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

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

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Jump to follow-up

After the announcement that the University of Central Lancashire (Uclan) was suspending its homeopathy “BSc” course, it seems that their vice chancellor has listened to the pressure, both internal and external, to stop bringing his university into disrepute.

An internal review of all their courses in alternative medicine was announced shortly after the course  closure.   Congratulations to Malcolm McVicar for grasping the nettle at last.  Let’s hope other universities follow his example soon.

I have acquired, indirectly, a copy of the announcement of the welcome news.

Homeopathy, Herbalism and cupuncture

Concern has been expressed by some colleagues as to whether the University should offer courses in homeopathy, Herbalism and Acupuncture. Therefore, to facilitate proper discussion on this matter I have set up a working party to review the issues.

I have asked Eileen Martin, Pro Vice-Chancellor and Dean of the Faculty of Health, to lead this working party and report to me as soon as possible. Whilst the review is taking place, we need to recognise that there are students and staff studying and teaching on these courses which have satisfied the University’s quality assurance procedures and been duly validated. I would therefore ask that colleagues would refrain from comment or speculation which would cause concern to these students and staff. Staff who wish to express their views on this issue should direct these to Eileen Martin, by the end of September.


Malcolm McVicar


Times Higher Education today reports

“The University of Central Lancashire is to review all its courses in homoeopathy, herbalism and acupuncture after some staff said it should not be offering degrees in “quackery”, Times Higher Education has learnt.

A university spokesman said: “As a university we value and practise transparency and tolerance and welcome all academic viewpoints.”

(Later, an almost identical version of the story ran on the Times Online.)

So far, so good.   But of course the outcome of a committee depends entirely on who is appointed to it.  Quite often such committees do no more than provide an internal whitewash.

It does seem a bit odd to appoint as chair the dean of the faculty where all these course are run, and presumably generate income.  Eileen Martin has often appeared to be proud of them in the past. Furthermore, the whole investigation will (or should) turn on the assessment of evidence.  It needs some knowledge of the design of clinical trials and their statistical analysis, As far as I can see, Ms Martin has essentially no research publications whatsoever.

I also worry about a bit about “satisfied the University’s quality assurance procedures and been duly validated”.  One point of the investigation should be recognise frankly that the validation process is entirely circular, and consequently worth next to nothing.  It must be hard for a vice-chancellor to admit that, but it will be an essential step in restoring confidence in Uclan.

Let’s not prejudge though. If there are enough good scientists on the committee, the result will be good.

I hope that transparency extends to letting us know who will be doing the judging.  Everything depends on that.


Well well, there’s a coincidence, Once again, the week after a there is an announcement about degrees in witchcraft, what should pop up again in the column of the inimitable Laurie Taylor in THE. The University of Poppleton’s own Department of Palmistry.

Letter to the editor

Dear Sir

I was shocked to see yet another scurrilous attack upon the work of my department in The Poppletonian. Although Palmistry is in its early days as an academic discipline it cannot hope to progress while there are people like your correspondent who insist on referring to it as “a load of superstitious nonsense which doesn’t deserve a place on the end of the pier let alone in a university”.

A large number of people claim to have derived considerable benefit from learning about life lines, head lines and heart lines and the role of the six major mounts in predicting their future. All of us in the Palmistry Department believe it vitally important that these claims are rigorously examined. How else can science advance?

Yours sincerely,

Janet Petulengro (Doctor)

Jump to follow-up

The first major victory in the battle for the integrity of universities seems to have been won. This email was sent by Kate Chatfield who is module leader for the “BSc” in homeopathic medicine at the University of Central Lancashire (UCLAN).

from Kate Chatfield…

Dear All,

It’s a sad day for us here at UCLan because we have taken the decision not to run a first year this year due to low recruitment. The course will be put ‘on hold’ for this year and next until we see what happens with the general climate. Fortunately our masters course is thriving and we have been asked to focus upon this area and homeopathy research for the time being.

Of late UCLan has been the subject of many attacks by the anti-homeopathy league. Colquhoun et al have kept the university lawyers and us quite fruitlessly busy by making claims for very detailed course information under the Freedom of Information Act. The latest demand is for 32 identified lesson plans with teaching notes, power points, handouts etc. The relentless attacks have taken their toll and it appears that they have won this small victory.

The university has been very clear that this decision has been taken solely on the grounds of poor educational experience and is nothing to do with the current furore. They continue to be supportive of us and our efforts.

Best wishes

Kate and Jean

There is some background here. In July 2006 I made a request to UCLAN under the Freedom of Information Act 2000, in which I asked to see some of their teaching materials. I appealed to UCLAN but Professor Patrick McGhee, Deputy Vice-Chancellor (Academic), also turned down two appeals. A letter sent directly to Professor Malcolm McVicar, vice-chancellor and president of UCLAN, failed to elicit the courtesy of a reply (standard practice I’m afraid, when a vice chancellor is faced with a difficult question). (Ironically, McVicar lists one of his interests as “health policy”.) So then I appealed to the Office of the Information Commissioner, in November 2006. Recently the case got to the top of the pile, and a judgment is expected any moment now.

Kate Chatfield’s letter to her colleagues is interesting. She describes a request ro see some of her teaching materials as an “attack”. If someone asks to see my teaching materials, I am rather flattered, and I send them. Is she not proud of what she teaches? Why all the secrecy? After all, you, the taxpayer, are paying for this stuff to be taught, so why should you not be able see it? Or is the problem that she feels that the “alternative reality” in which homeopaths live is just too complicated for mortals to grasp? Perhaps this attitude should be interpreted as flattering to the general public, because somewhere deep down she knows that the public will be able to spot gobbledygook when they see it. The revelation that the University of Westminster teaches first year undergraduates the “amethysts emit high yin energy” didn’t help their academic reputation much either.

Much credit for this decision must go also to the pressure from the many good academics at UCLAN. When it was revealed recently that UCLAN intended to open yet more courses in forms of medicine that are disproved or unproven, they naturally felt that their university was being brought into disrepute. Opposition to plans to introduce new “degrees” in acupuncture and Chinese herbal medicine were exposed in Times Higher Education recently. It particular, great credit must go to Dr Michael Eslea from UCLAN’s Psychology department. His open letter to his vice-chancellor is an example of scientific integrity in action.

The abandonment of this degree in medicines that contain no medicine is a small victory for common sense, for science and for the integrity of universities. Sadly, there is still a long way to go.

It is my understanding that ‘bringing the university into disrepute’ is a serious offence. Please note, vice-chancellor.

A few more judgments like that to suspend your homeopathy degree could work wonders for your reputation.

The follow-up

Watch this space.

The Guardian was quick off the mark -this story appeared on their education web site within 3 hours of my posting it “Homeopathy degrees suspended after criticism” by Anthea Lipsett. My comment there disappeared for a while because the Guardian legal people misunderstood the meaning of the last sentence. It’s back now, with blame allocated unambiguously to the vice-chancellors of the 16 or so universities who run this sort of course.

UCLAN’s web site seems to need some updating. The “BSc” in homeopathic medicine is still advertised there. as of 28 August.

UCLAN’s best ally. Dr Michael Eslea, has had some publicity for his attempts to rescue his university’s reputation. The story appeared in the “High Principals” column of Private Eye (Issue 1217, Aug 22, 2008). It also appeared in his local paper, the Lancashire Evening Post.

The Lancashire Evening Post catches up with homeopathy suspension story, two days after you read it here. But the UCLAN web site still advertises it.

Jump to follow-up

My original piece on Integrative Baloney@Yale was posted on May 16th, after I got back from a visit there. The talk I gave there included a short video. My movie, Integrative baloney@Yale, was made entirely from clips taken from Yale’s own YouTube movies which showed something approaching three hours of its “1st Annual Scientific [sic] symposium”, entitled “Complementary and Alternative Medicine: Evidence for Integration”. I had merely interspersed a few titles to show the worst scientific absurdities of that rather pathetic event. YouTube removed the movie last week.

You can download the movie here [15.8 Mb, wmv file].

It should soon reappear on YouTube (actually it took over a month and several reminders, but eventually  they kept their word in the end).

Yale’s lawyers had written to YouTube, to have my movie removed. I guess if you have no evidence, all you can do is resort to law to suppress the views of those who have the temerity to point out that the emperor is naked. Last week it was New Zealand Chiropractors’ Association Inc. This week the rather more substantial Yale University. We live in interesting times.

This is what I got on 15th August.

Dear Member

This is to notify you that we have removed or disabled access to the following material as a result of a third-party notification by Yale University, Yale School of Medicine (CME) claiming that this material is infringing:

Integrative baloney@Yale: http://uk.youtube.com/watch?v=HEl2fhfGBdI

Please Note: Repeated incidents of copyright infringement will result in the deletion of your account and all videos uploaded to that account. In order to prevent this from happening

If you clicked on the link you saw

“This video is no longer available due to a copyright claim by Yale University, Yale School of Medicine (CME)”

It seems that Yale’s Continuing Medical Education (CME) department was responsible.

Of course Yale is correct. I expect they own the copyright of their original movies, but they are not what I posted. I would argue that selecting 6 minutes from a 3 hour original amounts to “fair quotation”, no different from when one cites a short passage from somebody else’s book or paper. Perhaps Yale was just a bit jealous that my movie was getting viewed a lot more times than theirs. Or perhaps they were a bit peeved that a Google search for “Yale Integrative Medicine” produced my movie as #2 (add the word movie and I was #1).

My movie seems to me to be fair comment from someone who is a pharmacologist by trade. Apparently it didn’t seem that way to the apparatchiks of Yale Medical School, who seem to think that academic arguments should be settled by paying lawyers to suppress views they don’t like, rather than by rational discussion.

It’s interesting that the three hours of Yale’s own movie have also vanished from YouTube. Could that be because they realise that the remarks made at the meeting are so embarrassing intellectually that it would be better not to make them public? Actually, no.

What does Yale CME say?

Rather than publishing this straight away, I thought it better to delve a bit further into what had happened. I lodged an appeal with YouTube and I wrote to Ronald J. Vender, MD (Associate Dean, YSM Clinical Affairs, CMO, Yale Medical Group, Medical Director, Yale CME ). The outcome was rather interesting.

First, it turned out that the original posting of the three hours of the symposium proceedings on YouTube was itself unauthorised, which is why it suffered the same fate as my movie.

Dr Vender told me that he is new to the job, and didn’t know about the incident. What’s more surprising, he said he “did not know an Integrative Program even existed at Yale”. That does seem a bit odd indeed for an Associate Dean of Clinical Affairs.

However, Dr Vender turned out to be a very reasonable man,.After some amiable correspondence over the weekend, it took him only a day and a half to sort the matter out. After talking to Yale’s attorney, he wrote on 19th August, thus

“The University attorney believes that there is in fact a difference between the initial unauthorized filming of an entire conference as opposed to quoting from that conference. Therefore, she has agreed to withdraw the injunction that has been imposed on your use of the material. YouTube will be contacted.”

That’s good for me, but it isn’t the main thing. The movie would doubtless have been seen by more people if Yale had tried to maintain the ban. Much more impressively, Dr Vender also said

“As for this particular program, I will be speaking with Dr Belitsky and the program directors to encourage them to adopt a more critical view of the scientific basis for claims made by proponents of CAM. They will also be encouraged to develop a future program that includes faculty who have opposing points of view.”

It remains to be seen what actually happens, but so far, so good.

What next?

The removal of the original videos of the meeting is understandable because they were pretty embarrassing to Yale. But can that be the real reason? I was told that it is simply because their posting was “unauthorised”. But Yale Continuing Medical Education still boasts about the meeting on their own web site. They describe the meeting as “successful”, but if they are so proud of it, why remove the video from YouTube whether it was authorised or not? We are told

“The symposium, accredited for 7.5 AMA PRA Category 1 Credits, began what is hoped to be a long tradition at the Yale School of Medicine.”

They give credits for such miseducation?

Dr Katz’s phrase “we need a more fluid concept of evidence” now gets about 148 hits in Google, since I first helped him to publicise it.

Two of the six “learning objectives” that Yale CME lists for this symposium are particularly revealing.

  • Describe therapeutic benefits and recent scientific evidence supporting a wide range of safe and practical complementary treatments, including acupuncture, massage, yoga, meditation, nutrition and exercise
  • Identify and discuss barriers to CAM use, practice and research, as well as propose ways of overcoming these barriers

‘Describe the evidence supporting complementary treatments’? But don’t on any account describe the much more substantial evidence that does not support them? A question (or “learning objective”) put in this loaded way is the very antithesis of education.

Equally the second ‘learning objective’ carries with it the assumption that CAM works, otherwise why would anyone want to overcome the barriers to it?

This is indoctrination, not education. It betrays everything that a university should stand for.

Let’s hope the new head of CME, the admirable Dr Vender, succeeds in doing something about it


Success!. Well I think it is success. On 26 November 2008, the admirable Dr Vender wrote to me as follows.

“I do not know if another CAM/Integrative Medicine program is planned at Yale. However, based on the new ACCME standards, this program does not fulfil the standards for receiving CME accreditation (by my interpretation of the standards). At least one of last year’s program directors has been notified already.”

Samuel Hahnemann (1755 – 1843) was the originator of homeopathy. He was clearly a well-intentioned man.. There is good reason to believe that he thought dilution could not go on for ever, but he died 22 years before it became possible to calculate that his favourite 30C dilution already contained nothing at all.

The bible of homeopaths is Hahnemann’s Organon der rationellen Heilkunde, “Organon of the Medical Art”. His views on dosage, as expressed in the six editions of this book are almost as self-contradictory as the other bible. Hahnemann’s writing about ‘vital spirits’ sounds very silly now, but it is language that was quite common at the end of the 18th century, before much was known about medicine or physiology. But his interest in chemistry was entirely sensible.

Before 1800 Hahnemann started out with the very high doses that were conventional at the time. Unlike most of his contemporaries, he was smart enough to realise that giving 50 g of antimony was killing people so he kept reducing the dose until it was no longer toxic. Unfortunately he (like almost everyone else at the time) didn’t know about controls so he mistook lack of toxicity (because the dose was zero) for a beneficial effect. Nonetheless, for most of his life he did not advocate the extreme dilutions that many modern homeopaths use routinely.

In The Life and Letters of Dr Samuel Hahnemann by Thomas Lindsley Bradford, M.D.(or see Google books edition of the Organon), there is an interesting passage. According to the edition here pp. 237 – 238), this was a note attached to para. #283 in the first edition of the Organon.

” The doctrine of the divisibility of matter teaches us that we cannot make a part so small that it shall cease to be something, and that it shall not share all the properties of the whole.”

Here Hahnemann refers to the doctrine of divisibility, but appears to be saying that dilution can go on for ever. But he also says something that directly contradicts this view (Organon, Dudgeon’s translation see also here, page 239 ). The emphasis is mine.

“I must say that these procedures seem to show chiefly how high one can go with the potentized attenuation of medicines without their action on the human health becoming nil.

Although this claims that you can dilute a lot, it also admits that if the dilution goes too far the effect would eventually vanish, contrary to the usual homeopathic “principle” that it should keep getting stronger and stronger. and contrary to Hahnemann’s suggestions in other places that he thought matter was infinitely divisible.

This passage shows quite clearly that Hahnemann did not believe that his medicines would work if they were diluted so much that that there were no molecules left. That he believed this is confirmed by a letter that Hahnemann wrote in a letter to a Dr Schreter dated September 13th, 1829. This letter reprimanded Schreter for advocating extremely high dilutions.

there must be some limit to the thing. It cannot go on to infinity

The original German version was

“Es muss ein Ende geben, es kann nicht bis ins Unendliche weitergehen”

This confirms that Hahnemann was aware of, and accepted, that matter was not infinitely divisible and his medicines would not work if they contained nothing of the original material.

