Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
It may be only post-1992 universities that run degrees in nonsense, but you can find plenty even in the highest places. Like St Bartholomew’s (founded in 1123). That well known source of misleading medical advice, The Prince’s Foundation for Integrated Health (FiH), published last March, “Teaching integrated health at Barts and the London“. This consists of an interview with two members of staff from what is now known as the Barts and The London School of Medicine and Dentistry (SMD)..
| Dr Mark Carroll BSc (Hons), PhD, FHEA is Associate Dean (Education Quality) in the Centre for Medical Education (SMD), specialising in all aspects of quality assurance in the SMD |  |
| Prof Chris Fowler BSc MA MS FRCP FRCS(Urol) FEBU is Dean of Education |  |
They say they are dubious about alternative medicine, but rather keen on integrated medicine. Seems odd, since the latter is really just a euphemism for the former.
After seeing the FiH posting, I wrote to Carroll and Fowler to get more information.
From Carroll 20 March
We are at an early stage in the planning process for the “Integrated Health & Wellbeing” strand in our new MBBS curriculum. I can send you our ideas (attached). Much will depend on whether we can make a new appointment of someone who can lead on the planning
From Fowler 25 March 2008
Our discussions with the PFIH [Prince’s Foundation for Integrated Health] have only progressed to the stage of indicating an indicative curriculum for integrated health. We don’t have the sort of detail that you are asking for at present. We are hoping that they will work with us to get someone to champion the development.
. . .
Your views would be welcome
So I sent them some views on 26 March (read them here). I also said “I find it quite astonishing that a respectable medical school should feel it appropriate to have parts of its curriculum in the hands of the Prince of Wales.”. It seems, though, that only one sort of view was wanted. On 27 March. Fowler wrote
“I find your insinuation unnecessary and insulting. We have been working on a serious response to the GMC’s requirement that we teach medical students about the range of options available to patients. It is fatuous to suggest that the Prince of Wales is personally involved in any practical sense. The Prince’s Foundation for Integrated Health is an important stakeholder and I think that it entirely reasonable both to talk to them and to seek funding to help us to develop an area that is deficient in our current provision.”
Uhuh, not a very nice response to a rather moderate letter. Lesson 1: never trust anyone who uses the word “stakeholder”.
It does seem very odd that a medical school like Barts should turn to the Prince of Wales’ Foundation for advice on medicine. After all, the bad advice given by the “Patients Guide” is rather well documented (see also here). If messrs Fowler and Carroll were really unaware of that, I’d argue that they aren’t doing their job properly.
It seems that Barts, like Edinburgh, has over-reacted to pressure from the General Medical Council (GMC). Actually all that the GMC require is that
“They must be aware that many patients are interested in and choose to use a range of alternative and complementary therapies. Graduates must be aware of the existence and range of such therapies, why some patients use them, and how these might affect other types of treatment that patients are receiving.” (from Tomorrow’s Doctors, GMC)
There is nothing there about saying that they work. Certainly medical students need to be familiar with alternative medicine, given the number of theit patients that use it. That is a job I have done myself, both at UCL and at Kings College London. I’d argue that I am marginally better qualified to assess the evidence than the Prince of Wales.
Oddly enough, the bad education in Edinburgh came also from a Professor of Medical Education and Director of Undergraduate Learning and Teaching,
The result is manifested in two ways. Barts has a “Science in Medicine” course that has resulted in medical students being placed with homeopaths. And it has a Special Studies Module in Ayurvedic Medicine. Let’s take a look at them.
An Introduction to Ayurvedic Medicine
| The aims of this Special Study Module are “To introduce the concepts and principles which underpin Ayurvedic medicine. To introduce Year 1 and 2 medical students to the Ayurvedic approach to patient assessment, diagnosis and treatment”, and to “Critically evaluate the evidence base for Ayurvedic treatments and yoga therapy”. Just one small snag there. There is next to no evidence base to be assessed. |  Click to enlarge |
The module is given by Professor Shrikala Warrier, who is Dean of MAYUR: The Ayurvedic University of Europe. That sounds quite grand. But the web site of The Ayurvedic University of Europe is rather unusual for a university. It lists two courses but has no list of staff. Could it be that Professor Shrikala Warrier is the staff? Neither is it clear where Professor Warrier’s professorial title comes from. Her own private university perhaps?
