Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
Anti-science
| A paper published in the Postgraduate Medical Journal, October 2007, has been reported widely. In the same issue there was a commentary by Edzard Ernst. They show the astonishingly poor evidence than herbal treatments work, despite the fact that they have been around for thousands of years. They looked at 1330 published trials on herbal medicines and found 3 (yes three) that stood up to scrutiny, Of those three, two were negative and one indecisive |  Red clover, Derwentwater. |
A systematic review of randomised clinical trials of individualised herbal medicine in any indication, R. Guo, P. H. Canter, and E. Ernst, Postgrad Med J 83: 633-637 [Get the reprint]
Herbal medicine: buy one get two free, E. Ernst, Postgrad Med J 83: 615-617 [get the reprint]
Grab the reprints before I am told to remove them.
The paper says
“Systematic searches of electronic databases and contacting
experts and professional bodies in the field resulted in the
location of only three randomised clinical trials of individualised
herbal medicine. It should be stressed that professional
bodies representing the interests of different practitioner
factions from around the world were unable to contribute any
more studies than this. In view of the long history and
widespread use of medical herbalism, Chinese herbal medicine
and Ayurvedic herbal medicine in many and diverse indications,
this should be a cause for concern. It indicates that
individualised herbal medicine has an extremely sparse
evidence base and that there is no convincing evidence
supporting its use in any indication.”
The National Institute of Medical Herbalists says
“More and more people are turning to herbal medicine as a kinder alternative to mainstream medicine, with its over reliance on pharmaceutical products.”
Wrong. Herbal medicines are pharmaceutical products. They are just unstandardised, and often impure and contaminated, pharmaceutical products.
In the Guardian we find Ann Walker quoted thus.
“Ann Walker, director of the British Herbal Medicines Association, insisted that most herbalists were well-trained and knew when to refer patients. She said herbalists took a three or four-year degree course before accreditation.
She acknowledged the lack of proof of efficacy for individualised herbal medicine. “The evidence is scanty because the studies have only recently been started,” she said. This did not mean there was no efficacy.”
Just a thought: shouldn’t you have some evidence that they work before you start selling them? These things have been around for thousands of years but the “studies have only recently been started”. You couldn’t make it up. You can’t have a high level of training if there is no evidence. The paucity of trials makes it very hard to know how you can fill up a three or four year course with anything but idle speculations. Universities should not being giving degrees in idle speculation.
Quote of the day. . Of all the pathetic defences offered by herbalists, this one, quoted in the Daily Mail, is my favourite.
“Jane Gray, of the National Institute of Medical Herbalists, said: “We would challenge the conclusions reached by this study based on such little data.”
“We want more research, but we’re all in private practice and cannot afford to stop earning to run a trial over several months.”
The fact that there is “so little data” is the conclusion. And perish the thought that a herbalist should “stop earning” just in order to find out whether what they are selling does any good.
The regulation scam
Alison Denham, speaking for the National Institute of Medical Herbalists, is quoted as saying
“But there are certainly issues around the expertise of practitioners which need to be addressed, and we look forward to government regulation which imposes a high standard of training on anyone who wants to register.”
Like all forms of alternative medicine, herbalists are desperate for government “regulation” because they know it gives the appearance of official approval without requiring them to show that they can do the slightest good.
Reports on this paper
The BBC web site: “Tailored herbal medicine ‘futile'”.
The Guardian report, by Sarah Boseley, is pretty good. “Herbalists’ cocktails may do more harm than good, say researchers.”
- Call for individualised remedies to be banned
- Little evidence to support claims of efficacy
The Times has another excellent report by Nigel Hawkes. “High street herbalists can offer no evidence that their remedies work”
The Independent. “Natural medicine on trial: The trouble with herbs. Traditional herbal remedies have never been more fashionable: sales have almost doubled in eight years. There’s just one problem: science suggests that they don’t work.”. This time Jeremy Laurance got the headline right (unlike the acupuncture piece). But where did that list of “Herbal remedies that work” at the end come from? Had he checked the Cochrane Reviews? I think not.
The Daily Mail. “Herb cures that ‘do you more harm than good’ “. Pretty good report. specially for the Daily Mail.
The Scotsman. “A natural cure?” Lyndsay Moss. Sadly, and unusually, this is the only really poor report. Just look at the end of it.
Postscript
On Saturday morning (6 October) I did an interview on the Dublin radio station, Newstalk. The host, Brendan O’Brien spoke also to Mary Plunkett, from the Professional Register of Traditional Chinese Medicine. She assured us that that, although there may be no evidence that it works published in the West, there were lots written in Chinese. What a pity that I had not yet read Ben Goldacre’s column, on this week’s bad news for herbalists. He cited a reference that was new to me.
You can read the abstract here. [download pdf]. The paper, by Vickers, Niraj, Goyal, Harland and Rees (1998, Controlled Clinical Trials, 19, 159-166) has the title “Do Certain Countries Produce Only Positive Results? A Systematic Review of Controlled Trials”. The conclusion is riveting.
“In the study of acupuncture trials, 252 of 1085 abstracts met the inclusion criteria. Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR. In studies that examined interventions other than acupuncture, 405 of 1100 abstracts met the inclusion criteria. Of trials published in England, 75% gave the test treatment as superior to control. The results for China, Japan, Russia/USSR, and Taiwan were 99%, 89%, 97%, and 95%, respectively. No trial published in China or Russia/USSR found a test treatment to be ineffective.”
The British Medical Journal ran an article on “doctor bloggers” last week.
Photo ©Mark Thomas
The BMJ put the article behind a paywall, but you can download a reprint here.
Oops, no you can’t. The BMJ have dictated that their piece on bloggers should not be available to bloggers. If you want a copy, email me. The question of availability is more interesting than the article itself anyway. It is by a journalist, Rebecca Coombes. Contrary to what you might think from reading it, I have never met her. She asked for opinions by email, so I spent a while writing something out, which she cut and pasted into an article (and I spent another hour with their photographer, Mark Thomas, who took a lot of pictures). But I can’t use either the article or the photos freely. I don’t even get paid. The commercial journals, as always, do pretty well out of exploiting academics.
| The picture at the top should have been Ben Goldacre, whose badscience.net is now number two in the world. That picture prompted the child of a friend to ask if I was doing an impression of a velocirapter, I guess that is one better that gimpyblog’s perception of me as being a dead ringer for some computer game thug. So here is another one (possibly no less scary). |
Photo ©Mark Thomas |
By way of compensation, here is a picture of Goldacre.
