Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
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“In causing NHS Choices to publish content that is less than completely frank about the evidence on homeopathy, the DH have compromised the editorial standards of a website that they themselves established”. . . “. . . they have failed the general public, by putting special interests, politics, and the path of least resistance (as they saw it) before the truth about health and healthcare.” David Mattin, lately of NHS Choices |
NHS Choices is usually a good source of information for the public. But there is one exception: the information they provide about alternative medicine is poor. A Freedom of Information Act request has revealed that the attempt of NHS Choices to rewrite their pages more accurately was censored by the Department of Health in conjunction with the late Prince’s Foundation for Integrated Health. The Department of Health (DH) has misled the public.
The earliest version of the homeopathy information page recorded by the Wayback Machine was November 12 2007. It was still there on December 5 2010. The comments were mostly critical. One said, quite correctly,
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I find it most regrettable that the way NHS has covered this subject is to give uncritical voice to the claims of homoeopathy without giving readers the information they need to evaluate those claims. To refer readers to the websites of the British Homeopathy Association is like settling the question of the shape of planet by a reference to the website of the Flat Earth Society |
There were a lot of complaints, and to the credit of NHS Choices, the page vanished. Throughout 2011, and up to October 2012 the information page on homeopathy read
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Introduction Content on homeopathy has been removed from the website pending a review by the Department of Health policy team responsible for complementary and alternative medicines. Homeopathy is not part of mainstream medicine. Instead it is defined as a complementary or alternative medicine. If you are considering using homeopathy, talk to your GP first. For more information about homeopathy see the House of Commons Science and Technology Committee report on homeopathy published on 8 February 2010 and the Department of Health response to that report published in July 2010 (PDF, 69KB). |
Then, at the end of 2012, the page reappeared. It was a bit better than the original, but not much. Many of the comments criticise the misleading nature of the information (as well as the usual “it worked for me” comments). The “useful links” still has six links to flat-earth organisations like the Society of Homeopaths, and only one to a sensible source, the excellent pamphlet from Sense about Science. They do link at the end to the 2010 Science and Technology Committee Report: Evidence Check 2: Homeopathy (PDF, 1.61Mb), and to the Government Response to the Science and Technology Committee Report, Evidence Check 2: Homeopathy (PDF, 69kb) but no comment is made on the findings.
Policy-based evidence
I wondered why the NHS Choices page, after an absence of almost two years, had returned in such an unsatisfactory form. So I asked them. After a reminder, I was told that my queries were being dealt with not by NHS Choices, but had been referred to Dr Sunjai Gupta “the DH official with responsibility for this area”. Dr Sunjai Gupta OBE is Deputy Director of Public Health Strategy and Social Marketing, Department of Health.
Dr Gupta is not obviously sympathetic to woo. It’s hard to tell since he doesn’t seem to have published much. But one is not reassured by an article that he wrote for the Journal of Holistic Healthcare. It appears straight after an article by fantasy herbalist, Simon Mills.
Despite assurances that I’d hear from Dr Gupta shortly, nothing happened. So I sent a request for the correspondence under the Freedom of Information Act (2000). Although the request was addressed to NHS Choices, a public body, strenuous efforts were made to divert it to the Department of Health. These were resisted. Nevertheless when, after a long delay, the material arrived, it came not from NHS Choices, but from DH, who had evidently vetted it,. The emails were rather shocking [download all].
A mail dated 1 December 2009 said
This is the most direct statement I’ve seen that, in the Department of Health, policy dictates evidence. NHS Choices is meant to provide evidence, but what they say has to be checked by DH to make sure they “don’t clash with any policy messages”.
The re-written page
The original version of the re-written page was sent to me by David Mattin, who worked for NHS Choices until September 2012. You can download the whole draft here. It is an enormous improvement on the original page. For example, it says
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“Does it work?
