Here is an interchange of letters from this week’s BMJ. George Lewith says more money should be spent by the government on research on alternative medicine. Well, only if it is spent properly, and that is not what has happened in the past. (Letters here, if you have a subscription.)
In all probability money spent in this way would be money down the drain, just as it has proved to be in the USA. As pointed out by Wallace I. Sampson, M.D., NCCAM has spent almost a billion dollars on research into alternative medicine, and
“. . it has not proved effectiveness for any “alternative” method. It has added evidence of ineffectiveness of some methods that we knew did not work before NCCAM was formed.”
It is a bottomless pit, and there are more promising ways to spend the money.
| George T Lewith,
Reader in Complementary Medicine, University of Southampton
Primary Medical Care, Aldermoor Health Centre, Southampton SO16 5ST Send response to journal:
Re: Valuing Research
| I remain unclear about John Garrow and David Colquhoun’s position with respect to “funding CAM”. Are they suggesting that there should be no funding for CAM research or are they suggesting this embargo should apply to the provision of CAM services within the NHS? If the former, how do they justify this position with respect to the many UK taxpayers who use CAM each year and for whom the government has some obligation to provide information?
Competing interests: None declared
| John S. Garrow,
The Dial House, Rickmansworth, WD3 7DQ Send response to journal:
Re: Taxpayer funding of CAM research
| Dr Lewith wants clarification of my view about public funding of CAM research. It has changed over the last 7 years. In 2000 the House of Lords Select Committee (HLSC)advised the Department of Health to fund research on acupuncture, chiropractic, herbal medicine, homeopathy and osteopathy to see if these therapies were safe, more effective than placebo and good value for money, At the time I supported this decision. However in 2003 it was disclosed that £1.3m had funded 8 research projects, at the Universities of Leeds, Southampton, Bristol, Brunel, Sheffield and York, but none of these were directly testing the safety, efficacy or value-for- money of the main CAM therapies. I noted that these Universities did not have as good a record of research into the efficacy of CAM as Exeter, which had applied but failed to get funding. It was also noticable that the panel awarding the grants tended to work at the funded Universities.
CAM research is not so impoverished as Dr Lewith implies. The onus is now upon the researchers who received £1.3m from the taxpayer, and more from the Foundation for Integrated Health, to tell us what answers they have found to HLSC’s very pertinent questions. Only in the light of these answers can we judge if they deserve further public funding. If initially the Government had an “obligation” to fund CAM research I think the £1.3m discharged it, and now there is an obligation on CAM practitioners to show that they have not misappropriated these funds.
Garrow JS et al. UK government funds CAM research. FACT 8:397-402, 2003
Competing interests: None declared
| David Colquhoun,
Prof of Pharmacology
UCL Send response to journal:
Re: Funding for alternative medicine research
|I agree entirely with John Garrow’s response. A corollary of his analysis is that, if there is to be any more funding for research in alternative medicine, it is essential that the allocation of the money should not be in the hands of alternative medicine people. The reason for that is that past experience has shown that they will give the money to projects that don’t answer the real questions.
If no applications are received that address the proper questions with rigorous experimental design then the money should be clawed back and spent on something that has a better chance of being a real advance.
I am perpetually amazed by the reluctance of advocates of alternative medicine to subject their claims to proper tests. The only interpretation that I can see of this failure is that they themselves believe, deep down, that the tests would be failed. I hope that isn’t the explanation though, because if they were convinced that the tests would fail, it would mean that we are dealing with fraud, not just delusion.
Competing interests: None declared
If you read nothing else on the topic, read Ben Goldacre’s best ever piece, A Kind of Magic? (Guardian, 16 Nov 2007). This started as response to “In defence of homeopathy” in the same newspaper on 13 November. On the same day, the Lancet carried a rather more academic piece by Goldacre “Benefits and Risks of Homeopathy” , The same issue of the Lancet carried a commentary ” Pressure grows against homoeopathy in the UK“, as well as a sadder report, “Homoeopathy booming in India“.
There is going to be plenty of commentary on these pieces. There is one bit of “A Kind of Magic” that is particularly important, and that is about how to do a proper trial. It is one of the most persistent myths of all sorts of quack that, for reasons that are never explained, their particular form of magic is not susceptible to being tested in the normal and well-established way. This is simply not true, and the fact that the myth is repeated again and again is perhaps the best reason to doubt that homeopaths are really genuine in the beliefs that they claim to have. If they were really so confident they would do the tests. But they don’t and won’t. When the government supplied money for doing tests, the money was distributed by a committee of “experts in alternative medicine” (though it beats me how you can be an ‘expert’ in something that isn’t true), all the money was given to projects that were incapable of answering the main question, namely ‘does it work better than placebo?’.
How to do the test
Here is Goldacre’s description of how to do the test. It has been said before, but it must be said again and again. Until homeopaths take this seriously, there is no option but to regard them as frauds.
“You could do a randomised, controlled trial on almost any intervention you wanted to assess: comparing two teaching methods, or two forms of psychotherapy, or two plant-growth boosters – literally anything. The first trial was in the Bible (Daniel 1: 1-16, since you asked) and compared the effect of two different diets on soldiers’ vigour. Doing a trial is not a new or complicated idea, and a pill is the easiest thing to test of all.
Here is a model trial for homeopathy. You take, say, 200 people, and divide them at random into two groups of 100. All of the patients visit their homeopath, they all get a homeopathic prescription at the end (because homeopaths love to prescribe pills even more than doctors) for whatever it is that the homeopath wants to prescribe, and all the patients take their prescription to the homeopathic pharmacy. Every patient can be prescribed something completely different, an “individualised” prescription – it doesn’t matter.
Now here is the twist: one group gets the real homeopathy pills they were prescribed (whatever they were), and the patients in the other group are given fake sugar pills. Crucially, neither the patients, nor the people who meet them in the trial, know who is getting which treatment. ”
Winterson and the Maun Project and AIDS
This particular round of discussion was started by Jeanette Winterson’s “In defence of homeopathy“.
It is an interesting article because, like the whole world of homeopathy, Winterson herself is split between homeopathy as a harmless placebo and homeopathy as a dangerous “treatment” for dangerous diseases. On one hand she claims that she is all for proper anti-retroviral treatment of AIDS, yet at the bottom of the article it says “Jeanette Winterson is donating the fee for this article to the Maun homeopathy project. ” .
“Since 2002, The Maun Homeopathy Clinic has been running free homeopathy outreach clinics in Maun, a fast growing town in the north of Botswana, where over 35% of the people are infected with HIV or AIDS, one of the highest rates in the world.”
Hilary Fairclough, much praised by Winterson for reducing her high temperature with pills that (didn’t contain) any snake venom, describes herself as “clinical director” of the Maun project. She is, of course, qualified in neither science nor medicine, but is registered with the now notorious Society of Homeopaths. The Maun project newsletters have all the usual accounts of amazing cures. They quote
“The homeopaths are so loved here, and at the clinics we see daily miracles.”
Do they really believe in miraculous cures? I’m inexorably reminded of an earlier generation of missionaries who went to Africa, to impose on the poor benighted natives a different brand of irrationality. At least the missionaries did some education too, and didn’t, on the whole, kill people.
The ladies of Devon who contribute their money to this project, rather than proper treatment, are, sadly, contributing to the gentle art of homeopathic killing.
Referring to Goldacre’s article in the Lancet, Winterson says ” where is the scientific sense is saying that because we don’t understand something, even though we can discern its effects, we have to ignore it, scorn it, or suppress it?”. Needless to say, no pharmacologist has ever said anything of the sort. Quite the opposite. Goldacre comments
“The article does not say that, and I should know, because I wrote it. It is not an act of fusty authority, and I claim none: I look about 12, and I’m only a few years out of medical school. “
Winterson’s article goes on about ” boosting the patient’s immune system so they are better able to fight off the opportunistic viruses that follow behind HIV”.
Sorry, but there is not the slightest reason to think the sugar pills do anything whatsoever to the immune system: that is no more than a ritual form of words, a mantra recited by every homeopath.
Winterson also falls for the latest fashion in homeopathic gobbledygook, to describe it as nanopharmacology. It isn’t nano, it’s zero.
She also gives support, though it is intriguingly ambivalent, to the forthcoming conference of the Society of Homepaths, You can download the flyer for this conference, It defies belief. As well as Winterson’s homeopath, Hilary Fairclough, it features Harry van der Zee and Peter Chappell.
