Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
homeopathy
Interview with DC, vainly trying to counter the bunkum from the two previous speakers.
Read full entry on the original IMPROBABLE SCIENCE page.
The Consumers’ Association has had a good record in distinguishing true claims from false in washing machines and dishwashers. But in CAM, they seem to be out of their depth. They have been giving some very bad advice, of the sort you might expect from the lifestyle pages of the Daily Mail.
Read full entry on the original IMPROBABLE SCIENCE page.
The Royal Society , the UK’s national academy of science, has put a statement about alternative medicine on its “science issues” web site.
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The Royal Society believes that complementary and alternative medicines, like conventional medicines, should be subject to careful evaluation of their effectiveness and safety. It is important that treatments labelled as complementary and alternative medicines are properly tested and that patients do not receive misleading information about the effectiveness of complementary medicine. Furthermore, NHS provision for complementary and alternative medicines, as for conventional medicines, should be confined to treatments that are supported by adequate diagnosis together with evidence of both effectiveness and safety.
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Notice the very proper insistence that patents are not deceived about whether the “medicine” works or not. This is in stark contrast to the attitude of the MHRA, which has just endorsed misleading labelling.
The two chiropodists who run the Marigold Homeopathic Podiatry clinic (no, honestly, it’s real) at the Royal London Homeopathic Hospital seem to be spending much of their budget with a company that they themselves own. The UCLH Trust did not receive any notification of this until I told them about it.
This has been re-posted from the story on the old IMPROBABLE SCIENCE page.
It’s about time I dealt with the health fraud on my own doorstep. University College London Hospitals (UCLH) is not part of UCL, but is a National Health Service Foundation Trust. The trust is responsible for eight hospitals: University College Hospital, The Middlesex Hospital, Hospital for Tropical Diseases, National Hospital for Neurology & Neurosurgery, Elizabeth Garrett Anderson & Obstetric Hospital, Eastman Dental Hospital, The Royal London Homoeopathic Hospital and The Heart Hospital.These are all (but one) absolutely first class teaching hospitals, with responsibility for clinical teaching for UCL medical students. The one blot on the landscape is the Royal London Homeopathic Hospital. This hospital was acquired by UCLH in April 2002. Why on earth is a respectable NHS trust promoting quackery? The UCLH web site says
“The merger enables closer collaboration between complementary therapies and conventional medicine to provide better care for NHS patients. The merger co-incides with the government’s commitment to integrate complementary and conventional care within the NHS, where there is evidence of the effectiveness of complementary therapies.” Notice that the crucial proviso in this statement.
“. . . where there is evidence of the effectiveness of complementary therapies.”
That would be fine If there were evidence of effectiveness, but there is next to no such evidence. Why does UCLH brush this inconvenient fact under the carpet?
The Trust actually has an absolutely first class way of assessing the effectiveness of treatments that are used within UCLH. It is called the Use of Medicines Committee. All NHS Trusts are required to have such a committee, and UCLH’s committee was singled out for praise after a visit by the Parliamentary Select Committee on Health, in their 4th report. These committees are required to obtain good evidence that a proposed treatment works, and their evaluations may be more stringent than those of NICE.
Hansard records
“ During the inquiry, we visited University College London hospital to hear about its Use of Medicines Committee. We were incredibly impressed with its drug formulary, which is used not only by the hospital trust but by the nearby primary care trusts. Because members of those trusts are on the committee, it is also well accepted by the GPs in the area.”
So does the UCLH formulary contain homeopathic and herbal products? If so they will have bypassed entirely the high standards of evidence that are required by the Use of Medicines Committee for any other sort of medicine. If these standards were applied to homeopathic and herbal treatments, the Royal London Homeopathic Hospital would have to close down, because few of these alternatives to medicine would pass an evidence-based assessment. Presumably UCLH Management has foreseen this, and would rather adopt a double-standard than deal with the political fall-out that would result from applying rules of evidence to alternative medicine.
A fine example of the abuse of language: Homeopathic podiatry
The UCLH web site says (somewhat ungrammatically): “The Royal London Homoeopathic Hospital is celebrating the first decade of its Marigold Clinic which provides complementary treatment of homeopathic podiatry. ”
“ Dr Peter Fisher, RLHH Clinical Director, said: “It is an honour for the hospital to host the Marigold Clinic which has been tremendously successful. The Royal London Homoeopathic Hospital has a history of acting as a test bed for NHS innovation. The complementary cancer service and acupuncture are just two examples of therapies the RLHH has been the first to introduce on the NHS. I foresee the same thing happening with homoeopathic podiatry. It’s time has come, current reforms and patient choice are working in our favour.” ”
To describe as “innovation” a reversion to a totally discredited 19th century bit of delusional thinking, is a usage that defies belief. See, for example, here and here.
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It is embarrassing to a real university like UCL to see a conference, sponsored by RLHH, on ‘Improving the success of homeopathy’ branded with a logo that looks very like UCL’s own (old version) logo. The title carries the assumption that there is something to be ‘improved’. The conference dealt not only with marigold for bunions, but also HIV/AIDS |
What does the Royal London Homeopathic Hospital cost you, the taxpayer?
Guess what? Nobody knows. But with the help of the Freedom of Information Act 2000, I have been able to make some good guesses.
For a start, at least £18 million has been spent on refurbishing the RLHH. The recurrent costs are not so easy to discover. By use of the Freedom of Information Act 200, this is what I discovered.
