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Western herbal medicine need not be mystical nonsense, but it usually it is,

Plants often contain chemicals that have pharmacological actions, with all the possibilities for good and for harm that implies (see Plants
as medicines
).  It would be quite possible to teach about the plant constituents and their actions in an entirely scientific way, but it seems that this is not what courses in herbal medicine choose to do.  That is why they shouldn’t be called Bachelor of Science degrees.

We have recently revealed the ancient nonsense taught at Middlesex University in its "BSc (Hons)" degree in Traditional Chinese Medicine in Dangerous Chinese medicine taught at Middlesex University as well as similar dangerous gobbledygook from the University of Westminster: see Why degrees in Chinese medicine are a danger to patients.

Western Herbal medicine does not talk about "knotted spleen Qi", but has an equally barmy mystical vocabulary of its own. They have in common a tendency to divide herbs into hot and cold, a crude and baseless classification that dates from a time when nothing was known about physiology or the causes of disease.

A recent post described the problems of finding out what exactly is taught on these courses: Not much Freedom of Information at University of Wales, University of Kingston, Robert Gordon University or Napier University

I lodged a Freedom of Information (Scotland) Act with Napier University Edinburgh on 10th August 2009. As almost always, it was refused, as was the internal review of my request.  The response to the internal review came from Gerry Webber BA (Hons) 0 PHil MBA MCMI AUA (Fellow). Despite all those impressive sounding letters, he argued with a perfectly straight face that it was perfectly all right for the university to teach this sort of stuff. He ended

“On public interest grounds, I have therefore concluded that, in respect of the commercially sensitive information requested, the public interest is better served in withholding the information you have requested than in disclosing it.”

Despite all those impressive sounding letters after Dr Webber’s name, here was a solemn letter, on the university letterhead, defending the teaching of pseudoscientific nonsense   The experience is surreal, but far from unique.

Although we won a judgement that compelled disclosure from the Information Commissioner for England and Wales, the Scottish law is slightly different so I had to appeal to the Scottish Information commissioner. [Download appeal]

A similar appeal was lodged for Robert Gordon’s University Aberdeen. They have already sent some homeopathy materials, and closed down the homeopathy course, as described at: Robert Gordon University stops its homeopathy course. Quackademia is crumbling.  Napier University followed the same pattern, but a bit more slowly.  They sent some of what I asked for without waiting for a formal judgement, after they had been contacted by the Scottish Information Commissioner.

Napier also shut down the degree from which the slides, below, were used.  It is fascinating that so many places have done this shortly before what is taught is made public.  Before that time the courses are defended and advertised. no doubt by people who have never given a moment’s thought to what is taught.  In 2007, after my Nature article on the topic, the Glasgow Herald said

A spokeswoman for Napier University said it stood by the integrity of its BSc degrees.

“The BSc Herbal Medicine course uses an approach to teaching and training that we believe best prepares students for practice within a modern integrated healthcare system,” she said.

The university’s brochure for the course (still, carelessly, on the web at the time of writing), waxed lyrical about the herbal medicine course. Yet as soon as it becomes known what’s actually taught, the courses close.

### What was taught on Napier’s Herbal Medicine “BSc”.

Materia medica starts with hot and cold herbs

Yes, but one of the problems is that very little is known about the therapeutic actions of herbs from "controlled enquiry". The material just isn’t there to fulfil this aim. To paraphrase their quotation,,you can call anything medicine, but plenty of people will argue with you if you can’t produce the evidence.

This slide strikes me as pure pre-scientific gobbledygook. All herbs and all diseases seem to fall into the ‘hot’ or ‘cold’ class. The ‘argument’ is entirely circular. Pure pseudoscience (is that what the lecturer told them in response to the last question?).

What do all these conditions have in common? They are all "cold". How can anyone take this sort of baloney seriously?

This quotation appears to have no comprehensible meaning at all. It carries overtones of the great "detox" fraud, and so perhaps is useful justification for slimming the wallets of the gullible.

Now we come to a real herb.

There is some real chenistry in this slide. Unfortunately it simply isn’t known whether these chemicals have any useful function. Usually it isn’t known either what dose of them you are giving in tincture of valerian. When I worked in a pharmacy in the 1950s, you could still find tincture of valerian on the shelves of a normal pharmacy, but iit soon vanished as paople realised it wasn’t much use. Disappeared from normal medicine, that is. it is still alive and well among herbalists.

Notice too, the mention of "synergy". The perpetual excuse of herbalists for giving impure mixtures of chemicals is that they might act synergistically. They are undeterred by the fact that no such synergy has ever been demonstrated properly. I asked that question ot Liz Williamson. editor of Potter’s herbal Cyclopedia, but answer came there none.

I’d be interested to know what answer was given to the last question, which isn’t as simple as it sounds. I wouldn’t mind betting it didn’t include a critical description of isobol analysis.

So what does Valerian do?

It seems, even from the lecture, that there is no unanimity that it does anything useful at all.

There is no worthwhile evidence to think it is useful for "generalises anxiety disorder" Let’s take another opinion.

The National Center for Complementary and Alternative Medicine (NCCAM) is the branch of the US National Institutes of Health which has spent around a billion dollars of US taxpayers’ money on research into alternative medicine, For all that effort they have failed to come up with a single useful treatment. Clearly they should be shut down. Nevertheless, as an organisation that is enthusiastic about alternative medicine, it’s interesting to see what they have to say about valerian.

What the Science Says

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

Even NCCAM don’t pretend that there is any good reason to think it’s good for anything. So, you might ask, why are students being taught to treat people with it?

### Simon Mills on "hot and cold herbs"

Many of the slides refer to a book by herbalist Simon Mills. You can see a video of a talk he gave in which he ‘explains’ "hot and cold herbs". It strikes me as pure gobbledygook. Make up your own mind.

### Now take the test

This is a question from a Napier University exam paper

Which constituents are responsible for the actions of saw palmetto?  Which actions would they be?  This is what The National Center for Complementary and Alternative Medicine (NCCAM) says

What the Science Says

• Several small studies suggest that saw palmetto may be effective for treating BPH symptoms.
• In 2006, a large study of 225 men with moderate-to-severe BPH found no improvement with 320 mg saw palmetto daily for 1 year versus placebo. NCCAM cofunded the study with the National Institute of Diabetes and Digestive and Kidney Diseases.
• There is not enough scientific evidence to support the use of saw palmetto for reducing the size of an enlarged prostate or for any other conditions.
• Saw palmetto does not appear to affect readings of prostate-specific antigen (PSA) levels. PSA is protein produced by cells in the prostate. The PSA test is used to screen for prostate cancer and to monitor patients who have had prostate cancer.

### Magic Medicine

In the materials that I was sent, I see nothing to make me believe that herbalism is being taught as science. On the contrary, it all seems to confirm the definition given in the Patients’ Guide to Magic Medicine.

### Herbal medicine BSc degrees still  exist.

The vice-chancellors are named because they are the people who must take responsibility for this sort of nonsense being taught in their universities.

University of East London (vice-chancellor from Feb 2010 is Patrick McGhee, who, in his previous job at University of Central Lancashire, did so much to prevent me from getting hold of their teaching materials, but then closed the courses anyway)

University of Lincoln (Vice chancellor, Professor Mary Stuart)

London Metropolitan University (vice-chancellor, (interim vice chancellor, Alfred Morris)

Middlesex University (vice-chancellor, Professor Michael Driscoll)

And, of course, the home of woo, the University of Westminster (vice-chancellor, Professor Geoffrey Petts). Their students are taught that Amethysts emit high Yin energy and that dowsing and pendulums can be used for diagnosis and treatment.

By the same token, we may congratulate Professor Dame Joan Stringer, vice-chancellor of Napier University Edinburgh for closing down the course from which these slides came. Perhaps now she should consider closing their ‘degrees’ in aromatherapy and ‘reflexology’

### Follow-up

I was asked recently to write a reply to an article about "research managers" for the magazine Research Fortnight. This is a magazine that carries news of research and has a very useful list of potential research funding agencies.

The article to which I was asked to respond originally had the title “Researchers and Research Managers, a match made in heaven?“, before the subeditors got hold of it. It was written by Simon Kerridge, who is secretary of the Association for Research Managers and Administrators The printed version of his article can be downloaded here, and the printed version of my response here. My response, as submitted, is below with live links.

This invitation came at a strangely appropriate time, just at the moment that every university is having serious budget cuts, Well, here is a chance to make a good start on cutting out non-jobs..

### Researchers and Research Managers: an imminent divorce?

David Colquhoun, UCL.

 The web site of the Association of Research Managers and Administrators says it has 1600 individual members [1], but every scientist I have met is baffled about why they have suddenly sprung into existence.  The web site says “Our mission is to facilitate excellence in research by identifying and establishing best practice in research management and administration”.  I had to read that several times in an attempt to extract a meaning from the mangled bureaucratic prose.  “Our mission is to promote excellence in research”.  How can non-scientists with no experience of research possibly “promote excellence in research”?  They can’t, and that’s pretty obvious when you read the second half of the sentence.  They propose to improve science by promoting research management, i.e.  themselves.

Kerridge’s article didn’t help much either.  He seems to think that research managers are there to make that scientists fulfil “overall strategic aims of the University”.  In other words they are there to make sure that scientists obey the orders of non-scientists (or elderly ex-scientists) who claim to know what the future holds.  I can think of no better way to ruin the scientific reputation of a university and to stifle creativity.

We all appreciate good support.  We used to have a very helpful person in the department (not a ‘manager’) who could advise on some of the financial intricacies, but now it is run by a ‘manager’ it has been centralised, depersonalised and it is far less efficient.

The fact of the matter seems to be that “research managers” are just one more layer of hangers-on that have been inflicted on the academic enterprise during the time new labour was in power.  They are certainly not alone.  We have now have “research facilitators” and offshoots of HR running nonsense courses in things like Brain Gym [2].  All of these people claim they are there to support research.  They do no such thing.  They merely generate more paper work and more distraction from the job in hand.  Take a simple example.  At a time when there was a redundancy committee in existence to decide which academics should be fired in my own faculty, the HR department advertised two jobs (on near professorial salaries) for people trained in neurolinguistic programming (that is a well-known sort of pseudo-scientific psychobabble, but it’s big business [3]).

A quick look at what research managers actually do (in two research-intensive universities) shows that mostly they send emails that list funding agencies, and to forward emails you already had from someone else.  Almost all of it can be found more conveniently by a couple of minutes with Google.  Although they claim to reduce administrative work for scientists, it is usually quicker to do it yourself than to try to explain things to people who don’t understand the science.  They don’t save work, they make it.

One might well ask how it is that so much money has come to be spent on pseudo-jobs like “research managers”.  I can only guess that it is part of the ever-expanding tide of administrative junk that encumbers the work of people who are trying to do good creative science.  It also arises from the misapprehension, widespread among vice-chancellors, that you can get creative science by top down management of research by people who know little about it.

I’m reminded of the words of the “unrepentant capitalist”, Luke Johnson [4] (he was talking about HR but the words apply equally here).

“HR is like many parts of modern businesses: a simple expense, and a burden on the backs of the productive workers”,

“They don’t sell or produce: they consume. They are the amorphous support services”.

“I have radically downsized HR in several companies I have run, and business has gone all the better for it.”

The dangers are illustrated by the report [5] of a paper by the professor of higher education management at Royal Holloway (yes, we already have a chair in this non-subject).  It seems that “Research "can no longer be left to the whims and fortunes of individual academics" “.  It must be left to people who don’t do research or understand it.  It’s hard to imagine any greater corruption of the academic enterprise.

Oddly enough, the dire financial situation brought about by incompetent and greedy bankers provides an opportunity for universities to shed the myriad hangers-on that have accreted round the business of research.  Savings will have to be made, and it’s obvious that they shouldn’t start with the people who do the teaching and research on which the reputation of the university depends.  With luck, it may not be too late to choke off the this new phenomenon before it chokes us. If you want research, spend money on people who do it, not those who talk about it.

[2] When HR gets hold of academe, quackery and gobbledegook run riot. Times Higher Education 10 April 2008, http://www.timeshighereducation.co.uk/story.asp?sectioncode=26&storycode=401385  and expanded version at http://www.dcscience.net/?p=226

[3] What universities can do without. http://ucllifesciences.wordpress.com/2010/04/25/what-universities-can-do-without/

[4] Luke Johnson The Truth About the HR Department, Financial Times, Jnauary 30 2008 http://www.ft.com/cms/s/0/9e10714c-ced7-11dc-877a-000077b07658.html  and http://www.dcscience.net/?p=226

[5] Managers must be qualified to herd the academic cats. Times Higher Education 20 May 2010 http://www.timeshighereducation.co.uk/story.asp?sectioncode=26&storycode=411643

### Follow-up

 Hot off the press The Prince’s Foundation for Integrated Health (FIH) has been spreading misinformation about medicine since 1993.  It has featured often on this blog. Now it has closed its doors.

An announcement has appeared on the FIH website

 30 April 2010 The Trustees of The Prince’s Foundation for Integrated Health have decided to close the charity.

The announcement goes on

"Whilst the closure has been planned for many months and is part of an agreed strategy, the Trustees have brought forward the closure timetable as a result of a fraud investigation at the charity."

"The Trustees feel that The Foundation has achieved its key objective of promoting the use of integrated health. Since The Foundation was set up in 1993, integrated health has become part of the mainstream healthcare agenda, with over half a million patients using complementary therapies each year, alongside conventional medicine. . . "

While the immediate precipitating cause may have been the fraud (see below), the idea that the Foundation "has achieved its key objective of promoting the use of integrated health" seems like a ludicrous bit of make-believe. Well, make-believe is something with which the Foundation was quite familiar. At a time when university courses in quackery are vanishing like the snow in springtime, they can hardly believe that their aims have been achieved. But I guess one could not expect them to say "sorry folks, we were wrong all along".

The 2010 Conference is cancelled too

Judging by the quality of the 2009 conference, which I analysed at length last year, the cancellation of the 2010 conference is very welcome news (except perhaps to a few sycophants looking for honours).

What next? A College?

The rumour is that a “College of Integrated Medicine” may arise from the ashes of FIH. Or even, heaven forbid. a Royal College of Integrated baloney. Since universities seem to be deciding that it isn’t sensible to teach myth as truth, i is not unlikely.

Prince Charles’s aide at homeopathy charity arrested on suspicion of fraud

This headline, of an article in the Guardian, by Robert Booth, was not entirely unexpected.

The parlous state of the accounts at the Prince’s Foundation for Integrated Health has been documented already at
Gimpy’s blog
.

“An aide in Prince Charles’s campaign for wider use of complementary medicine in the NHS was arrested at dawn today on suspicion of fraud and money-laundering at the prince’s health charity.

