Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
evidence
I’m perfectly happy to think of alternative medicine as being a voluntary, self-imposed tax on the gullible (to paraphrase Goldacre again). But only as long as its practitioners do no harm and only as long as they obey the law of the land. Only too often, though, they do neither.
When I talk about law, I don’t mean lawsuits for defamation. Defamation suits are what homeopaths and chiropractors like to use to silence critics. heaven knows, I’ve becomes accustomed to being defamed by people who are, in my view. fraudsters, but lawsuits are not the way to deal with it.
I’m talking about the Trading Standards laws Everyone has to obey them, and in May 2008 the law changed in a way that puts the whole health fraud industry in jeopardy.
The gist of the matter is that it is now illegal to claim that a product will benefit your health if you can’t produce evidence to justify the claim.
I’m not a lawyer, but with the help of two lawyers and a trading standards officer I’ve attempted a summary. The machinery for enforcing the law does not yet work well, but when it does, there should be some very interesting cases.
The obvious targets are homeopaths who claim to cure malaria and AIDS, and traditional Chinese Medicine people who claim to cure cancer.
But there are some less obvious targets for prosecution too. Here is a selection of possibilities to savour..
- Universities such as Westminster, Central Lancashire and the rest, which promote the spreading of false health claims
- Hospitals, like the Royal London Homeopathic Hospital, that treat patients with mistletoe and marigold paste. Can they produce any real evidence that they work?
- Edexcel, which sets examinations in alternative medicine (and charges for them)
- Ofsted and the QCA which validate these exams
- Skills for Health and a whole maze of other unelected and unaccountable quangos which offer “national occupational standards” in everything from distant healing to hot stone therapy, thereby giving official sanction to all manner of treatments for which no plausible evidence can be offered.
- The Prince of Wales Foundation for Integrated Health, which notoriously offers health advice for which it cannot produce good evidence
- Perhaps even the Department of Health itself, which notoriously referred to “psychic surgery” as a profession, and which has consistently refused to refer dubious therapies to NICE for assessment.
The law, insofar as I’ve understood it, is probably such that only the first three or four of these have sufficient commercial elements for there to be any chance of a successful prosecution. That is something that will eventually have to be argued in court.
But lecanardnoir points out in his comment below that The Prince of Wales is intending to sell herbal concoctions, so perhaps he could end up in court too.
The laws
We are talking about The Consumer Protection from Unfair Trading Regulations 2008. The regulations came into force on 26 May 2008. The full regulations can be seen here, or download pdf file. They can be seen also on the UK Statute Law Database.
The Office of Fair Trading, and Department for Business, Enterprise & Regulatory Reform (BERR) published Guidance on the Consumer Protection from Unfair Trading Regulations 2008 (pdf file),
Statement of consumer protection enforcement principles (pdf file), and
The Consumer Protection from Unfair Trading Regulations: a basic guide for business (pdf file).
Has The UK Quietly Outlawed “Alternative” Medicine?
On 26 September 2008, Mondaq Business Briefing published this article by a Glasgow lawyer, Douglas McLachlan. (Oddly enough, this article was reproduced on the National Center for Homeopathy web site.)
“Proponents of the myriad of forms of alternative medicine argue that it is in some way “outside science” or that “science doesn’t understand why it works”. Critical thinking scientists disagree. The best available scientific data shows that alternative medicine simply doesn’t work, they say: studies repeatedly show that the effect of some of these alternative medical therapies is indistinguishable from the well documented, but very strange “placebo effect” ”
“Enter The Consumer Protection from Unfair Trading Regulations 2008(the “Regulations”). The Regulations came into force on 26 May 2008 to surprisingly little fanfare, despite the fact they represent the most extensive modernisation and simplification of the consumer protection framework for 20 years.”
The Regulations prohibit unfair commercial practices between traders and consumers through five prohibitions:-
- General Prohibition on Unfair Commercial
Practices (Regulation 3)- Prohibition on Misleading Actions (Regulations 5)
- Prohibition on Misleading Omissions (Regulation 6)
- Prohibition on Aggressive Commercial Practices (Regulation 7)
- Prohibition on 31 Specific Commercial Practices that are in all Circumstances Unfair (Schedule 1). One of the 31 commercial practices which are in all circumstances considered unfair is “falsely claiming that a product is able to cure illnesses, dysfunction or malformations”. The definition of “product” in the Regulations includes services, so it does appear that all forms medical products and treatments will be covered.
Just look at that!
| One of the 31 commercial practices which are in all circumstances considered unfair is “falsely claiming that a product is able to cure illnesses, dysfunction or malformations” |
Section 5 is equally powerful, and also does not contain the contentious word “cure” (see note below)
Misleading actions
5.—(1) A commercial practice is a misleading action if it satisfies the conditions in either paragraph (2) or paragraph (3).
(2) A commercial practice satisfies the conditions of this paragraph—
(a) if it contains false information and is therefore untruthful in relation to any of the matters in paragraph (4) or if it or its overall presentation in any way deceives or is likely to deceive the average consumer in relation to any of the matters in that paragraph, even if the information is factually correct; and
(b) it causes or is likely to cause the average consumer to take a transactional decision he would not have taken otherwise.
These laws are very powerful in principle, But there are two complications in practice.
One complication concerns the extent to which the onus has been moved on to the seller to prove the claims are true, rather than the accuser having to prove they are false. That is a lot more favourable to the accuser than before, but it’s complicated.
The other complication concerns enforcement of the new laws, and at the moment that is bad.
Who has to prove what?
That is still not entirely clear. McLachlan says
“If we accept that mainstream evidence based medicine is in some way accepted by mainstream science, and alternative medicine bears the “alternative” qualifier simply because it is not supported by mainstream science, then where does that leave a trader who seeks to refute any allegation that his claim is false?
Of course it is always open to the trader to show that his the alternative therapy actually works, but the weight of scientific evidence is likely to be against him.”
On the other hand, I’m advised by a Trading Standards Officer that “He doesn’t have to refute anything! The prosecution have to prove the claims are false”. This has been confirmed by another Trading Standards Officer who said
“It is not clear (though it seems to be) what difference is implied between “cure” and “treat”, or what evidence is required to demonstrate that such a cure is false “beyond reasonable doubt” in court. The regulations do not provide that the maker of claims must show that the claims are true, or set a standard indicating how such a proof may be shown.”
The main defence against prosecution seems to be the “Due diligence defence”, in paragraph 17.
Due diligence defence
17. —(1) In any proceedings against a person for an offence under regulation 9, 10, 11 or 12 it is a defence for that person to prove—
(a) that the commission of the offence was due to—
(i) a mistake;
(ii) reliance on information supplied to him by another person;
(iii) the act or default of another person;
(iv) an accident; or
(v) another cause beyond his control; and
(b) that he took all reasonable precautions and exercised all due diligence to avoid the commission of such an offence by himself or any person under his control.
If “taking all reasonable precautions” includes being aware of the lack of any good evidence that what you are selling is effective, then this defence should not be much use for most quacks.
Douglas McLachlan has clarified, below, this difficult question
False claims for health benefits of foods
A separate bit of legislation, European regulation on nutrition and health claims made on food, ref 1924/2006, in Article 6, seems clearer in specifying that the seller has to prove any claims they make.
Article 6
Scientific substantiation for claims
1. Nutrition and health claims shall be based on and substantiated by generally accepted scientific evidence.
2. A food business operator making a nutrition or health claim shall justify the use of the claim.
3. The competent authorities of the Member States may request a food business operator or a person placing a product on the market to produce all relevant elements and data establishing compliance with this Regulation.
That clearly places the onus on the seller to provide evidence for claims that are made, rather than the complainant having to ‘prove’ that the claims are false.
On the problem of “health foods” the two bits of legislation seem to overlap. Both have been discussed in “Trading regulations and health foods“, an editorial in the BMJ by M. E. J. Lean (Professor of Human Nutrition in Glasgow).
“It is already illegal under food labelling regulations (1996) to claim that food products can treat or prevent disease. However, huge numbers of such claims are still made, particularly for obesity ”
“The new regulations provide good legislation to protect vulnerable consumers from misleading “health food” claims. They now need to be enforced proactively to help direct doctors and consumers towards safe, cost effective, and evidence based management of diseases.”
In fact the European Food Standards Agency (EFSA) seems to be doing a rather good job at imposing the rules. This, predictably, provoked howls of anguish from the food industry There is a synopsis here.
“Of eight assessed claims, EFSA’s Panel on Dietetic Products, Nutrition and Allergies (NDA) rejected seven for failing to demonstrate causality between consumption of specific nutrients or foods and intended health benefits. EFSA has subsequently issued opinions on about 30 claims with seven drawing positive opinions.”
“. . . EFSA in disgust threw out 120 dossiers supposedly in support of nutrients seeking addition to the FSD’s positive list.
If EFSA was bewildered by the lack of data in the dossiers, it needn’t hav been as industry freely admitted it had in many cases submitted such hollow documents to temporarily keep nutrients on-market.”
Or, on another industry site, “EFSA’s harsh health claim regime”
“By setting an unworkably high standard for claims substantiation, EFSA is threatening R&D not to mention health claims that have long been officially approved in many jurisdictions.”
Here, of course,”unworkably high standard” just means real genuine evidence. How dare they ask for that!
Enforcement of the law
Article 19 of the Unfair Trading regulations says
19. —(1) It shall be the duty of every enforcement authority to enforce these Regulations.
(2) Where the enforcement authority is a local weights and measures authority the duty referred to in paragraph (1) shall apply to the enforcement of these Regulations within the authority’s area.
Nevertheless, enforcement is undoubtedly a weak point at the moment. The UK is obliged to enforce these laws, but at the moment it is not doing so effectively.
A letter in the BMJ from Rose & Garrow describes two complaints under the legislation in which it appears that a Trading Standards office failed to enforce the law. They comment
” . . . member states are obliged not only to enact it as national legislation but to enforce it. The evidence that the government has provided adequate resources for enforcement, in the form of staff and their proper training, is not convincing. The media, and especially the internet, are replete with false claims about health care, and sick people need protection. All EU citizens have the right to complain to the EU Commission if their government fails to provide that protection.”
This is not a good start. A lawyer has pointed out to me
“that it can sometimes be very difficult to get Trading Standards or the OFT to take an interest in something that they don’t fully understand. I think that if it doesn’t immediately leap out at them as being false (e.g “these pills cure all forms of cancer”) then it’s going to be extremely difficult. To be fair, neither Trading Standards nor the OFT were ever intended to be medical regulators and they have limited resources available to them. The new Regulations are a useful new weapon in the fight against quackery, but they are no substitute for proper regulation.”
Trading Standards originated in Weights and Measures. It was their job to check that your pint of beer was really a pint. Now they are being expected to judge medical controversies. Either they will need more people and more training, or responsibility for enforcement of the law should be transferred to some more appropriate agency (though one hesitates to suggest the MHRA after their recent pathetic performance in this area).
Who can be prosecuted?
Any “trader”, a person or a company. There is no need to have actually bought anything, and no need to have suffered actual harm. In fact there is no need for there to be a complainant at all. Trading standards officers can act on their own. But there must be a commercial element. It’s unlikely that simply preaching nonsense would be sufficient to get you prosecuted, so the Prince of Wales is, sadly, probably safe.
Universities who teach that “Amethysts emit high Yin energy” make an interesting case. They charge fees and in return they are “falsely claiming that a product is able to cure illnesses”.
In my view they are behaving illegally, but we shan’t know until a university is taken to court. Watch this space.
The fact remains that the UK is obliged to enforce the law and presumably it will do so eventually. When it does, alternative medicine will have to change very radically. If it were prevented from making false claims, there would be very little of it left apart from tea and sympathy
Follow-up
New Zealand must have similar laws.
Just as I was about to post this I found that in New Zealand a
“couple who sold homeopathic remedies claiming to cure bird flu, herpes and Sars (severe acute respiratory syndrome) have been convicted of breaching the Fair Trading Act.”
They were ordered to pay fines and court costs totalling $23,400.
A clarification form Douglas McLachlan
On the difficult question of who must prove what, Douglas McLachlan, who wrote Has The UK Quietly Outlawed “Alternative” Medicine?, has kindly sent the following clarification.
“I would agree that it is still for the prosecution to prove that the trader committed the offence beyond a reasonable doubt, and that burden of proof is always on the prosecution at the outset, but I think if a trader makes a claim regarding his product and best scientific evidence available indicates that that claim is false, then it will be on the trader to substantiate the claim in order to defend himself. How will the trader do so? Perhaps the trader might call witness after witness in court to provide anecdotal evidence of their experiences, or “experts” that support their claim – in which case it will be for the prosecution to explain the scientific method to the Judge and to convince the Judge that its Study evidence is to be preferred.
Unfortunately, once human personalities get involved things could get clouded – I could imagine a small time seller of snake oil having serious difficulty, but a well funded homeopathy company engaging smart lawyers to quote flawed studies and lead anecdotal evidence to muddy the waters just enough for a Judge to give the trader the benefit of the doubt. That seems to be what happens in the wider public debate, so it’s easy to envisage it happening a courtroom.”
The “average consumer”.
(3) A commercial practice is unfair if—
(a) it contravenes the requirements of professional diligence; and
(b) it materially distorts or is likely to materially distort the economic behaviour of the average consumer with regard to the product.
It seems,therefore, that what matters is whether the “average consumer” would infer from what is said that a claim was being made to cure a disease. The legal view cited by Mojo (comment #2, below) is that expressions such as “can be used to treat” or “can help with” would be considered by the average consumer as implying successful treatment or cure.
The drugstore detox delusion. A nice analysis “detox” at .Science-based Pharmacy
It’s hard enough to communicate basic ideas about how to assess evidence to adults without having the effort hindered by schools.
The teaching of quackery to 16 year-olds has been approved by a maze of quangos, none of which will take responsibility, or justify their actions. So far I’ve located no fewer than eight of them.
[For non-UK readers, quango = Quasi-Autonomous Non-Governmental Organisation].
A lot of odd qualifications are accredited by OfQual (see here). Consider, for example, Edexcel Level 3 BTEC Nationals in Health and Social Care (these exams are described here), Download the specifications here and check page 309.
Unit 23: Complementary Therapies for Health and Social Care
NQF Level 3: BTEC National
Guided learning hours: 60Unit abstract
“In order to be able to take a holistic view towards medicine and health care, health and social care professionals need to understand the potential range of complementary therapies available and how they may be used in the support of conventional medicine.”
Well, Goldacre has always said that homeopathy makes the perfect vehicle for teaching how easy it is to be deceived by bad science, so what’s wrong? But wait
“Learners will consider the benefits of complementary therapies to health and wellbeing, as well as identifying any contraindications and health and safety issues in relation to their use.”
Then later
“The holistic approach to illnesses such as cancer could be used as a focus here. For example, there could be some tutor input to introduce ideas about the role of complementary therapies in the treatment and management of cancer, this being followed up by individual or small group research by learners using both the internet and the services available locally/regionally. If available, a local homeopathic hospital, for example, would be an interesting place to visit.”
It’s true that to get a distinction, you have to “evaluate the evidence relating to the use of complementary therapies in contemporary society”, but it isn’t at all clear that this refers to evidence about whether the treatment works.
The really revealing bit comes when you get to the
“Indicative reading for learners
There are many resources available to support this unit.Websites
www.acupuncture.org.uk British Acupuncture Council
www.bant.org.uk British Association for Nutritional Therapy
www.exeter.ac.uk/sshs/compmed Exeter University’s academic department of Complementary medicine
www.gcc-uk.org General Chiropractic Council
www.nimh.org.uk National Institute of Medical Herbalists
www.nursingtimes.net The Nursing Times
www.osteopathy.org.uk General Osteopathic Council
www.the-cma.org.uk The Complementary Medical Association”
This list is truly astonishing. Almost every one of them can be relied on to produce self-serving inaccurate information about the form of “therapy” it exists to promote. The one obvious exception is the reference to Exeter University’s academic department of complementary medicine (and the link to that one is wrong). The Nursing Times should be an exception too, but their articles about CAM are just about always written by people who are committed to it.
It is no consolation that the 2005 version was even worse. In its classification of ‘therapies’ it said “Pharmaceutically mediated: eg herbalism, homeopathy “. Grotesque! And this is the examinng body!
The Teacher
This particular educational disaster came to my attention when I had a letter from a teacher. She had been asked to teach this unit, and wanted to know if I could provide any resources for it. She said that Edexcel hadn’t done so. She asked ” Do you know of any universities that teach CT’s [sic] so I could contact them about useful teaching resources?.” She seemed to think that reliable information about homeopathy could be found from a ‘university’ homeopathy teacher. Not a good sign. It soon emerged why.
She said.
“My students are studying BTEC National Health Studies and the link is Edexcel BTEC National Complimentary [sic] studies.”
“I am a psychotherapist with an MA in Education and Psychology. I am also trained in massage and shiatsu and have plenty of personal experience of alternative therapy”
Shiatsu uh? It seems the teacher is already committed to placebo medicine. Nevertheless I spent some time looking for some better teaching material for 16 year-old children. There is good stuff at Planet
Science, and in some of the pamphlets from Sense about Science, not least their latest, I’ve got nothing to lose by trying it – A guide to weighing up claims about cures and treatments. I sent all this stuff to her, and prefaced the material by saying
“First of all, I should put my cards on the table and say that I am quite appalled by the specification of Unit 23. In particular, it has almost no emphasis at all on the one thing that you want to know about any therapy, namely does it work? The reference list for reading consists almost entirely of organisations that are trying to sell you various sorts of quackery, There is no hint of balance; furthermore it is all quite incompatible with unit 22, which IS concerned with evidence.”
At this point the teacher the teacher came clean too, As always, anyone who disagrees with the assessment (if any) of the evidence by a true believer is unmeasured and inflammatory.