 Goldacre |
 Science writer award 2005 |
Goldacre said
“. . . blogs are popular because they are more honest than other media. It is hard to get away with misrepresenting stuff when the original source is but a click away. I see it as a way of making conversation public. What is good about it is you get unmediated expertise.”
“In the press it’s hard to know what is true. But with blogs people can link directly to the original source: this never happens in a newspaper.”
DC said
“I think they [blogs] have really had some success in spreading public understanding of science and even in influencing public affairs (firstly with the merger [of Imperial and UCL] and more recently with withdrawal of NHS funding for homoeopathy). My own research is on the stochastic properties of single ion channels. I love it, but it is specialist and of zero interest to the public. So it’s fun to talk about things that do interest the public. It’s also fun to be able to influence politicians and vice chancellors, though that is rather harder.”
Back pain is a big problem, and Ben Goldacre has already written about the new study
The German Acupuncture Trials (GERAC) for chronic low back pain
Randomized. Multicenter, Blinded, Parallel-Group Trial wth 3 groups.
Sadly, the Journal of the American Medical Association have told me to remove the link to the original paper, so if you want to know more about it, email me. There is something rather irresponsible in the way journals promote papers to the media, but then deny the public the right to see the original work.
There has been a real orgy of bad science reporting about this interesting paper The main conclusion is that both sham acupuncture and ‘real’ acupuncture have essentially the same effectiveness in reducing back pain. Both the real and the sham treatment came out better than the group given ‘conventional therapy’ (a combination of drugs, physical therapy, and exercise).
Perhaps it isn’t surprising that many of the headlines in the press were misleading. So was the press release for the journal, which had the title “Acupuncture Treatment May Be More Effective Than Conventional Therapy In Treating Lower Back Pain, German Study Finds “. The bad journalism can be blamed in part by the self-promotion of journals, as so often.
My first take on what this means is
- a theatrical treatment can have a strong placebo effect, or any old prick produces a long lasting physiological effect
and - acupuncture is a sham.
For an excellent account of the placebo effect, go to Goldacre.
This is the latest in a series of trials that shows essentially no difference between real and sham acupuncture. Here are examples.
This may not matter very much for patients, but it is enormously important in principle. It is enormously important for education, qualifications and for regulation. If, as seems to be the case, real acupuncture and sham are much the same, that means that all the ancient Chinese wisdom on which the acupuncture is allegedly based is just so much bunk. A typical statement of these was reproduced in the Dilemmas of Alternative Medicine.
. . . its advocates try to ‘explain’ the effects, along these lines.
- “There are 14 major avenues of energy flowing through the body. These are known as meridians”.
- The energy that moves through the meridians is called Qi.
- Think of Qi as “The Force”. It is the energy that makes a clear distinction between life and death.
- Acupuncture needles are gently placed through the skin along various key points along the meridians. This helps rebalance the Qi so the body systems work harmoniously.
I suppose, to the uneducated, the language sounds a bit like that of physics. But it is not. The words have no discernable meaning whatsoever. They are pure gobbledygook. Can any serious university be expected to teach such nonsense as though the words meant something?
| I’ll declare an interest. I get intermittent back pain too. The picture is an X-ray of my spinal cord, You can see two lumbar vertebrae bolted together from the front and back with huge titanium woodscrews. The vertebrae had become disconnected in what the surgeon called the worst spondylolisthesis he’d seen. One thing that I do know is that my back pain is enormously variable from day to day, for no obvious reason, That alone makes it almost impossible to tell whether any treatment helps. |
 |
| “The evidence that non-steroidal anti-inflammatory drugs relieve pain better than placebo is strong. Advice to stay active speeds up recovery and reduces chronic disability. Muscle relaxants relieve pain more than placebo, strong evidence also shows, but side effects such as drowsiness may occur. Conversely, strong evidence shows that bed rest and specific back exercises (strengthening, flexibility, stretching, flexion, and extension exercises) are not effective. These interventions mentioned were equally as effective as a variety of placebo, sham, or as no treatment at all. Moderate evidence shows that spinal manipulation, behavioural treatment, and multidisciplinary treatment (for subacute low back pain) are effective for pain relief. Finally, no evidence shows that other interventions (for example, lumbar supports, traction, massage, or acupuncture) are effective for acute low back pain” |
The main advice seems to be “avoid rest”. This is me avoiding
rest by walking across the Alps a few years ago.
The Times. The best so far seems to be from Nigel Hawkes in the Times “Sticking needles in a bad back “eases pain better than drugs”
“Acupuncture works better than conventional treatments in reducing lower back pain, according to researchers in Germany. But so does fake acupuncture, where the needles are inserted shallowly and in the wrong places.”
The BBC. The BBC report (anonymous) posted on 26th September misssed the point altogether, but a day later it is much better (could that have anything to do with the complaint that I made about it?).
The title changed overnight from “Acupuncture ‘best for back pain’.” to “Needles ‘are best for back pain’ Acupuncture – real or sham – is more effective at treating back pain than conventional
therapies, research suggests.”
“their findings suggest that the body may react positively to any thin needle prick – or that acupuncture may simply trigger a placebo effect.”
The Independent. On the other hand, The Independent makes a hash of it. “Acupuncture is best way to treat back pain, study finds” By Jeremy Laurance, Health Editor.
It starts “The ancient Chinese practice of acupuncture works better than anything modern medicine has devised for the treatment of back pain, scientists have concluded.”. That is precisely what they didn’t show. On the contrary they showed than any old pricking does as well as the ancient Chinese practice.
The Telegraph. Nic Fleming in the Telegraph missed the point too ” Acupuncture ‘best therapy for back pain’ By Nic Fleming, Science Correspondent. “Acupuncture can provide significantly more relief from lower back pain than conventional therapies, scientists say.”.
Postscript
There is an excellent comparison of the newspaper reports at “Journalists are shit, study finds“
21 September 2007
Channel 4 News reported on the pressure to save money by stopping NHS funding for “unproven and disproved treatments”.
Watch the video.
