Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
The National Health Executive (“the Independent Journal for Senior Health Service Managers) asked for an article about quackery. This is a version of that article with live links.
Download the pdf version.
There is a Russian translation here (obviously I can’t vouch for its accuracy).
On May 23 th 2006 a letter was sent to the chief executives of 467 NHS Trusts. It was reported as a front page story in the Times, and it was the lead item on the Today programme. The letter urged the government not to spend NHS funds on “unproven and disproved treatments”. Who can imagine anything more simple and self-evident than that? But in politics nothing is simple.
It turns out that quite a lot of patients are deeply attached to unproven and disproved treatments. They clamour for them and, since “patient choice” is high on the agenda at the moment, they quite often get them. Unproven and disproved treatments cost quite a lot of money that the NHS should be spending on things that work.
In January 2007, the Association of Directors of Public Health issued its own list of unproven and disproved treatments. It included, among others, tonsillectomy and adenoidectomy, carpal tunnel surgery and homeopathy. They all matter, but here I’ll concentrate on alternative treatments, of which homeopathy is one of the most widespread.
It should be simple. We have a good mechanism for deciding which treatments are cost-effective, in the form of the National Institute for Clinical Excellence (NICE). If homeopathy and herbalism are not good ways to spend NHS money, why has NICE not said so? The answer to that is simple. NICE has not been asked. It can consider only those questions that are referred to it by the Department of Health (DoH).
The government often says that it takes the best scientific advice, but the DoH seems to have something of a blank spot when it comes to alternative medicine. Nobody knows why. Perhaps it is the dire lack of anyone with a scientific education in government. Or could there be something in the rumour that the DoH lives in terror of being at the receiving end of a rant from the general direction of Clarence House if it doesn’t behave? Whatever the reason, the matter has still not been referred to NICE, despite many requests to do so.
A judgement from NICE would be useful, but it is hardly essential. It isn’t hard to understand. At its simplest the whole problem can be summed up very briefly.
- Homeopathy: giving patients medicines that contain no medicine whatsoever.
- Herbal medicine: giving patients an unknown dose of a medicine, of unknown effectiveness and unknown safety.
- Acupuncture: a rather theatrical placebo, with no real therapeutic benefit in most if not all cases.
- Chiropractic: an invention of a 19 th century salesmen, based on nonsensical principles, and shown to be no more effective than other manipulative therapies, but less safe.
- Reflexology: plain old foot massage, overlaid with utter nonsense about non-existent connections between your feet and your thyroid gland.
- Nutritional therapy: self-styled ‘nutritionists’ making unjustified claims about diet to sell unnecessary supplements.
Of these, ‘nutritional therapy’, or ‘nutritional medicine’, is a relative newcomer. At their worst, they claim that Vitamin C can cure AIDS, and have been responsible for many deaths in Africa. There isn’t the slightest need for them since the nutrition area is already covered by registered dietitians who have far better training.
There have been several good honest summaries of the evidence that underlies these interpretations, written in a style quite understandable by humanities graduates. Try, for example, Trick or Treatment (Singh & Ernst, Bantam Press 2008): a copy should be presented to every person in the DoH and every NHS manager. In some areas the evidence is now quite good. Homeopathy, when tested properly, comes out no different from placebo. That is hardly surprising because the ‘treatment’ pill contains no medicine so it is the same as the placebo pill.
Acupuncture has also been tested well in the last 10 years. A lot of ingenuity has been put into designing sham acupuncture to use as a control. There is still a bit of doubt in a few areas, but overwhelmingly the results show that real acupuncture is not distinguishable from sham. Acupuncture, it seems, is nothing more than a particularly theatrical placebo. All the stuff about meridians and “Qi” is so much mumbo-jumbo. In contrast, herbal medicines have hardly been tested at all.
It is quite easy to get an impression that some of these fringe forms of medicine work better than they do. They form efficient lobby groups and they have friends in high places. They long for respectability and they’ve had a surprising amount of success in getting recognised by the NHS. Some (like chiropractic) have even got official government recognition.
One can argue about whether it was money well-spent, but in the USA almost a billion dollars has been spent on research on alternative medicine by their National Center for Complementary and Alternative Medicine (NCCAM), which was set up as a result of political pressure from the (huge) alternative medicine industry. That has produced not a single effective alternative treatment, but at least it has shown clearly that most don’t work.
The letter of 23 May 2006 proved to be remarkably effective. Tunbridge Wells Homeopathic Hospital has closed and commissioning of homeopathic services has fallen drastically. That has released money for treatments that work, and providing treatments that work is the job of the NHS.