A 49-year old man, understood to be a former senior official at the Prince’s Foundation for Integrated Health, was taken into custody at a police station in north London. He was arrested alongside a 54-year-old woman, who was being held at the same address.

The arrests follow a police investigation into £300,000 unaccounted for in the books of the charity, of which the Prince is president.”

More news will appear here, as it comes in.

### Follow-up

Other posts on this topic appeared rapidly.

The Guardian 30 April. Robert Booth Prince of Wales’s health charity wound up in wake of fraud investigation

Dr Aust’s Spleen 30 April In memoriam. In which Dr Aust gets a bit poetic

Followed by the rest of the mainstream media.

Edzard Ernst 1 May 2010, in the Indepenndent. Better than any journalist. Why alternative medicine wins from the foundation’s demise. Read it! Here are some quotations.

“I therefore think that the FIH has become a lobby group for unproven and disproven treatments populated by sycophants.”

“The FIH has repeatedly been economical with the truth. For instance when it published a DoH-sponsored patient guide that was devoid of evidence. They claimed evidence was never meant to be included. But I had seen a draft where it was and friends have seen the contract with the DoH where “evidence” was an important element. “

“I hope that, after the demise of FIH, the discussion about alternative medicine in the UK can once more become rational. I also hope that Prince Charles has the greatness of selecting advisers who actually advise rather than “Yes Men” who are hoping to see their names on the next Honours List. “

1 May 2010. According to Martin Delgado, in the Daily Mail, the people who were arrested on suspicion of fraud were accountant George Gray and his wife. Gray was Finance Director and acting Chief Executive of FIH. About as senior as you can get.

Gray spent two weeks (two weeks?) at Diabetes UK in 2004 before becoming finance director at the Leadership Foundation For Higher Education.

There is something very offensive about the idea that a ‘bachelor of science’ degree can be awarded by a university, as a prize for memorising gobbledygook.

Once the contents of the ‘degrees’ has been exposed to public ridicule, many universities have stopped doing it. All (or nearly all) of these pseudo-degrees have closed at the University of Salford, the University of Central Lancashire, Robert Gordon University, the University of Buckingham, and even at the University of Westminster (the worst offender), one course has closed (with rumours of more to follow).

 I’ve already written about the course in Traditional Chinese Medicine at the University of Salford (Chinese medicine -acupuncture gobbledygook revealed) and at the University of Westminster: see Why degrees in Chinese medicine are a danger to patients. The former has closed, but not the latter. Here is another one. One place that has yet to come under close scrutiny is Middlesex University. Michael Driscoll, VC of Middlesex University. The buck stops with him.

Their “Complementary Health” courses are as follows (April 2010).

I asked Middlesex University for samples of their teaching materials under the Freedom of Information Act, and, as usual, the request was refused. As usual, I then asked for the mandatory internal review of the decision, and this time, most unusually, the internal review did not confirm the initial refusal and I was sent a bundle of teaching materials about Chinese Herbal Medicine, It was not all I asked for, but it is quite enough to show the absurd ideas that are still being taught as part of bachelor of Science degree in a UK University.

Not only are the ideas absurd, pre-scientific, indeed antiscientific.  They are also dangerous. People who have been taught this nonsense are going out and being let loose on sick people.

The vice-chancellor of Middlesex University, Professor Michael Driscoll, is an economist, not a biologist. Surely you don’t need to be a scientist to feel a bit suspicious when you read on the Middlesex web site about

Traditional Chinese Acupuncture and Moxibustion including distribution of meridians-collaterals and location of acupoints; needling and moxibustion techniques;

Have any of the members of the Executive ever thought to ask about what goes on in these courses?  Even if it is beyond an economist to see through the nonsense, surely it should be possible for Professor Margaret House, Deputy Vice-Chancellor Academic, whose interests lie in water quality, should be able to, though as Dean of the School of Health and Social Sciences she appears to sponsor the nonsense. And Professor Waqar Ahmad, Deputy Vice-Chancellor Research and Enterprise, who has written a s book on Ethnicity, Health and Health Care, should surely be able to distinguish sense from nonsense in health care? In that respect, I’d have less confidence in Katie Bell, Chief Marketing Officer, who joined Middlesex University in 2009 following a career in brand marketing for Nestlé UK and GlaxoSmithKline Consumer Healthcare. Marketing people seldom have much regard for truth.

Have any of the University’s Governors ever asked what is going on in their name? It’s true that none of the long list of distinguished-sounding governors is a scientist. Surely you don’t need to be to question whether or not what follows can be described as ‘science’.

My guess is that none of these distinguished people has ever bothered to look at the dangerous nonsense that is being taught in their University.  It is not in the nature of ‘managers’ to look far beyond ticked-boxes and profit,  They should have done of course, but to make it easier for them, here is a small selection of the slides that I was sent (the copyright for them lies with the university: these few slides come under the heading ‘ ‘fair quotation’ and it is undoubtedly in the public interest to show them).

Course CMH 1211

e

Uhuh, my spleen qi is well and truly knotted already though when I learned physiology it was not thought that the spleen had much to do with emotions.

Ah so at least the problem of heavy breathers is solved. But high temperature, abdominal pain and abnormal pulse can be signs of serious illness. If your only explanation for them is “preponderant evil Qi”, you are a menace to public health.

All these symptoms could be the result of a serious disease. It is not only antiquated nonsense to talk about them in terms of Yin, Yang and Qi.  It endangers people,

Course CMH 2212

Chinese materia medica.  Some of the herbs are likely to contain active ingredients (indeed some are very dangerous). It would be quite possible to study the ingredients of these herbs and to investigate how they work in the light of what has been learned about physiology and pharmacology in the last 200 years.  Pharmacology has a long history of doing that,  But is seems to play no part in this course.  Herbs are “cold” or “hot” and may “check the exuberance of yang”.

and so on, just preposterous, made-up nonsense from another era.

If it were taught as cultural history, it might be interesting. But it is being taught as though it were true, and an appropriate way to treat sick people.

Course CMH 3214

Would you trust your child to someone who’d been taught that “causes of paediatric diseases are relatively simple”, and “children are pure yang”?

Now some Chinese recipes

Course CMH 3100

This may or may not taste good, but to recommend it for diabetes is seriously irresponsible.

The programme specification for the “BSc (Hons) Traditonal Chinese medicine” can be found here. [local copy download]

It is written with all the official trappings, just as though the degree was about science.  It isn’t. It is a danger to public health.

I have asked the vice-chancellor, Michael Driscoll, to express his view of these comments

### Follow-up

A rather unexpected comment from a London acupuncturist.

“At least,I knew that Professor David Colquhoun is very skeptical about Chinese medicine. he comment Chinese medicine study”not only are the ideas absurd, pre-scientific, indeed antiscientific. They are also dangerous. People who have been taught this nonsense are going out and being let loose on sick people.” “

“But,I still like to read his blog as His article very is respectable. I think. Look this…”

The skeptic blog featured this post in its weekly roundup.

27 May 2010.  Times Higher Education reported the decision of Middlesex University to close its philosophy department. This department seems to have a remarkable reputation, not least for a post-1992 university. Three academics and four students have been suspended and gagged in classical bullying style.

This has happened while they continue to teach dangerous rubbish like that described above.

I left a comment at Times Higher, as follows.

It is a reflection on the quality of university management that Middlesex has chosen to shut its philosophy department while continuing to run degrees in quackery. These courses not only offer an Hons BSc for memorising chunks of anti-scientific nonsense. They also pose a real danger to patients. See http://www.dcscience.net/?p=2923

I can think of no better illustration than this of the crass nature of the judgements made by Middlesex’s management. They are either ignorant of what constitutes science, or they are corrupt. I see no other possibilities. In either case they should not be running a university.

I think Prof Michael Driscoll owes the world an explanation.

This post recounts a complicated story that started in January 2009, but has recently come to what looks like a happy ending.  The story involves over a year’s writing of letters and meetings, but for those not interested in the details, I’ll start with a synopsis.

### Synopsis of the synopsis

In January 2009, a course in "integrated medicine" was announced that, it was said, would be accredited by the University of Buckingham. The course was to be led by Drs Rosy Daniel and Mark Atkinson.   So I sent an assessment of Rosy Daniel’s claims to "heal" cancer to Buckingham’s VC (president), Terence Kealey,  After meeting Karol Sikora and Rosy Daniel, I sent an analysis of the course tutors to Kealey who promptly demoted Daniel, and put Prof Andrew Miles in charge of the course.  The course went ahead in September 2009.  Despite Miles’ efforts, the content was found to be altogether too alternative. The University of Buckingham has now terminated its contract with the "Faculty of Integrated Medicine", and the course will close. Well done.Buckingham.

### Synopsis

• January 2009. I saw an announcement of a Diploma in Integrated Medicine, to be accredited by the University of Buckingham (UB).  The course was to be run by Drs Rosy Daniel and Mark Atkinson of the College of Integrated Medicine, under the nominal directorship of Karol Sikora (UB’s Dean of Medicine). I wrote to Buckingham’s vice-chancellor (president), Terence Kealey, and attached a reprint of Ernst’s paper on carctol, a herbal cancer ‘remedy’ favoured by Daniiel.
• Unlike most vice-chancellors, Kealey replied at once and asked me to meet Sikora and Daniel. I met first Sikora alone, and then, on March 19 2009, both together. Rosy Daniel gave me a complete list of the speakers she’d chosen. Most were well-known alternative people, some, in my view, the worst sort of quack. After discovering who was to teach on the proposed course, I wrote a long document about the proposed speakers and sent it to the vice-chancellor of the University of Buckingham, Terence Kealey on March 23rd 2009..  Unlike most VCs, he took it seriously.  At the end of this meeting I asked Sikora, who was in nominal charge of the course, how many of the proposed tutors he’d heard of.  The answer was "none of them"
• Shortly before this meeting, I submitted a complaint to Trading Standards about Rosy Daniel’s commercial site, HealthCreation, for what seemed to me to be breaches of the Cancer Act 1939, by claims made for Carctol. Read the complaint.
• On 27th April 2009, I heard from Kealey that he’d demoted Rosy Daniel from being in charge of the Diploma and appointed Andrew Miles, who had recently been appointed as Buckingham’s Professor of Public Health Education and Policy &Associate Dean of Medicine (Public Health). Terence Kealey said "You’ve done us a good turn, and I’m grateful". Much appreciated. Miles said the course “needs in my view a fundamental reform of content. . . “
• Although Rosy Daniel had been demoted, she was still in charge of delivering the course at what had, by this time, changed its name to the Faculty of Integrated Medicine which, despite its name, is not part of the university.
• Throughout the summer I met Miles (of whom more below) several times and exchanged countless emails, but still didn’t get the revised list of speakers. The course went ahead on 30 September 2009. He also talked with Michael Baum and Edzard Ernst.
• By January 2010, Miles came to accept that the course was too high on quackery to be a credit to the university, and simply fired The Faculty of Integrated Medicine. Their contract was not renewed. Inspection of the speakers, even after revision of the course, shows why.
• As a consequence, it is rumoured that Daniel is trying to sell the course to someone else.  The University of Middlesex, and unbelievably, the University of Bristol, have been mentioned, as well as Thames Valley University, the University of Westminster, the University of Southampton and the University of East London. Will the VCs of these institutions not learn something from Buckingham’s experience? It is to be hoped that they would at the very least approach Buckingham to ask pertinent questions? But perhaps a more likely contender for an organisation with sufficient gullibility is the Prince of Wales newly announced College of Integrated Medicine. [but see stop press]

### The details of the story

The University of Buckingham (UB) is the only private university in the UK. Recently it announced its intention to start a school of medicine (the undergraduate component is due to start in September 2011). The dean of the new school is Karol Sikora.

Karol Sikora shot to fame after he appeared in a commercial in the USA. The TV commercial was sponsored by a far-right Republican campaign group, “Conservatives for Patients’ Rights” It designed to prevent the election of Barack Obama, by pouring scorn on the National Health Serrvice. A very curious performance.  Very curious indeed. And then there was a bit of disagreement about the titles that he claimed to have.

As well as being dean of medicine at UB. Karol Sikora is also medical research director of CancerPartnersUK. a private cancer treatment company. He must be a very busy man.

Karol Sikora’s attitude to quackery is a mystery wrapped in an enigma.  As well as being a regular oncologist, he is also a Foundation Fellow of that well known source of unreliable information, The Prince of Wales Foundation for Integrated Health. He spoke at their 2009 conference.

In the light of that, perhaps it is not, after all, so surprising thet the first action of UB’s medical school was to accredit a course a Diploma in Integrated Medicine. This course has been through two incarnations. The first prospectus (created 21 January 2009) advertised the course as being run by the British College of Integrated Medicine.But by the time that UB issued a press release in July 2009, the accredited outfit had changed its name to the Faculty of Integrated Medicine That grand title makes it sound like part of a university.  It isn’t.

Rosy Daniel runs a company, Health Creation which, among other things, recommended a herbal concoction. Carctol. to "heal" cancer, . I wrote to Buckingham’s vice-chancellor (president), Terence Kealey, and attached a reprint of Ernst’s paper on Carctol. . Unlike most university vice-chancellors, he took it seriously. He asked me to meet Karol Sikora and Rosy Daniel to discuss it.  After discovering who was teaching on this course, I wrote a document about their backgrounds and sent it to Terence Kealey.  The outcome was that he removed Rosy Daniel as course director and appointed in her place Andrew Miles, with a brief to reorganise the course. A new prospectus, dated 4 September 2009, appeared. The course is not changed as much as I’d have hoped, although Miles assures me that while the lecture titles themselves may not have changed, he had ordered fundamental revisions to the teaching content and the teaching emphases.

In the new prospectus the British College of Integrated Medicine has been renamed as the Faculty of Integrated Medicine, but it appears to be otherwise unchanged. That’s a smart bit of PR. The word : “Faculty” makes it sound as though the college is part of a university.   It isn’t.  The "Faculty" occupies some space in the Apthorp Centre in Bath, which houses, among other things, Chiropract, Craniopathy (!) and a holistic vet,

The prospectus now starts thus.

Most of these advisory board members are the usual promoters of magic medicine.  But three of them seem quite surprising,Stafford Lightman, Nigel Sparrow and Nigel Mathers.

Stafford Lightman? Well actually I mentioned to him in April that his name was there and he asked for it to be removed, on the grounds that he’d had nothing to do with the course. It wasn’t removed for quite a while, but the current advisory board has none of these people. Nigel Sparrow and Nigel Mathers, as well as Lightman, sent letters of formal complaint to Miles and Terence Kealey, the VC of Buckingham, to complain that their involvement in Rosy Daniel’s set-up had been fundamentally misrepresented by Daniel.   With these good scientists having extricated themselves from Daniel’s organisation, the FIM has only people who are firmly in the alternative camp (or quackery, as i’d prefer to call it). For example, people like Andrew Weil and George Lewith.

