Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
CAM
Sales of chondroitin and glucosamine are a worth billions of dollars, but the evidence that they work has never been good.
A new meta-analysis of clinical trials now shows that chondroitin on the symptoms of osteoarthritis is “minimal or nonexistent”.
(Reichenbach S and others. Meta-analysis: Chondroitin for osteoarthritis of the knee or hip. Annals of Internal Medicine 146:580-590, 2007: download the paper]
It is the same old story. Early trials were small and badly-designed. They seemed to show some effect, which was wildly exaggerated by the supplement hucksters to push sales. Eventually somebody does the trials properly, and it is found that there is little or no benefit.
Look at Figure 6 from the paper (below). It shows the size of the beneficial effect plotted against the year of publication. The black circles represent trials with a large number (over 200) patients, the white circles are smaller (and mostly badly-designed) trials. As soon as the trials are done properly, the alleged benefits vanish.
The authors conclude “Use of chondroitin in routine clinical practice should therefore be discouraged.”
Analyses by ConsumerLab.com has reported that 8 out of 20 products said to contain chondroitin failed its quality tests, with four containing between 0% and 8% of amount stated on the label.
Glucosamine shows a similar trend. Glucosamine is a synthetic chemical, but it is not a licensed medicine in the UK. It is marketed as a “food supplement”, not as a drug. It is not approved for precription on the NHS. The latest Cochrane review does not entirely rule out some benefit, but again the effects seem to get smaller as the trials get better.
Thanks to Quackwatch for the alert about the Reichenbach paper.
Twenty-five hospitals from London and southern and eastern England have already either stopped sending any patients to the Royal London Homeopathic Hospital or agreed to fund only a handful A campaign has started o save it, but the arguments are far from convincing.
This is reposted from the original IMPROBABLE SCIENCE page
The news is out. It was in February this year when I first saw some “Commissioning Intentions 2007-08” documents from several London NHS Primary Care Trusts (PCT), indicating their intention to break their contracts with the RLHH on the very reasonable grounds that homeopathy doesn’t work. It seemed better to wait for the intentions to be implemented before saying much, because of the inevitable outcry from those who want sugar pills at the taxpayers’ expense.
Then, in March 2007, the Health Services Journal carried a story “PCTs consider alternative to homeopathic hospitals” (free registration, or read it here).
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On 8 April 2007, The Observer carried a special report, prominently featured on page 3.
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 Fisher and Queen, Observer 8 April 2007 |
Peter Fisher, clinical director of the RLHH, is quoted as saying
“Twenty-five hospitals from London and southern and eastern England have already either stopped sending any patients to the RLHH or agreed to fund only a handful.”
“Prince Charles is sympathetic, supportive and concerned. But he doesn’t feel it’s appropriate to intervene in any way because there’s been some adverse publicity before about him ‘meddling’. ”
Fisher attributes this to the letter sent to PCTs by 13 of us, last May, in which we advocated that the NHS should not be paying for “unproven or disproved treatments”. The leading signatory on this letter, Professor Michael Baum, is quoted in the Observer thus.
“If the Royal London were to close because of PCT deficits we would scarcely miss it”.
“Homeopathy is no better than witchcraft. It’s no better than a placebo effect. It’s patronising and insulting for adults.”
“Instead you could have a centre for palliative and supportive care, which would be of greater benefit and involve half the cost. Rather than losing something, we would gain something.”
The backlash
The reaction seems to have started with a letter from homeopath Carol Boyce. Her letter starts thus.
| ROYAL LONDON HOMEOPATHIC HOSPITAL UNDER SIEGE “Death by stealth. The Royal London Homeopathic Hospital (RLHH) – the visible presence of homeopathy within Britain’s NHS – an institution putting homeopathy in the public mind for the last 150 years – the place where homeopathy was seen to perform so well in the cholera epidemic of the 1840s – is being dealt a DEATH BLOW” |
I’d guess the very first sentence must be something of an embarrassment to the RLHH’s clinical director, who is far too sensible to believe that cholera can be cured by homeopathic sugar pills.
The red herring about cholera is repeated ad nauseam on hundreds of homeopathy sites (though most are curiously silent about whether they really believe that sugar pills can cure cholera). It is based on the report that during the London Cholera epidemic of 1854, of the 61 cases of cholera treated at the London Homeopathic Hospital, 10 died (16.4%), whereas the neighbouring Middlesex Hospital reported 123 deaths out of 231 cases of cholera (53.2%). Apart from the lack of any knowledge of the state of the patients on entry to hospital, it was also the case at the time that conventional medicine was no more based on evidence than homeopathy. Indeed the initial popularity of homeopathy could well have resulted not only from wishful thinking, but also because doing nothing at all (i.e. homeopathy) was less harmful than blood letting. The fallacy of the argument was spotted very early on by Oliver Wendell Holmes (senior) in his famous essay, Homeopathy and its Kindred Delusions.
But medicine moved on and homeopathy didn’t. The history of cholera, like that of tuberculosis, contrary to what is suggested by homeopaths, is a triumph for evidence based medicine. The epidemic was halted not by homeopaths but by the careful observations of John Snow that led to his removing the handle of the Broad Street pump. If medicine had been left to homeopaths, people would still be dying of these diseases.
Carol Boyce invites you to write directly to Queen Elizabeth II, to save the RLHH. She has also started an e-petition on the UK government site. The petition includes the words
| ROYAL LONDON HOMEOPATHIC HOSPITAL UNDER SIEGE
“The RLHH has been part of the Health Service for 150 years. ” “In 2005, 67% of GPs and 85% of practices in it’s [sic] Primary Care Trust, referred patients to the hospital. The hospital provides effective and most importantly, COST-EFFECTIVE treatments.” |
Ms Boyce seems not to have noticed that the Prince of Wales’ own Smallwood report decided that there was not enough evidence to come to firm conclusions about cost-effectiveness.