It is sometimes asked, what is wrong with placebo effects as long as the patient feels better? First it must be said that much of the apparent benefit of placebos like homeopathy isn’t a placebo effect, but merely spontaneous recovery. Echinacea cures your cold in only seven days when otherwise it would have taken a week. But when there is a genuine psychosomatic placebo effect, it can be a real benefit. As always, though, one must consider the cost as well as the benefit.
And there are a lot of hidden costs in this approach. One cost is the need to lie to patients to achieve a good placebo effect. That contradicts the trend towards more openness in medicine. And there is a major cost to the taxpayer in the training of people. If the NHS employs homeopaths or spiritual healers because they are nice people who can elicit a good placebo effect, the Human Resources department will insist that they are fully-qualified in myths. ““Full National Federation of Spiritual Healer certificate. or a full Reiki Master qualification, and two years post certificate experience” (I quote). That is one reason why you can find in UK universities, undergraduates being taught at taxpayers’ expense, that “amethysts emit high Yin energy”.
There is a solution to all of this. There is room in the NHS for nice, caring people, to hold the hands of sick patients. They might be called ‘healthcare workers in supportive and palliative care’. They could do a good job, without any of the nonsense of homeopathy or spiritualism. Likewise, manipulative therapists could get together to dispense with the nonsense elements in chiropractic, and to make a real attempt to find out what works best.
All that stands in the way of this common sense approach is the rigidity of Human Resources departments which demand formal qualifications in black magic before you can cheer up sick patients. The over-formalisation of nonsense has done great harm. You have only to note that Skills for Health has listed ‘competences’ in Distant Healing (in the presence of the client or in the absence of the client).
When I asked Skills for Health if they would be defining a ‘competence’ in talking to trees, I was told, in all seriousness, ““You’d have to talk to LANTRA, the land-based organisation for that”.
I’m not joking. I wish I were.
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16 Responses to Medicines that contain no medicine and other follies
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This article ought to be in a national daily paper. Michael Baum expresses similar despair in his uncut interview with Richard Dawkins.
How apposite that Mike Rawlins appears on the cover, and that Karol Sikora (he of CANCERactive fame) is a contributor to this issue. Well done David – the correspondence column may prove interesting.
A very well written article.
I’ll post a link to it from my own blog.
Keep up the good work!!
[…] unknown wrote an interesting post today onHere’s a quick excerptThe government often says that it takes the best scientific advice, but the DoH seems to have something of a blank spot when it comes to alternative medicine. Nobody knows why. Perhaps it is the dire lack of anyone with a scientific … […]
Excellent! Let’s hope they take note. As Slartibartfast says, the letters pages could be interesting – can you let us know if there is anything interesting?
It is too bad folks don’t learn more before they comment. My family was treated by a M.D. homeopath for 45 years, raised 4 children on that alone. He was well received by a great surgeon and other specialists whose services he used when needed. Fortunately we only had one hospitalization in all that time. Our children are used to medicines that help and do not harm, and if anyone wants research it is available. I suggest anyone read “Homeopathy: Beyond Flat Earth Medicine” to learn more.
That is odd, JHH. My parents lived to 89 and 93 without any help at all from fraudulent sugar pills.
I notice that the author of the book that you recommend advocates treatment of acute infections with sugar pills, That could very easily be culpable homicide.
The author mentioned above by JHH,
Dooley, T.R. (ND NCNM 1978, MD OHSUSM 1989) states in that book [see here for the first edition, http://www.drdooley.net/Book.pdf%5D:
“Chapter 7 – Understanding Vital Force […it’s] an invisible, immaterial, yet dynamic force which animates the physical body […per a] vital principle [p.057…aka] chi, meaning life force […aka] prana, meaning vital energy […vitalists believe] illness is a disorder in the vital force [p.058…yet] modern science currently teaches that vital force is an outdated and discredited theory [p.059 — how true!].”
In fact, here in the U.S., the National Center For Science Education and the National Association of Biology Teachers state in “Voices For Evolution” (ISBN 0615204619; 3rd. ed., 2008) [see http://www.lulu.com/items/volume_63/1709000/1709901/9/print/1709901.pdf ]:
“nonscientific notions such as geocentricism, flat earth [!!!], creationism, young earth, astrology, psychic healing and vitalistic theory [!!!], therefore, cannot legitimately be taught, promoted, or condoned as science in the classroom [p.154].”
Dooley has an absurd logical structure:
promote the science-ejected vitalistic [the truly ‘flat-earth’ naturopathic-homeopathic {for more such, see http://thevitalismofnaturopathy.blogspot.com/ }] as if a legitimate premise,
and associate modern scientific medicine with the science-ejected [the falsely ‘flat-earth’].
The earth isn’t flat because of scientific evidence and THINKING, and that’s precisely what ejected the naturopathic-homeopathic sectarian belief known as vitalism from biology.
-r.c.
