Download Lectures on Biostatistics (1971).
Corrected and searchable version of Google books edition

Download review of Lectures on Biostatistics (THES, 1973).

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Every day one sees politicians on TV assuring us that nuclear deterrence works because there no nuclear weapon has been exploded in anger since 1945. They clearly have no understanding of statistics.

With a few plausible assumptions, we can easily calculate that the time until the next bomb explodes could be as little as 20 years.

Be scared, very scared.

The first assumption is that bombs go off at random intervals. Since we have had only one so far (counting Hiroshima and Nagasaki as a single event), this can’t be verified. But given the large number of small influences that control when a bomb explodes (whether in war or by accident), it is the natural assumption to make. The assumption is given some credence by the observation that the intervals between wars are random [download pdf].

If the intervals between bombs are random, that implies that the distribution of the length of the intervals is exponential in shape, The nature of this distribution has already been explained in an earlier post about the random lengths of time for which a patient stays in an intensive care unit. If you haven’t come across an exponential distribution before, please look at that post before moving on.

All that we know is that 70 years have elapsed since the last bomb. so the interval until the next one must be greater than 70 years. The probability that a random interval is longer than 70 years can be found from the cumulative form of the exponential distribution.

If we denote the true mean interval between bombs as $\mu$ then the probability that an intervals is longer than 70 years is

\[ \text{Prob}\left( \text{interval > 70}\right)=\exp{\left(\frac{-70}{\mu_\mathrm{lo}}\right)} \]

We can get a lower 95% confidence limit (call it $\mu_\mathrm{lo}$) for the mean interval between bombs by the argument used in Lecture on Biostatistics, section 7.8 (page 108). If we imagine that $\mu_\mathrm{lo}$ were the true mean, we want it to be such that there is a 2.5% chance that we observe an interval that is greater than 70 years. That is, we want to solve

\[ \exp{\left(\frac{-70}{\mu_\mathrm{lo}}\right)} = 0.025\]

That’s easily solved by taking natural logs of both sides, giving

\[ \mu_\mathrm{lo} = \frac{-70}{\ln{\left(0.025\right)}}= 19.0\text{ years}\]

A similar argument leads to an upper confidence limit, $\mu_\mathrm{hi}$, for the mean interval between bombs, by solving

\[ \exp{\left(\frac{-70}{\mu_\mathrm{hi}}\right)} = 0.975\]
\[ \mu_\mathrm{hi} = \frac{-70}{\ln{\left(0.975\right)}}= 2765\text{ years}\]

If the worst case were true, and the mean interval between bombs was 19 years. then the distribution of the time to the next bomb would have an exponential probability density function, $f(t)$,

\[ f(t) = \frac{1}{19} \exp{\left(\frac{-70}{19}\right)} \]

There would be a 50% chance that the waiting time until the next bomb would be less than the median of this distribution, =19 ln(0.5) = 13.2 years.


In summary, the observation that there has been no explosion for 70 years implies that the mean time until the next explosion lies (with 95% confidence) between 19 years and 2765 years. If it were 19 years, there would be a 50% chance that the waiting time to the next bomb could be less than 13.2 years. Thus there is no reason at all to think that nuclear deterrence works well enough to protect the world from incineration.

Another approach

My statistical colleague, the ace probabilist Alan Hawkes, suggested a slightly different approach to the problem, via likelihood. The likelihood of a particular value of the interval between bombs is defined as the probability of making the observation(s), given a particular value of $\mu$. In this case, there is one observation, that the interval between bombs is more than 70 years. The likelihood, $L\left(\mu\right)$, of any specified value of $\mu$ is thus

\[L\left(\mu\right)=\text{Prob}\left( \text{interval > 70 | }\mu\right) = \exp{\left(\frac{-70}{\mu}\right)} \]

If we plot this function (graph on right) shows that it increases with $\mu$ continuously, so the maximum likelihood estimate of $\mu$ is infinity. An infinite wait until the next bomb is perfect deterrence.


But again we need confidence limits for this. Since the upper limit is infinite, the appropriate thing to calculate is a one-sided lower 95% confidence limit. This is found by solving

\[ \exp{\left(\frac{-70}{\mu_\mathrm{lo}}\right)} = 0.05\]

which gives

\[ \mu_\mathrm{lo} = \frac{-70}{\ln{\left(0.05\right)}}= 23.4\text{ years}\]


The first approach gives 95% confidence limits for the average time until we get incinerated as 19 years to 2765 years. The second approach gives the lower limit as 23.4 years. There is no important difference between the two methods of calculation. This shows that the bland assurances of politicians that “nuclear deterrence works” is not justified.

It is not the purpose of this post to predict when the next bomb will explode, but rather to point out that the available information tells us very little about that question. This seems important to me because it contradicts directly the frequent assurances that deterrence works.

The only consolation is that, since I’m now 79, it’s unlikely that I’ll live long enough to see the conflagration.

Anyone younger than me would be advised to get off their backsides and do something about it, before you are destroyed by innumerate politicians.


While talking about politicians and war it seems relevant to reproduce Peter Kennard’s powerful image of the Iraq war.


and with that, to quote the comment made by Tony Blair’s aide, Lance Price


It’s a bit like my feeling about priests doing the twelve stations of the cross. Politicians and priests masturbating at the expense of kids getting slaughtered (at a safe distance, of course).


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.

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,


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".

jr to pow

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.


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

Jump to follow-up

[This an update of a 2006 post on my old blog]

The New York Times (17 January 2006) published a beautiful spoof that illustrates only too clearly some of the bad practices that have developed in real science (as well as in quackery). It shows that competition, when taken to excess, leads to dishonesty.

More to the point, it shows that the public is well aware of the dishonesty that has resulted from the publish or perish culture, which has been inflicted on science by numbskull senior administrators (many of them scientists, or at least ex-scientists). Part of the blame must attach to "bibliometricians" who have armed administrators with simple-minded tools the usefulness is entirely unverified. Bibliometricians are truly the quacks of academia. They care little about evidence as long as they can sell the product.

The spoof also illustrates the folly of allowing the hegemony of a handful of glamour journals to hold scientists in thrall. This self-inflicted wound adds to the pressure to produce trendy novelties rather than solid long term work.

It also shows the only-too-frequent failure of peer review to detect problems.

The future lies on publication on the web, with post-publication peer review. It has been shown by sites like PubPeer that anonymous post-publication review can work very well indeed. This would be far cheaper, and a good deal better than the present extortion practised on universities by publishers. All it needs is for a few more eminent people like mathematician Tim Gowers to speak out (see Elsevier – my part in its downfall).

Recent Nobel-prizewinner Randy Schekman has helped with his recent declaration that "his lab will no longer send papers to Nature, Cell and Science as they distort scientific process"

The spoof is based on the fraudulent papers by Korean cloner, Woo Suk Hwang, which were published in Science, in 2005.  As well as the original fraud, this sad episode exposed the practice of ‘guest authorship’, putting your name on a paper when you have done little or no work, and cannot vouch for the results.  The last (‘senior’) author on the 2005 paper, was Gerald Schatten, Director of the Pittsburgh Development Center. It turns out that Schatten had not seen any of the original data and had contributed very little to the paper, beyond lobbying  Scienceto accept it. A University of Pittsburgh panel declared Schatten guilty of “research misbehavior”, though he was, amazingly, exonerated of “research misconduct”. He still has his job. Click here for an interesting commentary.

The New York Times carried a mock editorial to introduce the spoof..

One Last Question: Who Did the Work?


In the wake of the two fraudulent articles on embryonic stem cells published in Science by the South Korean researcher Hwang Woo Suk, Donald Kennedy, the journal’s editor, said last week that he would consider adding new requirements that authors “detail their specific contributions to the research submitted,” and sign statements that they agree with the conclusions of their article.

A statement of authors’ contributions has long been championed by Drummond Rennie, deputy editor of The Journal of the American Medical Association,
and is already required by that and other medical journals. But as innocuous as Science‘s proposed procedures may seem, they could seriously subvert some traditional scientific practices, such as honorary authorship.

Explicit statements about the conclusions could bring to light many reservations that individual authors would not otherwise think worth mentioning. The article shown [below] from a future issue of the Journal of imaginary Genomics, annotated in the manner required by Science‘s proposed reforms, has been released ahead of its embargo date.

The old-fashioned typography makes it obvious that the spoof is intended to mock a paper in Science.


The problem with this spoof is its only too accurate description of what can happen at the worst end of science.

Something must be done if we are to justify the money we get and and we are to retain the confidence of the public

My suggestions are as follows

  • Nature Science and Cell should become news magazines only. Their glamour value distorts science and encourages dishonesty
  • All print journals are outdated. We need cheap publishing on the web, with open access and post-publication peer review. The old publishers would go the same way as the handloom weavers. Their time has past.
  • Publish or perish has proved counterproductive. You’d get better science if you didn’t have any performance management at all. All that’s needed is peer review of grant applications.
  • It’s better to have many small grants than fewer big ones. The ‘celebrity scientist’, running a huge group funded by many grants has not worked well. It’s led to poor mentoring and exploitation of junior scientists.
  • There is a good case for limiting the number of original papers that an individual can publish per year, and/or total grant funding. Fewer but more complete papers would benefit everyone.
  • Everyone should read, learn and inwardly digest Peter Lawrence’s The Mismeasurement of Science.


3 January 2014.

Yet another good example of hype was in the news. “Effect of Vitamin E and Memantine on Functional Decline in Alzheimer Disease“. It was published in the Journal of the American Medical Association. The study hit the newspapers on January 1st with headlines like Vitamin E may slow Alzheimer’s Disease (see the excellent analyis by Gary Schwitzer). The supplement industry was ecstatic. But the paper was behind a paywall. It’s unlikely that many of the tweeters (or journalists) had actually read it.

