Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
The two chiropodists who run the Marigold Homeopathic Podiatry clinic (no, honestly, it’s real) at the Royal London Homeopathic Hospital seem to be spending much of their budget with a company that they themselves own. The UCLH Trust did not receive any notification of this until I told them about it.
This has been re-posted from the story on the old IMPROBABLE SCIENCE page.
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.
Hansard records
“ 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 £1,881kThe 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.
A conflict of interest at RLHH
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 of a company called Marifold Footcare Ltd.
The UCLH Trust web site says
“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. |  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. |
According to a Current Appointments Report obtained from Companies House. Marigold Footcare Ltd has three directors.
- 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.
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.
And Marigold Footcare Ltd claims
“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, 0, 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.
17 Responses to Conflicts of interest at the Homeopathic Hospital
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[…] have been problems before with the herbal activities at the RLHH before (see Conflicts of Interest at the Homeopathic Hospital). It appeared that the Khans, who run the Marigold homeopathic podiatry clinic (no, seriously, it […]
The site should not confuse abuse with evidence. Where is the evidence that tagetes-based medicines do not improve foot conditions? I know people who have used them, and I have used them myself and found them very beneficial for fungal nails. They have no side effects, unless you count a pleasant smell. There is a whiff of East Anglia, on the other hand, about this site.
@tjmspjm
The abuse, I suggested, was to do with concealed financial interests. It was nothing to do with efficacy.
Concerning your remarks about efficacy, may I ask you a question? What would you say if Pfizer or GSK tried to justify the supply on the NHS of (say) an antidepressant by saying “where is the evidence that is doesn’t work?”. I fear that you are misunderstanding the meaning of the word ‘evidence’.
Perhaps you’d care to expand on what you mean by “a whiff of East Anglia”. I presume it is meant as some sort of insult, but it beats me what it is that you are objecting to.
We might expect that the Marigold Clinic would use marigolds (African tagetes, rather than English calendula), so where is the surprise if the clinic uses its own prodcuts? When I consulted the present Dr Khan’s late father privately, the remedies cost less than an NHS prescription. They were made from plants grown well away from pollution, which might be expected to make the costs higher, but there was clearly no question of profiteering. So – as the American presidential candidate asked – “Where’s the beef?”
You were asking about efficacy. The late Dr Khan senior had thousands and thousands of “before and after” photographs which he had taken with patients’ agreement. I expect his son continues the practice. Even had my wife and I not both experienced the very positive effects of marigold treatment, we would perhaps have been persuaded by the photographs. There is a family bunion of ours in there somewhere!
As for antidepressants, firstly I know nothing of the individual products of the companies to which you refer, but I do listen to a lot of Radio Four. Are you referring to the anitdepressants after which come patients have committed suicide (and yes, I knew about the fallacy ‘post hoc ergo propter hoc’ fifty years ago), or the ones after which some feel “like zombies” (a constant motif, I gather)?
East Anglia: it’s all right to change the criteria for peer review as long as our view is the only one heard. And yes, I think that global warming is (partly or wholly) caused by industrial and post-industrial activity. But science is an approach to the understanding of phenomena via falsifiable hypotheses, not a religion.
@tjmspjm
A thousand cases of “post hoc ergo propter hoc” don’t consitute scientific evidence.
I am no apologist for drug companies but I have no doubt that for every suicide, drug companies could produce photos of thousands of happy smiling former depressives if they so chose.
Taxpayers are being taken for a nice little ride by a cosy little arrangement very much to the benefit of the Khan family.
The objection is at two levels,
Firstly, it is considered quite wrong to prescribe a product in which you have a financial interest. Surely there is no need to explain why.
Secondly, these products have never been tested in proper clinical trials. That is unethical too, though sadly it is the norm in alternative medicine. Before and after pictures don’t provide any worthwhile evidence. Where is the control group? Like much of what else that goes on at the RLHH, it is essentially quackery.
