Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
BBC
It must be admitted that the human genome has yet to live up to its potential. The hype that greeted the first complete genome sequence has, ten years on, proved to be a bit exaggerated. It’s going to take longer to make sense of it than was thought at first. That’s pretty normal in science. Commerce, though, can’t wait. Big business has taken over and is trying to sell you all sorts of sequencing, with vastly exaggerated claims about what you can infer from the results.
There are two main areas that are being exploited commercially, health and ancestry. Let’s look at an example of each of them.
Private health screening is wildly oversold
There has been a long-running controversy about the value of screening for things like breast cancer. For a superb account, read Dr Margaret McCartney’s book, "The Patient Paradox: Why sexed-up medicine is bad for your health", “Our obsession with screening swallows up the time of NHS staff and the money of healthy people who pay thousands to private companies for tests they don’t need. Meanwhile, the truly sick are left to wrestle with disjointed services and confusing options”.
Many companies now offer DNA sequencing. It’s become so bad that a website, http://privatehealthscreen.org/ has been set up to monitor the dubious claims made by these companies. It’s run by Dr Peter Deveson, Dr Margaret McCartney, Dr Jon Tomlinson and others. They are on twitter as @PeteDeveson, @MgtMcCartney, @mellojonny. They explain clearly what’s wrong. They show examples of advertisements and explain the problems.
Genetic screening for ancestry is wildly-oversold
Many companies are now offering to tell you about your ancestors on the basis of your DNA. I’ll deal with only one example here because it is a case where legal threats were used to try to suppress legitimate criticism. The problem arose initially in an interview on BBC Radio 4’s morning news programme. Play the interview.
Today. I should make it clear that I’m a huge fan of Today. I listen every morning. I’m especially enthusiastic when the presenters include John Humphrys and James Naughtie. The quality of the interviews with politicians is generally superb. Humphrys’ interview with his own boss, George Entwhistle, was widely credited with sealing Entwhistle’s resignation. But I have often thought that is not always as good on science as it is on politics. It has suffered from the "false balance" problem, and from the fact that you don’t get to debate directly with your opponent. Everything goes through the presenter who, only too often, doesn’t ask the right questions.
These problems featured in Steve Jones’ report on the quality of BBC Science reporting, which was commissioned by the BBC Trust, and reported in August 2011. The programmes produced by science departments are generally superb. Just think of the Natural History Unit and David Attenborough’s programmes. But the news departments are more variable. One of Jones’ recommendations was that there should be an overall science editor. In January 2012, David Shukman was appointed to this job. But it seems that neither Shukman, nor Today‘s own science editor, Tom Feilden, was consulted about the offending interview.
My knowledge of genetics is not good enough to provide a critical commentary. But UCL has world-class experts in the area. The account that follows is based mainly on a draft written by two colleagues, Mark Thomas and David Balding.
Vincent Plagnol has posted on Genomes Unzipped a blog that explains in more detail the abuse of science, and the resort to legal threats by a public figure to try to cover up his errors and exaggerations.
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The interview was with the Rector of St Andrews University, Alastair Moffat, who also runs several businesses, including Britains DNA, Scotlands DNA, Irelands DNA, and Yorkshires DNA.
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 “Inside all of us lies a hidden history, the story of an immense journey told by our DNA.” |
All four sites are essentially identical (including lack of apostrophes. These companies will, for a fee, type some genetic markers in either the maternally-inherited mtDNA (mitochondrial DNA), or the male-only Y chromosome, and provide the customer with a report on their ancestry.
We’ll come back to the accuracy of these reports below, but as a preliminary guide, consider some of the claims made by Moffat on the BBC Radio 4 Today programme on July 9, 2012:
- there is scientific evidence for the existence of Adam and Eve
- nine people in the UK have the same DNA as the Queen of Sheba
- there is a man in Caithness who is “Eve’s grandson” because he differs by only two mutations from her DNA
- 33% of all men are extremely closely associated with the founding lineages of Britain
- we found people that have got Berber and Tuareg ancestry from the Saharan nomads
There was a persistent theme in the interview that DNA testing by Moffat’s company was “bringing the Bible to life” — of course their activities neither support nor detract from anything in the Bible. If you want to either laugh or cry at the shocking range of errors and exaggerations in the interview, listen to it yourself and then read the Genomes Unzipped blog. For example, Piagnol points out that::
"A bit of clarification on chromosome Y and mtDNA: these data represent only a small portion of the human genome and only provide information about the male (fathers of fathers of fathers…) and female (mother of mothers of mothers…) lineages. As an illustration, going back 12 generations (so 300 years approximately) we each have around 4,000 ancestors. mtDNA and chromosome Y DNA only provide information about 2 of them. So these markers provide a very limited window into our ancient ancestry."
Of most concern is that Moffat’s for-profit business was presented as a scientific study in which listeners were twice invited to participate. He admitted that they have to pay but “we subsidise it massively”. This phrase is important because it suggests that this is a genetic history project of such importance and public interest that it has been subsidised by the government or a charitable body. This doesn’t seem plausible – Britains DNA charges £170 for either mtDNA or Y typing, which is comparable with their competitors. There is nothing on the Britain’s DNA website to indicate that it is subsidised by anybody.
Instead of producing evidence, Moffat paid a lawyer to suppress criticism
When challenged by my two academic colleagues, Mark Thomas and David Balding, on this and other problems arising from the interview, Moffat failed to either clarify or withdraw the "massively subsidised" claim. Instead, his two challengers received letters from solicitors threatening legal action for defamation unless they fulfil conditions such as that they will not state that Mr Moffat’s science is wrong or untrue. In the face of so many obvious dubious claims in the Today interview, it would be a dereliction of the duty of an academic not to point out what is wrong.
The interview certainly sounded exaggerated to me. Luckily, a colleague of Thomas and Balding, Vincent Plagnol (lecturer in statistical genetics), has written a detailed refutation of many of Moffat’s claims on his post Exaggerations and errors in the promotion of genetic ancestry testing, on the Genomes Unzipped blog.
Thomas and Balding maintain that oversimpliifed and incorrect statements appear also on the web site of Britains DNA.
The interview sounded more like advertising than science
It is clearly unacceptable for a person in high public office to make a claim on national radio that appears to be untrue and intended to support his business interests, yet to refuse to withdraw or clarify it when challenged.
Complaints were made both by Thomas and Balding to the BBC, but they met with the usual defensive reply. The BBC seemed to be more interested in entertainment value than in science, in this case.
A few more aspects of this story are interesting. One of them is the role of Moffat’s business partners, Dr Jim Wilson of Edinburgh University and Dr Gianpiero Cavalleri of the Royal College of Surgeons in Ireland. It was these two academics to whom both Thomas and Balding sent emails about their concerns. And it was these emails that elicited the legal threat. They refused to clarify the “massively subsidised” claim, and they have not publicly disassociated themselves from the many misleading statements made by Moffat, from which as business partners they stand to benefit financially (they are both listed as directors and shareholders of The Moffat Partnership Ltd at Companies House). They have both responded to Thomas and Balding, misrepresenting their statements in a way that would support legal action.
Did James Naughtie think his interview was entertainment, not science?
Another interesting but depressing aspect to the story is the role of the BBC’s interviewer Jim Naughtie. In the face of the most outrageous claims about Eve, the Queen of Sheba and "bringing the Bible to life”, that a moment’s thought would have suggested can’t be true, Naughtie asked no sceptical, challenging or probing question. He even commented twice on individuals having "pure" DNA, which is appalling: nobody’s DNA is any purer than another’s; has he not heard of eugenics? Naughtie gave Moffat two opportunities to promote his business, even with details of the web address.
It turns out that Naughtie and Moffat are old friends: as Chancellor of the University of Stirling, Naughtie invited Moffat to sit on its Court, and he posted on YouTube a short video of him supporting Moffat’s campaign for Rector of St Andrews. No such connection was mentioned during the interview.
This interview is not the first. Naughtie also interviewed Moffat (broadcast on 1st June 2011) about a rather silly exercise in claiming – on the basis of Y-chromosome data – that Jim Naughtie is an Englishman . Again Naughtie gave Moffat ample opportunity to promote his business and as far as I am aware none of Moffat’s commercial rivals has been given any comparable opportunity for free business promotion on the BBC.
No suggestion is being made that there is anything corrupt about this. Naughtie is not a scientist, and couldn’t be expected to challenge scientific claims. The most likely interpretation of events is that Naughtie thought the subject was interesting (it is) and invited a friend to talk about it. But it was a mistake to do this without involving Today‘s science editor, Tom Feilden, or the new BBC science editor, David Shukman, and especially to fail to invite a real expert in the area to challenge the claims. There are lots of such experts close to the BBC in London.
Many other companies cash in on the ancestry industry.
Britains DNA is only one of many genetic ancestry companies that make scientifically unsupported claims about what can be inferred from Y chromosome or from mtDNA variants about an individual’s ancestry. This is a big industry, and arouses much public interest, yet in truth what can reliably be inferred from such tests is limited.
Our number of ancestors roughly doubles every generation in the past, so the maternal-only and paternal-only lineages rapidly become negligible among the large numbers of ancestors that each of us had even just 10 or 20 generations ago. Because migration is ubiquitous in human history, those ancestors are likely to have had diverse origins and the origins of just two of them (paternal-only and maternal-only lineages) may not give a good guide to your overall ancestry. Moreover if you have a DNA type that is today common in a particular part of the world, it doesn’t follow that your ancestors came from that location: such genetic tests can say little about where your ancestors were at different times in the past.
Faced with these limitations, but desiring to sell genetic tests, many companies succumb to the temptation to exaggerate and mislead potential clients about the implications of their tests, in some cases leading to disappointed clients who feel betrayed by the scientists in whom they placed trust.
If you have a few hundred pounds to spare, by all means get yourself sequenced for fun. But don’t imagine that the results will tell you much.
Follow-up
25 February 2013, Mark Thomas follwed up this post in the Guardian
“To claim someone has ‘Viking ancestors’ is no better than astrology. Exaggerated claims from genetic ancestry testing companies undermine serious research into human genetic history”
10 March 2014
After more than a year of struggling, the BBC did eventually uphold a complaint about this affair. Full accuonts can be found on the web site of UCL’s Molecular and Cultural Evolution Lab and on Debbie Kennett’s site
The mainstream media eventually catch up with bloggers. BBC1 TV (Wales) produced an excellent TV programme that exposed the enormous degree validation scam run by the University of Wales. It also exposed the uselessness of the Quality Assurance Agency (QAA). Both these things have been written about repeatedly here for some years. It was good to see them getting wider publicity.
Watch the video of the programme (Part 1, and Part 2) "Week In Week Out – University Challenged." “The programme examines how pop stars and evangelical Christians are running colleges offering courses validated by the University of Wales.” (I make a brief appearance, talking about validation of degrees in Chinese Medicine).
In October 2008 I posted Another worthless validation: the University of Wales and nutritional therapy. With the help of the Freedom of Information Act, it was possible to reveal the mind-boggling incompetence of the validation process used by the University of Wales.
McTimoney College of Chiropractic
The Chiropractic “degrees” from the McTimoney College of Chiropractic are also validated by the University of Wales by an equally incompetent, or perhaps I should say bogus, procedure. More details can be found at The McTimoney Chiropractic Association would seem to believe that chiropractic is “bogus”, and in a later post, Not much Freedom of Information at University of Wales, University of Kingston, Robert Gordon University or Napier University.
Andy Lewis has also written about chiropractic in The University of Wales is Responsible for Enabling Bogus* Chiropractic Claims to be Made.
Sadly the BBC programme did not have much to say about these domestic courses, but otherwise it was excoriating. In particular it had extensive interviews with Nigel Palastanga, whose astonishing admission that courses were validated withour seeing what was taught on them was revealed here two years ago. After that revelation, the vice-chancellor of UoW, Marc Clement BSc PhD CEng CPhys FIET FInstP, promoted Palastanga to be pro-vice-chancellor in charge of Learning, Teaching and Enhancement (I know, you couldn’t make it up).
In the documentary Palastanga said
"It’s a major business. We earn a considerable amount of money."
That was obvious two years ago, but it’s good to hear it from the horse’s mouth.
After a section that revealed a bit about what goes on at two very fundamentalist bible colleges which gave University of Wales degrees, A. C. Grayling commented thus.
"They are there to train advocates for the biblical message and that is absolutely not, by a very very long chalk, what a university should be doing.. . . A respectable British Higher education institution like the University of Wales shouldn’t be touching them with a bargepole."
Undaunted, Palastanga responded
“That’s his opinion. I would say they are validated to the highest standards. They match what are called QAA benchmark. We have serious academics looking at them, and their academic standards are established at the very highest level.”
And if you believe that, you will truly believe anything.
You can download here one of many moderator’s reports obtained under the Freedom of Information Act. This one is for the BSc (Hons) Chiropractic. It is entirely typical of theuncritical boxticking approach to validation, Nowhere does it say "subluxation is nonsense", though even the GCC now admit that.