“I have found your responses very unmeasured and inflammatory and I am sorry to say that this prejudicial attitude has meant that I have not found your comments useful.”
shortly followed by
“I am not coming from a scientific background, neither is the course claiming to be scientific.”
That will teach me to spend a couple of hours trying to help a teacher.
What does Edexcel say?
I wrote to Edexcel’s science subject advisors with some questions about what was being taught. The response that I got was not from the science subject advisors but from the Head of Customer support, presumably a PR person.
| From: (Bola Arabome) 12/11/2008 04.31 PM
Dear Professor Colquhoun Thank you for email communication concerning the complementary therapies unit which is available in our BTEC National in Health and BTEC National in Health and Social Care qualifications. I have replied on behalf of Stephen Nugus, our science subject advisor, because your questions do not refer to a science qualification. I would like to answer your questions as directly as possible and then provide some background information relating to the qualifications. The units and whole qualifications for all awarding bodies are accredited by the regulator, the Qualifications and Curriculum Authority. The resource reading list is also produced by us to help teachers and learners. The qualification as a whole is related to the National Occupational Standards for the vocational sectors of Health and Health and social care with consultation taken from the relevant sector skills councils . As you will be aware many of these complementary therapies are available in care centres and health centres under the NHS and in the private sector. The aim of BTEC qualifications is to prepare people for work in these particular sectors. Clearly a critical awareness is encouraged with reference to health and safety and regulation. There are other units, in some cases compulsory, within the qualification with a scientific approach. ‘ ‘ ‘ ‘ ‘ Stephen Harris Head of Customer Support |
Aha, so it seems that teaching people to treat sick patients is “not a science qualification”. Just a business qualification perhaps?. I haven’t yet managed to reach the people who make these decisions, so I persisted with the PR man. Here is part of the next letter (Edexcel’s reply in italic).
| 19 November
I find it quite fascinating that Edexcel regards the treatment of sick patients as not being part of science (“do not refer to a science qualification”). Does that mean Edexcel regard the “Health” part of “Health and Social Care” as being nothing to do with science, and that it therefore doesn’t matter if Health Care is unscientific, or even actively anti-scientific? I am sorry if my answer lacked clarity. My comment, that I had taken your enquiry on behalf of our Science Advisor because this was not a science qualification, was intended to explain why I was replying. It was not intended as a comment on the relationship between Health and Social Care and science. At Edexcel we use bureaucratic categories where we align our management of qualifications with officially recognised occupational sectors. Often we rely on sector bodies such as Sector Skills Councils to endorse or even approve the qualifications we offer. Those involved in production of our Science qualifications and our (4) You say “The qualification as a whole is related to the National Occupational Standards for the vocational sectors of Health and Health and social care with consultation taken from the relevant sector skills councils”. Are you aware that the Skills for Health specifications for Alternative medicine were written essentially by the Prince of Wales Foundation? The qualification was approved by both ‘Skills for Health’ and ‘Skills for Care and Development’ prior to being accredited by QCA. It uses the NOS in Health and Social Care as the basis for many of the mandatory units. The ‘Complementary Therapies’ NOS were not used. This was not a requirement of a ‘Health and Social Care’ qualification. “Are the NOS in Health and Social Care that you mention the ones listed here? http://www.ukstandards.org/Find_Occupational_Standards.aspx?NosFindID=1&ClassificationItemId=174 If so, I can see nothing there about ‘complementary therapies’. if I have missed it, I’d be very grateful if you could let me know where it is. If it is not there, I remain very puzzled about the provenance of Unit 23, since you say it is not based on Skills for Health.” |
Now we are immediately at sea, struggling under a tidal wave of acronyms for endless overlapping quangos. In this one short paragraph we have no fewer than four of them. ‘Skills for Health’, ‘Skills for Care and Development’ , ‘Quality and Curriculum Authority (QCA) and NOS.
It seems that the specification of unit 23 was written by Edexcel, but Harris (25 Nov) declines to name those responsible
“When I refer to our “Health and Social care team” I mean the mix of Edexcel Staff and the associates we employ on a contract basis as writers, examiners and external verifiers. The writers are generally recruited from those who are involved in teaching and assessment the subjects in schools and colleges. The editorial responsibility lies with the Edexcel Staff. I do not have access to the names of the writers and in any case would not be able to pass on this information. Specifications indicate the managers responsible for authorising publication”
“Edexcel takes full responsibility for its ethical position on this and other issues. However we can not accept responsibility for the opinions expressed in third party materials. There is a disclaimer to this effect at the beginning of the specification. ”
” You have the correct link to the Health NOS . These are the standards, which where appropriate, influence our qualifications. However in the case of Unit 23 I understand that there is no link with the Health NOS. I don’t know if the NOS cover the unit 23 content.”
So, contrary to what I was told at first, neither Skills for Health, nor NOS were involved Or were they (see below)?
So who does take responsibility? Aha that is secret. And the approval by the QCA is also secret.
“I cannot provide you with copies of any correspondence between Skills for Health and Edexcel. We regard this as confidential. “
What does the QCA say?
The strapline of the QCA is
“We are committed to building a world-class education and training framework. We develop and modernise the curriculum, assessments, examinations and qualifications.”
Referring school children to the Society of Homeopaths for advice seems to be world-class bollocks rather than world-class education.
When this matter was brought to light by Graeme Paton in the Daily Telegraph, he quoted Kathleen Tattersall, CEO of the QCA. She said
“The design of these diplomas has met Ofqual’s high standards. We will monitor them closely as they are delivered to make sure that learners get a fair deal and that standards are set appropriately.”
Just the usual vacuous bureaucratic defensive sound-bite there. So I wrote to Kathleen Tattersall myself with some specific questions. The letter went on 2nd September 2008. Up to today, 26 November, I had only letters saying
“Thank you for your email of 12 November addressed to Kathleen Tattersall, a response is being prepared which will be forwarded to you shortly.”
“Thank you for your email of 25th November addressed to Kathleen Tattersall. A more detailed response is being prepared which will be sent to you shortly.”
Here are some of the questions that I asked.
| I wrote to Edexcel’s subject advisors about unit 23 and I was told “your questions do not refer to a science qualification”. This seems to mean that if it comes under the name “Health Care” then the care of sick patients is treated as though it were nothing to do with science, That seems to me to be both wrong and dangerous, and I should like to hear your view about that question.
Clearly the fundamental problem here is that the BTEC is intended as a vocational training for careers in alternative medicine, As a body concerned with education, surely you cannot ignore the view of 99% of scientists and doctors that almost all alternative medicine is fraud. That doesn’t mean that you can’t make a living from it, but it surely does create a dilemma for an educational organisation. What is your view of that dilemma? |
Eventually, on 27th November, I get a reply (of sorts) It came not from the Kathleen Tattersall of the QCA but from yet another regulatory body, OfQual, the office of the Qualifications and Examinations Regulator. You’d think that they’d know the answers, but if they do they aren’t telling, [download whole letter. It is very short. The “more detailed response” says nothing.
|
Ofqual does not take a view on the detailed content of vocational qualifications as that responsibility sits with the relevant Sector Skills Council which represents employers and others involved in the sector. Ofqual accredits the specifications, submitted by sector-skilled professionals, after ensuring they meet National Occupational Standards. Ofqual relies on the professional judgement of these sector-skilled professionals to include relevant subjects and develop and enhance the occupational standards in their profession. The accreditation of this BTEC qualification was supported by both Skills for Health, and Skills for Care and Development, organisations which represent the emerging Sector Qualifications Strategies and comply with the relevant National Occupational Standards Isabel Nisbet Acting Chief Executive |
So no further forward. Every time I ask a question, the buck gets passed to another quango (or two, or three). This letter, in any case, seems to contradict what Edexcel said about the involvement of Skills for Health (that’s the talking to trees outfit),
A nightmare maze of quangos
You may well be wondering what the relationship is between Ofqual and the QCA. There is an ‘explanation’ here.
Ofqual will take over the regulatory responsibilities of the Qualifications and Curriculum Authority (QCA), with stronger powers in relation to safeguarding the standards of qualifications and assessment and an explicit remit as a market regulator. The QCA will evolve into the Qualifications and Curriculum Development Agency (QCDA): supporting Ministers with advice and undertaking certain design and delivery support functions in relation to the curriculum, qualifications, learning and development in the Early Years Foundation Stage, and National Curriculum and Early Years Foundation Stage assessments.
Notice tha QCA won’t be abolished. There will be yet another quango.
The result of all this regulatory bureaucracy seems to be worse regulation, Exactly the same thing happens with accreditiation of dodgy degrees in universities.
At one time, a proposal for something like Unit 23 would have been shown to any competent science teacher, who would have said”you must be joking” and binned it. Now a few hundred bureaucrats tick their boxes and rubbish gets approved.
There seems to be nobody in any of these quangos with the education to realise that if you want to know the truth about homeopathy, the last person you ask is the Society of Homeopaths or the Prince of Wales.
What next?
So the mystery remains. I can’t find out who is responsible for the provenance of the appallingly anti-science Unit 23, and I can’t find out how it got approved. Neither can I get a straight answer to the obvious question about whether it is OK to encourage vocational qualifications for jobs that are bordering on being fraudulent.
.All I can get is platitudes and bland assurances. Everything that might be informative is clouded in secrecy.
The Freedom of Information requests are in. Watch this space. But don’t hold your breath.
Follow-up
Here are some attempts to break through the wall of silence.
Edexcel. I sent them this request.
Freedom of Information Act
Hello
I should like to see please all documents from Edexcel and OfQual or QCA (and communications between then) that concern the formulation and approval of Unit 23 (Complementary Therapies) in the level3 BTEC (page 309 in attached document). In vew of the contentious nature of the subject matter, I believe that is is in the public interest that this information be provided
David Colquhoun
The answer was quite fast, and quite unequivocal, Buzz off.
| Dear Mr Colquhoun,
Thank you of your e-mail of today’s date. I note your request for information pursuant to The Freedom of Information Act. As you may know this Act only applies to public bodies and not to the private sector. Edexcel Limited is privately owned and therefore not subject to this Act. Edexcel is therefore not obliged to provide information to you and is not prepared to give you the information you seek. Please do not hesitate to contact me again if you have any further queries. Kate Gregory |
This lack of public accountability just compounds their appalling inability to distinguish education from miseducation.
International Therapy Examination Council (ITEC)
Mojo’s comment, below, draws attention to the Foundation degree in Complementary Therapies offered by Cornwall College, Camborne, Cornwall (as well as to the fact that the Royal National Lifeboat Institution has been wasting money on ‘research’ on homeopathy –write to them).
At least the courses are held on the Camborne campus of Cornwall College, not on the Duchy campus (do we detect the hand of the Quacktitioner Royal in all this nonsense?).
Cornwall College descends to a new level of barminess in its course Crystal Healing VTCT Level 3
“Who is this course for?
This course is designed to enhance the skills of the Holistic Therapist. Crystals may be used on their own in conjunction with other therapies such as Indian Head Massage, Aromatherapy and Reflexology. Due to the nature of the demands of the holistic programme this course is only suitable for students over the age of 18.”
“What will I be doing on the course?
Students will study the art of Crystal healing which is an energy based treatment where crystals and gemstones are used to channel and focus various energy frequencies.”
| .VTCT stands for the Vocational Training Charitable Trust.
It is yet another organisation that runs vocational exams, and it is responsible for this particular horror |
|
The crystals are here. I quote.
Objectives
- the use of interpersonal skills with client
- how to complement other therapies with crystals
- the types and effects of different crystals
- uses of crystals including cleansing, energising, configurations
- concepts of auras and chakras
This is, of course, pure meaningless nonsense. Utter bollocks being offered as further education
Cornwall College has many courses run by ITEC.
The College says
“You will become a professional practitioner with the International Therapy Examination Council (ITEC), study a number of essential modules to give a vocational direction to your study that include: Homeopathy and its application,”
| Who on earth, I hear you cry, are ITEC? That brings us to the seventh organisation in the maze of quangos and private companies involved in the miseducation of young people about science and medicine. It appears, like Edexcel, to be a private company though its web site is very coy about that. |  |
After the foundation degree you can go on to “a brand new innovative BSc in Complementary Health Studies (from Sept 2009)”
The ITEC web site says
- ITEC qualifications are accredited by the Office of the Qualifications and Examination Regulator (OFQUAL)
- ITEC qualifications are funded in the uk by the on behalf of Department for Innovation, Universities and Skills (DIUS)
- ITEC qualifications have been mapped to the National Occupational Standards, where they exist
Oddly enough, there is no mention of accreditation by a University (not that that is worth much). So a few more Freedom of Information requests are going off, in an attempt to find out why are kids are being miseducated about science and medicine.
Meanwhile you can judge the effect of all that education in physiology by one of the sample questions for ITEC Unit 4, reflexology.
The pancreas reflex:
A Extends across both feet
B Is on the right foot only
C Is on the left foot only
D Is between the toes on both feet
Uhuh, they seem to have forgotten the option ‘none of the above’.
Or how about a sample question from ITEC Unit 47 – Stone Therapy Massage
Which organ of the body is associated with the element fire?
A Heart
B Liver
C Spleen
D Pancreas
Or perhaps this?
Which incantation makes hot stones work best?
A Incarcerous
B Avada Kedavra,
C Dissendium
D Expelliarmus.
(OK I made the last one up, with help from Harry Potter, but it makes just about as much sense as the real ones).
And guess what? You can’t use the Freedom of Information Act to find out how this preposterous rubbish got into the educational system because ” ITEC is a private organisation therefore does not come under this legislation”. The ability to conduct business in secret is a side effect of the privatisation of public education is another reason why it’s a bad idea.
Ofsted
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Ofsted has inspected Cornwall College. They say “We inspect and regulate to achieve excellence in the care of children and young people, and in education and skills for learners of all ages.”. I can find no mention of this nonsense in their report, so I’ve asked them. |
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Ofsted has admitted a spectacular failure in its inspection of child care in the London Borough of Haringey. Polly Curtis wrote in the Guardian (6 Dec 2008) “We failed over Haringey – Ofsted head”. It was the front page story. But of course Ofsted don’t take the blame, they say they were supplied with false information,
That is precisely what happens whenever a committee or quango endorses rubbish. They look only at the documents sent to them and they don’t investigate, don’t engage their brains.
In the case of these courses in utter preposterous rubbish, it seems rather likely that the ultimate source of the misinformation is the Princes’ Foundation for Integrated Health. Tha views of the Prince of Wales get passed on to the ludicrous Skills for Health and used as a criterion by all the other organisations, without a moment of critical appraisal intervening at any point.
2 December 2008 A link from James Randi has sent the hit rate for this post soaring. Someone there left are rather nice comment.
“A quango seems to be a kind of job creation for the otherwise unemployable ‘educated ‘( degree in alternative navel contemplation) middle classes who can’t be expected to do anything useful like cleaning latines ( the only other thing they seem qualified for ). I really hate to think of my taxes paying for this codswollop.”
Today brings a small setback for those of us interested in spreading sensible ideas about science. According to a press release
“The BMJ Group is to begin publishing a medical journal on acupuncture from next year, it was announced today (Tuesday 11 November 2008).
This will be the first complementary medicine title that the BMJ Group has published.”
And they are proud of that? What one earth is going on? The BMJ group is a publishing company which says, of itself,
“Our brand stands for medical credibility. We are one of the world’s best known and most respected medical publishers.”
Well perhaps it used to be.
They have certainly picked a very bad moment for this venture. In the last year there have been at least five good books that assess the evidence carefully and honestly. Of these, the ones that are perhaps the best on the subject of acupuncture are Singh & Ernst’s Trick or Treatment and Barker Bausell’s Snake Oil Science. Both Ernst and Bausell have first hand experience of acupuncture research. And crucially, none of these authors has any financial interest in whether the judgement goes for acupuncture or against it.
Here are quotations from Singh & Ernst’s conclusions
“Reliable conclusions from systematic reviews make it clear that acupuncture does not work for a whole range of conditions, except as a placebo.”
“There are some high quality trials that support the use of acupuncture for some types of pain and nausea, but there are also high quality trials that contradict this conclusion. In short, the evidence is neither consistent nor convincing – it is borderline.”
The House of Lords’ report in 2000 tended to give acupuncture the benefit of the (very considerable) doubt that existed at the time the report was written. Since that time there have been a lot of very well-designed trials of acupuncture.
Now it is quite clear that, for most (and quite possibly all) conditions, acupuncture is no more than a particularly theatrical placebo. Perhaps that is not surprising insofar as the modern western practice of acupuncture owes more to Chinese nationalistic propaganda that started in the time of Mao-Tse Tung than it owes to ancient wisdom (which often turns out to be bunk anyway).
The BMJ Group has decided to endorse acupuncture at a time when it is emerging that the evidence for any specific effect is very thin indeed. Well done.
The journal in question is this.
Acupuncture in Medicine is a quarterly title, which aims to build the evidence base for acupuncture. It is currently self-published by the British Medical Acupuncture Society (BMAS).
One good thing can be said about the Society and the Journal. That is that they don’t espouse all the mumbo-jumbo about ‘meridians’ and ‘Qi’. This, of course, puts them at odds with the vast majority of acupuncture teaching. This sort of internecine warfare between competing sects is characteristic of all sorts of alternative medicine. But that is just ideology. What matters is whether or not sticking needles in you is actually anything more than a placebo.
British Medical Acupuncture Society (BMAS)
The British Medical Acupuncture Society (BMAS). is “a registered charity established to encourage the use and scientific understanding of acupuncture within medicine for the public benefit.”. The phrase “encourage the use” suggests that they do not even envisage the possibility that it might not work. Their web site includes these claims.