“Harry believes that using the [Chappell’s] PC1 remedy, the AIDS epidemic can be called to a halt, and that homeopaths are the ones that can do it. “
Peter Chappell’s web site says (no, really, seriously),
“Right now AIDS in Africa could be significantly ameliorated by a simple tune played on the radio across Africa. Or there is a slower solution using pills, and drops that works very well, but is harder to deliver. ”
“The second creative idea is again is implied by those above, and relates to the ability to deliver healing aurally, instead or orally, so healing downloads and ehealing is possible and practical. Instead of taking pills containing resonance information, you listen to a very short piece of music which contains the same information. “
Just beat that, if you can.
The music is not the download
The music is simply the carrier and alerts you to listen. The download is engrafted on the music by a special process. That is the new technology.
University of Westminster: a new course?
I hope that the University of Westminster is proud of the fact that its degree in homeopathy is recognised by the Society of Homeopaths , who are sponsoring this nonsense. Perhaps the university should consider an advanced third year module in “downloading therapeutic resonance music”.
Andy Lewis’s quackometer “Will Homeopathy and iTunes Cure AIDS?
Nick Cohen “The cranks who swear by citronella oil”
Jeremy Laurance in the Independent (17 Nov) “Homeopathic treatment of Aids attacked by medics“
This was not written by me, but by a homeopath, in an email that has been circulating recently. It comes from the editor of hpathy.com, not one of the bigger players in the homeopathic fantasy business.
Serious panic seems to be setting in.
One amusing aspect is the description of the “huge and systematic campaign”. Actually it’s just a few dozen people who decided it was time to speak up. After all, anyone can understand “the medicine contains no medicine”. And don’t you just love “Those who are organizing this anti-homeopathy campaign have been SO SUCCESSFUL that most homeopaths in UK have seen a 50% drop in their practice in the last 2 years. In fact most of them get to see only 3-4 patients a week.” I hope that is more reliable than most numbers one gets from homeopaths.
Once again we see the ambivalent attitude to the dangerous malaria scam, the “Gentle Art of Homeopathic Killing“. It is that problem that has set the Faculty of Homeopaths and the Society of Homeopaths on opposite sides in internecine warfare.
Here are some excerpts. Download the whole email.
Thanks to a correspondent for alerting me to a medical emergency in France.
You can read the press release here, from Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSAPS, the French equivalent of the MHRA or FDA).
Withdrawal of batches of Gingko biloba and Equisetum arvense
AFSSAPS has been informed by Laboratoires Boiron of an inversion of the labelling of two homeopathic medicaments, The bottles labelled “mother tincture of Gingko biloba” contain mother tincture of Equisetum arvense and vice versa
;. . .
“AFSSAPS has said that this mix-up does not pose any particular risk . . .”
. . .
“Laboratoires Boiron has asked pharmacists who stock these homeopathic medicaments to report, as far as possible, the inversion of labelling to any doctors in their neighbourhood who may have prescribed these items between May and October 2007.”
This gem brings to mind the interchange between Lord Broers and Ms Kate Chatfield of the Society of Homeopaths, as recorded in the minutes of evidence to the Select Committee on Science and Technology .
Q538 Lord Broers: I have a simple, technical question about homeopathy and drugs. Is it possible to distinguish between homeopathic drugs after they have been diluted? Is there any means of distinguishing one from the other?
Ms Chatfield: Only by the label.
You can read a lovely analysis of the views of Kate Chatfield here. She works at the University of Central Lancashire, where she is module leader for what the university, disgracefully, calls a “Bachelor of Science Degree” in Homeopathic Medicine. That is the university that refuses to reveal to the public what it is that they are teaching in these courses. I’m still waiting for the result of my appeal to the Information Commisioner: watch this space.
In contrast, Mike Eslea’s pages on pseudoscience are also from the University of Central Lancashire. They are very well worth reading.
Tnanks to the Breath Spa blog for drawing attention to the Broers – Chatfield interchange, in an excellent posting: ” Discouraging News from the Review of Allergy and Intolerance: Homeopathy Means We Need to Rewrite Textbooks”.
No longer are we just told what to do from the top. Important decisions are preceded by a long period of consultation. That is a wonderful contribution to democracy. Sometimes. But in truth, these consultations are only too often totally sham public relations exercises. Here are a couple of examples. The first is a government consultation, followed by consultations within universities.
Consultations on nuclear power stations
I am not using this example to propose a particular view on muclear power stations, but rather as an example of sham consultation.
The background is this.
The government was obliged to run the “fullest public consultation” ( pdf ) before changing its policy on nuclear power. In 2006 they tried to run one but it was descibed by a high court judge described it as “unfair”, “misleading”, “very seriously flawed” and ” procedurally unfair ” and he ordered them to do the whole thing again. In May 2007 the government announced a new nuclear consultation that would remedy all the
judge’s concerns. It has recently finished.
The government (again) paid a large amount of public money to an organisation called Opinion Leader Research (OLR) to run the consultation. One does not need to go further than their own web site to discover that, as its name suggests, this organisation exists not to discover public opinion but to influence it in whatever direction it is paid (in this case by the government) to do. Here are some of OLR’s own words.
|“Opinion Leader believe that research is an active part of the communications process enhancing the client’s reputation by positioning them as open, engaging, listening and responding.”
“We develop bespoke approaches to help our clients develop clear actionable insights.”
“Opinion Leader draws on the widest range of approaches to design research based solutions to address client challenges. Our work is tailor-made to suit the specific needs of our clients. We continually innovate and develop new approaches and thinking to help our clients achieve their ambitions.”
According to reports of what happened, that is exactly what OLR did. Here is what Channel 4 News said.
“In nine day-long meetings across Britain two weekends ago, nearly a thousand people were shown a series of videos, presentations and handouts – and their opinion on building new nuclear power stations canvassed.
The government got the result it wanted – 44 per cent said power companies should have option of building nuclear, 36 per cent said no. But day before, the environmental group, Greenpeace, along with other green groups, had pulled out, alleging the questions were loaded and the information biased, partial and factually inaccurate.
Greenpeace would say that, you could argue. But, independently, 20 senior academics too have come forward and will be writing to government with similar reservations.
They say the consultations were deliberately skewed by linking nuclear to fears about climate change – because the government knew past research had shown it’s the only way to get people to accept nuclear, albeit reluctantly.”
“In the videos – alternative viewpoints had doom-ridden music in the background. The government’s view was then given against calm, relaxing music. I feel I have been mugged.”
“Not at all a consultation, merely a sleek marketing ploy.”
“I went in with an open mind… myself and others felt we were being misled and manipulated.”
Channel 4 News also spoken to someone involved in the events. They want to remain anonymous but told us “…repeating the government view, on page after page, on videos and in handouts, acted to almost bludgeon it into their heads.”
You can see some of the slides that were used here. One of them reads thus.
“In the context of tackling climate change and ensuring energy security, do you agree or disagree that it would be in the public interest to give energy companies the option of investing in new nuclear power stations?”
One very apt comment on this was
“Guess what, a majority of people agreed, and when you count the “neither agree or disagree” (which will be tacitly taken to mean “go for it now, build build build!”) the figure goes well into an overall majority. You can’t beat a good loaded question to elicit the desired response.
It’s a bit like asking someone allergic to cats: Do you like fluffy kittens, or are you a Nazi?”
Opinion Leader Research. A family affair?
There’s some very interesting background about OLR here.
“According to this morning’s Independent the energy giant EDF has gone on a public relations offensive to promote it’s new reactors in conjunction with another supplier, Areva . They have launched a website with a generic design assessment called EPR Reactor , which is of course perfectly timed with the consultation upon which the Government appears to have already made up it’s mind.
What’s odd (given what you’d exepct the Indy line to be on things like nuclear) is that they don’t mention that Gordon Brown’s brother, Andrew, is the Head of Media Relations at EDF. Unbelievably good timing for a web site though, don’t you think? The Government makes an announcement of a nuclear consultation on Friday and in the space of two days the big boys have designed and completed
a new website to tell everyone all about the wonders of nuclear? They must have been whipping those Indian developers in Bangalore good this weekend.
It’s worth noting as well that they also don’t mention that Brown’s protege, the Secretary of State for Children, Schools and Families, Ed Balls, has a father-in-law, who just happens to be the former Chairman of the Nuclear Industry Association, and is now a non-executive director of the Government quango known as the Nuclear Decommissiong Authority .