Peter Fisher himself has appealed for the survival of the RLHH in a letter dated 9 March 2007 [download copy of letter].
“The Royal London Homoeopathic Hospital needs your support
09/03/2007By Dr. Peter Fisher, Homeopath to Her Majesty, the Queen.
There is no silly talk about cholera here, but there is a useful list of Trusts who have decided to abandon "unproven and disproved treatments". Fisher recommends you to read Marcia Angell’s book to learn about the deficiencies of the drug industry. I recommend that too. I also recommend Dan Hurley’s book on the even greater deficiencies of the quackery industry.
Fisher suggests you write to your MP to prevent closure of the RLHH.
I suggest you write to your MP to support closure of the RLHH.
The Times Higher Education Supplement (THES) published another bash at BSc degrees in anti-science. This one was accompanied by a defence from Brian Isbell, head of the department of complementary therapies at Westminster University. Isbell’s defence was different from Westminster’s first defence, but every bit as unsatisfactory, in my view.
Following the kerfuffle caused by Nature, THES asked for 800 words on the same topic, Bachelor of Science degrees in subjects that are anti-science (read it here). Every time I read an official validation document I am reminded inexorably of the inimitable Laurie Taylor, which is why the article starts thus.
| The vice-chancellor of Poppleton University is pleased to announce that the university’s finances have been transformed since the conversion of its old-fashioned department of physics and astronomy into the new department of alternative physics and astrology. Quality is ensured by the course validation and top Quality Assurance Agency rating, both awarded by a distinguished panel of academics with appropriate expertise in astrology. (Apologies to Laurie Taylor.) |
As it happens, Laurie Taylor’s column in the same issue of THES is on “Maintaining Standards”, and is as grimly hilarious as always. And his column in the following week (13th April) was about the report of the external examiner, Professor J.K.L. Anonymous, on the Universlity of Poppleton’s BSc in palmistry (“There were 36 first-class papers, 22 upper seconds and only one marginal failure”. Well, there’s a coincidence.
My piece ends thus.
| If a few vice-chancellors appear to value bums on seats more than honest science they should justify their views in public. |
THES plans soon to bring us some responses from the hitherto elusive vice chancellors. That should be interesting. Well they should have been interesting, but all but four of the sixteen letters that were sent by THES were ignored entirely, and the four replies that were received were deemed to be too boring to publish.
| This was accompanied by an article by Brian Isbell, who is head of the department of complementary therapies at Westminster University. He presumably had a hand in the (unsigned) response of Westminster to the Nature article, but this time the response was rather different (could that be because he’d read my comments on the original response?). This time there was no quoting of bad evidence, or the Society of Homeopaths, but rather a defence based on the fact that BSc degrees in CAM include some real scientific content. Let’s take a look at this new response. Isbell says |  Brian Isbell |
| “The shared philosophy across Westminster’s range of complementary therapy degrees is that students need a compulsory core of health sciences. This includes anatomy, physiology, biochemistry, pathology and differential diagnosis. Phytochemistry and pharmacology are included for degrees in herbal medicine and nutritional therapy.” Brian Isbell |
So on Mondays and Thursdays (for example) the students must believe that response increases with dose, but on Tuesdays and Fridays they are called upon to believe that response decreases with dose.
Isbell admits as much himself when he says “at times students have to work with conflicting scientific models that may not always fit with their clinical practice”. What he does not say is how this absurd conflict is resolved, or how it can be made compatible with science or simple common sense. The course evidently teaches you how to believe several mutually contradictory things at the same time, or at least on alternating days. You don’t need to be a scientist to see that is plain daft.
Not only are some of the doctrines of CAM incompatible with science or common sense, but they are often also incompatible with each other. Homeopaths subscribe to the bizarre doctrine that the less you give the bigger the effect, but herbalists do not. Herbal medicine is nothing other than pharmacology, albeit pharmacology as practised at the beginning of the 20th century, before biological standardisation was introduced to assure constant potency of medicines. So they want to give a sensible dose, but don’t know what it is. Nutritional therapists go to the opposite extreme and want to give huge (and sometimes toxic) doses.
I have been told that herbal medicine students at Westminster are instructed not to talk to the homeopaths in another part of Isbell’s school, because they talk rubbish. They even have separate sections on the university’s intranet, so that one sort of CAM can’t be polluted by the beliefs of a different sort of CAM. Likewise, students of reflexology are taught that a small area on the big toe is connected with the pituitary gland. Not only is this incompatible with physiology, but it is also incompatible with homeopathy, herbal medicine and nutritional therapy.
The department of complementary therapies seems to resemble a collection of religious sects at war with each other, rather than anything recognisable as science.
The second plank in Isbell’s new defence is that students are taught to develop research skills. Homeopathy students get one course (out of 22) called “Methods of Research in Complementary Medicine”, and a project, “Research in Practice”. It is impossible to know what is taught on these courses because the university refuses to release any of the course materials. But I find it hard to imagine that the courses are very critical when the official response from the university cited the Spence (2005) study as though it provided evidence for the efficacy of homeopathy.
If that is the best the teachers can do, what hope is there for the students?
The day after “Science degrees without the Science“ appeared in Nature, the University of Westminster issued a statement . In my view, their statement provides the strongest grounds so far to believe that the BSc is inappropriate.
