Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
CAM
Remember Kate Birch? She was the homeopath who was caught out recommending homeopathic treatment for malarie prevention (“Homeopathy is more effective that any western medication”). Still worse she advocated homeopathic cures for malaria at a clinic in Tanzania”.
The follow up to that outrageously wicked claim is posted here.
Imagine my amazement when Kate Birch knocked on my door on the morning of October 16th. Like most of the homeopaths I have met, she was earnest and rather charming. She was also, I have to say, on the high end of the delusional scale. The good thing is that she was kind enough to present me with a copy of her book,
Vaccine Free – Prevention and Treatment of Infectious Contagious Diseases with homeopathy . She seemed genuinely to think that if I read the book carefully. I would be persuaded that she was right. That is the book that first attracted the attention of a correspondent. I would not have been willing to pay £25 to buy it, but I am certainly be grateful to have the chance to quote a few passages from it.
One curious thing about the book is that the disease descriptions are given in straightforward standard scientific language. But that approach is quite inconsistent with the letter I got from North American Society of Homeopaths (NASH), which said
“NASH does not have a policy on the treatment of any disease category, in accordance with the tenet that homeopathy treats the whole person based on characteristic symptoms rather than a diagnosis.”
The claims to be able to cure serious diseases are also quite at odds with NASH’s Standards of Practice Guidelines which say
“Do not claim that you can treat any disease, condition or ailment or imply that you can do so.
Be extremely careful when speaking or writing about the treatment of particular diseases or conditions (and never offer or claim to help anybody). “
Yet Kate Birch is vice president of NASH. That organisation seems to be as much in chaos. and just as incapable of controlling irresponsible behaviour of its members, as its UK equivalent. The Society of Homeopaths.
Here are a few quotations.
Rabies.
“Curative action of the [hoemopathic] remedy depends on the degree of neurological involvement. Remedies given at the same time as the bite will act preventatively for the condition. If the mental state is strong, the appropriate remedy will help resolve it in the days following administration”
That reads to me like a claim that sugar pills will cure rabies (or is the insertion of the word “help” the getout?).
Tetanus
“Remedies given at the time of injury will reduce the susceptibilty to developing tetanus”.
Polio
“Gelsemium. This remedy is useful in early treatment with polio paralysis“. What does “useful” mean if it does not mean cure?
Diphtheria
“Diphtherinum . . . As a preventive in an epidemic, this remedy can be administered in a 200C potency once per week”.
Measles and German Measles
“The best prevention for both diseases is the homeopathic remedy Pulsatilla nigricans . . . If you are aware of being exposed, 30C daily for 7 days should be sufficient to subvert the disease.”
Smallpox
“Moreover, in the event of terrorist activity, may become prevalent once again. If this situation were to arise, there would be a need for and opportunity to use homeopathy in this area of public health.”
“The [homeopathic] remedies listed below will be useful for the treatment of the disease and for ailments from the vaccination”
Anthrax
“Homeopathy bases its prescriptions on the nature of symptoms. Because the disease progresses rapidly to death it is important commence treatment quickly and to monitor the recovery. Homeopathy can be used in addition to antibiotics if the case warrents.” Oops there seems to be a momentary touch of realism in that last sentence.
Plague
“Vipera, the homeopathic preparation of the snake venom, is useful for prevention and treatment.”
Tuberculosis
“As the person’s health deteriorates, and the tuberculosis becomes active, remedies such as Ferrum metallicum, Phosphorus, Stannum, Iodium, Kali carbonicum, or any of the remedies listed below may be more indicated to return the person to health”. See more on tuberculosis here
Hepatitis A, B and C
“In the homeopathic treatement of the acute form of hepatitis A, one would expect results within a few days to weeks of the correct homeopathic remedy.”
Dengue fever
“Homeopathy has been used succesfully around the world to treat and prevent Dengue fever.”
The list goes on an on. I am grateful to Kate Birch for giving me a copy of this book. Sincere she may be, but the advice given is, in my view a danger to humanity. This stuff leaves the Society of Homeopaths in the shade.
Follow up
The similar outrageous claims made by some members of the (UK) Society of Homeopaths have been investigated throughly on gimpyblog.
Many people now have written about the disgraceful and dangerous claims by homeopaths to be able to prevent and cure malaria. My contribution was “Homeopathic ‘cures. for malaria: a wicked scam”
One of the best contributions was on the Quackometer blog, The Gentle Art of Homeopathic Killing.
But the post vanished at midday on Thursday 11 October. Quackometer’s ISP has received threatening letters sent by lawyers on behalf of the Society of Homeopaths, who claim that the truth is defamatory, while being unwilling to say which statements are wrong. These threats have forced the removal of the post (for the moment), though you can still read it from the Google cache. And a lot of other places too.
.. . . At the very least, we could expect the Society of Homeopaths to try to stamp out this wicked practice? Could we? |
OK it’s fun to see the fantasy world of homeopaths riven by their internecine squabbles, but this is a serious matter.The Society of Homeopath’s substitute for answering reasonable questions is to try to suppress legitimate comment by brute (legal) force. It is hard to imagine such cowardly behaviour. I fear, though, that they may be in for a big surprise.Watch this space for developments.
Follow up
The storm begins.
Within 24 hours of the post being removed, it has sprung up again, all over the world. These are just the links that reproduce the whole text. Countless more refer to them.
“Blog post taken down by homeopathic complaint: a chill wind is blowing”
Gimpy’s blog: “The Society of Homeopaths silence criticism through cowardly legal means”
Andrew Clegg lends support: “A run-in with the Homeopathic Thought Police”. He reproduces the banished page.
And on Google groups in several places, for example here.
