Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
badscience
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, |
After writing the recent post Boots reaches new level of dishonesty with CoQ10 promotion, I sent a complaint about the dishonesty of the advertisements to the Advertising Standards Authority. I got a surprsingly fast response. On April 22 I got
“it appears you have a valid point and, with a view to acting quickly, have asked Boots to change their ad. We have asked them to remove the claims that CoQ1 0 can create “a spring in your step” and “boost energy levels”. Provided we get an assurance from the advertisers that they will change their ad, we will close the case.”
Then on 1 May, the ASA said
“We have now received a response from Boots and they have given us an assurance that they will not repeat the problematic claims for this product. We have therefore closed our file on that basis.”
Boots agreed to this request, so no full investigation will appear. That’s a win for reason, up to a point, but it also shows how toothless the rules about advertising are. Boots launch a big promotion with advertisements that are simply not true. The promotion is over and they got clean away with it. All they get is a little publicised rap on the knuckles and no doubt they’ll do the same again next time.
| Last year, Nature published a pretty forthright condemnation of the award of Bachelor of Science degrees in subjects that are not science: in fact positively anti-science. This topic has come up again in Times Higher Education (24 April 2008). A league table shows that the largest number of anti-science courses is run by the University of Westminster [download paper version]. |
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Vice chancellors have consistently refused to answer letters, from me, from the Times Higher Education or from the BBC, asking them to defend their practices.
The vice chancellors union, Universities UK, has simply refused to consider this very basic threat to academic standards.
It is particularly amazing that vice-chancellors continue to support courses in homeopathy when they have been condemned by no less a person than the head honcho of homeopathy in the UK, Dr Peter Fisher. He is clinical director of the Royal London Homeopathic Hospital and Homeopathic Physician to the Queen. Peter Fisher and I were interviewed on BBC London News after publication of the Nature article. At the end, Fisher was asked by the presenter, Riz Lateef, about whether homeopathy was a suitable subject for a science degree.[Watch the movie]
| Riz Lateef (presenter): “Dr Fisher, could you ever see it [homeopathy] as a science degree in the future? Dr Peter Fisher: “I would hope so. I wouldn’t deny that a lot of scientific research needs to be done, and I would hope that in the future it would have a scientific basis. I have to say that at the moment that basis isn’t comprehensive. To that extent I would agree with Professor Colquhoun.” |
The one exception was a response, of sorts, that I got from Westminster University.
I can interpret this lack of response only as a sign of guilt on the part of the vice chancellors of the 16 or so universities who teach this stuff. That interpretation is reinforced by the refusal of two of them to release their teaching materials, despite requests under the Freedom of Information Act 2000. Both the University of Central Lancashire and the University of Westminster have turned down appeals, and refused to hand over anything. The former case has been with the Information Commissioner for some time now, and if the ruling goes as a hope, the taxpayer may soon be able to see how their money is being spent.
But the wonderful thing about the electronic age is that it has become really quite difficult to keep secrets. Last year I managed to find an exam paper set by the University of Westminster in Homeopathic Materia Medica, and a question from that paper has already appeared in Nature.
I recently acquired copies of a course handbook. and of the powerpoint slides used for the lecture on ‘Vibrational Medicine’ by the University of Westminster. This appears to be from a course in Complementary Therapies, part of “Health Sciences: Complementary Therapies BSc Honours”, according to Westminster’s web site. A lot of people have access to this first year course material, so Westminster needn’t bother trying to guess how I got hold of this interesting material
In the public interest, here are a few quotations. Taxpayers should know how their money is being spent.
According to the handbook
“Complementary Therapies is a core module for the Therapeutic Bodywork, Herbal Medicine, Homœopathy, Nutritional Therapy and Complementary Therapies courses. Therefore all students of these degree courses are required to take this module.”
The University of Central Lancashire also has “Vitalistic Medicine” as part of its BSc Homeopathy (but, like Westminster, has some excellent people too).
There is a rather good Wikipedia entry on Vitalism, a topic that is now largely the preserve of cranks.
The handbook is wonderful. The word ‘evidence’. in the context of ‘does it work?’, does not occur a single time. There is plenty of the usual edu-bollocks jargon that is so beloved by bureaucrats, but not the slightest hint of critical thinking about assessment of the ‘therapies’.