Let’s take a look at it.
| “The BSc (Hons) Health Sciences: Homeopathy is a fully validated degree that satisfies internal and external quality assurance standards.” |
Well, since the University has so far refused to release any of the documents, it is hard to judge that that validation is worth. The validation documents will, no doubt, appear eventually. Watch this space.One mechanism that is intended to maintain the standard of degrees is the external examiner. Their identities, like almost everything else, are kept secret. In the case of the Westminster BSc in homeopathy, however, we are in luck. According to the Teaching Quality Information (TQI) site, their external examiner is the “Chair of the Society of Homoeopaths”. Since April 2004, that has been Andy Kirk RSHom, a homeopath in private practice, with no degree and no scientific qualifications. He, I imagine, is not likely to question the bizarre homeopathic doctrine that the smaller the dose you give, the bigger effect you get.Correction (4 April 2007). It seems that Westminster supplied wrong information to the TQI site, and the external examiner is not Kirk. They refuse to say who it is. But watch this space.
| “The University’s stance received the backing of the Society of Homeopaths, the UK’s largest register of professional homeopaths”. |
Yes, I’m sure it did. The Society of Homeopaths is an organisation for homeopaths who have no medical qualification. Their scientific credentials can be judged from this quotation from their web site.
“If they are so dilute, how can they work?
After each dilution the mixture is vigorously agitated in a machine that delivers a calibrated amount of shaking. This is called succussion. It is thought that this process imprints the healing energy of the medicinal substance throughout the body of water (the diluent) as if a message is passed on. The message contains the healing energy.”
This is pure gobbledygook. The word “energy” is being used in a way unknown to science. It is mere armwaving in an attempt to ‘explain’ a phenomenon that almost certainly doesn’t occur anyway.
| “In fact there is considerable evidence demonstrating the clinical effectiveness of homeopathic treatment, including a large outcomes study published in 2005, of an analysis of over 23,000 outpatient consultations at the Bristol Homeopathic Hospital, in which more than 7 per cent reported clinical improvement,” |
(Notice the Freudian slip. That should be 70%)
The study to which they allude here has to be the worst paper ever published. It is the infamous Spence (2005) study. Oddly enough, this paper is one that Westminster students were asked to assess critically. Sadly, though, it hasn’t been possible to see any marked answers.
The fact that this is the best evidence that the University can produce in response to criticisms is, perhaps, the best reason ever to think that the material being taught is not, in any sense, science, and is not appropriate for a BSc. It seems that they are hoist by their own petard.
A TV company funded a rather uninformative study of omega-3 fish oil by Prof Basant Puri if Imperial College and the Hammersmith Hospital. The media reports on the study were totally misleading It was not revealed that Prof Puri is named as “inventor” on a paten for the fish oil formulation, as discovered by Ben Goldacre.
Read more on the original IMPROBABLE SCIENCE page
The media reports on the alleged advantages of drinking purple grape juice were uniformly misleading. The study by Alan Crozier did not measure health benefits but was a chemical analysis. Its interpretation in terms of health were arguably over-optimistic.
Read more on the original IMPROBABLE SCIENCE page
This is reposted from the old IMPROBABLE SCIENCE page
The British Medical Journal (2007, 337, 508 – 509) held a debate on whether or not CAM should be referred for evaluation to the National Institute for Clinical Excellence (NICE) [see it here]. Two of the comments that followed the debate were as follows
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John R King, Consultant Psychiatrist David Colquhoun (“NICE should not have to evaluate alternative medicine”) makes a better case than Linda Franck et al. Space researchers do not, after all, waste time trying to disprove the beliefs of flat- earthists. Neither would it be helpful for a Nobel prizewinning chemist to stride into a church and denounce the holy water there as nothing more than H2O. There is a very large and ever expanding array of alternative treatments, some more bizarre than others, which could tie up the resources of NICE for an indefinite period. But if people want to believe in them – or in fairies or leprechauns – they should be left in peace to do so. It is no concern of scientific medicine. |
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David Colquhoun, UCL Nobody is proposing to ban fairies or leprechauns. It would be both undesirable and impossible. There does seem to be a case, though, for not providing leprechauns at the tax payers’ expense. And really all leprechauns that are sold to the public should have labels that don’t make false claims for their powers. Unfortunately the MLRA (Medicines and Leprechauns Regulatory Agency) has let us down in the matter of labelling. I suspect infiltration of the Department of Health by little green men |
Channel 4 TV, Monday 12th March. This is the title of the Channel 4 TV documentary, Dispatches.
Lord Wedderburn, QC, a life peer and Emeritus Professor of Law at the London School of Economics, tells the programme:
“If, in fact, nothing changed and he became King, then there would be a most almighty fuss and controversy, and eventually the whole fabric of the constitutional monarchy could be threatened.”
The Prince’s Foundation for Integrated Health (FIH) is the Prince’s lobby group which attempts to make the hard-pressed NHS spend more money on unproven and disproved treatments. The FIH publishes “Complementary Healthcare: a Guide for Patients”. This document is not just barmy, but positively dangerous. In the rebuttal of the programme on the FIH web site, they claim that they do not promote alternative medicine, but elsewhere on the site they state their aim as “makes safe and effective complementary therapies available to patients in conjunction with conventional healthcare”.
Which would be all very well if they didn’t consistently ignore the evidence for effectiveness.
