Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
homeopathy
Happy new year. not least to the folks at the homeopathy4health site . They are jubilant about a “proof” that homeopathic dilutions could produce effects. albeit only on wheat seedlings. But guess what? After some questioning it was found that they hadn’t actually read the paper. Well I have read it, and this is the result.
The paper is “A Biostatistical Insight into the As2O3 High Dilution Effects on the Rate and Variability of Wheat Seedling Growth”. Brizzi,
Lazzarato, Nani, Borghini, Peruzzi and Betti, Forsch Komplementärmed Klass Naturheilkd 2005;12:277–283
The authors compared these treatments (30 seedlings each).
- C1, C2, C3 (untreated water p.a. Merck, control);
- WP (potentized water p.A. Merck) 5x, 15x, 25x, 35x, 45x;
- AD (diluted arsenic trioxide) 10–5, 10–15, 10–25, 10–35, 10–45;
- AP (potentized arsenic trioxide) 5x, 15x, 25x, 35x, 45x.
The allocation of seedlings to treatments was stated to be blind and randomised. So far, so good.
But just look at the results in Figure 1. They are all over the place, with no obvious trend as ‘potency’ (i.e. dilution) is increased. The
results with homeopathic arsenic at 45 days (the only effect that is claimed to be real) is very little different from the that of shaken water (water that has been though the same process but with no arsenic present initially).
For some (unstated) reason the points have no standard errors on them. Using the values given in Table 3 I reckon that the observation for AP45 is 1.33 ± 0.62 and for the plain water (WP45). it is 1.05 ± 0.69. The authors claim (Table 3) that the former is ‘significant’ (with a profoundly unimpressive P = 0.04) and the latter isn’t. I can’t say that I’m convinced, and in any case, even if the effect were real, it would be tiny.
Later the authors do two things that are a very dubious from the statistical point of view. First they plot cumulative distributions which are notoriously misleading about precision (because the data in adjacent bins are almost the same). They then do some quite improper data snooping by testing only the half of the results that came out lowest. If this were legitimate (it isn’t) the results would be even worse for homeopaths, because the difference between the controls and plain water (WP45) now, they claim, comes out “significant”.
Homeopaths claim that the smaller the dose, the bigger the effect (so better water down your beer as much as possible, making sure to bang the glass on the bar to potentise it). I have yet to see any dose-response curve that has the claimed negative slope. Figure 1 most certainly doesn’t show it.
Of course there is no surprise at all for non-homeopaths in the discovery that arsenic 45x is indistinguishable from water 45x.
That is what we have been saying all along.
Well, guess what turned up in a brown envelope this morning. A copy of the Society of Homeopaths’ Newsletter
It makes interesting reading, not least when the homeopaths’ discussion group are abuzz with talk of the demise of homeopathy
“The Society is urging its members to be cautious when responding to phone calls and e-mails following reports of enquirers appearing to be trying to catch out homeopaths”
“It seems to be part of an organised campaign to discredit homeopathy, with enquiries focusing on AIDS, malaria and vaccination. Members’ responses are then being used on anti-homeopathy blogs and web sites”
Dead right there. And the reason that the answers are being used on anti-homeopathy web sites because they are very often utterly irresponsible. Now we see they are being told to tone down their claims in public, so if you want to know what a homeopath really recommends, the only way to discover is to ask them in private.
” . . . the Society is asking all members to check that their [web] sites adhere to the code of ethics and practice, and clearly differentiate between ‘evidence’ and ‘speculative theory’ “
Well of course that distinction is very rarely made – that alone shows that the SoH’s “regulation” is utterly ineffective.
“Chief executive Paula Ross said: “it is a sad state of affairs when members have to be suspicious of every call or e-mail, and it’s important not to let it cloud genuine interaction with people who are interested in having homeopathic treatment”
All this can have only one meaning: if a homeopath suspects that the enquirer is a sceptic, tell them one story, but if they are a paying customer tell them a different story.
Why on earth should the SoH make such a fuss about enquiries from anyone if they have nothing to hide?
Later, on page 21, the theme continues.
“Members urged to be wary when questioned” (by Trish Moroney, their Professional Conduct Officer)
“Case histories are useful and you can always preface your comments with ‘it is my opinion’, this makes it clear that what you are saying is opinion not fact.”
That comment is certainly well-worded. Indeed most of the advice you get from homeopaths is “not fact”.
“The Advertising Standards Agency (ASA) has clear guidelines for what may or may not be used in written advertisements, but this does not cover the web.
Words like ‘cure’ and ‘treat’ are not allowed to be used in advertising in any published form.”
Not allowed? You must be joking Ms Moroney.
You yourself are quoted thus: “Trish commented: “One of our products is a homeopathic birthing pack and I complement this with a treatment programme tailored specifically to the requirements of the individual.”. Or here ” She [Moroney] has also found that homeopathy is useful for treating a number of women’s problems including heavy or painful periods and the menopause. It can also help with a number of ailments in pregnancy including tiredness and nausea.”. Or how about this. “I was suffering from high blood pressure,” she [Moroney] said. “I went to a homeopath and after taking the right remedy my blood pressure dropped, even though my work situation had not changed. Homeopathy really can help.” If that is not a claim that homeopathy can treat high blood pressure, what is?
Moroney ends her article, by modestly comparing herself with Galileo
Yet again, one must quote Robert Park
“Alas, to wear the mantle of Galileo it is not enough that you be persecuted by an unkind establishment; you must also be right.”
But Moroney’s claims are very mild compared the those of people like Jeremy Sherr. Read all about him at gimpy’s blog. Sherr is (in)famous for his “provings” of hydrogen, plutonium and chocolate, and for his advocacy of homeopathic treatment of malaria and AIDS And look at the results of a complaint against the dangerous fantasies of homeopath Sue Young here.
The fact that Sherr is a Fellow of the Society of Homeopaths shows very clearly that the Society of Homeopaths’ attempts at regulating professional conduct are a no more than a pathetic sham.
A letter from the Chief Executive Paula Ross
The letter on page 5 starts “It’s been a tough few weeks for homeopathy” and it continues the grumbling about the number of complaints the SoH has been getting. More remarkably, Paula Ross boasts about the legal action that SoH took against the quackometer site (which she mistakenly confuses with the US site, Quackwatch). When one realises the major disaster for SoH that this legal action caused, it’s a bit surprising that the Chief Executive hasn’t been fired. The banned page, the Gentle Art of Homepathic Killing, popped up on at least 60 sites around the world, and a Google search for “the Society of Homeopaths” soon produced eight out of ten results on the first page of results that pointed to the banned page.