The trial was a well-designed randomised controlled trial that compared four treatments: placebo, vitamin E, memantine and Vitamin E + memantine.

Reading the paper gives a rather different impression from the press release. Look at the pre-specified primary outcome of the trial.

1ry utcome

The primary outcome measure was

" . . the Alzheimer’s Disease Cooperative Study/Activities of Daily Living (ADCSADL) Inventory.12 The ADCS-ADL Inventory is designed to assess functional abilities to perform activities of daily living in Alzheimer patients with a broad range of dementia severity. The total score ranges from 0 to 78 with lower scores indicating worse function."

It looks as though any difference that might exist between the four treaments is trivial in size. In fact the mean difference between Vitamin E and placebos was only 3.15 (on a 78 point scale) with 95% confidence limits from 0.9 to 5.4. This gave a modest P = 0.03 (when properly corrected for multiple comparisons), a result that will impress only those people who regard P = 0.05 as a sort of magic number. Since the mean effect is so trivial in size that it doesn’t really matter if the effect is real anyway.

It is not mentioned in the coverage that none of the four secondary outcomes achieved even a modest P = 0.05 There was no detectable effect of Vitamin E on

  • Mean annual rate of cognitive decline (Alzheimer Disease Assessment Scale–Cognitive Subscale)
  • Mean annual rate of cognitive decline (Mini-Mental State Examination)
  • Mean annual rate of increased symptoms
  • Mean annual rate of increased caregiver time,

The only graph that appeared to show much effect was The Dependence Scale. This scale

“assesses 6 levels of functional dependence. Time to event is the time to loss of 1 dependence level (increase in dependence). We used an interval-censored model assuming a Weibull distribution because the time of the event was known only at the end of a discrete interval of time (every 6 months).”

It’s presented as a survival (Kaplan-Meier) plot. And it is this somewhat obscure secondary outcome that was used by the Journal of the American Medical Assocciation for its publicity.


Note also that memantine + Vitamin E was indistinguishable from placebo. There are two ways to explain this: either Vitamin E has no effect, or memantine is an antagonist of Vitamin E. There are no data on the latter, but it’s certainly implausible.

The trial used a high dose of Vitamin E (2000 IU/day). No toxic effects of Vitamin E were reported, though a 2005 meta-analysis concluded that doses greater than 400 IU/d "may increase all-cause mortality and should be avoided".

In my opinion, the outcome of this trial should have been something like “Vitamin E has, at most, trivial effects on the progress of Alzheimer’s disease”.

Both the journal and the authors are guilty of disgraceful hype. This continual raising of false hopes does nothing to help patients. But it does damage the reputation of the journal and of the authors.

This paper constitutes yet another failure of altmetrics. (see more examples on this blog). Not surprisingly, given the title, It was retweeted widely, but utterly uncritically. Bad science was promoted. And JAMA must take much of the blame for publishing it and promoting it.


Jump to follow-up

We hear a lot about lifelong education, and a good thing too. But we have a government that seems to think life ends at 18. The contrast between official attitudes to schools and post-school education is striking. The contrast is most striking in two areas: religious discrimination and public support for costs.

Religous discriminatiion and selection

The Universities Tests Act was passed on 18 June 1871, while William Gladstone (Liberal) was Prime minister. It was "An Act to alter the law respecting Religious Tests in the Universities of Oxford, Cambridge, and Durham, and in the Halls and Colleges of those Universities". Of course UCL was founded in 1826, partly as a place that was free of religious discrimination. Since 1871 it has been illegal for a university to discriminate among applicants on the basis of their religious beliefs or lack of them. For the last 140 years it has been unimaginable that anyone would try to do such a thing.

In stark contrast, in 2010, religious discrimination among entrance to primary and secondary schools is not only legal, but is actively encouraged by the government. It was a trend that got worse while the ‘reverend’ Tony Blair (illiberal) was prime minister. The minister of education under the new conservative regime promised even more religious schools.

Why the rules should be diametrically opposite when you are younger than 18 from when you are over 18 is baffling.

It is equally baffling (and perhaps a partial explanation) that universities are not regarded by this government, or by Blair’s, as part of education at all. They are governed by the Department of Business, not the Department of Education.

Why should a postman pay for your university education?

I imagine that I’m not the only person who has wrestled with this question in the last few weeks (Stephen Law’s thoughts here)

In the UK it is a legal requirement to stay in full time education until the age of 16, and that should be increased to 18 by 2015. Although most children stay in school until 18, around 25% or 30% don’t. I have never heard anybody question the idea that education from 16 to 18 should not be supported 100 percent by the state, out of general taxation. That is the case despite the fact that not everybody stays in education up to 18.

Education up to the age of 18 is regarded as a common good and nobody questions for a moment that it should be free at the point of use.

Once again, everything changes entirely when you reach 18. Education is not regarded as a continuum, or as a life-long project. Suddenly at the age of 18, it stops being a public good worthy of state support, and becomes an optional extra for those who are rich, or those who are not deterred by the idea of going though life paying a debt that will, in some cases, approach the size of the mortgage on their house.

The ConDem coalition, on December 9th 2010, has come very close to privatising the teaching of humanities in universities. You are encouraged to learn languages from 16 – 18 and then these are dropped like a hot cake.

The result has been riots by schoolchildren and total discrediting of Liberal democrats who voted for one of the most philistine measures in living memory.

The discussion of this legislation has, in my view, focussed on the wrong thing. It has been almost entirely about the mechanisms for paying off an enormous debt. That was the wrong place to start. This is what should have been done.

(1) Consider what is being funded. Should the university system adapt to present circumstances, e.g by abolishing honours degrees and creating real graduate schools, as I suggested recently in the Times?   Disgracefully, the government has rushed headlong into changes in funding without waiting to consider what it should be funding. Equally disgracefuly, Universities UK (the vice-chancellors’ trade union) has made no constructive suggestions for change, but appears to be rendered immobile by a rift between the Russell group VCs who want to grab as much as they can as soon as possible, and other VCs who fear for their existence.

(2) After deciding what form universities should have in the future, you can then go on to discuss how much public money should be used to support the system.

(3) Only after both of these have been done, does it make sense to talk about how you pay back any contribution made by the student (and that contribution should be, at most, no bigger than now).

In their haste to make people pay high fees, the government seems to have got the worst of both worlds. They have devised a scheme that, in the long run, is likely to cost the taxpayer as much as, or even more than, the present system, while at the same time trebling fees to students. It’s hard to imagine greater incompetence than that.

But the question still lurks: why should a postman pay for your university education? My answer is yes, but not much. They should pay because, although they may not get any direct benefit themselves, their children certainly may. The fairest, most progressive, tax is income tax. If you are a postman, or indeed a graduate, on a low income you shouldn’t pay much tax, so you won’t pay much for, inter alia, other people’s university education.

I can see no reason for the sudden change in attitude to, and funding of, education that happens when you reach 18.

I see every reason why kids should be angry. I doubt that we have seen the last of the riots.

I hope not anyway.


See also UCL’s Beautiful Occupation. Students seem to think more clearly about what’s happening than either university management or the government.

December 10 2010, The New York Times points out that tuition fees in the UK will, under this scheme, be double those of public universities in the USA."this new policy is an utter failure."

December 11 2010. An NHS doctor writes

"I was slightly dissapointed when 7/8 of my first year medical students showed up for their last day of teaching at my practice on thursday December 9th. The eighth student was ill, so not one of them was protesting. When I asked them why not they said that in their first week as medical students they were told not to get involved in any protests because even a police caution would mean they might be thrown off the course and almost certainly they wouldn’t get a job. Images of Fascist Spain or Nazi Germany came immediately to mind (I have just read Alone in Berlin)"

December 11 2010. The Guardian reports:

Liberal Democrat grassroots hit back over tuition fees
Richard Grayson, former director of policy, says Liberal Democrats should move closer to Ed Miliband and Labour

That sounds better.

December 12 2010. The Observer reports:
“Police officers ‘tried to stop hospital staff treating injured protester’ Mother of injured student Alfie Meadows said that her son’s life could have been put at risk by the journey to another hospital”.

Jump to follow-up

The press may like to portray students as irresponsible and revolting . When I visited the occupied Jeremy Bentham room last week, i got a very different impression. That was more than confirmed yesterday (29 November). The students aren’t just sitting around grumbling. They have organised a very impressive series of events. Here is yesterday’s programme.

UCL-occ events

I volunteered to discuss with them some ideas of what could be done to further their aims. It was the same day that our letter came out in the Daily Telegraph, that pointed out the foolishness of deciding on funding before deciding what form universities should have in the future, I also suggested some possible changes along the lines of those proposed in the Times in October.

DC at UCLoccupation

I didn’t talk for long and the discussion that followed was lively and constructive. It was about education, not revolt.

I was asked if I’d like to come back a bit later for group discussions, so I did. I found the students had split into groups. It could well have been an academic conference.

group at uclocc

There was a cheerful but entirely serious discussion about what universities should be doing, about teaching methods and about research. There was also discussion about how the good atmosphere could be continued when the occupation eventually ends. Perhaps the most obvious thing is that the students were enjoying immensely being thrown together with people from other disciplines, whom they would never have met otherwise. There were two scientists in the group I joined, the rest being from a whole range of disciplines.