The MHRA recently, for the first time, betrayed its brief to nake sure that medicines work and are safe. This action has been condemned by just about every professional organisation. Nobody knows exactly what caused them to lose their heads in this way, but it is clear that they were under pressure from both the Department of Health and from the Prince of Wales. The Department of Health is clearly sympathetic to quackery, as shown by the letter below, and by their refusal to allow alternative medicine to be referred to NICE for assessment.
| The MHRA admit to having had at least seven letters form the Prince of Wales, and we know that an MHRA member has met the Prince at Clarence House at least once. But all the contents are secret from the public. The Chairman of the MHRA Agency Board, Prof Alasdair Breckenridge, and chairman of their Herbal Medicines committee, Prof Philip Routledge, have both admitted to me to having had pressure from the Prince of Wales, but neither will give any details, despite having been condemned by their own professional organisation, the British Pharmacological Society. |  |
The Pharmacological Society’s statement read thus.
| The British Pharmacological Society believes that any claim made for a medicine must be based on evidence, and that it is the duty of the regulatory authorities, in particular the MHRA, to ensure that no claims can be made for the efficacy of any form of medicine unless there is good evidence that the claim is true. Despite many years of investigation, we have no convincing scientific evidence that homeopathic remedies work any better than placebo. Pharmacologists have noted frequently that most homeopathic products are diluted to the extent that they contain no molecule of active ingredient, that is, no medicine, which is highly misleading to consumers who are unlikely to recognise the expression “30C” for example. Furthermore, there are serious concerns, even in cases where they are used for minor ailments, that officially endorsed use of such remedies may put patients at risk of delayed diagnosis. The Society is therefore surprised that the national rules scheme for licensing homeopathic products, which came into force on 1 September (Statutory Instrument 2006 1952), will regard non-scientific data as evidence of efficacy. |
An excellent article on this topic was published by Rose in The Biologist, British health care regulation moves away from science.
The appalling treatment of Professor Edzard Ernst
| Edzard Ernst was the UK’s first professor of complementary medicine, and he is rather unusual in that field because he is totally honest, and very careful about evidence (something that has not always endeared him to the alternative medicine industry).
A letter was sent from Clarence House to the vice-chancellor of Exeter University, Steve Smith. The letter alleged a breach of confidence by Ernst. Having been sent a draft of the Smallwood report, Ernst was so horrified by the scientific standards in that document, he felt obliged, in the public interest, to speak out about it. Ernst was contacted by a newspaper, which had a copy of the draft, and described the initial findings as “outrageous and deeply flawed”. He added: “It is based on such poor science, it’s just hair-raising. The Prince … also seems to have overstepped his constitutional role” |
Prof Edzard Ernst. |
Prof Ernst was doing exactly what academics are meant to do. As a result he was subjected to a very prolonged disciplinary procedure, and for a year it was not obvious whether he’d keep his job. For a Prince, in a constitutional monarchy, to put pressure on a university to silence a conspicuously honest academic is just not acceptable.
The Prince of Wales behaviour was bad enough, but, to be generous, he is perhaps, a well-meaning but poorly educated man, filling in his time as best he can.
| In the story of Edzard Ernst, the behaviour of the Vice-Chancellor of Exeter University, Prof Steve Smith seems to me to be unforgivable. Instead of supporting his staff, and supporting academic freedom, he appeared to cower before the Clarence House letterhead. After keeping Prof Ernst on tenterhooks for an entire year he eventually deigned not to fire him in the most grudging and unpleasant way imaginable. |
 Prof. Steve Smith, Vice chancellor. |
That is illustrated by the end of Smith’s letter to Professor Ernst on 13th October 2006. It was shown on the TV programme, and is reproduced below.
Click to enlarge
The Daily Mail also has features on the healthiness of HRH’s own food lines, after his criticism of MacDonalds, Dutchy Original Sins, and here.
They are worth reading because the advice comes from Catherine Collins, a real dietician, not a nutribollocks guru.
Some responses The story was reported round the world.
Max Hastings (Guardian)
“To make good use of evidence, it is essential to possess not only intelligence, but a capacity for disciplined analysis. The prince has considerable virtues, a good heart notable among them. But he has always lacked discipline in his life and in his treatment of issues. Again and again, he gets himself into trouble by seeking to address matters that are, frankly, beyond his intellectual reach.”
This post has been transferred from the old IMPROBABLE SCIENCE page.
Two interesting papers. One shows popular anti-oxidant ‘supplements’, beta carotene, and vitamins A and D, far from making you live longer, have the opposite effect. Another shows that garlic does not lower cholesterol. And some publicity for Dan Hurley’s book, Natural Causes. An update looks at the activities of the supplements industry spokesperson. Dr Ann Walker, who seems sometimes to forget to declare her interests.
First let’s reiterate the myth of antioxidants
Nutribollocks: the antioxidant myth
“Nutritional supplements” are one of the most profitable scams (see, for example, Healthwatch, Quackwatch, and Holfordwatch).
There is a nice article by Lisa Melton on The Antioxidant Myth: a medical fairy tale in tne New Scientist (and see here), [download as pdf] . Here are some quotations.
| Cranberry capsules. Green tea extract. Effervescent vitamin C. Pomegranate concentrate. Beta carotene pills. Selenium. Grape seed extract. High-dose vitamin E. Pine bark extract. Bee spit.You name it, if it’s an antioxidant, we’ll swallow it. According to some estimates around half of US adults take antioxidant pills daily in the belief that they promote good health and stave off disease. . . . In 1992 researchers at the US National Cancer Institute set about testing beta carotene. The trial was set to run for 6 years, but two-thirds of the way through the researchers pulled the plug after discovering, to their surprise and horror, that those taking supplements were doing worse than the controls. They had developed 28 per cent more cases of lung cancer, and their overall death rate was 17 per cent higher. It’s a similar story with the world’s most popular antioxidant. Vitamin E shot to fame in the early 1990s, after two large studies involving more than 127,000 people in total found that those with a diet high in vitamin E were significantly less likely to suffer cardiovascular disease. Use of vitamin E supplements soared. In 1990, almost nobody took vitamin E; by the end of the decade an estimated 23 million US citizens were knocking back daily doses. |
“Treatment with beta carotene, vitamin A, and vitamin E may increase mortality”
That is the conclusion of a recent paper in the Journal of the American Medical Association, “Mortality in Randomized Trials of Antioxidant Supplements for Primary and Secondary Prevention” Systematic Review and Meta-analysis”, [Get the full text].