The course seems to be a romp through almost every form of battiness known to humankind. Not just homeopathy, traditional Chinese medicine and nutritional therapy, but also dowsing, crystal healing and other forms of advanced delusional thinking. Before somebody grumbles, let me emphasise that ‘nutrition’ is to be distinguished from ‘nutritional therapy’: the latter involves imaginative claims that buying expensive supplements can prevent or cure almost anything. There’s a lot more about that here, and here.
Here are just 5 days from the timetable.
| 9am-1.00pm : Homœopathy (group work and video) |
| 9am-1.00pm : Traditional Chinese Medicine |
| 9am-10.45pm : BODYWORK THERAPIES |
| 11.15-1.00pm : Nutritional Therapy |
| 9am-1.00pm : Vibrational Medicine/Energy Concepts (L&P) |
All this can be yours -at a cost.
Full-time UK/EU fee – £3,145
Full-time Overseas fee – £9,450
The slides for the last of these lectures show some of the most glorious examples of the abuse of sciencey-sounding words that I’ve seen in a while.
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Sigh. All this is sheer imagination. It is ancient vitalism dressed up pretentiously in sciencey words.Then a bit later we come to the general theory -“energy concepts”.
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More plausible-sounding, but utterly meaningless words about vibrations. And then on to old superstitions about dowsing with rods and pendulums.
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Not a single word of scepticism appears about any of this mumbo jumbo. Can it get worse? Yes it can. CRYSTAL HEALING comes next.
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Are you having difficulty in understanding what all these words mean? I certainly hope so, because they have no meaning to understand. Don’t worry too much though, There are some helpful diagrams.
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Aura photographs? They are just fairground conjuring tricks. Well, that is what you thought. But here we see them presented, apparently in all seriousness, as part of a vocational bachelor of science degree in a UK
university.Never mind, it is all assessed properly, with all the right box-ticking jargon. The course handbook says
| Learning Outcomes On successful completion of this module you will be able to: • describe the theoretical basis and classification of a range of complementary therapies |
What theoretical basis? There isn’t any theoretical basis, just a meaningless jumble of words.
You just couldn’t make it up.
Westminster University is not all like this
This post is not intended as an attack on the University of Westminster as a whole. Last year I had an invitation from their biomedical people to give a talk there. They asked for a talk on “What is is the evidence for Alternative Medicine?”. But then I got an email from them saying
“I was surprised to be sat on heavily on return from said trip by the VC, Provosts and Deans (including Peter Davies the leader of the Alt Med School !) once news of your talk leaked out. Could you give a talk on your research instead- yep I know its pusillanimous of me and yep I know unis stand for freedom of speech and yep I know that fellow members of staff suggested you come and others were keen to listen to your views on quackery.”
So on November 2nd 2007 I gave a seminar about single ion channel work (our new ideas about partial agonists). Of course all the excellent staff whom I met agreed with me about the embarrassment that having degrees in homeopathy etc. The fault lies not with their academic staff, but with their administration. Freedom of speech does not seem to be high on their agenda.
Postscript I recently learned that when Times Higher Education asked Westminster about my seminar, they were given the following statement.
“Prof David Colquhoun was invited to take part in a research seminar series organised by the University’s School of Biosciences last year. As part of this series, on Friday 2 November 2007, he gave a talk on the agreed topic of “Single ion Channel studies suggest a new mechanism for partial agonism” – his area of research.”
Perhaps I am naive, but it truly shocks me that a university can issue such a dishonest account of what happened.
How irrational thinking in government and universities has led to the rise of new-age nonsense in the name of science.
This article appeared on 15th August 2007, on the Guardian Science web site.
The Guardian made very few cuts to the original version, but removed a lot of the links. If you want to have references to some of the claims that are made, try the original, which I reproduce here. [Download this as pdf]
The Guardian Science site also has a piece on this topic by Alok Jha: Reigniting the enlightenment How do we win back our civilisation from the jaws of darkness?
Comments can be left there too.
A German translation of this piece has been posted at the Mental health blog.
A Russian translation (draft version) has appeared here . There is also a Russian translation of How to Get Good Science which can be found here.
Etymological note. The word endarkenment has been used by several people as an antonym for the enlightenment, but the first time it caught my eye was in an article in 2005 by Gerald Weissman, The facts of evolution: fighting the Endarkenment. The article opens 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.”
