistic institution would still exist if it were not for the influence, spoken or unspoken, of the Queen.  Needless to say we will never be told.

The royal warrant for a firm that sells "meningitis vaccine" that contains nothing

Ainsworth’s homeopathic pharmacy is endorsed by both Prince Charles and the Queen: it has two Royal Warrants, one from each of them.  They sell “homeopathic vaccines” for meningitis, measles, rubella and whooping cough. These “vaccines” contain nothing whatsoever so they are obviously a real danger to public health. 

Despite the fact that Ainsworth’s had already been censured by the ASA in 2011 for selling similar products, Ainsworth’s continued to recommend them with a “casual disregard for the law”.

The regulator (the MHRA) failed to step in to stop them until it was eventually stirred into action by a young BBC reporter, Sam Smith who made a programme for BBC South West.  Then, at last, the somnolent regulator was stirred into action.  The MHRA “told Ainsworths to stop advertising a number of products” (but apparently not to stop making them or selling them). 

They still sell Polonium metal 30C and Swine Meningitis 36C, and a booklet that recommends homeopathic “vaccination”.

Ainsworth’s sales are no doubt helped by the Royal Warrants.  The consequence is that people may die of meningitis. In 2011, the MHRA Chief Executive Professor Kent Woods, was knighted. It was commented, justly, that

"Children will be harmed by this inaction. Children will die. And the fault must lie with Professor Sir Kent Woods, chairman of the regulator "

But the regulator has to fight the political influence of the Queen and Prince Charles. They lost.

The attorney general, while trying to justify the secrecy of Charles’ letters, said

“It is a matter of the highest importance within our constitutional framework that the Monarch is a politically neutral figure”.

Questions about health policy are undoubtedly political, and the highly partisan interventions of the Prince in the political process make his behaviour unconstitutional.

The Prince’s petulant outbursts not only endanger patients. They endanger the monarchy itself.  Whether that matters depends on how much you value the tourist business generated by the Gilbert & Sullivan flummery at which royals excel. 

The least that one can ask of the royal family is that they should not endanger the health of the nation. It would help if they refrained from using their influence on matters that are beyond their intellectual grasp.. 

If I wanted to know the winner of the 2.30 at Ascot, I’d ask a royal. For any other question I’d ask someone with more education.

Follow-up

The letters have made headlines in just about every newspaper. The Guardian had extensive coverage, of course.

The Times had a front page story "Revealed: how Charles got Blair to alter health policy" [pdf]

The British Medical Journal wrote "Prince Charles delayed regulation of herbal medicines" [pdf]

For me, the most shocking item was an interview given by Jack Straw, on Radio 4’s Today Programme. He was Home Secretary from 1997 to 2001 and Foreign Secretary from 2001 to 2006 under Tony Blair. From 2007 to 2010 he was Lord Chancellor. His response to the letters sounded like that of a right-wing conservative.

Like Blair. he deplored the Freedom of Information Act that his own government passed. He defended the secrecy, and supported the Conservative attorney-general’s attempt to veto the release of the letters. Perhaps his defence of secrecy is not surprising, He has a lot to hide, His involvement in the mendacity that led to the Iraq war, the dodgy dossier, his role in covering up torture (the "rendition" scandal). And He was suspended by the Labour party in February 2015 due to allegation of cash bribes.

He is certainly a man with plenty of things to hide.

Listen to the interview, with John Humphrys speaker

It makes a nice change to be able to compliment an official government report.

Ever since the House of Lords report in 2000, the government has been vacillating about what should be done about herbalists. At the moment both western herbalists and traditional Chinese medicine (TCM) are essentially unregulated. Many (but not all) herbalists have been pushing for statutory regulation, which they see as government endorsement. It would give them a status like the General Medical Council.

A new report has ruled out this possibility, for very good reasons [download local copy].

Back story (abridged!)

My involvement began with the publication in 2008 of a report on the Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine . That led to my post, A very bad report: gamma minus for the vice-chancellor. The report was chaired by the late Professor Michael Pittilo BSc PhD CBiol FIBiol FIBMS FRSH FLS FRSA, Principal and Vice-Chancellor of The Robert Gordon University, Aberdeen. The membership of the group consisted entirely of quacks and the vice -chancellor’s university ran a course in homeopathy (now closed).

The Pittilo report recommended statutory regulation and "The threshold entry route to the register will normally be through a Bachelor degree with Honours". It ignored entirely the little problem that you can’t run a BSc degree in a subject that’s almost entirely devoid of evidence. It said, for example that acupuncturists must understand " yin/yang, 5 elements/phases, eight principles, cyclical rhythms, qi ,blood and body fluids". But of course there is nothing to "understand"! They are all pre-scientific myths. This “training dilemma” was pointed out in one of my earliest posts, You’d think it was obvious, but nonetheless the then Labour government seemed to take this absurd report seriously.

In 2009 a consultation was held on the Pittilo report. I and many of my friends spent a lot of time pointing out the obvious. Eventually the problem was again kicked into the long grass.

The THR scheme

Meanwhile European regulations caused the creation of the Traditional Herbal Registration (THR) scheme. It’s run by the Medicines and Healthcare products Regulatory Authority (MHRA). This makes it legal to put totally misleading claims on labels of herbal concoctions, as long as they are registered with THR, They also get an impressive-looking certification mark. All that’s needed to get THR registration is that the ‘medicines’ are not obviously toxic and they have been in use for 30 years. There is no need to supply any information whatsoever about whether they work or not. This appears to contradict directly the MHRA’s brief:

"”We enhance and safeguard the health of the public by ensuring that medicines and medical devices work and are acceptably safe."

After much effort, I elicited an admission from the MHRA that there was no reason to think that any herbal concoctions were effective, and that there was nothing to prevent them from adding a statement to say so on the label. They just chose not to do so. That’s totally irresponsible in my opinion. See Why does the MHRA refuse to label herbal products honestly? Kent Woods and Richard Woodfield tell me. Over 300 herbal products have been registered under the THR scheme (a small percentage of the number of products being used). So far only one product of Tibetan medicine and one traditional Chinese medicine have been registered under THR. These are the only ones that can be sold legally now, because no herbs whatsoever have achieved full marketing authorisation -that requires good evidence of efficacy and that doesn’t exist for any herb.

The current report

Eventually, in early 2014, the Tory-led government set up yet another body, "Herbal Medicines and Practitioners Working Group " (HMPWG). My heart sank when I saw its membership (Annex A.2). The vice-chair was none other that the notorious David Tredinnick MP (Con, Bosworth). It was stuffed with people who had vested interests. I wrote to the chair and to the few members with scientific credentials to put my views to them.

But my fears were unfounded, because the report of the HMPWG was not written by the group, but by its chair only. David Walker is deputy chief medical officer and he had clearly listened. Here are some quotations.

The good thing about the European laws is that

"This legislation effectively banned the importation and sale of large-scale manufactured herbal medicine products. This step severely limited the scope of some herbal practitioners to continue practising, particularly those from the Traditional Chinese Medicine (TCM) and Ayurvedic traditions."

The biggest loophole is that

"At present under UK law it is permitted for a herbal practitioner to see individual patients, offer diagnoses and prepare herbal treatments on their own premises, as long as these preparations do not contain banned or restricted substances. This is unchanged by the Traditional Herbal Medicinal Products Directive. "

Walker recognised frankly that there is essentially no good evidence that any herb, western or Chinese, works well enough to make an acceptable treatment. And importantly he, unlike Pittilo, realised that this precludes statutory regulation.

"There are a small number of studies indicating benefit from herbal medicine in a limited range of conditions but the majority of herbal medicine practice is not supported by good quality evidence. A great deal of international, primary research is of poor quality. "

"ts. Herbal medicine practice is therefore currently based upon traditional practice rather than science. It is difficult to differentiate good practice from poor practice on the basis of this evidence in a way that could establish standards for statutory regulation"

The second problem was the harms done by herbs. Herbalists, western and Chinese, have no satisfactory way of reporting side effects

" . .   . there is very limited understanding of the risks to patient safety from herbal medicines and herbal practice. A review of safety data was commissioned from HMAC as part of this review. This review identified many anecdotal reports and case studies but little systematically collected data. Most herbal medicine products have not been through the rigorous licensing process that is required of conventional pharmaceutical products to establish their safety and efficacy. Indeed, only a small proportion have even been subject to the less rigorous Traditional Herbal Registration (THR) process. "

"The anecdotal evidence of risk to patients from herbal products in the safety review highlighted the prominence of manufactured herbal medicines in the high profile serious incidents which have been reported in recent years. Many of these reports relate to harm thought to be caused by industrially manufactured herbal products which contained either dangerous herbs, the wrong constituents, toxic contaminants or adulterants. All such industrially manufactured products are now only available under European regulations if their safety is assured through MHRA licensing or THR
accreditation; and specific dangerous herbs have been banned under UK law. This has weakened the case for introduction of statutory regulation as a further safety measure. "

Then Walker identified correctly the training dilemma. Although it seems obvious, this is a big advance for a government document. Degrees that teach nonsense are not good training: they are miseducation.

"The third issue is the identification of educational standards for training practitioners and the benchmarking of standards for accrediting practitioners. With no good data on efficacy or safety, it is difficult for practitioners and patients to understand or quantify the potential benefits and risks of a proposed therapeutic intervention. Training programmes could accredit knowledge and skills in some areas including pharmacology and physiology, professional ethics and infection control but without a credible evidence base relating to the safety and effectiveness of herbal medicine it is hard to see how they could form the basis of accreditation in this field of practice.

There are a number of educational university programmes offering courses in herbal medicine although the number has declined in recent years. Some of these courses are accredited by practitioner organisations which is a potential governance risk as the accreditation may be based on benchmarks established by tradition and custom rather than science.
"

"The herbal medicine sector is in a dilemma" is Walker’s conclusion.

"Some practitioners would like to continue to practise as
they do now, with no further regulation, and accept that their practice is based on tradition and personal experience rather than empirical science. The logical consequence of adopting this form of practice is that we should take a precautionary approach in order to ensure public safety. The public should be protected through consumer legislation to prevent false claims, restricting the use of herbal products which are known to be hazardous to health"

The problem with this is, if course, is that although there is plenty of law, it’s rarely enforced : see Most alternative medicine is illegal Trading Standards very rarely enforce the Consumer Protection Regulations (2008) but Walker is too diplomatic to mention that fact.

"The herbals sector must recognise that its overall approach (including the rationale for use of products and methods of treatment, education and training, and interaction with the NHS) needs to be more science and evidence based if in order to be established as a profession on the same basis as other groups that are statutorily regulated."

So what happens next?

In the short term nothing will happen.

The main mistake has been avoided: there wil be no statutory regulation.

The other options are (a) do nothing, or (b) go for accreditation of a voluntary register (AR) by the Professional Standards Authority for Health and Social Care (PSA). Walker ends up recommending the latter, but only after a lot more work (see pages 28-29 of report). Of particular interest is recommendation 5.

"As a first step it would be helpful for the sector organisations to develop an umbrella voluntary register that could support the development of standards and begin to collaborate on the collection of safety data and the establishment of an academic infrastructure to develop training and research. This voluntary register could in due course seek accreditation from the Professional Standards Authority for Health and Social Care (PSA)."

So it looks as though nothing will happen for a long time, and herbalists and TCM may end up with the utterly ineffectual PSA. After all, the PSA have accredited voluntary registers of homeopaths, so clearly nothing is too delusional for them. It’s very obvious that, unlike Walker, the PSA are quite happy to ignore the training dilemma.

Omissions from the report

Good though this report is, by Department of Health standards, it omits some important points.

Endangered species and animal cruelty aren’t mentioned in the report. Traditional Chinese medicine, and its variants, are responsible for the near-extinction of rhinoceros, tiger and other species because of the superstitious belief that they have medicinal value. It’s not uncommon to find animal parts in Chinese medicines sold in the UK despite it being illegal

And the unspeakably cruel practice of farming bears to collect bile is a direct consequence of TCM.

bile bear
A bile bear in a “crush cage” on Huizhou Farm, China (Wikipedia)

 

Statutory regulation of Chiropractors

The same arguments used in Walker’s report to deny statutory regulation of herbalism, would undoubtedly lead to denial of statutory regulation of chiropractors. The General Chiropractic Council was established in 1994, and has a status that’s the same as the General Medical Council. That was a bad mistake. The GCC has not protected the public, in fact it has acted as an advertising agency for chiropractic quackery.

Perhaps Prof. Walker should be asked to review the matter.

Follow-up

You can also read minutes of the HMPWG meetings (and here). But, as usual, all the interesting controversies have been sanitised.

Edzard Ernst has also commented on this topic: Once again: the regulation of nonsense will generate nonsense – the case of UK herbalists.

After an interchange on Twitter about how blogs get noticed, I commented that the best thing for me was being thrown off the UCL web site by Malcolm Grant, and the subsequent support that I got from Ben Goldacre. I am a big fan of just about everything that Goldacre has done. So are a lot of other people and his support was crucial.

When I looked up his 2007 post, I found a lot of links were now broken, and some characters didn’t render properly. So, as a matter of historical record, I’m reproducing the whole post with updated links where possible.

Goldacre’s comments, of course, greatly exaggerated my virtues. But they were very useful at the time, they quadrupled my readership overnight, and I’m eternally grateful to him.

Some of the history of this saga has already been transferred to this blog. The aftermath was interesting.

The Mighty David Colquhoun

June 9th, 2007 by Ben Goldacre in bad science, heroes of bad science, stifling criticism | 56 Comments »

[Update: Letter from Provost below]

Ben Goldacre

Saturday June 9, 2007

The Guardian

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. This week, for example, Professor David Colquhoun FRS – one of the most eminent scientists in the UK – has been forced to remove his quackbusting blog from the UCL servers where it has lived for many years, after complaints from disgruntled alternative therapists.

161514131211109

They objected, for example, to his use of the word “gobbledygook” to describe Red Clover as a “blood cleanser” or a “cleanser of the lymphatic system”. Somebody from the “European Herbal and Traditional Medicine Practitioners Association” complained that he’d slightly misrepresented one aspect of herbalists’ practice. One even complained about Colquhoun infringing copyright, simply for quoting the part of their website that he was examining. They felt, above all, that this was an inappropriate use of UCL facilities.

Now I don’t want to get into the to and fro here, but it is striking that none of them engaged the Prof himself on the issue of the ideas. In fact, they all ran behind his back to the Provost, or rather, to teacher; and the Provost, after serving up a sterling defense of academic freedom in responses to them, quietly asked Colquhoun to take his blog elsewhere, on the grounds that it was bringing the university too much flak. Rousing defenses of Colquhoun have already been written by Professors from Stanford, and senior academics from the UK. [Some are linked here, I’ve got the rest archived. The provost’s initial letter was actually rather stirring]

This episode reveals some unfortunate contrasts. Firstly, in a world where most orthodox "public engagement with science"  activity consists of smug, faux radical "science meets art" projects where ballet dancers watch each other prance about in brain scanners (and I am hardly caricaturing here) Colquhoun was showing the world what science really does.

He took dodgy scientific claims, or “hypotheses” as we call them in the trade, and examined the experimental evidence for them, in everyday language, with humour and verve. For all that being a world expert on single ion channels might make Colquhoun glamorous to me, I would say his blog is a bit more of a treat for the wider public, and arguably a rather good use of the time and resources of a public servant who has devoted his entire life to academia, on its relatively low wages, never once working for industry. Sharing ideas is an employment perk in academia.

Secondly, giving special attention to a blog shows that we may not have got to grips with new forms of social media yet. His blog is the problem in hand, but I’ve heard Prof Colquhoun speak about quackery in UCL lecture theatres. Was the electricity, the publicity material, the room rent, a misuse of public funds and resources? I’ve done talks myself, in universities and schools: are they all guilty of wasting public money on robust, challenging, childish and sarcastic discussion of ideas?

But lastly, if you’re worrying about the appropriate use of a science department’s resources, Prof Colquhoun is the bloke who made the fuss in Nature -the biggest academic journal in the world – about British universities giving away science degrees in quackery. The people who run the BSc "science" degrees in these pseudoscientific alternative therapies have still refused to answer questions from David, and from me, about what "science" they teach in their science degrees.

I notice that nobody is making the jokers behind these Quackery BSc’s take their gobbledygook -a word that sounds best being snorted through Colquhoun’s impressive nasal hair – off university webservers. Although courses in gobbledygook make money. And they are flattered by the Prince. And nobody can criticise them, because they actually refuse to tell us what they’e teaching. Now you tell me who should be booted out of a seat of learning.

Please send your bad science to ben@badscience.net

87654321

So:

Prof Colquhoun doesn’t really have impressive nasal hair, I just didn’t want the column to come across as too gushing. His quack page is definitely worth rooting about on:

www.dcscience.net

And as you can see, he needs WordPress advice even more than I do. Also his politics feed is quite jolly and if I could work out, for example, how to link directly to the Greenhalgh story, I would. Rummage away.

[DC edit: one of the best side effects of the move was getting a proper blog, rather than a bloated web page. The old politics page is archived and the Greenhalgh story link now works]

dcscience.net’/corrie.html



Letter from Provost:

This is an email from the Provost to someone who emailed him this morning, which he has allowed me to post, I understand he will be sending something similar to those who email him. It’s very much worth reading. I believe – as you can imagine – that an emeritus professor of pharmacology in his seventies making the link between science and real world claims for free in everyday language is a treat, but of course I have absolutely no doubt that Colquhoun’s public engagement with science activity did pose difficulties for UCL.

These difficulties were thrown into sharp relief by the fact that those who disagreed with Colquhoun enacted their grievances through the Freedom of Information Act, UK libel law, copyright law, complaints about the use of academic resources, and efforts to lean on senior figures from the university, rather than engaging on the science, or contacting Colquhoun.

There is a balance to be struck on whether Colquhoun’s public engagement with science activities were valued enough to be worth defending (through the miracle ofinstant context you can decide for yourself) and that is of course a decision for UCL to make.

If you are going to write to the Provost I hope I can rely on you to be polite and understanding about this balance, and understand that he’s a busy man who has already been leant on over what ideally should never have been a Provost’s concerns at such an early stage.

Andrew

If UCL had behaved in the way you seem to believe then your comments would be wholly justified, but of course it hasn’t.

Allow me to supply the missing facts. I;m copying this message also to Ben Goldacre and David Colquhoun.

Academic freedom is a fundamental precept of any institution fit to style itself a university. Like all freedoms, it comes with conditions, largely those that are necessary to underpin the freedoms of other people under the law, including criminal law, human rights, copyright, the laws of tort and contract, and statutory regulation.

When a university hosts a website it is taken to be the publisher of the material on it. That means that it is liable in law for any breaches of copyright, data protection and defamation. It is possible of course to engage in robust academic debate without infringing any of these rules.

But breaches of all of them have now been claimed in legal claims against UCL regarding David Colquhoun’s website, and with good reason.

A university can of course safeguard its position by moderating the content of the website. That is what I assume the Guardian does with its various blogs, and certainly is what it does with all its editorial content. Nobody sees that as a major assault on the freedom of expression of the press. To do this in a university would of course raise concerns that it constituted an incursion into academic freedom, and I also think it would be completely impractical.

Yet not to take appropriate action to protect UCL would be to expose us to potentially expensive legal action in respect of activity over which we have absolutely no control.

For the most part, academic websites don’t infringe the law. Indeed, in over 35 years as an academic this is the first such instance that I have any detailed knowledge of. If it has unlawful material that the author believes is essential for conveying his/her message, then there is no reason why they shouldn’t host it themselves and assume the consequences.

UCL has taken legal advice, which is to the effect that the website does contain material which breaks the law in several respects. Some of them have now been fixed: alleged breaches of copyright and data protection. But libel proceedings are now also in play, and Professor Colquhoun and I have a meeting on Monday with a senior defamation QC to explore the potential extent of UCL’s vicarious liability for certain statements on the website, and our possible options. There is also the question of Professor Colquhoun’s own personal liability, but of course a plaintiff will always prefer to go against a major institution because of our deep pockets.

On the basis of the advice that I receive then I shall have to determine UCL’s future course of action, and Professor Colquhoun likewise.