Andrew Weil, for example, while giving his address as the University of Arizona, is primarily a supplement salesman.  He was recently reprimanded by the US Food and Drugs Administration

“Advertising on the site, the agencies said in the Oct. 15 letter, says “Dr. Weil’s Immune Support Formula can help maintain a strong defense against the flu” and claims it has “demonstrated both antiviral and immune-boosting effects in scientific investigation.”

The claims are not true, the letter said, noting the “product has not been approved, cleared, or otherwise authorized by FDA for use in the diagnosis, mitigation, prevention, treatment, or cure of the H1N1 flu virus.”

This isn’t the first time I’ve come across people’s names being used to support alternative medicine without the consent of the alleged supporter.  There was, for example, the strange case of Dr John Marks and Patrick Holford.

Misrepresentation of this nature seems to be the order of the day. Could it be that people like Rosy Daniel are so insecure or, indeed, so unimportant within the Academy in real terms (where is there evidence of her objective scholarly or clinical stature?), that they seek to attach themselves, rather like limpets to fishing boats, to people of real stature and reputation, in order to boost their own or others’ view of themselves by a manner of proxy?

### The background

When the course was originally proposed, a brochure appeared. It said accreditation by the University of Buckingham was expected soon.

Not much detail appeared in the brochure, Fine words are easy to write but what matters is who is doing th teaching. So I wrote to the vice-chancellor of Buckingham, Terence Kealey. I attached a reprint of Ernst’s paper on carctol, a herbal cancer ‘remedy’ favoured by Daniel (download the cached version of her claims, now deleted).

Terence Kealey

Kealey is regarded in much of academia as a far-right maverick, because he advocates ideas such as science research should get no public funding,and that universities should charge full whack for student fees. He has, in fact, publicly welcomed the horrific cuts being imposed on the Academy by Lord Mandelson. His piece in The Times started

“Wonderful news. The Government yesterday cut half a billion pounds from the money it gives to universities”

though the first comment on it starts

"Considerable accomplishment: to pack all these logical fallacies and bad metaphors in only 400 words"

He and I are probably at opposite ends of the political spectrum. Yet he is the only VC who has been willing to talk about questions like this.  Normally letters to vice-chancellors about junk degrees go unanswered.  Not so with Kealey.  I may disagree with a lot of his ideas, but he is certainly someone you can do business with.

Kealey responded quickly to my letter, sent in January 2009, pointing out that Rosy Daniel’s claims about Carctol could not be supported and were possibly illegal. He asked me to meet Sikora and Daniel. I met first Sikora alone, and then, on March 19 2009, both together. Rosy Daniel gave me a complete list of the speakers she’d chosen to teach on this new Diploma on IM.

After discovering who was to teach on the proposed course, I wrote a long document about the proposed speakers and sent it to Terence Kealey on March 23rd 2009. It contained many names that will be familiar to anyone who has taken an interest in crackpot medicine, combined with a surprisingly large element of vested financial interests. Unlike most VCs, Kealey took it seriously.

The remarkable thing about this meeting was that I asked Sikora how many names where familiar to him on the list of people who had been chosen by Rosy Daniel to teach on the course. His answer was "none of them". Since his name and picture feature in all the course descriptions, this seemed like dereliction of duty to me.

After seeing my analysis of the speakers, Terence Kealey reacted with admirable speed. He withdrew the original brochure, demoted Rosy Daniel (in principle anyway) and brought in Prof Andrew Miles to take responsibility for the course. This meant that he had to investigate the multiple conflicts of interests of the various speakers and to establish some sort of way forward in the ‘mess’ of what had been agreed before Miles’ appointment to Buckingham

Andrew Miles.

Miles is an interesting character, a postdoctoral neuroendocrinologist, turned public health scientist.  I’d come across him before as editor-in-chief of the Journal of Evaluation in Clinical Practice    This is a curious journal that is devoted mainly to condemning Evidence Based Medicine.  Much of its content seems to be in a style that I can only describe as post-modernist-influenced libertarian.

The argument turns on what you mean by ‘evidence’ and, in my opinion, Miles underestimates greatly the crucial problem of causality, a problem that can be solved only by randomisation, His recent views on the topic can be read here.

An article in Miles’ journal gives its flavour: "Andrew Miles, Michael Loughlin and Andreas Polychronis, Medicine and evidence: knowledge and action in clinical practice". Journal of Evaluation in Clinical Practice 2007, 13, 481–503 [download pdf].  This paper launches an attack on Ben Goldacre, in the following passage.

“Loughlin identifies Goldacre [36] as a particularly luminous example of a commentator who is able not only to combine audacity with outrage, but who in a very real way succeeds in manufacturing a sense of having been personally offended by the article in question. Such moralistic posturing acts as a defence mechanism to protect cherished assumptions from rational scrutiny and indeed to enable adherents to appropriate the ‘moral high ground’, as well as the language of ‘reason’ and ‘science’ as the exclusive property of their own favoured approaches. Loughlin brings out the Orwellian nature of this manoeuvre and identifies a significant implication.”

"If Goldacre and others really are engaged in posturing then their primary offence, at least according to the Sartrean perspective adopted by Murray et al. is not primarily intellectual, but rather it is moral. Far from there being a moral requirement to ‘bend a knee’ at the EBM altar, to do so is to violate one’s primary duty as an autonomous being.”

This attack on one of my heroes was occasioned because he featured one of the most absurd pieces of post-modernist bollocks ever, in his Guardian column in 2006. I had a go at the same paper on this blog, as well as an earlier one by Christine Barry, along the same lines. There was some hilarious follow-up on badscience.net.  After this, it is understandable that I had not conceived a high opinion of Andrew Miles.  I feared that Kealey might have been jumping out of the frying pan into the fire.

After closer acquaintance I have changed my mind, In the present saga Andrew Miles has done an excellent job. He started of sending me links to heaven knows how many papers on medical epistemology, to Papal Encyclicals on the proposed relationship between Faith and Reason and on more than one occasion articles from the Catholic Herald (yes, I did read it). This is not entirely surprising, as Miles is a Catholic priest as well as a public health academic, so has two axes to grind. But after six months of talking, he now sends me links to junk science sites of the sort that I might get from, ahem, Ben Goldacre.

### Teachers on the course

Despite Andrew Miles best efforts, he came in too late to prevent much of the teaching being done in the parallel universe of alternative medicine,  The University of Buckingham had a pre-Miles, legally-binding contract (now terminated) with the Faculty of Integrated Medicine, and the latter is run by Dr Rosy Daniel and Dr Mark Atkinson.  Let’s take a look at their record.

Rosy Daniel BSc, MBBCh

Dr Rosy Daniel first came to my attention through her commercial web site, Health Creation. This site, among other things, promoted an untested herbal concoction, Carctol, for "healing" cancer.

Carctol: Profit before Patients? is a review by Edzard Ernst of the literature, such as it is, and concludes

Carctol and the media hype surrounding it must have given many cancer patients hope. The question is whether this is a good or a bad thing. On the one hand, all good clinicians should inspire their patients with hope [6]. On the other hand, giving hope on false pretences is cruel and unethical. Rosy Daniel rightly points out that all science begins with observations [5]. But all science then swiftly moves on and tests hypotheses. In the case of Carctol, over 20 years of experience in India and almost one decade of experience in the UK should be ample time to do this. Yet, we still have no data. Even the small number of apparently spectacular cases observed by Dr. Daniel have not been published in the medical literature.

On this basis I referred Health Creation to Trading Standards officer for a prima facie breach of the Cancer Act 1939. ]Download the complaint document]. Although no prosecution was brought by Trading Standards, they did request changes in the claims that were being made.  Here is an example.

A Google search of the Health Creation site for “Carctol” gives a link

Dr Daniel has prescribed Carctol for years and now feels she is seeing a breakthrough. Dr Daniel now wants scientists to research the new herbal medicine

But going to the link produces

You can download the cached version of this page, which shows the sort of claims that were being made before Trading Standards Officers stepped in.  There are now only a few oblique references to Carctol on the Health Creation site, e.g. here..

Both Rosy Daniel and Karol Sikora were speakers at the 2009 Princes’s Foundation Conference, in some odd company.

Mark Atkinson MBBS BSc (Hons) FRIPH

Dr Mark Atkinson is co-leader of the FiM course. He is also a supplement salesman, and he has promoted the Q-link pendant.  The Q-link pendant is a simple and obvious fraud designed to exploit paranoia about WiFi killing you. When Ben Goldacre bought one and opened it. He found

“No microchip. A coil connected to nothing. And a zero-ohm resistor, which costs half a penny, and is connected to nothing.”

“As someone who used to get tired sitting in front of computers and used to worry about the detrimental effects of external EMF’s, particularly as an avid user of mobile phones, I decided to research the various devices and technologies on the market that claim to strengthen the body’s subtle energy fields. It was Q Link that came out top. As a Q link wearer, I no longer get tired whilst at my computer, plus I’m enjoying noticeably higher energy levels and improved mental performance as a result of wearing my Q Link. I highly recommend it.” Dr Mark Atkinson, Holistic Medical Physician

Mark Atkinson is also a fan of Emo-trance. He wrote, In Now Magazine,

"I wanted you to know that of all the therapies I’ve trained in and approaches that I have used (and there’s been a lot) none have excited me and touched me so deeply than Emotrance."

"Silvia Hartmann’s technique is based on focusing your thoughts on parts of your body and guiding energy. It can be used for everything from insomnia to stress. The good news is that EmoTrance shows you how to free yourself from these stuck emotions and release the considerable amounts of energy that are lost to them."

Aha so this particular form of psychobabble is the invention of Silvia Hartmann. Silvia Hartmann came to my attention because her works feature heavily in on of the University of Westminster’s barmier “BSc” degrees, in ‘naturopaths’, described here. She is fanous, apart from Emo-trance, for her book Magic, Spells and Potions

“Dr Hartmann has created techniques that will finally make magic work for you in ways you never believed to be possible.”

Times Higher Education printed a piece with the title ‘Energy therapy’ project in school denounced as ‘psychobabble’. They’d phoned me a couple of days earlier to see whether I had an opinion about “Emotrance”.  As it happens, I knew a bit about it because it had cropped up in a course given at, guess where, the University of Westminster .   It seems that a secondary school had bought this extreme form of psychobabble.  The comments on the Times Higher piece were unusually long and interesting.