This attitude is actually not at all surprising, because Hahnemann was an educated man and he had a particular interest in chemistry. He cannot have failed to be aware of Dalton’s atomic theory, which was published between 1805 – 1810, while Hahnemann was writing the first edition of the Organon.

Peter Morrell, in Hahnemann and Homeopathy, says

“These were obviously developments that Hahnemann could not have failed to know about and indeed, was thoroughly excited about, It is clear from many of his asides that he regarded chemistry as the most important science.”

What is astonishing is that I can find no example of Hahnemann ever having mentioned Dalton or Avogadro. Perhaps he was a bit scared by the implications of their suggestions that molecules could not be divided without changing their nature.

The first edition of the Organon was published in 1810. but in the 5th edition appeared 1833, ten years before his death, These dates turn out to be important.

John Dalton (1776 – 1844) was able to estimate relative atomic masses of various molecules, the smallest unit that a chemical can exist in without losing irs identity. His values were soon improved by Amadeo
(1776 – 1856), in 1811. Avogadro made the very important proposal that the volume of a gas (strictly, of an ideal gas ) is proportional to the number of atoms or molecules that are present. More precisely, the relationship between the masses of the same volume of different gases (at the same temperature and pressure) corresponds to the relationship between their respective molecular weights. Hence, the relative molecular mass of a gas can be calculated from the mass of a sample of known volume.

BUT neither Avogadro nor Dalton knew how many molecules there were in a given mass of a substance

This is absolutely crucial because it means that, although Hahnemann realised that there was a limit to the dilutions that could be used, he had no way of knowing what that limit was,

The answer to that question was discovered only in 1865, 22 years after the death of Hahnemann.  It was discovered not by Avogadro, but by Johann Josef Loschmidt (1821 – 1895). It is Loschmidt, not Avogadro, who discovered the crucial numerical value of ‘Avogadro’s number‘, and in the German literature it is known, properly, as Loschmidt’sche Zahl.

This number is 6.022 x 1023 molecules per mole. One mole of a pure compound is its molecular mass in grams. The molecular mass of carbon (relative to hydrogen) is 12, so 12 grams of carbon contain 6.022 x 1023 carbon atoms. The molecular mass of of strychnine is 334.4 so 334.4 grams of strychnine contain 6.022 x 1023 strychnine molecules.

Armed with the numerical value of Avogadro’s number, it is easy to calculate that a 30 C homeopathic dilution contains nothing whatsoever. More precisely, it would contain, on average, a single molecule in spherical pill with a diameter equal to the distance from the earth to the sun.

But Hahnemann could not have known that. If had lived another 25 years he would almost certainly have renounced the idea of using 30 C dilutions.

He had a good excuse for getting it wrong. He was dead before the knowledge existed to do the calculation

But modern homeopaths have no excuse whatsoever for believing the impossible.

Hahnemann would have thought they were nuts, I suspect. He was too intelligent to believe that medicines that contain no medicine could be effective. In his words, “It cannot go on to infinity”.


I very grateful to ‘ Lindy’ for help in checking the references that are cited here, and for helpful discussions.

The article below is an editorial that I was asked to write for the New Zealand Medical Journal, as a comment on article in today’s edition about the misuse of the title ‘doctor’ by chiropractors [download pdf]. Titles are not the only form of deception used by chiropractors, so the article looks at some of the others too.  For a good collection of articles that reveal chiropractic for what it is, look at Chirobase


Journal of the New Zealand Medical Association

NZMJ 25 July 2008, Vol 121 No 1278; ISSN 1175 8716

URL: http://www.nzma.org.nz/journal/121-1278/3158/ ©NZMA

Doctor Who?
Inappropriate use of titles by some alternative “medicine” practitioners

David Colquhoun

Who should use the title ‘doctor’? The title is widely abused as shown by Gilbey1 in this issue of the NZMJ in an article entitled Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy. Meanwhile, Evans and colleagues 2, also in this issue, discuss usage and attitudes to alternative treatments.

Gilbey finds that the abuse of the title doctor is widespread and that chiropractors are the main culprits. An amazing 82% of 146 chiropractics used the title Doctor, andL most of them used the title to imply falsely that they were registered medical practitioners.

Although it is illegal in New Zealand to do that, it seems clear that the law is not being enforced and it is widely flouted. This is perhaps not surprising given the history of chiropractic. It has had a strong element of ruthless salesmanship since it was started in Davenport, Iowa by D.D. Palmer (1845–1913). His son, B.J. Palmer, said that their chiropractic school was founded on “a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell” (Shapiro 2008)3 It is the same now. You can buy advice on how to build “build high-volume, subluxation-based, cash-driven, lifetime family wellness practices”

In her recent book3 , Rose Shapiro comments on the founder of chiropractic as follows.

“By the 1890s Palmer had established a magnetic healing practice in Davenport, Iowa, and was styling himself “doctor”. Not everyone was convinced, as a piece about him in an 1894 edition of the local paper, the Davenport Leader, shows.

A crank on magnetism has a crazy notion hat he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious,those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method he has certainly profited by the ignorance of his victim. His increase in business shows what can be done in Davenport, even by a quack.”

D.D. Palmer was a curious mixture: grocer, spiritual healer, magnetic therapist, fairground huckster, religious cult leader—and above all, a salesman. He finally found a way to get rich by removing entirely imaginary “subluxations”.

Over 100 years later, it seems that the “weak-minded, ignorant, and superstitious” include the UK’s Department of Health, who have given chiropractics a similar status to the General Medical Council.

The intellectual standards of a 19th Century Mid-Western provincial newspaper journalist are rather better than the intellectual standards of the UK’s Department of Health, and of several university vice-chancellors in 2007.

Do the treatments work?

Neither Gilbey nor Evans et al. really grasp the nettle of judging efficacy. The first thing one wants to know about any treatment —alternative or otherwise — is whether it works. Until that is decided, all talk of qualifications, regulation, and so on is just vacuous bureaucratese. No policy can be framed sensibly until the question of efficacy has been addressed honestly.

It is one good effect of the upsurge of interest in alternative treatments that there are now quite a lot of good trials of the most popular forms of treatments (as well as many more bad trials). Some good summaries of the results are now available too. Cochrane reviews set the standard for good assessment of evidence. New Zealand’s Ministry of Health commissioned the Complementary and Alternative Medicine
website to assess the evidence, and that seems to have done a good job too. Their assessment of chiropractic treatment of low back pain is as follows:

There appears to be some evidence from one systematic review and four other studies, although not conclusive, that chiropractic treatment is as effective as other therapies but this may be due to chance. There is very little evidence that chiropractic is more effective than other therapies.

And two excellent summaries have been published as books this year. Both are by people who have had direct experience of alternative treatments, but who have no financial interest in the outcome of their assessment of evidence. The book by Singh and Ernst4 summarises the evidence on all the major alternative treatments, and the book by Bausell5 concentrates particularly on acupuncture, because the author was for 5 years involved in research in that area, Both of these books come to much the same conclusion about chiropractic. It is now really very well-established that chiropractic is (at best) no more effective than conventional treatment. But it has the disadvantage of being surrounded by gobbledygook about “subluxations” and, more importantly, it kills the occasional patient.

Long (2004)7 said “the public should be informed that chiropractic manipulation is the number one reason for people suffering stroke under the age of 45.

The chiropractors of Alberta (Canada) and the Alberta Government are now facing a class-action lawsuit8. The lead plaintiff is Sandra Nette. Formerly she was a fit 41 year old. Now she is tetraplegic. Immediately
after neck manipulation by a chiropractor she had a massive stroke as a result of a torn vertebral artery.

Acupuncture comes out of the assessments equally badly. Bausell (2007) concludes that it is no more than a theatrical placebo.

Are the qualifications even real?

It is a curious aspect of the alternative medicine industry that they often are keen to reject conventional science, yet they long for academic respectability. One aspect of this is claiming academic titles on the flimsiest of grounds. You can still be held to have misled the public into thinking you are a medical
practitioner, even if you have a real doctorate. But often pays to look into where the qualifications come from.

A celebrated case in the UK concerned the ‘lifestyle nutritionist’, TV celebrity and multi-millionaire, Dr Gillian McKeith, PhD. A reader of Ben Goldacre’s excellent blog, badscience.net did a little investigation. The results appeared in Goldacre’s Bad Science column in the Guardian9.

She claimed that her PhD came from the American College of Nutrition, but it turned out to come from a correspondence course from a non-accredited US ‘college’. McKeith also boasted of having “professional membership” of the American Association of Nutritional Consultants, for which she provided proof of her degree and three professional references.

The value of this qualification can be judged by the fact that Goldacre sent an application and $60 and as a result “My dead cat Hettie is also a “certified professional member” of the AANC. I have the certificate hanging in my loo”.

Is the solution government regulation?

In New Zealand the law about misleading the public into believing you are a medical practitioner already exists. The immediate problem would be solved if that law were taken seriously, but it seems that it is not.

It is common in both the UK and in New Zealand to suggest that some sort of official government regulation is the answer. That solution is proposed in this issue of NZMJ by Evans et al2. A similar thing has been proposed recently in the UK by a committee headed by Michael Pittilo, vice-chancellor of Robert Gordon’s University, Aberdeen.

I have written about the latter under the heading A very bad report. The Pittilo report recommends both government regulation and more degrees in alternative medicine. Given that we now know that most alternative medicine doesn’t work, the idea of giving degrees in such subjects must be quite ludicrous to any thinking person.

The magazine Nature7 recently investigated the 16 UK universities who run such degrees. In the UK, first-year students at the University of Westminster are taught that “amethysts emit high yin energy” . Their vice chancellor, Professor Geoffrey Petts, describes himself a s a geomorphologist, but he cannot be tempted to express an opinion about the curative power of amethysts.

There has been a tendency to a form of grade inflation in universities—higher degrees for less work gets bums on seats. For most of us, getting a doctorate involves at least 3 years of hard experimental research in a university. But in the USA and Canada you can get a ‘doctor of chiropractic’ degree and most chiropractic (mis)education is not even in a university but in separate colleges.

Florida State University famously turned down a large donation to start a chiropractic school because they saw, quite rightly, that to do so would damage their intellectual reputation. This map, now widely distributed on the Internet, was produced by one of their chemistry professors, and it did the trick.

Other universities have been less principled. The New Zealand College of Chiropractic [whose President styles himself “Dr Brian Kelly”,though his only qualification is B. App Sci (chiro)] is accredited by the New Zealand Qualifications Authority (NZQA). Presumably they, like their UK equivalent (the QAA), are not allowed to take into account whether what is being taught is nonsense or not. Nonsense courses are accredited by experts in nonsense. That is why much accreditation is not worth the paper it’s written on.

Of course the public needs some protection from dangerous or fraudulent practices, but that can be done better (and more cheaply) by simply enforcing existing legislation on unfair trade practices, and on false advertising. Recent changes in the law on unfair trading in the UK have made it easier to take legal action against people who make health claims that cannot be justified by evidence, and that seems the best
way to regulate medical charlatans.


For most forms of alternative medicine—including chiropractic and acupuncture—the evidence is now in. There is now better reason than ever before to believe that they are mostly elaborate placebos and, at best, no better than conventional treatments. It is about time that universities and governments recognised the evidence and stopped talking about regulation and accreditation.

Indeed, “falsely claiming that a product is able to cure illnesses, dysfunction, or malformations” is illegal in Europe10.

Making unjustified health claims is a particularly cruel form of unfair trading practice. It calls for prosecutions, not accreditation.

Competing interests: None.
NZMJ 25 July 2008, Vol 121 No 1278; ISSN 1175 8716
URL: http://www.nzma.org.nz/journal/121-1278/3158/ ©NZMA

Author information: David Colquhoun, Research Fellow, Dept of Pharmacology, University College London, United Kingdom (http://www.ucl.ac.uk/Pharmacology/dc.html)

Correspondence: Professor D Colquhoun, Dept of Pharmacology, University College London, Gower Street, London WC1E 6BT, United Kingdom. Fax: +44(0)20 76797298; email: d.colquhoun@ucl.ac.uk


1. Gilbey A. Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy. N Z Med J. 2008;121(1278). [pdf]

2. Evans A, Duncan B, McHugh P, et al. Inpatients’ use, understanding, and attitudes towards traditional, complementary and alternative therapies at a provincial New Zealand hospital. N Z Med J. 2008;121(1278).

3 Shapiro. Rose. Suckers. How Alternative Medicine Makes Fools of Us All Random House, London 2008. (reviewed here)

4. Singh S, Ernst E. Trick or Treatment. Bantam Press; 2008 (reviewed here)

5. Bausell RB. Snake Oil Science. The Truth about Complementary and Alternative Medicine. (reviewed here)
Oxford University Press; 2007

6. Colquhoun D. Science degrees without the Science, Nature 2007;446:373–4. See also here.

7. Long PH. Stroke and spinal manipulation. J Quality Health Care. 2004;3:8–10.

8. Libin K. Chiropractors called to court. Canadian National Post; June21, 2008.

9. Goldacre B. A menace to science. London: Guardian; February 12, 2007/

10. Department for Business Enterprise & Regulatory Reform (BERR). Consumer Protection from Unfair Trading Regulations 2008. UK: Office of Fair Trading.

Jump to follow-up

During the last year, there has been a very welcome flurry of good and informative books about alternative medicine. They are all written in a style that requires little scientific background, even the one that is intended for medical students.

CAM, Cumming | Trick or Treatment | Snake Oil Science |
Testing treatments | Suckers | Healing, Hype or Harm

I’ll start with the bad one, which has not been mentioned on this blog before.

Complementary and Alternative medicine. An illustrated text.

by Allan D. Cumming, Karen R. Simpson and David Brown (and 12 others). 94 pages, Churchill Livingstone; 1 edition (8 Dec 2006).

The authors of this book sound impressive

Allan Cumming, BSc(Hons), MBChB, MD, FRCP(E), Professor of Medical Education and Director of Undergraduate Learning and Teaching, and Honorary Consultant Physician, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK;

Karen Simpson, BA(Hons), RN, RNT, Fellow in Medical Education, College of Medicine and Veterinary Medicine

David Brown, MBChB, DRCOG, General Practitioner, The Murrayfield Medical Centre, and Honorary Clinical Tutor, University of Edinburgh

Sadly, this is a book so utterly stifled by political correctness that it ends up saying nothing useful at all. The slim volume is, I have to say, quite remarkably devoid of useful information. Partly that is a result of out-of-date and selective references (specially in the chapters written by alternative practitioners),

But the lack of information goes beyond the usual distortions and wishful thinking. I get the strong impression is that it results not so much for a strong commitment to alternative medicine (at least by Cumming) as from the fact that the first two authors are involved with medical education. It seems that they belong to that singularly barmy fringe of educationalists who hold that the teacher must not give information to s student for fear of imparting bias. Rather the student must be told how to find out the information themselves. There is just one little problem with this view. It would take about 200 years to graduate in medicine.

There is something that worries me about medical education specialists. Just look at the welcome given by Yale’s Dean of Medical Education, Richard Belitsky, to Yale’s own division of “fluid concepts of evidence”, as described at Integrative baloney @ Yale, and as featured on YouTube. There are a lot of cryptic allusions to alternative forms of evidence in Cumming’s book too, but nothing in enough detail to be useful to the reader.