Malcolm Grant

Just to be absolutely clear:

The item that has caused the fuss and complaint is this one. It has not been changed since the complaint, so you can decide for yourself how awful it is.

www.dcscience.net/improbable.html#walker1



++++++++++++++++++++++++++++++++++++++++++ 

If you like what I do, and you want me to do more, you can: buy my books Bad Scienceand Bad Pharma, give them to your friends, put them on your reading list, employ me to do a talk, or tweet this article to your friends. Thanks! ++++++++++++++++++++++++++++++++++++++++++ 



56 Responses




  1. woodchopper said,

    June 9, 2007 at 7:45 am

    I’m quite shocked. If people complain about the lack of understanding of science then they know where to look for an answer.

  2. SomeBeans said,

    June 9, 2007 at 8:03 am

    I’m guessing that if we all write the Provost a letter, it won’t really be troublesome enough to make him change his mind.

    This is really exactly the sort of thing a university should be supporting and encouraging, rather than censoring.

  3. evidencebasedeating said,

    June 9, 2007 at 8:44 am

    Rather depressing proof-positive (in a holistic, meaningful ,empathic way)of how our previously august and independent universities increasingly pander to the lowest-common-denominator ‘science-lite’ approach amidst concerns from woo practitioners and regal missives from Charlie Boy (Ernst at Exeter springs to mind).

    I wonder if the Provost took the decision unilaterally? Perhaps the university Senate should review both the case and the decision. They could take into account the dichotomy of Provost Malcolm Grant’s actions, versus his opening paragraph states his ‘vision’ of UCL – taken from the website, that states:

    “UCL is an exceptional institution, with a radical tradition and a distinctive character. The university’s commitment to excellence and innovation in research and teaching is central to its vision of enriching society’s intellectual, cultural, scientific, economic, environmental and medical spheres.”

    Er, so his role as Provost is to eradicate that ‘radical tradition’, ‘distinctive character’ and ‘vision of enriching society’s cultural and scientific spheres’.

    But I note his Professorship is in Law, not science.

    Explains a lot.

    Never mind, Colquhuon’s status in his professional and public spheres is independent of UCL. Just makes me consider the organisation in a much more ambivalent manner.

  4. Mojo said,

    June 9, 2007 at 9:04 am

    (Off-topic)

    This is odd: when I looked at this page first thing this morning, before there were any comments on it, it displayed fine. Now the text has slipped down the left-hand side again.

  5. jackpt said,

    June 9, 2007 at 9:36 am

    I missed out on all of this because I hadn’t checked his site for some time. You’d think UCL would be better than this, especially from the standpoint of precedents of which this is an appalling one. On a positive note I’m sure he could get free hosting or mirrors from places and people way out of the reach of scum trading on red clover etc. I for one would happily mirror any material under legal or informal threat from bread headed scum flogging false hopes and pseudoscience. The problem here is one of precedents, other universities may take note…

  6. le canard noir said,

    June 9, 2007 at 9:44 am

    It is most important that all fellow bloggers and site owners, change their links to DC’s pages asap!

    Need to get Google onto the move and make sure the pageranks for his stuff is up there again!

  7. terryhamblin said,

    June 9, 2007 at 10:53 am

    This is not just any university. This is UCL. Jeremy Bentham must be turning in his box seat.

  8. doctormonkey said,

    June 9, 2007 at 11:32 am

    This is a sad state of affairs

    Another large institution bullied into dropping something as good and funny as DC’s blog

    Personally I think they should drop the quackology BSc’s but failing that should allow parity and keep DC’s blog

    Then again, I have always disliked UCL but I am sad to have my un-thinking, I’m-from-another-London-college prejudice actually supported by fact

    17

  9. andrew said,

    June 9, 2007 at 12:21 pm

    The more you look at it, the worse it gets.

    Tobacco companies, anti-MMGW groups and other lobbyists frequently fire off

    legal challenges against individual scientists to maintain a general climate of harrassment.

    UCL’s message to the world is that their staff are easy meat, the college won’t stand by them.

    From Steven Shafer’s letter on Colquhoun’s web-site:

    “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.’ “

  10. JohnD said,

    June 9, 2007 at 12:59 pm

    I can’t belive that the Provost’s decision will stand. Less than a year ago, UCL signed the Magna Charta Universitatum, and bragged of it. That charter includes that, “all members of that institution’s academic community should have the freedom to work, teach and learn.”

    See:www.ucl.ac.uk/news/news-articles/0609/06092601

    I hope Professor Michael Worton, who signed on behalf of UCL is as uncomfortable as he should be with this.

    John

  11. j said,

    June 9, 2007 at 1:29 pm

    Great idea for the column: when ‘alternative’ practitioners get a website shut down by moaning about it, I think it’s important to give them as much publicity as possible as a result.

    Just to add a couple of extra details: the complaint that got DC’s site moved from UCL came from Alan Lakin (the husband of Ann Walker). Walker is (or at least was) the director of New Vitality – www.newvitality.org.uk/index.htm. She also has quite a few interesting online articles on herbal medicine which come up when you google her (e.g. www.healthspan.co.uk) Given the way in which DC was forced to move his site, it might be appropriate if a few people with health/science-related blogs collaborated to post articles fisking different pieces of Walker’s work: I like the idea of a load of critical articles springing up when one is forced to move 18

    Anyway, just going to update my blogroll link to DC’s excellent site.

    [DC edit- —Walker no longer has any obvious connection with Healthspan, but Google reveals that this incident gave rise to a lot of rather unflattering interest in her activities]

  12. Ben Goldacre said,

    June 9, 2007 at 3:50 pm

    dear all

    please see the email from the provost that has been added above.

  13. PK said,

    June 9, 2007 at 4:20 pm

    I do not find that letter remotely convincing. Sure, Colquhoun must not engage in libel, but it is hard never to (accidentally) stray into libelous territory when you are dealing with these people. If UCL is serious about academic freedom and scientific integrity, then they should fight this one.

  14. SomeBeans said,

    June 9, 2007 at 5:11 pm

    Thanks for posting the letter from the provost – most illuminating.

    Doesn’t give the impression of UCL helping David Colquhoun very much. I wonder if they still use his papers for their RAE’s.

    What’s the Guardian policy on this type of thing? I seem to remember that they fought Jonathan Aitken and won…

  15. jackpt said,

    June 9, 2007 at 5:17 pm

    The problem with the letter is is that it’s all couched in such vague terms. It seems to me that they’ve acted on the basis of something that could be libellous/in breach of copyright/etc rather than anything clear cut. If it were clear-cut there would be specific examples that he could point to. It’s the approach of a chicken because the letter is saying “we may be right but it’s not worth our trouble to fight” setting himself up as an arbiter of just causes. So if it’s not clear cut don’t expect any help from UCL. Grey areas not wanted.

  16. Andrew Clegg said,

    June 9, 2007 at 8:25 pm

    I also sent a letter complaining (being another less than impressed alumnus like Dr Nicholas above). Here’s some helpful thoughts…

    1. When you get a long personal reply back from the provost, it’s worth checking to see whether other people got the same reply word for word

    2. … rather than being so surprised that when you forward it to Ben and David with comments…

    3. … you forget to take Prof. Grant’s email off the header and end up looking like a muppet.

    But a since and well-intentioned muppet at least.

    Andrew.

  17. Andrew Clegg said,

    June 9, 2007 at 8:29 pm

    Err, unless that response Ben posted was his reply to my letter (just noticed the Dear Andrew at the top), not a standard form response, in which case I take back what I said about word-for-word copies, and look like slightly more of a muppet instead.

    I think I need to eat something, brain not working at 100% today.

    Andrew.

  18. pv said,

    June 9, 2007 at 9:41 pm

    They might well have acted on the threat of a libel action and just decided to cave in. A University is primarily a business these days while aspiring to be a centre of educational excellence is either secondary or coincidental. On that basis no-one should be surprised that it is compelled to act in a way that protects the interests of its financial supporters and sponsors – namely their money – before any wider academic interests or unnecessary luxuries like freedom of speech. I know it all appears to be lacking in integrity but freedom of business comes first these days, even (or especially) the right of quacks and charlatans to do business without hindrance.

  19. Art5 said,

    June 9, 2007 at 9:52 pm

    Perhaps it shouldn’t be surprising that they did just decide to cave in, but why does that entail asking DC to remove the whole blog and not just the contentious article? That looks incredibly unsupportive to me.

  20. igb said,

    June 10, 2007 at 12:43 am

    One of the defining characteristics of the `management’ of public sector bodies is their utter, craven cowardice in face of things that even smell of a court case. I don’t know when it happens in their career, but your typical school headmaster, hospital manager or (it would appear) University provost regards a dog-eared piece of paper saying “Oi will zue youse for libil” as being as frightening as the jury coming back in and saying `guilty’.

    Hence the rise in schools and universities being cowed by not even solicitor’s letters (which are, it should be noted, simply a letter from someone who happens to be a solicitor) but the threat of the same. If public bodies fought such cases through the courts, and then bankrupted the claimants when they lost (as they almost always would), after a year or so they and the ambulance chasers would get the hint. As things stand, public sector managers are encouraged to pay tribute, rather than spend on defence, and worse they are paying tribute to people with cardboard swords.

    Those who get their fortnightly dose of poor typography (and it’s not as funny as it was, is it?) will know of `Arkell vs Pressdram’. The rest of you can google for it. UCL’s response to a threatened libel case should be `bring it on’, with a plea of justification.

    The reason we know that David Irvine is a fraud and is because Deborah Lipstadt’s book, a copy of which is sat a few feet from me, was defended to the hilt by its publishers. Penguin Books have principles, and made a stand. It’s a shame that UCL appears to have a yellow stripe painted down its back where its spine used to be.

  21. rob said,

    June 10, 2007 at 6:14 am

    Pitiful cowardice from an institution that claims to be a world-class university. Until it is proven that the material is actually illegal, it should be their part to stand up for academic freedom.

  22. Moganero said,

    June 10, 2007 at 7:46 am

    le canard noir “Need to get Google onto the move and make sure the pageranks for his stuff is up there again!”

    UCL’s webmaster could set up a permanent redirect to Prof Colquhoun’s new URL – this would send the search engines to it and they’d index the new location. Anyone trying to see the blog at the old URL would automatically see it at the new location.

  23. TINSTAFL said,

    June 10, 2007 at 9:16 am

    Step on their toes until they apologize. They can wave their jargon at us and threaten libel, but they WILL NEVER ACTUALLY WANT TO BE IN COURT AND LOSE. And they want all this to happen quietly. Now that UCL has backed off, they will want to put pressure on UCL to censure the Prof. even more. And this is exactly what UCL is doing in response to a minor complaint. They are censuring him: cutting off his voice and officially rebuking his work on the site.

    It may even be possible that rather than protect themselves, they have opened themselves to litigation from both sides. 1) Dumping suggest merit to the complain and 2) that UCL provided the site in the place and then took it away means then have placed the good Prof. in an unsupported/dangerous situation.

    igb has the right idea. Fight them now and hard.

    I sent an email to the provost and I suggest that others do so as well. Even letters from well-intentioned muppets will help (I have certainly sent my own in my time, misspellings and all!). Certainly the provost responded the original bad-intentioned muppets who made the complaint. Even if he does not read them, having Prof. Colquoun’s name in the subject line of a large number of message will lend him the support that he needs and will make the provost think a bit. I will also make a head link link from my own anti quack site to his.

    I am willing to post my email if other are interested, but this may be up to Dr. Goldacre to decide if this is appropriate.

  24. Mojo said,

    June 10, 2007 at 10:06 am

    le canard noir said,

    (June 9, 2007 at 9:44 am) “Need to get Google onto the move and make sure the pageranks for his stuff is up there again!”

    Well, as long as Google aren’t as spineless as they were in the case of Howard’s page about TAPL:

    http://www.hakwright.co.uk/rants/Gillian_McKeith.html

    A search of google.co.uk still brings up the message at the bottom of the page saying “In response to a legal request submitted to Google, we have removed 1 result(s) from this page. If you wish, you may read more about the request at ChillingEffects.org.”

    Interestingly, while Howard’s page still appears on the first page for google.com, google.ca and google.com.au, the results for google.co.uk seem to have different rankings so that the message about the legal threat, sorry, request, now appears on the second page of results.

  25. Mojo said,

    June 10, 2007 at 10:35 am

    Incidentally, in some parts of intellectual property law (trade marks, patents and registered designs, but not copyright, unfortunately) it is a tort to make an unjustified threat to sue. Perhaps a case could be made for extending this to defamation.

  26. Dr Aust said,

    June 10, 2007 at 11:53 am

    I also wrote to the UCL Provost (as an academic scientist and UCL alumnus) and got the stock response several other people have mentioned about the time that had gone into handling complaints etc.

    I can see where he’s coming from, although on balance I think he is wrong (see the Stanford letter for why).

    I think the wider point about UK Univs turning pale at the merest whiff of a threat of legal action that igb mentioned is a genuine problem. It appears that in this case they have at least taken real legal advice… but I have seen many examples where merely the threat of (e.g.) a student sueing is enough to cause a fit of the vapours, and would trigger tens or even hundreds of person hrs of administrative hot air.

    I used to argue, without much success, that Univs should fight all these cases when they were sure they were right, especially when they dealt with “academic integrity” in the wider sense. And they should seek to recoup their adminstrative and legal costs against frivolous complainants like Walker and Lakin.

    …the point being that if people think complaining and shouting “lawyer” will get them an undeserved second or third chance at an exam resit, or a website taken down, or whatever, people will keep doing it. As igb says, you have to give them a real potential DOWNSIDE to doing it, as well as a potential upside.

    Incidentally, it is worth noting that Dr Walker is employed (although apparently now only in a part-time capacity, according to DC’s blog) by Reading University. Presumably they are happy about an academic from their School of Food Biosciences making public claims about unproven supplements and herbs that are scientific nonsense, and then waving M’Learned Friends when these claims are exposed. I wonder if she still teaches on their BSc in “Nutrition and Food Science”.

  27. Mojo said,

    June 10, 2007 at 1:05 pm

    Dr Aust said,

    “I used to argue, without much success, that Univs should fight all these cases when they were sure they were right, especially when they dealt with “academic integrity” in the wider sense. And they should seek to recoup their adminstrative and legal costs against frivolous complainants like Walker and Lakin.”

    While legal costs are recoverable (assumong the Uni won the case), I’m not sure that this would apply to the Uni’s administrative costs.

    Hence my suggestion above that the tort of falsely threatening to sue, at present only available in patent, trade mark and registered design disputes, might usefully be extended to libel. If it were, the Uni could then sue the frivolous complainants for their administrative costs as well.

  28. JohnK said,

    June 10, 2007 at 2:15 pm

    I don’t understand why UCL didn’t just ask DC to remove the offending material, which he has done anyway. Booting him off the server seems to be an attempt to hang him out to dry (“there is also the question of Professor Colquhoun’s own personal liability.”), but if UCL are deemed to be publishers, removing the content does not alter the past; if it was illegal, stopping doing it doesn’t redeem them. To paraphrase an old joke, “Have you stopped hosting allegedly defamatory material on your website?” – both answers get you in trouble.

    I wonder how much a lawsuit would actually cost if it came to it, and I wonder how much monetary value could be ascribed to DC’s RAE contribution.

  29. Dr Aust said,

    June 10, 2007 at 3:34 pm

    Mojo wrote: “While legal costs are recoverable (assuming the Uni won the case), I’m not sure that this would apply to the Uni’s administrative costs.”

    Shame. The main context for this was typically students contesting results, or complaining they had been treated unfairly, or denying they had been caught cheating, BTW. My argument was that a basic investigation of any alleged mistakes / irregularities was warranted and fair. For stuff beyond that we should be prepared to make people pay for the time and inconvenience caused by unfounded and often frivolous complaints.

    What would happen was that the Univ would investigate (at Faculty level) and write back and say: “We have investigated your allegation and found it to be groundless… (gives details). However, if you are not satisfied with this, you may…. (appeal to next rung up).

    The problem was that this gave people who were alleging a grievance no downside whatsoever to continuing to pursue groundless and often ludicrous claims, apart from their own time. In many cases it would go up the next one, or two, rungs in turn to the University’s senior administrator(s), with the same info being picked over multiple times by increasingly high-powered and expensive people.

    I thought we should say “…if you are not satified you may (appeal to next rung up). HOWEVER, as your complaint has been investigated by our standard procedures and judged groundless, any further administrative time, and costs of expert advice we find it necessary to take, incurred by us through your pursuit of a complaint will be recorded. In the event that your complaint is ultimately judged groundless, it will be our practise in all cases to pursue you in civil court for the recovery of all these costs.”

    Please somebody tell me that there is a case in law for doing this? Mojo’s posts above suggest not, which is sad.

    If there isn’t, there ought to be…!

    The point is that at some stage there needs to be a mechanism for making complainants judge whether they really have a case, or are just blustering for some other reason (like that they can’t admit, either for public consumption or even to themselves, that they were rumbled). They have to be made to do a “cost-benefit analysis” of wasting everyone’s time. Sadly at the moment cheats, charlatans, and obsessed nutters too often get a free ride.

    Coming back to Univs, I suspect the cost and “negative publicity” is the factor the administrators prioritize when pressing for settlement or (as in DC’s case) “minimizing the University’s liability”. But if Universities are mainly selling themselves on their academic reputation (which in the final analysis they are), they have to be prepared to defend that reputation in the open, every time, and without compromise.

    PS In terms of DC’s scientific standing and it’s worth to UCL, it has doubtless been worth a lot over the years.

    RAE rankings contain a lot of nonsense, as DC himself has eloquently argued elsewhere:

    voltaire.members.beeb.net/goodscience.htm

    – but it is fair to say the UCL Pharmacology Dept has generally been regarded as one of the two or three, or arguably the best, pharmacology dept in the UK for all of the 25 yrs I have been in the business. As for DC himself, the FRS (judged by your peers to be a top scientist, and the only such thing British scientists rate) says it all.

  30. Pepper said,

    June 11, 2007 at 1:31 am

    I see here 43 comments and a lot of people, which try to defend Prof. Colquhoun. But I’d like to know – is here just one man from UCL? And if the answer is “no”, then – what does this silence suggest? If DC is right, then why do his Alma Mater remain silent?

    It is merely question. And I’d like merely to learn answer.

  31. Filias Cupio said,

    June 11, 2007 at 2:32 am

    I know of one case where there was a significant downside to students for pushing too hard.

    Two students had been caught cheating in a terms test. A friend of mine (from whom I have the story) summoned them to his office, and told them that they would get zero for the test, and for all assignments they’d done up to this point, but they could appeal to the university’s disciplinary committee. They did so, and instead were expelled for a year.

  32. igb said,

    June 11, 2007 at 10:32 am

    “Isn’t the problem not so much that UCL are cowards as that the legal advice they have taken says they may lose with a heavy financial penalty. ”

    So suddenly the `precautionary principle’, which most people with the vaguest scientific background regard as silly, has become respectable? No lawyer can tell you that you will not lose, just as no scientist can tell you that mobile phones are absolutely safe. So `may’ is the coward’s shield.

    The reality is that a libel case fought by an individual against a large institution is almost imposssible to win, as legal aid is not available and most decisions can be appealed. In fact, “ the real issue the fact that people can use libel laws to restrict free speech” conceals the fact that current libel laws allow newspapers to accuse you of being a kiddie-fiddler whilst providing you with no redress, because libel cases are the strict preserve of the affluent.

    Bearing in mind the requirements of a libel case, the risk to UCL is approximately zero. But it’s not actually zero.

  33. Gimpy said,

    June 11, 2007 at 10:54 am

    igb I don’t see what the merits or otherwise of the precautionary principle have to do with this. I’m not defending UCL here, I’m just pointing out that libel law is abused as you correctly point out by the affluent. In this case the accusers are relatively wealthy.

    I’m assuming that libel is the main legal argument being used against UCL because breaches of copyright rarely stand up in court if swiftly corrected and apology issued (which has been done in this case).

    In this country the burden of proof in libel cases is on the defendant and there is no limit on the financial awards for damages. UCL obviously think there is a reasonable possibility that they may be liable for such damages and have taken what they consider appropriate action while they review the facts.

