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Royal London Homeopathic Hospital

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Last year the Royal London Homeopathic Hospital was rebranded as the Royal London Hospital for Integrated Medicine (RLHIM). The exercise seems to have been entirely cosmetic. Sadly, they still practise the same nonsense, as described in Royal London Homeopathic Hospital rebranded. But how different will things be at the Royal London Hospital for Integrated Medicine?.

Recently I came across a totally disgraceful pamphlet issued by the RLHIM [download pamphlet].

If you haven’t come across craniosacral therapy (and who could blame you, a new form of nonsense is invented daily), try these sources.

uclh-cranio-vs

In short, it is yet another weird invention of an eccentric American osteopath, dating from the 1930s. Like Osteopathy and Chiropractic, there is no ancient wisdom involved, just an individual with an eye for what makes money.

What the UCLH pamphlet claims

UCLH-cs2

The claims made in this pamphlet are utterly baseless. In fact there isn’t the slightest evidence that craniosacral therapy is good for anything. And its ‘principles’ are pure nonsense.

No doubt that is why the Advertising Standards Authority has already delivered a damning indictment of rather similar claims made in a leaflet issued by the Craniosacral Therapy Association (CSTA)

The Advertising Standards judgement concluded

" . . the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.1 (Health and beauty products and therapies)."

"We noted that the CSTA believed that the leaflet was merely inviting readers to try CST to see if it could alleviate some of their symptoms and did not discourage them from seeing a doctor. However, we considered that the list of serious medical conditions in the ad, and the references to the benefit and help provided by CST, could encourage readers to use CST to relieve their symptoms rather than seek advice from a medical professional. We therefore concluded that the ad could discourage readers from seeking essential treatment for serious medical conditions from a qualified medical practitioner.

Complaint through the official channels. It took 3 months to extract “No comment” from Dr Gill Gaskin

Given that I have every reason to be grateful to UCL Hospitals for superb care, i was hesitant to leap into print to condemn the irresponsible pamphlet issued by one of their hospitals. It seemed better to go through the proper channels and make a complaint in private to the UCL Hospitals Trust.

On 21st December 2010 I wrote to the directors of UCLH Trust

I have just come across the attached pamphlet.

“Craniosacral” therapy is a preposterous made-up invention.

More to the point, there is no worthwhile evidence for the claims made in the pamphlet.

The leaflet is, I contend, illegal under the Consumer protection regulations 2008. It is also deeply embarrassing that UCLH should be lending its name to this sort of thing.

If you can think of any reason why I should not refer the pamphlet to the Advertising Standards Association, and to the office of Trading Standards, please let me know quickly.

Best regards

David Colquhoun

On 7th January 2011 I got an acknowledgment, which told me that my letter had been forwarded to the Medical Director for Specialist Hospitals for a response.

The Specialist Hospitals of the Trust include the Eastman Dental Hospital, The Heart Hospital, The National Hospital for Neurology & Neurosurgery (the famous Queen’s Square hospital) and, yes, The Royal London Hospital for Integrated Medicine. I’ve been a patient at three of them and have nothing but praise, Queen’s Square and the UCLH baby unit saved the life of my wife and my son in 1984 (see Why I love the National Health Service).

The Medical Director for Specialist Hospitals is Dr Gill Gaskin, and it is to her that my letter was forwarded. Of course it is not her fault that, in 2002, the Royal London Homeopathic Hospital (as it then was) was acquired by the UCLH Trust in 2002, The excuse given at the time was that the space was needed and the nonsense espoused by the RLHH would be squeezed out. That hasn’t yet happened.

After that nothing happened so I wrote directly to Dr Gaskin on 14th February 2011

Dear Dr Gaskin
The letter below was sent to the Trust on 20 December last year. I am told it was forwarded to you. I’m disappointed that I have still had no reply, after almost two months.  It was a serious enquiry and it has legal implications for the Trust. Would it help to talk about it in person?
David Colquhoun

I got a quick reply, but sadly, as so often, the complaint had simply been forwarded to the object of the complaint. This sort of buck-passing is standard procedure for heading off complaints in any big organisation, in my experience.