What should a book about Alternative medicine tell you? My list would look something like this.

  • Why people are so keen to deceive themselves about the efficacy of a treatment
  • Why it is that are so often deceived into thinking that something works when it doesn’t
  • How to tell whether a medicine works better than placebo or not,
  • Summaries of the evidence concerning the efficacy and safety of the main types of alternative treatments.

The Cumming book contains chapters with titles like these. It asks most of the right questions, but fails to answer any of them. There is, time and time again, the usual pious talk about the importance of evidence, but then very little attempt to tell you what the evidence says. When an attempt is made to mention evidence, it is usually partial and out of date. Nowhere are you told clearly about the hazards that will be encountered when trying to find out whether a treatment works.

The usual silly reflexology diagram is reproduced in Cumming’s introductory chapter, but with no comment at all, The fact that it is obviously total baloney is carefully hidden from the reader.. What is the poor medical student meant to think when they perceive that it is totally incompatible with all the physiology they have learned? No guidance is offered.
You will look in vain for a decent account of how to do a good randomised controlled trial, though you do get a rather puerile cartoon, The chapter about evidence is written by a librarian. Since the question of evidence is crucial, this is a fatal omission.

Despite the lack of presentation of evidence that any of it works, there seems to be an assumption throughout the book that is is desirable to integrate alternative medicine into clinical practice. In Cumming’s chapter (page 6) we see

Since it would not be in the interests of patients to integrate treatments that don’t work with treatments that do work, I see only two ways to explain this attitude. Either the authors have assumed than most alternative methods work (in which case they haven’t read the evidence), or they think integration is a good idea even if the treatment doesn’t work. Neither case strikes me as good medical education.

The early chapters are merely vague and uninformative. Some of the later chapters are simply a disgrace.

Most obviously the chapter on homeopathy is highly selective and inaccurate, That is hardly surprising because it is was written by Thomas Whitmarsh, a consultant physician at Glasgow Homeopathic Hospital (one that has still survived). It has all the usual religious zeal of the homeopath. I honestly don’t know whether people like Whitmarsh are incapable of understanding what constitutes evidence, or are simply too blinded by faith to even try. Since the only other possibility is that they are dishonest, I suppose it must be one of the former.

The chapter on “Nutritional therapy” is also written by a convert and is equally misleading piece of special pleading.

The same is true of the chapter on Prayer and Faith Healing. This chapter reproduces the header of the Cochrane Review on “Intercessory prayer for the alleviation of Ill Health”, but then proceeds to ignore entirely its conclusion “Most of the studies show no real differences”).

If you want to know about alternative medicine, don’t buy this book. Although this book was written for medical students, you will learn a great deal more from any of the following books, all of which were written for the general public.

Trick or Treatment

by Simon Singh and Edzard Ernst, Bantam Press, 2008

Simon Singh is the author of many well-known science books, like Fermat’s Last Theorem. Edzard Ernst is the UK’s first professor of complementary and alternative medicine.

Ernst, unlike Cumming et. al is a real expert in alternative medicine. He practised it at an early stage in his career and has now devoted all his efforts to careful, fair and honest assessment of the evidence. That is what this book is about. It is a very good account of the subject and it should be read by everyone, and certainly by every medical student.

Singh and Ernst follow the sensible pattern laid out above, The first chapter goes in detail into how you distinguish truth from fiction (a little detail often forgotten in this area).

The authors argue, very convincingly, that the development of medicine during the 19th and 20th century depended very clearly on the acceptance of evidence not anecdote. There is a fascinating history of clinical trials, from James Lind (lemons and scurvy), John Snow and the Broad Street pump, Florence Nightingale’s contribution not just to hygiene, but also to the statistical analysis that was needed to demonstrate the strength of her conclusions (she became the first female member of the Royal Statistical Society, and had studied under Cayley and Sylvester, pioneers of matrix algebra).

There are detailed assessments of the evidence for acupuncture, homeopathy, chiropractic and herbalism, and shorter synopses for dozens of others. The assessments are fair, even generous in marginal cases.

Acupunture. Like the other good books (but not Cumming’s), it is pointed out that acupuncture in the West is not so much the product of ancient wisdom (which is usually wrong anyway), but rather a product of Chinese nationalist propaganda engineered by Mao Tse-tung after 1949. It spread to the West after Nixon’s visit Their fabricated demonstrations of open heart surgery under acupuncture have been known since the 70s but quite recently they managed again to deceive the BBC It was Singh who revealed the deception. The conclusion is ” . . . this chapter demonstrates that acupuncture is very likely to be acting as nothing more than a placebo . . . ”

Homeopathy. “hundreds of trials have failed to deliver significant or convincing evidence to support the use of homeopathy for the treatment of any particular ailment. On the contrary, it would be to say that there is a mountain of evidence to suggest that homeopathic remedies simply do not work”.

Chiropractic. Like the other good books (but not Cumming’s) there is a good account of the origins of chiropractic (see, especially, Suckers). D.D. Palmer, grocer, spiritual healer, magnetic therapist and fairground quack, finally found a way to get rich by removing entirely imaginary ‘subluxations’. They point out the dangers of chiropractic (the subject of court action), and they point out that physiotherapy is just as effective and safer.

Herbalism. There is a useful table that summarises the evidence. They conclude that a few work and most don’t Unlike homeopathy, there is nothing absurd about herbalism, but the evidence that most of them do any good is very thin indeed.

“We argue that it is now the time for the tricks to stop, and for the real treatments to take priority. In the name of honesty, progress and good healthcare, we call for scientific standards, evaluation and regulation to be applied to all types of medicine, so that patients can be confident that they are receiving treatments that demonstrably generate more harm than good.”

Snake Oil Science, The Truth about Complementary and Alternative Medicine.

R. Barker Bausell, Oxford University Press, 2007

Another wonderful book from someone who has been involved himself in acupuncture research, Bausell is a statistician and experimental designer who was Research Director of a Complementary and Alternative Medicine Specialised Research Center at the University of Maryland.

This book gives a superb account of how you find out the truth about medicines, and of how easy it is to be deceived about their efficacy.

I can’t do better than quote the review by Robert Park of the American Physical Society (his own book, Voodoo Science, is also excellent)

“Hang up your lantern, Diogenes, an honest man has been found. Barker Bausell, a biostatistician, has stepped out of the shadows to give us an insider’s look at how clinical evidence is manipulated to package and market the placebo effect. Labeled as ‘Complementary and Alternative Medicine’, the placebo effect is being sold, not just to a gullible public, but to an increasing number of health professionals as well. Bausell knows every trick and explains each one in clear language”

Bausell’s conclusion is stronger than that of Singh and Ernst.

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

Here are two quotations from Bausell that I love.

[Page 22] ” seriously doubt, however, that there is a traditional Chinese medicine practitioner anywhere who ever stopped performing acupuncture on an afflicted body in the presence of similarly definitive negative evidence. CAM therapists simply do not value (and most cases, in my experience, do not understand) the scientific process”

And even better,

[Page39] “But why should nonscientists care one iota about something as esoteric as causal inference? I believe that the answer to this question is because the making of causal inferences is part of our job description as Homo Sapiens.”

Testing Treatments: Better Research for Better Healthcare

by Imogen Evans, Hazel Thornton, Iain Chalmers, British Library, 15 May 2006

You don’t even need to pay for this excellent book (but buy it anyway, eg from Amazon). If you can’t afford, £15 then download it from the James Lind Library.

This book is a unlike all the others, because it is barely mentions alternative medicine. What it does, and does very well, is to describe he harm that can be done to patients when they are treated on the basis of guesswork or ideology, rather than on the basis of proper tests. This, of course, is true whether or not the treatment is labelled ‘alternative’.

It is worth noting that one of the authors of this book is someone who has devoted much of his life to the honest assessement of evidence, Sir Iain Chalmers, one of the founders of the Cochrane Collaboration , and Editor of the James Lind Library .

A central theme is that randomised double blind trial are essentially the only way to be sure you have the right answer. One of the examples that the authors use to illustrate this is Hormone Replacement Therapy (HRT). For over 20 years, women were told that HRT would reduce their risk of heart attacks and strokes. But when, eventually, proper randomised trials were done, it was found that precisely the opposite was true. The lives of many women were cut short because the RCT had not been done,

The reason why the observational studies gave the wrong answer is pretty obvious. HRT was used predominantly by the wealthier and better-educated women. Income is just about the best predictor of longevity. The samples were biassed, and when a proper RCT was done it was revealed that the people who used HRT voluntarily lived longer despite the HRT, not because of it. It is worth remembering that there are very few RCTs that test the effects of diet. And diet differs a lot between rich and poor people. That, no doubt, is why there are so many conflicting recommendations about diet. And that is why “nutritional therapy” is little more than quackery. Sadly, the media just love crap epidemiology. One of the best discussions of this topics was in Radio 4 Programme. “The Rise of the Lifestyle Nutritionists“, by Ben Goldacre.

One of the big problems in all assessment is the influence of money, in other words corruption, The alternative industry is entirely corrupt of course, but the pharmaceutical industry has been increasingly bad. Testing Treatments reproduces this trenchant comment.

Suckers. How Alternative Medicine Makes Fools of Us All

Rose Shapiro, Random House, London 2008

I love this book. It is well-researched, feisty and a thoroughly good read.

It was put well in the review by George Monbiot.

“A fascinating and excoriating book; witty, shocking and utterly convincing”

The chapters on osteopathy and chiropractic are particularly fascinating.

This passage describes the founder of the chiropractic religion.

“By the 1890s Palmer had established a magnetic healing practice in Davenport, Iowa, and was styling himself ‘doctor’. Not everyone was convinced as a piece about him in an 1894 edition of the local paper, the Davenport Leader, shows.”

A crank on magnetism has a crazy notion hat he can cure the sick and crippled with his magnetic hands. His victims are the eak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method . . . he has certainly profited by the ignorance of his victims . . . His increase in business shows what can be done in Davenport, even by a quack”

Over 100 years later, it seems that the “weak-minded, ignorant and superstitious” include the UK’s Department of Health, who have given these quacks a similar status to the General Medical Council.

The intellectual standards of a 19th Century mid-western provincial newspaper leader writer are rather better than the intellectual standards of the Department of Health, and of several university vice-chancellors in 2007.

Healing Hype or Harm

Edited by Imprint Academic (1 Jun 2008)
Download the contents page

My own chapter in this compilation of essays, “Alternative medicine in UK Universities” is an extended version of what was published in Nature last year (I don’t use the term CAM because I don’t believe anything can be labelled ‘complementary’ until it has been shown to work). Download a copy if the corrected proof of this chapter (pdf).

Perhaps the best two chapters, though, are “CAM and Politics” by Rose and Ernst, and “CAM in Court” by John Garrow.

CAM and politics gives us some horrifiying examples of the total ignorance of almost all politicians and civil servants about the scientific method (and their refusal to listen to anyone who does understand it).

CAM in Court has some fascinating examples of prosecutions for defrauding the public. Recent changes in the law mean we may be seeing a lot more of these soon. Rational argument doesn’t work well very well with irrational people. But a few homeopaths in jail for killing people with malaria would probably be rather effective.


Healing, Hype or Harm has had some nice reviews,  That isn’t so surprising from the excellent Harriet Hall at Science-Based Medicine. The introduction to my chapter was a fable about the replacemment of the Department of Physics and Astronomy by the new Department of Alternative Physics and Astrology. It was an unashamedly based on Laurie Taylor’e University of Poppleton column. Hall refers to it as “Crislip-style”, a new term to me. I guess the incomparable Laurie Taylor is not well-known in the USA, Luckily Hall gives a link to Mark Crislip’s lovely article, Alternative Flight,

“Americans want choice. Americans are increasingly using alternative aviation. A recent government study suggests that 75% of Americans have attempted some form of alternative flight, which includes everything from ultralights to falling, tripping and use of bungee cords.”

“Current airplane design is based upon a white male Western European model of what powered flight should look like. Long metal tubes with wings are a phallic design that insults the sensibilities of women, who have an alternative, more natural, emotional, way of understanding airplane design. In the one size fits all design of allopathic airlines, alternative designs are ignored and airplane design utilizing the ideas and esthetics of indigenous peoples and ancient flying traditions are derided as primitive and unscientific, despite centuries of successful use.”

Metapsychology Online Reviews doesn’t sound like a promising title for a good review of Healing, Hype or Harm, but in fact their review by Kevin Purday is very sympathetic. I like the ending.

“One may not agree with everything that is written in this book but it is wonderful that academic honesty is still alive and well.”

Jump to follow up

We have often had cause to criticise Boots Alliance, the biggest retail pharmacist in the UK, because of its deeply unethical approach to junk medicine. Click here to read the shameful litany. The problem of Boots was raised recently also by Edzard Ernst at the Hay Literary Festival. He said

“The population at large trusts Boots more than any other pharmacy, but when you look behind the smokescreen, when it comes to alternative medicines, that trust is not justified.”

Ernst accused Boots of breaching ethical guidelines drawn up by the Royal Pharmaceutical Society of Great Britain, by failing to tell customers that its homeopathic medicines contain no active ingredients and are ineffective in clinical trials.

Another chain, Lloyds Pharmacy, are just as bad. Many smaller pharmacies are no more honest when it comes to selling medicines that are known to be ineffective.

Pharmacists are fond of referring to themselves as “professionals” who are regulated by a professional body, the Royal Pharmaceutical Society of Great Britain (RPSGB). It’s natural to ask where their regulatory body stands on the question of junk medicine. So I asked them, and this is what I found.

17 April, 2008

I am writing an article about the role of pharmacists in giving advice about (a) alternative medicines and (b) nutritional supplements.

I can find no clear statements about these topics on the RPSGB web site.

Please can you give me a statement on the position of the Royal Pharmaceutical Society on these two topics.

In particular, have you offered guidance to pharmacists about how to deal with the conflict of interest that arises when they can make money by selling something that they know to have no good evidence for efficacy? This question has had some publicity recently in connection with Boots’ promotion of CCoQ10 to give you “energy”, and only yesterday when the bad effects of some nutritional supplements were in the news.

Here are some extracts from the first reply that I got from the RPSGB’s Legal and Ethical Advisory Service (emphasis is mine).

28 April 2008

Pharmacists must comply with the Code of Ethics and its supporting documents. Principle 5 of the Code of Ethics requires pharmacists to develop their professional knowledge and competence whilst Principle 6 requires pharmacists to be honest and trustworthy.

The Code states:


At all stages of your professional working life you must ensure that your knowledge, skills and performance are of a high quality, up to date and relevant to your field of practice. You must:

5.1 Maintain and improve the quality of your work by keeping your knowledge and skills up to date, evidence-based and relevant to your role and responsibilities.

5.2 Apply your knowledge and skills appropriately to your professional responsibilities.

5.3 Recognise the limits of your professional competence; practise only in those areas in which you are competent to do so and refer to others where necessary.

5.4 Undertake and maintain up-to-date evidence of continuing professional development relevant to your field of practice.


Patients, colleagues and the public at large place their trust in you as a pharmacy professional. You must behave in a way that justifies this trust and maintains the reputation of your profession. You must:
6.1 Uphold public trust and confidence in your profession by acting with honesty and integrity.

6.2 Ensure you do not abuse your professional position or exploit the vulnerability or lack of knowledge of others.

6.3 Avoid conflicts of interest and declare any personal or professional interests to those who may be affected. Do not ask for or accept gifts, inducements, hospitality or referrals that may affect, or be perceived to affect, your professional judgement.