Another reproduction of the whole banished page at A day at the pharmacy (“from a provincial, small-town pharmacy in the United Kingdom”).
A mirror of the whole original page has appeared at semiskimmed.net
and “The Gentle Art of Homeopathic Killing (Cowards and Bullies)” appeared on JDC325’s weblog.
Another at badchemist.net.
Apathysketchpad , from Andrew Taylor, in Manchester,
Very soon it appeared in the USA too
Orac’s Respectful Insolence site: “Homeopathic thuggery”. The Yale surgeeon/scientist has also reproduced the full text.
The whole banned page is at skepticaldog.com too.
And on the Inalienable Rights blog (Portland, Oregon). They add the forthright comment “Go Society of Homeopaths, good on you for being complicit in murder, you bloody moronic cowards.”
The whole text is on the NNSEEK news group search engine too.
And in Russia
The whole text is here.
And all this within 24 hours since the page was pulled. The lawyers for the Society of Homeopaths are going to be very busy.
They keep coming. More full texts here.
Some are so anonymous that you can’t even be sure which country they come from, though often the US ones are distinguishable because the link mainly to US sources. Now Saturday.
- The Voyage. A blog from Ireland “Big Altie Gags the Truth, or tries to”.
- White coat underground. A doctor from the US midwest speaks out.
- Science after Sunclipse. An east coast US blog “for math, physics and the New Enlightenment”
- Conspiracy Factory. Factition’s blog: “Homeopathy, Malaria & Free Speech”.
- The Bronze Blog. “Big Altie attempts to suppress truth”. A very anonymous US blog.
- Infophilia. The Streisand Effect. From Arlington Heights, Illinois,USA.
- HappyJihad’s House of Pancakes. Another anonymous US blog, with full text.
- The GAS blog
- Skeptico. Another site from USA.
- Be Lambic or Green. From Canada (I think)
That’s 25 reproductions of the page so far. Now Sunday 14 Oct,
- Nana’s Notions. Blog from a US accountant.
- A Night on the Tiles. From Stew who works in a tile factory in France.
- Powerup. From Tyler DiPietro, a student in New England, USA.
- Unfiltered Perception. blog.tjomlid.com, from a young Norwegian.
- Action Skeptics. “Kick my ass. Society of Homepaths”, From Indiana, USA.
- bankrupt artist v3. Nice version from Canada
- Sceptiphrenia . Another from the UK.
- Thinking is Dangerous. “Be shamed, Society of Homeopaths”, for Dr T, UK.
- Rants and Raves, From Kulvinder Singh Matharu. “Homeopathy; Failure of truth and integrity (again)”.
On Sunday night, for the first time, one of them comes up on the first page of Google search for “The Society of Homeopaths”
More on Monday 15 Oct. Now five of the first ten hits on a Google search for “The Society of Homeopaths” refer to this row.
- Skeptix, The Central Alberta Skeptics Association.
- No Nonsense. “Society of Homeopathetics – censoring unfavorable comment!”. From Italy?
- The Millenium Project, From Australia. “The constant misspelling of the word “millennium” with only one “n” inspired me to create a millenium – that is, a collection of a thousand arseholes.”
- Rich Speaks. From Richer Lockwood, UK.
And from Tuesday onwards, they kept coming.
- A rather fine rant from Song, by Toad. “The Gentle Art of Homeopathic Killing – Fuck You, Society of Homeopaths”
- EnoNomi. Another complete text, from Phoenix Arizona
- D-notice: homeopathic killing. From London
- The Macho Response. From Oakland California
- Homeopathiccompliants.
- Ordinarygirl. “Homeopaths censor blogger” from Kansas, USA.
- Tabasco da Gama From USA “Society of Homeopaths thug tactics”
- Planet Atheism
- Skeptikeren.
- Blogher. A curious on from US. The full text has been posted as a comment on a pro-homeopathy site.
- Dikki’s diatribe. Another from AUSTRALIA.
- Qnoodle
- Freeborn John. Internet censorship again
- Skeptobot. A UK PhD student
- And, at last, James Randi (with comments)
- Skeptigator Another US one
- Bishop Hill From “an Englisman lvining in rural Scotland”
- Counterknowledge. “This you have to read”. From UK writers.
- Ministry of Truth. “Shades of Uzmanov”
- The Wardman Wire. “Society of Homeopaths are doing an Usmanov”.
- Mediawatch.org.uk.
- Mike Powers. “Not just fat oligarchs” (another allusion to the Usmanov affair).
- Aharonic.net. Art and culture.
- Amused cynicism. From “a computer programmer living in north west Europe”.
- Humaniform.
- Chicken Yoghurt. from Justin McKeating. “The Usmanov strain -mutating”
- The Devil’s Kitchen. “Homeopathic, sociopathic, psychopathic”.
- Starshun.com. “Society of Homeopaths threaten blogger”
That’s 64 now, from UK, USA, Russia, Canada, France, Norway and Australia. And still counting. The story is now reaching the political blogs too.
On the morning of 25 October, six of the first ten links ona Google search fot the “The Society of Homeopaths” led to re-postings of “The Gentle Art of Homeopathic Killing”.
By 1st November, all the Google front page links apart fron the first two pointed to sceptical sites (one was to the BBC’s “Homeopathy’s Benefit Questioned“, the rest to harder-hitting criticism).
Andy Lewis and Ben Goldacre have both posted Andy’s incredibly polite email to the Society of Homeopaths. This is the letter that got no reply apart from another letter from lawyers.
More from quackometer
“You Very Naughty Girls and Boys.” Tut tut, look at al those postings!
“The Society of Homeopaths: Truth Matters” A follow up on recent events. In particular, a letter that the Society of Homeopaths wanted to publish is demolished.