Traditional Chinese Medicine
The University of Wales validates several courses in what almost everyone but them classifies as quackery. As well as chiropractic and “nutritional therapy”, there is herbalism. For example a course at a college in Barcelona issues University of Wales degrees in Traditional Chinese medicine, a subject that is a menace to public health.. I was asked to comment on the course, and on a bag of herbs that the presenter had been sold to treat depression.
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Radix Bupleuri Chinensis
Radix Angelicae Sinensis Radix Paeoniae Lactiflorae Rhizoma Atractylodis Macrocephalae Sclerotium Poriae Cocos Radix Glycyrrhizae Uralensis Cortex Moutan Radicis (Paeonia Suffruticosa) Fructus Gardeniae Jasminoidis Herba Menthae Haplocalycis Zingiber officinale rhizome-fresh |
 Ingredients of a custom mixture. |
There is no good evidence that any of the ingredients help depression, in fact next to nothing is known about most of them, apart from liquorice and ginger. Swallowing them would be rather reckless. They fall right into the description of any herbal medicine, in the Patients’ Guide, "Herbal medicine: giving patients an unknown dose of an ill-defined drug, of unknown effectiveness and unknown safety. "
Of the degrees, I said
"There’s no evidence that it [the herbs] does you any good. It may be dangerous because you have no idea of the dose. Degrees in Chinese Medicine consist of three years spent memorising myths and pre-scientific, er, untruths. That isn’t a degree, it’s a travesty."
Palastanga. responded
"We’ve had long debates in the Health Committee about where we would draw the line about what we validate. They have to demonstrate to us that there is some scientific basis for the practice, that there is an established curriculum, that there is an established safe practice."
The presenter asked him "So you are confident that Chinese medicine works? Palastanga replied
" I didn’t say that. I said that there is evidence that it does work . . We are trying to enforce these professions to undertake effective research."
That statement is simply not true, as shown by the response of the validation committee to the application for validation of the course in “Nutritional Therapy” at the Northern College of Acupuncture, documented previously. The fact of the matter is that the validation proceeded without looking at what was actually taught, and without even a detailed timetable of lectures. The committee looked only at the official documents presented to it and was totally negligent in failing to discover some of the bizarre beliefs of the people who were giving the course.
Palastanga went on to raise the usual straw man argument, about how little regular medicine is based on good evidence (though admittedly that is certainly true in his own field -he is a physiotherapist).
Fazley International College Kuala Lumpur
This business college in Kuala Lumpur offered University of Wales degrees. Its 32-year old president is a part time pop star with impressive looking qualifications
The presenter pointed out that
" His doctorate and his MBA were awarded in that citadel of education, Cambridge. Here he is, pictured at the city’s prestigious business school. He was there for all of four days and walked away with a doctorate. But the degree was not from the University of Cambridge, but from the now defunct "European Business School Cambridge". It never had the right to award degrees."
Neither the University of Wales nor the QAA had noticed this unfortunate fact. Once the TV team had done their job for them, the UoW withdrew support. though, as of 15 November 2010, that is not obvious from Fazley’s web site.
Mr (not Dr) Fazley seemed rather pleased about how students were attracted by the connection with the Prince of Wales. The fact that he is Chancellor of the University of Wales seems not inappropriate, given the amount of quackery they promote.
Quality Assurance Agency (QAA)
In 2007, I wrote, in Nature (see also here),
“Why don’t regulators prevent BSc degrees in anti-science? The Quality Assurance Agency for Higher Education (QAA) claims that “We safeguard and help to improve the academic standards and quality of higher education in the UK.” It costs taxpayers £11.5 million (US$22 million) annually. It is, of course, not unreasonable that governments should ask whether universities are doing a good job. But why has the QAA not noticed that some universities are awarding BSc degrees in subjects that are not, actually, science? The QAA report on the University of Westminster courses awards a perfect score for ‘curriculum design, content and organization,’ despite this content consisting largely of what I consider to be early-nineteenth-century myths, not science. It happens because the QAA judges courses only against the aims set by those who run the QAA, and if their aims are to propagate magic as science, that’s fine.”
That was illustrated perfectly in the documentary when Dr Stephen Jackson of the QAA appeared to try to justify the fact that the QAA had, like the University of Wales, failed entirely to spot any of the obvious problems. He had a nice dark suit, tie and poppy, but couldn’t disguise the fact that the QAA had given high ratings to some very dubious courses.
The QAA sent nine people to the other side of the globe, at a cost of £91,000. They could have done a lot better if they’d spent 10 minutes with Google at home.
Universities UK (UUK)
Needless to say, the Committee of Vice-Chancellors and Principals has said nothing at all. As usual, Laurie Taylor had it all worked out in Times Higher Education (4th November).
Speaking to our reporter Keith Ponting (30), he commended UUK’s decision to say absolutely nothing whatsoever about the abolition of all public funding for the arts and humanities.
He also praised UUK’s total silence on Lord Browne’s view that student courses should primarily be evaluated by their employment returns.
When pressed by Ponting for his overall view of UUK’s failure to respond in any way at all to any aspect of the Browne Review, he described it as “welcome evidence, in a world of change, of UUK’s consistent commitment over the years to ineffectual passivity”.
Meanwhile, a University of Wales video on YouTube
Caveat emptor
Follow-up
A couple of days later, a search of Google news for the “University of Wales” shows plenty of fallout. The vice-chancellor claims that ““The Minister’s attack came as a complete and total surprise to me”. That can’t be true. It is over two years since I told him what was going on, and if he was unaware of it, that is dereliction of duty. It is not the TV programme that brought the University into disrepute, it was the vice-chancellor.
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Steve Jones, UCL’s star geneticist, has been commissioned by the BBC Trust to write a report on the impartiality of science journalism on the BBC. It covers both TV and radio, and all channels. Current programmes can be found by the BBC Science home page. |
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It is not uncommon for bloggers to be critical of science reporting in the mainstream media. Now is our chance to do something constructive about it. If you have opinions about this, please leave them in the comments here, and/or email them to
Here are some of my own opinions, to get things going. Many programmes I haven’t seen/heard, so my selection may not be representative, but it is wide enough to include examples that are superb and examples of some that I think are not good enough.
Problem areas
There are two particular topics that are real problems for broadcasters. One is the whole area of alternative medicine and the ‘supplement’ industry. The other is anything to do with climate change. Both have formidable lobby groups which, to the inexperienced journalist, may sound like quite plausible scientists (some even have academic titles). Creationists can also be a problem. though not many programmes take them very seriously. Both quacks and climate deniers rarely have anything to say that is real science. They have different motivations. Examples are given below.
Many programmes are superb
David Attenbrough is an obvious example. His programmes can’t be bettered. The photography is breathtakingly beautiful and the science is always accurate. For me, they alone are worth the licence fee, and I don’t want the licence fee to be reduced. It helps that Attenborough knows the science so well. It also helps that most of the time the science isn’t very difficult and isn’t very controversial either.
There have been many other superb programmes. Steve Jones own 6-part TV series "In the blood" was a beautiful example. The fact that his comments are sought frequently by the BBC is greatly to their credit. Much depends on producers being sufficiently well-informed to know whom to ask.
More recently Brian Cox’s "Wonders" series has provided an excellent example of how science programmes can be made popular without being inaccurate,
Also excellent were Jim Al-Khalili’s Chemistry: A Volatile History and Michael Moseley’s Medical Mavericks.
Simon Singh has made consistently good programmes. His wonderful documentary on Fermat’s Last Theorem was a masterpiece.. He is a master at making programmes that make really difficult subjects accessible to the public, without making them misleading.
Tim Harford’s programm, More or Less has made a great contribution to public understanding of statistics.
Ben Goldacre‘s two part Radio 4 Programme, The Rise of the Lifestyle Nutritionists was a superb explanation of a contentious area.
It would be useful if all presenters of programmes with any scientific content had to listen to Harford or Goldacre. It might make them a bit more critical about the problem of causality that beset the observational epidemiology items that predominate among the items picked out from press releases by so many news programmes.
These programmes were so successful because they were made by people who know what they are talking about. They confirm the view that the best science programmes are made by scientists, not by journalists. There are exceptions of course. It could be argued that some of Robert Winston’s programmes have strayed too far from his area of expertise to reach the same high standards. And some journalists have produced excellent programmes. Two examples follow.
Geoff Watts has kept up a consistently high standard on Radio 4. from Science Now, through Medicine Now to Leading Edge, the standard has always been high. It is good straight science in its social context. He avoids controversies, for example his excellent programme about Charles Darwin does not include a creationist to provide (phony) ‘balance’.
After the demise of Medicine Now in 1998, Watts wrote in the BMJ thus.
In the early days of the programme you could have listened for several weeks in a row without hearing from patients. I used to defend this on the grounds that Medicine Now was there to talk about disease and its treatment, not the experience of disease and its treatment. I was wrong. To make that distinction is simply to parallel the fault for which doctors themselves take a deal of stick—being interested in the illness to the exclusion of the person who’s suffering from it. I was persuaded, reluctantly, to accept more lay voices, and I am now embarrassed that I didn’t sooner see the need for them.
The swing of the pendulum may push the whole patient experience thing too far: to a point at which it’s professional knowledge and objective analysis that is elbowed into the wings. One of the vogue concepts among BBC managers in recent years has been “accessibility”. But this is a weasel word, too easily used as justification for editing out anything that might require the audience to concentrate and think. If a patient has a rash, it’s a lot simpler for the reporter to inquire about the urge to scratch than to explore the events in the immune system that caused the skin to redden, swell, and itch in the first place. How sad if people lose an opportunity to hear from the researchers, speaking their own words, who are actually trying to find out.
This summarises a lot of the problems of science programmes. They too easily become trivial vox pops, and Watts resisted this tendency very successfully.
A great problem for programmes about medicine arises from the pressure exerted by the alternative medicine industry (ot which more later). Watts would not tolerate nonsense. He says
Medicine Now was stabled in the BBC’s Science Unit, and it was the broad acceptance of science and its methodology which shaped editorial choices. When complementary medicine was on the agenda, we expected evidence from our contributors not testaments of faith.
Material World is another good Radio 4 programme. Quentin Cooper does, on the whole, a good job. But sometimes even he falls foul of the phony balance argument After my piece in Nature on the shameful degrees in pseudo-scientific medicine got discussed on Material World, (audio here) but my opponent was not a scientist at all, but the head of “Complementary Therapies” at the University of Westminster, a man who presides over courses that teach “amethysts emit high Yin energy“. It is simply impossible to have a proper scientific discussion with people who believe nonsense like that. They don’t accept the ground rules at all. It is a good example of phony balance (see below).
Some programmes are quite bad
Alternative Medicine: the evidence. This series if three TV programmes was shown in February 2006 on BBC 2, in conjunction with the Open University. It illustrates well three problems with science programming. (1) Despite the title, tt was surprisingly weak at showing evidence, (2) It showed the defensive and unhelpful response that, only too often, the BBC shows when complaints are made. And (3) it showed that association with a university is not, per se, enough to guarantee quality.
Because of the title, I’d looked forward to this programme, and made minute by minute notes, which are recounted in BBC2 and the Open University on Alternative Medicine. It turned out that the evidence was thin on the ground, and what there was was not always accurate I complained to the BBC, but got nowhere [download my complaint and some subsequent correspondence]. I was fobbed off with defensive PR. (Much the same happened when I complained to the Open University.)
Worse still, a letter in defence of the programme that appeared in the Guardian, turned out to have been written by the BBC and was not even seen by some of its "signatories" -see .Alternative Medicine series: dirty tricks at the BBC? All this took a lot of work and got nowhere.
Simon Singh, the eminent science author, wrote two articles that exposed the very misleading portrayal of anaesthesia with acupuncture In the Guardian he wrote A groundbreaking experiment … or a sensationalised TV stunt?, and in the Daily Telegraph he wrote Did we really witness the ‘amazing power’ of acupuncture?. Singh also sent complaints to the BBC, but he persisted after the complaints were fobbed off and eventually his complaints reached the BBC Trustees. Two of his three serious complaints were upheld.
Phone-in programmes are notoriously bad for both balance and phony balance. In the alternative medicine field, equal time is always given to scientists, astrologers and crystal healers. The presenters are usually ill-informed and the callers are usually even less well informed. A particularly bad example follows.
Call You and Yours. The Radio 4 programme, You and Yours, at its best, can be quite good. It did a good job on a "snoring remedy" that I’d investigated, though it omitted some things that should, in my view, have been included. But they also have phone in versions of the programme. On 29th February 2010, they ran a phone-in programme about herbal medicine, hosted by Julian Worricker, someone who clearly was totally unaware of the controversies that surrounded this subject and, particularly, its regulation. The worst thing about this programme was that it featured a resident ‘expert’ That was Michael McIntyre who is chair of the European Herbal & Traditional Medicine Practitioners Association. McIntyre is a well known advocate of alternative medicine, who constantly fudges the need for proper evidence.