6.4 Be accurate and impartial when teaching others and when providing or publishing information to ensure that you do not mislead others or make claims that cannot be justified.

And, on over-the counter prescribing

In addition the “Professional Standards and Guidance for the Sale and Supply of Medicines” document which supports the Code of Ethics states:



When purchasing medicines from pharmacies patients expect to be provided with high quality, relevant information in a manner they can easily understand. You must ensure that:

2.1 procedures for sales of OTC medicines enable intervention and professional advice to be given whenever this can assist the safe and effective use of medicines. Pharmacy medicines must not be accessible to the public by self-selection.

Evidence-based? Accurate and impartial? High quality information? Effective use?

These words don’t seem to accord with Boots’ mendacious advertisements for CoQ10 (which were condemned by the ASA).

Neither does it accord with the appalling advice that I got from a Boots pharmacist about Vitamin B for vitality.

Or their bad advice on childhood diarrhoea.

Or the unspeakable nonsense of the Boots (mis)-education web site.

Then we get to the nub. This is what I was told by the RPSGB about alternative medicine (the emphasis is mine).



You must ensure that you are competent in any area in which you offer advice on treatment or medicines. If you sell or supply homoeopathic or herbal medicines, or other complementary therapies, you must:

8.1 assist patients in making informed decisions by providing them with necessary and relevant information.

8.2 ensure any stock is obtained from a reputable source.

8.3 recommend a remedy only where you can be satisfied of its safety and quality, taking into account the Medicines and Healthcare products Regulatory Agency registration schemes for homoeopathic and herbal remedies.”

Therefore pharmacists are required to keep their knowledge and skills up to date and provide accurate and impartial information to ensure that you do not mislead others or make claims that cannot be justified.

It does seem very odd that “accurate and impartial information” about homeopathic pills does not include mentioning that they contain no trace of the ingredient on the label. and have been shown in clinical trials to be ineffective. These rather important bits of information are missing from both advertisements and from (in my experience) the advice given by pharmacists in the shop.

If you look carefully, though, the wording is a bit sneaky. Referring to over-the-counter medicines, the code refers to “safe and effective use of medicines”, but when it comes to alternative medicines, all mention of ‘effectiveness’ has mysteriously vanished.

So I wrote again to get clarification.

29 April, 2008

Thanks for that information. I’d appreciate clarification of two matters in what you sent.

(1) Apropros of complementary and alternative medicine, the code says

8.3 recommend a remedy only where you can be satisfied of its safety and quality

I notice that this paragraph mentions safety and quality but does not mention efficacy. Does this mean that it is considered ethical to recommend a medicine when there is no evidence of its efficacy? Apparently it does. This gets to the heart of my question and I’d appreciate a clear answer.

This enquiry was followed by a long silence. Despite several reminders by email and by telephone nothing happened until eventually got a phone call over a month later (May 3) from David Pruce, Director of Practice & Quality Improvement, Royal Pharmaceutical Society of Great Britain. The question may be simple, but the RPSGB evidently it hard, or more likely embarrassing, to answer.

When I asked Pruce why para 8.3 does not mention effectiveness, his reply, after some circumlocution, was as follows.

Pruce: “You must assist patients in making informed decisions by providing necessary and relevant information . . . we would apply this to any medicine, the pharmacist needs to help the patient assess the risks and benefits.”

DC: “and would that include saying it doesn’t work better than placebo?”

Pruce “if there is good evidence to show that it ???????? ????? ????????may, but it depends on what the evidence is, what the level of evidence is, and the pharmacist’s assessment of the evidence”

DC “What’s your assessment of the evidence?”

Pruce, “I don’t think my personal assessment is relevant. I wouldn’t want to be drawn on my personal assessment”. “If a pharmacist is selling homeopathic medicines they have to assist the patient in making informed decisions”

“I don’t think we specifically talk about the efficacy of any other medicine” [DC: not true, see para 2.1, above]

We would expect pharmacists to be making sure that what they are providing to a patient is safe and efficacious

DC “So why doesn’t it mention efficacious in para 8.3”

Pruce “What we are trying to do with the Code of Ethics is not go down to the nth degree of detail ” . . . “there are large areas of medicine where there is an absence of data”

DC “Yes, actually homeopathy isn’t one of them. It used to be.”

Pruce. “uh, that’s again a debatable point”

DC I don’t think it’s debatable at all, if you’ve read the literature

Pruce. “well many people would debate that point” “This [homeopathy] is a controversial area where opinions are divided on it”

DC “Not informed opinions”

Pruce “Well . . . there are also a large number of people that do believe in it. We haven’t come out with a categorical statement either way.”

I came away from this deeply unsatisfactory conversation with a strong impression that the RPSGB’s Director of Practice & Quality Improvement was either not familiar with the evidence, or had been told not to say anything about it, in the absence of any official statement about alternative medicine.

I do hope that the RPSGB does not really believe that “there are also a large number of people that do believe in it” constitutes any sort of evidence.

It is high time that the RPSGB followed its own code of ethics and required, as it does for over-the-counter sales, that accurate advice should be given about “the safe and effective use of medicines”.

“The scientist on the High Street”

The RPS publishes a series of factsheets for their “Scientist in the High Street” campaign. One of these “factsheets” concerns homeopathy, [download pdf from the RPSGB]. Perhaps we can get an answer there?

Well not much. For the most part the “factsheet” just mouths the vacuous gobbledygook of homeopaths. It does recover a bit towards the end, when it says

“The methodologically “best” trials showed no effect greater than that of placebo”.

But there is no hint that this means pharmacists should not be selling homeopathic pills to sick people..

That is perhaps not surprising, because the Science Committee of the RPSGB copped out of their responsibility by getting the factsheet written by a Glasgow veterinary homeopath, Steven Kayne. You can judge his critical attitude by a paper (Isbell & Kayne, 1997) which asks whether the idea that shaking a solution increases its potency. The paper is a masterpiece of prevarication, it quotes only homeopaths and fails to come to the obvious conclusion. And it is the same Steven Kayne who wrote in Health and Homeopathy (2001)

“Homeopathy is not very good for treating bacterial infections directly, apart from cystitis that often responds to a number of medicines, including Berberis or Cantharis”.

So there is a bacterial infection that can be cured by pills that contain no medicine? Is this dangerous nonsense what the RPSGB really believes?

More unreliable advice

While waiting for the train to Cardiff on April 16th (to give a seminar at the Welsh School of Pharmacy), I amused myself by dropping into the Boots store on Paddington station.

DC I’ve seen your advertisements for CoQ10. Can you tell me more? Will they really make me more energetic?

Boots: Yes they will, but you may have to take them for several weeks.

DC. Several weeks? Boots: yes the effect develops only slowly

Peers at the label and reads it out to me

DC I see. Can you tell me whether there have been any trials that show it works?

Boots. I don’t know. I’d have to ask. But there must be or they wouldn’t be allowed to sell it.

DC. Actually there are no trials, you know

Boots. Really? I didn’t think that was allowed. But people have told me that they feel better after taking it.

DC You are a pharmacist?

Boots. Yes

Sadly, this abysmal performance is only too typical in my experience, Try it yourself.

The malaria question

After it was revealed that pharmacists were recommending, or tolerating recommendations, of homeopathic treatment of malaria, the RPSGB did, at last. speak out. It was this episode that caused Quackometer to write his now famous piece on ‘The gentle art of homeopathic killing‘ (it shot to fame when the Society of Homeopaths tried to take legal action to ban it) Recommending pills that contain no medicine for the treatment or prevention or treatment of malaria is dangerous. If it is not criminal it ought to be [watch the Neals Yard video]. .

The RPSGB says it is investigating the role of pharmacists in the Newsnight sting (see the follow-up here). That was in July 2006, but they are stlll unwilling to say if any action will be taken. Anyone want to bet that it will be swept under the carpet?

The statement issued by the RPSGB, 5 months after the malaria sting is just about the only example that I can find of them speaking out against dangerous and fraudulent homeopathic practices. Even in this case, it is pretty mild and restricted narrowly to malaria prevention.

The RPSGB and the Quacktioner Royal

The RPSGB submitted a response to the ‘consultation’ held by the Prince’s Foundation for Integrated Health, about their Complementary Healthcare; a guide for patients.

Response by the Royal Pharmaceutical Society of Great Britain
Dr John Clements, Science Secretary

“We believe that more emphasis should be given to the need for members of the public who are purchasing products (as opposed to services) to ask for advice about the product. Pharmacists are trained as experts on medicines and the public, when making purchases in pharmacies, would expect to seek advice from pharmacists”

So plenty of puffery for the role of pharmacists. But there is not a word of criticism about the many barmy treatments that are included in the “Guide for Patients”. Not just homeopathy and herbalism, but also Craniosacral therapy, Laying on of Hands, chiropractic, Reiki, Shiatsu –every form of barminess under the sun drew no comment from the RPS.

I can’t see how a response like this is consistent with the RPS’s own code of ethics.

A recent president of the RPSGB was a homeopath

Christine Glover provides perhaps the most dramatic reason of all for thinking thst, despite all the fine words, the RPSGB cares little for evidence and truth The NHS Blogdoctor published “Letter from an angry pharmacist”.

Mrs Glover was president of the RPSGB from 1999 to 2001, vice-president in 1997-98, and a member of the RPSGB Council until May 2005. She is not just a member, but a Fellow. (Oddly, her own web site says President from 1998 – 2001.)

So it is relevant to ask how the RPSGB’s own ex-president obeys their code of ethics. Here are some examples on how Ms Glover helps to assist the safe and effective use of medicines. . Much of her own web site seems to have vanished (I wonder why) so I’ll have to quote the “Letter from an angry pharmacist”., as revealed by NHS Blogdoctor,

“What has Christine got to offer?

  • “We offer a wide range of Homeopathic remedies (over 3000 different remedies and potencies) as well as Bach flower remedies, Vitamins, Supplements, some herbal products and Essential Oils.”
  • Jetlag Tablets highly recommended in ‘Wanderlust’ travel magazine. Suitable for all ages.
  • Wind Remedy useful for wind particularly in babies. In can be supplied in powder form for very small babies. Granules or as liquid potency.
  • Udder Care 100ml £80.00 One capful in sprayer filled with water. Two jets to be squirted on inner vulva twice daily for up to 4 days until clots reduced. Discard remainder. Same dose for high cell-counting cows detected.

Udder Care? Oh! I forgot to say, “Glover’s Integrated Healthcare” does cows as well as people. Dr Crippen would not suggest to a woman with sore breasts that she sprayed something on her inner vulva. But women are women and cows are cows and Dr Crippen is not an expert on bovine anatomy and physiology. But, were he a farmer, he would need some persuasion to spend £80.00 on 100 mls of a liquid to squirt on a cow’s vulva. Sorry, inner vulva.”

Nothing shows more clearly that the RPSGB will tolerate almost any quackery than the fact that they think Glover is an appropriate person to be president. Every item on the quotation above seems to me to be in flagrant breach of the RPSGB’s Code of Ethics. Just like the Society of Homeopaths, the code seems to be there merely for show, at least in the case of advice about junk medicine..

A greater role for pharmacists?

This problem has become more important now that the government proposes to give pharmacists a greater role in prescribing. Needless to say the RPSGB is gloating about their proposed new role. Other people are much less sure it is anything but a money–saving gimmick and crypto-privatisation.

I have known pharmacists who have a detailed knowledge of the actions of drugs, and I have met many more who haven’t. The main objection, though, is that pharmacists have a direct financial interest in their prescribing. Conflicts of interest are already rife in medicine, and we can’t afford them.


The Royal Pharmaceutical Society is desperately evasive about a matter that is central to their very existence, giving good advice to patients about which medicines work and which don’t. Pharmacists should be in the front line in education of the public, about medicines, the ‘scientist on the High Street’. Some of them are, but their professional organisation is letting them down badly.

Until such time as the RPSGB decides to take notice of evidence, and clears up some of the things described here, it is hard to see how they can earn the respect of pharmacists, or of anyone else.


Stavros Isaiadis’ blog, Burning Mind, has done a good piece on “More on Quack Medicine in High Street Shops“.

The Chemist and Druggist reports that the RPSGB is worried about the marketing of placebo pills (‘obecalp’ -geddit?). It does seem very odd that the RPSGB should condemn honest placebos, but be so very tolerant about dishonest placebos. You couldn’t make it up.

A complaint to the RPSGB is rejected

Just to see what happened, I made a complaint to thr RPSGB about branches of their own Code of Ethics at Boots in Hexham and in Evesham. Both of them supported Homeopathy Awareness Week These events had been publicised in those particularly unpleasent local ‘newspapers’ that carry paid advertising disguised as editorial material. In this case it was the Evesham Journal and the Hexham Courant.

Guess what? The RPSGB replied thus

“Your complaint has been reviewed bt Mrs Jill Williams and Mr David Slater who are both Regional Lead Inspectors. Having carried out a review they have concluded that support of homeopathic awareness week does not constitute a breach of the Society’s Code of Ethics or Professional Standards.”

In case you have forgotten, the Professional Standards say

2.1 procedures for sales of OTC medicines enable intervention and professional advice to be given whenever this can assist the safe and effective use of medicines.

The RPSGB has some very quaint ideas on how to interpret their own code of ethics

Jump to follow up

The extent to which irrationality has become established in US Medicine is truly alarming I wrote about Quackademics in the USA and Canada on my last trip to the USA, and on my May trip I visited Yale, where I decided to try a full frontal attack. [download the poster]

Several US blogs have written about this phenomenon. For example the incomparable Orac at the The Academic Woo Aggregator , and Dr RW (R.W. Donnell) , see particularly his articles on How did pseudoscience get admitted to medical school? and What is happening to our medical schools? Abraham Flexner is turning over in his grave. Excellent US stuff too at Science-based Medicine (try this and this). There is also a good analysis of what’s happening at Yale by Sandy Szwarc at Junkfood Science.

Remember that the terms ‘integrative’ and ‘complementary’ are euphemisms coined by quacks to make their wares sound more respectable, There is no point integrating treatments that don’t work with treatments that do work.

‘Integrative Medicine’ at Yale says, like all the others on the roll of shame, says “we aim to improve awareness and access to the best in evidence-based, comprehensive medical care available worldwide”. They all pay lip service to being “evidence based”, but there is just one snag. It is untrue. In almost all cases, the evidence is either negative or absent. But this does not put them off for a moment. The whole process is simply dishonest.

The evidence

The evidence has been summarised in several books recently, The following books are particularly interesting because they are all ‘views from the inside. Edzard Ernst is the UK’s first Professor of Complementary Medicine. Barker Bausell was research director of an NIH funded Complementary and Alternative Medicine Specialized Research Center at the University of Maryland.

The first two books go through the evidence fairly and carefully. They show no bias against alternative treatments (if anything, I’d say they are rather generous in cases of doubt).

For a first class US account try Barker Bausell’s Snake Oil Science

Bausell’s book gives an excellent account of how to test treatments properly, and of all the ways you can be fooled into thinking something works when it doesn’t. Bausell concludes

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

For an excellent account of how to find the truth, try Testing Treatments (Evans. Thornton and Chalmers). One of the authors, Iain Chalmers, is a founder of the Cochrane library and a world authotity on how to separate medical fact from medical myth.

It can now be said with some certainty that the number of alternative treatments that have been shown to work better than placebo is very small, and quite possibly zero,

With that settled, what’s going on at Yale (and many others on the roll of shame)?