Acupuncture can help in a variety of conditions:
- Pain relief for a wide range of painful conditions
- Nausea, especially postoperative nausea and vomiting
- Overactive bladder, also known as bladder detrusor instability
- Menstrual and menopausal problems, eg period pains and hot flushes
- Allergies such as hay fever and some types of allergic rashes
- Some other skin problems such as ulcers, itching and localised rashes
- Sinus problems and more
Presumably the word “help” is chosen carefully to fall just short of “cure”. The claims are vaguely worded, but let’s see what we can find about them from systematic reviews. It appears that the BMAS is being rather optimistic about the evidence.
BMJ Clinical Evidence is considered reliable and is particular interesting because it is owned by the BMJ Publishing Group.
Low Back Pain (chronic) Acupuncture is listed as being of “unknown effectiveness”.
Dysmenorrhoea Acupuncture is listed as being of “unknown effectiveness”.
Osteoarthritis of the knee. Acupuncture is listed as being of “unknown effectiveness”.
Psoriasis (chronic plaque) Acupuncture is listed as being of “unknown effectiveness”.
Neck pain “Acupuncture may be more effective than some types of sham treatment (not further defined) or inactive treatment (not further defined) at improving pain relief at the end of treatment or in the short term (less than 3 months), but not in the intermediate term (not defined) or in the long term (not defined)”
Headache (chronic tension-type) Acupuncture is listed as being of “unknown effectiveness”.
What about the greatest authority, the Cochrane Reviews?
Cochrane Reviews
Low back pain The data do not allow firm conclusions about the effectiveness of acupuncture for acute low-back pain. For chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and “alternative” treatments. The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low-back pain. Because most of the studies were of lower methodological quality, there certainly is a further need for higher quality trials in this area.
Chronic asthma. There is not enough evidence to make recommendations about the value of acupuncture in asthma treatment. Further research needs to consider the complexities and different types of acupuncture.
But most of the vaguely-worded claims made by BMAS have not been the subject of Cochrane reviews. The obvious interpretation of that is that there is not enough evidence to make it worth writing a review. In which case, why does BMAS claim that acupuncture can “help”?
Bandolier is another excellent source of high quality information, This was their view in September 2006
“Large, high-quality randomised trials of acupuncture have been published since the reviews. In fibromyalgia, chemotherapy-induced nausea and vomiting, breech presentation, tension headache, and migraine, all were negative compared with sham acupuncture. One in osteoarthritis of the knee, had statistical improvement over sham acupuncture at three months, but not later. Both large trials and this review of reviews come to the same general conclusion; that over a whole range of conditions and outcomes acupuncture cannot yet be shown to be effective.”
After thousands of years of acupuncture (or at least almost 40 years in the West) there seems to be very little to show for it.
The journal: Acupuncture in Medicine
What about the journal in question? Like all journals devoted to alternative medicine, it claims to be evidence-based. And like all journals devoted to alternative medicine it suffers from a fatal conflict of interest. If this journal were ever to conclude that acupuncture is a placebo, it would destroy the journal and the livelihoods of many of the people who write for it.
Scanning the first three issues of 2008 shows that it is very much like other alternative medicine journals. Most of the papers don’t address the critical question, is it a placebo. And most papers end up rather limply, with a statement along the lines “acupuncture may be useful for ***. More research is needed.”
The editor in chief of the journal is Dr Adrian White, and its editor is Michael Cummings. White is quoted by Ernst in the Guardian in 2004.
“We need to provide hard evidence to support what we all see in our clinics every day: that the modern approach to acupuncture works, and is highly relevant to the new, patient-centred NHS.” .
That means the answer is assumed in advance. That just isn’t science.. ‘We know the answer, all we have to do now is get some evidence’.
Why should the BMJ Group want to do a thing like this?
The press release says
Commenting on the move, BMJ and BMJ Journals Publishing Director, Peter Ashman, said “The journal is a good complement for our existing portfolio of journals and we’re certain that the Society’s members and other subscribers will appreciate the benefits of the decision the BMAS has made on their behalf.”
He continued: “The BMAS is ambitious for its journal to grow and flourish and we’re looking forward to working with the Society to develop an editorial and commercial strategy which will achieve the aims of BMAS and those of its members, while reaching out to the wider global community interested in this fascinating area of medicine.”
Yes, you got it. Money. The same motive that causes some vice-chancellors to bring their university into disrepute by awarding BSc degrees in subjects that are not only not science, but which are oftenly openly anti-science.
Conscience doesn’t seem to bother these people, so let’s put the problem in purely cash terms.
Both the BMJ Group and the vice-chancellors will have to decide whether the cash they gain is sufficient to counterbalance the corrosive effects of their actions on their own reputations.
Follow-up
Only a couple of days later, two new trials show acupuncture is no different from sham controls for helping IVF pregnancy rates. James Randerson in the Guardian writes thus.
“Acupuncture aimed at improving IVF success rates is widely offered by fertility clinics in the UK. In the first of the studies, researchers in Hong Kong split 370 women receiving IVF into two groups. One group received real acupuncture before and after having an IVF embryo implanted into their uterus. The other had the same procedure, except the treatment used retractable needles that did not penetrate the skin.”
“Of the 185 who received the sham treatment, 91 achieved a clinical pregnancy (foetal heartbeat identified using ultrasound) and 71 had a successful delivery. This compared with 72 clinical pregnancies in the true acupuncture group and 55 live births. The differences between the groups were not statistically significant.”
“In a second study, researchers in Chicago used a similar design in which 124 women received true or sham acupuncture. The control group had their skin punctured by real acupuncture needles, but not at genuine “Qi-lines” on the body. In the true acupuncture group, 43.9% achieved a clinical pregnancy, compared with 55.2% of the women given the sham treatment. “
The original paper for the first study can be seen here.
Jump to follow-up: Brian Kaplan
| Obama wins! Bush and Blair have gone. Could this mark the beginning of the end of the fashion for believing things that aren’t true? |
Trinity College Dublin: the Phil. “Creationism is a valid world view”
This is the 324th year of the Trinity College Philosophical Society (known locally as the ‘Phil’). Its former members include Bishop Berkeley, Dean Jonathan Swift, Oscar Wilde, Bram Stoker, Samuel Beckett, and E.T.S. Walton . It was founded for “discourse of philosophy, mathematics, and other polite literature ”, and is now a debating society.
The motion was Creationism is a Valid World view. At the dinner before the debate, the students all dutifully stood as one of them recited long graces in Latin both before and after eating. All very Oxbridge. So I wasn’t optimistic. However I hadn’t taken into account the conformist tendencies of undergraduates. Notwithstanding the Latin graces, the result of the debate was very clear indeed.
Result. The Creationists were totally wiped out. Almost the only vote for the motion was a young born-again student, who made a desperately sincere speech.
I don’t need to give the details of what happened, because the opposer of the motion, Bob Bloomfield (of the Natural History Museum) has given an excellent account (The Discovery Institute send big guns to Ireland but only manage to fire blanks) on the Beagle project blog. Two of the proposers were Americans, from the Discovery Institute, and they said what you’d expect: nothing that would impress anyone with any education. I’ll settle for Bloomfield’s description of me as “charmingly irascible”. Irascible, moi? Well it would make anyone mildly irritated to have to spend time arguing about creationism in 2008.
Religion, all religion, seems to me to be boring and not a thing worth wasting good time on thinking about, but the rise of barmy fundamentalism has made it essential, if only so that genetics can be taught without accusations of racism, I’m entirely with Dawkins, I can’t prove that there is no god, and I can’t guarantee
that the bottom of my garden is free of fairies. Both questions merit about the same amount of time, though if pressed, I’d go for the fairies. They are, allegedly, rather better behaved than gods.
The 24th president of the USA said, when asked for his thoughts on evolution, said
“of course like every other man of intelligence and education I do believe in organic evolution. It surprises me that at this late date such questions should be raised”.
Woodrow Wilson, 1922
That, of course, was from a president who has been described as ” leading intellectual of the Progressive Era”.
How things have changed in the time of Tony Blair, George Bush and Sarah Palin. Very few people had such barmy beliefs in 1960, never mind 1922. My thesis is much the same as that of Francis Wheen in “How mumbo-jumbo conquered the world” Sometime around 1980, with the conjunction of Thatcher, Reagan and Khomeini it came into fashion to believe things that aren’t true, just because you wished they were (actually I’d put it a bit earlier than Wheen: arguably it started when the Beatles went to that guru), It was after that when suddenly people started to believe in magic medicine, religious fundamentalism. weapons of mass destruction, and, ahem, that the market would make us rich if only we would remove all the regulations.
Tony Blair defended in parliament the Emmanuel School which is run by a young earth creationist and used car dealer, Peter Vardy. The head of the school, Nigel McQuoid, features strongly on the web site of the Christian Institute, This curious organisation seems to be devoted largely to creationism, homophobia and the virtue of beating children (a search of the site for “corporal punishment” gives 43 hits). An essay by Burns & McQuoid says
“There are those who argue that Science and Christianity can be harmoniously reconciled . ; ;. We cannot subscribe to this view”
The former head of science (yes, of science) at McQuoid’s school, Steven Layfield, had an article on the Christian Institute web site. It vanished as soon as it got some publicity but you can read it at http://www.darwinwars.com/lunatic/liars/layfield.html.
Try this quotation.
“Note every occasion when an evolutionary/old-earth paradigm (millions or billions of years) is explicitly mentioned or implied by a text-book, examination question or visitor and courteously point out the fallibility of the statement. Wherever possible, we must give the alternative (always better) Biblical explanation of the same data.”
| These guys are really at the fruit-cake end of the religious spectrum. In contrast, the young anglican chaplain of Trinity, Darren McCallig, spoke against creationism, eloquently and sensibly. His religiousness did seem at times to be diluted almost to homeopathic extremes, but all the better for that. He seems to have a sense of humour too, judging by the poster for his services. |  click to enlarge |
There is, of course, a very healthy opposition to creationists in the USA too, I like particularly Gerald Weissman’s article “The facts of evolution: fighting the Endarkenment” (it may have been the first time that I saw the wonderful word endarkenment, which describes so well the last 30 years). It starts thus.
“Those of us who practice experimental science are living in the best of times and the worst of times, and I’m not talking about A Tale of Two Cities, but a tale of two cultures. “
Here are a couple of pictures of the meeting.
Chris Stillman (geologist)
Berlinski (left) Luke Ryder (speaking), Bloomfield, DC, Stillman (right)
And some pictures of Dublin here
James Joyce, TCD quadrangle and Molly Malone. Click to view
UCL homeopathy debate
This was organised by the UCL students’ debating society. The Darwin Lecture theatre was surprisingly full for this debate, but they weren’t all students. As usual on these occasions, the homeopaths tried to pack the audience, but this time they failed. That tactic is fair enough I suppose, but it means that the vote failed to tell us anything much about the opinion of students, beyond the fact that not many of them opposed the motion.
There are a few though. To the horror of some of our pharmacology and neuroscience undergraduates, a student society devoted to medicines that don’t work has been started at UCL, for the first time ever. Luckily, it seems to be a rather small society. I was fascinated to see that they are going to hear about the evidence base for complementary therapies, from George Lewith. I had occasion a while ago to look at Dr Lewith’s attitude to evidence: see Lewith’s private clinic has curious standards.
| The proposers were Simon Singh and me. Simon is author of, among other things, Fermat’s Last Theorem and Trick or Treatment. I thought he did an excellent job. Singh pointed out that, contrary to the view propagated by quacks, science likes wacky ideas, as long as you can produce the evidence for them He cited dark matter as an example. |
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The main opposer was my old friend Peter Fisher, homeopathic physician to the Queen. It was a pleasure to show the video of Fisher agreeing with me that there is not enough science in homeopathy to justify a BSc degree in it. Fisher, in his papers, strikes me as one of the most honest of homeopaths. He was “very angry” when homeopaths were caught out recommending their sugar pills to prevent malaria. But is his speech, he struck me as less than honest. He cherry-picked the evidence quite shamelessly as usual. And his suggestion that there was an analogy between the ‘memory of water’ and a DVD was disposed of ably by a physics student who spoke from the floor.
The results were too close for comfort, 65 for, 53 against and an amazing 37 abstentions,
Sadly we’ll never know how the students voted, because of the imported homeopaths.
| Dr Brian Kaplan was there. He had given the meeting some advance publicity, in a web posting that also kindly gave publicity to our 2006 letter to the Times. He didn’t like the letter, which is unsurprising given that it turned out to be more effective than we could ever have hoped (see also here). |  |
On the second row, getting very excited, was homeopath Grace Da Silva-Hill and her husband, She runs the ‘Healing with Grace’ business. On her web site she makes the ludicrous claim that
“Homeopathy will treat the cause of your health problem, not just alleviate your symptom”
She also says, inter alia, that
“Homeopathy is effective in treating a wide range of conditions such as: asthma, . . . “
In contrast, the Cochrane review says
“There is not enough evidence to reliably assess the possible role of homeopathy in asthma. “
I have been sent her account of the debate (a reply to a query from the ubiquitous Dana Ullman).
“Hello Dana, The debate, on monday 20th Oct., organised by UCL debating society, was poorly managed, and biased, attended mostly by students, who appear to have gone there to practice their debating skills. The motion was lost by 12 (65 for and 53 against), with 37 abstentions. Peter Fisher put on a good show, and so did his second, in comparison with the rather stale and poor presentation of Simon and Qulquoun (sorry, can never spell this). My husband Ken did a rather
good caricature of him, unfortunately can’t share it here. Pity there were not more homeopaths/supporters there. Kind regards,”
Uhuh. Well, I guess she would say that.
You can judge the critical faculties of Mrs Da Silva-Hill from a comment she left on a piece in the Daily Telegraph, ‘Homeopathy putting lives at risk with claims’. I quote from it verbatim.
“The public does not care about the research available, the public care about having their health problem sorted, where conv. medicine has failed,”
(I apologise for attributing to Mrs Da Silva in the original post a quotation from the Telegraph that appeared above her name but was actually written by somebody else. I apologise also for using a picture of her without permission.)
On the way out of the debate, I walked back to Euston Road with another homeopath, William Alderson, who had come all the way from Kings Lynn to cast his vote. He was earnest and sincere, the conversation was amicable but his idea of evidence was so different from mine that no progress was made. You can read more about Alderson on Dr Aust’s blog.
It’s fascinating stuff.
Follow-up
Dr Brian Kaplan has posted some splenetic comments on this post. I suppose the paranoid tone is an indication that we are winning, but I do wish he’d be a bit more careful about the facts. Let me correct some of them.
(1)Neither the letter of May 2006, nor its follow up in May 2007, was written under the NHS letterhead. The follow-up letter of May 2007 contained the words
“If you have not already reviewed your own trust’s provision, you might find it useful to consider, in conjunction with your Director of Public Health, the paper that we have enclosed which, while not a full review of the scientific position, has been used by other trusts to promote evidence based commissioning.”
The enclosed form was a sample commissioning letter which reproduced the NHS logo with a notice saying “insert your NHS logo here”. The accompanying letter made it perfectly clear that the enclosed form was simply an example to help those who wanted to save money and not an official NHS communication.
(2) Kaplan says I accuse him of lying to his patients, but his reference is to (an old version of) my Dilemmas at the heart of alternative medicine. It says nothing of the sort. I have said many times that I believe homeopaths are perfectly sincere, but they are just deluded. The reference to lying in the ‘dilemmas’ concerns how to get the maximum placebo effect when you know it is a placebo. Homeopaths have not reached that stage yet.
All this information has been available since May 2007. He should have checked.
It seems that validation committees often don’t look beyond the official documents. As a result, the validations may not be worth the paper they are written on. Try this one.
One of the best bits of news recently was the downfall of Matthias Rath. He’s the man who peddled vitamin pills for AIDS in Africa, and encouraged the AIDS denialists in the South African government. Thabo Mbeki and his Health Minister, Mrs Beetroot, have gone now, thank heavens.
Rath was one of the best illustrations of the murderous effect of selling ineffective treatments. The fact that nobody in the “nutritional therapy” industry has uttered a word of condemnation for this man illustrates better than anything one can imagine the corrupt state of “nutritional therapy”. The people who kept silent include the British Association of Nutritional Therapists (BANT).
It might be surprising, then, to find the Northern College of Acupuncture proudly adding a course in alternative nutrition to its courses in acupuncture (now known to be a theatrical placebo) and Chinese herbal medicine (largely untested and sometimes toxic). It might be even more surprising to find the boast that the course is validated by the University of Wales. It seemed a good idea to find out a bit more about how this came about. Thanks to the Freedom of Information Act, some interesting things can be discovered.
Polly Toynbee’s superb article, Quackery and superstition – available soon on the NHS, written in January 2008, mentioned diplomas and degrees in complementary therapies offered by, among others, the University of Wales. This elicited a letter of protest to Toynbee from the Vice-Chancellor of the University of Wales, Professor Marc Clement BSc, PhD, MInstP, CEng,CPhys,FIET. He invited her to visit the university to see their “validation and monitoring procedures (including the University’s very specific guidelines on health studies disciplines”.
So let’s take a look at these validation procedures and guidelines.
The validation process
The Northern College of Acupuncture submitted a 148 page proposal for the course in October 2007. The document has all the usual edu-bollocks jargon, but of course doesn’t say much about clinical trials, though it does boast about an unblinded trial of acupuncture published in 2006 which, because of lack of appropriate controls, served only to muddy the waters. : This submission was considered by the University’s validation committee last December.
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The whole validation document is only four pages long [download it]. The most interesting thing about it is that the words ‘evidence’ or ‘critical’ do not occur in it a single time. It has all the usual bureaucratic jargon of such documents but misses entirely the central point.
Does that mean that the University of Wales doesn’t care about evidence or critical thinking? Well, not on paper. Two years previously a short document called Health Studies Guidelines had been written by Dr Brian Spriggs (Health Studies Validation Consultant, since retired) for the Health Studies Committee, and it was approved on 21 April 2005. It starts well.
“Degrees in the Health Studies field are expected to promote an understanding of the importance of the scientific method and an evidence-base to underpin therapeutic interventions and of research to expand that base.”