Two definitions of lawyers
Dice, n. Small polka-dotted cubes of ivory, constructed like a lawyer to lie on any side, but commonly the wrong one. [Bierce, Ambrose, The Enlarged Devil’s Dictionary, 1967]
The duty of an advocate is to take fees, and in return for those fees to display to the utmost advantage whatsoever falshoods the solicitor has put into his brief. [Bentham, Jeremy, The Elements of the art of packing as applied to special juries, 1821]
You know those silly e-petitions on the 10 Downing Street site?
Not only do they give you a spurious feeling that you are being listened to, but they are now being hijacked for surreptitious free advertising.
Just for a laugh, why not go to sign this one, at http://petitions.pm.gov.uk/health-claims/#detail
We the undersigned petition the Prime Minister to deplore the
use of e-petitions to generate free publicity for unproven
treatmentsI am concerned to see petitions calling for as yet unproven
medical treatments to be made available on the NHS, e.g.
http://petitions.pm.gov.uk/freefoodtests/ or
http://petitions.pm.gov.uk/Buteyko-4-free/#detail )
| A paper published in the Postgraduate Medical Journal, October 2007, has been reported widely. In the same issue there was a commentary by Edzard Ernst. They show the astonishingly poor evidence than herbal treatments work, despite the fact that they have been around for thousands of years. They looked at 1330 published trials on herbal medicines and found 3 (yes three) that stood up to scrutiny, Of those three, two were negative and one indecisive |  Red clover, Derwentwater. |
A systematic review of randomised clinical trials of individualised herbal medicine in any indication, R. Guo, P. H. Canter, and E. Ernst, Postgrad Med J 83: 633-637 [Get the reprint]
Herbal medicine: buy one get two free, E. Ernst, Postgrad Med J 83: 615-617 [get the reprint]
Grab the reprints before I am told to remove them.
The paper says
“Systematic searches of electronic databases and contacting
experts and professional bodies in the field resulted in the
location of only three randomised clinical trials of individualised
herbal medicine. It should be stressed that professional
bodies representing the interests of different practitioner
factions from around the world were unable to contribute any
more studies than this. In view of the long history and
widespread use of medical herbalism, Chinese herbal medicine
and Ayurvedic herbal medicine in many and diverse indications,
this should be a cause for concern. It indicates that
individualised herbal medicine has an extremely sparse
evidence base and that there is no convincing evidence
supporting its use in any indication.”
The National Institute of Medical Herbalists says
“More and more people are turning to herbal medicine as a kinder alternative to mainstream medicine, with its over reliance on pharmaceutical products.”
Wrong. Herbal medicines are pharmaceutical products. They are just unstandardised, and often impure and contaminated, pharmaceutical products.
In the Guardian we find Ann Walker quoted thus.
“Ann Walker, director of the British Herbal Medicines Association, insisted that most herbalists were well-trained and knew when to refer patients. She said herbalists took a three or four-year degree course before accreditation.
She acknowledged the lack of proof of efficacy for individualised herbal medicine. “The evidence is scanty because the studies have only recently been started,” she said. This did not mean there was no efficacy.”
Just a thought: shouldn’t you have some evidence that they work before you start selling them? These things have been around for thousands of years but the “studies have only recently been started”. You couldn’t make it up. You can’t have a high level of training if there is no evidence. The paucity of trials makes it very hard to know how you can fill up a three or four year course with anything but idle speculations. Universities should not being giving degrees in idle speculation.
Quote of the day. . Of all the pathetic defences offered by herbalists, this one, quoted in the Daily Mail, is my favourite.
“Jane Gray, of the National Institute of Medical Herbalists, said: “We would challenge the conclusions reached by this study based on such little data.”
“We want more research, but we’re all in private practice and cannot afford to stop earning to run a trial over several months.”
The fact that there is “so little data” is the conclusion. And perish the thought that a herbalist should “stop earning” just in order to find out whether what they are selling does any good.
The regulation scam
Alison Denham, speaking for the National Institute of Medical Herbalists, is quoted as saying
“But there are certainly issues around the expertise of practitioners which need to be addressed, and we look forward to government regulation which imposes a high standard of training on anyone who wants to register.”
Like all forms of alternative medicine, herbalists are desperate for government “regulation” because they know it gives the appearance of official approval without requiring them to show that they can do the slightest good.
Reports on this paper
The BBC web site: “Tailored herbal medicine ‘futile'”.
The Guardian report, by Sarah Boseley, is pretty good. “Herbalists’ cocktails may do more harm than good, say researchers.”
- Call for individualised remedies to be banned
- Little evidence to support claims of efficacy
The Times has another excellent report by Nigel Hawkes. “High street herbalists can offer no evidence that their remedies work”
The Independent. “Natural medicine on trial: The trouble with herbs. Traditional herbal remedies have never been more fashionable: sales have almost doubled in eight years. There’s just one problem: science suggests that they don’t work.”. This time Jeremy Laurance got the headline right (unlike the acupuncture piece). But where did that list of “Herbal remedies that work” at the end come from? Had he checked the Cochrane Reviews? I think not.
The Daily Mail. “Herb cures that ‘do you more harm than good’ “. Pretty good report. specially for the Daily Mail.
The Scotsman. “A natural cure?” Lyndsay Moss. Sadly, and unusually, this is the only really poor report. Just look at the end of it.
Postscript
On Saturday morning (6 October) I did an interview on the Dublin radio station, Newstalk. The host, Brendan O’Brien spoke also to Mary Plunkett, from the Professional Register of Traditional Chinese Medicine. She assured us that that, although there may be no evidence that it works published in the West, there were lots written in Chinese. What a pity that I had not yet read Ben Goldacre’s column, on this week’s bad news for herbalists. He cited a reference that was new to me.