It turned out that the inventor of “Emotrance”, Dr Silvia Hartmann PhD., not only wrote books about magic spells and potions, but also that her much vaunted doctorate had been bought from the Universal Life Church, current cost $29.99. ### The rest of the teachers The rest of the teachers on the course, despite valiant attempts at vetting by Andrew Miles, includes many names only too well-known to anybody who has taken and interest in pseudo-scientific medicine. Here are some of them. Damien Downing:, even the Daily Mail sees through him. Enough said. Kim Jobst, homoepath and endorser of the obviously fraudulent Q-link pendant . His Plaxo profile says About Kim A. Jobst Consultant, Wholystic Care Physician [sic!] , Medical Homoeopath, Specialist in Neurodegeneration and Dementia, using food state nutrition, diet and lifestyle to facilitate Healing and Growth; Catherine Zollman, Well known ally of HRH and purveyer of woo. Harald Walach, another homeopath, fond of talking nonsense about "quantum effects". Nicola Hembry, a make-believe nutritionist and advocate of vitamin C and laetrile for cancer Simon Mills, a herbalist who is inclined to diagnoses like “hot damp”, ro be treated with herbs that tend to “cool and dry.” David Peters, of the University of Westminster. Enough said. Nicola Robinson of Thames Valley University. Advocate of unevidenced treatmsnts. Michael Dixon, of whom more here. And last but not least, Karol Sikora. ### The University of Buckingham removes accreditation of the Faculty of Integrated Medicine The correspondence has been long and, at times, quite blunt. Here are a few quotations from it, The University of Buckingham, being private, is exempt from the Freedom of Information Act (2000) but nevertheless they have allowed me to reproduce the whole of the correspondence. The University, through its VC, Terence Keeley, has been far more open than places that are in principle subject to FOIA, but which, in practice, always try to conceal material. I may post the lot, as time permits, but meanwhile here are some extracts. They make uncomfortable reading for advocates of magic medicine. Miles to Daniel, 8 Dec 2009 ” . . . now that the University has taken his [Sikora’s] initial advice in trialing the DipSIM and has found it cost-ineffective, the way forward is therefore to alter that equation through more realistic financial contribution from IHT/FIM at Bath or to view the DipSIM as an experiment that has failed and which must give way to other more viable initiatives." "The University is also able to confirm that we hold no interest in jointly developing any higher degrees on the study of IM with IHT/FIM at Bath. This is primarily because we are developing our own Master’s degree in Medicine of the Person in collaboration with various leading international societies and scholars including the WHO and which is based on a different school of thought. " Miles to Daniel 15 Dec 2009 "Dear Rosy It appears that you have not fully assimilated the content of my earlier e-mails and so I will reiterate the points I have already made to you and add to them. The DipSIM is an external activity – in fact, it is an external collaboration and nothing more. It is not an internal activity and neither is it in any way part of the medical school and neither will it become so and so the ‘normal rules’ of academic engagement and scholarly interchange do not apply. Your status is one of external collaborator and not one of internal or even visiting academic colleague. There is no “joint pursuit” of an academically rigorous study of IM by UB and IHT/FIM beyond the DipSIM and there are no plans, and never have been, for the “joint definition of research priorities” in IM. The DipSIM has been instituted on a trial basis and this has so far shown the DipSIM to be profoundly cost-ineffective for the University. You appear to misunderstand this – deliberately or otherwise." Daniel to Miles 13 Jan 2010 "However, I am aware that weather permitting you and Karol will be off to the Fellows meeting for the newly forming National College (for which role I nominated you to Dr Michael Dixon and Prof David Peters.) I have been in dialogue with Michael and Boo Armstrong from FIH and they are strongly in favour of forming a partnership with FIM so that we effectively become one of many new faculties within the College (which is why we change our name to FIM some months ago). I have told Michael about the difficulties we are having and he sincerely hopes that we can resolve them so that we can all move forward as one. " Miles to Daniel 20 Jan 2010 "Congratulations on the likely integration of your organisation into the new College of Integrative Health which will develop out of the Prince’s Foundation for Integrated Health. This will make an entirely appropriate home for you for the longer term. Your image of David Colquhoun "alive and kicking" as the Inquisitor General, radiating old persecutory energy and believing "priestess healers" (such as you describe youself) to be best "tortured, drowned and even burnt alive", will remain with me, I suspect, for many years to come (!). But then, as the Inquisitor General did say, ‘better to burn in this life than in the next’ (!). Overall, then, I reject your conclusion on the nature of the basis of my decision making and playfully suggest that it might form part of the next edition of Frankfurt’s recent volume ["On Bullshit] http://press.princeton.edu/titles/7929.html I hope you will forgive my injection of a little academic humour in an otherwise formal and entirely serious communication. The nature of IM, with its foundational philosophy so vigorously opposed by mainstream medicine and the conitnuing national and international controversies which engulf homeopaths, acupuncturists, herbalists, naturopaths, transcendental meditators, therapeutic touchers, massagers, reflexologists, chiropractors, hypnotists, crystal users, yoga practitioners, aromatherapists, energy channelers, chinese medicine practitioners et al, can only bring the University difficulties as we seek to establish a formal and internationally recognised School of Medicine and School of Nursing. I do not believe my comments in relation to governance at Bath are "offensive". They are, on the contrary, entirely accurate and of concern to the University. There have been resignations at senior level from your Board due to misrepresentation of your position and there has been a Trading Standards Authority investigation into further instances of misrepresentation. I am advised that an audit is underway of your compliance with the Authority’s instructions. You have therefore not dealt with my concerns, you have merely described them as "offensive". I note from your e-mail that you are now in discussions with other universities and given the specific concerns of the University of Buckingham which I have dealt with exhaustively in this and other correspondences and the incompatibility of the developments at UB with the DipSIM and your own personal ambitions, etc., I believe you to have taken a very wise course and I wish you well in your negotiations. In these circumstances I feel it appropriate to enhance those negotiations by confirming that the University of Buckingham will not authorise the intake of a second cohort of students and that the relationship between IHT and the University will cease following the graduation of those members of the current course that are successful in their studies – the end of February 2011." From Miles 2 Feb 2010 "Here is the list of teachers – you can subtract me (I withdrew from teaching when the antics ay Bath started) and also Professor John Cox (Former President of The Royal College of Psychiatrists and Former Secretary General of the World Psychiatric Association) who withdrew when he learned of some of the stuff going on…. Karol Sikora continues to teach. Michael Loughlin and Carmel Martin are both good colleagues of mine and, I can assure you – taught the students solid stuff! Michael taught medical epistemology and Carmel the emerging field of systems complexity in health services (Both of them have now withdrawn from teaching commitments). The tutors shown are described by Rosy as the finest minds in IM teaching in the country. I interviewed tham all personally on (a) the basis of an updated CV & (b) via a 30 min telephone interview with me personally. Some were excluded from teaching because they were not qualified to do so academically (e.g. Boo Armstrong, Richard Falmer, not even a first degree, etc, etc., but gave a short presentation in a session presided over by an approved teacher) and others were approved because of their academic qualifications, PhD, MD, FRCP etc etc etc) and activity within the IM field. Each approved teacher was issued with highly specific teaching guidance form me (no bias, reference to opposing schools of thought, etc etc) and each teacher was required to complete and sign a Conflicts of Interest form. All of these documentations are with me here. Short of all this governance it’s impossible to bar them from teaching because who else would then do it?! Anyway, the end is in sight – Hallelujah! " From Miles 19 Feb 2010 "Dear David Just got back to the office after an excellent planning meeting for the new Master’s Degree in Person-centred Medicine and a hearty (+ alcoholic) lunch at the Ath! Since I shall never be a FRS, the Ath seems to me the next best ‘club’ (!). Michael Baum is part of the steering committee and you might like to take his thoughts on the direction of the programme. Our plans may even find their way into your Blog as an example of how to do things (vs how not to do things, i.e. CAM, IM, etc!). This new degree will sit well alongside the new degrees in Public Health – i.e. the population/utilitarian outlook of PH versus the individual person-centred approach., etc. " And an email from a senior UB spokesperson "Rumour has it that now that Buckingham has dismissed the ‘priestess healer of Bath’, RD [Rosy Daniel] , explorations are taking place with other universities, most of which are subject to FoI request from DC at the time of writing. Will these institutions have to make the same mistakes Buckingham did before taking the same action? Rumour also has it that RD changed the name of her institution to FIM in order to fit neatly into the Prince’s FIH, a way, no doubt, of achieving ‘protection’ and ‘accreditation’ in parallel with particularly lucrative IM ‘education’ (At £9,000 a student and with RD’s initial course attracting 20 mainly GPs, that’s £180,00 – not bad business…. And Buckingham’s ‘share of this? £12,000!” ### The final bombshell; even the Prince of Wales’ FIH rejects Daniel and Atkinson? Only today (31 March) I was sent, from a source that I can’t reveal, an email which comes from someone who "represent the College and FIH . . . ".. This makes it clear that the letter comes from the Prince of Wales’ Foundation for Integrated Health  Dr Rosy Daniel BSc MBBCh Director of the Faculty of Integrated Medicine Medical Director Health Creation 30th March 2010 RE: Your discussion paper and recent correspondence Thank you for meeting with [XXXXXX] and myself this evening to discuss your proposals concerning a future relationship between your Faculty of Integrated Medicine and the new College. As you know, he and I have been asked to represent the College and FIH in this matter. We are aware of difficulties facing your organisations and the FIM DipSIM course. As a consequence of these, it is not possible for the College to enter into an association with you, any of your organisations nor the DipSIM course at the present time. It would, therefore, be wrong to represent to others that any such association has been agreed. You will appreciate that, in these circumstances, you will not receive an invitation to the meeting of 15th April 2010 nor to other planned events. I am sorry to disappoint you in this matter. Yours sincerely ### Conclusions I’ll confess to feeling almost a little guilty for having appeared to persecute the particular individuals involved in thie episode. But patients are involved and so is the law, and both of these are more important than individuals, The only unfair aspect is that, while it seems that even the Prince of Wales’ Foundation for Integrated Health has rejected Daniel and Atkinson, that Foundation embraces plenty of people who are just as deluded, and potentially dangerous, as those two. The answer to that problem is for the Prince to stop endorsing treatments that don’t work. As for the University of Buckingham. Well, despite the ‘right wing maverick’ Kealey and the ‘anti-evidence’ Miles, I really think they’ve done the right thing. They’ve listened, they’ve maintained academic rigour and they’ve released all information for which I asked and a lot more. Good for them, I say. ### Follow-up 15 April 2010. This story was reported by Times Higher Education, under the title “It’s terminal for integrated medicine diploma“. That report didn’t attract comments. But on 25th April Dr Rosy Daniel replied with “‘Terminal’? We’ve only just begun“. This time there were some feisty responses. Dr Daniel really should check her facts before getting into print. 3 March 2011. Unsurprisingly, Dr Daniel is up and running again, under the name of the British College of Integrated Medicine. The only change seems to be that Mark Atkinson has jumped ship altogether, and, of course, she is now unable to claim endorsement by Buckingham, or any other university. Sadly, though, Karol Sikora seems to have learned nothing from the saga related above. He is still there as chair of the Medical Advisory Board, along with the usual suspects mentioned above. Jump to follow-up Every single request for information about course materials in quack medicine that I have ever sent has been turned down by universities, It is hardly as important as as refusal of FoI requests to see climate change documents, but it does indicate that some vice-chancellors are not very interested in openness. This secretiveness is exactly the sort of thing that leads to lack of trust in universities and in science as a whole. The one case that I have won took over three years and an Information Tribunal decision against the University of Central Lancashire (UCLAN) before I got anything. UCLAN spent £80,307.95.(inc VAT at 17.5%) in legal expenses alone (plus heaven knows how much in staff time) to prevent us from seeing what was taught on their now defunct “BSc (Hons) homeopathy”. This does not seem to me to be good use of taxpayers’ money. A small sample of what was taught has already been posted (more to come). It is very obvious why the university wanted to keep it secret, and equally obvious that it is in the public interest that it should be seen. UCLAN had dropped not only its homeopathy "degree" before the information was revealed, They also set up an internal inquiry into all the rest of their courses in magic medicine which ended with the dumping of all of them. Well, not quite all, There was one left. An “MSc” in homeopathy by e-learning. Why this was allowed to continue after the findings of UCLAN’s internal review, heaven only knows. It is run by the same Kate Chatfield who ran the now defunct BSc. Having started to defend the reputation against the harm done to it by offering this sort of rubbish, I thought I should finish. So I asked for the contents of this course too. It is, after all, much the same title as the course that UCLAN had just been ordered to release. But no, this request too was met with a refusal Worse still, the refusal was claimed under section 43(2) if the Freedom of Information Act 2000. That is the public interest defence, The very defence that was dismissed in scathing terms by the Information Tribunal less than two months ago, To add insult to injury, UCLAN said that it would make available the contents of the 86 modules in the course under its publication scheme, at a cost of £20 per module, That comes to £1,720 for the course, Some freedom of information. Because this was a new request, it now has to go through the process of an internal reviw of the decision before it can ne referred to the Information Commissioner. That will be requested, and since internal reviews have, so far, never changed the initial judgment. the appeal to the Information Commissioner should be submitted within the month. I have been promised that the Information Commissioner will deal with it much faster this time than the two years it took last time. ### And a bit more unfreedom Middlesex University I first asked Middlesex for materials from their homeopathy course on 1 Oct 2008. These courses are validated by Middlesex university (MU) but actually run by the Centre for Homeopathic Education. Thw MU site barely mentions homeopathy and all I got was the usual excuse that the uninsersity did not possess the teaching materials. As usual, the validation had been done without without looking at what was actually being taught. The did send me the validation document though [download it] As usual, the validation document shows no sign at all of the fact that the usbject of the "BSc" is utter nonsense. One wonderful passage says “. . . the Panel were assured that the Team are clearly producing practitioners but wanted to explore what makes these students graduates? The Team stated that the training reflects the professional standards that govern the programme and the graduateness is achieved through developing knowledge by being able to access sources and critically analyse these sources . . . “ Given that the most prominent characteristic of homeopaths (and other advocates of magic medicine) is total lack of critical ability, this is hilarious. If they had critical ability they wouldn’t be homeopaths. Hilarious is not quite the right word, It is tragic that nonsense like this can be found in an official university document. Middlesex, though it doesn’t advertise homeopathy, does advertise degrees in Traditional Chinese Medicine, Herbal Medicine and Ayurveda. On 2nd February 2010 I asked for teaching materials from these courses. Guess what? The request was refused. In this case the exemptions under FOIA were not even invoked but I was told that "All these materials are presently available only in one format at the University – via a student-only accessed virtual learning environment. ". Seems that they can’t print out the bits that I asked for, The internal review has been requested, then we shall see what the Information Commissioner has to say. Two other cases are at present being considered by the Information Commissioner (Scotland), after requests under the Scottish FoIA were refused. They are interesting cases because they bear on the decision, currently being considered by the government, about whether they should implement the recommendations of the execrable Pittilo report. Napier University Edinburgh. The first was for teaching material form the herbal medicine course at Napier University Edinburgh. I notice that this course no longer appears in UCAS or on Napier’s own web site, so maybe the idea that its contents might be disclosed has been sufficient to make the university do the sensible thing. Robert Gordon University Aberdeen The second request was for teaching material from the “Introduction to Homeopathy” course at the Robert Gordon University Aberdeen. The particular interest that attaches to this is that the vice-chancellor of Robert Gordon university is Michael Pittilo. The fact that he is willing to tolerate such a course in his own university seems to me to disqualify him from expressing any view on medical subjects. ### Michael Pittilo, Crohn’s disease and Andrew Wakefield Michael Pittilo has not been active in science for some time now, but Medline does show scientiifc publications for Pittilo RM, between 1979 anf 1998. Between 1989 and 1995 there are five papers published jointly with one Andrew Wakefield. These papers alleged a relationship between measles virus and Crohn’s disease. The papers were published before tha infamous 1998 paper by Wakefield in the Lancet (now retracted) that brought disgrace on Wakefield and probably caused unnecessary deaths.. The link between measles and Crohn’s disease is now equally disproved. The subject has been reviewed by Korzenik (2005) in Past and Current Theories of Etiology of IBD. Toothpaste, Worms, and Refrigerators “Wakefield et al proposed that Crohn’s results from a chronic infection of submucosal endothelium of the intestines with the measles virus [Crohn’s disease: pathogenesis and persistent measles virus infection. Wakefield AJ, Ekbom A, Dhillon AP, Pittilo RM, Pounder RE., Gastroenterology, 1995, 108(3):911-6]” "This led to considerable media interest and< public concern over use of live measles vaccine as well as other vaccines. A number of researchers countered these claims, with other studies finding that titers to measles were not increased in Crohn’s patients, granulomas were not associated with endothelium 49 , measles were not in granulomas50 and the measles vaccine is not associated with an increased risk of Crohn’s disease51–55 " This bit of history is not strictly relevant to the Pittilo report, but I do find quite puzzling how the government chooses people from whom it wishes to get advice about medical problems. ### Follow-up I notice that the Robert Gordon university bulletin has announced that “Professor Mike Pittilo, Principal of the University, has been made an MBE in the New Year Honours list for services to healthcare”. That is a reward for writing a very bad report that has not yet been implemented, and one hopes, for the sake of patients, will never be implemented. I do sometimes wonder about the bizarre honours system in the UK. Postcript. On 16th February, the death of Michael Pittilo was announced. He had been suffeing from cancer and was only 55 years old. I wouldn’t wish that fate on my worst enemy. Can’t resist another bit of straight plagiarism. In this week’s Times Higher Education, the inimitable Laurie Taylor wrote this.  Rock around the clock Professor Georgina Kunzite, the Head of our Department of Crystal Healing, has reacted strongly to the recent High Court ruling that the University of Central Lancashire must hand over teaching materials from its defunct homeopathy course to a campaigning sceptic. Speaking to our reporter, Keith Ponting (30), she said she had no intention of acceding to any similar request for materials from her own oversubscribed course in crystal therapy. Such a move, she argued, risked undermining the power of the crystals, which were notoriously wary of attempts to question their curative validity. She had initially been disconcerted by the court’s decision. “But since then I’ve taken to sleeping with a large lump of pink rhodochrosite crystal under my pillow. This does mildly disturb my partner, but it has certainly helped to rebalance my chakra.” Well well, where could he have got that idea? There is no topic more widely discussed than what one should eat in order to stay healthy. And there are few topics where there evidence is so lacking in quality. This post isn’t about quackery, but about something much more important. it is about the real science (if it merits that description) behind dietary advice. I’m not an expert in nutrition, but I do know a bit about the nature of evidence. I’m continually astonished by the weakness of the evidence for some things that have become received truths, and nowhere is that more true than in nutrition.  The BMJ used my review of Gary Taube’s book, The Diet Delusion, to start off their new Round Table feature [full text link to BMJ]. The published version had some big cuts so I publish the original version here. Taubes was kind enough to send me a copy of the book after I’d mentioned his wonderful New York Times piece in my previous excursion into the murky world of diet and health, Diet and health. What can you believe: or does bacon kill you? The biggest omission in the BMJ version was Taubes’ own ten point summary of his conclusions (on page 454). "“As I emerge from this research, though, certain conclusions seem inescapable to me, based on existing knowledge 1. Dietary fat, whether saturated or not, is not a cause of obesity, heart disease, or any other chronic disease of civilization 2. The problem is the carbohydrates in the diet, their effect on insulin secretion, and thus the hormonal regulation of homeostasis – the entire harmonic ensemble of the human body. The more easily digestible and refined the carbohydrates, the greater the effect on our health, weight, and well-being. 3. Sugars – sucrose and high-fructose corn syrup specifically – are particularly harmful, probably because the combination of fructose and glucose simultaneously elevates insulin levels while overloading the liver with carbohydrates. 