The direct cost of running the RLHH is £3.379 million per year of which £3.175 million per year are paid by the NHS. Approximately 75% of the direct costs are for salaries.These are the salary cost of staff working at the RLHH. The staff are medical, nursing, pharmacy, administrative and managerial, and ancillary. The balance of cost is for purchase of drugs, laboratory tests, use of patient beds in other Trust hospitals, building and office running costs.
As well as this, the NHS pays also for indirect services, but nobody seems to know the cost of these (and still less, their value). Indirect services are those not charged directly to the RLHH and will include the following. Payroll, payment and income services, accountancy, recruitment , training, personnel, governance and clinical audit, R and D management and governance, medical and nursing education, training and professional support, communications, I.M. and T., estates maintenance management and planning, catering, cleaning, security, insurance, depreciation, payment of public dividend. These sevices are supplied by the Finance Directorate, Workforce Directorate, Chief Nurse Directorate, Capital Investment Directorate, IM and T Directorate, R and D Directorate, Governance Directorate, Directorate of Corporate Sevices, Communications Directorate.
For the UCLH Trust as a whole, indirect costs amount to 39.2 percent of direct costs. If that proportion applies to RLHH, then the total annual cost of RLHH would be £4.7 million.
That sounds to me like a lot of money for a placebo effect.
The RLHH is 97.7 percent homeopathic
Their web site lists eight consultants, all described as “homeopathic consultants” and a ninth has been added recently, Dr H. Roniger. Thus it seems that Lord Winston made an error of fact when he defended the RLHH in the House of Lords by saying “My Lords, perhaps I may be allowed to break with tradition and come to the assistance of my noble friend. Is it not the case that the national homeopathic hospital conducts perfectly normative medicine and is it not justified in doing that, irrespective of the efficacy or otherwise of homeopathy, which I believe is only a small part of its practice?”
This is the breakdown of prescribing at the RLHH (audit taken August 2004, provided under the Freedom of Information Act). It refers to the number of items dispensed, not their value (which I am still trying to discover).
| Valid Percent | ||
| Valid | Homeopathy | 53.2 |
| Herbal tinctures and potencies <6x | 5.7 | |
| Iscador products | 2.8 | |
| Aromatherapy | .2 | |
| Marigold products | 4.2 | |
| Creams/ointments | 13.5 | |
| Tablets/nutritionals | 1.3 | |
| Supplements/homeopathic (New Era Products) | 7.8 | |
| Nutraceuticals | 3.4 | |
| Anthroposophicals medicine | 1.2 | |
| Allopathic products | 2.3 | |
| Weleda | 2.0 | |
| Flower essence | 1.5 | |
| other | 1.0 | |
| Total | 100.0 | |
NB: Creams are herbal or homeopathic.
And the cost of CAM in Glasgow
A freedom if Information Act request elicited the following costs. Much of
the information I asked for is not even recorded.
The cost of the Glasgow Homoeopathic Hospital.
The running costs for the Homoeopathic Hospital were:
2004/05 £1,658k
2005/06 £1,881kThe cost of all CAM services at Baillieston Health Centre
There is no record of any specific costs associated with CAM incurred at Baillieston Health Centre.There was many years ago a Baillieston Childrens’ Homoeopathic Clinic but this service was subsumed into the new Glasgow Homoepathic Hospital. That hospital opened in 1999 at a total capital and building cost of £2,780,189.The total cost came from the New Homoeopathic Hospital Endowment Fund.
3) The cost of CAM provided by GPs or any other part of the Trust.
There is no record of specific costs associated with GPs or others employed by the NHS Board providing complementary and alternative medicine. If homoeopathy, hypnosis, acupuncture or any other form of complementary medicine is provided it is not as a costed, discrete service.
A conflict of interest at RLHH
The table shown above shows the precribing habits at the Royal London Homeopathic Hospital, The 4.2 percent of precriptions labelled ‘Marigold products’ in the Table were for the products of a company called Marifold Footcare Ltd.
The UCLH Trust web site says
“Dr M Taufiq Khan founded the Marigold Clinic in 1981 at St Pancras Hospital, London, and then established it in 1992 at the RLHH. Dr Khan is the Director of Homeopathic Podiatory Sevices at the RLHH and specialises in the treatment. His son Dr Tariq Khan, is the Deputy Director.”
| The list above shows that 4.2% of all precriptions at RLHH were for “Marigold Products”. This company is Marigold Footcare Ltd., 134 Montrose Avenue, Edgeware, Middlesex, HA8 0DR. |  From left to right: Dr Taufiq Khan, Dr Peter Fisher, Lord Paul of Marylebone and Dr Taufiq Khan open the Sick Feet – Healing Flowers exhibition. |
According to a Current Appointments Report obtained from Companies House. Marigold Footcare Ltd has three directors.
- Dr Mohammed Taufiq Khan, PhD of 134 Montrose Avenue, Edgeware, Middlesex
- Mr Mohammed Taufiq Khan of Bedford House, 17 New North Street, London
- Mrs Shamim Fatima Khan of 134 Montrose Avenue, Edgeware, Middlesex
It appears that the director and deputy director of the Marigold Clinic are paying substantial amounts of NHS money to their own company.
Research-based? Which research?
The web site of the Marigold Clinic makes the following claim.
Research-based medicine:
Marigold therapy is an integral part of homoeopathic podiatry. It comprises specially formulated medication applied topically in conjunction with podiatry. It is research based medicine which has been clinically evaluated in double blind placebo controlled trials at British Universities and NHS Trusts.