  34. Dr Aust said,

    June 11, 2007 at 11:56 am

    Gimpy

    That may be part of the reason, but what heinous libel would DC have committed against Walker and Lakin? He pointed out that terms like “blood cleanser” or “lymphatic cleanser” have no meaning as applied to drugs; he pointed out that their claims had no foundation in published research; he pointed out that certain organisations were not neutral information services but actually exist to promote supplements; and he used the word “gobbledegook”, which in the context used could be taken to mean “scientically meaningless or nonsensical”.

    Would Walker and La kin they really ever want all this aired in open court? That is, that they use the pretence of “science”, and stuff that is arguably in breach of the trades descriptions, to relieve the gullible of their money? I find this inconceivable.

  35. vinnyr said,

    June 11, 2007 at 12:12 pm

    I’m sure UCL are covered by the same legislation as websites such as YouTube when it comes to copyright infringements.

    As they are only hosting the blog, all they need to do is inform Dr Colquhoun of problem with his blog and take down the page if he does not correct the infringement within a reasonable amount of time (usually ~24 hours).

  36. Gimpy said,

    June 11, 2007 at 12:12 pm

    Dr Aust – “but what heinous libel would DC have committed against Walker and Lakin?”

    I have no idea. All I was trying to do was see things from UCL’s side. It does seem a hasty decision on the part of UCL though. Anyway, the courts are not the place to establish the veracity of science nor indeed the truth in libel trials as the cases of Jeffry Archer and Jonathan Aitken prove.

  37. andrew said,

    June 11, 2007 at 12:20 pm

    Well, I’m no lawyer, and I see that Prof. Grant is.

    Nor am I going to start second-guessing that senior defamation QC they’ll be meeting today.

    On the other hand, for background info, outlaw.com is a solid source of information on internet law.

    Here’s their stuff on “User-generated content”

    www.out-law.com/page-7807

    and on “Liability of ISPs for third party material”

    www.out-law.com/page-488

  38. Dr Aust said,

    June 11, 2007 at 12:50 pm

    Point taken, Andrew.

    I think what worries us here is the possibility that UCL, and other comparable institutions, will seek to position themselves to have NO conceivable liability.

    I would imagine it is virtually impossible to utterly exclude liability unless (i) every page on a University’s website is scrutinized by a libel QC, or (ii) anything thought to be even vaguely “controversial” (read : “critical”) is blanket forbidden.

    In which case critics of misinformation stand a good chance of being silenced.

  39. andrew said,

    June 11, 2007 at 1:24 pm

    To clarify, the previous post is mainly to attention to outlaw.com‘s explanation of the E-commerce Directive and related material, e.g.

    “Article 12 [of the E-commerce Directive] provides that each member state shall ensure that service providers (which will include ISP s, VISPs and Web Hosts) will not be held liable for information transmitted on their sites provided that the relevant service provider:

    – Does not initiate the transmission;

    – Does not select the receiver of the transmission; and

    – Does not select or modify the information contained in the transmission.

    In other words, if the above criteria are met a service provider will be treated as a mere conduit as opposed to an author, editor or publisher. However, a service provider will still be required to remove unlawful and/or defamatory material from its site once it has received a complaint.”

    All I’m saying is that I’m not qualified to comment on how it applies in this case, you’ll have to make of it what you will.

  40. raygirvan said,

    June 11, 2007 at 1:55 pm

    > minor breaches of copyright, which DC could have (and has) corrected. And there was no “malicious intent” behind the infringement, since he did not do it specifically to steal their trademarked words. He did it to highlight that what they were saying was untrue.

    … which I would have said put it well into the territory of fair use for the purposes of comment or criticism.

  41. Symball said,

    June 11, 2007 at 2:56 pm

    I think the real shame here has been the obvious victory of harassment over principle. I don’t believe that UCL has done anything other than protect itself financially and try to draw a line between personal comment and university statements. To be honest there are not many organisations that would allow its IT resources to be used for anything other than some ‘fair use’ surfing. so it is not surprising it has asked for the blog to be removed.

    However it is sad that the woo’s have used similar tactics to the animal rights mob in simply harassing organisations into doing their bidding. Perhaps UCL could redress the balance by looking into the subject and publishing something in its own name instead

  42. Dr Aust said,

    June 11, 2007 at 3:45 pm

    I suspect UCL probably couldn’t use the “ISP defence” indicated by Andrew above. This is because a complainant could argue, with some plausibility, that DC’s “pseudoscience debunking” clearly stems from his work for UCL as a scientist. So hard to separate the two.

    But this just brings back to the “Is what DC said true?” issue.

    Quoting from a site talking about the law of defamation:

    webjcli.ncl.ac.uk/2005/issue3/lewis3.html

    “Where defamation is alleged, the first step is to consider the ordinary and natural meaning of the words used and what an ordinary person will infer.”

    “If a defendant can prove the substantial truth of the words complained about the defence of justification is established.”

    “Another defence in the law of defamation is that everyone is allowed to comment so long as the subject is a matter of public interest and the views were honestly held. The public interest has never been satisfactorily defined for these purposes but it is clear that it is to be broadly construed.”

    All these seem to offer fairly obvious defences.

    Of course, the UCL Provost has stated for the record that it was the “admin bother and nuisance” that was the issue, rather than the risk of liability at law. I still think, though, that they had some sort of wider moral obligation, as an institute of learning and “enlightenment”, to be SEEN to defend the right of scholars to oppose obfuscation and inaccuracy, especially when the latter were being used to sell things.

  43. igb said,

    June 11, 2007 at 8:10 pm

    “igb I don’t see what the merits or otherwise of the precautionary principle have to do with this. ”

    Because the basic argument seems to be “a lawyer says this bad thing _may_ happen” or even “a lawyer says this bad thing cannot be said never to happen”. That’s exactly the argument that idiots use about wifi: “can you tell me it’s absolutely safe with no caveats? No? Then we should assume the worst”.

    “libel law is abused as you correctly point out by the affluent. In this case the accusers are relatively wealthy.”

    I may be mis-judging the finances of alternatives, but I seriously doubt that the people making the theats have pockets as deep as would be required. UCL could quite justifiably demand that measures be taken to ensure their costs are paid should they win: that’s where the rubber meets the road.

    “I’m assuming that libel is the main legal argument being used against UCL because breaches of copyright rarely stand up in court if swiftly corrected and apology issued (which has been done in this case).”

    The same’s true of libel, because…

    “In this country the burden of proof in libel cases is on the defendant”

    No, it isn’t. If the defendant opts to run a defence of justification, the burden is on them (albeit only to a civil, “balance of probabilities” standard). But the burden resides with the plaintiff to show that the words are capable of having a defamtory meaning (which might be _very_ difficult in this case) and that the plaintiff suffered harm to their repution. And there’s a whole stack of defences which might apply in this case (notably a Reynolds defence, see Reynolds vs Times Newspaper) for which the reverse burden doesn’t apply in the same way.

    “UCL obviously think there is a reasonable possibility that they may be liable for such damages and have taken what they consider appropriate action while they review the facts.”

    I don’t see where `reasonable’ comes from. I might just as (in)acurrately say `remote’ in the same place. A case in which a University was held to be vicariously liable for the public statements of a professor, writing in a field which is his exact speciality, requires a sequence of events all of which have a probability distinctly less than one (the writ being served, the case making it to court, the case being held to be answerable, the judge being prepared to join UCL to the case, the case making it past a jury, the case making it past an appeal, the case having damages greater than the hundred quid that UCL will have paid into the court).

  44. John Craddock said,

    June 11, 2007 at 8:47 pm

    Re: mch’s comment;

    “Why has UCL a moral obligation to defend our rights? It’s a university – it has a business to run, students to teach, research to, well, search. Making a stand and getting sued will cost (and maybe not just money), and who is going to refund it?”

    UCL has an obligation to defend the freedom of its academics. If it doesn’t, then it reduces its role to that of a degree factory.

    I don’t know what the situation is in the UK but the universities act in Ireland (quoted below) is clear on the issue, I presume you have similar principles and laws over there.

    14.—(1) A university, in performing its functions shall—

    ( a ) have the right and responsibility to preserve and promote the traditional principles of academic freedom in the conduct of its internal and external affairs

    (2) A member of the academic staff of a university shall have the freedom, within the law, in his or her teaching, research and any other activities either in or outside the university, to question and test received wisdom, to put forward new ideas and to state controversial or unpopular opinions

  45. Dr Aust said,

    June 11, 2007 at 11:21 pm

    I suppose if a “justification defence” is deemed too risky there is always “fair comment in voicing a sincerely held view on a matter of public interest” (see my post above). The sincerity is not in doubt and the whole tenor of DC’s blog is malice-free – it always just asks “do these statements have scientific meaning” or sometimes “do these people have hidden interests they have not made clear?”

    I have read the words about Walker and Lakin and their product very carefully, first with my amateur barrack-room lawyer’s hat on, then as a scientist with an interest in the use of words, and finally as a “member of the public” – and I still can’t see anything that could not be construed as “DC’s sincerely held opinion”.

    I would still hope that in an analogous situation in the future a (any?) University would have the stones to put up the justification defence when the statements could be easily argued to be true. The point of pubically taking a stand specifically on justification would be, as mentioned by many here,

    “We stand by our guy and his right to try and inform the public about a matter of public interest, no matter what”.

    If Universities don’t stand for stuff like this, then mch is right and they are just businesses. But when they admit that, they are on the slide, because their business is based at bottom on their academic REPUTATION, which is based on their not being “biddable” by financial considerations alone. That is why, in science, research from Univs is by and large more trusted than research from drug companies.

    Stanford, though a private institution (and thus more of a “business” than UCL), seems to have understood this, judging by the tobacco company example the Stanford prof gave on DC’s blog:

    www.dcscience.net/quack.html#move1

    UCL has misjudged the same, IMHO.

    What I sincerely HOPE is happening behind the scenes is UCL offering DC legal advice about how to avoid problems going forward with his now “privatised” blog. That would go some way to restoring my faith in my old alma mater.

  46. Kells said,

    June 12, 2007 at 12:02 pm

    Whilst shutting down DC UCL would like you to give generously to this

    www.uclh.nhs.uk/New+developments/RLHH+redevelopment/

    they need 1/4 million to house thier CAM library full of non evidence based periodicals of absolute bullshit.

    Please give generously

  47. Dr Aust said,

    June 12, 2007 at 1:40 pm

    It’s more interesting than that – from the webpage:

    “…

    New specialist electronic library on complementary and alternative medicine (NeLCAM)

    The RLHH recently won the contract to provide the NHS "new specialist electronic library on complementary and alternative medicine (NeLCAM) in collaboration with the Research Council for Complementary Medicine (RCCM) and the University of Westminster’s School of Integrated Health. ..”

    This is, of course, the same Univ of Westminster School of Integrated Health that DC has been chiding on his blog and in the pages of Nature for awarding BScs in antiscience, and which awards a “B.Sc. in Homeopathy” for which the External Examiner is (surprise surprise) a non-scientifically qualified homeopath.

    The RLHH appeal is for money to fund their “open access CAM Information Centre”. Oh goody. They say this Centre will “work with other bodies within the world of complementary medicine, including the Research Council for Complementary Medicine, the British Homoeopathic Association, and The Prince of Wales’s Foundation for Integrated Health”.

    Boosters all, of course. Now why doesn’t that leave me feeling reassured?

  48. Pepper said,

    June 12, 2007 at 5:34 pm

    Well…

    And what next?

    DC’s webpage is expelled from UCL server. Quacks intend to frame up a case against DC. Homoeopaths are trying to edge in UCL.

    Scientific people have written to provost. Provost has answered.

    That’s all.

    And strange silence has settled…

    What is it? Is it defeat? Or the hush before the storm?

    Hey! Defenders of freedom and real Science! Or will this problem leave in the air? Will it exist further in present state?

    That will never do, IMHO. It’s unscientifically, after all.

    It is necessary right solution of this question.

  49. andrew said,

    June 13, 2007 at 10:19 am

    As an aside, Malcolm Grant is also catching flak over UCL’s armaments investments (£900k in Cobham PLC).

    New Statesman 11 June 2007:

    “Despite the overwhelming support of the Disarm UCL campaign, Grant refused to genuinely engage with the issue of divestment from Cobham. Instead he concentrated on criticizing students and suggested we were campaigning against UCL.”

    It’s been a rough week for poor Grant, and it’s still only Wednesday…

  50. Pepper said,

    June 13, 2007 at 1:38 pm

    Aha, Malcolm Grant gains money for UCL and UCL’s students by armaments investments.

    But UCL students can’t even tackle his provost to gain money by other way! The students and staff in other universities have done it. And UCL student can merely yelp against provost like silly pups and unroll antiwar banners. One question, please! Do they like to get stipends and salaries ill-gotten by their provost for them? Eh?

    No?? Then – let UCL students and staff propose their provost OTHER way to gain money for UCL. There are a lot of methods to get money from development of modern, knowledge-intensive, advanced technologies, from applied scientific research, etc., etc., etc.

    Who is richest man in the world? Bill Gates! Does Bill Gates sells the arms? He makes and cells computers.

    UCL students and staff must propose your provost best way to gain money. But if he refuse, then there will be only remaining resource – to put question about discharge him for inaptitude, so in this case his words about business and progress for UCL would be empty words and he would be merely wild aggressive politician of last centuries with backward opinions and policy.

  51. Pepper said,

    June 13, 2007 at 3:00 pm

    DAVID COLQUHOUN WON!!!

    Here is ad from his website:

    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.

    MY CONGRATULATIONS, DEAR DAVID!!!

    BE HAPPY AND HEALTHY!!!

  52. Pepper said,

    June 13, 2007 at 3:04 pm

    Here is link of UCL website about DC:

    www.ucl.ac.uk/news/news-articles/0706/07061303

  53. Tabazan said,

    June 13, 2007 at 4:20 pm

    Good statement . . nice to see common sense won through in the end

  54. Grathuln said,

    June 14, 2007 at 12:55 pm

    Perhaps the UK would benefit from “safe habour” laws, making site hosts immune from prosecution for content; I thought we must have something like this already but the Provos statement suggests otherwise. Perhaps we would also benefit from fair usage copyright laws, allowing the kind of use Dr. Colquhoun.

    I hope that if this does go to court on defamation it gets summarily kicked out and used as example of how such cases will be treated in the future.

  55. ihid said,

    December 18, 2009 at 10:37 am

    Yeah, this is really shocking!

Jump to follow-up

Despite the First Amendment in the US and a new Defamation Act in the UK, fear of legal threats continue to suppress the expression of honest scientific opinion.

I was asked by Nature Medicine (which is published in the USA) to write a review of Paul Offit’s new book. He’s something of a hero, so of course I agreed. The editor asked me to make some changes to the first draft, which I did. Then the editor concerned sent me this letter.

Thank you for the revised version of the book review.

The chief editor of the journal took a look at your piece, and he thought that it would be a good idea to run it past our legal counsel owing to the strong opinions expressed in the piece in relation to specific individuals. I regret to say that the lawyers have advised us against publishing the review.

After that I tried the UK Conversation. They had done a pretty good job with my post on the baleful influence of royals on medicine. They were more helpful then Nature Medicine, but for some reason that I can’t begin to understand, they insisted that I should not name Nature Medicine, but to refer only to "a leading journal". And they wanted me not to name Harvard in the last paragraph. I’m still baffled about why. But it seemed to me that editorial interference had gone too far, so rather than have an editor re-write my review, I withdrew it.

It is precisely this sort of timidity that allows purveyors of quackery such success with their bait and switch tactics. The fact that people seem so terrified to be frank must be part of the reason why Harvard, Yale and the rest have shrugged their shoulders and allowed nonsense medicine to penetrate so deeply into their medical schools. It’s also why blogs now are often better sources of information than established journals.

Here is the review. I see nothing defamatory in it.


 

Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine

Paul A. Offit
Harper, 2013
336 pp., hardcover $26.99
ISBN: 0062222961

Reviewed by David Colquhoun Research Professor of Pharmacology, UCL.

cover

Here’s an odd thing. There is a group of people who advocate the silly idea that you can cure all ills by stuffing yourself with expensive pills, made by large and unscrupulous Pharma companies.  No, I’m not talking about pharmacologists or doctors or dietitians.  They mostly say that stuffing yourself with pills is often useless and sometimes harmful, because that’s what the evidence says . 

Rather, the pill pushers are the true believers in the alternative realities of the “supplement” industry. They seem blithely unaware that the manufacturers are mostly the same big pharma companies that they blame for trying to suppress “natural remedies”.  Far from trying to suppress them, pharma companies love the supplement industry because little research is needed and there are few restrictions on the claims that can be made.

 Paul Offit’s excellent book concentrates on alternative medicine in the USA, with little mention of the rest of the world. He describes how American pork barrel politics have given supplement hucksters an almost unrestricted right to make stuff up. 

Following the thalidomide tragedy, which led to birth defects in babies in the 1950s and 60s, many countries passed laws that required evidence that a drug was both effective and safe before it could be sold.  This was mandate by the Kefauver-Harris amendment (1961) in the USA and the Medicines Act (1968) in the UK.  Laws like that upset the quacks, and in the UK the quacks got a free pass, a ‘licence of right‘, largely still in existence. 

In order to sell a herbal concoction in the UK you need to present no evidence at all that it works, just evidence of safety, in return for which you get a reassuring certification mark and freedom to use misleading brand names and labels.

THR mark
Tradional herbal mark

In the USA the restrictions didn’t last long.  Offit describes how a lobby group for vitamin sellers, the National Health Federation, had a board made up of quacks, some of whom, according to Offit (page 73) had convictions.  They found an ally in Senator William Proxmire who introduced in 1975 an amendment that banned the Food and Drugs Administration (FDA) from regulating the safety of megavitamins.  Tragically, this bill was even supported by the previously-respected scientist Linus Pauling.  Offit tells us that “to Proxmire” became a verb meaning to obstruct science for political gain.

The author then relates  how the situation got worse with the passage of the  Dietary Supplement Health and Education Act (DSHEA) in 1994. It was passed with the help of ex-vitamin salesman Senator Orin Hatch and lots of money from the supplement industry. 

This act iniquitously defined a “supplement” as “a product intended to supplement the diet that bears or contains one or more of the following ingredients: a vitamin, a mineral, an herb or other botanical, or an amino acid”.  At a stroke, herbs were redefined as foods.  There was no need to submit any evidence of either efficacy or even of safety, before marketing anything. All a manufacturer had to do to sell almost any herbal drug or megadose vitamin was to describe it as a “dietary supplement”.  The lobbying to get this law through was based on appealing to the Tea Party tendency –get the government’s hands off our vitamins. And it was helped by ‘celebrities’ such as Sissy Spacek and Mel Gibson (it’s impossible to tell whether they really believed in the magic of vitamins, or whether they were paid, or had Tea Party sympathies).

Offit’s discussion of vaccination is a heartbreaking story of venom and misinformation. As co-inventor of the first rotavirus vaccine he’s responsible for saving many lives around the world.  But he, perhaps more than anyone, suffered from the autism myth started by the falsified work of Andrew Wakefield.  

The scientific community took the question seriously and soon many studies showed absolutely no link between vaccination and autism.  But evidence did not seem to interest the alternative world.  Rather than Offit being lauded as a saver of children’s lives, he describes how he was subjected to death threats and resorted to having armed guards at meetings. 

Again, Offit tells us how celebrities were able to sway public opinion   For example (chapter 6), the actress Jenny McCarthy and talk-show hostess Oprah Winfrey promoted, only too successfully, the vaccine-autism link despite abundant evidence that it didn’t exist, and promoted a number of theories that were not supported by any evidence, such as the idea that autism can be “cured” by mega-doses of vitamins and supplements.

Of course vaccines like the one for rotavirus can’t be developed without pharmaceutical companies because, as Offit says, only they "have the resources and expertise to make a vaccine. We can’t make it in our garage".  When the Children’s Hospital of Philadelphia sold its royalty stake in the rotavirus vaccine for $182 million, Offit received an undisclosed share of the intellectual property, “in the millions ”. 

That’s exactly what universities love. We are encouraged constantly to collaborate with industry, and, in the process, make money for the university. It’s also what Wakefield, and the Royal Free Hospital where he worked, hoped to do.  But sadly, these events led to Offit being called names such as “Dr Proffit” and “Biostitute” (to rhyme with “prostitute”) by people like Jenny McCarthy and Robert F. Kennedy Jr.  The conspiritorialist public lapped up this abuse, but appeared not to notice that many quacks have become far richer by peddling cures that do not work.  