David L. Katz, MD, MPH, FACPM, FACP, is founder and director of the Integrative Medicine Center (IMC) at Griffin Hospital in Derby, Connecticut. He is also an associate professor, adjunct, of Public Health and director of the Prevention Research Center (PRC) at the Yale University School of Medicine in New Haven, Connecticut.

That sounds pretty respectable. But he is into not just good nutrition, exercise, relaxation and massage, but also utterly barmy and disproved things like homeopathy and ‘therapeutic touch’.

Watch the movie

It so happens that Yale recently held an “Integrative Medicine Scientific Symposium”. Can we find the much vaunted evidence base there? That is easy to answer because three hours of this symposium have appeared on YouTube. So this is the public face of Yale medical school.

There’s some interesting history and a great deal of bunkum and double-speak. To save you time, I’ve cut out about 6 minutes from the movies.

View or download the movie here > [18.5 Mb, flv file].

Dean of education Richard Belitsky and Dr David Katz

Pretty remarble uh? Dr Katz goes through several different trials, all of which come out negative. And what is his conclusion? You guessed.
His conclusion is not that the treatments don’t work but that we need a “more fluid concept of evidence” .

It’s equally bizarre to hear Richard Belitsky, Dean of Medical Education at Yale saying he is “very proud” of this betrayal of enlightenment values. If this is what Yale now considers to be education, it might be better to go somewhere else.

This is not science. It isn’t even common sense. It is a retreat to the dark ages of medicine when a physician felt free to guess the answer. In fact it’s worse. In the old days there was no evidence to assess. Now there is a fair amount of evidence, but Dr Katz feels free to ignore it and guess anyway. He refers to teaching about evidence as ‘indoctrination’, a pretty graphic illustration of his deeply anti-scientific approach to knowledge. And he makes a joke about having diverted a $1m grant from CDC, for much needed systematic reviews, into something that fits his aims better.

Katz asks, as one must, what should we do if there is no treatment that is known to help a patient. That is only too frequent a problem. The reasonable thing to say is “there is no treatment that is known to help”. But Dr Katz thinks it’s better to guess an answer. There is nothing wrong with placebo effects but there is everything wrong with trying to pretend that you are doing more than give placebos. Perhaps he should consider the dilemmas of alternative medicine.

You can read about more about Yale’s activities here and in interviews here. Dr Katz says “The founding approach—and I think Andrew Weil, MD, gets the lion’s share of credit for establishing the concept —is training conventional practitioners in complementary disciplines”. Let’s take a look at this hero. Try, for example, Arnold Relman’s “A trip to Stonesville“.

“According to Weil, many of his basic insights about the causes of disease and the nature of healing come from what he calls “stoned thinking,” that is, thoughts experienced while under the influence of psychedelic agents or during other states of “altered consciousness” induced by trances, ritual, magic, hypnosis, meditation, and the like.”

“To the best of my knowledge, Weil himself has published nothing in the peer-reviewed medical literature to document objectively his personal experiences with allegedly cured patients or to verify his claims for the effectiveness of any of the unorthodox remedies he uses.”

Here is the advertisment for Andrew Weil’s nutrition symposium.

Not only does this yet again propagate the great antioxidant myth, but a few moments with Google show that it is riddled with vested interests, as already pointed out on Quackademics in USA and Canada.

What has brought medical schools down to this level?

That isn’t hard to see, The main thing is simply money. Very few university administrators have the intellectual integrity to turn down money, whatever the level of dishonesty that is required by its acceptance. You can buy a lot of silence for $100m

The US Taxpayer has given almost a billion dollars, via NIH.

Wallace Sampson, MD says of NCCAM

“. . 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”

“Its major accomplishment has been to ensure the positions of medical school faculty who might become otherwise employed in more productive pursuits.”

“Special commercial interests and irrational, wishful thinking created NCCAM. It is the only entity in the NIH devoted to an ideological approach to health.”

NCCAM has given money from some very dubious trials too, Both Orac on Respectful Insolence and Dr RW (R.W. Donnell) have written recently about the NCCAM-funded trial of “chelation therapy”, as first exposed in a devastating article by Kimball C. Atwood IV, MD; Elizabeth Woeckner, AB, MA; Robert S. Baratz, MD, DDS, PhD; Wallace I. Sampson, MD on Medscape Today. This is a $30 million, 5-year, phase 3 Trial to Assess Chelation Therapy (TACT) for coronary artery disease.

“But how did such a crappy study ever come to be, much less be funded by the NIH to the tune of $30 million? The answer, not surprisingly, involves one of the foremost promoters of quackery in the federal government, Representative Dan Burton (R-IN).”

We conclude that the TACT is unethical, dangerous, pointless, and wasteful. It should be abandoned.”

Orac comments

“TACT is not the only example of an unethical and scientifically worthless trial being funded not because the science is compelling but because powerful lobbies and legislators who are true believers in woo applied pressure to the NIH to do them”

The Bravewell Collaboration is the other major source of money. Forbes Business says “Bravewell is not some flaky New Age group”. Well dead wrong there, That is precisely what it is.

This group of ultra-rich people, according to its boss, Christy Mack, has a

” . . common goal —fast-tracking integrative medicine into mainstream medicine”

So Bravewell is corrupting the search for real knowledge and real cures with big bucks. You can buy a lot of hokum for $100m.

The money comes from Morgan Stanley,

John Mack earned the nickname “Mack the Knife” during his ascension to the top of the company [Morgan Stanley] ladder, known for his aggressive cost cutting and consolidation, managerial efficiency, yelling matches, and brutal treatment of others.”

“From 2002 until July 2004, Mack was Co-CEO of Credit Suisse, where he eliminated about 10,000 jobs, cut costs by about $3 billion, and turned the company around to post a huge profit. Accused by SEC of insider trading in 2001, but escaped despite pressure from Senate Finance Committee Chairman Charles Grassley in 2006. Returned as CEO of Morgan Stanley in 2005.”

Bravewell is run by his wife, Christy Mack (Mack-the-wife?) Vice-President, The C.J. Mack Foundation, Member, Board of Directors, The Bravewell Collaborative.

The Flexner report.

The story of Bravewell stands in chilling contrast to another case of philanthropy. Andrew Carnegie’s foundation financed the report by Abraham Flexner, “Medical Education in the United States and Canada” (1910) [download, 15 Mb] . That report was responsible for dragging medical education out of the dark ages
almost a century ago. It resulted in creation of some of the best medical schools anywhere (including Yale).

“By educational patriotism I mean this: a university has a mission greater than the formation of a large student body or the attainment of institutional completeness, namely, the duty of loyalty to the standards of common honesty, of intellectual sincerity, of scientific accuracy.”

“The tendency to build a system out of a few partially apprehended facts, deductive inference filling in the rest, has not indeed been limited to medicine, but it has nowhere else had more calamitous consequences.”

Flexner (1910).

Now another philanthropist is using big bucks to reverse the process and push medicine back into the 19th century.

Flexner would have thought it quite inconceivable that in 2007 medical schools would be offering Continuing Medical Education in homeopathy.

Why are Yale’s academics so quiet about this?

Perhaps they don’t even know it’s happening. If they say firmly that they don’t want it, it will go,

It’s been done before

Florida State University, allegedly under political pressure, proposed to set up a school of Chiropractic. That would have made it Florida State school of snake-oil salesmanship. What a sad fate. [ Science magazine comment] [comment form Paul Lee] [Comment in St Petersburg Times]

But the academics stopped it. An FSU professor, Albert Stiegman, predicted the future campus map.

According to FSUnews

“The Florida Board of Governors voted 10-3 Thursday to deny Florida State University’s request to build a chiropractic school.”

“However, the passage of the bill for the chiropractic school by the Legislature seemingly bypassed the Board of Governors.”

In the end, reason won. Let’s hope that Yale follows their example.

Follow up

The problem of Yale has been taken up with great eloquence by some US commentators

Dr RW (R.W, Donnell): “Quackademic Medicine at Yale

“By the way, where’s the AAMC in all this? Aren’t they supposed to be guardians of integrity and professionalism in medical education? Are they asleep at the switch or is money silencing them too?”

Orac (Respectful Insolence): “Integrative” medicine at Yale: A more “fluid” concept of evidence?

“after the Dean of the Yale School Medicine embarrassed himself in the introduction by saying he’s proud of how far this nonsense has come, Dr. Katz takes the stage and demonstrates the sort of hostile attitude towards science that, if allowed to take root will be the death of scientific medicine in any meaningful form at U.S. medical schools”

Junkfood Science. Sandy Szwarc on “Quote of the day: ;We need a more fluid concept of evidence’

“Will healthcare professionals and consumers . . . . speak out against these wellness programs being enacted by government agencies, insurers and employers? Or is the money too good?”

Science-based Medicine. Steven Novella writes on “Changing the rules of evidence“. When alternative medicine people do not like the evidence, they change the rules to get the outcome that they want, as seen so graphically in this post. They have always done this, but it is only recently that this sort of behaviour has been endorsed by places like Yale.

The Macho Response, another US blog, comments bluntly, in “Yale wants a more fluid concept of evidence

This is beyond embarrassing – it’s a fucking crime – and it’s happening at Yale University and many others.

If you’re in the medical profession (and I know many of my readers are) you need to go here – now.

Kiosque Médias writes as follows

Pour ceux qui s’intéressent à la médecine et à la santé, le blog de David Colquhoun vaut probablement le détour. Ce professeur-chercheur au département de neurosciences, de physiologie et de pharmacologie de l’University College London y décrypte les résultats d’études médicales, en mettant l’accent sur les médecines alternatives. Et il est rarement tendre!

James Randi Newsletter. The hit rate soars after a recommendation this piece by the amazing Randi.

Hokum-Balderdash Assay. Edwardson writes

“Yale University is going to the ducks. It now has an Integrative Medicine program and in April held its first annual Integrative Medicine Scientific Symposium. I think there must’ve been a typo there. They must’ve meant “Ist Annual I.M. Pseudoscientific Symposium.” There! Now we’ve done away with the oxymoron.”

Why is Yale so secretive about its quackery department?,

Most universities are only to keen to boast about their grant income. Not in this case though. When I asked how they funded their quackery, all I got was a letter that had very obviously been drafted by a lawyer.

“As a private institution, Yale University is not generally subject to the U.S. Freedom of Information Act. We therefore respectfully decline to compile and provide the information you have requested.”

So pretty clear signs of guiltiness there.

Dr David Katz, yes, he of the “fluid concept of evidence”, has posted an article, Health Hazards of rhe Blogoshere. If it quacks like a duck . . .

It seems that he has been a bit alarmed by the reaction of the bloggers. It starts, rather pompously, thus.

“Being well educated does not guarantee you’ll always be right, and it certainly doesn’t guarantee everyone will agree with you. But it still matters. Or at least it used to “

But the rest if it reads less like a defence than as an admission of guilt, thus prompting the next item.

Paul Hutchinson’s blog

A quack who admits it picks out a quotation from Dr Katz’s response and turned into a cartoon, released to the public domain, So here it is.

Respectful Insolence.

Orac comments too, in “Fluid evidence” strikes back: Dr. Katz versus the skeptical blogsophere”. He does a terrific job in taking apart the response from the hapless Dr Katz.

“No, Dr. Katz does not like his first encounter with the medical blogosphere at all. Indeed, he is so unhappy that apparently a few weeks ago he tried t answer the bloggers who had raked him over the coals for blatantly advocating “integrating” unscientific woo like homeopathy with scientific medicine. Unfortunately for him, he did not do a particularly good job of it. Indeed, what most stood out as I read his rejoinder was that he does not answer a single substantive criticism leveled at his comments. Not one. Instead, he does what pretty much all woo-meisters do when criticized for shifting goalposts and appealing to other ways of knowing besides science as a means of “proving” that their preferred fairy dust works; he wraps himself in the mantle of the brave iconoclast willing to challenge accepted dogma and whines about the peons who criticized him, heaping contempt on the bloggers who had the temerity to criticize his advocacy for pseudoscience because to him they have not earned the right to criticize his (at least in his opinion, apparently) greatness in comparison to him.”

Last year, Nature published a pretty forthright condemnation of the award of Bachelor of Science degrees in subjects that are not science: in fact positively anti-science. This topic has come up again in Times Higher Education (24 April 2008).

A league table shows that the largest number of anti-science courses is run by the University of Westminster [download paper version].

Vice chancellors have consistently refused to answer letters, from me, from the Times Higher Education or from the BBC, asking them to defend their practices.

The vice chancellors union, Universities UK, has simply refused to consider this very basic threat to academic standards.

It is particularly amazing that vice-chancellors continue to support courses in homeopathy when they have been condemned by no less a person than the head honcho of homeopathy in the UK, Dr Peter Fisher. He is clinical director of the Royal London Homeopathic Hospital and Homeopathic Physician to the Queen. Peter Fisher and I were interviewed on BBC London News after publication of the Nature article. At the end, Fisher was asked by the presenter, Riz Lateef, about whether homeopathy was a suitable subject for a science degree.[Watch the movie]

Riz Lateef (presenter): “Dr Fisher, could you ever see it
[homeopathy] as a science degree in the future?

Dr Peter Fisher:
“I would hope so. I wouldn’t deny that a lot of scientific research needs to be done, and I would hope that in the future it would have a scientific basis. I have to say that at the moment that basis isn’t comprehensive. To that extent I would agree with Professor Colquhoun.”

The one exception was a response, of sorts, that I got from Westminster University.

I can interpret this lack of response only as a sign of guilt on the part of the vice chancellors of the 16 or so universities who teach this stuff. That interpretation is reinforced by the refusal of two of them to release their teaching materials, despite requests under the Freedom of Information Act 2000. Both the University of Central Lancashire and the University of Westminster have turned down appeals, and refused to hand over anything. The former case has been with the Information Commissioner for some time now, and if the ruling goes as a hope, the taxpayer may soon be able to see how their money is being spent.

But the wonderful thing about the electronic age is that it has become really quite difficult to keep secrets. Last year I managed to find an exam paper set by the University of Westminster in Homeopathic Materia Medica, and a question from that paper has already appeared in Nature.

I recently acquired copies of a course handbook. and of the powerpoint slides used for the lecture on ‘Vibrational Medicine’ by the University of Westminster. This appears to be from a course in Complementary Therapies, part of “Health Sciences: Complementary Therapies BSc Honours”, according to Westminster’s web site. A lot of people have access to this first year course material, so Westminster needn’t bother trying to guess how I got hold of this interesting material

In the public interest, here are a few quotations. Taxpayers should know how their money is being spent.

According to the handbook

“Complementary Therapies is a core module for the Therapeutic Bodywork, Herbal Medicine, Homœopathy, Nutritional Therapy and Complementary Therapies courses. Therefore all students of these degree courses are required to take this module.”

The University of Central Lancashire also has “Vitalistic Medicine” as part of its BSc Homeopathy (but, like Westminster, has some excellent people too).

There is a rather good Wikipedia entry on Vitalism, a topic that is now largely the preserve of cranks.

The handbook is wonderful. The word ‘evidence’. in the context of ‘does it work?’, does not occur a single time. There is plenty of the usual edu-bollocks jargon that is so beloved by bureaucrats, but not the slightest hint of critical thinking about assessment of the ‘therapies’.

The course seems to be a romp through almost every form of battiness known to humankind. Not just homeopathy, traditional Chinese medicine and nutritional therapy, but also dowsing, crystal healing and other forms of advanced delusional thinking. Before somebody grumbles, let me emphasise that ‘nutrition’ is to be distinguished from ‘nutritional therapy’: the latter involves imaginative claims that buying expensive supplements can prevent or cure almost anything. There’s a lot more about that here, and here.