Is there a homeopathic remedy for shooting yourself in the foot?
Institute launch marks a new era of research
The Newsletter has this headline on page 4. “The aim of the Homeopathic Research Institute (HRI) is to promote and facilitate high-quality scientific research, and communicating about the science relating to homeopathy” . Don’t hold your breath, I suggest. Neither of the two projects they list addresses the main questions . Their publications page lists only two papers, both by Clare Relton. The first of them is Patients treated by homeopaths registered with the Society of Homeopaths: a pilot study C Relton, K Chatfield, H Partington and L Foulkes Homeopathy 2007 Apr 96 (2):87-9 This paper concludes
| This was an uncontrolled study and participants were self-selected; there were no checks on whether homeopaths returned all MYMOP forms for consecutive patients. Despite the apparent improvement overall in MYMOP2 primary symptom scores and MYMOP2 profile scores reported by patients, due to the uncontrolled design of this pilot study we cannot draw any firm conclusions regarding the improvement that patients gain from homeopathic treatment with SoH homeopaths. |
Are medical homeopaths any better?
The same brown envelope that contained the SoH newsletter also brought me a copy of Health and Homeopathy, the magazine for friends of the British Homeopathic Association. This magazine, unlike SoH’s Newletter is available to anyone. Try it yourself. Mostly it reads like a medical textbook that was written at the beginning of the 19th century. Which, of course, is exactly what it is. So 200 years and no progress.
The British Homeopathic Association is a quite different outfit from SoH because it is allied to the Faculty of Homeopathy, which is for the small number of medically-qualified homeopaths. Needless to say, it has far fewer members than the non-medical Society of Homeopaths.
The Winter 2006 edition already had references to the declining support for homeopathic fantasies (as I would put it) . They had a whole article by Sally Penrose, Homeopathic Hospitals under Threat. Tunbridge Wells Homeopathic Hospital has gone. The Royal London is under great threat, and the Bristol Homeopathic Hospital is endangered. The only outposts of delusion that seem safe (for the moment) are in Glasgow and Liverpool.
This magazine may emanate from medical homeopaths who balk at claiming to be able to cure malaria and AIDS, but is in other ways no less delusional. For example eczema, it seems, can be cured by eating tiny amounts of common salt, as described here.
| “He prescribed six powders of Nat mur in increasing potencies to be taken on consecutive days and my eczema got better within a matter of weeks,” |
You couldn’t make it up.
Today is World AIDS Day, and the Society of Homeopaths is holding a meeting to “discuss the evidence” concerning the idea that you can treat AIDS with sugar pills. Needless to say, there is no evidence to discuss, but that doesn’t put them off for a moment.
Not content with killing people with malaria, some homeopaths are now into killing people with AIDS, by treating them with their funny water. That is a serious allegation, but how else can one interpret the treatment of people with serious diseases with sugar pills?
It isn’t only pharmacologists who believe that. Even the better-educated homeopaths would take a position not much different from mine. Of course they word it a bit more diplomatically than me, in a vain attempt to disguise the obvious fact that there is
now all out internecine warfare between medically-qualified homeopaths (in the Faculty of Homeopathy), and the far greater number of non-medical homeopaths (in the Society of Homeopaths, among other splinter groups).
For the malaria scandal, click here and here, and follow the links. Recall that Peter Fisher (of the Faculty of Homepaths) said of that scandal
“I’m very angry about it because people are going to get malaria – there is absolutely no reason to think that homeopathy works to prevent malaria and you won’t find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice.”
The two warring branches of homeopathy have fallen out over immunisation too.
The medical side, the Faculty of Homeopathy, recently issued a statement about AIDS.
| Statement from the Faculty of Homeopathy on HIV/AIDS 27-11-2007, 9:57 am In the light of current knowledge, homeopathic treatment of patients with HIV/AIDS should not replace, but may usefully sit alongside, conventional anti-retroviral treatment. However, the Faculty regrets that for many people in developing countries like Africa, antiretroviral drugs may not be available. . . . The Faculty of Homeopathy does not support the approach of and claims made by Peter Chappell for the use of “PC” remedies. |
Incidentally, one can’t help wondering if it is a coincidence that the Amma Resonance Healing Foundation (ARHF) has almost the same initials as AHRF, the totally respectable African HIV Research Forum. It was presumably in an attempt to gain respectability that the press release from the Society of Homeopaths, signed by Jayne Thomas, had a single link at the bottom to the National AIDS Trust (NAT). Or at least it did until the ever alert quackometer blogger told NAT about it, whereupon they were told by NAT to remove it. NAT is a serious organisation that has no truck with sugar pills.
Today Programme. The Society of Homeopaths’ conference was featured on the Today programme this morning, Hear the interview here [mp3 file, 1.6 Mb]Jayne Thomas spoke for the Society of Homeopaths. She is Vice Chair of the Society of Homeopaths, Chair of the Professional Standards Committee and Professional Conduct Director. When challenged about how they fail ever to find fault with a member, however grossly that member breaches the society’s own code of ethics, she denied everything (see links in the follow up for more on that)Jayne Thomas also said, of today’s conference
“today will afford a critical examination of those opportunities we may have to provide relief to patients”
The interviewer, Edward Stourton, said
“The ambition of the meeting sounds relatively modest. They’re just going to discuss the evidence and presumably if it doesn’t stack up to much we’ll hear that.”
I just hope that Today will have a follow-up to see what the “critical examination” will yield. Perhaps a statement from the Society of Homeopaths that there is no evidence and that it “doesn’t stack up to much”?
Somehow I doubt it. But watch this space.
Follow up
Letting off steam posted the results of a complaint against a member of the Society of Homeopaths, Sue Young. Young persistently makes claims to cure specific, serious diseases, in clear contravention of the SoH’s (utterly ineffective) code of ethics. Needless to say, the complaint got nowhere. Just read the account here if you were inclined to give a moment’s credence to Jayne Thomas’s remarks about self-regulation on the Today programme yesterday.
Quackometer has some relevant comments. In particular he points out the disgraceful and inconsistent attempts of the Society of Homeopaths to pretend that their members had nothing to do with the malaria scam.