One lesson from this sad story is that we need to think more about the potential for money to lead to good science being disbelieved, and sometimes to corrupt science.

Everyone should buy this book, and weep for the gullibility and corruption that it describes.

I recommend it especially to the deans of US Medical schools, from Harvard downwards, who have embraced “integrative medicine” departments. In doing so they have betrayed both science and their patients.

Abraham Flexner, whose 1910 report first put US medicine on a sound scientific footing, must be turning in his grave.

Fkexnwr
Flexner

Follow-up

30 August 2013

Quack lobby groups got a clause inserted into Obamacare that will make any attempt to evaluate whether a treatment actually works will leave insurance companies open to legal action for "discrimination".

"Discrimination? Yes! We must not allow the government to exclude health care providers just because those providers don’t cure anything."

The latest piece of well-organised corporate corruption by well-funded lobbyists is revealed by Steven Salzberg, in Forbes Magazine. The chaos in the US health system makes one even more grateful for the NHS and for the evaluation of effectiveness of treatments by NICE.

This article has appeared, in nearly identical form, on the UK Conversation . You can leave comments there or here.


charles X2
The modern major-general

A constitutional monarch is purely ceremonial and plays no part in politics.  Well actually in the UK it isn’t quite as simple as that. The first problem is that we have no constitution.  Things haven’t changed much since the 19th century when Walter Bagehot said "the Sovereign has, under a constitutional monarchy… three rights—the right to be consulted, the right to encourage, the right to warn."

These are not inconsiderable powers in a country which is meant to be run by elected representatives.  But nobody knows how these powers are used: it is all done in secret.  Well, almost all. Charles, Prince of Wales, has been unusually public in expressing his views.  He told a conference at St James’s Palace “I was accused once of being the enemy of the Enlightenment” “I felt proud of that.”  That’s a remarkable point of view for someone who, if he succeeds, will become the patron of that product of the age of enlightenment, the Royal Society.

I have no doubt that Prince Charles means well.  He can’t be blamed for his lack of education.  But his views on medicine date from a few centuries ago, and he has lost no opportunity to exploit his privileged position to proclaim them. 

Euphemisms for quackery

He set up the Prince’s Foundation for Integrated Health (PFIH) to promote his views. ( “Integrated”, in this context, is, of course, just the latest euphemism for “alternative” or “quack”.)   When the Foundation collapsed because of a financial scandal in 2010, it was replaced by the “College of Medicine”.  The name changed, but not the people behind it.  Initially this phoenix was to be named the “College of Integrated Health”, but by this time the prince’s views on medicine had become sufficiently discredited that the word “integrated” was quickly dropped.  This might be thought less than frank, but it is just employment of the classic bait and switch technique, beloved by used car salesmen.

His views were well publicised in a PFIH publication, “Complementary Healthcare: a Guide for Patients”. That volume either omitted or misrepresented the evidence about the one question that matters most to patients – does the treatment work or not?  It caused me to write a much shorter, but more accurate, version, the Patients’ Guide to Magic Medicine.  The PFIH guide was arguably a danger to public health. When, very properly, it was criticised by Edzard Ernst, a letter was sent from from the prince’s private secretary to Ernst’s vice-chancellor, Steve Smith.  Instead of defending Ernst’s public spirited action, Smith instituted disciplinary proceedings against Ernst that lasted for a year.  The prince had intervened directly in the affairs of the university.  Steve Smith was rewarded with a knighthood in 2011.

None of this criticism has dimmed the prince’s enthusiasm for barmy medical ideas.  He is well known to write many letters to government ministers to try to persuade them to adopt his ideas in a whole range of areas.  In July 2013, the Minister of Health, Jeremy Hunt, visited the prince at Clarence House.  The visit was reported to be to persuade the minister to defend homeopathy, though it was more likely to have been to press the case to confer a government stamp of approval on herbalists and traditional Chinese Medicine practitioners by giving them statutory regulation.  This is a matter that was recently raised again in parliament by Charles’ greatest ally, David Tredinnick MP (Con, Bosworth) who got into trouble for charging astrology software to expenses.  We shall never know what pressure was applied.  A ruling of the Information Commissioner judged, reasonably enough, that there was public interest in knowing what influences were being brought to bear on public policy.  But the Attorney General overruled the judgement on the grounds that “Disclosure of the correspondence could damage The Prince of Wales’ ability to perform his duties when he becomes King.”  That, of course, is exactly what we are worried about.

Influence on politics

The prince’s influence seems to be big in the Department of Health (DH).  He was given £37,000 of taxpayers’ money to produce his guide, and an astonishing £900,000 to prepare the ground for the setting up of the hapless self-regulator, the Complementary and Natural Healthcare Council (CNHC, also known as Ofquack).  When NHS Choices (itself set up by DH to assess evidence) tried to rewrite its web page about that most discredited of all forms of quackery, homeopathy, officials in DH referred the new advice to Michael Dixon, the medical director of the Prince’s Foundation and, were it not for the Freedom of Information act, the DH would have caused inaccurate information to be provided. The DH has a chief medical officer and two scientific advisors, but prefers to take the advice of the Prince of Wales.

The Prince of Wales’ business, Duchy Originals, has been condemned by the Daily Mail, (of all places) for selling unhealthy foods. And when his business branched into selling quack “detox” and herbal nonsense he found himself censured by both the MHRA and the Advertising Standards Authority (ASA) for making unjustifiable medical claims for these products.

Ainsworth’s homeopathic pharmacy is endorsed by both Prince Charles and the Queen: it has two Royal Warrants.  They sell “homeopathic vaccines” for meningitis, measles, rubella and whooping cough. These “vaccines” contain nothing whatsoever so they are obviously a real danger to public health.  Despite the fact that Ainsworth’s had already been censured by the ASA in 2011 for selling similar products, Ainsworth’s continued to recommend them with a “casual disregard for the law”. The regulator (the MHRA) failed to step in to stop them until it was eventually stirred into action by a young BBC reporter, Sam Smith, made a programme for BBC South West.  Then, at last, the somnolent regulator was stirred into action.  The MHRA “told Ainsworths to stop advertising a number of products” (but apparently not to stop making them or selling them).  They still sell Polonium metal 30C and Swine Meningitis 36C, and a booklet that recommends homeopathic “vaccination”. Ainsworth’s sales are no doubt helped by the Royal Warrants.  The consequence is that people may die of meningitis. In 2011, the MHRA Chief Executive Professor Kent Woods, was knighted.

It runs in the family

The Prince of Wales is not the only member of the royal family to be obsessed with bizarre forms of medicine. The first homeopath to the British royal family, Frederick Quin, was a son of the Duchess of Devonshire (1765-1824).  Queen Mary (1865-1953), wife of King George V, headed the fundraising efforts to move and expand the London Homeopathic Hospital. 

King George VI was so enthusiastic that in 1948 conferred the royal title on the London Homeopathic Hospital.  The Queen Mother loved homeopathy too (there is no way to tell whether this contributed to her need for a colostomy in the 1960s).

The present Queen’s homeopathic physician is Peter Fisher, who is medical director of what, until recently was called the Royal London Homeopathic Hospital (RLHH).  In 2010 that hospital was rebranded as the Royal London Hospital for Integrated Medicine (RLHIM) in another unsubtle bait and switch move. 

The RLHIM is a great embarrassment to the otherwise excellent UCLH Trust.  It has been repeatedly condemned by the Advertising Standards Authority for making false claims.  As a consequence, it has been forced to withdraw all of its patient information.

The patron of the RLHIM is the Queen, not the Prince of Wales.  It is hard to imagine that this anachronistic institution would still exist if it were not for the influence, spoken or unspoken, of the Queen.  Needless to say we will never be told.

Queen Fisher
The Queen and Peter Fisher
Observer 8 April 2007

The attorney general, while trying to justify the secrecy of Charles’ letters, said

“It is a matter of the highest importance within our constitutional framework that the Monarch is a politically neutral figure”.

Questions about health policy are undoubtedly political, and the highly partisan interventions of the prince in the political process make his behaviour unconstitutional. They endanger the monarchy itself.  Whether that matters depends on how much you value tradition and how much you value the tourist business generated by the Gilbert & Sullivan flummery at which royals excel. 

The least that one can ask of the royal family is that they should not endanger the health of the nation.  If I wanted to know the winner of the 2.30 at Ascot, I’d ask a royal. For any question concerning science or medicine I’d ask someone with more education.


Here is some more interesting reading

Michael Baum’s “An open letter to the Prince of Wales: with respect, your highness, you’ve got it wrong”

Gerald Weissman’s essay Homeopathy: Holmes, Hogwarts, and the Prince of Wales.

Channel 4 TV documentary HRH “meddling in politics”
 

Observer April 2007 "Royals’ favoured hospital at risk as homeopathy backlash gathers pace. The Queen loves it. But alternative medicine centre’s future looks uncertain as more NHS trusts axe funding"

Follow-up

It’s hard to know what to make of  David Tredinnick MP (Cons, Bosworth). He is certainly an extreme example of the scientific ignorance of our parliamentary representatives, but he isn’t alone in that. Our present minister of Education, Michael Gove, memorably referred to Newton’s Laws of Thermodynamics, blissfully unaware that thermodynamics was a 19th century development. And our present Minister of Health seems to think that magic water cures diseases.

But Mr Treddinick breaks every record for anti-scientific nonsense. That, no doubt, is why he was upset by the recent revision of come NHS Choices web pages, so that they now give a good account of the evidence (that’s their job, of course). They did that despite two years of obstruction by the Department of Health. which seemed to think that it was appropriate to take advice from Michael Dixon of the Prince’s Foundation for integrated Health. That shocking example of policy based evidence was revealed on this blog, and caused something of a stir.

Treddinick’s latest letter

A copy of a letter from Mr Tredinnick to the Minister of Health, Jeremy Hunt, has some into my possession by a tortuous route [download the letter]. It’s a corker. Here are a few quotations.

"1. UKIP moving onto our ground
Attached is an extract from a recent UKIP policy statement. The position which UKIP has taken is one with which most of our Daily Mail reading supporters of complementary medicine would agree."

It seems that Treddinick’s preferred authority on medicine is now Nigel Farage, leader of the UK’s far right party. UKIP’s policy on health is appended to the letter, and it’s as barmy as most of the other things they say.

"2. Herbal Medicine
. . .there is very real concern that the Government will not regulate Herbal Medicine and Traditional Chinese Medicine. The current situation is unacceptable, because herbal practitioners need regulation and cannot function as herbal therapists, nor can they cannot obtain stocks of their herbal remedies, without it.

This refers to a saga that has been running for at least 10 years. Herbalists are desperate to get a government stamp of approval by getting statutory regulation, much like real doctors have, despite the fact that they make money by selling sick people "an unknown dose of an ill-defined drug, of unknown effectiveness and unknown safety" (as quoted recently in the House of Lords).

Even  the US National Center for Complementary and Alternative Medicine (NCCAM) doesn’t claim that a single herbal treatment is useful. The saga of herbal regulation is long and tedious. The short version is that a very bad report, The Pittilo report, recommended regulation of herbalists. After years of prevarication, Andrew Lansley ignored the impartial scientific advice and yielded to the pressure from the herbal industry to accept the Pittilo report. But still nothing has happened.

Could it be that even Jeremy Hunt realises, deep down, that the regulation of nonsense is a nonsense that would harm the public?

We can only hope that a letter from Mr Tredinnick is the kiss of death. Perhaps his continuous pestering will only reinforce the doubts that seem to exist at the Department of Health.

Then Tredinnick returns (yawn) to his obsession with magic water. He vents his rage at the now excellent NHS Choices page on homeopathy.

3. Homeopathy

"Recently this wording has been removed and instead a comment by the Chief Medical Officer that homeopathy is placebo inserted in its place, as well as links to external organisations which campaign against homeopathy. For instance, there is a link to the Sense About Science website, and Caroline Finucane, who is Editor of new content at NHS Choices, also writes for the Sense About Science website. This is an organisation which has no expertise in homeopathy and traces its roots back to the ultra-left Revolutionary Communist Party (RCP)."

"I respectfully suggest that the original wording be reinstated and these links to external organisations be removed or changed to ensure a balanced view.".

So it seems that he prefers the medical views of Nigel Farage and the Prince of Wales to those of the Chief Medical Officer and the government’s chief scientist. Disgracefully, Tredinnick picks out one particular employee of NHS Choices among many, and one who does an excellent job. And he raises the hoary old myth that Sense About Science is a communist organisation. Odd, since others accuse it of being neo-libertarian. The actual history is here. The organisation that is a bit too libertarian for my taste is Spiked Online. I haven’t agreed with every word that Sense about Science has printed, but they have a totally honest belief in evidence.

To drag in the name of one person out of many, and to justify it by a false history shows, once again, how very venomous and vindictive the advocates of delusional medicine can be when they feel cornered.

A bit more information about Mr Treddinick

This is what the BBC News profile says about him.

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.

Tredinnick has also asserted 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. Luckily it was ignored by the government. I hope his latest letter will be treated similarly.

Picture of David Tredinnick MP from the Conservative Party

tredinnick

Follow-up

Jump to follow-up

The Scottish Universities Medical Journal asked me to write about the regulation of alternative medicine. It’s an interesting topic and not easy to follow because of the veritable maze of more than twenty overlapping regulators and quangos which fail utterly to protect the public against health fraud. In fact they mostly promote health fraud. The paper is now published, and here is a version with embedded links (and some small updates).

We are witnessing an increasing commercialisation of medicine. It’s really taken off since the passage of the Health and Social Security Bill into law. Not only does that mean having NHS hospitals run by private companies, but it means that “any qualified provider” can bid for just about any service.  The problem lies, of course, in what you consider “qualified” to mean.  Any qualified homeopath or herbalist will, no doubt, be eligible.  University College London Hospital advertised for a spiritual healer. The "person specification" specified a "quallfication", but only HR people think that a paper qualification means that spiritual healing is anything but a delusion.

uclh-spirit

The vocabulary of bait and switch

First, a bit of vocabulary.  Alternative medicine is a term that is used for medical treatments that don’t work (or at least haven’t been shown to work).  If they worked, they’d be called “medicine”.  The anti-malarial, artemesinin, came originally from a Chinese herb, but once it had been purified and properly tested, it was no longer alternative.  But the word alternative is not favoured by quacks.  They prefer their nostrums to be described as “complementary” –it sounds more respectable.  So CAM (complementary and alternative medicine became the politically-correct euphemism.  Now it has gone a stage further, and the euphemism in vogue with quacks at the moment is “integrated” or “integrative” medicine.  That means, very often, integrating things that don’t work with things that do.  But it sounds fashionable.  In reality it is designed to confuse politicians who ask for, say, integrated services for old people.

Put another way, the salespeople of quackery have become rather good at bait and switch. The wikepedia definition is as good as any.

Bait-and-switch is a form of fraud, most commonly used in retail sales but also applicable to other contexts. First, customers are “baited” by advertising for a product or service at a low price; second, the customers discover that the advertised good is not available and are “switched” to a costlier product.

As applied to the alternative medicine industry, the bait is usually in the form of some nice touchy-feely stuff which barely mentions the mystical nonsense. But when you’ve bought into it you get the whole panoply of nonsense. Steven Novella has written eloquently about the use of bait and switch in the USA to sell chiropractic, acupuncture, homeopathy and herbal medicine: "The bait is that CAM offers legitimate alternatives, the switch is that it primarily promotes treatments that don’t work or are at best untested and highly implausible.".

The "College of Medicine" provides a near-perfect example of bait and switch. It is the direct successor of the Prince of Wales’ Foundation for Integrated Health. The Prince’s Foundation was a consistent purveyor of dangerous medical myths. When it collapsed in 2010 because of a financial scandal, a company was formed called "The College for Integrated Health". A slide show, not meant for public consumption, said "The College represents a new strategy to take forward the vision of HRH Prince Charles". But it seems that too many people have now tumbled to the idea that "integrated", in this context, means barmpottery. Within less than a month, the new institution was renamed "The College of Medicine". That might be a deceptive name, but it’s a much better bait. That’s why I described the College as a fraud and delusion.

Not only did the directors, all of them quacks, devise a respectable sounding name, but they also succeeded in recruiting some respectable-sounding people to act as figureheads for the new organisation. The president of the College is Professor Sir Graham Catto, emeritus professor of medicine at the University of Aberdeen. Names like his make the bait sound even more plausible. He claims not to believe that homeopathy works, but seems quite happy to have a homeopathic pharmacist, Christine Glover, on the governing council of his college. At least half of the governing Council can safely be classified as quacks.

So the bait is clear. What about the switch? The first thing to notice is that the whole outfit is skewed towards private medicine: see The College of Medicine is in the pocket of Crapita Capita. The founder, and presumably the main provider of funds (they won’t say how much) is the huge outsourcing company, Capita. This is company known in Private Eye as Crapita. Their inefficiency is legendary. They are the folks who messed up the NHS computer system and the courts computer system. After swallowing large amounts of taxpayers’ money, they failed to deliver anything that worked. Their latest failure is the court translation service.. The president (Catto), the vice president (Harry Brunjes) and the CEO (Mark Ratnarajah) are all employees of Capita.

The second thing to notice is that their conferences and courses are a bizarre mixture of real medicine and pure quackery. Their 2012 conference had some very good speakers, but then it had a "herbal workshop" with Simon Mills (see a video) and David Peters (the man who tolerates dowsing as a way to diagnose which herb to give you). The other speaker was Dick Middleton, who represents the huge herbal company, Schwabe (I debated with him on BBC Breakfast), In fact the College’s Faculty of Self-care appears to resemble a marketing device for Schwabe.

Why regulation isn’t working, and can’t work

There are various levels of regulation. The "highest" level is the statutory regulation of osteopathy and chiropractic. The General Chiropractic Council (GCC) has exactly the same legal status as the General Medical Council (GMC). This ludicrous state of affairs arose because nobody in John Major’s government had enough scientific knowledge to realise that chiropractic, and some parts of osteopathy, are pure quackery,

The problem is that organisations like the GCC function more to promote chiropractic than to regulate them. This became very obvious when the British Chiropractic Association (BCA) decided to sue Simon Singh for defamation, after he described some of their treatments as “bogus”, “without a jot of evidence”.

In order to support Singh, several bloggers assessed the "plethora of evidence" which the BCA said could be used to justify their claims. When, 15 months later, the BCA produced its "plethora" it was shown within 24 hours that the evidence was pathetic. The demolition was summarised by lawyer, David Allen Green, in The BCA’s Worst Day.

In the wake of this, over 600 complaints were made to the GCC about unjustified claims made by chiropractors, thanks in large part to heroic work by two people, Simon Perry and Allan Henness. Simon Perry’s Fishbarrel (browser plugin) allows complaints to be made quickly and easily -try it). The majority of these complaints were rejected by the GCC, apparently on the grounds that chiropractors could not be blamed because the false claims had been endorsed by the GCC itself.

My own complaint was based on phone calls to two chiropractors, I was told such nonsense as "colic is down to, er um, faulty movement patterns in the spine". But my complaint  never reached the Conduct and Competence committee because it had been judged by a preliminary investigating committee that there was no case to answer. The impression one got from this (very costly) exercise was that the GCC was there to protect chiropractors, not to protect the public.

The outcome was a disaster for chiropractors, wno emerged totally discredited. It was also a disaster for the GCC which was forced to admit that it hadn’t properly advised chiropractors about what they could and couldn’t claim. The recantation culminated in the GCC declaring, in August 2010, that the mythical "subluxation" is a "historical concept " "It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease.". Subluxation was a product of the fevered imagination of the founder of the chiropractic cult, D.D. Palmer. It referred to an imaginary spinal lesion that he claimed to be the cause of most diseases. .Since ‘subluxation’ is the only thing that’s distinguished chiropractic from any other sort of manipulation, the admission by the GCC that it does not exist, after a century of pretending that it does, is quite an admission.