Many independent experts would respond to this question ‘no, homeopathy does not work’ There is no good quality clinical evidence to show that homeopathy is more successful than placebo in the treatment of any type of condition. Furthermore, if the principles of homeopath were true it would violate all the existing theories of science that we make use of today; not just our theory of medicine, but also chemistry, biology and physics. |
This original draft was sent to Mattin on 29 January 2010. After editing it for length Mattin sent it to DH for approval. Over the next two years, DH removed much of the accurate content. Mattin’s own comments on this evisceration are reproduced below.
The DH emails
All the names have been redacted. Needless to say, nobody is willing to take responsibility. But the number of people who support magic medicine is really quite small so the main players were easy to identify.
During the nearly 2 year absence of the homeopathy page, dozens of changes were made by DH. It seems that the policy message with which the NHS Choices draft failed to comply were those of the Prince’s Foundation for Integrated Health, and its successor (after April 2010), the College of Integrated Health, now known as the College of Medicine.
NHS Choices sought advice about their redrafted pages from the right person, Sir Iain Chalmers, one of the founders of the Cochrane Collaboration. On 3 Nov 2009, Chalmers advised
The most reliable source in the country - and one of the most reliable in the world - is Professor Edzard Ernst, professor of Complementary Medicine at the Peninsular Medical School, |
Ernst returned his suggestions in July 2010, but it seems that few of them survived the subsequent 18 months of revisions by DH.
On 2 December 2009, a mail from the NHS headquarters (Quarry House, Leeds) was sent to NHS Choices
This makes it perfectly clear that DH regards the Prince’s Foundation, and the equally flaky Complementary and Natural Healthcare Council (CNHC: known on the web as Ofquack) as appropriate guides for public health policy. The fact of the matter is that regulation of magic medicine by the government has been a total disaster, because, it seems, DH regards the Prince of Wales as a reliable source.
On 29 December 2009, the Prince’s Foundation went on the attack.
On 10th January 2010, two more letters were sent to DH by the Prince’s Foundation. At 13.48 they wrote
And at 22.14 on the same day, it was followed up with
The references to Devon and to Thought Field Therapy, make it very obvious that these letters were written by Dr Michael Dixon OBE, who was medical director of the Prince’s Foundation, and who is now a director of the “College of Medicine”. And the object of Dixon’s bile is obviously Edzard Ernst (the quotation is from his book, Trick or Treatment).
I find it fascinating to see just how venomous quacks become when the evidence contradicts their views. The cuddly “holistic” veneer quickly vanishes.
It gets worse. On 21 January 2010, a mail from NHS Choices to DH said
The only person in the country who fits this description is the (in)famous George Lewith. It is simply mind-boggling that DH regards him as an appropriate person to advise on anything.
After that, NHS Choices kept asking DH to sign off the documents, and changes continued to be made. Almost two years later, DH were still stalling.
The admission that “We are a bit short of doctors within DH these days” is interesting.
A bit short of anyone capable of critical thinking would be more accurate.
The most interesting document that I got from DH was an intermediate draft of the rewritten page on homeopathy (undated). Download the document. Here are a couple of extracts.
It’s a story of two years of meddling and procrastination. The end result misinforms the public.
Right at the start, the NHS Choices draft says, reasonably enough
A House of Commons Science and Technology Committee report said that homeopathic remedies perform no better than placebos and that the principles on which homeopathv is based are “scientifically implausible”.
But a comment, added apparently by DH, says
Can we remove this statement? This report is really quite contentious and we may well be subject to quite a lot of challenge from the Homeopathic community if published.
What on earth? The DH seems to think that that its job is not to present the evidence, but to avoid challenges from the homeopathic community! And true enough, this piece is missing from the final version.
A bit later, the NHS Choices draft was censored again
“A 2010 Science and Technology Committee report said that scientific tests had shown that homeopathic treatments don’t work”
But again this doesn’t appear in the final version. The comment, apparently from DH, says
“The DH response to this report (point 24) doesn’t support this statement though”
That’s a gross distortion of point 24, which actually concludes
“The Government Chief Scientific Adviser cannot envisage scientifically credible proposals for funding for research into homeopathy in the future”
NHS Choices was not happy with the result
Shortly before the revised page was published, Paul Nuki, Editor in Chief of NHS Choicea, sent an email to DH.
