Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
HRH
| The Prince of Wales’ Foundation for Integrated Health (FiH) is a propaganda organisation that aims to persuade people, and politicians, that the Prince’s somewhat bizarre views about alternative medicine should form the basis of government health policy.
His attempts are often successful, but they are regarded by many people as being clearly unconstitutional. |
 |
The FiH’s 2009 AnnualConferen ce conference was held at The King’s Fund, London 13 – 14 May 2009. It was, as always, an almost totally one-sided affair devoted to misrepresentation of evidence and the promotion of magic medicine. But according to the FiH, at least, it was a great success. The opening speech by the Quacktitioner Royal can be read here. It has already been analysed by somebody who knows rather more about medicine than HRH. He concludes
“It is a shocking perversion of the real issues driven by one man; unelected, unqualified and utterly misguided”.
We are promised some movie clips of the meeting. They might even make a nice UK equivalent of “Integrative baloney @ Yale“.
This post is intended to provide some background information about the speakers at the symposium. But let’s start with what seems to me to be the real problem. The duplicitous use of the word “integrated” to mean two quite different things.
The problem of euphemisms: spin and obfuscation
One of the problems of meetings like this is the harm done by use of euphemisms. After looking at the programme, it becomes obvious that there is a rather ingenious bit of PR trickery going on. It confuses (purposely?) the many different definitions of the word “integrative” . One definition of “Integrative medicine” is this (my emphasis).
” . . . orienting the health care process to engage patients and caregivers in the full range of physical, psychological, social, preventive, and therapeutic factors known to be effective and necessary for the achievement of optimal health.”
That is a thoroughly admirable aim. And that, I imagine, is the sense in which several of the speakers (Marmot, Chantler etc) used the term. Of course the definition is rather too vague to be very helpful in practice, but nobody would dream of objecting to it.
But another definition of the same term ‘integrative medicine’ is as a PR-friendly synonym for ‘alternative medicine’, and that is clearly the sense in which it is used by the Prince of Wales’ Foundation for Integrated Health (FIH), as is immediately obvious from their web site.
The guide to the main therapies supports everything from homeopathy to chiropractic to naturopathy, in a totally uncritical way. Integrated service refers explicitly to integration of ‘complementary’ medicine, and that itself is largely a euphemism for alternative medicine. For example, the FIH’s guide to homeopathy says
“What is homeopathy commonly used for?
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 there is not a word about the evidence, and perhaps that isn’t surprising because the evidence that it works in any of these conditions is essentially zero.
The FIH document Complementary Health Care: A Guide for Patients appears to have vanished from the web after its inaccuracy received a very bad press, e.g. in the Times, and also here. It is also interesting that the equally widely criticised Smallwood report (also sponsored by the Prince of Wales) seems to have vanished too).
The programme for the meeting can be seen here, for Day 1, and Day 2
Conference chair Dr Phil Hammond, GP, comedian and health service writer. Hammond asked the FIH if I could speak at the meeting to provide a bit of balance. Guess what? They didn’t want balance.
09:30 Opening session
Dr Michael Dixon OBE
09:30 Introduction: a new direction for The Prince’s Foundation for Integrated Health and new opportunities in integrated health and care. Dr Michael Dixon, Medical Director, FIH
Michael Dixon is devoted to just about every form of alternative medicine. As well as being medical director of the Prince’s Foundation he also runs the NHS Alliance. Despite its name, the NHS Alliance is nothing to do with the NHS and acts, among other things, as an advocate of alternative medicine on the NHS, about which it has published a lot.
Dr Dixon is also a GP at College Surgery, Cullompton, Devon, where his “integrated practice” includes dozens of alternative practitioners. They include not only disproven things like homeopathy and acupuncture, but also even more bizarre practitioners in ‘Thought Field Therapy‘ and ‘Frequencies of Brilliance‘.
To take only one of these, ‘Frequencies of Brilliance’ is bizarre beyond belief. One need only quote its founder and chief salesperson.
“Frequencies of Brilliance is a unique energy healing technique that involves the activation of energetic doorways on both the front and back of the body.”
“These doorways are opened through a series of light touches. This activation introduces high-level Frequencies into the emotional and physical bodies. It works within all the cells and with the entire nervous system which activates new areas of the brain.”
“Frequencies of Brilliance is a 4th /5th dimensional work. The process is that of activating doorways by lightly touching the body or working just above the body.”
“Each doorway holds the highest aspect of the human being and is complete in itself. This means that there is a perfect potential to be accessed and activated throughout the doorways in the body.”
Best of all, it can all be done at a distance (that must help sales a lot). One is reminded of the Skills for Health “competence” in distant healing (inserted on a government web site at the behest (you guessed it) of the Prince’s Foundation, as related here)
“The intent of a long distance Frequencies of Brilliance (FOB) session is to enable a practitioner to facilitate a session in one geographical location while the client is in another.
A practitioner of FOB that has successfully completed a Stage 5 Frequency workshop has the ability to create and hold a stable energetic space in order to work with a person that is not physically present in the same room.