4. Through their direct effect on insulin and blood sugar, refined carbohydrates, starches, and sugars are the dietary cause of coronary heart disease and diabetes. They are the most likely dietary causes of cancer, Alzheimer’s disease, and the other chronic diseases of civilization. 5. Obesity is a disorder of excess fat accumulation, not overeating, and not sedentary behaviour. 6. Consuming excess calories does not cause us to grow fatter, any more than it causes a child to grow taller. Expending more energy than we consume does not lead to long-term weight loss; it leads to hunger. 7. Fattening and obesity are caused by an imbalance – a disequilibrium – in the hormonal regulation of adipose tissue and fat metabolism. Fat synthesis and storage exceed the mobilization of fat from the adipose tissue and its subsequent oxidation. We become leaner when the hormonal regulation of the fat tissue reverses this balance. 8. Insulin is the primary regulator of fat storage. When insulin levels are elevated – either chronically or after a meal – we accumulate fat in our fat tissue. When insulin levels fall, we release fat from our fat tissue and use it for fuel. 9. By stimulating insulin secretion, carbohydrates make us fat and ultimately cause obesity. The fewer carbohydrates we consume, the leaner we will be. 10. By driving fat accumulation, carbohydrates also increase hunger and decrease the amount of energy we expend in metabolism and physical activity.” It is on these bases that Taubes suggests that the increase in obesity is, in part, a consequence of the recommendation of a low fat, and hence high sugar diet.  The Diet Delusion [ pp 601] (published in the USA as Good Calories, Bad Calories) Gary Taubes 2008 There is no topic more widely discussed than what one should eat in order to stay healthy. And there are few topics where the evidence is so lacking in quality. It is also a topic that is besieged by gurus, cranks and supplement hucksters. You need to beware of misleading titles. Dietitians are good. Nutritionists are sometimes good. But titles like ‘nutritional therapist’ and ‘nutritional medicine’ are usually warning signs of alternative therapists and/or pill salespeople. Gary Taubes is a journalist, but he is quite an exceptional journalist. His account of the importance of randomisation for the establishment of causality is one of the best ever and it was published not in an academic journal, but in the New York Times [1]. His book, The Diet Delusion, is in the same mould. It is more complete and more scholarly than most professional scientists could manage. Not only does it cover the literature right back to Samuel Johnson, but it is also particularly good at unravelling what one might call the politics of science. And by politics I don’t mean the vast lobbying industry that has built up with the aim of selling you unnecessary supplements, but the politics of academia. Obesity sounds simple. If you are fat it is because you eat too much or exercise too little, right? Well no, it’s not as simple as that. For a start, it has been shown time and time again that low fat diets, and exercise, have small and temporary effects on weight. The problem with diet and health revolves round causality. The law of conservation of energy is an inevitable truth, but says nothing about causality. It could imply that you get fat because you eat too much, or equally the causal arrow could point the other way and “we eat more, move less and have less energy to expend because we are metabolically or hormonally driven to get fat”. The assumption that positive caloric balance is the cause of weight gain has predominated since the 1970s and “this simple misconception has led to a century of misguided obesity research”. At the heart of the problem is the paucity of randomised trials, which are the only way to establish causality. Those that there are have usually shown that diet does not matter as much as we are told. Taubes concludes “It does little good to continue basing public health recommendations and dietary advice on association studies (the Framingham Heart study and the Nurses Health Study are prominent examples) that are incapable of reliably establishing cause and effect.” I think it can certainly be argued that the problem of causality has been greatly underestimated. We are warned constantly of the dangers of processed meat, on the basis of very unconvincing evidence [2]. This is one reason why we still know so little about the causes of obesity, diabetes and heart disease. For Taubes, a major villain was the US nutritionist Ancel Keys (1904 – 2004). His forceful advocacy of the low-fat hypothesis in the early 1970s, was, says Taubes, based on ignoring the many studies that did not agree with the idea. It seems that the sort of citation bias, recently described systematically by Greenberg [3], resulted in great exaggeration of the strength of the evidence. It is quite possible that there was rather more to be said for the Atkins diet than was apparent at the time. The fact that Atkins was not a university scientist, that his views were extreme and that he was so obviously out to make a lot of money from it, gave him all the appearance of being yet another profiteering diet guru. He was dismissed by the medical establishment as a quack. Taubes points out that conflict of interest cuts both ways. Atkins’ sternest critics at Harvard were funded by General Foods, Coca-Cola and the sugar industry. It adds up to a sorry story of a conflict of vested interests and scientific vanity. Taubes’ final judgement is harsh. He quotes Robert Merton’s description [4] of what science is, or should be. “The organization of science operates as a system of institutionalized vigilance, involving competitive cooperation” In such a system, scientists are at the ready to pick apart .and assess each new claim to knowledge. This unending exchange of critical appraisal, of praise and punishment, is developed in science to a degree that makes the monitoring of children’s behavior by their parents seem little more than child’s play". He then comments “The institutionalized vigilance, “this unending exchange of critical judgment”, is nowhere to be found in the study of nutrition, chronic disease, and obesity, and it hasn’t been for decades.” It took Taubes five years to write this book, and he has nothing to sell apart from his ideas. No wonder it is so much better than a scientist can produce. Such is the corruption of science by the cult of managerialism that no university would allow you to spend five years on a book [5]. I find all ten points in his summary convincing. But his most important conclusion is that you cannot have any certainty without randomised trials. The business of nutrition is greatly at fault for not having put more effort into organising randomised trials. Until they are done, we’ll never really know, and we shouldn’t pretend that we do. 1. Taubes G. Do we really know what makes us healthy? New York Times 2007 Sep 16.[full text link] [pdf file] 2. Colquhoun, D. (3 May 2009) Diet and health. What can you believe: or does bacon kill you?. 3. Greenberg, S.A.. 2009 How citation distortions create unfounded authority: analysis of a citation network. BMJ ;339:b2680 [pdf file]. 4. Merton, R. K. Behavior Patterns of Scientists . Leonardo, Vol.3 1970; 3(2):213-220. From Jstor [or pdf file] If length had allowed, there should certainly have been a reference here to Robert Lustig of UCSF. He is an academic nutritionist who supports the main thesis of Taubes’ book. See, for example, his 2005 review, Childhood obesity: behavioral aberration or biochemical drive? Reinterpreting the First Law of Thermodynamics [full text link ]. Lustig’s slide show, The Trouble with Fructose is available in the NIH web site. There are a couple of other articles by Taubes that are well worth reading. The Scientist and the Stairmaster Why most of us believe that exercise makes us thinner—and why we’re wrong. Gary Taubes, in New York Magazine, and We can’t work it out, in the Guardian. You can see Taubes in action on YouTube, for example in “on Cholesterol and Science Practices“, and “on Carbohydrates and Degenerative Diseases“. There is also a video of Taubes on medical grand rounds at Dartmouth-Hitchcock Medical Center in June 2009. You can see Robert Lustig on YouTube too: “Sugar: The Bitter Truth“. ### Follow-up 22 December.2009, Unlike the serious questions dealt with in the Diet Delusion, this concerns merely another bit of the ubiquitous nutribollocks that crops up in the media, While writing this I was listening to the excellent early evening news programme, PM, run by Eddie Mair, when a diet-related topic came up, it was nonsense about how a cocktail made with vodka, cointreau, acai juice and pomegranate juice would not give you a hangover. I suppose it was meant as christmas fun but whenever I hear the words ‘antioxidant‘ or ‘superfood; I feel an email coming on. It seems that Eddie Mair liked the fact that the email contained the words ‘quack’ and ‘codswallop’ because the next thing I knew I was asked to give an interview on next day’s programme. The mp3 is here. Snow on December 18th Roaring fire Lindy contributes acute comments regularly here. She is also an accomplished musician. She has kindly allowed me to post here four of her re-written carols. Adam lay ybounden The Middle English dialect is not easy to follow. In fact Wikipedia reveals that it is oit even standard Middle English, but Macaronic English. The original words are reproduced in the right hand column. The original, sung by choir of King’s College Chapel, is on YouTube.  Atoms lay y’bounden In primordial soup; Six billion years did pass A’fore they could regroup. For first had bin a big bang The universe was shook; Though through milennia For god it was mistook. Then particles of light did shine, ema- -nating from the sun. Out of soup arose archaea And so life was begun. Thanks be to the man This mystery did solve; Through him we celebrate how we Did from the bugs evolve. Adam lay ybounden, Bounden in a bond: Four thousand winter Thought he not too long. And all was for an apple, An appil that he took, As clerkè finden Written in their book. Ne had the apple taken been, The appil taken been, Ne had never our lady Abeen heavenè queen. Blessèd be the time That appil taken was, Therefore we moun singen, Deo gracias! . Hark the Herald Angels sing. This version is for Simon Singh. If you haven’t yet signed the new peition, please do it here. Mark this very dang’rous thing, Story is of Simon Singh. He got chiropractors riled, “Sod it! We have been defiled! Ployful all ye woosters rise, Join us to defend our lies, With us loudly please proclaim, Subluxations are our game” Christ, they all with one accord Took young Simon off to court. “We’ll put you before a judge, Since we always bear a grudge ‘Gainst all those who say our modus Operandi is all bogus; Mark the words of justice Eady, Gave his ruling oh so speedy. Mark the case of Simon Singh With support the web does ring. Ditch draconian libel laws, Without which they’d have no cause To sue those who would speak freely, Truth, opinion-and reason really Should prevail o’er all such things, Surely he his case must win. The Holly and the Ivy Dedicated to the Prince of Wales, certain vice-chancellors and other champions of the endarkenment. The folly and the lies, see How they’ve become full-blown; The braying of th’quackti’tioner Roy- Al, th’enlightenment has flown. Refrain: For deriding all the data (Such stunning stuff we hear)! The displaying of such cherry pick- -Ing, beats bringing in Chi square. The folly hears no critics It makes you quite struck dumb, Just put a poison substance in, And dilute to kingdom come. For deriding all the data etc. The folly so does blossom, Beguiles you with its charm, Just make some movements with your wrist And it will do no harm. For deriding all the data etc. The folly’s given credence If you are qualified With a BSc in pseudosci- -Ence, th’endarkenment is nigh! For deriding all the data etc. The folly bears a burden Now it has fallen down; F.O.I requests and publicity Have giv’n D.C. the crown. For deriding all the data etc. The folly is so fickle, How did they have the gall To tell us how their remedies Were here to treat us all? For deriding all the data etc. The folly and the lies, see How they must surely fail We’ll drink a toast to good evidence And let real science prevail! Alternative refrain: Oh the rising of the Reiki, Of acupuncture too, All Rolfering* and Tuina-ish, They all amount to woo. *The names Rolf and Roger seem remarkably similar in some circumstances so I get a little confused. Merry gentlemen Here is Lindy’s version of "god rest ye merry gentleman", composed in the wake of the admission by the Professional Standards director of Boots the Chemists that they sell homeopathic pills despite being aware of the fact that there is no reason to think they work. I arrest you merry gentlemen, Please kindly step this way. For you are selling sugar pills For which the people pay; We’re from the Trading Standards and through courts we’ll find a way To stop your profit-making ploy, Profiting ploy, We’ll stop your profiteering ploy”! The chemists calmly did defend Themselves though they were riled; “The people do demand these pills Because they’re not defiled With molecules (nor ‘owt at all), despite the claims so wild; We’ll continue our profiteering ploy, Profiting ploy, We’ll continue our profiteering ploy”. So Trading Standards did respond “We understand your aim To make more money, though if you Persist with bogus claim To cure disease with sugar pills, We’ll put you all to shame! We are stopping your profiteering ploy, Profiting ploy, We are stopping your profiteering ploy”. “You breach the regulations by selling pills, you see, Which claim to contain ‘aqua’ (dilute to 30C), Or ‘dolphin song’ or ‘canine testes’ – even ‘ATP’! So you’ll stop all this profiteering ploy, profiting ploy, So you’ll stop all this profiteering ploy”. The Dept of Health bangs on and on About a patient’s choice, But all good people must condemn These lies with one great voice. We dream of days when fibs are gone and we can all rejoice ‘Cos they’ve stopped all their profiteering ploy, Profiting ploy, ‘Cos they’ve stopped all their profiteering ploy It seems very reasonable to suggest that taxpayers have an interest in knowing what is taught in universities. The recent Pittilo report suggested that degrees should be mandatory in Acupuncture, Herbal Medicine and Traditional Chinese Medicine. So it seems natural to ask to see what is actually taught in these degrees, so one can judge whether it protects the public or endangers them. Since universities in the UK receive a great deal of public money, it’s easy. Just request the material under the Freedom of Information Act. Well, uh, it isn’t as simple as that. Every single application that I have made has been refused. After three years of trying, the Information Commissioner eventually supported my appeal to see teaching materials from the Homeopathy "BSc" at the University of Central Lancashire. He ruled that every single objection (apart from one trivial one) offered by the universities was invalid. In particular, it was ruled that univerities were not "commercial" organisations for the purposes of the Act. So problem solved? Not a bit of it. I still haven’t seen any of the materials from the original request because the University of Central Lancashire appealed against the decision and the case of University of Central Lancashire v Information Commissioner is due to be heard on November 3rd, 4th and 5th in Manchester. I’m joined (as lawyers say) as a witness. Watch this space. UCLan is not the exception. It is the rule. I have sought under the Freedom of Information Act, teaching materials from UClan (homeopathy), University of Salford (homeopathy, reflexology and nutritional therapy), University of Westminster (homeopathy, reflexology and nutritional therapy), University of West of England, University of Plymouth and University of East London, University of Wales (chiropractic and nutritional therapy), Robert Gordon University Aberdeen (homeopathy), Napier University Edinburgh (herbalism). In every single case, the request for teaching materials has been refused. And that includes the last three, which were submitted after the decision of the Information Commissioner. They will send things like course validation documents, but these are utterly uninformative box-ticking documents. They say nothing whatsoever about what is actually taught. The fact that I have been able to discover quite a lot about what’s being taught owes nothing whatsoever to the Freedom of Information Act. It is due entirely to the many honest individuals who have sent me teaching materials, often anonymously. We should be grateful to them. Their principles are rather more impressive than those of their principals. Since this started about three years ago, two of the universities, UCLan and Salford, have shut down entry to all of their CAM courses. And Westminster has shut two of them, with more rumoured to be closing soon. They are to be congratulated for that, but is far from being the end of the matter. The Department of Health, and some of the Royal Colleges, have yet to catch up with the universities, The Pittolo report, which recommends making degrees compulsory, is being considered by the Department of Health. The consultation ends on November 2nd: if you haven’t yet responded, please do so now (see how here, and here). A common excuse: the university does not possess teaching materials (yes, really) Several of the universities claim that they cannot send teaching materials, because they have no access to them. This happens when the university has accredited a course that is run by another, privately run, institution. The place that does the actual teaching, being private, is exempt from the Freedom of Information Act. The ludicrous corollary of this excuse is that the university has accredited the course without checking on what is taught, and in some cases without even having seen a timetable. ### The University of Wales In fact the University of Wales doesn’t run courses at all. Like the (near moribund) University of London, it acts as a degree-awarding authority for a lot of Welsh Universities. It also validates a lot of courses in non-university institutions, 34 or so of them in the UK, and others scattered round the world. Many of them are theological colleges. It does seem a bit odd that St Petersburg Christian University, Russia, and International Baptist Theological Seminary, Prague, should be accredited by the University of Wales. The 34 UK institutions include the Scottish School of Herbal Medicine, the Northern College of Acupuncture and the Mctimoney College of Chiropractic. The case of the Nutritional Therapy course has been described already in Another worthless validation: the University of Wales and nutritional therapy. It emerged that the course was run by a grade 1 new-age fantasist. It is worth recapitulating the follow up. What does the University of Wales say? So far, nothing. Last week I sent brief and polite emails to Professor Palastanga and to Professor Clement to try to discover whether it is true that the validation process had indeed missed the fact that the course organiser’s writings had been described as “preposterous, made-up, pseudoscientific nonsense” in the Guardian. So far I have had no reply from the vice-chancellor, but on 26 October I did get an answer from Prof Palastanga.  As regards the two people you asked questions about – J.Young – I personally am not familiar with her book and nobody on the validation panel raised any concerns about it. As for P.Holford similarly there were no concerns expressed about him or his work. In both cases we would have considered their CV’s as presented in the documentation as part of the teaching team. In my experience of conducting degree validations at over 16 UK Universities this is the normal practice of a validation panel. I have to say this reply confirms my worst fears. Validation committees such as this one simply don’t do their duty. They don’t show the curiosity that is needed to discover the facts about the things that they are meant to be judging. How could they not have looked at the book by the very person that they are validating? After all that has been written about Patrick Holford, it is simply mind-boggling that the committee seems to have been quite unaware of any of it. It is yet another example of the harm done to science by an unthinking, box-ticking approach. Incidentally, Professor Nigel Palastanga has now been made Pro Vice-Chancellor (Quality) at the University of Wales and publishes bulletins on quality control. Well well. The McTimoney College of Chiropractic was the subject of my next Freedom of Information request to the University of Wales. The reasons for that are, I guess, obvious. They sent me hundreds of pages of validation documents, Student Handbooks (approx 50 pages), BSc (Hons) Chiropractic Course Document. And so on. Reams of it. The documents mostly are in the range of 40 to 100 pages. Tons of paper, but none of it tells you anyhing whatsover of interest about what’s being taught. They are a testament to the ability of universities to produce endless vacuous prose with very litlle content. They did give me enough information to ask for a sample of the teaching materials on particular topics. But I gor blank refusal, on the grounds that they didn’t possess them. Only McTimoney had them. Their (unusually helpful) Freedom of Information officer replied thus. “The University is entirely clear about the content of the course but the day to day timetabling of teaching sessions is a matter for the institution rather than the University and we do not require or possess timetable information. The Act does not oblige us to request the information but there is no reason you should not approach McTimoney directly on this.” So the university doesn’t know the timetable. It doesn’t know what is taught in lectures, but it is " entirely clear about the content of the course". This response can be described only as truly pathetic. Either this is a laughably crude form of obstruction of my request, or perhaps, even more frighteningly, the university really believes that its endless box-ticking documents actually provide some useful control of quality. Perhaps the latter interpretation is more charitable. After all, the QAA, CHRE, UUK and every HR department share similar delusions about what constitutes quality. Perhaps it is just yet another consequence of having science run largely by people who have never done it and don’t understand it. Validation is a business. The University of Wales validates no fewer than 11,675 courses altogether. Many of these are perfectly ordinary courses in universities in Wales, but they validate 594 courses at non-Welsh accredited institutions, an activity that earned them £5,440,765 in the financial year 2007/8. There’s nothing wrong with that if they did the job properly. In the two cases I’ve looked at, they haven’t done the job properly. They have ticked boxes but they have not looked at what’s being taught or who is teaching it. ### The University of Kingston The University of Kingston offers a “BSc (Hons)” in acupuncture. In view of the fact that the Pittilo group has recommended degrees in acupuncture, there is enormous public interest in what is taught in such degrees, so I asked. They sent the usual boring validation documents and a couple of sample exam papers . The questions were very clinical, and quite beyond the training of acupuncturists. The validation was done by a panel of three, Dr Larry Roberts (Chair, Director of Academic Development, Kingston University), Mr Roger Hill (Accreditation Officer, British Acupuncture Accreditation Board) and Ms Celia Tudor-Evans (Acupuncturist, College of Traditional Acupuncture, Leamington Spa). So nobody with any scientific expertise, and not a word of criticism.  