From: <Gill.Gaskin@uclh.nhs.uk>

To: <d.colquhoun@ucl.ac.uk>

Cc: <jocelyn.laws@uclh.nhs.uk>, <Rachel.Maybank@uclh.nhs.uk>

Dear Professor Colquhoun
 
I received your email in January.
I have now received the response from the Associate Clinical Director of the Royal London Hospital for Integrated Medicine, which is as set out below.
 

The brochure makes no claims of efficacy for Craniosacral Therapy (CST).  In terms of safety, only two randomised trials have reported adverse effects, neither found an excess of adverse effects of CST over control interventions (disconnected magnetotherapy equipment and static magnets respectively):
 
(Castro-Sanchez A et al.  A randomized controlled trial investigating the effects of craniosacral therapy on pain and heart rate variability in fibromyalgia patients. Clin Rehabil 2011 25: 25–35.  published online 11 August 2010 DOI: 10.1177/0269215510375909
Mann JD et al. Craniosacral therapy for migraine: Protocol development for an exploratory controlled clinical trial.   BMC Complementary and Alternative Medicine 2008, 8:28 published 9 June 2008 doi:10.1186/1472-6882-8-28)

The only reports of adverse effects of CST relate to its use in traumatic brain injury.  (Greenman PE, McPartland JM. Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome. J Am Osteopath Assoc 1995;95:182-88).

The RLHIM does not treat this condition and it is not mentioned in the brochure. 

The Craniosacral Therapy Association is planning a safety audit, to be launched later this year.  The RLHIM intends to participate in this.

With best wishes
 
Gill Gaskin



Dr Gill Gaskin

Medical Director

Specialist Hospitals Board

UCLH NHS Foundation Trust



I don’t know who wrote this self-serving nonsense because there is no sign on the web of a job called "Associate Clinical Director of the Royal London Hospital for Integrated Medicine".

It is absurd to say that the leaflet makes “makes no claims of efficacy”. It says "Craniosacral therapy can be offered to children and adults for a variety of conditions:" and then goes on to list a whole lot of conditions, some of which are potentially serious, like "Recurrent ear infections and sinus infections, glue ear " and "Asthma". Surely anyone would suppose that if a UCLH Hopsital were offering a treatment for conditions like these, there would be at least some evidence that they worked. And there is no such evidence. This reply seemed to me to verge on the dishonest.

Remember too that this response was written on 16th February 2011, long after the Advertising Standards Association had said that there is no worthwhile evidence for claims of this sort, on 8th September 2010.

I replied at once

Thanks for the reply, but I thought that this was your responsibility. Naturally the RLHIM will stick up for itself, so asking them gets us nowhere at all.  The buck stops with the Trust (in particular with you, I understand) and it is for you to judge whether pamphlets such as that I sent bring the Trust into disrepute

. . ..

I’d be very pleased to hear your reaction (rather than that of the RLHIM) to these comments.  It seems a reasonable thing to ask for, since responsibility for the RLHIM rests with you

David Colquhoun

On the 13th March, after a couple of reminders, Dr Gaskin said "I will respond to you tomorrow or Tuesday,". No such luck though. On 25th March, more than three months after I first wrote, I eventually got a reply (my emphasis).

I do not wish to comment further on the matter of the leaflets as a complaint to the advertising standards authority would be dealt with formally.

I am aware of your views on complementary medicine, and of course am entirely open to you pointing out areas where you believe there is misleading information, and I ask colleagues to review such areas when highlighted.

I would make several additional comments:

– patients are referred into NHS services by their GPs (or occasionally by consultants in other services) and cannot self-refer

– patients attending the Royal London Hospital for Integrated Medicine report positively on NHS Choices

– GPs continue to make referrals to the Royal London Hospital for Integrated Medicine and many request that patients stay under follow-up, when UCLH seeks to reconfirm this

– UCLH is engaging with North Central London NHS commissioners on work on their priorities, and that includes work on complementary medicine (and combinations of conventional and complementary approaches)

I think you will understand that I will not wish to engage in lengthy correspondence, and have many other competing priorities at present.

