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Written by David
Colquhoun. [email me].
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"Some of you will probably be more or less troubled by
that parody of medieval theology which finds its dogma in the
doctrine of homeopathy, its miracle of transubstantiation in
the mystery of its dilutions, its church in the people who have
mistaken their century, and its priests in those who have
mistaken their calling."
[Oliver Wendell Holmes, Medical
Essays. The Young Practitioner, [A Valedictory Address delivered to the Graduating
Class of the Bellevue Hospital College, March 2, 1871.] ”
“There is currently insufficient evidence of effectiveness either to recommend homeopathy as a treatment for any specific condition.” NHS CENTRE FOR REVIEWS AND DISSEMINATION (University of York) [get pdf]
The dilemmas at the heart of 'alternative medicine'
All forms of ineffective treatment, 'alternative' or otherwise,
pose real dilemmas that are usually neglected.
The definition dilemma
Once any treatment is shown beyond doubt to be effective, it ceases to be 'alternative' and becomes just like any other part of medical knowledge. That means that 'alternative medicine' must consist entirely of unproven treatments.
The lying dilemma
Suppose that a treatment owes all its effectiveness to the placebo effect,
e,g. homeopathy (even Peter Fisher almost admitted as much). But in some people, at least, the placebo effect is quite
real. It may be a genuine physical response, though one that does not depend
in any activity of the drug, or other treatment.
If the placebo effect is real, it would be wrong to deprive patients of
them, if there is nothing more effective available. For example, if terminal
cancer patients say they feel better after having their feet tickled by
a 'reflexologist', why should they not have that small pleasure?
If the foregoing argument is granted, then it follows that it would be our
duty to maximise the placebo effect. In the absence of specific research,
it seems reasonable to suppose that individuals who are susceptible to
placebo effects, will get the best results if their treatment is surrounded
by as much impressive mumbo jumbo as possible.
This suggests that, in order to maximixe the placebo effect, it will be
important to lie to the patient as much as possible, and certainly to disguise
from them the fact that, for example, their homeopathic pill contains nothing
but lactose.
Therein lies the dilemma. The whole trend in medicine has been to be more
open with the patient and to tell them the truth. To maximise the
benefit of alternative medicine, it is necessary to lie to the patient
as much as possible.
As if telling lies to patients were not enough, the dilemma has another aspect,
which is also almost always overlooked. Who trains CAM practitioners? Are the
trainers expected to tell their students the same lies? Certainly that is
the normal practice at the moment. Consider some examples.
The training dilemma
If feet tickling makes patients
feel better, it might be thought necessary to hire professional feet
ticklers who have been trained in 'reflexology'. But who does the training? It cannot be expected that a university
will provide a course that preaches the mumbo jumbo of meridians, energy
lines and so on.
A good example is acupuncture. It is often stated that one of the best
documented forms of 'alternative medicine' is acupuncture. Certainly
the act of pushing needles into to your body elicits real physiological
responses. But recent experiments suggest that it matters very little where the
needles are inserted. There are no 'key' points: it is the pricking that does it. But
its advocates try to 'explain' the effects, along these lines.
"There are 14 major avenues of energy flowing through the body. These are known as meridians".
The energy that moves through the meridians is called Qi.
Think of Qi as "The Force". It is the energy that makes a clear distinction between life and death.
Acupuncture needles are gently placed through the skin along various key points along the meridians. This helps rebalance the Qi so the body systems work harmoniously.
I suppose, to the uneducated,
the language sounds a bit like that of physics. But it is not.
The words have no discernable meaning whatsoever. They are pure gobbledygook.
Can any serious university be expected to teach such nonsense as though
the words meant something? Of
course not. Well so you'd think, though a few 'universities' have
fallen for this, to their eternal shame (e.g, Westminster, Thames
Valley, Salford, Central Lancashire, Lincoln: see below
for more).
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More students apply for CAM courses: Celia Bell's defence
Sigh! The Times Higher Education Supplement (27 July 2007) reports an 31.5% increase in applications for 'university' courses in complementary medicine.
Compare this with 19 per cent fall in applications for places on anatomy, physiology and pathology courses, and a relatively low 6 per cent rise in applications for pharmacology, toxicology and pharmacy.
David Colquhoun, professor of pharmacology at University College London, said he was "appalled" by the development. "These courses are basically anti science. Universities that run them should be ashamed of themselves," he said. "They are cashing in on people's wishful thinking when there is no evidence that complementary medicine works. They might as well offer degrees in astrology."
Edzard Ernst, professor of complementary medicine research at the Peninsula College of Medicine and Dentistry, said most complementary medicine degrees were "scandalously unacademic".
He said: "I am quite cross with British universities for teaching these subjects in such an uncritical way. We need to build up research evidence of what works and what doesn't before offering courses."
But Celia Bell, head of Middlesex University's department of natural sciences, which runs courses in Western and Chinese herbal medicine, said the critics were "out of step with the times".
She said: "There are now millions of people seeking complementary medicine treatments, and we have to ensure that the practitioners are safe and competent and properly trained."
Hang on a moment. Something is missing surely, How can a practitioner be "competent and properly trained" if the whole basis of their practice is nonsense and anti-scientific?
And there are "millions of people" who read astrology columns. There are "millions of people" who believe they have been abducted by aliens. There are "millions of people" who don't believe in evolution. Can Dr Bell believe seriously that this is a good argument for providing degrees in astrology, the physics of flying saucers and Creationism?
Dr Celia Bell is Chair, Human and Healthcare Sciences Academic Group at Middlesex University (soon to become “Natural Sciences”). She is not a herbalist by training. She has a B.Sc. in Human Sciences from University College London, a Masters Degree in Human Nutrition at the London School of Hygiene and Tropical Medicine and a PhD in Biochemistry at the Royal Postgraduate Medical School.
So what happened to her critical faculties? I can find in Medline only two recent
publications, and they are only short abstracts of the proceedings of a conference in 2003. Before that you have to go back to 1991
See here and here.
The second abstract has the title "Herbal treatment for osteoarthritis: a pilot
study investigating outcomes". The conclusion is "These preliminary results
suggest that the herbal treatment for osteoarthritis provided during this study
does appear to benefit patients.". But there appears that there is
no control group whatsoever!. If that is really the case (Dr Bell declined to confirm or deny this), the results
are absolutely worthless. No better than the infamous Spence
(2005).
The only other publication I can find is back in 1991, Chocolate is a migraine-provoking agent. This was a very small study (12 patients on chocolate, 8 on placebo) but a least it did have a control group.
Reports on this item in the Daily
Mail, and Daily Telegraph.
After the fuss about the BBC Alternative Medicine series (see
next item), it
was good to see the excellent report on the news last night (16th July 2007)
about the appearence of the notorious Andrew Wakefield to
face charges of professional misconduct. They showed graphs of the increase in
the incidence of measles which has followed the fall in MMR vaccination.
They reported on the many studies that have shown no link between MMR and autism.
And most fascinatingly, they showed a movie of Wakefield's speech at the Mind
Institute.
The movie has now appeared on youtube. Here it is.
And here is a transcript taken from
the excellent account at Brian
Dear's site (see also Autismdiva).
Wakefield jokes about the unethical taking of blood samples at his son's birthday
party
“ They all get paid £5, which doesn’t translate into many dollars
I’m afraid.
"But, and, they put their arms out and they have the blood taken. All entirely voluntary. [laughter]. "And when we did this at that party, two children fainted, one threw up over his mother [laughter].
"One child, who’s my son’s best friend, Ollie, he put his arm out, very bold, had the tourniquet put on, and then went very pale and sort of … wait till next year. He was nine at the time, and his four year old sister came up, stuck her arm out, had the blood taken, took her five pounds and went off.
"And (NAME) burst into tears. Ruined his birthday party. But people said to me, Andrew, look, you know, you can’t do this, people, children won’t come back to you. [laughter]. I said you’re wrong, I said: 'Listen, we live in a market economy. Next year they’ll want ten pounds!'"
Given the superb standards of many BBC science programmes, this series was certainly very disappointing, for the reasons, for the reasons listed in detail below. At the time, my own complaints to the BBC got nowhere at all. The series producer came to see me, but remained adamant that the presentation of evidence had been fair.
Simon Singh's excellent critiques in the Telegraph and
the Guardian got
some good publicity, but no retraction from the BBC. On the contrary,
a letter was sent to the Guardian, apparently signed by scientists who
were involved in making the programme. I discovered that this
letter had been written by the BBC itself, and had not even been
seen by some of the people whose names appeared at the bottom. Simon
Singh also lodged a complaint to the BBC, which was rejected. But he
is made of sterner stuff than most people. He appealed, but again the
complaint was rejected. Singh then appealed to the highest level (Board
of Trustees) and at last the complaint was upheld. At least two of the
most serious complaints were upheld.
“First, the BBC agreed that the acupuncture open heart surgery sequence "could have misled the audience". Second, the BBC agreed that their attempts to discredit my criticism of the series "was a breach of trust with the audience" because the BBC had not disclosed its role in organising critical letters ”
This is good news and we should all be grateful to Simon Singh for
his persistence. Two of his three serious complaints were upheld, though seven
"less serious" ones were not (but should have been). Read the full
judgement of the BBC Trustees. Let's hope lessons have been learned.
Westminster Health Forum discusses "Integrative medicine"
The Westminster Diet and Health Forum "aims to provide the premier environment where parliamentarians, senior policy advisors, regulators and other decision makers can discuss critical issues, and exchange ideas and information with leaders from industry, responsible interest groups, analysts, academics, journalists and others".
Their meeting on Thursday 5 July 2007 had the title "Integrating Complementary
and Conventional Approaches to Health Care". Despite some good contributions by Edzard Ernst and Simon Singh, the meeting failed to live up to the aims
of the forum, partly because the representatives from the Department of Health
failed to turn up (because of the changes following the accession of Gordon
Brown), and partly because of the choice of speakers. For a
start the audience consisted
almost entirely of advocates of various forms of alternative medicine. And the meeting was chaired by David Tredinnick MP (Cons, Bosworth). This is what the BBC News profile says
about him.
David Tredinnick is an old style Conservative MP, being an Eton-educated former Guards officer, who has sat in the Commons since 1987.
However, his ambition for high office was thwarted by his role in one of the sleaze stories which helped to sink the Major government.
He accepted £1,000 from an undercover reporter to ask parliamentary questions about a fictitious drug.
He was obliged to resign from his role as a PPS and was suspended from the Commons for 20 sitting days. He has not sat on the frontbench since.
He is an orthodox Conservative loyalist, though he is more supportive of the European Union than many of his colleagues.
He has, however, carved himself a niche as the Commons' most enthusiastic supporter of complementary medicine.
He has wearied successive health secretaries with his persistent advocacy of any and all homeopathic remedies.
He has also supported their use in prisons and even suggested them as an aid in alleviating the foot and mouth crisis.
The chairmanship was punctuated by party political speeches, and,
more remarkably, by the apparently serious assertion that he was aware
of a psychiatric hospital that doubled its staff at full moon (this is
an old urban myth, and is, of course, quite
untrue). His advocacy of homeopathic borax as a way to control the
2001 epidemic of foot and mouth diease can be read
here.
Kim Lavely, chief executive of the Prince's Foundation for
Integrated Health (FIH), was chosen as
the keynote speaker. She made (several times)
the quite remarkable assertion that Prince's Foundation did not advocate complementary
medicine. That's not quite the impression given by their web site, and I have
to say I find the dissimulation of speeches like this hard to take. Just as
with her boss, the Prince of
Wales, the message seems to be tailored to the audience.
Kim Lavely, and Boo Armstrong (of GetWell UK), tried to persuade me that
the 'audit' of the effects of Pater Hain's infliction of privatised
alternative medicine in Northern Ireland would tell us something useful.
Of course it won't provide any useful information. The efforts of Ben Goldacre
to explain to the public what
constitutes a trial and what doesn't have not made much progress here. Edzard
Ernst's request for an example of a treatment that could not be
tested in a randomised controlled trial produced no response.
Regulation of complementary medicine is the topic that
occupied much of the time. The obvious question is 'how can one have a professional
body for a therapy that doesn't work?'. This crucial question was consistently
ignored. Alternative medicine advocates are mostly desparate to gain
respectability by becoming regulated professionals, though only, of course,
as along as the regulations do not require them to demonstrate that they
can actually benefit patients (see
letter, below).
The Council for Healthcare Regulatory Excellence (CHRE)
is yet another quango. I was unaware of its existence until their "head of
Fitness to practice" gave a talk. This organisation gets over £2
million per year of taxpayer's money. What does it do? Well "CHRE is
a statutory overarching body, covering all of the United Kingdom and separate
from Government, established from April 2003. It promotes best practice and
consistency in the regulation of healthcare professionals by the following
nine regulatory bodies". But these bodies include not only the General Medical
Council and the General Dental Council, but also the two forms of alternative
medicine that have so far succeeded in getting 'regulated' status, the General
Chiropractic Council and the General Osteopathic Council (for information on
Chiropractic see below and here).
H.L. Mencken (1924) on chiropractic
"This preposterous quackery flourishes lushly in the back reaches of the Republic, and begins to conquer the less
civilized folk of the big cities." (source)
I asked the CHRE representative, Mike
Andrews, what would happen if a question of fitness to practice in medicine
arose that involved inappropriate use of form of alternative medicine that
was also represented by CHRE, but of course I got no answer. Such cases
have happened in the UK, for example Dr
Marisa Viegas was suspended by the GMC advising a patient to stop heart
medication which led to her death. And a Dutch doctor was struck off the register after the death of Sylvia Millecam.
The CHRE seems to be yet another expensive
form of 'box-ticking' bureaucratic regulation that ends up doing more harm than good. We have become very familiar with such things in universities, where "quality assurance regulators" approve people like Patrick Holford, and pursue policies that end up harming good science, not helping it.
Using potassium dichromate to treat patients in intensive care (rather than to clean the glassware)?
No, that isn't a joke. The respectable journal, Chest, official journal of the American College of Chest Physicians, published an article that purported to show that homeopathic potassium dichromate (i.e. water) was a useful way to treat patients in
intensive care. [Frass M, Dielacher C, Linkesch M, et al. Influence of
potassium dichromate on tracheal secretions in critically ill patients. Chest 2005; 27:936–941].
The title and abstract don't mention the word 'homeopathy' at all. Potassium dichromate, like all hexavalent chromium compounds, is very toxic, but luckily for the patients there was no potassium dichromate present whatsoever in the treatment (it was a 30C dilution). The editor of Chest didn't seem to think that there was anything very odd about this, but he did publish a response from me: Treating Critically Ill Patients With Sugar Pills, Chest, 131 , 645, 2007 [Get pdf ].
“It is one thing to tolerate homeopathy as a harmless 19th
century eccentricity for its placebo effect in minor self-limiting
conditions like colds. It is quite another to have it recommended
for seriously ill patients. That is downright dangerous.”
This was accompanied by an unrepentant response from Frass.
The Frass paper has now received some close attention on the Respectful Insolence blog. Someone posting under the name 'getzal' has done a nice analysis which shows that the control group must have contained patients who were were more seriously ill than the homeopathically-treated group.
The saga of the excommunication of this page, and its de-excommunication, is described here, and here, and here.
I am supposed to be on holiday, but the Red Lion in Grasmere has a wireless network, and this is just too good not to post at once. So, after a distinctly moist walk over Loughrigg Fell, and an excellent dinner, here goes.
Panorama from half way up Loughrigg Fell, with Grasmere on left and Rydal Water on write, taken just before the downpour started.
Loughrigg Fell and Rydal Water on left. Grasmere Lake above and Grasmere village (right) with GPS track.
The main trigger for the allegations of defamation seems to have been the fact that I said (and still say), apropos of Dr Ann Walker's description of red clover, “What on earth is a "blood cleanser" or a "cleanser of the lymphatic system". This is so much meaningless gobbledygook”.
This set me wondering about the origin of the term "blood cleanser", and who better to ask than the erudite Micheal Quinion of the wonderful World Wide Words site. His weekly newsletter is invariably fascinating. And buy his books.
Michael Quinion has kindly given permission for me to reproduce his "non-definitive" investigation into the use of the term "blood cleanser". It seems to have been a favourite of snake oil salesmen in thw 19th century. Of course, none of them defined what it means. You are just meant to know that it's something good.
Quinion on “Blood Cleanser"
“The exact phrase “blood cleanser” is known no later than the nineteenth
century. The earliest I've found is from an advertisement in the Ohio
Democrat for 30 June 1871 (it ran regularly from then on) “D.B. FAHRNEY'S
Blood Cleanser or Panacea, for sale by Miller & O'Donnel, is becoming a
popular family medicine." There was also Prof. Chapins' Blood Cleanser,
advertised the following year.
But the concept of cleansing the blood is very much older, of course.
I have found another advertisement, in the Milwaukee Evening Courier of
Wisconsin, dated 22 March 1847: “As a SPRING and FALL PURIFIER it cannot
be surpassed, working its way through the system with a silent and
effective force,--Cleansing the BLOOD; Removing DYSPEPTIC INFLUENCES;
Soothing the NERVES; Removing INTERNAL Obstructions and diseases that
would otherwise cause injury to the LIVER and LUNGS.”
Variations on the phrase also occur several times in Culpeper's Herbal
(1653 edition) in the section on hops: “In cleansing the blood they help
to cure the French diseases, and all manner of scabs, itch, and other
breakings-out of the body; as also all tetters, ringworms, and spreading
sores, the morphew and all discolouring of the skin.” Another example is:
“The roots of this Bastard Rhubarb are used in opening and purging diet-
drinks, with other things, to open the liver, and to cleanse and cool the
blood.”
It also appears earlier still in The Anatomy of Melancholy by Richard
Burton (1621): “And because the spleen and blood are often misaffected in
melancholy, I may not omit endive, succory, dandelion, fumitory, &c.,
which cleanse the blood, Scolopendria, cuscuta, ceterache, mugwort,
liverwort, ash, tamarisk, genist, maidenhair, &c., which must help and
ease the spleen.”
No doubt a more thorough search will turn up still earlier examples. (My
sources are poor before the eighteenth century.)”
The reversal of UCL's request to remove this page from UCL's server was, in
large part, the result of the power
of the blogosphere (see here and here). Here
are some of the things that did the trick.
“Moved to tears by the beauty of blogs”. Goldacre wraps up the affair in the Guardian, and on badscience.net ("Stifling Debate - When Bloggers Attack").
He gives links to the close examination of the work of Dr Ann Walker that that
is now appearing.
“UCL have just issued a smashing statement on Prof Colquhoun’s de-excommunication.” Comment from badscience.
This episode seems to have sparked a close inspection of some of the claims made by Ann Walker, Here are some examples.
“In one piece, Walker promotes the idea that neanderthals were not a distinct kind of human, but degenerate and malnourished versions of ordinary humans: buy pills or regress to a sub-human state, seems to be Walker’s message. Yikes.”
“Ann Walker festival: "There is no convincing evidence that Ginkgo biloba is efficacious for dementia and cognitive impairment" ” Holfordwatch takes a cool look at more claims by Ann Walker.
“Red Clover comments leave a bitter aftertaste” Click here
“ . . . the Provost and Professor Colquhoun have taken advice from
a senior defamation Queen’s Counsel, and we are pleased to announce that Professor
Colquhoun’s
website – with some modifications effected by him on counsel’s advice - will
shortly be restored to UCL’s servers.”
I am grateful to UCL for its legal support, and I'm very grateful too for
the enormous support I've had from many people, especially since Ben
Goldacre mentioned the site move. Now all I need is a bit of help to get
it into a more convenient format. The page will stay at its present address
until there is time to sort things out. For some of the fallout from these
events, click here. The name of the page has
been changed from quack.html to improbable.html on tha advice of lawyers, but
the old addresses still work.
Announcement 30 May 2007.
My
item about claims made for alleged benefits of the
red clover and other herbs has resulted in complaints
being made to the provost of UCL (Malcolm Grant), and to Chair of Council
(Lord Woolf). The complaints have come from Alan Lakin, husband of
Ann Walker. I have received no complaints from them myself.
In the six or so years
that I have been running this attempt to improve public understanding of
science, I am aware of only two serious complaints being made, and as far as
I know, this is the first to reach the level of the provost. This one resulted
in a request to remove of this page from the UCL server, but that is now reversed.
The Islington Tribune (11 May 2007) revealed that spiritual healers are being
paid by the NHS. The National
Secular Society commented
“Spiritual healers” using up scarce NHS resources
The University College London Hospital is to spend £80,000 on testing
whether "spiritual healers" can have an effect on cancer.
“Healers” – who wave their hands over the patient and claim to transmit some
kind of undefined 'energy' – want to find out whether their efforts increase
the number of white blood cells in cancer sufferers.
Astonishingly, UCLH has a dedicated team of 10 "healers", who cost the hospital
around £80,000 a year to maintain. They are the idea of department manager
Angela Buxton who first became interested in “spiritual healing” after the
death of her seven-year-old son from leukaemia. She told the local paper: “Science
has not caught up with how it works. Anecdotal evidence shows it works but
we need hard evidence.”
A defence of this procedure was offered in an email from Martin Lerner (Divisional
Manager, Cancer Services)' He cites cancertherapies.org.uk as
saying.
"Today we are also entering the era where appropriate scientific studies of complementary therapy will begin to show specific improvements in outcome for some patients."
Hang on. Aren't you meant to get the scientific studies before you start treating patients?
Lerner goes on to say
“UCLH does employ the staff and provide some of the budget (about £90,000 this year) towards the cost of this service, with a similar amount raised through charitable fundraising. By making these complementary therapy services an integral part of the clinical service, we show that we take responsibility for the whole of the patient's wellbeing, . . . ”
Spiritual healing clearly comes under the heading of “dishonest” placebo
effects. Nobody is disputing the value to some patients of palliative treatments.
The placebo effect can be quite powerful. But is seems the proponents of laying-on-of
hands have not considered adequately the lying
dilemma
The laying-on-of hands also gives rise to the training
dilemma. What does it mean to be "trained", In something that is essentially
mumbo-jumbo?. Well this poses no problem for the box-ticking mentality of the
corporate administrator, Just tick the box. Here is the application form. It
seems that if you can produce a piece of paper saying you are well-qualified
in mumbo-jumbo, then everything is fine.
There is more on the box-ticker
mentality elsewhere.
It is only too typical of the "efficient administration" that results from
corporatisation of the health service, and universities, and the removal of
power from those who know what they are talking about.
What is the evidence about “spiritual healing” ?
Very little it seems. There is an interesting paper with the title “Psychotherapy
and Survival in Cancer: The Conflict Between Hope and Evidence”, by Coyne, Stefanek & Palmer (2007) [download the paper]. They conclude that, despite the popular belief to the contrary, there is little reason to believe that psychotherapy can prolong life in cancer patients. Insofar as complementary treatments are placebos, they count as a form of psychotherapy.
No doubt, mumbo-jumbo can make some people feel better, and to that extent it
is justified. But it can and should done be honestly (for example, foot massage
is fine, 'reflexology' isn't). Lies to patients should be minimised and universities
should not be tempted to hand out certificates in mumbo jumbo.
Saturday 9 June 2007. The wires (and my hit counter) are melting after Ben Goldacre's comments on the move of this web site from UCL's servers. That's understandable: his excellent badscience.net site gets 12,000 hits a day and 95,000 unique visitors per month.
Like all the other comments, his badscience column in today's Guardian, was not solicited by me, but it's wonderful to know that somebody cares. His badscience.net version ("The Mighty David Colquhoun"!) was even more over-the-top. I can't say I'm feeling very "mighty" at the moment.
Goldacre's piece starts "I've always said you'd get a lot more kids interested in science if you told them it involves fighting - which of course it does." A correspondent today enlarged on the theme "you have got me thinking and yes my kids would be far more interested in science if a playstation game was created whereby Prof. Colquhoun was zapping disgruntled alternative therapists". The mind boggles. Making money out of selling mindless violence (in the news again today) must be even worse than making money out of selling useless pills. A university should be one of the few places left where one cannot be accused of knowing the price
of everything, and the value of nothing.
Contrary to what some people seem to think, I don't enjoy rows. They keep me awake at night. But some things are just too important to duck out of them.
Read the provost's reply.
Goldacre has posted the complete text of the provost's reply to one of the
many people who have written to him. You should read the other side of the
story too (click
here and search for "letter from provost"). Grant has a real problem. He
shouldn't have to spend time fending off herbalists. Yet if they aren't fended
off, more attacks will occur. Who'd be a provost? That is all sorted out now.
OK this isn't really bad science, but it's caused inconvenience to me and
to readers. It still puzzles me that UCL has not got the resources to deal
with a herbalist (the reason that I was given for the move).
On Friday 1 June, when it was announced that the IMPROBABLE SCIENCE page had
been moved from the UCL server, several people sent letters to the provost.
Here is one of them. I have never met Prof Shafer, but his letter, and
other similar ones, lightened an otherwise bad day.
Dear Dr. Grant:
I am very sorry to learn that you have requested Dr. Colquhoun to remove his
"Improbable Science" web page from the computer system at University College
London. It is particularly disheartening to learn that you made this request
after receiving a complaint from a practitioner of nonscientific medicine.
I don't know how many of your faculty publish in Nature (Colquhoun D.
Science degrees without the science. Nature. 2007;446:373-4). However, based
on my experience at Stanford, I would guess precious few. You now appear to
be attempting to squelch his academic freedom, or at least disassociate UCL
from his efforts to educate the public about quack science.
Perhaps you were put off by the "unprofessional appearance" of the web page.
If so then you have misunderstood its purpose. The public is inundated by
junk science, A large portion come from the Internet. There are almost no
Internet resources where a lay reader can find a counterweight to the
extensive claims of pseudoscientists. Dr. Colquhoun's blog is a unique
resource. The format may put off a scientific reader, but it is exactly the
format required to get the message to the web surfer with a 10 second
attention span. In my view the Improbable Science web page was among the
most important public services made available by the University College
London.
I don't know the facts of your decision. Perhaps there are policies,
procedures, and regulations that Dr. Colquhoun has violated in creating the
Improbable Science web page. However, I do know that any request to remove
the page that follows a complaint from an individual offended by the page is
entirely inappropriate. Even were your request otherwise reasonable, the
mere appearance of academic censorship should have been absolutely
unacceptable to you. (Think of it like conflict of interest - there is a
need to avoid not only true conflict of interest, but the mere appearance of
conflict of interest. Requesting removal of these pages may not represent
censorship, but it certainly appears to be censorship, which is anathema to
the academic credo.)
It is thus with shock, sadness, and disappointment that I have learned of
this decision by the University College London. I hope that you will
reconsider. The present course makes it appear that UCL has caved in to
pseudoscientists and is engaged in academic censorship of possibly the most
important public service offered by the UCL.
Sincerely,
Steve Shafer
Steven L. Shafer, MD
Editor-in-Chief, Anesthesia & Analgesia
Professor, Department of Anesthesia, Stanford University
Adjunct Professor, Biopharmaceutical Sciences, UCSF
Stanford University Medical Center
Stanford, CA 94305
No doubt it is an exaggeration to say "the Improbable Science web page was
among the most important public services made available by the University College
London". But thanks anyway.
After an unrepentent response, Professor Shafer
replied thus.
Dear Provost Grant:
I appreciate your taking the time to respond. I'm sure that as provost you
live on the receiving end of a firehose of correspondence, as do I as a
professor and a journal Editor-in-Chief. I'm sorry to have added to the
e-mail overload. I appreciate your finding time to respond.
It would be my hope that Stanford University would shoulder the
responsibility of dealing with whatever harassment would come my way by
virtue of my scientific and academic pursuits. Yes, when legal action is
threatened, and staff are consumed with processing paperwork, I'm sure my
Dean, Provost, and President would prefer to transfer everything to me.
However, the effect would be chilling. Universities are supposed to provide
a haven to insulate scientists from harassment. I've looked at Dr.
Colquhoun's publications via PubMed. He is a top drawer investigator. He is
also a very public advocate for critical thinking.
You note that Dr. Colquhoun "accepts that he needs to be in a position where
he shoulders directly the burden of responding to Dr Lakin." I applaud his
fortitude, but note that are only 24 hours in a day. If the administrative
resources of University College London are inadequate to respond to Dr.
Lakin, how is Dr. Colquhoun, on his own, without the resources of UCL,
expected to survive the harassment, legal challenges, and other pressures to
silence him?
As a counter example, the University of California at San Francisco stood
solidly behind Stanton Glantz when the cigarette industry tried to destroy
him for his efforts to expose their activities. Had he agreed to "shoulder
directly the burden", we would never have known of the extensive research
conducted by the cigarette industry over two decades that identified the
health risks, and guided their extensive disinformation campaign. I would
hope that Stanford University would following the UCSF example, and devote
the necessary resources to defend my academic freedom, rather than the UCL
example, and ask me to "shoulder the burden."
Again, I appreciate your responding to my e-mail. I hope that my perspective
is a least thought provoking on the complex mutual responsibilities between
a prestigious University and an equally prominent faculty member with
outspoken views.
A different sort of bad science: the use of silly numerical indices for the assessment of the worth of people.
An essay that illustrates the numbskulled nature of assessment metrics (as used at Imperial College Medical School) is on a new site, http://goodscience.org.uk. This is an extended version of comments made in the Times Higher Education Supplement, June 1 2007.
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,
Much has been written here (and here),
and especially by Ben Goldacre,
about the irresponsible promotion of omega-3 fatty acids and fish oil on the
basis of next-to-no evidence. Now the National Insitute for Clinical Excellence
(NICE) is reported as recommending fish oil (e.g. BBC).
The report concerns only the question of how to minimise the chances of
another heart attack (myocardial infarction, MI) after you have had one. One
section of the advice (among many) concerns diet.
Patients should be advised not to take supplements containing beta-carotene, and should not be advised to take antioxidant supplements (vitamin E and/or C) or folic acid to reduce cardiovascular risk.
Patients should be advised to consume at least 7 g of omega 3 fatty acids per week from two to four portions of oily fish.
For patients who have had an MI within 3 months and who are not achieving 7 g of omega 3 fatty acids per week, consider providing at least 1 g daily of omega-3-acid ethyl esters treatment licensed for secondary prevention post MI for up to 4 years.
Initiation of omega-3-acid ethyl esters supplements is not routinely recommended for patients who have had an MI more than 3 months earlier.
Patients should be advised to eat a Mediterranean-style diet (more bread, fruit, vegetables and fish; less meat; and replace butter and cheese with products based on vegetable and plant oils).
Later, on page 27, the evidence is assessed.
What is the clinical and cost effectiveness of omega-3-acid ethyl esters treatment in all patients after an MI?
One trial has shown a benefit of treatment with omega-3-acid ethyl esters in patients within 3 months of an MI. However, other secondary prevention treatment had not been optimised in this trial and the majority of patients had preserved left ventricular function. There is some uncertainty about how much additional benefit patients after acute MI optimally managed for secondary prevention, including those with left ventricular systolic dysfunction, will obtain from the addition of omega-3-acid ethyl esters treatment. There is also a paucity of evidence for the effectiveness of treating patients who have had an MI in the past, at least 3 months earlier. The efficacy of omega-3-acid ethyl esters treatment in patients both early and later after MI deserves further research.
Lord Hunt thinks “psychic surgery” is a “profession”
A colleague wrote to his MP to ask if anything could be done about the defrauding of the public by "psychic surgeons". He wrote, in particular, about Stephen Turoff.
Turoff was the subject of the first episode of "Trust me I'm a Healer", a programme that looked at "fake psychic healers". They are the BBC's own words (see badpsychics.com).
“Psychic surgery is nothing but a total hoax.”
“Psychic surgery was discredited by the U.S. Federal Trade
Commission in 1975. In a unanimous opinion, the commission declared that "'psychic
surgery' is nothing but a total hoax." Judge Daniel H. Hanscom, in granting
the FTC an injunction against travel agencies promoting psychic surgery tours,
said: "Psychic surgery is pure and unmitigated fakery. The 'surgical operations'
of psychic surgeons ... with their bare hands are simply phony." (see here) ”
Eventually my colleague got an answer from Lord Hunt, junior minister at the Department of Health (generally loyal Blairite, but he did resign over Iraq).
The response makes one wonder what planet the minister is living on Psychic fraud a "profession"? And capable of self-regulation? This letter is just surreal.
Clearly misunderstanding the nature of science is not restricted to any political
party. In any case, regulation of crackpot medicine arguably does more harm
than good (see letter, below).
Most
sorts of crackpot medicine are desparate to be "regulated" by the
government. They know that the regulation is ineffective, and they know that
it gives them a stamp of governnment approval with few obligations on their
part. They can then claim to be "professional" psychic surgeons
(or whatever) and pretend to be proper doctors. And foremost
among those pressing for this sort of phony respectability has been the Prince
of Wales Foundation for Integrated Health (see here and here)
Conservative party supports homeopathy: official(!)
The list of NHS Trusts that are cutting funding for homeopathy keeps growing (they are listed in a letter from Peter Fisher, no less). There is real hope that reason will prevail. Part of the backlash has been the tabling of an early day motion (1240) in parliament (these aren't voted on, but are just a sort of publicity stunt). EDM1240 opposes closure of homeopathic hospitals, though it is curiosly ambiguous
“complementary medicine has the potential to offer clinically-effective and cost-effective solutions” (my italics)
The list if signatories is pretty depressing. It includes some MPs whom, in other ways. I particularly admire, for example Glenda Jackson and Robert Marhsall-Andrews, as well as quite a lot whom I don't admire a bit. Ignorance of science is, sadly, pretty common in all parties. The signatories include my own MP, Mike Penning (a rather right wing conservative). I wrote to him, and was surprised to hear that support for homeopathy is official Conservative policy. I quote from his reply.
“As you can see from the enclosed standard letter the Conservative Party's
view is that there should be a small amount of money made available for
homeopathic hospitals.”
OK, it is pretty half-hearted support, presumably based as much on the fact that believers in magic have more votes than scientists. The acccompanying statement says, with fine disregard for the facts,
“Homeopathy and alternative treatments are a valuable
resource for doctors to be able to draw upon when offering treatments.”
Well, I guess the Conservatives' belief in the irrational magic is no worse that that of the Blairs.
Multivitamins linked to increased death rate from prostate cancer (?)
Another blow for the "Nutritional therapy" scam has appeared in the Journal
of the National Cancer Institute. Men who take large doses of multivitamin (and other) supplements had a relative risk of fatal prostate cancer almost twice as big as those who don't.
Does this mean that taking vitamin supplements increases you risk of death? The BBC report says "Taking lots of multivitamins may increase the risk of deadly prostate cancer, say US researchers". Somebody (does anyone know who?) said never bother to read a report with 'may' in the title. The result was reported widely in the papers, but none of the reports bothered to explain why the ubiquitous 'may' appeared. To find out more you have to read the original paper (download it here).
The study was a big one. It involved 294 344 men (age 50 - 71) selected from 3.5 million people who had been recruited for a long term study of diet and health. They filled in questionnaires in 1995 - 6 and in 1996 - 7, to establish their (reported) intake of vitamin supplements and other relevant data.
This is good because it is a prospective study: the people who take part are selected before the outcome is known, On the other hand, it is bad because it was not a randomised study. This may sound a bit recondite, but it is very fundamental. If we want to know whether vitamin supplements cause fatal prostate cancer the study would have to be done differently. We would have to select a sample of men and allocate them randomly to two groups, one group taking the vitamins, the other taking similar dummy tablets. This is the famous randomised controlled trial and it has been well-understood since the 1930s. If people choose for themselves whether or not to take vitamins, as in this (and most other) studies, the evidence is necessarily much weaker, because the sort of people who decide to stuff vitamins are likely to differ in all sorts of other ways from those who don't.
All this is explained openly and clearly in the DIscussion section of the original paper (but not by the reports in newspapers). For example
“The increased risk of advanced prostate cancer and prostate
cancer mortality with heavy use of multivitamins among men with
a positive family history of prostate cancer could be due to men
with a positive family history taking additional, unspecified supplements
as part of a “prostate health” package to prevent the future
development of prostate cancer.”
Also, the observations could not distinguish between effects of vitamins and effects of other things like iron, zinc, selenium, folic acid, beta-carotene and saw palmetto which are also often taken by invetarate pill-poppers. Other recent observations have suggested that supplements make actually do harm (see here and here).
So what are we meant to believe? The evidence, at a minimum, does not support the idea that any of these supplements do you any good, so just don't take them. That will save you money and it may even be better for your health.
It's a bit like the food-colouring debate. The evidence that the green dye in you frozen peas does you any harm is ambiguous, but you just don't need it, so why eat it?
Interesting name uh? What could it be meant for? Any resemblance to 'carcinoma' is just coincidental of course. After all it is illegal both in the USA and the UK to sell something as a cancer cure.
“Introducing CarcinPLUS a brand new concept in homeopathic medicine with multiple applications for both humans and animals ”
but it is strangely coy about what these "multiple applications" are.
You are referred to a publication in "The International Journal of Healing and Caring – On Line". This is not a journal that appears in the National Library of Medicine. The article is by M Sue Benford, president of PHISinc, and it is nothing if not bizarre. Here is the abstract.
“This paper reports a potentially novel discovery pertaining to a method of transferring adaptive genetic
traits from one organism to another via a homeopathic process. Two anti-cancer homeopathic
nosode remedies were created representing different adaptive mutations. These remedies were used
and evaluated independently in both humans and animals. Anecdotal and case study reports are
provided for a remedy developed from the blood of a human donor with genes with a known familial
predisposition to long life and anti-cancer mutation mtDNA C150.”
“The author suggests that transference of actual genetic traits/information via
usage of the homeopathic process is a novel discovery with significant potential.”
“This first remedy was created from the blood of a human donor with breast cancer (DCIS with
microinvasive ductal carcinoma, comedo, high-grade) who showed improvement in her disease
through the exclusive use of complementary and alternative medicine (CAM) therapies. The donor
refused all traditional treatments, e.g., surgery, chemotherapy, hormone therapy and radiation, and
began using CAM therapies involving both bioenergy treatments and nutritional supplements. The
’bioenergy’ treatments included both generalized ’laying-on-of hands’ and Reiki. The anti-cancer
supplements consisted of the intermittent use of proteolytic enzymes, Quercetin, Turmeric,
Coenzyme Q-10, Folic Acid, and Omega-3 fatty acids.”
So Sue Benford seems to be suggesting that the blood of a patient who was, allegedly, cured by laying-on-of-hands, has some characteristic that can be passed on to somebody else via a pill that contains nothing whatsoever (a 200C pill, as recommended by Benford, would contain one molecule from the patient's blood in a sphere of radius equal to the distance between the sun and the earth). And if a single pill doesn't work, “the dose should be increased one pill per day, up to three 200C per day” (hang on a moment, I thought that more meant less).
”Here is the appeal Jonathan sent me yesterday for the study participants. He says he knows nothing more about "Sue" (the researcher) except that she is "totally on top of her subject and that she is involved in bona fide research." She does not want to attract FDA attention at this stage of the study.” [My emphasis]
An enquiry by a friend got this reply from Benford.
“One thing we have observed with nearly all the cancer patients using C+ is an improvement in quality of life. In some instances, the cancer also goes into remission but this isn't a guarantee.”
These pills, which contain no active ingredient, will, I am told, cost the patient $110.45 for 100 doses.
How did I come across these amazing claims? Benford was foolish enough to try a get a bit of free advertising by sending a response to the debate in the British Medical Journal about assessment of homeopathy. See it here.
That wasn't smart, given her wish to avoid the attention of the FDA. And it got me looking too. This was my response in the BMJ.
Thanks to Ms Benford for drawing the attention of BMJ readers to her web site http://www.phisinc.com/.
The company comes very close indeed to offering to cure cancer with homeopathy. Of course it contains the usual disclaimer which amounts to saying 'anything you read here may be untrue'. Nonetheless, the message is clear.
Claims to be able to cure cancer, without good evidence, are illegal both in the USA and in the UK. I have heard that phisinc.com has been referred to the FDA, so visit their site quickly. It may not be there much longer. You'd then miss the chance to
"View an extraordinary video that demonstrates a novel new technology that images the bioholographic field of living organisms and detects very early stage cancers."
Regardless of legality, claims to be able to cure cancer of this sort are, in my view, plain wicked.
Can't get more bizarre than that?
Well perhaps you can. The same Sue Benford has a publication, listed in Medline. It purports to “demystify unexplained anomalies such as
idiopathic thermogenesis, halos and auras, and incorruptibility of human corpses”. Beat that.
Medical Hypotheses (2001) 56(1), 33–39
Radiogenic metabolism: an alternative cellular energy source
M. S. Benford
PreComp Inc. and Public Health Information Services Inc., Dublin, Ohio,USA
Summary The concept of ‘healing energy’ is commonly used in complementary and alternative medicine; however,
efforts to define this concept using contemporary scientific theory, and measure it using modern scientific methods,
have been limited to date. Recent experimental testing by Benford et al. observed a uniform, substantial, and
consistent decrease in gamma radiation during alternative healing sessions, thus supporting a new energy-balance
paradigm hypothesizing ionizing radiation as an alternative cellular energy source. This hypothesis extends the known
elements of radiogenic metabolism to potentially explain a number of presumably biopositive energy-related
phenomena, including fasting and radiation hormesis, as well as to demystify unexplained anomalies such as
idiopathic thermogenesis, halos and auras, and incorruptibility of human corpses.
Precomp Inc, of Dublin Ohio, the biotechnology start-up company mentioned in the address, is something of a mystery. Benford was its president and CEO. In 1996 it received two NIH Small Business Innovative Research (SBIR) awards ($281,811), but these were apparently for perfectly good science, done not by Benford, but by Ohio University Scientists.
Exploring New Vistas of Science and Spirit is yet another Benford web site, this one run in collaboration with Joseph Marino, a catholic priest. That, I suppose, might explain the arcane interest in spontaneous human combustion and the incorruptibility of human corpses.
And if you believe all this, you'll believe anything.
Yes, you read that correctly. The Mail published a powerful piece by Michael
Baum "Homeopathy is worse than witchcraft - and the NHS must stop paying for
it". Read
it here.
“The majority of homeopathic physicians are nice, kind people and they're not stupid.
They will claim homeopathy is a complementary therapy, not an alternative to medicine. But how does homeopathy complement other medicine? Bogus potions aren't complementary, they are a deception and provide false hope.
What we don't have in the NHS is adequate palliative and supportive care that really does complement what people like me do. So I have a solution for the ailing Homeopathic Hospital and the £5million a year it receives from our NHS trust.
Stop peddling placebos and turn the hospital into a centre for evidence-based, supportive care for people with life-threatening or terminal illnesses. A centre with psychologists, masseurs, counsellors, art and music therapists.”
Tunbridge Wells Homeopathic Hospital: please help to make sure it shuts
The BBC News reports the expected resistance to the closure of the Tunbridge Wells Homeopathic Hospital, which was announced last year.
“Members of the public are being invited to five discussion events in May. The consultation is due to end in July.
The events are being held at Preston Hall, Maidstone, on 8 May, and Gravesham Community Hospital on 11 May, while three sessions are taking place at the Camden Centre, Tunbridge Wells, on 16 and 21 May.
A public consultation document entitled "Should the NHS pay for homeopathy?", which will be the focus of discussion, is due to be published on Thursday. ”
The West Kent PCT has a report
from their "Directorate of Civic Engagement". This lists "underlying basic principles
that the PCT is committed to". This list contains, inter alia, “The
pursuit and performance of evidence based clinical practise”
The bad news is thay you can send in the feedback form only if you live in
West Kent. As someone has already pointed out on Badscience, it isn't a good
idea to falsify the form, But I see no reason why one shouldn't write to the
PCT to express and opinion, while declaring that you aren't in the local area.
The address is
“FREEPOST RRJX JYUR UYAC, West Kent PCT,
Wharf House, Medway Wharf Road, Tonbridge TN9 1RE or email jonathan.barnes@swkentpct.nhs.uk
We need your response by 2 July 2007.”
And just to keep your conscience clear, better put a stamp on it.
The Health Supplements Information Service (HSIS) is a spin organisation for the supplements industry. It was mentioned below, when they attempted to discredit a report that suppplements could
actually increase mortality. In that case Ann Walker spoke for HSIS.
The same Ann Walker wrote an editorial for the British Journal of General
Practice (January 2007), "Potential micronutrient deficiency lacks recognition in diabetes". The conclusion is "Although still considered to be controversial by some, taking a daily multinutrient supplement would bridge the gap between intake and requirements and ensure that nutrient target intakes are met". The affiliation given is senior lecturer in nutrition at the University of Reading, where she has a one-tenth full time appointment. No competing interests are declared. The University of Reading tells me that she has "consultancies for two supplement companies and for the Health Supplement Information Service. Dr Walker has also declared a private patients clinic".