I went through the programme carefully, making detailed notes, which appear at Some truly appalling reporting of science by the BBC. It was one of the most biassed programmes on the topic I have ever heard. i sent a complaint to the BBC, referring to the detailed analysis which had already appeared here. To my dismay, they wouldn’t accept a complaint in the form. They wanted me to type the whole thing in a little box on the complaint site. where there is no formatting and no live links. I protested in vain that if they wanted a printed version, all the had to do was print the web page. At this point I decided that there was no point in spending yet more time to cope with the inflexibility of the complaints procedure.
Today programme. I’m an avid listener toToday, the best news programme on radio John Humphrys has no greater fan than I. For politics it is superb. But for science it is, sad to say, not always so good. One reason is that the presenters don’t know enough about the topics to ask the same sort of tough questions that they fire at politicians. Another reason is that they suffer badly from the phony balance problem (see below). A third reason is that they tend to pick up on silly survey press releases (the sort of ‘men with long big toes are better in bed’ pseudo-science); They may quite rightly laugh at them but this sort of thing doesn’t count as science reporting.. The Today programme is admirably serious about politics, but the science is often dumbed down and uncritical.
What needs to be done to improve BBC science
Link to the sources. Despite pressure from bloggers, the BBC web site still does not usually link to original sources, the paper on which claims are based. The whole virtue of the web is that it makes this very easy to do.
Anonymity of reporters. Too often reports of science on the BBC web site are anonymous. There is no excuse for that. Every report should carry the name and email address of the person who wrote it, Most newspapers do this, but the BBC is lagging behind.
Reaction to criticism. In most cases that I’ve tried, the reaction to constructive criticism has been obstructive and defensive. Producers seem very reluctant to admit that any mistakes were made. That needs to be changed.
Science correspondents are too often uncritical. A few more with the approach of investigative journalists would improve standards. An example is provided by a recent report “It’s good to think – but not too much, scientists say“. This is typical of the sort of work that many people find a bit hard to take seriously, but the report reads a bit like a regurgitation of press releases. There is no link to original sources and no attempt at evaluation.
Press releases. One reason for misleading reports stems from misleading press releases. Press releases often come from media departments who regard their job as getting their university into the headlinse, rather than explaining science. Worse still, sometimes the misleading hyps stems from the authors themselves (one example here, but there are hundreds to choose from). This makes it very important that science reporters should read the paper and have good enough critical faculties to read through the hype.
Complaints procedure needs to be improved. Complaints should be accepted in any form, The present web form is suitable only for short and simple criticicisms. An email address should be provided and it should accept attached documents. Certainly complaints in the form of web pages should be welcomed, because the live links provide the simplest way to refer to source documents.
The problem of phony balance. This is biggest problem of the lot.
In the wake of the report by the Science and Technology Committee (STC) on the lack of evidence for homeopathy, and the Chinese medicine poisoning, the BBC carried at least three very bad reports. Being a strong supporter of the BBC that saddens me. These cases are summarised at Some truly appalling reporting of science by the BBC. The worst was the case of Call You and Yours. There was also a totally imbalanced and ill-informed report on statutory regulation, and a very irresponsible video of a woman who claimed homeopathy cured her cancer. .
The question of balance is important. Ofcom imposes an obligation that reporting should reflect the balance of viewpoints. Section 5 of Ofcom’s broadcasting code says (emphasis is mine).
“Section 5: Due Impartiality and Due Accuracy and Undue Prominence of Views and Opinions”
“To ensure that news, in whatever form, is reported with due accuracy and presented with due impartiality.”
“Meaning of “due impartiality”: “Due” is an important qualification to the concept of impartiality. Impartiality itself means not favouring one side over another. “Due” means adequate or appropriate to the subject and nature of the programme. So “due impartiality” does not mean an equal division of time has to be given to every view, or that every argument and every facet of every argument has to be represented.”
The BBC Trust has a very similar definition of “due impartiality”.
Thus the rules stare quite explicitly that "impartial" does not mean giving equal time to any view, however batty,
In practice, though, producers often seem to play it too safe, and choose to give the same time time to the view that the earth is flat as is does to the view that the earth is spherical (OK, an oblate ellipsoid). This often gives a quite misleading impression of the state of play of informed opinion. Inappropriate use of “equal time” is the most common cause for misleading reports
on science.
Minority views should be heard of course, but they should not be given equal prominence to views that are held by the vast majority of informed people. Inevitably the worst cases arise in the areas of quack medicine, climate change and evolution.
Somebody said recently, it is as though after an air crash one gave equal time to the air accident investigator and a representative gravity-deniers association. That is scarcely an exaggeration of what happens on the BBC too often.
Worse still, far more time was given (especially on ‘Call You and Yours’) to the viewpoint that any scientist, indeed any informed person, would regard as quackery.
One thing that could be done about this false balance is to have better informed producers, or, more likely, to have better informed science reporters who can give advice on the state of opinion (and to make sure that their advice is sought).
Unless the BBC starts to be more critical in some of its reports, it could lose its preeminence. In the last few years it has become increasingly the case that the best critical evaluations of science are to be found not in the BBC or other mainstream media, but on blogs written by working scientists. Perhaps the BBC should ask them more often than it does at present.
Now give your opinions, below or email them to trust.science@bbc.co.uk
Follow-up
The Open University is a wonderful institution
I should have made it clear the Open University has played a big role in producing some of the best programmes. I was, quite rightly, corrected by a letter from an OU scientist. I’ll quote from it.
David Attenborough’s series on Life In Cold Blood, Charles Darwin and the Tree Of Life, Life – these are all Open University commissions. Life In Cold Blood also won a BAFTA and we have a string of other awards. I believe this is some of the very best science broadcasting the Open University puts out and I’m not surprised to see it at the top of your list.
More Or Less is an Open University commission – see e.g. http://www.open2.net/moreorless/
Material World is another one of our occasional commissions -see e.g. http://www.open2.net/materialworld/index.html
Geoff Watts contributed to the BBC Darwin season last year, which was heavily supported by Open University programmes.
See for example http://www.bbc.co.uk/darwin/We support the series with a considerable amount of on-line material both for credit and not for credit. This material is accessible to the public at these open2.net sites, and at http://www.open.ac.uk/openlearn/.
It is clear that the criticisms levelled at the Alternative Medicine series are very much the exception to the usual excellent work of the OU. I’m told that that programme had nothing to do with the science faculty. Clearly it was an unusual aberation. I presume it was connected with the OU’s course K221, which I wrote about in 2006, under the title Open University Quacks. That sort of thing is quite atypical of the Open University, and something of an embarrassment to the many top rate people who work there. As usual, the blame lies not with scientists but with senior managers. After hearing about course K221, I had a long correspondence with Professor David Vincent, a pro-vice chancellor. He made sympathetic noises, but did absolutely nothing. That’s par for the course with senior administrators.
The Open University has been a magnificent success from the outset. Its first vice-chancellor was Walter Laing Macdonald Perry . Before he took that job, he was professor of Pharmacology in Edinburgh (and one of my Ph.D. supervisors). He did a great job.
Failure to report negative results
A classic example of a sin of omission by the BBC (and the rest of the mainstream media too) occurred recently in the reporting of the alleged effect of B vitamins on the development of Alzheimer’s disease. A positive trial was widely reported, but two weeks later a trial appeared that measured the eight thing -cognitive deficiency – and that showed no effect at all. As far as I can tell it was barely reported at all, The details are at https://www.dcscience.net/?p=3516
First the MHRA lets down the public by allowing deceptive labelling of sugar pills (see here, and this this blog). Now it is the turn of NICE to betray its own principles.
The National Institute for Health and Clinical Excellence (NICE) describes its job thus
“NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.”
Its Guidance document on Low Back Pain will be published on Wednesday 27 May 2009, but the newspapers have already started to comment, presumably on the assumption that it will have changed little from the Draft Guidance of September 2008. These comments may have to be changed as soon as the final version becomes available.
The draft guidance, though mostly sensible, has two recommendations that I believe to be wrong and dangerous. The recommendations include (page 7) these three.
- Consider offering a course of manual therapy including spinal manipulation of up to 9 sessions over up to 12 weeks.
- Consider offering a course of acupuncture needling comprising up to 10 sessions over a period of up to 12 weeks.
- Consider offering a structured exercise programme tailored to the individual.
All three of this options are accompanied by a footnote that reads thus.
“A choice of any of these therapies may be offered, taking into account patient preference.”
On the face if it, this might seem quite reasonable. All three choices seem to be about as effective (or ineffective) as each other, so why not let patients choose between them?
Actually there are very good reasons, but NICE does not seem to have thought about them. In the past I have had a high opinion of NICE but it seems that even they are now getting bogged down in the morass of political correctness and officialdom that is the curse of the Department of Health. It is yet another example of DC’s rule number one.
Never trust anyone who uses the word ‘stakeholder’.
They do use it, often.
So what is so wrong?
For a start, I take it that the reference to “spinal manipulation” in the first recommendation is a rather cowardly allusion to chiropractic. Why not say so, if that’s whar you mean? Chiropractic is mentioned in the rest of the report but the word doesn’t seem to occur in the recommendations. Is NICE perhaps nervous that it would reduce the credibility of the report if the word chiropractic were said out loud?
Well, they have a point, I suppose. It would.
That aside, here’s what’s wrong.
The Evidence
I take as my premise that the evidence says that no manipulative therapy has any great advantage over the others. They are all more or less equally effective. Perhaps I should say, more or less equally ineffective, because anyone who claims to have the answer to low back pain is clearly deluded (and I should know: nobody has fixed mine yet). So for effectiveness there are no good grounds to choose between exercise, physiotherapy, acupuncture or chiropractic. There is, though, an enormous cultural difference. Acupuncture and chiropractic are firmly in the realm of alternative medicine. They both invoke all sorts of new-age nonsense for which there isn’t the slightest good evidence. That may not poison your body, but it certainly poisons your mind.
Acupuncturists talk about about “Qi”, “meridians”, “energy flows”. The fact that “sham” and “real” acupuncture consistently come out indistinguishable is surely all the evidence one needs to dismiss such nonsense. Indeed there is a small group of medical acupuncturists who do dismiss it. Most don’t. As always in irrational subjects, acupuncture is riven by internecine strife between groups who differ in the extent of their mystical tendencies,
Chiropractors talk of “subluxations”, an entirely imaginary phenomenon (but a cause of much unnecessary exposure to X-rays). Many talk of quasi-religious things like “innate energy”. And Chiropractic is even more riven by competing factions than acupuncture. See, for example, Chiropractic wars Part 3: internecine conflict.
The bait and switch trick
This is the basic trick used by ‘alternative therapists’ to gain respectability.
There is a superb essay on it by the excellent Yale neurologist Steven Novella: The Bait and Switch of Unscientific Medicine. The trick is to offer some limited and reasonable treatment (like back manipulation for low back pain). This, it seems, is sufficient to satisfy NICE. But then, once you are in the showroom, you can be exposed to all sorts of other nonsense about “subluxations” or “Qi”. Still worse, you will also be exposed to the claims of many chiropractors and acupuncturists to be able to cure all manner of conditions other than back pain. But don’t even dare to suggest that manipulation of the spine is not a cure for colic or asthma or you may find yourself sued for defamation. The shameful legal action of the British Chiropractic Association against Simon Singh (follow it here) led to an addition to DC’s Patients’ Guide to Magic Medicine.
(In the face of such tragic behaviour, one has to be able to laugh).
Libel: A very expensive remedy, to be used only when you have no evidence. Appeals to alternative practitioners because truth is irrelevant.
NICE seems to have fallen for the bait and switch trick, hook line and sinker.
The neglected consequences
Once again, we see the consequences of paying insufficient attention to the Dilemmas of Alternative Medicine.
The lying dilemma
If acupuncture is recommended we will have acupuncturists telling patients about utterly imaginary things like “Qi” and “meridians”. And we will have chiropractors telling them about subluxations and innate energy. It is my opinion that these things are simply make-believe (and that is also the view of a minority of acupuncturist and chiropractors). That means that you have to decide whether the supposed benefits of the manipulation are sufficient to counterbalance the deception of patients.
Some people might think that it was worth it (though not me). What is unforgivable is not to consider even the question. The NICE guidance says not a word about this dilemma. Why not?
The training dilemma
The training dilemma is even more serious. Once some form of alternative medicine has successfully worked the Bait and Switch trick and gained a toehold in the NHS, there will be an army of box-ticking HR zombies employed to ensure that they have been properly trained in “subluxations” or “Qi”. There will be quangos set up to issue National Occupational Standards in “subluxations” or “Qi”. Skills for Health will issue “competences” in “subluxations” or “Qi” (actually they already do). There will be courses set up to teach about “subluxations” or “Qi”, some even in ‘universities’ (there already are).