Gimpy blog makes related points
Badscience this week is on the ball, as always, with “AIDS Quackery International Tour”
Here is an interchange of letters from this week’s BMJ. George Lewith says more money should be spent by the government on research on alternative medicine. Well, only if it is spent properly, and that is not what has happened in the past. (Letters here, if you have a subscription.)
In all probability money spent in this way would be money down the drain, just as it has proved to be in the USA. As pointed out by Wallace I. Sampson, M.D., NCCAM has spent almost a billion dollars on research into alternative medicine, and
“. . it has not proved effectiveness for any “alternative” method. It has added evidence of ineffectiveness of some methods that we knew did not work before NCCAM was formed.”
It is a bottomless pit, and there are more promising ways to spend the money.
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| George T Lewith, Reader in Complementary Medicine, University of Southampton Primary Medical Care, Aldermoor Health Centre, Southampton SO16 5ST Send response to journal: Re: Valuing Research |
I remain unclear about John Garrow and David Colquhoun’s position with respect to “funding CAM”. Are they suggesting that there should be no funding for CAM research or are they suggesting this embargo should apply to the provision of CAM services within the NHS? If the former, how do they justify this position with respect to the many UK taxpayers who use CAM each year and for whom the government has some obligation to provide information? Competing interests: None declared |
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| John S. Garrow, vice-chairman HealthWatch The Dial House, Rickmansworth, WD3 7DQ Send response to journal: Re: Taxpayer funding of CAM research |
Dr Lewith wants clarification of my view about public funding of CAM research. It has changed over the last 7 years. In 2000 the House of Lords Select Committee (HLSC)advised the Department of Health to fund research on acupuncture, chiropractic, herbal medicine, homeopathy and osteopathy to see if these therapies were safe, more effective than placebo and good value for money, At the time I supported this decision. However in 2003 it was disclosed that £1.3m had funded 8 research projects, at the Universities of Leeds, Southampton, Bristol, Brunel, Sheffield and York, but none of these were directly testing the safety, efficacy or value-for- money of the main CAM therapies.[1] I noted that these Universities did not have as good a record of research into the efficacy of CAM as Exeter, which had applied but failed to get funding. It was also noticable that the panel awarding the grants tended to work at the funded Universities. CAM research is not so impoverished as Dr Lewith implies. The onus is now upon the researchers who received £1.3m from the taxpayer, and more from the Foundation for Integrated Health, to tell us what answers they have found to HLSC’s very pertinent questions. Only in the light of these answers can we judge if they deserve further public funding. If initially the Government had an “obligation” to fund CAM research I think the £1.3m discharged it, and now there is an obligation on CAM practitioners to show that they have not misappropriated these funds. [1]Garrow JS et al. UK government funds CAM research. FACT 8:397-402, 2003 Competing interests: None declared |
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| David Colquhoun, Prof of Pharmacology UCL Send response to journal: Re: Funding for alternative medicine research |
I agree entirely with John Garrow’s response. A corollary of his analysis is that, if there is to be any more funding for research in alternative medicine, it is essential that the allocation of the money should not be in the hands of alternative medicine people. The reason for that is that past experience has shown that they will give the money to projects that don’t answer the real questions. If no applications are received that address the proper questions with rigorous experimental design then the money should be clawed back and spent on something that has a better chance of being a real advance. I am perpetually amazed by the reluctance of advocates of alternative medicine to subject their claims to proper tests. The only interpretation that I can see of this failure is that they themselves believe, deep down, that the tests would be failed. I hope that isn’t the explanation though, because if they were convinced that the tests would fail, it would mean that we are dealing with fraud, not just delusion. Competing interests: None declared |
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If you read nothing else on the topic, read Ben Goldacre’s best ever piece, A Kind of Magic? (Guardian, 16 Nov 2007). This started as response to “In defence of homeopathy” in the same newspaper on 13 November. On the same day, the Lancet carried a rather more academic piece by Goldacre “Benefits and Risks of Homeopathy” , The same issue of the Lancet carried a commentary ” Pressure grows against homoeopathy in the UK“, as well as a sadder report, “Homoeopathy booming in India“.
There is going to be plenty of commentary on these pieces. There is one bit of “A Kind of Magic” that is particularly important, and that is about how to do a proper trial. It is one of the most persistent myths of all sorts of quack that, for reasons that are never explained, their particular form of magic is not susceptible to being tested in the normal and well-established way. This is simply not true, and the fact that the myth is repeated again and again is perhaps the best reason to doubt that homeopaths are really genuine in the beliefs that they claim to have. If they were really so confident they would do the tests. But they don’t and won’t. When the government supplied money for doing tests, the money was distributed by a committee of “experts in alternative medicine” (though it beats me how you can be an ‘expert’ in something that isn’t true), all the money was given to projects that were incapable of answering the main question, namely ‘does it work better than placebo?’.
How to do the test
Here is Goldacre’s description of how to do the test. It has been said before, but it must be said again and again. Until homeopaths take this seriously, there is no option but to regard them as frauds.
“You could do a randomised, controlled trial on almost any intervention you wanted to assess: comparing two teaching methods, or two forms of psychotherapy, or two plant-growth boosters – literally anything. The first trial was in the Bible (Daniel 1: 1-16, since you asked) and compared the effect of two different diets on soldiers’ vigour. Doing a trial is not a new or complicated idea, and a pill is the easiest thing to test of all.
Here is a model trial for homeopathy. You take, say, 200 people, and divide them at random into two groups of 100. All of the patients visit their homeopath, they all get a homeopathic prescription at the end (because homeopaths love to prescribe pills even more than doctors) for whatever it is that the homeopath wants to prescribe, and all the patients take their prescription to the homeopathic pharmacy. Every patient can be prescribed something completely different, an “individualised” prescription – it doesn’t matter.
Now here is the twist: one group gets the real homeopathy pills they were prescribed (whatever they were), and the patients in the other group are given fake sugar pills. Crucially, neither the patients, nor the people who meet them in the trial, know who is getting which treatment. ”
Winterson and the Maun Project and AIDS
This particular round of discussion was started by Jeanette Winterson’s “In defence of homeopathy“.
It is an interesting article because, like the whole world of homeopathy, Winterson herself is split between homeopathy as a harmless placebo and homeopathy as a dangerous “treatment” for dangerous diseases. On one hand she claims that she is all for proper anti-retroviral treatment of AIDS, yet at the bottom of the article it says “Jeanette Winterson is donating the fee for this article to the Maun homeopathy project. ” .