You can read the abstract here. [download pdf]. The paper, by Vickers, Niraj, Goyal, Harland and Rees (1998, Controlled Clinical Trials, 19, 159-166) has the title “Do Certain Countries Produce Only Positive Results? A Systematic Review of Controlled Trials”. The conclusion is riveting.
“In the study of acupuncture trials, 252 of 1085 abstracts met the inclusion criteria. Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR. In studies that examined interventions other than acupuncture, 405 of 1100 abstracts met the inclusion criteria. Of trials published in England, 75% gave the test treatment as superior to control. The results for China, Japan, Russia/USSR, and Taiwan were 99%, 89%, 97%, and 95%, respectively. No trial published in China or Russia/USSR found a test treatment to be ineffective.”
The British Medical Journal ran an article on “doctor bloggers” last week.
Photo ©Mark Thomas
The BMJ put the article behind a paywall, but you can download a reprint here.
Oops, no you can’t. The BMJ have dictated that their piece on bloggers should not be available to bloggers. If you want a copy, email me. The question of availability is more interesting than the article itself anyway. It is by a journalist, Rebecca Coombes. Contrary to what you might think from reading it, I have never met her. She asked for opinions by email, so I spent a while writing something out, which she cut and pasted into an article (and I spent another hour with their photographer, Mark Thomas, who took a lot of pictures). But I can’t use either the article or the photos freely. I don’t even get paid. The commercial journals, as always, do pretty well out of exploiting academics.
| The picture at the top should have been Ben Goldacre, whose badscience.net is now number two in the world. That picture prompted the child of a friend to ask if I was doing an impression of a velocirapter, I guess that is one better that gimpyblog’s perception of me as being a dead ringer for some computer game thug. So here is another one (possibly no less scary). |
Photo ©Mark Thomas |
By way of compensation, here is a picture of Goldacre.
 Goldacre |
 Science writer award 2005 |
Goldacre said
“. . . blogs are popular because they are more honest than other media. It is hard to get away with misrepresenting stuff when the original source is but a click away. I see it as a way of making conversation public. What is good about it is you get unmediated expertise.”
“In the press it’s hard to know what is true. But with blogs people can link directly to the original source: this never happens in a newspaper.”
DC said
“I think they [blogs] have really had some success in spreading public understanding of science and even in influencing public affairs (firstly with the merger [of Imperial and UCL] and more recently with withdrawal of NHS funding for homoeopathy). My own research is on the stochastic properties of single ion channels. I love it, but it is specialist and of zero interest to the public. So it’s fun to talk about things that do interest the public. It’s also fun to be able to influence politicians and vice chancellors, though that is rather harder.”
| At a meeting of the West Kent PCT board, on 27 September 2007, it was decided to withdraw all funding for homeopathy from the end of this financial year. This means the end for the Tunbridge Wells Homeopathic Hospital.. |
 |
Congratulations to Dr James Thallon (Medical Director of the West Kent PCT) who done a good job for patients in his area by ensuring that NHS money is well spent. He appeared briefly on Channel 4 News to explain that if the cost of the Hospital were saved, a lot of patients would be able to benefit from the latest treatments.
The announcement of intention to withdraw NHS funding was followed by a public consultation. But the supporters of homeopathy could muster only 6273 votes and they were spread over four petitions (we shall never know how many people signed all four). A web site for the supporters of the homeopathic hospital has a movie of their town centre demonstration. The numbers there were less than overwhelming, though they were led by a rather fine piper.
The local MP, Greg Clark (Cons, Tunbridge Wells) made a short speech, but sounded, it must be said, less than convinced. He is an MP better known for his support for nuclear missiles.
At 08.30, the morning talk show on BBC Radio Kent that preceded the meeting had a discussion about the homeopathic hospital. If you can stand talk shows, listen here (a London homeopath, DC and Sally Penrose from British Homeopathic Association). The first speaker says “someone even called it crackpot medicine”. Ahem. Could that have been me?
Who owns the Homeopathic Hospital?
You might expect to be able to find out from NHS Choices, but that site is unhelpful (how does the Department of Health manage it?). Here is the information that I have.
The Tunbridge Wells Homeopathic Hospital building is owned by the Mental Health Trust. The building houses three services. (1) The homeopaths, who are owned by Maidstone Tunbridge Wells (MTW) Acute Trust, (2) a child and adolescent mental health service CAMHS, which is owned by the Mental Health Trust, and (3) Community Paediatrics which owned by W Kent PCT. It will be for MTW as provider to decide if they want to close the department in the light of the commissioning decision but if they did then the building itself would continue to house medical services though not the Department of Homeopathy.
Follow up in the press
BBC News 24 had a short report.
The Times said ” Patients will no longer be able to receive homoeopathy treatments at a specialist hospital because they are a waste of money and do not work, an NHS trust said. ”
The final outcome
According to a report in the local newspaper, a year later it is, at last happening. Peter Fisher of the Royal London Homeopathic Hospital said
“Of course homeopathy needs more research, but so do many areas of conventional medicine – without these NHS hospitals, this research won’t get done.”
The first part might be true, but the second is fantasy. The hospital did not produce a shred of good research. The report goes on.
“The PCT originally decided to withdraw funding for homeopathy – which costs the trust £200,000-a-year for 750 patients – last September, but the decision was challenged by patients through a judicial review which proved unsuccessful and led to the final decision being made last week.
Current patients will finish their treatment over the next eight months but the PCT will not pay for further routine homeopathic consultations or treatments after the end of March next year.”
Back pain is a big problem, and Ben Goldacre has already written about the new study
The German Acupuncture Trials (GERAC) for chronic low back pain
Randomized. Multicenter, Blinded, Parallel-Group Trial wth 3 groups.