The respectability problem
But worst of all, it will become possible for aupuncturists and chiropractors to claim that they now have official government endorsement from a prestigious evidence-based organisation like NICE for “subluxations” or “Qi”. Of course this isn’t true. In fact the words “subluxations” or “Qi” are not even mentioned in the draft report. That is the root of the problem. They should have been. But omitting stuff like that is how the Bait and Switch trick works.
Alternative medicine advocates crave, above all, respectability and acceptance. It is sad that NICE seems to have given them more credibility and acceptance without having considered properly the secondary consequences of doing so,
How did this failure of NICE happen?
It seems to have been a combination of political correctness, failure to consider secondary consequences, and excessive influence of the people who stand to make money from the acceptance of alternative medicine.
Take, for example, the opinion of the British Pain Society. This organisation encompasses not just doctors. It
includes “doctors, nurses, physiotherapists, scientists, psychologists, occupational therapists and other healthcare professionals actively engaged in the diagnosis and treatment of pain and in pain research for the benefit of patients”. Nevertheless, their response to the draft guidelines pointed out that the manipulative therapies as a whole were over-represented.
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Manipulation The guidelines assess 9 large groups of interventions of which manual therapies are only one part. The full GDG members panel of 13 individuals included two proponents of spinal manipulation/mobilisation (P Dixon and S Vogel). In addition, the chair of the panel (M Underwood) is the lead author of the UKBEAM trial on which the positive recommendation for |
It seems that the Pain Society were quite right.
LBC 97.3 Breakfast Show (25 May 2009) had a quick discussion on acupuncture (play mp3 file). After I had my say, the other side was put by Rosey Grandage. She has (among other jobs) a private acupuncture practice so she is not quite as unbiassed as me). As usual, she misrepresents the evidence by failing to distinguish between blind and non-blind studies. She also misrepresented what I said by implying that I was advocating drugs. That was not my point and I did not mention drugs (they, like all treatments, have pretty limited effectiveness, and they have side effects too). She said “there is very good evidence to show they (‘Qi’ and ‘meridians’] exist”. That is simply untrue.
There can’t be a better demonstration of the consequences of falling for bait and switch than the defence mounted by Rosey Grandage. NICE may not mention “Qi” and “meridians”; but the people they want to allow into the NHS have no such compunctions.
I first came across Rosey Grandage when I discovered her contribution to the Open University/BBC course K221. That has been dealt with elsewhere. A lot more information about acupuncture has appeared since then. She doesn’t seem to have noticed it. Has she not seen the Nordic Cochrane Centre report? Nor read Barker Bausell, or Singh & Ernst? Has she any interest in evidence that might reduce her income? Probably not.
Where to find out more
An excellent review of chiropractic can be found at the Layscience site. It was written by the indefatigable ‘Blue Wode’ who has provided enormous amounts of information at the admirable ebm-first site (I am authorised to reveal that ‘Blue Wode’ is the author of that site). There you will also find much fascinating information about both acupuncture and about chiropractic.
I’m grateful to ‘Blue Wode’ for some of the references used here.
Follow-up
It seems that validation committees often don’t look beyond the official documents. As a result, the validations may not be worth the paper they are written on. Try this one.
One of the best bits of news recently was the downfall of Matthias Rath. He’s the man who peddled vitamin pills for AIDS in Africa, and encouraged the AIDS denialists in the South African government. Thabo Mbeki and his Health Minister, Mrs Beetroot, have gone now, thank heavens.
Rath was one of the best illustrations of the murderous effect of selling ineffective treatments. The fact that nobody in the “nutritional therapy” industry has uttered a word of condemnation for this man illustrates better than anything one can imagine the corrupt state of “nutritional therapy”. The people who kept silent include the British Association of Nutritional Therapists (BANT).
It might be surprising, then, to find the Northern College of Acupuncture proudly adding a course in alternative nutrition to its courses in acupuncture (now known to be a theatrical placebo) and Chinese herbal medicine (largely untested and sometimes toxic). It might be even more surprising to find the boast that the course is validated by the University of Wales. It seemed a good idea to find out a bit more about how this came about. Thanks to the Freedom of Information Act, some interesting things can be discovered.
Polly Toynbee’s superb article, Quackery and superstition – available soon on the NHS, written in January 2008, mentioned diplomas and degrees in complementary therapies offered by, among others, the University of Wales. This elicited a letter of protest to Toynbee from the Vice-Chancellor of the University of Wales, Professor Marc Clement BSc, PhD, MInstP, CEng,CPhys,FIET. He invited her to visit the university to see their “validation and monitoring procedures (including the University’s very specific guidelines on health studies disciplines”.
So let’s take a look at these validation procedures and guidelines.
The validation process
The Northern College of Acupuncture submitted a 148 page proposal for the course in October 2007. The document has all the usual edu-bollocks jargon, but of course doesn’t say much about clinical trials, though it does boast about an unblinded trial of acupuncture published in 2006 which, because of lack of appropriate controls, served only to muddy the waters. : This submission was considered by the University’s validation committee last December.
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The whole validation document is only four pages long [download it]. The most interesting thing about it is that the words ‘evidence’ or ‘critical’ do not occur in it a single time. It has all the usual bureaucratic jargon of such documents but misses entirely the central point.
Does that mean that the University of Wales doesn’t care about evidence or critical thinking? Well, not on paper. Two years previously a short document called Health Studies Guidelines had been written by Dr Brian Spriggs (Health Studies Validation Consultant, since retired) for the Health Studies Committee, and it was approved on 21 April 2005. It starts well.
“Degrees in the Health Studies field are expected to promote an understanding of the importance of the scientific method and an evidence-base to underpin therapeutic interventions and of research to expand that base.”
It even goes on to say that a BSc degree in homeopathy is “unacceptable”. Don’t get too excited though, because it also says that acupuncture and Chinese herbal stuff is quite OK. How anyone can imagine they live up to the opening sentence beats me. And it gets worse. It says that all sorts of rather advanced forms of battiness are OK if they form only part of another degree. They include Homeopathy, Crystal therapy. Dowsing, Iridology; Kinesiology, Radionics, Reflexology, Shiatsu, Healing, and Maharishi Ayurvedic Medicine.
Dowsing? Crystal therapy? Just let me remind you. We are living in 2008. It is easy to forget that when ploughing through all this new age junk.
The Validation Handbook of Quality Assurance: Health Studies (2007) runs to an astonishing 256 pages [download the whole thing]. On page 12 we find the extent of the problem.
“The University of Wales validates a number of schemes in the Health Studies field. At the current time we have undergraduate and/or postgraduate degree schemes in Acupuncture, Animal Manipulation, Chiropractic, Herbal Medicine, Integrative Psychotherapy, Osteopathy, Osteopathic Studies, Traditional Chinese Medicine and Regulatory Affairs, both in the UK and overseas.”
That sounds pretty shocking. Further down on page 12, though, we find this.
“Degrees in the Health Studies field are expected to promote an understanding of the importance of the scientific method and an evidence-base to underpin therapeutic interventions and of research to expand that base. The mission is to promote and require the critical evaluation of the practices, doctrines, beliefs, theories and hypotheses that underlie the taught therapeutic measures of the discipline.”
They are indeed fine words. The problem is that I can detect no sign in the submission, nor in its consideration by the validation committee, that any attempt whatsoever was made to ensure that the course complied with these requirements.
The only sign of concern I could detect of any concern about the quality of what was being taught came in a minute to a meeting of the Health Studies Committee meeting on 24th April 2008.
“Members received a copy of an article entitled Quackery and superstition available soon on the NHS which appeared in The Guardian newspaper in January 2008, and a copy of the Vice- Chancellors response. Members agreed that this article was now historical but felt that if/when the issue were to arise again; the key matter of scientific rigour should be stressed. The Committee agreed that this was the most critical element of all degree schemes in the University of Wales portfolio of health studies schemes. It was felt it would be timely to re-examine the schemes within the portfolio as well as the guidelines for consideration of Health Studies schemes at the next meeting. The Committee might also decide that Institutions would be required to include literature reviews (as part of their validation submission) to provide evidence for their particular profession/philosophy. It was agreed that the guidelines would be a vital document in the consideration of new schemes and during preliminary visits to prospective Institutions. “
The Press Office had passed Polly Toynbee’s article to them. Curiously the Health Studies Committee dismissed it as “historical”, simply because it was written three months earlier. That is presumably “historical” in the sense that the public will have forgotten about it, rather than in the sense that the facts of the matter have changed since January. So, at least for the nutrition degree, Toynbee’s comments were simply brushed under the carpet.
After a few cosmetic changes of wording the validation was completed on 16th January 2008. For example the word “diagnosis” was removed in 43 places and “rewritten in terms of evaluation and assessment”. There was, needless to say, no indication that the change in wording would change anything in what was taught to students.
You may think that I am being a bit too harsh. Perhaps the course is just fine after all? The problem is that the submission and the reaction of the validation committee tell you next to nothing about what actually matters, and that is what is taught. There is only a vague outline of that in the submission (and part of it was redacted on the grounds that if it were made public somebody might copy ;it. Heaven forbid).
That is why I have to say, yet again, that this sort of validation exercise is not worth the paper it’s written on.
How can we find out a bit more? Very easily as it happens. Just Google. What matters is not so much formal course outlines but who teaches them.
The nutrition course
The title of the course is just “Nutrition”, not ‘Nutritional Therapy’ or ‘Alternative Nutrition’. That sounds quite respectable but a glance at the prospectus shows immediately that it is full-blown alternative medicine.
Already in July 2007, the glowing press releases for the course had attracted attention from the wonderfully investigative web site HolfordWatch. I see no sign that the validation committee was aware of this. But if not, why not? I would describe is as dereliction of academic duty.
“This pioneering course is unique in that it is firmly rooted in both Western nutritional science and naturopathic medicine and also covers concepts of nutrition within traditional Chinese, Japanese, Tibetan and Ayurvedic medicine.
This means that graduates will gain comprehensive understanding of both modern scientific knowledge and ancient wisdom concerning nutrition and dietetics.”
Ancient wisdom, of course, means something that your are supposed to believe though there is no good reason to think it’s true. In the end, though, almost the only thing that really matters about any course is who is running it. The brochure shows that all of the people are heavily into every form of alternative nuttiness.
Course Director and Tutor: Jacqueline Young nutritionist, naturopath, clinical psychologist and Oriental medical practitioner
Nutrition Tutors:
Elaine Aldred (qualified as a chiropractor with the Anglo European Chiropractic College, as an acupuncturist with the British College of Acupuncture and as a Western Medical Herbalist with the College of Phytotherapy. She recently also qualified in Chinese herbal medicine with the Northern College of Acupuncture.)
Sue Russell (3 year diploma in nutritional therapy at the Institute of Optimum Nutrition. She currently practises as a nutritional therapist and also works part-time as a manager at the Northern College of Homeopathic Medicine.)
Anuradha Sharma (graduated as a dietician from Leeds Metropolitan University in 2002 and subsequently completed a Naturopathy certificate and a post-graduate diploma in acupuncture).
Guest Lecturers include : Dr John Briffa, Professor Jane Plant, M.B.E. (a geochemist turned quack), and, most revealingly, none other than the UK’s most notorious media celebrity and pill peddler, Patrick Holford.
So much has been written about Holford’s appalling abuse of science, one would have thought that not even a validation committee could have missed it.
“The course has been created by Jacqueline Young“, so let’s look a bit further at her track record.
Jacqueline Young has written a book, ‘Complementary Medicine for Dummies’ [Ed: ahem shouldn’t that be Dummies for Complementary Medicine?]. You can see parts of it on Google Books. Did the validation committee bother to look at it? As far as I can tell, the words ‘randomised’ or ‘clinical trial’ occur nowhere in the book.
The chapter on Tibetan medicine is not very helpful when it comes to evidence but for research we are referred to the Tibetan Medical and Astrology Institute. Guess what? That site gives no evidence either. So far not a single university has endorsed Astrology (there is a profitable niche there for some vice-chancellor).
Here are few samples from the book. The advice seems to vary from the undocumented optimism of this
Well researched? No. Safe? Nobody knows. Or this
Mandarin peel prevents colds and flu? Old wive’s tale. Then there are things that verge on the weird, like this one
or the deeply bizarre like this
The problem of Jacqueline Young’s fantasy approach to facts was pointed out at least as far back as 2004, by Ray Girvan., who wrote about it again in May 2005. The problems were brought to wider attention when Ben Goldacre wrote two articles in his Badscience column, Imploding Researchers (September 2005), and the following week, Tangled Webs.
“we were pondering the ethics and wisdom of Jacqueline Young dishing out preposterous, made-up, pseudoscientific nonsense as if it was authoritative BBC fact, with phrases such as: “Implosion researchers have found that if water is put through a spiral its electrical field changes and it then appears to have a potent, restorative effect on cells.” “
and later
“Take this from her article on cranial osteopathy, riddled with half truths: “Sutherland found that the cranial bones (the skull bones encasing the brain) weren’t fused in adulthood, as was widely believed, but actually had a cycle of slight involuntary movement.” In fact the cranial bones do fuse in adulthood.