“Since 2002, The Maun Homeopathy Clinic has been running free homeopathy outreach clinics in Maun, a fast growing town in the north of Botswana, where over 35% of the people are infected with HIV or AIDS, one of the highest rates in the world.”
Hilary Fairclough, much praised by Winterson for reducing her high temperature with pills that (didn’t contain) any snake venom, describes herself as “clinical director” of the Maun project. She is, of course, qualified in neither science nor medicine, but is registered with the now notorious Society of Homeopaths. The Maun project newsletters have all the usual accounts of amazing cures. They quote
“The homeopaths are so loved here, and at the clinics we see daily miracles.”
Do they really believe in miraculous cures? I’m inexorably reminded of an earlier generation of missionaries who went to Africa, to impose on the poor benighted natives a different brand of irrationality. At least the missionaries did some education too, and didn’t, on the whole, kill people.
The ladies of Devon who contribute their money to this project, rather than proper treatment, are, sadly, contributing to the gentle art of homeopathic killing.
Referring to Goldacre’s article in the Lancet, Winterson says ” where is the scientific sense is saying that because we don’t understand something, even though we can discern its effects, we have to ignore it, scorn it, or suppress it?”. Needless to say, no pharmacologist has ever said anything of the sort. Quite the opposite. Goldacre comments
“The article does not say that, and I should know, because I wrote it. It is not an act of fusty authority, and I claim none: I look about 12, and I’m only a few years out of medical school. “
Winterson’s article goes on about ” boosting the patient’s immune system so they are better able to fight off the opportunistic viruses that follow behind HIV”.
Sorry, but there is not the slightest reason to think the sugar pills do anything whatsoever to the immune system: that is no more than a ritual form of words, a mantra recited by every homeopath.
Winterson also falls for the latest fashion in homeopathic gobbledygook, to describe it as nanopharmacology. It isn’t nano, it’s zero.
She also gives support, though it is intriguingly ambivalent, to the forthcoming conference of the Society of Homepaths, You can download the flyer for this conference, It defies belief. As well as Winterson’s homeopath, Hilary Fairclough, it features Harry van der Zee and Peter Chappell.
“Harry believes that using the [Chappell’s] PC1 remedy, the AIDS epidemic can be called to a halt, and that homeopaths are the ones that can do it. “
That is a direct claim for a cure. It is as good example as any of the Gentle Art of Homeopathic Killing, in the now immortal words of the quackometer blog.
Peter Chappell’s web site says (no, really, seriously),
“Right now AIDS in Africa could be significantly ameliorated by a simple tune played on the radio across Africa. Or there is a slower solution using pills, and drops that works very well, but is harder to deliver. ”
“The second creative idea is again is implied by those above, and relates to the ability to deliver healing aurally, instead or orally, so healing downloads and ehealing is possible and practical. Instead of taking pills containing resonance information, you listen to a very short piece of music which contains the same information. “
Just beat that, if you can.
You can get free samples here. Try the tuberculosis tune. Sounds like pretty standard 50s or 60s jazz (anyone recognise it?). Don’t be fooled though. It’s explained that
The music is not the download
The music is simply the carrier and alerts you to listen. The download is engrafted on the music by a special process. That is the new technology.
University of Westminster: a new course?
I hope that the University of Westminster is proud of the fact that its degree in homeopathy is recognised by the Society of Homeopaths , who are sponsoring this nonsense. Perhaps the university should consider an advanced third year module in “downloading therapeutic resonance music”.
Read more
Andy Lewis’s quackometer “Will Homeopathy and iTunes Cure AIDS?
Nick Cohen “The cranks who swear by citronella oil”
Jeremy Laurance in the Independent (17 Nov) “Homeopathic treatment of Aids attacked by medics“
This was not written by me, but by a homeopath, in an email that has been circulating recently. It comes from the editor of hpathy.com, not one of the bigger players in the homeopathic fantasy business.
Serious panic seems to be setting in.
One amusing aspect is the description of the “huge and systematic campaign”. Actually it’s just a few dozen people who decided it was time to speak up. After all, anyone can understand “the medicine contains no medicine”. And don’t you just love “Those who are organizing this anti-homeopathy campaign have been SO SUCCESSFUL that most homeopaths in UK have seen a 50% drop in their practice in the last 2 years. In fact most of them get to see only 3-4 patients a week.” I hope that is more reliable than most numbers one gets from homeopaths.
Once again we see the ambivalent attitude to the dangerous malaria scam, the “Gentle Art of Homeopathic Killing“. It is that problem that has set the Faculty of Homeopaths and the Society of Homeopaths on opposite sides in internecine warfare.
Here are some excerpts. Download the whole email.
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Thanks to a correspondent for alerting me to a medical emergency in France.
You can read the press release here, from Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSAPS, the French equivalent of the MHRA or FDA).
 Withdrawal of batches of Gingko biloba and Equisetum arvense AFSSAPS has been informed by Laboratoires Boiron of an inversion of the labelling of two homeopathic medicaments, The bottles labelled “mother tincture of Gingko biloba” contain mother tincture of Equisetum arvense and vice versa ;. . . “AFSSAPS has said that this mix-up does not pose any particular risk . . .” . . . “Laboratoires Boiron has asked pharmacists who stock these homeopathic medicaments to report, as far as possible, the inversion of labelling to any doctors in their neighbourhood who may have prescribed these items between May and October 2007.” |
This gem brings to mind the interchange between Lord Broers and Ms Kate Chatfield of the Society of Homeopaths, as recorded in the minutes of evidence to the Select Committee on Science and Technology .
Q538 Lord Broers: I have a simple, technical question about homeopathy and drugs. Is it possible to distinguish between homeopathic drugs after they have been diluted? Is there any means of distinguishing one from the other?
Ms Chatfield: Only by the label.
You can read a lovely analysis of the views of Kate Chatfield here. She works at the University of Central Lancashire, where she is module leader for what the university, disgracefully, calls a “Bachelor of Science Degree” in Homeopathic Medicine. That is the university that refuses to reveal to the public what it is that they are teaching in these courses. I’m still waiting for the result of my appeal to the Information Commisioner: watch this space.
In contrast, Mike Eslea’s pages on pseudoscience are also from the University of Central Lancashire. They are very well worth reading.
Tnanks to the Breath Spa blog for drawing attention to the Broers – Chatfield interchange, in an excellent posting: ” Discouraging News from the Review of Allergy and Intolerance: Homeopathy Means We Need to Rewrite Textbooks”.