Sadly, the Journal of the American Medical Association have told me to remove the link to the original paper, so if you want to know more about it, email me. There is something rather irresponsible in the way journals promote papers to the media, but then deny the public the right to see the original work.
There has been a real orgy of bad science reporting about this interesting paper The main conclusion is that both sham acupuncture and ‘real’ acupuncture have essentially the same effectiveness in reducing back pain. Both the real and the sham treatment came out better than the group given ‘conventional therapy’ (a combination of drugs, physical therapy, and exercise).
Perhaps it isn’t surprising that many of the headlines in the press were misleading. So was the press release for the journal, which had the title “Acupuncture Treatment May Be More Effective Than Conventional Therapy In Treating Lower Back Pain, German Study Finds “. The bad journalism can be blamed in part by the self-promotion of journals, as so often.
My first take on what this means is
- a theatrical treatment can have a strong placebo effect, or any old prick produces a long lasting physiological effect
and - acupuncture is a sham.
For an excellent account of the placebo effect, go to Goldacre.
This is the latest in a series of trials that shows essentially no difference between real and sham acupuncture. Here are examples.
This may not matter very much for patients, but it is enormously important in principle. It is enormously important for education, qualifications and for regulation. If, as seems to be the case, real acupuncture and sham are much the same, that means that all the ancient Chinese wisdom on which the acupuncture is allegedly based is just so much bunk. A typical statement of these was reproduced in the Dilemmas of Alternative Medicine.
. . . its advocates try to ‘explain’ the effects, along these lines.
- “There are 14 major avenues of energy flowing through the body. These are known as meridians”.
- The energy that moves through the meridians is called Qi.
- Think of Qi as “The Force”. It is the energy that makes a clear distinction between life and death.
- Acupuncture needles are gently placed through the skin along various key points along the meridians. This helps rebalance the Qi so the body systems work harmoniously.
I suppose, to the uneducated, the language sounds a bit like that of physics. But it is not. The words have no discernable meaning whatsoever. They are pure gobbledygook. Can any serious university be expected to teach such nonsense as though the words meant something?
| I’ll declare an interest. I get intermittent back pain too. The picture is an X-ray of my spinal cord, You can see two lumbar vertebrae bolted together from the front and back with huge titanium woodscrews. The vertebrae had become disconnected in what the surgeon called the worst spondylolisthesis he’d seen. One thing that I do know is that my back pain is enormously variable from day to day, for no obvious reason, That alone makes it almost impossible to tell whether any treatment helps. |
 |
| “The evidence that non-steroidal anti-inflammatory drugs relieve pain better than placebo is strong. Advice to stay active speeds up recovery and reduces chronic disability. Muscle relaxants relieve pain more than placebo, strong evidence also shows, but side effects such as drowsiness may occur. Conversely, strong evidence shows that bed rest and specific back exercises (strengthening, flexibility, stretching, flexion, and extension exercises) are not effective. These interventions mentioned were equally as effective as a variety of placebo, sham, or as no treatment at all. Moderate evidence shows that spinal manipulation, behavioural treatment, and multidisciplinary treatment (for subacute low back pain) are effective for pain relief. Finally, no evidence shows that other interventions (for example, lumbar supports, traction, massage, or acupuncture) are effective for acute low back pain” |
The main advice seems to be “avoid rest”. This is me avoiding
rest by walking across the Alps a few years ago.
The Times. The best so far seems to be from Nigel Hawkes in the Times “Sticking needles in a bad back “eases pain better than drugs”
“Acupuncture works better than conventional treatments in reducing lower back pain, according to researchers in Germany. But so does fake acupuncture, where the needles are inserted shallowly and in the wrong places.”
The BBC. The BBC report (anonymous) posted on 26th September misssed the point altogether, but a day later it is much better (could that have anything to do with the complaint that I made about it?).
The title changed overnight from “Acupuncture ‘best for back pain’.” to “Needles ‘are best for back pain’ Acupuncture – real or sham – is more effective at treating back pain than conventional
therapies, research suggests.”
“their findings suggest that the body may react positively to any thin needle prick – or that acupuncture may simply trigger a placebo effect.”
The Independent. On the other hand, The Independent makes a hash of it. “Acupuncture is best way to treat back pain, study finds” By Jeremy Laurance, Health Editor.
It starts “The ancient Chinese practice of acupuncture works better than anything modern medicine has devised for the treatment of back pain, scientists have concluded.”. That is precisely what they didn’t show. On the contrary they showed than any old pricking does as well as the ancient Chinese practice.
The Telegraph. Nic Fleming in the Telegraph missed the point too ” Acupuncture ‘best therapy for back pain’ By Nic Fleming, Science Correspondent. “Acupuncture can provide significantly more relief from lower back pain than conventional therapies, scientists say.”.
Postscript
There is an excellent comparison of the newspaper reports at “Journalists are shit, study finds“
21 September 2007
Channel 4 News reported on the pressure to save money by stopping NHS funding for “unproven and disproved treatments”.
Watch the video.
The report started badly when the journalist, Victoria Macdonald, said that the bottles of homeopathic pills contained “only natural ingredients”.
Wrong
They contain NO ingredients. That is just as well perhaps, when you recall that natural ingredients in homeopathic pills include things like polonium. In the Nature newsblog that followed my piece about BSc degrees in anti-science, I responded
“Well CAM is a bit like university management. Don’t try to satirise it, because the next thing you know the satire has come true.