This isn’t original research, but a meta analysis that attempts to collate existing data taking into account the reliability of each source. The aim was to analyze the effects of antioxidant supplements (beta carotene, vitamins A and E, vitamin C [ascorbic acid], and selenium) on deaths (from any cause) in adults. The analysis seems to have been done well, and the results are startling. They aren’t just a waste of money, but some of them are actually bad for you. In 47 low-bias trials with 180 938 participants, beta carotene increased death rates by 7 per cent, vitamin A by 16 per cent, and vitamin E by 4 per cent (when taken separately). Vitamin C gave contradictory results and selenium showed no detectable effect.
This work got an excellent write-up in The Times, by their health correspondent, Nigel Hawkes. This was followed by a predictably silly defence of nutribollocks by the Times’ Dr Thomas Stuttaford (known in Private Eye as Dr Utterfraud). Luckily, this was neutralised by a second piece on the same page by Nigel Hawkes, “Phooey. Sensible balanced diet is the best investment”:
“ In nutrition, a plausible idea and a little bit of evidence are all that is needed to create a market. And such is the megaphone of marketing and the influence of countless “healthy eating” articles that these ideas, even the half-baked ones, can lodge very firmly in the national psyche.”
It’s a nice coincidence that this study came out while I was reading Dan Hurley’s book, Natural Causes (see below). This book sets out dramatically the harm, sometimes serious harm, that untested “supplements” have done to some individuals. But for me the most interesting part is the revelation of the political lobbying by this $20 billion supplement industry, with the aim (largely successful) of undermining the FDA and escaping from any effective regulation of its absurd, but exceedingly profitable, claims. The supplements industry puts the Prince of Wales in the shade when it comes to subverting common sense and good science.
The Health Supplements Information Service (HSIS)
Needless to say, the supplements industry has already organised vilification of this excellent bit of work.
According to their web site,
“HSIS is funded by The Boots Company PLC, Bayer PLC, Perrigo, Seven Seas Ltd and Wyeth Consumer Healthcare. The campaign is co-ordinated by PAGB (Proprietary Association of Great Britain)”.
So it’s no surprise that their spokesperson. Dr Ann Walker, immediately tried to discredit the study, saying “The results of these mixed-sample metaanalyses are worthless” (The Times).
This same Ann Walker recently wrote and editorial in the British Journal of General Practice (January 2007). The editorial concludes “Although still considered to be controversial by some, taking a daily multinutrient supplement would bridge the gap between intake and requirements and ensure that nutrient target intakes are met.” But in this editorial her affiliation is given as Senior Lecturer in Human Nutrition, University of Reading. No mention at all of her role as spokesperson for the Supplements industry. Tut tut.
Patrick Holford too
Needless to say, supplement salesman Patrick Holford has weighed into the vilification. His objections have been dealt with nicely on the cutely named web site stopholfordtalkingrubbish.blogspot.com. Find the answers here.
Holford is the man who, in the BMJ said “Competing interests: none declared”, when promoting his supplements.
No interests? Holford himself has said
“any product, be it a publication, seminar, food or supplement, that is authored/invented by me has my name on it and earns me a royalty/payment. That is how I live and fund my research.”
So what about the galaxy of supplements being sold at “Health products for Life”? They say “we only supply supplements, foods and drinks that are recommended by nutrition expert, Patrick Holford.” And at the bottom of the page it says “©Copyright 2007 Holford and Associates. All Rights Reserved”. Companies House lists the sole shareholder in ‘Health Products for Life’ as P.J. Holford.
Garlic is no good either
Another interesting recent paper has appeared in Archives of Internal Medicine
Garlic is widely promoted as a cholesterol-lowering agent, but the evidence so far has been lousy. In this trial, 192 adults with low-density lipoprotein cholesterol (LDL-C) concentrations of 130 to 190 mg/dL (3.36-4.91 mmol/L) were randomly assigned to one of the following four treatment arms: raw garlic, powdered garlic supplement, aged garlic extract supplement, or placebo.
“Conclusions None of the forms of garlic used in this study, including raw garlic, when given at an approximate dose of a 4-g clove per day, 6 d/wk for 6 months, had statistically or clinically significant effects on LDL-C or other plasma lipid concentrations in adults with moderate hypercholesterolemia.”
| Last night I saw a magnificent ENO production of La Bohème at the London Coliseum. During the tear-wrenching death of Mimi in the last act, it occurred to me that if we had taken advice from homeopaths and the like, people would still be dying young from tuberculosis. |  Death of Mimi |
For me, Verdi beats even Puccini with the pathos and drama of the death of Violetta from consumption in La Traviata.Listen to the last minute of La Traviata (the Joan Sutherland and Carlo Bergonzi recording): click to listen
Look at the excellent ENO ‘insideout’ web site about the production.