The report started badly when the journalist, Victoria Macdonald, said that the bottles of homeopathic pills contained “only natural ingredients”.
Wrong
They contain NO ingredients. That is just as well perhaps, when you recall that natural ingredients in homeopathic pills include things like polonium. In the Nature newsblog that followed my piece about BSc degrees in anti-science, I responded
“Well CAM is a bit like university management. Don’t try to satirise it, because the next thing you know the satire has come true.
There is even a whole book about homeopathic polonium, and you can by not only polonium, but also holmium, dysprosium, europium, gadolinium, Terbium, Thulium (this is beginning to sound like Tom Lehrer), And don’t forget Excrementum caninum (yes, you got it, dog shit). With the 3C “potency” of the latter you might even get a few molecules of it. All this at http://www.archibel.com/homeopathy/synthesis/newremedies/
And don’t forget your homeopathic bioterrorism protection kit.”
The thrust of the report was to suggest that our attempts to improve NHS treatment were some sort of Big Pharma funded conspiracy to suppress those nice homeopaths and so kill old ladies whose lives depended on taking medicines that contain no medicine.
Peter Fisher sounded a bit desperate in his attempts to associate me and my colleagues with the defence of GM foods, a topic on which, as far as I know, none of us uttered a word in public.
Sorry, Dr Fisher, but there is no conspiracy, and no involvement of Big Pharma. Just a disparate bunch of doctors and scientists who decided it was time to do something about the spending of scarce NHS money being spent on new age nonsense. It really is that simple.
I’m always a bit amused when people who make a lot of money from alternative medicine accuse me of representing some vested interest. The media ‘nutritional therapist’, Patrick Holford, said, in the British Medical Journal
“I notice that Professor David Colquhoun has so far not felt it relevant to mention his own competing interests and financial involvements with the pharmaceutical industry “
To which my reply was
” Oh dear, Patrick Holford really should check before saying things like “I notice that Professor David Colquhoun has so far not felt it relevant to mention his own competing interests and financial involvements with the pharmaceutical industry”. Unlike Holford, when I said “no competing interests”, I meant it. My research has never been funded by the drug industry, but always by the Medical Research Council or by the Wellcome Trust. Neither have I accepted hospitality or travel to conferences from them. That is because I would never want to run the risk of judgements being clouded by money. The only time I have ever taken money from industry is in the form of modest fees that I got for giving a series of lectures on the basic mathematical principles of drug-receptor interaction, a few years ago.”
I spend a lot of my spare time, and a bit of my own money, in an attempt to bring some sense into the arguments. The alternative medicine gurus make their livings (in some cases large fortunes) out of their wares.
So who has the vested interest?
Sorry Dr Fisher, but there is no conspiracy. Tim Crayford (Association of Directors of Public Health), put the matter very simply in the interview.
It is more to do with a point of principle. There are very many really effective treatments that the NHS can’t currently afford to provide. And we should we not be ensuring that the limited resources we’ve got in the NHS go to the things that really work well, and are going to save lives”
That is all there is to it.
A new judgment today from the Advertising Standards Authority .
A direct mailing for books by Patrick Holford, a nutritionist, contained a booklet entitled “100%health”. Headline text stated “You don’t swallow junk food. Why swallow junk health advice?” Text in a letter from the “Editor of 100%health”, Patrick Holford, on an inner page of the booklet stated
“I would like you and your family to stay healthy, free of pain and the need for drugs. But if I told you the truth in this letter, I would break the law … I’d love to tell you how powerful nutrition is, both for your mind and body. But I can’t. Why? Because advertising law prohibits me saying anything that claims to ‘treat, prevent or cure’ any condition! Even if there’s undisputed proof that nutrient ‘x’ cures condition ‘y’ I’m not allowed to tell you here. By law, I can tell you in my newsletters, but I can’t in this publication … So, excuse me if you have to read between the lines …”.
The ASA upheld a complaint against this passage
” the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness), 50.1 (Health & beauty products and therapies – General) and 50.20 (Health & beauty products and therapies – Vitamins, minerals and other food supplements). “
Text on a separate page stated “Don’t waste your money on vitamins Myth: ‘If you eat a balanced diet you get all the vitamins and minerals you need.’ WRONG!”. The ASA upheld a complaint against this passage too.
the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.21 (Health & beauty products and therapies – Vitamins, minerals and other food supplements).
The code for “truthfulness” reads thus
7.1 No marketing communication should mislead, or be likely to mislead, by inaccuracy, ambiguity, exaggeration, omission or otherwise.
What a pity that Mr Holford has been judged not to live up to this criterion.
This was not a first offence either. In 2003 four complaints to the ASA about Holford were all upheld, as pointed out in the comment by Shinga, below.
Read more at badscience.net
And at quackometer
Steven Novella, MD, an academic neurologist at Yale University, runs The Skeptics Guide to the Universe: Your Escape to Reality
He is author of Weird Science , a monthly column featured in the New Haven Advocate. He is the co-founder and President of the New England Skeptical Society, Associate Editor of the Scientific Review of Alternative Medicine , and a contributing editor of Quackwatch , a consumer advocacy website dealing with all types of health fraud.
At 5 am on 12 September he phoned to record a podcast. You can here the whole thing here. It includes various items of skeptical news and an interview with James Randi too.
Steve Novella quizzed me about the circumstances surrounding the request to move my web site from UCL’s server, and we discussed the incursion of endarkenment values into universities and politics. My bit is here.
It sounds as though Tennessee pharmacist, Larry Rawdon, is in trouble. According to a report in the Tennessean (11 Sept, 2007)
|
 |
Then, in authentic Tennessee style,
“Rawdon calls his approach to health care “Health God’s Way.” It’s a form of naturopathy” using natural remedies such as foods, herbs and minerals to treat illness. Naturopathy is legal in some states, but not in Tennessee.
“It’s not me healing people, it’s God,” Rawdon said.
“God sent Joshua into the Promised Land and told him not to destroy the fruit trees because in them is a man’s life that he can eat and live,” he said. “So the life force that is in the fruits and vegetables, it’s what our cells need for the healing process.” ”
. . . .
The Board of Medical Examiners found Rawdon guilty of treating patients without a medical license in addition to practising naturopathy.