It even goes on to say that a BSc degree in homeopathy is “unacceptable”. Don’t get too excited though, because it also says that acupuncture and Chinese herbal stuff is quite OK. How anyone can imagine they live up to the opening sentence beats me. And it gets worse. It says that all sorts of rather advanced forms of battiness are OK if they form only part of another degree. They include Homeopathy, Crystal therapy. Dowsing, Iridology; Kinesiology, Radionics, Reflexology, Shiatsu, Healing, and Maharishi Ayurvedic Medicine.
Dowsing? Crystal therapy? Just let me remind you. We are living in 2008. It is easy to forget that when ploughing through all this new age junk.
The Validation Handbook of Quality Assurance: Health Studies (2007) runs to an astonishing 256 pages [download the whole thing]. On page 12 we find the extent of the problem.
“The University of Wales validates a number of schemes in the Health Studies field. At the current time we have undergraduate and/or postgraduate degree schemes in Acupuncture, Animal Manipulation, Chiropractic, Herbal Medicine, Integrative Psychotherapy, Osteopathy, Osteopathic Studies, Traditional Chinese Medicine and Regulatory Affairs, both in the UK and overseas.”
That sounds pretty shocking. Further down on page 12, though, we find this.
“Degrees in the Health Studies field are expected to promote an understanding of the importance of the scientific method and an evidence-base to underpin therapeutic interventions and of research to expand that base. The mission is to promote and require the critical evaluation of the practices, doctrines, beliefs, theories and hypotheses that underlie the taught therapeutic measures of the discipline.”
They are indeed fine words. The problem is that I can detect no sign in the submission, nor in its consideration by the validation committee, that any attempt whatsoever was made to ensure that the course complied with these requirements.
The only sign of concern I could detect of any concern about the quality of what was being taught came in a minute to a meeting of the Health Studies Committee meeting on 24th April 2008.
“Members received a copy of an article entitled Quackery and superstition available soon on the NHS which appeared in The Guardian newspaper in January 2008, and a copy of the Vice- Chancellors response. Members agreed that this article was now historical but felt that if/when the issue were to arise again; the key matter of scientific rigour should be stressed. The Committee agreed that this was the most critical element of all degree schemes in the University of Wales portfolio of health studies schemes. It was felt it would be timely to re-examine the schemes within the portfolio as well as the guidelines for consideration of Health Studies schemes at the next meeting. The Committee might also decide that Institutions would be required to include literature reviews (as part of their validation submission) to provide evidence for their particular profession/philosophy. It was agreed that the guidelines would be a vital document in the consideration of new schemes and during preliminary visits to prospective Institutions. “
The Press Office had passed Polly Toynbee’s article to them. Curiously the Health Studies Committee dismissed it as “historical”, simply because it was written three months earlier. That is presumably “historical” in the sense that the public will have forgotten about it, rather than in the sense that the facts of the matter have changed since January. So, at least for the nutrition degree, Toynbee’s comments were simply brushed under the carpet.
After a few cosmetic changes of wording the validation was completed on 16th January 2008. For example the word “diagnosis” was removed in 43 places and “rewritten in terms of evaluation and assessment”. There was, needless to say, no indication that the change in wording would change anything in what was taught to students.
You may think that I am being a bit too harsh. Perhaps the course is just fine after all? The problem is that the submission and the reaction of the validation committee tell you next to nothing about what actually matters, and that is what is taught. There is only a vague outline of that in the submission (and part of it was redacted on the grounds that if it were made public somebody might copy ;it. Heaven forbid).
That is why I have to say, yet again, that this sort of validation exercise is not worth the paper it’s written on.
How can we find out a bit more? Very easily as it happens. Just Google. What matters is not so much formal course outlines but who teaches them.
The nutrition course
The title of the course is just “Nutrition”, not ‘Nutritional Therapy’ or ‘Alternative Nutrition’. That sounds quite respectable but a glance at the prospectus shows immediately that it is full-blown alternative medicine.
Already in July 2007, the glowing press releases for the course had attracted attention from the wonderfully investigative web site HolfordWatch. I see no sign that the validation committee was aware of this. But if not, why not? I would describe is as dereliction of academic duty.
“This pioneering course is unique in that it is firmly rooted in both Western nutritional science and naturopathic medicine and also covers concepts of nutrition within traditional Chinese, Japanese, Tibetan and Ayurvedic medicine.
This means that graduates will gain comprehensive understanding of both modern scientific knowledge and ancient wisdom concerning nutrition and dietetics.”
Ancient wisdom, of course, means something that your are supposed to believe though there is no good reason to think it’s true. In the end, though, almost the only thing that really matters about any course is who is running it. The brochure shows that all of the people are heavily into every form of alternative nuttiness.
Course Director and Tutor: Jacqueline Young nutritionist, naturopath, clinical psychologist and Oriental medical practitioner
Nutrition Tutors:
Elaine Aldred (qualified as a chiropractor with the Anglo European Chiropractic College, as an acupuncturist with the British College of Acupuncture and as a Western Medical Herbalist with the College of Phytotherapy. She recently also qualified in Chinese herbal medicine with the Northern College of Acupuncture.)
Sue Russell (3 year diploma in nutritional therapy at the Institute of Optimum Nutrition. She currently practises as a nutritional therapist and also works part-time as a manager at the Northern College of Homeopathic Medicine.)
Anuradha Sharma (graduated as a dietician from Leeds Metropolitan University in 2002 and subsequently completed a Naturopathy certificate and a post-graduate diploma in acupuncture).
Guest Lecturers include : Dr John Briffa, Professor Jane Plant, M.B.E. (a geochemist turned quack), and, most revealingly, none other than the UK’s most notorious media celebrity and pill peddler, Patrick Holford.
So much has been written about Holford’s appalling abuse of science, one would have thought that not even a validation committee could have missed it.
“The course has been created by Jacqueline Young“, so let’s look a bit further at her track record.
Jacqueline Young has written a book, ‘Complementary Medicine for Dummies’ [Ed: ahem shouldn’t that be Dummies for Complementary Medicine?]. You can see parts of it on Google Books. Did the validation committee bother to look at it? As far as I can tell, the words ‘randomised’ or ‘clinical trial’ occur nowhere in the book.
The chapter on Tibetan medicine is not very helpful when it comes to evidence but for research we are referred to the Tibetan Medical and Astrology Institute. Guess what? That site gives no evidence either. So far not a single university has endorsed Astrology (there is a profitable niche there for some vice-chancellor).
Here are few samples from the book. The advice seems to vary from the undocumented optimism of this
Well researched? No. Safe? Nobody knows. Or this
Mandarin peel prevents colds and flu? Old wive’s tale. Then there are things that verge on the weird, like this one
or the deeply bizarre like this
The problem of Jacqueline Young’s fantasy approach to facts was pointed out at least as far back as 2004, by Ray Girvan., who wrote about it again in May 2005. The problems were brought to wider attention when Ben Goldacre wrote two articles in his Badscience column, Imploding Researchers (September 2005), and the following week, Tangled Webs.
“we were pondering the ethics and wisdom of Jacqueline Young dishing out preposterous, made-up, pseudoscientific nonsense as if it was authoritative BBC fact, with phrases such as: “Implosion researchers have found that if water is put through a spiral its electrical field changes and it then appears to have a potent, restorative effect on cells.” “
and later
“Take this from her article on cranial osteopathy, riddled with half truths: “Sutherland found that the cranial bones (the skull bones encasing the brain) weren’t fused in adulthood, as was widely believed, but actually had a cycle of slight involuntary movement.” In fact the cranial bones do fuse in adulthood.
She goes on: “This movement was influenced by the rhythmic flow of cerebrospinal fluid (the nourishing and protective fluid that circulates through the spinal canal and brain) and could become blocked.” There have now been five studies on whether “cranial osteopaths” can indeed feel these movements, as they claim, and it’s an easy experiment to do: ask a couple of cranial osteopaths to write down the frequency of the rhythmic pulses on the same person’s skull, and see if they give the same answer. They don’t. A rather crucial well-replicated finding to leave out of your story.
That was in 2005 and since then all of Young’s “preposterous, made-up, pseudoscientific nonsense” (along with most of the other stuff about junk medicine) has vanished from the BBC’s web site, after some people with a bit of common sense pointed out what nonsense it was. But now we see them resurfacing in a course validated by a serious university. The BBC had some excuse (after all, it is run largely by arts graduates). I can see no excuses for the University of Wales.
Incidentally, thanks to web archive you can still read Young’s nonsense, long after the BBC removed it. Here is a quotation.
“Implosion researchers have found that if water is put through a spiral its ,field changes and it then appears to have a potent, restorative effect on cells. In one study, seedlings watered with spiralised water grew significantly faster, higher and stronger than those given ordinary water.”
The vice-chancellor of the University of Wales, Marc Clement, is a physicist (Department of Electrical and Electronic Engineering), so can he perhaps explain the meaning of this?
Selection committees for jobs (especially senior jobs) and validation committees for courses, might make fewer mistakes if they didn’t rely so much on formal documents and did a little more investigation themselves. That sort of thing is why the managerial culture not only takes a lot more time, but also gives a worse result.
It would have taken 10 minutes with Google to find out about Young’s track record, but they didn’t bother. As a result they have spent a long time producing a validation that isn’t worth the paper it’s written on. That makes the University of Wales a bit of a laughing stock. Worse still, it brings science itself into disrepute.
Follow-up
What does the University of Wales say? So far, nothing. Last week I sent brief and polite emails to Professor Palastanga and to Professor Clement to try to discover whether it is true that the validation process had indeed missed the fact that the course organiser’s writings had been described as “preposterous, made-up, pseudoscientific nonsense” in the Guardian.
So far I have had no reply from the vice-chancellor, but on .26 October I did get an answer from Prof Palastaga.
| As regards the two people you asked questions about – J.Young – I personally am not familiar with her book and nobody on the validation panel raised any concerns about it. As for P.Holford similarly there were no concerns expressed about him or his work. In both cases we would have considered their CV’s as presented in the documentation as part of the teaching team. In my experience of conducting degree validations at over 16 UK Universities this is the normal practice of a validation panel. |
I have to say this reply confirms my worst fears. Validation committees such as this one simply don’t do their duty. They don’t show the curiosity that is needed to discover the facts about the things that they are meant to be judging. How could they not have looked at the book by the very person that they are validating? After all that has been written about Patrick Holford, it is simply mind-boggling that the committee seems to have been quite unaware of any of it.
It is yet another example of the harm done to science by an unthinking, box-ticking approach.
Pharmacology. A Handbook for Complementary Healthcare Professionals
Elsevier were kind enough to send me an inspection copy of this book, which is written by one of the nutrition course tutors, Elaine Aldred. She admits that pharmacology is “considered by most students to be nothing more that a ‘hoop-jumping’ exercise in the process of becoming qualified”. She also says. disarmingly. that “I was certainly not the most adept scientist at school and found my university course a trial”.
The book has all the feel of a cut and paste job. It is mostly very simple (if not simplistic). though for no obvious reason it starts with a long (and very amateur) discussion of chemical bonding Then molecules are admitted to be indivisible (but, guess what, the subject of homeopathy is avoided). There is a very short section on ion channels, though, bizarrely, it appears under the heading “How do drugs get into cells?”. Since the author is clearly not able to make the distinction between volts and coulombs, the discussion is more likely to confuse the reader than to help.
Then a long section on plants. It starts of by asserting that “approximately a quarter of prescription drugs contain at least one chemical that was originally isolated and extracted from a plant”.. This cannot be even remotely correct. There are vast tables showing complicated chemical structures, but the usual inadequate
list of their alleged actions This is followed by a quick gallop through some classes of conventional drugs, illustrated again mainly by chemical structures not data. Hormone replacement therapy is mentioned, but the chance to point out that it is one of the best illustrations of the need for RCTs is missed.
The one thing that one would really like to see in such a book is a good account of how you tell whether or not a drug works in man. This is relegated to five pages at the end of the book, and it is, frankly, pathetic. It
is utterly uncritical in the one area that matters more than any other for people who purport to treat patients. All you get is a list of unexplained bullet points.
If this book is the source of the “scientific content” of the nutrition course, things are as bad as we feared.
Today is a good day for anyone who deplores dangerous confidence tricksters. In particular it is a good day for Ben Goldacre, and for the Guardian which defended him at potentially enormous expense.
| Matthias Rath, the Dutch (or is it German) vitamin salesman has dropped his libel action against the Guardian. He is the man who is, without doubt, responsible for many deaths form AIDS in Africa, as a result of peddling vitamin pills as cures. The action was taken after Goldacre said, in the Guardian, that Rath aggressively sells his message to Aids victims in South Africa that Rath vitamin pills are better than medication”. |  |
Here is some of what has appeared already today
Fall of the doctor who said his vitamins would cure Aids – from The Guardian, with a video of the villain.
Goldacre’s Badscience blog article on his victory .
Profile of Zackie Achmat – from The Guardian, Mr Achmat is the founder of the Treatment Action Campaign , instrumental in exposing Rath.
Extract from witness statements from the defence in the trial .
And a lot of publicity from Gimpyblog (“Ben Goldacre and The Guardian triumph over murderous Matthias Rath”), Holfordwatch , Quackometer and jdc325 blogs.
Then more in the Guardian the next day, Chris McGreal investigates the Rath Foundation
Nutritional therapist?
Let’s be clear about what the words mean. Nutritional therapists are not like dietitians, and they are not like nutritionists. Nutritional therapists are solidly in the camp of alternative medicine practitioners, Don’t
take my word for it. They say so themselves.
“For nutritional therapists (who practise Complementary and Alternative Medicine) optimum nutrition encompasses individual prescriptions for diet and lifestyle in order to alleviate or prevent ailments and to promote optimal gene expression through all life stages. Recommendations may include guidance on natural detoxification, procedures to promote colon health, methods to support digestion and absorption, the avoidance of toxins or allergens and the appropriate use of supplementary nutrients, including phytonutrients.”
They love to use imaginary words like “detoxification”, and, much more dangerously, they love to pretend that they can cure diseases by changes in diet. As long as you buy from them a stack of expensive “supplement” pills, of course. That means they are selling medicines, but by pretending they are selling food supplements they manage to evade the law that requires medicines to be safe and effective. That will not be so easy under new legislation though, and we can look forward to a few prosecutions soon.
Guess who runs an “Honours BSc degree” in Nutritional Therapy. No prizes for realising it is the UK’s leading university purveyor of woo.
The University of Westminster
On their web site we learn that the Course Leader is Heather Rosa, and the Deputy Course Leader is Val Harvey. Harvey qualified in the subject at the Institute of Optimum Nutrition, the private college run by none other than the famous pill-peddler, Patrick Holford, about whom so very much has been written (try Holfordwatch, or the masterly chapter in Goldacre’s Bad Science)
We don’t know much about what is taught on the Nutritional Therapy course because the University of Westminster has refused repeated requests to say (but watch this space).. One can only assume that, whatever it is, they are not very proud of it. It seems a little unlikely that they will go as far as Matthias Rath and claim to cure AIDS -we’ll just have to wait and see. Meanwhile we can get an inkling by looking elsewhere.
Course leader, Heather Rosa, pops up for example, on the expert panel of a web site called Supplements Compared.com. “Supplements Compared is designed to help you find the best dietary supplement product for your health needs.” And what sort of advice do you find there? Try the page that compares 10 brands of CoQ10 (that is the stuff I wrote about recently, in “Boots reaches new level of dishonesty with CoQ10 promotion” – their advertising was deemed improper by the ASA ). It isn’t a recommended treatment for anything at all, but you certainly wouldn’t guess that from what is written by the ‘expert panel’. The winners are, according to the ‘expert panel’, Boots’ CoQ10 and Holland and Barrett’s CoQ10. Winners? Perhaps the explanation for that comes elsewhere, under “How are we funded?”. “Manufacturers who are awarded “best product” and “worth a look” are given the opportunity to promote this fact throughout the site for an additional fee.”. Well well.
Deputy Course leader, Val Harvey has her own web site and business (I do hope thar Westminster does not pay these people a full time salary too). What can we glean from there? It has the usual scare tactics “Why
you are at risk?“. Never fear; buy enough vitamin pills and you’ll be saved.
Her home page makes some pretty drastic claims.
“Potential health benefits of your nutritional programme
An appropriate Nutritional Programme can benefit many conditions including:
Allergies
Arthritis
Asthma
Bloating, indigestion
Chronic degenerative diseases
Chronic fatigue, ME
Constipation, diarrhoea
Cystitis
Depression, mood swings
Digestive or bowel problems
Eczema, psoriasis, other skin problems
Food sensitivities
Frequent infections
Hormone imbalanceHypertension or elevated cholesterol
Irritable bowel syndrome
Low energy
Menopausal symptoms
Migraines, headaches
Parasitic and fungal infections
Pre-conceptual issues
Premenstrual syndrome (PMS)
Sinus congestion
Stress
Thrush
Weight problems
and many others ….
These are just some of the wide range of health problems that may be helped by nutritional therapy. Even those who consider themselves well and healthy may be able to enhance their physical and mental health, as well as their performance, including athletic performance, by improving their nutrition.”
There is, in my view, not the slightest bit of good evidence that swallowing vitamin pills can benefit most of these conditions.
But at least the list doesn’t contain AIDS, so is all this really relevant to the case of Matthias Rath?
Yes, I believe it is. The University of Westminster may well not support the views of Matthias Rath (they won’t say), but we have heard no choruses of protests about him from any nutritional therapists, as far as I’m aware. There is no mention of him at all on the web site of the British Association of Nutritional Therapists (BANT), the UK club for these people. BANT, by the way, has a rather curious code of ethics. It allows its members to take undisclosed financial kickbacks for the pills they prescribe to patients. If doctors were caught doing that they’d be struck off the register.