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Date: 7th September 2011 Time: 3:33:42 pm Hi I’ve been through the CAM articles and asked that we publish them asap as requested. For the record, we will be publishing these pieces outside of the normal editorial process. Although originally signed off by a suitably qualified clinician, the time lapse and policy changes have been so substantial as to render that null and void. We also don’t have a formal |
It doesn’t need much reading between the lines to see that he was unhappy with the result. It will be interesting to see whether the Information Standard people at the Royal Society for Public Health do anything about it.
The Department of Health has not just ignored evidence but actively opposed it.
That’s the only possible conclusion from the documents that I was sent. And it’s pretty shocking that the DH has preferred advice from the Prince’s Foundation and its handful of acolytes (in particular Michael Dixon and George Lewith) to the findings of the Science and Technology Select Committee and the views of the Chief Scientific Advisor.
In January this year, the Chief medical Officer, Dame Sally Davies, said, in a rare outburst of candour
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‘I’m very concerned when homeopathic practitioners try to peddle this way of life to prevent malaria or other infectious disease,” she said. “I am perpetually surprised that homeopathy is available on the NHS.” Dame Sally, who is England’s most senior doctor, concluded by remarking that homeopathy “is rubbish”. |
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So one part of DH is working to contradict another part. the Chief Medical Officer. Perhaps Sally Davies should have a word with Dr Gupta.
This all predates the advent of Jeremy Hunt (and known defender of homeopathy) as health minister. But the sympathies of some DH people are made obvious by the presence on the DH web site of an article “Personal health budgets: A new way of accessing complementary therapies?”. This astonishing piece confirms the worst fears that quacks will see personal health budgets as a commercial opportunity to peddle their wares. The article is by Jim Rogers of Lincoln University. What his paper does not mention is Rogers’ conflict of interest. He’s a homeopath, and he has a paper in the International Journal of High Dilution Research (yes, there is a journal for every form of make-believe). You can download a reprint of this paper. It advocates more research into homeopathic provings, something that even George Lewith seems to have given up on.
It’s about time that the DH started to listen to the Chief Medical Officer. As it is, some people at DH seem to prefer the advice of the Prince’s Foundation, and to actively suppress employees who prefer evidence to anecdote.
One thing is clear. The DH is an unholy mess. Parts of it are intent on producing policy-based evidence.
Comment by David Mattin, who edited the first draft for NHS Choices
David Mattin left NHS Choices in September, 2012. He edited the new version and lived through the two years of wrangling with DH during which much of the best content was eviscerated. He sent me this statement about the affair.
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As an editor at NHS Choices, I viewed it as my job to present evidence-based information to the public. The article we prepared on homeopathy stayed true to that central purpose: it made clear to readers that there is no good quality evidence that homeopathy is an effective treatment for any health condition, and also presented the broad scientific consensus that the supposed method of action of homeopathy is implausible.
What followed was a two year story of delay, and eventual suppression, of that article. My strong impression was of DH civil servants who lacked the courage, and, frankly, the energy to stand up to the criticism from special interest groups that they anticipated would arise because of the article; and that did indeed arise when a draft of the article and other draft content on complementary and alternative medicines fell into the hands of the Prince’s Foundation and other CAM groups.
The attitude of DH civil servants, broadly, was simply to tell us ‘we can’t say this about homeopathy, people will complain’. They seemed to have no interest in making an appraisal of the evidence on homeopathy themselves to see if what we were saying was actually true or not. We repeatedly pushed back with the message: ‘some people may very well complain, but if what we are saying about the evidence base is true – and it is – then we must simply weather those complaints, and stand by our content. Our duty is to supply our readers with the best information, not to please the homeopathy community.’ But these arguments were disregarded. The DH civil servants were almost entirely concerned with the politics of the situation – that is, the politics as they saw them – and the possibility that this article may create new work for them, and very little concerned with the evidence itself, or the presentation of this evidence to the public.