She goes on: “This movement was influenced by the rhythmic flow of cerebrospinal fluid (the nourishing and protective fluid that circulates through the spinal canal and brain) and could become blocked.” There have now been five studies on whether “cranial osteopaths” can indeed feel these movements, as they claim, and it’s an easy experiment to do: ask a couple of cranial osteopaths to write down the frequency of the rhythmic pulses on the same person’s skull, and see if they give the same answer. They don’t. A rather crucial well-replicated finding to leave out of your story.
That was in 2005 and since then all of Young’s “preposterous, made-up, pseudoscientific nonsense” (along with most of the other stuff about junk medicine) has vanished from the BBC’s web site, after some people with a bit of common sense pointed out what nonsense it was. But now we see them resurfacing in a course validated by a serious university. The BBC had some excuse (after all, it is run largely by arts graduates). I can see no excuses for the University of Wales.
Incidentally, thanks to web archive you can still read Young’s nonsense, long after the BBC removed it. Here is a quotation.
“Implosion researchers have found that if water is put through a spiral its ,field changes and it then appears to have a potent, restorative effect on cells. In one study, seedlings watered with spiralised water grew significantly faster, higher and stronger than those given ordinary water.”
The vice-chancellor of the University of Wales, Marc Clement, is a physicist (Department of Electrical and Electronic Engineering), so can he perhaps explain the meaning of this?
Selection committees for jobs (especially senior jobs) and validation committees for courses, might make fewer mistakes if they didn’t rely so much on formal documents and did a little more investigation themselves. That sort of thing is why the managerial culture not only takes a lot more time, but also gives a worse result.
It would have taken 10 minutes with Google to find out about Young’s track record, but they didn’t bother. As a result they have spent a long time producing a validation that isn’t worth the paper it’s written on. That makes the University of Wales a bit of a laughing stock. Worse still, it brings science itself into disrepute.
Follow-up
What does the University of Wales say? So far, nothing. Last week I sent brief and polite emails to Professor Palastanga and to Professor Clement to try to discover whether it is true that the validation process had indeed missed the fact that the course organiser’s writings had been described as “preposterous, made-up, pseudoscientific nonsense” in the Guardian.
So far I have had no reply from the vice-chancellor, but on .26 October I did get an answer from Prof Palastaga.
| As regards the two people you asked questions about – J.Young – I personally am not familiar with her book and nobody on the validation panel raised any concerns about it. As for P.Holford similarly there were no concerns expressed about him or his work. In both cases we would have considered their CV’s as presented in the documentation as part of the teaching team. In my experience of conducting degree validations at over 16 UK Universities this is the normal practice of a validation panel. |
I have to say this reply confirms my worst fears. Validation committees such as this one simply don’t do their duty. They don’t show the curiosity that is needed to discover the facts about the things that they are meant to be judging. How could they not have looked at the book by the very person that they are validating? After all that has been written about Patrick Holford, it is simply mind-boggling that the committee seems to have been quite unaware of any of it.
It is yet another example of the harm done to science by an unthinking, box-ticking approach.
Pharmacology. A Handbook for Complementary Healthcare Professionals
Elsevier were kind enough to send me an inspection copy of this book, which is written by one of the nutrition course tutors, Elaine Aldred. She admits that pharmacology is “considered by most students to be nothing more that a ‘hoop-jumping’ exercise in the process of becoming qualified”. She also says. disarmingly. that “I was certainly not the most adept scientist at school and found my university course a trial”.
The book has all the feel of a cut and paste job. It is mostly very simple (if not simplistic). though for no obvious reason it starts with a long (and very amateur) discussion of chemical bonding Then molecules are admitted to be indivisible (but, guess what, the subject of homeopathy is avoided). There is a very short section on ion channels, though, bizarrely, it appears under the heading “How do drugs get into cells?”. Since the author is clearly not able to make the distinction between volts and coulombs, the discussion is more likely to confuse the reader than to help.
Then a long section on plants. It starts of by asserting that “approximately a quarter of prescription drugs contain at least one chemical that was originally isolated and extracted from a plant”.. This cannot be even remotely correct. There are vast tables showing complicated chemical structures, but the usual inadequate
list of their alleged actions This is followed by a quick gallop through some classes of conventional drugs, illustrated again mainly by chemical structures not data. Hormone replacement therapy is mentioned, but the chance to point out that it is one of the best illustrations of the need for RCTs is missed.
The one thing that one would really like to see in such a book is a good account of how you tell whether or not a drug works in man. This is relegated to five pages at the end of the book, and it is, frankly, pathetic. It
is utterly uncritical in the one area that matters more than any other for people who purport to treat patients. All you get is a list of unexplained bullet points.
If this book is the source of the “scientific content” of the nutrition course, things are as bad as we feared.
We have often had cause to criticise Boots Alliance, the biggest retail pharmacist in the UK, because of its deeply unethical approach to junk medicine. Click here to read the shameful litany. The problem of Boots was raised recently also by Edzard Ernst at the Hay Literary Festival. He said
“The population at large trusts Boots more than any other pharmacy, but when you look behind the smokescreen, when it comes to alternative medicines, that trust is not justified.”
Ernst accused Boots of breaching ethical guidelines drawn up by the Royal Pharmaceutical Society of Great Britain, by failing to tell customers that its homeopathic medicines contain no active ingredients and are ineffective in clinical trials.
Another chain, Lloyds Pharmacy, are just as bad. Many smaller pharmacies are no more honest when it comes to selling medicines that are known to be ineffective.
Pharmacists are fond of referring to themselves as “professionals” who are regulated by a professional body, the Royal Pharmaceutical Society of Great Britain (RPSGB). It’s natural to ask where their regulatory body stands on the question of junk medicine. So I asked them, and this is what I found.
| 17 April, 2008
I am writing an article about the role of pharmacists in giving advice about (a) alternative medicines and (b) nutritional supplements. I can find no clear statements about these topics on the RPSGB web site. Please can you give me a statement on the position of the Royal Pharmaceutical Society on these two topics. In particular, have you offered guidance to pharmacists about how to deal with the conflict of interest that arises when they can make money by selling something that they know to have no good evidence for efficacy? This question has had some publicity recently in connection with Boots’ promotion of CCoQ10 to give you “energy”, and only yesterday when the bad effects of some nutritional supplements were in the news. |
Here are some extracts from the first reply that I got from the RPSGB’s Legal and Ethical Advisory Service (emphasis is mine).
| 28 April 2008
Pharmacists must comply with the Code of Ethics and its supporting documents. Principle 5 of the Code of Ethics requires pharmacists to develop their professional knowledge and competence whilst Principle 6 requires pharmacists to be honest and trustworthy. The Code states: 5. DEVELOP YOUR PROFESSIONAL KNOWLEDGE AND COMPETENCE At all stages of your professional working life you must ensure that your knowledge, skills and performance are of a high quality, up to date and relevant to your field of practice. You must: 5.1 Maintain and improve the quality of your work by keeping your knowledge and skills up to date, evidence-based and relevant to your role and responsibilities. 5.2 Apply your knowledge and skills appropriately to your professional responsibilities. 5.3 Recognise the limits of your professional competence; practise only in those areas in which you are competent to do so and refer to others where necessary. 5.4 Undertake and maintain up-to-date evidence of continuing professional development relevant to your field of practice. 6. BE HONEST AND TRUSTWORTHY Patients, colleagues and the public at large place their trust in you as a pharmacy professional. You must behave in a way that justifies this trust and maintains the reputation of your profession. You must: 6.2 Ensure you do not abuse your professional position or exploit the vulnerability or lack of knowledge of others. 6.3 Avoid conflicts of interest and declare any personal or professional interests to those who may be affected. Do not ask for or accept gifts, inducements, hospitality or referrals that may affect, or be perceived to affect, your professional judgement. 6.4 Be accurate and impartial when teaching others and when providing or publishing information to ensure that you do not mislead others or make claims that cannot be justified. |
And, on over-the counter prescribing
| In addition the “Professional Standards and Guidance for the Sale and Supply of Medicines” document which supports the Code of Ethics states:
“2. SUPPLY OF OVER THE COUNTER (OTC) MEDICINES STANDARDS When purchasing medicines from pharmacies patients expect to be provided with high quality, relevant information in a manner they can easily understand. You must ensure that: 2.1 procedures for sales of OTC medicines enable intervention and professional advice to be given whenever this can assist the safe and effective use of medicines. Pharmacy medicines must not be accessible to the public by self-selection. |
Evidence-based? Accurate and impartial? High quality information? Effective use?
These words don’t seem to accord with Boots’ mendacious advertisements for CoQ10 (which were condemned by the ASA).
Neither does it accord with the appalling advice that I got from a Boots pharmacist about Vitamin B for vitality.
Or their bad advice on childhood diarrhoea.
Or the unspeakable nonsense of the Boots (mis)-education web site.
Then we get to the nub. This is what I was told by the RPSGB about alternative medicine (the emphasis is mine).
| 8. COMPLEMENTARY THERAPIES AND MEDICINES
STANDARDS You must ensure that you are competent in any area in which you offer advice on treatment or medicines. If you sell or supply homoeopathic or herbal medicines, or other complementary therapies, you must: 8.1 assist patients in making informed decisions by providing them with necessary and relevant information. 8.2 ensure any stock is obtained from a reputable source. 8.3 recommend a remedy only where you can be satisfied of its safety and quality, taking into account the Medicines and Healthcare products Regulatory Agency registration schemes for homoeopathic and herbal remedies.” Therefore pharmacists are required to keep their knowledge and skills up to date and provide accurate and impartial information to ensure that you do not mislead others or make claims that cannot be justified. |
It does seem very odd that “accurate and impartial information” about homeopathic pills does not include mentioning that they contain no trace of the ingredient on the label. and have been shown in clinical trials to be ineffective. These rather important bits of information are missing from both advertisements and from (in my experience) the advice given by pharmacists in the shop.
If you look carefully, though, the wording is a bit sneaky. Referring to over-the-counter medicines, the code refers to “safe and effective use of medicines”, but when it comes to alternative medicines, all mention of ‘effectiveness’ has mysteriously vanished.
So I wrote again to get clarification.
| 29 April, 2008
Thanks for that information. I’d appreciate clarification of two matters in what you sent. (1) Apropros of complementary and alternative medicine, the code says 8.3 recommend a remedy only where you can be satisfied of its safety and quality I notice that this paragraph mentions safety and quality but does not mention efficacy. Does this mean that it is considered ethical to recommend a medicine when there is no evidence of its efficacy? Apparently it does. This gets to the heart of my question and I’d appreciate a clear answer. |
This enquiry was followed by a long silence. Despite several reminders by email and by telephone nothing happened until eventually got a phone call over a month later (May 3) from David Pruce, Director of Practice & Quality Improvement, Royal Pharmaceutical Society of Great Britain. The question may be simple, but the RPSGB evidently it hard, or more likely embarrassing, to answer.
When I asked Pruce why para 8.3 does not mention effectiveness, his reply, after some circumlocution, was as follows.
Pruce: “You must assist patients in making informed decisions by providing necessary and relevant information . . . we would apply this to any medicine, the pharmacist needs to help the patient assess the risks and benefits.”
DC: “and would that include saying it doesn’t work better than placebo?”
Pruce “if there is good evidence to show that it may, but it depends on what the evidence is, what the level of evidence is, and the pharmacist’s assessment of the evidence”
DC “What’s your assessment of the evidence?”
Pruce, “I don’t think my personal assessment is relevant. I wouldn’t want to be drawn on my personal assessment”. “If a pharmacist is selling homeopathic medicines they have to assist the patient in making informed decisions”
“I don’t think we specifically talk about the efficacy of any other medicine” [DC: not true, see para 2.1, above]
“We would expect pharmacists to be making sure that what they are providing to a patient is safe and efficacious”
DC “So why doesn’t it mention efficacious in para 8.3”
Pruce “What we are trying to do with the Code of Ethics is not go down to the nth degree of detail ” . . . “there are large areas of medicine where there is an absence of data”
DC “Yes, actually homeopathy isn’t one of them. It used to be.”
Pruce. “uh, that’s again a debatable point”
DC I don’t think it’s debatable at all, if you’ve read the literature
Pruce. “well many people would debate that point” “This [homeopathy] is a controversial area where opinions are divided on it”
DC “Not informed opinions”
Pruce “Well . . . there are also a large number of people that do believe in it. We haven’t come out with a categorical statement either way.”
I came away from this deeply unsatisfactory conversation with a strong impression that the RPSGB’s Director of Practice & Quality Improvement was either not familiar with the evidence, or had been told not to say anything about it, in the absence of any official statement about alternative medicine.
I do hope that the RPSGB does not really believe that “there are also a large number of people that do believe in it” constitutes any sort of evidence.
It is high time that the RPSGB followed its own code of ethics and required, as it does for over-the-counter sales, that accurate advice should be given about “the safe and effective use of medicines”.