It is the existence of degrees in subjects like “nutritional therapy” that gives the subject a spurious air of respectability which allows seriously dangerous people like Rath to flourish with very little criticism. In an indirect way, the vice-chancellors who allow it to flourish (and Universities UK who do nothing about it) must bear some small part of the responsibility for the deaths of thousands of people from AIDS.
It is about time they did something about it.
Follow-up
ANH. The first reaction from the supplement-peddling industry comes from the Alliance for Natural Health on 16th September. It contains not one word of condemnation for Rath’s murderous activities. It’s hard to believe how low they will sink.
The Prince’s Foundation for Integrated Health remains totally silent about Rath. HRH’s concern for health seems to dry up if things don’t suit his views.
The British Association of Nutritional Therapists shows it’s total irresponsibility after a letter was sent to them to ask about their reaction. Their answer , on jdc325’s weblog was “The association has no opinion to offer on Dr Raths vitamin trials.”.
The publication of Gilbey’s paper and my editorial in the New Zealand Medical Journal (NZMJ) led to a threat of legal action by the NZ Chiropractors’ Association Inc for alleged defamation. After publishing a defiant editorial, the editor of the NZMJ offered chiropractors the chance to put their case.
In the last issue of NZMJ (22 Aug 2008) three letters appeared. One was from Brian Kelly, (President, New Zealand College of Chiropractic) [download letter]. One was from Karl Bale (CEO/Registrar, Chiropractic Board New Zealand) [download letter], and one was from Simon Roughan (Registered Chiropractor and Acting President of the New Zealand Chiropractors’ Association) [download letter].
In the current issue (5 September 2008) Gilbey, Ernst and I responded.{download Gilbey response] [download Ernst response].
Here’s mine. The printed version differs in minor ways [download pdf]
| I’m grateful for the opportunity to reply to the defences of chiropractic from Kelly1, Roughan2 and Bale3 in your last issue.
I’d like first to deal with the minor matter of titles, before getting on to the more important question of vidence. I notice that Brian Kelly signs his letter “Dr Brian Kelly B App Sci (Chiro)” in his letter to NZMJ. He seems to be a bit less careful in his use of titles on his own school’s web site where his president’s welcome4 is signed simply “Dr Brian Kelly”, a title he adopts in at least three other places. Karl Bale3 (CEO/Registrar, Chiropractic Board New Zealand) points out that “Failure to qualify the use of the title ‘Doctor’ may contravene the provisions of the Medical Practitioners Act 1995”. One wonders whether Bale has done anything to stop Kelly’s apparent breaches of this rule? This example makes on wonder whether the Chiropractic Board take its responsibilities seriously? It seems often to be the case that ‘voluntary self-regulation’ doesn’t work, because there are too many vested interests. Karl Bale points out that some ruthless sales methods characteristic of chiropractic are also contrary to the Chiropractic Board’s code of ethics. One would hope their well-known antipathy to vaccination and to medicine as a whole were also considered unethical. These practices seem to continue so the the code of ethics It seems to me quite remarkable that none of the letters mentions the ‘subluxation’ that lies at the heart of their subject6. Could that be because they are reluctant to admit openly that it is a mere metaphysical concept, that no one can see or define? It is sad that so many patients are subjected to X-rays in search of this phantom idea. It is this metaphysical nature of chiropractic that separates it quite clearly from science. Brian Kelly says “How can any reader take seriously, anything suggested by a writer who opines that a 19th Century journalist possessed superior “intellectual standards” to “the UK’s Department of Health” and “several university vice chancellors”. The views of the Davenport Leader on chiropractic were mild compared with those of the great H.L. Mencken (1924)7 who wrote “This preposterous quackery flourishes lushly in the back reaches of the Republic, and begins to conquer the less civilized folk of the big cities….” The problem is that the Department of Health is full of arts graduates who may be very good at classics but can’t understand the nature of evidence. And the UK has one vice-chancellor, a geomorphologist, who defends a course in his university that teaches that “amethysts emit high yin energy”8 I’ll admit, though, that perhaps ‘intellect’ is not what’s deficient in this case, but rather honesty. Your correspondents seem to confuse the duration of a course with its intellectual content. You can study homeopathy for years too, but after all that they are still treating sick people with medicines that contain no medicine. Anyone who works in a university knows that you can easily get accreditation for anything whatsoever if you choose the right people to sit on the committee. I have seen only too many of these worthless pieces of paper. “Amethysts emit high yin energy”8 was part of an accredited course (at the University of Westminster) too. Need I say more? Now to the real heart of the problem, namely the question of evidence. Brian Kelly says that the book by Singh and Ernst9 shows “extreme bias”, but what that book actually shows is an extremely scrupulous regard for evidence, Ernst is in a better position to do this than just about anyone else. He has qualified and practised both regular and alternative medicine, and he was appointed to his present position, as professor of complementary and alternative medicine to assess the evidence. Perhaps most importantly of all, his position allows him to do that assessment with complete lack of bias because, unlike Kelly, his livelihood does not depend on any particular outcome of the assessment. I’m afraid that what Kelly describes as “extreme bias” is simply a display of pique because it has turned out that when all the evidence is examined dispassionately, the outcome is not what chiropractors hoped. The fact of the matter is that when you look at all of the evidence, as Singh & Ernst do, it is perfectly clear that chiropractic is at best no better than conventional treatments even for back pain. For all other conditions its benefits fail to outweigh its risks – contrary to the many claims by chiropractors. Both the New Zealand and the UK governments have got themselves into an impossible position by giving official recognition to chiropractic before the evidence was in. Since the conventional manipulative treatments are cheaper, and may be well be safer, and because they involve no quasi-religious ideas like “subluxation” or “innate intelligence”, the only reasonable conclusion is that there is no need for chiropractic to exist at all. They do nothing they do that could not be done as well by medical practitioners and physiotherapists. What will governments do about that, I wonder? David Colquhoun 1. Kelly, B. New Zealand College of Chiropractic response to 2. Roughan, S. Setting the record straight: New Zealand Chiropractors’ Association response letter. NZMJ 22 3. Bale, 4. http://www.nzchiro.co.nz/about_president.php 6. http://www.chirobase.org/01General/chirosub.html 7. http://www.geocities.com/healthbase/mencken_chiro.html 8. http://dcscience.net/?p=227 9. Singh S, Ernst E. Trick or Treatment. Bantam Press; 2008 |
The wars within chiropractic
Although the chiropractors seem to be rather upset by the criticisms that have been levelled against them, the most interesting war is not between chiropractors and people who think that medicine should not be based on metaphysics. It’s the war within chiropractic itself.
The internecine wars within chiropractic have been going almost from the day it was invented. The (ex-)insider’s view gives us a rare insight into what chiropractic schools actually do. Now support has come from a rather unexpected quarter. An article by five chiropractors has just appeared by Murphy et al. (Chiropractic & Osteopathy, 2008, 16:10).
Although the authors declare that they have “a financial interest in the success” of chiropractic, the changes that they propose are so drastic that, if implemented, tthey would leave little left to distinguish chiropractic from, say, physiotherapy. The authors ask the very pertinent question, ‘why is it that podiatry (chiropody in the UK) is well accepted and chiropractic remains on the controversial fringe of medicine?.. Here are some quotations.
“It is also vital that those chiropractors who dogmatically oppose common public health practices, such as immunization [15] and public water fluoridation, cease such unfounded activity.”
“We are concerned that the common perception (which is well supported, in our experience) that chiropractors are only interested in “selling” a lifetime of chiropractic visits may be one of the primary factors behind our low standing in the minds of members of the public [2].”
“One of the problems that we encounter frequently in our interaction with chiropractic educational institutions is the perpetuation of dogma and unfounded claims. Examples include the concept of spinal subluxation as the cause of a variety of internal diseases and the metaphysical, pseudo-religious idea of “innate intelligence” flowing through spinal nerves, with spinal subluxations impeding this flow. These concepts are lacking in a scientific foundation [27] [28] [29] and should not be permitted to be taught at our chiropractic institutions as part of the standard curriculum. Much of what is passed off as “chiropractic philosophy” is simply dogma [30], or untested (and, in some cases, untestable) theories [27] which have no place in an institution of higher learning, except perhaps in an historical context.”
“The Council on Chiropractic Education requirement of 250 adjustments forces interns to use manipulation on patients whether they need it or not, and the radiographic requirement forces interns to take radiographs on patients whether they need them or not.”
“They [podiatrists] did not invent a “lesion” and a “philosophy” and try to force it on the public. They certainly did not claim that all disease arose from the foot, without any evidence to support this notion. The podiatric medical profession simply did what credible and authoritative professions do [32] – they provided society with services that people actually wanted and needed.”
“In the beginning, DD Palmer invented a lesion, and a theory behind this lesion, and developed a profession of individuals who would become champions of that lesion. This is not what credible professions do.”
“In the interim it [chiropractic] has seen its market share dwindle from 10% of the population [4] to 7.5% [3] [42]. Even amongst patients with back pain, the proportion of patients seeing chiropractors dropped significantly between 1987 and 1997, a period of time in which the proportion seeing both medical doctors and physical therapists increased [43].”
“When an individual consults a member of any of the medical professions, it is reasonably expected that the advice and treatment that he or she receives is based in science, not metaphysics or pseudoscience.”
“The chiropractic profession has an obligation to actively divorce itself from metaphysical explanations of health and disease as well as to actively regulate itself in refusing to tolerate fraud, abuse and quackery, which are more rampant in our profession than in other healthcare professions [46].”
“Podiatric medicine is a science-based profession dedicated to the diagnosis and treatment of foot disorders. Foot reflexology is a metaphysically-based group consisting of non-physicians who believe that many physical disorders arise from the foot. Podiatrists have rejected foot reflexology as an unproven and unscientific practice, and do not consider it part of mainstream podiatric practice.”
“We must finally come to the painful realization that the chiropractic concept of spinal subluxation as the cause of “dis-ease” within the human body is an untested hypothesis [27]. It is an albatross around our collective necks that impedes progress.”
All this, remember, comes from five chiropractors. That looks like all out war between their view of chiropractic and that taught in New Zealand College of Chiropractic, and, in the UK by the three chiropractic colleges in the UK.
Follow-up
A report in the New Zealand Herald (18 September 2008) is rather relevant to all this.
Chiropractor to apologise after patient has stroke
A chiropractor has been recommended to apologise to a woman patient who suffered a stroke after he treated her.
The case report is here.
The Advertising Standards Authority has had a bit to say about chiropractors too.
After the announcement that the University of Central Lancashire (Uclan) was suspending its homeopathy “BSc” course, it seems that their vice chancellor has listened to the pressure, both internal and external, to stop bringing his university into disrepute.
An internal review of all their courses in alternative medicine was announced shortly after the course closure. Congratulations to Malcolm McVicar for grasping the nettle at last. Let’s hope other universities follow his example soon.
I have acquired, indirectly, a copy of the announcement of the welcome news.
| Homeopathy, Herbalism and cupuncture Concern has been expressed by some colleagues as to whether the University should offer courses in homeopathy, Herbalism and Acupuncture. Therefore, to facilitate proper discussion on this matter I have set up a working party to review the issues. I have asked Eileen Martin, Pro Vice-Chancellor and Dean of the Faculty of Health, to lead this working party and report to me as soon as possible. Whilst the review is taking place, we need to recognise that there are students and staff studying and teaching on these courses which have satisfied the University’s quality assurance procedures and been duly validated. I would therefore ask that colleagues would refrain from comment or speculation which would cause concern to these students and staff. Staff who wish to express their views on this issue should direct these to Eileen Martin, by the end of September. Regards Malcolm McVicar Vice-Chancellor |
Times Higher Education today reports
“The University of Central Lancashire is to review all its courses in homoeopathy, herbalism and acupuncture after some staff said it should not be offering degrees in “quackery”, Times Higher Education has learnt.
A university spokesman said: “As a university we value and practise transparency and tolerance and welcome all academic viewpoints.”
(Later, an almost identical version of the story ran on the Times Online.)
So far, so good. But of course the outcome of a committee depends entirely on who is appointed to it. Quite often such committees do no more than provide an internal whitewash.
It does seem a bit odd to appoint as chair the dean of the faculty where all these course are run, and presumably generate income. Eileen Martin has often appeared to be proud of them in the past. Furthermore, the whole investigation will (or should) turn on the assessment of evidence. It needs some knowledge of the design of clinical trials and their statistical analysis, As far as I can see, Ms Martin has essentially no research publications whatsoever.
I also worry about a bit about “satisfied the University’s quality assurance procedures and been duly validated”. One point of the investigation should be recognise frankly that the validation process is entirely circular, and consequently worth next to nothing. It must be hard for a vice-chancellor to admit that, but it will be an essential step in restoring confidence in Uclan.
Let’s not prejudge though. If there are enough good scientists on the committee, the result will be good.
I hope that transparency extends to letting us know who will be doing the judging. Everything depends on that.
Follow-up
Well well, there’s a coincidence, Once again, the week after a there is an announcement about degrees in witchcraft, what should pop up again in the column of the inimitable Laurie Taylor in THE. The University of Poppleton’s own Department of Palmistry.
| Letter to the editor
Dear Sir I was shocked to see yet another scurrilous attack upon the work of my department in The Poppletonian. Although Palmistry is in its early days as an academic discipline it cannot hope to progress while there are people like your correspondent who insist on referring to it as “a load of superstitious nonsense which doesn’t deserve a place on the end of the pier let alone in a university”. A large number of people claim to have derived considerable benefit from learning about life lines, head lines and heart lines and the role of the six major mounts in predicting their future. All of us in the Palmistry Department believe it vitally important that these claims are rigorously examined. How else can science advance? Yours sincerely, |
My original piece on Integrative Baloney@Yale was posted on May 16th, after I got back from a visit there. The talk I gave there included a short video. My movie, Integrative baloney@Yale, was made entirely from clips taken from Yale’s own YouTube movies which showed something approaching three hours of its “1st Annual Scientific [sic] symposium”, entitled “Complementary and Alternative Medicine: Evidence for Integration”. I had merely interspersed a few titles to show the worst scientific absurdities of that rather pathetic event. YouTube removed the movie last week.
You can download the movie here [15.8 Mb, wmv file].
It should soon reappear on YouTube (actually it took over a month and several reminders, but eventually they kept their word in the end).
Yale’s lawyers had written to YouTube, to have my movie removed. I guess if you have no evidence, all you can do is resort to law to suppress the views of those who have the temerity to point out that the emperor is naked. Last week it was New Zealand Chiropractors’ Association Inc. This week the rather more substantial Yale University. We live in interesting times.
This is what I got on 15th August.
| Dear Member
This is to notify you that we have removed or disabled access to the following material as a result of a third-party notification by Yale University, Yale School of Medicine (CME) claiming that this material is infringing: Integrative baloney@Yale: http://uk.youtube.com/watch?v=HEl2fhfGBdI Please Note: Repeated incidents of copyright infringement will result in the deletion of your account and all videos uploaded to that account. In order to prevent this from happening |
If you clicked on the link you saw
“This video is no longer available due to a copyright claim by Yale University, Yale School of Medicine (CME)”
It seems that Yale’s Continuing Medical Education (CME) department was responsible.
Of course Yale is correct. I expect they own the copyright of their original movies, but they are not what I posted. I would argue that selecting 6 minutes from a 3 hour original amounts to “fair quotation”, no different from when one cites a short passage from somebody else’s book or paper. Perhaps Yale was just a bit jealous that my movie was getting viewed a lot more times than theirs. Or perhaps they were a bit peeved that a Google search for “Yale Integrative Medicine” produced my movie as #2 (add the word movie and I was #1).
My movie seems to me to be fair comment from someone who is a pharmacologist by trade. Apparently it didn’t seem that way to the apparatchiks of Yale Medical School, who seem to think that academic arguments should be settled by paying lawyers to suppress views they don’t like, rather than by rational discussion.
It’s interesting that the three hours of Yale’s own movie have also vanished from YouTube. Could that be because they realise that the remarks made at the meeting are so embarrassing intellectually that it would be better not to make them public? Actually, no.
What does Yale CME say?
Rather than publishing this straight away, I thought it better to delve a bit further into what had happened. I lodged an appeal with YouTube and I wrote to Ronald J. Vender, MD (Associate Dean, YSM Clinical Affairs, CMO, Yale Medical Group, Medical Director, Yale CME ). The outcome was rather interesting.
First, it turned out that the original posting of the three hours of the symposium proceedings on YouTube was itself unauthorised, which is why it suffered the same fate as my movie.
Dr Vender told me that he is new to the job, and didn’t know about the incident. What’s more surprising, he said he “did not know an Integrative Program even existed at Yale”. That does seem a bit odd indeed for an Associate Dean of Clinical Affairs.
However, Dr Vender turned out to be a very reasonable man,.After some amiable correspondence over the weekend, it took him only a day and a half to sort the matter out. After talking to Yale’s attorney, he wrote on 19th August, thus
“The University attorney believes that there is in fact a difference between the initial unauthorized filming of an entire conference as opposed to quoting from that conference. Therefore, she has agreed to withdraw the injunction that has been imposed on your use of the material. YouTube will be contacted.”
That’s good for me, but it isn’t the main thing. The movie would doubtless have been seen by more people if Yale had tried to maintain the ban. Much more impressively, Dr Vender also said
“As for this particular program, I will be speaking with Dr Belitsky and the program directors to encourage them to adopt a more critical view of the scientific basis for claims made by proponents of CAM. They will also be encouraged to develop a future program that includes faculty who have opposing points of view.”
It remains to be seen what actually happens, but so far, so good.
What next?
The removal of the original videos of the meeting is understandable because they were pretty embarrassing to Yale. But can that be the real reason? I was told that it is simply because their posting was “unauthorised”. But Yale Continuing Medical Education still boasts about the meeting on their own web site. They describe the meeting as “successful”, but if they are so proud of it, why remove the video from YouTube whether it was authorised or not? We are told
“The symposium, accredited for 7.5 AMA PRA Category 1 Credits, began what is hoped to be a long tradition at the Yale School of Medicine.”