Now “Dr” (of pharmacy) Rawdon seems to work for Wellness America (no mention there of the fine). Their mission statement is
| Our Mission is to gather, educate, and empower individuals to take control of their health and wealth by applying biblical principles to their everyday life. To promote prevention of illness, wellness from sickness, fitness for the body, freedom from debt, and health for the whole man BODY – SOUL – SPIRIT. |
You couldn’t make it up.
Very interesting uh? Someone fined a million dollars for pretending to be able to cure serious diseases by nutrition and supplements. I wonder if that could ever happen here?
The British Pharmaceutical Conference (2007) staged a debate on “Homeopathy or Allopathy. Which would you choose”. On one side was Felicity Lee (ex Chair of the Society of Homeopaths). I was on the other side. Ben Goldacre was there and he recorded the whole thing. You can listen to it here (if you have nothing better to do).
Thanks to the high-tech equipment at the conference, I was able to show in place of a slide, a section of an article written by Felicity Lee with the title “What health problems can it help with?“. These include, for example, migraine. But if you look at the National Electronic library of Complementary and Alternative medicine (which is compiled by CAM people) what you find is this.
“There is insufficient evidence to support or refute the use of homeopathy for managing tension type, cervicogenic, or migraine headache. The studies reviewed possessed several flaws in design.”
Goldacre also recorded, after the debate, an interview with Felicity Lee. It is rather more interesting than the debate itself. It’s fascinating because, as in the debate, she refuses again and again to be drawn into discussing the evidence and is quite unable to say why she thinks it is not possible to do proper trials.
She did mention that a suitable condition for a trial might be osteoarthritis, but seemed to be quite unaware that such a trial was done in 2001 by no less a person than Peter Fisher (clinical director of the Royal London homeopathic Hospital and the Queen’s homeopathic physician). The outcome of this paper (download it) was that homeopathy didn’t work any better than placebo.
The paper ended with this memorable statement.
“Over these years we have come to believe that conventional RCTs [randomised controlled trials] are unlikely to capture the possible benefits of homeopathy . . . . It seems more important to define if homeopathists can genuinely control patients’ symptoms and less relevant to have concerns about whether this is due to a ‘genuine’ effect or to influencing the placebo response.”
That is the nearest that Fisher has ever come in public to admitting it is all placebo effect, though at other times, of course, he has denied that strenuously.
I have received today (11 September 2007) a rather threatening letter from Patrick Holford. He says
“I am writing to you directly to complain about both your article in The Guardian of 15 August, in which you falsely claim that my advocacy that Vitamin C is better than conventional drugs to treat AIDS is “truly scary”, and in respect of the equally false claims you have posted on your website, DC Improbable Science, particularly in relation to Dr John Marks.”
He ends, more threateningly,
“I nonetheless believe it appropriate that you withdraw the allegations you have made and apologise for making these unwarranted and defamatory allegations. Provided that we can agree the wording of an apology and the removal of the false claims, I am prepared to leave it there. However, I fully reserve my right to take this matter further should my complaint not be resolved to my satisfaction.”
Here are responses to these two allegations.
(Some follow ups on this post have been added below)
Vitamin C and AIDS
What does Holford actually say about HIV/AIDS? On page 208 of his New Optimum Nutrition Bible (2003) we read (see Google books)
| “Yet for the last 100 years, medicine has focused on drugs designed to destroy the invader -antibiotics, anti-viral agents, chemotherapy. By their very nature, these drugs are poison to the body. AZT, the first prescribable anti-HIV drug, is potentially harmful and proving less effective than vitamin C (23)” |
You can read this paper here. If you get that far, you might well be surprised to find that it is not a study of people with HIV/AIDS, but merely shows that vitamin C can, under lab conditions, inhibit HIV in cells in a dish. You might be even more surprised that the paper does not compare vitamin C and AZT. In fact AZT is not mentioned at all (except for a brief reference in the discussion).It is true, that on his web site, as opposed to his book, Holford expands on this theme a bit. For example here he says. of reference 23,
“Ref 23. These in vitro studies on human T-cells shows that vitamin C suppresses the HIV virus in both chronically and latently infected cells, while AZT has no significant effect. It is a tragedy that this simple, non-toxic treatment hasn’t been further tested. ”
Harakeh S, Jariwalla RJ.Ascorbate effect on cytokine stimulation of HIV production. Nutrition. 1995 Sep-Oct;11(5 Suppl):684-7.
But the reference given here (which does use AZT) is not reference 23 (which does not test AZT at all). Holford himself acknowleges that his book cites the wrong reference in his book.
Holford also forgets to mention (or perhaps didn’t notice) that the concentrations of Vitamin C that are used in these in vitro studies are something like 10 times greater than can be achieved in man even with very high oral doses,
More recently he has backed off a bit. For example, here he says
“There is no doubt that anti-retroviral drugs save lives. So too may high dose vitamin C, but we just won’t know until the definitive research trial is done.”
Why, one wonders, has Holford not done studies in man himself? His name does not appear in the research literature at all (search Pubmed for ‘Holford PJ’ yourself). And Holford is not a poor man.
It still seems to me that anyone reading his New Optimum Nutrition Bible (2003) will be misled into thinking that Vitamin C is better than AZT for curing HIV/AIDS in man.
You can read more interesting stuff on this question at Holfordwatch.
What did Dr Marks actually say?
I’m accused of malicious behaviour, because I posted a letter from Dr Marks which set out his present views All I did was ask Dr Marks about what happened, and, with his encouragement, published his
answer. I also suggested to Dr Marks that he should write to Holford to ask for the basis on which Marks was quoted. When Marks received no reply, we decided to go ahead anyway.
I am, therefore, very grateful to Mr Holford for sending me a letter, dated 16 September 1997, that was sent to him by Dr Marks. The whole letter can be downloaded here.
It seems that in the ten years since that letter was written, Dr Marks has changed his mind a bit about Holford. but the main interest attached to the letter is the selective quotations that have been made from it.
In his 1997 letter to Holford, Marks says “On the basis of this I am entirely happy for you to quote as much or as little of the following comments as you wish. If you change the order of phrases or omit portions of sentences I am confident that you will not alter the general sense”.
Judge for yourself whether the general sense has been changed in this case.