Remember Kate Birch? She was the homeopath who was caught out recommending homeopathic treatment for malarie prevention (“Homeopathy is more effective that any western medication”). Still worse she advocated homeopathic cures for malaria at a clinic in Tanzania”.
The follow up to that outrageously wicked claim is posted here.
Imagine my amazement when Kate Birch knocked on my door on the morning of October 16th. Like most of the homeopaths I have met, she was earnest and rather charming. She was also, I have to say, on the high end of the delusional scale. The good thing is that she was kind enough to present me with a copy of her book,
Vaccine Free – Prevention and Treatment of Infectious Contagious Diseases with homeopathy . She seemed genuinely to think that if I read the book carefully. I would be persuaded that she was right. That is the book that first attracted the attention of a correspondent. I would not have been willing to pay £25 to buy it, but I am certainly be grateful to have the chance to quote a few passages from it.
One curious thing about the book is that the disease descriptions are given in straightforward standard scientific language. But that approach is quite inconsistent with the letter I got from North American Society of Homeopaths (NASH), which said
“NASH does not have a policy on the treatment of any disease category, in accordance with the tenet that homeopathy treats the whole person based on characteristic symptoms rather than a diagnosis.”
The claims to be able to cure serious diseases are also quite at odds with NASH’s Standards of Practice Guidelines which say
“Do not claim that you can treat any disease, condition or ailment or imply that you can do so.
Be extremely careful when speaking or writing about the treatment of particular diseases or conditions (and never offer or claim to help anybody). “
Yet Kate Birch is vice president of NASH. That organisation seems to be as much in chaos. and just as incapable of controlling irresponsible behaviour of its members, as its UK equivalent. The Society of Homeopaths.
Here are a few quotations.
Rabies.
“Curative action of the [hoemopathic] remedy depends on the degree of neurological involvement. Remedies given at the same time as the bite will act preventatively for the condition. If the mental state is strong, the appropriate remedy will help resolve it in the days following administration”
That reads to me like a claim that sugar pills will cure rabies (or is the insertion of the word “help” the getout?).
Tetanus
“Remedies given at the time of injury will reduce the susceptibilty to developing tetanus”.
Polio
“Gelsemium. This remedy is useful in early treatment with polio paralysis“. What does “useful” mean if it does not mean cure?
Diphtheria
“Diphtherinum . . . As a preventive in an epidemic, this remedy can be administered in a 200C potency once per week”.
Measles and German Measles
“The best prevention for both diseases is the homeopathic remedy Pulsatilla nigricans . . . If you are aware of being exposed, 30C daily for 7 days should be sufficient to subvert the disease.”
Smallpox
“Moreover, in the event of terrorist activity, may become prevalent once again. If this situation were to arise, there would be a need for and opportunity to use homeopathy in this area of public health.”
“The [homeopathic] remedies listed below will be useful for the treatment of the disease and for ailments from the vaccination”
Anthrax
“Homeopathy bases its prescriptions on the nature of symptoms. Because the disease progresses rapidly to death it is important commence treatment quickly and to monitor the recovery. Homeopathy can be used in addition to antibiotics if the case warrents.” Oops there seems to be a momentary touch of realism in that last sentence.
Plague
“Vipera, the homeopathic preparation of the snake venom, is useful for prevention and treatment.”
Tuberculosis
“As the person’s health deteriorates, and the tuberculosis becomes active, remedies such as Ferrum metallicum, Phosphorus, Stannum, Iodium, Kali carbonicum, or any of the remedies listed below may be more indicated to return the person to health”. See more on tuberculosis here
Hepatitis A, B and C
“In the homeopathic treatement of the acute form of hepatitis A, one would expect results within a few days to weeks of the correct homeopathic remedy.”
Dengue fever
“Homeopathy has been used succesfully around the world to treat and prevent Dengue fever.”
The list goes on an on. I am grateful to Kate Birch for giving me a copy of this book. Sincere she may be, but the advice given is, in my view a danger to humanity. This stuff leaves the Society of Homeopaths in the shade.
Follow up
The similar outrageous claims made by some members of the (UK) Society of Homeopaths have been investigated throughly on gimpyblog.
Many people now have written about the disgraceful and dangerous claims by homeopaths to be able to prevent and cure malaria. My contribution was “Homeopathic ‘cures. for malaria: a wicked scam”
One of the best contributions was on the Quackometer blog, The Gentle Art of Homeopathic Killing.
But the post vanished at midday on Thursday 11 October. Quackometer’s ISP has received threatening letters sent by lawyers on behalf of the Society of Homeopaths, who claim that the truth is defamatory, while being unwilling to say which statements are wrong. These threats have forced the removal of the post (for the moment), though you can still read it from the Google cache. And a lot of other places too.
.. . . At the very least, we could expect the Society of Homeopaths to try to stamp out this wicked practice? Could we? |
OK it’s fun to see the fantasy world of homeopaths riven by their internecine squabbles, but this is a serious matter.The Society of Homeopath’s substitute for answering reasonable questions is to try to suppress legitimate comment by brute (legal) force. It is hard to imagine such cowardly behaviour. I fear, though, that they may be in for a big surprise.Watch this space for developments.
Follow up
The storm begins.
Within 24 hours of the post being removed, it has sprung up again, all over the world. These are just the links that reproduce the whole text. Countless more refer to them.
“Blog post taken down by homeopathic complaint: a chill wind is blowing”
Gimpy’s blog: “The Society of Homeopaths silence criticism through cowardly legal means”
Andrew Clegg lends support: “A run-in with the Homeopathic Thought Police”. He reproduces the banished page.
And on Google groups in several places, for example here.
Another reproduction of the whole banished page at A day at the pharmacy (“from a provincial, small-town pharmacy in the United Kingdom”).
A mirror of the whole original page has appeared at semiskimmed.net
and “The Gentle Art of Homeopathic Killing (Cowards and Bullies)” appeared on JDC325’s weblog.
Another at badchemist.net.
Apathysketchpad , from Andrew Taylor, in Manchester,
Very soon it appeared in the USA too
Orac’s Respectful Insolence site: “Homeopathic thuggery”. The Yale surgeeon/scientist has also reproduced the full text.
The whole banned page is at skepticaldog.com too.
And on the Inalienable Rights blog (Portland, Oregon). They add the forthright comment “Go Society of Homeopaths, good on you for being complicit in murder, you bloody moronic cowards.”