If you’re thinking right now “father-in-law?” and “Cooper?” the answer is yes. He is the father of the Minister of State for Housing (attending Cabinet) at the Department for Communities and Local Government, Yvette Cooper. Purely as an aside, you have to love the doublespeak style in the name of the NDA don’t you? It makes it sound like its interests are somehow opposite to the interests of the nuclear industry. “
There is more on this at the Guido Fawkes blog
“Gordon’s pollster Deborah Mattinson sits on the board of Gordon’s think-tank, the Smith Institute. Her relationship with Gordon has been very profitable for her firm, OLR. According to today’s Sunday Telegraph , government contracts totalling some £3 milllion have
come her way. ”
“the taxpayer is paying OLR £153,484.38 for one-day seminars “
“On Saturday 8 events were run across the UK to consult 1,100 people on the future of nuclear power. This was the second time the government had run the consultation. The previous being judged to be “seriously flawed” and “manifestly inadequate and unfair” by the high court. The inadequacies stemmed partly from poor management and a lack of time for people to state their views, but also because leading politicians had publicly made up their mind to support nuclear which critically undermined the consultation.
The same problem rose its head again on Friday when Britain’s leading environmental groups formally withdrew from the second nuclear consultation, citing serious concerns with our new Prime Minister, Gordon Brown telling parliament that a decision to continue with nuclear power had been taken “and that is why the security of our energy supply is best safeguarded by building a new generation of nuclear power stations”. The prime minister qualified his remarks a week later after a warning letter from Greenpeace’s lawyers.
The green groups were also concerned that the “ [consultation] document was full of pro-nuclear opinion masquerading as fact …
This document is fundamentally flawed and cannot form the basis for a full public consultation.” “
Sham consultations in universities
In universities one might hope things would be done better. But sadly, it is not so. We too have become accustomed to sham consultations. In many places, for example Edinburgh, staff have been consulted, but what they say has had little effect. The same has happened at UCL. As a matter of historical record, it is worth giving a very abbreviated account of our own sham consultation.
For two years meetings were held. It was made pretty clear at the outset, what the plans were. Few people had the courage to oppose them in a public meeting. Those who did were largely ignored. Most people didn’t even come to the meetings anyway. Most people cynically, or perhaps just realistically, presumed it would be a waste of time and effort. As a result, the voices of our top scientists were rarely heard, and had little influence.
The next stage was external review. Surely that should provide an independent voice? Four possible plans were put to the external review committee. It was made clear to the external review committee that plan 1 (the least disastrous one) was what “we” preferred, though in fact none of the plans had been agreed or even properly discussed by most of the people who do the research and the teaching. Plan 1 involved removal of all existing departments, with consequent destruction of brand names that, over a long period, have reflected well on the reputation of UCL. The external review obligingly said that plan 1 was OK, though they made one (very important) criticism. They said that the size of the research groups was too big. That criticism was rejected by UCL’s senior management team (SMT). We therefore ended up with precisely what the SMT had put to the external reviewers in the first place. With a fine bit of spin. this is represented as following the advice of the external reviewers.
So far, the whole procedure has born an eerie resemblance to the Blairite idea of what constitutes consultation. But the changes had, according to UCL’s statutes, to be recommended to Council by the Academic Board (which consists of all professors and many non-professorial representatives). That safeguard proved ineffective. At the Academic Board meeting of May 24 2007, the consultation stopped, with jaw-dropping speed. In an item that was not even marked for discussion, Academic Board was persuaded to relinquish its statutory powers, and to leave all future decisions about organisation of the Faculty of Life Sciences to the SMT. After three years of talking, it suddenly became apparent that no opposition would be tolerated. No wonder so few people turned up at the Academic Board meeting on November 7th. What point would there be in going, when all power had already been removed from them?
A report on the meeting of the Academic Board on May 24 was sent to a member of UCL Council (at his request). In the interests of completing the historical record I have now made it available to download (with names removed).
This may seem very odd to people outside the biosciences area, but in recent years a business has grown up that will write a paper for you, on the basis of data supplied by a pharmaceutical company. The person who actually did the writing will usually not appear as an author at all This practice is known as ghost writing.
It is obvious from the last two posts ( here and here ) that ghost writing of papers has became a major menace to science in the clinical world. The authors may have not even seen all of the data, and some “authors” may even not have seen the paper at all. Awareness of the size of the problem has increased, especially since the paper by Healy & Catell (2003) [ download the pdf ] (see also here ).
“a process of changing scientific authorship that could conceivably culminate in a situation in which the dominant figures in therapeutics actually have comparatively little first-hand research experience and few raw data that they can share with others.”
See also “Declaration of Medical Writing Assistance in International Peer-Reviewed Publications”, Wooley et al ., 2006, JAMA, 296, 932 – 3 [get pdf ], and a Professional Ethics Report published by the American Association for the Advancement of Science.
I recently had a conversation with a “medical writer” (don’t bother asking me who, I’m not saying). I’m very grateful that he spoke to me, because this is the sort of information that is usually concealed carefully from public view. He was clearly a person with integrity, but nonetheless what he had to say was quite disturbing. Here are some of the things that I learned.
- So called ‘Medical education agencies’ are also marketing agencies. They give expert advice to industry on how to select information from large clinical studies and how to cut and slice it to generate numerous papers. They advise on ‘publication planning’ and on which journals are best to reinforce particular messages that the companies want to convey.
- Medical writers who are acting as ‘ghost writers’ often interact with clients in the industry and don’t necessarily interact with the proposed academic authors. Opportunities to talk to the authors directly can be very limited and discussions are often mediated by a third party.
- Medical writers often do not see evidence that all authors have approved the submitted manuscript. It is perceived that only the primary author has actually approved the manuscript.
- Even if medical writers are aware of their responsibilities concerning ‘good publication practice’ and publication ethics it can be difficult to persuade clients to adopt all of these practices.
- Often medical writers do not see all of the raw data for a study or publication, they can get pre-selected data or just tables and figures for inclusion in the paper. Medical writers who are relatively inexperienced do not realise that this is not ‘best practice and will prepare a paper without requesting further background data.
- Medical writers can be pressurised by clients to include ambiguous data or marketing terms in manuscripts. When medical writers have problems with clients, support from their employers can be limited as clients are paying the bills. In this context, the ‘client’ is the company who produce the drug, not the people who eventually appear as authors.
- Ghost written papers have a number of authors. Often the most important is the primary author; this can be a selected ‘key opinion leader’ whose reputation is relied on by the company for promotion of the product.
In defence he did say that 99% of those working in the pharmaceutical industry are a pretty decent bunch. They understand that the consequences of manipulating data or employing unethical publication practices, if discovered, can be disastrous for the company and their product.
He also said that unethical publication practices occur regularly in purely academic environments. And in that he is, unfortunately, absolutely right. After all, the business of “medical writing” would not exist at all if senior academics were not willing to attach their names to papers that they have not written, and may well not even have seen all of the data.
Still worse, having been caught out doing that, they may be defended by their vice chancellors rather than condemned. Indeed anyone who dares to mention that it is going on is taking the risk of being fired. There is a shocking example here.
The Corporate Corruption of Higher Education: part 2.
|Scientists are no longer perceived exclusively as guardians of objective truth, but also as smart promoters of their own interests in a media-driven marketplace.
Haerlin & Parr, Nature, 1999, 400, 499.
University of Sheffield and Proctor & Gamble
Dr Aubrey Blumsohn MBBCh, PhD, MSc, BSc(hons), FRCPath was, until 2006, a senior lecturer and honorary consultant in metabolic bone diseases at Sheffield University. He, and his boss, Richard Eastell, were doing a clinical study of a Procter & Gamble Pharmaceuticals (P&G) drug, Actonel (risedronate), The work was funded by Procter & Gamble.
Richard Eastell is Professor of Bone Metabolism, and was Research Dean.
Proctor & Gamble refused, from 2002 onwards, to release the randomisation codes for the trial to the authors whose names appear on the paper. After trying to see the data for years, and getting little support from his employer, Blumsohn subsequently got hold of it in 2005, and then discovered flaws in the analysis provided by P&G’s statistician. P&G wrote papers on which the names of university academics as authors. Blumsohn did the only thing that any honest scientist could do: he went public with his complaint.
The result? Blumsohn has had to leave Sheffield Richard Eastell remains.
Attempts to find out what has been done by the University of Sheffield meet with silence.
Compare and contrast these two extracts (the emphasis is mine).