Further to your recent request for information I am writing to advise that the University does not hold the following requested information: (1) Lecture handouts/notes and powerpoint presentations for the following sessions, mentioned in Template 3rd year weekend and weekday course v26Aug2009_LRE1.pdf (a) Skills 17: Representational systems + Colour & Sound ex. Tongue feedback 11 (b) Mental Disease + Epilepsy Pulse feedback 21 (c) 18 Auricular Acupuncture (d) Intro. to Guasha + practice Cupping, moxa practice Tongue feedback 14 (2) I cannot see where the students are taught about research methods and statistics. I would like to see Lecture handouts/notes and PowerPoint presentations for teaching in this area, but the ‘timetables’ that you sent don’t make clear when or if it is taught. The BSc Acupuncture is delivered by a partner college, the College of Integrated Chinese Medicine (CICM), with Kingston University providing validation only. As such, the University does not hold copies of the teaching materials used on this course. In order to obtain copies of the teaching materials required you may wish to contact the College of Integrated Chinese Medicine directly. This completes the University’s response to your information request. So again we see that Kingston has validated the course but has not seen a timetable, far less what is taught. My reply was thus  Yes I am exceedingly unhappy about it. The university attaches its name to the course so it must obviously be able to get the material simply by asking for it (I’m surprised that the university should endorse a course without knowing what is taught on it, but that’s another matter). I request formally that you obtain this material. If necessary please read this as a formal appeal. I await with interest. In every single case so far, the internal review has merely confirmed the initial refusal. It means a bit of a delay before the case goes to the Information Commisssioner’s Office. ### Napier University Edinburgh Napier University runs a "BSc (Hons) Herbal medicine". (brochure here). Since herbal medicine is a subject of the Pittilo recommendations, there is enormous public interest in what they teach. So I asked, under the Freedom of Information (Scotland) Act (2002). They sent quite quickly validation and accreditation documents, some examination papers, timetables and lecture lists. The validation was the usual vacuous box-ticking stuff though it did reveal that the course “made extensive use of techniques such as tongue and pulse diagnosis”, which are well known phoney diagnosis methods, about as much use as a pendulum (as used at Westminster University). As at Kingston University, the exam papers they chose to send were mostly "pretend doctor" stuff. One of them was Discuss the herbal practitioner’s role in the management of IHD [ischaemic heart disease) How one would like to see what the students said, and, even more one would like to see the model answer. Amateurs who try to treat potentially serious conditions are a danger to the public. So then we got to the interesting bit, the request for actual teaching materials.  I have looked at the material that you sent and I’d now like to make the following supplementary request (A) Lecture notes/handouts and powerpoint slides for the following small smaple of lectures HRB09102 Materia Medica 4 (1) Zingiber officinalis, Eleutherococcus senticosus, Valeriana officinalis (2) Gelsemium sempervirens, Cimicifuga racemosa, Datura stramonium, Piscidia erythrina (3) Betula pendula, Capsella bursa-pastoris, Ephedra sinica, Solidago virgaurea Materia Medica 3 HRB08103 (1) Cardiovascular system (2) Nervous system Clinical Medicine and Diagnosis 4 (HRB09104) (1) Neuro-sensory deficits, paraesthesiae, head pain HRB09100 Materia Medica & Herbal Practice Week 7 Compiling a therapeutic plan and prescription building BSc Herbal Medicine : Materia Medica HRB07102 Week 3 History of Herbal Medicine Gothean tasting session Week 10 Energetics the basic concepts Ayurveda Lastly, I can see nowhere in the timetable, lectures that deal with Research methods, clinical trial design and statistics. If such lectures exist, please send notes and powerpoints for them too No prizes for guessing the result Total refusal to send any of them. To make matters worse, the main grounds for refusal were the very "commercial interests" which, after careful legal examination, the Information Commissioner (for England and Wales) had decided were invalid. They say too that "The public interest in withholding the information is greater than the public interest in its release".. It is hard to see how the public interest is served by concealing from the people who pay for the degrees what is taught on degrees that Pittilo wants to make compulsory. [Download the whole response] The matter is now under internal appeal (read the appeal) and eventually we shall find out whether the Scottish Information Commissioner backs the judgement. ### Robert Gordon University Aberdeen This case has particular interest because the Vice-Chancellor of Robert Gordon University is Professor Michael Pittilo, chair of the highly contentious steering group that recommended degress in CAM. Robert Gordon University (RGU) does not teach herbal medicine or acupuncture. But they do run An Introduction to Homeopathy. All the degrees in homeopathy have closed. It is perhaps the daftest and most discredited of all the popular forms of Magic Medicine. But Professor Pittilo thinks it is an appropriate subject to teach in his university. So again I asked for information under the Freedom of Information (Scotland) Act 2002. They sent me quite quckly a list of the powerpoint presentations used on the courses [download it]. I asked for a small sample of the powerpoints. And again the university did not possess them!  I should like to see only the following three powerpoint presentations in the first instance, please. Please can you let me know also who produced the powerpoints. (1) Evidence for homeopathy (2) First aid remedies (3) Allergies I note that you will have to request them but since they are being offered as part of a course offered by RGU, so RGU is responsible for their quality, I presume that this should cause no problem. The request was refused on much the same grounds as used by Napier University. As usual, the internal review just confirmed the initial proposal (but dropped the obviously ludicrous public interest defence). The internal review said “it is mainly the quality of our courses (including course material) and teaching which has given us the position of "the best modern university in Scotland" I am bound to ask, if the university is so proud of its course material, why is it expending so much time and money to prevent anyone from seeing a small sample of it? My appeal has been sent to the Scottish Information Commissioner [download the appeal]. ### What are vice-chancellors thinking about? I find it very difficult to imagine what is going through the heads of vice-chancellors who run courses in mumbo-jumbo. Most of them don’t believe a word of it (though Michael Pittilo might be an exception) yet they foist it on their students. How do they sleep at night? Recently the excellent Joe Collier wrote a nice BMJ blog which applauded the lack of respect for authority in today’s students, Joe Collier says good riddance to old-fashioned respect. I couldn’t resist leaving a comment.  I couldn’t agree more. There is nothing quite so unnerving as being addressed as “Sir”. It is an advantage of age that you realise what second-rate people come to occupy very grand positions. Still odder since, if occasionally they are removed for incompetence, they usually move to an even grander position. I guess that when I was an undergraduate, I found vice-chancellors somewhat imposing. That is, by and large, not a view that survives closer acquaintance. ### Should teaching materials be open to the public? There is only one university in the world that has, as a matter of policy, made all of its teaching material open to the public, that is the Massachusetts Institute of Technology (MIT). I can recommend strongly course 18.06, a wonderful set of lectures on Linear Algebra by Gilbert Strang. (It is also a wonderful demonstration of why blackboards may be better than Powerpoint for subjects like this). Now they are on YouTube too. A lot of other places have made small moves in the same direction, as discussed recently in Times Higher Education, Get it Out in the Open Now the OU is working with other British universities to help them develop and share open course materials. In June, at the celebrations for the 40th anniversary of the OU, Gordon Brown announced funding to establish the Support Centre for Open Resources in Education at the OU, as part of a £7.8 million grant designed to enhance the university’s national role. The funding follows a separate grant of £5.7 million from the Higher Education Funding Council for England for universities across the sector to make thousands of hours of free learning materials available. Much material is available on the web, when individual teachers choose to place it there, but at the same time there is a move in the other direction. In particular, the widespread adoption of Moodle has resulted in a big decrease in openness. Usually you have to be registered on a course to see the material. Even other people in the university can’t see it. I think that is a deplorable development (so, presumably, does HEFCE). ### Conclusion I was told by the Univerity of Kingston that “The course is one which the University has validated and continues to be subject to the University’s quality assurance procedures, such as internal subject reviews, annual monitoring and external examining” The only conclusion to be drawn from this is that “quality arrurance procedures” work about as well in universities as they did in the case of baby Peter. No doubt they were introduced with worthy aims. But in practice they occupy vast amounts of time for armies of bureaucrats, and because the brain does not need to be engaged they end up endorsing utter nonsenes. The system is broken. ### Resistance is futile. You can see a lot of the stuff here It is hard to keep secrets in the internet age. Thanks to many wonderful people who have sent me material. you can see plenty of what is taught, despite the desperate attempts of vice-chancellors to conceal it. Try these links. What is actually taught Chinese medicine -acupuncture gobbledygook revealed http://www.dcscience.net/?p=1950 Consultation opens on the Pittilo report: help top stop the Department of Health making a fool of itself http://www.dcscience.net/?p=2007 Why degrees in Chinese medicine are a danger to patients http://www.dcscience.net/?p=2043 More make-believe from the University of Westminster. This time its Naturopathy http://www.dcscience.net/?p=1812 The last BSc (Hons) Homeopathy closes! But look at what they still teach at Westminster University. http://www.dcscience.net/?p=1329 The opposite of science http://www.dcscience.net/?p=1191 Bad medicine. Barts sinks further into the endarkenment. http://www.dcscience.net/?p=1143 A letter to the Times, and progress at Westminster http://www.dcscience.net/?p=984 Nutritional Fairy Tales from Thames Valley University http://www.dcscience.net/?p=260 Westminster University BSc: amethysts emit high yin energy http://www.dcscience.net/?p=227 References for Pittilo report consultation A very bad report: gamma minus for the vice-chancellor http://www.dcscience.net/?p=235 The Times (blame subeditor for the horrid title) http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article4628938.ece Some follow up on the Times piece http://www.dcscience.net/?p=251 The Health Professions Council breaks its own rules: the result is nonsense http://www.dcscience.net/?p=1284 One month to stop the Department of Health endorsing quackery. The Pittilo questionnaire, http://www.dcscience.net/?p=2310 An excellent submission to the consultation on statutory regulation of alternative medicine (Pittilo report) http://www.dcscience.net/?p=2329 ### Follow-up Two weeks left to stop the Department of Health making a fool of itself. Email your response to tne Pittilo consultation to this email address HRDListening@dh.gsi.gov.uk I’ve had permission to post a submission that has been sent to the Pittilo consultation. The whole document can be downloaded here. I have removed the name of the author. It is written by the person who has made some excellent contributions to this blog under the pseudonym "Allo V Psycho". The document is a model of clarity, and it ends with constructive suggestions for forms of regulation that will, unlike the Pittilo proposals, really protect patients Here is the summary. The full document explains each point in detail.  Executive Summary Statutory regulation lends prestige, but needs to be balanced by a requirement for practitioners to be competent, as is the case for doctors and nurses. Regulation almost exclusively deals with conduct, but the unique risks posed by alternative medicine are not addressed by this. The harms which will arise from licensing practitioners who are not required to show evidence of competence and efficacy are: Harm 1. Misdiagnosis of serious conditions. Alternative practitioners offer to diagnose illnesses without proper training. This can lead to avoidable death, such as treating an ectopic pregnancy with ginger. Harm 2. Withdrawal from treatment. Clients of alternative practitioners risk being encouraged to withdraw from life saving treatments in favours of treatments without evidence, as in the death of baby Gloria Thomas. Harm 3. Harms arising from the nature of the alternative practice, but not covered by the regulatory framework, such as adulterated herbal remedies. Harm 4. Lack of informed consent. If alternative practitioners are not required to study or show evidence of efficacy, how can they inform patients of their options? Harm 5. Equity. Doctors and nurses have to use evidence based methods, but it is proposed that alternative practitioners are not held to this standard. Is this fair? Health Minsters should ask themselves if they advocate withdrawing the requirement for evidence based treatment from doctors and nurses. If not, why not? And if not, why should alternative practitioners be treated differently? Harm 6. Promotion of irrationality. If no evidence of efficacy is required, where do you draw the line? Witch doctoring is a ‘traditional practice’ in communities in the UK, and astrology is used by some herbal healers. Harm 7. Opportunity Costs. If no evidence of efficacy is required of alternative medicine, significant sums will be wasted by individuals and by the NHS. Harm 8. Reputational harms for UK Higher Education. UK Honours Degrees are based on the ability to think critically and to assess evidence. Alternative medicine Degree programmes do not require this. These positions are not compatible. Harm 9. Health care futures. We are making slow but steady progress on health indicators through the use of evidence based methods. Why should the requirement for evidence be abandoned now? Instead, safe regulation of alternative practitioners should be through: The Medicines and Healthcare Products Regulatory Agency The Office of Trading Standards via the Unfair Trading Consumer Protection Regulations, A new Health Advertising Standards Authority, modelled on the successful Cancer Act 1939. The first two recommendations for effective regulation are much the same as mine, but the the third one is interesting. The problem with the Cancer Act (1939), and with the Unfair Trading regulations, is that they are applied very erratically. They are the responsibility of local Trading Standards offices, who have, as a rule, neither the expertise nor the time to enforce them effectively. A Health Advertising Standards Authority could perhaps take over the role of enforcing existing laws. But it should be an authority with teeth. It should have the ability to prosecute. The existing Advertising Standards Authority produces, on the whole, excellent judgements but it is quite ineffective because it can do very little. ### A letter from an acupuncturist I had a remarkable letter recently from someone who actually practises acupuncture. Here are some extracts.  “I very much enjoy reading your Improbable Science blog. It’s great to see good old-fashioned logic being applied incisively to the murk and spin that passes for government “thinking” these days.” “It’s interesting that the British Acupuncture Council are in favour of statutory regulation. The reason is, as you have pointed out, that this will confer a respectability on them, and will be used as a lever to try to get NHS funding for acupuncture. Indeed, the BAcC’s mission statement includes a line “To contribute to the development of healthcare policy both now and in the future”, which is a huge joke when they clearly haven’t got the remotest idea about the issues involved.” “Before anything is decided on statutory regulation, the British Acupuncture Council is trying to get a Royal Charter. If this is achieved, it will be seen as a significant boost to their respectability and, by implication, the validity of state-funded acupuncture. The argument will be that if Physios and O.T.s are Chartered and safe to work in the NHS, then why should Chartered Acupuncturists be treated differently? A postal vote of 2,700 BAcC members is under-way now and they are being urged to vote “yes”. The fact that the Privy Council are even considering it, is surprising when the BAcC does not even meet the requirement that the institution should have a minimum of 5000 members (http://www.privy-council.org.uk/output/Page45.asp). Chartered status is seen as a significant stepping-stone in strengthening their negotiating hand in the run-up to statutory regulation.” “Whatever the efficacy of acupuncture, I would hate to see scarce NHS resources spent on well-meaning, but frequently gormless acupuncturists when there’s no money for the increasing costs of medical technology or proven life-saving pharmaceuticals.” “The fact that universities are handing out a science degree in acupuncture is a testament to how devalued tertiary education has become since my day. An acupuncture degree cannot be called “scientific” in any normal sense of the term. The truth is that most acupuncturists have a poor understanding of the form of TCM taught in P.R.China, and hang on to a confused grasp of oriental concepts mixed in with a bit of New Age philosophy and trendy nutritional/life-coach advice that you see trotted out by journalists in the women’s weeklies. This casual eclectic approach is accompanied by a complete lack of intellectual rigour. My view is that acupuncturists might help people who have not been helped by NHS interventions, but, in my experience, it has very little to do with the application of a proven set of clinical principles (alternative or otherwise). Some patients experience remission of symptoms and I’m sure that is, in part, bound up with the psychosomatic effects of good listening, and non-judgemental kindness. In that respect, the woolly-minded thinking of most traditional acupuncturists doesn’t really matter, they’re relatively harmless and well-meaning, a bit like hair-dressers. But just because you trust your hairdresser, it doesn’t mean hairdressers deserve the Privy Council’s Royal Charter or that they need to be regulated by the government because their clients are somehow supposedly “vulnerable”.” ### Earlier postings on the Pittilo recommendations A very bad report: gamma minus for the vice-chancellor http://www.dcscience.net/?p=235 Article in The Times (blame subeditor for the horrid title) http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article4628938.ece Some follow up on The Times piece http://www.dcscience.net/?p=251 The Health Professions Council breaks its own rules: the result is nonsense http://www.dcscience.net/?p=1284 Chinese medicine -acupuncture gobbledygook revealed http://www.dcscience.net/?p=1950 Consultation opens on the Pittilo report: help top stop the Department of Health making a fool of itself http://www.dcscience.net/?p=2007 Why degrees in Chinese medicine are a danger to patients http://www.dcscience.net/?p=2043 One month to stop the Department of Health endorsing quackery. The Pittilo questionnaire, http://www.dcscience.net/?p=2310 ### Follow-up Jump to follow-up The King’s Fund recently published Assessing complementary practice Building consensus on appropriate research methods [or download pdf]. It is described as being the “Report of an independent advisory group”. I guess everyone knows by now that an “expert report” can be produced to back any view whatsoever simply by choosing the right “experts”, so the first things one does is to see who wrote it. Here they are. • Chair: Professor Dame Carol Black • Harry Cayton, Chief Executive, Council for Healthcare Regulatory Excellence • Professor Adrian Eddleston, then Vice-Chairman, The King’s Fund • Professor George Lewith, Professor of Health Research, Complementary and Integrated Medicine Research Unit, University of Southampton • Professor Stephen Holgate, MRC Clinical Professor of Immunopharmacology, University of Southampton • Professor Richard Lilford, Head of School of Health and Population Sciences, University of Birmingham We see at once two of the best known apologists for alternative medicine, George Lewith (who has appeared here more than once) and Stephen Holgate Harry Cayton is CEO of Council for Healthcare Regulatory Excellence (CHRE) which must be one of the most useless box-ticking quangos in existence. It was the CHRE that praised the General Chiropractic Council (GCC) for the quality of its work. That is the same GCC that is at present trying to cope with 600 or so complaints about the people it is supposed to regulate (not to mention a vast number of complaints to Trading Standards Offices). The GCC must be the prime example of the folly of giving government endorsement to things that don’t work. But the CHRE were not smart enough to spot that little problem. No doubt Mr Cayton did good work for the Alzheimer’s Society. His advocacy of patient’s choice may have helped me personally. But it isn’t obvious to me that he is the least qualified to express an opinion on research methods in anything whatsoever. According to the Guardian he is “BA in English and linguistics from the University of Ulster; diploma in anthropology from the University of Durham; B Phil in philosophy of education from the University of Newcastle.” Adrian Eddlestone is a retired Professor of Medicine. He has been in academic administration since 1983. His sympathy for alternative medicine is demonstrated by the fact that he is also Chair of the General Osteopathic Council, yet another “regulator” that has done nothing to protect the public from false health claims (and which may, soon, find itself in the same sort of trouble as the GCC). Richard Lilford is the only member of the group who has no bias towards alternative medicine and also the only member with expertise in clinical research methods His credentials look impressive, and his publications show how he is the ideal person for this job. I rather liked also his article Stop meddling and let us get on.. He has written about the harm done by postmodernism and relativism, the fellow-travellers of alternative medicine. Most damning of all, Lewith, Eddlestone and Holgate (along with Cyril Chantler, chair of the King’s Fund, and homeopaths, spiritual healers and Karol Sikora) are Foundation Fellows of the Prince of Wales Foundation for Magic Medicine, an organisation that is at the forefront of spreading medical misinformation. I shall refer here to ‘alternative medicine’ rather than ‘complementary medicine’ which is used in the report. It is not right to refer to a treatment as ‘complementary’ until such time as it has been shown to work. The term ‘complementary’ is a euphemism that, like ‘integrative’, is standard among alternative medicine advocates whose greatest wish is to gain respectability. ### The Report The recommendations On page 10 we find a summary of the conclusions. The report identifies five areas of consensus, which together set a framework for moving forward. These are: • the primary importance of controlled trials to assess clinical and cost effectiveness. • the importance of understanding how an intervention works • the value of placebo or non-specific effects • the need for investment and collaboration in creating a sound evidence base • the potential for whole-system evaluation to guide decision-making and subsequent research. The first recommendation is just great. The rest sound to me like the usual excuses for incorporating ineffective treatments into medical practice. Notice the implicit assumption in the fourth point that spending money on research will establish “a sound evidence base". There is a precedent, but it is ignored. A huge omission from the report is that it fails to mention anywhere that a lot of research has already been done. ### Much research has already been done (and failed) The report fails to mention at all the single most important fact in this area. The US National Institutes of Health has spent over a billion dollars on research on alternative medicines, over a period of more than 10 years. It has failed to come up with any effective treatments whatsoever. See, for example Why the National Center for Complementary and Alternative Medicine (NCCAM) Should Be Defunded; Should there be more alternative research?; Integrative baloney @ Yale, and most recently,$2.5B Spent, No Alternative Med Cures found. .