The whole text is on the NNSEEK news group search engine too.
And in Russia
The whole text is here.
And all this within 24 hours since the page was pulled. The lawyers for the Society of Homeopaths are going to be very busy.
They keep coming. More full texts here.
Some are so anonymous that you can’t even be sure which country they come from, though often the US ones are distinguishable because the link mainly to US sources. Now Saturday.
- The Voyage. A blog from Ireland “Big Altie Gags the Truth, or tries to”.
- White coat underground. A doctor from the US midwest speaks out.
- Science after Sunclipse. An east coast US blog “for math, physics and the New Enlightenment”
- Conspiracy Factory. Factition’s blog: “Homeopathy, Malaria & Free Speech”.
- The Bronze Blog. “Big Altie attempts to suppress truth”. A very anonymous US blog.
- Infophilia. The Streisand Effect. From Arlington Heights, Illinois,USA.
- HappyJihad’s House of Pancakes. Another anonymous US blog, with full text.
- The GAS blog
- Skeptico. Another site from USA.
- Be Lambic or Green. From Canada (I think)
That’s 25 reproductions of the page so far. Now Sunday 14 Oct,
- Nana’s Notions. Blog from a US accountant.
- A Night on the Tiles. From Stew who works in a tile factory in France.
- Powerup. From Tyler DiPietro, a student in New England, USA.
- Unfiltered Perception. blog.tjomlid.com, from a young Norwegian.
- Action Skeptics. “Kick my ass. Society of Homepaths”, From Indiana, USA.
- bankrupt artist v3. Nice version from Canada
- Sceptiphrenia . Another from the UK.
- Thinking is Dangerous. “Be shamed, Society of Homeopaths”, for Dr T, UK.
- Rants and Raves, From Kulvinder Singh Matharu. “Homeopathy; Failure of truth and integrity (again)”.
On Sunday night, for the first time, one of them comes up on the first page of Google search for “The Society of Homeopaths”
More on Monday 15 Oct. Now five of the first ten hits on a Google search for “The Society of Homeopaths” refer to this row.
- Skeptix, The Central Alberta Skeptics Association.
- No Nonsense. “Society of Homeopathetics – censoring unfavorable comment!”. From Italy?
- The Millenium Project, From Australia. “The constant misspelling of the word “millennium” with only one “n” inspired me to create a millenium – that is, a collection of a thousand arseholes.”
- Rich Speaks. From Richer Lockwood, UK.
And from Tuesday onwards, they kept coming.
- A rather fine rant from Song, by Toad. “The Gentle Art of Homeopathic Killing – Fuck You, Society of Homeopaths”
- EnoNomi. Another complete text, from Phoenix Arizona
- D-notice: homeopathic killing. From London
- The Macho Response. From Oakland California
- Homeopathiccompliants.
- Ordinarygirl. “Homeopaths censor blogger” from Kansas, USA.
- Tabasco da Gama From USA “Society of Homeopaths thug tactics”
- Planet Atheism
- Skeptikeren.
- Blogher. A curious on from US. The full text has been posted as a comment on a pro-homeopathy site.
- Dikki’s diatribe. Another from AUSTRALIA.
- Qnoodle
- Freeborn John. Internet censorship again
- Skeptobot. A UK PhD student
- And, at last, James Randi (with comments)
- Skeptigator Another US one
- Bishop Hill From “an Englisman lvining in rural Scotland”
- Counterknowledge. “This you have to read”. From UK writers.
- Ministry of Truth. “Shades of Uzmanov”
- The Wardman Wire. “Society of Homeopaths are doing an Usmanov”.
- Mediawatch.org.uk.
- Mike Powers. “Not just fat oligarchs” (another allusion to the Usmanov affair).
- Aharonic.net. Art and culture.
- Amused cynicism. From “a computer programmer living in north west Europe”.
- Humaniform.
- Chicken Yoghurt. from Justin McKeating. “The Usmanov strain -mutating”
- The Devil’s Kitchen. “Homeopathic, sociopathic, psychopathic”.
- Starshun.com. “Society of Homeopaths threaten blogger”
That’s 64 now, from UK, USA, Russia, Canada, France, Norway and Australia. And still counting. The story is now reaching the political blogs too.
On the morning of 25 October, six of the first ten links ona Google search fot the “The Society of Homeopaths” led to re-postings of “The Gentle Art of Homeopathic Killing”.
By 1st November, all the Google front page links apart fron the first two pointed to sceptical sites (one was to the BBC’s “Homeopathy’s Benefit Questioned“, the rest to harder-hitting criticism).
Andy Lewis and Ben Goldacre have both posted Andy’s incredibly polite email to the Society of Homeopaths. This is the letter that got no reply apart from another letter from lawyers.
More from quackometer
“You Very Naughty Girls and Boys.” Tut tut, look at al those postings!
“The Society of Homeopaths: Truth Matters” A follow up on recent events. In particular, a letter that the Society of Homeopaths wanted to publish is demolished.
Two definitions of lawyers
Dice, n. Small polka-dotted cubes of ivory, constructed like a lawyer to lie on any side, but commonly the wrong one. [Bierce, Ambrose, The Enlarged Devil’s Dictionary, 1967]
The duty of an advocate is to take fees, and in return for those fees to display to the utmost advantage whatsoever falshoods the solicitor has put into his brief. [Bentham, Jeremy, The Elements of the art of packing as applied to special juries, 1821]
| At a meeting of the West Kent PCT board, on 27 September 2007, it was decided to withdraw all funding for homeopathy from the end of this financial year. This means the end for the Tunbridge Wells Homeopathic Hospital.. |
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Congratulations to Dr James Thallon (Medical Director of the West Kent PCT) who done a good job for patients in his area by ensuring that NHS money is well spent. He appeared briefly on Channel 4 News to explain that if the cost of the Hospital were saved, a lot of patients would be able to benefit from the latest treatments.
The announcement of intention to withdraw NHS funding was followed by a public consultation. But the supporters of homeopathy could muster only 6273 votes and they were spread over four petitions (we shall never know how many people signed all four). A web site for the supporters of the homeopathic hospital has a movie of their town centre demonstration. The numbers there were less than overwhelming, though they were led by a rather fine piper.
The local MP, Greg Clark (Cons, Tunbridge Wells) made a short speech, but sounded, it must be said, less than convinced. He is an MP better known for his support for nuclear missiles.