Thanks very much daijiobu, for unearthing all that detail about Dooley.
It seems that once you have abandoned any attempt at reason, no idea whatsoever seems absurd. Perhaps even worse, the crazier the idea, the more enthusiastically it is promoted. Could it be that they get some perverse pleasure from the derision that is heaped on them. or is it just the money they make from it that keeps them going?
The problem is that often they fool gullible and uninformed politicians.
Your comment also led me to your web site at http://naturocrit.blogspot.com/ and some interesting stuff about “naturopathy”
I suggest it’s the money.
Dr Fooley’s website says:
“Initial appointments for a chronic condition are $360. Please allow up to an hours and a half hour for the initial consultation. Initial appointments for children twelve and under are generally $240. Allow up to one hour. Initial appointments for children under 1 year are $180. Allow up to 45 minutes. Routine follow-up visits are $92. The charge for other appointments varies”.
But I do think they also get a feeling of huge importance from being able to tell serious scientists that they don’t understand the science of homeopathy. In the book Fooley says (page 4 of online first edn),
“Yet homeopathy is a highly developed science and is used throughout the world”.
And page 36,
“Homeopathy was and is a therapeutic science based on reproducible data and clinical experience”.
More alarming are the implications that DC mentions above, about hom. being tried and tested in the treatment of serious disease. p.38 “…irrefutable success of homeopathy, not only in acute epidemic diseases such as typhoid and cholera, but also in chronic disease…”.
An interesting thought is whether booksellers are really allowed to sell books that make false claims (other than in obvious fiction) any more than crank shops can leave leaflets beside pills and potions making claims about what these can do?
DC wrote: “the problem is that often they fool gullible and uninformed politicians”:
yup, and here’s such an example of foolery / deception by the North American NDs, from my archives
[see http://www.scribd.com/doc/2203649/AANPAlliance-Science-Based-Not-Belief-Claim ],
wherein AANP naturopathy states:
“naturopathic physician’s are the modern day science based primary care doctor […] it is not a belief system.”
The statement is completely false: naturopathy is a belief system [e.g. vitalism, or one thing] that is not science-based [unless a science-ejected belief is the same as what’s science-based].
This Alliance Workbook was a web page written to accelerate licensure of NDs in the U.S. and Canada in the late 1990s.
It was addressed to lawmakers per “your constituents want us.”
[Jedi mind trick?!?!?!?!?!].
It’s also very possible that politicians don’t live up to the ethos of ‘due diligence’ when they decide that its worthwhile to advocate for such licensure laws.
-r.c.
DC’s article is fair and very clear and should be published in a national newspaper. The reasons why so many ineffective CAM treatments prosper are greed – on the part of the CAM purveyors, and ignorance – on the part of the public. If article’s like DC’s were more widely available we could at least tackle the second problem.
With euphoria at the exit of George Bush and the historical inauguration of Obama it would have been easy to miss this in yesterday’s Guardian newspaper. I only just spotted it. It is good to see that there are some MPs who recognise rubbish and are not afraid to say so. Members of a select committee are critical of the new government chief scientific advisor and of the funding of homeopathy in the NHS.
http://www.guardian.co.uk/science/2009/jan/20/homeopathy-cannabis-john-beddington
Following the miniblog links, ‘We need evidence, not a register’
and the earlier ‘Ofquack’s Toothless Squawk ‘ makes alarming reading.
Looking at Ofquack’s requirements for its practitioners, Ben Bradshaw is being pretty optimistic when he says that they will have to meet minimum requirements for training. This is all they need, and of course it includes the ludicrous ‘competency’ buzzword:
‘If a practitioner has the CNHC kitemark it means that they:
Have undertaken a programme of education and training which meets, as a minimum, the National Occupational Standards for that profession/discipline
or
Have achieved competency to the level of the National Occupational Standards for the therapy/discipline concerned by means of relevant experience of at least three years and /or relevant training and been assessed by their peers as having met those standards
and
Have met the agreed standards of proficiency for that profession/discipline……’
The minutes (20/11/08) of the Federal (what?) Registration Board of OQ ( o sorry that should read CNHC) look highly unprofessional, rather more like a group of inexperienced people having a little chat about how they can make it all terribly nice and then everyone will rush to register. It is minuted that someone went on the BBC1 politics show and also how there was discussion of how to make use of patients’ ‘good news stories’ which we know about here.
But best of all was the agreement that the Ofquack website is to be designed by a company called ‘Imaginit’.
[…] Recently I wrote a piece for the National Health Executive (”the Independent Journal for Senior Health Service Managers”), with the title Medicines that contain no medicine and other follies. […]
[…] is a short guide, adapted and expanded from the list published here. It isn’t exactly a scientific review. but it seems to me to sum up most of what a patient needs […]