Science in an Age of Endarkenment
“Education: Elitist activity. Cost ineffective. Unpopular with Grey Suits. Now largely replaced by Training.” Michael O’Donnell, in A Sceptic’s Medical Dictionary (BMJ publishing, 1997).
The enlightenment was a beautiful thing. People cast aside dogma and authority. They started to think for themselves. Natural science flourished. Understanding of the real world increased. The hegemony of religion slowly declined. Real universities were created and eventually democracy took hold. The modern world was born. Until recently we were making good progress. So what went wrong?
The past 30 years or so have been an age of endarkenment. It has been a period in which truth ceased to matter very much, and dogma and irrationality became once more respectable.
This matters when people delude themselves into believing that we could be endangered at 45 minute’s notice by non-existent weapons of mass destruction.It matters when reputable accountants delude themselves into thinking that Enron-style accounting is acceptable.
It matters when people are deluded into thinking that they will be rewarded in paradise for killing themselves and others.
It matters when bishops attribute floods to a deity whose evident vengefulness and malevolence leave one reeling. And it matters when science teachers start to believe that the earth was created 6000 years ago.
These are serious examples of the endarkenment mentality, but I’ll stick with my day job and consider what this mentality is doing to science.
One minor aspect of the endarkenment has been a resurgence in magical and superstitious ideas about medicine. The existence of homeopaths on the High Street won’t usually do too much harm. Their sugar pills contain nothing. They won’t poison your body; the greater danger is that they poison your mind.
It is true that consulting a homeopath could endanger your health if it delays proper diagnosis, or if they recommend sugar pills to prevent malaria, but the real objection is cultural. Homeopaths are a manifestation of a society in which wishful thinking matters more than truth; a society where what I say three times is true and never mind the facts.
If this attitude were restricted to half-educated herbalists and crackpot crystal gazers, perhaps one could shrug it off. But it isn’t restricted to them. The endarkenment extends to the highest reaches of the media, government and universities. And it corrupts science itself.
Even respectable newspapers still run nonsensical astrology columns. Respected members of parliament seem quite unaware of what constitutes evidence. Peter Hain (Lab., Neath) set back medicine in Northern Ireland. David Tredinnick (Cons., Bosworth) advocated homeopathic treatment of foot and mouth disease. Caroline Flint condoned homeopathy, and Lord Hunt referred to ‘psychic surgery’ as a “profession” in a letter written in response to question by a clinical scientist
Under the influence of the Department of Health, normally sane pharmacologists on the Medicines and Health Regulatory Authority, which is meant to “ensure the medicines work”, changed the rules to allow homeopathic and herbal products to be labelled, misleadingly, with “traditional” uses, while requiring no evidence to be produced that they work.
Tony Blair himself created religiously-divided schools at a time when that has never been more obviously foolish, and he defended in the House of Commons, schools run by ‘young-earth creationists‘, the lunatic fringe of religious zealots. The ex-Head Science teacher at Emmanuel College said
“Note every occasion when an evolutionary/old-earth paradigm . . . is explicitly mentioned . . . we must give the alternative (always better) Biblical explanation of the same dataâ€:
That is not from the fundamentalists of the southern USA, but from Gateshead, UK.
The Blairs’ fascination with pendulum wavers, crystals and other new age nonsense is well known. When their elders set examples like that, is it any surprise that over 30% of students in the UK now say they believe in creationism and “intelligent design”? As Steve Jones has pointed out so trenchantly, this makes it hard to teach them science at all. Welcome back, Cardinal Bellarmine.
Homeopaths and herbalists may be anti-science but they are not nearly as worrying as the university vice-chancellors who try to justify the giving of bachelor of science degrees in subjects that are anti-science to their core. How, one may well ask, have universities got into the embarrassing position of having to answer questions like that?
Here are a couple of examples of how. The University of Bedfordshire (in its previous incarnation as the University of Luton) accredited a Foundation Degree course in ‘nutritional therapy’, at`the Institute of Optimum Nutrition (IoN). The give-away is the term Nutritional Therapy . They are the folks who claim, with next to no evidence, that changing your diet, and buying from them a lot of expensive ‘supplements’, will cure almost any disease (even AIDS and cancer).
The IoN is run by Patrick Holford, whose only qualification in nutrition is a diploma awarded to himself by his own Institute. His advocacy of vitamin C as better than conventional drugs to treat AIDS is truly scary. His pretensions have been analysed effectively by Ben Goldacre, and by Holfordwatch.. See the toe-curling details on badscience.net .