And Marigold Footcare Ltd claims
“The safety and efficacy of Marigold Therapy have been demonstrated through extensive clinical use in podiatry clinics and numerous studies and in randomised, double blind, placebo controlled trials: (1) at the University of Brighton (Faculty of Health); (2) University of East London (Institute of Health and Rehabilitation, Faculty of Health and Science); (3) University of London (Faculty of Medicine, School of Pharmacy and the Royal London Homeopathic Hospital).”
This sounds impressive, but what exactly is this research? All I can find in Pubmed about marigold treatment in podiatry is two papers. One is in the Journal of Pharmacy and Pharmacology (1996, 48, 768-770) and one is in Phytotherapy Research (1996, 0, 211-214).
And who is the first author on both of these papers? You guessed: M.T. Khan.
The first paper (Khan, 1996) is from the School of Pharmacy, the second (Khan, Potter and Birch, 1996) is from School of Pharmacy and the podiatry department, Leaf Hospital, Brighton. I can find no trace of publications from the University of East London or from RLHH. Repeated requests for references elicited no reply at all for a long time.
Eventually, I had a reply from M. Tariq Khan in response to my request for references to back the claim on their company’s web site. He sent a list of 54 assorted conference communications and student projects, and 28 “papers” published in Journals. Every one of these 82 items bore the names of one or both M. T. Khans. There were no more ‘serious’ papers than Pubmed had revealed. There appears to be no independent verification whatsoever of their claims.
Reaction of the UCLH Trust
The UCLH Trust, when notified about what was going on, referred the matter to Dr Peter Fisher, the homeopath and clinical director at rhe RLHH. Tonia Ramsden, Director of Corporate Services for UCLH told me on July 27 2006
“I can confirm that I have received and registered the declaration of Interest.”
Quite true, It was only later that I was told that the declaration of interest was received by the Trust only after I had told them about what was going on!
Peter Fisher, assured me that he was aware of the Khan’s behaviour. Rather surprisingly, he seemed to think that no conflict of interest was involved. He said
“Thank you for drawing to my attention the potential conflict of interest in relation to podiatry. The management of the RLHH has always been aware of the situation”
That was it. No comment at all was made on the propriety of the Khans’ behaviour. Dr Fisher also assured me that the evidence for the efficacy of marigold products was good, without actually citing what this evidence was. I replied thus.
“I find it quite disturbing that you say below that “the RLHH is committed to evidence-based practice”, but that you seem to regard as evidence two small papers, both from the same people with a financial interest in the outcome, and not replicated elsewhere. Incidentally neither of these papers declared the authors’ financial interest. It is equally disturbing that your letter to me does not seem to give a realistic idea of the strength of the evidence. I had to find that for myself. ”
Declarations of interest shoud be public, but are not,
A declaration of conflict of interest is, I suppose, better than nothing. But these pieces of paper sit in a drawer in the Trust. They are kept secret from both the public and the patients. The patient should know when the prescriber has a financial interest in what he prescribes, but they are kept in the dark. When I wrote to the UCLH clinical governance committee to suggest a bit more openness would be desirable, they did not even bother to reply. That is when I decided to make this information public.
Gerald Weissmann, editor-in-chief of FASEB journal, talks straight.
It seems that our letter to NHS chiefs has crossed the Atlantic. In a gloriously scholarly and funny editorial, Gerald Weissmann MD, of New York University, puts the knife into homeopathy and its royal advocate. Click here to read the whole thing. Here’s something to whet your appetite.
After publication of our letter . . .
“Prince Charles was unfazed—on the day the Open Letter was published, he stopped at St Tydfil’s Hospital in South Wales to watch alternative medicine at work. He accepted a “spiritual” crystal, as if he were Albus Dumbledore, headmaster of Hogwarts School, accepting the Philosopher’s Stone. Unlike Dumbledore, however, who only professed witchcraft and wizardry, Prince Charles called up every form of “integrative therapy” against Alzheimer’s disease (9). One notes that when Prince Charles and other fans of unproven or disproved medical practices use terms such as “integrated therapy” or “alternative medicine”, they’re following the lead of creationists who hide under the term “intelligent design”—these are all convenient slogans that permit the credulous to con the gullible.”
“Hogwarts is certainly on the move! If the trend persists, perhaps MIT or Cal Tech will march in step with the medical schools and offer prizes for integrative alchemy or alternative engineering. But Dr. Oliver Wendell Holmes, dean of the Harvard Medical School before age of Oprah had the last word on homeopathy:
“Some of you will probably be more or less troubled by that parody of medieval theology which finds its dogma in the doctrine of homeopathy, its miracle of transubstantiation in the mystery of its dilutions, its church in the people who have mistaken their century, and its priests in those who have mistaken their calling.”
[Oliver Wendell Holmes, Medical
Essays. The Young Practitioner, [A Valedictory Address delivered to the Graduating Class of the Bellevue Hospital College, March 2, 1871.] ”
For more delightful writing by Gerald Weissmann, click here.
Special recommendations
Darwin’s Audubon: Gerald Weissmann on the Art of Science.
Swift-boating Darwin: alternative or complementary science
The facts of evolution: fighting the Endarkenment. . The word ‘endarkenment’ sums up only too well much of what appears here.
The prince’s unconstitutional interventions in public policy continue as he launchs an organisation called Integrated Health Associates (IHA).
Read full entry on the original IMPROBABLE SCIENCE page.
The Independent has a good medical column br Dr Fred Kavalier. The column has an insert for readers’ letters. On 1st August 2006 the ‘readers write’ section had this letter “I know homeopathy has taken a bit of a bashing recently but homeopathic remedies for travel sickness have a long and excellent reputation for working. The most important ones are cocculus, petroleum and tabacum.”.