The two courses it offers are B.Sc.(Hons) Ayurveda and B.Sc.(Hons) Yoga. It says that the course the “BA(Hons)Ayurvedic Studies is a three year programme of study developed in collaboration with Thames Valley University in London”. That’s odd too, because there is no mention of it on the Thames Valley University web site (and TVU is not in London, it’s in Slough). Elsewhere it is stated that the “programme has been validated by MAHE, which is also the degree awarding body”. MAHE is not explained but it appears to refer to the Manipal Academy of Higher Education, in Goa, India. That looks like a pretty good place. It does not offer degrees in Ayurveda, though there is a small Department of Ayurvedic medicine within the otherwise entirely conventional Kasturba Medical College-Manipal. Their first year physiology exam would tax our students.
Elsewhere we see the same address, 81 Wimpole Street, listed as The Manipal Ayurvedic University of Europe (a joint venture between The Manipal University and the Ayurvedic Company of Great Britain) Prof. S. Warrier, B.A.(Hons), M.A., Ph.D., MILT, Dean of Academic Planning.
If one checks Mayur Ltd at Companies House, one finds that it has two directors, Lady Sarah Morritt and Professor Shrikala Warrier. The company report shows that no accounts have been filed up to now and their 2008 accounts are overdue.
The business history of ayurveda is nothing if not tortuous. The London Gazette (May 2008) notifies us that
AYURVEDA HOLDINGS LIMITED (chairman Lady Sarah Morritt) was passed a Special Resolution: “That the company be wound up voluntarily.”
If you email the Ayurvedic University of Europe, the reply comes not from a University address but from unififiedherbal.com. That seems to be some sort of marketing company, at the same address, 81 Wimpole Street. But efforts to find out more about it from Companies House show that UnifiedHerbal.com was dissolved on 3 October 2006.
Several of the links are broken on the web site of Ayurvedic University of Europe, but one that does work is ‘products’. That takes you to the sales pages of http://www.drwarrier.co.uk/. That doesn’t look much like a university, but no prizes for guessing the address. Yes, it’s 81 Wimpole Street again. They will sell you all sorts of cosmetics, though Companies House lists Dr Warrier Limited, and tells us
Last Accounts Made Up To : 31/08/2007 (DORMANT) and
Next Return Due : 26/09/2008 OVERDUE. Their registered office is
at Harold House, Waltham Cross EN8 7AF.
From drwarrier.co.uk you can buy, for example,
The most commonly prescribed Ayurvedic formula. Triphala is an effective blood purifier that detoxifies the liver, helps digestion and assimilation, and reduces serum cholesterol and lipid levels.
Blood purifier? Detox? Where have we seen this sort of utter gobbledygook before? Or perhaps she can sell you some
Traditionally used for obesity and overweight, and reducing and preventing accumulation of cholesterol (LDL). Its anti-inflammatory and detoxifying actions help reduce arthritic pain and swelling.
There isn’t the slightest evidence for these effects in man. Hence, no doubt, the usual weasel words. “traditionally used for . . . ”
The sales department alone casts rather a large doubt on Prof Warrier’s ability to teach medical students how to “critically evaluate the evidence base for Ayurvedic treatments”.
It does seem a bit surprising that a top flight medical school should think that this is an appropriate place to educate its students.
Medicine in Society
The syllabus at Barts includes something called Medicine and Society. Page 5 of the second year Tutor Guide mentions “complementary therapies” as part of the course. There is little hint about what that means in practice.
It turns out that the alt med placements are at the Greenwich Natural Health Centre. Nothing is too barmy for them Acupuncture. Cranial Osteopathy, Craniosacral Therapy, Herbal Therapy, Homeopathy, Hot Stone Therapy and Nutritional therapy to name but a few of the preposterous make-believe stuff that is on offer.
Medical students are having to spend their time listing to stuff like this, on ‘hot stone therapy’.
“Hot stone therapy / massage is a kind of massage that uses treated volcanic rocks such as basalt and basinite that are believed to promote relaxation as well as eliminating negative energy within the client’s body, mind and soul.”
“These stones are carefully gathered and handcrafted for various sizes, shapes and weights according to what part of the body it will be use on.”
Or this, on ‘nutritional therapy’.
“Many of us lack the basic raw materials (from food and drink) to function at our best. Intensive farming, pollution, stress, stimulants and an over-reliance on processed foods are just some of the reasons for us being deficient in vital nutrients. As a result, we may develop serious degenerative diseases like cancer or arthritis.”
“Some clients may experience reactions like headaches, skin eruptions or bad breath during the first stage of treatment. These are quite normal and are due to detoxification, which is usually followed by a sense of well-being and increased energy.”
That must be about as close as you can get to claiming you can prevent cancer by taking vitamin pills. It is wrong and it is dangerous,
Sigh. What century are we living in?