The documents that relate to this accreditation are mind-boggling. One of the recommended books for the course, on “Energy Medicine” (a subject that is pure fantasy) has been reviewed thus.
“This book masquerades as science, but it amounts to little more than speculation and polemic in support of a preconceived belief.”.
The report of Luton’s Teaching Quality and Enhancement Committee (May 24th 2004) looks terribly official, with at least three “quality assurance” people in attendance. But the minutes show that they discussed almost everything about the course apart from the one thing that really matters, the truth of what was being taught. The accreditation was granted. It’s true that the QAA criticised Luton for this, but only because they failed to tick a box, not because of the content of the course.
The University of Central Lancashire ‘s justification for its BSc in Homeopathic Medicine consists of 49 pages of what the late, great Ted Wragg might have called “world-class meaningless bollocks”. All the buzzwords are there “multi-disciplinary delivery”, “formative and summative assessment”, log books and schedules. But not a single word about the fact that the course is devoted to a totally discredited early 19th century view of medicine. Not a single word about truth and falsehood. Has it become politically incorrect to ask questions like that? The box-ticking mentality is just another manifestation of the endarkenment thought. If you tick a box to say that you are fully-qualified at laying-on-of-hands, that is good enough. You have done the course, and it is irrelevant whether the course teaches rubbish.
These examples, and many like them, result, I believe from the bureaucratisation and corporatisation of science and education. Power has gradually ebbed away from the people who do the research and teaching, and become centralised in the hands of people who do neither.
The sad thing is that the intentions are good. Taxpayers have every right to expect that their money is well spent, and students have every right to expect that a university will teach them well. How, then, have we ended up with attempts to deliver these things that do more harm than good?
One reason is that the bureaucrats who impose these schemes have no interest in data. They don’t do randomised tests, or even run pilot schemes, on their educational or management theories because, like and old-fashioned clinician, they just know they are right. Enormous harm has been done to science by valuing quantity over quality, short-termism over originality and, at the extremes, fraud over honesty. Spoofs about the pretentiousness and dishonesty of some science, like that published in The New York Times last year, are too close to the truth to be very funny now.
Science, left to itself, and run by scientists, has created much of the world we live in. It has self-correcting mechanisms built in, so that mistakes, and the occasional bit of fraud, are soon eliminated. Corporatisation has meant that, increasingly, you are not responsible to your conscience, just to your line manager. The result of this, I fear, is a decrease in honesty, and in the long run inevitably a decrease in quality and originality too.
If all we had to worry about was a few potty homeopaths and astrologers, it might be better to shrug, and get on with trying to find some truths about the world. But now the endarkenment extends to parliament, universities and schools, it is far too dangerous to ignore.
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.
Jump to Open University course K221
BBC2 TV showed a much-advertised series on alternative medicine, in February 2006. The programmes seem to be linked with a dubious Open University course.
| The programmes are presented by Kathy Sykes, who is professor of the public understanding of science at Bristol University. She has done some excellent work in that area, for example, in the Rough Science TV series. |  |
The first programme: acupuncture
The first programme, on acupuncture, was shown on 24th January, 2006. The programme did not start
in a very promising way. Just lots of testimonials from happy patients, the staple diet of all snake oil salesmen.
They are watchable, of course, but don’t do anything at all to promote public understanding of what constitutes evidence.
There is, of course, little doubt that sticking needles into your body can produce physiological responses. Two things remain uncertain.
- Just how useful are these responses in helping particular conditions?
- Is there anything at all in the mumbo jumbo of meridians and chi?.
With a big flourish we were shown “a 21-year-old Shanghai factory worker undergoing open-heart surgery with only the needles to control her pain”. It turns out that this was a sham. The patient was doped on opiates and local anaesthetics. The needles were merely cosmetic. Why were we not told?
The apparently contradictory trials suggested that, at least the alleged principles of acupuncture are nonsense. The programme concentrated on a trial by Berman (Ann Intern Med. 2004,
141, 901-10 ) which used ‘sham acupuncture’, with ‘stage dagger needles’, on osteoarthritis of the knees. In this sort of trial there is no actual penetration, and the sham needles are placed on the places dictated by the mumbo jumbo. This procedure was justly criticised by a subsequent letters in the same journal (Ann
Intern Med 2005, 142, 871).