Dr Kavalier was appropriately apologetic about this, and published my response on 15th August.
Readers write DC, a scientist from London, replies to last week’s homeopath: |
The question of where delusion ends and fraud begins is an interesting one. A book by Robert Park of the American Physical Society discusses the question particularly well.
Voodoo Science: the road from foolishness to fraud (Oxford
University Press) is an excellent read. [Amazon].
| Robert Park deals with everything from perpetual motion macines to homeopathy. His thesis is that those who propagate these ideas often start with a genuine belief that what they say is true. Rejection of the ideas by sensible people just makes them more determined. Eventually, though, it probably dawns on many of them that they have made a terrible mistake. At this point, some recant, but more often they have so much reputation to defend, and frequently too much income to protect, that they will continue to propagate their ideas even after they have realised that they are wrong. |  |
That is when foolishness becomes fraud. I have often wondered how many middle-aged homeopaths still really believe their own nonsense?
“Alas, to wear the mantle of Galileo it is not enough that you be persecuted by an unkind establishment; you must also be right.” (Robert Park)
The Independent recommended the Helios Homeopathy Travel kit as one of its Ten Best. They made amends by publishing a letter pointing out that the pills contained nothing whatsoever.
Read full entry on the original IMPROBABLE SCIENCE page.
The Institute of Science in Society purports to be about promoting a socially responsible approach to science. It combines some reasonable stuff about global warming with a lot of utter rubbish about homeopathy (mainly written by the Institute’s director, Dr Mae-Wan Ho).
(This item has been transferred from the old IMPROBABLE SCIENCE page.)
I just stumbled across this organisation. At first sight, its theme of “science, society and sustainability” sounded right up my street. It seems to be predominantly an anti-GM, pro-organic farming, organisation. Although some of their contributors seem to be somewhat paranoid, there is much that I can agree with in what they say about that.
But they completely ruin their case by including quite barmy homilies about homeopathy (and here), water structure and traditional chinese medicine. There is also an amazing piece of sheer pseudo-scientific nonsense, “Homeopathic Medicine is Nanopharmacology” by Dana Ullman (though elsewhere on the site, nanotechnology gets a bad press).
Most of the nutty content seems to be written by the director of the Institute herself. Dr Mae-Wan Ho, who is listed as “Reader in Biology at the Open University” (that’s odd -no trace of her on the Open University web site). In fact some doubts have been cast on her biography. Wikipedia says “She is former head of the Bio-Electrodynamics laboratory at the Open University in Milton Keynes after either having been fired for incompetence or resigning because of personal reasons.” Whatever the truth in that may be, she clearly doesn’t understand homeopathy.
The board of directors of the Institute includes Zac Goldsmith (editor of The Ecologist) and it is advised by some apparently respectable scientists.
It is sad that an organisation with a respectable sounding title like the Institute of Science in Society is being used to propagate some pure pseudo-scientific gobblydegook. Is it any wonder that journalists and the general public get confused?
The Newsnight TV programme did an undercover investigation. Ten out of ten homeopaths, including two big companies Nelsons and Helios, told patients that malaria could be prevented by homeopathic pills alone. So much for the idea that homeopathy is harmless.
It is often said that, although homeopathy does no good,at least it does no harm. But that is not true if using homeopathy delays diagnosis of serious disease like cancer. It is not true if homeopaths persuade you not to be vaccinated, and as a consequence you get smallpox, mumps, measles, and spread them in the community. And it is not true if you listen to the ill-informed advice that is given by many homeopaths about how to avoid malaria when you visit countries where it is common.
The Newsnight programme on BBC2 TV (13th July 2006) did a marvelous bit of secret filming.
“Newsnight followed up their research with a hidden camera. A researcher went to Nelsons Pharmacy off Oxford Street in London, which claims to be Britain’s biggest manufacturer of homeopathic remedies – and that was all they recommended for malaria.
Even when the researcher said she planned to go to Malawi – a high risk area – Nelsons only suggested the addition of garlic, oil of citronella and vitamins rather than a trip to the doctors.
The Nelsons adviser told the researcher that the homeopathic compounds would protect her. “They make it so your energy doesn’t have a malaria-shaped hole in it so the malarial mosquitos won’t come along and fill that in.” ”
This last bit of advice means nothing whatsoever. It is sheer gobblydegook. It would just be silly if its effects were not so potentially serious.
On the programme, Melanie Oxley, from the Society of Homeopaths, wriggled uncomfortably when faced with the evidence (and Simon Singh). She protested that members of her organisation do not advise against proper malaria prevention, or against vaccination (and here). Well, they DO. So much for “professional regulation”. You cannot regulate the delusional. and the attempts of organisations like Oxley’s clearly don’t work. Apart from their inability to stop their members giving lethal advice, the regulators themselves are deluded.
Peter Fisher (see here and here), from the Royal London Homeopathic Hospital (and here) said “I’m very angry about it because people are going to get malaria – there is absolutely no reason to think that homeopathy works to prevent malaria and you won’t find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice.” The Queen’s homeopathic physician has the sense to acknowledge that homeopathy does not work for serious conditions, yet persists in his delusion that it works for milder illnesses.
What the homeopaths recommended
Malaria nosodes 30C
The source material is so diluted that not a single molecule is left. The medicines therefore contain no medicine. They are nothing but sugar pills. To sell pills that contain nothing whatsoever and to pretend that they will protect you against malaria strikes me as nothing short of criminal. In the EU in 2000, 15 528 cases of malaria were reported to the World Health Organization in returning travellers. The source material is, incidentally, not stated. One source says it is made from “African swamp water containing impurities, algae and plants as well as mosquito slough, larvae and eggs.” Luckily there is none of it left in the pill you get.