The first one is from Eastell, Barton, Hannon, Chines, Garnero and Delmas, 2003. (Barton and Chines were employees of Proctor & Gamble, who paid for the study). Read the full paper here
We would like to acknowledge the help of Dr Simon Pack and Lisa Bosch of Procter & Gamble Pharmaceuticals, as well as the help of Oldham Hospital Clinical Chemistry
Department for measuring urinary CTX and creatinine. This study was supported by grants from Procter & Gamble Pharmaceuticals, Inc. (Cincinnati, OH) and Aventis Pharma, Bridgewater, NJ. Employees of Procter & Gamble Pharmaceuticals and Aventis Pharma participated in the design and execution of the study, the analysis of the data, and the preparation of the manuscript. All authors had full access to the data and analyses.
|In the original paper,(1) one of the authors, a statistician working for P&G (IB), had full access to all data. P&G (like most pharmaceutical companies we contacted over this issue)
used the PhRMA guidelines in relation to publication of clinical trial data, and these restrict the release of original data to investigators (http://www.phrma.org/).At the time of writing (2002/03), not all the original authors were given access to the raw data. In 2006, the American Association of Medical Colleges published recommendations regarding access to raw data. These proposed that the sponsor may conduct all the analyses but that the investigators should be able to conduct their own analysis if they deem it to be necessary, and we endorse these recommendations.
“The only thing that we have to watch all the time is our relationship with P&G. Because we are… we have the big Sheffield Centre Grant which is a good source of income, we have got to really watch it. So, the reason why I worry is the network within P&G is like lightning. So if Ian [Barton] is unhappy it goes to Arkadi [Chines, global medical director of P&G Pharmaceuticals] and before we know it, there is an issue, there is a problem.”
Just listen to the audio recording, and weep for academic integrity
More detailed accounts of this story
This is a particularly interesting case because so much information about it is now available. A particularly good edition of the BBC Radio 4 programme, You and Yours, gave a lot of the evidence. Martin Bland. Professor of Medical Statistics at York University, explains that there is actually no evidence for the plateau effect claimed by P&G and by Eastell, an effect which, if real, would allow P&G to claim that Actonel was as good as its Merk rival, Fosomax. Your can read Martin Bland’s report here.
The presenter, Vivienne Parry, concludes
“But, what it very much looks like here is that we have a company buying independent scientific expertise to give its research that veneer of credibility, only for it to withold the data generated from independent scrutiny when the results don’t suit its marketing objectives”.
Blumsohn commented thus.
“Following a protracted period of trying to contact a number of university officials to discuss this problem, I realised that raising of the problem within the university was going to prove impossible. I then engaged a lawyer and very shortly after the university suspended me from my position on the principal grounds of disobeying a supposedly reasonable mangemant instruction by communicating with the media.”
Here are some links..
- BBC Radio 4: You and Yours (2 February, 2006). ” [download realplayer file]
- Investigative Journalist, by Jennifer Washburn gave an excellent account of this whole sorry affair ” Rent-a-Researcher. Did a British university sell out to Procter & Gamble?”. It has links to many of the emails that were sent.
- Observer (4 December 2005) How the drugs giant and a lone academic went to war.
- The Alliance for Human Reserach Protection. An account from this New York-based organisation, “Scientific fraud and corruption” , and an earlier (Nov 2005) report.
- Aubrey Blumsohn’s own account, with original data and links to many sources, Proctor Research Shenanigans
- Freedom to care, “Drug Company’s Pretence“
- The Times Higher Education Supplement published a series of reports on the case. They are available only with a subscription, but click here for the latest,”Expert admits he did not have full access to data“
- A collection of media reports can be seen here.
Many of the emails make you shudder. For example, the following are extracts from an invitation to have a paper ghost-written by the Company that was sent to Eastell and Blumsohn by the company’s statistician (see the whole mail here). The emphasis is mine.
|To: firstname.lastname@example.org, email@example.com
CC: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com
Date: Thu, 24 Apr 2003 14:36:41 +0100
Dear Richard and Aubrey
I wanted to introduce you to one of The Alliance’s external medical writers, Mary Royer.Mary is based in New York and is very familiar with both the risedronate data and our key
messages, in addition to being well clued up on competitor and general osteoporosis publications.. . .. . are you thinking of drafting the publications first and then let Mary take over or would you like Mary to write from the beginning? I’m very flexible. Mary and I have just finished writing a publication with Steven Boonen (Richard you will be contacted as you’re a co-author!) and Mary was involved at the very beginning and wrote from scratch.
If you could let both Mary and I [sic] know how you envisage us all working together that would be extremely helpful.
Why has the University of Sheffield done nothing about it?
It is one thing to find that some individuals are less than honest about reporting research. It is far more serious when the University does nothing about it. On the contrary, Sheffield effectively fired the wrong person, the person who was too honest to go along with the lies. Blumsohn eventually managed to get complete evidence, and indeed Eastell himslef, in the 2007 paper, admits that he’d lied about having complete access to the data. Yet nothing happened when Blumsohn wrote to Eastell, his Dean, his vice-chancellor or his personnel manager (the links show you the letters he sent). Because the university seemed intent on covering-up the wrongdoing, Blumsohn, very properly, did the only think that was left to him, and went to the media (e.g. THES).
This was then used by the university as an excuse to fire him.
Sheffield University has behaved abominably in this matter. And they refuse to say anything about it. After I wrote to the (new) vice-chancellor. Keith Burnett, this is what I got.
|I would like to reassure you that the University of Sheffield takes very seriously its responsibilities in the area of research integrity and always strives to act in a manner that upholds this, in accordance with its reputation.|
What can be done about corruption in universities?
Nature this week (1 Nov 2007) published an editorial, “Who is accountable“. Here are some quotations.
We suggest that journals should require that every manuscript has at least one author per collaborating research group who will go on record in a way that collectively vouches for the paper’s standards. Each would sign a statement with reference to Nature ‘s publication policies
“I have ensured that every author in my research group has seen and approved this manuscript. The data that are presented in the figures and tables were reviewed in raw form, the analysis and statistics applied are appropriate and the figures are accurate representations of the data. Any manipulations of images conform to Nature ‘s guidelines. All journal policies on materials and data sharing, ethical treatment of research subjects, conflicts of interest, biosecurity etc. have been adhered to. I have confidence that all of the conclusions presented are based on accurate
extrapolations from the data collected for this study and that my colleagues listed as co-authors have contributed and deserve the designation ‘author’.”
Misconduct investigators go out of their way to spare anyone apart from the direct perpetrators, but they have indicated concerns over the degree of oversight within collaborations. If the damage to reputations were more widespread in the event of fraud, researchers would be even more fastidious about the data emanating from their labs and the due diligence they would impose. The chances of major frauds, with their disproportionate impact on the reputation of science as a whole, would be diminished.”
Wakefield, MMR and the Royal Free Hospital
This has been written about endlessly. Wakefield’s bad science has resulted in deaths from measles, and the safety of MMR has been investigated very thoroughly.
Again, the odd bad scientist is inevitable. What I would like to have seen investigated more openly is the complicity of the medical school (all this happened, thank heavens, shortly before the Royal Free Hospital Medical School became part of UCL). According to the very thorough investigation by Brian Deer:
“This “finding”, and massive publicity that the Royal Free hospital and medical school encouraged for it [through a press release , video news release and a televised press conference] launched a worldwide scare over the vaccine’s safety, triggering falls in immunisation rates, outbreaks of potentially fatal or disabling diseases, and an epidemic of unwarranted self-recrimination among parents of autistic children. ”
“Although Wakefield had performed no research upon which to credibly base such a recommendation, this attack on MMR had been orchestrated through a 20-minute video news release , prepared weeks in advance and issued to journalists by the Royal Free hospital’s press office. In this video, which doctors knew was likely to cause public alarm, and damage to immunisation rates, Wakefield four times claimed that single shots were likely to be safer than MMR, which he said should be withdrawn by the government. ”
“Unknown to the public prior to the Dispatches investigation, nearly nine months before the press conference, Wakefield and the Royal Free medical school had filed the first in a string of patent applications for extraordinary products which could only have stood any chance of success if MMR’s reputation was damaged. These included, firstly, a single vaccine against measles – a potential competitor to MMR – and, secondly, purported remedies, perhaps even what they bizarrely called a ” complete cure “, for both inflammatory bowel disease and autism. “
May 2005. Eastell was suspended from his NHS post after allegations that he had wrongly charged the health service for lab tests carried out for his university work outside the NHS. He resigned before a verdict could be delivered and thus escaped judgement.