Opera Desire, Disease, Death (University of Nebraska Press), by Michael and Linda Hutcheon is about disease in Opera. A review of the book by Roger Burford Mason appeared in the Canadian Medical Association Journal (1996, 154, 821-823). La Traviata appeared in 1853, and at that time the cause of tuberculosis was not known.
“Generations of languishing, beautiful women were not considered dangerous or infectious, but only glamorously frail, their short lives akin to the beauty of moths fluttering around a candle flame.”
According to J. F. Murray
“Some experts advocated contagion, others a constitutional hereditary defect, atmospheric imbalances, the depredations of stress, or an inevitable consequence of the degeneration of the human race; even the role of divine retribution was occasionally evoked”
But by the time La Bohème was first performed in 1896, things were quite different. In 1882 Robert Koch had discovered the real cause of the disease, Mycobacterium tuberculosis (Koch R., Die Aetiologie der Tuberculose: Berlin klin. Wochschr. 1882;19:221-230: translation in Am. Rev. Tuberc. 1932;25:298-323). Paul Ehrlich is quoted as saying of Koch’s talk to the Berlin Physiological Society, on March 24th 1882, “This evening remains imprinted on my memory as the most awe-inspiring scientific event I have ever attended”
The Hutcheons suggested that the reason that Rodolfo abandoned Mimi was because it was known by the time of La Bohème that tuberculosis was contagious, and he didn’t want to die too. In subsequent correspondence, a letter from Mimi Divinski MD (yes, Mimi) mounted a defence of Rodolfo: “Rodolfo knows that Mimi is dying and cannot bear to watch her and feel so helpless”. “Rodolfo is a hero”. You can read that letter, and the Hutcheons’ response, here.
Homeopaths poison your mind, not your body
It is often said that homeopathy, and some other forms of quackery, though not effective, are at least harmless. This history shows otherwise. Sugar pills do not, of course, poison your body. They poison your mind. Belief in their crude and irrational delusions inhibits search for the real causes of disease and for real cures.
 Robert Koch in 1883 Medical genius |
Like creationists, homeopathists and their ilk take the lazy approach. Don’t do the work, it’s much easier to read the holy book. If we had listened to them, people would still be dying of tuberculosis and cholera. |  Samuel Hahnemann Medical dim-wit |
This is not just historical either. At the present time, alternative medicine practitioners endanger the lives of children and adults by consistently advising against vaccination (download Schmidt & Ernst, 2003),Tuberculosis continued to kill long after Robert Koch, and long after La Bohème.
| Streptomycin was discovered in 1943, and shortly afterwards, a simple synthetic drug, isoniazid, was discovered in the labs of the pharmaceutical companies Hoffman La Roche, Farbenfabriken Bayer, and Squibb Institute for Medical Research. The first clinical trial was in 1952. And they came just in time to save my own sister who was diagnosed with tuberculosis in 1954 at the age of 14. She did not become another Violetta. Between them these drugs ended a centuries-old scourge. |  Chemical structure of isoniazid |
Another purveyor of nutribollocks who has been dissected and exposed by Ben Goldacre. His views on AIDS are a menace to humanity. And, incredibly his course has been accredited by the University of Bedfordshire (formerly known as the University of Luton).
Read full entry on the original IMPROBABLE SCIENCE page.
This week’s abusive email
For a bit of light amusement, I decided to publish the occasional bit ot email correspondence. This one arrived on 9th Feb 2007.
| From: “Stephanie Ginn”To: d.colquhoun@ucl.ac.uk Subject: homoeopathic medicine If Homoeopathic medicine doesn’t work, and it is all in the mind, how is it that if I give the wrong remedy my patients don’t get better, but when I find the right one they frequently do?This is as true of sore throats and ear infections in small children as it is to asthma and Rheumatoid Arthritis in adults. You really should do more research before shouting your mouth off over things you clearly know nothing about. We can’t all be that stupid… Stephanie |
| Dear Ms Ginn Thanks for writing. I’m always interested to hear from people like you. (though my reply will be a bit more courteous than your letter). You say “how is it that if I give the wrong remedy my patients don’t get better, but when I find the right one they frequently do? I think that you have hit the nail on the head, If you can produce the numbers to show that what you say is true, then I and everyone else I know will believe you (it would, of course, have to be done by comparison with an appropriate control group). The problem is that the homeopathic community have had 200 years to produce the evidence, and so far it has not been forthcoming.I suppose it is true to say that the evidence would have to be good in view of the inherent implausibility of homeopathy. If it turned out that it was possible to produce an effect with no molecules present, the whole of present day chemistry and physics would be overturned and since it seems to work rather well that would be surprising. Nevertheless, it is what would happen if you produced the evidence (and you’d probably get a Nobel prize too).I think though, it is your responsibility to do the research, not mine Best regards David Colquhoun |
| Thank you for your reply. Homoeopathy may sound implausible, I agree, it does if you only look at modern so called science. There are plenty of things in life which are unexplained, such as love…you can’t see it but would you deny it’s existance? I am sure and hope that you must have felt it? You are right so far in that to convince people they need proof. However, for most of us as Homoeopaths, our proof is that our patients get well, and they do, most of the time. That is generally enough proof for our patients too, especially when their brain tumours disappear. Of course there will always be some placebo effect in some people as in medicine of any sort. Perhaps you should try it for yourself and FEEL the proof…you will probably find that to be enough for you too.. Oh and by the way I think that present day physics and chemistry beliefs need overturning, desperately. Stephanie |
| Thanks for those comments. I see that you really do appreciate the need to produce evidence if you are to convince people, however convinced you may be yourself. Your most intriguing comment, though, was ” I think that present day physics and chemistry beliefs need overturning, desperately”. But it seems to me that your scepticism about the success of chemistry and physics doesn’t extend to computers, email, the web, mobile phones, motor cars and aircraft. They are all products of the application of chemistry and physics and 100 years ago they would have seemed miraculous). That leaves me wondering which bits of chemistry and physics you don’t like! Best regards David Colquhoun |
At this point, all I got back was
| Ok maybe redefining and definately [sic] rethinking are closer to the mark.Stephanie |
On Monday 5 Feb 2007, the BBC ran a piece entirled Alternative therapy put on trial. It started
“An experiment in allowing NHS patients easier access to alternative and complementary therapies has been launched by NI Secretary Peter Hain.”