China
China Off is made from Cinchona bark which should contain quinine (how much is not stated. China Sulph is made from quinine itself (presumably purified, it is not stated). Quinine in large (potentially toxic) doses can cure malaria but is not a recommended treatment. But these preparations contain only minute amounts of quinine that cannot possibly have any effect at all. There is not the slightest reason to think that these pills could protect you against malaria, and to recommend them for that purpose is no more than fraud. The only recommended use for quinine is for treatment iof malaria in pregnant women. The dose is 600 mg, three times a day. because of the inadequate labelling it is impossible to know exactly how much quinine is present in China Sulph 8X,, but it is probably about 100 millionth of the recommended dose.(less than 1 nanogram)
The consequences.
“The fourth case was a 26-year-old man who visited Ghana and Burkina Faso in October and November 1994. He used China D-6 for prophylaxis. This is a homeopathic preparation of the bark from the cinchona tree. Not even trace amounts of quinine were found in the tablets with a very sensitive high-performance liquid chromatographic method.2 Four days after returning from Africa he fell ill with P. falciparum malaria ” (Quotation from Carlsson et al. J Travel Med. 1996 Mar 1;3(1):62. (PMID: 9815426)
In another case of a patient who resorted to homeopathy “for two months she received intensive care for multiple organ system failure due to P falciparum .This case confirms the inefficacy of homoeopathic drugs for malaria prevention and treatment. ”
Natrum Mur.
Natrum Muriaticum is sodium chloride. Just common salt (except that it is so dilute that there is little or no salt there). If you believe this will prevent malaria, you will truly believe anything. Yet it is being recommended and sold.
What the papers say about it
“Malaria risk for tourists who trust alternative practitioners”. A long report by Mark Henderson, in The Times.
“Homoeopathy: voodoo on the NHS” by Jamie White in The Times on the next day (July 15th)
“It is outrageous that the NHS should knowingly promote this quackery. And it is knowing. The NHS Direct website points out that homoeopathy is contrary to everything we know about chemistry and medicine, and that there is no experimental evidence to support its preposterous claims. Yet the NHS still promotes it, because “despite the lack of clinical evidence, homoeopathy remains one of the most popular complementary therapies in the UK”.”
“Homeopaths ‘endangering lives’ by offering malaria remedies” in The Guardian
“Do not rely on homeopathy to protect against malaria, doctors warn”. Excellent health advice (for a change) in the Daily Mail. They quote Dr Evan Harris (Lib Dem) of the all-party parliamentary malaria group, as saying
“This sort of outrageous quackery is unacceptable. Vulnerable people are being duped into handing over cash for useless remedies and are having their health put at risk through grossly inadequate advice. People need to consider homeopathy in the same way as the treat faith-healing and witchcraft – that is not to risk their life or health on it.”
Talk show interview, DC with Tania Shillam on Colourful Radio (“Colourful is a new national digital Talk, cross-cultural radio station. Launched on 30 May 2006, the station’s format is a rich mix of news, current affairs and journalism, agenda-setting coverage, short documentaries, drama, panel discussions, phone-ins and a liberal sprinkling of music”). Listen to it.
Originaly posted on the oldl IMPROBABLE SCIENCE page.
George Lewith, who is an advocate of CAM research, appears to have rather different standards in his private clinic.
Some interesting emails have come into my possession recently. They concern the Centre for Complementary and Integrated Medicine, which gives its address as Harley House, Brunswick Place (Formerly Upper Harley St.), London NW1 4PR (don’t you just love “formerly Upper Harley Street”?).
This centre lists its doctors as Dr Nick Avery, Dr Mike Clark and Professor George Lewith.
Their web site claims “There are several approaches that we use in complementary medicine that may be of help to people with fibromyalgia. There is at least one positive clinical trial that indicates that homeopathy can help this condition.”
An enquiry was sent to the clinic, as follows.
| My GP diagnosed my pain as fibromyalgia almost 2 years ago, but I have not had much relief from the treatment I’ve had so far. I have never tried alternative treatments, but I have looked at your web site and I see that you say “There is at least one positive clinical trial that indicates that homeopathy can help this condition”. I wonder if you could give me some more details about that before I commit myself to trying it? |
After some delay, a polite response came from Dr Avery.
| We treat an enormous number of patients with fibromyalgia and there are many things that can help. In practise [sic] we tend to use combinations of diet, nutrition, homeopathy and acupuncture.In my experience fibromyalgia patients are almost all suffering from magnesium deficiency which, once corrected, can have an enormous impact on symptoms. If this is not corrected, then conventional treatment cannot help. Homeopathy seems to be a fundamental part of treating the (whole person) and it is the combination that seems to be so helpful.If you would like to come and see me then please ring my receptionists |
But no mention there of a trial. A second enquiry gave a fascinating
result.
| I am forwarding you the information you requested about the clinical trial for homeopathy used in helping with Fibromyalgia. I will pass Dr. Lewith’s reply to Dr. Avery who will be able to write to you with more detail when he’s at the clinic this Thursday. Best wishes Catherine (Reception) —– Original Message —– From: “Lewith G.” < gl3@soton.ac.uk> To: “CCIM” < harley@complemed.co.uk >; < nickavery@tiscali.co.uk> Sent: Friday, May 26, 2006 10:50 PM Subject: RE: Message from Dr Avery Its a BMJ paper in the late 1980’s by Peter Fisher. He used Rhus Tox 6C and it was a small positive trial.He will have it. G |
This paper must be the one that I was asked to check by the producer of a television programme (QED), (Fisher, P., Greenwood, A., Huskisson, E. C., Turner, P., & Belon, P. (1989). Effect of homoeopathic treatment on fibrositis (primary fibromyalgia) British Medical Journal 299, 365-366.).