There is even a whole book about homeopathic polonium, and you can by not only polonium, but also holmium, dysprosium, europium, gadolinium, Terbium, Thulium (this is beginning to sound like Tom Lehrer), And don’t forget Excrementum caninum (yes, you got it, dog shit). With the 3C “potency” of the latter you might even get a few molecules of it. All this at http://www.archibel.com/homeopathy/synthesis/newremedies/
And don’t forget your homeopathic bioterrorism protection kit.”
The thrust of the report was to suggest that our attempts to improve NHS treatment were some sort of Big Pharma funded conspiracy to suppress those nice homeopaths and so kill old ladies whose lives depended on taking medicines that contain no medicine.
Peter Fisher sounded a bit desperate in his attempts to associate me and my colleagues with the defence of GM foods, a topic on which, as far as I know, none of us uttered a word in public.
Sorry, Dr Fisher, but there is no conspiracy, and no involvement of Big Pharma. Just a disparate bunch of doctors and scientists who decided it was time to do something about the spending of scarce NHS money being spent on new age nonsense. It really is that simple.
I’m always a bit amused when people who make a lot of money from alternative medicine accuse me of representing some vested interest. The media ‘nutritional therapist’, Patrick Holford, said, in the British Medical Journal
“I notice that Professor David Colquhoun has so far not felt it relevant to mention his own competing interests and financial involvements with the pharmaceutical industry “
To which my reply was
” Oh dear, Patrick Holford really should check before saying things like “I notice that Professor David Colquhoun has so far not felt it relevant to mention his own competing interests and financial involvements with the pharmaceutical industry”. Unlike Holford, when I said “no competing interests”, I meant it. My research has never been funded by the drug industry, but always by the Medical Research Council or by the Wellcome Trust. Neither have I accepted hospitality or travel to conferences from them. That is because I would never want to run the risk of judgements being clouded by money. The only time I have ever taken money from industry is in the form of modest fees that I got for giving a series of lectures on the basic mathematical principles of drug-receptor interaction, a few years ago.”
I spend a lot of my spare time, and a bit of my own money, in an attempt to bring some sense into the arguments. The alternative medicine gurus make their livings (in some cases large fortunes) out of their wares.
So who has the vested interest?
Sorry Dr Fisher, but there is no conspiracy. Tim Crayford (Association of Directors of Public Health), put the matter very simply in the interview.
It is more to do with a point of principle. There are very many really effective treatments that the NHS can’t currently afford to provide. And we should we not be ensuring that the limited resources we’ve got in the NHS go to the things that really work well, and are going to save lives”
That is all there is to it.
A new judgment today from the Advertising Standards Authority .
A direct mailing for books by Patrick Holford, a nutritionist, contained a booklet entitled “100%health”. Headline text stated “You don’t swallow junk food. Why swallow junk health advice?” Text in a letter from the “Editor of 100%health”, Patrick Holford, on an inner page of the booklet stated
“I would like you and your family to stay healthy, free of pain and the need for drugs. But if I told you the truth in this letter, I would break the law … I’d love to tell you how powerful nutrition is, both for your mind and body. But I can’t. Why? Because advertising law prohibits me saying anything that claims to ‘treat, prevent or cure’ any condition! Even if there’s undisputed proof that nutrient ‘x’ cures condition ‘y’ I’m not allowed to tell you here. By law, I can tell you in my newsletters, but I can’t in this publication … So, excuse me if you have to read between the lines …”.
The ASA upheld a complaint against this passage
” the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness), 50.1 (Health & beauty products and therapies – General) and 50.20 (Health & beauty products and therapies – Vitamins, minerals and other food supplements). “
Text on a separate page stated “Don’t waste your money on vitamins Myth: ‘If you eat a balanced diet you get all the vitamins and minerals you need.’ WRONG!”. The ASA upheld a complaint against this passage too.
the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.21 (Health & beauty products and therapies – Vitamins, minerals and other food supplements).
The code for “truthfulness” reads thus
7.1 No marketing communication should mislead, or be likely to mislead, by inaccuracy, ambiguity, exaggeration, omission or otherwise.
What a pity that Mr Holford has been judged not to live up to this criterion.
This was not a first offence either. In 2003 four complaints to the ASA about Holford were all upheld, as pointed out in the comment by Shinga, below.
Read more at badscience.net
And at quackometer
The current issue of the British Journal of Clinical Pharmacology has what looks like a good placebo controlled trial of homeopathy from France. “Effect of homeopathy on analgesic intake following knee ligament reconstruction: a phase III monocentre randomized placebo controlled study, Paris et al., 2007″.
Conclusion The complex of homeopathy tested in this study (Arnica montana 5 CH, Bryonia alba 5 CH, Hypericum perforatum 5 CH and Ruta graveolens 3 DH) is not superior to placebo in reducing 24 h morphine consumption after knee ligament reconstruction
Another thing that makes the paper interesting is that one of the authors is Philippe Belon. who is a director of the huge French homeopathic company, Boiron. This is properly declared at the end.
Conflicts of interest: Dr Belon is the head of the clinical research department of Laboratoires Boiron. The Laboratoires Boiron financially supported the study. None of the other investigators had any conflict of interest.
Boiron makes profits from homeopathy of about 20 million euros a year, on net operating revenues of about 300 million euros. It is big business. Philippe Belon has an interesting record.
He was one of the authors of the notorious Benveniste paper(see also here), which lead to Beneveniste’s dismissal from INSERM in disgrace. Benveniste’s results were refuted by, among others, Hirst, Hayes, Burridge, Pearce and Foreman (1993, Nature.366, 525-7.