Dr Marks said (in 1997)
“There have been dramatic changes over the past decade in our views about that area of health care which comes under the general term “alternative medicine” and Patrick Holford, author of this book has been right at the forefront of many of these changes, particularly those associated with our revised appreciation of human nutrition. I commend this book to you on the basis that it is well researched and written with a substantial backing ofreferences from reliable and peer reviewed scientific and medical journals.
I do not accept all his conclusions and I suspect that his other readers will not agree with all that he says. On the other hand there is considerable food for thought in each chapter and adequate arguments on which you will be able to make up your own mind about the ideas which he puts forward. The road to bad medicine and bad health is built on the foundation of dogma and it is very refreshing to have, in a single readable volume, much of this dogma subjected to fresh examination.”
Compare this with the quotation attributed to Dr Marks in the CV which was submitted by Holford to the University of Teesside.
“There have been dramatic changes over the past decade in our views about healthcare and Patrick Holford has been right at the forefront of many of these changes, particularly with our revised appreciation of nutrition. The road to bad medicine and bad health is built on the foundation of dogma. It is refreshing to have this dogma subjected to fresh examination.”
So what happened to the bit where Marks refers to the work as “Alternative Medicine”.
And what happened to the bit where Marks says “I do not accept all his conclusions and I suspect that his other readers will not agree with all that he says.”
They seem to have vanished without trace.
I rest my case.
Some comments that followed this post
At Holfordwatch “Patrick Holford Refers to Someone Else as Inaccurate”.
And at Quackometer ” Patrick Holford – No Comment”
Curiouser and curiouser. Not only have we the curious case of Dr Marks, but Holford’s CV on his web site, and as submitted to the University of Tesside, has alway said that his degree from the University of York in experimental psychology was taken in 1973 – 1976. But an enquiry to the registrar of the University of York, elicited this response.
| Dear Professor Colquhoun Your enquiry about a claim to hold a degree from the University of York has been passed to me. I can confirm that a BSc in Psychology was awarded to a P J Holford in 1979, as published in the Yorkshire Evening Press on 7 July 1979. Sue Hardman Academic Registrar University of York |
Read much more about all these inconsistencies at Holfordwatch and at Quackometer.
Update 17th September 2007
Another email today from the Registrar reveals that Mr Holford got a 2.2 degree.
Two more high quality trials have failed to show any benefit from alternative medicine.
Acupuncture no help for knee osteoarthritis
This trial is particularly interesting because osteoarthritis of the knee is the one thing that is always cited as a triumph for acupuncture. It is common to hear people talk about acupuncture as though it were the acceptable, or even accepted, face of alternative medicine. Perhaps that is because it is not so obviously preposterous as homeopathy. Sticking a needle into you obviously produces a signal in the brain. That is just sensory physiology. But the evidence that this produces any real benefit for patients is, in fact, almost thin as for homeopathy. This paper seems to have been done very well. It is another nail in the coffin of needle quacks.
Osteoarthritis of the knee is what was cited by the Prince of Wales in his speech to WHO. In that speech he stuck to things that he thought were safe, in contrast to the far more barmy claims on his own web site.
The paper is “Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial”, Foster et al. (BMJ 2007;335;436), and the British Medical Journal has made it available freely: read it here..
Patients were allocated randomly to one of three groups
- Advice and exercise (112 patients)
- Advice, exercise, and true acupuncture (112 patients)
- Advice, exercise, and non-penetrating acupuncture (115 patients)
The question of controls is crucial. In this trial, “non-penetrating acupuncture” was done with ‘stage dagger’ needles: blunt needles that retract into the handle, without actually penetrating the skin at all, but which create an illusion of insertion.
Patients were told that they would receive physiotherapy advice and exercise and “may receive acupuncture, using one of two different types of acupuncture needle”, but were not told that one type of needle would not penetrate the skin.
The bottom line
“Our trial failed to show that acupuncture is a useful adjunct to a course of individualised, exercise based physiotherapy for older adults with knee osteoarthritis.”
| Conclusions Our trial addressed the three important questions recommended by the House of Lords report on complementary and alternative medicine in 2000.
|
Acupuncture delivered by physiotherapists as part of an integrated package of health care with advice and exercise, for older adults with osteoarthritis of the knee, provided no additional improvement in pain scores compared with advice and exercise alone measured on the Western Ontario and McMaster Universities osteoarthritis index at six and 12 months. Small benefits were shown for pain intensity and unpleasantness but these effects were greater and sustained for longer in the group receiving non-penetrating acupuncture than in the group receiving true acupuncture. This finding makes it unlikely that the observed effects were due to needling effects of needle penetration, manual stimulation throughout treatment, and elicitation of the de qi sensation.
We have shown that there are no differences when a credible, non-penetrating acupuncture treatment, delivered under strict participant blinded conditions, and true acupuncture, involving needle penetration, manual stimulation, and elicitation of the de qi sensation are added to a course of advice and exercise. Indeed patient satisfaction, credibility of intervention at six weeks, and reduction in pain intensity and unpleasantness were significantly greater for the advice and exercise plus non-penetrating acupuncture group than for the advice and exercise group but not for the advice and exercise plus true acupuncture group.
Vitamins C and E and Beta Carotene fail again
The anti-oxidant myth is already well-documented. A recent report even suggested that beta carotene, vitamin A, and vitamin E
might do harm rather than good.
Another good trial has confirmed the uselessness of these “supplements” (other than for making a great deal of money for supplement hucksters).
“A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women” Cook et al. Arch Intern Med. 2007;167:1610-1618. [Download the paper here].
Here is the summary taken from the invaluable Consumer Health Digest (a free weekly e-mail newsletter edited by Stephen Barrett, M.D., and cosponsored by NCAHF and Quackwatch), 16-08-07
| Antioxidants for cardiovascular disease flunk another test. A 10-year double-blind, placebo-controlled study has found that women at high risk for cardiovascular disease derived no benefit from taking vitamin C (500 mg/day), vitamin E (600 international units every other day), or beta carotene (50 mg every other day). The researchers looked at the incidence of myocardial infarction, stroke, coronary artery surgery, and cardiovascular disease death among 8171 female health professionals, 40 years or older, with a history of cardiovascular disease or 3 or more cardiovascular disease risk factors. |
There was some surprise when the University of Teesside recently appointed as a visiting professor, Patrick Holford, the “media nutritionist” and supplement salesman. This has elicited some indignation from within Teesside as well as without.