They give credits for such miseducation?
Dr Katz’s phrase “we need a more fluid concept of evidence” now gets about 148 hits in Google, since I first helped him to publicise it.
Two of the six “learning objectives” that Yale CME lists for this symposium are particularly revealing.
- Describe therapeutic benefits and recent scientific evidence supporting a wide range of safe and practical complementary treatments, including acupuncture, massage, yoga, meditation, nutrition and exercise
- Identify and discuss barriers to CAM use, practice and research, as well as propose ways of overcoming these barriers
‘Describe the evidence supporting complementary treatments’? But don’t on any account describe the much more substantial evidence that does not support them? A question (or “learning objective”) put in this loaded way is the very antithesis of education.
Equally the second ‘learning objective’ carries with it the assumption that CAM works, otherwise why would anyone want to overcome the barriers to it?
This is indoctrination, not education. It betrays everything that a university should stand for.
Let’s hope the new head of CME, the admirable Dr Vender, succeeds in doing something about it
Follow-up
Success!. Well I think it is success. On 26 November 2008, the admirable Dr Vender wrote to me as follows.
“I do not know if another CAM/Integrative Medicine program is planned at Yale. However, based on the new ACCME standards, this program does not fulfil the standards for receiving CME accreditation (by my interpretation of the standards). At least one of last year’s program directors has been notified already.”
| A report has appeared on Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine. The report is written by people all of whom have vested interests in spreading quackery. It shows an execrable ability to assess evidence, and it advocates degrees in antiscience It would fail any examination. Sorry, Prof Pittilo, but it’s gamma minus.[Download the report] |  |
Alice Miles put it well in The Times, today.
“This week came the publication of the “Report to Ministers from the Department of Health Steering Group on the Statutory Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and Other Traditional Medicine Systems Practised in the UK”. Otherwise known as twaddle.” . . .
“Regulate the practitioners – for safety, note, not for efficacy, as that is impossible to prove – and you give them official recognition. From recognition it is but a short hop to demand and then prescription: packet of Prozac, bit of yoga and a bag of dodgy herbs for you, sir.” . . .
“The Government responded on Monday – with a three-month consultation. So join in. Write to the Health Minister Ben Bradshaw at Richmond House, 79 Whitehall, SW1A 2NS. Write, on behalf of the NHS: “What I want for my 60th birthday is… the chance to provide medical, dental, and nursing care to all. And absolutely nothing else.”
Judging by Ben Bradshaw’s speech to the Prince’s Foundation, there may be a problem in conveying to him the evidence, but one can and must try.
Why is it that a health joutnalist can do so much better than a university head? Yes, the chair of the steering group is Professor R. Michael Pittilo BSc PhD CBiol FIBiol FIBMS FRSH FLS FRSA, Principal and Vice-Chancellor of The Robert Gordon University, Aberdeen. Despite all those impressive-lookin initials after his name, I believe that this is a very bad report.
Here is something about Prof Pittilo from his university’s web site (the emphasis is mine).
Professor Michael Pittilo joined The Robert Gordon University, Aberdeen, as Principal and Vice-Chancellor on 5th September, 2005.
After postdoctoral research on arterial disease at the University of London, he was appointed to Kingston University where he became Head of Life Sciences. In 1995 he became Foundation Dean of the Faculty of Health and Social Care Sciences at Kingston University and St George’s Medical School (University of London). He was appointed Pro Vice Chancellor at the University of Hertfordshire in 2001.
Professor Pittilo has held a number of additional roles, including chairing Department of Health working groups, and as a trustee for the Prince of Wales’s Foundation for Integrated Health. “
Notice that Prof Pittilo is a Trustee of the Prince’s Foundation for Integrated Health, source of some of the least reliable information about alternative medicine to be found anywhere.
This steering group is, as so often, a nest of vested interests. It does not seem to have on it any regular medical or clinical scientist whatsoever. Why not? They just might produce some embarrassing facts perhaps? Like most government committees its members seem to have been chosen to produce the desired outcome.
For a start, the university run by Prof Pittilo, Robert Gordon’s University, is itself involved in a few antiscientific courses. Since his report recommends that degrees in quackery should become mandatory, I expect he’d welcome the chance to run more. Amazingly, Robert Gordon’s University runs an Introduction to Homeopathy, just about the daftest of all the common sorts of magic medicine.
Most of the the members of the steering group represent vested interests, though strangely this is not made clear in the list of members. An earlier report, in 2006, from the steering group was more open about this. Twelve of the members of the group represent Herbal Medicine, Chinese Medicine and Acupuncture (four from each). Most of the rest are lay members or bureaucrats. With membership like that it is, I suppose, not surprising that the assessment of evidence is, to put it kindly, grossly distorted and woefully inadequate.
The report starts badly by failing to mention that the House of Lords report (2000), and the government’s response to it, set the following priorities. Both state clearly
“… we recommend that three important questions should be addressed in the following order . .
- (1) does the treatment offer therapeutic benefits greater than placebo?
- (2) is the treatment safe?
- (3) how does it compare, in medical outcome and cost-effectiveness, with other forms of treatment?
The word ‘placebo’ does not occur a single time in the main report (and only twice in the text of the seven appendices). But they do say (page 11):
“We recommend that public funding from the NHS should be used to fund CAM therapies where there is evidence of efficacy, safety and quality assurance.”
The evidence
The problem is that the assessment of the evidence for efficacy in the report is pathetically poor. The report, sad to say, consists essentially of 161 pages of special pleading by the alternative medicine industry, served up with the usual large dose of HR gobbledygook.
There is really no excuse for this utterly incompetent assessment. There have been plenty of books this year alone that make excellent summaries of the evidence, mostly written for the lay public. They should, therefore, be understandable by any university vice-chancellor (president). The one benefit of the upsurge in public interest in magic medicine is that there are now quite a lot of good clinical trials, and when the trials are done properly, they mostly confirm what we thought before: in most cases the effects are no more than placebo.
Here is one example. Annexe1 concerns “Developing Research and Providing an Evidence Base for Acupuncture and Herbal/Traditional Medicine Treatment”. The wording of the title itself suggests, rightly, that this evidence base does not exist, in which case why on earth are we talking about them as “professions”? The discussion of the evidence in Annexe 1 is nothing if not partial. But what do you expect if you ask herbalists to assess herbal medicine? An honest assessment would put them out of business. The eternal mantra of the alternative industry appears as usual, “Absence of evidence is, of course, not evidence of absence”. True of course, but utterly irrelevant. Annexe 1 says
“Acupuncture is a complex intervention and lack of a suitable placebo control has hindered efforts to evaluate efficacy”
This is simply untrue, In recent years enormous efforts have been put into devising controls for assessment of acupuncture, but they are entirely ignored here. One thing that has been established quite clearly is that it makes no difference where you put the needles, so all the talk of Qi and meridians is obvious mumbo-jumbo.
Have the authors of Annexe 1, and Professor Pittilo, not read the relevant studies? Two books this year have dealt with the question of evidence with great care. They are both by people who have been involved personally with acupuncture research, Prof Edzard Ernst and Dr Barker Bausell. Edzard Ernst is the UK’s first Professor of Complementary Medicine. Barker Bausell was research director of an NIH-funded Complementary and Alternative Medicine Specialized Research Center at the University of Maryland.
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Singh and Ernst discuss thoroughly the question of controls and assess all the evidence carefully. Their conclusions include the following.
- The traditional principles of acupuncture are deeply flawed, as there is no evidence at all to demonstrate the existence of Ch’i [Qi] or meridians.
- By focussing on the increasing number of high-quality research papers, reliable conclusions from systematic reviews make it clear that acupuncture does not work for a whole range of conditions, except as a placebo.
- In short, the evidence is neither consistent nor convincing. It is borderline.
Barker Bausell was himself involved in designing and analysing trialsof acupuncture. His conclusions are even less positive.
“There is no compelling, credible scientific evidence to suggest that any CAM therapy benefits any medical condition or reduces any medical symptom (pain or otherwise) better than a placebo”.
These are serious authors with direct experience in CAM research, which is more than can be said of anyone on the steering group. Why are their conclusions ignored entirely? That is sheer incompetence.
Degrees in anti-science
One conclusion of the report is that
“The threshold entry route to the register will normally be through a Bachelor degree with Honours”
This is utter nonsense. It is quite obvious surely that you can’t award honours degrees until after you have the evidence. You can read on page 55 of the report
“3a: Registrant acupuncturists must:
understand the following aspects and concepts for traditional East-Asian acupuncture:
– yin/yang, /5 elements/phases, eight principles, cyclical rhythms, qi ,blood and body fluids, different levels of qi, pathogenic factors, 12 zang fu and 6 extraordinary fu, jing luo/ meridians, the major acupuncture points, East-Asian medicine disease categorisation, the three burners, the 4 stages/levels and 6 divisions
– causes of disharmony/disease causation
– the four traditional diagnostic methods: questioning, palpation, listening and observing”
This is utter baloney. Anyone who advocates giving honours degrees in such nonsense deserves to be fired for bringing his university into disrepute (and, in the process, bringing all universities and science itself into disrepute).
That includes also degrees that teach that “amethysts emit high yin energy“.
So what should be done?
If making peole do degrees in mumbo-jumbo is not the answer, what is? Clearly it would be far too draconian to try to ban quackery (and it would only increase its popularity anyway).
The answer seems to me to be quite simple. All that needs to done is to enforce existing laws. It is already illegal to sell contaminated and poisonous goods to the public. It is already illegal to make fraudulent advertisemants and to sell goods that are not as described on the label.
The only problem is that the agencies that enforce these rules are toothless and that there are a lot of loopholes and exceptions that work in favour of quackery. I have tried myself to complain about mislabelling of homeopathic pills to the Office of Fair Trading on the grounds that are labelled Arnica 30C but contain no Arnica. They solemnly bought a bottle and sent it to an analyst and of course they found no arnica, But nothing happened, because an exception to the usual law applies to homeopathic pills.
The Advertising Standards Authority is good as far as it goes. They quickly told Boots Pharmacies to withdraw advertisements that claimed CoQ10 “increased vitality”. But they can exact no penalties and they can’t deal with lies that are told to you orally, or with anything at all on the web.
The Health Professions Council (HPC) says that one of the criteria for registering new professions is aspirant groups must “Practise based on evidence of efficacy”. If that were actually applied, none of this process would occur anyway. No doubt the HPC will fail to apply its own criteria. On past form, it can be expected to adopt a “fluid concept of evidence“.,
One more thing, New European legislation was described recently in the BMJ
“Consumers in the United Kingdom are to receive stronger legal safeguards against products that claim, without any identifiable scientific evidence, to provide physical and mental health benefits such as tackling obesity or depression.”
“The scope of the legislation is deliberately wide and is the biggest shake up in consumer law for decades. It targets any unfair selling to consumers by any business.”
Politicians seem to be immune to rational argument when it comes to quackery. But a few legal actions under these laws could bring the house of cards tumbling so fast that this gamma-minus report would become rapidly irrelevant. There will be no shortage of people to bring the actions. I can’t wait.
Follow up
Dominic Lawson, 24 June 2008. An excellent column appeared today in the Independent. Dominic Lawson writes about the Pittilo report: “So now we will have degrees in quackery. What, really, is the difference between acupuncture and psychic surgery?“. The reference to that well known conjuring trick, “psychic surgery” as a “profession”, revealed here, causes Lawson to say
“It makes it clear that the lunatics have taken over the asylum. For a start, how could Philip Hunt, previously director of the National Association of Health Authorities and Trusts, possibly have thought that “psychic healing” constituted a “profession” – let alone one which would “develop its own system of voluntary self-regulation?”
“One can see how this might fit in with the Government’s “never mind the quality, feel the width” approach to university education. One can also see how established practitioners of such therapies might see this as a future source of income – how pleasant it might be to become Visiting Professor of Vibrational Medicine at the University of Westminster.
Thus garlanded with the laurels of academic pseudo-science, the newly professionalised practitioners of “alternative medicine” can look down on such riff-raff as the “psychic surgeons”
Once again I have to ask, how is it that we have to rely on journalists to prevent vice-chancellors eroding academic standards; indeed eroding simple common sense? I guess it is just another sign of the delusional thinking engendered by the culture of managerialism that grips universities.
We have often had cause to criticise Boots Alliance, the biggest retail pharmacist in the UK, because of its deeply unethical approach to junk medicine. Click here to read the shameful litany. The problem of Boots was raised recently also by Edzard Ernst at the Hay Literary Festival. He said
“The population at large trusts Boots more than any other pharmacy, but when you look behind the smokescreen, when it comes to alternative medicines, that trust is not justified.”
Ernst accused Boots of breaching ethical guidelines drawn up by the Royal Pharmaceutical Society of Great Britain, by failing to tell customers that its homeopathic medicines contain no active ingredients and are ineffective in clinical trials.
Another chain, Lloyds Pharmacy, are just as bad. Many smaller pharmacies are no more honest when it comes to selling medicines that are known to be ineffective.
Pharmacists are fond of referring to themselves as “professionals” who are regulated by a professional body, the Royal Pharmaceutical Society of Great Britain (RPSGB). It’s natural to ask where their regulatory body stands on the question of junk medicine. So I asked them, and this is what I found.
| 17 April, 2008
I am writing an article about the role of pharmacists in giving advice about (a) alternative medicines and (b) nutritional supplements. I can find no clear statements about these topics on the RPSGB web site. Please can you give me a statement on the position of the Royal Pharmaceutical Society on these two topics. In particular, have you offered guidance to pharmacists about how to deal with the conflict of interest that arises when they can make money by selling something that they know to have no good evidence for efficacy? This question has had some publicity recently in connection with Boots’ promotion of CCoQ10 to give you “energy”, and only yesterday when the bad effects of some nutritional supplements were in the news. |
Here are some extracts from the first reply that I got from the RPSGB’s Legal and Ethical Advisory Service (emphasis is mine).
| 28 April 2008
Pharmacists must comply with the Code of Ethics and its supporting documents. Principle 5 of the Code of Ethics requires pharmacists to develop their professional knowledge and competence whilst Principle 6 requires pharmacists to be honest and trustworthy. The Code states: 5. DEVELOP YOUR PROFESSIONAL KNOWLEDGE AND COMPETENCE At all stages of your professional working life you must ensure that your knowledge, skills and performance are of a high quality, up to date and relevant to your field of practice. You must: 5.1 Maintain and improve the quality of your work by keeping your knowledge and skills up to date, evidence-based and relevant to your role and responsibilities. 5.2 Apply your knowledge and skills appropriately to your professional responsibilities. 5.3 Recognise the limits of your professional competence; practise only in those areas in which you are competent to do so and refer to others where necessary. 5.4 Undertake and maintain up-to-date evidence of continuing professional development relevant to your field of practice. 6. BE HONEST AND TRUSTWORTHY Patients, colleagues and the public at large place their trust in you as a pharmacy professional. You must behave in a way that justifies this trust and maintains the reputation of your profession. You must: 6.2 Ensure you do not abuse your professional position or exploit the vulnerability or lack of knowledge of others. 6.3 Avoid conflicts of interest and declare any personal or professional interests to those who may be affected. Do not ask for or accept gifts, inducements, hospitality or referrals that may affect, or be perceived to affect, your professional judgement. 6.4 Be accurate and impartial when teaching others and when providing or publishing information to ensure that you do not mislead others or make claims that cannot be justified. |
And, on over-the counter prescribing
| In addition the “Professional Standards and Guidance for the Sale and Supply of Medicines” document which supports the Code of Ethics states:
“2. SUPPLY OF OVER THE COUNTER (OTC) MEDICINES STANDARDS When purchasing medicines from pharmacies patients expect to be provided with high quality, relevant information in a manner they can easily understand. You must ensure that: 2.1 procedures for sales of OTC medicines enable intervention and professional advice to be given whenever this can assist the safe and effective use of medicines. Pharmacy medicines must not be accessible to the public by self-selection. |
Evidence-based? Accurate and impartial? High quality information? Effective use?
These words don’t seem to accord with Boots’ mendacious advertisements for CoQ10 (which were condemned by the ASA).
Neither does it accord with the appalling advice that I got from a Boots pharmacist about Vitamin B for vitality.
Or their bad advice on childhood diarrhoea.
Or the unspeakable nonsense of the Boots (mis)-education web site.
Then we get to the nub. This is what I was told by the RPSGB about alternative medicine (the emphasis is mine).
| 8. COMPLEMENTARY THERAPIES AND MEDICINES
STANDARDS You must ensure that you are competent in any area in which you offer advice on treatment or medicines. If you sell or supply homoeopathic or herbal medicines, or other complementary therapies, you must: 8.1 assist patients in making informed decisions by providing them with necessary and relevant information. 8.2 ensure any stock is obtained from a reputable source. 8.3 recommend a remedy only where you can be satisfied of its safety and quality, taking into account the Medicines and Healthcare products Regulatory Agency registration schemes for homoeopathic and herbal remedies.” Therefore pharmacists are required to keep their knowledge and skills up to date and provide accurate and impartial information to ensure that you do not mislead others or make claims that cannot be justified. |
It does seem very odd that “accurate and impartial information” about homeopathic pills does not include mentioning that they contain no trace of the ingredient on the label. and have been shown in clinical trials to be ineffective. These rather important bits of information are missing from both advertisements and from (in my experience) the advice given by pharmacists in the shop.
If you look carefully, though, the wording is a bit sneaky. Referring to over-the-counter medicines, the code refers to “safe and effective use of medicines”, but when it comes to alternative medicines, all mention of ‘effectiveness’ has mysteriously vanished.