According to Barts’ second year Tutor Guide, “Placement tutors are responsible for student assessment”.
What sort of grade will the student get if they tell their tutor in homeopathy or ‘Nutritional therapy’ that they are talking nonsense?
What do the students think?
Could the Ayurvedic course be the very same course that is referred to by a second year medical student on the Unprotected Text blog?
“When I found out my friend had been attached to a “doctor” in Ayurvedic “medicine” for the year I was horrified, as was she, and the school would not allow her to change claiming that the point is not to learn the medicine but its role in the multidisciplinary healthcare team.
I don’t believe that there is such a role.
The very fact that a student is forced to put up with this as a part of their education is appalling.”
A comment left on Unprotected Text by someone writing as ‘Barts Medic’ said
“I was HORRIFIED to hear that some of my friends have their medsoc placements
at such RUBBISH places too!last week, they were forced into a room one by room to be touched up (‘massaged’)
by the ‘doctor-person’ to HEAL them. she rubbed them all over, and CHANTED! WTF.if i was given a CRAPPY placement like that, i wouldnt turn up either”.
And there is an excellent statement about “holistic medicine” on Unprotected Text. Better, perhaps, than you’d get from the GMC.
“Holistic medicine is in fact a world away from homeopathy, although the two are often confused predominantly by homeopaths trying to validate their branch of “medicine”. Much of what is taught in medical school is in fact, holistic, and so it should be. The importance of mentality, or spirituality in medicine should not be used to excuse homeopathy.”
“That doesn’t seem to add up” is another blog that relates the experiences of another student who has been exposed to “Enforced quackery Day 1, “, “Enforced quackery Day 2“, “Enforced quackery Days 3 and 4“. He says
“. . .by the end of day 3 the students *still* hadn’t seen any patients and that, when confronted with this fact the person in charge is reported to have said that this was because she was scared of what the students might say to the patients… Apart from this being a massive insult to the professionalism of the students, it is at least an encouraging sign that they have not been very effectively indoctrinated.”
It seems that we shall soon have some more documentary evidence. It is truly impressive to find that Barts’ medical students are so bright and that they have the courage to speak up about it.
So there is one good thing. We have some very perspicacious medical students in London.
Pity that one can’t say the same thing of their teachers.
Follow-up
I have it on good authority that the unhappy students who were placed at the Greenwich Natural Health Centre were presented with one of the more absurd documents ever to be produced by homeopaths, “An Overview of positive homeopathy research and surveys“.
There is no need to argue about whether homeopaths cherry-pick the evidence. The selective use of evidence is announced proudly, right there in the title.
What excuse can Bart’s have for exposing medical students to such profoundly anti-educational stuff as this?
Later there appeared on the That doesn’t seem to add up blog, Enforced
Quackery – the literature. The unfortunate students who were pushed into a homeopathic placement were give a print out of a page from Sue Young’s homeopathic web site. It is merely a bit of phony history that attempts to link Pasteur with homeopathy.
Sue Young, incidentally, is a homeopath who has consistently breached the Code of Ethicsof the Society of Homeopaths by claiming to treat serious diseases, though needless to say the Society did nothing about it. She is also the person who wrote a wholly inaccurate account of the reasons why my blog left the UCL server (see alse here and here). She didn’t, needless to say, ask me, but luckily she was soon corrected on quackometer and in the Guardian.
Incidentally, the Unprotected Text blog continues to provide a fascinating student view on medical education. Students show more sense than their teachers not only about alternative nonsense but also about other gimmicks like ‘problem based learning’.
20 Responses to St Bartholomew’s teaches antiscience, but students revolt
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I find it interesting that, as is depressingly common in relation to CAM, there seems to be confusion in the minds of people deciding on course content. As DC says, the GMC’s statement that
“They must be aware that many patients are interested in and choose to use a range of alternative and complementary therapies. ….” does not indicate endorsement of CAM. Just because people tend to be taken in by suggestions that they are not really well, that they could have improved ‘wellness’ (aaargh) or that having their ‘energies’ altered will protect them from serious illness, far from bringing it all into the mainstream academic managers surely have a duty to protect the public from misleading claims and to ensure that critical analysis is at the top of the agenda for students.
I understand that a lot of people favour the death penalty: this does not mean that it would be ethically correct to re-introduce it.