It is to the credit of UCL that they haven’t brought in bailiffs or cut off access to toilets. So a lot more sensible than Warwick university’s management for example. An email was shown on the screen from Rex Knight, vice provost (operations) who seems to have been put in charge of mediation. He’s the one who refused to do anything about it when HR were advertising for people trained in that curious form of psychobabble/pyramid selling scheme, neurolinguistic programming. He decined to meet the students. These days, you just can’t get the staff.

You can just walk in and out of the Jeremy Bentham room quite freely. Some students left for lectures and then returned. Others were away that afternoon on a demonstration outside TopShop on Oxford Street. If people like Top Shop owner Philip Green paid the taxes that they should do, the crisis might not be as bad as it is.

And between the earnest intellectual stuff they have fun too. This is the dance-off against the Oxford occupation.

And this is their weekend Ceilidh

Their blog is impressive. as is their organisation. They they have an events organiser with their own email address. You can follow the activities on Twitter @ucloccupation. In just a few days they have picked up more followers on Twitter than I have,

Even the BBC reporter, Sean Coughlan, sees this a something a bit different.

These are well-dressed, articulate youngsters, there’s no damage to the room, and the occupation leaflets are mixed up with sleeping bags and text books about biology and Spanish grammar.

This looks like a revolution that probably does the hoovering when it’s finished. Any stereotypes about rent-a-rioter are way off the mark.


It’s the Hogwarts kids, with their strong sense of right and wrong, who are now putting up the barricades.

And they seem as distant from the old left as they do from the new right.

This could be the best educational experience of the year for some of them, and they were making the most of it.

It is really rather beautiful.


Sad to say. UCL’s management soon managed to lose the moral high ground and went to court to evict the students. Their blog says

On Friday 3rd December two students on behalf of the UCL Occupations attended a hearing to resist the university’s application for a possession order. After almost an hour of legal debate, the judge acknowledged the occupying students’ rights to freedom of expression and freedom of assembly and concluded that no possession order could be granted without a full hearing of all the legal arguments. The hearing has been adjourned till Tuesday 7th December at 10:30am.

6 December 2010.Hobbled into work, for hospital appointment. The Slade School of Art is now occupied too. The signs are quite, eh, artistic.


Vince Cable, the Secretary of State for Business, Innovation and Skills, said on the Radio 4 Today programme on September 8th 2010

“There was some estimate on the basis of surveys done recently that something in the order of 45 per cent of the research grants that were going through was to research that was not of excellent standard. So the bar will have to be raised.”

The suggestion that 45 percent of research is mediocre provoked a storm, first on Twitter, than in blogs. One of the earlier blogs was In one day, Vince Cable has become an object of ridicule and loathing  Those that followed were scarcely more flattering. The number he quoted was simply wrong.

Unravelling Cable says "when the text of the speech was released, I was shocked by what it revealed about the Secretary of State’s grasp of his brief.".

A legion of people have tried to decode what he meant. The purpose of this post is to go a bit further, to investigate the problem of mediocre research and to suggest a change of policy that might help.

This appears to be what Cable should have said.

(1) His comments don’t refer to the main source of money for research at all. They refer to "quality-related" (QR) money given to universities by the Higher Education Finding Council. It is intended to support the infrastructure for support, but it vanishes into the ever-expanding administration and most researchers don’t see a penny of it.

(2) QR money is not given to individual researchers to do research, it is given to the university retrospectively, on the basis of the score in a vast, time-consuming, assessment known as the Research Assessment exercise. This grades departments on the basis of the amount of grade 1 2 3 or 4 research they do.

(3) Cable’s comment . on the BBC Radio 4 Today Programme that  “45% of research grants were not of excellent standard", caused uproar, and rightly so, because it shows a total lack of grasp of how science is funded, The "45%" doesn’t refer to grants at all, but it is the percentage of work that was judged in the RAE to be grade 1 or 2 (less good) rather than 3 or 4 (very good).

(4) Work that is graded 2 gets little QR money, and 1 gets none at all. David Sweeney, a HEFCE bureaucrat not generally noted for his understanding of research, points out that the 45 percent of 1 and 2 work gets only 7 percent of the funds. Using Cable’s criterion his number should have been 7% not 45%.

(5) In physics at least, the RAE panel claims it was told to use norm-referencing. This means that they are told roughly what fractions 3 and 4 grades to produce. HEFCE deny this is the case, but it is quite usual for big organisations to lie about this sort of thing. Insofar as norm-referencing was imposed, the fraction of research that is labelled mediocre is pre-determined, and is quite independent of quality. It means no more than saying that half the people are below average. It is just a statistical inevitability (if the distribution is symmetrical). It tells you absolutely nothing about the quality of research,

(6) A figure far more important than any of these is that only 10 – 20% of research grant applications get funded. It takes a long time to write a research grant application, something like two months. That is a major time-consuming activity for scientists, who should be thinking about science and doing experiments. Around 85% of that effort is fruitless. The cost in salaries and lost output of writing grants that fail is enormous. Being high alpha rated is certainly no guarantee of getting funds. That is the number that Cable should have produced, but didn’t.

So what did Cable get right, and why?

This is the bit that hasn’t been discussed much in the comments so far.

If it so hard to get a grant, why is there a widespread perception that quite a lot of published work is, if not wrong, at least trivial?

(1) Most work has always been trivial. Great breakthroughs are very rare events. But let’s accept, for the sake of argument, that the widespread view that it is worse now that in used to be, or at least that quality hasn’t improved.

(2) There is now enormously more research than before. That means more top-rate work, but, perhaps, even more bad or trivial work

(3) The Research Assessment Exercise (RAE) is on of the main reasons why the fraction of good papers is perceived to have decreased. It has probably done more harm to research standards than any other single change in my lifetime.

(4) Although it is tempting to blame politicians for the harm done by the RAE, the greatest harm is actually done by senior academics and other ex-researchers, and their numerous administrative hangers-on, who apply intolerable pressure on their juniors to publish large numbers of papers, preferably in one of three ‘top’ journals. This inevitably leads to large numbers of trivial papers being produced, because people think they won’t be promoted if the don’t go along with the senior bullies,

(5) The fate of young researchers is made even worse by HR’s attempts at "well-being" (major post coming up on that topic), the money wasted on ‘Roberts agenda’ skills training and the utterly vacuous Concordat

(6) A consequence of this sort of pressure is that anyone who wants to think deeply, or to understand properly, the basis of what they are doing, is quite likely to be fired for lack of "productivity" before they produce their best work (I speak here of biomedical sciences. I presume that physicists can’t get way so easily with poor understanding of principles of their subject).

(7) The result is a system that is not just over-competitive, but positively cruel to young scientists. The miracle to me is that anyone wants to work in science at all in the present state of universities. It is a sign, I guess, of just how wonderful it is to find something new, that people still put up with a system that seems, at times, not much different from slavery. See, for example, The Mismeasurement of Science by Peter A. Lawrence


(8) Not all the slavery is, of course, quite was bad as the famous chemist at Caltech who berated his slaves for not working (for his glory) seven days a week (though things not far short of this are quite common). And not all universities are quite so stupid as the Texas A&M University, which is reported to be thinking of hiring on the basis of the amount of grant income you bring in, although Imperial College London got alarmingly close to this sort of insanity. I guess I shouldn’t feel bad about other universities behaving in a way that makes anyone who is any good not want to work for them, but the matter is too important for one to worry about inter-university rivalry.

(9) The over-competitiveness and encouragement of trivial science, quantity rather than quality, has been going on for long enough now, that people who have risen on that basis now have power, and are to be found even on review panels of grant-giving bodies.

(10) Organisations like the Medical Research Council used to have permanent staff who developed a high level of expertise in the subjects they dealt with, and a great deal of expertise in the critical duties of knowing which referees to select, and how to judge what they wrote. More recently, the turnover of MRC staff has been too great for that sort of expertise to be well-developed, I have no axe to grind myself. My last program grant as PI (1999 – 2004) was funded, as was its successor (2004 – 2009, in which I was co-applicant). But recently I have seen feedback on failed grant applications (not mine) that suggest that the review panel either hadn’t read or hadn’t understood them.

(11) There is an enormous shortage of money for ‘response-mode’ grants. That means grants submitted by individuals to fund projects that the individual thinks will work. One reason for that is the research councils and charities have, increasingly, ring-fenced funds for work in a particular area, which some committee has decided ie important. Often this results in money being given to projects that don’t work very well (as I have seen at first hand when on the panel for the BBSCR Neuron initiative). These "initiatives" may sound good on paper to politicians, but they result in mis-spending of taxpayers’ money.

(12) One thing that Cable is dead right about ir that the ‘graduate tax’ is by far the fairest way to fund degrees. Sadly vice-chancellors line up to condemn it (you can’t get the staff these days).

So what can be done?

I’ve listed a lot of criticisms, but what can be done about it?

I can see a couple of things that could be done. The main thing is to reduce the intense competitiveness that leads to low quality. The competitiveness arises in part because of the large increase in the number of universities that took place in 1992, when the then Conservative government converted at a stroke polytechnics and technical colleges into universities, This was done largely to increase the number of undergraduate students, something of which I advocate strongly. I also feel strongly that teaching at an advanced level should be done by people who are doing research in the area they are teaching about. This is what governments have tried to do since 1992, but the numbers just don’t add up. There are simply not enough good researchers to teach half the population, yet the promotion of everyone has been made to depend largely on research.

One way would be to retain honours degrees but make the post-1992 universities into teaching only institutions. That would be the wrong solution in my view. It would result in a lot of teaching being done by people barely able to cope with advanced stuff.

My proposal.

(1) The conservatism of some senior academics has meant that they have failed to recognise that the traditional honours degree is quite unsuitable for a mass education system in which 50% of people do a degree.