“The scientist on the High Street”
The RPS publishes a series of factsheets for their “Scientist in the High Street” campaign. One of these “factsheets” concerns homeopathy, [download pdf from the RPSGB]. Perhaps we can get an answer there?
Well not much. For the most part the “factsheet” just mouths the vacuous gobbledygook of homeopaths. It does recover a bit towards the end, when it says
“The methodologically “best” trials showed no effect greater than that of placebo”.
But there is no hint that this means pharmacists should not be selling homeopathic pills to sick people..
That is perhaps not surprising, because the Science Committee of the RPSGB copped out of their responsibility by getting the factsheet written by a Glasgow veterinary homeopath, Steven Kayne. You can judge his critical attitude by a paper (Isbell & Kayne, 1997) which asks whether the idea that shaking a solution increases its potency. The paper is a masterpiece of prevarication, it quotes only homeopaths and fails to come to the obvious conclusion. And it is the same Steven Kayne who wrote in Health and Homeopathy (2001)
“Homeopathy is not very good for treating bacterial infections directly, apart from cystitis that often responds to a number of medicines, including Berberis or Cantharis”.
So there is a bacterial infection that can be cured by pills that contain no medicine? Is this dangerous nonsense what the RPSGB really believes?
More unreliable advice
While waiting for the train to Cardiff on April 16th (to give a seminar at the Welsh School of Pharmacy), I amused myself by dropping into the Boots store on Paddington station.
| DC I’ve seen your advertisements for CoQ10. Can you tell me more? Will they really make me more energetic?
Boots: Yes they will, but you may have to take them for several weeks. DC. Several weeks? Boots: yes the effect develops only slowly Peers at the label and reads it out to me DC I see. Can you tell me whether there have been any trials that show it works? Boots. I don’t know. I’d have to ask. But there must be or they wouldn’t be allowed to sell it. DC. Actually there are no trials, you know Boots. Really? I didn’t think that was allowed. But people have told me that they feel better after taking it. DC You are a pharmacist? Boots. Yes |
Sadly, this abysmal performance is only too typical in my experience, Try it yourself.
The malaria question
After it was revealed that pharmacists were recommending, or tolerating recommendations, of homeopathic treatment of malaria, the RPSGB did, at last. speak out. It was this episode that caused Quackometer to write his now famous piece on ‘The gentle art of homeopathic killing‘ (it shot to fame when the Society of Homeopaths tried to take legal action to ban it) Recommending pills that contain no medicine for the treatment or prevention or treatment of malaria is dangerous. If it is not criminal it ought to be [watch the Neals Yard video]. .
The RPSGB says it is investigating the role of pharmacists in the Newsnight sting (see the follow-up here). That was in July 2006, but they are stlll unwilling to say if any action will be taken. Anyone want to bet that it will be swept under the carpet?
The statement issued by the RPSGB, 5 months after the malaria sting is just about the only example that I can find of them speaking out against dangerous and fraudulent homeopathic practices. Even in this case, it is pretty mild and restricted narrowly to malaria prevention.
The RPSGB and the Quacktioner Royal
The RPSGB submitted a response to the ‘consultation’ held by the Prince’s Foundation for Integrated Health, about their Complementary Healthcare; a guide for patients.
| Response by the Royal Pharmaceutical Society of Great Britain Dr John Clements, Science Secretary “We believe that more emphasis should be given to the need for members of the public who are purchasing products (as opposed to services) to ask for advice about the product. Pharmacists are trained as experts on medicines and the public, when making purchases in pharmacies, would expect to seek advice from pharmacists” |
So plenty of puffery for the role of pharmacists. But there is not a word of criticism about the many barmy treatments that are included in the “Guide for Patients”. Not just homeopathy and herbalism, but also Craniosacral therapy, Laying on of Hands, chiropractic, Reiki, Shiatsu –every form of barminess under the sun drew no comment from the RPS.
I can’t see how a response like this is consistent with the RPS’s own code of ethics.
A recent president of the RPSGB was a homeopath
| Christine Glover provides perhaps the most dramatic reason of all for thinking thst, despite all the fine words, the RPSGB cares little for evidence and truth The NHS Blogdoctor published “Letter from an angry pharmacist”. |  |
Mrs Glover was president of the RPSGB from 1999 to 2001, vice-president in 1997-98, and a member of the RPSGB Council until May 2005. She is not just a member, but a Fellow. (Oddly, her own web site says President from 1998 – 2001.)
So it is relevant to ask how the RPSGB’s own ex-president obeys their code of ethics. Here are some examples on how Ms Glover helps to assist the safe and effective use of medicines. . Much of her own web site seems to have vanished (I wonder why) so I’ll have to quote the “Letter from an angry pharmacist”., as revealed by NHS Blogdoctor,
“What has Christine got to offer?
- “We offer a wide range of Homeopathic remedies (over 3000 different remedies and potencies) as well as Bach flower remedies, Vitamins, Supplements, some herbal products and Essential Oils.”
- Jetlag Tablets highly recommended in ‘Wanderlust’ travel magazine. Suitable for all ages.
- Wind Remedy useful for wind particularly in babies. In can be supplied in powder form for very small babies. Granules or as liquid potency.
- Udder Care 100ml £80.00 One capful in sprayer filled with water. Two jets to be squirted on inner vulva twice daily for up to 4 days until clots reduced. Discard remainder. Same dose for high cell-counting cows detected.
Udder Care? Oh! I forgot to say, “Glover’s Integrated Healthcare” does cows as well as people. Dr Crippen would not suggest to a woman with sore breasts that she sprayed something on her inner vulva. But women are women and cows are cows and Dr Crippen is not an expert on bovine anatomy and physiology. But, were he a farmer, he would need some persuasion to spend £80.00 on 100 mls of a liquid to squirt on a cow’s vulva. Sorry, inner vulva.”
Nothing shows more clearly that the RPSGB will tolerate almost any quackery than the fact that they think Glover is an appropriate person to be president. Every item on the quotation above seems to me to be in flagrant breach of the RPSGB’s Code of Ethics. Just like the Society of Homeopaths, the code seems to be there merely for show, at least in the case of advice about junk medicine..
A greater role for pharmacists?
This problem has become more important now that the government proposes to give pharmacists a greater role in prescribing. Needless to say the RPSGB is gloating about their proposed new role. Other people are much less sure it is anything but a money–saving gimmick and crypto-privatisation.
I have known pharmacists who have a detailed knowledge of the actions of drugs, and I have met many more who haven’t. The main objection, though, is that pharmacists have a direct financial interest in their prescribing. Conflicts of interest are already rife in medicine, and we can’t afford them.
Conclusion
The Royal Pharmaceutical Society is desperately evasive about a matter that is central to their very existence, giving good advice to patients about which medicines work and which don’t. Pharmacists should be in the front line in education of the public, about medicines, the ‘scientist on the High Street’. Some of them are, but their professional organisation is letting them down badly.
Until such time as the RPSGB decides to take notice of evidence, and clears up some of the things described here, it is hard to see how they can earn the respect of pharmacists, or of anyone else.
Follow-up
Stavros Isaiadis’ blog, Burning Mind, has done a good piece on “More on Quack Medicine in High Street Shops“.
The Chemist and Druggist reports that the RPSGB is worried about the marketing of placebo pills (‘obecalp’ -geddit?). It does seem very odd that the RPSGB should condemn honest placebos, but be so very tolerant about dishonest placebos. You couldn’t make it up.
A complaint to the RPSGB is rejected
Just to see what happened, I made a complaint to thr RPSGB about branches of their own Code of Ethics at Boots in Hexham and in Evesham. Both of them supported Homeopathy Awareness Week These events had been publicised in those particularly unpleasent local ‘newspapers’ that carry paid advertising disguised as editorial material. In this case it was the Evesham Journal and the Hexham Courant.
Guess what? The RPSGB replied thus
“Your complaint has been reviewed bt Mrs Jill Williams and Mr David Slater who are both Regional Lead Inspectors. Having carried out a review they have concluded that support of homeopathic awareness week does not constitute a breach of the Society’s Code of Ethics or Professional Standards.”
In case you have forgotten, the Professional Standards say
2.1 procedures for sales of OTC medicines enable intervention and professional advice to be given whenever this can assist the safe and effective use of medicines.
The RPSGB has some very quaint ideas on how to interpret their own code of ethics
Thursday 24 Jan.
One of the original reasons for going to North America was an invitation from the Toronto Secular Alliance and Center for Inquiry. The talk for them was given a lot of publicity, for example here and here and from the totally admirable Orac.
Toronto seems to be no worse than anywhere else when it comes to delusional thinking about medicine. It is, of course, the home of Ryerson University, the place that produced one of the most outrageous pieces of postmodernist nonsense on record. But when this sort of thing gets into really good universities, it is more worrying.
As a result of the publicity there was some media coverage (and a record 7109 hits on this site on Sunday).
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Friday 25th January, Reception and talk: Center for Inquiry. Science in an Age of Endarkenment: Some Examples from Scientific Fraud, Quackery, Religion and University Politics |
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The interview was broadcast on Sunday morning (28 Jan) and elicited a lot of correspondence. CBC made it available as a podcast which can be downloaded from CBC here. The endarkenment interview was the last 22 minutes (out of 64 minutes) [play the interview here (mp3, 20 Mb)]. |
Sunday Edition: the follow-upThe week following this CBC show, the backlash started. The Sunday Edition wrote
“A stirred-up hornet’s nest is a mild disturbance compared to the firestorm we unleashed last week over my conversation with Dr. David Colquhoun. Dr. Colquhuon [sic] is a gangly, pipe-puffing British pharmacologist who thinks all alternative medicine, all of it, is a fraud perpetrated by quacks. But he went further, somehow suggesting that those who believe in it probably supported Margaret Thatcher, Ronald Reagan and the Ayatollah Khomeini. He pooh-poohed acupuncture, chiropractic, homeopathy, even vitamins.
Well, his remarks opened the floodgates of listener mail, screaming for Dr. Colquhoun’s head on a pike. In a few moments, alternative or complimentary [sic] medicine strikes back. With the help of two experts, we will try to give the other side of contentious Colquhounism.”
The programme for 3 Feb 2008 started with a few emails from listeners, mainly of the “homeopathy cured my granny” type. Nothing of much significance there. But then Enright interviewed Dugald Seely of the Canadian College of Naturopathic Medicine and Dr. Kien Trinh of the DeGroote School of medicine at McMaster University in Hamilton. You can download the podcast here.
The flat earth problem.
Michael Enright was a good interviewer, but Sunday Edition suffers, like the BBC, from a problem. It is admirable that CBC, like the BBC, should strive to be ‘fair and balanced’, but it is not always easy to see what that means in practice. Is it fair and balanced to give equal time to people who think that the earth is flat and those who think it is spherical (OK, an oblate ellipsoid)? Perhaps, but it also
quite misleading because it can easily convey a very distorted idea of the balance of informed opinion. In this case the flat-earthers are the homeopaths and other alternative medicine advocates. That would not matter so much if the interviewers had enough knowledge of the subject to pin down the falt-earth advocates with the sort of penetrating questions that people like John Humphrys (of the BBC’s Today programme) are so very good at. When it comes to science, though, the flat-earthers tend to get away with murder, and the public can easily be left with a very distorted view. Which “expert” should they believe? If I had been given the option, I would have loved to debate the problems of alternative medicine directly with Trinh and Seely I could have asked then a few questions that Enright missed.
Let’s take a look at what happened at the follow-up.
Quackery at McMaster University
McMaster is one of many universities in North America that has chosen to betray the intellectual tradition of the enlightenment by buying into superstition (see the roll of shame here). The ‘contemporary medical acupuncture program appears to run under the aegis of the anaesthesia
department, though the fact that is doen’t appear on the department’s front page suggests there may be some embarrassment about it. The medical acupuncture program itself, has separate web pages which don’t seem to be on the McMaster server at all (they are on a private server, ThePlanet.com Internet Services, Inc.
As so often, these pages pay lip service to an ‘evidence based’ or ‘scientific’ approach, while doing nothing of the sort. In his CBC interview Kien Trinh agreed (twice) with my contention that trials had shown that it doesn’t matter where you put the needles. But then he failed totally to draw the obvious conclusion that ‘meridians’ are mumbo jumbo. He went right on taking the conventional mystical view of meridians and “energy” flow. Like most proponents of alternative medicine, Trinh seems to live in some sort of parallel universe in which the normal rules of logic don’t apply.
On wouldn’t expect regular anaesthetists to accept this sort of mystical nonsense, but it seems one would be wrong. When I wrote to the Chair of the Department of Anesthesia, at McMaster to ask about their relationship with acupuncturists there was no hint of embarrassement. Dr Norman Buckley, BA (Psych), MD, FRCPC, wrote
“It operates under the principles of evidence based medicine, and relates the concepts raised by the Acupuncture/traditional Chinese medicine to physiology anatomy et as it is more usually taught in Western schools.”