The CV that was submitted to the University of Teesside in support of his appointment at Teesside included the following glowing endorsement from “Dr John Marks, Life Fellow and former Director of Medical Studies, Cambridge University.”
“There have been dramatic changes over the past decade in our views about healthcare and Patrick Holford has been right at the forefront of many of these changes, particularly with our revised appreciation of nutrition. The road to bad medicine and bad health is built on the foundation of dogma. It is refreshing to have this dogma subjected to fresh examination.”
Dr John Marks, Life Fellow and former Director of Medical Studies, Cambridge University
Download the CV that was submitted.
The same endorsement appears in the CV on Holford’s web site.
Dr Marks is also cited prominently as a reviewer of Holford’s book, “The H factor” (2003 edition), thus.
“This book covers the exciting developments of the story of homocysteine in current clinical nutrition and medicine. The authors have examined with commendable clarity the controversy which inevitably surrounds any such cutting-edge subject.”
Dr John Marks, former Director of Medical Studies at Girton College, University of Cambridge
And this is the top of the back cover of Holford’s book, “Optimum Nutrition for the Mind (2003 edition)”, as it appears on the Amazon
web site
Dr Marks appears again in a 2004 press release at on Holford’s site.
“Monday 25 October 2004
OPTIMUM NUTRITION UK SURVEY
Britain’s Largest – Ever Health and Diet Survey
. . . .
“Scientific advisors to the survey include Professor Helga Refsum, Professor Jeff Holly, Professor Jane Plant, Professor Andre Tylee, Dr John Marks and Dr Derek Shrimpton. “
Who is Dr Marks?
It turns out that he is now long-retired from his job as Director of Medical Studies at Girton College. Clearly, and very understandably, Dr Marks would now much rather tend his garden than get involved in this sort of unpleasantness. When I drew his attention to the way his name was being used. he said “I agree that he must be stopped but not by running myself into yet more difficulties I want to reduce difficulties for myself having reached middle age (83).”.
Nevertheless, as a public service, he has kindly given me permission to reproduce his initial response.
| Dear Professor Colquhoun Oh dear, my foolishness of youth has come home to haunt me, luckily too late to hurt me. Way back in, I would guess, the late 1970s or early 1980s I was doing some writing on the vitamins. Essentially my contention was that because of inappropriate eating patterns, it was not possible to say that “a normal mixed diet (as consumed today) provided all the nutrients that are needed”. I used the term “optimum nutrition” to indicate one which did precisely that. Some of this was at least reasonable given the understanding of the day. I know that much of it is no longer accepted (certainly by me), but I have a suspicion that we have swung probably a little too far the other way recently. At that stage Patrick Holford wrote an article or a book on “optimal nutrition” quoting me, inter alia. I did write at his request some comments which were broadly favourable about it, though the text that you quote does not look like mine. Thereafter he has hounded me with pre-publication copies of books etc, each of which has been more exaggerated and less scientific. I was also involved with him at the start of his work on nutritional standards in ordinary members of the public, but it soon became obvious that the whole study was unsupportable and I withdrew completely from it. I also challenged one of his books but got nowhere, even though I suggested that it be not published until he had confirmed some of his ‘observations’. Shortly after that I wrote to him to say that I was not prepared any longer to support his work or views in any way and to please stop using my name as a supporter of his work, and stop writing to me. I had thought and hoped that the whole sad story of my early support for him had died a death, but from what you tell me it seems not. I have to admit that I have not wasted time and effort reading any of his recent work. In fact I should have difficulty doing so since I am effectively blind. I hope that this puts you in the picture. I hope that the wording you quote was from his first book, but even that wording does not look what I might have written even in my foolish youth. Thank you for drawing my attention to the situation but I shall not waste my time issuing denials. It is too late now. With my thanks and best wishes John Marks |
” to say that I was not prepared any longer to support his work or views in any way and to please stop using my name as a supporter of his work and stop writing to me.”
Dr Marks has now written to Holford to ask for the source of these quotations, having destroyed all his own records that relate to Holford some time ago. If and when he gets a reply it will be posted here.
It is for you, and the luminaries of the University of Teesside, to decide whether or not this amounts to falsification of the CV that Holford submitted in support of his appointment as a visiting professor.
It isn’t just Marks
According to some investigation by HolfordWatch, it seems the Prof Andree Tylee has suffered a similar fate to that of Dr Marks. Tylee is Professor of Primary Care Mental Health, at the Institute of Psychiatry, Holford has been citing him too, contrary to his wishes.
A recent post, Homeopathic “cures” for malaria: a wicked scam, revealed two more cases of claims to cure malaria with homeopathic funny water.
One was the claim of Kate Birch, the vice president of the North American Society of Homeopaths, that “Homeopathy is more effective that any western medication”
for treatment of malaria.
This is so dangerous that some action was needed.
The other was a claim by a UK company that claims for Demal 200 (which contains nothing but 15% alcohol)
“Demal 200 is highly effective in treating all types of Malaria even the strains that have developed a resistance to chemical based drugs”
But on checking the web site in 28 Aug, 18 days after the original post, guess what? Demal 200 has vanished. I wonder who told them to do that? The advert was still in the Google cache, and you can download it here, as it appeared on 10th August. Don’t worry though, 20 seconds with Google shows that there are plenty of other people willing to sell this expensive hooch. For example ‘Blueturtle Remedial Sciences’. They give a lot of email addresses to which you can write for further information.
I made a lot of complaints about these wickedly dangerous claims. So far, the result is close to zero.
The Society of Homeopaths, both UK and USA, refuse point blank to give any opinion about the ability of homeopaths to cure malaria.
The Society of Homeopaths is also making its contribution to deaths in Africa by its utterly delusional attitude to AIDS.
They do nothing to stop their many members who do make such claims from killing people. As regulatory organisations, they are just a sick joke.
The Advertising Standards Authority and the Trading Standards people disclaim any responsibility, as does the Center for Disease Control (USA). The FDA and the MHRA have yet to reply, but they did very little after the revelation that homeopaths claimed to be able to prevent malaria.
Nobody seems willing to do anything at all.
But is characteristic of quasi-religious organisations that they split in to warring sects. The Faculty of Homeopaths (UK), in stark contrast to the Society of Homeopaths,
” . . . does not promote the use of homeopathy for the prevention of malaria.