(2) We should abandon altogether the honours degree system, which attempts in 3 years to take people from high school level to research level in 3 years (even with smaller numbers of people it often failed to do that anyway).

(3) We should start with much wider general degrees where teaching could be at a lower level and be done in universities that did little research. Such degrees would still aim at critical thinking rather than being purely vocational. Reluctant though I am to see teaching and research separated, it has become an economic necessity and the harm should not be too great if the separation applies only to general first degrees,

(4) After this general first degree, students would either do vocational training, or if they wished to continue along the academic line, they would go to graduate school.

(5) By graduate school, I mean teaching in the advanced aspects of their chosen subject, as is done in the USA. Most UK universities now have something called a graduate school, but they are largely charades which teach advanced powerpoint presentation but nothing intellectual. Our own summer school was originally taught as part of the UCL graduate school, but was dropped by them on the grounds that it was education not training. Protests that a knowledge of mathematics was the ultimate transferable skill in science, fell on deaf ears.

(6) The graduate schools would be the place where the advanced teaching was done, and also where most research was done. To make this feasible for the staff, they would have little, or even no, undergraduate teaching. They’d be more like ‘institutes of advanced studies’.

(7) This proposed system is, of course, much more like the system in the USA than the present UK system. It’s worked rather well there. We should try it.

Once again some members of the Israeli defence force have shown behaviour worthy of an Auschwitz guard. Once again the old conflicts in my own mind are stirred up.  It is a bit like the second great march against the Iraq war.  Time has proved how right the marchers were, but we found ourselves walking alongside Islamic fundamentalists with whom we felt very little in common.  All it proves is the undesirable behaviour that results from religion – any religion.  Whether it is islam, judaism or christianity, the outcome is mayhem and murder.  There is no human so irrational and dangerous as those who believe they have god on their side. 

It also shows, in my view, tha major mistake that was made after the second world war when the west tried to purge its collective remorse for the holocaust, but chose to do so at the expense of Palestinians. It was downright stupid to think that it was possible to put the clock back so far.

Two good sources for today’s news. 
Gaza flotilla activists were shot in head at close range

And the eyewitness account by Swedish crime writer Henning Mankel who was on one of the original flotilla boats: ‘I
think they went out to murder’

You can follow the progress of MV Rachel Corrie as she approaches Gaza at the WitnessGaza site

MV Rachel Corrie

The name of Rachel Corrie is imprinted on my mind. It was the news that this 23-year old American college student had been callously crushed to death by an Israeli army bulldozer (made in the USA). That was the incentive to start my politics blog. I stopped maintaining that when Blair left office, but may occasionally get political here.

Read about Corrie on her family’s memorial web site. It is excruciatingly sad.

In her memory, here is a reproduction of my first political post, from 2003.

A Great American.

On Sunday, 16th March 2003, a 23-year-old American peace activist, Rachel Corrie, was crushed to death by a bulldozer as she tried to prevent the Israeli army destroying homes in the Gaza Strip

You can read here some of the emails that she sent home before she died. And a reaction from Naomi Klein in the Globe and Mail (Toronto).

” Katharine Viner has edited her writings for a new play, on an ordinary woman with an extraordinary passion”. [Guardian]

John Sutherland documents some of the terrifyingly violent reactions of ‘patriotic’ Americans. [Guardian]

One ‘patriot’ wrote

“Anyone who would burn an American flag deserves to be bulldozed to death!!! Hopefully the US government will aim some bulldozers at the next group of war protesters, those anti-American motherfuckers.”

And now another: Tom Hurndall

A British peace activist shot in the head while observing the Israeli army in Gaza, in April 2003, has died in hospital.

Tom Hurndall, 22, was overcome by pneumonia at the Royal Hospital for Neurodisability, in south-west London.

Click here for the sad details.
The Thomas Hurndall Fund has the latest news.

Watch videos of the murder and of an interview with his mother.

A conviction at last!

Latest: after an indefatigable campaign by his parents to discover the truth, on 27 June 2005, a former Israeli soldier has been found guilty of the manslaughter of Tom Hurndall.

Ex-sergeant Taysir Hayb was convicted at a military court in Ashkelon for the shooting of Mr Hurndall in April 2003. Hayb will be sentenced at a later date.

In addition to the manslaughter verdict, Hayb was found guilty of obstruction of justice, incitement to false testimony, false testimony and improper conduct.

[Hurndall’s father said] “We’re concerned that there is a policy which seems to be prevalent in Gaza, amongst the Israeli soldiers and army, that they feel able to shoot civilians really without any accountability whatsoever.”

Civil liberties group Human Rights Watch last week accused Israel of investigating less than 5% of hundreds of cases of Palestinians killed since 2000.

On 11 August 2005 the BBC reported that Hayb was convicted to 8 years in jail, 7 years for manslaughter and 1 year for the other charges. Amnesty International’s Kate Allen said that while the person responsible for Mr Hurndall’s death had been brought to justice, it was

“striking that this was almost entirely due to tireless campaigning by his family”.

“The strong suspicion is that if Mr Hurndall’s family had not shown utter determination to uncover the truth of their son’s death, then no-one would ever have faced justice for what happened to Tom,”

One member of parliament, above all others, has championed reason for the last 13 years, But Evan Harris was not re-elected in Oxford West and Abingdon. On May 6th he got 23,730 votes, a mere 176 votes fewer than his conservative rival.

Click picture to see hero movie (be patient) (or right click to download mpg file)

Let me declare an interest. Evan Harris is one of the most principled men I have ever had the pleasure to meet. His stands on human rights, civil rights and libel law reform have been exemplary. He is also one of the few (and now fewer) members of parliament who understands how science works and its importance for the future of the UK. He has been a tireless advocate for the idea that policy should be based on evidence (as opposed to guesswork)..

Harris is also an atheist, something that one would not expect to be very relevant in a country where the influence of religion has declined progressively for many years. It would not be relevant if it were not for the fact that his defeat was brought about by poisonous lies propagated by, ahem, evangelical christians. I’m an atheist too, but I have met some good christians, I think they are wrong about their sky fairies, but I also think they should be free to believe in them if they want. Some of them do good things as a result of their beliefs. But not in Oxford West and Abingdon.

The (just) winner was conservative Nicola Blackwood. She is a member of the Conservative Christian Fellowship. But curiously a search of her web site for ‘christian’ shows not a single result. Shouldn’t voters know about your beliefs? It seems distinctly dishonest not to admit that your views come from an old book as interpreted by old men, The voter should know your motives.
  Her profile at the Conservative Christian Fellowship says

“Along with many Christians, she is concerned that right to freedom of religion is being undermined without proper understanding of the potential consequences for faith groups or the wider community. In particular, she fears that the voice of Christians and people of other faiths on key issues of conscience is too readily dismissed in public debate.”

But what did Nicola Blackwood know about the smear leaflets?

Nicola Blackwood’s web site not only doesn’t mention the word ‘christian. It says very little about policies of any sort, There is no
mention of euthanasia or any of the other questions raised in pamphlets that were distributed throughout the constituency. There is a well hidden disclaimer

"Nicola has distanced the Conservative Party from literature distributed by private individuals and special interest and pressure groups attacking her opponent".

That is a pretty weak response to the poisonous and inaccurate leaflets that were circulated (they can be seen here). The worst stuff came form two sources

The Reverend Lynda Rose.

Lynda Rose is an Anglican minister who seems to think it appropriate to call a good man "Dr Death" because of her religious ‘principles’. Here is part of her leaflet

Lynda Rose leaflet

Lynda Rose has extreme "pro-life" views, more like those of the pope than of the average anglican. She seems not unlike the extreme right wing fundamentalist religious groups found in the USA. Harris told the Oxford Mail that

“It is a pity that, instead of putting up a candidate to contest the election, an anonymous group, using money from no-one knows where, is distributing an inaccurate personal attack leaflet in this constituency for the first time ever.

“It is offensive and I would say profoundly unchristian to use the term Dr Death – associated with Nazi murderer Joseph Mengele or mass-murderer Harold Shipman – to describe any politician.”

The Reverend Rose replied to the this in a letter to the Oxford Mail (April 26th) that is reproduced on the web site Anglican
("Anglo-catholic, Evangelical, Orthodox, Charismatic, Mainstream"). There is not a word of apology for vilely defamatory use of “Dr Death”, but merely a huffy defence of Hansard’s voting records.

That takes some beating as uncharitable, intolerant, inaccurate (and defamatory) comment. But there is even worse to come.

Keith Mann was another candidate in the same election. In 1994 Mann was sentenced to 14 years in jail, reduced to 11 years on appeal, for 21 offences including possession of explosives, incitement, criminal damage, and escape from custody (from Wikipedia). His leaflets were even worse than those of the Reverend Lynda Rose.

Mann leaflet header

This vile calumny, full of inaccurate allegations and written by someone wth a serious criminal record, was aimed at a deeply-principled man. No doubt helped Nicola Blackwood to scrape in, but I can find no direct denunciation of it from Ms Blackwood. Christians don’t seem to be fussy about their allies.

Then there were the newspapers, in particular the Daily Telegraph.

Cristina Odone was editor of the Catholic Herald from 1991 to 1996.  She is another ‘good christian’ who wrote an abominably nasty piece in the Daily Telegraph on April 19th. The Lib Dems are a Jekyll and Hyde party. Forget nice Mr Clegg. What about ‘Dr Death’? It is worth looking at it as a prime example of inaccurate, ad hominem, nastiness. It is also worth looking at for the comments: there were a lot of comments (thanks to an alert via Twitter) and most of them were along the lines of this of one of the first, from the redoubtable skepchick

"Thanks for the heads up, Cristina! Now I know to cheer for the LibDems. I want to know that if I end up in a vegetative state, I’m given a peaceful death rather than my own Telegraph column."