Here are just 5 days from the timetable.

9am-1.00pm : Homœopathy (group work and video)
9am-1.00pm : Traditional Chinese Medicine
11.15-1.00pm : Nutritional Therapy
9am-1.00pm : Vibrational Medicine/Energy Concepts (L&P)

All this can be yours -at a cost.
Full-time UK/EU fee – £3,145
Full-time Overseas fee – £9,450

The slides for the last of these lectures show some of the most glorious examples of the abuse of sciencey-sounding words that I’ve seen in a while.

Sigh. All this is sheer imagination. It is ancient vitalism dressed up pretentiously in sciencey words.Then a bit later we come to the general theory -“energy concepts”.

More plausible-sounding, but utterly meaningless words about vibrations. And then on to old superstitions about dowsing with rods and pendulums.


Not a single word of scepticism appears about any of this mumbo jumbo. Can it get worse? Yes it can. CRYSTAL HEALING comes next.

Are you having difficulty in understanding what all these words mean? I certainly hope so, because they have no meaning to understand. Don’t worry too much though, There are some helpful diagrams.

Aura photographs? They are just fairground conjuring tricks. Well, that is what you thought. But here we see them presented, apparently in all seriousness, as part of a vocational bachelor of science degree in a UK
university.Never mind, it is all assessed properly, with all the right box-ticking jargon. The course handbook says

Learning Outcomes

On successful completion of this module you will be able to:

• describe the theoretical basis and classification of a range of
complementary therapies

What theoretical basis? There isn’t any theoretical basis, just a meaningless jumble of words.

You just couldn’t make it up.

Westminster University is not all like this

This post is not intended as an attack on the University of Westminster as a whole. Last year I had an invitation from their biomedical people to give a talk there. They asked for a talk on “What is is the evidence for Alternative Medicine?”. But then I got an email from them saying

“I was surprised to be sat on heavily on return from said trip by the VC, Provosts and Deans (including Peter Davies the leader of the Alt Med School !) once news of your talk leaked out. Could you give a talk on your research instead- yep I know its pusillanimous of me and yep I know unis stand for freedom of speech and yep I know that fellow members of staff suggested you come and others were keen to listen to your views on quackery.”

So on November 2nd 2007 I gave a seminar about single ion channel work (our new ideas about partial agonists). Of course all the excellent staff whom I met agreed with me about the embarrassment that having degrees in homeopathy etc. The fault lies not with their academic staff, but with their administration. Freedom of speech does not seem to be high on their agenda.

Postscript I recently learned that when Times Higher Education asked Westminster about my seminar, they were given the following statement.

“Prof David Colquhoun was invited to take part in a research seminar series organised by the University’s School of Biosciences last year. As part of this series, on Friday 2 November 2007, he gave a talk on the agreed topic of “Single ion Channel studies suggest a new mechanism for partial agonism” – his area of research.”

Perhaps I am naive, but it truly shocks me that a university can issue such a dishonest account of what happened.

This blog, along with many others, has had plenty to say about the Prince of Wales’ unconstitutional meddling in public affairs. The lovely description, Quacktitioner Royal, was coined by NHS Blog doctor.

The Times published a letter from Edzard Ernst and Simon Singh on April 16th. In their forthcoming book, Trick or Treatment? Alternative Medicine on Trial, they go carefully through all the evidence for all sorts of ‘alternative’ treatments. They find some evidence that a handful of them work. For most the answer is ‘not enough evidence’, and for a number there is good evidence that many of them don’t work to any useful extent.

“Sir, For over two decades the Prince of Wales has been actively promoting alternative medicine and his Foundation for Integrated Health continues to encourage the use of treatments such as homoeopathy or reflexology.””In light of this “rigorous scientific evidence”, we strongly advise that the Prince of Wales and the Foundation for Integrated Health withdraw the publications Complementary Health Care: A Guide for Patients and the Smallwood report. They both contain numerous misleading and inaccurate claims concerning the supposed benefits of alternative medicine. The nation cannot be served by promoting ineffective and sometimes dangerous alternative treatments.”

Thank heavens that someone has the courage to say it as it is.

If only the ineffectual and ill-educated people in the Department of Health wouold do the same. But no, instead they gave £37 000 to the Prince of Wales Foundation to write their make-believe guides. And £900 000 to write nonsense for the Complementary and Natural Healthcare Council (also known as Ofquack), and Skills for Health,

The next day The Times ran an article by their science editor, Mark Henderson, Prince of Wales’s guide to alternative medicine ‘inaccurate’. Natasha Finlayson, of the Prince’s Foundation for Integrated Health, is quoted as saying “The foundation does not promote complementary therapies.”. That takes some beating for sheer bare-faced dishonesty.

Edzard Ernst appeared on the Today Program on 18th April. He was interveiwed by the formidable John Humphrys, along with Kim Lavely, Chief Executive, The Prince’s Foundation for Integrated Health (FIH). Ernst points out that the FIH guide suggests that chiropractic is effective in asthma, and that acupuncture is good for addiction, whereas the evidence says the opposite. Lavely retorts, rather lamely (OK I’m biassed).

Lavely: ” . . . we didn’t attempt to give detailed evidence on every therapy”. “We think they [the public] have the right to know and what doesn’t”

Humphrys: “Well isn’t that the whole point? the professor is saying here is that these things do not work, at least in terms of the claims that are made for them, such as homeopathy and chiropractic . . . ”

Lavely: “There are no claims made in this guide for what works and what doesn’t. What we have said is that some therapies are used for some things but we aren’t saying they are effective for those things . . . “

So, one might ask, what on earth is the use of a guide is it that offers no indication of effectiveness? Lavely’s second quotation contradicts directly her first. A pretty pathetic performance.
Listen to the interview [mp3 file]

The Sunday Times, on April 20th, pblished a pretty good review of Trick of Treatment?. “Their case against the folly, vanity and damage of HRH et al. is hard to argue with.”

Of course, the letters column drew the expected response from the quacks, most verging on the hilarious.

Another blow for the alternative industry came in the same week, The authoratitve Cochrane review confirmed earlier reports that vitamin supplements not only do not help you but some actually increase mortality. The antioxidant myth nevertheless rumbles on, and on, and on. There is too much money in it for it to die easily.

Predictably enough, the conclusions were denied by the Health Food Manufacturers’ Association (HFMA). They wheeled out several pop singers to say how wonderful their products are. Read about that pathetic defence on Holfordwatch.

Who is behind HFMA? Incidentally, HFMA are strangely reticent about the identity of their 120 members. They will not reveal who they are. Does anybody out there know the answer? I’ll buy a good dinner for anyone who can root this out.  If it is anything like the ‘Health Supplements Information Service‘ it is likely to be backedby the very big pharmaceutical companies that the alternative industry loves to hate.

Take the test

Prince of Wales Guide

“Reflexologists work with a wide range of conditions including certain types of pain, particularly back and neck pain, migraine and headaches, chronic fatigue, sinusitis, arthritis, insomnia, digestive problems such as irritable bowel syndrome, and constipation, stress-related disorders and menopausal symptoms.”

Singh & Ernst

“The notion that reflexology can be used to diagnose health problems has been disproved and there is no convincing evidence that it is effective for any condition.”

In a wonderful demonstration of common sense, the BBC has removed all the alternative medicine pages from BBC Health web site. I expect that it was helped in making that decision by the many complaints it had received about statements on these pages that were simply not true, The existence of these pages was just not compatible with the BBC’s commitment to accuracy.

Needless to say, this decision was greeted with howls of rage from the alternative world. Some wrote to the BBC to complain (and I wrote to congratulate them). Until today I haven’t been able to find any BBC statement on the matter. This one appeared on Healthypages, one of the zaniest sites on the net. Nothing is too barmy for them. This is the picture they used to show how wrong the BBC is
Picture from Healthypages

A recent offer on Healthypages, not to be missed, comes from “Innerjoy”.

“I do a range of spiritual healing practices and can offer an energetic healing session including techniques from the Order of Melchizedek and about 10 forms of Reiki in exchange for a Theta Healing session.”

And just in case you don’t know about the Melchidezek method, here is a picture of a poster in the window of my local “health food” shop.

The explanation says

“Using ancient holographic technology, the basis of the techniques presented is the activation of the Merkaba, a rotating lightfield awakening your spherical consciousness. This raises one’s quotient of light vibration within the human atomic cell structure. Once activated. the merkaba assists us in accessing our naturally ascended consciousness state: the healing capabilities are enhanced a hundred-fold. The Hologram of Love has the ability to heal and rejuvenate any form of creation as it is the living conscious holographic pattern of God Source vibration.”

There, and I’ll bet you thought holography was a recent invention. As an example of sciencey-sounding words used in random order, this one takes a bit of beating. It really is an insult to human intellect.

Anyway, back to the BBC. This is their diplomatic response (what they should have said really was, ‘those pages were nonsense so we removed them’).

BBC issued the following statement, dated 22 Feb 2008:

We received complaints about the Complementary section of the BBC Health website being disbanded

The BBC’s response

The decision to remove the complementary medicine area of the health website was taken as part of a wider review of all the health content in order to enable the BBC to focus its efforts on creating new and exciting content.

In order to release resources for this redevelopment work, we’re reviewing existing content from an editorial and value-for-money perspective.The complementary health section was incomplete and, therefore, not of a satisfactory editorial standard.

It also represented a small proportion of traffic to the site but was disproportionately time-consuming.Therefore, the decision to take it down was based on a combination of factors: how much work it needed to maintain to a high editorial standard, how much this cost and how popular it was with site users.We have already removed other sections of the health site and plan to reduce or remove others.

We appreciate people are disappointed this area of the site has been removed and apologise if the decision has appeared abrupt to site users or inconvenienced other sites linking to BBC Health.

The BBC will continue to cover complementary health in other areas of its output, such as TV, radio and news programmes, and may reassess its complementary health content in future.

The news of the BBC’s return to honesty was greeted with consternation in CAM magazine too. The March 2008 issue notes that there used to be over 40 pages of alternative medicine on the BBC, now all gone, They quote an email from ‘Mardi’, thus,

” . . . However the site has in recent months been targetted by the self-appointed ‘quackbusters’ ( . . . such as David Colquhoun), who sent a deluge of letters and emails claiming that complementary therapies such as homeopathy and cranial osteopathy were ‘unscientific’ and should be removed.”

Well thanks for the credit, but sorry, there was no deluge. I wrote no more than a couple of times myself, and I suspect that a handful of friends did the same. I didn’t even ask them to remove the whole lot, merely to correct particular statements that were not true,

‘Mardi’ goes on

“Rather than taking a reasoned view and considering the evidence from good research studies on complementary medicine, these individuals seem simply hell bent on trying to stamp out complementary medicine”

That really is a bit rich. Suddenly the alternative industry are invoking evidence from good research studies. It is precisely the other way round. It is because that evidence is almost all negative that the BBC have decided to remove their coverage.

Of course it may have helped that the BBC had to spend a lot of time defending itself against criticism of the BBC 2 TV series on Alternative Medicine from February 2006. After initially rejecting complaints, an appeal to the highest level, the Board of Trustees, two of the most serious complaints were upheld against these programmes.

This is the third post based on a recent trip to North America (here are the first and second)

One aspect of the endarkenment, the Wal-Mart model of a university, is very much the same in the US as in the UK. At one US university, an excellent scientist offered the theory that an alien spacecraft had scattered spores across the land which developed into HR staff who appeared at first sight to be human, and who colonised academia.

The penetration of quackademics into US universities is a bit different from in the UK.

In the UK, the plague is restricted to sixteen or so ex-polytechnic universities which, to their great shame, actually offer Bachelor of Science degress in subjects like homeopathy. There are bits of quackery in good teaching hospitals (such as laying-on-of-hands at UCLH), but not very much.

In the USA and Canada, this sort of “vocational” training does not occur much in universities, but in separate colleges. The situation is worse there though, insofar as these colleges have been allowed to award titles like ‘doctor of naturopathic medicine (ND)’, for work that in no respect compares with what the rest of the world has to do to earn a doctorate. This prostitution of academic titles has not happened to anything like the same extent in the UK. How our own quacks would love it if they were allowed to call themselves ‘doctor’ and sport the initials ND (so easily mistaken for MD at first sight).

It is on the clinical side where the situation is far worse than in the UK. Almost every university hospital, including Harvard, Yale and Stanford, has departments devoted to fairy-tale medicine.

Quacks use a number of euphemisms to make themselves sound more respectable. First they became ‘alternative medicine’, then ‘complementary medicine’. Now the most-used euphemism is ‘integrative medicine’, which is favoured by most US universities (as well as by the Prince of Wales). Raymond Tallis pointed out that this seems to mean integration of treatments that don’t work with treatments that do work.

An official roll of shame for North American universities can be seen here (35 in USA and 4 in Canada).

A bigger collection of 44 universities has been posted by the incomparable Orac at the The Academic Woo Aggregator. He’s had good support in the USA from DrRW (R.W. Donnell), see particularly his articles on How did pseudoscience get admitted to medical school? and What is happening to our medical schools? Abraham Flexner is turning over in his grave.

All these outfits have two things in common. They all claim to be scientific and evidence-based, and none has produced any real evidence that any of their treatments work.

Here are a few examples of what’s going on.

Yale University School of Medicine

The usual theme is expressed thus.

“Through open-minded exploration and rigorous scientific inquiry, we aim to improve awareness and access to the best in evidence-based, comprehensive medical care available worldwide, with the goal of optimizing health and healing for patients”

The driving force behind the woo seems to be a fourth year medical student, Rachel Friedman, so I wrote to her to ask what useful alternative treatments had been established by research at Yale. But she could not identify any. All I got was this.

“My best advice would be to do some medline searching of metaanalyses” there’s been enough research into some of these modalities to provide for a metaanalysis.”

So she was unable to produce nothing (and anyway. metanalyses, useful though they may be, are not research).. A glance at the Yale publications page shows why.

The Scripps Institute

Scripps Center for Integrative Medicine says

“In use at Scripps since 1993, Healing Touch is an energy-based, non-invasive treatment that restores and balances energy to help decrease pain and relieve associated anxiety.

Healing Touch is performed by registered nurses who recognize, manipulate and balance the electromagnetic fields surrounding the human body, thereby promoting healing and the well-being of body, mind and spirit.”

“Balances energy”?

“manipulate and balance the electromagnetic fields surrounding the human body”?

This is just meaningless baloney. And it come from the Scripps Institute.

The Oregon Health & Science University

OHSU is an excellent and well-respected research university where I have many friends. It was a pleasure to meet them recently.

But it also has a big department of “Complementary and alternative medicine” and an “Integrated medicine service”. There are some good bits of advice mixed up with a whole range of crazy stuff. Take their page on homeopathy.

“This therapy treats ailments with very small amounts of the same substance that causes the patient’s symptoms.”

WRONG. In most cases it is zero amount. To brush this fact under the carpet is simply dishonest (and perhaps a sign of guilt). Then comes this (my emphasis)..

Explanations for why homeopathy works range from the idea that homeopathic medicine stimulates the body’s own natural defenses to the idea that homeopathic medicine retains a “memory” of the original substance.

However, there is no factual explanation for why homeopathy works and more research is needed.”

WRONG. This statement carries (twice) the expicit message that homeopathy does work, quite contrary to a mountain of good evidence that it is merely a placebo. The statement is deceptive and dishonest. And it comes with the OHSU logo.

The University of Arizona

” Heal medicine”, “Transform the world?” Modest uh?