At 08.30, the morning talk show on BBC Radio Kent that preceded the meeting had a discussion about the homeopathic hospital. If you can stand talk shows, listen here (a London homeopath, DC and Sally Penrose from British Homeopathic Association). The first speaker says “someone even called it crackpot medicine”. Ahem. Could that have been me?
Who owns the Homeopathic Hospital?
You might expect to be able to find out from NHS Choices, but that site is unhelpful (how does the Department of Health manage it?). Here is the information that I have.
The Tunbridge Wells Homeopathic Hospital building is owned by the Mental Health Trust. The building houses three services. (1) The homeopaths, who are owned by Maidstone Tunbridge Wells (MTW) Acute Trust, (2) a child and adolescent mental health service CAMHS, which is owned by the Mental Health Trust, and (3) Community Paediatrics which owned by W Kent PCT. It will be for MTW as provider to decide if they want to close the department in the light of the commissioning decision but if they did then the building itself would continue to house medical services though not the Department of Homeopathy.
Follow up in the press
BBC News 24 had a short report.
The Times said ” Patients will no longer be able to receive homoeopathy treatments at a specialist hospital because they are a waste of money and do not work, an NHS trust said. ”
The final outcome
According to a report in the local newspaper, a year later it is, at last happening. Peter Fisher of the Royal London Homeopathic Hospital said
“Of course homeopathy needs more research, but so do many areas of conventional medicine – without these NHS hospitals, this research won’t get done.”
The first part might be true, but the second is fantasy. The hospital did not produce a shred of good research. The report goes on.
“The PCT originally decided to withdraw funding for homeopathy – which costs the trust £200,000-a-year for 750 patients – last September, but the decision was challenged by patients through a judicial review which proved unsuccessful and led to the final decision being made last week.
Current patients will finish their treatment over the next eight months but the PCT will not pay for further routine homeopathic consultations or treatments after the end of March next year.”
21 September 2007
Channel 4 News reported on the pressure to save money by stopping NHS funding for “unproven and disproved treatments”.
Watch the video.
The report started badly when the journalist, Victoria Macdonald, said that the bottles of homeopathic pills contained “only natural ingredients”.
Wrong
They contain NO ingredients. That is just as well perhaps, when you recall that natural ingredients in homeopathic pills include things like polonium. In the Nature newsblog that followed my piece about BSc degrees in anti-science, I responded
“Well CAM is a bit like university management. Don’t try to satirise it, because the next thing you know the satire has come true.
There is even a whole book about homeopathic polonium, and you can by not only polonium, but also holmium, dysprosium, europium, gadolinium, Terbium, Thulium (this is beginning to sound like Tom Lehrer), And don’t forget Excrementum caninum (yes, you got it, dog shit). With the 3C “potency” of the latter you might even get a few molecules of it. All this at http://www.archibel.com/homeopathy/synthesis/newremedies/
And don’t forget your homeopathic bioterrorism protection kit.”
The thrust of the report was to suggest that our attempts to improve NHS treatment were some sort of Big Pharma funded conspiracy to suppress those nice homeopaths and so kill old ladies whose lives depended on taking medicines that contain no medicine.
Peter Fisher sounded a bit desperate in his attempts to associate me and my colleagues with the defence of GM foods, a topic on which, as far as I know, none of us uttered a word in public.
Sorry, Dr Fisher, but there is no conspiracy, and no involvement of Big Pharma. Just a disparate bunch of doctors and scientists who decided it was time to do something about the spending of scarce NHS money being spent on new age nonsense. It really is that simple.
I’m always a bit amused when people who make a lot of money from alternative medicine accuse me of representing some vested interest. The media ‘nutritional therapist’, Patrick Holford, said, in the British Medical Journal
“I notice that Professor David Colquhoun has so far not felt it relevant to mention his own competing interests and financial involvements with the pharmaceutical industry “
To which my reply was
” Oh dear, Patrick Holford really should check before saying things like “I notice that Professor David Colquhoun has so far not felt it relevant to mention his own competing interests and financial involvements with the pharmaceutical industry”. Unlike Holford, when I said “no competing interests”, I meant it. My research has never been funded by the drug industry, but always by the Medical Research Council or by the Wellcome Trust. Neither have I accepted hospitality or travel to conferences from them. That is because I would never want to run the risk of judgements being clouded by money. The only time I have ever taken money from industry is in the form of modest fees that I got for giving a series of lectures on the basic mathematical principles of drug-receptor interaction, a few years ago.”
I spend a lot of my spare time, and a bit of my own money, in an attempt to bring some sense into the arguments. The alternative medicine gurus make their livings (in some cases large fortunes) out of their wares.
So who has the vested interest?
Sorry Dr Fisher, but there is no conspiracy. Tim Crayford (Association of Directors of Public Health), put the matter very simply in the interview.
It is more to do with a point of principle. There are very many really effective treatments that the NHS can’t currently afford to provide. And we should we not be ensuring that the limited resources we’ve got in the NHS go to the things that really work well, and are going to save lives”
That is all there is to it.
The current issue of the British Journal of Clinical Pharmacology has what looks like a good placebo controlled trial of homeopathy from France. “Effect of homeopathy on analgesic intake following knee ligament reconstruction: a phase III monocentre randomized placebo controlled study, Paris et al., 2007″.
Conclusion The complex of homeopathy tested in this study (Arnica montana 5 CH, Bryonia alba 5 CH, Hypericum perforatum 5 CH and Ruta graveolens 3 DH) is not superior to placebo in reducing 24 h morphine consumption after knee ligament reconstruction
Another thing that makes the paper interesting is that one of the authors is Philippe Belon. who is a director of the huge French homeopathic company, Boiron. This is properly declared at the end.
Conflicts of interest: Dr Belon is the head of the clinical research department of Laboratoires Boiron. The Laboratoires Boiron financially supported the study. None of the other investigators had any conflict of interest.
Boiron makes profits from homeopathy of about 20 million euros a year, on net operating revenues of about 300 million euros. It is big business. Philippe Belon has an interesting record.
He was one of the authors of the notorious Benveniste paper(see also here), which lead to Beneveniste’s dismissal from INSERM in disgrace. Benveniste’s results were refuted by, among others, Hirst, Hayes, Burridge, Pearce and Foreman (1993, Nature.366, 525-7.