Ann Walker is also course director for an organisation called New
Vitality. And she "operates a Clinic from her home on two days a week,
using a combination of nutritional therapy and herbal medicine to treat patients
with a wide variety of conditions." All this sounds rather less academic.
And so it is. Take red clover. New Vitality's view is shown on the right What
on earth is a "blood cleanser" or a "cleanser of the lymphatic system". This
is so much meaningless gobbledygook. The term "blood cleanser" means nothing whatsoever.
An enquiry about what "blood cleanser" means has yet to produce a reply.
The description of red clover on the New Vitality site
And is red clover really good for "symptoms of the menopause"? There is quite a different
view on Medline
Plus. This is an information service run by the US National Librery of
Medicine and National Institutes of Health. They say, of red clover for menopausal
symptoms,
“most of the available human studies are poorly designed and short in duration (less than 12 weeks of treatment).As results of published studies conflict with each other, more research is needed before a clear conclusion can be drawn.”
Medline Plus lists six other indications for red clover that have been suggested
by herbalists. The conclusion in all seven cases is "Unclear scientific
evidence for this use"
Likewise, New Vitality says of elderflower
“The primary use of elderflowers is for colds and influenze where its anti-viral properties come into play.”
“it remains unclear whether there is truly any benefit from elder for this condition. Additional research is needed in this area before a firm conclusion can be reached. Elder should not be used in the place of other more proven therapies, and patients are advised to discuss influenza vaccination with their primary healthcare provider. It should be noted that the berries must be cooked to prevent nausea or cyanide toxicity.”
Complaints about this item
I have had no complaints myself, but Ann Walker's husband has written directly
to the Provost of UCL and even to the chair of UCL's Council. The provost made
it clear that he has no legal grounds for complaint (see
above). I also heard indirectly of a complaint from the University of
Reading's marketing director (yes, marketing dirrector!), Ann Wilstead. The
main objection seemed to be to my use of the word "gobbledygook". On 22nd
May, I replied to Ms Wilstead as follows.
“I'd also be grateful if you could provide me with definitions of the terms "blood cleanser" or a "cleanser of the lymphatic system". It is true that I describe these terms as gobbledygook, because they are terms unknown to science. If you can persuade me otherwise I'll happily change the description.”
Thus far I have had no reply.
Lakin's complaint was,
no doubt, technically correct when he said that I had breached copyright by
reproducing a graphic from the New Vitality web site. This free advertising
was evidently not appreciated. I apologise for that, and the offending graphic
has now been replaced with another one that quotes their words.
“There is no consistent evidence that acupuncture, acupressure, laser therapy or electrostimulation are effective for smoking cessation, but methodological problems mean that no firm conclusions can be drawn.”
And how many times have you read that? One inconclusive trial after another. More on acupuncture below
These two, brought to my attention by correspondents, are unusually outrageous in that the advertised ingredients don't even exist!
Pherlure Cologne for men
This wonder product "will help you attract sexual attention instantly from the
opposite sex". Or so it says at http://www.pherlure.com/.
And what's the evidence?
“A recent study conducted at The University of Chicago reports that
the "Novel human pheromone formulation (Di-Dehydroepiandrosterone) increases
sexual attractiveness." ”
“ Results indicated that Pherlure users "sexual intercourse
activity levels increased by 62.4%" while the forty-one placebo
controls increased by only 2.8%, respectively. ”
But guess what? The alleged ingredient, "Di-Dehydroepiandrosterone", is not
any known chemical. And nobody can trace the alleged study. There is a very
thorough debunking at http://www.pherlure.info/
Anatrim.
There has been a barrage of spam email advertising this wonder slimming treatment. Much of the advertising says it contains "Anatrim gordonii", a non-existent plant. It is widely supposed that this is Hoodia gordinii cactus from Southern Africa. Nobody knows who makes the stuff. The origin of some of the advertising has been traced to China. The good thing is that several web sites have sprung up to debunk this scam, e.g. http://www.anatrim.org/.
Chondroitin does not work for osteoarthritis (and probably glucosamine doesn't work either)
Sales of chondroitin and glucosamine are a worth billions of dollars, but the evidence that they work has never been good.
A new meta-analysis of clinical trials now shows that chondroitin on the symptoms of osteoarthritis is "minimal or nonexistent".
(Reichenbach S and others. Meta-analysis: Chondroitin for osteoarthritis of the knee or hip. Annals of Internal Medicine 146:580-590, 2007: download the paper]
It is the same old story. Early trials were small and badly-designed. They seemed to show some effect, which was wildly exaggerated by the supplement hucksters to push sales. Eventually somebody does the trials properly, and it is found that there is little or no benefit.
Look at Figure 6 from the paper (right). It shows the size of the beneficial effect plotted against the year of publication. The black circles represent trials with a large number (over 200) patients, the white circles are smaller (and mostly badly-designed) trials. As soon as the trials are done properly, the alleged benefits vanish.
The authors conclude "Use of chondroitin in routine clinical practice should therefore
be discouraged."
Analyses by ConsumerLab.com has reported that 8 out of 20 products said to contain chondroitin failed its quality tests, with four containing between 0% and 8% of amount stated on the label.
Glucosamine shows a similar trend. Glucosamine is a synthetic chemical, but it is not a licensed medicine in the UK. It is marketed as a "food supplement", not as a drug. It is not approved for precription on the NHS. The latest Cochrane review does not entirely rule out some benefit, but again the effects seem to get smaller as the trials get better.
Thanks to Quackwatch for the alert about the Reichenbach paper.
This fine bit of abuse is on glastoburyofthemind. Just for the record, my research has been funded by the MRC and the Wellcome Trust: it has never been funded by the pharmaceutical industry. Here is one reason why. I will admit, though, that I've never heard of Spank Rock. The power of Verdi's requiem is wonderful (especially because Verdi was a non-believer). Just don't pretend that use of the word "power" has anything to do with science. The amazing thing about quacks is that they love to use the language of science while at the same time despising it.
Very annoyed that The Independent Thursday March 23rd 2007 page 5 gives Doctor David Colquhoun, a London based pharmacologist, free reign to spurt some of the medical lobby’s ongoing anti homeopathy drive. According to Colquhoun one of the problems with homeopathy is that it uses words “borrowed from science’. Such as? “Force and energy they are used in a way that has no scientific meaning whatsoever.” Well EXCUUUUUU-SSSSE ME! “Science” (Is that science PLC you vested interest protecting weasel?) owns words does it? When did it corral them up and put them in the science camp? What a load of hogwash. Haven’t you ears haven’t you heard Spank Rock, James Brown, Jimi Hendrix, The Clash, Public Enemy, ad infibloodynitum? Haven’t they all got as great a right to OWN the energy and power words as a self important self appointed lobby of pharmaceutically funded fucks? Just curious.
The Royal London Homeopathic Hospital (RLHH) has problems
The news is out. It was in February this year when I first saw some "Commissioning Intentions 2007-08" documents from several London NHS Primary Care Trusts (PCT), indicating their intention to break their contracts with the RLHH on the very reasonable grounds that homeopathy doesn't work. It seemed better to wait for the intentions to be implemented before saying much, because of the inevitable outcry from those who want sugar pills at the taxpayers' expense.
Then, in March 2007, the Health Services Journal carried a story "PCTs consider alternative to homeopathic hospitals" (free registration, or read it here).
On 8 April 2007, The Observer carried a special report, prominently featured on page 3.
“Royals' favoured hospital at risk as homeopathy backlash gathers pace
The Queen loves it. But alternative medicine centre's future looks uncertain as more NHS trusts axe funding”
Peter Fisher, clinical director of the RLHH, is quoted as saying
“Twenty-five hospitals from London and southern and eastern England have already either stopped sending any patients to the RLHH or agreed to fund only a handful.”
“Prince Charles is sympathetic, supportive and concerned. But he doesn't feel it's appropriate to intervene in any way because there's been some adverse publicity before about him 'meddling'. ”
Fisher and Queen,
Observer 8 April 2007
Fisher attributes this to the letter sent to PCTs by 13 of us, last May, in which we advocated that the NHS should not be paying for "unproven or disproved treatments". The leading signatory on this letter, Professor Michael Baum, is quoted in the Observer thus.
“If the Royal London were to close because of PCT deficits we would scarcely miss it”.
“Homeopathy is no better than witchcraft. It's no better than a placebo effect. It's patronising and insulting for adults.”
“Instead you could have a centre for palliative and supportive care, which would be of greater benefit and involve half the cost. Rather than losing something, we would gain something.”
The backlash
The reaction seems to have started with a letter from homeopath Carol Boyce. Her letter starts thus.
ROYAL LONDON HOMEOPATHIC HOSPITAL UNDER SIEGE
“Death by stealth. The Royal London Homeopathic Hospital (RLHH) – the visible presence of homeopathy within Britain’s NHS - an institution putting homeopathy in the public mind for the last 150 years – the place where homeopathy was seen to perform so well in the cholera epidemic of the 1840s - is being dealt a DEATH BLOW”
I'd guess the very first sentence must be something of an embarrassment to the RLHH's clinical director, who is far too sensible to believe that cholera can be cured by homeopathic sugar pills.
The red herring about cholera is repeated ad nauseam on hundreds of homeopathy sites (though most are curiously silent about whether they really believe that sugar pills can cure cholera). It is based on the report that during the London Cholera epidemic of 1854, of the 61 cases of cholera treated at the London Homeopathic Hospital, 10 died (16.4%), whereas the neighbouring Middlesex Hospital reported 123 deaths out of 231 cases of cholera (53.2%). Apart from the lack of any knowledge of the state of the patients on entry to hospital, it was also the case at the time that conventional medicine was no more based on evidence than homeopathy. Indeed the initial popularity of homeopathy could well have resulted not only from wishful thinking, but also because doing nothing at all (i.e. homeopathy) was less harmful than blood letting. The fallacy of the argument was spotted very early on by Oliver Wendell Holmes (senior) in his famous essay, Homeopathy and its Kindred Delusions.
But medicine moved on and homeopathy didn't. The history of cholera, like that of tuberculosis, contrary to what is suggested by homeopaths, is a triumph for evidence based medicine. The epidemic was halted not by homeopaths but by the careful observations of John Snow that led to his removing the handle of the Broad Street pump. If medicine had been left to homeopaths, people would still be dying of these diseases.
Carol Boyce invites you to write directly to Queen Elizabeth II, to save the RLHH. She has also started an e-petition on the UK government site. The petition includes the words
ROYAL LONDON HOMEOPATHIC HOSPITAL UNDER SIEGE
“The RLHH has been part of the Health Service for 150 years. ”
“In 2005, 67% of GPs and 85% of practices in it’s [sic] Primary Care Trust, referred patients to the hospital. The hospital provides effective and most importantly, COST-EFFECTIVE treatments.”
Ms Boyce seems not to have noticed that the Prince of Wales' own Smallwood report decided that there was not enough evidence to come to firm conclusions about cost-effectiveness.
Peter Fisher himself has appealed for the survival of the RLHH in a letter dated 9 March 2007.
“The Royal London Homoeopathic Hospital needs your support
09/03/2007
By Dr. Peter Fisher, Homeopath to Her Majesty, the Queen”
There is no silly talk about cholera here, but there is a useful list of Trusts who have decided to abandon "unproven and disproved treatments". Fisher recommends you to read Marcia Angell's book to learn about the deficiencies of the drug industry. I recommend that too. I also recommend Dan Hurley's book on the even greater deficiencies of the quackery industry.
Fisher suggests you write to your MP to prevent closure of the RLHH.
I suggest you write to your MP to support closure of the RLHH.
Times Higher Education Supplement (THES), and another response from Westminster
Following the kerfuffle caused by Nature, THES asked for 800 words on the same topic, Bachelor of Science degrees in subjects that are anti–science (read it here). Every time I read an official validation document I am reminded inexorably of the inimitable Laurie Taylor, which is why the article starts thus.
The vice-chancellor of Poppleton University is pleased to announce that the university's finances have been transformed since the conversion of its old-fashioned department of physics and astronomy into the new department of alternative physics and astrology. Quality is ensured by the course validation and top Quality Assurance Agency rating, both awarded by a distinguished panel of academics with appropriate expertise in astrology. (Apologies to Laurie Taylor.)
As it happens, Laurie Taylor's column in the same issue of THES is on "Maintaining Standards", and is as grimly hilarious as always. And his column in the following week (13th April) was about the report of the external examiner, Professor J.K.L. Anonymous, on the Universlity of Poppleton's BSc in palmistry ("There were 36 first-class papers, 22 upper seconds and only one marginal failure". Well, there's a coincidence.
My piece ends thus.
If a few vice-chancellors appear to value bums on seats more than honest science they should justify their views in public.
THES plans soon to bring us some responses from the hitherto elusive vice chancellors. That should be interesting.
This was accompanied by an article by Brian Isbell, who is head of the department of complementary therapies at Westminster University. He presumably had a hand in the (unsigned) response of Westminster to the Nature article, but this time the response was rather different (could that be because he'd read my comments on the original response?). This time there was no quoting of bad evidence, or the Society of Homeopaths, but rather a defence based on the fact that BSc degrees in CAM include some real scientific content. Let's take a look at this new response. Isbell says
Brian Isbell
“The shared philosophy across Westminster's range of complementary therapy degrees is that students need a compulsory core of health sciences. This includes anatomy, physiology, biochemistry, pathology and differential diagnosis.
Phytochemistry and pharmacology are included for degrees in herbal medicine and nutritional therapy.” Brian Isbell
In fact homeopaths at Westminster get two courses on Physiology and two on anatomy out of a total of 22 courses. They get no biochemistry and no pharmacology at all. The standard of these courses is quite unknown because the university refuses to disclose any of its teaching materials. Let’s suppose, for the sake of argument, that they are good. You can’t learn physiology without subscribing to the principles of chemistry and physics. These principles include Avogadro’s number and the very basic idea that response to a drug usually increases as you increase the dose. Both of these ideas are inconsistent with “homeopathic philosophy” (also the subject of four courses).
So on Mondays and Thursdays (for example) the students must believe that response increases with dose, but on Tuesdays and Fridays they are called upon to believe that response decreases with dose.
Isbell admits as much himself when he says “at times students have to work with conflicting scientific models that may not always fit with their clinical practice”. What he does not say is how this absurd conflict is resolved, or how it can be made compatible with science or simple common sense. The course evidently teaches you how to believe several mutually contradictory things at the same time, or at least on alternating days. You don't need to be a scientist to see that is plain daft.
Not only are some of the doctrines of CAM incompatible with science or common sense, but they are often also incompatible with each other. Homeopaths subscribe to the bizarre doctrine that the less you give the bigger the effect, but herbalists do not. Herbal medicine is nothing other than pharmacology, albeit pharmacology as practised at the beginning of the 20th century, before biological standardisation was introduced to assure constant potency of medicines. So they want to give a sensible dose, but don't know what it is. Nutritional therapists go to the opposite extreme and want to give huge (and sometimes toxic) doses.
I have been told that herbal medicine students at Westminster are instructed not to talk to the homeopaths in another part of Isbell’s school, because they talk rubbish. They even have separate sections on the university’s intranet, so that one sort of CAM can’t be polluted by the beliefs of a different sort of CAM. Likewise, students of reflexology are taught that a small area on the big toe is connected with the pituitary gland. Not only is this incompatible with physiology, but it is also incompatible with homeopathy, herbal medicine and nutritional therapy.
The department of complementary therapies seems to resemble a collection of religious sects at war with each other, rather than anything recognisable as science.
The second plank in Isbell's new defence is that students are taught to develop research skills. Homeopathy students get one course (out of 22) called "Methods of Research in Complementary Medicine", and a project, "Research in Practice". It is impossible to know what is taught on these courses because the university refuses to release any of the course materials. But I find it hard to imagine that the courses are very critical when the official response from the university cited the Spence (2005) study as though it provided evidence for the efficacy of homeopathy.
If that is the best the teachers can do, what hope is there for the students?
Th first response from the University of Westminster
The day after the Nature commentary, the University of Westminster issued
a statement in response. Let's take a look at it.
“The BSc (Hons) Health Sciences: Homeopathy is a fully validated degree that satisfies internal and external quality assurance standards.”
Well, since the University has so far refused to release any of the documents, it is hard to judge what that validation is worth. The validation documents will, no doubt, appear eventually. Watch this space.
One mechanism that is intended to maintain the standard of degrees is the
external examiner. Their identities, like almost everything else, are kept
secret. In the case of the Westminster BSc in homeopathy, however, we are in
luck. According to the Teaching Quality Information (TQI) site,
their external examiner is the "Chair of the Society of Homoeopaths". Since
April 2004, that has been Andy
Kirk RSHom, a homeopath in private practice, with no degree and no scientific
qualifications. He, I imagine, is not likely to question the bizarre homeopathic
doctrine that the smaller the dose you give, the bigger effect you
get.
Correction (4 April 2007). It seems that Westminster supplied wrong information to the TQI site, and the external examiner is not Kirk. They refuse to say who it is. But watch this space.
“The University’s stance received the backing of the Society of Homeopaths,
the UK’s largest register of professional homeopaths”.
Yes, I'm sure it did. The Society
of Homeopaths is an organisation for homeopaths who have no medical
qualification. Their scientific credentials can be judged from this quotation from
their web site.
“If they are so dilute, how can they work?
After each dilution the mixture is vigorously agitated in a machine that delivers
a calibrated amount of shaking. This is called succussion. It is thought that
this process imprints the healing energy of the medicinal substance throughout
the body of water (the diluent) as if a message is passed on. The message contains
the healing energy.”
This is pure gobbledygook. The word "energy" is being used in a way unknown
to science. It is mere armwaving in an attempt to 'explain' a phenomenon that
almost certainly doesn't occur anyway.
“In fact there is considerable evidence demonstrating the clinical effectiveness of homeopathic treatment, including a large outcomes study published in 2005, of an analysis of over 23,000 outpatient consultations at the Bristol Homeopathic Hospital, in which more than 7 per cent reported clinical improvement,”
(Notice the Freudian slip. That should be 70%)
The study to which they allude here has to be the worst paper ever published.
It is the infamous Spence (2005) study, which is dealt with
below. Oddly enough, this paper is one that Westminster students were asked
to assess critically. Sadly, though, it hasn't been possible to see any marked
answers.
The fact that this is the best evidence that the University can produce
in response to criticisms is, perhaps, the best reason ever to think that
the material being taught is not, in any sense, science, and is not appropriate
for a BSc. It seems that they are hoist by their own petard.
and a Nature podcast [listen
to podcast]. Here is some
of the coverage of this commentary (more soon, including some of the abuse). A
transcript pf the podcast is
here.
Material World (BBC Radio 4). This excellent science programme,
presented by Quentin Cooper, had a longer version of DC versus David
Peters (Westminster University). There was helpful intervention from
Michael Marmot who had talked, in the first half of the programme, about his
longitudinal population studies. [listen to part 2].
Radio 5 Live interview.
BBC London News (BBC1 TV), An interview of DC and Peter Fisher
by the News Presenter, Riz Lateef. Dr Fisher, who
is clinical director of the Royal London Homeopathic Hospital, made a very
interesting comment, at the end of a discussion about whether homeopathy was
a suitable subject for a science degree. [watch the video]
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.”
“. . .if you look in the Cochrane library, . . . you will find that there are two treatments for flu that appear to be effective, and one of them is homeopathic”
I presume this refers to the Cochrane review "Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes". What this actually says is
“Trials do not show that homoeopathic Oscillococcinum can prevent influenza. However, taking homoeopathic Oscillococcinum once you have influenza might shorten the illness, but more research is needed.”
Well, it might, but even if it did, the average length of the putative "shortening" of the illness was a mere 0.28 days, i.e. 6.7 hours. To call that "effective" seems to me to be just a tiny bit of an exaggeration.
The newspapers
“Faith-based degree ‘damages science’ ”
Mark Henderson, Science Editor, The
Times. I love that title: it says it all.
“Homeopathy science degrees 'gobbledygook' ”
Ian Sample, science correspondent, The Guardian.
“Alternative medicine degrees 'anti-scientific' ”
Roger Highfield, Science Editor, in the Daily Telegraph
“Universities 'are duping students with homeopathy science degrees' ”
Steve Connor, science correspondent The Independent
“Less than complementary?”
James Morgan in the Glasgow Herald
“Alternative therapy degree attack”
“UK universities are teaching "gobbledygook" following the explosion in
science degrees in complementary medicine, a leading expert says.” BBC News web site
“University homoeopathy degrees 'gobbledygook', claims Professor”
Fiona McRae in the Daily Mail.
and the story even got into the free London papers, Metro and The London
Paper
And some from abroad
“British health expert brands homeopathy 'gobbledygook'”
From 'our correspondent' at DailyIndia.com.
“Homeopathic Degree in Britain Puts Scientific Gloss on Nonscientific Dross, Critics Say”
Susan Brown in The Chronicle of Higher Education (USA)
“A matter of degree. Why the letters after a homoeopath’s name really do count”
Mark Henderson, 24th March, in The Times (Body and Soul section)
Ann Robinson, in the Guardian's Comment is Free (Sunday 25th March) gives me a bit of a slagging off. But her piece is followed by a flood of comments, almost all of them thoroughly sensible. One comment, from 'Midas' ends thus.
“So why not homeopathy alongside medicine?”
Right. Why not Levitation alongside Aeronautical Engineering?
And the blogs: quite a lot of blogs picked up the story.
Thanks to everyone who sent letters of support, not least the regular scientists from Westminster, and University of Central Lancashire who are clearly rather embarrassed by their homeopathic colleagues.
Inevitably there were a few bits of hate mail too, each answered politely, and some even resulting in a degree of agreement. The only one worth quoting is a rather mild one from George Lewith (see below).
“Do you realise that your own university (University College London) offers a BSc in architecture? I have yet to find that this particular course (from personal experience) involves a single piece of science. You might like to investigate at the Bartlett.” . . .
“I suggest you make a formal complaint to your Provost, the Dean of the Medical School, and the committee of UK Vice-Chancellors of Medical Schools. You must know that you are completely out of sync but perhaps you don’t?
Kind regards
George”
I guess one of us is out of sync anyway. Unlike George (it appears), I know little about architecture, but the idea of design for a tower block based on homeopathic principles sounds a bit scary to me.
The second week in March 2007 was a champion. Two different nutrition stories hit the headlines, both misreported and neither very informative. More fish oil (below) and the alleged benefits of grape juice.
Fish oil, VegEPA and Professor Puri
The inimitable Ben Goldacre has dealt with yet another story about the miraculous effects of omega-3. Read it on badscience.net.
The media were full of utterly uncritical reports of a programme that was to be broadcast by Channel 5 TV. For example, "Supplement 'boosts' brain power" [BBC].
The report in the Times was particularly uncritical. "Fat pupils on fish oils make a mental leap", with a subtitle "Fatty acids can help children in exams and improve their behaviour in class and at home, a study suggests.". But the "study" was on only four (very untypically heavy) children, it had no control group, and it did not measure behaviour or exam performance, but rather a chemical in the brain.
“The results were astonishing,” said Professor Basant Puri, who led the study. “In three months you might expect to see a small NAA increase. But we saw as much growth as you would normally see in three years
Professor Basant Puri is head of the Lipid Neuroscience Group at Imperial College London, and MRC Clinical Sciences Centre, Hammersmith Hospital. He has published quite a lot in this area.
Dr Alex Richardson (Oxford), who has worked a lot with Prof Puri, has dissociated herself from this study.
Professor Puri gave a talk on the use EPA for "Beating the blues, M.E and tiredness" at the Inner Potential Centre. Other talks in the series there include "Psychic Weekends", "Tibetan Mountain Body Movements", "Self-healing in minutes with iiYoga", "Divine Earth mysteries by dowsing" and "Holistic Cancer Solutions". The mind boggles.
Why is it that we discover only from Ben Goldacre that Professor Puri seems to have something of a vested interest in the outcome of his studies? He is the registered inventor on patent GB2409644, for "Formulation comprising eicosapentanoic acid or an ester thereof and a triterpene or an ester therof". The applicant/proprieter on this patent is IGENNUS Ltd of Cambridge.
The Channel 5 TV programme in which this work was featured was mysteriously cancelled at the last moment. I wonder why?
Latest miracle cure: purple grape juice
Following a press release from the University of Glasgow, news media round the world carried the story that grape juice could prolong your life more than any other sort of fruit juice. David Rose in The Times: "The juicy route to good health". Jeremy Laurence in the Independent "Why a glass of grape may be best way to start your day". ; The BBC: "Study shows fruit juice benefits". The BBC report goes on "A diet rich in fruit juice could cut the risk of Alzheimer's disease and other diseases, according to research", and "Grape juice was found to be one of the most beneficial juices".
But the study to which these reports refer did not measure any health benefits whatsoever. The paper is "Evaluation of Phenolic Compounds in Commercial Fruit Juices and Fruit Drinks (W. Mullem, S.C. Marks and Alan Crozier. It was an exercise in analytical chemistry.
Furthermore, the Independent was the only newspaper to spot that
“The research was funded by the National Grape Co-operative, a consortium of farmers in the US owned by Welch's, makers of Concord purple grape juice.”
This is not mentioned in the University's press release (though it was in the paper itself). Of course the sponsorship does not mean there is anything wrong with the results, but declaration of financial is now considered to be very important.
The paper concludes that
“The [Welch's] purple grape juice contained the highest levels of phenolics and antioxidants”
But does this really mean better health? The anti-oxidant story, after all, has been pretty thoroughly discredited some time ago (though it is still live and well in the advertisements of the supplements industry).
So where does the health come in? Professor Alan Crozier said, in his paper
“In view of the recent findings of the Kame project indicating that
long-term fruit juice consumption can provide protection against Alzheimer’s disease (Dai et al. Am.
J. Med. 2006, 379, 464-475), it is suggested that the protective effects may be enhanced by
consumption of a combination of juices rich in phenolics and containing a diverse variety of individual
phenolic compounds, namely, juices derived from purple grapes, grapefruit, cranberries, and apples.”
The Kame project was a prospective study over 10 years on 1836 Japanese Americans. It was not randomised: people who reported drinking a lot of juice seemed to have a lower chance of developing Alzheimer's disease over 10 years (but no correlation was seen with intake of vitamins E, C, or beta-carotene or tea consumption). Because the participants were not randomly assigned, it was necessary to make corrections to the results to allow for the fact that those who drink a lot of juice are likely to differ in all sorts of ways from those who don't. For example, corrections were made for years of education, smoking status, tea-drinking frequency, regular physical activity and total fat intake. Such corrections are fallible, and of course there is no guarantee that all the possible relevant factors have been thought of.
Dr Dai, first author on the Kame project is careful to point out that the project gave no information on what sort juice of juice was drunk, and that it was not known what constituents of the juice produced the putative effects. He is quoted thus
“However promising the study results appear, Dai cautioned, it’s important that the general public not jump the gun regarding the value of juice as a preventive measure for Alzheimer’s disease.
“A few years ago, hormone replacement therapy, NSAIDs (nonsteroidal anti-inflammatory drugs) and antioxidant vitamins showed promise (in preventing or slowing Alzheimer’s disease), but recent clinical trials indicate that they do not,” Dai said. “More study, I think, is needed.” ”
If the media reporters, and Glasgow university's PR dapartment, had read and understood some of this background, their reporting might have been a bit more accurate.
Professor Crozier has research funding from the following.
World Cancer Research Fund (WCRF)
Biotechnology & Biological Sciences Research Council
Brewing Research International
Nestlé Research Centre
Beverage Partners Worldwide (Europe)
The Beverage Institute for Health and Wellness, a scientific organization within The Coca-Cola
Company
It must be hard to be seen as independent when you take money fron Nestlé and Coca Cola. The WCRF, incidentally, is not a conventional cancer researh organisation but is dedicated to the view that cancer can be prevented by changes in diet and lifestyle. Many of its claims are unproven.
The British Medical Journal (2007, 337, 508 – 509) held a debate on whether or not CAM should be referred for evaluation to the National Institute for Clinical Excellence (NICE) [see it here]. Two of the comments that followed the debate were as follows
John R King, Consultant Psychiatrist
David Colquhoun (“NICE should not have to evaluate alternative medicine”) makes a better case than Linda Franck et al. Space researchers do not, after all, waste time trying to disprove the beliefs of flat- earthists. Neither would it be helpful for a Nobel prizewinning chemist to stride into a church and denounce the holy water there as nothing more than H2O. There is a very large and ever expanding array of alternative treatments, some more bizarre than others, which could tie up the resources of NICE for an indefinite period. But if people want to believe in them – or in fairies or leprechauns – they should be left in peace to do so. It is no concern of scientific medicine.
David Colquhoun, UCL
Nobody is proposing to ban fairies or leprechauns. It would be both undesirable and impossible.
There does seem to be a case, though, for not providing leprechauns at the tax payers' expense. And really all leprechauns that are sold to the public should have labels that don't make false claims for their powers. Unfortunately the MLRA (Medicines and Leprechauns Regulatory Agency) has let us down in the matter of labelling. I suspect infiltration of the Department of Health by little green men
Channel 4 TV, Monday 12th March, The is the title of the Channel 4 TV documentary, Dispatches.
Lord Wedderburn, QC, a life peer and Emeritus Professor of Law at the London School of Economics, tells the programme:
“If, in fact, nothing changed and he became King, then there would be a most almighty fuss and controversy, and eventually the whole fabric of the constitutional monarchy could be threatened.”
The Prince's Foundation for Integrated Health (FIH)
is the Prince's lobby group which attempts to make the hard-pressed NHS spend
more money on unproven and disproved treatments. The FIH publishes "Complementary
Healthcare: a Guide for Patients". This document is
not just barmy, but positively dangerous. In the rebuttal of the programme
on the FIH web site, they claim that they do not promote alternative medicine,
but elsewhere on the site they state
their aim as "makes safe and effective complementary
therapies available to patients in conjunction with conventional healthcare".
Which would be all very well if they didn't consistently ignore the evidence
for effectiveness.
The MHRA recently, for the first time, betrayed its brief to nake sure that medicines work and are safe. This action has been condemned by just about every professional organisation. Nobody knows exactly what caused them to lose their heads in this way, but it is clear that they were under pressure from both the Department of Health and from the Prince of Wales. The Department of Health is clearly sympathetic to quackery, as shown by the letter below, and by their refusal to allow alternative medicine to be referred to NICE for assessment.
The MHRA admit to having had at least seven letters form the Prince of Wales, and we know that an MHRA member has met the Prince at Clarence House at least once. But all the contents are secret from the public. The Chairman of the MHRA Agency Board, Prof Alasdair Breckenridge, and chairman of their Herbal Medicines committee, Prof Philip Routledge, have both admitted to me to having had pressure from the Prince of Wales, but neither will give any details, despite having been condemned by their own professional organisation, the British Pharmacological Society.
The appalling treatment of Professor Edzard Ernst
Edzard Ernst was the UK's first professor of complementary medicine, and he is rather unusual in that field because he is totally honest, and very careful about evidence (something that has not always endeared him to the alternative medicine industry).
A letter was sent from Clarence House to the vice-chancellor of Exeter University, Steve Smith. The letter alleged a breach of confidence by Ernst. Having been sent a draft of the Smallwood report, Ernst was so horrified by the scientific standards in that document, he felt obliged, in the public interest, to speak out about it. Ernst was contacted by a newspaper, which had a copy of the draft, and described the initial findings as "outrageous and deeply flawed". He added: "It is based on such poor science, it's just hair-raising. The Prince ... also seems to have overstepped his constitutional role"
Prof Edzard Ernst.
Prof Ernst was doing exactly what academics are meant to do. As a result he was subjected
to a very prolonged disciplinary procedure, and for a year it was not obvious
whether he'd keep his job. For a Prince, in a constitutional monarchy, to put pressure
on a university to silence a conspicuously honest academic is just not acceptable.
The Prince of Wales behaviour was bad enough, but, to be generous, he is perhaps, a well-meaning but poorly educated man, filling in his time as best he can.
In the story of Edzard Ernst, the behaviour of the Vice-Chancellor of Exeter
University, Prof Steve Smith seems
to me to be unforgiveable. Instead of supporting his staff, and supporting
academic freedom, he appeared to cower before the Clarence House letterhead. After
keeping Prof Ernst on tenterhooks for an entire year he eventually deigned
not to fire him in the most grudging and unpleasant way imaginable. That
is illustrated by the end of Smith's letter to Professor Ernst on 13th October
2006. It was shown on the TV programme, and is reproduced below.
Prof. Steve Smith,
Vice chancellor.
The Daily Mail also has features on the healthiness of HRH's own food lines,
after his criticism of MacDonalds, Dutchy
Original Sins, and here.
They are worth reading because the advice comes from Catherine Collins, a real
dietician, not a nutribollocks guru.
Some responses The story was reported round the world.
“To make good use of evidence, it is essential to possess not only intelligence, but a capacity for disciplined analysis. The prince has considerable virtues, a good heart notable among them. But he has always lacked discipline in his life and in his treatment of issues. Again and again, he gets himself into trouble by seeking to address matters that are, frankly, beyond his intellectual reach.”
“Treatment with beta carotene, vitamin A, and vitamin E may increase mortality”
That is the conclusion of a recent paper in the Journal of the American Medical Association, “Mortality in Randomized Trials
of Antioxidant Supplements for
Primary and Secondary Prevention”
Systematic Review and Meta-analysis”, [Get the full text].
This isn't original research, but a meta analysis that attempts to collate existing data taking into account the reliability of each source. The aim was to analyze the effects of antioxidant supplements (beta carotene, vitamins A and
E, vitamin C [ascorbic acid], and selenium) on deaths (from any cause) in adults. The analysis seems to have been done well, and the results are startling. They aren't just a waste of money, but some of them are actually bad for you. In 47 low-bias trials with 180 938 participants, beta carotene increased death rates by 7 per cent, vitamin A by 16 per cent, and vitamin E by 4 per cent (when taken separately). Vitamin C gave contradictory results and selenium showed no detectable effect.
This work got an excellent write-up in The Times, by their health correspondent, Nigel Hawkes. This was followed by a predictably silly defence of nutribollocks by the Times' Dr Thomas Stuttaford (known in Private Eye as Dr Utterfraud). Luckily, this was neutralised by a second piece on the same page by Nigel Hawkes, "Phooey. Sensible balanced diet is the best investment":
“ In nutrition, a plausible idea and a little bit of evidence are all that is needed to create a market. And such is the megaphone of marketing and the influence of countless “healthy eating” articles that these ideas, even the half-baked ones, can lodge very firmly in the national psyche.”
It's a nice coincidence that this study came out while I was reading Dan Hurley's book, Natural Causes (see right). This book sets out dramatically the harm, sometimes serious harm, that untested "supplements" have done to some individuals. But for me the most interesting part is the revelation of the political lobbying by this $20 billion supplement industry, with the aim (largely successful) of undermining the FDA and escaping from any effective regulation of its absurd, but exceedingly profitable, claims. The supplements industry puts the Prince of Wales in the shade when it comes to subverting common sense and good science.
The Health Supplements Information Service (HSIS)
Needless to say, the supplements industry has already organised vilification of this excellent bit of work.
"HSIS is funded by The Boots Company PLC, Bayer PLC, Perrigo, Seven Seas Ltd and Wyeth Consumer Healthcare. The campaign is co-ordinated by PAGB (Proprietary Association of Great Britain)".
So it's no surprise that their spokesperson. Dr Ann Walker, immediately tried to discredit the study, saying "The results of these mixed-sample metaanalyses are worthless" (The Times).
This same Ann Walker recently wrote and editorial in the British Journal of General Practice (January 2007). The editorial concludes "Although still considered to be
controversial by some, taking a daily multinutrient supplement would bridge the
gap between intake and requirements and
ensure that nutrient target intakes are met.” But in this editorial her affiliation is given as Senior Lecturer in Human Nutrition, University of Reading. No mention at all of her role as spokesperson for the Supplements industry. Tut tut.
Patrick Holford too
Needless to say, supplement salesman Patrick Holford has weighed into the vilification. His objections have been dealt with nicely on the cutely named web site stopholfordtalkingrubbish.blogspot.com. Find the answers here.
“any product, be it a publication, seminar, food or supplement, that is authored/invented by me has my name on it and earns me a royalty/payment. That is how I live and fund my research.”
Garlic is widely promoted as a cholesterol-lowering agent, but the evidence so far has been lousy. In this trial, 192 adults with low-density lipoprotein cholesterol (LDL-C) concentrations of 130 to 190 mg/dL (3.36-4.91 mmol/L) were randomly assigned to one of the following four treatment arms: raw garlic, powdered garlic supplement, aged garlic extract supplement, or placebo.
“Conclusions None of the forms of garlic used in this study, including raw garlic, when given at an approximate dose of a 4-g clove per day, 6 d/wk for 6 months, had statistically or clinically significant effects on LDL-C or other plasma lipid concentrations in adults with moderate hypercholesterolemia.”
La Traviata, La Bohème, and how quacks poison your mind
Last night I saw a magnificent ENO production of La Bohème at the London Coliseum. During the tear-wrenching death of Mimi in the last act, it occurred to me that if we had taken advice from homeopaths and the like, people would still be dying young from tuberculosis. For me, Verdi beats even Puccini with the pathos and drama of the death of Violetta from consumption in La Traviata.
Listen to the last minute of La Traviata (the Joan Sutherland and Carlo Bergonzi recording): click to listen
Opera Desire, Disease, Death (University of Nebraska Press), by Michael and Linda Hutcheon is about disease in Opera. A review of the book by Roger Burford Mason appeared in the Canadian Medical Association Journal (1996, 154, 821-823). La Traviata appeared in 1853, and at that time the cause of tuberculosis was not known.
“Generations
of languishing, beautiful
women were not considered dangerous
or infectious, but only glamorously
frail, their short lives akin to
the beauty of moths fluttering around a candle flame.”
“Some experts advocated contagion, others a constitutional hereditary defect, atmospheric imbalances, the depredations of stress, or an inevitable consequence of the degeneration of the human race; even the role of divine retribution was occasionally evoked”
But by the time La Bohème was first performed in 1896, things were quite different. In 1882 Robert Koch had discovered the real cause of the disease, Mycobacterium tuberculosis (Koch R., Die Aetiologie der Tuberculose: Berlin klin. Wochschr. 1882;19:221–230: translation in Am. Rev. Tuberc. 1932;25:298–323). Paul Ehrlich is quoted as saying of Koch's talk to the Berlin Physiological Society, on March 24th 1882, "This evening remains imprinted on my memory as the most awe-inspiring scientific event I have ever attended"
The Hutcheons suggested that the reason that Rodolfo abandoned Mimi was because it was known by the time of La Bohème that tuberculosis was contagious, and he didn't want to die too. In subsequent correspondence, a letter from Mimi Divinski MD (yes, Mimi) mounted a defence of Rodolfo: “Rodolfo knows that Mimi is dying and cannot bear to watch her and feel so helpless”. “Rodolfo is a hero”. You can read that letter, and the Hutcheons' response, here.
Homeopaths poison your mind, not your body
Robert Koch in 1883
Medical genius
It is often said that homeopathy, and some other forms
of quackery, though not effective, are at least harmless. This history
shows otherwise. Sugar pills do not, of course, poison your body. They
poison your mind. Belief in their crude and irrational delusions inhibits
search for the real causes of disease and for real cures. Like creationists,
homeopathists and their ilk take the lazy approach. Don't do the work,
it's much easier to read the holy book. If we had listened to them, people
would still be dying of tuberculosis and cholera.
This is not just historical either. At the present time, alternative
medicine practitioners endanger the lives of children and adults by
consistently advising against vaccination (download
Schmidt & Ernst, 2003),
Samuel Hahnemann
Medical dim-wit
Tuberculosis continued to kill long after Robert Koch, and long after La Bohème. Streptomycin was discovered in 1943, and shortly afterwards, a simple synthetic drug, isoniazid, was discovered in the labs of the pharmaceutical companies Hoffman La Roche, Farbenfabriken Bayer, and Squibb Institute for Medical Research. The first clinical trial was in 1952. And they came just in time to save my own sister who was diagnosed with tuberculosis in 1954 at the age of 14. She did not become another Violetta. Between them these drugs ended a centuries-old scourge.
Why, I wonder, does quackery seem to have become rife in Scotland. In
the 19th century Scottish medicine was preeminent, and several of UCL's
first professors came from Scotland (science, at that time, was not very
evident in Oxford and Cambridge). A fascinating insight into this
period (roughly 1820-1840) is given in Adrian Desmond's book, The
Politics of Evolution: Morphology, Medicine and Reform in Radical London (University
of Chicago Press,1992).
I have already written below about
homeopathy and aromatherapy in Edinburgh. A Dalkeith GP made a big mistake
when he prescribed homeopathiv belladonna for the feverish son of one
of my colleagues!
The Medical School, Teviot Place Edinburgh in
1884. I did my PhD there in 1960 - 64.
Now a more systematic account has appeared in the British
Journal of Clinical Pharmacology, which has just published a disturbing
paper, Homoeopathic and herbal prescribing in general practice in Scotland,
Sarah Ross, Colin R. Simpson & James S. McLay,2006, Br J Clin
Pharmacol, 62, 647–652).
Sixty per cent of doctors' surgeries in Scotland prescribe homeopathic or herbal remedies
“Forty-nine percent of practices prescribed homoeopathic and 32% herbal remedies.
A total of 193 homoeopathic and 17 herbal remedies were prescribed, with 5% of
practices accounting for 46% of patients and 50% of remedies. Four thousand one
hundred and sixty patients (2.2/1000 registered patients) were prescribed at least
one homoeopathic remedy during the study period, with the highest prevalence to
children under 12 months of age (9.5/1000 children of that age). Children under
the age of 16 made up 16% of the population prescribed homoeopathic remedies
(2.2/1000 registered patients of that age). Three hundred and sixty-one patients
(0.2/1000 registered patients) were prescribed at least one herbal remedy during
the study period, 44 of whom were children under
16 years old. Patients prescribed a
homoeopathic or herbal remedy were also prescribed a median of four and five
conventional medicines, respectively. Of patients prescribed an oral herbal remedy,
4% were also concomitantly prescribed a conventional medicine with which a drug–
herb interaction has been documented.
Conclusions
Our study reports that a substantial number of Scottish general practitioners prescribe
homoeopathic and herbal remedies, with an approximate doubling in the number of
children prescribed homoeopathic remedies. The level of homoeopathic and herbal
prescribing raises questions about homoeopathic/herbal provision in the National
Health Service and should prompt critical review.
The majority of patients prescribed homoeopathy
were female, with a median age of 48, possibly reflecting
the gender split of patients attending their GP rather
than any gender bias [11], although available data suggest
that women between the ages of 35 and 60 are the
main consumers of over-the-counter remedies or consulters
of CAM practitioners [12].”
The highlands are at it too
And just look at this bit of wishful thinking from
the Highland NHS (complete with personal testimonials, just like every
snake-oil advertisement).
In the Independent ,
20 Feb, 2007, Thomas Sutcliffe writes thus.
“It's never easy being a world leader in any field - you're always liable to be demoted by some upstart. So it must be good news for Los Angelos that their city has cemented its reputation as the global epicentre of New Age dim-wittedness by hiring a feng shui expert to advise on the construction of a monkey enclosure at Los Angeles Zoo. Simona Mainini was reportedly paid $4,500 for feng shui-ing a new home for three Chinese golden monkeys, left. She has advised that the angle of the monkey house be rotated a few degrees to "transform the energy distribution" and that a water feature be added. The zoo hasn't revealed whether the monkeys will also receive high colonics, botox and reiki massages - but anything less would surely count as cruel neglect. ”
Patrick Holford, the Institute of Optimum Nutrition, AIDS and the University of Bedfordshire
Here is a very odd looking cover for an academic brochure. It's just one big new-age
quack medicine advertisement.
It is the brochure for the Institute of Optimum Nutrition. In between the advertisements it describes a number of course that sound quite academic. The give-away is the term Nutritional Therapy. They are the folks who claim, with next to no evidence, that changing your diet, and buying from them a lot of expensive 'supplements' will cure almost any disease. The brochure claims that it offers.
The most well-established and widely respected nutritional
therapy qualification in the UK<
Confers Qualified Nutritional Therapist status
Fully meets the National Occupational Standards as
specified by the Nutritional Therapy Council (NTC)
Accredited as a Foundation Science Degree by the University
of Luton with 240 credits at Higher Education levels 1/2.