So I wrote again to get clarification.
| 29 April, 2008
Thanks for that information. I’d appreciate clarification of two matters in what you sent. (1) Apropros of complementary and alternative medicine, the code says 8.3 recommend a remedy only where you can be satisfied of its safety and quality I notice that this paragraph mentions safety and quality but does not mention efficacy. Does this mean that it is considered ethical to recommend a medicine when there is no evidence of its efficacy? Apparently it does. This gets to the heart of my question and I’d appreciate a clear answer. |
This enquiry was followed by a long silence. Despite several reminders by email and by telephone nothing happened until eventually got a phone call over a month later (May 3) from David Pruce, Director of Practice & Quality Improvement, Royal Pharmaceutical Society of Great Britain. The question may be simple, but the RPSGB evidently it hard, or more likely embarrassing, to answer.
When I asked Pruce why para 8.3 does not mention effectiveness, his reply, after some circumlocution, was as follows.
Pruce: “You must assist patients in making informed decisions by providing necessary and relevant information . . . we would apply this to any medicine, the pharmacist needs to help the patient assess the risks and benefits.”
DC: “and would that include saying it doesn’t work better than placebo?”
Pruce “if there is good evidence to show that it may, but it depends on what the evidence is, what the level of evidence is, and the pharmacist’s assessment of the evidence”
DC “What’s your assessment of the evidence?”
Pruce, “I don’t think my personal assessment is relevant. I wouldn’t want to be drawn on my personal assessment”. “If a pharmacist is selling homeopathic medicines they have to assist the patient in making informed decisions”
“I don’t think we specifically talk about the efficacy of any other medicine” [DC: not true, see para 2.1, above]
“We would expect pharmacists to be making sure that what they are providing to a patient is safe and efficacious”
DC “So why doesn’t it mention efficacious in para 8.3”
Pruce “What we are trying to do with the Code of Ethics is not go down to the nth degree of detail ” . . . “there are large areas of medicine where there is an absence of data”
DC “Yes, actually homeopathy isn’t one of them. It used to be.”
Pruce. “uh, that’s again a debatable point”
DC I don’t think it’s debatable at all, if you’ve read the literature
Pruce. “well many people would debate that point” “This [homeopathy] is a controversial area where opinions are divided on it”
DC “Not informed opinions”
Pruce “Well . . . there are also a large number of people that do believe in it. We haven’t come out with a categorical statement either way.”
I came away from this deeply unsatisfactory conversation with a strong impression that the RPSGB’s Director of Practice & Quality Improvement was either not familiar with the evidence, or had been told not to say anything about it, in the absence of any official statement about alternative medicine.
I do hope that the RPSGB does not really believe that “there are also a large number of people that do believe in it” constitutes any sort of evidence.
It is high time that the RPSGB followed its own code of ethics and required, as it does for over-the-counter sales, that accurate advice should be given about “the safe and effective use of medicines”.
“The scientist on the High Street”
The RPS publishes a series of factsheets for their “Scientist in the High Street” campaign. One of these “factsheets” concerns homeopathy, [download pdf from the RPSGB]. Perhaps we can get an answer there?
Well not much. For the most part the “factsheet” just mouths the vacuous gobbledygook of homeopaths. It does recover a bit towards the end, when it says
“The methodologically “best” trials showed no effect greater than that of placebo”.
But there is no hint that this means pharmacists should not be selling homeopathic pills to sick people..
That is perhaps not surprising, because the Science Committee of the RPSGB copped out of their responsibility by getting the factsheet written by a Glasgow veterinary homeopath, Steven Kayne. You can judge his critical attitude by a paper (Isbell & Kayne, 1997) which asks whether the idea that shaking a solution increases its potency. The paper is a masterpiece of prevarication, it quotes only homeopaths and fails to come to the obvious conclusion. And it is the same Steven Kayne who wrote in Health and Homeopathy (2001)
“Homeopathy is not very good for treating bacterial infections directly, apart from cystitis that often responds to a number of medicines, including Berberis or Cantharis”.
So there is a bacterial infection that can be cured by pills that contain no medicine? Is this dangerous nonsense what the RPSGB really believes?
More unreliable advice
While waiting for the train to Cardiff on April 16th (to give a seminar at the Welsh School of Pharmacy), I amused myself by dropping into the Boots store on Paddington station.
| DC I’ve seen your advertisements for CoQ10. Can you tell me more? Will they really make me more energetic?
Boots: Yes they will, but you may have to take them for several weeks. DC. Several weeks? Boots: yes the effect develops only slowly Peers at the label and reads it out to me DC I see. Can you tell me whether there have been any trials that show it works? Boots. I don’t know. I’d have to ask. But there must be or they wouldn’t be allowed to sell it. DC. Actually there are no trials, you know Boots. Really? I didn’t think that was allowed. But people have told me that they feel better after taking it. DC You are a pharmacist? Boots. Yes |
Sadly, this abysmal performance is only too typical in my experience, Try it yourself.
The malaria question
After it was revealed that pharmacists were recommending, or tolerating recommendations, of homeopathic treatment of malaria, the RPSGB did, at last. speak out. It was this episode that caused Quackometer to write his now famous piece on ‘The gentle art of homeopathic killing‘ (it shot to fame when the Society of Homeopaths tried to take legal action to ban it) Recommending pills that contain no medicine for the treatment or prevention or treatment of malaria is dangerous. If it is not criminal it ought to be [watch the Neals Yard video]. .
The RPSGB says it is investigating the role of pharmacists in the Newsnight sting (see the follow-up here). That was in July 2006, but they are stlll unwilling to say if any action will be taken. Anyone want to bet that it will be swept under the carpet?
The statement issued by the RPSGB, 5 months after the malaria sting is just about the only example that I can find of them speaking out against dangerous and fraudulent homeopathic practices. Even in this case, it is pretty mild and restricted narrowly to malaria prevention.
The RPSGB and the Quacktioner Royal
The RPSGB submitted a response to the ‘consultation’ held by the Prince’s Foundation for Integrated Health, about their Complementary Healthcare; a guide for patients.
| Response by the Royal Pharmaceutical Society of Great Britain Dr John Clements, Science Secretary “We believe that more emphasis should be given to the need for members of the public who are purchasing products (as opposed to services) to ask for advice about the product. Pharmacists are trained as experts on medicines and the public, when making purchases in pharmacies, would expect to seek advice from pharmacists” |
So plenty of puffery for the role of pharmacists. But there is not a word of criticism about the many barmy treatments that are included in the “Guide for Patients”. Not just homeopathy and herbalism, but also Craniosacral therapy, Laying on of Hands, chiropractic, Reiki, Shiatsu –every form of barminess under the sun drew no comment from the RPS.
I can’t see how a response like this is consistent with the RPS’s own code of ethics.
A recent president of the RPSGB was a homeopath
| Christine Glover provides perhaps the most dramatic reason of all for thinking thst, despite all the fine words, the RPSGB cares little for evidence and truth The NHS Blogdoctor published “Letter from an angry pharmacist”. |  |
Mrs Glover was president of the RPSGB from 1999 to 2001, vice-president in 1997-98, and a member of the RPSGB Council until May 2005. She is not just a member, but a Fellow. (Oddly, her own web site says President from 1998 – 2001.)
So it is relevant to ask how the RPSGB’s own ex-president obeys their code of ethics. Here are some examples on how Ms Glover helps to assist the safe and effective use of medicines. . Much of her own web site seems to have vanished (I wonder why) so I’ll have to quote the “Letter from an angry pharmacist”., as revealed by NHS Blogdoctor,
“What has Christine got to offer?
- “We offer a wide range of Homeopathic remedies (over 3000 different remedies and potencies) as well as Bach flower remedies, Vitamins, Supplements, some herbal products and Essential Oils.”
- Jetlag Tablets highly recommended in ‘Wanderlust’ travel magazine. Suitable for all ages.
- Wind Remedy useful for wind particularly in babies. In can be supplied in powder form for very small babies. Granules or as liquid potency.
- Udder Care 100ml £80.00 One capful in sprayer filled with water. Two jets to be squirted on inner vulva twice daily for up to 4 days until clots reduced. Discard remainder. Same dose for high cell-counting cows detected.
Udder Care? Oh! I forgot to say, “Glover’s Integrated Healthcare” does cows as well as people. Dr Crippen would not suggest to a woman with sore breasts that she sprayed something on her inner vulva. But women are women and cows are cows and Dr Crippen is not an expert on bovine anatomy and physiology. But, were he a farmer, he would need some persuasion to spend £80.00 on 100 mls of a liquid to squirt on a cow’s vulva. Sorry, inner vulva.”
Nothing shows more clearly that the RPSGB will tolerate almost any quackery than the fact that they think Glover is an appropriate person to be president. Every item on the quotation above seems to me to be in flagrant breach of the RPSGB’s Code of Ethics. Just like the Society of Homeopaths, the code seems to be there merely for show, at least in the case of advice about junk medicine..
A greater role for pharmacists?
This problem has become more important now that the government proposes to give pharmacists a greater role in prescribing. Needless to say the RPSGB is gloating about their proposed new role. Other people are much less sure it is anything but a money–saving gimmick and crypto-privatisation.
I have known pharmacists who have a detailed knowledge of the actions of drugs, and I have met many more who haven’t. The main objection, though, is that pharmacists have a direct financial interest in their prescribing. Conflicts of interest are already rife in medicine, and we can’t afford them.
Conclusion
The Royal Pharmaceutical Society is desperately evasive about a matter that is central to their very existence, giving good advice to patients about which medicines work and which don’t. Pharmacists should be in the front line in education of the public, about medicines, the ‘scientist on the High Street’. Some of them are, but their professional organisation is letting them down badly.
Until such time as the RPSGB decides to take notice of evidence, and clears up some of the things described here, it is hard to see how they can earn the respect of pharmacists, or of anyone else.
Follow-up
Stavros Isaiadis’ blog, Burning Mind, has done a good piece on “More on Quack Medicine in High Street Shops“.
The Chemist and Druggist reports that the RPSGB is worried about the marketing of placebo pills (‘obecalp’ -geddit?). It does seem very odd that the RPSGB should condemn honest placebos, but be so very tolerant about dishonest placebos. You couldn’t make it up.
A complaint to the RPSGB is rejected
Just to see what happened, I made a complaint to thr RPSGB about branches of their own Code of Ethics at Boots in Hexham and in Evesham. Both of them supported Homeopathy Awareness Week These events had been publicised in those particularly unpleasent local ‘newspapers’ that carry paid advertising disguised as editorial material. In this case it was the Evesham Journal and the Hexham Courant.
Guess what? The RPSGB replied thus
“Your complaint has been reviewed bt Mrs Jill Williams and Mr David Slater who are both Regional Lead Inspectors. Having carried out a review they have concluded that support of homeopathic awareness week does not constitute a breach of the Society’s Code of Ethics or Professional Standards.”
In case you have forgotten, the Professional Standards say
2.1 procedures for sales of OTC medicines enable intervention and professional advice to be given whenever this can assist the safe and effective use of medicines.
The RPSGB has some very quaint ideas on how to interpret their own code of ethics
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The Times published a letter from Edzard Ernst and Simon Singh on April 16th. In their forthcoming book, Trick or Treatment? Alternative Medicine on Trial, they go carefully through all the evidence for all sorts of ‘alternative’ treatments. They find some evidence that a handful of them work. For most the answer is ‘not enough evidence’, and for a number there is good evidence that many of them don’t work to any useful extent.
“Sir, For over two decades the Prince of Wales has been actively promoting alternative medicine and his Foundation for Integrated Health continues to encourage the use of treatments such as homoeopathy or reflexology.””In light of this “rigorous scientific evidence”, we strongly advise that the Prince of Wales and the Foundation for Integrated Health withdraw the publications Complementary Health Care: A Guide for Patients and the Smallwood report. They both contain numerous misleading and inaccurate claims concerning the supposed benefits of alternative medicine. The nation cannot be served by promoting ineffective and sometimes dangerous alternative treatments.”
Thank heavens that someone has the courage to say it as it is.
If only the ineffectual and ill-educated people in the Department of Health wouold do the same. But no, instead they gave £37 000 to the Prince of Wales Foundation to write their make-believe guides. And £900 000 to write nonsense for the Complementary and Natural Healthcare Council (also known as Ofquack), and Skills for Health,
The next day The Times ran an article by their science editor, Mark Henderson, Prince of Wales’s guide to alternative medicine ‘inaccurate’. Natasha Finlayson, of the Prince’s Foundation for Integrated Health, is quoted as saying “The foundation does not promote complementary therapies.”. That takes some beating for sheer bare-faced dishonesty.
Edzard Ernst appeared on the Today Program on 18th April. He was interveiwed by the formidable John Humphrys, along with Kim Lavely, Chief Executive, The Prince’s Foundation for Integrated Health (FIH). Ernst points out that the FIH guide suggests that chiropractic is effective in asthma, and that acupuncture is good for addiction, whereas the evidence says the opposite. Lavely retorts, rather lamely (OK I’m biassed).
Lavely: ” . . . we didn’t attempt to give detailed evidence on every therapy”. “We think they [the public] have the right to know and what doesn’t”
Humphrys: “Well isn’t that the whole point? the professor is saying here is that these things do not work, at least in terms of the claims that are made for them, such as homeopathy and chiropractic . . . ”
Lavely: “There are no claims made in this guide for what works and what doesn’t. What we have said is that some therapies are used for some things but we aren’t saying they are effective for those things . . . “
So, one might ask, what on earth is the use of a guide is it that offers no indication of effectiveness? Lavely’s second quotation contradicts directly her first. A pretty pathetic performance.
Listen to the interview [mp3 file]
The Sunday Times, on April 20th, pblished a pretty good review of Trick of Treatment?. “Their case against the folly, vanity and damage of HRH et al. is hard to argue with.”
Of course, the letters column drew the expected response from the quacks, most verging on the hilarious.
Another blow for the alternative industry came in the same week, The authoratitve Cochrane review confirmed earlier reports that vitamin supplements not only do not help you but some actually increase mortality. The antioxidant myth nevertheless rumbles on, and on, and on. There is too much money in it for it to die easily.
Predictably enough, the conclusions were denied by the Health Food Manufacturers’ Association (HFMA). They wheeled out several pop singers to say how wonderful their products are. Read about that pathetic defence on Holfordwatch.
Who is behind HFMA? Incidentally, HFMA are strangely reticent about the identity of their 120 members. They will not reveal who they are. Does anybody out there know the answer? I’ll buy a good dinner for anyone who can root this out. If it is anything like the ‘Health Supplements Information Service‘ it is likely to be backedby the very big pharmaceutical companies that the alternative industry loves to hate.
Take the test
Prince of Wales Guide
“Reflexologists work with a wide range of conditions including certain types of pain, particularly back and neck pain, migraine and headaches, chronic fatigue, sinusitis, arthritis, insomnia, digestive problems such as irritable bowel syndrome, and constipation, stress-related disorders and menopausal symptoms.”
Singh & Ernst
“The notion that reflexology can be used to diagnose health problems has been disproved and there is no convincing evidence that it is effective for any condition.”
This is a fuller version, with links, of the comment piece published in Times Higher Education on 10 April 2008. Download newspaper version here.
If you still have any doubt about the problems of directed research, look at the trenchant editorial in Nature (3 April, 2008. Look also at the editorial in Science by Bruce Alberts. The UK’s establishment is busy pushing an agenda that is already fading in the USA.
Since this went to press, more sense about “Brain Gym” has appeared. First Jeremy Paxman had a good go on Newsnight. Skeptobot has posted links to the videos of the broadcast, which have now appeared on YouTube.
Then, in the Education Guardian, Charlie Brooker started his article about “Brain Gym” thus
Dr Aust’s cogent comments are at “Brain Gym” loses its trousers. |
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The Times Higher’s subeditor removed my snappy title and substituted this.
So here it is.
“HR is like many parts of modern businesses: a simple expense, and a burden on the backs of the productive workers”, “They don’t sell or produce: they consume. They are the amorphous support services” .
So wrote Luke Johnson recently in the Financial Times. He went on, “Training advisers are employed to distract everyone from doing their job with pointless courses”. Luke Johnson is no woolly-minded professor. He is in the Times’ Power 100 list, he organised the acquisition of PizzaExpress before he turned 30 and he now runs Channel 4 TV.
Why is it that Human Resources (you know, the folks we used to call Personnel) have acquired such a bad public image? It is not only in universities that this has happened. It seems to be universal, and worldwide. Well here are a few reasons.
Like most groups of people, HR is intent on expanding its power and status. That is precisely why they changed their name from Personnel to HR. As Personnel Managers they were seen as a service, and even, heaven forbid, on the side of the employees. As Human Resources they become part of the senior management team, and see themselves not as providing a service, but as managing people. My concern is the effect that change is having on science, but it seems that the effects on pizza sales are not greatly different.
The problem with having HR people (or lawyers, or any other non-scientists) managing science is simple. They have no idea how it works. They seem to think that every activity
can be run as though it was Wal-Mart That idea is old-fashioned even in management circles. Good employers have hit on the bright idea that people work best when they are not constantly harassed and when they feel that they are assessed fairly. If the best people don’t feel that, they just leave at the first opportunity. That is why the culture of managerialism and audit. though rampant, will do harm in the end to any university that embraces it.
As it happens, there was a good example this week of the damage that can be inflicted on intellectual standards by the HR mentality. As a research assistant, I was sent the Human Resources Division Staff Development and Training booklet. Some of the courses they run are quite reasonable. Others amount to little more than the promotion of quackery. Here are three examples. We are offered a courses in “Self-hypnosis”, in “Innovations for Researchers” and in “Communication and Learning: Recent Theories and Methodologies”. What’s wrong with them?
“Self-hypnosis” seems to be nothing more than a pretentious word for relaxation. The person who is teaching researchers to innovate left science straight after his PhD and then did courses in “neurolinguistic programming” and life-coaching (the Carole Caplin of academia perhaps?). How that qualifies him to teach scientists to be innovative in research may not be obvious.