| But it is NOT a trial, and NOT an experiment. Journalists seem incapable of understanding the meaning of these words, and the result is irresponsible reports (though one might detect a hint of irony in the picture that the BBC used to illustrate acupuncture; right). |
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There is nothing new in the failure of journalists to distinguish good science from junk. We saw this very clearly in the case of the phoney fish oil “trials” going on in Durham (see Ben Goldacre’s account of these).
In the case of Durham the effect is to use public money to produce bad evidencethat can be used to promote the dubious claims of a private company, in the case “Eye Q” pills made by Equazen.
In the case of Northern Ireland, £200,000 of taxpayers’ money will be paid to a private company, GetwellUK, GPs in two areas will be able to refer patients for therapies like acupuncture, homeopathy and massage. Nothing there about seeing whether the treatments work! But Peter Hain seems to think he knows the answer already. He said
“I am certain, as a user of complementary medicine myself, that this has the potential to improve health substantially,”
He was “delighted that Northern Ireland is leading the way in integrating complementary and alternative therapies into the National Health Service”
Peter Hain used to be something of a hero to me. In the 70s his work for the Anti-apartheid movement was an inspiration (see his autobiographical notes). Now he has sunk to promoting junk science. Very sad.So what is Hain’s attitude to alternative medicine, and how did he come to ally himself with the batty medical opinions of the Prince of Wales? On his web site he had a section on this topic. For some reason it has now been deleted, but thanks (again) to Google’s cache, here is a quotation from a speech he made to The Prince of Wales Foundation for Integrated Health (12th October 2005).
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 Peter Hain now  Peter Hain in 1970 |
So instead, we turned to complementary medicine. And with the help of homeopathy and tight restrictions on the sort of food that our son could eat – avoiding in particular wheat and milk products- both ailments went away.”
Hang on! You changed diet and gave homeopathic sugar pills. And that is a reason for the taxpayer to fund homeopathy? Any fool can see that this anecdote means that either (a) change in diet helped, (b) homeopathy helped, or (c) the eczema would have got better anyway. According to the National Eczema Society, “60-70% of children are virtually clear of the condition by the time they reach their mid-teens”. They “grow out” of it. Evidently a First Class Honours Degree in Economics and Political Science is not enough to teach Peter Hain what constitutes evidence and what does not.
On the other hand, the in the same speech Peter Hain also said
“I would certainly never advocate the squandering of public money on so called treatments that have no proven benefits and which take money away from existing therapies that are shown to work.”
But they have “no proven benefits”. Just how inconsistent can you get?
Who are GetwellUK?
GetwellUK is a private company financed largely by taxpayers’ money. And guess who supports it? The Prince of Quacks, once again exerting his unconstitutional influence on public policy. This is done partly through yet another of the Prince’s lobby groups, “GP Associates” (report in BMJ). It seems that “GP Associates” was the forerunner of the recently-launched “Integrated Health Associates”. The inaugural meeting of Integrated Health Associates” was sponsored by a drug company, Solgar Vitamins, a purveyor of unnecessary ‘supplements’ that is a trading arm of Boots Herbal Stores (no connection with that other well-known purveyor of misleading information, Boots the Chemists).
The Company says Support came from the government in February 2005 when the Parliamentary Under-Secretary for the Department of Health, Melanie Johnson, said in the House of Commons, “I thank the hon. Gentleman for notice of the question in relation to Get Well UK. We understand the benefit that many people get from complementary therapies. Local commissioning is a matter for local discretion, but we can see the benefits to local practices of an intermediary pulling together a range of services in the area for alternative medical treatments.” [Hansard].
“We were delighted to be selected as one of the first investees of Futurebuilders – a Treasury fund established to assist capacity building in community organisations who deliver public sector services. The investment will help Get Well UK to serve more NHS patients.”
Prince of Wales with Boo Armstrong (Managing director of Getwell UK)
GetWellUK publish an evaluation of a “pilot project” in London, “Does it Work?”, by Nicola Robinson (Head of the Centre for Complementary Healthcare & Integrated Medicine,Thames Valley University).
The report tells us nothing whatsoever about the effectiveness of the treatments, because the “pilot” study was not designed to do so. It is 40 pages of waffle.
The report also says “Get Well UK is a not for profit organisation established in response to a recommendation by the House of Lords in 2000 that complementary therapies should be made available through the NHS. This is a gross misrepresentation of the House of Lords report which said this should be done ONLY if the treatments worked better than placebo. And, with very few exceptions, that still remains to be shown.
For their efforts in setting back medicine to the 19th century, they have had money from UnLtd Ventures (“provides consultancy support to a number of outstanding social entrepreneurs” and taxpayers’ money from Futurebuilders. And they are getting £200 000 of taxpayers’ money from Paul Goggins, the Northern Ireland Health Secretary
At the end of the “pilot scheme” there will have been no proper assessment of the effectiveness of the treatments. We shall be none the wiser.