The University of Arizona Program in Integrative Medicine is certainly not modest in its claims, but its publications page shows that it doesn’t even attempt to find out if its “therapies” actually work.

Here is an example. They are advertising their Nutrition and Health conference

There’s nothing wrong with good nutrition of course, but the ‘alternative’ approach is instantly revealed by the heavy reliance on the great antioxidant myth.

And look at the sponsors. The logo at the top is for Pistachio Health, a company that promotes pistachio nuts: “Delicious and good-for-you, pistachios are nature’s super heart-healthy snack. Nutrient dense, full of fiber and antioxidants, pistachios give you more bang per calories than any other nut.”.

The other advertisement is ‘POM Wonderful’, a company that sells and promotes pomegranate juice, “POM is the only pomegranate juice you can trust for real pomegranate health benefits”

No doubt pistachio nuts and pomegranate juice are perfectly good foods. But the health claims made for them are just marketing and have very little basis in fact.

Now let’s look at the speakers. Take, for example, Dr David Heber, MD., PhD. He is director of the UCLA Center for Human Nutrition at the University of California, Los Angeles, a professor of Medicine and Public Health, and the founding Chief of the Division of Clinical Nutrition in the Department of Medicine. He is the author of several books including “What Color is Your Diet” and the “L.A. Shape Diet.” With the possible exception of the books, you can’t sound like a more respectable and impartial source of advice than that.

But hang on. Dr Heber is to be seen in a video on the Pistachio Health web site doing what amounts to a commercial for pistachio nuts.

OK let’s take a look at one of Dr Heber’s papers. Here’s one about, guess what, pomegranate juice. “Pomegranate Juice Ellagitannin Metabolites Are Present in Human Plasma and Some Persist in Urine for Up to 48 Hours”. The work was “Supported by the Stewart and Lynda Resnick Revocable Trust and from the NIH/NCI grant P50AT00151”. So no problems there. Well not until you check POM Wonderful in Wikipedia, where you find out that Stewart and Lynda Resnick just happen to be founders of POM.

Of course none of these interesting facts proves that there is anything wrong with the work. But they certainly do show that the alternative nutrition business is at least as much hand-in-glove with big business as any other form of medicine. And we know the problems that that has caused.

So, if you want impartial advice on nutrition, sign up for the 6th Annual Nutrition and Health meeting. For “MD, DO, ND & other doctors”, it will cost you only $845 to register .

The meeting is being run by The University of Arizona College of Medicine and Columbia University’s College of Physicians and Surgeons.

The University of Arizona is, incidentally, also the home of the famous (or perhaps infamous) Gary Schwartz (see also, here). He “photographs” non-existent “energy fields” and claims to be able to communicate with the dead, and he is director of its Human Energy Systems Laboratory at the University of Arizona. He is also head of the inappropriately-named Veritas Research Program and “Centre for Frontier Medicine in Biofield Science”. All of these activities make homeopathy look sane, but he is nevertheless part of an otherwise respectable university. In fact he is He is Gary E. Schwartz, Ph.D. is professor of psychology, medicine, neurology, psychiatry and surgery at the University of Arizona. Even more incredibly, this gets NIH funding.

Columbia University, along with Cornell, also has its own “Complementary, alternative, and integrative medicine“, defined as “the use of treatments, such as homeopathic medicine, ayurveda, botanical dietary supplements”. And their “Integrative Therapies Program for Children” is intimately tied up with a company called Origins, which is more a cosmetics company, Origins” (with all the mendacity that implies). They say

“Origins understands the importance of addressing wellness through an integrative approach,” says Daria Myers, President of Origins Natural Resources. “With our recent Dr. Andrew Weil collaboration, Origins demonstrated its support for the integrative wellness concept. Now, with the introduction of the new Nourishing oil for body and massage, we hope to bring not only a moment of comfort but also a healthy future to children enduring the fight of their life.”

Andrew Weil is, of course, the promoter of the Arizona meeting.

The corruption of Universities by this sort of activity is truly amazing.

Thursday 24 Jan.

One of the original reasons for going to North America was an invitation from the Toronto Secular Alliance and Center for Inquiry. The talk for them was given a lot of publicity, for example here and here and from the totally admirable Orac.

Toronto seems to be no worse than anywhere else when it comes to delusional thinking about medicine. It is, of course, the home of Ryerson University, the place that produced one of the most outrageous pieces of postmodernist nonsense on record. But when this sort of thing gets into really good universities, it is more worrying.

As a result of the publicity there was some media coverage (and a record 7109 hits on this site on Sunday).

Friday 25th January, Reception and talk: Center for Inquiry. Science in an Age of Endarkenment: Some Examples from Scientific Fraud, Quackery, Religion and University Politics

An interview to the National Post (a newish right-of-centre national Canadian paper that was founded by the now-notorious Conrad Black). It was interesting that the reporter had views not unlike my own about the rise of the MBA mentality. That, he said, was what gave us Enron. The article appeared on page 3 of the National Post on Saturday 26 January under the heading “Anti-Nutty Professor” (or download newspaper version as pdf file).

Friday morning was spent at CBC recording with Michael Enright, for the Sunday Edition.

The interview was broadcast on Sunday morning (28 Jan) and elicited a lot of correspondence. CBC made it available as a podcast which can be downloaded from CBC here. The endarkenment interview was the last 22 minutes (out of 64 minutes) [play the interview here (mp3, 20 Mb)].

Sunday Edition: the follow-upThe week following this CBC show, the backlash started. The Sunday Edition wrote

“A stirred-up hornet’s nest is a mild disturbance compared to the firestorm we unleashed last week over my conversation with Dr. David Colquhoun. Dr. Colquhuon [sic] is a gangly, pipe-puffing British pharmacologist who thinks all alternative medicine, all of it, is a fraud perpetrated by quacks. But he went further, somehow suggesting that those who believe in it probably supported Margaret Thatcher, Ronald Reagan and the Ayatollah Khomeini. He pooh-poohed acupuncture, chiropractic, homeopathy, even vitamins.

Well, his remarks opened the floodgates of listener mail, screaming for Dr. Colquhoun’s head on a pike. In a few moments, alternative or complimentary [sic] medicine strikes back. With the help of two experts, we will try to give the other side of contentious Colquhounism.”

The programme for 3 Feb 2008 started with a few emails from listeners, mainly of the “homeopathy cured my granny” type. Nothing of much significance there. But then Enright interviewed Dugald Seely of the Canadian College of Naturopathic Medicine and Dr. Kien Trinh of the DeGroote School of medicine at McMaster University in Hamilton. You can download the podcast here.

The flat earth problem.

Michael Enright was a good interviewer, but Sunday Edition suffers, like the BBC, from a problem. It is admirable that CBC, like the BBC, should strive to be ‘fair and balanced’, but it is not always easy to see what that means in practice. Is it fair and balanced to give equal time to people who think that the earth is flat and those who think it is spherical (OK, an oblate ellipsoid)? Perhaps, but it also
quite misleading because it can easily convey a very distorted idea of the balance of informed opinion. In this case the flat-earthers are the homeopaths and other alternative medicine advocates. That would not matter so much if the interviewers had enough knowledge of the subject to pin down the falt-earth advocates with the sort of penetrating questions that people like John Humphrys (of the BBC’s Today programme) are so very good at. When it comes to science, though, the flat-earthers tend to get away with murder, and the public can easily be left with a very distorted view. Which “expert” should they believe? If I had been given the option, I would have loved to debate the problems of alternative medicine directly with Trinh and Seely I could have asked then a few questions that Enright missed.

Let’s take a look at what happened at the follow-up.

Quackery at McMaster University

McMaster is one of many universities in North America that has chosen to betray the intellectual tradition of the enlightenment by buying into superstition (see the roll of shame here). The ‘contemporary medical acupuncture program appears to run under the aegis of the anaesthesia
department, though the fact that is doen’t appear on the department’s front page suggests there may be some embarrassment about it. The medical acupuncture program itself, has separate web pages which don’t seem to be on the McMaster server at all (they are on a private server, ThePlanet.com Internet Services, Inc.

As so often, these pages pay lip service to an ‘evidence based’ or ‘scientific’ approach, while doing nothing of the sort. In his CBC interview Kien Trinh agreed (twice) with my contention that trials had shown that it doesn’t matter where you put the needles. But then he failed totally to draw the obvious conclusion that ‘meridians’ are mumbo jumbo. He went right on taking the conventional mystical view of meridians and “energy” flow. Like most proponents of alternative medicine, Trinh seems to live in some sort of parallel universe in which the normal rules of logic don’t apply.

On wouldn’t expect regular anaesthetists to accept this sort of mystical nonsense, but it seems one would be wrong. When I wrote to the Chair of the Department of Anesthesia, at McMaster to ask about their relationship with acupuncturists there was no hint of embarrassement. Dr Norman Buckley, BA (Psych), MD, FRCPC, wrote

“It operates under the principles of evidence based medicine, and relates the concepts raised by the Acupuncture/traditional Chinese medicine to physiology anatomy et as it is more usually taught in Western schools.”

That would be all very well if it were true, but it simply isn’t true. The evidence just isn’t there, and the departments involved make no serious attempts to get evidence. In a later letter, Dr Buckley seems to acknowledge that it may be all placebo, but seems reluctant to offend anyone by saying so. That, I suspect, is how quackery has gained such a foothold.

It is good to keep an open mind, but if it is too open your brains fall out. Or, in another variant, if it is too open, someone will fill it with trash.

One looks in vain on Trinh’s web site for any good evidence. They quote approvingly the conclusion of a 1997 NIH Consensus statement that says “There is sufficient evidence of acupuncture’s value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.”, but forget to mention that this document is headed “This statement is more than five years old and is provided solely for historical purposes.”. The department doesn’t seem to do much original research, just to write endless reviews of other peoples’ work. The reviews aren’t too bad, and mostly they come to the right conclusion, that there is not enough evidence to come to firm conclusions. The difference from science is that this doesn’t dent their confidence for a moment. A typical sort of conclusion seems to be

Elbow pain. A review by Green et al. concluded “needle acupuncture [is] of short-term benefit with respect to pain, but this finding [is] based on the results of two small trials, the results of which [are] not able to be combined in metaanalysis.”

The results of thousands of years experience with acupuncture seem to be pretty pathetic so far..

Quackery at the Canadian College of Naturopathic Medicine (CCNM)

Unlike McMaster, CCNM isn’t a proper university, though nonetheless is hands out ‘doctorates’. Dugald Seely’s contribution was interesting insofar as he admitted that there was a lot of fraud and unjustified claims in the alternative medicine industry (never forget there are megabucks involved). What he didn’t explain was how he himself could be distinguished from the frauds. The problem, as always is the second-rate research that goes on in this area.
Take one of Seely’s papers, Adaptogenic Potential of a Polyherbal Natural Health Product: Report
on a Longitudinal Clinical Trial
. Is only too typical: a small non-randomised, open-label (not blind) “trial” of a complex herbal mixture on 17 patients. The conclusion was, as it almost always is,

“Further research using a randomized controlled design is necessary to confirm the findings from this pilot study.”

In other words, no conclusion at all. Why is it that the proper trial never seems to appear? Could it be that naturopaths, and the wealthy industry behind them, are afraid to do proper trials? That is certainly the impression they give.

One way in which the alternative medicine industry operates is to invent new words with ill-defined meanings (and Big Pharma does it too). In case you were wondering about the word “adaptogen” it is defined as “Essentially the adaptogen supports the body’s ability to ‘adapt’ ideally to its environment. Essentially the adaptogen supports the body’s ability to ‘adapt’ ideally to its environment. ”

Whatever that means.

The Canadian College of Naturopathic Medicine offers the following “therapies”.

  • acupuncture/Asian medicine
  • botanical medicine
  • physical medicine (massage, hydrotherapy, etc.)
  • clinical nutrition
  • homeopathic medicine
  • lifestyle counseling

Well, nothing wrong with nutrition and lifestyle counseling as long as the claims aren’t exaggerated. But, as always, the claims that are made are vastly exaggerated. For example they claim

Homeopathic remedies are particularly effective for:

  • depression
  • anxiety
  • allergies
  • infections
  • gynecological concerns
  • skin conditions
  • digestive problems
  • chronic and acute conditions including colds and flu

These claims are simply not true, in my view. If you don’t believe me, check NELCAM (the NHS Complementary and Alternative Medicine Specialist Library). This is written by advocates of alternative medicine, yet it finds no convincing evidence for effectiveness of homeopathy in any of the conditions listed above.

Or, even more remarkably, from a report in Newsweek.

“Dr. Jack Killen, acting deputy director of the National Center for Complementary and Alternative Medicine, says homeopathy “goes beyond current understanding of chemistry and physics.” He adds: “There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment.”

The National Center for Complementary and Alternative Medicine (NCCAM) has, incidentally, spent almost one billion US$ billion of US taxpayers’ money and has come up with next-to-nothing useful.

So the claims made by the Canadian College of Naturopathic Medicine are not backed up even by people who are directly involved in alternative medicine You don’t have to be a rocket scientist to understand that the medicine contains no medicine.

This is the first of a several posts that have arisen from a visit to North America. One thing that the trip led to was an interest in how HR departments influence science -if you have a story about that, please email me.

Following the media publicity that surrounded the lecture in Toronto, I was sent this poem by Anne Spencer, of Canada.

It is based on the style of Jonathan Swift (1667-1745), and she had earlier went a more political version, below, which was a runner up in the international Swift satire poetry competition, 2004. Anne Spencer has been kind enough to let me reproduce both her poems here.

What men wish, they like to believe.
Julius Caesar

Verses on folly, faith and fantasy

Great Caesar saw what we still find

In much of modern humankind,

That wishful thinking will suppress

The reason we should all possess.

Take health. That is a main concern.

We look for cures at every turn

For sicknesses that cause unease

And nasty things that bring disease.

But from the science of the age

Too many now will disengage,

Forget the studies, evidence

Of remedies that will dispense

A tested way of healing those

Conditions doctors diagnose.

They say they’ve lost their confidence

In science, and have a preference

For substances that they perceive

Fit in with what they all believe

In nature’s realm of field and flowers,

Along with supernatural powers

Or energies that ebb and flow

And are released by those who know

The proper touch or breath or spell

For proper paying clientele.

And other forms of therapy

Like healing touch they all agree

Despite their failure to explain

Result in easing of their pain.

For grave conditions that could kill

It’s nature’s bounty fills the bill,

From goats a serum crushes AIDS

And grape juice makes Altzheimers fade,

Red clover makes the blood come clean

And sugar pills become routine

As remedies for things they feel

They cannot count on science to heal.

And substances that they produce

To cure complaints or pain reduce

They say they must dilute and then

Dilute, dilute, dilute again

Because the less you have, not more

Will guarantee a better cure.

(Conclusions such as this imply

There’s no attempt to reason why.)

And quite impervious they stay

To anything their critics say

About placebos and effects

That challenge rational intellects.

Their gurus sanction their belief

That things they give them bring relief

From anything they want to try,

(Because the more they wish, they buy)

If people give them hope and say

That black is white, then that’s OK.

But there’s the rub – for harm can come

By seeing this as rule of thumb

For if you disregard the facts

That science tells, then this detracts

From treatments that show evidence

Of beneficial consequence.

More harm than good can come to those

Rejecting treatments that propose

Results that doctors can compile

Which don’t depend upon a smile

Or harmony with sundry forces

Brought to bear by doubtful sources.

So those who wish upon a star

Or herb or potion in a jar

To grant relief from ache or pain

Could well decide to think again

And weigh the chances that desire

Not reason is what we require

To make us well when we succumb

To ailments that are troublesome.