The President of the BCA himself admitted in November 2011

“The BCA sued Simon Singh personally for libel. In doing so, the BCA began one of the darkest periods in its history; one that was ultimately to cost it financially,”

As a result of all this, the deficiencies of chiropractic, and the deficiencies of its regulator were revealed, and advertisements for chiropractic are somewhat less misleading. But this change for the better was brought about entirely by the unpaid efforts of bloggers and a few journalists, and not at all by the official regulator, the GCC. which was part of the problem. not the solution. And it was certainly not helped by the organisation that is meant to regulate the GCC, the Council for Health Regulatory Excellence (CHRE) which did nothing whatsoever to stop the farce.

At the other end of the regulatory spectrum, voluntary self-regulation, is an even worse farce than the GCC. They all have grand sounding "Codes of Practice" which, in practice, the ignore totally.

The Society of Homeopaths is just a joke. When homeopaths were caught out recommending sugar pills for prevention of malaria, they did nothing (arguably such homicidal advice deserves a jail sentence).

The Complementary and Natural Healthcare Council (CNHC) is widely know in the blogosphere as Ofquack. I know about them from the inside, having been a member of their Conduct and Competence Committee, It was set up with the help of a £900,000 grant from the Department of Health to the Prince of Wales, to oversee voluntary self-regulation. It fails utterly to do anything useful.. The CNHC code of practice, paragraph 15 , states

“Any advertising you undertake in relation to your professional activities must be accurate. Advertisements must not be misleading, false, unfair or exaggerated”. 

When Simon Perry made a complaint to the CNHC about claims being made by a CNHC-registered reflexologist, the Investigating Committee upheld all 15 complaints.  But it then went on to say that there was no case to answer because the unjustified claims were what the person had been taught, and were made in good faith. 
This is precisely the ludicrous situation which will occur again and again if reflexologists (and many other alternative therapies) are “accredited”.  The CNHC said, correctly, that the reflexologist had been taught things that were not true, but then did nothing whatsoever about it apart from toning down the advertisements a bit. They still register reflexologists who make outrageously false claims.

Once again we see that no sensible regulation is possible for subjects that are pure make-believe.

The first two examples deal (or rather, fail to deal) with regulation of outright quackery. But there are dozens of other quangos that sound a lot more respectable.

European Food Standards Agency (EFSA). One of the common scams is to have have your favourite quack treatment classified as a food not as a medicine. The laws about what you can claim have been a lot laxer for foods. But the EFSA has done a pretty good job in stopping unjustified claims for health benefits from foods. Dozens of claims made by makers of probiotics have been banned. The food industry, needless to say, objects very strongly to be being forced to tell the truth. In my view, the ESFA has not gone far enough. They recently issued a directive about claims that could legally be made. Some of these betray the previously high standards of the EFSA. For example you are allowed to say that "Vitamin C contributes to the reduction of tiredness and fatigue" (as long as the product contains above a specified amount of Vitamin C. I’m not aware of any trials that show vitamin C has the slightest effect on tiredness or fatigue, Although these laws do not come into effect until December 2012, they have already been invoked by the ASA has a reason not to uphold a complaint about a multivitamin pill which claimed that it “Includes 8 nutrients that can contribute to the reduction in tiredness and fatigue”

The Advertising Standards Authority (ASA). This is almost the only organisation that has done a good job on false health claims. Their Guidance on Health Therapies & Evidence says

"Whether you use the words ‘treatment’, ‘treat’ or ‘cure’, all are likely to be seen by members of the public as claims to alleviate effectively a condition or symptom. We would advise that they are not used"

"Before and after’ studies with little or no control, studies without human subjects, self-assessment studies and anecdotal evidence are unlikely to be considered acceptable"

"Before and after’ studies with little or no control, studies without human subjects, self-assessment studies and anecdotal evidence are unlikely to be considered acceptable"

They are spot on.

The ASA’s Guidance for Advertisers of Homeopathic Services is wonderful.

"In the simplest terms, you should avoid using efficacy claims, whether implied or direct,"

"To date, the ASA has have not seen persuasive evidence to support claims that homeopathy can treat, cure or relieve specific conditions or symptoms."

That seems to condemn the (mis)labelling allowed by the MHRA as breaking the rules.. Sadly, though, the ASA has no powers to enforce its decisions and only too often they are ignored. The Nightingale collaboration has produced an excellent letter that you can hand to any pharmacist who breaks the rules

The ASA has also judged against claims made by "Craniosacral therapists" (that’s the lunatic fringe of osteopathy). They will presumably uphold complaints about similar claims made (I’m ashamed to say) by UCLH Hospitals.

The private examination company Edexcel sets exams in antiscientific subjects, so miseducating children. The teaching of quackery to 16 year-olds has been approved by a maze of quangos, none  of which will take responsibility, or justify their actions. So far I’ve located no fewer than eight of them. The Office of the Qualifications and Examinations Regulator (OfQual), Edexcel, the Qualifications and Curriculum Authority (QCA), Skills for Health, Skills for Care, National Occupational Standards (NOS), private exam company VTCT and the schools inspectorate, Ofsted.. Asking any of these people why they approve of examinations in imaginary subjects meets with blank incomprehension. They fail totally to protect tha public from utter nonsense.

The Department of Education has failed to do anything about the miseducation of children in quackery. In fact it has encouraged it by, for the first time, giving taxpayers’ money to a Steiner (Waldorf) school (at Frome, in Somerset). Steiner schools are run by a secretive and cult-like body of people (read about it). They teach about reincarnation, karma, gnomes, and all manner of nonsense, sometimes with unpleasant racial overtones. The teachers are trained in Steiner’s Anthroposophy, so if your child gets ill at school they’ll probably get homeopathic sugar pills. They might well get measles or mumps too, since Steiner people don’t believe in vaccination.

Incredibly, the University of Aberdeen came perilously close to appointing a chair in anthroposophical medicine. This disaster was aborted by bloggers, and a last minute intervention from journalists. Neither the university’s regulatory mechanisms. nor any others, seemed to realise that a chair in mystical barmpottery was a bad idea.

Trading Standards offices and the Office of Fair Trading.

It is the statutory duty of Trading Standards to enforce the Consumer Protection Regulations (2008) This European legislation is pretty good. it caused a lawyer to write " Has The UK Quietly Outlawed “Alternative” Medicine?". Unfortunately Trading Standards people have consistently refused to enforce these laws. The whole organisation is a mess. Its local office arrangement fails totally to deal with the age of the internet. The situation is so bad that a group of us decided to put them to the test. The results were published in the Medico-Legal Journal, Rose et al., 2012. "Spurious Claims for Health-care Products: An Experimental Approach to Evaluating Current UK Legislation and its Implementation". They concluded "EU directive 2005/29/EC is
largely ineffective in preventing misleading health claims for consumer products in
the UK"

Skills for Health is an enormous quango which produces HR style "competences" for everything under the son. They are mostly quite useless. But those concerned with alternative medicine are not just useless. They are positively harmful. Totally barmy. There are competences and National Occupational Standards for every lunatic made-up therapy under the sun. When I phoned them to discover who’d written them, I learned that the had been drafted by the Prince of Wales’ Foundation for Magic Medicine. And when I joked by asking if they had a competence for talking to trees, I was told, perfectly seriously, “You’d have to talk to LANTRA, the land-based organisation for that.”

That was in January 2008. A lot of correspondence with the head of Skills for Health got nowhere at all. She understood nothing and it hasn’t improved a jot.

This organisation costs a lot of taxpayers’ money and it should have been consigned to the "bonfire of the quangos" (but of course there was no such bonfire in reality). It is a disgrace.

The Quality Assurance Agency (QAA) is supposed to ensure the quality of university courses. In fact it endorses courses in nonsense alternative medicine and so does more harm than good. The worst recent failure of the QAA was in the case of the University of Wales: see Scandal of the University of Wales and the Quality Assurance Agency. The university was making money by validating thousands of external degrees in everything from fundamentalist theology to Chinese Medicine. These validations were revealed as utterly incompetent by bloggers, and later by BBC Wales journalist Ciaran Jenkins (now working for Channel 4).

The mainstream media eventually caught up with bloggers. In 2010, BBC1 TV (Wales) produced an excellent TV programme that exposed the enormous degree validation scam run by the University of Wales. The programme can be seen on YouTube (Part 1, and Part 2). The programme also exposed, incidentally, the uselessness of the Quality Assurance Agency (QAA) which did nothing until the scam was exposed by TV and blogs. Eventually the QAA sent nine people to Malaysia to investigate a dodgy college that had been revealed by the BBC. The trip cost £91,000. It could have been done for nothing if anyone at the QAA knew how to use Google.

The outcome was that the University of Wales stopped endorsing external courses, and it was soon shut down altogether (though bafflingly, its vice-chancellor, Marc Clement was promoted). The credit for this lies entirely with bloggers and the BBC. The QAA did nothing to help until the very last moment.

Throughout this saga Universities UK (UUK), has maintained its usual total passivity. They have done nothing whatsoever about their members who give BSc degrees in anti-scientific subjects. (UUK used to known as the Committee of Vice-Chancellors and Principals).

Council for Health Regulatory Excellence (CHRE), soon to become the PSAHSC,

Back now to the CHRE, the people who failed so signally to sort out the GCC. They are being reorganised. Their consultation document says

"The Health and Social Care Act 20122 confers a new function on the Professional Standards Authority for Health and Social Care (the renamed Council for Healthcare Regulatory Excellence). From November 2012 we will set standards for organisations that hold voluntary registers for people working in health and social care occupations and we will accredit the register if they meet those standards. It will then be known as an ‘Accredited Register’. "

They are trying to decide what the criteria should be for "accreditation" of a regulatory body. The list of those interested has some perfectly respectable organisations, like the British Psychological Society. It also contains a large number of crackpot organisations, like Crystal and Healing International, as well as joke regulators like the CNHC.

They already oversee the Health Professions Council (HPC) which is due to take over Herbal medicine and Traditional Chinese Medicine, with predictably disastrous consequences.

Two of the proposed criteria for "accreditation" appear to be directly contradictory.

Para 2.5 makes the whole accreditation pointless from the point of view of patients

2.5 It will not be an endorsement of the therapeutic validity or effectiveness of any particular discipline or treatment.

Since the only thing that matters to the patient is whether the therapy works (and is safe), accrediting of organisations that ignore this will merely give the appearance of official approval of crystal healing etc etc. This appears to contradict directly

A.7 The organisation can demonstrate that there either is a sound knowledge base underpinning the profession or it is developing one and makes that explicit to the public.

A "sound knowledge base", if it is to mean anything useful at all, means knowledge that the treatment is effective. If it doesn’t mean that, what does it mean?

It seems that the official mind has still not grasped the obvious fact that there can be no sensible regulation of subjects that are untrue nonsense. If it is nonsense, the only form of regulation that makes any sense is the law.

Please fill in the consultation. My completed return can be downloaded as an example, if you wish.

Medicines and Healthcare products Regulatory Agency (MHRA) should be a top level defender of truth. Its strapline is

"We enhance and safeguard the health of the public by ensuring that medicines and medical devices work and are acceptably safe."

The MHRA did something (they won’t tell me exactly what) about one of the most cruel scams that I’ve ever encountered, Esperanza Homeopathic Neuropeptide, peddled for multiple sclerosis, at an outrageous price ( £6,759 for 12 month’s supply). Needless to say there was not a jot of evidence that it worked (and it wasn’t actually homeopathic).

Astoundingly, Trading Standards officers refused to do anything about it.

The MHRA admit (when pushed really hard) that there is precious little evidence that any of the herbs work, and that homeopathy is nothing more than sugar pills. Their answer to that is to forget that bit about "ensuring that medicines … work"

Here’s the MHRA’s Traditional Herbal Registration Certificate for devils claw tablets.

vitabiotics

The wording "based on traditional use only" has to be included because of European legislation. Shockingly, the MHRA have allowed them to relegate that to small print, with all the emphasis on the alleged indications. The pro-CAM agency NCCAM rates devil’s claw as "possibly effective" or "insufficient evidence" for all these indications, but that doesn’t matter because the MHRA requires no evidence whatsoever that the tablets do anything. They should, of course, added a statement to this effect to the label. They have failed in their duty to protect and inform the public by allowing this labelling.

But it gets worse. Here is the MHRA’s homeopathic marketing authorisation for the homeopathic medicinal product Arnicare Arnica 30c pillules

It is nothing short of surreal.

hom1
hom2

Since the pills contain nothing at all, they don’t have the slightest effect on sprains, muscular aches or bruising. The wording on the label is exceedingly misleading.

If you "pregnant or breastfeeding" there is no need to waste you doctor’s time before swallowing a few sugar pills.

"Do not take a double dose to make up for a missed one". Since the pills contain nothing, it doesn’t matter a damn.

"If you overdose . . " it won’t have the slightest effect because there is nothing in them

And it gets worse. The MHRA-approved label specifies ACTIVE INGREDIENT. Each pillule contains 30c Arnica Montana

No, they contain no arnica whatsoever.

hom3
hom4

It truly boggles the mind that men with dark suits and lots of letters after their names have sat for hours only to produce dishonest and misleading labels like these.

When this mislabeling was first allowed, it was condemned by just about every scientific society, but the MHRA did nothing.

The Nightingale Collaboration.

This is an excellent organisation, set up by two very smart skeptics, Alan Henness and Maria MacLachlan. Visit their site regularly, sign up for their newsletter Help with their campaigns. Make a difference.

Conclusions

The regulation of alternative medicine in the UK is a farce. It is utterly ineffective in preventing deception of patients.

Such improvements as have occurred have resulted from the activity of bloggers, and sometime the mainstream media. All the official regulators have, to varying extents, made things worse.

The CHRE proposals promise to make matters still worse by offering "accreditation" to organisations that promote nonsensical quackery. None of the official regulators seem to be able to grasp the obvious fact that is impossible to have any sensible regulation of people who promote nonsensical untruths. One gets the impression that politicians are more concerned to protect the homeopathic (etc, etc) industry than they are to protect patients.

Deception by advocates of alternative medicine harms patients. There are adequate laws that make such deception illegal, but they are not being enforced. The CHRE and its successor should restrict themselves to real medicine. The money that they spend on pseudo-regulation of quacks should be transferred to the MHRA or a reformed Trading Standards organisation so they can afford to investigate and prosecute breaches of the law. That is the only form of regulation that makes sense.

 

Follow-up

The shocking case of the continuing sale of “homeopathic vaccines” for meningitis, rubella, pertussis etc was highlighted in an excellent TV programme by BBC South West. The failure of the MHRA and the GPC do take any effective action is a yet another illustration of the failure of regulators to do their job. I have to agree with Andy Lewis when he concludes

“Children will die. And the fault must lie with Professor Sir Kent Woods, chairman of the regulator.”

Jump to follow-up

Although many university courses in quackery have now closed, two subjects that hang on in a few places are western herbalism, and traditional Chinese medicine (including acupuncture). The University of Westminster still runs Chinese medicine, and Western herbal medicine (with dowsing). So do the University of Middlesex and University of East London.

Since the passing of the Health and Social Security Act, these people have been busy with their customary bait and switch tactics, trying to get taxpayers’ money. It’s worth looking again at the nonsense these people talk.

Take for example, the well known herbalist, Simon Mills. At one time he was associated with the University of Exeter, but no longer. Perhaps his views are too weird even for their Third Gap section (the folks who so misrepresented their results in a trial of acupuncture). Unsurprisingly, he was involved in the late Prince’s Foundation for Magic Medicine, and, unsurprisingly, he is involved with its successor, the "College of Medicine", where he spoke along similar lines. You can get a good idea about his views from the video of a talk that he gave at Schumacher College in 2005. It’s rather long, and exceedingly uncritical, so here’s a shorter version to which some helpful captions have been added.

That talk is weird by any standards. He says, apparently with a straight face, that "all modern medicines are cold in the third degree"..And with ginger and cinnamon "You can stop a cold, generally speaking, in its tracks" (at 21′ 30" in the video). This is simply not true, but he says it, despite the fact that the Plant Medicine with site (of which he’s a director) which he is associated gives them low ratings

Simon Mills is also a director of SustainCare. Their web site says

SustainCare Community Interest Company is a social enterprise set up to return health care to its owners: “learning to look after ourselves and our families in ways that make sense and do not cost the earth“. It is founded on the principle that one’s health is a personal story, and that illness is best managed when we make our health care our own. The enterprise brings clinical expertise, long experience of academia, education and business, and the connections and resources to deliver new approaches.

"As its own social enterprise contribution to this project Sustaincare set up and supported Café Sustain as a demonstration Intelligent Waiting Room at Culm Valley Integrated Centre for Health in Devon". (yes, that’s Michael Dixon, again]

In the talk (see video) Mills appears to want to take medicine back to how it was 1900 years ago, in the time of Galen. The oblique speaking style is fascinating. He never quite admits that he thinks all that nonsense is true, but presumably it is how he treats patients. Yet a person with these bizarre pre-scientific ideas is thought appropriate to advise the MHRA

It’s characteristic of herbalists that they have a very long list of conditions for which each herb is said to be good. The sort of things said by Mills differ little from the 1900-year old ideas of Galen, io the 17th century ideas of Culpepper.

You can see some of the latter in my oldest book, Blagrave’s supplement to Culpepper’s famous herbal, published in 1674.

blagrave-1

See what he has to say about daffodils

daff

It is "under the dominion of Mars, and the roots hereof are hot and dry almost in the third degree".

"The root, boyled in posset drink, and drunk, causeth vomiting, and is used with good successe in the beginning of Agues, especiallyTertians, which frequently rage in the spring-time: a plaister made of the roots with parched Barley meal, and applied to swellings and imposthumes do dissolve them; the juice mingled with hony, frankincense, wine and myrrhe, and dropped into the Eares, is good against the corrupt filth and running matter of the Eares; the roots made hollow and boyled in oyl doth help Kib’d heels [or here]: the juice of the root is good for Morphew, and discolourings of the skin."

It seems that daffodils would do a lot in 1674. Even herbalists don’t seem to use it much now. A recent herbal site describes daffodil as "poisonous".

But the descriptions are very like those used by present day herbalists, as you can hear in Simon Mills’ talk.

Chinese medicine is even less tested than western herbs. Not a single Chinese herb has been shown to be useful for treating anything (though in a very few case, they have been found to contain drugs that are useful when purified, notably the anti-malarial compound, artemesinin). They are often contaminated, some are dangerously toxic. And they contribute to the extinction of tigers and rhinoceros because of the silly myths that these make useful medicines. The cruelty of bear bile farming is legendary.

In a recent report in China Daily (my emphasis).

In a congratulation letter, Vice-Premier Li Keqiang called for integration of TCM and Western medicine.

TCM, as a time-honored treasure of Chinese civilization, has contributed to the prosperity of China and brought impacts to world civilization, Li said.

He also urged medical workers to combine the merits of TCM with contemporary medicine to better facilitate the ongoing healthcare reform in China.

The trade in Chinese medicines survives only for two reasons. One is that thay are a useful tool for promoting Chinese nationalism. The other is that they are big business. Both are evident in the vice-premier’s statement.

I presume that it’s the business bit that is the reason why London South Bank University (ranked 114 ou ot 114) that led to one of their main lecture theatres being decorated with pictures like this.“Mr Li Changchun awarding 2010 Confucius Institute of the year to LSBU Vice Chancellor” . I’ll bet Mr Li Changchun uses real medicine himself, as most Chinese who can afford it do.

SBU

Presumably, what’s taught in their Confucius Institute is the same sort of dangerous make-believe nonsense.that’s taught on other such courses.

The "College of Medicine" run a classical bait and switch operation. Their "First Thursday lectures" have several good respectable speakers, but then they have Andrew Flower, He is "a former president of the Register of Chinese Herbal Medicine, a medical herbalist and acupuncturist. He has recently completed a PhD exploring the role of Chinese herbal medicine in the treatment of endometriosis". He’s associated with the Avicenna Centre for Chinese Medicine, and with the University of Southampton’s quack division The only bit of research I could find by Andrew Flower was a Cochrane review, Chinese herbal medicine for endometriosis. The main results tell us

"Two Chinese RCTs involving 158 women were included in this review. Both these trials described adequate methodology. Neither trial compared CHM with placebo treatment."