East Anglia is a bit of a diversion from the subject of this post, but for what it’s worth, I think that both Jones and the university handled it very badly indeed. They should have been out on every TV and radio station explain the data and explaining what the emails meant. By giving the impression of ‘going to earth’, they made a terrible impression. They played right into the hands of every right wing Republican group and oil company. It’s lucky that ideas about climate change come from many labs all over the world and aren’t dependent on what one lab may or may not have done.
One good outcome is likely to be to accelerate the movement, already well under way, all raw data and analysis programs on the web. The more open the better.
@toots
Your first point is spot on. The plural of anecdote is not data.
No doubt you are right too about the ability to produce photographs, but they would not constitute useful evidence, In fact I chose the example of antidepressants because, as better and better trials are done it is slowly becoming apparent that they are little if any better than placebo in mild or moderate depression. That conclusion has, sadly, been rather delayed because companies with vested interests tried to conceal some of the unflattering data. But in the end the trials have been done and the truth is emerging.
That is something that quacks virtually never do. When did you ever hear of a quack saying “I’m sorry but this treatment which we previously thought to be effective has turned out not to work after all”? That is the difference between quackery and science.
Ah, just to clarify, David. In no way was I expressing an opinion about the medical value of anti-depressive drugs. If drug companies relied on individual testimonials they would be as scientifically useless as they are for marigold. I am more than willing to accept your personal pharmacological expertise on the subject of anti-depressives.
That’s the trouble with patients. They want anecdotes much more than they want double-blind trials. I notice that I’m the only person who has put any dissident view in the last three years. I conclude (post hoc, ergo propter hoc) that this is a site for the converted. Hence, perhaps, its crazily complicated passwords. But I recognise that it’s a waste of time trying to put another view to scientists. Since the eighteenth century science has been improving our world out of all recognition. By the end of this century that process may well be complete.
tjmspjm
Err…. hardly. Aren’t you forgetting our friend DangerCon..? And there have been others too, e.g. Anti-D and notawitchdoctor.
Letting the browser remember them works quite well for me – it does, so that you don’t have to. Not recommended for online banking, but for Internet ranting it is fine.
Or: a lot of scientists read and comment here.
Unsurprisingly, they tend to have quite similar views about the difference(s) between science and non-science (nonsense?)
Thanks Dr Aust
@tjmspjm can’t have been looking very carefully if he thinks there are no arguments. I virtually never censor people who disagree with my views and usually try to reply politely.
In your case, I find it hard to know exactly what argument you are making. You say
I’d maintain that the opposite is the case. If you can produce good evidence (which so far you haven’t) you can persuade a scientist of almost anything.
Then you say
The last bit seems to me to wildly over-optimistic, but that apart, this passage sounds more like a tribute to the scientific method, than a criticism of it.
What patients want, on the whole, is neither RCTs nor anecdotes. They just want to get better. Without RCTs there is a great danger that they will be misled. I think you underestimate enormously the difficulty of finding out whether a treatment works or not.
I think the second bit you quoted was tjm… being ironic, David – for:
<blockquote"…that process may well be complete"
read “..end of the world”.
Arrgh – HTML fail. Blame Yuletide stress.
We don’t need less science – less effort to understand the world better; we need greater wisdom – better use of our limited understanding. Clinical trials are an imperfect attempt to do better than rely on even less perfect anecdotal evidence.
[…] was rather surprised to find this is still running. In 2006, I wrote about it in Conflicts of interest at the Homeopathic Hospital. It turned out that the prescription costs if the clinic were spent on Marigold paste, made by a […]
[…] through his web site at marigoldfootcare.com. Apparently, as was spotted by David Colquhoun, 4.2% of all prescriptions at RLHH are paid to Marigold Footcare Ltd. It’s a rather blatant conflict of interest – the […]
[…] through his web site at marigoldfootcare.com. Apparently, as was spotted by David Colquhoun, 4.2% of all prescriptions at RLHH are paid to Marigold Footcare Ltd. It’s a rather blatant conflict of interest – the […]