Why did the committee think this irrelevant? I can’t imagine. You guess.

The report says

“This report outlines areas of potential consensus to guide research funders, researchers, commissioners and complementary practitioners in developing and applying a robust evidence base for complementary practice.”

As happens so often, there is implicit in this sentence the assumption that if you spend enough money evidence will emerge. That is precisely contrary to the experence in the USA where spending a billion dollars produced nothing beyond showing that a lot of things we already thought didn’t work were indeed ineffective.

And inevitably, and tragically, NICE’s biggest mistake is invoked.

“It is noteworthy that the evidence is now sufficiently robust for NICE to include acupuncture as a treatment for low back pain.” [p ]

Did the advisory group not read the evidence used (and misinterpeted) by NICE? It seems not. Did the advisory group not read the outcome of NIH-funded studies on acupuncture as summarised by Barker Bausell in his book, Snake Oil Science? Apparently not. It’s hard to know because the report has no references.

George Lewith is quoted [p. 15] as saying “to starve the system of more knowledge means we will continue to make bad decisions”. No doubt he’d like more money for research, but if a billion dollars
in the USA gets no useful result, is Lewith really likely to do better?

### The usual weasel words of the alternative medicine industry are there in abundance

“First, complementary practice often encompasses an intervention (physical treatment or manipulation) as well as the context for that intervention. Context in this setting means both the physical setting for the delivery of care and the therapeutic relationship between practitioner and patient.” [p. 12]

Yes, but ALL medicine involves the context of the treatment. This is no different whether the medicine is alternative or real. The context (or placebo) effect comes as an extra bonus with any sort of treatment.

“We need to acknowledge that much of complementary practice seeks to integrate the positive aspects of placebo and that it needs to be viewed as an integral part of the treatment rather than an aspect that should be isolated and discounted.” [p. 13]

This is interesting. It comes very close (here and elsewhere) to admitting that all you get is a placebo effect, and that this doesn’t matter. This contradicts directly the first recommendation of the House of Lords report (2000).. Both the House of Lords report on Complementary and Alternative Medicine, and the Government’s response to it, 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 crunch comes when the report gets to what we should pay for.

“Should we be prepared to pay for the so-called placebo effect?

The view of the advisory group is that it is appropriate to pay for true placebo (rather than regression to the mean or temporal effects).” [p 24]

Perhaps so, but there is very little discussion of the emormous ethical questions:that this opinion raises:

• How much is one allowed to lie to patients in order to elicit a placebo effect?
• Is is OK if the practitioner believes it is a placebo but gives it anyway?
• Is it OK if the pratitioner believes that it is not a placebo when actually it is?
• Is it OK for practitioners to go degrees taught by people who believe that it is not a placebo when actually it is?

The report fails to face frankly these dilemmas.  The present rather absurd position in which it is considered unethical for a medical practitioner to give a patient a bottle of pink water, but
perfectly acceptable to refer them to a homeopath. There is no sign either of taking into account the cultural poison that is spread by telling people about yin, yang and meridians and such like preposterous made-up mumbo jumbo.  That is part of the cost of endorsing placebos. And just when one thought that believing things because you wished they were true was going out of fashion

Once again we hear a lot about the alleged difficulties posed by research on alternative medicine. These alleged difficulties are, in my view, mostly no more than excuses. There isn’t the slightest
difficulty in testing things like herbal medicine or homeopathy, in a way that preserves all the ‘context’ and the ways of working of homeopaths and herbalists. Anyone who reads the Guardian knows
how to do that.