With best wishes

Gill Gaskin

So, after three months’ effort, all I could get was ‘no comment‘, plus some anecdotes about satisfied customers -the stock in trade of all quacks.

I guess it is well known that complaints against any NHS organisation normally meet with a stonewall. That happens with any big organisation (universities too). Nevertheless it strikes me as dereliction of duty to respond so slowly, and in the end to say nothing anyway.

The Advertising Standards Authority have already given their judgement, and it appears to be based on sounder medicine than Dr Gaskin’s ‘reply’..

There are plans afoot to refer the UCLH pamphlet to the the Office of Trading Standards.IIt is for them to decide whether to prosecute the UCLH Trust for making false health claims. It is sad to have to say that they deserve to be prosecuted.

Follow-up

28 March 2011. Two days after this post went up, a Google search for “Dr Gill Gaskin” brought up this post as #5 on the first page. Amazing.

On 25 May, the same search alluded to this post in positions 2, 3, 4 and 5 on the first page of Google.

29 June 2013

Despite several judgements by the Advertising Standards Authority (ASA) against claims made for craniosacral therapy, nothing was done.
But after UCLH Trust was comprehensively condemned by the ASA for the claims made for acupuncture by the RLHIM, at last we got action. All patient pamphlets have been withdrawn, and patient information is being revised.

. It isn’t obvious why this has taken more that two years (and one can only hope that the revised information will be more accurate)

On Friday 25 August 2006, Michael Baum and I went to visit the rather palatial headquarters of the UCL Hospitals Trust (that is part of the NHS, not of UCL).  We went to see David Fish, who was, at that time, in charge of specialist hospitals.  That included world-leading hospitals like the National Hospital Queen Square, and Great Ormond Street children’s hospital.  It also includes that great national embarrassment, the Royal London Homeopathic Hospital (RLHH).

It came as something of a surprise that the man in charge did not know the barmy postulates of homeopathy and he looked appropriately embarrassed when we told him.

Michael Baum is not only a cancer surgeon. but he has also taken the lead in thinking about palliative and spiritual needs of patients who suffer from cancer. Listen to his Samuel gee lecture: it is awe-inspiring. It is available in video, Concepts of Holism in Orthodox and Alternative Medicine.

The problem for UCLH Trust is that the RLHH has royal patronage   One can imagine the frantic green-ink letters that would emanate form the Quacktitioner Royal, if it were to be shut down.  Instead, we suggested that the name of the RLHH should be changed. Perhaps something like Hospital for palliative and supportive care?  Well, four years later it has been changed, but the outcome is not at all satisfactory. From September it is to be known as the Royal London Hospital for Integrated Medicine.

What’s wrong with that?  You have to ask what is to be "integrated" with what?.  In practice it usually means integrating things that don’t work with things that do.  So not much advance there.  In fact the weasel word "integrated" is just the latest in a series of euphemisms for quackery.  First it was ‘alternative’ medicine. But that sounds a bit ‘new age’ (it is), so then it was rebranded ‘complementary medicine’.  That sounds a bit more respectable.  Now it is often "integrated medicine" (in the USA, "integrative").  That makes it sound as though it is already accepted.  It is intended to deceive. See, for example, Prince of Wales Foundation for magic medicine: spin on the meaning of ‘integrated’, and What ‘holistic’ really means.

Of course the amount of homeopathy practised at the RLHH has fallen considerably over the last few years. Already by 2007 there were signs of panic among homeopaths, They are beginning to realise that the game is up. Some of the gaps were filled with other sorts of unproven and disproved medicine.

What the hospital is called matters less than what they do, The current activities can be seen on the UCLH web site.