It also supports steps to inform the public of the dangers of malaria and the need to follow government guidance. Last year the Faculty worked with the Health Protection Agency (HPA) on a statement for the HPA website: http://www.hpa.org.uk/infections/topics_az/malaria/homeopathic_statement_260705.htm “
All that can be said for the malaria scandal is that it has revealed that the curious world of homeopathy is in in chaos when it comes to serious diseases. And it shows very starkly how utterly meaningless self-regulation of homeopathy is, and how government agencies disclaim responsibility
There is lots more about this wickedness on the web: try The Gentle Art of Homeopathic Killing.
Here are some of the results of complaints.
Society of Homeopaths (SoH) (UK)
I wrote (13 Aug) to the Society of Homeopaths (SoH) to ask about the use of the initials RSHom and RSHom (NA), and to ask about their attitude to the claims made for Demal 200.”Please could you tell me the opinion of the Society of Homeopaths about someone describing herself as RSHom behaving in this way, and also about Demal 200.”
I had a very quick reply from Paula Ross, chief executive of the SoH. She said
“There is no connection between The Society of Homeopaths (whose registered members use the designation ‘RSHom’) and the North American Society of Homeopaths (whose registered members use the designation ‘RSHom NA’).”
But she ignored the second question.
| My other question was about whether SoH would like to comment on Demal 200.A company called giftofafrica says of its homeopathic malaria treatment. “Demal 200 is highly effective in treating all types of Malaria even the strains that have developed a resistance to chemical based drugs.†The company selling this is based in Wolverhampton, UK. and their claim seems to contradict directly your statement at http://www.homeopathy-soh.org/whats-new/patientinfo.aspxBest regardsDavid Colquhoun |
Paula Ross. However a correspondent sent a similar enquiry to the Society of Homeopaths, asking of Demal 200
“Would you recommend this product for use in Malaria regions or are the claims bogus?”
This was the ‘response’.
| Dear ***, Thank you for your email.May I suggest you contact one of the Homeopathic manufacturers who will be able to advise you and give you more information regarding Demal 200.For our list of Pharmacies please visit our website www.homeopathy-soh.org Regards Melissa Wootton Office Administrator The Society of Homeopaths. 11 Brookfield, Duncan Close, Moulton Park, Northampton NN3 6WL Website: www.homeopathy-soh.org |
13 Aug 2007
Recently the Society of Homeopaths (UK) issued a statement that read thus I can see no such statement on the NASH web site. In fact there are some things that seem to suggest that NASH approves of homeopathic treatment of infectious diseases (not least Kate Birch’s book), despite the fact that your Standards of Practice Guidelines says “Do not claim that you can treat any disease, condition or ailment or imply that you can do so. Please could you give me a clear statement of your policy concerning homeopathic treatment of malaria, AIDS, cholera, typhoid fever, yellow fever and tuberculosis. Best regards David Colquhoun |
| Dear Mr. Colquhoun, Thank you for your inquiry of 8/13/07. NASH does not have a policy on the treatment of any disease category, in accordance with the tenet that homeopathy treats the whole person based on characteristic symptoms rather than a diagnosis. Sincerely, Liz Bonfig NASH Administrator============================== The NORTH AMERICAN SOCIETY OF HOMEOPATHS PO BOX 450039, Sunrise, FL 33345-0039, USA ~ Tel: 206-720-7000 ~ Fax: 208-248-1942 343 Carrville Road, Richmond Hill, ONT L4C 6E4, CANADA ~ Tel: 905-886-1060 ~ Fax: 905-886-1418 |
| X-UCL-MailScanner-From: katebhom@hotmail.commy final statement to you is: The personal response that was solicited from me on my private e-mail does not represent the views of the North American Society of Homeopaths. |
| It has come to my attention that a Ms Kate Birch (vice chair of the North American Society of Homeopaths), is advocating homeopathic treatment of malaria and also yellow fever, typhoid, dengue fever and cholera. She does this through her book and also in emails to potential customers.This seems to me to be very dangerous, so I have asembled some of the relevant evidence at http://dcscience.net/?p=24Please can you tell me if it is legal in the USA to claim to cure serious diseases like these with “remedies” that contain nothing but water and alcohol? |
| Dear Mr. Colquhoun,I forwarded your email to one of our staff scientists; his response was as follows:—–Original Message—–FDA regulates medicines, vaccines, and drugs. States regulate the practice of medicine.Charlatans and quacks can be reported to these regulatory agencies.However, the Constitution guarantees freedom of the press and authors can write all kinds of wacky stuff that is bad for your health.
Thank you for your inquiry. Internet Response Team National Center for Infectious Diseases Centers for Disease Control and Prevention |
Demal 200 UK
This UK company makes the outrageuous claim that their 15% alcohol “”Demal 200 is highly effective in treating all types of Malaria even the strains that have developed a resistance to chemical based drugs”
A complaint about this to the Advertising Standards Authority about this mendacious
advertisement produced a quick reply which said it did not come under their remit,
They suggested trying the Trading Standards people. The Trading Standards Authority replied on 28 Aug 07 (Adrian Winter).
” . . . this is not a matter that falls under the jurisdiction of
Trading Standards. The Medicines and HeathcareProducts Regulatory Agency (MHRA) is the appropriate body in this instance.”
I’d already written to the MHRA (13 Aug 2007) thus,
A company called giftofafrica says of its homeopathic malaria treatment:
This direct claim of effectiveness seems to me to be mind-bogglingly irresponsible. The company selling this stuff is based in Wolverhampton, UK. It costs £31.99 (or $56.40) for 30 ml of 15% alcohol (and 200C homeopathic dilutions, .i.e., nothing) Please can you tell me about the legal position concerning claims to be able to cure infectious diseases, and whether or not the MHRA has any responsibility in cases like this. Best regards David Colquhoun |
On 21 August 2007, the Taxpayers’ Alliance produced a report that
“compiled Britain’s first ever list of university ‘non-courses’; university degrees that lend the respectability of scholarly qualifications to non-academic subjects and calculated their annual cost to students and taxpayers.”
In this they list 400 degree course, at 91 institutions in the UK, which they describe as “non-courses”. They claim that these courses cost the taxpayer £40 million per year.