But surely some mistake here? The problems with this paper have already been here. Fisher et al. had made a naive mistake in their statistical analysis, and in fact the homeopathic treatment had no demonstrable effect whatsoever, a result that was published soon after in the Lancet: Colquhoun, D. (1990), Reanalysis of a clinical trial of a homoeopathic treatment of fibrositis. Lancet 336, 441-442.). [Get the pdf]
So why does Professor Lewith cite the Fisher paper without mentioning that it provides no evidence at all? Professor Lewith says that he was unaware of this history. That does seem odd for someone who is devoted to assessment of CAM (all you have to do is search for ‘fibromyalgia and homeopathy’ in Medline). Very baffling.
Despite these puzzles, when I showed a draft for this site to Prof Lewith he said “Nick [Avery] and I have thought very carefully about the responses and we are very happy with them”.
| There are now more papers on the treatment of fibromyalgia, as Prof Lewith has pointed out to me. They are all from the University of Arizona, and all appear to refer to the same set of patients. One of these suggests that homeopathic treatment is effective (Bell IR; Lewis DA; Brooks AJ; Schwartz GE; Lewis SE; Walsh BT; Baldwin CM, Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo. Rheumatology. 2004; 43: 77-582). But a second paper about the same patients seems much less sure. The trial was organised as an ‘optional crossover trial’, and there was no significant difference between the proportion of patients who opted to swap treatments between those who were initially on placebo and those who were initially on homeopathy. Evidently they couldn’t tell the difference! (Bell et al., 2004, J. Alt Comp Med, 10, 269 383). |
 |
Both of these papers, incidentally, have as a co-author the famous (or perhaps infamous) Gary Schwartz, of the “Centre for Frontier Medicine in Biofield Science”, which is, believe it or not, part of the University of Arizona, and which, even more incredibly, gets NIH funding. He “photographs” non-existent “energy fields” and claims to be able to communicate with the dead (critique here).Well I guess the immortality is an even better seller than homeopathy. The picture on the right is what the “Biofield science” centre uses on its web site.
The AMI test and the Vega test
Dr Avery also sent “our information leaflet on Fibromyalgia”. This document was rather interesting.
| We find that a lot of patients with this condition suffer from food intolerance, which can be identified and treated. . . .Other measurements using the “AMI” which measures imbalances in the body can also indicate the whereabouts of the most significant internal dysfunction.Dietary and nutritional approaches can be enhanced by using acupuncture, classical and, in particular, complex homeopathy. Remedies can be identified using the Vega test, which measures energetic imbalances in the body, helping the practitioner to target the most appropriate areas in each individual patient. |
The Vega test and the AMI machine
What are these tests? The Vega test is one of the older con tricks. Dr Avery seems to be misinformed. The Vega test does not measure “energetic imbalances” (whatever that means), it measures skin conductance. So it resembles the infamous lie detector (perhaps it should be tried on its advocates). It has been the subject of several legal actions (listed here, by the Quackwatch site). Here are three of many examples.
- In 1985, the FDA notified a distributor that Vegatest devices could not be marketed as a medical devices without FDA approval (which they do not have).
- In 1990, the New Zealand Medical Journal described how a homeopathic physician had used a Vega device to diagnose allergies in three infants. In each case, the device was applied to the mother with the child on the mother’s lap or roaming about the examining room. The doctor also diagnosed “miasms,” which, if not removed, would prove fatal later in life. The Medical Practitioners Disciplinary Committee ordered that he be censured, pay a penalty of NZ$900 plus NZ$25,000 for costs and expenses, and follow certain standards of care for three years
- In 2002, the British Advertising Standards Agency concluded that a leaflet offering Vega testing as a “complete test for hidden problems” was misleading and advised the advertiser to withdraw it .
In 2003, the BBC did its own investigation.
“We sent Inside Out’s Chris Packham to three Holland and Barrett stores across the South to find out more.
Chris took the Vega test in Newbury, Chichester and Farnborough, only to discover that his allergy results differed from store to store.
In total, Chris was sensitive to over 33 different foods, including staples like wheat, potatoes, milk, tomatoes, tea and coffee. But out of the 33 products, there was only two that all three testers agreed on – cheese and chocolate.
Chris was also advised by Holland and Barrett staff to take a total of 20 different vitamins and minerals. But again, the testers can’t seem to agree and all three testers advised different supplements.
It seems your allergies may not be determined by food alone, but also your location.
”
Professor Lewith told me, when I asked about the Vega test,
“I use it to help with homeopathic diagnoses, your next question of course is why on earth would you want to make an irrational diagnosis about a completely irrational subject.”
Yes, indeed it is! But that question has not been answered.
To make matters still odder, Professor Lewith has himself published a paper showing that the Vega test does not work. Why, then, does he use it in his private clinic? The paper in question is in British Medical Journal, 2001;322:131-4. It concludes “Electrodermal testing cannot be used to diagnose environmental allergies.”
Despite his own conclusion in the BMJ, the homeopathy page of the Rosedale Clinic concludes
The Vega offers one of the most exciting advances in modern medicine to appear in recent years, an accurate method of non-invasive deep physiological investigation
I would like to dedicate this section to Dr’s LEWITH, KENYON and SCHIMMEL for their tuition and helpful guidance with the Vega technique.