Services:

It would be tedious to go through all of them, but here are some samples.

The Children’s Clinic

"The mainstay of treatments offered include Homeopathy, Herbal remedies, Flower essences, Essential oils, Tissue salts and Acupuncture. We also assess nutritional status, provide dietary advice and supplementation. Psychotherapeutic techniques including Neuro-Linguistic Programming (NLP), and Visualisation are sometimes used where indicated, to gain better understanding of the presenting problems".

So a wide range of woo there. And they claim to be able to treat some potentially serious problems

"What can be treated

A wide variety of clinical conditions are being treated including:

  • Recurrent infections
  • Skin diseases such as eczema
  • Allergic disorders including asthma
  • Food intolerances and eating disorders
  • Functional developmental and learning problems
  • Behavioural disorders including ADHD (hyperactivity) and autism."

There is, of course, no evidence worth mentioning thar any of these conditions can be treated effectively by “Homeopathy, Herbal remedies, Flower essences, Essential oils, Tissue salts and Acupuncture”.

They describe their success rate thus:

An internal audit questionnaire showed that 70% of children responded well to homeopathic treatment

So, no published data, and no control group. This is insulting to any patient with half a brain.

These claims should be referred to the Advertising Standards Authority and/or Trading standards. They are almost certainly illegal under the Consumer Protection Regulations (May 2008). The UCLH Trust should be ashamed of itself.

Education Services offers mainly courses in homeopathy, the medicines that contain no medicine,

Pharmacy Services stock thousands of bottles of pills, most of which are identical sugar pills. It’s hard to imagine a greater waste of money.

The Marigold Clinic – Homeopathic Podiatry and Chiropody 

I was rather surprised to find this is still running. In 2006, I wrote about it in Conflicts of interest at the Homeopathic Hospital. It turned out that the prescription costs if the clinic were spent on Marigold paste, made by a company owned by the people who run the clinic. UCLH claimed that they were aware of this conflict of interest, but had no obligation to make it public. That is an odd ethics in itself. Even odder when I discovered that the Trust had been notified of the conflict of interest only after I’d started to ask questions.

The same people are still running the clinic. They may well be good chiropodists, If so why surround the service with woo. There are, almost needless to say, no good trials of the efficacy of marigold paste (and it isn’t homeopathic).

Conclusion

At the moment, it appears that the renaming of the RLHH is empty re-branding. No doubt UCLH Trust see homeopathy as something that brings shame on a modern medical service. But to remove the name while retaining the nonsense is simply dishonest. Let’s hope that the name change will be followed by real changes in the sort of medicine practised, Changes to real medicine, one hopes.

Other blogs on this topic

Gimpyblog was first, with Farewell to the RLHH, hello to the RLHIM

Quackometer posted An Obituary: Royal London Homeopathic Hospital, 1849-2010

Follow-up

Twenty-five hospitals from London and southern and eastern England have already either stopped sending any patients to the Royal London Homeopathic Hospital or agreed to fund only a handful A campaign has started o save it, but the arguments are far from convincing.

This is reposted from the original IMPROBABLE SCIENCE page

The news is out. It was in February this year when I first saw some “Commissioning Intentions 2007-08” documents from several London NHS Primary Care Trusts (PCT), indicating their intention to break their contracts with the RLHH on the very reasonable grounds that homeopathy doesn’t work. It seemed better to wait for the intentions to be implemented before saying much, because of the inevitable outcry from those who want sugar pills at the taxpayers’ expense.

Then, in March 2007, the Health Services Journal carried a story “PCTs consider alternative to homeopathic hospitals” (free registration, or read it here).

On 8 April 2007, The Observer carried a special report, prominently featured on page 3.

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

Fisher and Queen
Fisher and Queen,
Observer 8 April 2007

Peter Fisher, clinical director of the RLHH, is quoted as saying

“Twenty-five hospitals from London and southern and eastern England have already either stopped sending any patients to the RLHH or agreed to fund only a handful.”