Another large study was ignored by the TV programme altogether. This was by Linde et al. (Journal of the American Medical Association. 2005 293(17):2118-25). This study concluded
“Acupuncture was no more effective than sham acupuncture in reducing migraine headaches although both interventions were more effective than a waiting list control.”
As pointed out above, this study is, in many ways, much more interesting than Berman’s, because the control group did not have ‘sham acupuncture’. Needles were really inserted, but they were inserted in points that have nothing to do with the mumbo jumbo of meridians. The fact that the controls were much the same as the treated group suggests that, whatever effect the needles produce, it doesn’t matter much where they are inserted. The only obvious interpretation of this is that the ‘principles’ on which acupuncture is based are so much nonsense (and, therefore, it is not a subject that can possibly be taught in a university).
This crucial point was ignored by the TV programme. A big fuss was made of a functional magnetic resonance experiment, staged for TV, that showed that the effects on brain ‘activation’ are different for superficial needling and for real needling. There is nothing in the least surprising in the observation that have a needle pushed into you affects the brain, but it really does not help at all in answering the important questions. Incidentally that experiment had already been done anyway.
In summary, the first programme, failed to give a fair assessment of current knowledge about acupuncture, and failed to consider the important questions of what sort of controls are appropriate, and whether talk of meridians means anything whatsoever. Sadly, I can’t agree with the boast that “It’s the deepest investigation into the efficacy of alternative medicine ever attempted on TV”. Let’s hope the second programme is a bit more critical.
The second programme: healing
The second programme (31st January, 2006). I liked this programme much better than the first, even if it left the crucial questions unresolved.
| The programme started with a healing meeting by the notorious Benny Hinn. The meeting had all the mass hysteria of a Nuremburg rally, though no mention was made of the fact that this (very rich) man’s financial malpractice had been revealed by a CBC TV programme. |  |
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On the right is his receipt for £3347 for two nights at the Lanesborough hotel in London (that did not include $1700 he gave in tips).
The lovely Ghanaian lady who cleans my office and lab every morning gives gives money to this mega-rich man because “he needs it to preach the gospel”.
The National Institutes of Health provided $1.8 m of US taxpayers’ money for this project which seems not to do real research at all. After seeing a demonstration of the “Gas Discharge Visualization”, GDV, or Kirlian camera, given by a very gullible Dr Melinda Connor, Sykes comments that this ‘research’ “is not so much trying to find the evidence for ‘healing energy’, but is rather working on the basis that there is one”
Kathy Sykes did, though show a pretty healthy degree of scepticism about the people who pretend to photograph “auras” and other imaginary “force fields”. She visited the “Center for Frontier Medicine in Biofield Science” at the University of Arizona.
In other words, the ‘research’ is a con. Once again (see above) we see money given by well-intentioned governments diverted form the purpose for which it was given. For more first class boloney on ‘imaging’, see for example, Biofield Sciences in Exeter (UK) and ‘electro-crystal therapy’. The list is endless.
Kathy Sykes went on to show several interesting experiments on placebo effects. For example sham healers (played by actors) do at least as well as ‘real’ healers. And sham knee surgery may be as effective as real surgery, though the programme failed to mention the obvious possibility that this could mean nothing more than that real knee surgery is itself pretty ineffective. As so often in this series, the producers failed to talk to the right people.
She concludes “healing does not work beyond placebo”.
So I’m right with her, though it would have been better if there had been a more critical mention of the fact that not all placebo effects are real. Many probably depend on the natural fluctuations in the intensity of the patient’s condition. Anything can ‘cure a cold’, because you recover from a cold in a few days anyway,
Sykes concludes, speaking of the placebo effect, “I want to see that power properly harnessed -we’d be mad not to”. But that, disappointingly, was the end of the programme. That point is where the problems begin. How do you harness the placebo effect? How do you justify lying to the patient in order to maximize the effect? How do you train the ‘healers’? Are they themselves to believe the same lies, or are they to be trained in the art of deception? As pointed out in a recent review of the neurobiology of placebos (Colloca and Benedetti, 2005)
“For example, the assertion that placebos, fake therapies, fresh water and sugar pills could positively affect the brain biochemistry in the appropriate psychosocial context might lead to a dangerous justification for deception, lying and quackery”.
These are the central dilemmas of sCAM, as listed at the top of this page. The programme did nothing to solve them, or even to draw attention to them.