The whole episode is an insight into the way special interest groups can influence the workings of government and the public sector simply by making a lot of noise, and having a few powerful friends. In causing NHS Choices to publish content that is less than completely frank about the evidence on homeopathy, the DH have compromised the editorial standards of a website that they themselves established, and that they fund. They have sold out the NHS Choices editorial team, who work tirelessly to fulfil their remit. And, most seriously, they have failed the general public, by putting special interests, politics, and the path of least resistance (as they saw it) before the truth about health and healthcare.
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Follow-up
13 February 2013 The Guardian version of this story, written by Sarah Boseley, is Prince’s charity lobbied government to water down homeopathy criticism. It’s fine as far as it goes but it doesn’t name any names. There are some good comments though.
14 February 2013. The printed Guardian gave the story full 5 column-width coverage. [download print version]
And news has reached the USA: there’s an account of the affair on the Neurologica blog: Politics trumping science at the NHS.
On 14 February, the Guardian version was Editor’s Choice by lunchtime, and the Guardian web version already had 414 comments, mostly sensible (though this blog got far more referrals from twitter than from the Guardian)
And news has reached the USA: there’s an account of the affair on the Neurologica blog: Politics trumping science at the NHS.
15 February 2013. The Daily Mail had very fair coverage of the story.
The Guardian closed the comments on the story when it had got 642 comments, most of them very sensible. And this page got almost 6000 hits in 24 hours. The majority of the referrals came from Twitter rather than from the Guardian, despite the direct link to the page from the Guardian.
18 February 2013. The affair featured in BMJ News [download the reprint]. The item featured prominently on the BMJ news page.
19 February 2013 Only six days of this post, the NHS Choices page has been re-written again, in a much improved form. That looks like bloggers 1, DH 0. It is baffling that it’s left to bloggers, working for nothing, to extract a bit of sense from the highly-paid civil servants at the Department of Health. But at least they listened this time, which is a lot more than happens often. Paul Nuki, who runs NHS Choices, deserves congratulations. Of course the revised page still doesn’t call a spade a spade, but it gets close at times. I like the way it starts "Homeopathy is a ‘treatment’ based". Notice the quotation marks.
Reputation management?
Incidentally, NHS Choices is outsourced to the (in)famous company, Capita. And the moderation of the comments on their site is outsourced again to Tempero, which describes itself as a "reputation management" company. Each of them creams off money meant of patient care. This discovery might explain why I and others have had comments rejected by NHS Choices several times. "Reputation management" is the antithesis of evidence. It is public relations, i.e. paid lying. That is quite wrong for a site that is meant to provide dispassionate information.
21 February 2013. Sadly a step backwards. Part of the improved page was removed. This bit.
The Chief Medical Officer, Professor Dame Sally Davies, has said there is no scientifically plausible way that homeopathy can prevent or cure diseases. She has made it clear she is particularly concerned about the use of homeopathy in developing countries as a so-called cure for malaria.
We can only speculate why this was removed, because it was true. In fact she accurately described homeopathy as "rubbish". Why she should not be quoted beats me.
36 Responses to Policy-based evidence. Department of Health and Prince’s Foundation censor accurate information about magic medicines
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*David,
well done for bringing this to public attention.
God save our gracious Queen,
Long live our noble Queen
🙂
This is truly alarming. However, as an American, I am relieved (in a perverse sense) to learn that we are not the only country teeming with scientific illiterates who have an disturbingly profound effect on public policies! What is next? Teaching the geocentric solar system as a viable alternative to heliocentrism? Equal time in the public debate for Flat Earthers? Leechcraft as a required course for MD training?
[…] information on this can be found on David Colqhuons blog. It seems when the Prince isn’t directly causing a constitutional crisis he is doing his […]
Indeed.
I think the attitude of the Department for Health can be summed up as: “we don’t want the angry letters“. They are craven and a disgrace.
This report is really quite contentious and we may well be subject to quite a lot of challenge from the Homeopathic community if published.
What “homeopathic community”? There is a longer argument but it’s a small group lacking cohesion. Homeopathy is very fringe in terms of both support and opposition and I doubt very much that it plays a part in the voting intentions of all but a very, very, very tiny minority.