But the plain language summary says

"This review suggests that Chinese herbal medicine (CHM) may be useful in relieving endometriosis-related pain with fewer side effects than experienced with conventional treatment."

It sounds to me as though people as partisan as the authors of this should not be allowed to write Cochrane reviews.

Flower’s talk is followed by one from the notorious representative of the herbal industry, Michael McIntyre, talking on Herbal medicine: A major resource for the 21st century. That’s likely to be about as objective as if they’d invited a GSK drug rep to talk about SSRIs.

The people at Kings College London Institute of Pharmaceutical Sciences are most certainly not quacks. They have made a database of chemicals found in traditional Chinese medicine. It’s sold by a US company, Chem-TCM and it’s very expensive (Commercial license: $3,740.00. Academic/government license: $1,850.00). Not much open access there. It’s a good idea to look at chemicals of plant origin, but only as long as you don’t get sucked into the myths. It’s only too easy to fall for the bait and switch of quacks (like TCM salespeople). The sample page shows good chemical and botanical information, and predicted (not observed) pharmacological activity. More bizarrely, it shows also analysis of the actions claimed by TCM people.

cme-tcb-4a

chem-tcb-4b

It does seem odd to me to apply sophisticated classification methods to things that are mostly myth.

The multiple uses claimed for Chinese medicines are very like the make-believe claims made for western herbs by Galen, Culpepper and (with much less excuse) by Mills.

They are almost all untrue, but their proponents are good salesmen. Don’t let them get a foot in your door.

Follow-up

10 June 2012. No sooner did this post go public when I can across what must be one of the worst herbal scams ever: “Arthroplex

31 July 2012. Coffee is the subject of another entry in the 1674 edition of Blagrave.

blagrave2

Blagrave evidently had a lower regard for coffee than I have.

“But being pounded and baked, as do it to make the Coffee-liquor with, it then stinks most loathsomly, which is an argument of some Saturnine quality in it.”

“But there is no mention of an medicinal use thereof, by any Author either Antient of Modern”

Blagrave says also

“But this I may truly say of it [coffee]: Quod Anglorum Corpora quae huic liquori, tantopere indulgent, in Barbarorum naturam degenerasse videntur,”

This was translated expertly by Benet Salway, of UCL’s History department

“that the bodies of the English that indulge in this liquor to such an extent seem to degenerate into the nature of barbarians” 

My boss, Lucia Sivolotti got something very like that herself. Be very impressed.

Salway suggested that clearer Latin would have been “quod corpora Anglorum, qui tantopere indulgent huic liquori, degenerasse in naturam barbarorum videntur”.

I’d have passed that on to Blagrave, but I can’t find his email address.

I much prefer Alfréd Rényi’s aphorism (often misattributed to Paul Erdös)

“A mathematician is a machine for turning coffee into theorems”

Jump to follow-up

Much has been written on this blog about Dr Michael Dixon, and about the "College of Medicine", which is the direct inheritor of the mantle of the late, unlamented, Prince’s Foundation for Integrated Health. At the time of the foundation of the College it was stated that "The College represents a new strategy to take forward the vision of HRH Prince Charles".

Michael Dixon has also been chairman of the NHS Alliance since 1998. That was one of very few organisations to support Andrew Lansley’s Health Bill. No doubt he will be happy for Crapita Capita to supply alternative nonsense at public expense.

Dr Dixon took offence to a review in The Times of Mark Henderson’s new book, The Geek Manifesto.

aaron.

The review, by David Aaronovitch, said, apropos of the 1023 campaign,

" . . .there was now, almost for the first time, a group of people who were not content to see claims made for discredited treatments without making everyone aware of the science that disproved those claims. And second, what they were doing had implications for public policy."

and

"The geeks represent, for me, one of the most encouraging recent developments in British public life."

This excellent review evidently upset Dr Dixon, because on 20th May, his letter appeared in the Times.

David Aaronovitch is right to argue for a robust scientific approach in medicine. However, he is not being logical or scientific when he says that if something is suspected to be placebo then it has no benefit and the NHS should not pay for it.

What about scientific research on remedies that many believe to be placebo? These frequently show that there is a benefit but this is confined to those who believe in the treatment given. Surely, in such cases, it would be logical to say that the treatment was beneficial albeit in a specific group of “believers”. From there, it would be good science to compare the safety costs of this supposed placebo remedy with its currently given alternative before deciding whether “believers” should be able to receive such a remedy on the NHS.

The problem here is that belief and mindset play an enormous part in healing – science needs to take account of this. Patients’ symptoms are frequently metaphors and effective treatment can often be symbolic and culturally dependent. The mind, in the right circumstances, can produce its own healing chemicals often mimicking those given in conventional medicine. Until science can explain healing in psychosocial as well as biomedical language, we must be cautious about “voting for the geeks” as Mr Aaronovitch suggests. It is far better surely that individual treatment should be tailored, within reason, to the patient and their beliefs and perspectives. Further more, might it not be wiser to direct NHS resources according to pragmatic trials of cost effectiveness and safety rather than a limited interpretation of science that excludes the effect of the mind?

Dr Michael Dixon

Chair of Council College of Medicine.

This letter seemed remarkable to me. It is very close to being an admission that alternative medicine is largely placebo. It called for a reply.

We have been here before. Many people have discussed the dubious ethics of deceiving patients by giving placebos while pretending they are no such thing. There is wide agreement that it is not only unethical, but also unnecessary. Kevin Smith has written a scholarly essay on the topic. Edzard Ernst wrote Mind over matter? Margaret McCartney, the Glasgow GP, and author of The Patient Paradox, has explained it. Some views of Dr Dixon’s approach are less flattering than mine. For example, from the USA, Steven Novella’s Dr. Michael Dixon – “A Pyromaniac In a Field of (Integrative) Straw Men”. And, from Majikthyse, Michael Dixon caught red-handed!, and Dr Aust’s Dr Michael Dixon is annoyed.  The list is almost endless.

.Two replies were published in the Times on 26 May (and they were the lead letters -bold print). One from the excellent Evan Harris, and one from me.

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letters

Here they are as text.

Sir, Dr Michael Dixon’s letter (May 21) is fascinating. He is, of course, a well-known advocate of alternative medicine. Yet he seems now to believe that much alternative medicine is just a placebo. That’s something the geeks have been saying for years, and he appears, at last, to have accepted it.

That being the case, it follows that we have to ask whether placebos produce useful benefits, and whether it is ethical to prescribe them. Nobody denies the existence of placebo effects. But recent research has shown that they are usually both small and transient. Often they are not big enough to provide a useful degree of relief. For example, a recent paper on acupuncture in the British Journal of General Practice showed that it had a remarkably small placebo effect. And placebos have no effect at all on the course of cancer or infectious diseases.

There has been an admirable movement in medicine for doctors to be open and honest with patients. Prescribing of medicines that contain no active ingredient involves lying to patients. That is old-fashioned and unethical.

It is fair to ask why so many people seem to believe in alternative medicine, if even their placebo effects are small. The answer seems to lie in the “get better anyway” effect (known to geeks as regression to the mean). Most of the conditions for which placebos seem to work are things that wax and wane naturally. You take the “cure” when you are at your worst, and next day you are better. You would have been better anyway, but it’s hard to avoid attributing the improvement to whatever you took. That is why alternative medicine is advertised largely on the basis of anecdotal testimonials. And it is doubtless why Dr Dixon advocates “pragmatic” trials: that’s a euphemism for trials without a proper control group.

Psychosocial problems may indeed be very important for some patients. But deceiving such patients with dummy pills is not the proper way to deal with their problems.

D. Colquhoun, FRS Professor of Pharmacology, University College London


Sir, Dr Michael Dixon argues that the NHS should fund placebo treatments such as homeopathy (though he stops short of agreeing that homeopathy is a placebo) on the basis that they can offer limited help to those who “believe” in them. It is no part of modern ethical medical practice to deceive patients into thinking — or failing to disabuse them of the belief — that an inert substance or ineffective medicine has beneficial effects. This can not be justified by the hope — or even expectation — of deriving for that patient the limited psychologically based improvement in symptoms that may follow from the deployment of the placebo.

Pedlars of homeopathy for profit in the private sector will, alas, always seek to fool people into believing the hocus pocus of “memory of water” and the effects of infinite dilution and a lot of bottle-shaking. But doctors have responsibilities not to deceive their patients, even out of a paternalistic wish to assist them to manage their symptoms; and public policy demands that the NHS spends its resources only on treatments that work without deception in a cost-effective way.

Dr Evan Harris Oxford

Follow-up

Jump to follow-up

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

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

Her own company’s web site says

"Worried about beating colds and flu this winter? We have several approaches to help you build your immune system."

The approaches are, of course, based on sugar pills. The claim is untrue and dangerous. My name for that is fraud.

glover

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

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

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

The involvement of Capita

According to their web site

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

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

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

brunjes

That isn’t the end of it. The vice-president of the College of Medicine is Dr Harry Brunjes. There is an article about him in the May 2012 issue of Director Magazine.

It has to be said that he doesn’t sound like a man with much interest in the National Health Service..

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

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

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

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

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

dixon

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

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

Secrecy at the College of Medicine

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

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

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

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

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

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

Three people who ought to know better

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

catto

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

kennedy

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

halligan

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

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

The stated aims of the College sound good.

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

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

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

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

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

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

Unprofitable for Crapita, that is.

Follow-up

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

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

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

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

There’s been no official announcement, but four more of Westminster’s courses in junk medicine have quietly closed.

For entry in 2011 they offer

University of Westminster (W50) qualification
Chinese Medicine: Acupuncture (B343) 3FT Hon BSc
Chinese Medicine: Acupuncture with Foundation (B341) 4FT/5FT Hon BSc/MSci
Complementary Medicine (B255) 3FT Hon BSc
Complementary Medicine (B301) 4FT Hon MHSci
Complementary Medicine: Naturopathy (B391) 3FT Hon BSc
Herbal Medicine (B342) 3FT Hon BSc
Herbal Medicine with Foundation Year (B340) 4FT/5FT Hon BSc/MSci
Nutritional Therapy (B400) 3FT Hon BSc
 

But for entry in 2012

University of Westminster (W50) qualification
Chinese Medicine: Acupuncture (B343) 3FT Hon BSc
Chinese Medicine: Acupuncture with Foundation (B341) 4FT/5FT Hon BSc/MSci
Herbal Medicine (B342) 3FT Hon BSc
Herbal Medicine with Foundation Year (B340) 4FT/5FT Hon BSc/MSc

 

At the end of 2006, Westminster was offering 14 different BSc degrees in seven flavours of junk medicine. In October 2008, it was eleven. This year it’s eight, and next year only four degrees in two subjects. Since "Integrated Health" was ‘merged’ with Biological Sciences in May 2010, two of the original courses have been dropped each year. This September there will be a final intake for Nutrition Therapy and Naturopathy. That leaves only two, Chinese Medicine (acupuncture and (Western) Herbal Medicine.

The official reason given for the closures is always that the number of applications has fallen. I’m told that the number of applications has halved over the last five or six years. If that’s right, it counts as a big success for the attempts of skeptics to show the public the nonsense that’s taught on these degrees. Perhaps it is a sign that we are emerging from the endarkenment.

Rumour has it that the remaining degrees will eventually close too. Let’s hope so. Meanwhile, here is another helping hand.

There is already quite a bit here about the dangers of Chinese medicine, e.g. here and, especially, here. A submission to the Department of Health gives more detail. There has been a lot on acupuncture here too. There is now little doubt that it’s no more than a theatrical, and not very effective, placebo. So this time I’ll concentrate on Western herbal medicine.

Western Herbal Medicine

Herbal medicine is just a branch of pharmacology and it could be taught as such. But it isn’t. It comes overlaid with much superstitious nonsense. Some of it can be seen in slides from Edinburgh Napier University (the difference being that Napier closed that course, and Westminster hasn’t)

Even if it were taught properly, it wouldn’t be appropriate for a BSc for several reasons.

First, there isn’t a single herbal that has full marketing authorisation from the MHRA. In other words, there isn’t a single herb for which there is good evidence that it works to a useful extent.

Second, the fact that the active principals in plants are virtually always given in an unknown dose makes them potentially dangerous. This isn’t 1950s pharmacology. It’s 1920s pharmacology, dating from a time before methods were worked out for standardising the potency of natural products (see Plants as Medicines).

Third, if you are going to treat illness with chemicals, why restrict yourself to chemicals that occur in plants?

It was the herbal medicine course that gave rise to the most virulent internal complaints at the University of Westminster. These complaints revealed the use of pendulum dowsing by some teachers on the course and the near-illegal, and certainly dangerous, teaching about herbs in cancer.

Here are a few slides from Principles of Herbal Medicine(3CT0 502). The vocabulary seems to be stuck in a time warp. When I first started in the late 1950s, words like tonic, carminative, demulcent and expectorant were common Over the last 40 years all these words have died out in pharmacology, for the simple reason that it became apparent that there were no such actions. But these imaginary categories are still alive and well in the herbal world.

There was a lecture on a categories of drugs so old-fashioned that I’ve never even heard the words: "nervines". and "adaptogens".

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N3
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N4

The "tonics" listed here seem quite bizarre. In the 1950s, “tonics” containing nux vomica (a small dose of strychnine) and gentian (tastes nasty) were common, but they vanished years ago, because they don’t work. None of those named here even get a mention in NCCAM’s Herbs-at-a-glance. Oats? Come on!

The only ‘relaxant’ here for which there is the slightest evidence is Valerian. I recall tincture of Valerian in a late 1950s pharmacy. It smells terrible,

According to NCCAM

  • Research suggests that valerian may be helpful for insomnia, but there is not enough evidence from well-designed studies to confirm this.
  • There is not enough scientific evidence to determine whether valerian works for other conditions, such as anxiety or depression.

Not much, for something that’s been around for centuries.

And for chamomile

  • Chamomile has not been well studied in people so there is little evidence to support its use for any condition.

None of this near-total lack of evidence is mentioned on the slides.

n5

What about the ‘stimulants‘? Rosemary? No evidence at all. Tea and coffee aren’t medicine (and not very good stimulants for me either).

Ginseng, on the other hand, is big business. That doesn’t mean it works of course. NCCAM says of Asian ginseng (Panax Ginseng).

  • Some studies have shown that Asian ginseng may lower blood glucose. Other studies indicate possible beneficial effects on immune function.
  • Although Asian ginseng has been widely studied for a variety of uses, research results to date do not conclusively support health claims associated with the herb. Only a few large, high-quality clinical trials have been conducted. Most evidence is preliminary—i.e., based on laboratory research or small clinical trials.

 

n8

Thymoleptics – antidepressants are defined as "herbs that engender a feeling of wellbeing. They uplift the spirit, improve the mood and counteract depression".

Oats, Lemon balm, Damiana, Vervain. Lavender and Rosemary are just old bits of folklore

NCCAM says

Some “sleep formula” products combine valerian with other herbs such as hops, lavender, lemon balm, and skullcap. Although many of these other herbs have sedative properties, there is no reliable evidence that they improve insomnia.

 

n10

The only serious contender here is St John’s Wort. At one time this was the prize exhibit for herbalists. It has been shown to be as good as the conventional SSRIs for treatment of mild to moderate depression. Sadly it has turned out that the SSRIs are themselves barely better than placebos. NCCAM says

  • There is scientific evidence that St. John’s wort may be useful for short-term treatment of mild to moderate depression. Although some studies have reported benefits for more severe depression, others have not; for example, a large study sponsored by NCCAM found that the herb was no more effective than placebo in treating major depression of moderate severity.

"Adaptogens" are another figment of the herbalists’ imaginations. They are defined in the lecture thus.

  • Herbs that have a normalising or balancing effect.
  • Mind and body are restored to optimum normal peak,
  • Increase threshold to physical and mental trauma and damage
  • Mental and physical activity and performance improved.
n12

Well, it would be quite nice if such drugs existed. Sadly they don’t.

NCCAM says

  • The evidence for using astragalus for any health condition is limited. High-quality clinical trials (studies in people) are generally lacking.

Another lecture dealt with "stimulating herbs". No shortage of them, it seems.

s2

Well at least one of these has quite well-understood effects in pharmacology, ephedrine, a sympathomimetic amine. It isn’t used much because it can be quite dangerous, even with the controlled dose that’s used in real medicine. In the uncontrolled dose in herbal medicines it is downright dangerous.

s1
s3
s4

 

This is what NCCAM says about Ephedra

  • An NCCAM-funded study that analyzed phone calls to poison control centers found a higher rate of side effects from ephedra, compared with other herbal products.
  • Other studies and systematic reviews have found an increased risk of heart, psychiatric, and gastrointestinal problems, as well as high blood pressure and stroke, with ephedra use.
  • According to the U.S. Food and Drug Administration (FDA), there is little evidence of ephedra’s effectiveness, except for short-term weight loss. However, the increased risk of heart problems and stroke outweighs any benefits.

It seems that what is taught in the BSc Herbal Medicine degree consists largely of folk-lore and old wives’ tales. Some of it could be quite dangerous for patients.

A problem for pharmacognosists

While talking about herbal medicine, it’s appropriate to mention a related problem, though it has nothing to do with the University of Westminster.

My guess is that not many people have even heard of pharmacognosy. If it were not for my humble origins as an apprentice pharmacist in Grange Road, Birkenhead (you can’t get much more humble than that) I might not know either.

Pharmacognosy is a branch of botany, the study of plant drugs. I recall inspecting powered digitalis leaves under a microscope. In Edinburgh, in the time of the great pharmacologist John Henry Gaddum, medical students might be presented in the oral exam with a jar of calabar beans and required to talk about their anticholinesterase effects of the physostigmine that they contain.

The need for pharmacognosy has now all but vanished, but it hangs on in the curriculum for pharmacy students. This has engendered a certain unease about the role of pharmacognists. They often try to justify their existence by rebranding themselves as "phytotherapists". There are even journals of phytotherapy. It sounds a lot more respectable that herbalism. At its best, it is more respectable, but the fact remains that there no herbs whatsoever that have well-documented medical uses.

The London School of Pharmacy is a case in point. Simon Gibbons (Professor of Phytochemistry, Department of Pharmaceutical and Biological Chemistry). The School of Pharmacy) has chosen, for reasons that baffle me, to throw in his lot with the reincarnated Prince of Wales Foundation known as the “College of Medicine“. That organisation exists largely (not entirely) to promote various forms of quackery under the euphemism “integrated medicine”. On their web site he says "Western science is now recognising the extremely high value of herbal medicinal products . . .", despite the fact that there isn’t a single herbal preparation with efficacy sufficient for it to get marketing authorisation in the UK. This is grasping at straws, not science.

The true nature of the "College of Medicine" is illustrated, yet again, by their "innovations network". Their idea of "innovation" includes the Bristol Homeopathic Hospital and the Royal London Hospital for Integrated medicine, both devoted to promoting the utterly discredited late-18th century practice of giving people pills that contain no medicine. Some "innovation".

It baffles me that Simon Gibbons is willing to appear on the same programme as Simon Mills and David Peters, and George Lewith. Mills’ ideas can be judged by watching a video of a talk he gave in which he ‘explains’ “hot and cold herbs”. It strikes me as pure gobbledygook. Make up your own mind. He too has rebranded himself as "phytotherapist" though in fact he’s an old-fashioned herbalist with no concern for good evidence. David Peters is the chap who, as Clinical Director of the University of Westminster’s ever-shrinking School of Quackery, tolerates dowsing as a way to select ‘remedies’.

The present chair of Pharmacognosy at the School of Pharmacy is Michael Heinrich. He, with Simon Gibbons, has written a book Fundamentals of pharmacognosy and phytotherapy. As well as much good chemistry, it contains this extraordinary statement

“TCM [traditional Chinese medicine] still contains very many remedies which were selected by their symbolic significance rather than their proven effects; however this does not mean that they are all ‘quack’remedies! There may even be some value in medicines such as tiger bone, bear gall, turtle shell, dried centipedes, bat dung and so on. The herbs, however, are well researched and are becoming increasingly popular as people become disillusioned with Western Medicine.”