This Institute is run by the totally unqualified Patrick Holford, whose prententions
have been analysed so effectively by Ben
Goldacre. His advocacy of vitamin C as a cure for AIDS alone makes him
a menace to humanity. See the details on badscience,net: Goldacre says
“Holford is going on a speaking tour of South Africa next month. My blood runs cold at the thought. If McKeith is a danger to the public understanding of science, Holford, in this case, may be that danger realised”
How on earth can an outfit like this be accredited by a university? What
on earth is the University of Bedfordshire (formerly Luton) thinking of?
Not much, one suspects.
Ms Gillian McKeith - Banned From Calling Herself A Doctor!
This is just brilliant. The Advertising Standards authority have stopped
the foromost purveyor of nutribollocks from using her phoney PhD to lend
an air of verisimulutude to her otherwise bald and unconvincing narratives.
Read all about it on Ben Goldacre's masterly exposé at badscience.net.
Sadly, the person who thought of referring Ms McKeith to the ASA wants to remain anonymous. Whoever it was, they deserve a medal. It is high time science fought back actively against the tide of rubbish that engulfs us. Try Goldacre's Activism forum, for a start. Do it yourself. It's fun.
The print edition of the Guardian gave this story a magnificent spread (right), under the heading A Menace to Science.
Postscript. McKeith's web site has a "note of thanks" for "wonderful emails" from, for example, the Health Food Manufacturers Association (no surprise there), and The Centre for Nutrition Education and Lifestyle Management, an organisation that offers honours "BSc" degrees validated by Middlesex University.
Also an excellent article by Marina Hyde, Shamelessness: the TV route to rehabilitation; she points out that TV bosses don't give a damn. Never mind the truth: being caught out is all good publicity.
For a bit of light amusement, I decided to publish the occasional bit ot email correspondence. This one arrived on 9th Feb 2007.
From: "Stephanie Ginn"
To: d.colquhoun@ucl.ac.uk
Subject: homoeopathic medicine
If Homoeopathic medicine doesn't work, and it is all in the mind, how is it that if I give the wrong remedy my patients don't get better, but when I find the right one they frequently do?
This is as true of sore throats and ear infections in small children as it is to asthma and Rheumatoid Arthritis in adults.
You really should do more research before shouting your mouth off over things you clearly know nothing about.
We can't all be that stupid...
Stephanie
Dear Ms Ginn
Thanks for writing. I'm always interested to hear from people like you. (though my reply will be a bit more courteous than your letter).
You say "how is it that if I give the wrong remedy my patients don't get better, but when I find the right one they frequently do?
I think that you have hit the nail on the head, If you can produce the numbers to show that what you say is true, then I and everyone else I know will believe you (it would, of course, have to be done by comparison with an appropriate control group). The problem is that the homeopathic community have had 200 years to produce the evidence, and so far it has not been forthcoming.
I suppose it is true to say that the evidence would have to be good in view of the inherent implausibility of homeopathy. If it turned out that it was possible to produce an effect with no molecules present, the whole of present day chemistry and physics would be overturned and since it seems to work rather well that would be surprising. Nevertheless, it is what would happen if you produced the evidence (and you'd probably get a Nobel prize too).
I think though, it is your responsibility to do the research, not mine
Best regards
David Colquhoun
Thank you for your reply.
Homoeopathy may sound implausible, I agree, it does if you only look at modern so called science. There are plenty of things in life which are unexplained, such as love...you can't see it but would you deny it's existance? I am sure and hope that you must have felt it?
You are right so far in that to convince people they need proof. However, for most of us as Homoeopaths, our proof is that our patients get well, and they do, most of the time. That is generally enough proof for our patients too, especially when their brain tumours disappear. Of course there will always be some placebo effect in some people as in medicine of any sort. Perhaps you should try it for yourself and FEEL the proof...you will probably find that to be enough for you too..
Oh and by the way I think that present day physics and chemistry beliefs need overturning, desperately.
Stephanie
Thanks for those comments. I see that you really do appreciate the need to produce evidence if you are to convince people, however convinced you may be yourself.
Your most intriguing comment, though, was " I think that present day physics and chemistry beliefs need overturning, desperately". But it seems to me that your scepticism about the success of chemistry and physics doesn't extend to computers, email, the web, mobile phones, motor cars and aircraft. They are all products of the application of chemistry and physics and 100 years ago they would have seemed miraculous).
That leaves me wondering which bits of chemistry and physics you don't like!
Best regards
David Colquhoun
At this point, all I got back was
Ok maybe redefining and definately [sic] rethinking are closer to the mark.
Prince of Wales inspects “Anti-MRSA aromatherapy inhaler”
Another case of "you couldn't make it up if you tried". Today's print edition of the Times carries a picture of the Prince of Quacks inspecting an "Anti-MRSA aromotherapy inhaler" during his visit to the Christie Hospital, Manchester (9th Feb 2007). On the face of it, that sounds pretty dangerous, even by his standards.
A bit of investigation shows that the report is based on some perfectly good scientific work on antimicrobial properties of essential oils by Peter Warn. Nothing 'alternative' about that. Unfortunately, though, Manchester University's media department has chosen to publicise the matter not only before clinical trials have begun, but even before the lab work has been published. Now we have to contend not only with inaccurate journalists but also with University publicists who insist on talking before there is anything to say.
“An experiment in allowing NHS patients easier access to alternative and complementary therapies has been launched by NI Secretary Peter Hain.”
But it is NOT a trial, and NOT an experiment. Journalists seem incapable
of understanding the meaning of these words, and the result is irresponsible
reports (though one might detect a hint of irony in the picture that the
BBC used to illustrate acupuncture; right).
There is nothing new in the failure of journalists to distinguish good
science from junk. We saw this very clearly in the case of the phoney fish
oil "trials" going
on in Durham (see Ben
Goldacre's account of these).
In the case of Durham the effect is to use public money to produce bad evidence
that can be used to promote the dubious claims of a private company, in the
case "Eye Q" pills made by Equazen.
In the case of Northern Ireland, £200,000 of taxpayers' money will be
paid to a private company, GetwellUK, GPs in two areas will be able to refer
patients for therapies like acupuncture, homeopathy and massage. Nothing there
about seeing whether the treatments work! But Peter Hain seems to think he
knows the answer already. He said
"I am certain, as a user of complementary medicine myself, that this has the potential to improve health substantially,"
He was "delighted that Northern Ireland is leading the way in integrating complementary and alternative therapies into the National Health Service"
Peter Hain used to be something of a hero to me. In the 70s his work for the Anti-apartheid movement was an inspiration (see his autobiographical notes). Now he has sunk to promoting junk science. Very sad.
So what is Hain's attitude to alternative medicine, and how did he come to ally himself with the batty medical opinions of the Prince of Wales? On his web site he had a section on this topic. For some reason it has now been deleted, but thanks (again) to Google's cache, here is a quotation from a speech he made to The Prince of Wales Foundation for Integrated Health (12th October 2005).
“Our first baby, Sam, was born with eczema. Later, he developed asthma too. At first, we relied on conventional treatments. Various creams were prescribed, and a steroidal spray. But they didn't work. In fact, the spray seemed to make him more dependent.
So instead, we turned to complementary medicine. And with the help of homeopathy and tight restrictions on the sort of food that our son could eat – avoiding in particular wheat and milk products – both ailments went away.”
Hang on! You changed diet and gave homeopathic sugar pills. And
that is a reason for the taxpayer to fund homeopathy? Any fool can see that
this anecdote means that either (a) change in diet helped, (b) homeopathy helped,
or (c) the eczema would have got better anyway. According to the National
Eczema Society, “60-70% of children are virtually clear of the condition
by the time they reach their mid-teens”. They "grow out" of it. Evidently
a First Class Honours Degree in Economics and Political Science is not enough
to teach Peter Hain what constitutes evidence and what does not.
Peter Hain now
Peter Hain in 1970
On the other hand, the in the same speech Peter Hain also said
“I would certainly never advocate the squandering of public money on so called treatments that have no proven benefits and which take money away from existing therapies that are shown to work.”
But they have "no proven benefits". Just how inconsistent can you get?
Who are GetwellUK?
GetwellUK is a private company
financed largely by taxpayers' money. And guess who supports it? The Prince
of Quacks, once again exerting his unconstitutional influence on public
policy. This is done partly through yet another of the Prince's lobby
groups, "GP Associates" (report
in BMJ). It seems that "GP Associates" was the forerunner of the recently-launched "Integrated Health Associates". The inaugural meeting of Integrated Health Associates" was sponsored by a drug company, Solgar Vitamins, a purveyor of unnecessary 'supplements' that is a trading arm of Boots Herbal Stores (no connection with that other well-known purveyor of misleading information, Boots the Chemists).
“Support came from the government in February 2005 when the Parliamentary Under-Secretary for the Department of Health, Melanie Johnson, said in the House of Commons, "I thank the hon. Gentleman for notice of the question in relation to Get Well UK. We understand the benefit that many people get from complementary therapies. Local commissioning is a matter for local discretion, but we can see the benefits to local practices of an intermediary pulling together a range of services in the area for alternative medical treatments." [Hansard].
We were delighted to be selected as one of the first investees of Futurebuilders - a Treasury fund established to assist capacity building in community organisations who deliver public sector services. The investment will help Get Well UK to serve more NHS patients.”
Prince of Wales with Boo Armstrong (Managing director of Getwell UK)
GetWellUK publish an evaluation of a "pilot project" in London, "Does
it Work?", by Nicola Robinson (Head of the
Centre for Complementary Healthcare & Integrated Medicine,Thames Valley University).
The report tells us nothing whatsoever about the effectiveness of the treatments,
because the "pilot" study was not designed to do so. It is 40 pages of waffle.
The report also says "Get Well UK is a not for profit organisation established
in response to a recommendation by the House of Lords in 2000 that complementary
therapies should be made available through the NHS. This is a gross misrepresentation
of the House of Lords report which said this should be done ONLY if the treatments
worked better than placebo. And, with very few exceptions, that still remains
to be shown.
For their efforts in setting back medicine to the 19th century, they have had money from UnLtd Ventures ("provides consultancy support to a number of outstanding social entrepreneurs" and taxpayers' money from Futurebuilders. And they are getting £200 000 of taxpayers' money from Paul Goggins, the Northern Ireland Health Secretary
At the end of the "pilot scheme" there will have been no proper assessment of the effectiveness of the treatments. We shall be none the wiser.
Last year I investigated the very dubious evidence for 'Helps
Stop Snoring', and the concealed financial interests of the author of
the clinical trial. The story was spotted by the Radio 4 consumer programme You
and Yours. On Monday 5 February 2007 they broadcast the story. Other
contributors included Stephen
Senn, the distinguished medical statistician.
GSK, Seroxat and academics for hire: a shocking story
BBC TV's Panorama programme showed the latest investigation of GlaxoSmithKline's suppression of evidence of side effects of Paroxetine (Seroxat, Paxil). It seems that television journalists and lawyers have been a great deal more effective in unearthing the evidence than the regulatory authorities or the police. The MHRA has been working on the case for three years and has still not produced its report. Read the transcript here.
Lawyers in the USA managed to extract many secret emails from GSK, and they tell a sad story. Since the deregulation of industry that started around 1979 with Ronald Reagan and Margaret Thatcher, one has become accustomed to dishonesty by big business. But academics are involved too
GSK organised three large scale clinical trials of Seroxat on children with
depression, in the hope of getting Seroxat licensed for this use. The biggest
of these is known as 'Study 329'. It is these trials that have given
rise to the charge that GSK tried to suppress evidence that Seroxat caused
an increase risk of suicide in young people.
Martin Keller is chair of psychiatry at Brown University. The evidence found by Panorama also shows that his reputation seems to be for hire. His university home page shows that he holds many influential politicians. It does not mention that in one year he got half a million dollars from drug companies including GSK. In one email Keller thanks a ghost writer who worked for a PR company hired by GSK.
"You did a superb job with this. Thank you very much. It is excellent. Enclosed are some rather minor changes from me..."
In another mail from the ghost writer to Dr Keller says that all the necessary materials are enclosed so that he can submit study 329 for publication, even down to the covering letter which says: "please re-type on your letterhead. Revise if you wish.". Perhaps Keller at least checked the results carefully? But it seems not. Keller said
"I've reviewed data analytic tables, I don't recall how raw it was. The huge printouts that list items by item number.. you know, item numbers, invariable numbers and don't even have words on 'em. I tend not to look at those. I do better with words than I do with symbols."
The BBC reporter, Shelley Jofre, comments “Inside GSK, though, the discussion was all about what a failure study 329 had been. This is what another of its PR people wrote when asked if the journal article would be publicised.”
“Originally we had planned to do extensive media relations surrounding this study until we actually viewed the results. Essentially the study did not really show it was effective in treating adolescent depression which is not something we want to publicise.” [Email dated: 5th March 2001]
This is bad as any quackery, and the collusion of academics is very sad.
Brown University does not appear to have learned the lesson. The news section on their web site boasts of this ghost written work
“The largest clinical trial studying the use of antidepressants for treating major depression in adolescents suggests that paroxetine, sold under the brand name Paxil, may be successful.
"This is the first substantial evidence of a safe and effective treatment with an antidepressant for adolescents," said Martin B. Keller, M.D., who led the study, which appears in the July issue of the Journal of the Academy of Child and Adolescent Psychiatry.”
Fiona Godlee, editor of the British Medical Journal, spoke on the programme. She had spotted the problems with the paper and declined to publish it. She comments
“Another journal had peer reviewers who also spotted a number of the problems but the paper was published nonetheless relatively unchanged, and I think the journal must take some responsibility for that.”
The editor of the 'other journal' (Journal of the Academy of Child and Adolescent Psychiatry) expressed no regrets.
See also "Ghost Authorship in Industry-Initiated Randomised Trials" by Gatzsche et al. (Plos Medicine 2007), and the commentary by Wagner, "Authors, Ghosts, Damned Lies, and Statisticians". The latter concludes
"perhaps we should now admit that there are four types of lie: lies, damned lies, statistics, and the authorship lists of scientific papers, and that statisticians may be able to help prevent both the third and fourth types.".
The amazing decision of the Prescription Pricing Authority to allow the NHS to pay for magnetic bandages has been covered in detail here (part 1, part 2, part 3), as has the extreme reluctance of the PPA and the Department of Health to give any useful information (here, and here). More on this topic elsewhere. Eventually the decision was referred to the Office of Fair Trading has delivered its judgement. MagnoPulse Limited was told to remove most of its absurd claims from its advertising.
It remains to be seen whether the PPA admit their mistake and reverse their decision.
Les Rose versus Katherine Armitage on Radio London
The Vanessa Feltz show (09.00 to 12.00 on Radio London) had a phone-in concerning a rumour (nothing more so far) that Hammersmith Primary Care Trust was refusing to refer NHS patients to the Royal London Homeopathic Hospital on the grounds that there is no good reason to think that homeopathy works. The highlight of the show was a 10 minute debate between Les Rose (see also below) and a homeopath, Katherine Armitage.
I have clipped the relevant 10 minutes from the show, in the expectation that most people won't want to listen to the preceding 2 hr 9 min of phone-in. [Listen to (or download) the mp3 clip]
Peter Fisher said "it is true that there is not as much
evidence as you would like" for the efficacy of homeopathy. Hear it in
his own words.
Of course he went on to insist that it was not all placebo
effect.(For
more on Peter Fisher, see here, and here,
and
here). He
said he'd been converted to alternative medicine by a visit to China at the
height of the 'cultural revolution' where he seems to have fallen for the well
known scam of anaesthesia produced by acupuncture, a bit of crude Maoist
propoganda.
Katherine Armitage produced some amazing gems of wisdom. How about these.
“Evidence–based medicine is based on Newtonian physics which was superseded by quantum physics.”
“Homeopathy, we are still working out how it works with quantum physics”
Don't you love the "we"? This, from someone whose knowledge of physics is clearly next to zero! Rose challenged her to produce any published peer-reviewed evidence for her assertions about quantum physics and of course she could produce none, because there isn't any. This was a prime display of the well-known tendency of quacks to use words borrowed from real science, words that they don't begin to understand, but which may fool the gullible. Having failed on quantum physics, Ms Armitage's next assertion was
“Western medicine is the third biggest killer in the Western World.”
Rose pointed out that in China, only 14% of the population opt for traditional Chinese medicine, all the rest prefer Western medicine.
Vanessa Feltz summed up saying to the homeopath “He's pretty much trounced you on every point”.
“I'm Katherine Armitage, I work as a homeopath from Health Foods, Fulham Road. I use flower essences and homeopathy as my main therapies. I also work as a healer. A lady from up the road was getting very bad hot flushes and last week she came in and I suggested a remedy to her - apis mel - which is honey bee sting in potency. She’s a very busy lady, always rushing around, not very much time for herself and busy like a busy bee flying around. And apis has helped her enormously with her hot flushes”
And if you believe that, you'll truly believe anything.
Katherine Armitage, incidentally is connected with an organisation called innerpotential.org. Their activities are not limited to the usual battiness of homeopathy and acupuncture. They are much more ambitious. Their courses include magic (no, seriously, but don't worry, it's white magic), "tuning the psychic vibration", and the energize"power2 zone and the power2". They'll relieve you of a lot of money for all this. They'll even sell you a “radionic pendulum” (how typical to use a scientific-sounding word like radionic to describe a lump of wood).
This would be laughable if people were not parting with hard-earned money for false promises. It breaks my heart to see people getting rich on this stuff, when my university is full of young people, working very hard, for modest salaries, trying to discover something that is actually true.
Postscript. In a letter to Les Rose, Hammersmith and Fulham Primary Care Trust says
“The PCT has a duty to use public money appropriately and at present homeopathy does not have a clear evidence base to support its effectiveness. We therefore feel it is not appropriate to provide general funding.”
In the course of a long correspondence with the MHRA about their endorsement of a dishonest label for a herbal preparation, arnica gel, I eventually got an admission from them that the stuff doesn't work.
“As you have clearly identified the Directive is far from perfect. The vast majority of herbal products currently on the UK market without claims are of unproven benefit.”
Dr Linda Anderson, B.Pharm., PhD,
Pharmaceutical assessor at the MHRA.
Which herbal medicines have been assessed by the Regulator?
Look for PL or THR on the product labels. Herbal medicines licensed in the UK have a PL (product licence) number on the label.
Traditional herbal medicines registered in the UK have a THR (traditional herbal registration) number on the label. The first registered products under this new scheme are expected to reach the UK market in the coming months.
Both these kinds of medicines are regulated by the MHRA and meet assured standards.
Other herbal medicines on the UK market have not been assessed by the MHRA.
"Both these kinds of medicines are regulated by the MHRA and meet assured standards." would, by most people, be interpreted to mean that the MHRA was providing some sort of asssurance that the stuff worked. It doesn't. This wording is, to my mind, misleading and disgraceful.
One is accustomed to pseudo-scientific nonsense from quacks. Why is it that people who probably can't even differentiate exp(x), much less understand quantum theory, love to spout this nonsense? No doubt, as usual, it is a matter of making money out of the gullible. Surely they don't really think it means something? Normally it isn't even worth comment, but a correspondent has brought to my attention a particularly zany example of the genre..
“It is an approach to bodywork that focuses on the Energetic Body.
The Energetic Body is much more expansive than the physical body, though
the physical body forms its core.
Quantum Shiatsu developed into a system under the influence of Quantum
Physics--in particular, the theory of relativity and quantum mechanics--and
its relevance to human healing. By applying quantum principles to shiatsu,
contact with faster, more expansive energy became possible. This resulted
in the inclusion of chakras as well as meridians into a shiatsu framework.”
The prime exponent of this gobbledygook in the UK seems to be Cliff
Andrew, of Norwich Shiatsu centre (photo on right)
In the USA you can find similar fantasies from Mike Webster, for example, here.
The supply of this sort of stuff is almost endless. Ben Goldacre has drawn my attention to another example that is seriously bonkers. Lynne McTaggart writes pseudo-scientific nonsense using language that sounds vaguely like physics -try here if you can stand it. Do these people really believe that the words they use have any meaning? Or is it all just a callous charade to make money. You'll have to make up your own mind about that.
"Nutritional supplements" are one of the most profitable scams (see, for example, Healthwatch and Quackwatch).
There is a nice article by Lisa Melton on The Antoxidant Myth in tne New Scientist (free version here), Here are some quotations.
Cranberry capsules. Green tea extract. Effervescent vitamin C. Pomegranate concentrate. Beta carotene pills. Selenium. Grape seed extract. High-dose vitamin E. Pine bark extract. Bee spit.
You name it, if it’s an antioxidant, we’ll swallow it. According to some estimates around half of US adults take antioxidant pills daily in the belief that they promote good health and stave off disease.
. . .
In 1992 researchers at the US National Cancer Institute set about testing beta carotene. The trial was set to run for 6 years, but two-thirds of the way through the researchers pulled the plug after discovering, to their surprise and horror, that those taking supplements were doing worse than the controls. They had developed 28 per cent more cases of lung cancer, and their overall death rate was 17 per cent higher.
It’s a similar story with the world’s most popular antioxidant. Vitamin E shot to fame in the early 1990s, after two large studies involving more than 127,000 people in total found that those with a diet high in vitamin E were significantly less likely to suffer cardiovascular disease. Use of vitamin E supplements soared. In 1990, almost nobody took vitamin E; by the end of the decade an estimated 23 million US citizens were knocking back daily doses.
Latest news: these supplements may be worse than useless. They may shorten your life.
Learned Societies speak out against CAM, and the MHRA
The Medicines and Healthcare products Regulatory Agency (MHRA) is an executive agency of the Department of Health). It is roughly the UK equivalent of the Food and Drugs Administration (FDA) in the USA.
The MHRA has just betrayed the trust placed in it by the public by allowing untrue claims to be put on the labels of homeopathis and herbal treatments, apparently under pressure from the government and the Prince of Wales, as described below, and here. The cause such outrage that the MHRA was censured by an annulment debate.in the House of Lords, It also caused condemnations to be issued by the many learned societies, most of which you can read at the links here. For example, Royal Society, the Medical Research Council, the Academy of Medical Sciences, the Royal College of Pathologists, the Biosciences Federation (which represents 40 affiliated societies), the Physiological Society and the British Pharmacological Society.
In contrast, the main medical organisations have kept disgracefully silent. Nothing has been heard from the British Medical Association (I hear that a move to say something was heavily defeated). Nothing either from the Royal College of General Practitioners or from the Royal Society of Medicine.
The Physiological Society 's Newsletter for December 2006 published and excellent leading article 'Homeopathic mumbo-jumbo], by Austin Elliott [read it here].
The Physiological Society
“The Physiological Society is concerned with
the scientific investigation of how the body
works … It is our view that "alternative
medicine" has, with very few exceptions, no
scientific foundation, either empirical or
theoretical. As an extreme example, many
homeopathic medicines contain no
molecules of their ingredient, so they can
have no effect (beyond that of a placebo).
To claim otherwise it would be necessary to
abandon the entire molecular basis of
chemistry. The Society believes that any
claim made for a medicine must be based
on evidence, and that it is a duty of the
regulatory authorities to ensure that this is
done.”
Austin Elliott comments thus.
“And as the web site of the European Council
for Classical Homeopathy (6) puts it: ‘To make
such a claim, the manufacturers need only
show that the product has been used to treat
those particular conditions within the
homeopathic industry.’ No scientific basis. No
clinical trials. No evidence of effectiveness.
The homeopaths, and the companies that
produce over-the-counter homeopathic
remedies, are understandably delighted.
Well, you might say, so what? The placebo
effect is not new, and a fool and his/her money
are soon parted. Most scientists would agree
that the labelling is a joke, but in a world awash
with ridiculous claims, why get worked up?
Well, firstly, perhaps, because the MHRA,
acting on our behalf, is supposed to care –
their web site states they ‘enhance and
safeguard the health of the public by ensuring
that medicines and medical devices work, and
are acceptably safe.’
Secondly, . . . there is a principle at
stake, namely that decisions of this kind should
be made on the basis of scientific and medical
evidence and understanding.”
The debate on "Does Homeopathy Work?" at the Natural History Museum can be
seen as streaming video here. The audience seemed to contain a large number of homeopaths. I
can't imagine how Ben Goldacre kept so calm. He was sweetly reasonable and
tried to explain the nature of evidence to an audience that was clearly not
interested.
The debate started with 30 minutes from Peter Fisher, clinical
director of the Royal London Homeopathic Hospital, and homeopathic physician to the Queen(more on Peter Fisher here and here). His powerpont slides, to
the acute embarrassment of pharmacologists at UCL, all bore the UCLH logo.
We were treated to half an hour of shameless cherry-picking of the evidence.
This puzzles me, because Fisher is a medical doctor, and he (unlike many homeopaths),
is quite sound when it comes to the really dangerous aspects of homeopathy
such as recommending homeopathic malaria prevention, and recommending against
vaccination. That is a lot more than can be said for Melanie
Oxley from
the Society of Homeopaths (who was in the audience): she is a clear danger
to the health of the Nation. Fisher rightly condemns such absurdities. He also
is one of the few homeopaths who has published negative results for homeopathy.
Despite all that, his discussion of the evidence was selective to the point of dishonesty. Somehow,
I doubt that he intended to be dishonest: rather he seems to be in the grip
of such strong delusions that his assessment of the data is seriously distorted.
The champion bit for me was at the end of Peter Fisher's talk (26.5
minutes into the video).
"It's
true, If you take a homeopathic medicine to an analytical chemisr and say
'what's in here?', he'll say it's lactose, water and alcohol. Which is quite
true".
He then went on to say that his gigabyte memory stick would, according to
a chemist would be made almost entirely of
silica with trace impurities of boron and phosphorus. Yet it can hold a lot
of information. "So
this property of simple chemicals storing large amounts of information is
actually commonplace. What actually is so implausible about this? The possibilty
that water actually stores information and then transmits it to the body."
Peter Fisher with his memory stick
These comments betray such a basic misunderstanding of physical chemistry
that I am lost for words. Do these words show a genuine inability to understand
basic physics? Or are they a wilful distortion of physics designed
to add an air of verisimilitude to an otherwise bald and unconvincing narrative?
I confess that I have no idea.
Either way, it's a stunning bit of pseudoscience. . For the real story on the memory of water, see below.
Quack AIDS "cure". The goat serum scam in Swaziland
It is a matter of perennial interest to know how many quacks are genuinely deluded, and how many are cynically in it for the money. Presumably the directors of big companies like Boots the Chemists or Holland and Barrett are in the latter category. One case that is undoubtedly a dishonest scam was unveiled in a very nice bit of investigative journalism by Paul Mason for the BBC2 Newsnight programme, on 1st December 2006.
“ “The trials have now to this date gone through three phases, all of which have proved totally reliable in the cure of Aids” – that is what it said on the business plan.
If the claim were true it would be headline news for the world. Instead the headline news tonight, on Newsnight, is that we have uncovered a scheme by a British company to test a totally unproven “cure” for AIDS on patients in the African kingdom of Swaziland. The “cure” is based on goat serum.
The scheme was proposed by a British-based company called CARD [Commercial African Development Ltd.], run by a man called Michael Hart Jones. He approached film actor Richard E Grant to front the scheme: Richard was born in Swaziland – fortunately he was not born yesterday: he came to us....”
There is not, of course, the slightest reason to think that goat serum cures anything. Newsnight gives some very interesting background on Mr Hart Jones.
“He was in the Rhodesian military and after the fall of Ian Smith ran a private security company for mines all over Africa, employing 300 ex-soldiers. Then he got into financing the brutal military regime of Major Johnny Paul Koroma in Sierra Leone. Read the testimony about him here, at the truth and reconciliation commission website. Then he got involved in the goat serum business.”
The cruel goat serum scam was started by a US doctor called Gary Davis, who claimed (this isn't a joke) that a dream about injecting goats "was a revelation from God that goats can cure HIV." You couldn't make it up if you tried.
The US FDA [Food and Drug Administration] issued a warning about use of goat serum.
Swaziland has about 300 000 people with HIV, but only 15 000 are receiving anti-retroviral drugs.
“Medics in Swaziland told us that to meet the WHO target of 75% they need more money and focus by government and, guess what? A stronger message against traditional medicine and the belief in "miracle cures". ”
This appears to be a major criminal enterprise. You can read here some of the original documents that were unearthed by Newsnight.
My pharmacological curiosity was stirred by a TV advertisement for a spray that, it was claimed, could stop you snoring. It's hardly a life threatening condition, but it can be marriage-threatening. But what's in it, and does it work?
“CLINICAL TRIALS
Many products claim to have undergone tests, but Helps Stop Snoring is the only natural snoring remedy in the UK have undergone to a full, double blind clinical trial, conducted by a practicing Ear, Nose and Throat Consultant Surgeon.
Lasting over 18 months, the trial involved 140 snorers and their partners, and
the results showed a headline success rate of 82%. The trial was conducted by
Andrew Pritchard FRCS, Ear Nose and Throat Consultant at the Royal Shrewsbury
Hospital and one of the UK`s leading specialists in the field of snoring and
sleep disorders.
In a further first for a snore remedy the results of the trial were published in Phytology Research, an international journal, in October 2004.”
This claim was not so easy to check because the manufacturer mis-spells both the name of the author and the name of the journal. The paper in question seems to be this. Prichard AJ., The use of essential oils to prevent snoring Phytother Res. 2004 18(9), 696-9 [get the pdf].
Sadly this paper is not very convincing. The paper does describe the work
as "preliminary", but the manufacturer's web site does not. There's a surprise.
For those who are interested, here are a few details.
140 adult snorers
were recruited to the study via a snoring clinic. Snorers were randomly allocated
to receive a metered dose of "Stop
snoring "gargle, "Stop
snoring " spray
or placebo gargle (there was no placebo spray at all). It isn't obvious
what placebo could mimic the peppermint, lemon, clove, thyme, eucalyptus
and pine oils that the "remedy" contains (among other things). Their concentrations
aren't stated. The paper makes no mention of what was used as placebo, but
Dr Prichard tells me "The content of the placebo could not be an essential
oil. I have been told by the manufacturer that we used a sugar type mix".
Actually it contained water, sodium saccharin, polysorbate 20, potassium sorbate and citric acid. It would be have been obvious tor the patient whether
they got the placebo or not.
"A simple comparison was made between the 14-day
control period and the 14-day period of 'treatment'
either with product or placebo. Statistical analysis was
performed using the Wilcoxon non-parametric test."
The comparison that is made is before and after in each treatment group, rather than comparing the groups.
The eminent statistician, Stephen Senn, has some trenchant criticisms of
this sort of experimental design.
Figure 4. Placebo gargle
Figure 2. "Stop snoring" spray
Senn points out that "Having made the mistake of using
the within treatment group to baseline comparison he ought to then use the
Wilcoxon signed ranks test rather than the rank sum but he doesn't say which".
The results are pretty odd too. In the placebo group, 4 out of 11 patients
show a big reduction in snoring severity (Fig. 4). In the spray group, a smaller
proportion, 5 out of 28 show a big improvement (Fig 2). The changes in the
rest of the patients are mostly very small, but there are more slight improvements
in the spray group than in the placebo group. The percent of patients that "improve" (by
any amount, however small, is therefore bigger in the spray group than control,
but the difference in mean snoring severity was much smaller
Financial interests in the snoring study
Sadly, it is essential to consider vested interests indrug assessment, as
I have noted below (and here,
and here).
Prichard's paper states openly that it was "Sponsored by
Essential Health Products Ltd, 4 Top Farm Barns, Pitchford, Shropshire, SY5
7DW, UK." That
doesn't mean it's wrong, though the bias associated with sponsorship is well
known,
But there is no mention of shareholdings
Companies House will, only £1,
sell you company reports. The records show that Helen Jane Prichard, holds 2000
shares in Essential Health Products Ltd.
Is this just a coincidence of names? I think
not. If you look up. Dr Andrew Prichard in the phone book, you see that his
address is exactly the same as that of Helen Jane Prichard.
Oh dear: looks
like yet another undisclosed financial interest in a clinical study.
Many thanks to the inimitable Ben Goldacre fot the totally over-the-top link to this item: it has done wonders for my hit rate.
Boots the Chemists is selling the same stuff
True to their philosophy of making money and never mind the evidence, the "Boots Alternatives" range of snake oil products has, for £14.99,
exactly the same stuff. They claim the Boots Alternatives Snoring Remedy is "effective in reducing snoring for 4 out of 5 users". The "4 out of 5" was what Essential Health Products told Boots, so it must be based on Figure 2, above.
Enquiries to Boots about this product have not been answered or have been
answered inaccurately. See also below for Boots miseducation
pages. And here's the ironical bit.
Boots web site makes a big point about CSR (Corporate
Social Responsibility). (Thanks to Sean Kehoe for spotting this.)
“TRUST BOOTS
As you may have noticed, that's the tagline which in 2005 we adopted as the sign-off to all our advertising. But it's much more than just a slogan. It's a concise statement of our entire corporate strategy. Our aim is to make Boots the world's best health and beauty retailer, and we're 100% clear that the unique trust in which we are held provides the key to achieving this. Which means, of course, that those two words are also the rationale for all our CSR activities. Everything we do that builds trust is good for our business; anything which could compromise it, a risk we can't afford to take.”
MHRA clobbers the infamous quack, Gillian McKeith.
On Nov 21st 2006, an MHRA
press release made a surprisingly strong statement.
“Dr Gillian McKeith’s organisation has had to detox its own products after MHRA officers discovered it was advertising and selling goods without legal authorisation whilst making medicinal claims about their efficacy. Dr McKeith’s products,
'Fast Formula Wild Pink' for women and 'Fast Formula Horny' for men promised to deliver wonders for all in the bedroom.
The MHRA determined that both products were medicines because of the presence of some well-known medicinal herbs and because of the claims being made by Dr McKeith's organisation. Only licensed medicines may be advertised to the public. ”
Very good, but if the MHRA can do this, how do they manage simultaneously
to rule that it's OK to say that arnica gel "it helps to relieve symptoms including: muscular stiffness,
sprains, bruises etc ", The evidence that that's true is just about as flimsy
as the evidence that McKeith's potions are aphrodisiac.
The MHRA's new policy towards
CAM have already received a well–deserved
drubbing in the House of Lords. Now have the first
example of the MHRA allowing totally misleading labels to be put on over-the-counter treatements.
A press
release dated November 8th 2006 gives the shocking news.
MHRA grants landmark registration for Traditional Herbal Medicine
The Medicines and Healthcare products Regulatory Agency (MHRA) has granted
the first UK product registration under the European Directive on traditional herbal
medicinal products.
.
.
Professor Kent Woods, Chief Executive of the MHRA said:"This first product
registration is an important landmark. We hope that Atrogel Arnica Gel will
be the first of many products to receive a traditional herbal registration.
Our aim is to enable those consumers who wish to take herbal medicines to
make an informed choice from a wide range of products which have been made
to assured standards of safety, quality and patient information."
Atrogel is not yet on the market here but the application is from Bioforce(UK). But presumably it will be something like the Swiss product of Bioforce AG.
What is the evidence that Arnica Gel does the
slightest good for the conditions that will appear on the label? The
answer is essentially
none. There
are only two papers in Medline. The first shows no detectable effect of arnica
gel (compared with vehicle alone) (Alonso D, Lazarus MC, Baumann L., Effects
of topical arnica gel on post-laser treatment bruises. Dermatol Surg. 2002
Aug;28(8):686-8.)
The second paper claims a positive effect, but it is worthless because it was an open trial with no proper controls. (Knuesel O, Weber M, Suter A. Arnica montana gel in osteoarthritis of the knee: an open, multicenter clinical trial. Adv Ther. 2002 Sep-Oct;19(5):209-18.). The last author on this paper, incidentally, gives his address as Bioforce AG.
So yes, the MHRA's press release is indeed a landmark. It is the first time that they have allowed a medicine to be labelled with a therapeutic claim when there is no reason to believe it to be true.
The bottom of the press release says (my emphasis) "The MHRA is the government
agency that is responsible for ensuring that medicines and
medical devices work, . . .".
Uhm, surely some inconsistency
there.
But no, Kent Woods tells me "The strap-line you refer to is a highly simplified statement of our role in making regulatory judgements based on risk/benefit analysis in the real world. "
The bizarre behaviour of the MHRA is based on European
Directive 2004/24/EC.This contains (para 6) the following prime example
of pre-enlightenment thought.
“The long tradition of the medicinal product makes it
possible to reduce the need for clinical trials, in so far
as the efficacy of the medicinal product is plausible on
the basis of long-standing use and experience.
Pre-clinical tests do not seem necessary, where the
medicinal product on the basis of the information on
its traditional use proves not to be harmful in specified
conditions of use.”
Evidently the MHRA have decided to go along with the licence for snake-oil
salesman that this provides. It isn't clear that they were compelled to do
so (MHRA's
response here).
This is what the packet looks like. On the right, one panel is enlarged.
The claim "It helps relieve symptoms including:" is quite outrageous. There
isn't the slightest reason to believe anything of the sort. I know
the bit above that says "based exclusively on long-standing use", but it
certainly won't be obvious to most shoppers that this is meant to imply that
the clear claim that "it helps to relieve symptoms" may be so much nonsense.
Last Friday (3 Nov 06) I went to Oxford to hear Tony Blair talking about science
policy. He's still a plausible an prepossessing speaker, but it was only too
clear that he sees science only as a means of increasing economic prosperity.
I've nothing against that, of course, but he does not seem to have realised
two things that seem obvious to me.
If universities concentrate on applied research for industry, the new ideas that feed the next generation of industry will wither. His view seems to be very short term.
If research is done under contract to industry, and in particular if the experimenter has a financial interest in the outcome of the experiment, then honesty in science (already a bit fragile) will suffer.
A lot of nice things were said about science in his speech, but of course
with an audience of scientists he kept away from contentious areas. Only
a couple of days earlier he had been asked some more awkward questions in an
interview for the New Scientist, published in full here.
In certain areas, we seem to be moving further away from rational
thought, whether it's the rise of fundamentalist religious beliefs or the
use of unproven alternative therapies. Do you see any shift in this direction?
I don't. I think most people today have a rational view about science. My
advice for the scientific community would be, fight the battles you need to
fight. I wouldn't bother fighting a great battle over, say, homeopathy. It's
not going to determine the future of the world.
One subject that is of great concern to scientists is creationism.
There has been a suggestion that creationism is being taught in some British
schools. What are your views on this?
This can be hugely exaggerated. I've visited one of the schools in question
and as far as I'm aware they are teaching the curriculum in a normal way.
This attitude won't do. Vast numbers of people take quack "remedies" and
a
recent
survey found that even among students more than 30% say they believe in
creationism and "intelligent design" (that being the lie used
in an attempt to get religion into US schools). Such beliefs show only too
clearly why "we seem to be moving further away from rational
thought". But Mr Blair can't see it.
The regulations that allow unjustified claims to be made
for homeopathic pills were the subject of an annulment debate in the House
of Lords on 26 October 2006. The regulations were introduced as a statutory instrument.
"Statutory Instruments (SIs) are a form of
legislation which allow the provisions of an Act of
Parliament to be subsequently brought into force
or altered without Parliament having to pass a
new Act."
In other words a minister just decides to do it without any debate or parliamentary approval
"The instrument is laid after making, subject to annulment if a motion to annul (known
as a 'prayer') is passed within 40 days."
The BBC Today programme covered
the event before the debate. Lord (Dick) Taverne put the view of reason and
common sense superbly, against some totally evasive fantasies from Imogen Spencer
of the Society of Homeopaths. He is the author of "The
March of Unreason: Science, Democracy, and the New Fundamentalism").
[Listen to the interview: mp3 file,
5.6 Mb]
Read the debate
The debate can be read in Hansard. In the archaic language of the House.
"Lord Taverne rose to move, That an humble Address be presented to Her Majesty praying that the regulations, laid before the House on 21 July, be annulled (S.I. 2006/1952). [44th Report from the Merits Committee].". Here are a few quotations.
Lord Taverne
“There is one very important, absolutely fundamental objection to this regulation. For the first time in the history of the regulation of medical products, it allows claims of efficacy to be made without scientific evidence. It is an abandonment of science and the evidence-based approach. Under this new regulation, the sole basis on which claims of efficacy can be made for homeopathic products quite legally is “homeopathic provings”. There is no need for clinical or scientific tests.
Homeopathy is not based on science and is not a science in any sense whatever.”
.
Let me read just three of the comments, the first from the British Pharmacological Society. I quote it first because two members of the MHRA, including the chairman, have pharmacological qualifications. The society says:
"The British Pharmacological Society believes that any claim for a medicine must be based on evidence, and that it is the duty of the regulatory authorities, in particular the MHRA, to ensure that no claims can be made for the efficacy of any form of medicine unless there is good evidence that the claim is true. Despite many years of investigation, we have no convincing scientific evidence that homeopathic remedies work any better than placebo".
.
“What it has done is to promote what is in effect the selling of snake oil. This statutory instrument should be withdrawn—it is a disgrace. I beg to move.”
Lord Rees of Ludlow (Martin Rees, President of the Royal Society)
“ My Lords, the Royal Society, of which I have the honour to be president, believes that all complementary and alternative medicines should be subject to careful evaluation of their efficacy and their safety. All treatments so labelled should be properly tested and patients should not receive misleading information.
There are no great concerns about the safety of homeopathic treatments. What is at issue is their effectiveness. Obviously placebo effects can be powerful, nobody denies that. It is, however, quite different to assert that homeopathic treatments offer benefits beyond a placebo. Indeed, if medicines can really work even when so diluted that barely a single molecule is left, this would entail some fundamentally new scientific principle with amazingly broad ramifications. It would mean that materials like water carry imprints of their past and can remember their history, as it were, in some quite novel and mysterious way. If that were the case, it would have fundamental implications for precise experiments over the whole of science.
So it seems to me that the burden of proof on homeopathic remedies should actually be higher, not lower, than for conventional ones. Extraordinary claims demand extraordinary evidence. To put it mildly, so-called “homeopathic provings” seem to fall far short of that. That is why I wholeheartedly support what the noble Lord, Lord Taverne, is saying on this issue.
Excellent speeches were made on the side of reason by Lord Turnberg (ex-professor of medicine and ex-president of the Royal College of Physicians) andLord Jenkin of Roding . (who, as Patrick Jenkin, was a member of Margaret Thatcher's government).
The 30th Countess of Mar
All of this counted for little with the Countess of Mar, a heriditary peer and organic farmer who opposed the annulment. She was, I fear, rather selective with the evidence. She quotes, for example,
“Professor Madeleine Ennis of Queen’s University, Belfast, with a large pan-European research team led by Professor Roberfroid of the Catholic University, Louvain, set out to show that homeopathy and water memory were utter nonsense. This was an exercise conducted with extreme scientific rigour.” . . . “In the end, she had to concede that high dilutions of the active ingredients in homeopathic solutions worked, whether or not the active ingredient was present in the water”
Bits of Lady Mar's speech bear an extraordinary resemblence to an article
written in the
Guardian in 2001, by Lionel Milgrom (maverick chemist and apologist
for homeopathy). I wonder who wrote it for her?
The Noble Countess appears not to have noticed that the first author on both
of Ennis's papers was Philippe Belon. who is a director of
the huge French homeopathic company, Boiron. In fact
the address on the papers is not the University of Belfast (or Louvain), but
it is "Boiron,
20 rue de la Liberation, 69110 Sainte-Foy-Les-Lyon, France."
Boiron makes profits from homeopathy of about 20 miilion 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 below), which lead to Beneveniste's dismissal form INSERM in disgrace. The Countess also seems to have missed the careful refutation of Benveniste's results by 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 Journal299,
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 treament at all, as described below.
This correction was published (Colquhoun, D. (1990). Reanalysis of a clinical
trial of a homoeopathic treatment of fibrositis. Lancet336,
441-442.), though the correction is usually ignored by homeopaths (see below). [Get pdf].
How odd that all Belon's papers seem to favour homeopathy.
Lord Colwyn
(The Rt Hon Lord Colwyn, CBE, a Conservative peer) also supported mumbo jumbo. Don't you love this bit?
“I went on a course about 15 years ago on the relationship between quantum physics and homeopathy. I probably did not understand a word I was told at the time, but at least there was evidence that the two were linked.”
But he shouldn't worry if he didn't understand a word: it was just gobbledygook.
Lord Colwyn finished his speech thus.
“It is interesting to consider why homeopathy, which of all complementary therapies is probably at most variance with orthodox medicine, should have received sufficient support from the Government to be able to maintain a number of specialised hospitals.”
Well, agreed again, it is interesting -in fact it's quite incredible.