BBC’s You and Yours programme (a lunchtime consumer programme) ran a good piece on “Helps Stop Snoring”, a dubious herbal “remedy” for snoring. They picked up the story from my site. Listen to the programme [mp3 file]
“Helps stop snoring” claims to work on the basis of a clinical trial. But the trial is flawed in many ways. In addition the author, Dr Andrew Prichard, seems to have quite forgotten to mention that a Helen Prichard who lives at the same address holds 2000 shares in the company that makes this wonder cure. [transferred from old improbable science page].
My pharmacological curiosity was stirred by a TV advertisement for a spray that, it was claimed, could stop you snoring. It’s hardly a life threatening condition, but it can be marriage-threatening. But what’s in it, and does it work?
A visit to the web site of Essential Health Products Limited looks promising. Their claim is this.
“CLINICAL TRIALS
Many products claim to have undergone tests, but Helps Stop Snoring is the only natural snoring remedy in the UK have undergone to a full, double blind clinical trial, conducted by a practicing Ear,Nose and Throat Consultant Surgeon.
Lasting over 18 months, the trial involved 140 snorers and their partners, and the results showed a headline success rate of 82%. The trial was conducted by Andrew Pritchard FRCS, Ear Nose and Throat Consultant at the Royal Shrewsbury Hospital and one of the UK`s leading specialists in the field of snoring and sleep disorders.
In a further first for a snore remedy the results of the trial were published in Phytology Research, an international journal, in October 2004.”
This claim was not so easy to check because the manufacturer mis-spells both the name of the author and the name of the journal. The paper in question seems to be this. Prichard AJ., The use of essential oils to prevent snoring Phytother Res. 2004 18(9), 696-9 [get the pdf].
Sadly this paper is not very convincing. The paper does describe the work as “preliminary”, but the manufacturer’s web site does not. There’s a surprise. For those who are interested, here are a few details.
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140 adult snorers were recruited to the study via a snoring clinic. Snorers were randomly allocated to receive a metered dose of “Stop snoring “gargle, “Stop snoring ” spray or placebo gargle (there was no placebo spray at all). It isn’t obvious what placebo could mimic the peppermint, lemon, clove, thyme, eucalyptus and pine oils that the “remedy” contains (among other things). Their concentrations aren’t stated. The paper makes no mention of what was used as placebo, but Dr Prichard tells me “The content of the placebo could not be an essential oil. I have been told by the manufacturer that we used a sugar type mix”. Actually it contained water, sodium saccharin, polysorbate 20, potassium sorbate and citric acid. It would be have been obvious tor the patient whether they got the placebo or not.
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The comparison that is made is before and after in each treatment group, rather than comparing the groups. The eminent statistician, Stephen Senn, has some trenchant criticisms of this sort of experimental design.
Senn points out that “Having made the mistake of using the within treatment group to baseline comparison he ought to then use the Wilcoxon signed ranks test rather than the rank sum but he doesn’t say which”. The results are pretty odd too. In the placebo group, 4 out of 11 patients show a big reduction in snoring severity (Fig. 4). In the spray group, a smaller proportion, 5 out of 28 show a big improvement (Fig 2). The changes in the rest of the patients are mostly very small, but there are more slight improvements in the spray group than in the placebo group. The percent of patients that “improve” (by any amount, however small, is therefore bigger in the spray group than control, but the difference in mean snoring severity was much smaller
Financial interests in the snoring study
Sadly, it is essential to consider vested interests in drug assessment, as I have noted below (and here, and here). Prichard’s paper states openly that it was “Sponsored by Essential Health Products Ltd, 4 Top Farm Barns, Pitchford, Shropshire, SY5 7DW, UK.” That doesn’t mean it’s wrong, though the bias associated with sponsorship is well known,
But there is no mention of shareholdings
Companies House will, only £1, sell you company reports. The records show that Helen Jane Prichard, holds 2000 shares in Essential Health Products Ltd.
Is this just a coincidence of names? I think not. If you look up. Dr Andrew Prichard in the phone book, you see that his address is exactly the same as that of Helen Jane Prichard.
Oh dear: looks like yet another undisclosed financial interest in a clinical study.
Many thanks to the inimitable Ben Goldacre fot the totally over-the-top link to this item: it has done wonders for my hit rate.
Boots the Chemists is selling the same stuff True to their philosophy of making money and never mind the evidence, the “Boots Alternatives” range of snake oil products has, for £14.99, exactly the same stuff. They claim the Boots |
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Enquiries to Boots about this product have not been answered or have been answered inaccurately. See also below for Boots miseducation pages.
And here’s the ironical bit. Boots web site makes a big point about CSR (Corporate Social Responsibility). (Thanks to Sean
Kehoe for spotting this.)
“TRUST BOOTS
As you may have noticed, that’s the tagline which in 2005 we adopted as the sign-off to all our advertising. But it’s much more than just a slogan. It’s a concise statement of our entire corporate strategy. Our aim is to make Boots the world’s best health and beauty retailer, and we’re 100% clear that the unique trust in which we are held provides the key to achieving this. Which means, of course, that those two words are also the rationale for all our CSR activities. Everything we do that builds trust is good for our business; anything which could compromise it, a risk we can’t afford to take.”
Trust Boots to provide straight answers.
They must be joking.
BBC’s Panorama programme broadcast the content of secret emails. They show that GSK was aware of evidence the Seroxat increased risk of suicide in young patients, and suppressed it. They also showed that Prof Martin Keller’s paper on the topic was ghost-written by a PR firm working for GSK.
Moved to this blog from the old IMPROBABLE SCIENCE page: see Universities Inc