Belon was also senior author in Fisher, P., Greenwood, A., Huskisson, E. C., Turner, P., & Belon, P. (1989). (Effect of homoeopathic treatment on fibrositis (primary fibromyalgia) British Medical Journal 299, 365-366.). That is the paper which I was asked to check (by a TV programme). After Peter Fisher gave me the raw data I found that a naive mistake had been made in the statistical analyis. There was NO evidence for the effect of the treatment at all, as described here. This correction was published (Colquhoun, D. (1990). Reanalysis of a clinical trial of a homoeopathic treatment of fibrositis. Lancet 336, 441-442.), though the correction is usually ignored by homeopaths (see here). [Get pdf].
The Truth about Homeopathy
This is the title of a commentary on the Paris et al. paper by Edzard Ernst, published in the same issue if British Journal of Clinical Pharmacology.
“Heavens!” I hear the homeopathic fraternity shout. “We need more research!” But are they correct? How much research is enough to show that any treatment does not work (sorry, is not superior to placebo)? Here we go full circle: should we really spend several lifetimes in order to arrive at a more robust conclusion?”
“Most readers and even many homeopaths will be surprised to learn that that has already happened! During the Third Reich the (mostly pro-homeopathy) Nazi leadership wanted to solve the homeopathy question once and for all. The research programme was carefully planned and rigorously executed. A report was written and it even survived the war. But it disappeared nevertheless – apparently in the hands of German homeopaths. Why? According to a very detailed eye-witness report [9 – 12], they were wholly and devastatingly negative.”
Ernst sums up the situation incisively –download a copy of his paper.
Steven Novella, MD, an academic neurologist at Yale University, runs The Skeptics Guide to the Universe: Your Escape to Reality
He is author of Weird Science , a monthly column featured in the New Haven Advocate. He is the co-founder and President of the New England Skeptical Society, Associate Editor of the Scientific Review of Alternative Medicine , and a contributing editor of Quackwatch , a consumer advocacy website dealing with all types of health fraud.
At 5 am on 12 September he phoned to record a podcast. You can here the whole thing here. It includes various items of skeptical news and an interview with James Randi too.
Steve Novella quizzed me about the circumstances surrounding the request to move my web site from UCL’s server, and we discussed the incursion of endarkenment values into universities and politics. My bit is here.
It sounds as though Tennessee pharmacist, Larry Rawdon, is in trouble. According to a report in the Tennessean (11 Sept, 2007)
|
 |
Then, in authentic Tennessee style,
“Rawdon calls his approach to health care “Health God’s Way.” It’s a form of naturopathy” using natural remedies such as foods, herbs and minerals to treat illness. Naturopathy is legal in some states, but not in Tennessee.
“It’s not me healing people, it’s God,” Rawdon said.
“God sent Joshua into the Promised Land and told him not to destroy the fruit trees because in them is a man’s life that he can eat and live,” he said. “So the life force that is in the fruits and vegetables, it’s what our cells need for the healing process.” ”
. . . .
The Board of Medical Examiners found Rawdon guilty of treating patients without a medical license in addition to practising naturopathy.
Now “Dr” (of pharmacy) Rawdon seems to work for Wellness America (no mention there of the fine). Their mission statement is
| Our Mission is to gather, educate, and empower individuals to take control of their health and wealth by applying biblical principles to their everyday life. To promote prevention of illness, wellness from sickness, fitness for the body, freedom from debt, and health for the whole man BODY – SOUL – SPIRIT. |
You couldn’t make it up.
Very interesting uh? Someone fined a million dollars for pretending to be able to cure serious diseases by nutrition and supplements. I wonder if that could ever happen here?
The British Pharmaceutical Conference (2007) staged a debate on “Homeopathy or Allopathy. Which would you choose”. On one side was Felicity Lee (ex Chair of the Society of Homeopaths). I was on the other side. Ben Goldacre was there and he recorded the whole thing. You can listen to it here (if you have nothing better to do).
Thanks to the high-tech equipment at the conference, I was able to show in place of a slide, a section of an article written by Felicity Lee with the title “What health problems can it help with?“. These include, for example, migraine. But if you look at the National Electronic library of Complementary and Alternative medicine (which is compiled by CAM people) what you find is this.
“There is insufficient evidence to support or refute the use of homeopathy for managing tension type, cervicogenic, or migraine headache. The studies reviewed possessed several flaws in design.”
Goldacre also recorded, after the debate, an interview with Felicity Lee. It is rather more interesting than the debate itself. It’s fascinating because, as in the debate, she refuses again and again to be drawn into discussing the evidence and is quite unable to say why she thinks it is not possible to do proper trials.
She did mention that a suitable condition for a trial might be osteoarthritis, but seemed to be quite unaware that such a trial was done in 2001 by no less a person than Peter Fisher (clinical director of the Royal London homeopathic Hospital and the Queen’s homeopathic physician). The outcome of this paper (download it) was that homeopathy didn’t work any better than placebo.
The paper ended with this memorable statement.
“Over these years we have come to believe that conventional RCTs [randomised controlled trials] are unlikely to capture the possible benefits of homeopathy . . . . It seems more important to define if homeopathists can genuinely control patients’ symptoms and less relevant to have concerns about whether this is due to a ‘genuine’ effect or to influencing the placebo response.”
That is the nearest that Fisher has ever come in public to admitting it is all placebo effect, though at other times, of course, he has denied that strenuously.
I have received today (11 September 2007) a rather threatening letter from Patrick Holford. He says
“I am writing to you directly to complain about both your article in The Guardian of 15 August, in which you falsely claim that my advocacy that Vitamin C is better than conventional drugs to treat AIDS is “truly scary”, and in respect of the equally false claims you have posted on your website, DC Improbable Science, particularly in relation to Dr John Marks.”