Most importantly, read the calm, diginified and polite response from Evan Harris himself.

I have never said that that the current abortion rate is not of import (you just made that up Christina!) and indeed have argued for more effective sex and relationships education as other countries manage and which also delays first sexual intercourse. And for better access to effective contraception. We can disagree on that too but best to have a rational discussion rather than a distortion.

I have never said “God is bad, his followers mad”. You made that up again Christina! I respect the religious view actually but believe that the state should be neutral on religion and it should not be privileged by the state above other beliefs.

My own comment took a while because of the Telegraph’s clunky registration system.

“This truly vile piece of writing shows all the tolerance of an Ayatollah who advocates rule by religious dogma (well actually, of course, by his own opinions). There could hardly be a worse moment to seek to impose catholic values on the rest of society. That church, including its head, has been seem to fail to report to the police the most vile crimes. It is in deep disgrace precisely because of its lack of moral principles.

One thing was very clear: she doesn’t understand the web. Her follow-up article seemed to think that the response was organised by Lib Den HQ! The Lib Dems’ spooky posse of internet pests. Sorry, Ms Odone, but these days concerned individuals can speak up.

The Reverand Goerge Pitcher, anglican minister at St Bride’s church, Fleet Street, was the next priest to bring disgrace on christianity with another incredibly nasty piece, again in the Telegraph, The best result of the election: Let’s rejoice that Lib Dem Evan Harris has lost his seat.

Again there were many hostile comments, including quite a lot from christians.

“Speaking as a Christian, I find it amazing how many Christians are capable of being thoroughly nasty about people they dislike. I have made a mental note that if I ever find myself seeking a church in central London, I shall avoid St Brides, Fleet St like the plague.”

and from ex-christians

“Dr Evan Harris is more of a doctor than either you or Nadine Dorris are “human beings”. You are both spiteful, evil people, and you are exactly the sort of person that drove me to reject the Catholic Church, and ask for an official notice of my defection to be placed in the baptismal register of my parish.”


Father Raymond Blake is another cleric who thinks you should vote according to his interpretation of the bible. His web site is as political as that of the christian taleban of the southern USA,
and just about as charitable.  He too uses the "Dr Death" abuse, with no consideration of what Harris actually advocates.

How is it that christians (and homeopaths) can be quite so unpleasant?

Religious people, and those with other belief systems that resemble religions are supposed, traditionally, to be warm, caring people, charitable, forgiving and selfless, That, at least is the image they like to cultivate. Of course it has never been quite as simple as that. Just think of the inquisition, the warring catholics and protestants and, right now, the sordid disgrace of child rape, and its cover up by the highest officials of the vatican.

Last easter, I added a bit to the 2008 diary section of this blog about why I’m not a christian It seems to be worth repeating here.

"When I was about 15 I went to a Summer camp which turned out to be run by christian evangelists (my parents swore they didn’t realise that it was a brain-washing camp).  I was converted and became rather earnest.  Then, at 18, I met a nurse.   Being on Merseyside, she was Irish. And being 18, I was rather interested in sex.  The price of sex was to go with her to mass, so of course I went.  It was Easter and they were doing the Twelve Stations of the Cross.  I still recall watching this, with mounting horror.  The priests were just enjoying it too much.  It was almost like a sado-masochistic orgy.  The priests seemed to be almost masturbating.   It was simply sick."

I was reminded of this streak of cruelty that runs through christianity by the comment made by an aide to Tony Blair who said

“I couldn’t help feeling TB was rather relishing his first blooding as PM, sending the boys into action. Despite all the necessary stuff about taking action ‘with a heavy heart’, I think he feels it is part of his coming of age as a leader.”

His enthusiasm for a war that has killed over 100,000 people (and cost a small fortune) seems sadly consistent with his catholicism,

Despite all this, some individual religious people have done good for humankind.

Likewise proponents of magic medicine are proud of their individual caring approach and this may indeed be helpful in eliciting a good placebo response.

The problem seems to be that neither group can tolerate criticism. They aren’t interesting in discussing anything, because they just know they are right. And if anyone tries to express an opinion that differs from their own, the niceness vanishes like the snow in spring.

The quotations above show the downright nasty vindictiveness of religious people towards an honourable man who happens to hold somewhat different views to their own.

Likewise the cuddly homeopaths show astonishing abusive nastiness to anyone who doesn’t believe in their magic. I allow them to say what they want on this blog but they routinely delete comments. Along with most of my scientific friends, I’ve been subject to abuse and utterly incorrect allegations. I don’t enjoy it, but if its the price of free speech, so be it.

I fear that these things represent the incursion into UK politics of the extreme polarisation seen in the USA. a place where religious people seem to think it is moral to shoot doctors who do abortions.

Some morality. Thank you Tony Blair.

Some other blogs on this topic

Dr Aust wrote Catholicism plus writing in the Telegraph apparently makes you barking mad.

Tessera wrote Playing dirty politics. Attacks on Dr Evan Harris

A liberal Dose (Neil Fawcett) wrote Extremists to the left of me, fundies to the right.

Richard Dawkins wrote Evan Harris: Is this why he lost his seat?

Ophelia Benson wrote three good posts (via comment from Swiss Frank)



http://www.butterfliesandwheels.org/2010/peculiar-george/and, via Butterflies and Wheels,

Clifford Longley has trenchant comment on Platitude of the Day


Texas schools board rewrites US history with lessons promoting God and guns.     Chris McGreal, in the Guardian writes about the sort of thing that the clerics mentioned here might love.

“US Christian conservatives drop references to slave trade and sideline Thomas Jefferson who backed church-state separation”

“Several changes include sidelining Thomas Jefferson, who favoured separation of church and state, while introducing a new focus on the “significant contributions” of pro-slavery Confederate leaders during the civil war.”

“The new curriculum asserts that “the right to keep and bear arms” is an important element of a democratic society. Study of Sir Isaac Newton is dropped in favour of examining scientific advances through military technology.

There is also a suggestion that the anti-communist witch-hunt by Senator Joseph McCarthy in the 1950s may have been justified.

The education board has dropped references to the slave trade in favour of calling it the more innocuous “Atlantic triangular trade”, and recasts the Israeli-Palestinian conflict as driven by Islamic fundamentalism.”

I voted labour in every election (apart from my very first) up to and including 1997.  This is about my feelings for the 2010 election.  Make up your own mind (but don’t let Rupert Murdoch manipulate you).


Downloadable button from Mark Golding at http://www.coia.org.uk

Don’t Get Fooled Again “I agree with Rupert

By 2001 election, I had been forced to the conclusion that Tony Blair had views that were well to the right of Margaret Thatcher’s, in many areas that mattered to me. so I voted Lib Dem. That was before 9/11 After that event, all doubt was gone, so the 2005 election it was Lib Dem again. 

I won’t even consider the Conservative party much.  I have never understood how anyone could vote for them, ever. The only choice for me is Lib Dem versus Labour.  Let’s try to be fair.  Labour has done some good things (though most of them would probably have been done by Lib Dems too).

  • Minimum Wage Act 1998 was a great innovation 
  • The Freedom of Information Act (2000) was a major step forward for openness and democracy.
  • Nursery school places have increased
  • Heating allowances for pensioners (though not sure that I should have got it)
  • The funding for the NHS was increased considerably and it has been very good for me (see Why I love the NHS).
  • Funding for science increased considerably

Against the big increases for the NHS must be set the huge increase in the number of highly-paid managers, relative to the number of nurses and doctors, that has occurred under Labour.

Bad things that labour has done

It was obvious from an early stage that Labour were in favour of selective schools (but were not honest about).  They certainly favoured religious selective schools, and still do.

The explicit support of Tony Blair for creationist schools and his implicit support for homeopathy are distasteful, but not in themselves sufficient reason for voting against him. The decisive thing for me is the Labour government’s careless attitude to human rights and free speech.

Nothing made that clearer than the Iraq war and its aftermath.

Saddam Hussein was a wicked dictator, Sadly the world has many wicked dictators. One wishes they would all go away. But only one of the world’s wicked dictators was singled out to be invaded. It was already clear before 1997that Iraq had been picked out by American neoconservatives as a ‘special case’. They didn’t get far until the election of George Bush in 2001, and the tragedy of the twin towers, 9/11, gave them the chance they sought.

George Bush was perhaps the most extreme right wing president in US History (as well as one of the most stupid). As someone who seemed to have difficulty in distinguishing between real life and a B-movie, his behaviour may not be surprising, but it brought shame on his country. His regime’s legitimisation of torture is, to my mind, the greatest disgrace that has happened during my adult lifetime.

It was with increasing incredulity that I watched Tony Blair’s poodle-like behaviour to Bush. It seemed incredible that any normal human. let alone a Labour prime minister could behave like that. The sight of two such men, both believing that god was on their side was scary in the extreme.

Some things are in danger of being forgotten with the passing of time.  All these and much more were documented on my politics blog, up to the point when Blair left office.

  • Remember the US governments legalisation of torture. That caused no wavering in Blair’s support.
  • Remember the plagiarised dossier? Any student would have been fired for that, but Blair shrugged it off.
  • Remember how the attorney general mysteriously changed his mind about the legality of the war?
  • Remember Abu Ghraib?  If not, read Seymour Hersh.
  • Remember the ex-aide to Blair who said

    “I couldn’t help feeling TB was rather relishing his first blooding as PM, sending the boys into action. Despite all the necessary stuff about taking action ‘with a heavy heart’, I think he feels
    it is part of his coming of age as a leader.”

        and how the government tried to tone down his remarks.