It is irresponsible to give any solace at all to the wicked industries that kill tigers and torture bears to extract their bile. And it is simple untrue that “herbs are well-researched”. Try the test,

A simple test for herbalists. Next time you encounter a herbalist, ask them to name the herb for which there is the best evidence of benefit when given for any condition. Mostly they refuse to answer, as was the case with Michael McIntyre (but he is really an industry spokesman with few scientific pretensions). I asked Michael Heinrich, Professor of Pharmacognosy at the School of Pharmacy. Again I couldn’t get a straight answer. Usually, when pressed, the two things that come up are St John’s Wort and Echinacea. Let’s see what The National Center for Complementary and Alternative Medicine (NCCAM) has to say about them. NCCAM is the branch of the US National Institutes of Health which has spent around a billion dollars of US taxpayers’ money on research into alternative medicine, For all that effort they have failed to come up with a single useful treatment. Clearly they should be shut down. Nevertheless, as an organisation that is enthusiastic about alternative medicine, their view can only be overoptimistic.

For St John’s Wort . NCCAM says

  • There is scientific evidence that St. John’s wort may be useful for short-term treatment of mild to moderate depression. Although some studies have reported benefits for more severe depression, others have not; for example, a large study sponsored by NCCAM found that the herb was no more effective than placebo in treating major depression of moderate severity.

For Echinacea NCCAM says

  • Study results are mixed on whether echinacea can prevent or effectively treat upper respiratory tract infections such as the common cold. For example, two NCCAM-funded studies did not find a benefit from echinacea, either as Echinacea purpurea fresh-pressed juice for treating colds in children, or as an unrefined mixture of Echinacea angustifolia root and Echinacea purpurea root and herb in adults. However, other studies have shown that echinacea may be beneficial in treating upper respiratory infections.

If these are the best ones, heaven help the rest.

Follow-up

Jump to follow-up

Universities, like most businesses, cite glowing testimonials from grateful students, I doubt whether universities are any more honest than anyone else in their choice of what to publish. When I asked to see any letters that had been sent to the university, I was sent only one and extracts from it appear in the last post on Westminster. More dangerous nonsense from the University of Westminster: when will Professor Geoffrey Petts do something about it? But I knew (don’t ask how) that there had been more than that, and a slightly widened FOIA request produced some interesting results (though I’m aware of other letters that were not supplied -not good).

As always, the information came with the caveat

"Copyright in our response to your request belongs to the University of Westminster. All rights are reserved. This document is for personal use only and may not be copied, or stored in any electronic form, or reproduced in any other way or used for any other purpose, either in whole or in part, without the prior written consent of the University of Westminster.".

Why else would anyone ask for information but to make it public? And since the letter was sent in electronic form, it would be hard to comply with the second part. As always, I rely on the fair quotation and public interest defences to quote parts of the letters.

The main players here are Peter Davies (Head of herbal medicine and nutritional therapy), Julie Whitehouse (Course Leader for MSci Herbal Medicine and the BSc Honours Health Sciences), David Peters (Clinical director of Westminster’s School of Integrated Health), and the dean of the School of Life Sciences. Jane Lewis. There’s no woo about Jane Lewis. I suspect she’d have got rid of all the nonsense, given a chance. Who, I wonder, is stopping her?

Julie Whitehouse is, I see, a co-author of Brock et al. (2010) American skullcap (Scutellaria lateriflora): an ancient remedy for today’s anxiety, British Journal of Wellbeing1 (4), 25-30. I had no idea there was such a journal. UCL does not subscribe so if anyone has a reprint I’d love to see it. Judging by the abstract it’s yet more ‘preliminary work’. That’s very typical. Next to no CAM research gets past the preliminary report.

Some testimonials

Here are some quotations from “a part-time student on the herbal medicine (HM) BSc course, currently in my 3rd year of study. I have first class honours degree in ecology, am a qualified staff nurse, and am an experienced performance and business manager."

cc Professor Jane Lewis, Dean of School: Biosciences

"Dear Professor Petts,

I hope you do not mind me writing to you personally. I am a part-time student on the herbal medicine (HM) BSc course, currently in my 3rd year of study. I have first class honours degree in ecology, am a qualified staff nurse, and am an experienced performance and business manager. I regard myself as scientist."

"I would like to express to you my disappointment and frustration with my own studies at Westminster. I thought (erroneously, I have since discovered) that I was paying for a Bachelor of Science degree, and that science and scientific thinking would underpin my studies. How wrong I have been.

Based on my experience at Westminster, two things really need to be done to restore credibility in the herbal medicine degree, viz. removing the antiscience and pseudoscience, and strengthening the scientific basis of both our core and herbal medicine modules. The current degree is confusing and infuriating in that it really does not know what it is."

"Here is a quote from a handout (on ‘The Galenic Constitutional System in Practice’) given to 3rd year herbalists last semester: ‘Treating particular disease/conditions is more successful if the disease can be analysed in terms on hot, cold, wet and dry’. If I showed this to any modern (not 17th century) doctor they would be rolling around on the floor in hysterics and condemning this type of nonsense in the strongest possible language. I am ashamed to tell anybody what we are being taught. Is this clandestine teaching or is the University actually sanctioning this pre-scientific view of medicine?"

Anti-science ideas need to be, not only banished from teaching material, but also robustly challenged every time they are raised by students (or lecturers) in the polyclinic or the classroom. But, constantly challenging anti-scientific and erroneous ideas is very wearing and wearying for me as a student, as I am sure it is for scientists on your staff. (I should say here that there are some excellent scientists who have supported and encouraged me in my studies at Westminster; Dr Gillian Shine in the core modules and Christopher Robbins in HM, leap to mind).
Your ‘You Tube’ video says that you hope we enjoy our studies at Westminster. I do want to enjoy my studies. I want to think that Westminster is a respected

academic institution. I should not feel threatened by challenging what I am taught when it is plainly pseudoscience or antiscience and my University should be supporting me in my challenge, which I am sure you will.

And from the same student, this time addressed to Julie Whitehouse and copied to the dean, Jane Lewis (in 2009) [some details removed to preserve patient confidentiality].

… a patient attended who had been treated with a Reiki [typo for Reishi] mushroom tincture and another herbal tincture (about 6 herbs) by an HM clinic supervisor. The patient had also been advised to do ‘body brushing’ which I understand was for ‘detoxification’. This lady is being treated by an oncologist for [***] cancer and is currently undergoing chemotherapy. I do not believe her oncology team were informed before we initiated treatment and the bottles of tincture were not labelled with what they contained.

I have serious ethical problems with treating anyone with cancer with herbs, but someone in the middle of chemotherapy?

Not only are patients’ lives being put at risk, but students are not getting clear messages about the limitations of HM or the professional ethics involved in treating someone with cancer. I have seen patient files with ‘anti-mitotic’ or ‘anti-cancer’ herbs written in the notes. I question whether this is also bordering on the illegal. At the very least it betrays a naive belief that herbs can treat cancer. I was ignored earlier this year when I queried students being encouraged to go to a herbalist’s cancer seminars in Bristol (and she claimed to cure cancer) and this case highlights to me the dangers of Wmin condoning and teaching the ‘we treat people not diseases’ mantra.

This second letter elicited a response from the university, and the response is worth looking at.

The response

2 What was done following the complaint

021209 Clinical Director met with the tutor. Reviewed notes. No indication that the patient was seeking ‘alternatives’ to chemo, nor that she was led to believe the prescription was designed to do other than support her coping with chemo which in her experience had previously been physically demanding and distressing. Procedures regarding communication with oncologists, informed consent, labeling of medicines need reviewing and reinforcing. Action by Course leader/herbal team. Report back to PC Exec 210110

151209 The student who (though she had not been present during this session, had objected to way this case was handled met with the course leader in the presence of the Senior Clinical supervisor and another tutor. The meeting was supportive rather than confrontational. The student was asked to reflect on the consequences of her (frequent) impulsive emailing and the time and effort she demands of others – and to consider the Code of Conduct she has signed.

So the whistle-blowing student seems to have been patted on the head and told to shut up. Nevertheless the complaint had some effect, though not much.

050110 Course leader proposed to review current Polyclinic policies and procedures, and discuss current practice in cases of serious disease and how doctors are informed and patients consented

The response included "Extracts from Smith J, Rowan N & Sullivan (2000) Medicinal Mushrooms: Their therapeutic properties and current medical usage with special emphasis on cancer treatment” from Cancer Research UK."

In almost all the examples that will be discussed in this chapter the polysaccharides act mainly as immune- stimulants with little or no adverse drug reactions. Furthermore, several of these extracts have been shown to stimulate apoptosis in cancer cells (e.g. Fullerton et al., 2000). While there are examples where the mushroom polysaccharides have shown efficacy against specific types of cancer as monotherapy, the overwhelming successes have been demonstrated when they function together with proven and accepted chemotherapeutic agents.

I could not find that document at Cancer Research UK though there is a similar report, dated May 2002, "Medicinal Mushrooms: Their therapeutic properties and current medical usage with special emphasis on cancer treatments" by Smith, Rowan and Sullivan. It can be downloaded at the Cancer Research UK page, Medicinal Mushrooms and Cancer. That page, last updated 7 August 2006, lists John Smith BSc MSc PhD DSc FIBiol FRSE as Emeritus Professor of Applied Microbiology, University of Strathclyde. amd Chief Scientific Officer, MycoBiotech Ltd, Singapore, and Richard Sullivan BSc MD PhD as Head of Clinical Programmes, Cancer Research UK (a job he left in 2008). Professor John Smith is still Chief Scientific Advisor to Mycobiotech Inc, based in Singapore. This company sells various mushroom products. They are all marketed as “nutriceuticals” or “functional foods”, not as pharmaceuticals. These descriptions are a very common way of making medicinal claims for products, while describing them as foods to avoid the strict regulations about claims made for medicines.

It does not seem to me to be a good idea for Cancer Research UK to have advice on its web site from someone with a very obvious financial interest.

The quotations from the Smith report are obviously intended to defend the practice of prescribing mushrooms to people on chemotherapy. But the fact that in 2011, five years after the CRUK page, Mycobiotech still has no approved medicine approved for cancer speaks for itself. They sell Shiitake Herbal Soups. They also sell Essence of Shiitake which, they say, contains Lentinan, “which has been confirmed through research, to be an immuno-enhancer. Lentinan has been found to reduce tumour growth and to prolong the life of cancer patients”. That sounds to me like a rather strong medicinal claim for a “food”. Even Nutra-ingredients, the industry site for nutriceuticals, doesn’t claim much for it.

Now back to Westminster’s response to the student’s complaint.

I have found no evidence that herbal practitioners in the Polyclinic are making explicit claims to treat cancer.
However, the use of the term ‘anti-tumour’ in the notes implies an ambivalent rationale for prescribing. It also illustrates the potential for ambiguity in the clinical notes. However, there is substantial research – both laboratory and clinical – to support the ‘anti-tumour’ and ‘immune stimulant’ properties of certain mushroom species. p222 see appx 2

And, from David Peters.

DP**There is one item in the notes however which I think we need to comment on. While the paper-trail in all other respects shows that the herbal prescription was supportive, one herb in the prescription is categorised as ‘anti-tumour’. Although I am convinced after reviewing the notes and talking with the tutor involved, that the aim was to support the patient through her chemotherapy, this part of the prescription nonetheless signifies some ambivalence at least, about whether the aim was or was not to treat cancer

But then, from Julie Whitehouse

JW Yes there is antitumour as an action for many herbs and nutritional components – and several relevant actions including anything as general as anti- oxidant even – it doesn’t mean we are suggesting they are being used as treatment

It doesn’t take much reading between the lines to see the tension between Whitehouse and Peters. The former is very reluctant to give up the myths, the latter is slightly more cautious about claims to treat cancer.

Let’s be clear about one thing. The student was dead right. There is so little reliable information about mushrooms that neither Cochrane Reviews nor NCCAM has anything relevant to say about them. Antioxidants are a myth, much beloved by marketing people and "boosting the immune system" is the universal mantra of every advocate of magic medicine when they can’t think of anything else to make up. Why can’t Peters and Whitehouse admit it?

More complaints

This one is from a member of staff who teaches on the herbal medicine course. It was addressed to Julie Whitehouse and copied to the dean and vice-chancellor.(10 July 2009).

"During last week (5-9th May) I witnessed a member of the Herbal Team and a student dowsing with a pendulum to divine herbal drugs to prescribe for the student. When I approached and spoke, they defensively hid the pendulum and were clearly embarrassed. I discussed what they were doing. They freely said they were prescribing herbal medicine and cited other staff as their ‘authority’ and ‘instructors’.

Diagnosing or prescribing by pendulum has no scientific credibility. Further, it is dangerous for prescribing as it both fails to identify any appropriate drugs (except by chance) and may select dangerous drugs for a patient.

I know other staff have raised with you the teaching or use of such mediaeval and unscientific practices on the Wmin HM course."

"I feel that such practice in the HM Course teaching or in the Polyclinic should be proscribed. I would like to suggest that you address and resolve this matter urgently.

Dowsing is in conflict with the VC’s recent letter to SIH staff, specifically expecting more evidence of science within the teaching of CT Courses."

"I expect that were the Department of Health to be aware of the unscientific teaching and promotion of practices like dowsing, (and crystals, iridology, astrology, and tasting to determine pharmacological qualities of plant extracts) on the Wmin HM Course, progress towards the Statutory Regulation of Herbal Medicine could be threatened."

The writer seems to have overestimated the sense in the Department of Health. They were aware of these practices (I told them) but nevertheless went ahead with a silly form of statutory regulation.

The same lecturer wrote on 27 July 2009

"This happened with a supervisor, students and patient in the consultation room. The patient was invited to dowse her own "remedies" using a pendulum. A set of Bach Flower remedies (also proscribed in the HM Clinics) was placed in front of the patient and a pendulum was produced. On the basis of the dowsing, a prescription of ‘remedies’ was dispensed."

"Although Julie says dowsing has been proscribed, she has been unable to present and document saying as such. Bach Flower Remedies have been proscribed for HM Clinics."

Some of the replies were sent to me. Julie Whitehouse replied to the lecturer and Peter Davies on 10 August 2009

“I have written and circulated the text to be put into the handbook and have had approval from most members of the herbal team – but [the lecturer who complained] was not there at the time – hope he approves of the statement. It does not specifically say we do not dowse – but it does I think state clearly what we do – we surely do not want a list of what we don’t do – where would it end – there could be many things in a list of what we don’t do.”

So she explicitly refused to ban the use of dowsing in Westminster’s clinic. The lecturer replied, pointing out the unreasonableness of this attitude.

Dear Julie,

I am afraid that I have not received any copy (home or University) of your ‘statement’ so cannot comment. Please resend me another copy.

I don’t understand your not wanting ‘a list of what we don’t do – where would it end’. It is commonplace to have proscribed activities in both social and professional activities, and these are usually for clear reasons of safety and public good. Eg.: Herbal practice is constrained by the prohibitions in the Medicines Act 1968 and following, the maximum dosages under Schedule III of that Act, the prohibited herbal drugs under the MCA, Trading Standards regulations, etc.

It seems that, despite the vice-chancellor’s assurance that the courses would become more scientific, there are still apologists for diagnosis with a pendulum, and for treating cancer with mushrooms at Westminster University.

This saga sounds only top characteristic. Complaints through official channels usually get you nowhere with big organisations. Sadly, the only way to get change is public embarrassment.

Some action from Vice-chancellor Geoftrey Petts is long overdue.

Follow-up

A kind reader sent me a copy of Brock, Whitehouse, Tewfik & Towell,. (2010) American skullcap (Scutellaria lateriflora): an ancient remedy for today’s anxiety, British Journal of Wellbeing1 (4), 25-30.. This is the paper that I described above, on the basis of the abstract, as "preliminary study".. Now that I’ve seen it I realise it isn’t study at all. They simply emailed 377 members of the National Institute of Medical Herbalists to ask what they thought of S. laterifloria. Only 62 replied (16%) and their anecdotes are listed in the paper. It is this sort of worthless information that gets herbal medicine a bad name.

10 August 2011. I notice that Professor Petts has replied to a letters sent to him by the Nightingale Collaboration. He said “Whilst I understand your concerns, colleagues of the School of Life Sciences where these courses are offered do not share them. They are not teaching pseudo-science, as you claim,…”. Well I know at least two member of the Life Sciences department who are very worried. One has now left and one has retired. The rest are presumably too scared to speak out. How he has the nerve to claim that they don’t teach pseudo-science all the teaching materials that have been revealed on this blog is hard to imagine. It is simply not true and he must know it. I find it deeply worrying when vice-chancellors say things which they know to be untrue.

The latest example to come to light is cited by Andy Lewis on his Quackometer blog

“There are some even odder characters too, such as Roy Riggs B.Sc who descibes himself as a “Holistic Geobiologist” and is “an “professional Earth Energy dowser”. He guest lectures at the London Westminster University’s School of Integrative Medicine and The Baltic Dowser’s Association of Lithuania.”

I do wonder who Professor Petts thinks he’s fooling.

Jump to follow-up

One of my first posts about nonsense taught in universities was about the University of Westminster (April 2008): Westminster University BSc: “amethysts emit high yin energy”. since then, there have been several more revelations.

Jump to follow-up

Petts

Professor Petts

The vice-cnancellor of Westminster, Professor Geoffrey Petts, with whom the buck stops, did have an internal review but its report was all hot air and no action resulted (see A letter to the Times, and Progress at Westminster). That earned Professor Petts an appearence in Private Eye Crystal balls. Professor Petts in Private Eye (and it earned me an invitation to a Private Eye lunch, along with Francis Wheen, Charlie Booker, Ken Livingstone . . ). It also earned Petts an appearence in the Guardian (The opposite of science).

By that time Salford University had closed down all its CAM, and the University of Central Lancashire was running an honest internal review which resulted in closure of (almost) all of their nonsense degrees. But Westminster proved more resistant to sense and, although they closed down homeopathy, they still remain the largest single provider of degrees in junk medicine. See, for example More make-believe from the University of Westminster. This time it’s Naturopathy, and
The last BSc (Hons) Homeopathy closes! But look at what they still teach at Westminster University.

It’s interesting that Westminster always declined to comply with Freedom of Information requests, yet I had more from them than from most places. All the information about what’s taught at Westminster came from leaks from within the university. Westminster has more moles than a suburban garden. They were people with conscience who realised that the university was harming itself. They would claim that they were trying to save the university from some remarkably bad management. I claim also that I’m working in the interests of the university.

In the wake of the victory at the Information Tribunal, I sent a Freedom of Information Act (FOIA) request for for samples of teaching materials from all of their courses. This time they couldn’t legally refuse. The first batch has just arrived, so here are a few selected gems of utter nonsense. Well, it is worse than nonsense because it endangers the health of sick people.

A letter to the university from a student

Before getting on to the slides, here’s a letter that was supplied under FOIA. It was sent anonymously to the university. I was told that this was the only letter of complaint but I happen to know that’s not true so I’ve asked again. This one was forwarded to the vice-chancellor in 2008, and to the review committee. Both seem to have ignored it. Judging from the wording, one would guess that it came from one of their own undergraduates. :Here are some extracts.[download whole letter]

It is a flagrant contradiction of a ‘science’ in the BSc to have these practices, but it also jeopardises our profession, which is under DoH review and being constantly attacked in the media Gustifiable I suggest).

We are taught that simply tasting plant tinctures can tell us which part of the body they work. on and what they do in the body. We are given printed charts with an outline of the body on to record our findings on. This is both nonsense, but is dangerous as it implies that the pharmacology of plant tinctures can be divined by taste alone. In class we are taught that we can divine the drug actions or use of an unknown plant simply by tasting an alcohol extract. Science? or dangerous fantasy.

There are lecturers taking clinics who allow students to dowse and partake themselves in dowsing or pendulums to diagnose and even to test suitability of plant drugs.

Dowsing is taught to us by some lecturers and frowned upon by others but we feel it brings the herbal medicine into a poor light as it is unscientific and bogus nonsense. We are concerned that we have seen the course leader brush over this practice as though she is frightened to make a stand.

The letter seems to refer to a course in herbal medicine. That is a subject that could be studied scientifically, though to do so would leave students unemployed because so few herbal treatments have been shown to work. It obviously is not being studied scientifically: but even teaching students about dowsing and pendulums does not seem to have stirred the vice-chancellor into action.

David Peters: wishful thinking?