The link with Open University Course K221
The blurb on this programme on the Open University/BBC site concludes
“So, could the power of the mind explain the benefits people experience from healers? And have healers tapped into this power somehow? The conclusion throws new light on all healing processes, and has a surprising and inspirational message for every practitioner and patient.”
But what is to be done about this “inspiration”? Nothing is said about that. The TV programme was immediately followed by voice-over that advertised an Open University pamphlet, which is publicity for their course K221. That course, judging from what is posted on the web, is run by true believers who are a lot less sceptical than Sykes. She says that she did the voice-over but has not yet been shown the contents of the course.
The third programme: herbalism
Oooh dear. The third programme was, in my view, by far the worst. Hardly a single critical voice was heard. Despite the odd word of reservation, the programme left the impression of being an advertisement for the herbal medicine industry. Did the BBC not think of asking a pharmacologist? In my view, this programme was a disservice to human knowledge. Let’s look at some of the details.
The programme once again starts with dramatic testimonials from satisfied customers. No hint is given to the viewer of the total unreliability of such testimonials. References, in awed voice, are mad to “a vast body of ancient knowledge that herbalists draw on”. No mention of the superb track record that ‘ancient knowledge’ has for turning out to being dead wrong. It was 11 minutes into the programme before the question of evidence was even mentioned and then we had a herbalist wandering through a field. At 13 minutes, the herbalist, Simon Mills, was interviewed -he rattled on about dampness. marshy conditions. “There
are herbs for heating and drying”. Sheer gobbledygook. And still no discussion of evidence.
Sutherlandia At 18 minutes “To get another view I’m going to a country where herbs are claimed to have dramatic effects”. Off to Africa to spend a good 10 minutes on Sutherlandia, a totally unverified treatment for AIDS. Why spend all this time (and licence-payers money) to end up with the conclusion that clinical trials have
not been done yet, and we have no real idea whether it works or not? A search of Pubmed for Sutherlandia and AIDS produces a mere five papers. Mills et al. Nutrition Journal 2005, 4:19 write as follows.
“Despite the popularity of their use and the support of Ministries of Health and NGOs in some African countries, no clinical trials of efficacy exist, and low-level evidence of harm identifies the potential for drug interactions with antiretroviral drugs.”
(and one of the authors on that paper is from the Canadian College of Naturopathic Medicine: hardly likely to have a bias against herbs). The comments made in the programme about AIDS were irresponsible and potentially dangerous: they could kill people..
It took until almost half way through the programme, before we got round to the question of whether any of these claims are true. Very impressive to learn that the Nazis pushed herbal medicine, but totally uninformative (or does it mean that herbalism appeals to nutters?). We are shown the German herbal bible, but again it is pointed out that it contains no evidence about their efficacy. So no further forward yet. Then we are introduced to chromatography: very pretty, but still no evidence about whether herbs help people.
At 9.34 pm we are last get round to some evidence. Or do we? Not yet, just another personal testimonial about the the wonders of St John’s Wort. St John’s Wort (Hypericum) is an interesting case, because there is at least some evidence that it works, though certainly not enough for it to be described as a “superherb”, as Sykes did. Of course depression (like knee surgery -above) makes a pretty good case for herbalists, because conventional antidepressants are so very unsatisfactory themselves. It doesn’t take much to do better than Seroxat (Paxil, paroxetine). At 9.38 pm we get the first actual numbers. And very selective numbers they are
too. The view presented in the programme was desperately over-optimistic about the wondrous effects of St John’s wort. Consider the recent review by Linde et al. (2005 Brit J. Psychiatry, 186, 99-107) (read
it yourself –download pdf file). The conclusion was as follows.
“Current evidence regarding Hypericum extracts inconsistent and confusing. In patients who meet criteria for major depression, several recent placebo-controlled trials suggest that Hypericum has minimal beneficial effects while other trials suggest that Hypericum and standard antidepressants have similar beneficial effects. ”
And another trial, again not mentioned in the programme, was published in Journal of the American Medical Association, 2002, 287, 1807 – 1814) [download the pdf file]. This paper was interesting because it compared placebo, St John’s Wort and sertraline (Zoloft), a drug of the same class as Seroxat). All three were indistinguishable (on the two primary outcome measures). So St John’s Wort was as good as Zoloft, but only because Zoloft was no better than placebo either. The paper concluded thus.