  • Remember David Kelly? The death of a good man must be largely the fault of Blair’s government.
  • Remember how, eventually, generals and even neocons turned on Bush, but Blair would still not admit any mistake?
  • Remember the Hutton report, and the vicious attacks on the BBC’s independence that followed it?
  • Remember the attempts to conceal ‘rendition’ (i.e. .torture by proxy).
  • Remember the wonderful efforts of UCL lawyer, Phillipe Sands, to expose illegal activities by both US and UK governments. He is someone of whom UCL can be very proud.

The good done by the Freedom of Information Act has to be set against their sloppy attitude to human rights, as evidenced by their constant attempts to extended detention without charge or trial. In 2004 I made the following poster, based on a dramatic front page of the Independent, 18th Dec. 2004. It is still relevant.

magna carta
Click to enlarge

This followed the ruling pf the Law Lords that the government’s detention policy was illegal

“The real threat to the life of the nation, in the sense of a people living in accordance with its traditional laws and political values, comes not from terrorism but from laws such as these. That is the true measure of what terrorism may achieve. It is for Parliament to decide whether to give the terrorists such a victory.” Lord Justice Hoffmann, in the 8-1 ruling of the Law Lords that the UK government’s policy of detention without charge is illegal. [Washington Post] , [Original report]

The sight of Blair acquiescing to the wish of the most right-wing neoconservative government in the western world sickened me unspeakably, and still does, The happy days of 1997 seemed to be a long way away.

That was Blair, but Gordon Brown and most of the Labour cabinet looked on and did nothing.

David Miliband said “You’ve punished us enough about Iraq”. Well no, you haven’t been punished at all, Yet. As someone said on twitter, resuscitate the 100,000 dead and we’ll forgive you.


I’m still baffled about why the crowd that gathered in UCL’s quad for the start of the second great march on 20th March 2003, were able to predict the outcome of the invasion so much more accurately than the government.


UCL  quadrangle 20 March 2003

Click here to download high resolution

Apart from the war

Brown is guilty not only of supporting the war.

He has supported segregated religious schools and the reintroduction of "academy" schools, both being ways of surreptitiously re-introducing selection into the education system

He and Blair presided over an endless multiplication of box-ticking quangos. The intention was, no doubt to increase quality, but the effect has been exactly the opposite. Just look, for example, at Skills for Health, the QAA, the QCA and a multitude of others.

These are some of the reasons that I cannot vote "Labour" this time. They have become. in many ways, a party of the right, barely distinguishable from the Conservative party (and in some respects, further to the right). Remember that the Conservatives supported Blair in his love affair with George Bush, they support selective schools, they support religious schools. And they are even more likely that Labour to sell their soul to Rupert Murdoch. Imagine Fox "News" coming to the UK and be afraid, very afraid.

Why Liberal Democrats?

Since I find it impossible to vote Labour this time. they are the only option. But I think one can be a bit more positive than that.

Some of the reasons why are listed in a letter in today’s Guardian (the list of signatories is remarkable). The Lib Dem manifesto is here.

  • The Lib Dems are more likely than the other parties to roll back New Labour’s attack on civil liberties
  • Lib Dems tax and green policies look pretty good to me.
  • The cost of replacing Trident missiles could be around £100 billion, and if that were spent it is doubtful whether what you get is useful under present conditions. Only Lib Dems would rethink this ghastly waste of money. Brown and Cameron prefer macho posturing.
  • Brown’s judgment about banks was wrong, yet he still won’t separate the casino banks and the savings banks. Lib Dem’s would.
  • Lib Dems have been more open about how cuts would be made than other parties (if not 100%). Vince Cable for Chancellor.
  • Nick Clegg’s response to the letter sent party leaders by the Campaign for Science & Engineering CaSE) was clearly better than the others,in many respects. See also Lib Dems science policy test
  • Can you imagine a better science minister than Dr Evan Harris?. I can’t.


JJump to follow-up

Update 12 March. Six more dimwits signed.

An‘early day motion1 (EDM 908) has been tabled in parliament which opposes the conclusions of the science and technology committee report on the evidence for homeopathy. After two weeks it has been signed by an amazing 55 MPs. That is 8.5% of all 646 MPs.  Nothing shows more clearly the scientific illiteracy that prevails in the House of Commons (and, perhaps, the results of the mass mailing of MPs by homeopaths, who are clutching at straws)..

These MPs are all people who have difficulty with the idea that pills which contain nothing can have no effect above placebo.  It isn’t rocket science.

Those of us who spend quite a lot of unpaid time trying to communicate the joy of science to the public, rather resent having our efforts undermined by these members of parliament.  But at least we now have a handy list of them.

In case this seems a bit harsh, it is only necessary to point out that the EDM was tabled by David Treddinick (Cons, Bosworth). Mr Treddinick is renowned as the most extreme advocate of magic medicine
in the House of Commons.  The EDM twists and distorts the evidence in exactly the way the committee’s report condemned so sternly.

Nothing is too barmy for Treddinick to espouse. His education at Eton and Oxford has led him to advocate homeopathic borax for the treatment of foot and mouth disease, and he has backed homeopathic treatment of AIDS and malaria. He is a major danger to public health. By way of background, Tredinnick was suspended for a month without pay for taking a £1000 bribe in the cash for questions scandal. And he was again in trouble during the expenses scandal. It was reported that

“The MP for Bosworth struck a deal with the parliamentary standards commissioner to pay back the £755 which he claimed for a computer programme that states it can help users to predict their health via the stars.”

Yes, really, astrology! You couldn’t make it up.

One would think that, with a reputation like this, nobody with half a brain would want to sign an EDM proposed by Treddinick. Well, not so. The list of signatories is amazing, and shocking.

The state of the parties is interesting.

Unionists (Northern Ireland): no fewer than 77% (7 out of 9 MPs) signed, including the infamous Ian Paisley and the recently famous Peter Robinson. Disheartening though this is, perhaps it isn’t so surprising from a group noted for religious belief, and consequently predisposed to believing things that aren’t true.

The seriously sad thing is that second place in the stupid race is held by – wait for it – the Liberal Democrats, with 15.9% (10 of their 63 MPs). That is tragic in the light of the fact that two of the very few MPs in the House with any appreciation of evidence are also Lib Dems, Phil Willis and Evan Harris (both on the Science and Technology Committee).

After them Conservatives with 8.3% (16 out of 193), and the best is Labour 5.8% (20 out of 346 MPs)

Here is the roll of shame, updated on 12 March (the last six signed in the last 24 hours)

Tredinnick, David Con
Simpson, Alan  Lab
 Russell, Bob LibDem
 Pound, Stephen Lab
 Dismore, Andrew Lab
 Simpson, David Democratic unionist
 McDonnell, John Lab
 Campbell, Gregory Democratic unionist
 Cohen, Harry Lab
 Corbyn, Jeremy Lab
 Drew, David Lab
 Gray, James Con
 Hancock, Mike LibDem
 Hermon, Lady Ulster unionist
 Key, Robert Con
 Hemming, John LibDem
 Bone, Peter  Con
 Davies, Dai Independent
Mates, Michael  Con
Dodds, Nigel  Democratic unionist
Wyatt, Derek  Lab
Sarwar, Mohammad  Lab
Hamilton, Fabian  Lab
Winterton, Nicholas  Con
Davies, Philip Con
Leigh, Edward Con
Barlow, Celia Lab
Ellwood, Tobias Con
Leech, John  Lib Dem
Main, Anne Lab
Robinson, Peter Democratic unionist
McCrea, Dr William Democratic unionist
Paisley, Ian Democratic unionist
Brady, Graham Con
Cook, Frank  Lab
Hall, Patrick Lab
Binley, Brian Con
Pugh, John  Lib dem
Davey, Edward Lib dem
Weir, Mike Scottish Nationalist
Sharma, Virendra Kumar Lab
Abbott, Diane  Lab
Williams, Mark Lib dem
Horam, John Con
Widdecombe, Ann Con
Browne, Jeremy Lib dem
Spicer, Michael Con
Maclean, David Con
McCafferty, Chris Lab
Buck, Karen Lab
George, Andrew Lib Dem
Vis, Rudi Lab
Walter, Robert  Lab
Whittingdale, John Con
Farron, Timothy Lib Dem

I haven’t contacted most of these MPs, and of those I have only two have replied.  I had a rather curt reply from one of the most surprising signatories (John Hemming, who was a Scholar in Theoretical, Atomic and Nuclear Physics at Magdalen College, Oxford.

Mark Twain’s letter

Thanks to @Count_Stuff on Twitter for reminding me about
a letter written in 1905 by Mark Twain.  It refers to an Elixir of Life.  By curious coincidence this popped up a week after I saw Donizetti’s L’Elisir d’Amore at ENO (and a couple of days after I bumped into its producer, Jonathan Miller, in the RADA café). I’d love to quote Kelly Rourke’s witty translation of the quack’s song, but can’t find the libretto.

Given the ludicrous libel laws in the UK. I’d like to make it clear that the following item has absolutely nothing to do with EDM 908.  Please sign the petition at http://libelreform.org/

You’re an idiot of the 33rd degree

In November of 1905, an enraged Mark Twain sent this superb letter to J. H. Todd, a patent medicine salesman who had just attempted to sell bogus medicine to the author by way of a letter and leaflet delivered to his home.