November 2009 Eastell faced a General Medical Council “fitness to practice” hearing. The GMC evidently does not consider that lying in a scientific paper is misconduct (no, really). The hearing said that Eastell’s actions had not been “deliberately misleading or dishonest”, although he may have been negligent in making “untrue” and “misleading” declarations; the council did not make a finding of misconduct.. There is no "may have been", It is in print, in black and white. The GMC were utterly pusillanimous in this case. Another example of a useless regulator.
18 February 2010. A young radiologist in Sheffield, Guirong Jiang, found results which suggested that the field of osteoporosis might be distorted by the over-diagnosis of vertebral fractures (a finding that might reduce the sales of osteoporosis drugs). She was told by Eastell not to publish it. She had to go through disciplinary proceedings. Like Blumsohn, she got no support from the university: quite on the contrary. The university said her actions breached the terms of a 2007 contract with Sanofi-Aventis, an agreement that she had neither seen nor signed.
When universities behave like this it becomes hard to believe anything published by the University of Sheffield.
The Corporate Corruption of Higher Education: part 1
The next post is about examples from the UK.
The problem in the USA came to the fore with the passage of the Bayh-Dole Act (1980). This act allowed universities to patent ‘inventions’ that came from research funded by the taxpayer, and, far worse, allowed them to grant exclusive licences to a single commercial company. Although as originally formulated the act contained safeguards, these were mostly stripped out by the time it was passed. The nominal reason for the Act was “to bring ideas out of the ivory tower and into the market place more quickly”.
Nothing wrong with that of course. But Washburn chronicles how, not only did it fail to fulfil that aim, but corrupted universities as well. In fact with only a handful of exceptions, it did not even generate any large income for the universities. Nevertheless, the Act is still in place.Here are some examples from the USA. Examples from the UK are in a separate post.
Stanford University, Garry Nolan and Rigel Pharmaceuticals
David Zapol went from MIT to be a graduate student in Stanford, in June 1996. At the time he arrived his supervisor, Garry Nolan, set up a company, Rigel Pharmaceuticals Inc. to exploit genomic screening Stanford licensed to technology exclusively to Nolan’s company.
Although the lab was meant to be separate from the Company, that was obviously impossible. Zapol, and fellow student Michael Rothenberg,. were asked by Nolan to work on “proof of concept” for Rigel’s technology. The students found that “I can;t get time with my adviser and he’s completely preoccupied” [with the company]. A year later, Rothenberg came to the lab distraught, and told Zapol he’d been at Rigel’s offices hand had seen their “proof of concept” work shown in a company presentation for investors, with no acknowldegment of their authorship. Only they and Nolan knew about the work.
When I asked Nolan to to respond to Zapol’s allegations concerning Rigel’s misuse of his students’ data, he replied in writing
“I do not have a memory of this event”
The research on which the spin-off company was based was (as so often) still unproven, and the two graduate students found themselves competing with scientists in the (better-finded) company owned by their supervisor. If the latter won, the university graduate students would end up with nothing to publish.
When, in 1997, Rothenberg emailed his supervisor, Nolan, the reply he got was openly threatening
“Please, do not be referring to this situation as ‘Rigel’s inappropriate use of my data without referencing me’ “. “Be careful what you say”
In April 1997, Rothenberg (who worked in the university remember) was warned by an executive of the company, Donald Payan, not to communicate with a colleague in another university who was working in the same area.
“You should know that he is one of the founders of Selectide, a major competitor of ours . . . ” “. The guys here will be less than pleased if the ideas they give you re structures etc . . . end up in the hands of Selectide. Get my drift?”.
Stanford seems to have made few attempts to investigate the matter properly. Both graduate students left (with no peer-reviewed publications). Nolan is still there. Why is this? Stanford University (as well as Nolan) had substantial equity in Rigel (sold in 2000-01 for over $0.9m) and Stanford owned six of Nolan’s patents. What do the careers of two graduate studenst matter when there are big bucks at stake? Not much it seems.
Rigel, incidentally, has yet to produce a useful drug, eleven years after
Washburn’s book has many such examples. What is particularly upsetting about them is, in many cases, not so much the behaviour of greedy or dishonest scientists, but the behaviour of their employers. In any case where much money is at stake, the university fails to defend the honest scientists, but is more interested in its income than in truth. One has come to expect companies to behave in this way. It is a shock to see universities do the same.
GSK, Seroxat and Brown University: academics for hire, a shocking story
BBC TV’s Panorama programme showed the latest investigation of GlaxoSmithKline’s suppression of evidence of side effects of Paroxetine (Seroxat, Paxil). It seems that television journalists and lawyers have been a great deal more effective in unearthing the evidence than the regulatory authorities or the police. The MHRA has been working on the case for three years and has still not produced its report. Read the transcript here .
Lawyers in the USA managed to extract many secret emails from GSK, and they tell a sad story. Since the deregulation of industry that started around 1979 with Ronald Reagan and Margaret Thatcher, one has become accustomed to dishonesty by big business. But academics are involved too GSK organised three large scale clinical trials of Seroxat on children with depression, in the hope of getting Seroxat licensed for this use. The biggest of these is known as ‘Study 329’. It is these trials that have given rise to the charge that GSK tried to suppress evidence that Seroxat caused an increase risk of suicide in young people.
|Martin Keller is chair of psychiatry at Brown University. The evidence found by Panorama also shows that his reputation seems to be for hire. His university home page shows that he holds many influential politicians. It does not mention that in one year he got half a million dollars from drug companies including GSK.In one email Keller thanks a ghost writer who worked for a PR company hired by GSK.
In another mail from the ghost writer to Dr Keller says that all the necessary materials are enclosed so that he can submit study 329 for publication, even down to the covering letter which says: “please re-type on your letterhead. Revise if you wish.”. Perhaps Keller at least checked the results carefully? But it seems not. Keller said
“I’ve reviewed data analytic tables, I don’t recall how raw it was. The huge printouts that list items by item number.. you know, item umbers, invariable numbers and don’t even have words on ’em. I tend not to look at those. I do better with words than I do with symbols.”
The BBC reporter , Shelley Jofre, comments “Inside GSK, though, the discussion was all about what a failure study 329 had been. This is what another of its PR people wrote when asked if the journal article would be publicised.” “Originally we had planned to do extensive media relations surrounding this study until we actually viewed the results. Essentially the study did not really show it was effective in treating adolescent depression which is not something we want to publicise.” [Email dated: 5th March 2001]
This is bad as any quackery, and the collusion of academics is very sad.
Brown University does not appear to have learned the lesson. The news section on their web site boasts of this ghost written work
“The largest clinical trial studying the use of antidepressants for treating major depression in adolescents suggests that paroxetine, sold under the brand name Paxil, may be successful.
“This is the first substantial evidence of a safe and effective treatment with an antidepressant for adolescents,” said Martin B. Keller, M.D., who led the study, which appears in the July issue of the Journal of the Academy of Child and Adolescent Psychiatry .”
Fiona Godlee , editor of the British Medical Journal, spoke on the programme. She had spotted the problems with the paper and declined to publish it. She comments “Another journal had peer reviewers who also spotted a number of the problems but the paper was published nonetheless relatively unchanged, and I think the journal must take some responsibility for that.”The editor of the ‘other journal’ ( Journal of the Academy of Child and Adolescent Psychiatry ) expressed no regrets.
See also “Ghost Authorship in Industry-Initiated Randomised Trials” by Gotzsche et al. ( PLOS Medicine 2007 ), and the commentary by Wagner , “Authors, Ghosts, Damned Lies, and Statisticians”. The latter concludes
“perhaps we should now admit that there are four types of lie: lies, damned lies, statistics, and the authorship lists of scientific papers, and that statisticians may be able to help prevent both the third and fourth types.”.
Remember Kate Birch? She was the homeopath who was caught out recommending homeopathic treatment for malarie prevention (“Homeopathy is more effective that any western medication”). Still worse she advocated homeopathic cures for malaria at a clinic in Tanzania”.
The follow up to that outrageously wicked claim is posted here.
Imagine my amazement when Kate Birch knocked on my door on the morning of October 16th. Like most of the homeopaths I have met, she was earnest and rather charming. She was also, I have to say, on the high end of the delusional scale. The good thing is that she was kind enough to present me with a copy of her book,
Vaccine Free – Prevention and Treatment of Infectious Contagious Diseases with homeopathy . She seemed genuinely to think that if I read the book carefully. I would be persuaded that she was right. That is the book that first attracted the attention of a correspondent. I would not have been willing to pay £25 to buy it, but I am certainly be grateful to have the chance to quote a few passages from it.