What a pity, though, that Lord Colwyn quite forgot to declare his interests. He is vice-president of the Blackie Foundation Trust. This trust was "founded by Dr Margery Blackie in 1971, at that time homoeopathic physician to Her Majesty, the Queen. Dr Blackie saw the need to promote homoeopathic remedies to the wider community and to educate the public about the success of homoeopathy in treating illness.".
He also forgot to mention that he is a patron of the National Federation of Spiritual Healers.
Lord Warner
(Lord Warner of Brockley, Minister of State at the Department of Health) defended quackery on behalf of the government. He says the legislation
"will, for the first time since the PLR scheme in 1971, allow homeopathic products to be marketed with information to the consumer about what they can be used for. This will provide better information to the consumer and reduce the risk of confusion. "
Lord Warner makes no comments about how claims made for efficacy
in the absence of evidence can be called "better information" for the consumer
"We have done much as a Government to support science and research,
and will continue to do so. Homeopathic products are, however, in a different
category. Provided that such products are safe, properly manufactured and
clearly labelled without making false claims, which they will be under the
new national rules scheme, patients should not be denied access to them for
the conditions to which they relate. "
What, one wonders, does "a different category" mean? The magic category? And
since the manufacturers have just been excused from producing any evidence of
efficacy, who is to judge what are "false claims".
Here is some truly sad news. Applications to univerities have declined in number for hard subjects: not only physics and chamistry, but also laguages and history.
But guess what subject showed the largest rise in number of applications? No it wasn't media studies. It was complementary medicine! The BBC report comments
"So all those future graduates, suffering from the stress of big debts and difficult career choices, will in future be able to turn for some much-needed relief to a plentiful supply of aromatherapists, reflexologists and acupuncturists."
Of course this disgraceful state of affairs could not have arisen if it were not for the fact that a few universities are dishonest enough to give "BSc" degrees in subjects that are not, by any stretch of the imagination, science.
DC with Jumoké Fashola on
Radio London. I was preceded by Zhi Gang Sha who did a prolonged plug for
his book (Soul Mind Body Medicine: A Complete Soul Healing System for Optimum
Health and Vitality), and by Teresa Hale of the Hale Clinic (£90 for
an hour of Reiki mumbo jumbo).
Listen to the interview, or download
the mp3 file.
Consumers' Association (CA) has some odd ideas about evidence
The Consumers' Association, publishers of Which? magazine, used to have a rather good reputation for distinguishing truth from fiction. In the case of alternative medicine, though, they have been showing all the credulity of a Daily Mail lifestyle supplement.
Clara McKaye, speaking for the CA, seems to be totally unfamiliar with the (lack of) evidence, despite her impressive sounding title "senior policy researcher in health". Search for her name on the web, and you find that her comments are cited by dozens of crackpot web sites as an endorsement of CAM. And she seems to be under the illusion that chiropracters and osteopaths are "mainstream" medicine. Perhaps she should read some of the stuff on quackwatch, chirobase. and healthwatch.
This sad situation was brought to my attention by a member of the CA. He said
“Their main advice is to take care to go to a qualified expert. So I phoned them to ask how they knew that a qualified homeopathist was better than an unqualified one?”
That is exactly the right question. The CA seem to have fallen hook, line and sinker for the argument that if fraudsters have some initials after their names, then they must be OK. And they don't seem to have noticed that in the CAM business "regulation" usually amounts to little more than government endorsement of dishonest claims.
Wearing magnets in the hope of benefit is one of the best know delusions (see
below). It was therefore a shock when the NHS said it would pay for magnetic
bandages. Using the Freedom of Information Act (FoI) II asked the Prescription
Pricing Authority (PPA), and then the Department of Health (DoH), for documents
that referred to this bizarre decision. Both refused, as related
below.
When the Department of Health refused my FoI request, I asked for an internal review. Nothing happened for months, but on 10th Oct 2006, a parcel of papers arrived.
“Therefore, no firm conclusions can be made on the basis of this study
alone.”
The PPA do not seem to have noticed the endless evidence from other sources
that magnets are boloney (see
below)
And the the PPA do not seem to have noticed that the author of this paper
is the is the Founder, CEO and Medical Director of one of the wackiest alternative
medicine clinics, the Chiron
Clinic (see below).
He will charge you £135
for a consultation for which you'll get magnets and
phony nutrient treatment.
A correspondent has passed on to me a letter from Caroline Flint, Minister of State at the Department of Health. She describes herself as "New Labour [sic] Member of Parliament for the Don Valley constituency in South Yorkshire."
My correspondent describes himself as "a non-scientist member of the general public who has nevertheless become very concerned about the continuing rise of pseudoscience and quackery, particularly its penetration of the government and some institutions who ought to know better.". Join the club! His reaction to this reply was "I am speechless".
The minister offers the opinion that homeopathy works and refers him to the Faculty of Homeopathy, "which has a network of advisors around the country who are pleased to offer advice to members of the public about homeopathic issues". They, of course, will tell him the usual lies. What are Ms Flint's qualifications for offering this appalling advice?. BA Hons in American Literature & History, University of East Anglia, Former local government officer, and Senior researcher/political officer GMB 1991-7.
Ill-informed views like these are certainly consistent with the view that the recent bizarre decision by the MHRA, to allow dishonest labelling of homeopathic products, was taken under instructions from the Department of Health.
O2 AUG 2006
Thank you for your letter of 25 July to Patricia Hewitt enclosing correspondence from your constituent *** about homeopathy on the NHS. I am replying as the Minister responsible for this policy area.
I understand Mr *** is concerned that homeopathic therapy has been made available on the NHS. The Department of Health acknowledges that there are now numerous complementary therapies available in the UK. Some of these therapies have been known to alleviate the symptoms of certain illnesses in cases where orthodox medicine does not seem to have offered a complete solution.
However, it is the responsibility of local NHS organisations to commission healthcare packages for NHS patients, be it complementary or orthodox. Complementary and alternative medicine treatments are clearly attractive to a number of people and so in principle could feature in a range of services offered by local NHS organisations. Primary Care trusts (PCTs) often have specific policies on the extent to which their patients can be given access to complementary medicines and within these policies, it is open to GPs to give access to specific therapies where they consider it is in the interests of the individual patient. The cost-effectiveness, availability and evidence in support of specific therapies are all issues that are taken into account when deciding what treatment to provide.
Mr *** may wish to contact his local PCT and find out what their policies are on complementary therapies including homeopathy. The contact details are:
Kennet and North Wiltshire PCT
Southgate House
Pans Lane
Devizes
SN10 5EQ
Tel: 01380 728 899
Website: www.kennetandwiltspct.nhs.uk/
Mr *** may also wish to contact the Faculty of Homeopathy, which has a network of advisors around the country who are pleased to offer advice to members of the public about homeopathic issues:
Faculty of Homeopathy
15 Clerkenwell Close
London
EC1R 0AA
Tel: 020 7566 7810
Website: www.trusthomeopathy.org
I hope this reply is helpful.
Yours
Caroline Flint
Approved by the Minister's Private Office and signed electronically in her absence.
The MHRA breaks its founding principle: it is an intellectual disgrace
The Medicines and Healthcare products Regulatory Agency (MHRA) (an executive agency of the Department of Health) states that
“We enhance and safeguard the health of the public by ensuring that medicines and medical devices work, and are acceptably safe.”
They have just utterly betrayed the important job with which they
are charged, "ensuring that medicines . . . work", by allowing
homeopathic products to be labelled with indications without requiring
any evidence that the claims are true (they aren't).
The MHRA chief executive,
Professor Kent Woods, should be fired immediately for dereliction of
the duty of the MHRA to protect the public from medicines that don't work.
The MHRA was founded in 2003 by merging the Medicines Control Agency (MCA) and the Medical Devices Agency (MDA). The MCA was created by the UK Medicines Act 1968, in the wake of the thalidomide disaster.
The MHRA have, incredibly, made it legal to advertise things like
this gem from Nelsons
"Nelsons Coldenza is a homeopathic remedy specifically designed to bring fast, effective relief for the symptoms of cold and flu."
"Active [sic] ingredients: 6c homeopathic potency of Gelsemium sempervirens."
"Precautions: Keep out of the reach of children. If symptoms persist or worsen, consult your doctor or homeopath."
Needless to say there isn't the slightest reason to think that these sugar
pills will influence the course of a cold or flu. Thiis is not "information" for
the patient. It is misinformation. It is lies, endorsed by the MHRA. Take
a look at Ben
Goldacre's comments on this.
Who is responsible for this farce?
MHRA staff are listed here. My latest information suggests, though, that the MHRA were acting under instructions from the Department of Health, and the Executive Board failed to resist bad instructions.
The Executive Board
Professor Kent Woods qualified in medicine from Cambridge in 1972, followed by higher clinical training in Birmingham and epidemiological training at Harvard School of Public Health. In 1984 he was appointed Senior Lecturer in Clinical Pharmacology at Leicester University, where he now holds a personal chair in therapeutics.
Professor Sir Alasdair Breckenridge , CBE, was most recently Professor of Clinical Pharmacology at the University of Liverpool. He has been Chair of the Committee on Safety of Medicines (CSM) since 1999, a role which he relinquished when he became chair of the MHRA on its creation in April 2003.
Professor Angus Mackay , OBE, is Mental Health Service Director / Consultant Psychiatrist at the Argyll and Bute Hospital.
Michael Fox has been Chief Executive of the Prince of Wales' Foundation for Integrated Health since 1998.
Shelley Dolan has worked at the Royal Marsden NHS Trust since 1989, now as Nurse Consultant Cancer & Critical Care
Charles Kernahan is Chief executive of the National Kidney Research Fund, the leading organisation supporting research into renal disease in the UK. His career in healthcare products and service provision spans over 25 years, having held the positions of Vice President Marketing EMEA for ConvaTec (a division of Bristol Myers Squibb) and Group Managing Director for Allied Healthcare (UK) Ltd,
Garry Watts is a Chartered Accountant employed as Chief Executive of SSL International plc, an international healthcare company with a turnover of circa £540m,
Lisa Arnold is currently involved on a voluntary basis with RAFT, a medical research charity, both as a Trustee and on a consultancy basis. Prior to that she had more than fourteen years' experience as a senior pharmaceuticals and healthcare marketing analyst in the investment banking sector,
So the group that is responsible for advising on whether or not medicines work consists of one pharmacologist, one psychiatrist, a representative of an organisation devoted to crackpot medicine, a nurse and three accountants/bankers/marketers with strong industry connections.
Perhaps that accounts for their bizarre decision. One can only assume that the one pharmacologist was outvoted. The MHRA now seems to regard its role as promotion of the "homeopathic industry"
The decision of the MHRA to allow indications to appear on the label of sugar pills was not required by European legislation. It was a decision of the MHRA by itself (or perhaps as a result of pressure from ministers?). Their discussion document says (with my comments)
“The industry as a whole will benefit from the opportunity to gain indications for products for which use within the homeopathic tradition can be demonstrated, but cannot currently carry indications.”
[what part of the MHRA's brief says that it is their job to promote any industries?]
“Legislation enabling the products to be labelled with indications is also considered to be of significant benefit to patients.
[how does lying to patients benefit them?]”
“Reviewing the PLRs will provide an opportunity to rectify any cases where products are being marketed with inappropriate indications.”
[and who will decide what indications are 'appropriate' for pills that contain nothing whatsoever?]
The Times Doctors attack natural remedy claims
By Nigel Hawkes and Mark Henderson. They quote
“Professor Kent Woods, chief executive of the MHRA, said: “This is a significant step forward in the way homoeopathic medicines are regulated. Products will have to comply with recognised standards of quality, safety and patient information." ”
Patient misinformation is more like it. There is NO reason to believe the claims that will now appear on labels!
BBC News “Michael Baum, emeritus professor of surgery at University College London said: "This is like licensing a witches' brew as a medicine so long as the bat wings are sterile." ”
Sense about Sciencequotes comments on the MHRA's bizarre behaviour. Here are three examples.
Dr Evan Harris MP, Liberal Democrat Science Spokesman, said:
“It’s wrong that this country’s medicines regulatory arrangements, which need to be scientific and rigorous, are being diluted and polluted by processes which allow ineffective products to be licensed as medicines without having to provide any scientific evidence of effectiveness. There are very tight standards for proper medicines for very good reasons—the need to protect vulnerable consumers from exploitation.”
Professor David Colquhoun, Professor of Pharmacology, University College London
“The new government regulations allow claims to be made that sugar pills can treat illnesses when there isn’t a fragment of reason to believe the claims are true. This is simply government-endorsed lying.”
Professor Edzard Ernst, Professor of Complementary Medicine, University of Exeter
“This makes a mockery out of evidence-based medicine.”
The Department of Health seems to be responsible
On 1 October 2006 I had a reply from the MHRA (from Sue Harris, Assessment
Team Manager, Licensing Division), in response to my question about how the
decision was made.
“The decision to implement the National Rules Scheme was agreed by the Executive Board in response to the ministerial request and not by the Agency Board as the Agency Board does not have executive responsibility. The Chair and non-executive board members were not involved in the decision making process and the final decision was taken by the Minister.
”
This certainly suggests that the MHRA made their bizarre decision on instructions from above (not, perhaps, surprising in view of the Minister of State's views). It does not explain why the MHRA knuckled under and implemented a policy that is in direct contradiction to their mission.
“Drug regulators too seem unequal to their task.”
That was the opinion offered by the editor of the BMJ, Fiona Godlee, in editorial
comment on an problems with suicide by patients on antideoressants, e.g that
by David
Healy. She wrote
"Drug regulators too seem unequal to their task. Critics focus on their close relationship with industry; their lack of transparency; and an emphasis on efficacy over patient safety, which favours industry"
Which? magazine (October 2006, pages 24-25) published an article, Drugs
watchdog fails public, and quotes the MHRA as responding thus.
"our role is not to protect industry interests. We have a responsibility to ensure that regulation is designed to enable rather than hinder the development of new products that would improve health."
Quite right too. But this claim stands in stark contrast with the MHRA's "Explanatory Memornadum", which says this (my emphasis).
"Although the development of national rules by Member States under Directive 2001/83/EC is optional, failing to introduce the scheme would inhibit the expansion of the homeopathic industry by the prevention of the development of new products with indications."
The Royal Society believes that complementary and alternative medicines, like conventional medicines, should be subject to careful evaluation of their effectiveness and safety. It is important that treatments labelled as complementary and alternative medicines are properly tested and that patients do not receive misleading information about the effectiveness of complementary medicine. Furthermore, NHS provision for complementary and alternative medicines, as for conventional medicines, should be confined to treatments that are supported by adequate diagnosis together with evidence of both effectiveness and safety.
Notice the very proper insistence that patents are not deceived about whether the "medicine" works or not. This is in stark contrast to the attitude of the MHRA, which has just endorsed misleading labelling.
Another study of acupuncture that tells us nothing
After the BMJ published a pair of papers about acupuncture. the Daily Express trumpeted "Acupuncture is the best remedy for backpain" albeit with some reservations from me). That isn't surprising in view of the BMJ's press release. The paper attracted a flood of critical comments. In fact the effects seen were tiny, and there was no reason to interpret such effects as there were as meaning anything but 'acupuncture + normal treatment (in a private clinic) has a very slightly better placebo effect than normal treatment alone in an NHS clinic'. So no progress, yet again.
“Prince Charles was unfazed—on the day the Open
Letter was published, he stopped at St Tydfil's Hospital
in South Wales to watch alterative medicine at work. He
accepted a "spiritual" crystal, as if he were Albus Dumbledore,
headmaster of Hogwarts School, accepting the
Philosopher's Stone. Unlike Dumbledore, however,
who only professed witchcraft and wizardry, Prince
Charles called up every form of “integrative therapy”
against Alzheimer's disease (9). One notes that when
Prince Charles and other fans of unproven or disproved
medical practices use terms such as "integrated
therapy" or "alternative medicine", they're following
the lead of creationists who hide under the term
"intelligent design"—these are all convenient slogans
that permit the credulous to con the gullible.”
“Hogwarts is certainly on the move! If the trend
persists, perhaps MIT or Cal Tech will march in step
with the medical schools and offer prizes for integrative
alchemy or alternative engineering. But Dr. Oliver
Wendell Holmes, dean of the Harvard Medical School
before age of Oprah had the last word on homeopathy:
"Some of you will probably be more or less troubled by
that parody of medieval theology which finds its dogma in the
doctrine of homeopathy, its miracle of transubstantiation in
the mystery of its dilutions, its church in the people who have
mistaken their century, and its priests in those who have
mistaken their calling." [Oliver Wendell Holmes, Medical
Essays. The Young Practitioner, [A Valedictory Address delivered to the Graduating
Class of the Bellevue Hospital College, March 2, 1871.] ”
For more delightful writing by Gerald Weissmann, click here.
The South West Kent PCT intends to close the Homeopathic Hospital, in Tunbridge Wells, which treats up to 1,000 patients a year. This will save them £160,000 per year, which will be available for treatments that work.
James Thallon, of the PCT said
"Homeopathy has been around since the 18th Century and has got a large body of very convinced adherents, but in the era of evidence-based medicine it's beginning to struggle a little bit, so I'm afraid that we're reflecting this in our decision."
Let's hope that the inevitable band of deluded objectors don't prevent common sense from prevailing.
“Welcome to the UK's number 1 holistic information web site for accurate, evidenced-based and objective information on orthodox, complementary and alternative cancer therapies. We even cover cancer prevention and possible causes too!”
One of its patrons is that indefatigable campaigner for evidence-free medicine,
Dr Michael Dixon, OBE, NHS Alliance and Vice Chair of Prince of Wales Foundation
for Integrated Health. They even speak approvingly of the notorious Gerson
treatment.
So what are the "evidence-based" treatments touted on their "products of choice" pages? They include
D-Mannose
“Mannose is a prime ingredient and powerful factor in improving both quality and quantity of the immune system. Four Noble [sic] Prizes in 10 years on polysaccharides say something!
”
Chlorella
“The DNA content of 3 per cent total volume and RNA of 0.2 - 0.3 per cent means it is nucleic acid rich - good for both growth and anti-ageing. ”
These are evidence based cancer treatments?! There is plenty of the usual bunkum about "detox" and they'll sell you mobile phone shields too. And don't forget the donations page.
This site is run by Chris Woollams, who was unfortunate enough to have his
daughter, Catherine, die of a brain tumour in 2004. His motives, I believe,
are nothing but good. That makes it all the sadder that he seems to have allowed
himself to become a front for the "supplements" industry. The fact of the
matter is that, despite claims to the contrary, there isn't the slightest reason
to think that Chlorella, Mannose or L-carnitine will do any good. To advocate
them at best may give false hope, and at worst may kill people. Doctors
have been disciplined and even struck off for this sort of thing. The
site shows a good deal of hostility to conventional medicine and the pharmaceutical
industry. And it's true that their behaviour is not always good, as documented,
for example, here and here.
But they are like angels compared with the supplement industry, as recently
documented by Dan Hurley.
In yet another unconstitutional intervention in public policy, the Foundation has announced that it will launch an organisation called Integrated Health Associates (IHA). The announcement starts with a quotation.
“The medical system has been wholly traditional but I think that’s changing. The more scope we have to use different treatments that can help different systems and put them all together- that’s the true basis of integrated medicine. We’re offering the patient a much better model, more choice and a better success rate. Dr Millie Saha, GP”
This is presumably the Millie Saha
who offers Homoeopathy, Spiritual/Faith Healing amd Vibrational Medicine. Well there is a great medical advance.
It isn't clear yet what this organisation will do. Watch this space.
Here's another cracker, from the "homeopathy for everyone" site. It appears under the section labelled, hilariously, 'Scientific Research in Homeopathy'. It is yet another example of a homeopath using words that sound like science in a way that makes no sense whatsoever.
Homeopaths are, of course, desparate to argue that solutes can leave some
sort of 'imprint' in water when there are no longer any molecules of solute
present. There attempts to argue their way out of this, using long words that
they don't understand, leave one, as so often, wondering whether this comes
about as a result of delusion or of an intent to defraud.
My theory
- Homeopathic remedies are made by spallation, a minute coruscation, by means of a nuclear reaction in which many particles are ejected from an atomic nucleus from the crude tincture being hit or shaken and incident particles of sufficiently high energy get transferred and captured into the alcohol or immediate surroundings potentizing the substance or solution.
Carole Franske”
So if you want to split the atom, forget all about the expense of hadron colliders.
Just get a homeopath to give it a good shake.
What is the truth about the 'memory' of water?
The study of the structure of water is an important and fascinating area of
physical chemistry. The strong interactions between water molecules are
what cause water to be a liquid, despite its low molecular weight. As
a result liquid water does indeed have structures, and these structures will
be altered by dissolved molecules, BUT these structures persist for a very
short time only. Because of the rapid thermal motion of the water molecules,
a structure that is formed at one moment will be completely gone a few picoseconds
later. A picosecond is 0.000000000001 seconds. A millionth of a millionth
of a second, That is the length of the 'memory' of water. Your homeopathic
'remedy' has a rather short shelf life.
Recent work suggests that the 'memory' may be even shorter than this, more
like 50 femtoseconds (Cowan et
al.,Nature 434, 199-202, 10 March 2005),Ultrafast
memory loss and energy redistribution in the hydrogen bond network of liquid
H2O. They conclude
“Our results highlight the efficiency of energy redistribution
within the hydrogen-bonded network, and that liquid water
essentially loses the memory of persistent correlations in its
structure within 50 fs.”
Furthermore a specific study of homeopathic 'remedies' with
high sensitivity proton nuclear magnetic resonance spectroscopy has been done
D.J. Annick (2004) (High
sensitivity 1H-NMR spectroscopy of
homeopathic remedies made in water ), The conclusion was as follows.
“No discrete signals suggesting a difference between remedies and controls were seen, via high sensitivity 1H-NMR spectroscopy. The results failed to support a hypothesis that remedies made in water contain long-lived non-dynamic alterations of the H-bonding pattern of the solvent.”
In short, homeopaths' babble about the 'memory of water' is pure rubbish.
The Australasian Society of Clinical Immunology and Allergy (ACAI) has issued a superbly reasoned analysis of about 30 allergy-related tests and treatments that "have been promoted in the absence of any scientific rationale." [Mullins RJ. Unorthodox techniques for the diagnosis and treatment of allergy, asthma and immune disorders.
Among the many scams that are discussed is the infamous Vega
test (as used
in George Lewith's private
clinic). The conclude "Results are not reproducible in blinded studies,
and do not correlate with results from conventional testing." And "
substitution of homeopathic 'vaccines' for those with proven effectiveness has
both individual and public health implications. "
Why the National Center for Complementary and Alternative Medicine (NCCAM) Should Be Defunded
This article by Wallace I. Sampson, M.D. describes clearly what is wrong with NCCAM. This organisation had government funding of $122.7 million in 2006. Since its foundation (as the Office of Alternative Medicine), it has received not much short of a billion dollars ($842 m). What has the US taxpayer had for this money?
“. . 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. NCCAM proposals for 2002 and 2003 promise no
more. Its major accomplishment has been to ensure the positions of medical
school faculty who might become otherwise employed –in more productive
pursuits.”
“NCCAM is ridden with potential and actual conflicts of interest. Ten individuals
account for 20% of NCCAM awards. None of them has produced a definitively
positive or negative report. Most recipients have produced no report at all.
Two individuals originally on the Advisory Council that approves NCCAM policy
were awarded over $4 million and $5 million in repeated awards. ”
“NCCAM recently awarded $15 million to nine medical schools to develop teaching
of these subjects—all by advocates of "CAM." It gave no funds to the five
medical school courses with curricula already developed that teach about
the subject rationally. In other words, NCCAM's research agenda fits its
congressional supporters' ideological vision and finds unproductive ways
to use up its ballooning appropriations. ”
“NCCAM could be dissolved, its functions returned to other NIH centers,
with no loss of knowledge, and an economic gain. Funds could be invested
into studies of how such misadventures into "alternative" medicine can be
avoided, and on studying the warping of human perceptions and beliefs that
led to the present situation. ”
The Independent has a good medical column br Dr Fred Kavalier. The
column has an insert for readers' letters. On 1st August 2006 the 'readers
write' section had this letter "I know homeopathy has taken a bit of a bashing
recently but homeopathic remedies for travel sickness have a long and excellent
reputation for working. The most important ones are cocculus, petroleum and
tabacum.".
Dr Kavalier was appropriately apologetic about this, and published my response
on 15th August.
Readers write
DC, a scientist from London, replies to last week’s homeopath:
“The homeopath from Devon commented last week that ‘homeopathy has taken a bit of a bashing recently’. So it should. Selling pills that contain nothing whatsoever but sugar as medicines isn't just delusional, it's fraud. One of the recommendations for travel sickness was for cocculus. That is a plant that contains the poisonous alkaloid, picrotoxin. Luckily, the label on the bottle is untrue and the pills contain none. Travel sickness is known to be influenced by expectations. That makes it a good candidate for placebo effects. And also good for the income of charlatans.”
The question of where delusion ends and fraud begins is an interesting one. A book by Robert Park of the American Physical Society discusses the question particularly well.
Voodoo Science: the road from foolishness to fraud (Oxford
University Press) is an excellent read. [Amazon].
Robert Park deals with everything from perpetual motion macines to homeopathy.
His thesis is that those who propagate these ideas often start with a
genuine belief that what they say is true. Rejection of the ideas by
sensible people just makes them more determined. Eventually, though,
it probably dawns on many of them that they have made a terrible mistake. At
this point, some recant, but more often they have so much reputation
to defend, and frequently too much income to protect, that they will
continue to propagate their ideas even after they have realised that
they are wrong. That is when foolishness becomes fraud,
I have often wondered how
many middle-aged homeopaths still really believe their own nonsense?
"Alas, to wear the mantle of Galileo it is not enough that
you be persecuted by an unkind establishment; you must also be right." (Robert
Park)
Andrew Wakefield's poor research caused a world-wide scare. And, no doubt,
it caused the deaths of children who were not vaccinated as a result. The role
of money in this saga is a frightening illustration of why money and research
don't mix. The Royal Free Hospital behaved in a pretty shameful way too, when
it distributed videos to journalists to promote bad work, while at the same
time taking out patents on the single vaccine (in June 1997). This, thank heavens,
was before the Royal Free Medical School merged with UCL's in August 1998.
Helios Homeopathic Travellers' kit: the Independent publishes a
correction
On 24th July 2006, the Independent published a feature "The
Ten Best Travel First aid kits". One of these was the Helios
Homeopathy Travellers Kit, price £38.95.
On the following Friday,
they published this correction (slightly shortened).
First-aid kit is no aid
Sir:
On Monday 24th July you featured The Ten Best Travel first aid kits.
One of these was the Helios Homeopathy Travellers'
kit. All the "remedies"
in this kit are in the 30C dilution. They therefore contain no trace of
the substance on the label .You pay £38.95 for a lot of sugar pills. To
get even one molecule you'd have to swallow a sphere with a diameter equal
to the distance from the earth to the sun. That is hard to swallow.
Helios was one of the companies that was pilloried by the Newsnight programme
when their representative recommended homeopathic prevention of malaria. That
was condemned even by some homeopaths as dangerous and irresponsible.
It is quite simple. This medicine contains no medicine. You are
endangering your readers by recommending it.
David Colquhoun PROFESSOR OF PHARMACOLOGY
UNIVERSITY COLLEGE LONDON
LONDON WC1
This page is about dodgy or fraudualent science. That is why it is mostly about things like homeopathy. Sadly, as I have noted above (here and here, and here), bad behaviour is not limited to homeopaths.
“In the early afternoon of Monday, March 6, half a dozen men in suits surrounded Dr. Gleason, a Maryland psychiatrist, at a train station on Long Island and handcuffed him.
Dr. Gleason, 53, was taken aback because he was arrested, and later charged, for doing something that has become common among doctors: promoting a drug for purposes other than those approved by the federal government.
But prosecutors say that Dr. Gleason went too far. At hundreds of speeches and seminars where he was rewarded with generous fees, Dr. Gleason advised other physicians that a powerful drug for narcolepsy could be prescribed for depression and pain relief. In doing so, he conspired with the drug’s manufacturer to recommend it for potentially dangerous uses, the prosecutors claim.
The case has put the spotlight on the murky financial relationships between drug companies and the physicians they use to promote their medicines. Companies cannot directly advertise drugs for purposes not approved by the Food and Drug Administration.”
. . .
“Dr. Gleason acknowledges that he received more than $100,000 last year alone from Jazz Pharmaceuticals, which makes Xyrem, the narcolepsy drug he has promoted.”
Let's hope Dr Gleason gets punished, if matters are as they are reported. One does wonder why no homeopaths have yet been handcuffed for fraudulent promotion of their (non)-drugs. Not yet anyway. Though of course some have been punished.
Another case of undisclosed interests in US psychiatry
“The device begged for some more public analysis. But few if any outside experts knew the data well enough to raise questions. And the scientists who did know the science and the data were all on the company’s payroll.”
And another
The next day. 28th July, the New York Times business section reported on 'free' lunches provided by drug companies in the USA. A few universities have banned them. "It’s an issue of professionalism and integrity, really."
I just stumbled across this organisation. At first sight, its theme of "science, society and sustainability" sounded right up my street. It seems to be predominantly an anti-GM, pro-organic farming, organisation. Although some of their contributors seem to be somewhat paranoid, there is much that I can agree with in what they say about that.
Most of the nutty content seems to be written by the director of the Institute herself. Dr Mae-Wan Ho, who is listed as "Reader in Biology at the Open University" (that's odd -no trace of her on the Open University web site). In fact some doubts have been cast on her biography. Wikipedia says "She is former head of the Bio-Electrodynamics laboratory at the Open University in Milton Keynes after either having been fired for incompetence or resigning because of personal reasons." Whatever the truth in that may be, she clearly doesn't understand homeopathy.
The board of directors of the Institute includes Zac Goldsmith (editor of The Ecologist) and it is advised by some apparently respectable scientists.
It is sad that an organisation with a respectable sounding title like the Institute of Science in Society is being used to propagate some pure pseudo-scientific gobblydegook. Is it any wonder that journalists and the general public get confused?
Lethal advice from homeopaths about malaria prevention
It is often said that, although homeopathy does no good,at least it does no harm. But that is not true if using homeopathy delays diagnosis of serious disease like cancer. It is not true if homeopaths persuade you not to be vaccinated, and as a consequence you get smallpox, mumps, measles, and spread them in the community. And it is not true if you listen to the ill-informed advice that is given by many homeopaths about how to avoid malaria when you visit countries where it is common.
The Newsnight programme on BBC2 TV (13th July 2006) did a marvelous bit of secret filming.
“Newsnight followed up their research with a hidden camera. A researcher went to Nelsons Pharmacy off Oxford Street in London, which claims to be Britain's biggest manufacturer of homeopathic remedies - and that was all they recommended for malaria.
Even when the researcher said she planned to go to Malawi - a high risk area - Nelsons only suggested the addition of garlic, oil of citronella and vitamins rather than a trip to the doctors.
The Nelsons adviser told the researcher that the homeopathic compounds would protect her. "They make it so your energy doesn't have a malaria-shaped hole in it so the malarial mosquitos won't come along and fill that in." ”
This last bit of advice means nothing whatsoever. It is sheer gobblydegook.
It would just be silly if its effects were not so potentially serious.
On the programme, Melanie Oxley,
from the Society of Homeopaths, wriggled uncomfortably when faced with the
evidence (and Simon Singh). She protested that members of her organisation
do not advise against proper malaria prevention, or against vaccination
(and here). Well,
they DO. So much for "professional regulation". You cannot
regulate the delusional. and the attempts of organisations like Oxley's clearly
don't work. Apart from their inability to stop their members giving lethal
advice, the regulators themselves are deluded.
Peter Fisher (see here and here),
from the Royal London Homeopathic Hospital (and here)
said "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 Queen's
homeopathic physician has the sense to acknowledge that homeopathy does not
work for serious conditions, yet persists in his delusion that it works for
milder illnesses.
What the homeopaths recommended
Malaria nosodes 30C
The source material is so diluted that not a single molecule is left.
The medicines therefore contain no medicine. They are nothing but sugar pills.
To sell pills that contain nothing whatsoever and to pretend that they will
protect you against malaria strikes me as nothing short of criminal. In the
EU in 2000, 15
528 cases of malaria were reported to the World Health Organization in
returning travellers. The source material is, incidentally, not stated. One source says it is made from "African swamp water containing impurities, algae and plants as well as mosquito slough, larvae and eggs." Luckily there is none of it left in the pill you get.
China China Off is made from Cinchona bark which should contain quinine (how much is not stated. China Sulph is made from quinine itself (presumably purified, it is not stated). Quinine in large (potentially toxic) doses can cure malaria but is not a recommended treatment. But these preparations contain only minute amounts of quinine that cannot possibly have any effect at all.
There is not the slightest reason to think that these pills could protect you against malaria, and to recommend them for that purpose is no more than fraud. The only recommended use for quinine is for treatment iof malaria in pregnant women. The dose is 600 mg, three times a day. because of the inadequate labelling it is impossible to know exactly how much quinine is present in China Sulph 8X,, but it is probably about 100 millionth of the recommended dose.(less than 1 nanogram)
The consequences.
"The fourth case was a 26-year-old man who visited Ghana and Burkina Faso in
October and November 1994. He used China D-6 for prophylaxis. This is a homeopathic
preparation of the bark from the cinchona tree. Not even trace amounts of quinine
were found in the tablets with a very sensitive high-performance liquid chromatographic
method.2 Four days after returning from Africa he fell ill with P. falciparum
malaria " (Quotation from Carlsson
et al. J
Travel Med. 1996 Mar 1;3(1):62. (PMID: 9815426)
In another
case of a patient who resorted to homeopathy "for two months she received
intensive care for multiple organ system failure due to P falciparum .This case
confirms the inefficacy of homoeopathic drugs for malaria prevention and treatment.
"
Natrum Mur.
Natrum Muriaticum is sodium chloride. Just common salt (except that it is so
dilute that there is little or no salt there). If you believe this will prevent
malaria, you will truly believe anything. Yet it is being recommended and sold.
What the papers say about it
"Malaria risk for tourists who trust
alternative practitioners". A long report by Mark Henderson, in The
Times.
“Homoeopathy: voodoo on the NHS” by Jamie White in The Times on the next day (July 15th)
“It is outrageous that the NHS should knowingly promote this quackery. And it is knowing. The NHS Direct website points out that homoeopathy is contrary to everything we know about chemistry and medicine, and that there is no experimental evidence to support its preposterous claims. Yet the NHS still promotes it, because "despite the lack of clinical evidence, homoeopathy remains one of the most popular complementary therapies in the UK".”
"Homeopaths 'endangering lives' by offering malaria remedies" in The
Guardian
"Do not rely on homeopathy to protect against malaria, doctors warn". Excellent
health advice (for a change) in the Daily
Mail. They quote Dr Evan Harris (Lib Dem) of the all-party parliamentary
malaria group, as saying
“This sort of outrageous quackery is unacceptable. Vulnerable
people are being duped into handing over cash for useless remedies and are
having their health put at risk through grossly inadequate advice. People need
to consider homeopathy in the same way as the treat faith-healing and witchcraft
- that is not to risk their life or health on it.”
Talk show interview, DC with Tania Shillam on Colourful
Radio ("Colourful is a new national digital Talk, cross-cultural radio station. Launched on 30 May 2006, the station’s format is a rich mix of news, current affairs and journalism, agenda-setting coverage, short documentaries, drama, panel discussions, phone-ins and a liberal sprinkling of music"). Listen to it.
Centre for Complementary and Integrated Medicine: economical with the truth?
Some interesting emails have come into my possession recently. They concern the Centre for Complementary and Integrated Medicine, which gives its address as Harley House, Brunswick Place (Formerly Upper Harley St.), London NW1 4PR (don't you just love "formerly Upper Harley Street"?).
This centre lists its doctors as Dr Nick Avery, Dr Mike Clark and Professor George Lewith.
Their web site claims "There are several approaches that we use in complementary medicine that may be of help to people with fibromyalgia. There is at least one positive clinical trial that indicates that homeopathy can help this condition."
An enquiry was sent to the clinic, as follows.
My GP diagnosed my pain as fibromyalgia
almost 2 years ago, but I have not had much relief from the treatment I've
had so far. I have never tried alternative treatments, but I have looked at
your web site and I see that you say "There
is at least one positive clinical trial that indicates that homeopathy can
help this condition". I wonder if you could give me some more details about
that before I commit myself to trying it?
After some delay, a polite response came from Dr Avery.
We treat an enormous number of patients with fibromyalgia and there are
many things that can help. In practise we tend to use combinations of
diet,
nutrition, homeopathy and acupuncture.
In my experience fibromyalgia patients are almost all suffering from
magnesium deficiency which, once corrected, can have an enormous impact
on
symptoms. If this is not corrected, then conventional treatment cannot
help.
Homeopathy seems to be a fundamental part of treating the (whole
person) and
it is the combination that seems to be so helpful.
If you would like to come and see me then please ring my receptionists
But no mention there of a trial. A second enquiry gave a fascinating
result.
I am forwarding you the information you requested about the clinical
trial
for homeopathy used in helping with Fibromyalgia. I will pass Dr.
Lewith's
reply to Dr. Avery who will be able to write to you with more detail
when
he's at the clinic this Thursday.
Best wishes
Catherine (Reception)
----- Original Message -----
From: "Lewith G." < gl3@soton.ac.uk >
To: "CCIM" < harley@complemed.co.uk >; < nickavery@tiscali.co.uk >
Sent: Friday, May 26, 2006 10:50 PM
Subject: RE: Message from Dr Avery
Its a BMJ paper in the late 1980's by Peter Fisher. He used Rhus Tox 6C
and it was a small positive trial.
He will have it. G
This paper must be the one that I was asked to check by the producer of a television programme (QED),
(Fisher, P., Greenwood, A., Huskisson, E. C., Turner, P., & Belon, P. (1989).
Effect of homoeopathic treatment on fibrositis (primary fibromyalgia) British
Medical Journal299, 365-366.).
But surely some mistake here? The problems with this paper have
already been described
above. Fisher et
al. had made a naive mistake in their
statistical analysis, and in fact
the homeopathic treatment had no demonstrable effect whatsoever, a result that
was published soon after in the Lancet: Colquhoun, D. (1990), Reanalysis
of a clinical trial of a homoeopathic treatment of fibrositis. Lancet336,
441-442.). [Get pdf]
So why does Professor Lewith cite the Fisher paper without mentioning
that it provides no evidence at all? Professor Lewith says that he
was unaware of this history. That does seem odd for someone who is devoted
to assessment of CAM (all you have to do is search for 'fibromyalgia and homeopathy' in Medline). Very
baffling.
Despite these puzzles, when I showed a draft for this site to Prof Lewith
he said "Nick [Avery] and I have thought very carefully about the responses and we are
very happy with them".
There are now more papers on the treatment of fibromyalgia, as Prof
Lewith has pointed out to me. They are all from the University
of Arizona, and all appear to refer to the same set of patients. One
of these suggests that homeopathic treatment is effective (Bell IR; Lewis
DA; Brooks AJ; Schwartz GE; Lewis SE; Walsh BT; Baldwin CM, Improved
clinical status in fibromyalgia patients treated with individualized
homeopathic remedies versus placebo. Rheumatology. 2004; 43:
577-582).
But a second paper about the same patients seems much less sure. The
trial was organised as an 'optional crossover trial', and there was no
significant difference between the proportion of patients who opted to
swap treatments between those who were initially on placebo and those
who were initially on homeopathy. Evidently they couldn't tell the difference!
(Bell et al., 2004, J. Alt Comp Med, 10, 269 383).
Both of these papers, incidentally, have as a co-author the famous (or
perhaps infamous) Gary
Schwartz, of the "Centre
for Frontier Medicine in Biofield Science", which is, believe it or not,
part of the University of Arizona, and which, even more incredibly, gets
NIH funding. He "photographs" non-existent "energy
fields" and
claims to be able to communicate with the dead (critique
here). Well
I guess the immortality is an even better seller than homeopathy. The
picture on the right is what the "Biofield science" centre uses
on its web site.
The AMI test and the Vega test
Dr Avery also sent "our information leaflet on Fibromyalgia". This document was rather interesting.
We find that a lot of patients with this condition suffer from food intolerance, which can be identified and treated. . . .
Other measurements using the “AMI” which measures imbalances in the body can also indicate the whereabouts of the most significant internal dysfunction.
Dietary and nutritional approaches can be enhanced by using acupuncture, classical and, in particular, complex homeopathy. Remedies can be identified using the Vega test, which measures energetic imbalances in the body, helping the practitioner to target the most appropriate areas in each individual patient.
The Vega test and the AMI machine
What are these tests? The Vega test is one of the older con tricks. Dr
Avery seems to be misinformed. The Vega test
does not measure "energetic imbalances" (whatever that means),
it measures skin conductance. So it resembles the infamous lie detector
(perhaps it should be tried on its advocates). It
has been the subject of several legal actions (listed
here, by the Quackwatch site). Here are three of many examples.
In 1985, the FDA notified a distributor that Vegatest devices could not be marketed as a medical devices without FDA approval (which they do not have).
In 1990, the New Zealand Medical Journal described how a homeopathic physician had used a Vega device to diagnose allergies in three infants. In each case, the device was applied to the mother with the child on the mother's lap or roaming about the examining room. The doctor also diagnosed "miasms," which, if not removed, would prove fatal later in life. The Medical Practitioners Disciplinary Committee ordered that he be censured, pay a penalty of NZ$900 plus NZ$25,000 for costs and expenses, and follow certain standards of care for three years
In 2002, the British Advertising Standards Agency concluded that a leaflet offering Vega testing as a "complete test for hidden problems" was misleading and advised the advertiser to withdraw it .
“We sent Inside Out’s Chris Packham to three Holland and Barrett stores across the South to find out more.
Chris took the Vega test in Newbury, Chichester and Farnborough, only to discover that his allergy results differed from store to store.
In total, Chris was sensitive to over 33 different foods, including staples like wheat, potatoes, milk, tomatoes, tea and coffee. But out of the 33 products, there was only two that all three testers agreed on - cheese and chocolate.
Chris was also advised by Holland and Barrett staff to take a total of 20 different vitamins and minerals. But again, the testers can’t seem to agree and all three testers advised different supplements.
It seems your allergies may not be determined by food alone, but also your location.
”
Professor Lewith told me, when I asked about the Vega test,
"I use it to help with homeopathic diagnoses, your next question of course
is why on earth would you want to make an irrational diagnosis about a completely
irrational subject."
Yes, indeed it is! But that question has not been answered.
To make matters still odder, Professor Lewith has
himself published a paper showing that the Vega test does not work. Why,
then, does he use it in his private clinic? The paper in question is in British Medical Journal, 2001;322:131-4. It concludes "Electrodermal testing cannot be used to diagnose environmental allergies."
Despite his own conclusion in the BMJ, the homeopathy page of the Rosedale
Clinic concludes
The Vega offers one of the most exciting advances in modern medicine to appear in recent years, an accurate method of non-invasive deep physiological investigation
I would like to dedicate this section to Dr's LEWITH, KENYON and SCHIMMEL for their tuition and helpful guidance with the Vega technique.
Wow!
The AMI
machine is much less well-known. It presumably refers to "Apparatus
for Measuring the Functions Of the Meridians and Corresponding Internal Organ".
Again it is said the the mysterious and undefined "imbalances". The most
likely interpretation seems to be that it just another galvanometer.
For a sane description of bizarre 'allergy tests', look
here.
I have always thought that our undergraduates had difficulty in expressing themselves clearly, in simple words. But they are models of clear thought compared with Christine Barry's recent paper (Social Science and Medicine, 62, 2464-2657, 2006).
Barry's work rivals Alan Sokal's famous spoof paper, "Transgressing the boundaries: the Hermeneutics of quantum gravity". Sokal's paper opens as follows.
“There are many natural scientists, and especially physicists, who continue
to reject the notion that the disciplines concerned with social and cultural
criticism can have anything to contribute, except perhaps peripherally, to their
research. Still less are they receptive to the idea that the very foundations
of their worldview must be revised or rebuilt in the light of such criticism.
Rather, they cling to the dogma imposed by the long post-Enlightenment hegemony
over the Western intellectual outlook, which can be summarized briefly as follows:
that there exists an external world, whose properties are independent of any
individual human being and indeed of humanity as a whole; that these properties
are encoded in "eternal" physical laws; and that human beings can obtain reliable,
albeit imperfect and tentative, knowledge of these laws by hewing to the "objective"
procedures and epistemological strictures prescribed by the (so-called) scientific
method.”