“This study fails to support the efficacy the efficacy of H. perforatum [St John’s Wort] in moderately severe major depression. The result may be due to low assay sensitivity of the trial, but the complete absence of trends suggestive of efficacy for H. perforatum is noteworthy.”
Why were we not told about trials like these?
At 9.43 pm, almost three quarters of the way through the programme, we are eventually told that ginseng, echinacea and evening primrose oil do not work. What took so long?
9.46 pm. Off to South Africa to look at research in Johannesburg on Sutherlandia by Carl Albrecht (more of him below). Some impressive stuff about flavonoids but no results. Flavonoids can’t be absorbed, but, aha, it contains saponins too. Perhaps they allow the flavonoids into cells. Well perhaps.
But this is not information, it is idle speculation.
At 9.51, we get back to brain imaging, this time at Imperial College. Professor Sykes seems to be excessively impressed by brain imaging. We are then treated to more idle speculation about how ginko might help in Alzheimer’s disease. Dr Warner is running a clinical trial to find out whether ginko really helps. But there were no results yet. In that case why not wait until there is a result, before telling us all about it?
We are told that herbs now “have to go through rigorous quality standards”. It was NOT made clear that the standards don’t include anything about the herb actually doing anything useful. The standards may give some protection against your being poisoned. They do nothing at all to guarantee you’ll be helped.
The conclusions
“What’s really impressed me is the way that different ingredients from particular herb can combine together and have really powerful effects on us humans. So I believe that herbs are going to play a key role in medicines of the future”
“What started as an ancient wisdom may just might provide new medicines that will help us all live longer, fuller lives”
These statements are quite outrageous! The first statement has no basis whatsoever. It is sheer idle speculation. It could be true, but there is no reason to believe it is.
The second statement is content-free. Yes, it “may just” do that. On the other hand it may not.
The web site for the third programme. (7th February, 2006, 2100-2200) concludes thus.
“So, what’s their secret? Working with fellow scientists, Kathy discovers that plants contain much more than a single – or even two or three – active ingredients. They are enormously complex
Chemical cocktails that have medicinal properties modern pharmaceuticals simply can’t reproduce.”
Just one snag (apart from the misleading implication the Sykes was doing pharmacological experiments), There is not the slightest reason, thus far, to think there is any advantage in using an “enormously complex chemical cocktail”.
Stop press: on Saw palmetto (one of the “superherbs” of the TV series)
The New England Journal of Medicine, for February 9th 2006 (354, 557 – 566), reports a clinical trial of “Saw Palmetto for Benign Prostatic Hyperplasia”. This is what they say.
“Saw palmetto is used by over 2 million men in the United States for the treatment of benign prostatic hyperplasia and is commonly recommended as an alternative to drugs approved by the Food and Drug Administration.”
“In this double-blind trial, we randomly assigned 225 men over the age of 49 years who had moderate-to-severe symptoms of benign prostatic hyperplasia to one year of treatment with saw palmetto extract (160 mg twice a day) or placebo.”
“Conclusions. In this study, saw palmetto did not improve symptoms or objective measures of benign prostatic hyperplasia.”
I hope that the BBC, the Open University and Prof Sykes now appreciate the folly of judging treatments before the results are in.
Postscript. Some reviews of the TV programmes
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There has been some lively discussion of the BBC2 series on a forum of the James Randi Educational Foundation, on the BBC2/Open University site, on Ben Goldacres’s Badscience site, and at ebm-first.com.
- The Times TV critic was unenthusiastic.
“So having started out as a sceptic, Sykes ended the programme chirruping, like a born-again Christian, about how herbs contain complex combinations of chemicals that scientists cannot yet reproduce&”;
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Simon Singh writes in the Daily Telegraph (14 Feb., 2006): "Did we really witness the ‘amazing power’ of acupuncture?
“A BBC series on unorthodox therapies was devoid of scepticism and rigour, says Simon Singh.”
“Although the second programme was indeed a rational look at the placebo effect, the other two episodes were little more than rose-tinted adverts for the alternative medicine industry.”
“For example, the scene showing a patient punctured with needles and undergoing open heart surgery left viewers with the strong impression that acupuncture was providing immense pain relief. In fact, in addition to acupuncture, the patient had a combination of three very powerful sedatives (midazolam, droperidol, fentanyl) and large volumes of local anaesthetic injected into the tissues on the front of the chest.