Wow!
The AMI machine is much less well-known. It presumably refers to “Apparatus for Measuring the Functions Of the Meridians and Corresponding Internal Organ”. Again it is said the the mysterious and undefined “imbalances”. The most likely interpretation seems to be that it just another galvanometer.
For a sane description of bizarre ‘allergy tests’, look here.
A lovely article by Dominic Lawson, in The Independent.
[moved from the old IMPROBABLE SCIENCE page.]
Can you tell the difference between homeopaths and witch doctors?
The answer is: witch doctors are not publicly funded within the NHS. Not so far, anyway
Dominic Lawson, The Independent, 26 May 2006 gave support to the letter (though I get very uncomfortable when I get branded as part of the establishment). [Get whole article]
“Hence homeopaths believe – they really do -that the most effective remedy is one in which there is no longer a single molecule of the active ingredient in the water. However – please bear with me – the water has “a memory” of the active ingredient, and it is this which will cure the sufferer.
As the Australian Council Against Health Fraud remarks: “Strangely, the water offered as treatment does not remember the bladders it has been stored in, or the chemicals that may have come into contact with its molecules, or the other contents of the sewers it may have been in, or the cosmic radiation which has blasted through it.” I suppose you might say that the medicinal water of the homeopath has a selective memory.”
The Prince of Wales addressed the World Health Organisation in Geneva. Some bits were excellent, but in the end it was irresponsible, dishonest, and perhaps unconstitutional too.
Read full entry on the original IMPROBABLE SCIENCE page.
This letter was sent to the chief executives of 476 NHS Trusts (acute and primary care trusts). It was the main headline in The Times, and the lead item on the BBC’s Today Programme.
| From Professor Michael Baum and others 19th May 2006 Dear Re Use of ‘alternative’ medicine in the NHS We are a group of physicians and scientists who are concerned about ways in which nproven or disproved treatments are being encouraged for general use in the NHS. We would ask you to review practices in your own trust, and to join us in representing our concerns to the Department of Health because we want patients to benefit from the best treatments available. There are two particular developments to which we would like to draw your attention. First, there is now overt promotion of homeopathy in parts of the NHS (including the NHS Direct website). It is an implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness. Despite this, a recently-published patient guide, promoting use of homeopathy without making the lack of proven efficacy clear to patients, is being made available through government funding. Further suggestions about benefits of homeopathy in the treatment of asthma have been made in the ‘Smallwood Report’ and in another publication by the Department of Health designed to give primary care groups “a basic source of reference on complementary and alternative therapies.” A Cochrane review of all relevant studies, however, failed to confirm any benefits for asthma treatment. Secondly, as you may know, there has been a concerted campaign to promote complementary and alternative medicine as a component of healthcare provision. Treatments covered by this definition include some which have not been tested as pharmaceutical products, but which are known to cause adverse effects, and others that have no demonstrable benefits. While medical practice must remain open to new discoveries for which there is convincing evidence, including any branded as ‘alternative’, it would be highly irresponsible to embrace any medicine as though it were a matter of principle. At a time when the NHS is under intense pressure, patients, the public and the NHS are best served by using the available funds for treatments that are based on solid evidence. Furthermore, as someone in a position of accountability for resource distribution, you will be familiar with just how publicly emotive the decisions concerning which therapies to provide under the NHS can be; our ability to explain and justify to patients the selection of treatments, and to account for expenditure on them more widely, is compromised if we abandon our reference to evidence. We are sensitive to the needs of patients for complementary care to enhance well-being and for spiritual support to deal with the fear of death at a time of critical illness, all of which can be supported through services already available within the NHS without resorting to false claims. These are not trivial matters. We urge you to take an early opportunity to review practice in your own trust with a view to ensuring that patients do not receive misleading information about the effectiveness of alternative medicines. We would also ask you to write to the Department of Health requesting evidence-based information for trusts and for patients with respect to alternative medicine. Yours sincerely   and Professor Frances Ashcroft FRSUniversity Laboratory of Physiology, Oxford Professor Sir Colin Berry Professor Gustav Born FRS Professor Sir James Black FRS Professor David Colquhoun FRS Professor Peter Dawson Professor Edzard Ernst Professor John Garrow Professor Sir Keith Peters FRS Mr Leslie Rose Professor Raymond Tallis Professor Lewis Wolpert CBE FRS |
As soon as this appeared the phone started ringing.
Michael Baum did an excellent job on the Today Programme, and on BBC Birmingham, BBC55, BBC world service, ITN news (interviewed for 20 minutes outdoor in the rain), Sky News live, and as well as all that he saw patients, and missed lunch while in the operating theatre. Michael comments ” How was your day your Royal Highness? “.
Leslie Rose did BBC Breakfast TV interview and various radio stations.
I did interviews for BBC News24, BBC1 News, Chanel 5 News, Sky news, the Jeremy Vine Show (radio 2), BBC Radio Solent, and wrote something for the Scotsman. Today it’s Radio London at 10.35 pm and tomorrow, Radio Foyle (Derry).
Listen to the Today Programme 08.10 interview
John Humphrys, on the Today Programme, interviews Michael Baum (lead signatory on the letter), and Peter Fisher of the Royal London Homeopathic Hospital (For more on Peter Fisher, see here, and here, and here). Listen to the interview [mp3 file, 4.4 Mb]
Leslie Rose interviewed on BBC
Breakfast TV. Watch the interview (Realplayer file).
Interview for Sky News.