Compare this with the opening of Barry's paper.
“Calls for ‘gold standard’ randomised controlled trial evidence, by both biomedical
and political establishments, to legitimise the integration of alternative medicine into healthcare systems, can be interpreted
as deeply political. In this paper, the supposed objectivity of scientific, biomedical forms of evidence is questioned through
an illumination of the multiple rhetorics embedded in the evidence-based medicine phenomenon, both within biomedicine
itself and in calls for its use to evaluate alternative therapeutic systems.”
and, later,
“I wish to problematise the call from within
biomedicine for more evidence of alternative medicine's
effectiveness via the medium of the randomised
clinical trial (RCT).”
“Ethnographic research in alternative medicine is
coming to be used politically as a challenge to the
hegemony of a scientific biomedical construction of
evidence.”
“The science of biomedicine was perceived as old fashioned
and rejected in favour of the quantum
and chaos theories of modern physics.”
“In this paper, I have deconstructed the powerful
notion of evidence within biomedicine, . . .”
Just one difference, though, Sokal's paper was a spoof, which briiliantly
exploded the pretentious nonsense of post-modernism. Barry's paper, is, I
very much fear, intended to be serious.
To make matters worse, this work
was funded by the Department of Health.
Sokal's story is told in his devastating book, "Intellectual Impostures".
Strongly recommended, if you want to retain your sanity. [Link to Amazon].
Here
is a quotation from the book, concerning Jacques-Marie-Émile Lacan
(1901 – 1981),
a French psychoanalyst and psychiatrist.
In it the square root of -1 is related
to erectile function in a piece of gobbledygook which shows an understanding
of mathematics about as profound as Barry's understanding of "the quantum
and chaos theories of modern physics".
[Jouissance = enjoyment; the word appears in French in the translations.]
Pseudoscience and Postmodernism: Antagonists or Fellow-Travelers?
This an essay by Alan Sokal, published in Archaeological Fantasies: How Pseudoarchaeology Misrepresents the Past and Misleads the Public, edited by Garrett G. Fagan (Routledge, 2006), pp. 286-361. It is available on-line.
This is a wonderful essay. It could hardly be more relevant to the Barry paper. It explains why so much of the philosophy science has moved so far in a relativist direction that it has become barely distinguishable from CAM and astrology, apart from the more pretentious language of the former. Little wonder that it is almost entirely ignored by scientists.
Here are some quotations.
Introduction
“In this essay I propose to investigate the paradoxical relation
between two broad categories of thought:
pseudoscience and postmodernism
(both will be defined more precisely in a moment).
At first glance, pseudoscience and postmodernism
would appear to be opposites: pseudoscience is characterized by extreme credulity,
while postmodernism is characterized by extreme skepticism.
More specifically, adherents of pseudoscience
believe in theories or phenomena that mainstream science
considers thoroughly unsupported by evidence (at best) or even preposterous, rejects as utterly implausible,
while adherents of postmodernism withhold belief in theories that mainstream science
considers to be established beyond any reasonable doubt.
Or rather, postmodernists profess to withhold such belief.
Whether they actually do so in practice — for example,
when they are seriously ill and must decide which type of
medicine to follow — is a different question.”
And yet, I will argue, there is, at least in some instances,
a curious convergence between pseudoscience and postmodernism.”
Part of conclusions
I am indeed mildly disconcerted by a society in which
50% of the adult populace believes in extrasensory perception,
42% in haunted houses, 41% in possession by the devil,
36% in telepathy, 32% in clairvoyance, 28% in astrology,
15% in channeling, and 45% in the literal truth of the
creation story of Genesis. But I am far more profoundly worried
by a society in which 21-32% believe that the Iraqi government
under Saddam Hussein was directly involved in the attacks of
September 11, 2001, 43-52% think that U.S. troops in Iraq
have found clear evidence that Saddam Hussein was working closely
with al-Qaeda, and 15-34% think that U.S. troops have found
Iraqi weapons of mass destruction. And if I am concerned about
public belief in clairvoyance and the like, it is largely because of
my suspicion that credulity in minor matters prepares the mind
for credulity in matters of greater import -- and, conversely,
that the kind of critical thinking useful for distinguishing
science from pseudoscience might also be of some use in
distinguishing truths in affairs of state from lies.
The degree of validity (if any) of this conjecture is an
empirical question, which merits careful investigation by
psychologists, sociologists and educational researchers.
And finally
For a bit of fun, try the post-modern essay generator.
Click the link at the bottom to generate a new essay in a moment. If you are worried about your RAE rating you could always try submitting one to a journal.
“Deconstructing the evidence-based
discourse in health sciences: truth,
power and fascism”
Unbelievably, this prime piece of postmodernist bollocks is even worse than Barry's paper!
Download (if you can bear it) the full paper here (if you can bear it). Dave Holmes RN PhD, Stuart J Murray PhD, Amélie Perron RN PhD(cand) and Geneviève Rail PhD, Int J Evid Based Health 2006; 4: 180–186.
The authors of this paper are from Department of English, Ryerson University Toronto, Ontario, Canada, and Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa. Ryerson University is an ex-polytechnic which became a university in 1971. It runs courses in Traditional Chinese Medicine (but, at least, no homeopathy). In Canada, as here, it seems that such institutions are the first to damage their new reputations by encouraging gobbledygook like this. Stuart J. Murray lists his interests as “phenomenology, Foucault, bioethics,
biopolitics, and psychoanalysis. Currently researching a project on
posthuman "life" in digital and mediatized contexts.” In his contribution to the McLuhan International Festival of the Future he says (apropos of McLuhan) “We will be frustrated if we look here for a firm, communicable content.” Well that's very true.
Abstract
Background “Drawing on the work of the late French philosophers Deleuze and
Guattari, the objective of this paper is to demonstrate that the evidence-based movement
in the health sciences is outrageously exclusionary and dangerously normative with regards
to scientific knowledge. As such, we assert that the evidence-based movement in health
sciences constitutes a good example of microfascism at play in the contemporary scientific
arena.
Objective The philosophical work of Deleuze and Guattari proves to be useful in showing
how health sciences are colonised (territorialised) by an all-encompassing scientific research
paradigm – that of post-positivism – but also and foremost in showing the process by
which a dominant ideology comes to exclude alternative forms of knowledge, therefore
acting as a fascist structure.
Conclusion The Cochrane Group, among others, has created a hierarchy that has been
endorsed by many academic institutions, and that serves to (re)produce the exclusion of
certain forms of research. Because 'regimes of truth' such as the evidence-based movement
currently enjoy a privileged status, scholars have not only a scientific duty, but also an
ethical obligation to deconstruct these regimes of power.”
.
.
“Unfortunately, the nature of this
scientific fascism makes it attractive to all of us – the subjected.
In Foucault’s words:
the major enemy, the strategic adversary is fascism. . . . And not
only historical fascism, the fascism of Hitler and Mussolini – which
was able to mobilize and use the desire of the masses so effectively
– but also the fascism in us all, in our heads and in our
everyday behavior, the fascism that causes us to love power, to
desire the very thing that dominates and exploits us. (p. xiii)
Fascism does not originate solely from the outside; it is
a will within us to desire, although often unwittingly, a life
of domination. Such a ‘lovable’ fascism requires little more
than the promise of success (grants, publications, awards,
recognition, etc.) within its system to get us to participate
wholeheartedly. Perhaps it is time to think about governing
structures that impose their imperatives (academic, scientific,
political, economic) on academics and researchers, and
to ask ourselves what drives us to love fascist and exclusionary
structures.
The Cochrane Group has created a hierarchy that has
been endorsed by many academic institutions, and that
serves to (re)produce the exclusion of certain forms of
knowledge production. Because EBM, as a ‘regime of truth’,
currently enjoys a privileged status, there exists a scientific
and ethical obligation to deconstruct such regime. Given the
privileged relation to knowledge defining the intellectual
mission, intellectuals are well located to deconstruct the
‘truth’ and to ‘speak truth to power’, to use Foucault’s
expression. Unfortunately, most would prefer not to hear
alternative, marginalised discourses because the latter tend
to expose the very power relations that create our current
situation and prop up those academics/scientists with a
vested interest in the status quo. However, we believe that
one of the roles of the intellectual is to decolonise, to deterritorialise
the vast field of health sciences as it is currently
mapped out by the EBM.”
.
. Final remarks
“Critical intellectuals should work towards the creation of a
space of freedom (of thought), and as such, they constitute
a concrete threat to the current scientific order in EBHS and
the health sciences as a whole. It is fair to assert that the
critical intellectuals are at 'war' with those who have no
regards other than for an evidence-based logic. The war
metaphor speaks to the 'critical and theoretical revolt'
that is needed to disrupt and resist the fascist order of scientific
knowledge development.”
“The profound significance of S & B's [Sokal and Bricmont's] wonderfully written, deeply passionate and authentically erudite book, is that, by shining real light on the fake jewellery of the leading postmodernist theorists, it has shown what has happened to academic humanities over the last thirty years under the influence of individuals like Kristeva for whom intellectual legerdemain has become a way of life.”
“Academics intending to continue as postmodern theorists in the interdisciplinary humanities after S&B should first read Intellectual Impostures and ask themselves whether adding to the quantity of confusion and untruth in the world is a good use of the gift of life or an ethical way to earn a living. After S & B, they may feel less comfortable with the glamorous life that can be forged in the wake of the founding charlatans of postmodern Theory. Alternatively, they might follow my friend Roger into estate agency -- though they should check out in advance that they are up to the moral rigours of such a profession. ”
And it seems that some people still haven't noticed. But then the abuse of scientific language by people who don't understand it (or whose intent is to deceive) has been the mainstay of quackery for several hundred years. Plus ça change.
What can one say in the face of such gross betrayal of everything we have learned since the enlightenment? I suppose one simple explanation that its paranoid style, and its imagined conspiracies are all a manifestation of a giant chip on the shoulder from people who feel that their genius has not been recognised appropriately by those who fund research. But that is a matter for psychiatrists, not me.
Ben Goldacre, who first drew my attention to this paper,
comments on his Badscience site,
and has now written about it in his regular column in the Guardian.
“Even from looking at the title, you just know this academic paper from the September edition of the International Journal of Evidence-based Healthcare is going to be an absolute corker. And it uses the word "fascist" (or elaborate derivatives) 28 times in six pages, . . . ”
Can you tell the difference between homeopaths and witch doctors?
The answer is: witch doctors are not publicly funded within the NHS. Not so far, anyway
Dominic Lawson, The Independent, 26 May 2006 gave support to the letter (though I get very uncomfortable when I get branded as part of the establishment). [Get whole article]
“Hence homeopaths believe - they really do -that the most effective remedy is one in which there is no longer a single molecule of the active ingredient in the water. However - please bear with me - the water has "a memory" of the active ingredient, and it is this which will cure the sufferer.
As the Australian Council Against Health Fraud remarks: "Strangely, the water offered as treatment does not remember the bladders it has been stored in, or the chemicals that may have come into contact with its molecules, or the other contents of the sewers it may have been in, or the cosmic radiation which has blasted through it." I suppose you might say that the medicinal water of the homeopath has a selective memory.”
This is a topic that I have kept well away from, because I have an obvious vested interest: "no pipe, no algebra". But the topic does make an interesting example of the effect of political correctness on people who are otherwise impeccable in there attitude to evidence. Tim Luckhurst writes about this in The Independent (2 May, 2006).
“On Desert Island Discs in 2001, Sir Richard Doll, the man who proved the incontrovertible causal link between active smoking and lung cancer, said: "The effect of other people smoking in my presence is so small it doesn't worry me."
He was right not to fret. One of the largest studies of the health consequences of secondary smoking was published in the British Medical Journal in 2003. It tracked the health of 118,000 Californians over four decades in a rigorous attempt to identify a causal relationship between environmental tobacco smoke (the scientific term for secondary smoke) and premature death. It concluded: "The results do not support a causal relationship between ETS and tobacco-related mortality." ”
The paper in question is 'Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98', James E Enstrom and Geoffrey C Kabat 2003, BMJ, 326, 1057. The publication was followed by a torrent of abuse, more reminiscent of religious zealotry than of science. The responses have been analysed in an article in Public Understanding of Science (2005, 14, 5–23) by Ungar and Bray, 'Silencing science: partisanship and the career of a publication disputing the dangers of secondhand
smoke' [download pdf].
I don't know what the final answer will be about the risks of passive smoking, but as a pharmacologist, the higher levels of damage reported seem barely credible, bearing in mind that
“Reputable research shows that a non-smoker inhales between a 500th and 1,000th of the toxins inhaled by the smoker himself.”
It does seem that it is not only big drug companies, and deluded homeopaths, who are happy to distort evidence for their own purposes. Well-meaning zealots can do it too. That is just as scary.
“Isambard Kingdom Brunel's 40-a-day cigar habit is held responsible for some of the greatest triumphs of British engineering. Unfortunately, it also represents an upturned middle finger towards the politically-correct mandarins of modern academia. With this in mind, Brunel University has removed the famous stoogie from a new, life-size statue of the eminent Victorian. The bronze is based on the National Portrait Gallery's iconic photograph of Brunel standing next to the launching chains of his ship, the SS Great Eastern, in 1857. It was unveiled last week, revealing a close likeness, but - to the annoyance of Brunel fans, historians and the smoking lobby alike - no cigar.” The
Independent, 18th July 2006.
This is the title of a piece by Francis Wheen in the London Evening Standard, 16 May 2006
“Prince Charles
travels to Geneva next
week to deliver the keynote speech
at the annual assembly of the World Health Organisation.
Some mistake, surely?”
“The WHO describes Charles as
the president of the Prince's Foundation
for Integrated Health and
"patron of a number of health charities".
It omits to add that his views
on medicine are barmy - and pernicious.
”
“WHO delegates from 192 nations
have plenty to discuss during their
five-day meeting - HIV/Aids,
sickle-cell anaemia, preparations
for a flu pandemic, the eradication
of polio and smallpox. Why waste
precious time listening to the heir to
the British throne, who has spent
more than 20 years displaying his
ignorance of medical science?”
“The prince has never met a snake oil
vendor he didn't like. A couple of
years ago he urged doctors to prescribe
coffee enemas to cancer
patients, a suggestion which provoked
this rebuke from Professor
Michael Baum of University College
London: "The power of my authority
comes with a knowledge built on
40 years of study and 25 years of
active involvement in cancer research. Your power and authority
rest on an accident of birth." ”
“Homeopathy is most often used to treat
chronic conditions such as asthma;
eczema; arthritis; fatigue disorders like ME;
headache and migraine; menstrual and
menopausal problems; irritable bowel
syndrome; Crohn’s disease; allergies;
repeated ear, nose, throat and chest infections or urine infections; depression
and anxiety.”
but says nothing at all about whether or not they work. That is just irresponsible. And
to describe pills that contain no trace of the substance on the label as ''very
diluted" is plain dishonest .
Both the House of Lords report on Complementary and Alternative Medicine, and the Government's response to it, state clearly “. . . we recommend that three important questions should be addressed in the following order:”. (1) does the treatment offer therapeutic benefits greater than placebo? (2) the treatment safe? (3) how does it compare, in medical outcome and cost-effectiveness, with other forms of treatment? These recommendations seem admirable, but they have not been followed. The money has gone, almost (if not completely) to projects that address the second and third questions, before it has been established that the treatments have anything other than a placebo effect. This interesting case is debated in Debate: UK government funds CAM research (Focus on Alternative and Complementary Therapies , 8, 397-401 (DC's bit, pp 400-401)).
[Get PDF of whole debate]
Both the House of Lords report and the Government response to it, state clearly "... we recommend that three important questions should be addressed in the following order: . . .
(1) does the treatment offer therapeutic benefits greater than placebo?
(2) is the treatment safe?
(3) how does it compare, in medical outcome and cost-effectiveness, with other forms of treatment?
These aims seem admirable, but to what extent do the projects that have been funded match these recommendations?
The answer, sad to say, is that they do not seem to follow the recommended order of priorities at all.
None of the studies in the first initiative (Tovey, Corner and Shaw) appears to address the question that the recommendations specify should be done first. With the possible exception of White, none of those in the second phase (Shaw, Barry, Weatherley-}ones, White and MacPherson) do. (Dr White, like most other recipients, has declined to provide any information about his project so it is impossible to be sure.) None really addresses ,the second priority directly. The third recommendation is worded much more vaguely than the first two, but it is
only this third aim, the one that was meant to be done last, that might be furthered by most of these studies.
The rationalisation given by some of the applicants for uncontrolled, or 'pragmatic' trials is that they are conducted under real clinical conditions and tell you what the patient actually thinks. It is quite true that, from the point of view of the patient, it does not matter in the least whether they feel better because of a placebo effect or because of a specific effect of the treatment. That is an important consideration but it is not the only one.
If the first priority had been addressed first (which it has not) it is quite possible that the outcome could be that the entire effect could be a placebo effect. Such a possibility has been envisaged by no less a luminary of the CAM world than Peter Fisher (ref 1). If that were to turn out to be the case it might matter little to the patient but it would matter a great deal to universities, which are under continual pressure from CAM people to run degree courses (though only a few have acquiesced).
If the whole effect were placebo, it follows that the 'principles' of homoeopathy, reflexology, etc. are mere mambo jumbo and so not appropriate for teaching in universities (or, indeed, anywhere else). The question of courses and 'training' cannot be considered until the first question is answered because, until then, we do not know if there is anything real to train people about. That is why it is the first priority. There would however, be a dilemma for clinical practice. The placebo effect does appear to be useful, so the question would then become how best to produce a good. placebo effect without too much intellectual dishonesty. Perhaps that is a question that deserves more research.
The fact of the matter is that the Department of Health has ended up spending £1.3 million of public money in a way that directly contravenes the recommendations of the House of Lords and of the government (with one possible exception). They claim that this happened because very few applications were received that addressed the government's first priority. That alone says something about the extent to which the CAM world is interested in tests against placebo hardly surprising since a negative result would destroy their livelihood. But, arguably, if few applications were received that addressed the first priority, then the funding should have been postponed until appropriate applications were forthcoming. The reason that this did not happen is, I fear, only too obvious. The judging panel was dominated by CAM people who clearly share the lack of interest shown by the rest of the CAM community in answering the most important question first. If such research must be done, because of public demand for it, it should have been organised by the Medical Research Council using the same criteria they would use for any other treatment.
References
1 Fisher P, Scott DL. A randomized controlled trial
of homeopathy in rheumatoid arthritis. Rheumatology
(Oxford) 2001; 40: 1052-55.
David CoIquhoun, FRS, A. J. Clark Professor of Pharmacology, University College London; Hon. Director, Wellcome Laboratory for Molecular Pharmacology, Department of Pharmacology, University College London, Gower Street, London WClE 6BT, UK.
This letter was sent to the chief exectutives of 476 NHS Trusts (acute and primary care trusts). It was the main headline in The Times, and the lead item on the BBC's Today Programme.
From Professor Michael Baum and others
19th May 2006
Dear
Re Use of ‘alternative' medicine in the NHS
We are a group of physicians and scientists who are concerned about
ways in which unproven or disproved treatments are being encouraged for
general use in the NHS. We would ask you to review practices in your
own trust, and to join us in representing our concerns to the Department
of Health because we want patients to benefit from the best treatments
available.
There are two particular developments to which we would like to draw
your attention. First, there is now overt promotion of homeopathy in
parts of the NHS (including the NHS Direct website). It is an implausible
treatment for which over a dozen systematic reviews have failed to produce
convincing evidence of effectiveness. Despite this, a recently-published
patient guide, promoting use of homeopathy without making the lack of
proven efficacy clear to patients, is being made available through government
funding. Further suggestions about benefits of homeopathy in the treatment
of asthma have been made in the ‘Smallwood Report' and in another publication
by the Department of Health designed to give primary care groups “a basic
source of reference on complementary and alternative therapies.” A Cochrane
review of all relevant studies, however, failed to confirm any benefits
for asthma treatment.
Secondly, as you may know, there has been a concerted campaign to promote
complementary and alternative medicine as a component of healthcare provision.
Treatments covered by this definition include some which have not been
tested as pharmaceutical products, but which are known to cause adverse
effects, and others that have no demonstrable benefits. While medical
practice must remain open to new discoveries for which there is convincing
evidence, including any branded as ‘alternative', it would be highly
irresponsible to embrace any medicine as though it were a matter of principle.
At a time when the NHS is under intense pressure, patients, the public
and the NHS are best served by using the available funds for treatments
that are based on solid evidence. Furthermore, as someone in a position
of accountability for resource distribution, you will be familiar with
just how publicly emotive the decisions concerning which therapies to
provide under the NHS can be; our ability to explain and
justify to patients the selection of treatments, and to account for
expenditure on them more widely, is
compromised if we abandon our reference to evidence. We are sensitive
to the needs of patients for complementary care to enhance well-being
and for spiritual support to deal with the fear of death at a time of
critical illness, all of which can be supported through services already
available within the NHS without resorting to false claims.
These are not trivial matters. We urge you to take an early opportunity
to review practice in your own trust with a view to ensuring that patients
do not receive misleading information about the effectiveness of alternative
medicines. We would also ask you to write to the Department of Health
requesting evidence-based information for trusts and for patients with
respect to alternative medicine.
Yours sincerely
and
Professor Frances Ashcroft FRS
University Laboratory of Physiology, Oxford
Professor Sir Colin Berry
Emeritus Professor of Pathology, Queen Mary, London
Professor Gustav Born FRS
Emeritus Professor of Pharmacology, Kings College London
Professor Sir James Black FRS
Kings College London
Professor David Colquhoun FRS
University College London
Professor Peter Dawson
Clinical Director of Imaging, University College London
Professor Edzard Ernst
Peninsula Medical School , Exeter
Professor John Garrow
Emeritus Professor of Human Nutrition, London
Professor Sir Keith Peters FRS
President, The Academy of Medical Sciences
Mr Leslie Rose
Consultant Clinical Scientist
Professor Raymond Tallis
Emeritus Professor of Geriatric Medicine, University of Manchester
Professor Lewis Wolpert CBE FRS
University College London
As soon as this appeared the phone started ringing.
Michael Baum did an excellent job on the Today Programme, and
on BBC Birmingham, BBC55, BBC world service, ITN news (interviewed for 20 minutes
outdoor in the rain), Sky News live, and as well as all that he saw patients,
and missed lunch while in the operating theatre. Michael comments " How
was your day your Royal Highness? ".
Leslie Rose did BBC Breakfast TV interview and various radio stations.
I did interviews for BBC News24, BBC1 News, Chanel 5 News, Sky
news, the Jeremy Vine Show (radio 2), BBC Radio Solent, and wrote something
for the Scotsman. Today it's Radio London at 10.35 pm and tomorrow, Radio Foyle
(Derry).
The Late Show on BBC Radio London (24 May), host Stephen
Rhodes, DC versus Gary Trainer: click
to listen
Radio Foyle (N. Irelend) Talk show with Mark Patterson. The local health
food shop manager told me that 'arthritis is a build up of toxins in the body',
and that glucosamine and chondroitin are herbal! Click to listen
Michael Baum's 2004 Open letter. "An open letter to the
Prince of Wales: with respect, your highness, you've got it wrong". Download
pdf file.
Coverage in The Times, 23 May 2006. The front page headline.
New International has forced me to remove the pictures of the front page, but the front page headline was
NHS told to abandon alternative medicine
Top doctors say money should go to conventional treatment
Top doctors say money should go to conventional treatment
A GROUP of Britain’s leading doctors has urged every NHS trust to stop paying for alternative medicine and to use the money for conventional treatments.
Their appeal is a direct challenge to the Prince of Wales’s outspoken campaign to widen access to complementary therapies.
Public funding of “unproven or disproved treatments” such as homoeopathy and reflexology, which are promoted by the Prince, is unacceptable while huge NHS deficits are forcing trusts to sack nurses and limit access to life-saving drugs, the doctors say.
The 13 scientists, who include some of the most eminent names in British medicine, have written to the chief executives of all 476 acute and primary care trusts to demand that only evidence-based therapies are provided free to patients.
Their letter, seen by The Times, has been sent as the Prince today steps up his crusade for increased provision of alternative treatments with a controversial speech to the World Health Organisation assembly in Geneva.
The Prince, who was yesterday given a lesson in crystal therapy while touring a complementary health unit in Merthyr Tydfil, will ask the WHO to embrace alternative therapies in the fight against serious disease. His views have outraged clinicians and researchers, who claim that many of the therapies that he advocates have been shown to be ineffective in trials or have never been properly tested.
The letter criticises two of his flagship initiatives on complementary medicine: a government-funded patient guide prepared by his Foundation for Integrated Medicine, and the Smallwood report last year, which he commissioned to make a financial case for increasing NHS provision.
Both documents, it is claimed, give misleading information about scientific support for therapies such as homoeo-pathy, described as “an implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness”.
The letter’s signatories include Sir James Black, who won the Nobel Prize for Medicine in 1988, and Sir Keith Peters, president of the Academy of Medical Science, which represents Britain’s leading clinical researchers.
It was organised by Michael Baum, Emeritus Professor of Surgery at University College London, and other supporters include six Fellows of the Royal Society, Britain’s national academy of science, and Professor Edzard Ernst, of the Peninsula Medical School in Exeter, who holds the UK’s first chair in complementary medicine.
The doctors ask trust chief executives to review their policies so that patients are given accurate information, and not to waste scarce resources on therapies that have not been shown to work by rigorous clinical trials.
They conclude: “At a time when the NHS is under intense pressure, patients, the public and the NHS are best served by using the available funds for treatments that are based on solid evidence.”
Professor Baum, a cancer specialist, said that he had organised the letter because of his “utter despair” at growing NHS acceptance of alternative treatments while drugs of proven effectiveness are being withheld. “At a time when we are struggling to gain access for our patients to Herceptin, which is absolutely proven to extend survival in breast cancer, I find it appalling that the NHS should be funding a therapy like homoeopathy that is utterly bogus,” he said.
He said that he was happy for the NHS to offer the treatments once research has proven them effective, such as acupuncture for pain relief, but that very few had reached the required standards.
“If people want to spend their own money on it, fine, but it shouldn’t be NHS money.”
The Department of Health does not keep figures on the total NHS spending on alternative medicine, but Britain’s total market is estimated at £1.6 billion.
Prince of Wales Addresses World Health Organisation: good in parts
Prince Charles addressed the WHO in Geneva on 23 May 2006, The full text of his speech is on the WHO web site. Some bits of it I rather liked. Who could disagree with this bit.
“The state of our health reflects the food we eat, the exercise we take, the water we drink, the air we breathe and the quality of our housing and sanitation. I believe it also extends to our social needs and circumstances – the need to belong to a community, the need for meaningful work and daily purpose. The need in our lives for dignity and kindness, for self-respect, for hope and, above all, for harmony and, dare I say it, beauty. It encompasses the power of art, the healing properties of loving human relationships and the role of the human spirit. Human health is the sum of all these parts.”
Yes, go on, why not say 'beauty'? But that is, for me, the problem. I go along with John Keats (John Keats. 1795–1821, Ode on a Grecian Urn).
“Beauty is truth, truth beauty,—that is all
Ye know on earth, and all ye need to know.”
The problem for me, is that talk of mysterious 'energy flows', 'auras', 'meridians', 'yin and yang', 'potentisation', and such like mumbo jumbo is, almost certainly, not true. And for me, that makes it ugly. Ugly and dishonest.
The speech, it has to be said, was relatively restrained. The Prince made pretty modest claims -nothing much beyond acupuncture for osteoarthritis of the knee, and St John's Wort for non-severe depression. There was no mention at all of homeopathy, reflexology or any other of the myriad variants of alternative medicine. Why, I wonder, was this? Has the Prince of Wales lost faith in homeopathy? Does he realise now that the evidence for its efficacy is appalling? If that is the case, then it would have been nicer if he'd said so.
The other interpretation is that he thought it expedient to suppress some of his more curious beliefs. If so, that would not be very honest. The impression given of homeopathy is very favourable in Complementary healthcare: a guide for patients, which is published by the Prince’s Foundation for Integrated Health (see above). So why not in his WHO speech? Surely something wrong there.
The speech also included the following words (you can see this bit on Sky
News, together with a reply from me).
“in the ceaseless rush to “modernize”, many beneficial approaches, which have
been tried and tested and have shown themselves to be effective, have been
cast aside because they are deemed to be “old-fashioned” or “irrelevant” to
today's needs. ”
All this shows that his idea of " tried and tested and have shown themselves to be effective" is very different from any idea of good evidence that would seem acceptable today.
Follow-up after yesterday's letter and HRH's speech
Today, 24 May 2006, there is a lot of follow-up.
The Times
Several articles appeared on 24th May. "'Misrepresented' Charles refuses to
follow his doctors' orders". by Andrew
Pierce and Mark Henderson. They quote a statement from Clarence House.
"What the Prince is arguing for, and always has argued for, is for a combination of treatments where it is appropriate and where it is proven to work."
So, straight back to the question of what you mean by "proven". They also
quote Michael Baum, thus.
“Professor Baum said that where the Prince’s remarks were not meaningless, they were wrong. "What the Prince calls the biophysical model of the body is infinitely more beautiful, not to mention more useful, than anything conjured up by the alternative wing,” he said. “The body is a beautiful orchestration of recognisable biological and physiological processes, which can be observed and understood." ”
And, from the House of Commons,
“Evan Harris, a Liberal Democrat member of the Commons Science and Technology Committee, said that the Prince was abusing his constitutional position by taking a controversial stance without allowing himself to be cross-questioned.”
Mark Henderson and Fran Yeoman also wrote "NHS must audit spending on alternative therapy, MPs say. Health officials admit they have no idea how much such treatment costs"
"The Department of Health admitted that it had no idea how much taxpayers’ money was being spent on non-conventional therapies.
Phil Willis, chairman of the Commons Science and Technology Select Committee, said the department had a duty to collect accurate information on the extent of NHS support. "
The Times leading
article on the topic was a bit less sympathetic, but ended with an impeccable
conclusion.
"All can seek these at their own expense, but this debate is ultimately about the use of taxpayers’ money, which only therapies that are proven to be safe and effective deserve."
Homeopathy is bunkum
This was the title of a very nice piece by Sue Blackmore (read it here). It starts thus.
“Oh yes, I'll get in trouble for saying "quackery"; I'll be told that alternative therapists are not quacks, that they are all kind, caring, open-minded people who help the sick and fight against the oppression of closed-minded scientists who don't understand the holistic nature of these truly spiritual human beings.
But these poor doctors will have it worse. They will get hate mail from people who claim to be more loving and caring than them; they will be called "arrogant" by people who "just know" that homeopathy works; they will be threatened and ridiculed by people whose children have been "saved" from the horrors of modern medicine by a homeopathic remedy that their hardhearted doctor denied them on the NHS”
The Royal Society
A statement from the Royal Society (at last) was quoted in The Times
“The Prince’s speech came as the letter critical of alternative medicine was backed by the Royal Society, six of whose Fellows had signed it. Professor David Read, vice-president, said: "We share the concerns that some treatments labelled as complementary and alternative medicines have not been properly tested and are known to cause adverse effects, while others have no demonstrable benefits. We also support the view that patients should not receive misleading information about the effectiveness of complementary medicine." ”
The Daily Mail
Michel Hanlon wrote a magnifiently sensible piece in the Daily Mail. It starts thus.
"Let's be clear about this: there is no such thing as alternative trust
medicine. There is medicine which works and medicine which doesn't. Anything
which doesn't work is snake oil, and anyone who buys such stuff is either
being duped, or has more money than sense."
The Guardian
Good pieces by Sarah Boseley, and, especially by Dylan Evans, whose "Crazy Medicine" concluded with a recognition of the dilemmas, thus.
“There is always the possibility, of course, that doing away with the crackpot theories that provide alternative therapies with some of their appeal may actually rob them of their effectiveness, by destroying the vital belief that enables these therapies to mobilise the placebo response. In such cases, we face a choice of a clearly ethical nature: to preserve the effectiveness of these therapies by perpetuating crazy theories, or to seek the truth at the risk of robbing some patients of their favourite therapeutic resources.”
Der Spiegel
Nobelpreisträger gegen Prinz Charles: report in Der
Spiegel
The Scotsman (24 May 2006)
Lynday Moss, the Scotsman's
Health Correspondent, wrote aboutou letter, and the WHO speech. She mentiond
that "NHS Lanarkshire provides complementary therapies for cancer patients
and their relatives, including aromatherapy and reflexology, at an annual
cost of about £27,000.", followed up by an abbreviated piece that she asked
me to write. The unabbreviated version follows.
Recently 13 physicians and scientists write a letter to the chief executives of 476 NHS Trusts. We are concerned about the extent to which the NHS is spending money on unproven, and even disproved, treatments.
The sort of treatments we have in mind are things like homeopathy, aromatherapy, reflexology and a myriad of other sorts of so-called Complementary and Alternative Medicine (CAM). A handful of such treatments may have real effects, but most seem to be no better than a placebo. Of course lots of people can be found who are quite convinced that homeopathy, for example, has done them good, despite the fact that the medicine contains no medicine whatsoever. Most homeopathic ‘medicines’ are so diluted that the pill is most unlikely to contain even a single molecule of the substance named on the label. Normally, if you were to sell a pill that did not contain what its label says, you would be in deep trouble, but when it comes to homeopathy double standards are applied, by the NHS, the Department of Health and by the Advertising Standards Authority.
Consider one example. The University College London Hospitals Foundation Trust, like many others, has a considerable deficit. Yet it spends around £4 million a year running the Royal London Homeopathic Hospital, ans has just spent about £20 million renovating it. This is going one while jobs are being lost in the other seven normal hospitals in the Trust and patients are struggling to get new treatments for cancer like herceptin and the new aromatase inhibitors. The Trust has an excellent ‘Use of Drugs Committee’ but that committee has come under pressure to apply quite standards for assessment of complementary treatments that are quite different form the standards it applies to normal treatments. It is hard to see how such double standards can be justified.
Where does the pressure to apply double standards come from? Partly it comes from ancillary organisations like The NHS Alliance and The NHS Trusts Association, whch lobby for more CAM (despite the official sounding names, and their use of the NHS logo, these are not part of the NHS). Partly it comes too, from Royal Patronage. The Prince of Wales has today made a speech to the World health organisation in Geneva in which he advocated more NHS spending on unproven treatments rather than rather than less In a constitutional monarchy the exertion of such influence on public policy must surely be dubious.
The popularity of CAM among the public raises a real dilemma, but this dilemma should be faced honestly. For individual patients who say they feel better after having a foot massage by reflexologist it does not matter whether they feel better only because of expectations, because of time being spent with them, because of a placebo effect. For them, better is better, whatever the reason. But the ‘principles’ underlying reflexology are no more that primitive mumbo-jumbo. It is nonsense to employ qualified reflexologists and still worse nonsense to expect universities to train them. By all means let patients be massaged if it makes them happy, but don’t invent phony mumbo-jumbo or make exaggerated claims for what massage can achieve. The question that has not yet been faced openly is, to what extent is it acceptable to lie to the patient in order to produce the best placebo effect?
The letter sent to NHS chiefs ended thus.
"We are sensitive to the needs of patients for complementary care to enhance well-being and for spiritual support to deal with the fear of death at a time of critical illness, all of which can be supported through services already available within the NHS without resorting to false claims."
There is nothing inhuman, or un-holistic in thinking that false claims are undesirable. All that our letter asked is for double standards to be removed in the interests of sick patients.
"In fact, there is considerable evidence to show that homeopathy is effective in the treatment of a wide range of illnesses, including a large study at the end of 2005, of the outcomes from 6,500 patients at the Bristol Homeopathic Hospital, over a period of six years, in which 75% reported improvement."
What a wonderful response! They have chosen to cite, in their own defence,
quite the worst study to come out for years (see the commentary
above). It is precisely because homeopaths mistake things like
the Spence study for evidence that we felt our letter was needed.
The Complementary Medical Association has posted a rather angrier response here.
“Baum and colleagues imply that these “Alternatives” are “unproven or disproven”. Again, sadly they are mistaken and really need to look at the research before they undertake a smear campaign such as this. ”
But the first bit of 'research' they cite is, astonishingly, the same Spence study. It is quite hard to conduct any sort of sensible dialogue with people whose understanding of the principles of inference is so rudimentary. Nevertheless, we'll keep trying.
The Daily Mail quotes Terry Cullen, chairman of the British Complementary Medicine Association, as saying that the group's stance was "frustrating". He said
"It's very frustrating that senior responsible people dismiss complementary medicine for the sole reason that it doesn't have the definitive scientific proof that other drugs have.
So we have it from the horse's mouth, After 100s, or even 1000s, of years
there is still no
good evidence.
“Working in partnership with the online health and lifystyle magazine Complementary alternatives we have been able to make this invaluable resource accesible to all. ” [sic]
This lifestyle magazine (oops. NHS guide) is not content with the usual suspects, acupuncture, homeopathy etc, but also lists such totally barmy frauds as crystal therapy, radionics and iridology. It listed for me 24 'crystal therapists'. Are these really available on the NHS?
Just in case you are feeling a bit sceptical (!), the site kindly tells you how crystal therapy works.
“They do however assess the condition of the bio-magnetic field of a client before choosing appropriate crystals to help bring it back into balance and harmony. Since the state of the bio-magnetic field relates to and influences the state of the physical body, this process will help activate, support and often accelerate the natural self-healing processes.”
This utterly unsupported claim is written in the usual pseudo scientific language.
It is an insult to any educated person, and it is being propagated by what
sound like am official NHS source. In fact I am assured that the 'NHS
Trusts Association', despite its impreesive name, has no official status at
all. It seems that here is nothing to stop professional/academic bodies which
work with the NHS using ‘NHS’ in their name, NHSTA has not got a .nhs.uk web
site and does not show the NHS logo (rules about this are
here).
It seems a great pity that people like Tod are allowed to masquerade as official
NHS sources when they are not. Nonetheless, the NHSTA does seem to have
influence in official circles. Their web site saya
“The NHS Trusts Association (formerly the Association of Primary Care Groups & Trusts, APCGT) held its inaugural meeting in Westminster on 27th April 2000, attended by the press and addressed by senior members of the Department of Health.
The meeting unanimously approved the Constitution and appointed Dr David Tod OBE FRCGP Chief Executive. The NHS Trusts Association’s membership is now approaching 70% of PCTs, with new members joining on a regular basis.”
The NHS Alliance appears to be in the same category. It
is not an official NHS organisation (its address is not .nhs.uk) but it is
used by its chairman, Michael Dixon, to spread propaganda for alternative medicine.
Official or not, it features strongly on the Department
of Health web site. More of this soon.
Aromatherapy on NHS for patients with brain injuries was the title of an article in the Edinburgh Evening News, 21 April 2006. It said
“NHS Lothian has agreed to fund the aromatherapy after patients said their health improved after receiving treatment.”
“A survey conducted by ECAS [an Edinburgh–based charity] found that half the patients questioned after an aromatherapy treatment reported improvements in joint mobility.”
I WAS sorry to read that the Lothian NHS trust is to spend taxpayers' money on aromatherapy.
Of course some people will be cheered up by nice smells, but where do you stop? I expect some people would love Chanel Number 5 on the NHS too.
When I phoned ECAS, they told me that their survey on the effects of aromatherapy, which you cite, will not be made public. I wonder why not.
You cite Robert Aitken, manager of the Astley Ainslie Hospital in Edinburgh, as saying "aromatherapy was no longer considered an alternative therapy". I have to say that makes me wonder which century Edinburgh medicine is now living in. It seems to have regressed since the time I did my PhD in Teviot Place.
Dr David Colquhoun
Professor of Pharmacology, University College London
In fact ECAS is, in general, a throughly admirable charitable organisation. But in this case, they seem to have misunderstood what constitutes evidence, and not thought about the dilemmas of CAM.
More CAM in the Lothian NHS area: the Dalkeith Medical Practice.
A good friend (and ex-postoc) of mine, when his young son had a fever, took him to the local GP. As a good scientist he was horrified to be offered an unsolicited homeopathic treatment, Belladonna 6C. His letter of protest elicited a reply from Dr Wolfgang Walter (14 Dec 2001) that was astoundingly condescending. For example he wrote
What seems even more amazing is that he admitted with no obvious embarrassement that there was no reason to believe that his prescription worked.
Dr Walter seems since then to have moved to Bristol, another area with more than its fair share of homeopaths, but the homeopathic head of the practice, Dr Michael S. WIlson, is still there.
Dutch doctor struck off for use of complementary medicine
This report appeared in the British Medical Journal332 22 April, 2006. It is yet another example that shows homeopathy is not harmless. Ignoring facts and distorting evidence costs lives.
“The Amsterdam Medical Disciplinary
Tribunal has struck off
one doctor and suspended two
others for their exclusive use of
complementary treatments—
including “vegatests,” homoeopathic
medicine, and food
supplements—to treat Sylvia Millecam,
the Dutch actor and
comedian who died from breast
cancer in 2001 at the age of 45.”
“In the high profile test case
for use of complementary medicine
the doctors, who were not
identified by the tribunal, were
judged to have ignored existing
standards for treating breast
cancer, used unsatisfactory
methods, and withheld information
during their treatment of
Ms Millecam.”
“ . . she turned to a GP,
identified as “B,” who carried out
a vegatest, which measures the
electrical resistance of connective
tissue under the skin. This
doctor diagnosed a bacterial
infection, which he treated using
non-registered medicines, thus
leaving the cancer untreated for
months.”
Only struck off? Not manslaughter? And why did it take five years?
Sylvia Millecam died after
receiving complementary
treatment for breast cancer
(photo, BMJ)
Another case. In 2004 two doctors working in private practice and treating their patients with complementary medicine were found guilty of serious professional misconduct by the General Medical Council. Edzard Ernst comments “The GMC seems to be reminding us that the integration of complementary medicine has to be based on scientific evidence; otherwise it is in danger of amounting to professional misconduct” (see details here ).
Unfortunately a great deal of such professional misconduct is still being funded by the NHS.
“Dr Michelle Langdon risked the health of an 11-month-old girl and failed to get proper consent before using homeopathic medicine, the GMC's professional conduct committee decided on Thursday.
Dr Langdon, a partner at the Brunswick Medical Centre in Camden, north London, treated the baby's stomach infection by using a "dowsing" ritual to select a remedy, the hearing had heard.
She was found guilty of serious professional misconduct and banned from practising medicine for three months.”
A bit of “serious professional misconduct” does not seem to have prevented Dr Langdon from being a committee member of the British Society for Integrated Medicine. Their Founder President, Dr Julian Kenyon, writes thus, in their newsletter (Feb 2006)
Yes indeed? When can we look forward to some prosecutions? (At least you can't be prosecuted for using kids' fonts.)
Boots the Chemists is a very big business in the UK. There are 1,450 Boots stores in the UK, employing over 68,000 people. At one time they were sufficiently ethical not to deal in homeopathy. But no longer.
When asked for evidence that the things they sell actually work, the Boots help desk is astonishingly coy, as related here (thanks to ebm-first.com for giving publicity to this report).
When 'a friend' asked Boots about their 'Alternatives Hayfever Relief Tablets', the answer came, after some delay, "This is a homeopathic product, further information on
homeopathic products is available from the Nelson company who make this
particular product for Boots. " This company has been making homeopathic products for many years and
may well be able to help you further. You may also find general
information about homeopathic medicines in reference books in the public
library". The email address that they gave me for Nelson's did not work, and writing to another Nelson's address produced no reply at all. Clearly any letter that contains the word "evidence" arouses suspicion and is simply deflected.
Dangerous advice from Boots: a small sting. I have been into several Boots stores, sought out the most senior pharmacist that I can find, and asked them the following question. "I have a 5 year old son who has had diarrhoea for three days now. Please can you recommend a natural remedy". The response was interesting. In every case but one, the pharmacist reached for a copy of the Boots pamphlet on homeopathy, and thumbed through it, while desperately, but unsuccessfuly, trying to retain an air of professional authority. Then one or another homeopathic treatment from the booklet was recommended. In only one case out of six did the pharmacist even mention the right answer (GP and rehydration). One pharmacist, who turned out to have qualified in Germany, was very insistent that homeopathic treatment was inappropriate and that I should should start rehydration and take the child to the GP. The other five, including one who had an impressive-looking badge saying "consultant pharmacist", did not even mention rehydration. Conclusion The education of the pharmacists was clearly insufficient for them to give reliable advice. On the contrary, their advice was downright dangerous.