One curious thing about the book is that the disease descriptions are given in straightforward standard scientific language. But that approach is quite inconsistent with the letter I got from North American Society of Homeopaths (NASH), which said
“NASH does not have a policy on the treatment of any disease category, in accordance with the tenet that homeopathy treats the whole person based on characteristic symptoms rather than a diagnosis.”
The claims to be able to cure serious diseases are also quite at odds with NASH’s Standards of Practice Guidelines which say
“Do not claim that you can treat any disease, condition or ailment or imply that you can do so.
Be extremely careful when speaking or writing about the treatment of particular diseases or conditions (and never offer or claim to help anybody). “
Yet Kate Birch is vice president of NASH. That organisation seems to be as much in chaos. and just as incapable of controlling irresponsible behaviour of its members, as its UK equivalent. The Society of Homeopaths.
Here are a few quotations.
“Curative action of the [hoemopathic] remedy depends on the degree of neurological involvement. Remedies given at the same time as the bite will act preventatively for the condition. If the mental state is strong, the appropriate remedy will help resolve it in the days following administration”
That reads to me like a claim that sugar pills will cure rabies (or is the insertion of the word “help” the getout?).
“Remedies given at the time of injury will reduce the susceptibilty to developing tetanus”.
“Gelsemium. This remedy is useful in early treatment with polio paralysis“. What does “useful” mean if it does not mean cure?
“Diphtherinum . . . As a preventive in an epidemic, this remedy can be administered in a 200C potency once per week”.
Measles and German Measles
“The best prevention for both diseases is the homeopathic remedy Pulsatilla nigricans . . . If you are aware of being exposed, 30C daily for 7 days should be sufficient to subvert the disease.”
“Moreover, in the event of terrorist activity, may become prevalent once again. If this situation were to arise, there would be a need for and opportunity to use homeopathy in this area of public health.”
“The [homeopathic] remedies listed below will be useful for the treatment of the disease and for ailments from the vaccination”
“Homeopathy bases its prescriptions on the nature of symptoms. Because the disease progresses rapidly to death it is important commence treatment quickly and to monitor the recovery. Homeopathy can be used in addition to antibiotics if the case warrents.” Oops there seems to be a momentary touch of realism in that last sentence.
“Vipera, the homeopathic preparation of the snake venom, is useful for prevention and treatment.”
“As the person’s health deteriorates, and the tuberculosis becomes active, remedies such as Ferrum metallicum, Phosphorus, Stannum, Iodium, Kali carbonicum, or any of the remedies listed below may be more indicated to return the person to health”. See more on tuberculosis here
Hepatitis A, B and C
“In the homeopathic treatement of the acute form of hepatitis A, one would expect results within a few days to weeks of the correct homeopathic remedy.”
“Homeopathy has been used succesfully around the world to treat and prevent Dengue fever.”
The list goes on an on. I am grateful to Kate Birch for giving me a copy of this book. Sincere she may be, but the advice given is, in my view a danger to humanity. This stuff leaves the Society of Homeopaths in the shade.
Many people now have written about the disgraceful and dangerous claims by homeopaths to be able to prevent and cure malaria. My contribution was “Homeopathic ‘cures. for malaria: a wicked scam”
One of the best contributions was on the Quackometer blog, The Gentle Art of Homeopathic Killing.
But the post vanished at midday on Thursday 11 October. Quackometer’s ISP has received threatening letters sent by lawyers on behalf of the Society of Homeopaths, who claim that the truth is defamatory, while being unwilling to say which statements are wrong. These threats have forced the removal of the post (for the moment), though you can still read it from the Google cache. And a lot of other places too.
.. . .
At the very least, we could expect the Society of Homeopaths to try to stamp out this wicked practice? Could we?
OK it’s fun to see the fantasy world of homeopaths riven by their internecine squabbles, but this is a serious matter.The Society of Homeopath’s substitute for answering reasonable questions is to try to suppress legitimate comment by brute (legal) force. It is hard to imagine such cowardly behaviour. I fear, though, that they may be in for a big surprise.Watch this space for developments.
The storm begins.
Within 24 hours of the post being removed, it has sprung up again, all over the world. These are just the links that reproduce the whole text. Countless more refer to them.
Andrew Clegg lends support: “A run-in with the Homeopathic Thought Police”. He reproduces the banished page.
And on Google groups in several places, for example here.
Another reproduction of the whole banished page at A day at the pharmacy (“from a provincial, small-town pharmacy in the United Kingdom”).
A mirror of the whole original page has appeared at semiskimmed.net
and “The Gentle Art of Homeopathic Killing (Cowards and Bullies)” appeared on JDC325’s weblog.
Another at badchemist.net.
Very soon it appeared in the USA too
Orac’s Respectful Insolence site: “Homeopathic thuggery”. The Yale surgeeon/scientist has also reproduced the full text.
The whole banned page is at skepticaldog.com too.
The whole text is on the NNSEEK news group search engine too.
And in Russia
The whole text is here.
And all this within 24 hours since the page was pulled. The lawyers for the Society of Homeopaths are going to be very busy.
They keep coming. More full texts here.
Some are so anonymous that you can’t even be sure which country they come from, though often the US ones are distinguishable because the link mainly to US sources. Now Saturday.
- The Voyage. A blog from Ireland “Big Altie Gags the Truth, or tries to”.
- White coat underground. A doctor from the US midwest speaks out.
- Science after Sunclipse. An east coast US blog “for math, physics and the New Enlightenment”
- Conspiracy Factory. Factition’s blog: “Homeopathy, Malaria & Free Speech”.
- The Bronze Blog. “Big Altie attempts to suppress truth”. A very anonymous US blog.
- Infophilia. The Streisand Effect. From Arlington Heights, Illinois,USA.
- HappyJihad’s House of Pancakes. Another anonymous US blog, with full text.
- The GAS blog
- Skeptico. Another site from USA.
- Be Lambic or Green. From Canada (I think)
That’s 25 reproductions of the page so far. Now Sunday 14 Oct,
- Nana’s Notions. Blog from a US accountant.
- A Night on the Tiles. From Stew who works in a tile factory in France.
- Powerup. From Tyler DiPietro, a student in New England, USA.
- Unfiltered Perception. blog.tjomlid.com, from a young Norwegian.
- Action Skeptics. “Kick my ass. Society of Homepaths”, From Indiana, USA.
- bankrupt artist v3. Nice version from Canada
- Sceptiphrenia . Another from the UK.
- Thinking is Dangerous. “Be shamed, Society of Homeopaths”, for Dr T, UK.
- Rants and Raves, From Kulvinder Singh Matharu. “Homeopathy; Failure of truth and integrity (again)”.
On Sunday night, for the first time, one of them comes up on the first page of Google search for “The Society of Homeopaths”
More on Monday 15 Oct. Now five of the first ten hits on a Google search for “The Society of Homeopaths” refer to this row.
- Skeptix, The Central Alberta Skeptics Association.
- No Nonsense. “Society of Homeopathetics – censoring unfavorable comment!”. From Italy?
- The Millenium Project, From Australia. “The constant misspelling of the word “millennium” with only one “n” inspired me to create a millenium – that is, a collection of a thousand arseholes.”
- Rich Speaks. From Richer Lockwood, UK.
And from Tuesday onwards, they kept coming.
- A rather fine rant from Song, by Toad. “The Gentle Art of Homeopathic Killing – Fuck You, Society of Homeopaths”
- EnoNomi. Another complete text, from Phoenix Arizona
- D-notice: homeopathic killing. From London
- The Macho Response. From Oakland California
- Ordinarygirl. “Homeopaths censor blogger” from Kansas, USA.
- Tabasco da Gama From USA “Society of Homeopaths thug tactics”
- Planet Atheism
- Blogher. A curious on from US. The full text has been posted as a comment on a pro-homeopathy site.
- Dikki’s diatribe. Another from AUSTRALIA.
- Freeborn John. Internet censorship again
- Skeptobot. A UK PhD student
- And, at last, James Randi (with comments)
- Skeptigator Another US one
- Bishop Hill From “an Englisman lvining in rural Scotland”
- Counterknowledge. “This you have to read”. From UK writers.
- Ministry of Truth. “Shades of Uzmanov”
- The Wardman Wire. “Society of Homeopaths are doing an Usmanov”.
- Mike Powers. “Not just fat oligarchs” (another allusion to the Usmanov affair).