The DH have demonstrated that they are perfectly prepared to ignore other interest groups that are far larger that are involved in issues that the public care sufficiently about to influence voting decisions.
*I submitted the following using the NHS Choices site contact facility:
I received the following reply:
So no response to the point I made that the information on the NHS Choices site is misleading other than the claims that some of the information on the NHS Choices site is not misleading and that the site also has links to sites which tell the truth about homeopathy.
The claim that “The Department of Health does not take a view on complementary and or alternative therapies including homeopathy” is quite bizarre given that the Department of Health is manifestly preventing the NHS Choices from presenting clear, accurate, and unequivocal information about “complementary and or alternative therapies including homeopathy”.
Mike Ward
@Badly Shaved Monkey
Actually I suspect you are on to something there. It is the Queen, not Prince Charles who is the patron of what used to be known as the Royal London Homeopathic Hospital. I strongly suspect that it is her influence that accounts for its continued existence. Although it has shrunk in size a lot, it continues to be a great embarrassment to UCLH. not least because of the number of times the Advertising Standards Authority has censured it. At least with Charles, his lunacy is public. The Queen’s is hidden from everyone. That should not happen in a constitutional monarchy.
[…] several times on this blog, homeopathy lacks a solid evidence base (to put it mildly). There are powerful organisations which attempt to mislead the public about this fact, but most homeopathy-fans know this only too […]
Medlatest is a UK-based medical device news site, routinely covering the latest medtech developments.We have no reason to cover homeopathy, but as editor (and a scientist) I just couldn’t resist giving this story our airtime. Actually, more as a taxpayer. And Jeremy Hunt’s an advocate? Has he seen the lack of evidence? Just imagine if homeopathy could get the profile of horsemeat or PIP breasts…he’d be running away at that point I reckon, but as long as enough “voters” rely on this bunkum we’re probably stuck with it. Anyway, find my coverage of your piece here. Congratulations.
[…] David now brings us a dramatically clear example of the latter. The NHS Choices page on homeopathy used to contain some clear language about the evidence. David goes over the history in more detail, but briefly – the original NHS Choices page on homeopathy looked like it was written by a homeopath. It was soundly criticized and as a result was removed pending revision. David was sent the draft of the revision, which included the following section: […]
1.
Excellent work,
David.
2.
Have you seen my
10 February 2013 BMJ rapid response on chief scientific advisers (CSAs), the Department
of Health and homeopathy?
http://www.bmj.com/content/346/bmj.f688/rr/630093
[…] came into being has been tenaciously pursued by David Colquhoun and set out this week in his Improbable Science blog and covered by The […]
Excellent. It is not uncommon to be pressured to say things that please interest groups and sponsors when writing a report: good people say no. When negotiating the dollar loan in 1945, Keynes was asked to rewrite a paper he wrote because “the Americans won’t like it”. He replied “So, because they won’t listen to sense, you want me to talk nonsense ?”
[…] site to make it more pleasing to homeopaths and the Prince of Wales. The story was uncovered by a Freedom of Information request by Professor David […]
[…] NHS Choices website, following the remarkable revelations about its article on homeopathy and the Department of Health’s insistence that homeopathic feathers are not ruffled, shows up something rather […]
[…] skepticus, professor David Colquhoun, doet op zijn blog DC’s Improbable Science uit te doeken hoe de tekst over homeopathie op de website verschillende keren is aangepast en hoe […]
[…] homeopathy, is revealed in correspondence from the department discussing the new guidance. It was released under the Freedom of Information Act to Prof David Colquhoun of University College London, a Fellow of the Royal Society and prominent science blogger. Read […]
[…] homeopathy, is revealed in correspondence from the department discussing the new guidance. It was released under the Freedom of Information Act to Prof David Colquhoun of University College London, a Fellow of the Royal Society and prominent science […]
I just found out that NHS Choices will very quickly remove any comment underneath the article if you flag it as unsuitable. All you have to do is provide a few comments highlighting inaccuracies in the posters comments/logic etc. I just got rid of two bizarre pro-CAM comments which made completely fabricated and misleading claims. The posts were gone within 15 minutes and I got e-mails confirming this.