He ends, more threateningly,
“I nonetheless believe it appropriate that you withdraw the allegations you have made and apologise for making these unwarranted and defamatory allegations. Provided that we can agree the wording of an apology and the removal of the false claims, I am prepared to leave it there. However, I fully reserve my right to take this matter further should my complaint not be resolved to my satisfaction.”
Here are responses to these two allegations.
(Some follow ups on this post have been added below)
Vitamin C and AIDS
What does Holford actually say about HIV/AIDS? On page 208 of his New Optimum Nutrition Bible (2003) we read (see Google books)
| “Yet for the last 100 years, medicine has focused on drugs designed to destroy the invader -antibiotics, anti-viral agents, chemotherapy. By their very nature, these drugs are poison to the body. AZT, the first prescribable anti-HIV drug, is potentially harmful and proving less effective than vitamin C (23)” |
You can read this paper here. If you get that far, you might well be surprised to find that it is not a study of people with HIV/AIDS, but merely shows that vitamin C can, under lab conditions, inhibit HIV in cells in a dish. You might be even more surprised that the paper does not compare vitamin C and AZT. In fact AZT is not mentioned at all (except for a brief reference in the discussion).It is true, that on his web site, as opposed to his book, Holford expands on this theme a bit. For example here he says. of reference 23,
“Ref 23. These in vitro studies on human T-cells shows that vitamin C suppresses the HIV virus in both chronically and latently infected cells, while AZT has no significant effect. It is a tragedy that this simple, non-toxic treatment hasn’t been further tested. ”
Harakeh S, Jariwalla RJ.Ascorbate effect on cytokine stimulation of HIV production. Nutrition. 1995 Sep-Oct;11(5 Suppl):684-7.
But the reference given here (which does use AZT) is not reference 23 (which does not test AZT at all). Holford himself acknowleges that his book cites the wrong reference in his book.
Holford also forgets to mention (or perhaps didn’t notice) that the concentrations of Vitamin C that are used in these in vitro studies are something like 10 times greater than can be achieved in man even with very high oral doses,
More recently he has backed off a bit. For example, here he says
“There is no doubt that anti-retroviral drugs save lives. So too may high dose vitamin C, but we just won’t know until the definitive research trial is done.”
Why, one wonders, has Holford not done studies in man himself? His name does not appear in the research literature at all (search Pubmed for ‘Holford PJ’ yourself). And Holford is not a poor man.
It still seems to me that anyone reading his New Optimum Nutrition Bible (2003) will be misled into thinking that Vitamin C is better than AZT for curing HIV/AIDS in man.
You can read more interesting stuff on this question at Holfordwatch.
What did Dr Marks actually say?
I’m accused of malicious behaviour, because I posted a letter from Dr Marks which set out his present views All I did was ask Dr Marks about what happened, and, with his encouragement, published his
answer. I also suggested to Dr Marks that he should write to Holford to ask for the basis on which Marks was quoted. When Marks received no reply, we decided to go ahead anyway.
I am, therefore, very grateful to Mr Holford for sending me a letter, dated 16 September 1997, that was sent to him by Dr Marks. The whole letter can be downloaded here.
It seems that in the ten years since that letter was written, Dr Marks has changed his mind a bit about Holford. but the main interest attached to the letter is the selective quotations that have been made from it.
In his 1997 letter to Holford, Marks says “On the basis of this I am entirely happy for you to quote as much or as little of the following comments as you wish. If you change the order of phrases or omit portions of sentences I am confident that you will not alter the general sense”.
Judge for yourself whether the general sense has been changed in this case.
Dr Marks said (in 1997)
“There have been dramatic changes over the past decade in our views about that area of health care which comes under the general term “alternative medicine” and Patrick Holford, author of this book has been right at the forefront of many of these changes, particularly those associated with our revised appreciation of human nutrition. I commend this book to you on the basis that it is well researched and written with a substantial backing ofreferences from reliable and peer reviewed scientific and medical journals.
I do not accept all his conclusions and I suspect that his other readers will not agree with all that he says. On the other hand there is considerable food for thought in each chapter and adequate arguments on which you will be able to make up your own mind about the ideas which he puts forward. The road to bad medicine and bad health is built on the foundation of dogma and it is very refreshing to have, in a single readable volume, much of this dogma subjected to fresh examination.”
Compare this with the quotation attributed to Dr Marks in the CV which was submitted by Holford to the University of Teesside.
“There have been dramatic changes over the past decade in our views about healthcare and Patrick Holford has been right at the forefront of many of these changes, particularly with our revised appreciation of nutrition. The road to bad medicine and bad health is built on the foundation of dogma. It is refreshing to have this dogma subjected to fresh examination.”
So what happened to the bit where Marks refers to the work as “Alternative Medicine”.
And what happened to the bit where Marks says “I do not accept all his conclusions and I suspect that his other readers will not agree with all that he says.”
They seem to have vanished without trace.
I rest my case.
Some comments that followed this post
At Holfordwatch “Patrick Holford Refers to Someone Else as Inaccurate”.
And at Quackometer ” Patrick Holford – No Comment”
Curiouser and curiouser. Not only have we the curious case of Dr Marks, but Holford’s CV on his web site, and as submitted to the University of Tesside, has alway said that his degree from the University of York in experimental psychology was taken in 1973 – 1976. But an enquiry to the registrar of the University of York, elicited this response.
| Dear Professor Colquhoun Your enquiry about a claim to hold a degree from the University of York has been passed to me. I can confirm that a BSc in Psychology was awarded to a P J Holford in 1979, as published in the Yorkshire Evening Press on 7 July 1979. Sue Hardman Academic Registrar University of York |
Read much more about all these inconsistencies at Holfordwatch and at Quackometer.
Update 17th September 2007
Another email today from the Registrar reveals that Mr Holford got a 2.2 degree.