- Aharonic.net. Art and culture.
- Amused cynicism. From “a computer programmer living in north west Europe”.
- Chicken Yoghurt. from Justin McKeating. “The Usmanov strain -mutating”
- The Devil’s Kitchen. “Homeopathic, sociopathic, psychopathic”.
- Starshun.com. “Society of Homeopaths threaten blogger”
That’s 64 now, from UK, USA, Russia, Canada, France, Norway and Australia. And still counting. The story is now reaching the political blogs too.
On the morning of 25 October, six of the first ten links ona Google search fot the “The Society of Homeopaths” led to re-postings of “The Gentle Art of Homeopathic Killing”.
By 1st November, all the Google front page links apart fron the first two pointed to sceptical sites (one was to the BBC’s “Homeopathy’s Benefit Questioned“, the rest to harder-hitting criticism).
More from quackometer
“You Very Naughty Girls and Boys.” Tut tut, look at al those postings!
“The Society of Homeopaths: Truth Matters” A follow up on recent events. In particular, a letter that the Society of Homeopaths wanted to publish is demolished.
Two definitions of lawyers
Dice, n. Small polka-dotted cubes of ivory, constructed like a lawyer to lie on any side, but commonly the wrong one. [Bierce, Ambrose, The Enlarged Devil’s Dictionary, 1967]
The duty of an advocate is to take fees, and in return for those fees to display to the utmost advantage whatsoever falshoods the solicitor has put into his brief. [Bentham, Jeremy, The Elements of the art of packing as applied to special juries, 1821]
You know those silly e-petitions on the 10 Downing Street site?
Not only do they give you a spurious feeling that you are being listened to, but they are now being hijacked for surreptitious free advertising.
Just for a laugh, why not go to sign this one, at http://petitions.pm.gov.uk/health-claims/#detail
We the undersigned petition the Prime Minister to deplore the
use of e-petitions to generate free publicity for unproven
I am concerned to see petitions calling for as yet unproven
medical treatments to be made available on the NHS, e.g.
|A paper published in the Postgraduate Medical Journal, October 2007, has been reported widely. In the same issue there was a commentary by Edzard Ernst. They show the astonishingly poor evidence than herbal treatments work, despite the fact that they have been around for thousands of years. They looked at 1330 published trials on herbal medicines and found 3 (yes three) that stood up to scrutiny, Of those three, two were negative and one indecisive||
Red clover, Derwentwater.
A systematic review of randomised clinical trials of individualised herbal medicine in any indication, R. Guo, P. H. Canter, and E. Ernst, Postgrad Med J 83: 633-637 [Get the reprint]
Herbal medicine: buy one get two free, E. Ernst, Postgrad Med J 83: 615-617 [get the reprint]
Grab the reprints before I am told to remove them.
The paper says
“Systematic searches of electronic databases and contacting
experts and professional bodies in the field resulted in the
location of only three randomised clinical trials of individualised
herbal medicine. It should be stressed that professional
bodies representing the interests of different practitioner
factions from around the world were unable to contribute any
more studies than this. In view of the long history and
widespread use of medical herbalism, Chinese herbal medicine
and Ayurvedic herbal medicine in many and diverse indications,
this should be a cause for concern. It indicates that
individualised herbal medicine has an extremely sparse
evidence base and that there is no convincing evidence
supporting its use in any indication.”
“More and more people are turning to herbal medicine as a kinder alternative to mainstream medicine, with its over reliance on pharmaceutical products.”
Wrong. Herbal medicines are pharmaceutical products. They are just unstandardised, and often impure and contaminated, pharmaceutical products.
“Ann Walker, director of the British Herbal Medicines Association, insisted that most herbalists were well-trained and knew when to refer patients. She said herbalists took a three or four-year degree course before accreditation.
She acknowledged the lack of proof of efficacy for individualised herbal medicine. “The evidence is scanty because the studies have only recently been started,” she said. This did not mean there was no efficacy.”
Just a thought: shouldn’t you have some evidence that they work before you start selling them? These things have been around for thousands of years but the “studies have only recently been started”. You couldn’t make it up. You can’t have a high level of training if there is no evidence. The paucity of trials makes it very hard to know how you can fill up a three or four year course with anything but idle speculations. Universities should not being giving degrees in idle speculation.
Quote of the day. . Of all the pathetic defences offered by herbalists, this one, quoted in the Daily Mail, is my favourite.
“Jane Gray, of the National Institute of Medical Herbalists, said: “We would challenge the conclusions reached by this study based on such little data.”
“We want more research, but we’re all in private practice and cannot afford to stop earning to run a trial over several months.”
The fact that there is “so little data” is the conclusion. And perish the thought that a herbalist should “stop earning” just in order to find out whether what they are selling does any good.
The regulation scam
Alison Denham, speaking for the National Institute of Medical Herbalists, is quoted as saying
“But there are certainly issues around the expertise of practitioners which need to be addressed, and we look forward to government regulation which imposes a high standard of training on anyone who wants to register.”
Like all forms of alternative medicine, herbalists are desperate for government “regulation” because they know it gives the appearance of official approval without requiring them to show that they can do the slightest good.
Reports on this paper
The BBC web site: “Tailored herbal medicine ‘futile'”.
The Guardian report, by Sarah Boseley, is pretty good. “Herbalists’ cocktails may do more harm than good, say researchers.”
- Call for individualised remedies to be banned
- Little evidence to support claims of efficacy
The Times has another excellent report by Nigel Hawkes. “High street herbalists can offer no evidence that their remedies work”
The Independent. “Natural medicine on trial: The trouble with herbs. Traditional herbal remedies have never been more fashionable: sales have almost doubled in eight years. There’s just one problem: science suggests that they don’t work.”. This time Jeremy Laurance got the headline right (unlike the acupuncture piece). But where did that list of “Herbal remedies that work” at the end come from? Had he checked the Cochrane Reviews? I think not.
The Daily Mail. “Herb cures that ‘do you more harm than good’ “. Pretty good report. specially for the Daily Mail.
The Scotsman. “A natural cure?” Lyndsay Moss. Sadly, and unusually, this is the only really poor report. Just look at the end of it.
On Saturday morning (6 October) I did an interview on the Dublin radio station, Newstalk. The host, Brendan O’Brien spoke also to Mary Plunkett, from the Professional Register of Traditional Chinese Medicine. She assured us that that, although there may be no evidence that it works published in the West, there were lots written in Chinese. What a pity that I had not yet read Ben Goldacre’s column, on this week’s bad news for herbalists. He cited a reference that was new to me.
You can read the abstract here. [download pdf]. The paper, by Vickers, Niraj, Goyal, Harland and Rees (1998, Controlled Clinical Trials, 19, 159-166) has the title “Do Certain Countries Produce Only Positive Results? A Systematic Review of Controlled Trials”. The conclusion is riveting.
“In the study of acupuncture trials, 252 of 1085 abstracts met the inclusion criteria. Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR. In studies that examined interventions other than acupuncture, 405 of 1100 abstracts met the inclusion criteria. Of trials published in England, 75% gave the test treatment as superior to control. The results for China, Japan, Russia/USSR, and Taiwan were 99%, 89%, 97%, and 95%, respectively. No trial published in China or Russia/USSR found a test treatment to be ineffective.”
The British Medical Journal ran an article on “doctor bloggers” last week.
Photo ©Mark Thomas
The BMJ put the article behind a paywall, but you can download a reprint here.
Oops, no you can’t. The BMJ have dictated that their piece on bloggers should not be available to bloggers. If you want a copy, email me. The question of availability is more interesting than the article itself anyway. It is by a journalist, Rebecca Coombes. Contrary to what you might think from reading it, I have never met her. She asked for opinions by email, so I spent a while writing something out, which she cut and pasted into an article (and I spent another hour with their photographer, Mark Thomas, who took a lot of pictures). But I can’t use either the article or the photos freely. I don’t even get paid. The commercial journals, as always, do pretty well out of exploiting academics.
|The picture at the top should have been Ben Goldacre, whose badscience.net is now number two in the world. That picture prompted the child of a friend to ask if I was doing an impression of a velocirapter, I guess that is one better that gimpyblog’s perception of me as being a dead ringer for some computer game thug.
So here is another one (possibly no less scary).
Photo Â©Mark Thomas
By way of compensation, here is a picture of Goldacre.
Science writer award 2005
“. . . blogs are popular because they are more honest than other media. It is hard to get away with misrepresenting stuff when the original source is but a click away. I see it as a way of making conversation public. What is good about it is you get unmediated expertise.”