[…] properMaxwelloQ wrote an interesting post today onHere’s a quick excerptCertainly medical students need to be familiar with alternative medicine, given the number of theit patients that use it. That is a job I have done myself, both at UCL and at Kings College London. I’d argue that I am marginally better … […]
A small observation re the link to the Times article (17th April 2008) publicising the challenge made by Edzard Ernst and Simon Singh to The Prince of Wales to withdraw two FIH guides promoting alternative medicine (Complementary Health Care: A Guide for Patients and the Smallwood report) – it looks like the challenge might have been partly successful.
If you search the FIH site for the ‘Smallwood Report’ it returns nil results, and it’s also no longer available on the FreshMinds site (it was the research agency involved in the report). This was its original URL:
Click to access THE%20REPORT.pdf
And the 2005 ‘Complementary Health Care: A Guide for Patients’ also seems to be no longer available on the FIH site – at least not in its original form. Apparently it was updated on 12th September 2008 and it can currently be viewed in a draft(?) Word document here (see first result):
http://www.fih.org.uk/applications/site_search/?term=Complementary+Healthcare%3A+A+guide+for+patients&searchreferer_id=1&submit.x=39&submit.y=16
I suppose they’re being balanced by placing their students with practitioners of Ayurveda as well as with homoeopaths. After all, Ayurveda is (unlike modern medicine) pretty close to what Hahnemann would have recognised as “allopathy”.
[…] unknown wrote an interesting post today onSt Bartholomewâ??s teaches antiscience, but students revoltHere’s a quick excerptThat seems to be some sort of marketing company, at the same address, 81 Wimpole Street. But efforts to find out more about it from Companies House show that UnifiedHerbal.com was dissolved on 3 October 2006. … […]
It seems obvious to me that the GMC advice is for clinicians to devise tactful, sympathetic, appropriate ways of dealing with people who come to them and start talking about CAM, rather than just shouting, “Pish! That’s a load of cobblers and you’re a fool!” (or similar).
This is analogous to clinicians devising tactful, sympathetic, appropriate ways of dealing with people who come to them and claim they have diagnosed themselves off the internet.
Reading the GMC’s advise as supportive of CAM would be as daft as telling a patient, “Oh, it was on Wikipedia? Well, what the heck do I know?”
Yes. “Awareness” is one thing, while “letting practitioners of belief-based healing wizardry grade medical students on their professional attitude” (a la Barts)
– is a lot more that that.
DC is also exactly correct, I think, that it matters critically who presents a lecture on “What is the evidence base for CAM?”. Sadly, most people from the CAM side who would volunteer to do this are pretty much guaranteed to treat it as a promotional opportunity, and that goes for the ones within Universities just as much as the ones outside. And there are also people in health science faculties who have become so utterly PC that they won’t challenge “sincere belief” in CAM even for therapies that have zero evidence base.
There are, of course, plenty of ways to foster “awareness” without allowing uncritical promotion or an attitude of complete laissez faire. We had a medical student debate about CAM a little while back, with the (preclinical) students proposing and opposing CAM use. We have backed it up with a few places they could go for more info, including a link to Trick or Treatment?
The key point we try to get across is that the approach to CAM in medicine can be from the “patient health belief” viewpoint, or via a discussion of the placebo effect, or other approaches. But in all cases critical evaluation of the evidencemust be central, just as it is for all mainstream medical therapies.
Bart’s is presumably the med school referred to in this blog:
http://eucalculia.blogspot.com/2008_10_01_archive.html
Unfortunately the author hasn’t followed up the initial postings
Thanks for that link BobP. That initial post has been followed up now and I’ve added the links above to the ‘That doesn’t seem to add up’ blog. It’s great to find students who speak out when they have rubbish forced on them.
I suspect that students objecting may have more force these days than staff in mainstream science and medicine objecting… although both students and staff objecting is probably best of all.
I would have less problem with simply sending the students to see what happens in Zones of Alt.Reality provided any analysis / debrief / assessment of this was happening in the medical school proper. You could legitimately and usefully ask “Why do people seek help from the Alt Health crew? How does the way the Alties interact with them compare to how mainstream health people do? What do you think is the underlying basis of what the “patients” think they get from the “treatments”? ”
…And so on.
But… to use it as a way to bulk out the number of placements in “experience of healthcare practise”, and claim that it is a serious training experience, when you are basically letting the Alt.Reality people run the show on their own terms… that is plain dishonest, in my view.
PS Perhaps any Barts student asked to do this module should e-Mail a link to Steve Novella’s latest summary on CAM to the Preclinical Dean.
I find this really terrifying. I am finishing up my primary degree and am currently trying to secure a place in one of the medical schools in the UK. The idea that after studying as an undergraduate for four years in science and having critical thinking bashed into me by caring lecturers I will be expected to do a placement in one of these wretched institutions of fake medicine, forced to listen to the pseudoscientific ramblings of an NHS quack makes me nauseous.