That would be all very well if it were true, but it simply isn’t true. The evidence just isn’t there, and the departments involved make no serious attempts to get evidence. In a later letter, Dr Buckley seems to acknowledge that it may be all placebo, but seems reluctant to offend anyone by saying so. That, I suspect, is how quackery has gained such a foothold.
It is good to keep an open mind, but if it is too open your brains fall out. Or, in another variant, if it is too open, someone will fill it with trash.
One looks in vain on Trinh’s web site for any good evidence. They quote approvingly the conclusion of a 1997 NIH Consensus statement that says “There is sufficient evidence of acupuncture’s value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.”, but forget to mention that this document is headed “This statement is more than five years old and is provided solely for historical purposes.”. The department doesn’t seem to do much original research, just to write endless reviews of other peoples’ work. The reviews aren’t too bad, and mostly they come to the right conclusion, that there is not enough evidence to come to firm conclusions. The difference from science is that this doesn’t dent their confidence for a moment. A typical sort of conclusion seems to be
Elbow pain. A review by Green et al. concluded “needle acupuncture [is] of short-term benefit with respect to pain, but this finding [is] based on the results of two small trials, the results of which [are] not able to be combined in metaanalysis.”
The results of thousands of years experience with acupuncture seem to be pretty pathetic so far..
Quackery at the Canadian College of Naturopathic Medicine (CCNM)
Unlike McMaster, CCNM isn’t a proper university, though nonetheless is hands out ‘doctorates’. Dugald Seely’s contribution was interesting insofar as he admitted that there was a lot of fraud and unjustified claims in the alternative medicine industry (never forget there are megabucks involved). What he didn’t explain was how he himself could be distinguished from the frauds. The problem, as always is the second-rate research that goes on in this area.
Take one of Seely’s papers, Adaptogenic Potential of a Polyherbal Natural Health Product: Report
on a Longitudinal Clinical Trial. Is only too typical: a small non-randomised, open-label (not blind) “trial” of a complex herbal mixture on 17 patients. The conclusion was, as it almost always is,
“Further research using a randomized controlled design is necessary to confirm the findings from this pilot study.”
In other words, no conclusion at all. Why is it that the proper trial never seems to appear? Could it be that naturopaths, and the wealthy industry behind them, are afraid to do proper trials? That is certainly the impression they give.
One way in which the alternative medicine industry operates is to invent new words with ill-defined meanings (and Big Pharma does it too). In case you were wondering about the word “adaptogen” it is defined as “Essentially the adaptogen supports the body’s ability to ‘adapt’ ideally to its environment. Essentially the adaptogen supports the body’s ability to ‘adapt’ ideally to its environment. ”
Whatever that means.
The Canadian College of Naturopathic Medicine offers the following “therapies”.
- acupuncture/Asian medicine
- botanical medicine
- physical medicine (massage, hydrotherapy, etc.)
- clinical nutrition
- homeopathic medicine
- lifestyle counseling
Well, nothing wrong with nutrition and lifestyle counseling as long as the claims aren’t exaggerated. But, as always, the claims that are made are vastly exaggerated. For example they claim
Homeopathic remedies are particularly effective for:
- depression
- anxiety
- allergies
- infections
- gynecological concerns
- skin conditions
- digestive problems
- chronic and acute conditions including colds and flu
These claims are simply not true, in my view. If you don’t believe me, check NELCAM (the NHS Complementary and Alternative Medicine Specialist Library). This is written by advocates of alternative medicine, yet it finds no convincing evidence for effectiveness of homeopathy in any of the conditions listed above.
Or, even more remarkably, from a report in Newsweek.
“Dr. Jack Killen, acting deputy director of the National Center for Complementary and Alternative Medicine, says homeopathy “goes beyond current understanding of chemistry and physics.” He adds: “There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment.”
The National Center for Complementary and Alternative Medicine (NCCAM) has, incidentally, spent almost one billion US$ billion of US taxpayers’ money and has come up with next-to-nothing useful.
So the claims made by the Canadian College of Naturopathic Medicine are not backed up even by people who are directly involved in alternative medicine You don’t have to be a rocket scientist to understand that the medicine contains no medicine.
The press releases (STOP PRESS)
Uhuh, here we go again.
All over the media we see headlines like “Honey ‘beats cough medicine’ “.
Take for example, the Daily Telegraph, where Ben Farmer writes “Honey is better at treating children’s coughs than an ingredient used in many over-the-counter medicines, according to new research”.
That is NOT what the research found This is what the research paper itself says (DM refers to the standard ‘cough suppressant’ dextromethorphan, which is already known to be ineffective).
| “honey was significantly superior to no treatment for cough frequency’ DM was not better than no treatment for any outcome. Comparison of honey with DM revealed no significant differences.” |
See it? No detectable difference between honey and standard cough medicine.
Everyone in the media misinterpreted what the paper said, but at least one blogger is already on to it, with Today’s “duh” study is a honey”.
At first sight, the results seem contradictory, No difference between honey and DM, No difference between DM and ‘no treatment’. So how can honey be better than ‘no treatment’?
The study was by Ian M. Paul, MD, MSc; Jessica Beiler, MPH; Amyee McMonagle, RN; Michele L. Shaffer, PhD; Laura Duda, MD; Cheston M. Berlin Jr, MD, published in Archives of Pediatrics & Adolescent Medicine 2007, 161, 1140 – 1146.
What was done
The design of this trial was pretty good apart from one thing Three things were compared (a) buckwheat honey, (b) a standard ‘cough suppressant’, dextromethorphan in a honey-flavoured syrup that was designed to be similar to the honey (DM for short), and (c) no treatment whatsoever.
The median age of the children who completed the study was 5.2 years (range, 2.2 – 16.9 years). They all had coughs attributed to upper respiratory tract infection. Thirty-five patients received honey, 33 received DM, and 37 received no treatment.The good thing is that the treatments were allocated randomly to the children, and that the person doing the assessment didn’t know which treatment each child had received. The children didn’t know whether they were getting honey or DM either, but they DID know when they got ‘no treatment’. The trial was carried out over two days. On day one nobody got a treatment, but they filled in a survey that asked, for example, “How frequent was your child’s coughing last night”. The parent had to tick one of seven boxes, from ‘not at all’ (score zero) to ‘extremely’ (score 6). They were then given the treatment allocated to them in a brown paper bag, so the person who gave it didn’t know which it was. The patients then went home and on the next day the same survey was completed by the same parent, over the telephone.
What happened?
First look at the raw data. Here is Figure 2 from the original paper.
The charts show the results for 5 different measures of the severity of cough, and the last chart (F) shows the aggregate score for all the criteria.
The first thing to notice is that there are no error bars on these charts. In my area, at least, no journal would accept a chart like this with no indication of scatter. There is a snag, though. Each patient acts as his/her own control, and that would not be reflected properly if errors bars were calculated for the numbers plotted in Fig. 2. It would therefore have been better to have a chart in which the difference in score between day 1 and day 2 was calculated from each patient, and the size of these differences plotted, with a standard deviation of the mean to indicate the amount of scatter in the observations. I have asked Dr Paul to send me a version that indicates the scatter of the numbers in this way (but I don’t think it will come).
The second thing to notice is that there is there is quite a big difference between the score on the first day (pale columns) and on the second day (dark columns), even in the no treatment group .
Thirdly, the pale columns are all much the same. On the first day the average score was about 4 (“a lot”) though on the second day, even with no treatment, the score fell quite a lot, to something between 2 (“a little”) and 3 (“somewhat”). This is a bit baffling because no treatment was given on either day. Presumably it results from the different settings in which the survey was given, or because the kids were getting better anyway.
Fourthly, insofar as the pale columns (baseline values) are all much the same, the thing you need to concentrate on is the difference, on each chart, between the height of the dark bars, for honey, DM and no treatment. These differences are pretty small, but on all the charts, the honey score is slightly smaller than the DM score, and the DM score is slightly smaller than the ‘no treatment’ score. What are we to make of that?
Here beginneth the statistical lesson.
Because the differences are small, and the scatter is quite big, we have to ask whether the differences are just random fluctuations rather than a result of any real difference between the treatments. That means we need statistics. Here is how the statistical argument works. Put roughly, we ask “how probable is it that the observations could arise by chance”. More precisely, the question is this. If there were no difference between the treatments, what is the probability that we would observe by chance a difference as big as, or bigger than, that seen in the experiment? (You need the subjunctive mood to explain statistics -pity it’s vanishing.)
Above each chart in the Figure we see P < 0.001. This means that there is less than a one in 1000 chance of the results arising by chance. More precisely, if all three treatments (honey, DM and no treatment) were actually identical, it is very unlikely that we’d see these results. The reasonable conclusion is, therefore, that all three treatments are not identical. The problem with this argument is that it tells you nothing about where the differences lie, so it is of no help whatsoever to a patient who is trying to decide what to do about a cough. The other problem is that it includes the ‘no treatment’ group, which was not blind. Both the children and parents were well aware that no treatment was given.
The most helpful comparison is really the properly-blinded comparison between honey and DM. And when this was looked at the result was no significant differences. In other words the small differences between the heights of the dark columns for honey and DM could perfectly well have arisen by chance if honey and DM were identical in their properties.
There isn’t any reason at all to think that honey is better than the standard (but ineffective) cough medicine.
The direct comparison between DM and ‘no treatment’ also shows no significant difference. Yet there are signs of a real difference between ‘no treatment’ and honey, though only for the cough frequency, not the other four measures. The aggregate measure (F in the figure) gave P = 0.04 for the comparison, so the authors are running a risk of 1 in 25 of being wrong in claiming a real effect. Although some people seem to regard a value of P = 0.05 as indicating a real effect, the fact that you’ll make a fool of yourself 1 time in 20 by claiming a real effect when none exists has never seemed to me to be good enough odds to stake one’s reputation on.
The ‘no treatment’ group certainly has some interest, but the fact that it was not blind means that the fact that honey was marginally better than ‘no treatment’ could perfectly well mean that taking honey has a better placebo effect that doing nothing at all. It provides no evidence at all that honey has any genuine therapeutic effect. If it had, one would then have to find out if the therapeutic effect was specific to buckwheat honey, or whether any old honey would do. It could be argued that even if the effect were real rather than placebo, the size of the effect is too small to make all that effort worthwhile.
A couple more things
It is already well known, from several good studies, that DM is useless, no better than placebo. This inconvenient fact has not yet reached many places that it should have (not even mentioned on wikipedia for example), but the American Academy of Pediatrics says
“Numerous prescription and nonprescription medications are currently available for suppression of cough, a common symptom in children. Because adverse effects and overdosage associated with the administration of cough and cold preparations in children have been reported, education of patients and parents about the lack of proven antitussive effects and the potential risks of these products is needed.”
The discussion in the paper by Paul et al, seems surprisingly upbeat about honey, in the light of their own findings. I’m surprised that they use the term ‘demulcent’ which I had thought to have died out, like the word ‘tonic’, on the grounds that it had no defined meaning
It is because meaningless terms and useless medicines die out eventually that medicine makes progress. The problem with alternative medicine is that nothing dies out: on the contrary they keep adding myths.
And finally
Always look at the end of the paper. On this one we see that the study was paid for by the National Honey Board. Dr Paul assures me that the funding source had no say in the design or analysis, which is as it should be.
Financial Disclosure: Dr Paul has been a consultant to the Consumer Healthcare Products Association and McNeil Consumer Healthcare.
Funding/Support: This work was supported by an unrestricted research grant from the National Honey Board, an industry-funded agency of the US Department of Agriculture.
So what is the practical outcome?
My conclusion from all this is simple. If you have got a cough, tough luck. There isn’t really anything available, conventional or alternative, that does much good. You’ll just have to wait for it to get better. But if you want to take something that tastes nice, why not honey? It almost certainly won’t do any good but it tastes good and it’s safer than the standard cough medicine.
The sponsor’s interpretation
It seems that the sponsor of the work is happy with the misinterpretation.
Charlotte Jordan a project manager of research at the National Honey Board, believes the finding confirms what your grandmother told you.
“This is a really exciting finding,” she said. “For a long time it’s been folklore medicine to use honey when you have a cough or a cold, but it’s exciting to have a scientific study to back that up.”
Just one problem, That is NOT what the paper says.
How did all this mis-reporting happen?
One reason is misleading press releases. Universities and Academic journals now engage in shameless PR, spin and hype. They prostitute good science.
Download press releases from Penn State, JAMA and Press Association [pdf file]
Here is the highly misleading bit of hype that came from the Press Office of the Pennsylvania State University. The headline is “Honey a better option for childhood cough than OTCs” (OTC means over-the-counter medicines that contain DM). That contradicts directly the paper which says “Comparison of honey with DM revealed no significant differences”.
Likewise the statement in the Penn State release “Honey did a better job reducing the severity, frequency and bothersome nature of nighttime cough from upper respiratory infection than DM or no treatment” is equally incompatible with “Comparison of honey with DM revealed no significant differences”. Its only possible justification is from the 3 way comparison by analysis of variance and that does not tell us what we need to know.