The Jeremy Vine show interview (Radio 2)
The Late Show on BBC Radio London (24 May), host Stephen
Rhodes, DC versus Gary Trainer: click to listen
Radio Foyle (N. Irelend) Talk show with Mark Patterson. The local health
food shop manager told me that ‘arthritis is a build up of toxins in the body’,
and that glucosamine and chondroitin are herbal! Click to listen
Michael Baum’s 2004 Open letter. “An open letter to the Prince of Wales: with respect, your highness, you’ve got it wrong”. Download pdf file.
Coverage in The Times, 23 May 2006. The front page headline.
New International has forced me to remove the pictures of the front page, but the front page headline was
NHS told to abandon alternative medicineTop doctors say money should go to conventional treatment |
Here is Mark Henderson’s article.
NHS told to abandon alternative medicineBy Mark Henderson, Science Editor Top doctors say money should go to conventional treatment A GROUP of Britain’s leading doctors has urged every NHS trust to stop paying for alternative medicine and to use the money for conventional treatments. Their appeal is a direct challenge to the Prince of Wales’s outspoken campaign to widen access to complementary therapies. Public funding of “unproven or disproved treatments” such as homoeopathy and reflexology, which are promoted by the Prince, is unacceptable while huge NHS deficits are forcing trusts to sack nurses and limit access to life-saving drugs, the doctors say. The 13 scientists, who include some of the most eminent names in British medicine, have written to the chief executives of all 476 acute and primary care trusts to demand that only evidence-based therapies are provided free to patients. Their letter, seen by The Times, has been sent as the Prince today steps up his crusade for increased provision of alternative treatments with a controversial speech to the World Health Organisation assembly in Geneva. The Prince, who was yesterday given a lesson in crystal therapy while touring a complementary health unit in Merthyr Tydfil, will ask the WHO to embrace alternative therapies in the fight against serious disease. His views have outraged clinicians and researchers, who claim that many of the therapies that he advocates have been shown to be ineffective in trials or have never been properly tested. The letter criticises two of his flagship initiatives on complementary medicine: a government-funded patient guide prepared by his Foundation for Integrated Medicine, and the Smallwood report last year, which he commissioned to make a financial case for increasing NHS provision. Both documents, it is claimed, give misleading information about scientific support for therapies such as homoeo-pathy, described as “an implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness”. The letter’s signatories include Sir James Black, who won the Nobel Prize for Medicine in 1988, and Sir Keith Peters, president of the Academy of Medical Science, which represents Britain’s leading clinical researchers. It was organised by Michael Baum, Emeritus Professor of Surgery at University College London, and other supporters include six Fellows of the Royal Society, Britain’s national academy of science, and Professor Edzard Ernst, of the Peninsula Medical School in Exeter, who holds the UK’s first chair in complementary medicine. The doctors ask trust chief executives to review their policies so that patients are given accurate information, and not to waste scarce resources on therapies that have not been shown to work by rigorous clinical trials. They conclude: “At a time when the NHS is under intense pressure, patients, the public and the NHS are best served by using the available funds for treatments that are based on solid evidence.” Professor Baum, a cancer specialist, said that he had organised the letter because of his “utter despair” at growing NHS acceptance of alternative treatments while drugs of proven effectiveness are being withheld. “At a time when we are struggling to gain access for our patients to Herceptin, which is absolutely proven to extend survival in breast cancer, I find it appalling that the NHS should be funding a therapy like homoeopathy that is utterly bogus,” he said. He said that he was happy for the NHS to offer the treatments once research has proven them effective, such as acupuncture for pain relief, but that very few had reached the required standards. “If people want to spend their own money on it, fine, but it shouldn’t be NHS money.” The Department of Health does not keep figures on the total NHS spending on alternative medicine, but Britain’s total market is estimated at £1.6 billion. |
There’s no remedy for the Prince of Quacks
This is the title of a piece by Francis Wheen in the London Evening Standard, 16 May 2006. Francis Wheen is the author of the Top ten delusions.
“Prince Charles travels to Geneva next week to deliver the keynote speech at the annual assembly of the World Health Organisation. Some mistake, surely?” “The WHO describes Charles as the president of the Prince’s Foundation for Integrated Health and “patron of a number of health charities”. It omits to add that his views on medicine are barmy – and pernicious. ”
“WHO delegates from 192 nations have plenty to discuss during their five-day meeting – HIV/Aids, sickle-cell anaemia, preparations for a flu pandemic, the eradication of polio and smallpox. Why waste precious time listening to the heir to the British throne, who has spent more than 20 years displaying his ignorance of medical science?”
“The prince has never met a snake oil vendor he didn’t like. A couple of years ago he urged doctors to prescribe coffee enemas to cancer patients, a suggestion which provoked this rebuke from Professor Michael Baum of University College London: “The power of my authority comes with a knowledge built on 40 years of study and 25 years of active involvement in cancer research. Your power and authority rest on an accident of birth.” ”
The Prince’s Foundation for Integrated Health publishes Complementary healthcare: a guide for patients which is full of wishful thinking. For example, it tells the unfortunate patient that
“Homeopathy is most often used to treat chronic conditions such as asthma; eczema; arthritis; fatigue disorders like ME; headache and migraine; menstrual and menopausal problems; irritable bowel syndrome; Crohn’s disease; allergies; repeated ear, nose, throat and chest infections or urine infections; depression and anxiety.”
but says nothing at all about whether or not they work. That is just irresponsible. And to describe pills that contain no trace of the substance on the label as ”very diluted” is plain dishonest .
This item was transferred from the old IMPROBABLE SCIENCE page.