Does anyone know of a way I can find out which medical schools have taken the GMC guidelines in the spirit intended? That is, that a physician in training should be aware of these therapies but not, certainly, be forced to learn any of them.
I think that the medical school at Swansea has politely declined to indulge the bullies and complainers, preferring instead to rely on real science and medicine to teach their students. http://ecam.oxfordjournals.org/cgi/content/abstract/nem185 Well done Wales! Please ignore the criticism…
But if Bart’s and Edinburgh have both fallen to this epidemic of ill thinking, what is next? Where is safe? How can I trust my own education in a society like this?
Apologies for the rant I just got a really big scare…
Angua
I haven’t attempted an exhaustive list of medical schools that do this sort of thing.
Newcastle seems to have succumbed badly too.
You’d be safe at UCL and at King’s (London) and at Aberdeen. Also Manchester, I believe. I’m sure there must be many more.
Keep it in perspective though. Offensive though it is, it isn’t a huge part of the course. You could always take the chance to educate your teachers.
Professor,
Sorry, that must have seemed a bit cheeky. I didn’t really expect anyone to spend hours trawling through syllabi for me! I suppose the real issue here, as I said, is that I want to be able to trust my own medical education. I would hate to feel that my training as a physician is being compromised because of these people. I think it’s important that medical students are able to trust their educators and this is an example of a total breach, in my opinion, of that trust.
However, part of the reason for the move towards graduate programs is that the students will be slightly older and more mature, as well as having experience and training in critical thinking when they start. This means that they will be more willing to question their teachers, one can assume!
I may, myself, at some stage examine the different medical schools on the basis of their willingness to stand strong against the onslaught of vocal opponents to tried and tested modern medicine. I will of course offer this information up to any prospective medical students who might be interested!
The lack of critical thinking that DC sets out here and which we are seeing in medical schools and universities in relation to CAM and its lack of evidence-base, and also in schools regarding the teaching of creationism alongside science, is perhaps more prevalent than we think. It is being applied also to legal protest through laws that are not only Orwellian but which allow banning of demonstrations and possible conviction of protesters without evidence.
George Monbiot in the Guardian explains how the Protection from Harassment Act 1997 is being used to demonise those who protest against, for example, the use of a local beauty spot for waste from power stations. This law can be enhanced by a clause added in 2005 (presumably through an Order in Council since it was not debated) to the Serious Organised Crime and Police Act, allowing the banning of any protest. These laws can also be used to brand a protester as a “domestic extremist”.
The similarity to CAM and creationism is evident in that “….the purpose of obtaining injunctions under the act is ‘the criminalisation of civil disobedience’. One advantage of this approach is that very low standards of proof are required: “hearsay evidence … is admissable in civil courts”. The injunctions ….. criminalise all further activity, even though, as he admits, “any allegations made remain untested and unproven”.
So there we have it. Evidence is out, even in courts when people exercise one of the rights that all the ‘protective’ laws and actions are supposed to help us maintain. Monbiot explains it all in a most chilling way and with his usual candour so I won’t expand further.
I seem to remember that Alan Sokal (someone please correct me if I am wrong) suggested that one of the reasons it is important to challenge anti-science at all levels and opportunities is that, even though items such as CAM may seem small fry in the general scheme of things, gullibility at that level makes it easier for governments to dupe the public on matters such as invading Iraq and on who should be branded as extremeists.
Happy New Year!
Thanks Lindy. I agree entirely. .Endarkenment thinking brings problems far greater than quackery. There’s plenty to do 2009.
[…] It is not so long ago that I discovered that the very sensible medical students at Barts were protesting vigourously about being forced to mix with various quacks. A bit of investigation soon showed that the students were dead right: see St Bartholomew’s teaches antiscience, but students revolt. […]
[…] of the familiarisation myself. In other good medical schools, the students get some shocking stuff. St Bartholomew’s Hospital medical School was one example. Edinburgh University was another. But there is one Russell group […]
[…] Although all of the degrees in magic medicine are from post-1992 universities, the subject has crept into more prestigious universities. Of these, the University of Southampton is perhaps the worst, because of the presence of George Lewith, and his defender, Stephen Holgate. Others have staunch defenders of quackery, including the University of Warwick, University of Edinburgh and St Batholomew’s. […]
[…] students who, very reasonably, objected to having course work marked by homeopaths (see St Bartholomew’s teaches antiscience, but students revolt, and, later, Bad medicine. Barts sinks further into the endarkenment). In that case he was not […]