Belon was also senior author in Fisher, P., Greenwood, A., Huskisson, E. C., Turner, P., & Belon, P. (1989). (Effect of homoeopathic treatment on fibrositis (primary fibromyalgia) British Medical Journal 299, 365-366.). That is the paper which I was asked to check (by a TV programme). After Peter Fisher gave me the raw data I found that a naive mistake had been made in the statistical analyis. There was NO evidence for the effect of the treatment at all, as described here. This correction was published (Colquhoun, D. (1990). Reanalysis of a clinical trial of a homoeopathic treatment of fibrositis. Lancet 336, 441-442.), though the correction is usually ignored by homeopaths (see here). [Get pdf].
The Truth about Homeopathy
This is the title of a commentary on the Paris et al. paper by Edzard Ernst, published in the same issue if British Journal of Clinical Pharmacology.
“Heavens!” I hear the homeopathic fraternity shout. “We need more research!” But are they correct? How much research is enough to show that any treatment does not work (sorry, is not superior to placebo)? Here we go full circle: should we really spend several lifetimes in order to arrive at a more robust conclusion?”
“Most readers and even many homeopaths will be surprised to learn that that has already happened! During the Third Reich the (mostly pro-homeopathy) Nazi leadership wanted to solve the homeopathy question once and for all. The research programme was carefully planned and rigorously executed. A report was written and it even survived the war. But it disappeared nevertheless – apparently in the hands of German homeopaths. Why? According to a very detailed eye-witness report [9 – 12], they were wholly and devastatingly negative.”
Ernst sums up the situation incisively –download a copy of his paper.
Steven Novella, MD, an academic neurologist at Yale University, runs The Skeptics Guide to the Universe: Your Escape to Reality
He is author of Weird Science , a monthly column featured in the New Haven Advocate. He is the co-founder and President of the New England Skeptical Society, Associate Editor of the Scientific Review of Alternative Medicine , and a contributing editor of Quackwatch , a consumer advocacy website dealing with all types of health fraud.
At 5 am on 12 September he phoned to record a podcast. You can here the whole thing here. It includes various items of skeptical news and an interview with James Randi too.
Steve Novella quizzed me about the circumstances surrounding the request to move my web site from UCL’s server, and we discussed the incursion of endarkenment values into universities and politics. My bit is here.
The British Pharmaceutical Conference (2007) staged a debate on “Homeopathy or Allopathy. Which would you choose”. On one side was Felicity Lee (ex Chair of the Society of Homeopaths). I was on the other side. Ben Goldacre was there and he recorded the whole thing. You can listen to it here (if you have nothing better to do).
Thanks to the high-tech equipment at the conference, I was able to show in place of a slide, a section of an article written by Felicity Lee with the title “What health problems can it help with?“. These include, for example, migraine. But if you look at the National Electronic library of Complementary and Alternative medicine (which is compiled by CAM people) what you find is this.
“There is insufficient evidence to support or refute the use of homeopathy for managing tension type, cervicogenic, or migraine headache. The studies reviewed possessed several flaws in design.”
Goldacre also recorded, after the debate, an interview with Felicity Lee. It is rather more interesting than the debate itself. It’s fascinating because, as in the debate, she refuses again and again to be drawn into discussing the evidence and is quite unable to say why she thinks it is not possible to do proper trials.
She did mention that a suitable condition for a trial might be osteoarthritis, but seemed to be quite unaware that such a trial was done in 2001 by no less a person than Peter Fisher (clinical director of the Royal London homeopathic Hospital and the Queen’s homeopathic physician). The outcome of this paper (download it) was that homeopathy didn’t work any better than placebo.
The paper ended with this memorable statement.
“Over these years we have come to believe that conventional RCTs [randomised controlled trials] are unlikely to capture the possible benefits of homeopathy . . . . It seems more important to define if homeopathists can genuinely control patients’ symptoms and less relevant to have concerns about whether this is due to a ‘genuine’ effect or to influencing the placebo response.”
That is the nearest that Fisher has ever come in public to admitting it is all placebo effect, though at other times, of course, he has denied that strenuously.
One year from our first letter to NHS Trusts, we sent another. Listen to the interview by John Humphrys on the Radio 4 Today Programme, with Raymond Tallis and Peter Fisher. :And hear Fisher suggest that he works for UCL (not true). You can also download a summary of the current evidence in the form of an example commissioning document which accompanied our letter.
May 23, 2007. A year ago, our letter to NHS Trusts urged them to stop paying for “unproven and disproved treatments”. A year on, we sent a second letter. Read it here.
On May 23 2007, John Humphrys introduced coverage of this on the Radio 4 Today Programme with the words
“Doctors who think homeopathy is a waste of time and money seem to be winning the argument”
To listen to his interview with Raymond Tallis and Peter Fisher click here. In the interview, Peter Fisher not only misrepresented the evidence, as usual, but also he said
“We are integrating it [homeopathy] within NHS services in University College London which is one of the leading, you know, biomedical centres in the country.”
Hang on a moment! I’m glad that Fisher thinks that UCL is a “leading biomedical centre”, but he does not work for UCL (which is a university), but for the UCLH Trust, which is an NHS Trust. This shameless attempt to use the reputation of a quite different institution to bolster his case smacks of desperation (not to mention mendacity).
After Fisher’s emphasis on “integration”, Tallis commented
“The use of the word integrate is interesting. I mean I suppose you can regard combining medicines that don’t work with medicines that do work as a kind of integrative approach . . “;
The evidence
Our second letter to NHS Trusts said “If you have not already reviewed your own trust’s provision, you might find it useful to consider, in conjunction with your Director of Public Health, the paper that we have enclosed which, while not a full review of the scientific position, has been used by other trusts to promote evidence based commissioning.”. This letter has a summary of the evidence,
Good reports in the newspapers include
“Hard-up NHS trusts cut back on unproven homoeopathy treatment”: Mark Henderson in The Times
“Doctors renew drive to ban NHS homeopathy”: James Randerson, in the Guardian
[This post has been transferred from my old IMPROBABLE SCIENCE page]
Follow-up
Homeopaths have been harping on about our alleged misuse of the NHS logo, ever since this second letter was sent. It is often said that the letter was sent under the NHS letterhead. As so often, they don’t bother to check. There was no NHS logo on the letter. The only place the logo occurred was on the sample template fo commissioners that was sent with the letter. That template has always been available for download from this post. It is very obviously intended to be a template, with sections that are to be completed by commissioners highlighted. There is no way it could be taken to be representing itself as a letter from the NHS. This is how it starts.