Miseducation by Boots the chemists
Boots also run an "educational" web site for children, the 'Boots learning store'. Click on the section for 'pupils', and then '16+' and you find their education about alternative medicine (do their pharmacists do this course, I wonder?). The slide show that follows is an insult to human intelligence,
“‘POTENCY‘ is the term used to describe the dilution of a remedy. The weaker the solution the more potent the medication.”
Then follows a totally misleading slide about enzymes.
There is nothing wrong with the enzyme bit, but the analogy with homeopathy is baseless and misleading. Enzymes don't work when there are no molecules present.
But in the next slide, enzymes and catalysts are forgotten anyway, This is how it works.
This meaningless mediaeval gobbledygook about 'vital forces' is being peddled as 'education' by the biggest retail pharmacy chain in the UK. What hope is there for kids?
But there is more. Now for the exam. If you click on the 'teacher' section you can download the students' notes and the test. The 'Student Notes' include the following direct claim that homeopathy can cure diseases.
Now take the test, Here is question 1, and the answer.
I suppose that if the educators at Boots classify Hahnemann's provings as a 'clinical trial' it goes a long way to explain the quality of their learning store, and the quality of the advice given by their pharmacists.
Postcript: "Nurses and pharmacists are to be given greater powers to prescribe drugs"
The foregoing history does not give one much confidence in the government's latest money-saving wheeze. [BBC]
“The latest measures mean nurses and pharmacists will be able to prescribe treatments for more serious conditions such as heart disease and diabetes - traditionally the domain of GPs.
Health Secretary Patricia Hewitt said: "Nurse and pharmacist independent prescribing is a huge step forward in improving patient accessibility to medicines from highly skilled and well trained staff."
And Chief Pharmaceutical Officer Dr Keith Ridge added: "For pharmacists, this is the dawn of a new era. It will help transform the public's perception of pharmacy and the services they deliver to patients.”
This is not a new story. There was much about it in Marcia Angell's book. But now a set of essays has appeared in the journal PLOS Medicine (part of the Public Library of Science, freely available to everyone. Read them here. Ben Goldacre's Badscience column has, as usual, some good sense on this topic too,
This notice appeared recently in the window of my local “health food shop”. I've seen plenty of lunatic stuff, but this has to take some sort of record. It is a random jumble of words, designed, as usual, to extract money from the gullible.
For a bit more about Melchizedek click here (fraudulent
nonsense) or here (history)
.
It's not just homeopathy. The Sunday Times, (26 February, 2006) reports that the National Health Service has fallen for another scam.
“IT COULD be called the Cleopatra Effect. Magnetic therapy, which has held the rich and powerful in thrall from ancient Egypt to modern Downing Street, is about to be made available on the National Health Service.
NHS accountants are so impressed by the cost-effectiveness of a “magnetic leg wrap” called 4UlcerCare that from Wednesday doctors will be allowed to prescribe it to patients.”
This is nicely timed to coincide with an Editorial in the British Medical Journal, by Finegold & Flamm (2006) (click to download pdf file). The editorial title was "Magnet therapy. Extraordinary claims, but no proved benefits". They conclude
“Patients should be advised that magnet therapy has no proven benefits. If they insist on using a magnetic device, they could be advised to buy the cheapest – this will alleviate the pain in their wallet,”
For example, Carter et al,, 2002 found no detectable effect of magnet therapy for treatment of wrist pain Attributed to Carpal Tunnel Syndrome (30 patients,double blind, careful controls). Winemiller et al., 2003 (Journal of American Medical Association, 290, 1474–78), found no benefit of magnets vs sham-magnets in treatment of plantar heel pain in 101 patients.
Magnets are said to be one of Cherie Blair's several curious and irrational beliefs. It is alleged, according to the Daily Telegraph, that “Cherie Blair did not allow her youngest child, Leo, to have the controversial MMR vaccine and instead asked a New Age healer to wave a "magic" pendulum over him”. A few more examples are documented here and here.
The accountants at the Prescription Pricing Authority have decided that the "the magnets will save money on bandages and nurses’ time by healing the wounds." I dare say they could save even more money by removing all effective treatments.
The evidence in favour of the magnetic treatment all seems to come from a Dr Nyjon Eccles. The Sunday Times describes him as an "NHS GP in north London", but elsewhere he is described as "Founder, CEO and Medical Director of the Chiron Clinic" in Harley Street. A look at their web site shows that they offer a full range of alternative scams. Cancer patients can get
“LYMPH DETOXIFICATION - This is achieved by non-invasive scalar, oxygen-fed light beam therapy. This helps to detoxify the tissues by assisting the body in dissolving lymph blockages and restoring normal lymph flow using the Nobel quantum scalar technology coupled with oxygen for remarkable healing potential.”
This is total gobbledygook, designed to take advantage of the desperate.
The only real evidence to be provided by Dr Eccles that the device works is a small (26 patients) double blind trial that has not yet been published in a peer-reviewed journal, and which suffered from a number of problems (dropouts, outliers). What, I wonder, does NICE think of evidence like this?
In the discussion of magnets on the Badscience site, a Michael King says that 4ulcercare will be included in Part IX of the Drug Tariff because it meets the criteria of the Prescription Pricing Authority (PPA).
I presume this Michael King is Director of Planning and Corporate Affairs at the PPA, though he does not say so.
Michael King says
“There is no judgement offered about whether a product in the Drug Tariff
is more (or less) efficacious than any other, or the placebo effect.”
The criteria for inclusion in
Part IX of the Drug Tariff () include, in section 10 iii, “They are cost
effective”
Will he please explain how a device can be cost-effective, if it is ineffective (relative to placebo)?
What the PPA says
Michael King has replied to my question by email (1 Mar 2006). He says
“The cost-effectiveness threshold for inclusion in the Drug Tariff is met if the 'effectiveness' of the device, as seen in data submitted by the manufacturer in support of the application, exceeds its cost to the NHS. ”
Sadly this is still ambiguous. It seems to suggest that that whatever data
are submitted by the manufacturer are taken at face value, without any attempt
to evaluate their quality. So I phoned King to ask if this was the case. He
was helpful, but he said that it was not the case. He told me that
the data were subject
to some sort of low level evaluation, short of the sort of evaluation that
NICE would do. This seems to contradict his earlier statement (above) that
inclusion in the Tariff implies no judgement about whether a device is better
than a placebo.
King said also that listing in the Tariff
". . . is not a licensing decision nor a recommendation akin to the outcome of a NICE review"
The problem is, of course, that listing is seen as a recommendation by the public, by the Daily
Mail, and certainly by the manufacturer.
One thing, at least, is clear in this case. Whatever evaluation was done,
it was done very badly. But in order to try to find out exactly what evaluation
was done, and by whom, I'm having to resort to the Freedom of Information Act.
Watch this space.
What NICE says
Fraser Woodward (Communications Manager, National Institute for Health and Clinical Excellence (NICE)) writes as follows.
“The test of "cost effectiveness" applied by the PPA when determining whether or not a device should go on the tariff is very different to the way cost effectiviness is assessed by NICE”
That is pretty obvious, but how is the public meant to know that, when they hear that the NHS has declared a treatment to be 'cost-effective', that statement can mean two entirely different things according to which part of the bureaucracy the statement comes from?
Magnets and the Freedom of Information Act 2000. Can you believe this?
In an attempt to discover how the PPA managed to calculate the cost-effectiveness of magnetic treatment of leg ulcers, I lodged with them a request under the Freedom of Information Act 2000.
The result beggars belief.
“I am writing to advise you that following a search of our paper and electronic records,
I have established that the information you requested is not held by the Authority.”
The PPA say that they retain no copies of anything related to their recent decision. The Department of Health is now being asked for the same information.
Dear Mr Colquhoun
Re: Freedom of Information
I refer to your request under the above legislation, which I received on 27 February 2006 for information about “I should like to see all documents and correspondence that relate to the decision of the PPA to approve the buying of the magnetic device '4ulcercare' (and other magnetic devices, if any)”.
I am writing to advise you that following a search of our paper and electronic records,
I have established that the information you requested is not held by the Authority.
Under the act I have a duty to advise and assist you and with regard to that duty you need to be aware that documents and correspondence in respect of applications for listing of appliances in Part IX of the Drug Tariff are supplied to the Authority for the purposes of making a listing decision and following the addition of an item to the Drug Tariff (or its rejection) all information is returned to the Department of Health.
It would seem, therefore, that your request would be more appropriately addressed to the Department of Health. You can make an FOI request to them by sending an e-mail to dhmail@dh.gsi.gov.uk and marking it “Freedom of Information”. If, however, you would like me to do this for you, please get back in touch and I will action accordingly.
.
.
.
Yours sincerely
Gordon Wanless
Project Manager (Information Security and Data Protection)
In response to a second Freedom of Information request I was sent a document that gives some procedures for handling applications, including the making of paper files and spreadsheets. Paragraph 6.5 says
“6.5 Once the application has been accepted or rejected . . . the file
can then be closed and set to the Department of Health . . .”
It says nothing about destroying all copies, emails and spreadsheets. But
Mr Wanless tells me "I did check it out by discussing it with the dealing department
and I can confirm that it does appear to be the case (i.e. that the electronic
records are deleted). The e-mails are printed out and kept in the paper file
and then deleted also". It seems that the PPA keeps no records
of its activities whatsoever. Very curious.
Well this beats everything. Following the advice of the PPA, I re-submitted
my request under the Freedom of Information Act to the Department of Health
(DoH), which is where the PPA claimed to to have sent very single bit of information
concerning their decision to make magnetic ulcer treatment available on the
NHS.
When I mananged to decode the result (the DoH seem incapable of sending legible emails) this is what they said.
As you are aware, the decision by the PPA to allow Magnopulse’s 4Ulcercare on Part IX of the Drug Tarriff is a recent one and the documentation that went along with the application are still very much restricted as ‘commercially sensitive’. We have therefore decided to withhold this information under the FOI Act.
Section 43: Commercial Interests – Section 43 exempts information whose disclosure would be likely to prejudice the commercial interests of any person. It also includes a specific exemption for trade secrets
Trade secrets in magnets? They are one of the oldest scams of the health fraud industry! Are the DoH really so enthusiastic to protect these non-existent trade secrets? (The company whose trade secrets the DoH are so eager to protect are under invesitgation by the Office of Fair Trading!) Or is the DoH merely colluding to cover up the cockup at the PPA?
Either way, the Freedom of Information Act 2000 has yet to prove it's worth the paper it's written on.
Why not write to your MP to ask them to approach the DoH about this
absurd misuse of the Act?
I have requested an internal investigation by the DoH. Next the appeal goes to the Ombudsman.
Misleading advertising of magnets. Office of Fair Trading acts
A major problem in stopping CAM fraud is the generally toothless attitude
of the Advertising Standards Authority and of the Office of Fair Trading.
Not this time though. The OFT
Press Release reads thus.
“The OFT is seeking an injunction preventing publication of advertisements
making the following claims about the company's products:
the products have a therapeutic effect, caused by a specified physiological
mechanism, due to the magnets they contain
the therapeutic effect of the products, due to the magnets they contain,
is clinically proven or established by scientific trials, or is widely accepted
in the scientific or medical communities
unqualified claims the products have a therapeutic effect and/or that wearing
products containing magnets will always produce such an effect, due to their
magnets
that products magnetise or ionise water as a result of the magnets they
contain.
Magno-Pulse Limited contends that the advertisements are not misleading and
has refused to stop publishing adverts making these kinds of claims. Accordingly,
the OFT has issued proceedings so the courts can decide the matter. Magno-Pulse
Limited has indicated it intends to defend the proceedings.
Christine Wade, Director of Consumer Regulation Enforcement said:
"Where advertisements claim products have therapeutic effects it is important they do not mislead consumers. The OFT is asking the High Court to decide if Magno-Pulse Limited’s advertisements are misleading."
It cannot have escaped the attention of the PPA (above) that this action makes them look pretty foolish.
Let's hope the High Court is not fooled.
“Universities” that offer BSc degrees in subjects that are not science: fraudulent or mickey-mouse?
Universities are meant to be places where truth can be separated from fiction, free from commercial and superstitious influences. They have not always done this very well, but it is a fine aspiration.
That makes it particularly sad that a handful of the new universities are now offering Bachelor of Science degrees in subjects that are not science at all. This is one aspect of the central dilemma of CAM. At a time when the ex-polytechnics are struggling to establish a reputation as serious academic institutions, they are heading firmly in the opposite direction.
The new universities have been much-mocked for offering degrees in subjects like Golf Course Management (e.g. Bournemouth, Lincoln). While it is true that there is little relationship between the intellectual content of such courses and that of a B.Sc. in Physics, Golf Course Management is not dishonest. I dare say it is useful for some people. As far as I know, there is not yet a B.Sc. in plumbing, but it would be just as intellectual, and a lot more useful than golf.
What is truly disgraceful is not so much that degrees are being offered in subjects with little intellectual content, but that degrees are being offered in subjects that have negative intellectual content. Degrees in subjects where the words have no discernable meaning at all, but are pure mumbo jumbo.
It is true that the sceptic might say that degrees in theology from our oldest universities have a long tradition of doing precisely that. Personally, I have much sympathy with that view, and that's one reason why I prefer to work at UCL, which does not do it. But no university has ever offered a bachelor of science degree in theology. Nobody pretends that religion is a subject that is amenable to the methods of science. Consider a couple of examples.
Take a typical exposition of the 'principles' of acupuncture.
"There are 14 major avenues of energy flowing through the body. These are known as meridians".
The energy that moves through the meridians is called Qi.
Think of Qi as "The Force". It is the energy that makes a clear distinction between life and death.
Acupuncture needles are gently placed through the skin along various key points along the meridians. This helps rebalance the Qi so the body systems work harmoniously.
I suppose, to the uneducated, this language sounds a bit like that of physics. But it is not. The words have no discernable meaning whatsoever. No respectable university could subject students to this sort of mumbo-jumbo, pretending that it is science.
Here is another, equally nonsensical, example.
Reflexologist believe that sensitive and trained hands can detect tiny deposits and imbalances in the feet. And by working on these points the reflexologist can release blockages and restore the free flow of energy to the whole body. it is believed
that nerve endings are unable to transmit their impulses because of crystalline deposits that build up and block their pathway. Reflexology is believed to clear these crystalline deposits.
Incredibly, it is possible to find places that offer B.Sc. degrees in subjects like homeopathy that bear no relationship to science whatsoever. Hapless students are taught this nonsense
“The School has developed the widest range of complementary therapy courses in Europe. The BSc (Hons) Health Sciences degrees in herbal medicine, homoeopathy, nutritional therapy and therapeutic bodywork and the Traditional Chinese Medicine: Acupuncture course were the first named degrees of their kind in the UK. They have recently been supplemented by a new pathway in naturopathy.”
“Complementary Medicine BSc (Hons) - Lincoln
This exciting and innovative degree programme will give you an appreciation of the orthodox western model of health and illness as a foundation to your complementary medicine studies in either western herbal medicine or traditional Chinese acupuncture.”
Another institution at the forefront of promoting gobbledygook in the name of acience, is Thames Valley University, whose brochure offers aromatherapy, reflexology and shiatsu massage as though they were science (B.Sc (Hons)). If a B.Sc. is too much for you, Thames Valley University also offer a short course in homeopathy, which is described thus.
“Would you like to know how to treat your relatives and friends for colds and flu, injuries, travel illnesses, pre-exam stress and acute emotional difficulties? These are just some of the conditions that can be treated with Homeopathy medicine and which will be covered in the course.”
(The suggestion that homeopathy can cure colds and flu is false, and in the light of the possible imminence of a severe flu epidemic, the suggestion that flu can be treated is, arguably, verging on being wicked.)
“If you complete all of the homeopathy modules in the degree you will be able to apply for entry into year two of the four-year part-time homeopathy professional training programme at the North West College of Homeopathy in Manchester. You will also receive a certificate in Homeopathic First Aid.”
What will be offered next? B.Sc. degrees in Black Magic and the Casting of
Spells? Astrology? Why not? They would be little different from things on offer
already. There would be no objection to teaching homeopathy etc as part of
the history of ideas, or as a sociological phenomenon. What is deeply objectionable,
if not downright fraudulent, is to label them as science.
University of Maryland Medical Center promoting quackery
This one is a serious indication of how far universities have acquiesced in delusional thinking. The University of Maryland Medical Center has (or perhaps had) a good reputation in medicine. It isn't a second rate ex-polytechnic. Yet now their website has a whole section devoted to "Alternative / Complementary Medicine". The wording of the articles there is slightly more circumspect than the average high street "healthfood" store, but the effect is just the same, In fact it is worse, because the bad advice comes from what seems like an authoritative source. Try looking under prostate cancer: there you will find the following.
Red Clover (Trifolium pratense)
In one report, a 66 year old man who took red clover every day for a week prior to having a prostatectomy for prostate cancer showed reduced signs of cancer in the diseased prostate tissue.
This might (or might not) be a suggestive lead for some good experiments. But to post it on a site that purports to give medical advice is, in my view, totally irresponsible.
Dr Stephen Barrett, of Quackwatch (recommended) searched the Maryland site with Google and found articles that promote homeopathy for about 300 health problem. Try it for yourself. Barrett comments "Most of the bad articles also include unsubstantiated recommendations for dietary supplements and herbs".
Homeopathy on the NHS in Bristol: Dr Spence's paper
On 21 November, 2005, Dr David Spence appeared on the BBC's Today Programme. He was being interviewed about a report that, he said, provided evidence for the effectiveness of homeopathy. In fact it does nothing of the sort.
Dr Spence's paper was published in the Journal of Alternative and Complementary Medicine. It is not really research at all. They simply asked 6544 patients who had had homeopathic treatment whether they felt better or not. Half the patients (50.7%) said they were 'better' ot 'much better'. A further 20% said they were 'slightly better'. The patients who had homeopathic treatment were not compared with anything whatsoever!
This is reported in a straighforward way. What is quite ludicrous is the stated conclusion of the paper:
"The study results show that homeopathic treatment is a valuable intervention".
It is obvious that there is not the slightest reason to attribute the answers given by patients to the fact that they had been given homeopathic treatment. That would be the crudest form of post hoc ergo propter hoc error. It does not even show that the homeopathic treatment was producing a placebo effect.
Papers like this do not add to human knowledge, they detract from it. By reverting to pre-enlightment forms of argument, they mislead rather than enlighten. To make matters worse, this work was done at public expense, by the Directorate of Homeopathic Medicine, United Bristol Healthcare, National Health Service Trust, Bristol, United Kingdom.
What on earth is a respectable hospital and medical school, like those in Bristol, wasting money with this sort of mediaeval hindrance to medical knowledge? We are truly living in an age of delusions.
Now the University of Pennsylvania medical school succumbs to mumbo jumbo.
Thanks to Michael White (Professor and Chair, Department of Pharmacology & Physiology,
Drexel University College of Medicine, Philadelphia), who has written to me
saying, inter
alia,
"similar nonsense
goes on in our institutions of higher learning (and not only in California!)". "The
University of Pennsylvania ("America's first School
of Medicine") has entered into an agreement with the Tai Sophia
Institute of Applied Healing Arts to collaborate ".
So another real medical
school has decided to forget science and throw in its lot with the delusional
age. The University of Pennsylvania press
release reads thus.
The University of Pennsylvania School of Medicine and the Tai Sophia Institute for the Applied Healing Arts of Laurel, Maryland, have signed an affiliation agreement to collaborate on education, research and clinical activities in complementary and alternative medicine.
Three initiatives relating to medical education, clinical activities, and the monitoring of the quality of herbal medicines and herbal products are initial targets for the program. The initiatives will include the creation of a Master's Degree in Complementary and Alternative Medicine, to be offered by the Tai Sophia Institute and developed in collaboration with Penn School of Medicine faculty. “This degree program is one of the first of its kind in the nation,” states Alfred P. Fishman, MD, Senior Associate Dean for Program Development at Penn's School of Medicine and co-director of the collaboration.
So, no mention there of finding out whether the mumbo jumbo produces benefits. What exactly is the Tai Sophia Institute? It isn't easy to tell when institutions use words that have no discernable meaning, but try their 'instititional values'.
“All members of Tai Sophia Institute's community – faculty, staff, administration, and students will
Operate from a Declaration of Oneness, a unity with all creation.
Use nature and the rhythms of the earth as a guide in teaching our students and each other.”
So the usual new age gobbledygook. The values go on "Continue our learning in the presence of each other, acting not as truth-tellers but as guides for self-discovery.". Aha, "not as truth tellers". You can say that again.
You could also try the Tai Sophia bookstore. Here you can buy such gems as "Hidden Messages in Water". Here's the description.
“Here is an eye-opening theory demonstrating how water is deeply connected to people's individual and collective consciousness in its ability to absorb, hold, and even retransmit human feelings and emotions. Using high-speed photography, he found that crystals formed in frozen water reveal changes when specific, concentrated thoughts are directed toward it. Emoto believes that since people are 70 percent water, and the Earth is 70 percent water, we can heal our planet and ourselves by consciously expressing love and goodwill.”
What on earth was the University of Pennsylvania thinking about when it associated itself with such pathetic twaddle? Is it that their senior people are so in the grip of the delusional age that they no longer care what's true and what isn't? Or did they just spot a good chance to make money from the gullible public?
It is particularly sad to see such respected places as U Penn fall to
this level. Somehow one is a little less surprised to see Creighton
University is at it too. Where? I hear you say. "Creighton
is a Jesuit university, rooted in the Catholic tradition", in Omaha Nebraska. Perhaps
that goes some way to explaining why they seem to have no difficulty in believing
the impossible.
I have just discovered that anyone is free to suggest a topic to be referred
to NICE (
National Institute for Health and Clinical Excellence). Just click
here and fill in the form. I have just suggested that homeopathy as a
whole be referred to NICE. The objection is likely to be that there is not
a suffciently good evidence base for NICE to deal with it. That, of course,
is exactly why NICE should deliver a verdict. To say otherwise is
to perpetuate the existing double-standard. I tried to counter this argument
in the comment section.
The best chance of success is probably for them to get a flood of
requests –DO IT NOW!
The "evidence" for the effectiveness of magnetic treatments of leg ulcers
was mentioned above all appears to come from a Dr Nyjon Eccles of the Chiron
Clinic in Harley Street (see above). According to emails
in my possession, a patient wrote to the Chiron clinc as follows.
“I have been troubled with leg ulcers for some time
now, and nothing seems to help them. The Daily Mail
said that you have a treatment that uses magnets that
might help. ”
The reply from Dr Eccles said
“Thank you for your query. I am sure we can help you. You are right, a combination of the 4Ulcercare magnetic device with key nutrients should help resolve the problem.
“Cost of consultation is £135. The 4 Ulcercare can be prescribed now as you know and nutrients are likely to cost around £30 for a month's supply.”
So, no more expensive than a real consultant phsyician. But it does seem a little odd that the need for magnets, and the
cost of nutritional supplements could be determined so precisely before the
patient, who "suffered from leg ulcers" had been seen.
The New York Times (17 January 2006) published a beautiful spoof that illustrates only too clearly some of the bad practices that have developed in real science (as well as in quackery). They show, only too clearly, that competition, when taken to excess, leads to dishonesty.
The spoof is, of course, based on the fraudulent papers by Korean cloner,
Woo Suk Hwang, which were published in Science, in 2004 and 2005. As
well as the original fraud, this sad episode exposed the practice of 'guest
authorship', putting your name on a paper when you have done little or no work,
and cannot vouch for the results. The last ('senior') author on the 2005
paper, was Gerald Schatten,
Director of the Pittsburgh Development Center. It turns out that Schatten had
not seen any of the original data and had contributed very little to the paper,
beyond lobbying Science to accept it. A University of Pittsburgh panel
declared Schatten guilty of "research misbehavior", though he was, amazingly,
exonerated of "research misconduct". He still has his job. Click
here for an interesting commentary.
One Last Question: Who Did the Work?
By NICHOLAS WADE
In the wake of the two fraudulent articles on embryonic stem cells published
in Science by the South Korean researcher Hwang Woo Suk, Donald Kennedy,
the journal's editor, said last week that he would consider adding
new requirements that authors "detail their specific contributions to the research submitted," and
sign statements that they agree with the conclusions of their article.
A statement of authors' contributions has long been championed by Drummond
Rennie, deputy editor of The Journal of the American Medical
Association,
and is already required by that and other medical journals. But as innocuous
as Science's proposed procedures may seem, they could seriously subvert
some traditional scientific practices, such as honorary authorship.
Explicit
statements about the conclusions could bring to light many reservations
that individual authors would not otherwise think worth mentioning. The
article shown at left from a future issue of the Journal of Imaginary
Genomics, annotated in the manner required by Science's proposed reforms,
has been released ahead of its embargo date.
Big Pharma and unethical trials
In December 2005, the financial journal, Bloomberg Markets (hardly a revolutionary
organisation) has published a lengthy investigative report which contends that "the
clinical trial drug industry is poorly regulated, riddled with conflicts of
interest, and sometimes deadly."
The problem arises for the privatisation of drug testing. (See also, Marcia Angell's book, above.) The big companies distance themselves from the methods used to do the testing, but they pay the testing companies, who are therefore far from being unbiased. Here are a few quotations from the report.
These medical success stories mask a clinical drug trial industry
that is poorly regulated, riddled with conflicts of interest— and sometimes deadly. Every year, trial participants are injured or killed.
Pharmaceutical companies sponsored 36,839 new clinical trials from 2001 to ’04,
six times more than in the period from 1981 to ’85.
In 1991, 80 percent of industry-sponsored drug trials were conducted by medical
faculty at universities, with protection for participants
provided by the school’s own oversight boards, according
to the New England Journal of Medicine. Now, more than 75 percent of all clinical
trials paid for by pharmaceutical companies are done in private test centers
or doctors’ offices, according to CenterWatch.
The U.S. Food and Drug Administration, the principal federal agency charged
with policing the safety of human drug testing, has farmed out much of that
responsibility to a network of private companies and groups called institutional
review boards, or IRBs. The IRBs that oversee drug company
trials operate in such secrecy that the names of their members often aren't disclosed
to the public. These IRBs are paid by Big Pharma –just like the testing centers
they're supposed
to be regulating.
The oldest and largest review company is Western IRB, founded in 1977 by Angela Bowen, an endocrinologist. WIRB, an Olympia, Washington-based for-profit company, is responsible
for protecting people in 17,000 clinical trials in the U.S. The company oversaw tests in California and Georgia in the 1990s for which doctors were criminally charged and jailed for lying to the FDA and endangering the lives of trial participants.
No action was taken against WIRB.
“The FDA's backbone has been Jell-O,
” says Michael Hensley, a former FDA investigator. “The FDA stopped
enforcing the rules years ago.”
London quackery: The Royal London Homeopathic Hospital
It's about time I dealt with the health fraud on my own doorstep. University
College London Hospitals (UCLH) is not part of UCL, but is a National
Health Service Foundation Trust. The trust is responsible for eight
hospitals: University College Hospital, The Middlesex Hospital, Hospital
for Tropical Diseases, National Hospital for Neurology & Neurosurgery,
Elizabeth Garrett Anderson & Obstetric Hospital, Eastman
Dental Hospital, The Royal London Homoeopathic Hospital and The Heart Hospital.
These are all (but one) absolutely first class teaching hospitals, with responsibility for clinical teaching for UCL medical students. The one blot on the landscape is the Royal London Homeopathic Hospital. This hospital was acquired by UCLH in April 2002. Why on earth is a respectable NHS trust promoting quackery? The UCLH web site says
“The merger enables closer collaboration between complementary therapies and conventional medicine to provide better care for NHS patients. The merger co-incides with the government's commitment to integrate complementary and conventional care within the NHS, where there is evidence of the effectiveness of complementary therapies.”
Notice that the crucial proviso in this statement.
“. . . where there is evidence of the effectiveness of complementary therapies.”
That would be fine If there were evidence of effectiveness, but there is
next to no such evidence. Why does UCLH brush this inconvenient fact under the carpet?
The Trust actually has an absolutely first class
way of assessing the effectiveness of treatments that are used within UCLH.
It is called the Use of Medicines Committee, All
NHS Trusts are required to have such a committee, and UCLH's committee was
singled out for praise after a visit by the Parliamentary Select Committee
on Health, in their
4th report. These committees are required to obtain good evidence
that a proposed treatment works, and their evaluations may be more stringent
than those of NICE.
“ During the inquiry, we visited University College London hospital
to hear about its Use of Medicines Committee. We were incredibly impressed
with its drug formulary, which is used not only by the hospital trust but
by the nearby primary care trusts. Because members of those trusts are on
the committee, it is also well accepted by the GPs in the area.”
So does the UCLH formulary contain homeopathic
and herbal products? If so they will have bypassed entirely the high
standards of evidence that are required by the Use of Medicines Committee
for any other sort of medicine. If these standards were applied to
homeopathic and herbal treatments, the Royal London Homeopathic Hospital
would have to close down, because few of these alternatives to medicine
would pass an evidence-based assessment. Presumably UCLH
Management has foreseen this, and would rather adopt a double-standard
than deal with the political fall-out that would result from applying
rules of evidence to alternative medicine.
A fine example of the abuse of language: Homeopathic podiatry
The UCLH web site says (somewhat ungrammatically): "The Royal London Homoeopathic Hospital is celebrating the first decade of its Marigold Clinic which provides complementary treatment of homeopathic podiatry. "
“ Dr Peter Fisher, RLHH Clinical Director, said: "It is an honour for the hospital to host the Marigold Clinic which has been tremendously successful. The Royal London Homoeopathic Hospital has a history of acting as a test bed for NHS innovation. The complementary cancer service and acupuncture are just two examples of therapies the RLHH has been the first to introduce on the NHS. I foresee the same thing happening with homoeopathic podiatry. It's time has come, current reforms and patient choice are working in our favour." ”
To describe as "innovation" a reversion to a totally discredited 19th century bit of delusional thinking, is a usage that defies belief. See, for example, here and here.
It is embarrassing to a real university like UCL to see a conference,
sponsored by RLHH, on 'Improving
the success of homeopathy' branded with a logo that looks very like
UCL's own (old version) logo. The title carries the assumption that there
is something to be 'improved'. The conference dealt not only with marigold
for bunions, but also HIV/AIDS
What does the Royal London Homeopathic Hospital cost you, the taxpayer?
Guess what? Nobody knows. But with the help of the Freedom of Information
Act 2000, I have been able to make some good guesses.
For a start, at least £18 million has been spent on refurbishing the RLHH. The recurrent costs are not so easy to discover. By use of the Freedom of Information Act 200, this is what I discovered.
The direct cost of running the RLHH is £3.379 million per year of which £3.175 million per year are paid by the NHS. Approximately 75% of the direct costs are for salaries.These are the salary cost of staff working at the RLHH. The staff are medical, nursing, pharmacy, administrative and managerial, and ancillary. The balance of cost is for purchase of drugs, laboratory tests, use of patient beds in other Trust hospitals, building and office running costs.
As well as this, the NHS pays also for indirect services, but nobody seems to know the cost of these (and still less, their value). Indirect services are those not charged directly to the RLHH and will include the following. Payroll, payment and income services, accountancy, recruitment , training, personnel, governance and clinical audit, R and D management and governance, medical and nursing education, training and professional support, communications, I.M. and T., estates maintenance management and planning, catering, cleaning, security, insurance, depreciation, payment of public dividend. These sevices are supplied by the Finance Directorate, Workforce Directorate, Chief Nurse Directorate, Capital Investment Directorate, IM and T Directorate, R and D Directorate, Governance Directorate, Directorate of Corporate Sevices, Communications Directorate.
For the UCLH Trust as a whole, indirect costs amount to 39.2 percent
of direct costs. If that proportion applies to RLHH, then the total annual
cost of RLHH would be £4.7 million.
That sounds to me like a lot of money for a placebo effect.
The RLHH is 97.7 percent homeopathic
Their web site lists eight
consultants, all described as "homeopathic consultants"
and a ninth has been added recently, Dr H. Roniger. Thus it seems that
Lord Winston made an error of fact when he defended the RLHH in the House
of Lords by saying "
My Lords, perhaps I may be allowed to break with tradition and come to the assistance
of my noble friend. Is it not the case that the national homeopathic hospital
conducts perfectly normative medicine and is it not justified in doing that,
irrespective of the efficacy or otherwise of homeopathy, which I believe is
only a small part of its practice?"
This is the breakdown of prescribing at the RLHH (audit taken August 2004,
provided under the Freedom of Information Act). It refers to the number of
items dispensed, not their value (which I am still trying
to discover).
Valid Percent
Valid
Homeopathy
53.2
Herbal tinctures and potencies <6x
5.7
Iscador products
2.8
Aromatherapy
.2
Marigold products
4.2
Creams/ointments
13.5
Tablets/nutritionals
1.3
Supplements/homeopathic (New Era Products)
7.8
Nutraceuticals
3.4
Anthroposophicals medicine
1.2
Allopathic products
2.3
Weleda
2.0
Flower essence
1.5
other
1.0
Total
100.0
NB: Creams are herbal or homeopathic.
And the cost of CAM in Glasgow
A freedom if Information Act request elicited the following costs. Much of
the information I asked for is not even recorded.
The cost of the Glasgow Homoeopathic Hospital.
The running costs for the Homoeopathic Hospital were:
2004/05 £1,658k
2005/06 £1,881k
The cost of all CAM services at Baillieston Health Centre
There is no record of any specific costs associated with CAM incurred at Baillieston Health Centre.There was many years ago a Baillieston Childrens' Homoeopathic Clinic but this service was subsumed into the new Glasgow Homoepathic Hospital. That hospital opened in 1999 at a total capital and building cost of £2,780,189.The total cost came from the New Homoeopathic Hospital Endowment Fund.
3) The cost of CAM provided by GPs or any other part of the Trust.
There is no record of specific costs associated with GPs or others employed by the NHS Board providing complementary and alternative medicine. If homoeopathy, hypnosis, acupuncture or any other form of complementary medicine is provided it is not as a costed, discrete service.
The table shown above shows the precribing habits at the Royal London Homeopathic Hospital, The 4.2 percent of precriptions labelled 'Marigold products' in the Table were for the products od a company called Marifold Footcare Ltd.
“Dr M Taufiq Khan founded the Marigold Clinic in 1981 at St Pancras Hospital, London, and then established it in 1992 at the RLHH. Dr Khan is the Director of Homeopathic Podiatory Sevices at the RLHH and specialises in the treatment. His son Dr Tariq Khan, is the Deputy Director.”
The list above shows that 4.2% of all precriptions at RLHH were for "Marigold Products". This company is Marigold Footcare Ltd., 134 Montrose Avenue, Edgeware, Middlesex, HA8 0DR.
Dr Mohammed Taufiq Khan, PhD of 134 Montrose Avenue, Edgeware, Middlesex
Mr Mohammed Taufiq Khan of Bedford House, 17 New North Street, London
Mrs
Shamim Fatima Khan of 134 Montrose Avenue, Edgeware, Middlesex
It appears that the director and deputy director of the Marigold Clinic are
paying substantial amounts of NHS money to their own company.
From left to right: Dr Taufiq Khan, Dr
Peter Fisher, Lord Paul of
Marylebone and Dr Taufiq Khan
open the Sick
Feet - Healing
Flowers exhibition.
Research-based? Which research?
The web site of the Marigold Clinic makes the following claim.
Research-based medicine:
Marigold therapy is an integral part of homoeopathic podiatry. It comprises specially formulated medication applied topically in conjunction with podiatry. It is research based medicine which has been clinically evaluated in double blind placebo controlled trials at British Universities and NHS Trusts.
“The safety and efficacy of Marigold Therapy have been demonstrated through extensive clinical use in podiatry clinics and numerous studies and in randomised, double blind, placebo controlled trials: (1) at the University of Brighton (Faculty of Health); (2) University of East London (Institute of Health and Rehabilitation, Faculty of Health and Science); (3) University of London (Faculty of Medicine, School of Pharmacy and the Royal London Homeopathic Hospital).”
This sounds impressive, but what exactly is this research? All I can find in Pubmed about marigold treatment
in podiatry is two papers. One is in the Journal of Pharmacy and Pharmacology (1996,
48, 768-770) and one is in Phytotherapy Research (1996, 10, 211-214).
And who is the first author on both of these papers? You guessed: M.T. Khan.
The first paper (Khan, 1996) is from the School of Pharmacy, the second (Khan,
Potter and Birch, 1996) is from School of Pharmacy and the podiatry department,
Leaf Hospital, Brighton. I can find no trace of publications from the University
of East London or from RLHH. Repeated requests for references elicited
no reply at all for a long time.
Eventually, I had a reply from M. Tariq Khan in response to my request for references to back the claim on their company's web site. He sent a list of 54 assorted conference communications and student projects, and 28 "papers" published in Journals. Every one of these 82 items bore the names of one or both M. T. Khans. There were no more 'serious' papers than Pubmed had revealed. There appears to be no independent verification whatsoever of their claims.
Reaction of the UCLH Trust
The UCLH Trust, when notified about what was going on, referred the matter
to Dr Peter Fisher, the homeopath and clinical director at rhe RLHH. Tonia
Ramsden, Director of Corporate Services for UCLH told me on July 27 2006
"I
can confirm that I have received and registered the declaration of Interest."
Quite true, It was only later that I was told that the
declaration of interest was received by the Trust only after I had
told them about what was going on!
Peter Fisher, assured me that he was aware of the Khan's behaviour. Rather surprisingly, he seemed to think that no conflict of interest was involved. He said
“Thank you for drawing to my attention the potential conflict of interest in relation to podiatry. The management of the RLHH has always been aware of the situation”
That was it. No comment at all was made on the propriety of the Khans' behaviour. Dr Fisher also assured me that the evidence for the efficacy of marigold products was good, without actually citing what this evidence was. I replied thus.
“I find it quite disturbing that you say below that “the RLHH is committed to evidence-based practice”, but that you seem to regard as evidence two small papers, both from the same people with a financial interest in the outcome, and not replicated elsewhere. Incidentally neither of these papers declared the authors’ financial interest. It is equally disturbing that your letter to me does not seem to give a realistic idea of the strength of the evidence. I had to find that for myself. ”
Declarations of interest shoud be public, but are not,
A declaration of conflict of interest is, I suppose, better than nothing.
But these pieces of paper sit in a drawer in the Trust. They are kept secret
from both the public and the patients. The patient should know when the
prescriber has a financial interest in what he prescribes, but they are kept
in the dark. When I wrote to the UCLH clinical governance committee
to suggest a bit more openness would be desirable, they did not even bother to
reply. That is when I decided to make this information public.
“In Fall 2003, we introduced the first CAM-oriented, science-based MS program at a US Medical Center.”
“With the tremendous public interest in complementary & alternative medicine (CAM), we anticipate the need for scientists and physicians trained to understand the basic principles of both Western biomedicine and CAM modalities”
Which 'basic principles' of CAM? The 'basic principles' of things like homeopathy and acupuncture are just pseudo-scientific gobbledygook. There is nothing comprehensible to learn.
The CAM MS in Physiology is designed for students who fit into any of several categories in terms of background and eventual career placement:
* Those interested in a research career (often with further training at the doctoral level) in a CAM-related area
* Students wishing to pursue a career within the CAM industry
* Those interested in administrative or regulatory affairs careers related to CAM within the public sector
* Practioners or potential practitioners of CAM modalities seeking basic science education relevant to their practices
* Those who wish to have a strong understanding of CAM modalities while pursuing a career in medicine
The sort of people it is designed for, those "wishing to pursue a career in
the CAM industry", makes a nonsense of the claim that the course is scientific.
If it were, the graduates would certainly not wish to work in such a dishonest
industry. Georgetown University does describe itself as "Catholic and
Jesuit", but surely that does not preclude a bit of honesty?
The course description sounds harmless enough, "
This course provides an accessible but rigorous introduction to complementary
and alternative approaches to health.". But just how rigorous is
it? The game is given away when you see that the "experts" seem mostly
to be true believers, people who make their living from alternative medicine.
How can such people be expected to the merits of the systems of beliefs that
are the basis of their livelihood? It is rather like having a rigorous discussion about the existence of god in which all the course tutors are priests. Take some examples.
The bit about Testing
Therapies is by Elaine Weatherley-Jones, She is in clinical practice as a homeopath. And as you might expect the three pages
on the web about 'testing therapies' are highly partisan and selective. Try
these quotations.
“In homeopathy, the vital force is said to be responsible for maintaining health, combating disease by recruiting the body's natural tendency to cure itself. In the homeopathy model, disease occurs when the vital force is not working efficiently to keep the balance of health.”
“. . . in The Manual of Conventional Medicine for Alternative Practitioners: "The
essence of alternative medical thought is that there is a vitalistic principle
behind and encompassing any physical object", explaining that "vitalistic" means
that there are "objects which are non-physical in part or whole". The vital
force of homeopathy and qi of TCM are non-physical – it's impossible to see
them, no matter how powerful an electron microscope was used. Qi and the vital
force are ideas that are put forward to explain how the body heals itself.”
"Vital forces"? Which century are we living in? If this were offered as
social studies, perhaps it would not matter, but the Open University is offering
this course as part of a B.Sc. degree. Then we get the usual weasel words about
the impossiblity of testing empirically whether alternative medicines (CAM)
produce an effect, regardless of how they work. That is the important question.
After all we are pretty vague about how some conventional drugs work. In a mind-boggling
passage we are told that it is impossible to test CAM against a placebo,
but quite possible to test CAM against an orthodox treatment.
It seems, incidentally, that the author's grasp of pharmacology, and of the literature, is a bit weak.
“. . . when Belon and his colleagues reported research in 2004 in the journal Inflammation Research, they showed that ultra-high dilutions of histamines (which are proteins involved in allergic reactions and causes, for example, inflammation of the breathing tubes in asthma) are active in influencing human cell activity.
”
Histamine (there is only one), is not a protein? This is meant to be a university
course! Belon, of course, is a committed homeopath. This passage conveniently
ignores the fact that his experiments have been repeated at least twice by
respectable scientists, and they find no such effect. Surprisingly enough, they
find that no drug gives no response. Amazingly, it seems that the OU would
have us think otherwise.
The rest of the course seems to be much the same. The dispassionate expert
on Herbal
medicine is a herbal practitioner who makes his living from it, and is just
as uncritical as one might expect in that circumstance. Unlike Weatherley–Jones,
though, he does come clean (more or less) about the lack of evidence as to
efficacy of herbal remedies (though that evidently does not deter him from
practising the subject).
The "expert" on
acupuncture, Rosey Grandage, is a bit more interesting on the history of
her subject, but is every bit as committed to CAM as the others.
She works at the University
of Westminster as course leader of the Diploma in
Qi Gong Tuina and also lectures on the BSc Acupuncture course.
"
Rosey practices as a physiotherapist, acupuncturist and tuina practitioner in
West London". Hardly an unbiased observer.
“ . . . it is this growing popularity which answers the question of whether acupuncture has a place in the modern world.”
Is it not obvious that the long persistence, and popularity, of an idea cannot
possibly be used as an index of truth? One merely has to think of the long-persistent
and popular ideas about the 'one true god'. Clearly at most one of these can
be true. The history of medicine is replete with popular and persistent ideas
that turned out to be untrue. Take nux vomica. For hundreds of years conventional
medicine regarded strychnine as a 'tonic'. That persisted right up to the 1950s.
But it became apparent that it just did not work, and strychnine, and
the very word 'tonic', vanished from the vocabulary of rational medical people.
You won't be surprised to find, though, that is still widely touted by fraudulent
herbalists.
It could be argued that the course is intended as sociology rather than science, though the course description does not say so, and the course can count towards a BSc. Even as sociology though, it would seem better if the viewpoint of the tutors was rather broader.
The course books
I have now obtained copies of the three course books that
were used for K221 last year.. They are indeed written largely as sociology
not as science. But
it is a highly biased sort of sociology, as one might have expected from the
commitments of the authors. Although there are occasional references
to lack of evidence, this does not seem to deter the authors from their relentless
pursuit of the 'integration' of CAM into medical practice. A superficial
reading by a naive student might give an impression that the books are a "rigorous
introduction to CAM". The more sophisticated student is likely to
see them as subtle, even insidious, propaganda. I won't claim to have read all three books. Opening almost any page makes obvious their not-very-hidden agenda. Here are a few examples from CAM: Structures and Safeguards (eds. Geraldine Lee–Treweek, Tom Heller, Hilary MacQueen, Julie Stone and Sue Spurr).
Chapter 5 (Homeopathy: principles practice and controversies) contains a ludicrously biased account ot the affair of Jacques Benveniste (see here and here). There is no mention of the fact that his results were disproved at the time, and at least twice since, I know of only one group that has claimed similar results, and that group, like Benveniste's, contained committed homeopaths. There is no mention of Beneveniste's two Ignobel prizes. There is no mention of the fact that after he left France in disgrace, he went on to claim that the properties of the alleged memory of water could be sent by email, a claim so absurd that it has not persisted even within CAM.