They even removed a comment recommending homeopathy when I said it was unsuitable due to there being a lack of clinical trial data showing any effect above and beyond placebo. At least it seems their moderators are not unaware of the lack of evidence.
Feel free to set to work on any of the remaining comments everyone!
@Colonel_Mad
That’s interesting. Both I and some friends have had comments rejected. But I contacted the boss who said he’d “read the riot act” and that critical comments would be accepted from now on.
[…] The homeopathy entry on the NHS Choices website has been rewritten, following the media storm resulting from the revelation that the Department of Health censored accurate information about hom…. […]
[…] of this is depressing enough, but it becomes worse when you look at what Professor David Colquhoun discovered, that the changes to the NHS Choices page seem to have been driven by an organisation supported by […]
[…] David Colquhoun (who thinks that current research evidence does not support the use of homeopathy) recently discovered through a Freedom of Information request that, when the NHS Choices tried to re-write their pages on homeopathy to say that there is no […]
[…] David Colquhoun (who thinks that current research evidence does not support the use of homeopathy) recently discovered through a Freedom of Information request that, when the NHS Choices tried to re-write their pages on homeopathy to say that there is no […]
I am having an exchange with my (Tory) MP about this. Here are some thoughts I have just sent him.
The DH says that all NHS Choices articles “must be signed off by…the Department of Health. This is to check that the articles don’t clash with any policy messages”.
This is also stated on the policy page of NHS Choices, at Phase 3. What this page does not say is what happens when the content differs from DH policy. We now know of course. What is very strange is that, if the DH says ad nauseam that it has no policy on homeopathy, why did it have to review the NHS Choices text at all? Either there is a policy message or there isn’t.
What this appears to mean is that DH policy always overrides informed medical advice, as provided by the expert editors of NHS Choices. The DH has its policies upside down. The policies should be driven by evidence, not the messages to the public by policies. I don’t think any number of weasel words can absolve the DH of what it has been doing here. What I am hoping to hear is that the Dept has learned from this and will take proper advice and act on it in future. But I am doubtful of that, after years of obfuscation from successive ministers.
As I have repeatedly said, homeopathy is a very minor player in the NHS. I am much more concerned that this episode has revealed a policy of political interference in the provision of health care advice to the public. Is this happening in other areas of NHS Choices? What the NHS Choices policy should be saying, is that content will be checked by the DH to ensure that government policy is aligned with the evidence as collated by NHS Choices. Or is that too much to ask?
@Majikthyse
Your comment hits the nail on the head. Please tell us what sort of response you get. I can’t say I’m optimistic.
[…] I'd just talk tothis guy: http://www.dcscience.net/?p=5778 […]
[…] Prince’s Foundation for integrated Health. That shocking example of policy based evidence was revealed on this blog, and caused something of a […]
[…] Orwellian lobbying by Prince Charles‘s former Foundation for Integrated Medicine charity in censoring public information critical of homeopathy’s evidential […]
[…] to Orwellian lobbying by Prince Charles‘s former Foundation for Integrated Medicine charity in censoring public information critical of homeopathy’s evidential […]
[…] There are two big problems in understanding whether an intervention works, whether it’s a medical treatment or social intervention such as changing methods for teaching reading or testing approaches to crime and punishment. One is the financial incentive to exaggerate, the prevalence of PR in promoting universities and scientists, and the pressure to publish regardless of quality. The other is the lack of understanding about what constitutes evidence. Everyone should readTesting Treatments and the Cabinet Office paper on how to get good evidence. That might result in more evidence-based policy, rather than policy-based evidence. […]
[…] By and large, NICE does a good job of preventing that. But NICE has not been allowed by the Department of Health to look at […]
[…] homeopathy (the medicines that contain no medicine) the new advice took two years to appear. It was held up in the Department of Health while consultations were made with the Prince’s Foundation for Integrated Health. That’s […]
[…] on homeopathy (the medicines that contain no medicine) the new advice took two years to appear. It was held up in the Department of Health while consultations were made with the Prince’s Foundation for Integrated Health. […]