David Peters is a nice man. He’s the Clinical Director of Westminster’s School of Integrated Health. I debated with him on the excellent Radio 4 Programme, Material World.

[listen to Material World].

His lecture on "Complementary Healthcare in the NHS" showed some fine wishful thinking.

peters2

It shows the progress of the euphemisms that quacks use to try to gain respectability, but little else. Interestingly, later slides show a bit more realism.

peters3
peters4

So he has noticed that the tide has turned and that a lot of people are no longer willing to be palmed off with new age gobbledygook. And yes, courses are shutting. Perhaps his course will be the next to shut?

According to an internal Westminster email that found its way to me,

The following courses have been closed/identified for closure due to poor recruitment :

  • BSc degrees in Homeopathy and Remedial Massage & Neuromuscular Therapy, students completing by September 2011
  • MA degrees in International Community development, Community development and Faith-based Community development, students completing by September 2011
  • BSc degree Complementary Medicine
  • Graduate diploma BMS

The following courses have been identified as ‘at risk’ (School definition) and will be discussed at the APRG and University Review Group2, due to poor recruitment and high cost of delivery:

  • Integrated Health Scheme: BSc Complementary Medicine, Naturopathy; BSc Chinese Medicine; BSc Nutritional Therapy; BSc Herbal Medicine

The BSc (Hons) degree in naturopathy

Naturopathy us pretty bizarre, because it consists largely of doing nothing at all, beyond eating vegetables . Being ill is good for you.

Perhaps the best source to judge claims is the US National Center for Complementary and Alternive Medicine (NCCAM), a branch of the National Institutes of Health. This is the outfit that has spent over a billion dollars of US taxpayers’ money testing alternative medicines and for all that money has not come up with a single useful treatment. They never link to any sort of critical comment, and are nothing if not biassed towards all things alternative. If they can’t come up with evidence. nobody can. Two useful links to NCCAM are Herbs at a glance, and Health Topics A – Z.

Uses of herbal teas in naturopathic dietary care

I was sent a set of over 50 slides on "Herbal Teas/Decoctions (3CMWS03, 1/02, Uses of herbal teas in naturopathic dietary care). About half of them amount to little more than ‘how to make a cup of tea’. but then we get onto uses, but then a lot of fantasy ensues.

What NNCAM says about dandelion. There is no compelling scientific evidence for using dandelion as a treatment for any medical condition.

What Westminster says

tea 2

tea1
Well I know what a diuretic is, but "blood purifier" and "liver tonic" are meaningless gobbledygook. We’ve been through this before with Red Clover (see Michael Quinion’s .look at the term "blood cleanser"). Using words like them is the very opposite of education.

What NCCAM says.about chamomile: Chamomile has not been well studied in people so there is little evidence to support its use for any condition.

What Westminster says

tea 4

So, judging by NCCAM, these claims are unjustified. It’s teaching folk-lore as though it meant something.

More dangerous advice comes when we get to the ‘repertories’.

tea 3

Infections can kill you, They are one of the modest number of things that pharmacology can usually cure, rather than treat symptomatically. If you go to a Westminster-trained naturopath with a serious infection and follow their advice to put garlic in your socks, you will not just be smelly, You could die.

Allergy and Intolerance 3CMwS03 18/02

Treating allergies, misdiagnosed by fraudulent tests, is very big business for the ‘health food industry’,

This lecture, by R. Newman Turner ND, DO, BAc, started tolerably but descended to a nadir when it mentions, apparently seriously, two of the best known fraudulent methods of allergy diagnosis, the Vega test and "Applied Kinesiology".

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

all 1

Could this be the same R Newman Turner who wrote a book on Naturopathic First Aid? The mind boggles.

Naturopathic Detoxification 23 CMES03 25/02 Detox Myth of Fact


This lecture was the responsibility of Irving S Boxer ND DO MRN LCH, a naturopath, homeopath and osteopath in private practice.

Don’t be fooled by the implied question in the title. It might have been taken to suggest a critical approach. Think again.

There is all the usual make-believe about unspecified and imaginary toxins that you must get rid of with enemas and vegetables.

detox1
detox 2

The skin brushing does not quite plumb the depths of Jacqueline Young’s Taking an air bath , but presumably it is something similar.

"Liver activation" by castor oil packs is pure unadulterated gobblydygook. The words mean nothing.

Their attempt to divide all foods into those that cleanse and those that clog sounds reminiscent of the Daily Mail’s ontological oncology project.

detox3
detox4

The practice of healing (3CMSS01 2/12)

Next we retreat still further into fantasy land

heal1
heal2

All pure hokum, of course’ She could have added "craniosacral therapy" (at present the subject of a complaint against the UCL Hospitals Trust (that’s the NHS, not UCL) to the Advertising Standards Authority,

heal3
heal4

Is that definition quite clear?

In fact this sort of nonsense about rays coming from your hands was disproved experimentally, in a rather famous paper, the only paper in the Journal of the American Medical Association to have been written by a 9-year old. Emily Rosa. She (with some help from her parents) devised a simple test for her 4th (US) grade science fair project. It was later repeated under more controlled conditions and written up for JAMA [download reprint] . It showed that the claims of ‘therapeutic touch" practitioners to be able to detect "auras" were totally false. No subsequent work has shown otherwise. Why, then, does the University of Westminster teach it as part of a Bachelor of Science degree?

You can see Emily Rosa herself explain why “therapeutic touch is bullshit” with Penn and Teller, in Penn and Teller Expose Therapeutic Touch.

Environmental stress

The last bit of hokum (for the moment) is one of the best. This one has every myth under the sun (including some I hadn’t heard of).

env1

The lecturer, Val Bullen, was also responsible for the infamous "Amethysts emit high Yin energy" slide. One of her own students desribes her as "sweet but deluded". I have nothing against Ms Bullen, She can believe whatever she wants. My problem is with the vice-chancellor, Prof Geoffrey Petts, who seems to think that this sort of stuff is appropriate for a BSc.

env2

 

Everything barmy is here. Mobile phones, power lines, underwater streams, ley lines, sick building syndrome, are all reasons why you don’t feel 100 percent, Actually my reason is having to read this junk. The "definitions" are, as always, just meaningless words.

env3

env4

env5

env6
env7

env8
env9

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But don’t despair. Help is at hand.

env12

Just in case you happen to have run out of Alaskan Calling All Angels Essence, you can buy it from Baldwin’s for £19.95. It’s "designed to invoke the nurturing, uplifting and joyful qualities of the angelic kingdom.", and what’s more "can also use them any time to cleanse, energize, and protect your auric field." Well that’s what it says.in the ad.

Yarrow Environmental Solution looks like good stuff too. Only £7.95 for 7.5 ml. For that you get a lot. It will

" . . strengthen and protect against toxic environmental influences, geopathic stress, and other hazards of technology-dominated modern life. This includes the disruptive effects of radiation on human energy fields from X-rays, televisions, computer monitors, electromagnetic fields, airplane flights or nuclear fall-out."

OK stop giggling. This is serious stuff, taught in a UK university as part of a BSc degree, and awarded a high score by the Quality Assurance Agency (QAA).

Professor Petts, are you listening? I believe it is you, not I, who is bringing your university into disrepute.

 

The slides shown here are copyright of the University of Westminster or of the author of the lecture. They are small sample of what I was sent and are reproduced under the “fair quotation” provision, in the public interest.

Follow-up

5 May 2011. By sheer coincidence, Emily and Linda Rosa were passing through London. They called for lunch and here’s a picture (with Ben Goldacre) in UCL’s (endangered) Housman room. Linda kindly gave me a copy of her book Attachment Therapy on Trial: The Torture and Death of Candace Newmaker. [Download reprint of Rosa’s paper..]

.

6 May 2011. Talking of the “vibrational medicine” fantasy, I had an email that pointed out a site that plumbs new depths in fantasy physics. It’s on the PositiveHealthOnline website: A post there, Spirals and Energy in Nature, was written by Robert McCoy. He claims to have worked on microprocessor layout design, but anyone with school physics could tell that the article is sheer nonsense. In a way it is much more objectionable that the silly slides with coloured rays used in the Westminster course. McCoy’s post seeks to blind with sciencey-sounding language, that in fact makea no sense at all. Luckily my retweet of the site attracted the attention of a real physicist, A.P. Gaylard, who made a very welcome return to blogging with Fantasy physics and energy medicine. He dismantles the physics, line-by-line, in a devastating critique. This sort of junk physics is far more dangerous than the perpetual motion pundits and the cold-fusion fantasists. At PositiveHealthOnline it is being used to push pills that do you no good and may harm you. It is a danger to public health.

Jump to follow-up

The absurdness of allowing statutory regulation of herbal medicines, both Western and Chinese has already been pointed out here, in Government lends credibility to quacks and charlatans, and by Andrew Lewis in  “How to Spot Bad Regulation of Alternative Medicine

The harm done by the government’s endorsement of herbal products could be ameliorated if they were labelled honestly. The labelling is a matter for the Medicines and Healthcare products Regulatory Authority (MHRA), and for a while I have been writing to the head of the MRH, Kent Woods, and to Richard Woodfield (head of MHRA herbal medicine policy), in an attempt to work out their reasons for not telling the consumer the simple truth.

A similar (but even worse) problem arises in the labels that have been allowed by the MHRA for homeopathic pills. That has been discussed in Pseudo-regulation: another chance to save the MHRA from looking idiotic . The matter is not yet decided, but on past performance, I’m pessimistic about whether the MHRA will listen to scientists.

The Traditional Herbal Registration (THR) scheme allows herbal medicines that are registered on this scheme to be sold if they are safe, and have been in use for 30 years. There is need to supply any information whatsoever about whether they work or not. That itself is very odd, given that the MHRA’s strap line says

"We enhance and safeguard the health of the public by ensuring that medicines and medical devices work and are acceptably safe."

In the case of herbals, the bit about ensuring that medicines work has been brushed under the carpet.

A typical dishonest label

Take "Echina Cold Relief". The Traditional Herbal Regulation document specifies the label.

Note, first of all, the therapeutic claim in the brand name itself. This is blatant practice for most herbals and appears to be unregulated. The label says

echina label


It is my contention that most people would interpret this label as a claim that the tablets would have a beneficial effect on the symptoms of "common cold and influenza type infections". The impression is reinforced by the government stamp of approval on the package.

The MHRA tell me that no tests have been done to discover how shoppers interpret these words. They should have been done.

 

kite mark

Why is there nothing on the label that tells the plain, unvarnished truth? Perhaps something like this

 "There is no evidence that this product works for the indications mentioned". 

Or

"Clinical trials have shown this product to be ineffective for xxx "

or, at a minimum

"The MHRA kite mark does not imply that this product is effective"

Some Evidence

Echinacea is a generous choice of example because, unlike most herbs, there is a bit of evidence about its effectiveness. A Cochrane review says

Sixteen trials including a total of 22 comparisons of Echinacea preparations and a control group (19 placebo, 2 no treatment, 1 another herbal preparation) met the inclusion criteria. All trials except one were double-blinded. The majority had reasonable to good methodological quality. Three comparisons investigated prevention; 19 comparisons investigated treatment of colds. A variety of different Echinacea preparations were used. None of the prevention trials showed an effect over placebo. Comparing an Echinacea preparation with placebo as treatment, a significant effect was reported in nine comparisons, a trend in one, and no difference in six. Evidence from more than one trial was available only for preparations based on the aerial parts of Echinacea purpurea (E. purpurea). 

“It seems that some preparations based on the herb of Echinacea purpurea might be effective for this purpose in adults, while there is no clear evidence that other preparations are effective or that children benefit. Side effects were infrequent but rashes were reported in one trial in children.”

The US agency NCCAM has spent over a billion dollars on testing various sorts of alternative treatment, and has failed to find a single useful treatment, They say

"Two NCCAM-funded studies did not find a benefit from echinacea, either as Echinacea purpurea fresh-pressed juice for treating colds in children, or as an unrefined mixture of Echinacea angustifolia root and Echinacea purpurea root and herb in adults."

So the evidence is a mess. There is no evidence that Echinacea can prevent colds, and, at the very best, it might shorten slightly the time for which cold symptoms last. The most likely interpretation of the mixture of contradictory results, many negative trials with a handful of small positive effects, is that for practical purposes, echinacea is useless. There is NO treatment known that affects the duration of a cold to any useful extent.

I wrote to Kent Woods in February 2011

Hello

Sorry to bother you again, but recent events have caused me to think about a rather fundamental question, and I have never seen it discussed in any official documents.  I suspect it needs to be answered at the highest level.

Question,  Do you make any distinction between (a) herbs that have unknown efficacy (most of them). and (b) herbs that have been shown in good trials to have no useful effect (like echinacea)?

It is one thing to say “traditionally used for …” when you don’t know whether it is true or not.

It is quite another thing to say “traditionally used for. . . ” when you know it is untrue

No such distinction seems to be made at the moment.

Is that because the distinction has never been considered by the MHRA?

Or is it because it has been considered, but dismissed as unimportant?

Or is it considered important but you are prevented from doing anything about it (and, if this is the case, what prevents you?)

Best wishes

David

His reply was, essentially, that herbs come in so many different forms that they can’t all be tested so it is never possible to say that a herb “does not work to any useful extent”

. . .

Based on our experience of regulating herbal medicines, we think it unlikely for the foreseeable future that there would be available for particular herbs a comprehensive body of published studies that meet medicines regulatory standards and cover systematically the numerous possible permutations as to type of extract, plant species and part of plant. Consequently, it is unlikely that evidence would be available for MHRA to know that a traditional herbal product did not have efficacy.

In summary, you suggest an interesting scenario the handling of which would be worthy of further consideration in the event of major advances in the range and quality of clinical trials of herbal medicines – but for the foreseeable future we would see the dilemma as largely a theoretical one.

Regards

Kent Woods

This strikes me as a cop-out. It amounts to saying that it’s impossible ever to say that a treatment us useless. If NICE took the same view, no medicine would ever be ruled out as having no useful effect.

Then I asked about a press release from the MHRA, dated 18 March 2011.

Hello
I really must object to the wording of today’s press release
http://www.mhra.gov.uk/NewsCentre/Pressreleases/CON111687

It says (my emphasis)

"The growth of the THR scheme means that consumers will have access to a wide choice of over-the-counter herbal medicines made to assured standards.

"The current signs are that the market will be lively and competitive. The key difference for consumers is that in future they will be in the driving seat and able to make an informed choice when they wish to use these medicines.
"

Since the main sort of information that people want about a medicine is whether it works, and you have explicitly ruled out any information about that, the description "informed choice" seems to me to be exaggerated to the point of dishonesty.

This raises another question.  Many people think that the wording that you approve is deceptive.  can you tell me whether you have yet done tests to discover whether or not the average consumer interprets your wording as suggesting effectiveness?  This was raised (apropos oh homeopathics) with Kent Woods at the SciTech enquiry and they were assured such tests had been done.  Still nobody has seen the result of such tests.  Please will you let me know if they have been done, and, if they have, what the results were?  if they have not been done, why not?

Best regards
David Colquhoun

The legal requirement

In response to my letter, Richard Woodfield said

"Specifically on the question of wording affecting efficacy, we have to comply with the requirements of the herbals Directive which specifies the required product information about the traditional basis of the registration. We have not user tested the required statement in the Directive.
"

The European Herbals directive 2004/24/EC [download it] does make it mandatory to include the words used by the MHRA

“In addition to the requirements of Articles 86 to 99, any advertisement for a medicinal product registered under this chapter shall contain the following statement: Traditional herbal medicinal product for use in specified indication( s) exclusively based upon long-standing use.”  

Telling the truth on the label

I asked the MHRA whether there was any legal reason why they could not add the following notice to the wording required by the European Directive. I had to ask the question several times before I got a straight answer, but the answer eventually turned out to be that there is no legal reason that bars honest labels. Eventually Richard Woodfield told me there was no legal reason.

Dear Prof Colquhoun

There is no specific bar in the European Directive that would definitely preclude requiring additional statements that were consistent with the Directive. Obviously one would have to look at the specifics of what was proposed.

The main bar is that of Government policy.  Under the previous Administration when the scheme was set up there was a strong policy of avoiding gold plating of European legislation – and this would clearly be a case of gold plating.  Under the new Government that policy of avoiding gold plating has been strengthened further.  And added to that there is now a presumption that wherever possible Directives should be transposed by “copy out” of the text rather than elaborating upon the requirements of the Directive.

The onus would be on those seeking gold plating to demonstrate that it was necessary.  In the present absence of evidence of significant detriment under the THR scheme to consumers who for example choose to take a THR to help with a condition such as mild indigestion we have no present plans to propose the introduction of a form of retrospective gold plating of this legislation.

As recognised in your last email, I think that is about as far as we can usefully comment on the issue for the time being.

Regards

Richard Woodfield

So, at last we have the answer. And pretty pathetic it is. “Gold-plating” is a term that is used by the anti-European lobby to describe the process of not simply implementing European law but making it more strict that is essential. In this case, I would claim that making the label honest was the opposite of gold-plating, The European law is obviously designed to encourage the herbal industry by disguising the lack of evidence for the herbs. The MHRA should correct that deficiency but has declined to do so.

Safety

The herbal medicine business, especially the Chinese Traditional medicine, is riddled with impure, contaminated and sometimes lethally toxic rubbish. Of course it is right that the public should be protected from this. Probably it is a job that should be done by Trading Standards officers, but sadly they have shown themselves time and time again to be incompetent and unwilling to enforce the law when it comes to false health claims. The MHRA make a reasonably good job on this front, but that is no reason for them to endorse misleading labels. Statutory regulation by the HPC will do nothing to help: on the contrary it will endorse courses that teach dangerous nonsense.

The Herbal Medicines Advisory Committee

The MHRA’s Herbal Medicines Advisory Committee should have resisted this misleading labelling, but they do not seem to have not done so (it’s hard to tell because the published minutes are totally free of any useful information). The chairman of that committee is Professor Philip A Routledge OBE MB BS MD FRCP FRCPE. If I had been in his position, I would have resigned. I believe that he has let down honest science, and potentially endangered patients by not insisting on honest labels. I do hope that this was not a result of pressure from the Prince of Wales. We know he has lobbied Kent Woods and Philip Routledge. Incidentally, Routledge is president elect of the British Pharmacological Society. Quackery has crept in even there.

What can be done

There us no reason why, even now, the MHRA could not change the labels to something honest. I expect the government is pressing them to support the herbal industry, and big business usually wins over regulators (as with banks).

Freedom of choice by consumers was mentioned several times by the MHRA. That’s fine. Nobody wants to ban echinacea. The whole point of labels is to ensure that it is informed choice. Labels that mislead do not help anyone. They hurt the consumer and they are disastrous for the reputation for integrity of the MHRA.

We should keep up the pressure on the MHRA. Here are a couple of my recent efforts, on BBC Breakfast TV.

The second interview was joint with Dick Middleton. It should have been made clear that Middleton is a pharmacist who is technical director of Schwabe Pharma, a company that sells expensive herbal pills, so has a vested financial interest in disguising the lack of evidence for efficacy,

Follow-up

1 May 2011. The new herbal regulations have come into effect. Radio 5 put me up against the herbal industry representative, Michael McIntyre (chair of the European Herbal & Traditional Medicine Practitioners Association). I was pleased to get the chance to debate directly with him, because he has been misrpresenting the evidence for years. See, for example, Some truly appalling reporting of science by the BBC. and Government lends credibility to quacks and charlatans. I was able, at last, to ask him directly, which herb had the best evidence for its efficacy. He repeatedly refused to answer: “I’m not going to get into detail”. Eventually he resorted to the argument that herbalists treat people not diseases. I pointed out that the MHRA-approved labels list all sorts of diseases. No response. He then misquotes Sackett, who did NOT say that experience was as good as RCTs.

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

Then a caller came in to swear that Chinese Medicine had cured his prostate problem and his wife’s hair. Of course he hadn’t any idea of how is prostate would have progressed if he hadn’t taken the Chinese medicine. Luckily for him, he didn’t have prostate cancer (the people who take Chinese medicine for cancer are probably dead so they can’t appear on the radio). These people are difficult to deal with without appearing rude, by saying they are gullible and deceived. I tried. Interestingly McIntyre did not leap to the defence of Chinese herbs.

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