With such a cocktail of chemicals, the acupuncture needles were apparently cosmetic. In short, this memorable bit of telly was emotionally powerful, but scientifically meaningless in building a case for acupuncture. ”“This TV series pretended to be scientific and had the chance to set the record straight, but instead it chickened out of confronting the widespread failure of alternative medicine. ”
- Advertisers cash in. Sadly, but predictably, the programme on herbalism has
already been exploited by vendors of unproven treatments. While it is true that the programme did not actually assert that this herb cured AIDS, it certainly left the impression that it was good stuff. Here is an example: “As seen on BBC2”“In South Africa, BBC 2 TV presenter, Professor Kathy Sykes learnt of the herb Sutherlandia, which is being touted as a new weapon in the fight against HIV and ”
“It is with thanks to programmes such as Alternative Medicine shown on BBC 2 on Tuesday 7th February, and the work carried out by Professor Kathy Sykes that medicinal herbs can receive the acknowledgement they truly deserve, and this knowledge be passed on to the general public.”
“Bioharmony Sutherlandia is available from Revital Ltd in 60 x 300mg tablets for £19.99rrp. ”
- A groundbreaking experiment … or a sensationalised TV stunt?
Simon Singh, in The Guardian (25 March 2006) followed through with some more details on the BBC2 series. It’s not only pharmacologists who were unhappy about it. So were several of the people who advised the BBC and/or appeared on the programme.
“But this week scientists involved in the series have complained that elements of the programmes were misleading, the production team was uninformed, and scientists were used as “marionettes” ”
At the end of the first programme a “hugely ambitious” imaging experiment was shown with an enormous flourish. The outcome was, roughly speaking, that pushing needles into yourself produces a signal in the brain. Good heavens! Who’d have thought it? Even George Lewith, normally an apologist for CAM, was critical.
“The interpretation of the science in this particular programme was not good and was inappropriately sensationalised by the production team. I think all of us on the experiment felt like that.”
“The experiment was not groundbreaking, its results were sensationalised and there was insufficient time to analyse the data properly and so draw any sound conclusions. It was oversold and over-interpreted. We were encouraged to over-interpret, and proper scientific qualifications that might suggest alternative interpretations of the data appear to have been edited out of the programme.”
Edzard Ernst, professor of complementary medicine at Exeter University, and the main consultant for the series says:
“The BBC decided to do disturbingly simple storylines with disturbingly happy endings. But none of these stories is as simple as they presented, nor do they have such happy endings. Even when the evidence was outright negative, they somehow bent over backwards to create another happy ending.
“I feel that they abused me in a way. It was as if they had instructions from higher up that this had to be a happy story about complementary medicine without any complexity, and they used me to give a veneer of respectability.”The BBC, thus far, remain unapologetic
“We take these allegations very seriously and we strongly refute them.We used two scientific consultants for the series, Prof Ernst and Dr Jack Tinker, dean emeritus of the Royal Society of Medicine, both of whom signed off the programme scripts.”
This is the same Jack Tinker who, as Chairman of the Ethics Committee of the Dr Foster organisation, also approved their “COMPLEMENTARY therapists Guide 2004”, and the utterly uncritical complementary practioner directory. The ‘Dr Foster’ organisation is a commercial business that supplies "management information", "market research services", "marketing services" and "information for the public". Let’s hope their services in conventional health care are a bit more critical than their evaluation of CAM. Their “Guide to [CAM] therapies” repeats all the usual pseudo-scientific gobbledygook in a totally uncritical way.
Singh’s article ended with some quotations from this site, concerning Sutherlandia and AIDS, with the remark made above, highlighted: "Comments about Aids were irresponsible and potentially dangerous".
- Science accuses BBC of medical quackery
Lois Rogers, in the Sunday Times for 26th March, reports on the same topic.
“Ernst yesterday released the contents of a letter that he has written to Martin Wilson, the series producer, criticising him for promoting “US-style anti-science”.
He said he felt “abused” by the programme makers: “It was as if they had instructions from higher up that this had to be a happy story about complementary medicine without any complexity, and they used me to give a veneer of respectability.” “
“This is no longer a fringe game played by new age people,” said Colquhoun. “It is beginning to erode intellectual standards at real universities.”
Later a letter appeared in defence of the programmes. Investigation showed that this letter had actually been written by the BBC and not all of the ‘signatories’ had seen it.This is dealt with in a separate post, Alternative Medicine series: dirty tricks at the BBC?