For wishful thoughts beguile the mind

But leave reality behind.

And here is the political version of Anne Spence’s poem

Great Caesar, famed in Gallic wars,

A champion of the Roman cause,

Who came, and saw and conquered when

The sword was mightier than the pen,

Was yet a statesman, author, who

Knew much of human nature too.

For Caesar saw what we still find

In much of modern humankind,

That wishful thinking reason dims

And validates our selfish whims.

But more we see in public spheres

How much this maxim oft appears,

To show how leaders are consumed

By things believed their wish presumed.

And lately this seems quite okay

With rulers of the USA.

(But we, like Swift, will make our claim

By ‘lashing vice’ but sparing name).

With politics that are complex

Illusions tend to blur the specs

When men believe whate’er they wish

Some policies get devilish.

And when you add religion too

We have a complicated brew,

And here a leader we can see

Who joins the ruling company

Of men who demonstrate the state

Of those who wish with truth equate.

He left a weak addicted past

To seek his destiny at last.

Became a Christian, born again

Aspiring to a higher plane.

(Genetically he was ahead

Since daddy had the nation led.)

But, once elected by a fluke,

(That all just men would sure rebuke)

He saw his mission godly sent

To show the world enlightenment.

And he believed that evil dwelt

Within an oil producing belt,

Its ruler evil incarnate

A tyrant quite degenerate.

And so when terrorists attacked

The World Trade towers, this proved the fact,

Or so he said, for who could not

Connect events with dot to dot?

He’d purge the world of evil’s stain

In person of Saddam Hussein.

He would not shrink from duty’s call

To seek Saddam’s decline and fall,

For he believed his destiny

Proclaimed by God – Divine decree.

He’d find the hidden weapons and

He’d bring new freedom to the land

Where western values were deplored

By villains who lived by the sword

(Or torture, rape, or nasty gases

With which they murdered ethnic masses).

And so he would avenge the dead,

Depose the tyrant, and instead

Lead on his troops –at least he’d send

Them forth to bring about this end.

God chose him evil to despoil

(And as reward he’d get the oil).

Despite the cautions he received

He was inspired, he still believed

His mission was to crush this foe

Both God and Tony told him so.

So off to conquer all that’s bad

The forces left to bomb Baghdad.

Their leader stayed at home to see

How his crusade looked on tv.

The mighty tanks, the skies aflame

Were better than a video game.

The statues fell, the prisoners freed

The regime’s downfall guaranteed

The patriot missiles, patriot men

Would soon, he thought, be home again.

Though some had breathed their final breath

The ‘victory’ justified their death

And they’d be heroes ever more

While blest upon another shore.

They played their part, they fought the fight,

Their president bid them goodnight.

They left behind a populace

Who now could western life embrace.

Well, most of it – religiously

They kept their views on sanctity.

Their heaven, they said, was nicer, and

They could have virgins on demand.

(It seems this wish- belief thing will

For any culture fill the bill).

But though the war, it seemed, was won

The problems only had begun.

The leader’s view that freedom would

Make people act the way they should

Once out from under evil’s thrall,

It turned out didn’t work at all.

Because he’d only wished , not thought

Things through with wisdom as he ought,

The leader found his plans rejected

Much more than he had once expected.

His mandate from his holy source

Was not so easy to enforce.

His ignorance of tribal clans,

Of loyalties and partisans,

Reliance on intelligence

Which didn’t make a lot of sense,

Attending to his favourites

And lots of other deficits,

Caused wild confusion in the land

So hard for him to understand.

The law and order that he craved,

Now he’d removed the ones depraved

Was not forthcoming, but instead

A lot more people ended dead.

But still he had to carry on,

With pressure from the Pentagon,

Because he thought and wished it so

That God would help him beat the foe,

Despite continual loss of life

Of those confronting all the strife.

But strange! His enemies were sure

That Allah would their cause secure.

So God to God and wish to wish

The conflict grew more feverish.

And back at home the leader found

Himself on much more shaky ground,

And world opinion, never sure

He really had the grounds for war

Began to further criticize

His too aggressive enterprise.

(As still ongoing was the strife

With still ongoing loss of life).

And God and Allah seem, to date,

Not sure which side to vindicate.

And so men’s own reality

Ignores that it’s their vanity

That is at root the primal cause.

This makes us think and gives us pause.

For men in highest places show

How vain beliefs can bring us low.

And those our leaders who are prone

To wish for things we can’t condone,

Believing they are in the right,

Might look up at the sky at night.

To wish upon a star is nice

Less likely to elicit vice,

Corrupt belief and common sense

Or make ambition too intense.

(And Judy Garland did endorse

The great celestial resource)

But when as president they act

They’d better base beliefs on fact.

The truth will out, and leaders who

Ignore it, they should exit too.

As I have often said, you don’t need to be a scientist to see that most alternative medicine is bunk, though it is bunk that is supported and propagated by an enormously wealthy industry..

There were two good examples this week, John Sutherland, who was until recently professor of English literature at UCL, understands it very well. And so does political columnist, Polly Toynbee.

“Complementary and Natural Healthcare Council”

Polly Toynbee’s column, “Quackery and superstition – available soon on the NHS“, was prompted by the announcement in The Times that the government was to set up a “Natural Healthcare Council”.  It was soon renamed the “Complementary and Natural Healthcare Council” (CNHC)   It  was instantly dubbed ‘OfQuack’ in an admirable analysis by quackometer.a>

href=”http://www.quackometer.net/blog/2008/01/prince-charles-ofquack-is-dead-duck.html” target=”_blank”>
The very name is tendentious and offensive to any thinking person. What is “natural” about sticking needles in yourself, or taking homeopathic polonium?

Toynbee comments

“Put not your trust in princes, especially not princes who talk to plants. But that’s what the government has decided to do. The Department of Health has funded the Prince of Wales Foundation for Integrated Healthcare to set up the Natural Healthcare Council to regulate 12 alternative therapies, such as aromatherapy, reflexology and homeopathy. Modelled on the General Medical Council, it has the power to strike therapists off for malpractice.”

There was only one thing wrong in this article. Toynbee says

“The alternative lobby replies that conventional medicine can also do more harm than good. They chortle with glee at an article in the Lancet suggesting there is no scientific evidence for the efficacy of 46% of conventional NHS treatments. But that’s no reason to encourage more of it.”

Professor John Garrow has pointed out (see, also Healthwatch )

“It is true they chortle, but they have got their facts wrong. The 46% of treatments which are not proven to be effective is 46% of all treatments for 240 common conditions – and very few are used in the NHS. The great majority are treatments used by alternative practitioners. “

The unconstitutional interference by the Prince of Wales in public affairs has been noted often before, and it seems that it’s happening again.

For example, there is the TV programme, “Charles, the Meddling Prince”, or, for a US view, see “Homeopathy: Holmes, Hogwarts, and the Prince of Wales“. And then there’s Michael Baum’s superb “An open letter to the Prince of Wales: with respect, your highness, you’ve got it wrong“.

It isn’t that regulation isn’t needed, but that the sort of regulation being proposed won’t do the trick. The framework for the “Natural Healthcare Council” has been set up by Professor Dame Joan Higgins, and it seems to be very much along the lines proposed by the Prince of Wales. Here’s what’s wrong.

Professor Dame Joan Higgins (Jan 10th) says “Complementary therapists have been in practice for many years” and “If complementary therapy is not to be banned, is it not, therefore, wise to regulate it and offer the public some measure of protection”.

That’s fine, but I think the sort of regulation that she, and the Prince of Wales, are proposing won’t do the trick. We don’t need new laws, or new quangos, just the even-handed application of existing laws. Homeopathic arnica 30C contains no arnica, and one would expect that the Office of Fair Trading would have banned it. It is no different from selling strawberry jam that contains no strawberries. But absurd legal loopholes make homeopaths immune to prosecution for this obvious mislabeling, whereas jam fraudsters would be in deep trouble.

The Advertising Standards Authority, likewise, is prevented from doing its job by legal loopholes, and by the fact that it has no jurisdiction over web advertising, which is now the main source of untrue claims. If alternative medicine advocates had to obey the same laws as the rest of us, the public would be better protected from fraud and delusion.

What won’t work is to insist that homeopaths are “properly trained”. If one takes the view that medicines that contain no medicine can’t work, then years of being trained to say that they do work, and years spent memorizing the early 19th century mumbo-jumbo of homeopathy, does not protect the public, it imperils them.

The “Natural Healthcare Council” isn’t the only example either. Try Skills for Health.

Skills for Health

This appears to be a vast bureaucratic enterprise devoted to HR-style box-ticking. Just in case you don’t know about this latest bit of HR jargon, there is a flash movie that explains all.

“Competences are descriptors of the performance criteria, knowledge and understanding that are required to undertake work activities. They describe what individuals need to do, and to know, to carry out the activity -regardless of who performs it.”

That sounds OK until you realise that no attention whatsoever is paid to the little problem of whether the “knowledge and understanding” are pure gobbledygook or not. It’s rather like the HR form that ensures UCLH that you are a fully-qualified spiritual healer “Laying on of hands: just tick the box“.

It is an invidious insult to human intelligence to suppose that exercises like this are an appropriate way to select people for jobs. They have precisely the opposite effect to that intended.

An indication of the level of their critical thinking is provided what is written about the 62 items listed under “Complementary Medicine” These include “CHH5 Provide Healing”.

“This workforce competence is applicable to:

  • healing in the presence of the client
  • distant healing in contact with the client
  • distant healing not in contact with the client

Both healing in the presence of the client and distant healing use exactly the same mental and spiritual processes. Clearly, however, distant healing does not involve many of the physical aspects of healing in the presence of the client. The performance criteria have been written so as to be able to be interpreted for use in any healing situation.

The workforce competence links to CHH6 which is about evaluating the effectiveness of the healing.”

It also includes homeopathy, for example “HM_2: Plan, prescribe and review homeopathic treatment“.

I sent an email to Skills for Health to ask who wrote this stuff. A reply from their Technical Development Director failed to elicit any names.

We develop competences to fit sector needs and demands. When that need is moved into a competence project we establish a number of groups from the specific area to work with us to develop the competences. One of these groups is a “reference” group which is made up of experts from the field. In effect these experts give us the content of the competences, we write them in our format.

So I guess the answer as to who is the author is Skills For Health, but with more complexity behind statement.Please do not hesitate to get in touch with me for further clarity.

A conversation with Skills for Health

I did want more clarity, so I phoned Skills for Health. Here are some extracts from what I was told.

“It’s not quite as simple as that”

“the competencies on our data base are written by “experts in the field”

DC. Yes and it is their names that I was asking for

“I’m not sure I can give you the names . . . We’re starting to review them in the New Year. Those competencies are around six years old. ”

“We are working with the Prince’s Foundation for Integrated Health [FIH] via Ian Cambray-Smith to review these competencies, all the complementary therapy competences on our web site”

“They are written as a consensus decision across a wide number of stakeholders across that area of …”

DC. Written by whom though?

“written by a member of Skills for Health staff or a contractor that we employ simply to write them, and the writing is a collation of information rather than their original thoughts, if you like”

DC yes, I still think the sources can and should be given.

“FIH didn’t spend any money with us on this project. This project was funded by the Education act regulatory bodies, QCA, the Qualifications and Curriculum Authority . . . ”

“They [FIH] may well have put in and supported members of their professions or groups to do part of this . . they were there as experts on that particular area of complementary therapy ”

DC it’s their names that I was after

“There may well have been members [of FIH] on the reference groups that I’ve referreed to who are members of the FiH . . .they were there as experts from that area of complementary therapies.”

DC Oh, and are the names of [the people on] these reference groups published?

“No they are not published”

DC ah, why not?

“We do not consider it necessary”

DC Well, I consider it very necessary myself

“Tell me why”

DC It’s a question of public accountability

“I guess the accountability lies with us as the owners of those competencies”

DC Uh I’m afraid your bureaucratic jargon is a bit much for me there. “The owners of those competencies”? I’m not sure what that means

“Why do you want the information?”

DC haha, well if you want me to be entirely blunt, it’s because I’m appalled that this black magic is appearing on a government web site

“. . . can I say that as an organisation funded by a number of sources, one being Department of Health England, none of our work condones the practice you’ve just suggested. Our work supports best practice in areas that are evidence- and research-based”

DC Ah would you mind pointing me to the evidence for homeopathy and distant healing?

“Uh [pause] there is [pause]”

DC Yes, go on

“Well homeopathy is a contentious issue, because every newspaper article I read seems to suggest that homeopathy, in itself, is not an appropriate, uh, not an, uhm, appropriate, uh, therapy.”

DC Yes so why are you laying down standards in it?. You know I’m curious. I’m genuinely curious about this

“The areas involved in them have asked us to, including the Prince’s Trust hence the reason we are doing . . .”

DC But the Prince’s Trust is not part of government. Ha, it behaves as though it was , I agree, sometimes but it is surely for the Department of Health to ask you to do these things, not the Prince of Wales.

“We cover the whole health sector.. We don’t purely work for, or are an organisation of, the Department of Health.”

DC. I’m very baffled by the fact that you say, you very accurately the research on homeopathy, namely that it doesn’t work, but you are still setting standards for it. It’s quite baffling to me.

“Working with the Foundation for Integrated Health, as we are doing, homeopathy is one of the 10 areas that is listed for regulation by FIH ”

DC. Well yes the Prince of Wales would like that. His views on medicine are well known, and they are nothing if not bizarre. Haha are you going to have competencies in talking to trees perhaps?

“You’d have to talk to LANTRA, the land-based organisation for that.”

DC. I’m sorry, I have to talk to whom?

“LANTRA which is the sector council for the land-based industries uh, sector, not with us sorry . . . areas such as horticulture etc.”

DC. We are talking about medicine aren’t we? Not horticulture.

“You just gave me an example of talking to trees, that’s outside our remit ”

After explaining that talking to trees was a joke, the conversation continued

DC So can I clarify then? Who is it that said you must include these fairly bizarre things like distance healing and homeopathy? Who decides whether it goes in?

“We did”

“We are going to do a major review. We are doing that review in partnership with the FiH and the awarding bodies that award the qualifications that are developed from these competencies”

“When that need is moved into a competence project we establish a number of groups from the specific area to work with us to develop the competences. One of these groups is a “reference” group which is made up of experts from the field. In effect these experts give us the content of the competences, we write them in our format.”

Conclusions from this dialogue

We still don’t know the names of the people who wrote the stuff, but a Freedom of Information Act request has been submitted to find out

The Skills for Health spokesperson seems to a a bit short of a sense of humour when it comes to talking to trees.

The statement that “Our work supports best practice in areas that are evidence- and research-based” is not true, and when pressed the spokesperson more or less admitted as much.

Most importantly, though, we do now know that the revision of this gobbledygook will be carried out entirely by the Prince’s Foundation for Integrated Health and the people who set exams in the relevant form of gobbledygook. No critical voice will have an input, so don’t expect much improvement. “We are working with the Prince’s Foundation for Integrated Health [FIH] via Ian Cambray-Smith to review these competencies”. And in case you don’t know about the medical expertise of Ian Cambray-Smith, it is described on the FIH web site. He is the FIH’s Health Professionals Manager.

Ian Cambray-Smith acts as the focus for FIH’s involvement with healthcare professionals. He works collaboratively to develop a range of work programmes, policies and initiatives to support healthcare professionals and help them to deliver a truly integrated approach to health. Ian’s background is in plastics research, project management and business development; he has an MSc in polymer technology. He joined the Foundation in 2006.