“Prince Charles is sympathetic, supportive and concerned. But he doesn’t feel it’s appropriate to intervene in any way because there’s been some adverse publicity before about him ‘meddling’. ”

Fisher attributes this to the letter sent to PCTs by 13 of us, last May, in which we advocated that the NHS should not be paying for “unproven or disproved treatments”. The leading signatory on this letter, Professor Michael Baum, is quoted in the Observer thus.

“If the Royal London were to close because of PCT deficits we would scarcely miss it”.

“Homeopathy is no better than witchcraft. It’s no better than a placebo effect. It’s patronising and insulting for adults.”

“Instead you could have a centre for palliative and supportive care, which would be of greater benefit and involve half the cost. Rather than losing something, we would gain something.”

The backlash

The reaction seems to have started with a letter from homeopath Carol Boyce. Her letter starts thus.

ROYAL LONDON HOMEOPATHIC HOSPITAL UNDER SIEGE
Death by stealth. The Royal London Homeopathic Hospital (RLHH) – the visible presence of homeopathy within Britain’s NHS – an institution putting homeopathy in the public mind for the last 150 years – the place where homeopathy was seen to perform so well in the cholera epidemic of the 1840s – is being dealt a DEATH BLOW”

I’d guess the very first sentence must be something of an embarrassment to the RLHH’s clinical director, who is far too sensible to believe that cholera can be cured by homeopathic sugar pills.

The red herring about cholera is repeated ad nauseam on hundreds of homeopathy sites (though most are curiously silent about whether they really believe that sugar pills can cure cholera). It is based on the report that during the London Cholera epidemic of 1854, of the 61 cases of cholera treated at the London Homeopathic Hospital, 10 died (16.4%), whereas the neighbouring Middlesex Hospital reported 123 deaths out of 231 cases of cholera (53.2%). Apart from the lack of any knowledge of the state of the patients on entry to hospital, it was also the case at the time that conventional medicine was no more based on evidence than homeopathy. Indeed the initial popularity of homeopathy could well have resulted not only from wishful thinking, but also because doing nothing at all (i.e. homeopathy) was less harmful than blood letting. The fallacy of the argument was spotted very early on by Oliver Wendell Holmes (senior) in his famous essay, Homeopathy and its Kindred Delusions.

But medicine moved on and homeopathy didn’t. The history of cholera, like that of tuberculosis, contrary to what is suggested by homeopaths, is a triumph for evidence based medicine. The epidemic was halted not by homeopaths but by the careful observations of John Snow that led to his removing the handle of the Broad Street pump. If medicine had been left to homeopaths, people would still be dying of these diseases.

Carol Boyce invites you to write directly to Queen Elizabeth II, to save the RLHH. She has also started an e-petition on the UK government site. The petition includes the words

ROYAL LONDON HOMEOPATHIC HOSPITAL UNDER SIEGE

“The RLHH has been part of the Health Service for 150 years. ”

“In 2005, 67% of GPs and 85% of practices in it’s [sic] Primary Care Trust, referred patients to the hospital. The hospital provides effective and most importantly, COST-EFFECTIVE treatments.”

Ms Boyce seems not to have noticed that the Prince of Wales’ own Smallwood report decided that there was not enough evidence to come to firm conclusions about cost-effectiveness.

Peter Fisher himself has appealed for the survival of the RLHH in a letter dated 9 March 2007 [download copy of letter].

“The Royal London Homoeopathic Hospital needs your support
09/03/2007

By Dr. Peter Fisher, Homeopath to Her Majesty, the Queen.

There is no silly talk about cholera here, but there is a useful list of Trusts who have decided to abandon "unproven and disproved treatments". Fisher recommends you to read Marcia Angell’s book to learn about the deficiencies of the drug industry. I recommend that too. I also recommend Dan Hurley’s book on the even greater deficiencies of the quackery industry.

Fisher suggests you write to your MP to prevent closure of the RLHH.
I suggest you write to your MP to support closure of the RLHH.

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