“In the press it’s hard to know what is true. But with blogs people can link directly to the original source: this never happens in a newspaper.”
“I think they [blogs] have really had some success in spreading public understanding of science and even in influencing public affairs (firstly with the merger [of Imperial and UCL] and more recently with withdrawal of NHS funding for homoeopathy). My own research is on the stochastic properties of single ion channels. I love it, but it is specialist and of zero interest to the public. So it’s fun to talk about things that do interest the public. It’s also fun to be able to influence politicians and vice chancellors, though that is rather harder.”
|At a meeting of the West Kent PCT board, on 27 September 2007, it was decided
to withdraw all funding for homeopathy from the end of this financial year. This means the end for the Tunbridge Wells Homeopathic Hospital..
Congratulations to Dr James Thallon (Medical Director of the West Kent PCT) who done a good job for patients in his area by ensuring that NHS money is well spent. He appeared briefly on Channel 4 News to explain that if the cost of the Hospital were saved, a lot of patients would be able to benefit from the latest treatments.
The announcement of intention to withdraw NHS funding was followed by a public consultation. But the supporters of homeopathy could muster only 6273 votes and they were spread over four petitions (we shall never know how many people signed all four). A web site for the supporters of the homeopathic hospital has a movie of their town centre demonstration. The numbers there were less than overwhelming, though they were led by a rather fine piper.
The local MP, Greg Clark (Cons, Tunbridge Wells) made a short speech, but sounded, it must be said, less than convinced. He is an MP better known for his support for nuclear missiles.
At 08.30, the morning talk show on BBC Radio Kent that preceded the meeting had a discussion about the homeopathic hospital. If you can stand talk shows, listen here (a London homeopath, DC and Sally Penrose from British Homeopathic Association). The first speaker says “someone even called it crackpot medicine”. Ahem. Could that have been me?
Who owns the Homeopathic Hospital?
You might expect to be able to find out from NHS Choices, but that site is unhelpful (how does the Department of Health manage it?). Here is the information that I have.
The Tunbridge Wells Homeopathic Hospital building is owned by the Mental Health Trust. The building houses three services. (1) The homeopaths, who are owned by Maidstone Tunbridge Wells (MTW) Acute Trust, (2) a child and adolescent mental health service CAMHS, which is owned by the Mental Health Trust, and (3) Community Paediatrics which owned by W Kent PCT. It will be for MTW as provider to decide if they want to close the department in the light of the commissioning decision but if they did then the building itself would continue to house medical services though not the Department of Homeopathy.
Follow up in the press
BBC News 24 had a short report.
The Times said ” Patients will no longer be able to receive homoeopathy treatments at a specialist hospital because they are a waste of money and do not work, an NHS trust said. ”
The final outcome
According to a report in the local newspaper, a year later it is, at last happening. Peter Fisher of the Royal London Homeopathic Hospital said
“Of course homeopathy needs more research, but so do many areas of conventional medicine – without these NHS hospitals, this research won’t get done.”
The first part might be true, but the second is fantasy. The hospital did not produce a shred of good research. The report goes on.
“The PCT originally decided to withdraw funding for homeopathy – which costs the trust £200,000-a-year for 750 patients – last September, but the decision was challenged by patients through a judicial review which proved unsuccessful and led to the final decision being made last week.
Current patients will finish their treatment over the next eight months but the PCT will not pay for further routine homeopathic consultations or treatments after the end of March next year.”
Back pain is a big problem, and Ben Goldacre has already written about the new study
The German Acupuncture Trials (GERAC) for chronic low back pain
Randomized. Multicenter, Blinded, Parallel-Group Trial wth 3 groups.
Sadly, the Journal of the American Medical Association have told me to remove the link to the original paper, so if you want to know more about it, email me. There is something rather irresponsible in the way journals promote papers to the media, but then deny the public the right to see the original work.
There has been a real orgy of bad science reporting about this interesting paper The main conclusion is that both sham acupuncture and ‘real’ acupuncture have essentially the same effectiveness in reducing back pain. Both the real and the sham treatment came out better than the group given ‘conventional therapy’ (a combination of drugs, physical therapy, and exercise).
Perhaps it isn’t surprising that many of the headlines in the press were misleading. So was the press release for the journal, which had the title “Acupuncture Treatment May Be More Effective Than Conventional Therapy In Treating Lower Back Pain, German Study Finds “. The bad journalism can be blamed in part by the self-promotion of journals, as so often.
My first take on what this means is
- a theatrical treatment can have a strong placebo effect, or any old prick produces a long lasting physiological effect
- acupuncture is a sham.
For an excellent account of the placebo effect, go to Goldacre.
This is the latest in a series of trials that shows essentially no difference between real and sham acupuncture. Here are examples.
This may not matter very much for patients, but it is enormously important in principle. It is enormously important for education, qualifications and for regulation. If, as seems to be the case, real acupuncture and sham are much the same, that means that all the ancient Chinese wisdom on which the acupuncture is allegedly based is just so much bunk. A typical statement of these was reproduced in the Dilemmas of Alternative Medicine.
. . . its advocates try to ‘explain’ the effects, along these lines.
- “There are 14 major avenues of energy flowing through the body. These are known as meridians”.
- The energy that moves through the meridians is called Qi.
- Think of Qi as “The Force”. It is the energy that makes a clear distinction between life and death.
- Acupuncture needles are gently placed through the skin along various key points along the meridians. This helps rebalance the Qi so the body systems work harmoniously.
I suppose, to the uneducated, the language sounds a bit like that of physics. But it is not. The words have no discernable meaning whatsoever. They are pure gobbledygook. Can any serious university be expected to teach such nonsense as though the words meant something?
|I’ll declare an interest. I get intermittent back pain too.
The picture is an X-ray of my spinal cord, You can see two lumbar vertebrae bolted together from the front and back with huge titanium woodscrews. The vertebrae had become disconnected in what the surgeon called the worst spondylolisthesis he’d seen.
One thing that I do know is that my back pain is enormously variable from day to day, for no obvious reason, That alone makes it almost impossible to tell whether any treatment helps.
|“The evidence that non-steroidal anti-inflammatory drugs relieve pain better than placebo is strong. Advice to stay active speeds up recovery and reduces chronic disability. Muscle relaxants relieve pain more than placebo, strong evidence also shows, but side effects such as drowsiness may occur. Conversely, strong evidence shows that bed rest and specific back exercises (strengthening, flexibility, stretching, flexion, and extension exercises) are not effective. These interventions mentioned were equally as effective as a variety of placebo, sham, or as no treatment at all. Moderate evidence shows that spinal manipulation, behavioural treatment, and multidisciplinary treatment (for subacute low back pain) are effective for pain relief. Finally, no evidence shows that other interventions (for example, lumbar supports, traction, massage, or acupuncture) are effective for acute low back pain”|
The main advice seems to be “avoid rest”. This is me avoiding
rest by walking across the Alps a few years ago.
The Times. The best so far seems to be from Nigel Hawkes in the Times “Sticking needles in a bad back “eases pain better than drugs”
“Acupuncture works better than conventional treatments in reducing lower back pain, according to researchers in Germany. But so does fake acupuncture, where the needles are inserted shallowly and in the wrong places.”
The BBC. The BBC report (anonymous) posted on 26th September misssed the point altogether, but a day later it is much better (could that have anything to do with the complaint that I made about it?).
The title changed overnight from “Acupuncture ‘best for back pain’.” to “Needles ‘are best for back pain’ Acupuncture – real or sham – is more effective at treating back pain than conventional
therapies, research suggests.”
“their findings suggest that the body may react positively to any thin needle prick – or that acupuncture may simply trigger a placebo effect.”
The Independent. On the other hand, The Independent makes a hash of it. “Acupuncture is best way to treat back pain, study finds” By Jeremy Laurance, Health Editor.
It starts “The ancient Chinese practice of acupuncture works better than anything modern medicine has devised for the treatment of back pain, scientists have concluded.”. That is precisely what they didn’t show. On the contrary they showed than any old pricking does as well as the ancient Chinese practice.
The Telegraph. Nic Fleming in the Telegraph missed the point too ” Acupuncture ‘best therapy for back pain’ By Nic Fleming, Science Correspondent. “Acupuncture can provide significantly more relief from lower back pain than conventional therapies, scientists say.”.
There is an excellent comparison of the newspaper reports at “Journalists are shit, study finds“