In the case of acupuncture, great ingenuity has gone into divising controls. The sham and the ‘real’ acupuncture always come out the same. In a non-blind comparison between acupuncture and no acupuncture the latter usually does a bit worse, but the effects are small and transient and entirely compatible with the view that it is a theatrical placebo.

Despite these shortcomings, some of the conclusions [p. 22] are reasonable.

“The public needs more robust evidence to make informed decisions about the use of complementary practice.

Commissioners of public health care need more robust evidence on which to base decisions about expenditure of public money on complementary practice.”

What the report fails to do is to follow this with the obvious conclusion that such evidence is largely missing and that until such time as it is forthcoming there should be no question of the NHS paying for alternative treatments.

Neither should there be any question of giving them official government recognition in the form of ‘statutory regulation’. The folly of doing that is illustrated graphically by the case of chiropractic which is now in deep crisis after inspection of its claims in the wake of the Simon Singh defamation case. Osteopathy will, I expect, suffer the same fate soon.

In the summary on p.12 we see a classical case of the tension

Controlled trials of effectiveness and cost-effectiveness are of primary importance

We recognise that it is the assessment of effectiveness that is of primary importance in reaching a judgement of different practices. Producing robust evidence that something works in practice – that it is effective – should not be held up by the inevitably partial findings and challenged interpretations arising from inquiries into how the intervention works.

The headline sounds impeccable, but directly below it we see a clear statement that we should use treatments before we know whether they work.  “Effectiveness”, in the jargon of the alternative medicine business, simply means that uncontrolled trials are good enough. The bit about “how it works” is another very common red herring raised by alternative medicine people. Anyone who knows anything about pharmacology that knowledge about how any drug works is incomplete and often turns out to be wrong. That doesn’t matter a damn if it performs well in good double-blind randomised controlled trials.

One gets the impression that the whole thing would have been a lot worse without the dose of reality injected by Richard Lilford. He is quoted as a saying

“All the problems that you find in complementary medicine you will encounter in some other kind of treatment … when we stop and think about it… how different is it to any branch of health care – the answer to emerge from our debates is that it may only be a matter of degree.” [p. 17]

I take that to mean that alternative medicine poses problems that are no different from other sorts of treatment. They should be subjected to exactly the same criteria. If they fail (as is usually the case) they should be rejected.  That is exactly right.  The report was intended to produce consensus, but throughout the report, there is a scarcely hidden tension between believers on one side, and Richard Lilford’s impeccable logic on the other.

### Who are the King’s Fund?

The King’s Fund is an organisation that states its aims thus.

“The King’s Fund creates and develops ideas that help shape policy, transform services and bring about behaviour change which improve health care.”

It bills this report on its home page as “New research methods needed to build evidence for the effectiveness of popular complementary therapies”. But in fact the report doesn’t really recommend ‘new research methods’ at all, just that the treatments pass the same tests as any other treatment. And note the term ‘build evidence’.  It carries the suggestion that the evidence will be positive.   Experience in the USA (and to a smaller extent in the UK) suggests that every time some good research is done, the effect is not to ‘build evidence’ but for the evidence to crumble further

If the advice is followed, and the results are largely negative, as has already happened in the USA, the Department of Health would look pretty silly if it had insisted on degrees and on statutory regulation.

The King’s Fund chairman is Sir Cyril Chantler and its Chief Executive is Niall Dickson.  It produces reports, some of which are better than this one. I know it’s hard to take seriously an organisation that wants to “share its vision” withyou, but they are trying.

“The King’s Fund was formed in 1897 as an initiative of the then Prince of Wales to allow for the collection and distribution of funds in support of the hospitals of London. Its initial purpose was to raise money for London’s voluntary hospitals,”

It seems to me that the King’s Fund is far too much too influenced by the present Prince of Wales. He is, no doubt, well-meaning but he has become a major source of medical misinformation and his influence in the Department of Health is deeply unconstitutional.  I was really surprised to see thet Cyril Chantler spoke at the 2009 conference of the Prince of Wales Foundation for Integrated Health, despite having a preview of the sort of make-believe being propagated by other speakers. His talk there struck me as evading all the essential points. Warm, woolly but in the end, a danger to patients. Not only did he uncritically fall for the spin on the word “integrated”, but he also fell for the idea that “statutory regulation” will safeguard patients.

Revelation of what is actually taught on degrees in these subjects shows very clearly that they endanger the public.

But the official mind doesn’t seem ever to look that far. It is happy ticking boxes and writing vacuous managerialese. It lacks curiosity.

### Follow-up

The British Medical Journal published today an editorial which also recommends rebranding of ‘pragmatic’ trials.  No surprise there, because the editorial is written by Hugh MacPherson, senior research fellow, David Peters, professor of integrated healthcare and Catherine Zollman, general practitioner. I find it a liitle odd that the BMJ says “Competing Interests: none. David Peters interest is obvious from his job description. It is less obvious that Hugh MacPherson is an acupuncture enthusiast who publishes mostly in alternative medicine journals. He has written a book with the extraordinary title “Acupuncture Research, Strategies for Establishing an Evidence Base”. The title seems to assume that the evidence base will materialise eventually despite a great deal of work that suggests it won’t. Catherine Zollman is a GP who is into homeopathy as well as acupuncture. All three authors were speakers at the Prince of Wales conference, described at Prince of Wales Foundation for magic medicine: spin on the meaning of ‘integrated’.

The comments that follow the editorial start with an excellent contribution from James Matthew May. His distinction between ‘caring’ and ‘curing’ clarifies beautifully the muddled thinking of the editorial.

Then a comment from DC, If your treatments can’t pass the test, the test must be wrong. It concludes

“At some point a stop has to be put to this continual special pleading. The financial crisis (caused by a quite different group of people who were equally prone to wishful thinking) seems quite a good time to start.”

This post has been translated into Belorussian..

Chinese medicine and herbal medicine are in the news at the moment.  There is a real risk that the government could endorse them by accepting the Pittilo report.

In my view traditional Chinese medicine endangers people.   The proposed ‘regulation’ would do nothing to protect the public.  Quite on the contrary, it would add to the dangers, by giving an official stamp of approval while doing nothing for safety.

The government’s idea of improving safety is to make sure that practitioners are ‘properly trained’.  But it is the qualifications that cause the danger in the first place.  The courses teach ideas that are plain wrong and often really dangerous.

Why have government (and some universities) not noticed this?  That’s easy to see. Governments, quangos and university validation committees simply don’t look.  They tick boxes but never ask what actually goes on.  Here’s some examples of what goes on for them to think about. They show clearly the sort of dangerous rubbish that is taught on some of these ‘degrees’.

These particular slides are from the University of Westminster, but similar courses exist in only too many other places.  Watch this space for more details on courses at Edinburgh Napier University, Middlesex University and the University of East London

Just a lot of old myths. Sheer gobbledygook,

SO much for a couple of centuries of physiology,

It gets worse.

Plain wrong.

Curious indeed.  The fantasy gobbledygook gets worse.

Now it is getting utterly silly. Teaching students that the brain is made of marrow is not just absurd, but desperately dangerous for anyone unlucky (or stupid) enough to go to such a person when they are ill.

Here’s another herbal lecture., and this time the topic is serious. Cancer.

### Herbal approaches for patients with cancer.

I’ve removed the name of the teacher to spare her the acute embarrassment of having these dangerous fantasies revealed.  The fact that she probably believes them is not a sufficient excuse for endangering the public. There is certainly no excuse for the university allowing this stuff to be taught as part of a BSc (Hons).

First get them scared with some bad statistics.

No fuss there about distinguishing incidence, age-standardisation and death rates. And no reference. Perhaps a reference to the simple explanation of statistics at Cancer Research UK might help? Perhaps this slide would have been better (from CDC). Seems there is some mistake in slide 2.

Straight on to a truly disgraceful statement in slide 3

The is outrageous and very possibly illegal under the Cancer Act (1939).  It certainly poses a huge danger to patients.  It is a direct incentive to make illegal, and untrue claims by using weasel words in an attempt to stay just on the right side of the law. But that, of course, is standard practice in alternative medicine,

Slide 11 is mostly meaningless. “Strengthen vitality” sounds good but means nothing. And “enhancing the immune system” is what alternative medicine folks always say when they can think of nothing else. Its meaning is ill-defined and there is no reason to think that any herbs do it.

The idea of a ‘tonic’ was actually quite common in real medicine in the 1950s. The term slowly vanished as it was realised that it was a figment of the imagination. In the fantasy world of alternative medicine, it lives on.

Detoxification, a marketing term not a medical one, has been extensively debunked quite recently.  The use of the word by The Prince of Wales’ company, Duchy Originals recently fell foul of the Advertising Standards Authority, and his herbal ‘remedies’ were zapped by the MHRA (Medicines and Health Regulatory Authority).

And of course the antioxidant myth is a long-disproved hypothesis that has become a mere marketing term.

“Inhibits the recurrence of cancer”!   That sounds terrific. But if it is so good why is it not even mentioned in the two main resources for information about herbs?

In the UK we have the National Library for Health Complementary and Alternative Medicine Specialist Library (NeLCAM), now a part of NHS Evidence.  It was launched in 2006.  The clinical lead was none other than Peter Fisher, clinical director of the Royal London Homeopathic Hospital, and the Queen’s homeopathic physician. The library was developed with the School of Integrated Health at the University of Westminster (where this particular slide was shown to undergraduates). Nobody could accuse these people of being hostile to magic medicine,

It seems odd, then, that NeLCAM does not seem to thnk to think that Centella asiatica, is even worth mentioning.

In the USA we have the National Center for Alternative and Complementary Medicine (NCCAM), an organisation that is so friendly to alternative medicine that it has spent a billion dollars on research in the area, though it has produced not a single good treatment for that vast expenditure. But NCCAM too does not even mention Centella asiatica in its herb list. It does get a mention in Cochrane reviews but only as a cosmetic cream and as an unproven treatment for poor venous circulation in the legs.

What on earth is a “lymph remedy”. Just another marketing term?

especially valuable in the treatment of breast, throat and uterus cancer.

That is a very dramatic claim. It as as though the hapless students were being tutored in doublespeak. What is meant by “especially valuable in the treatment of”? Clearly a desperate patient would interpret those words as meaning that there was at least a chance of a cure. That would be a wicked deception because there isn’t the slightest reason to think it works. Once again there this wondrous cure is not even mentioned in either NELCAM or NCCAM.  Phytolacca is mentioned, as Pokeweed, in Wikipedia but no claims are mentioned even there. And it isn’t mentioned in Cochrane reviews either. The dramatic claims are utterly unfounded.

Ah the mistletoe story, again.

NHS Evidence (NeLCAM) lists three completed assessments. One concludes that more research is needed. Another concludes that “Rigorous trials of mistletoe extracts fail to demonstrate efficacy of this therapy”, and the third says “The evidence from RCTs to support the view that the application of mistletoe extracts has impact on survival or leads to an improved ability to fight cancer or to withstand anticancer treatments is weak”.

NCCAM says of mistletoe

• More than 30 human studies using mistletoe to treat cancer have been done since the early 1960s, but major weaknesses in many of these have raised doubts about their findings (see Question 6).
• Very few bad side effects have been reported from the use of mistletoe extract, though mistletoe plants and berries are poisonous to humans (see Question 7).
• The U.S. Food and Drug Administration (FDA) has not approved mistletoe as a treatment for cancer or any other medical condition (see Question 8).
• The FDA does not allow injectable mistletoe to be imported, sold, or used except for clinical research (see Question 8).

Cochrane reviews lists several reviews of mistletoe with similar conclusions. For example “The evidence from RCTs to support the view that the application of mistletoe extracts has impact on survival or leads to an improved ability to fight cancer or to withstand anticancer treatments is weak”.

Anthroposophy is one of the highest grades of fantasy you can find.  A post on that topic is in the works.

Indicated for cancers  . . . colon/rectal, uterine, breast, lung“. A cure for lung cancer? That, of course, depends on how you interpret the weasel words “indicated for”. Even Wikipedia makes no mention of any claims that Thuja benefits cancer. NHS Evidence (NeLCAM) doesn’t mention Thuja for any indication. Neither does NCCAM. Nor Cochrane reviews. That is not the impression the hapless students of this BSc lecture were given.  In my view suggestions that you can cure lung cancer with this tree are just plain wicked.

Pure snake oil, and not even spelled correctly, Harry Hoxsey’s treatment centres in the USA were closed by court order in the 1950s.

At least this time it is stated that there is no hard evidence to support this brand of snake oil.

More unfounded claims when it says “treated successfully many cancer patients”. No references and no data to support the claim.  It is utterly unfounded and claims to the contrary endanger the public.

Gerson therapy is one of the most notorious and unpleasant of the quack cancer treatments. The Gerson Institute is on San Diego, but their clinics are in Mexico and Hungary. It is illegal in the USA. According to the American Cancer Society you get “a strict low-salt, low-fat, vegetarian diet and drinking juice from about twenty pounds of fresh fruits and vegetables each day. One glass of juice is consumed each hour, thirteen times a day. In addition, patients are given several coffee enemas each day. Various supplements, such as potassium, vitamin B12, pancreatic enzymes, thyroid hormone, and liver extracts, are used to stimulate organ function, particularly of the liver and thyroid.”. At one time you also got several glasses of raw calf liver every day but after infections killed several people] carrot juice was given instead.

Cancer Research UK says “there is no evidence to show that Gerson therapy works as a cure for cancer”, and “The Gerson diet can cause some very serious side effects.” Nobody (except perhaps the Price of Wales) has any belief in this unpleasant, toxic and expensive folk-lore.

Again patients are endangered by teaching this sort of stuff.

And finally, the usual swipe at vaccines. It’s nothing to do with herbalism. but just about every alternative medicine advocate seems to subscribe to the anti-vaccination lobby.. It is almost as though they have an active preference for things that are known to be wrong. They seem to believe that medicine and science are part of an enormous conspiracy to kill everyone.

Perhaps this dangerous propaganda might have been ameliorated if the students had been shown this slide (from a talk by Melinda Wharton).

Click to enlarge

Left to people like this, we would still have smallpox, diphtheria. tetanus and rabies,  Take a look at Vaccine-preventable diseases.

This is the sort of ‘education’ which the Pittilo report wants to make compulsory.

Smallpox in Baltimore, USA, 1939. This man was not vaccinated.

### Conclusion

This selection of slides shows that much of the stuff taught in degrees in herbal medicine poses a real danger to public safety and to public health.

Pittilo’s idea that imposing this sort of miseducation will help safety is obviously and dangerously wrong. The Department of Health must reject the Pittilo recommendations on those grounds.