At the top of their list they place a BA (Hons) degree in Outdoor Adventure and Philosophy, at Marjon College in Plymouth. They include also in their list 60 different courses in alternative medicine.
I don’t agree entirely with the Alliance. They fail, I think, to make a vital distinction, between things that are untrue, and things that a merely not a great intellectual challenge. In “Science degrees in anti-science” I said
“What matters here is that degrees in things such as golf-course management are honest. They do what it says on the label. That is quite different from awarding BSc degrees in subjects that are not science at all, but are positively anti-science.”
Nevertheless the 400 “non-courses” include 60 in alternative medicine, and they are quite unacceptable.
So how does Universities UK (UUK) react? (They are the folks who used to have the sensibly self-explanatory title “Committee of Vice-Chancellors and Principals”, before they had their Consignia moment). Nothing short of a blanket defence, according to the BBC News
But Universities UK said the alliance had failed to understand developments in higher education or the labour market.
“Had they done a little more research, they would have found that these so-called ‘non-courses’ are in fact based on demand from employers and developed in association with them,”
“Graduates on these courses are in demand from employers who are looking for people with specific skills alongside the general skills acquired during a degree such as critical thinking, team-working, time management and IT skills – a point lost on the authors of this rag-bag of prehudices and outdated assumptions.”
All courses were checked rigorously to ensure they met appropriate standards. “This is academic snobbery, as predictable as it is unfounded.”
Does UUK really think that that is a sufficient justification for BSc degrees in homeopathy?
Does UUK really think that degrees in homeopathy teach “critical thinking”?
Does UUK really think that “rigorous checking” of a degree in homeopathy is possible?
If so, the endarkenment has certainly reached high places.
Postcript
An email from the president of UUK, Rick Trainor says that
“. . . degree courses change over time, are independently assessed for academic rigour and quality and provide a wider education than the simple description of the course might suggest”
Professor Trainor, Principal of King’s College London, is a social historian, not a scientist. But you don’t have to be a scientist to understand that it is simply preposterous to think that the smaller the dose the bigger the effect. The defence of such ideas on the basis that they have been “independently assessed for academic rigour” (assessed, of course, by fellow believers in magic) is equally preposterous.
SO I wrote again to explain the difference between honest and dishonest vocational degrees. It reall isn’t very difficult to grasp. This time all I got was
| Dear David Thank you very much for your comments, which I have read with interest. Best wishes Rick Trainor |
There is no nutrional “therapist” whose doings have been the butt of more attention on the web. Ben Goldacre has been through his writings in meticulous detail. “Patrick Holford – “Food Is Better Than Medicine” South Africa Tour Blighted By HIV Claim” is particularly rivetting. The Holfordwatch web site is a mine of carefully-researched information.
It is bad enough that the University of Bedfordshire (in its previous incarnation as the University of Luton) accredited a Foundation Degree course in ‘nutritional therapy’, at`his Institute of Optimum Nutrition (IoN).
That saga was discussed in “Science in an age of endarkenment” as an example of how university accreditation committees can produce long pompous official reports that fail to discuss anything that matters (like ‘is it true?’).
Then came the even more mind-boggling news that Patrick Holford had been made a visiting professor at the University of Teesside. What on earth can be the university’s criteria be for awarding the title of professor? Download them and find out.
One criterion is “their contribution by research to the furtherance of knowledge”. Well it’s obviously not that one.
Another criterion is
“the application of knowledge in a systematic and original manner, designed to enhance wealth creation and/or the quality of life”
Well he has certainly created a lot of wealth for himself. The “application of knowledge” bit is just a little worrisome though.
Case for Patrick Holford as a Visiting Professor is a university document, obtained under the Freedom of Information Act (download the whole document). The opening words are “Patrick Holford has an international reputation in terms of nutrition and mental health.”
I guess he has an international reputation. But to find what sort of reputation, just check the references at the top of this post. Unfortunately the document is anonymous. I guess that makes it safe to say that whoever wrote it must be a scientific ignoramus.
The case for Holford mentions the possibility of starting a northern Brain Bio centre. If you want to know more about that wheeze, check Holfordwatch. And now Holfordwatch has done a nice analysis of the whole document
Teesside’s Assistant Dean Research, Dr Barry Doyle sent an email to his vice chancellor, Graham Henderson, with this case document and “curriculum vitae, with extensive personal commentary” (missing -I’ve asked for it) (download the email).
It did the trick.
An “Extract from minutes of University of Teesside Professorial Conferment Committee, 25/06/2007” (download it) recorded the conferment of title. If there was any real discussion it has been cut out (I’ve asked for more). Or perhaps there was no discussion. It seems to be just another example of the box-ticking mentality that has become so prominent as universities succumb to the cult of managerialism. Those present were
Professor G Henderson, Vice-Chancellor (Chair)
Professor A Unsworth, University of Durham
Professor C Hardcastle, Deputy-VC (Research & Enterprise)
Professor E E Green, School of Social Sciences & Law
Professor F Nabhani, School of Science & Technology
Professor M Rampley, School of Arts & Media
How is it that the combined intellect of these luminaries seemed to be incapable of finding out about the candidate the facts that any teenager could unearth on five minutes with Google?
One despairs
Postscript
It seems that some of the staff at Teesside are not at all happy about the appointment either. On 24th August, this email arrived.
| Colleagues I wish to confirm that Professor Patrick Holford has been Conferred with the title of Visiting Professor at the University of Teesside through the School of Social Sciences and Law.He has not been Conferred with the title of Visiting Professor in Nutrition. He has no association with the School of Health & Social Care and in particular, the Institute of Health Sciences and Social Care Research which is led by Professor Carolyn Summerbell, Professor in Nutrition and Assistant Dean for Research.PaulProfessor Paul Keane, Dean School of Health & Social Care Centuria Building University of Teesside |
Some more information
In response to a Freedom of Information act request, sent on 7 December 2007, the University of Teesside has been quite forthcoming in providing documents that relate to Holford’s appointment. It is pretty clear that the whole episode has been a bit of an embarrassment to them. As a result of internal dissension within Teesside, Holford was banned from using the title “Visiting Professor” or “Visiting Professor in mental health and/or nutrition” but to use only “Visiting Professor in the School of Social Sciences”.
Download all the documents. (zip file, i.5 Mb)
There are comments on some of these documents here.