This chapter
uses the standard CAM trick of redefining the word efficacy. Rather
than its usual meaning of having an effect greater than placebo, it is conveniently
redefined to mean, roughly, 'patients say they feel better',
“Although the issue of whether or how homeopathic remedies 'work' is a major
bone of contention for medical scientists, the fact that they perceive that
the remedies do work makes it attractive to many orthodox medical practitioners.”
So that's OK then. Don't trouble yourself with what's true.
Chapter 1 of 'CAM: Structures and Safeguards' has the title "Knowledge,
names, fraud and trust", and is by Geralidine Lee-Treweek. It is a fine
example of relativism -almost post-modernist in style. This is a discussion
of knowledge in which the words 'true' and 'false' barely appear. The student
who lent me the book has scribbled in the margin "If it is not true and
right –then it is not knowledge". Pass the student, fail the
tutor. (in fairness, it has to be pointed out that the student passed
with distinction, despite her scepticism.)
So does Open University course K221 really give you a "rigorous
introduction to complementary and alternative approaches to health. " No it seems that it does not. Here are some more reasons.
A student who has successfully completed course K221 has told me that
“It was very anti-science and anti-orthodoxy in places”
“I had several 'discussions' with her [OU tutor] in our online tutor
group, some about her anti-vaccination stance and the fact that she was happy
to give homeopathic anti-malarials to travellers.”
The argument that homeopaths at least do no harm (see above) seems to be destroyed by their advocacy of policies that will lead to more children getting measles, and which will contribute to the spread of malaria. There is an ultimate irony in OU tutors preaching against vaccination. Walter Perry, the first vice-chancellor of the OU, before he was my supervisor in Edinburgh, had been Director of Biological Standards at the Medical Research Council's labs. In that job he had responsibility for introduction of polio vaccine in UK. That effectively eliminated the scourge of polio.
This is not what a real university should be doing, as part of a B.Sc. degree.
BBC2 TV showed a much-advertised series on alternative
medicine.
The programmes seem to be linked with the dubious Open University course described above.
The programmes are presented by Kathy
Sykes, who is professor of the public understanding of science
at Bristol University. She has done some excellent work in that area,
for example, in the Rough
Science TV series.
The first programme: acupuncture
The first programme,
on acupuncture, was shown on 24th January, 2006. The programme did not start
in a very promising way. Just lots of testimonials from happy patients, the
staple diet of all snake oil salesmen.
They are watchable, of course, but don't do anything at all to promote public
understanding of what constitutes evidence.
There is, of course, little doubt that sticking needles into your body can
produce physiological responses. Two things remain uncertain.
Just how
useful are these responses in helping particular conditions?
Is there
anything at all in the mumbo jumbo of meridians and chi?.
With a big flourish we were shown “a 21-year-old Shanghai factory
worker undergoing open-heart surgery with only the needles to control her
pain”. It turns out that this was a sham. The patient was doped on opiates
and local anaesthetics. The needles were mrely cosmetic. Why were we not told?
The apparently contradictory trials reported above suggested
that, at least the alleged principles of acupuncture are nonsense. The programme
concentrated on a trial by Berman (Ann
Intern Med. 2004,
141, 901-10 ) which used 'sham acupuncture', with 'stage dagger
needles', on osteoarthritis of the knees. In this sort of trial there is no
actual penetration, and the sham needles are placed on the places dictated
by the mumbo jumbo. This procedure was justly criticised by a subsequent letters
in the same journal (Ann
Intern Med 2005, 142, 871).
Another large study was ignored by the TV programme altogether. This was by Linde et al. (Journal of the American Medical Association. 2005 293(17):2118-25). This study concluded
“Acupuncture was no more effective than sham acupuncture in reducing
migraine headaches although both interventions were more effective than a waiting
list control.
”
As pointed out above, this study is, in many ways, much
more interesting than Berman's, because the control group did not have 'sham
acupuncture'. Needles were really inserted, but they were inserted in points
that have nothing to do with the mumbo jumbo of meridians. The fact that the
controls were much the same as the treated group suggests that, whatever effect
the needles produce, it doesn't matter much where they are inserted. The only
obvious interpretation of this is that the 'principles' on which acupuncture
is based are so much nonsense (and, therefore, it is not a subject that can
possibly be taught in a university).
This crucial point was ignored by the TV programme. A big fuss was made
of a functional magnetic resonance experiment, staged for TV, that showed
that the effects on brain 'activation' are different for superficial needling
and for real needling. There is nothing in the least surprising in the observation
that have a needle pushed into you affects the brain, but it really does not
help at all in answering the important questions. Incidentally that experiment
had already been done anyway.
In summary, the first programme, failed to give a fair assessment
of current knowledge about acupuncture, and failed to consider the important
questions of what sort of controls are appropriate, and whether talk of meridians
means anything whatsoever. Sadly, I can't agree with the boast that
"It's the deepest investigation into the efficacy of alternative medicine
ever attempted on TV". Let's
hope the second programme is a bit more critical.
The second programme: healing
The second
programme (31st January, 2006). I liked this programme much better than
the first, even if it left the crucial questions unresolved.
The programme started
with a healing meeting by the notorious Benny Hinn. The meeting had
all the mass hysteria of a Nuremburg rally, though no mention was made
of the fact that this (very rich) man's financial malpractice had been
revealed by a CBC TV
programme. On the right is his receipt for £3347 for two
nights at the Lanesborough hotel in London (that did not include $1700 he
gave in tips).
The lovely Ghanaian lady who cleans my office and lab every morning gives
gives money to this mega-rich man because "he needs it to preach the gospel".
Kathy Sykes did, though show a pretty healthy degree of scepticism about the
people who pretend to photograph "auras" and other imaginary "force fields".
She visited the "Center
for Frontier Medicine in Biofield Science" at the University of Arizona.
The National Institutes of Health provided $1.8 m of US taxpayers' money for
this project which seems not to do real research at all. After seeing a demonstration
of the "Gas Discharge Visualization", GDV, or Kirlian camera, given by a very
gullible Dr Melinda Connor, Sykes comments that this 'research'
“is not so much trying to find the evidence for 'healing energy',
but is rather working on the basis that there is one”
In other words, the 'research' is a con. Once again (see
above) we see money
given by well-intentioned governments diverted form the purpose for which
it was given. For more first class boloney on 'imaging', see for example,
Biofield Sciences in Exeter
(UK) and 'electro-crystal
therapy'. The list is endless.
Kathy Sykes went on to show several interesting experiments on placebo effects.
For example sham healers (played by actors) do at least as well as 'real' healers. And
sham knee surgery may be as effective as real surgery, though the programme
failed to mention the obvious possibility that this could mean nothing more
than that real knee surgery is itself pretty ineffective. As so often
in this series, the producers failed to talk to the right people.
She concludes "healing does not work beyond placebo".
So I'm right with her, though it would have been better if there had been
a more critical mention of the fact that not all placebo effects are real.
Many probably depend on the natural fluctuations in the intensity of
the patient's condition. Anything can 'cure a cold', because you recover
from a cold in a few days anyway,
Sykes concludes, speaking of the placebo effect, "I want to see
that power properly harnessed -we'd be mad not to". But
that, disappointingly, was the end of the programme. That point is
where the problems begin. How do you harness the placebo effect? How
do you justify lying to the patient in order to maximize the effect? How
do you train the 'healers'? Are they themselves to believe the same lies,
or are they to be trained in the art of deception? As pointed out in
a recent review of the neurobiology of placebos (Colloca and Benedetti, 2005)
"For example, the assertion
that placebos, fake therapies, fresh water and sugar pills could positively affect the brain biochemistry in the
appropriate psychosocial context might lead to a dangerous justification for deception,
lying and quackery".
These are the central dilemmas
of sCAM, as listed
at the top of
this page. The programme did nothing to solve them, or even to draw attention
to them.
“So, could the power of the mind explain the benefits people experience from healers? And have healers tapped into this power somehow? The conclusion throws new light on all healing processes, and has a surprising and inspirational message for every practitioner and patient.”
But what is to be done about this "inspiration"? Nothing is said
about that. The
TV programme was immediately followed by voice-over that
advertised an Open University pamphlet, which is publicity for their course K221. That course, judging
from what is posted on the web, is run by true believers who are a lot less
sceptical than Sykes. She says that she did the voice-over but has not yet been shown the contents of the course.
The third programme: herbalism
Oooh dear. The third programme was, in my view, by far the worst.
Hardly a single critical voice was heard. Despite the odd word of reservation,
the programme left the impression of being an advertisement for
the herbal medicine industry. Did the BBC not think of asking
a pharmacologist? In my view, this
programme was a disservice to human knowledge. Let's look at some of
the details.
The programme once again starts with dramatic testimonials from satisfied
customers. No hint is given to the viewer of the total unreliability of such
testimonials. References, in awed voice, are mad to "a vast body of ancient
knowledge that herbalists draw on". No mention of the superb track
record that 'ancient knowledge' has for turning out to being dead wrong. It
was 11 minutes into the programme before the question of evidence was even
mentioned and then we had a herbalist wandering through a field. At 13 minutes,
the herbalist, Simon Mills, was interviewed -he rattled on about dampness.
marshy conditions. "There
are herbs for heating and drying".
Sheer gobbledygook. And still no discussion of evidence.
Sutherlandia At 18 minutes "To
get another view I'm going to a country where herbs are claimed to have dramatic
effects". Off to Africa to spend a good 10 minutes on Sutherlandia,
a totally unverified treatment for AIDS. Why spend all this time (and
licence-payers money) to end up with the conclusion that clinical trials have
not been done yet, and we have no real idea whether it works or not? A
search of Pubmed for Sutherlandia and AIDS produces a mere five papers. Mills et
al. Nutrition Journal 2005, 4:19 write as follows.
"Despite the popularity of their use and the support of
Ministries of Health and NGOs in some African countries, no clinical trials of efficacy exist, and
low-level evidence of harm identifies the potential for drug interactions with antiretroviral drugs."
(and one of the authors on that paper is from the Canadian College of Naturopathic
Medicine: hardly likely to have a bias against herbs). The comments
made in the programme about AIDS were irresponsible and potentially dangerous:
they could kill people..
It took until almost half way through
the programme, before we got round to the question of whether any of these
claims are true. Very impressive to learn that the Nazis pushed herbal medicine,
but totally uninformative (or does it mean that herbalism appeals to nutters?).
We are shown the German herbal bible, but again it is pointed out that it
contains no evidence about their efficacy. So no further forward yet. Then
we are introduced to chromatography: very pretty, but still no evidence
about whether herbs help people.
At 9.34 pm we are
last get round to some evidence. Or do we? Not yet, just another personal testimonial
about the the wonders of St John's Wort. St John's Wort (Hypericum)
is an interesting case, because there is at least some evidence that it works,
though certainly not enough for it to be described as a "superherb",
as Sykes did. Of course depression (like knee surgery -above) makes a pretty good
case for herbalists, because conventional antidepressents are so very unsatisfactory
themselves. It doesn't take much to do better than Seroxat (Paxil, paroxetine). At
9.38 pm we get the first actual numbers. And very selective numbers they are
too. The view presented in the programme was desperately over-optimistic about
the wondrous effects of St John's wort. Consider the recent review by
Linde et al. (2005 Brit J. Psychiatry, 186, 99-107) (read
it yourself -download pdf file). The
conclusion was as follows.
“Current evidence regarding Hypericum extracts inconsistent
and confusing. In patients who meet criteria for major depression, several
recent placebo-controlled trials suggest that Hypericum has minimal
beneficial effects while other trials suggest that
Hypericum and standard antidepressants have similar beneficial
effects. ”
And another trial, again not mentioned in the programme, was published in Journal
of the American Medical Association, 2002, 287, 1807 – 1814)
[download the pdf file]. This paper was
interesting because it compared placebo, St John's Wort and sertraline (Zoloft,
a drug of the same class as Seroxat). All three were indistinguishable
(on the two primary outcome measures). So St John's
Wort was as good as Zoloft, but only because Zoloft was no better than placebo
either. The
paper concluded thus.
“This study fails to support the efficacy the efficacy of H. perforatum [St
John's Wort] in moderately severe major depression. The result may be due to
low assay sensitivity of the trial, but the complete absence of trends suggestive
of efficacy for H. perforatum is noteworthy.”
Why were we not told about trials like these?
At 9.43 pm, almost three quarters of the way through the
programme, we are eventually told that ginseng, echinacea and evening primrose
oil do not work. What took so long?
9.46 pm. Off to South Africa to look at research in Johannesburg
on Sutherlandia by Carl Albrecht (more of him below).
Some impressive stuff about flavonoids but no
results. Flavonoids
can't be absorbed, but, aha, it contains saponins too. Perhaps they allow the
flavonoids into cells. Well perhaps.
But this is not information, it is idle speculation.
At 9.51, we get back to brain imaging, this time at Imperial College. Professor
Sykes seems to be excessively impressed by brain imaging. We are then treated
to more idle speculation about how ginko might help in Alzheimer's
disease. Dr Warner is running a clinical trial to find out whether ginko really
helps. But there were no results yet. In that case why not wait until there
is a result, before telling us all about it?
We are told that herbs now "have to go through rigorous quality standards". It
was NOT made clear that the standards don't include anything about the herb
actually doing anything useful. The standards may give some protection
against your being poisoned. They do nothing at all to guarantee you'll
be helped.
The conclusions
"What's really impressed me is the way that different ingredients from particular herb can combine together and have really powerful
effects on us humans. So I believe that herbs are going to play a key role
in medicines of the future"
"What started as an ancient wisdom may just might provide new medicines that will help us all live longer, fuller lives"
These statements are quite outrageous! The first statement has
no basis whatsoever. It is sheer idle speculation. It could be
true, but there is no reason to believe it is.
The second statement is content-free. Yes, it "may just" do
that. On the other hand it may not.
The web site for the third programme. (7th February, 2006, 2100-2200) concludes thus.
“So, what's their secret? Working with fellow scientists, Kathy discovers that plants contain much more than a single – or even two or three – active ingredients. They are enormously complex chemical cocktails that have medicinal properties modern pharmaceuticals simply can't reproduce.”
Just one snag (apart from the misleading implication the Sykes was
doing pharmacological experiments), There is not the slightest reason, thus
far, to think there is any advantage in using an "enormously
complex chemical cocktail".
Stop press: on Saw palmetto (one of the “superherbs” of
the TV series)
The New England Journal of Medicine, for February 9th 2006 (354, 557 – 566), reports a clinical trial of "Saw Palmetto for Benign Prostatic Hyperplasia". This is what they say.
“Saw palmetto is used by over 2 million men in the United States for the treatment
of benign prostatic hyperplasia and is commonly recommended as an alternative to
drugs approved by the Food and Drug Administration.”
“In this double-blind trial, we randomly assigned 225 men over the age of 49 years
who had moderate-to-severe symptoms of benign prostatic hyperplasia to one year
of treatment with saw palmetto extract (160 mg twice a day) or placebo.”
“Conclusions. In this study, saw palmetto did not improve symptoms or objective measures of
benign prostatic hyperplasia.”
I hope that the BBC, the Open University and Prof Sykes now appreciate the
folly of judging treatments before the results are in.
Three pharmacological ideas are relevant. None of them were mentioned in the programmes.
Evolution of plants
Plants didn't evolve for our benefit. Natural
selection ensures that plants, like every other living thing, evolve in a way
that maximises their own chance of survival. To ensure that, plants should
be as toxic as possible to anything that might eat them. The more harm
a plant does to humans, the better its chance of survival. It is
sheer luck that some of the toxic principles evolved by plants occasionally
turn out to be useful.
Memo to: The members of the Kansas Board of Education
From: God
Re: Your decision to eliminate the teaching of evolution as science
'Thank you for your support. Much obliged. Now, go forth and multiply.
Beget many children. And yea, your children shall beget children. And
their children shall beget children, and their children's children after
them. And in time the genes that made you such pinheads will be eliminated
through natural selection. Because that is how it works.' . . . ; By Gene Weingarten, Washington Post Staff Writer Saturday, August 14, 1999; Page C01
Naturalness
Here are some products of nature. That doesn't mean they are good for you.
Lead, uranium, radon, arsenic, thallium, strychnine, cyanide (in Sorghum and Prunus species),
Stinging nettles, poison ivy, yew, deadly nightshade, castor beans (ricin), tobacco, curare, foxglove, fly agaric, (muscarine), death cap (amanita phalloides), . . ..
Foxgloves, heart failure and biological standardisation
Here is a bit of relevant pharmacological history.
The 24th edition of Martindale's Extra Pharmacopoeia (1958) describes Digitalis
Leaf (B.P., I.P.), also known as Digit. Fol.; Digitalis; Foxglove Leaf; Feuille de Digitale; Fingerhutblatt; Hoja de digital. It was defined as "the
dried leaves of Digitalis purpurea (Scrophulariaceae)."
At that time it was sometimes prescribed as Prepared Digitalis (BP),
which is "Digitalis leaf reduced to powder, no part being rejected, and biologically
assayed the strength being stated in units per g. For therapeutic purposes
it must be adjusted to contain 10 units in 1 g."
Sometimes foxglove leaf was prescribed
as Tincture of Digitalis (B.P., I.P.). “It may
be made from unstandardised leaf, the tincture being subsequently biologically
assayed, or it may be made from prepared digitalis, using a quantity containing
1000 units per litre, by percolation or maceration, with alcohol (70 %). It
contains 1 unit per ml. I.P. allows also 1 unit per g. Dose: 0.3 to 1 ml. (5
to 15 minims). ”
Although these preparations are now totally defunct, they were still better
than the sort of thing that is now advocated by herbalists. Why? They
were better because they were standardised.
[I should make it clear
that herbalists cannot prescribe digitalis itself: I am talking about plant extracts in general].
Foxglove leaves contain several chemical compunds that are useful in certain
forms of hear failure. But the margin of safety is quite low. Take
a bit too much and it kills you not cures you. One batch of foxglove leaves
will contain different amounts of active compounds from the last batch, and
that endangered patients.
From the 1930s onwards, pharmacologists developed
methods of biological assay that overcame this problem. An international
standard digitalis leaf sample was established. Every new batch had to be assayed
against this standard, and diluted to a fixed level of biological activity.
This ensured that each batch of digitalis powder had the same biological
potency as the last batch. It was a great pharmacological advance in its
time. But of course it did involve the use of animals for the biological
assay.
All this was solved when the active principles were purified from the foxglove
leaves. There was no longer any need to uses animals for biological assays.
The right amount of pure digoxin or digitoxin could be weighed out.
Fortunately herbalists are not allowed to prescribe anything as potentially
dangerous as digitalis. But in general herbalists are happy to use pre-1930,
unstandardised plant extracts. I can think of no case in which there
is the slightest reason to think that the mixture of chemicals in the plant
is any better than the purified active principles. Of course there could be
such cases. But that is all idle speculation, something we saw only too much
of in the TV programmes.
“So having started out as a sceptic, Sykes ended the programme chirruping, like a born-again Christian, about how herbs contain complex combinations of chemicals that scientists cannot yet reproduce”
Simon Singh writes in the Daily
Telegraph (14 Feb., 2006): "Did
we really witness the 'amazing power' of acupuncture?
“A BBC series on unorthodox therapies was devoid of scepticism
and rigour, says Simon Singh.”
“Although the second programme was indeed a rational look at the placebo effect, the other two episodes were little more than rose-tinted adverts for the alternative medicine industry.”
“For example, the scene showing a patient punctured with needles and undergoing open heart surgery left viewers with the strong impression that acupuncture was providing immense pain relief. In fact, in addition to acupuncture, the patient had a combination of three very powerful sedatives (midazolam, droperidol, fentanyl) and large volumes of local anaesthetic injected into the tissues on the front of the chest.
With such a cocktail of chemicals, the acupuncture needles were apparently cosmetic. In short, this memorable bit of telly was emotionally powerful, but scientifically meaningless in building a case for acupuncture. ”
“This TV series pretended to be scientific and had the chance to set
the record straight, but instead it chickened out of confronting the widespread
failure of alternative medicine. ”
Advertisers cash in. Sadly, but predictably, the programme on herbalism has
already been exploited by vendors of unproven treatments. While it is true
that the programme did not actually assert that this herb cured AIDS, it certainly
left the impression that it was good stuff. Here is an example: "As
seen on BBC2"
“In South Africa, BBC 2 TV presenter, Professor Kathy Sykes learnt of the herb Sutherlandia, which is being touted as a new weapon in the fight against HIV and AIDS.”
“It is with thanks to programmes such as Alternative Medicine shown on BBC 2 on Tuesday 7th February, and the work carried out by Professor Kathy Sykes that medicinal herbs can receive the acknowledgement they truly deserve, and this knowledge be passed on to the general public.”
“Bioharmony Sutherlandia is available from Revital Ltd in 60 x 300mg tablets for £19.99rrp. ”
A groundbreaking experiment ... or a sensationalised TV stunt?
Simon Singh, in The Guardian (25 March 2006) followed through with some more details on the BBC2 series. It's not only pharmacologists who were unhappy about it. So were several of the people who advised the BBC and/or appeared on the programme.
“But this week scientists involved in the series have complained that elements of the programmes were misleading, the production team was uninformed, and scientists were used as "marionettes" ”
At the end of the first programme a "hugely ambitious" imaging experiment was shown with an enormous flourish. The outcome was, roughly speaking, that pushing needles into yourself produces a signal in the brain. Good heavens! Who'd have thought it? Even George Lewith, normally an apologist for CAM, was critical.
“The interpretation of the science in this particular programme was not good and was inappropriately sensationalised by the production team. I think all of us on the experiment felt like that.”
“The experiment was not groundbreaking, its results were sensationalised and there was insufficient time to analyse the data properly and so draw any sound conclusions. It was oversold and over-interpreted. We were encouraged to over-interpret, and proper scientific qualifications that might suggest alternative interpretations of the data appear to have been edited out of the programme.”
Edzard Ernst, professor of complementary medicine at Exeter University, and the main consultant for the series says:
"The BBC decided to do disturbingly simple storylines with disturbingly happy endings. But none of these stories is as simple as they presented, nor do they have such happy endings. Even when the evidence was outright negative, they somehow bent over backwards to create another happy ending.
"I feel that they abused me in a way. It was as if they had instructions from higher up that this had to be a happy story about complementary medicine without any complexity, and they used me to give a veneer of respectability."
The BBC, thus far, remain unapologetic
"We take these allegations very seriously and we strongly refute them.We used two scientific consultants for the series, Prof Ernst and Dr Jack Tinker, dean emeritus of the Royal Society of Medicine, both of whom signed off the programme scripts."
This is the same Jack Tinker who, as Chairman of the Ethics Committee of the Dr Foster organisation, also approved their "COMPLEMENTARY therapists Guide 2004", and the utterly uncritical complementary practioner directory. The 'Dr Foster' organisation is a commercial business that supplies "management information", "market research services", "marketing services" and "information for the public". Let's hope their services in conventional health care are a bit more critical than their evaluation of CAM. Their "Guide to [CAM] therapies" repeats all the usual pseudo-scientific gobbledygook in a totally uncritical way.
Singh's article ended with some quotations from this site, concerning Sutherlandia and AIDS, with the remark made above, highlighted: "Comments about Aids were irresponsible and potentially dangerous".
Science accuses BBC of medical quackery
Lois Rogers, in the Sunday Times for 26th March, reports on the same topic.
“Ernst yesterday released the contents of a letter that he has written
to Martin Wilson, the series producer, criticising him for promoting “US-style
anti-science”.
He said he felt “abused” by the programme makers: “It was as if they
had instructions from higher up that this had to be a happy story about
complementary medicine without any complexity, and they used me to give
a veneer of respectability.” ”
“This is no longer a fringe game played by new age people,” said Colquhoun. “It
is beginning to erode intellectual standards at real universities.”
Later a letter appeared in defence of the programmes. This is dealt with below.
Alternative Medicine series: dirty tricks at the BBC?
Following the article by Simon Singh in the Guardian ((25 March 2006), two
letters appeared on April 1, 2006. The first, from Prof. Edzard Ernst, confirmed that he felt the BBC had ignored and misrepresented his advice.
In its response to our criticism of the Alternative Medicine series, the BBC says "it is extremely unusual that Professor Ernst should make these comments so long after the series was aired" (Report, March 25). I made my criticism in writing two months before the programme was broadcast. The reason why I reiterated them when I did was simply because Simon Singh interviewed me in my capacity as adviser to the BBC. Extremely unusual? Long after? I don't think so. Prof Edzard Ernst
Peninsula Medical School, Exeter
The second letter defended the BBC. It was unequivocal in its support of the
entire series of programmes, and its appearence surprised me. In the
light of all that has been written, one might have hoped that the BBC would
listen and learn from its mistakes. The letter has ten signatories.
We are all scientists involved as consultants or contributors to the BBC2 series, Alternative Medicine. We do not in any way recognise the experience of working on the series as described in your article (Was this proof of acupuncture's power ... or a sensationalised TV stunt?, Science, March 25), nor do we share the views of those scientists you have quoted in it. In all its dealings with us, the BBC asked for advice and input where needed, took on board our feedback and incorporated our comments into the final edit of the programme as transmitted, where appropriate. Far from feeling dissatisfied with the final outcome, we feel the series seemed well balanced and informative, doing full justice to the subject matter it addressed.
Dr Jack Tinker
Royal Society of Medicine
Prof Brian Berman
University of Maryland
Prof Liz Williamson
Reading University
Dr Andrew Vickers
Memorial Sloane-Kettering Cancer Center, New York
Dr James Warner
Imperial College London
Dr Mike Cummings
British Medical Acupuncture Society
Prof Gary Green
York University
Dr Carl Albrecht
University of Johannesburg
Dr Jen Cleland
University of Aberdeen
Professor Irving Kirsch
University of Plymouth
But all is not what it seems. Contrary to appearances, this letter
was actually written by the BBC who also compiled the signatories (it seems
to have been the responsibility of Kim Creed, of BBC Factual Publicity).
One of the signatories. Dr James Warner, had never seen the letter until after it was published, and tells me that "[I] substantially do not agree with the sentiments expressed therein. Indeed, we had to resist attempts by the programme makers to sensationalise our work". The Guardian has published a correction.
Six other signatories tell me that their approval was limited to the way
their own contribution was treated, and was not intended as approval of the
whole series. One commented " I've obviously been naïve, and I am very fed up with this whole thing". Another says "
I suppose I (foolishly by the sounds of things) extrapolated from my own programme and experience, without considering the wider implications of the concluding sentence".
Only one of the eight signatories whom I've asked has actually
seen all three programmes, as they were transmitted. This makes it rather
odd that they should appear to endorse so unequivocally the whole series.
One of the signatories, Carl Albrecht, gives his address as "University
of Johannesburg", but oddly the BBC forgot to mention that Dr Albrecht is
co-owner (at least until very recently) of the South African Company, Phyto
Nova, that makes, promotes and sells the untested herb, Sutherlandia,
for treatment of AIDS (see, for example,
here).
He is, therefore, highly biassed. He is also exceedingly controversial. One
of his strongest critics has been Stuart Thomson, Director of the Gaia
Research Institute, hardly an organisation that is biassed against "natural
medicines". Albrecht is indeed a very curious choice of advisor for a programme
about science.
Three of the signatories (Berman, Cummings and Albrecht) are heavily
committed to CAM, and so unlikely to be critical of anything that favours it,
even apart from financial interests in the outcome. Brian Berman even has is
own an entry in Quackwatch.
So several of the signatories are pretty much committed in advance. Asking
them if they endorse the programmes is about as informative as asking a group
of priests if the endorse god.
It gets worse. This morning, 6th April, I heard from Andrew Vickers, of the Memorial Sloan-Kettering Cancer Center, New York. This is what he says.
“I didn’t sign this letter ”
“I was shown the text of the letter but didn’t fully agree with it and told them so. I said something along the lines that the series didn’t do “full justice to the subject matter” (how could it possibly?) but that what they did was fair and reasonable within the constraints set by the medium. You are also right to point out that my comments only go so far as the acupuncture episodes (which I saw) rather than the other two shows (which I did not). No doubt had I been shown a final version for signature I would have also pointed this out.”
The BBC brought us superb programmes like Life on Earth
and Planet Earth. They bring us superb news (I'm listening to the incomparable
John Humphrys on the Today Programme right now). They have suffered unjustly
at the hands of spin-meisters like Alastair Campbell and the execrable Hutton
Report (If the Hutton Report had been an undergraduate essay, it would have
scored alpha-plus for collection of evidence and gamma-minus for ability to
connect evidence to conclusions).
How ironic it is, then, to see the BBC behaving in this case like
spin artists. Deny everything, and, if necessary, falsify the evidence.
John Sutherland, until recently, was Lord Northcliffe Professor of Modern English Literature, here at UCL, and a visiting professor at the California Institute of Technology. Judging by his column in The Guardian, 29th August 2005, he is also a pretty good pharmacologist. How's this for delusional behaviour?
“America loves "how to" books. Typically they are about how to be a better American: richer, thinner, happier, sexier, and more beautiful. For the past few weeks the how-to charts have been headed by a book which has provoked more controversy than anything since The Anarchist's Cookbook instructed America's disaffected youth how to make Molotov cocktails.
Kevin Trudeau's book, Natural Cures "They" Don't Want You To Know About, offers, for a mere $25 (£14), "natural cures for more than 50 specific diseases" - including cancer, heart disease, bad breath, gout, male erectile dysfunction, obesity, dandruff, multiple sclerosis and gloom.
Buy this book, Trudeau promises, and "never get sick again". That's not quite accurate. Buy this book together with products that have included coral calcium on Trudeau's website, www.naturalcures.com, and subscribe to his email newsletter (lifetime subscription $499) and then enjoy eternal health. Just because it's natural, doesn't mean it's free.
Mr Trudeau has no medical, pharmaceutical or therapeutic qualifications. He did, however, spend two terms in Federal prison for credit-card fraud. In his book, he admits that "I have made major mistakes in my life. I have paid my price and I have turned my life around."”
. . . .
“It would be easy to dismiss Trudeau's ability to separate the great American public from their hard-earned dollars as confirmation that there's one born every minute and somebody else eager to profit by it. But the runaway success of Natural Cures also bears witness to genuinely troubling aspects of the American healthcare system. It has been estimated that some 50 million citizens have no health insurance. For these desperate people, who fall sick like everybody else, "natural cures" are all they can afford.”
“Even by the standards of the alternative therapies said to be used by Cherie Blair, submitting her husband's toenail clippings to a health guru's pendulum is taking her alleged New Age obsession to a higher level.”
All good stuff, such as you might expect from an intelligent newspaper. All good, that is, until in another part of the same paper you come to Chakra power . This article, by Jane Feinmann, is as fine a piece of new age nonsense as anything Mrs Blair could manage. The subtitle of this appallingly misleading bit of journalism is "Western science has finally proved the value of Eastern medicine." I have news for Ms Feinmann. Western science, and indeed any sensible educated person, has no time for nonsense like this.
“My therapist at the Kailash Centre of Oriental Medicine (clients include Tara Palmer-Tomkinson, Meg Mathews and Geri Halliwell) is Momo Kovacevic, a bio-energy practitioner from Sarajevo, who claims to have an inherited gift. His mother was a psychic and his sister and brother have some of his power. He says he is able to feel people's pain and anguish and knows exactly where and how to draw out negative energy and replace it with positive.”
And if you believe that, you will truly believe anything.
Prince Charles, never shy of using his wealth to promote his views, commissioned a report on The Role of Complementary and Alternative Medicine in the NHS. The report was published on 9 August 2005. [Get the report here]
The report says the evidence that CAM works is slim, and simply passed the buck.
“Our principal recommendation therefore is that the Health Ministers should
invite the National Institute for Health and Clinical Excellence (NICE) to carry
out a full assessment of the cost effectiveness of the therapies which we have
identified and their potential role within the NHS in particular with a view
to the closing of 'effectiveness gaps'.”
The report, therefore, does NOT recommend that more CAM be made available on the
NHS, contrary to widespread misreporting of its conclusions. Even the normally
very reliable BBC News got this wrong. That judgement was passed on to NICE.
Play DC's (short) interview on BBC News24 (5.30 pm, 6 Oct, 2005) [Play the .wmv file]
The report was written by an economist, Christopher Smallwood. The style is curiously schizoid: clearly the author would love to say that CAM would make a wonderful contribution to the NHS, yet he is smart enough to realise that the evidence is very poor. Neither does the report address at all, the central dilemma of CAM. So does it tell us anything other than the well-known views of its sponsor?
The answer to that is, very little. It goes over the old ground about evidence,
and the lack thereof, in a reasonably competent way, with the help of 'expert
advice'. The problem with expert advice, especially in a field like this, is
knowing which 'experts' to choose. The list of Interview summaries does not contain
a single pharmacologist (clinical or otherwise), nor does it contain any statistician.
Eight of the 10 names are deeply committed to CAM and/or make their living
from it. The only exceptions are Professor Peter Littlejohns (National Institute
for Clinical Excellence (NICE), and Dr
John Appleby (Chief economist of the Kings Fund). Otherwise there is not a
single respectable scientist among the 'experts'. Take a couple of examples. Evidence was given by Professor David Peters (University of Westminster) and Professor Nicola Robinson (Thames Valley University). These two institutions, are, sadly for the reputation of the new universities, among those that have been most prominent in allowing goobledygook nonsense to masquerade as science. A few details will be found in the next section.
It is, I suppose, a trubute to Smallwood that despite the views of his sponsor, and despite the very unbalanced group of people from whom he took evidence, he nevertheless concludes (albeit somewhat reluctantly) that not enough is known about benefits to do a cost-benefit analysis. The buck is simply passed to NICE, who will, presumably, come to a similar conclusion.
This is a contribution to a debate in Edzard Ernst's journal, Homoeopathy: relic of the past or medicine of the future? (Marking Samuel Hahnemann’s 250th anniversary). It proposes that homeopathy is but one example of a wider fashion for delusional behaviour. Here are a couple of quotations.
“Arguably, these are all signs of a culture in which truth matters little (but
money matters a lot). Ronald Reagan had his astrologer and allegedly the
Blairs took their son to a pendulum waver rather than having him immunised
(not to mention some really creative delusions when it comes to interpretation
of intelligence reports). We have a royal family that are devoted to
homoeopathy and talking to trees. With leaders like these perhaps it is not
surprising that delusional behaviour has flourished for a quarter of a century.”
“With luck, the present fashion for not
using your brain, in both East and West, will soon come to be seen as a brief
hiccough in the course of human progress. Then homoeopathy and its kindred
delusions will pass into history.”
That is the title of the Editorial in The Lancet (336, 690, 2005(, in the issue in which a new evaluation is published. The editorial says
“That homoeopathy fares poorly when compared with
allopathy in Aijing Shang and colleagues' systematic
evaluation is unsurprising. Of greater interest is the fact
that this debate continues, despite 150 years of
unfavourable findings. The more dilute the evidence for
homoeopathy becomes, the greater seems its popularity.
For too long, a politically correct laissez-faire attitude
has existed towards homoeopathy, . . . ”
“Going one step further, the Swiss Government, after a 5-year
trial, has now withdrawn insurance coverage for
homoeopathy and four other complementary
treatments because they did not meet efficacy and cost-effectiveness
criteria.”
“Surely the time has passed for selective analyses,
biased reports, or further investment in research to
perpetuate the homoeopathy versus allopathy debate.
Now doctors need to be bold and honest with their
patients about homoeopathy's lack of benefit, and
with themselves about the failings of modern medicine
to address patients' needs for personalised care.”
Interpretation Biases are present in placebo-controlled trials of both homoeopathy
and conventional medicine. When
account was taken for these biases in the analysis, there was weak evidence
for a specific effect of homoeopathic
remedies, but strong evidence for specific effects of conventional interventions.
This finding is compatible with the
notion that the clinical effects of homoeopathy are placebo effects.
Fifteen years of review and meta-analysis (click here) gives a survey of recent attempts to discern any effect at all of homeopathy. It was, helpfully, posted by vets who are against the maltreatment of animals by giving them pills that contain nothing.
Other reports on 16 August 2005.
"Medics attack use of homeopathy" [BBC News],
"As a fourth study says it's no better than a placebo, is this the end for homeopathy? " [Guardian]
“Effects of homeopathy 'are all in the mind' ” [Independent]
The UK's only professor of alternative medicine, Edzard Ernst of Exeter, has
come out very clearly against homeopathy in Trends in
Pharmacological Sciences (2005 Get the PDF).
“Homeopathy is a popular but implausible form of
medicine. Contrary to many claims by homeopaths,
there is no conclusive evidence that highly dilute
homeopathic remedies are different from placebos.
The benefits that many patients experience after
homeopathic treatment are therefore most probably
due to nonspecific treatment effects. Contrary to widespread
belief, homeopathy is not entirely devoid of risk.
Thus, the proven benefits of highly dilute homeopathic
remedies, beyond the beneficial effects of placebos, do
not outweigh the potential for harm that this approach
can cause.”
See also "Professor savages homeopathy" Observer (18 Dec, 2005).
The supply of fraudulent claims for "health foods" is endless, and normally
I don't bother with them here. My concern is largely to protect Universities
from becoming caught up in them (as shown on this page, many universities have
already gone down that dishonest path). I became caught up in the Noni-juice
business because I found that it was being marketed from the village where
I live, on the basis of quite extraordinarily dishonest claims (includung alleged
benefits in cancer).
I was instrumental in getting the Hertfordshire Trading Standards Department
to shut down a local noni juice marketing organisation. I have a dossier on
the dishonest literature which they were distributing then. The promotional
web site used then (http://www.essential-energies.com/)
was closed down, though I notice that the site is now back to life, operating
from the same address, but this time it is marketing miracle shampoo!)
It recently came to my attention though, that noni-juice is still being marketed
door-to-door in my area (possibly from the same address?) though it has vanished
from the web. I know this because they tried to recruit my son as a salesman.
He was given a booklet ('Doctor to Doctor. Clear answers
to your patients' questions abouit noni', 2004) which purports to give
medical advice about its use. This booklet is written by the impressive sounding "Dr
Neil Solomon MD, PhD". A
little further investigation shows that Neil Solomon gave up his US Medical
Licence in 1993, after admitting to sexual malpractices with his patients.
He is quoted on the site noni.worldwidewarning.net,
and there you can find much interesting information on the dishonest promotion
tactics used by the noni juice promoters.
"I admit that for at least the past 20 years, I have used my position as a physician
to instigate a wide range of sexual relations with at least eight woman patients.
This conduct included acts of sexual intercourse, as well as other explicit sex
acts. These activities took place in my medical office during patient visits,
as well as in other locations. I admit that I engaged in sexual misconduct with
my patients during the physician/patient relationship. I admit that I engaged
in this conduct with multiple patients over the same time period." -- Neil Solomon,
October 27, 1993 (see
it here)
Schmidt and Ernst (2003, Vaccine21. 1044–1047) found that homeopaths advise against vaccination. So much for the argument that homeopathy at least does no harm. [get the pdf]
“Online referral directories listing e-mail addresses of UK homeopaths,
chiropractors and general practitioners and private websites were visited. All addresses thus located received a letter of a (fictitious) patient
asking for advice about the MMR vaccination. After sending a follow-up letter explaining the nature and aim of this project and offering the
option of withdrawal, 26% of all respondents withdrew their answers. Homeopaths yielded a final response rate (53%, n = 77) compared to
chiropractors (32%, n = 16). GPs unanimously refused to give advice over the Internet. No homeopath and only one chiropractor advised
in favour of the MMR vaccination. Two homeopaths and three chiropractors indirectly advised in favour of MMR.”
Acupuncture is no better at reducing migraines than fake treatment, researchers say today.
A study involving more than 300 patients found the healing method did reduce headaches, but only by the same amount as placing needles at non-acupuncture points.
Unfortunately the Daily Telegraph's reporters did nothing to help the confused reader. No comment was made on the apparent contradiction. In this particular case, there is an obvious explanation.
The first (favourable) article was said to be published in Nature, though in fact it was published in Neuroimage (Pariente J., White P., Frackowiak , Richard S. J. & Lewith G. Neuroimage, 25. 1161 - 1167, 2005). Presumably the reporter had picked it up from a rather uncritical synopsis on the news site, nature.com. It was conducted on 14 patients with painful osteoarthritis. Contrary to the first line of the Telegraph's report ("Acupuncture has a genuine ability to relieve pain"), the work did not measure pain at all. In fact the summary of the paper says
“The three interventions, all of which were sub-optimal acupuncture treatment, did not modify the patient’s pain.”
What the paper actually did was to use positron emission tomography (PET) to measure 'activation' of certain parts of the brain when needles were inserted. Some parts were activated more by having acupuncture needles piercing ths body than by 'stage-dagger' needles which retracted and did not pierce the body. I have no criticism of these findings: my purpose here is to explore the apparent contradiction between this trial and another.
The second, unfavourable, report was of a much bigger study, 302 patients with migraine headaches. It was published by Linde et al. (Journal of the American Medical Association. 2005 293(17):2118-25). This study concluded
“Acupuncture was no more effective than sham acupuncture in reducing
migraine headaches although both interventions were more effective than a waiting
list control.
”
These two studies were on quite different conditions, used different methods,
and very different numbers of patients. But suppose we take them at face value,
are they not contradictory? No, not necessarily, because they used
quite different sorts of control group.
The study that was reported as showing that acupuncture worked compared patients that had real acupuncture with patients who had treatment with "stage dagger" needles that appeared to pierce the skin but did not.
The study that was reported as showing that acupuncture did not work (Linde et
al.) used a different sort of control group, acupuncture needles that
pierced the skin but were inserted in the wrong places (as defined by the
'principles' of acupuncturists). No difference was found between 'real acupuncture'
and control.
There is nothing incompatible about these two studies if one adopts the view that piercing the skin with a needle can produce a physiological response that makes the patient feel that other sorts of pain are less painful, but that it does not matter where the skin is pierced. The latter hypothesis means, of course, that all talk about "meridians"` and "energy flow" that acupuncturists use, is no more than mumbo jumbo.
Dr Lewith is quoted as saying, of the negative study, "This is a badly conceived
study that just adds more confusion to the debate because it uses non-site
specific acupuncture as a control." Quite on the contrary, the
Linde study seems more interesting to me, because it unveils the mumbo jumbo
of meridians (at least for the particular points used in
this study). Dr
Lewith may find this conclusion unpalatable, but it is the obvious implication
of this pair of studies.
Another study confirms that the principles of acupuncture are nonsense
A trial by Melchart and colleagues on 270 patients shows conclusively that acupuncture
can indeed produce amelioration of tension-type headache when compared with
no treatment, BUT the relief is produced whether or not needles are inserted
at 'acupuncture points'. Very similar results were found with 'superficial needling
at non-acupuncture points'. British
Medical Journal, 15 August 2005. Yet again it is shown
that the mumbo-jumbo of meridians and magic points is nonsense. Yet again, that
is a good reason why universities cannot be expected to train acupuncturists.
Our business is to minimise mumbo-jumbo, not to propagate it.
An unusually big clinical trial (748 patients) of the efficay of prayer was published in The Lancet (July 2005). The same study tested also “music, imagery and touch” (MIT) therapy.
748 patients undergoing percutaneous coronary intervention or elective catheterisation in nine USA centres were assigned in a 2×2 factorial randomisation either off-site prayer by established congregations of various religions or no off-site prayer (double-blinded) and MIT therapy or none (unmasked). The primary endpoint was combined in-hospital major adverse cardiovascular events and 6-month readmission or death.
371 patients were assigned prayer and 377 no prayer; 374 were assigned MIT therapy and 374 no MIT therapy. The factorial distribution was: standard care only, 192; prayer only, 182; MIT therapy only, 185; and both prayer and MIT therapy, 189. No significant difference was found for the primary composite endpoint in any treatment comparison.
Neither masked prayer nor MIT therapy significantly improved clinical outcome after elective catheterisation or percutaneous coronary intervention.
It is common enough to hear criticism of the big drug companies by people
in alternative medicine. That is not surprising -they are both chasing the
same pool of money (yours). The interesting thing about these three sources
is that they are not written by CAM people, nor by conspiracy theorists, nor
my revolutionary marxists. They are written by people who, until recently,
were editors of very well known medical journals. Marcia Angell was formerly
Editor in chief of the New England Journal of Medicine. Richard Smith
was until 2004, editor of the British Medical Journal, and Richard
Horton was editor of The Lancet. They
know what they are talking about, and if they are worried, we should be too. Smith starts thus.