Nov. 20. 1905

J. H. Todd 
1212 Webster St.
San Francisco, Cal.

Dear Sir,

Your letter is an insoluble puzzle to me. The handwriting is good and exhibits considerable character, and there are even traces of intelligence in what you say, yet the letter and the accompanying advertisements profess to be the work of the same hand. The person who wrote the advertisements is without doubt the most ignorant person now alive on the planet; also without doubt he is an idiot, an idiot of the 33rd degree, and scion of an ancestral procession of idiots stretching back to the Missing Link. It puzzles me to make out how the same hand could have constructed your letter and your advertisements. Puzzles fret me, puzzles annoy me, puzzles exasperate me; and always, for a moment, they arouse in me an unkind state of mind toward the person who has puzzled me. A few moments from now my resentment will have faded and passed and I shall probably even be praying for you; but while there is yet time I hasten to wish that you may take a dose of your own poison by mistake, and enter swiftly into the damnation which you and all other patent medicine assassins have so remorselessly earned and do so richly deserve.

Adieu, adieu, adieu!

Mark Twain

1 For those who are not familiar with the quaint customs of the UK parliament, early day motions can be tabled by any MP but are rarely debated and even more rarely lead to any action.


The Guardian had picked up on this story on the same day that it was posted, in a nice article by Ian Sample .

Des Spence, a general practitioner in Glasgow, has revealed a memorandum that was allegedly leaked from the Department of Health. It was published in the Britsh Medical Journal (17 June 2009, doi:10.1136/bmj.b2466, BMJ 2009;338:b2466). It seemed to me to deserve wider publicity, so with the author’s permission, I reproduce it here. It may also provide a suitable introduction to a forthcoming analysis of a staff survey.

Re: The use of ‘note pads’ in the NHS and allied service based agencies.

Hi, all care providers, managers of care, care managers, professions allied to care providers, carers’ carers, and stakeholders whose care is in our care. (And a big shout to all those service users who know me.)

We report the findings from a quality based review, with a strong strategic overview, on the use of “note pads” across all service user interfaces. This involved extensive consultation with focus groups and key stakeholders at blue sky thinking events (previously erroneously known as brain storming). This quality assured activity has precipitated some heavy idea showers, allowing opinion leaders to generate a national framework of joined-up thinking. This will take this important quality agenda forward. A 1000 page report is available to cascade to all relevant stakeholders.

The concentric themes underpinning this review are of confidentiality. Notes have been found on the visual interface devices on computers and writing workstations throughout the NHS work space. Although no actual breach of confidentiality has been reported, the independent external consultants reported that note pads “present a clear and present danger” to the NHS, and therefore there is an overarching responsibility to protect service users from scribbled messages in felt tip pen. Accordingly all types of note pads will be phased out in the near time continuum. A validated algorithm is also attached to aid this process going forward.

This modernising framework must deliver a paradigm shift in the use of note pads. Care provider leaders must employ all their influencing and leverage talents to win the hearts and minds of the early adopter. A holistic cradle to grave approach is needed, with ownership being key, and with a 360 degree rethink of the old think. All remaining note pads must be handed over in the next four week ” note pad armistice” to be shredded by a facilitator (who is currently undergoing specialist training) and who will sign off and complete the audit trail.

(Please note that the NHS’s email system blocks all attachments, so glossy, sustainable, wood based hard copies will be sent directly to everyone’s waste recycling receptacles.)

Cite this as: BMJ 2009;338:b2466

Spence added a footnote, Note: The BMJ’s lawyers have insisted that I make it clear that this is a spoof, just in case you were wondering.


Here are a few more

There is an initiative underway to determine what we do as an organisation in the realms of drug discovery. The intention is to identify internal and appropriate external capabilities to foster a pipeline of competencies that enable some of our basic research outputs to better impact healthcare.


One of the most extraordinary bits of journalism I’ve read for a long time appeared as an editorial in the Sri Lankan newspaper, the Sunday Leader, on Sunday January 11th 2009   It was reproduced in the Guardian on 13th January, and in The Times.  It was written by Lasantha Wickrematunge, editor of the Sunday Leader, and it was the last thing he wrote. Days after writing it he was assassinated.

It is a plea for freedom of speech. In particular, for the freedom of journalists to tell the truth,  It is deeply moving and it is also written in more beautiful English than many native speakers can manage. The second person to leave a comment in the Guardian said

“Extraordinary, humbling and deeply moving.

Cif Eds, please leave this at the top of the page for about a week, and then nail copies it to every available surface at Guardian HQ.”

Writing blogs like this one (and a thousand others) need some of the skills of investigative journalism.  Those skills are not so different from those you need in science, Curiosity, a willingness to look under stones, a preference for truth over myth, some skill with  Google and a good deal of tenacity.  You also need to be resilient to abuse and defamation by people who disagree with you.  But you do not risk your life. It does not take much courage.  That isn’t true in large parts of the world.

Read it all. Here are a few quotations to persuade you it’s worth the time.

“No other profession calls on its practitioners to lay down their lives for their art save the armed forces – and, in Sri
, journalism. In the course of the last few years, the independent media have increasingly come under attack. Electronic and print institutions have been burned, bombed, sealed and coerced. Countless journalists have been harassed, threatened and killed. It has been my honour to belong to all those categories, and now  especially the last.”

“The Sunday Leader has been a controversial newspaper because we say it like we see it: whether it be a spade, a thief or a murderer, we call it by that name. We do not hide behind euphemism. The investigative articles we print
are supported by documentary evidence thanks to the public-spiritedness of citizens who at great risk to themselves pass on this material to us. We have exposed scandal after scandal, and never once in these 15 years has anyone proved us wrong or successfully prosecuted us.”

“The free media serve as a mirror in which the public can see itself sans mascara and styling gel. From us you learn the state of your nation, and especially its management by the people you elected to give your children a better future.”

“It is well known that I was on two occasions brutally assaulted, while on another my house was sprayed with machine-gun fire. Despite the government’s sanctimonious assurances, there was never a serious police inquiry into the perpetrators of these attacks, and the attackers were never apprehended.

In all these cases, I have reason to believe the attacks were inspired by the government. When finally I am killed, it will be the government that kills me.”

“In the wake of my death I know you will make all the usual sanctimonious noises and call upon the police to hold a swift and thorough inquiry.

But like all the inquiries you have ordered in the past, nothing will come of this one, too. For truth be told, we both know who will be behind my death, but dare not call his name. Not just my life but yours too depends on it.

As for me, I have the satisfaction of knowing that I walked tall and bowed to no man. And I have not travelled this journey alone. Fellow journalists in other branches of the media walked with me: most are now dead, imprisoned
without trial or exiled in far-off lands.”

“People often ask me why I take such risks and tell me it is a matter of time before I am bumped off. Of course I know that: it is inevitable. But if we do not speak out now, there will be no one left to speak for those who cannot,
whether they be ethnic minorities, the disadvantaged or the persecuted. An example that has inspired me throughout my career in journalism has been that of the German theologian, Martin Niemöller. In his youth he was an antisemite and an admirer of Hitler. As nazism took hold of Germany, however, he saw nazism for what it was. It was not just the Jews Hitler sought to extirpate, it was just about anyone with an alternate point of view. Niemöller spoke out, and for his trouble was incarcerated in the Sachsenhausen and Dachau concentration camps from 1937 to 1945, and very nearly executed. While incarcerated, he wrote a poem that, from the first time I read it in my teenage years, stuck hauntingly in my mind:

First they came for the Jews
and I did not speak out because I was not a Jew.

Then they came for the Communists
and I did not speak out because I was not a Communist.

Then they came for the trade unionists
and I did not speak out because I was not a trade unionist.

Then they came for me and there was no one left to speak out for me.

If you remember nothing else, let it be this: the Leader is there for you, be you Sinhalese, Tamil, Muslim, low-caste, homosexual, dissident or disabled.”

This man puts to shame the those who won’t speak out in the safety of the West, despite the fact that they have nothing to lose but their ministerial jobs or their knighthoods. Or running the risk of being sued by chiropractors.

How about some nominations for Western journalists who live up to these ideals?   I’d start with Seymour Hersh and Paul Krugman in the USA, and our own Ben Goldacre.   It’s interesting though, that two of these three are not full time journalists. Blogs do rather better than most newspapers. They have become an important force for freedom of speech. That more than counterbalances the use of the web for promoting junk. It is a lot harder to keep a secret than it used to be.

There is an obituary of Lasantha Wickrematunge in the Sunday Leader, and a report from Amnesty International.

Jump to follow up

A report has appeared on Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine. The report is written by people all of whom have vested interests in spreading quackery. It shows an execrable ability to assess evidence, and it advocates degrees in antiscience It would fail any examination. Sorry, Prof Pittilo, but it’s gamma minus.[Download the report]

Alice Miles put it well in The Times, today.

“This week came the publication of the “Report to Ministers from the Department of Health Steering Group on the Statutory Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and Other Traditional Medicine Systems Practised in the UK”. Otherwise known as twaddle.” . . .

“Regulate the practitioners – for safety, note, not for efficacy, as that is impossible to prove – and you give them official recognition. From recognition it is but a short hop to demand and then prescription: packet of Prozac, bit of yoga and a bag of dodgy herbs for you, sir.” . . .

“The Government responded on Monday – with a three-month consultation. So join in. Write to the Health Minister Ben Bradshaw at Richmond House, 79 Whitehall, SW1A 2NS. Write, on behalf of the NHS: “What I want for my 60th birthday is… the chance to provide medical, dental, and nursing care to all. And absolutely nothing else.”

Judging by Ben Bradshaw’s speech to the Prince’s Foundation, there may be a problem in conveying to him the evidence, but one can and must try.

Why is it that a health joutnalist can do so much better than a university head? Yes, the chair of the steering group is Professor R. Michael Pittilo BSc PhD CBiol FIBiol FIBMS FRSH FLS FRSA, Principal and Vice-Chancellor of The Robert Gordon University, Aberdeen. Despite all those impressive-lookin initials after his name, I believe that this is a very bad report.