The third course teaches, among other things, the “core principles” of neurolinguistic programming, the Sedona method (“Your key to lasting happiness, success, peace and well-being”), and, wait for it, Brain Gym. This booklet arrived within a day or two of Ben
Goldacre’s spectacular demolition of Brain Gym “Nonsense dressed up as neuroscience”
“Brain Gym is a set of perfectly good fun exercise break ideas for kids, which costs a packet and comes attached to a bizarre and entirely bogus pseudoscientific explanatory framework”
“This ridiculousness comes at very great cost, paid for by you, the taxpayer, in thousands of state schools. It is peddled directly to your children by their credulous and apparently moronic teachers”
And now, it seems, peddled to your researchers by your credulous and
moronic HR department.
Neurolinguistic programming is an equally discredited form of psycho-babble, the dubious status of which was highlighted in a Beyerstein’s 1995 review, from Simon Fraser University.
“ Pop-psychology. The human potential movement and the fringe areas of psychotherapy also harbor a number of other scientifically questionable panaceas. Among these are Scientology, Neurolinguistic Programming, Re-birthing and Primal Scream Therapy which have never provided a scientifically acceptable rationale or evidence to support their therapeutic claims.”
The intellectual standards for many of the training courses that are inflicted on young researchers seem to be roughly on a par with the self-help pages of a downmarket women’s magazine. It is the Norman Vincent Peale approach to education. Uhuh, sorry, not education, but training. Michael O’Donnell defined Education as “Elitist activity. Cost ineffective. Unpopular with Grey Suits . Now largely replaced by Training .”
In the UK most good universities have stayed fairly free of quackery (the exceptions being the sixteen post-1992 universities that give BSc degrees in things like homeopathy). But now it is creeping in though the back door of credulous HR departments. Admittedly UCL Hospitals Trust recently advertised for spiritual healers, but that is the NHS not a university. The job specification form for spiritual healers was, it’s true, a pretty good example of the HR box-ticking mentality. You are in as long as you could tick the box to say that you have a “Full National Federation of Spiritual Healer certificate. or a full Reiki Master qualification, and two years post certificate experience”. To the HR mentality, it doesn’t matter a damn if you have a certificate in balderdash, as long as you have the piece of paper. How would they know the difference?
A lot of the pressure for this sort of nonsense comes, sadly, from a government that is obsessed with measuring the unmeasurable. Again, real management people have already worked this out. The management editor of the Guardian, said
“What happens when bad measures drive out good is strikingly described in an article in the current Economic Journal. Investigating the effects of competition in the NHS, Carol Propper and her colleagues made an extraordinary discovery. Under competition, hospitals improved their patient waiting times. At the same time, the death-rate e emergency heart-attack admissions substantially increased.”
Two new government initiatives provide beautiful examples of the HR mentality in action, They are Skills for Health, and the recently-created Complementary and Natural Healthcare Council.(already dubbed OfQuack).
The purpose of the Natural Healthcare Council .seems to be to implement a box-ticking exercise that will have the effect of giving a government stamp of approval to treatments that don’t work. Polly Toynbee summed it up when she wrote about “ Quackery
and superstition – available soon on the NHS “ . The advertisement for its CEO has already appeared, It says that main function of the new body will be to enhance public protection and confidence in the use of complementary therapists. Shouldn’t it be decreasing confidence in quacks, not increasing it? But, disgracefully, they will pay no attention at all to whether the treatments work. And the advertisement refers you to
the Prince of Wales’ Foundation for Integrated Health for more information (hang on, aren’t we supposed to have a constitutional monarchy?).
Skills for Health, or rather that unofficial branch of government, the Prince of Wales’ Foundation, had been busy making ‘competences’ for distant healing, with a helpful bulletted list.
“This workforce competence is applicable to:
- healing in the presence of the client
- distant healing in contact with the client
- distant healing not in contact with the client”
And they have done the same for homeopathy and its kindred delusions. The one thing they never consider is whether they are writing ‘competences’ in talking gobbledygook. When I phoned them to try to find out who was writing this stuff (they wouldn’t say), I made a passing joke about writing competences in talking to trees. The answer came back, in all seriousness,
“You’d have to talk to LANTRA, the land-based organisation for that”,
“LANTRA which is the sector council for the land-based industries uh, sector, not with us sorry . . . areas such as horticulture etc.”.
Anyone for competences in sense of humour studies?
The “unrepentant capitalist” Luke Johnson, in the FT, said
“I have radically downsized HR in several companies I have run, and business has gone all the better for it.”
Now there’s a thought.
The follow-up
The provost’s newletter for 24th June 2008 could just be a delayed reaction to this piece? For no obvious reason, it starts thus.
“(1) what’s management about?
Human resources often gets a bad name in universities, because as academics we seem to sense instinctively that management isn’t for us. We are autonomous lone scholars who work hours well beyond those expected, inspired more by intellectual curiosity than by objectives and targets. Yet a world-class institution like UCL obviously requires high quality management, a theme that I reflect on whenever I chair the Human Resources Policy Committee, or speak at one of the regular meetings to welcome new staff to UCL. The competition is tough, and resources are scarce, so they need to be efficiently used. The drive for better management isn’t simply a preoccupation of some distant UCL bureaucracy, but an important responsibility for all of us. UCL is a single institution, not a series of fiefdoms; each of us contributes to the academic mission and good management permeates everything we do. I despair at times when quite unnecessary functional breakdowns are brought to my attention, sometimes even leading to proceedings in the Employment Tribunal, when it is clear that early and professional management could have stopped the rot from setting in years before. UCL has long been a leader in providing all newly appointed heads of department with special training in management, and the results have been impressive. There is, to say the least, a close correlation between high performing departments and the quality of their academic leadership. At its best, the ethos of UCL lies in working hard but also in working smart; in understanding that UCL is a world-class institution and not the place for a comfortable existence free from stretch and challenge; yet also a good place for highly-motivated people who are also smart about getting the work-life balance right.”
I don’t know quite what to make of this. Is it really a defence of the Brain Gym mentality?
Of course everyone wants good management. That’s obvious, and we really don’t need a condescending lecture about it. The interesting question is whether we are getting it.
There is nothing one can really object to in this lecture, apart from the stunning post hoc ergo propter hoc fallacy implicit in “UCL has long been a leader in providing all newly appointed heads of department with special training in management, and the results have been impressive.”. That’s worthy of a nutritional therapist.
Before I started writing this response at 08.25 I had already got an email from a talented and hard-working senior postdoc. “Let’s start our beautiful working day with this charging thought of the week:”.
He was obviously rather insulted at the suggestion that it was necessary to lecture academics with words like ” not the place for a comfortable existence free from stretch and challenge; yet also a good place for highly-motivated people who are also smart about getting the work-life balance right.”. I suppose nobody had thought of that until HR wrote it down in a “competence”?
To provoke this sort of reaction in our most talented young scientists could, arguably, be regarded as unfortunate.
I don’t blame the postdoc for feeling a bit insulted by this little homily.
So do I.
Now back to science.
This afternoon I went to the Coliseum to see a revival of Jonathan Miller’s 1986 production of the Mikado. It was beautifully staged. The well-known patter song of Ko-Ko, the Lord High Executioner of Japan, begged for a version that deals with anti-science (original here). The serious post will come later. Meanwhile here’s some late night rhyming.
Ko-Ko
As some day it may happen that a victim must be found,
I’ve got a little list — I’ve got a little list
Of society offenders who might well be underground,
And who never would be missed — who never would be missed!
There’s the pestilential bureaucrats who want to send you on a course —
The HR folks who treat you not as human but as mere resource
Skills specialists who think that education just means training
And all ex-scientists who used to work, but now are only feigning
They’d none of ’em be missed — they’d none of ’em be missed!
Chorus.
He’s got ’em on the list — he’s got ’em on the list;
And they’ll none of ’em be missed — they’ll none of ’em be missed.
Ko-Ko
And that deluded nuisance, whom no one understands
The homeopathist – I’ve got her on the list!
All Reiki folks, pill hucksters and layers on of hands
They’d none of ’em be missed — they’d none of ’em be missed.
And herbalists and Princes who like to talk to trees
Those phony nutritionists who’ll treat you for large fees
And that singular anomaly, the acupuncturist —
I don’t think they’d be missed — I’m sure they’d not be missed!
Chorus.
You may put ’em on the list — you may put ’em on the list;
And they’ll none of ’em be missed — they’ll none of ’em be missed!
Ko-Ko
There’s the vision statement writer, and others of that sort
And the crystal therapist — I’ve got him on the list!
And the people who think long words are a substitute for thought
They never would be missed — they never would be missed!
Then those whose knight starvation makes them crave the honours list
So all below must suffer in case their chance is missed
And those who think that science can be judged by its citations
And so kill creativity by funding only applications
But it really doesn’t matter whom you put upon the list,
For they’d none of ’em be missed — they’d none of ’em be missed!
Chorus
You may put ’em on the list — you may put ’em on the list;
And they’ll none of ’em be missed — they’ll none of ’em be missed!
Postscript
I replaced two lines after my pedantic sister pointed out their imperfect rhyme and scansion. Personally I’m with Charles Babbage.
Here is letter that Babbage is said to have written to Tennyson after reading “The vision of sin”.
In your otherwise beautiful poem there is a verse that reads:
“Every moment dies a man
Every moment one is born”It must be manifest that, were this true, the population of the world would be at a standstill. In truth the rate of birth is slightly in excess of that of death. I would suggest that in the next edition of your poem you have it read:
“Every moment dies a man
Every moment 1 1/16 is born”Strictly speaking this is not correct. The actual figure is a decimal so long that I cannot get it in the line, but I believe that 1 1/16 will be sufficiently accurate for poetry.
I am etc,
(The Mathematical Gazette, 1927, p270)
This is the third post based on a recent trip to North America (here are the first and second)
One aspect of the endarkenment, the Wal-Mart model of a university, is very much the same in the US as in the UK. At one US university, an excellent scientist offered the theory that an alien spacecraft had scattered spores across the land which developed into HR staff who appeared at first sight to be human, and who colonised academia.
The penetration of quackademics into US universities is a bit different from in the UK.
In the UK, the plague is restricted to sixteen or so ex-polytechnic universities which, to their great shame, actually offer Bachelor of Science degress in subjects like homeopathy. There are bits of quackery in good teaching hospitals (such as laying-on-of-hands at UCLH), but not very much.
In the USA and Canada, this sort of “vocational” training does not occur much in universities, but in separate colleges. The situation is worse there though, insofar as these colleges have been allowed to award titles like ‘doctor of naturopathic medicine (ND)’, for work that in no respect compares with what the rest of the world has to do to earn a doctorate. This prostitution of academic titles has not happened to anything like the same extent in the UK. How our own quacks would love it if they were allowed to call themselves ‘doctor’ and sport the initials ND (so easily mistaken for MD at first sight).
It is on the clinical side where the situation is far worse than in the UK. Almost every university hospital, including Harvard, Yale and Stanford, has departments devoted to fairy-tale medicine.
Quacks use a number of euphemisms to make themselves sound more respectable. First they became ‘alternative medicine’, then ‘complementary medicine’. Now the most-used euphemism is ‘integrative medicine’, which is favoured by most US universities (as well as by the Prince of Wales). Raymond Tallis pointed out that this seems to mean integration of treatments that don’t work with treatments that do work.
An official roll of shame for North American universities can be seen here (35 in USA and 4 in Canada). 
A bigger collection of 44 universities has been posted by the incomparable Orac at the The Academic Woo Aggregator. He’s had good support in the USA from DrRW (R.W. Donnell), see particularly his articles on How did pseudoscience get admitted to medical school? and What is happening to our medical schools? Abraham Flexner is turning over in his grave.
All these outfits have two things in common. They all claim to be scientific and evidence-based, and none has produced any real evidence that any of their treatments work.
Here are a few examples of what’s going on.
Yale University School of Medicine
The usual theme is expressed thus.
“Through open-minded exploration and rigorous scientific inquiry, we aim to improve awareness and access to the best in evidence-based, comprehensive medical care available worldwide, with the goal of optimizing health and healing for patients”
The driving force behind the woo seems to be a fourth year medical student, Rachel Friedman, so I wrote to her to ask what useful alternative treatments had been established by research at Yale. But she could not identify any. All I got was this.
“My best advice would be to do some medline searching of metaanalyses” there’s been enough research into some of these modalities to provide for a metaanalysis.”
So she was unable to produce nothing (and anyway. metanalyses, useful though they may be, are not research).. A glance at the Yale publications page shows why.
The Scripps Institute
Scripps Center for Integrative Medicine says
“In use at Scripps since 1993, Healing Touch is an energy-based, non-invasive treatment that restores and balances energy to help decrease pain and relieve associated anxiety.
Healing Touch is performed by registered nurses who recognize, manipulate and balance the electromagnetic fields surrounding the human body, thereby promoting healing and the well-being of body, mind and spirit.”
“Balances energy”?
“manipulate and balance the electromagnetic fields surrounding the human body”?
This is just meaningless baloney. And it come from the Scripps Institute.
The Oregon Health & Science University
OHSU is an excellent and well-respected research university where I have many friends. It was a pleasure to meet them recently.
But it also has a big department of “Complementary and alternative medicine” and an “Integrated medicine service”. There are some good bits of advice mixed up with a whole range of crazy stuff. Take their page on homeopathy.
“This therapy treats ailments with very small amounts of the same substance that causes the patient’s symptoms.”
WRONG. In most cases it is zero amount. To brush this fact under the carpet is simply dishonest (and perhaps a sign of guilt). Then comes this (my emphasis)..
Explanations for why homeopathy works range from the idea that homeopathic medicine stimulates the body’s own natural defenses to the idea that homeopathic medicine retains a “memory” of the original substance.
However, there is no factual explanation for why homeopathy works and more research is needed.”
WRONG. This statement carries (twice) the expicit message that homeopathy does work, quite contrary to a mountain of good evidence that it is merely a placebo. The statement is deceptive and dishonest. And it comes with the OHSU logo.
The University of Arizona
” Heal medicine”, “Transform the world?” Modest uh?
The University of Arizona Program in Integrative Medicine is certainly not modest in its claims, but its publications page shows that it doesn’t even attempt to find out if its “therapies” actually work.
Here is an example. They are advertising their Nutrition and Health conference
heavily.
There’s nothing wrong with good nutrition of course, but the ‘alternative’ approach is instantly revealed by the heavy reliance on the great antioxidant myth.
And look at the sponsors. The logo at the top is for Pistachio Health, a company that promotes pistachio nuts: “Delicious and good-for-you, pistachios are nature’s super heart-healthy snack. Nutrient dense, full of fiber and antioxidants, pistachios give you more bang per calories than any other nut.”.
The other advertisement is ‘POM Wonderful’, a company that sells and promotes pomegranate juice, “POM is the only pomegranate juice you can trust for real pomegranate health benefits”
No doubt pistachio nuts and pomegranate juice are perfectly good foods. But the health claims made for them are just marketing and have very little basis in fact.
Now let’s look at the speakers. Take, for example, Dr David Heber, MD., PhD. He is director of the UCLA Center for Human Nutrition at the University of California, Los Angeles, a professor of Medicine and Public Health, and the founding Chief of the Division of Clinical Nutrition in the Department of Medicine. He is the author of several books including “What Color is Your Diet” and the “L.A. Shape Diet.” With the possible exception of the books, you can’t sound like a more respectable and impartial source of advice than that.
But hang on. Dr Heber is to be seen in a video on the Pistachio Health web site doing what amounts to a commercial for pistachio nuts.
OK let’s take a look at one of Dr Heber’s papers. Here’s one about, guess what, pomegranate juice. “Pomegranate Juice Ellagitannin Metabolites Are Present in Human Plasma and Some Persist in Urine for Up to 48 Hours”. The work was “Supported by the Stewart and Lynda Resnick Revocable Trust and from the NIH/NCI grant P50AT00151”. So no problems there. Well not until you check POM Wonderful in Wikipedia, where you find out that Stewart and Lynda Resnick just happen to be founders of POM.
Of course none of these interesting facts proves that there is anything wrong with the work. But they certainly do show that the alternative nutrition business is at least as much hand-in-glove with big business as any other form of medicine. And we know the problems that that has caused.
So, if you want impartial advice on nutrition, sign up for the 6th Annual Nutrition and Health meeting. For “MD, DO, ND & other doctors”, it will cost you only $845 to register .
The meeting is being run by The University of Arizona College of Medicine and Columbia University’s College of Physicians and Surgeons.
The University of Arizona is, incidentally, also the home of the famous (or perhaps infamous) Gary Schwartz (see also, here). He “photographs” non-existent “energy fields” and claims to be able to communicate with the dead, and he is director of its Human Energy Systems Laboratory at the University of Arizona. He is also head of the inappropriately-named Veritas Research Program and “Centre for Frontier Medicine in Biofield Science”. All of these activities make homeopathy look sane, but he is nevertheless part of an otherwise respectable university. In fact he is He is Gary E. Schwartz, Ph.D. is professor of psychology, medicine, neurology, psychiatry and surgery at the University of Arizona. Even more incredibly, this gets NIH funding.
Columbia University, along with Cornell, also has its own “Complementary, alternative, and integrative medicine“, defined as “the use of treatments, such as homeopathic medicine, ayurveda, botanical dietary supplements”. And their “Integrative Therapies Program for Children” is intimately tied up with a company called Origins, which is more a cosmetics company, Origins” (with all the mendacity that implies). They say
“Origins understands the importance of addressing wellness through an integrative approach,” says Daria Myers, President of Origins Natural Resources. “With our recent Dr. Andrew Weil collaboration, Origins demonstrated its support for the integrative wellness concept. Now, with the introduction of the new Nourishing oil for body and massage, we hope to bring not only a moment of comfort but also a healthy future to children enduring the fight of their life.”
Andrew Weil is, of course, the promoter of the Arizona meeting.
The corruption of Universities by this sort of activity is truly amazing.