“'Journals have devolved into
information laundering
operations for the
pharmaceutical industry',
wrote Richard Horton, editor of the
Lancet, in March 2004 [1]. In the same
year, Marcia Angell, former editor of
the New England Journal of Medicine,
lambasted the industry for becoming
'primarily a marketing machine' and
co-opting 'every institution that might
stand in its way' ”
Doctors may not be
as uninfluenced by the advertisements
as they would like to believe, but in
every sphere, the public is used to
discounting the claims of advertisers.
The much bigger problem lies with
the original studies, particularly the
clinical trials, published by journals.
Far from discounting these, readers see randomised controlled trials as one of
the highest forms of evidence.
For a drug
company, a favourable trial is worth
thousands of pages of advertising,
which is why a company will sometimes
spend upwards of a million dollars
on reprints of the trial for worldwide
distribution.
The evidence is strong that
companies are getting the results they
want, and this is especially worrisome
because between two-thirds and threequarters
of the trials published in the
major journals—Annals of Internal
Medicine, JAMA, Lancet, and New
England Journal of Medicine—are funded
by the industry
The admirable European rules (see above) to limit the fraud that can be perpetrated by the "nutritional supplement" industry are now in danger.[BBC News]
The Food Supplements Directive, approved by EU governments in 2002, is designed to tighten controls on the growing market in products sold under the health food heading - natural remedies, vitamin supplements and mineral plant extracts. Under the new rules, only vitamins and minerals on an approved list can be used in supplements. There will also be restrictions on the upper limits of vitamin dose.
The case was brought by industry groups the British Health Food Manufacturers Association (HFMA), National Association of Health Stores (NAHS) and Alliance for Natural Health (ANH) ahead of the law change in August. UK companies were supported by the Conservative Party and actress Jenny Seagrove, star of the TV mini-series Woman of Substance.
Shadow (Conservative) Health Minister Chris Grayling added: "This is not the final ruling, but I am confident we are in a position where we're close to winning the battle to scrap this controversial measure, which would have banned hundreds of vitamins from our shelves."
Many papers report that Tony Blair spoke to EU leaders this month, to oppose
the very sensible and modest European Food Supplements directive ( for example
The
Independent, 20 June, 2005). This directive is a small move
to prevent the most fraudulent claims for 'food supplements' and to prevent
sale of those that are actually dangerous. It would, for example, prevent
the sale of Viridian Trace
Mineral Complex, which contains Manganese, Selenium, Boron, Copper, Vanadium,
Chromium and Molybdenum. And a good thing too.
Does Tony Blair really believe the new age nonsense of supplement salesmen? Given his notorious defence in the House of Commons, of the teaching of Young Earth Creationism, at the taxpayers' expense, one can believe that he does. Given, also, his apparent difficulties in distinguishing truth from fiction in the matter of the Iraq war, one can believe his capacity for self-delusion approaches even that of George Bush. On the other hand, Blair has made sensible noises about climate change (even if the action has, so far, been limited). Perhaps, in the matter of quackery, he is under the influence of his wife, Cherie Blair, whose dabblings in the mystical leave Nancy Reagan's astrologer in the shade. Much h as been written about this (Libby Purves, in The Times is pretty good, as is Nick Hume ). But my favourite is the following account, quoted from Francis Wheen's wonderful book, “How Mumbo-Jumbo Conquered the World: A Short History of Modern Delusions”
Even the no-nonsense Margaret Thatcher was a devotee of mystical "electric baths" and Ayurveda therapy. But she was a mere dabbler compared with more recent inhabitants of Downing Street. Cherie Blair found her devout Catholicism no impediment to flirtations with New Age spirituality - inviting a feng-shui expert to rearrange the furniture at No 10 and wearing a "magic pendant" known as the BioElectric Shield, which has "a matrix of specially cut quartz crystals" that surround the wearer with "a cocoon of energy" to ward off evil forces.
The catholicism - if not Catholicism - of her tastes was further demonstrated in 2002 by the revelation that she employed a former member of the Exegesis cult, Carole Caplin, as a "lifestyle guru". Through Caplin, the prime minister's wife was introduced to an 86-year-old "dowsing healer", Jack Temple, who treated her swollen ankles by swinging a crystal pendulum over the affected area and feeding her strawberry leaves grown within the "electro-magnetic field" of a neolithic circle he had built in his back garden.
It was long assumed that Tony Blair, who wears his Christianity on his sleeve, did not share his wife's unorthodox enthusiasms. But that was before he and Cherie had a "rebirthing experience" under the supervision of one Nancy Aguilar while holidaying on the Mexican Riviera in the summer of 2001. The Times's detailed account of the prime ministerial mudbath is worth quoting at some length:
"Ms Aguilar told the Blairs to bow and pray to the four winds as Mayan prayers were read out ... Within the Temazcal, a type of Ancient Mayan steam bath, herb-infused water was thrown over heated lava rocks, to create a cleansing sweat and balance the Blairs' 'energy flow'.
"Ms Aguilar chanted Mayan songs, told the Blairs to imagine that they could see animals in the steam and explained what such visions meant. They were told the Temazcal was like the womb and those participating in the ritual must confront their hopes and fears before 'rebirth' and venturing outside. The Blairs were offered watermelon and papaya, then told to smear what they did not eat over each other's bodies along with mud from the Mayan jungle outside.
"The prime minister, on holiday just a month before the 11 September attacks, is understood to have made a wish for world peace. Before leaving, the Blairs were told to scream out loud to signify the pain of rebirth. They then walked hand in hand down the beach to swim in the sea."
Although Mayan rebirthing rituals are not yet available in Britain through the National Health Service, some of Cherie Blair's other peculiar obsessions have already been adopted as official policy. In January 1999 the government recruited a feng-shui consultant, Renuka Wickmaratne, for advice on how to improve inner-city council estates. "Red and orange flowers would reduce crime," she concluded, "and introducing a water feature would reduce poverty. I was brought up with this ancient knowledge."
Two years later, the government announced that, for the first time since the creation of the NHS, remedies such as acupuncture and Indian ayurvedic medicine could be granted the same status as conventional treatments. According to the Sunday Times, "The inclusion of Indian ayurvedic medicine, a preventative approach to healing using diet, yoga and meditation, is thought to have been influenced by Cherie Blair's interest in alternative therapy." An all too believable suggestion, since Cherie was a client of the ayurvedic guru Bharti Vyas and officiated at the opening ceremony for her holistic therapy centre in London.
The swelling popularity of quack potions and treatments in recent years is yet another manifestation of the retreat from reason and scientific method. According to a 1998 survey by the Journal of the American Medical Association, the use of homeopathic preparations in the United States more than doubled between 1990 and 1997. In Britain, by the end of the 20th century the country's 36,000 general practitioners were outnumbered by the 50,000 purveyors of complementary and alternative medicine - some of whom receive the seal of royal approval.
The Queen carries homeopathic remedies with her at all times. Princess Diana was a devotee of reflexology, the belief that pressure applied to magical "zones" in the hands and feet can heal ailments elsewhere in the body. Prince Charles has been a prominent champion of "holistic" treatments since 1982.
Most alternative therapies, homeopathy included, are closer to mysticism than to medicine. This may explain their appeal to the British royal family, whose survival depends on another irrational faith - the magic of hereditary monarchy, so fiercely debunked by Tom Paine and other Enlightenment pamphleteers.
It has even been alleged, according to the Daily Telegraph, that “Cherie Blair did not allow her youngest child, Leo, to have the controversial MMR vaccine and instead asked a New Age healer to wave a "magic" pendulum over him” “Peter Foster, the convicted fraudster, claims that Jack Temple, a former market gardener with no medical qualifications, was also asked by Mrs Blair to swing his crystal pendulum over a lock of the Prime Minister's hair and some of his finger-nail clippings.” It must be said, though, that the source of this information, plausible though it may be, is less than reliable.
The European Court has decided to tighten rules on the sale of vitamins and minerals.[BBC News]
The ruling is, thank heavens, a small step towards reducing the mega-fraud perpetrated on a gullible public by the 'supplements' industry. But only a very small step. Very little will end up being stopped. It is not legal to sell washing machines that don't work, yet even with this ruling it will remain legal to sell medicines (dishonestly labelled as 'supplements') without producing any evidence at all that they work.
"COULD 20 million French people be wrong, and the Prince of Wales, David Beckham and Bill Clinton? France’s most august medical authority yesterday dismissed homoeopathic remedies in a damning report."
"Alternative medicine is flourishing around the world, but the Académie de Médecine, an advisory body of distinguished physicians, has upset practitioners and the homoeopathic industry by saying that they subscribe to mumbo jumbo."
"In the latest episode of a 200-year-old quarrel over the treatment of illness with minute doses of natural medicines, the academy urged the state to stop subsidising homoeopathy through the national health service.". The report said
"Homoeopathy is a method dreamed up two centuries ago, based on prejudices that were devoid of any foundation. It has survived as a doctrine completely outside the remarkable scientific movement which has been transforming medicine for two centuries."
"Homoeopathic treatments should not be viewed as medicines because they were not subject to clinical testing and no proof of their effectiveness was required, it said, adding that it was an aberration for the state to pay 35 per cent of patients’ fees for consultations with homoeopaths."
Florida State University, allegedly under political pressure, is proposing to set up a school of Chiropractic. If that happens, it will be hard to take it seriously as a 'university' in the future: it will become the Florida State school of snake-oil salesmanship. What a sad fate. [Science] [comment]
An FSU professor. Albert Stiegman, has predicted the future campus map.
Essential reading! Francis Wheen's book "How Mumbo-Jumbo Conquered the World: A Short History of Modern Delusions" is a wonderful analysis (despite the rather silly title) of the common thread that links astrology, quack medicine and neocon politics -the abandonment of reason . Buy it now.
In the USA and Canada, this book is called Idiot Proof: Deluded Celebrities, Irrational Power Brokers, Media Morons, and the Erosion of Common Sense, and you can buy it here
George W Bush thinks so, as do Tony Blair and Osama bin Laden and an alarmingly high percentage of other important figures in today's world. After September 11 2001 Blair claimed that religion was the solution not the problem, since "Jews, Muslims and Christians are all children of Abraham" - unaware that the example of Abraham was also cited by Mohammed Atta, hijacker of the one of the planes that shattered the New York skyline. RH Tawney wrote in Religion and the Rise of Capitalism that "modern social theory, like modern political theory, developed only when society was given a naturalistic instead of a religious explanation". In which case modern social and political theory would now seem to be dead.
2. The market is rational
3. There is no such thing as reality
4. We mustn't be "judgmental"
5. Laissez-faire capitalism is the prerequisite for trade and prosperity
6. Astrology and similar delusions are "harmless fun"
Those who say this never explain what is either funny or harmless in promoting a con-trick which preys on ignorance and anxiety. Yet even the Observer, Britain's most venerable and enlightened Sunday newspaper, now has a horoscope page.
7. Thin air is solid
8. Sentimental hysteria is a sign of emotional maturity
9. America's economic success is entirely due to private enterprise
10. "It could be you. . ."
Things are no better in the world of animal health. But all is not lost. To oppose the irrational use of CAM on dumb animals, if you are a vet you can join the The British Veterinary Voodoo Society. To read the row in the letter columns of the Veterinary Times, in which the Royal College of Veterinary Surgeons is castigated for giving homeopathy "diplomatic immunity", click here.
They have some wonderful links too: try Homeopathy - all the idiocy that fits.
I reproduce here, the application form for this learned society. But before
applying, read their stated aims.
Aims of the Society
To achieve a specialist listing for Voodoo practitioners in the RCVS Register. The syllabus and examination are now available for members wishing to work towards the the the diploma of VetMFVoo and the Fellowship award of VetFFVoo, to the standard approved by the Holistic Health Academy. We are confident of achieving specialist listing for holders of these prestigious accolades.
To achieve recognition as a Specialist Division by the BVA. Sadly, there is at present no indication that the BVA, unlike the RCVS, is supportive of magical systems of medicine. However, should there ever be any suggestion that the Association is becoming open to the concept of embracing magical thinking within the Specialist Divisions, the BVVS will immediately apply for recognition.
To achieve equal academic representation for Voodoo Medicine in all UK veterinary schools in which other branches of Sympathetic Magic are taught within the undergraduate course.
Application for Membership of the BVVS
I, ......................................... MRCVS / FRCVS* undertake to advance the cause of Voodoo Medicine in every situation where magical thinking is accepted as legitimate medical practice. I further undertake to highlight the issues of listing in the RCVS Register, BVA Specialist Divisional status and undergraduate education in Sympathetic Magic to the best of my ability.
* delete as appropriate.
I undertake to pay the membership fee of 10p per annum, if demanded.
Signed ............................................... Date .................................
Please print form and return to George Tribe or Morag Kerr, c/o 6 Corfe Close, Southwater, Horsham, West Sussex, RH13 9XL, or email details to Morag_Kerr@CompuServe.com .
Latest news. A "homeopathic vet",
Mr John Hoare, has made a formal complaint to the RCVS. He alleges
that making disparaging remarks
against veterinary surgeons who practise homoeopathy may bring the profession
into disrepute. Perhaps Mr Hoare is a bit lacking in the sense of humour
department? Does
he think the Vet Voodoo society is serious?
Can this be the same John Hoare, of Lyme Regis, who was reported in the Daily
Telegraph as believing that animals are affected by the phases
of the moon? "I am not surprised that the moon affects animals - and people
for that matter. After all, we are mostly made up of water and the moon
affects the tides." Wow!
Any reasonable
person would, of course, think that it was Mr Hoare's magic that brought the
veterinary profession into disrepute. But the complaint may yet do good if it
forces the RCVS to stop vacillating about quackery.
Olivia Stewart-Liberty (The Mail on Sunday, 18 April 2004)
The original text of my comments on the medication prescribed by Dr Joshi was as follows. It appears in shortened form as a text box in the newspaper
If you are a pregnant, vegan teenager who eats no fruit and lacks a pancreas, there might just be some point in taking this load of overpriced junk. For anyone on anything like a normal diet it will do nothing to help you. They will certainly not help you to lose weight (apart from your wallet, which will lose weight fast). There is not the slightest reason to think they'll make you either happier or healthier. They may well make you feel worse, though it might be hard to say what was doing the harm since there are over 60 separate substances. The first thing to notice is that terms like “metabolic detox”, “liver cleanse” and “kidney support”: they sound good but they are just bits of fine-sounding mumbo jumbo that are used to shift quack medicines.
Many of the ingredients are simple amino acids (e.g. glutamic acid, glutamine, glycine, lysine, methionine), which you get by the bucket load when you eat anything that contains protein. Many others are standard vitamins and minerals that almost everyone gets in plenty from their diet –taking more of them does you no good at all, and may do harm. The remaining ingredients are mostly herbs, the therapeutic and toxic effects of which are largely unknown. The only good thing that can be said about the prescription is that the doses are mostly not so big that they would be expected to be toxic. Some substances like chromium picolinate are known to be potentially dangerous, (the dose of chromium is quite small, but it is not stated what form the chromium is supplied in). Selenium, zinc, iron, vitamins A and B6 are all known to be toxic in excessive doses, and the doses of vitamin A (and also vitamin C) are well above the recommended amounts, and that of zinc is high.
The “Digest-aid” consists mainly of digestive enzyme (probably of animal or bacterial origin –it is not stated). Unless you have pancreatic exocrine insufficiency, cystic fibrosis or chronic pancreatitis, you just don't need them.
Perhaps the most shocking of the prescriptions is the “Metabolic Detox”, for several reasons. Firstly the name is mumbo jumbo, and the amounts of the ingredients are not stated. Not may people are likely to recognize that Jethhi-Madh is the Hindi name for common or garden liquorice, or that cassia angustifolia is the Latin name for Senna (pods or leaves?), a rather old-fashioned laxative that might well account for patient's discomfort if given in a sufficient dose (the dose is unstated). The other ingredients, vidang, himej, ajwain are spices used in ayurvedic medicine which have never been tested for effectiveness or toxicity, and 'unaqua soddi chloredum' is nothing known in medicine (it sounds suspiciously like incorrect Latin for water-free common salt). Vidang and ajwain are herbs that are alleged to cure worm parasites, but they have not been tested properly. The last ingredient, 'niscot', is a mystery.
It seems that you reporter has been ripped off in a serious way. Why, it may be asked, is nothing done to protect the gullible public form such charlatans? There are two answers –one is loopholes in the law that allow outrageous claims to be made with impunity. The other reason is lack of will on the part of the government to regulate alternative medicine in the same way that conventional medicine is regulated. In order to sell a conventional drug, you must, reasonably enough, produce evidence that it is safe and that it does what is claimed for it. This process may be fallible, but it is a lot better than the regulations that the government are now proposing to apply to herbal medicines which do not require any evidence at all that the product actually possesses the effects that are claimed for it. That is a bit like saying, yes you may sell transistor radios, but it does not matter whether they work or not.
I have often wondered how it is that it seems to be so very hard to find out whether a drug is truly effective (not just CAM, but any treatment). How is it that trials, each apparently well-conducted, so often disagree? On reason, no doubt, is the heterogenity of diseases that have the same name. Another reason seems to be money. Three good articles on this topic have appeared recently. {see below, for update)
Junket time in Munich for the medical profession - and it's all on the drug firms
How 'opinion leaders' among doctors are won over by cash on offer from the giants of the pharmaceutical trade
"It is an interdisciplinary journal that explores the healing arts, consciousness, spirituality, eco-environmental issues, and basic science as all these fields relate to health."
Acupuncture/Acupressure • Ayurveda • Biofeedback • Botanical or Herbal Medicine • Chiropractic
• Consciousness • Creative Therapies • Diet/Nutrition/Nutritional Supplements • Environmental Medicine
• Holistic Medicine/Nursing • Homeopathy • Indigenous Medical Practices • Manual Therapies
• Mind-Body Therapies • Naturopathy • Osteopathic Medicine • Qigong/Tai Chi • Touch Therapies
• Spiritual/Transpersonal Healing/Prayer • Tibetan Medicine • Traditional Chinese Medicine • Yoga
The following review of a CAM teaching program, and the responses to it, were published in the Bulletin of the British Pharmacological Society, 2001.
Alternative Therapies
Authors Kamran Amwar, Nicholas S.Y. Jim, Kath Huckbody and Ian Hughes
Distributor pharma-CAL-ogy, British Pharmacological Society,
16 Angel Gate, City Road, London, EC1V 2SG. United Kingdom. Tel: 44-(0)20-
7417-0382. Fax: 44-(0)20-7417-0114. E-mail: cal@bps.ac.uk.
Software type Macromedia Authorware
Subject area Alternative Therapies/Clinical trials
Intended audience 16 plus -Undergraduate
Cost £25.00 UKHE and £350.00 others
Documentation Tutor’s notes and software installation guidelines
It is unique in my experience for a teaching document to start with the warning that what follows may well
be a load of nonsense. This beautifully-produced program starts with the statement “Please note that many
of the statements/claims made concerning the therapies in this program are those of the practitioners of the
therapies. The claims may or may not have a factual basis, and are not necessarily the views of the authors”.
What follows consists of two things. Firstly the flights of fancy, meaningless statements, and downright
fraud which are already available by the truck load on the internet. Secondly, there is a quite serious attempt
to describe the principles of clinical trials. But these two aspects are never brought together. There is no
attempt whatsoever to assess the truth of any of the statements and claims that are made. To that extent, the
program is not about science at all.
The main topics are acupuncture, aromatherapy, chiropractic, herbalism, homeopathy, osteopathy and
hypnotherapy. After describing what is claimed for them, an example of a clinical trial follows. This bit is
done quite well if viewed as tutorial on clinical trial design, but it contributes nothing to the subject of the
program. In the cases of chiropractic and homeopathy (though not aromatherapy) the results of the trial are
assessed as positive, but there is no attempt at all to say whether this trial is typical, or whether the treatment
is really thought to be effective.
In one particularly bizarre part of the acupuncture section we are invited to click to discover about the
“classical Chinese theory” and the “Western scientific theory” of how acupuncture works [sic]. The former
is the usual mumbo jumbo about “meridians” (not defined) and “energy” (not defined). But what really
takes the biscuit is what is offered as the Western scientific theory: “Western science has shown that cells
are influenced by patterns of electrons flowing through them (sometimes called ‘bioelectrons’)”. Funny –I
always understood that currents were carried by ions –this is as nonsensical as the classical explanation.
There is also a category named “other” that gives briefer details on 24 other “therapies” from crystal healing
and Gerson therapy (one of the more unpleasant frauds) to reflexology and urine therapy. Brief, and totally
uncritical, information is provided on what their proponents claim.
The program contains many quizzes to assess your knowledge of homeopathy, acupuncture etc. In order to
do well on these tests you have to assent to all sorts of untrue, or often simply meaningless, statements. For
example I was marked “wrong” because I failed to tick the box that says measles is “wholly treatable by
chiropractic”. Is this a sensible way to teach pharmacology?
I take pharmacology to be the science concerned with what drugs do and how they do it. And I take science
to be concerned with distinguishing truth from fiction. By those criteria, this program is concerned with
neither pharmacology nor science. It is a disgrace to both.
Quality of content *
Accuracy of content *
Ease of installation ****
Ease of use *****
Quality of interface/navigation ****
Clarity of leaning objective *
Value to teacher *
(*****Maximum)
D. Colquhoun FRS, A . J. Clark Professor of Pharmacology, University College London
Reply by Prof. Ian Hughes, University of Leeds
A great deal of money is spent by members of the public on a considerable variety of alternative or
complementary medicines. Our current medical students will discover that many of their patients are
experiencing or have considered this type of treatment. With increasing use of the Internet such patients will
often be well informed (or misinformed) about alternative treatments and in a patient centred NHS will
expect their medical practitioner also to be aware that alternatives exist. "No, I've never heard of it, I don't
know anything about it but I'm sure it's useless" is not an answer which helps the partnership with the patient
nor does it generate further confidences. A large number of patients, particularly those with chronic
diseases, believe their circumstances are improved by alternative or complementary therapies and surely that
is what it is all about. Patients expect their doctors to live in the real world in which alternative therapies do
exist, are widely used and are perceived by individuals to be of real benefit.
With regard to effectiveness it is too easy to take the stance that any trial with a positive outcome for an
alternative therapy must, by definition, be a poor trial and be flawed. There is no need for the mechanism to
be understood for a treatment to be effective. Can we really say we understand how antidepressants work?
Nor is the lack of current acceptance an indicator of correctness. How long were purinergic nerves or
helicobacter pylorii crying in the wilderness?
The "Alternative Therapies" program attempts to inform medical students about the variety of alternative
therapies and the claims made for such treatments. It also attempts to equip medical students with the ability
to judge evidence and come to their own conclusions rather than to adopt the prejudices of their teachers. It
is for this reason that the program teaches about clinical trials, particularly on how to judge the quality of a
clinical trial and the reliance that can be placed upon it. The reviewer has clearly not reached the section of
the program in which this analysis is applied to six trials of different alternative therapies to illustrate how
medical students should approach such evidence and make judgments. I would rather see my medical
students able to form their own judgments (about evidence-based orthodox and alternative therapies) rather
than simply adopt the views of their teachers.
The reviewer's comment on the clarity of the learning objectives ("Who Cares?") is answered by student's
repeated requests for such information when it is unavailable. Some teachers may not care about learning
objectives though it would be normal to take these into account when reviewing a computer assisted
learning program. Students however do value clear learning objectives which are perceived as improving
the student learning experience as has now been appreciated by at least some of the units which scored
poorly in the last QAA review process.
Patient's expectations of medicine are changing and we should be equipping our medical students so they
can communicate better with their patients, have knowledge about the real world and can practice evidencebased
medicine while considering each patient as an individual. I do not claim the program achieves all
these aims but it does provide information about what is claimed for Alternative Therapies and helps
medical students to make their own judgments.
D.C. Replies:
Hughes makes my point perfectly. Purinergic receptors were (rightly) in the wilderness while the evidence for them was weak, and they (again rightly) came out of the wilderness as soon as the evidence became strong.
His suggestion seems to be that "my medical students" should be given only the tools for assessment of evidence, but that any attempt by the teacher to try to assess the current state of the evidence is mere imposition of the prejudices of the teacher. It is almost 'here is the library and here is how you do a t test -sort it out for yourself'. This is as ludicrous an approach to teaching as I ever heard, but it does explain why the Alternative Therapies program is as it is.
This letter to The Times points out the folly of making regulations that do not require any demonstration that the product works. Can you imagine a regulation for television sets that required only that they do no harm, but did not specify that they should show a picture?
From Professor D. Colquhoun, FRS
Sir, Congratulations on your report on the deficiencies found in complementary medicine practitioners (Body & Soul, January 10). In the face of such evidence it is natural to ask for more effective regulation of this very profitable industry. But the question is quis custodiet ipsos custodes? This question has serious implications for the universities as well as for the public (and the industry).
The House of Lords report and the Government’s response to it pointed out that the first step was to find out whether the complementary treatment worked (better than a placebo). They recommended that the Department of Health should fund research on complementary medicine, the first priority being to find out whether each therapy worked.
The problem is that you cannot regulate properly an area when it is not, in most cases, known whether the product being offered has no effect above that of wishful thinking. This raises a serious question for universities, because it leads, naturally enough, to demands for better training. But how can a university run a course on a subject about which there is so little hard evidence?
Tragically (for their own reputation), some of the new universities are running three-year BSc courses in such subjects as complementary therapies. I’m quite happy to believe that nice smells produce good placebo effects, but aromatherapy is not, by any stretch of the imagination, science, and in my view it is not honest to award Bachelor of Science degrees in it.
The effect of such courses will be not to promote better regulation, but to give spurious respectability to an industry that, according to the Government, should (but does not) have, as its first priority, to find out what works and what doesn’t.
Yours faithfully,
DAVID COLQUHOUN,
A. J. Clark Professor of Pharmacology,
University College London,
Gower Street, WC1E 6BT.
d.colquhoun@ucl.ac.uk
January 10.
Prince Charles' article, "We have become allergic to our western way of life.
Complementary healthcare has a vital role to play in the 21st century",
appeared in The Guardian on Saturday February 28, 2004. It started "t seems extraordinary to me that despite a recent poll indicating that 75% of people would like complementary medicine to be available to all on the NHS, there are still only a handful of clinics offering integrated healthcare for free. . . .".
This article drew several sceptical responses which were published under the heading The Placebo Response on the following Monday. These included the following (given here in its unshortened form ).
Prince Charles' article today was well intentioned, but it contained a huge inconsistency, He says, more or less rightly, that "there are 30,000 chemicals in products that we use which have never been tested". But then he advocates that the taxpayer should pay for a thousands of alternative treatments that are also almost all untested. Either you believe in evidence or you don't, but you really can't have your cake and eat it. And I fear that his account of clinical trials (selective, to put it mildly), and his suggestion that "modern computational techniques" can tell us how the human body will react to foreign chemicals (good or bad), are both pure wishful thinking. Would that life were so simple.
David Colquhoun
A question for constitutional lawyers?
The Prince of Wales Foundation for Integrated Health, is, incidentally, represented on groups like the Herbal Medicine Regulatory Working Group. One wonders how it is that in the UK, where the royal family are supposed to be divorced from politics, that a lobby group sponsored by the Prince of Wales is able to have more direct influence on government policy in this area than most scientists are allowed.
Give your opinion: protect your university from teaching mumbo jumbo!
The Department of Health has opened a consultation on the proposals for 'regulation' of herbal medicine and acupuncture, at their web site. Go there to have your say.
These proposals will, in my view, have exactly the opposite of the intended effect. The reasons were given briefly in my letter above, and at greater (and more amusing) length, by Alice Miles in her comment "Alternative Medicine is too silly to regulate" in The Times (or get pdf version). The proposed 'regulation' will give the appearence of state-endorsed respectability to people who are selling untested products, without doing anything at all about their unjustified claims of efficacy.
Another effect of the proposed regulation will be to protect the herbal industry from the much stricter European regulation which might require the industry to provide evidence that its products actually work (not, on the face of it, an unreasonable thing to ask). This is no accident. The proposals arise from the recommendations of the Herbal Medicine Regulatory Working Group (click here). This group consisted almost entirely of representatives of the industry, including Michael McIntyre of the European Herbal Practitioners Association. Their web site makes it quite clear that the aim of the recommendations is to protect the industry from European legislation, rather than to protect patients.
The admirable European rules are, of course, being opposed the health fraud industry, and also by the Conservative Party (see below).
From the point of view of universities, the ominous part of the recommendations is the requirement for "training". If you do not want your university to end up running courses in herbalism etc. (what next? Astrology?), then express your opinion to the Department of Health now, by clicking here.
The curious case of NADH and chronic fatigue syndrome
During research for a talk on quack medicines. I came across several web sites that were selling the common co-enzyme, NADH, for a whole variety of ailments. One of these sites, Wizards Gate, no longer sells NADH ("because the profit is too small"). but continues to carry the following advertisement for it.
A
recent Georgetown University Medical Center clinical pilot study among CFS patients
reports that participants taking ENADA® were four times more likely than those taking a
placebo to experience a reduction in symptoms.
Please click on the links
below for more information.
What this does NOT mention is that the huge column on the left represents eight people out of 26, and the tiny one on the right represents two people (out of 26)!
The reader is then referred to ImmuneSupport.com, who describe NADH as follows (with my comments in italics).
Improves cellular energy[This, as it stands, is meaningless]
Elevates mental clarity [There is no evidence that this is true]
Promotes mental alertness and concentration [Again, there is no evidence that this is true]
The ImmuneSupport site goes on to say
"NADH is proven to trigger energy production through ATP generation [true].
A naturally occurring coenzyme found in all living cells,
NADH helps supply cells with energy.[true]. Thus, as NADH levels rise in the body, the cells become more energized, helping the body feel stronger and more vitalized. [This sentence confuses energy in the technical sense that is used in physics, with the everyday use of the term to describe a mental and physical state, In fact there is no reason to think that NADH "helps the body feel stronger" to any greater extent than a placebo].
The clinical trial referred to in all of these advertisements is Forsyth, L. M., Preuss, H. G., MacDowell, A. L., Chiazze, L., Jr., Birkmayer, G. D., & Bellanti, J. A. (1999). Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome.Ann.Allergy Asthma Immunol. 82, 185-191.
It is very clear from the letter below that this trial is flawed, but it is impossible to see exactly how flawed it is because the authors, in breach of all guidelines on such matters, have refused, for over a year, to make available the raw data that would allow a correct analysis to be done.
We should like to comment on the paper by Forsyth et al. 1
This paper claims, on the basis of a randomized double-blind clinical trial,
that NADH is effective in the treatment of chronic fatigue syndrome. It
seems that there are several problems with the work described in this paper.
On page 187, the 'raw symptom score' is defined as a score from a questionnaire
normalized to lie between 0 and 1 (the questionnaire had 50 questions,
each scored 1, 2, 3 or 4, so raw scores are in the range 50 to 200). This
was normalized to lie between 0 and 1 by first subtracting 50 and then
dividing by 150. However, patients with chronic fatigue syndrome are said
to have scores ranging from 10.9 to 55.8, so the normalized score has presumably
been expressed as a percentage, whereas in the case of normal patients
the values of 0.01 to 0.13 suggest that proportions have been used. Furthermore,
even using percentages rather than proportions, we cannot reproduce the
ranges given for patients. For example, a raw score of 66 yields a normalized
score of 10.7 whereas the next possible value 67 translates to 11.3.
How in that case could Forsyth et al get 10.9? Similarly 133 yields a score
of 55.3 but 134 yields 56. So what raw score can have produced 55.8?
It is stated that, "an individual was considered improved if s/he demonstrated
at least a 10% improvement," but then it is also stated that, "the degree
of improvement for the results to show a positive effect was an improvement
by one point in 10 questions or by 2 points in 5 questions" (p 187). This
corresponds to a decrease in the raw score of 10 points, not a "10% improvement."
Table 5 gives the scores (presumably normalized score x 100) for each of
the 26 patients on each of the tests. It is stated that 8/26 improve on
NADH and 2/26 improve on placebo. This appears to be a change in normalized
score (x 100) by 10, not to a change in raw score of 10.
The method of analysis given on page 187 is a test of difference between
two independent estimates of a binomial proportion. This is entirely inappropriate
for the analysis of a crossover trial. 2
Most importantly, nothing whatsoever is said about which of the 26 patients
in Table 5 received which treatment. Without knowing which treatment was
given in which period it is impossible for the reader to repeat the analysis
using methods more appropriate for crossover trials. The simple addition
of one column here, giving the sequence to which the patient was allocated,
would have permitted others to have performed the necessary calculations.
Drs Forsythe and Bellanti were asked in June 1999 to provide the raw data,
in particular the crucial information on sequences that would allow re-analysis
of their results. Despite several further requests we have not had any
response. This is made all the more disturbing in view of fact that their
paper is being used to justify vigorous marketing 3
of NADH as a treatment that "Enhances energy naturally, elevates mental
clarity, improves alertness, and concentration," which treatment is also
being claimed by some to be useful for everything from improving athletic
performance to Alzheimer's disease. In view of this it seems that the least
that it is owed the readers of your journal is for the authors to produce
the original data so that their claims can be verified.
David Colquhoun
Stephen Senn
Professor of Pharmacology, University College London, Hon, Director
Wellcome Laboratory for Molecular Pharmacology, Dept of Pharmacology, University
College London, London, United Kingdom and , Professor of Pharmaceutical
and Health Statistics, Department of Epidemiology & Public Health,
and Department of Statistics, University College London, London, United
Kingdom
REFERENCES
1. Forsythe LM, Preuss HG, MacDowell AL, et al. Ann Allergy Asthma Immunol
1999;82:185-191.
We have reviewed the two "Letters to the Editor" from Professors Colquhoun
and Senn and from Professor Lorden and wish to respond to both. Recognizing
that there are various methods and points of view concerning statistical
analyses, since this was a preliminary study and not a definitive one,
we chose to analyze the data in the manner described. This was done to
determine whether there was a basis for the therapeutic efficacy of NADH
in chronic fatigue syndrome and, if so, then to proceed to a larger, more
definitive study. We feel that we have accomplished this goal in obtaining
sufficient evidence to proceed further. We are grateful for the constructive
elements of the readers' comments and we shall take these into consideration
as we plan the definitive studies.
Joseph A Bellanti, MD
Professor of Pediatrics and Microbiology-Immunology
Georgetown University School of Medicine
Washington, DC
This reply from Professor Bellanti stands in contrast to his own statement in a recent report
presented to Annual Meeting of American College of Allergy, Asthma and Immunology
in which he says "We have recently demonstrated the clinical effectiveness of
reduced nicotinamide adenine dinucleotide (NADH) in a group of 26 patients with CFS in a
double-blinded, placebo-controlled, crossover study". There is no mention here (or in any of the advertisements) of the study being "preliminary" or "not definitive". (The measurement of 5-HIAA urinary concentration as a possible predictive marker of disease activity and therapeutic efficay of NADH in the chronic fatigue syndrome. Joseph A Bellanti MD; Linda M Forsyth MD; Ana Luiza MacDowell-Carneiro MD; Dawn B. Wallerstedt, MSN, FNP; Harry G Preuss MD and Georg D Birkmayer MD. PhD ).
This reply gives no reason at all for refusing to disclose the raw data, to allow others to check the conclusions. It does say that "there are various methods and points of view concerning statistical analyses", but does not (unsurprisingly) refer to anyone who thinks that a test of difference between two independent estimates of a binomial proportion is an appropriate way to analyse a cross over trial.
Financial interests
The editor of Annals of Allergy, Asthma, & Immunology, Dr Edward O'Connell, tells me that the journal requires authors to disclose any financial interest in the work, and that no such interests were declared in the case of Forsyth et al. This seems very odd, since the address of one of the authors, Dr G.D Birkmayer is given as Birkmayer Pharmaceuticals (Vienna), who market the ENADA brand of NADH, on which Dr Birkmayer holds patents. Birkmayer Pharmacuticals supported the work by a grant, and analysed the data.
Latest news
The case of the Bellanti paper was referred to the Georgetown University's Research Integrity Committee for review, in February 2001. That committee has reported that "no violation within the purview of the Code has been committed". In the light of the facts concerning (a) improperly analysed data, (b) non-disclosure of financial interest and (c) the refusal to allow independent analysis of the data, it seems the the University has a novel view of what constitutes research integrity!
I was asked by the producer of a television programme (QED) to look
at a paper that claimed a beneficial effect of homeoepathic treatmemt of fibrositis
(Fisher, P., Greenwood, A., Huskisson, E. C., Turner, P., & Belon, P. (1989).
Effect of homoeopathic treatment on fibrositis (primary fibromyalgia) British
Medical Journal299, 365-366.).
It appeared from the paper that the crossover trial had been analysed incorrectly (each patient had been counted twice). The homoeopath, Peter Fisher, was kind enough to give me the raw data for re-analysis. When this was done no significant effects were found. Astonishingly, the British Medical Journal declined to publish the correction, but their rival, the Lancet, did so with alacrity (Colquhoun, D. (1990). Reanalysis of a clinical trial of a homoeopathic treatment of fibrositis. Lancet336, 441-442.). [Get pdf]
Incidentally, the result of this exercise, despite the fact that it had been commissioned by the television producer, was entirely misrepresented in the final TV programme. The producer was evidently less interested in discovering the truth, than in giving the public what he thought they wanted, i.e. wishful thinking. In this he must have been successful, because the first letter that I received after the programme was from a lady in Fulham, who asked me to recommend a source of homeopathic flu jabs for her cat.
Peter Fisher (Fisher, P. & Scott, D. L. (2001). A randomized controlled trial of homeopathy in rheumatoid arthritis. Rheumatology.(Oxford)40, 1052-1055.)
This paper is remarkable in several ways. Fisher is a dedicated homeopath who
has just been appointed homeopathic physician to the Queen. It is remarkable
because he finds that placebo was, if anything, better than homeopathic treatment
for rheumatoid arthritis, and has published it. However, what is really amazing
is his conclusion.
"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"
This last bit appears to me to be an admission from the UK's leading homeopathist that homeopathy has been based on an intellectual fraud. It is as near as you can get to admitting it is all placebo effect. Agreement at last!
Aha it is not so simple. In October 2004, Peter Fisher appeared on the BBC Radio 4 programme, "The Other Medicine". He said " . . . pool them [clinical trials] using a statistical technique called metanalysis. Everybody who's done that concludes that the evidence says homeopathy really does work compared to placebo, it is not a placebo effect."
This article was written by Edzard Ernst, professor of Complementary Medicine at the University of Exeter, in Focus on Alternative and Complementary Medicine (FACT), Volume 6 (2) June 2001 101
In praise of the data-free discussion. Towards a new paradigm
Edzard Ernst
Editor-in-Chief of FACT and Chair in Complementary Medicine at the University of Exeter, 25 Victoria Park Road, Exeter EX2 4NT, UK.
Eight years ago, when I decided to go full-time into complementary/alternative medicine (CAM) research, I was a narrow-minded and short-sighted man! Narrow-minded because I had been under the impression that data are an essential element in any scientific debate and short-sighted because I failed to realise how efficiently one can expand one's mind if only one manages to overcome science's obsessional insistence with data, facts and evidence. Today, after attending about 300 conferences on CAM, I have learned an important lesson and realised the true value and enlightened bliss of data-free discussions, meetings and other debates.
Their advantages are multifold. First, they are far less tedious. Under the old paradigm, one had to prepare, research, read and study for every presentation. Some speakers had to spend days, even weeks or months preparing a single lecture. The new CAM paradigm has made this so much easier. No more time-wasting preparatory work; one can now walk straight into the middle of the action and be part of it. The time thus saved allows one to extend one's scope of topics almost ad infinitum and to attend even more meetings and data-free discussions for the benefit of everyone.
Second, data can be frightfully intimidating and non-egalitarian. In the past, those with knowledge had a distinct advantage over those without. Under the data-free paradigm, all can join in and all are equal The less you are aware of the facts, the more light-heartedly you can go to work. Data are ever so patronising; they weigh you down and limit your freedom. Data-free debates, in contrast, can be such liberating fun!
Third, data do get in the way of our real aims in life. Data-free meetings are much more practical if you really want to achieve something quickly. All you need to do is to invite speakers who vaguely agree with your own views, let them talk at length and finally reach a groundbreaking, barrier-crashing consensus. If you want to be absolutely sure to succeed, invite a few VIPs to nod their wise heads along the way. Who on earth would dare to disagree with a consensus? Data-free discussion can be immensely productive.
Fourth, under the old paradigm, one set of data often opposed another set. Unavoidably, controversy ensued, people became emotional and in the end someone got hurt. Not so with data-free events! Where there are no data, there can be no disagreement. Here is the energy that will truly heal the medicine for the New Millennium. Data-free discussions provide the true basis for ubiquitous peace, love and happiness.
I, for one, am convinced -the bad old times when scientific meetings focused on data and evidence must be over once and for all. This is particularly true for CAM. The last thing we want is the slaying of our beautiful hypotheses by some nasty, ugly facts.
In his article on cannabis legislation, John O'Farrell writes in The Guardian as follows.
"It is the more pernicious drugs that the police should be concentrating on. I don't mean heroin or cocaine or ecstasy, I mean the real social menace: echinacea and arnica and all the herbal remedies that are sold at great expense and don't do anything whatsoever.
All over Britain traumatised children are being forced to take fish oil while the callous pushers in the health food shop buy another gold-studded collar for their rottweilers and laugh at the gullibility of the liberal middle classes. "Wanna score some more St John's wort man? It'll cost you, brother, this is good shit, I ain't cutting in no low-grade marigold." Armed police burst in. "This is a raid! Hand over your royal jelly!"
These definitions are taken from A Sceptic's Medical Dictionary (BMJ publishing,
1997). by Michael O'Donnell.
Faith
"A valuable ally in achieving a 'cure' and a dangerous enemy in assessing it"
He quotes Sir Peter Medawar thus.
"Exaggerated claims for the efficacy of a medicament are very seldom the consequence of any intention to deceive; they are usually the outcome of a kindly conspiracy in which everybody has the very best intentions. The patient wants to get well, his physician wants to have made him better, and the pharmaceutical company would have liked to have put it into the physician's power to have made him so. The controlled clinical trial is an attempt to avoid being taken in by this conspiracy of good will." (From Advice
to a Young Scientist, published in 1979.)
Clinical experience
“Making the same mistakes with increasing confidence over an impressive
number of years.”
Knight starvation
“Affective disorder that afflicts senior doctors . . . A progressive
condition that deteriorates with the publication of each Honours List and,
in longstanding cases, can produce serious erosion of judgement and integrity.”
Education.
“Elitist activity. Cost ineffective.
Unpopular with Grey Suits. Now largely replaced by Training.”
Little Atoms. Website of "Little Atoms" Radio show, broadcast fortnightly
on Fridays from 16:30 to 17:30 on Resonance
104.4 FM . Little Atoms is a live discussion show, Produced and presented
by Neil Denny and Richard Sanderson. Little Atoms explores the science of politics
and the politics of science. Download their mp3s.
Skeptico Critical thinking for an irrational world
These feeds can be used to produce a list of titles of additions to
these pages via any newsreader program. The two methods that I like are these
Use the Firefox browser. If an RSS feed is available, you'll see the red 'live bookmark' icon to the right of the web site address (in earlier versions it may appear in the status bar; bottom right).
Click on the icon, and save the bookmark. This will be a 'live bookmark'; it is a folder that contains links that update themselves automatically.
Another good way to use them is to go to http://www.netvibes.com and
set up a page for yourself there. Right click on the RSS logo above, choose
'copy link location'. The on the netvibes page, click 'add content'. then 'add
my feed', and paste the feed address into the upper box ('Enter an RSS/ATOM
feed link :'). The link should read, for example, 'http://www.ucl.ac.uk/Pharmacology/dc-bits/dcpolitics.xml'
for the politics feed. You can set up links to BBC and newspaper sites similarly, whenever you
see the RSS logo.
Hint for biologists. You can make a similar self-updating Pubmed search
by going to http://www.hubmed.org/, doing
a search on the topics that interest you, right click on the 'FEEDS' button
(top right) and paste that link into your netvibes page, as above.
RSS feed for DC's IMPROBABLE
SCIENCE
(click
here for hints). Recent, or changed, links shown in red. 
“And as the web site of the European Council
for Classical Homeopathy (6) puts it: ‘To make
such a claim, the manufacturers need only
show that the product has been used to treat
those particular conditions within the
homeopathic industry.’ No scientific basis. No
clinical trials. No evidence of effectiveness.