To make matters worse, the media office is not to blame this time. Ms Manlove told me tonight that the press release had been approved by Dr Paul himself.
| Contact: Megan W. Manlove Penn State Honey a better option for childhood cough than OTCs A new study by a Penn State College of Medicine research team found that honey may offer parents an effective and safe alternative than over the counter children’s cough medicines. The study found that a small dose of buckwheat honey given before bedtime provided better relief of nighttime cough and sleep difficulty in children than no treatment or dextromethorphan (DM), a cough suppressant found in many over-the-counter cold medications. Honey did a better job reducing the severity, frequency and bothersome nature of nighttime cough from upper respiratory infection than DM or no treatment. Honey also showed a positive effect on the sleep quality of both the coughing child and the child’s parents. DM was not significantly better at alleviating symptoms than no treatment. . . . |
All that Candice Yakel, of the Office for Research Protections at Penn State had ro say in the matter was
“Our investigators stand by the conclusions of the study as reported in the Archives of Pediatric and Adolescent Medicine and as characterized in our press release of December 3, 2007.”
And here is the equally misleading bit of hype issued by the Journal of the American Medical Association (Ms Manlove tells me that this was also approved bt Dr Paul).
| JAMA and Archives Journals Study suggests honey may help relieve children’s cough, improve sleep during colds
|
The Press Association release was equally bad, and probably the one used by many of the reporters as a basis for stories in the media. The opening statement is totally wrong.
| 1 HEALTH Honey Embargoed to 2100 Monday December 3 HONEY BEST FOR KIDDIES’ COUGHS SAY RESEARCHERS By John von Radowitz, PA Science Correspondent Natural honey is a better remedy for children’s coughs than expensive over-the-counter medicines, researchers said today. A dose of buckwheat honey before bedtime easily outperformed a cough suppressant widely used in commercial treatments, a US study found. . . . |
Follow-up
There is a review of over-the-counter cough medicines in the BMJ (2002) [free full text]. It concludes “Recommendation of over the counter cough medicines to patients is not justified by current evidence”.
Today is World AIDS Day, and the Society of Homeopaths is holding a meeting to “discuss the evidence” concerning the idea that you can treat AIDS with sugar pills. Needless to say, there is no evidence to discuss, but that doesn’t put them off for a moment.
Not content with killing people with malaria, some homeopaths are now into killing people with AIDS, by treating them with their funny water. That is a serious allegation, but how else can one interpret the treatment of people with serious diseases with sugar pills?
It isn’t only pharmacologists who believe that. Even the better-educated homeopaths would take a position not much different from mine. Of course they word it a bit more diplomatically than me, in a vain attempt to disguise the obvious fact that there is
now all out internecine warfare between medically-qualified homeopaths (in the Faculty of Homeopathy), and the far greater number of non-medical homeopaths (in the Society of Homeopaths, among other splinter groups).
For the malaria scandal, click here and here, and follow the links. Recall that Peter Fisher (of the Faculty of Homepaths) said of that scandal
“I’m very angry about it because people are going to get malaria – there is absolutely no reason to think that homeopathy works to prevent malaria and you won’t find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice.”
The two warring branches of homeopathy have fallen out over immunisation too.
The medical side, the Faculty of Homeopathy, recently issued a statement about AIDS.
| Statement from the Faculty of Homeopathy on HIV/AIDS 27-11-2007, 9:57 am In the light of current knowledge, homeopathic treatment of patients with HIV/AIDS should not replace, but may usefully sit alongside, conventional anti-retroviral treatment. However, the Faculty regrets that for many people in developing countries like Africa, antiretroviral drugs may not be available. . . . The Faculty of Homeopathy does not support the approach of and claims made by Peter Chappell for the use of “PC” remedies. |
Incidentally, one can’t help wondering if it is a coincidence that the Amma Resonance Healing Foundation (ARHF) has almost the same initials as AHRF, the totally respectable African HIV Research Forum. It was presumably in an attempt to gain respectability that the press release from the Society of Homeopaths, signed by Jayne Thomas, had a single link at the bottom to the National AIDS Trust (NAT). Or at least it did until the ever alert quackometer blogger told NAT about it, whereupon they were told by NAT to remove it. NAT is a serious organisation that has no truck with sugar pills.
Today Programme. The Society of Homeopaths’ conference was featured on the Today programme this morning, Hear the interview here [mp3 file, 1.6 Mb]Jayne Thomas spoke for the Society of Homeopaths. She is Vice Chair of the Society of Homeopaths, Chair of the Professional Standards Committee and Professional Conduct Director. When challenged about how they fail ever to find fault with a member, however grossly that member breaches the society’s own code of ethics, she denied everything (see links in the follow up for more on that)Jayne Thomas also said, of today’s conference
“today will afford a critical examination of those opportunities we may have to provide relief to patients”
The interviewer, Edward Stourton, said
“The ambition of the meeting sounds relatively modest. They’re just going to discuss the evidence and presumably if it doesn’t stack up to much we’ll hear that.”
I just hope that Today will have a follow-up to see what the “critical examination” will yield. Perhaps a statement from the Society of Homeopaths that there is no evidence and that it “doesn’t stack up to much”?
Somehow I doubt it. But watch this space.
Follow up
Letting off steam posted the results of a complaint against a member of the Society of Homeopaths, Sue Young. Young persistently makes claims to cure specific, serious diseases, in clear contravention of the SoH’s (utterly ineffective) code of ethics. Needless to say, the complaint got nowhere. Just read the account here if you were inclined to give a moment’s credence to Jayne Thomas’s remarks about self-regulation on the Today programme yesterday.
Quackometer has some relevant comments. In particular he points out the disgraceful and inconsistent attempts of the Society of Homeopaths to pretend that their members had nothing to do with the malaria scam.
Gimpy blog makes related points
Badscience this week is on the ball, as always, with “AIDS Quackery International Tour”
A new paper, with a very large sample, almost 300 000 men, shows an association between taking large doses of multivitamin supplements and death from prostate cancer. But this, like most observations on diet, was not a randomised study. The paper itself discusses the interpretation carefully. The reports in the newspapers did not.
Read more on the original IMPROBABLE SCIENCE page
Les Rose debates with homeopath Katherine Armitage on the Vanessa Feltz show on BBC Radio London. Listen to the clip to hear some of the best pseudo-scientific gobbeldygook on record.
Read full entry on the original IMPROBABLE SCIENCE page.
Interview with DC, vainly trying to counter the bunkum from the two previous speakers.
Read full entry on the original IMPROBABLE SCIENCE page.
The Consumers’ Association has had a good record in distinguishing true claims from false in washing machines and dishwashers. But in CAM, they seem to be out of their depth. They have been giving some very bad advice, of the sort you might expect from the lifestyle pages of the Daily Mail.
Read full entry on the original IMPROBABLE SCIENCE page.
Brain Deer has produced a very detailed account of the MMR scandal. It shows the corrupting influence of money on research, and the harm done, bath by Dr Wakefield, and by the Royal Free Hospital which sought to profit from him.
Read full entry on the original IMPROBABLE SCIENCE page.
The Newsnight TV programme did an undercover investigation. Ten out of ten homeopaths, including two big companies Nelsons and Helios, told patients that malaria could be prevented by homeopathic pills alone. So much for the idea that homeopathy is harmless.
It is often said that, although homeopathy does no good,at least it does no harm. But that is not true if using homeopathy delays diagnosis of serious disease like cancer. It is not true if homeopaths persuade you not to be vaccinated, and as a consequence you get smallpox, mumps, measles, and spread them in the community. And it is not true if you listen to the ill-informed advice that is given by many homeopaths about how to avoid malaria when you visit countries where it is common.
The Newsnight programme on BBC2 TV (13th July 2006) did a marvelous bit of secret filming.
“Newsnight followed up their research with a hidden camera. A researcher went to Nelsons Pharmacy off Oxford Street in London, which claims to be Britain’s biggest manufacturer of homeopathic remedies – and that was all they recommended for malaria.
Even when the researcher said she planned to go to Malawi – a high risk area – Nelsons only suggested the addition of garlic, oil of citronella and vitamins rather than a trip to the doctors.
The Nelsons adviser told the researcher that the homeopathic compounds would protect her. “They make it so your energy doesn’t have a malaria-shaped hole in it so the malarial mosquitos won’t come along and fill that in.” ”
This last bit of advice means nothing whatsoever. It is sheer gobblydegook. It would just be silly if its effects were not so potentially serious.
On the programme, Melanie Oxley, from the Society of Homeopaths, wriggled uncomfortably when faced with the evidence (and Simon Singh). She protested that members of her organisation do not advise against proper malaria prevention, or against vaccination (and here). Well, they DO. So much for “professional regulation”. You cannot regulate the delusional. and the attempts of organisations like Oxley’s clearly don’t work. Apart from their inability to stop their members giving lethal advice, the regulators themselves are deluded.
Peter Fisher (see here and here), from the Royal London Homeopathic Hospital (and here) said “I’m very angry about it because people are going to get malaria – there is absolutely no reason to think that homeopathy works to prevent malaria and you won’t find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice.” The Queen’s homeopathic physician has the sense to acknowledge that homeopathy does not work for serious conditions, yet persists in his delusion that it works for milder illnesses.
What the homeopaths recommended
Malaria nosodes 30C
The source material is so diluted that not a single molecule is left. The medicines therefore contain no medicine. They are nothing but sugar pills. To sell pills that contain nothing whatsoever and to pretend that they will protect you against malaria strikes me as nothing short of criminal. In the EU in 2000, 15 528 cases of malaria were reported to the World Health Organization in returning travellers. The source material is, incidentally, not stated. One source says it is made from “African swamp water containing impurities, algae and plants as well as mosquito slough, larvae and eggs.” Luckily there is none of it left in the pill you get.
China
China Off is made from Cinchona bark which should contain quinine (how much is not stated. China Sulph is made from quinine itself (presumably purified, it is not stated). Quinine in large (potentially toxic) doses can cure malaria but is not a recommended treatment. But these preparations contain only minute amounts of quinine that cannot possibly have any effect at all. There is not the slightest reason to think that these pills could protect you against malaria, and to recommend them for that purpose is no more than fraud. The only recommended use for quinine is for treatment iof malaria in pregnant women. The dose is 600 mg, three times a day. because of the inadequate labelling it is impossible to know exactly how much quinine is present in China Sulph 8X,, but it is probably about 100 millionth of the recommended dose.(less than 1 nanogram)
The consequences.
“The fourth case was a 26-year-old man who visited Ghana and Burkina Faso in October and November 1994. He used China D-6 for prophylaxis. This is a homeopathic preparation of the bark from the cinchona tree. Not even trace amounts of quinine were found in the tablets with a very sensitive high-performance liquid chromatographic method.2 Four days after returning from Africa he fell ill with P. falciparum malaria ” (Quotation from Carlsson et al. J Travel Med. 1996 Mar 1;3(1):62. (PMID: 9815426)
In another case of a patient who resorted to homeopathy “for two months she received intensive care for multiple organ system failure due to P falciparum .This case confirms the inefficacy of homoeopathic drugs for malaria prevention and treatment. ”
Natrum Mur.
Natrum Muriaticum is sodium chloride. Just common salt (except that it is so dilute that there is little or no salt there). If you believe this will prevent malaria, you will truly believe anything. Yet it is being recommended and sold.
What the papers say about it
“Malaria risk for tourists who trust alternative practitioners”. A long report by Mark Henderson, in The Times.
“Homoeopathy: voodoo on the NHS” by Jamie White in The Times on the next day (July 15th)
“It is outrageous that the NHS should knowingly promote this quackery. And it is knowing. The NHS Direct website points out that homoeopathy is contrary to everything we know about chemistry and medicine, and that there is no experimental evidence to support its preposterous claims. Yet the NHS still promotes it, because “despite the lack of clinical evidence, homoeopathy remains one of the most popular complementary therapies in the UK”.”
“Homeopaths ‘endangering lives’ by offering malaria remedies” in The Guardian
“Do not rely on homeopathy to protect against malaria, doctors warn”. Excellent health advice (for a change) in the Daily Mail. They quote Dr Evan Harris (Lib Dem) of the all-party parliamentary malaria group, as saying
“This sort of outrageous quackery is unacceptable. Vulnerable people are being duped into handing over cash for useless remedies and are having their health put at risk through grossly inadequate advice. People need to consider homeopathy in the same way as the treat faith-healing and witchcraft – that is not to risk their life or health on it.”
Talk show interview, DC with Tania Shillam on Colourful Radio (“Colourful is a new national digital Talk, cross-cultural radio station. Launched on 30 May 2006, the station’s format is a rich mix of news, current affairs and journalism, agenda-setting coverage, short documentaries, drama, panel discussions, phone-ins and a liberal sprinkling of music”). Listen to it.
Originaly posted on the oldl IMPROBABLE SCIENCE page.