Here is something about Prof Pittilo from his university’s web site (the emphasis is mine).

Professor Michael Pittilo joined The Robert Gordon University, Aberdeen, as Principal and Vice-Chancellor on 5th September, 2005.

After postdoctoral research on arterial disease at the University of London, he was appointed to Kingston University where he became Head of Life Sciences. In 1995 he became Foundation Dean of the Faculty of Health and Social Care Sciences at Kingston University and St George’s Medical School (University of London). He was appointed Pro Vice Chancellor at the University of Hertfordshire in 2001.

Professor Pittilo has held a number of additional roles, including chairing Department of Health working groups, and as a trustee for the Prince of Wales’s Foundation for Integrated Health.

Notice that Prof Pittilo is a Trustee of the Prince’s Foundation for Integrated Health, source of some of the least reliable information about alternative medicine to be found anywhere.

This steering group is, as so often, a nest of vested interests. It does not seem to have on it any regular medical or clinical scientist whatsoever. Why not? They just might produce some embarrassing facts perhaps? Like most government committees its members seem to have been chosen to produce the desired outcome.

For a start, the university run by Prof Pittilo, Robert Gordon’s University, is itself involved in a few antiscientific courses. Since his report recommends that degrees in quackery should become mandatory, I expect he’d welcome the chance to run more. Amazingly, Robert Gordon’s University runs an Introduction to Homeopathy, just about the daftest of all the common sorts of magic medicine.

Most of the the members of the steering group represent vested interests, though strangely this is not made clear in the list of members. An earlier report, in 2006, from the steering group was more open about this. Twelve of the members of the group represent Herbal Medicine, Chinese Medicine and Acupuncture (four from each). Most of the rest are lay members or bureaucrats. With membership like that it is, I suppose, not surprising that the assessment of evidence is, to put it kindly, grossly distorted and woefully inadequate.

The report starts badly by failing to mention that the House of Lords report (2000), and the government’s response to it, set the following priorities. Both state clearly

“… we recommend that three important questions should be addressed in the following order . .

  • (1) does the treatment offer therapeutic benefits greater than placebo?
  • (2) is the treatment safe?
  • (3) how does it compare, in medical outcome and cost-effectiveness, with other forms of treatment?

The word ‘placebo’ does not occur a single time in the main report (and only twice in the text of the seven appendices). But they do say (page 11):

“We recommend that public funding from the NHS should be used to fund CAM therapies where there is evidence of efficacy, safety and quality assurance.”

The evidence

The problem is that the assessment of the evidence for efficacy in the report is pathetically poor. The report, sad to say, consists essentially of 161 pages of special pleading by the alternative medicine industry, served up with the usual large dose of HR gobbledygook.

There is really no excuse for this utterly incompetent assessment. There have been plenty of books this year alone that make excellent summaries of the evidence, mostly written for the lay public. They should, therefore, be understandable by any university vice-chancellor (president). The one benefit of the upsurge in public interest in magic medicine is that there are now quite a lot of good clinical trials, and when the trials are done properly, they mostly confirm what we thought before: in most cases the effects are no more than placebo.

Here is one example. Annexe1 concerns “Developing Research and Providing an Evidence Base for Acupuncture and Herbal/Traditional Medicine Treatment”. The wording of the title itself suggests, rightly, that this evidence base does not exist, in which case why on earth are we talking about them as “professions”? The discussion of the evidence in Annexe 1 is nothing if not partial. But what do you expect if you ask herbalists to assess herbal medicine? An honest assessment would put them out of business. The eternal mantra of the alternative industry appears as usual, “Absence of evidence is, of course, not evidence of absence”. True of course, but utterly irrelevant. Annexe 1 says

“Acupuncture is a complex intervention and lack of a suitable placebo control has hindered efforts to evaluate efficacy”

This is simply untrue, In recent years enormous efforts have been put into devising controls for assessment of acupuncture, but they are entirely ignored here. One thing that has been established quite clearly is that it makes no difference where you put the needles, so all the talk of Qi and meridians is obvious mumbo-jumbo.

Have the authors of Annexe 1, and Professor Pittilo, not read the relevant studies? Two books this year have dealt with the question of evidence with great care. They are both by people who have been involved personally with acupuncture research, Prof Edzard Ernst and Dr Barker Bausell. Edzard Ernst is the UK’s first Professor of Complementary Medicine. Barker Bausell was research director of an NIH-funded Complementary and Alternative Medicine Specialized Research Center at the University of Maryland.

Singh and Ernst discuss thoroughly the question of controls and assess all the evidence carefully. Their conclusions include the following.

  • The traditional principles of acupuncture are deeply flawed, as there is no evidence at all to demonstrate the existence of Ch’i [Qi] or meridians.
  • By focussing on the increasing number of high-quality research papers, reliable conclusions from systematic reviews make it clear that acupuncture does not work for a whole range of conditions, except as a placebo.
  • In short, the evidence is neither consistent nor convincing. It is borderline.

Barker Bausell was himself involved in designing and analysing trialsof acupuncture. His conclusions are even less positive.

“There is no compelling, credible scientific evidence to suggest that any CAM therapy benefits any medical condition or reduces any medical symptom (pain or otherwise) better than a placebo”.

These are serious authors with direct experience in CAM research, which is more than can be said of anyone on the steering group. Why are their conclusions ignored entirely? That is sheer incompetence.

Degrees in anti-science

One conclusion of the report is that

“The threshold entry route to the register will normally be through a Bachelor degree with Honours”

This is utter nonsense. It is quite obvious surely that you can’t award honours degrees until after you have the evidence. You can read on page 55 of the report

3a: Registrant acupuncturists must:

understand the following aspects and concepts for traditional East-Asian acupuncture:

– yin/yang, /5 elements/phases, eight principles, cyclical rhythms, qi ,blood and body fluids, different levels of qi, pathogenic factors, 12 zang fu and 6 extraordinary fu, jing luo/ meridians, the major acupuncture points, East-Asian medicine disease categorisation, the three burners, the 4 stages/levels and 6 divisions

– causes of disharmony/disease causation

– the four traditional diagnostic methods: questioning, palpation, listening and observing”

This is utter baloney. Anyone who advocates giving honours degrees in such nonsense deserves to be fired for bringing his university into disrepute (and, in the process, bringing all universities and science itself into disrepute).

That includes also degrees that teach that “amethysts emit high yin energy“.

So what should be done?

If making peole do degrees in mumbo-jumbo is not the answer, what is? Clearly it would be far too draconian to try to ban quackery (and it would only increase its popularity anyway).

The answer seems to me to be quite simple. All that needs to done is to enforce existing laws. It is already illegal to sell contaminated and poisonous goods to the public. It is already illegal to make fraudulent advertisemants and to sell goods that are not as described on the label.

The only problem is that the agencies that enforce these rules are toothless and that there are a lot of loopholes and exceptions that work in favour of quackery. I have tried myself to complain about mislabelling of homeopathic pills to the Office of Fair Trading on the grounds that are labelled Arnica 30C but contain no Arnica. They solemnly bought a bottle and sent it to an analyst and of course they found no arnica, But nothing happened, because an exception to the usual law applies to homeopathic pills.

The Advertising Standards Authority is good as far as it goes. They quickly told Boots Pharmacies to withdraw advertisements that claimed CoQ10 “increased vitality”. But they can exact no penalties and they can’t deal with lies that are told to you orally, or with anything at all on the web.

The Health Professions Council (HPC) says that one of the criteria for registering new professions is aspirant groups must “Practise based on evidence of efficacy”. If that were actually applied, none of this process would occur anyway. No doubt the HPC will fail to apply its own criteria. On past form, it can be expected to adopt a “fluid concept of evidence“.,

One more thing, New European legislation was described recently in the BMJ

“Consumers in the United Kingdom are to receive stronger legal safeguards against products that claim, without any identifiable scientific evidence, to provide physical and mental health benefits such as tackling obesity or depression.”

“The scope of the legislation is deliberately wide and is the biggest shake up in consumer law for decades. It targets any unfair selling to consumers by any business.”

Politicians seem to be immune to rational argument when it comes to quackery. But a few legal actions under these laws could bring the house of cards tumbling so fast that this gamma-minus report would become rapidly irrelevant. There will be no shortage of people to bring the actions. I can’t wait.

Follow up

Dominic Lawson, 24 June 2008. An excellent column appeared today in the Independent. Dominic Lawson writes about the Pittilo report: “So now we will have degrees in quackery. What, really, is the difference between acupuncture and psychic surgery?“. The reference to that well known conjuring trick, “psychic surgery” as a “profession”, revealed here, causes Lawson to say

“It makes it clear that the lunatics have taken over the asylum. For a start, how could Philip Hunt, previously director of the National Association of Health Authorities and Trusts, possibly have thought that “psychic healing” constituted a “profession” – let alone one which would “develop its own system of voluntary self-regulation?”

“One can see how this might fit in with the Government’s “never mind the quality, feel the width” approach to university education. One can also see how established practitioners of such therapies might see this as a future source of income – how pleasant it might be to become Visiting Professor of Vibrational Medicine at the University of Westminster.

Thus garlanded with the laurels of academic pseudo-science, the newly professionalised practitioners of “alternative medicine” can look down on such riff-raff as the “psychic surgeons”

Once again I have to ask, how is it that we have to rely on journalists to prevent vice-chancellors eroding academic standards; indeed eroding simple common sense? I guess it is just another sign of the delusional thinking engendered by the culture of managerialism that grips universities.