The space that is consciously created in the Frequencies of Brilliance work is known as the “Gap”. It is a space of nonlinear time. It contains ”no time and no space” or respectively “all time and all space”. Within this “Gap” a clear transfer of the energies takes place and is transmitted to an individual at a time and location consciously intended. Since this dimensional space is in non-linear time the work can be performed and sent backward or forward in time as well as to any location.
The Frequencies of Brilliance work cuts through the limitations of our physical existence and allows us to experience ourselves in other dimensional spaces. Therefore people living in other geographic locations than a practitioner have an opportunity to receive and experience the work.
The awareness of this dimensional space is spoken about in many indigenous traditions, meditation practices, and in the world of quantum physics. It is referred to by other names such as the void, or vacuum space, etc.”
This is, of course, preposterous gobbledygook. It, and other things in Dr Dixon’s treatment guide, seem to be very curious things to impose on patients in the 21st century.
Latest news. The Mid-Devon Star announces yet more homeopathy in Dr Dixon’s Cullompton practice. This time it comes in the form of a clinic run from the Bristol Homeopathic Hospital. I guess they must be suffering from reduced commissioning like all the other homeopathic hospitals, but Dr Dixon seems to have come to their rescue. The connection seems to be with Bristol’s homeopathic consultant, Dr Elizabeth A Thompson. On 11 December 2007 I wrote to Dr Thompson, thus
|
In March 2006, a press release http://www.ubht.nhs.uk/press/view.asp?257 announced a randomised trial for homeopathic treatment of asthma in children. This was reported also on the BBC http://news.bbc.co.uk/1/hi/england/bristol/4971050.stm . I’d be very grateful if you could let me know when results from this trial will become available. Yours sincerely David Colquhoun |
The reply, dated 11 December 2007, was unsympathetic
|
I have just submitted the funders report today and we have set ourselves the deadline to publish two inter-related papers by March 1st 2007. Can I ask why you are asking and what authority you have to gain this information. I shall expect a reply to my questions, |
I answered this question politely on the same day but nevertheless my innocent enquiry drew forth a rather vitriolic complaint from Dr Thompson to the Provost of UCL (dated 14 December 2007). In this case, the Provost came up trumps. On 14 January 2008 he replied to Thompson: “I have looked at the email that you copied to me, and I must say that it seems an entirely proper and reasonable request. It is not clear to me why Professor Colquhoun should require some special authority to make such direct enquiries”. Dr Thompson seems to be very sensitive. We have yet to see the results of her trial in which I’m still interested.
Not surprisingly, Dr Dixon has had some severe criticism for his views, not least from the UK’s foremost expert on the evidence for efficacy, Prof Edzard Ernst. Accounts of this can be found in Pulse,
and on Andrew Lewis’s blog.
Dixon is now (in)famous in the USA too. The excellent Yale neurologist, Steven Novella, has written an analysis of his views on Science Based Medicine. He describes Dr. Michael Dixon as “A Pyromaniac In a Field of (Integrative) Straw Men”
Peter Hain
09:40 Politics and people: can integrated health and care take centre stage in 2009/2010? Rt Hon Peter Hain MP
It seems that Peter Hain was converted to alternative medicine when his first baby, Sam, was born with eczema. After (though possibly not because of) homeopathic treatment and a change in diet, the eczema got better. This caused Hain, while Northern Ireland Secretary to spend £200,000 of taxpayers’ money to set up a totally uninformative customer satisfaction survey, which is being touted elsewhere in this meeting as though it were evidence (see below). I have written about this episode before: see Peter Hain and Get Well UK: pseudoscience and privatisation in Northern Ireland.
I find it very sad that a hero of my youth (for his work in the anti-apartheid movement) should have sunk to promoting junk science, and even sadder that he does so at my expense.
There has been a report on Hain’s contribution in Wales Online.
09:55 Why does the Health Service need a new perspective on health and healing? Sir Cyril Chantler, Chair, King’s Fund, previous Dean, Guy’s Hospital and Great Ormond Street
Cyril Chantler is a distinguished medical administrator. He also likes to talk and we have discussed the quackery problem several times. He kindly sent me the slides that he used. Slide 18 says that in order to do some good we “need to demonstrate that the treatment is clinically effective and cost effective for NHS use”. That’s impeccable, but throughout the rest of the slides he talks of integrating with complementary” therapies, the effectiveness of which is either already disproved or simply not known.
I remain utterly baffled by the reluctance of some quite sensible people to grasp the nettle of deciding what works. Chantler fails to grasp the nettle, as does the Department of Health. Until they do so, I don’t see how they can be taken seriously.
10.05 Panel discussion
The Awards
10:20 Integrated Health Awards 2009 Introduction: a review of the short-listed applications
10:45 Presentations to the Award winners by the special guest speaker
11:00 Keynote address by special guest speaker
Getting integrated
Dr David Peters
12:00 Integration, long term disease and creating a sustainable NHS. Professor David Peters, Clinical Director and Professor of Integrated Healthcare, University of Westminster
I first met David Peters after Nature ran my article, Science Degrees without the Science. .One of the many media follow-ups of that article was on Material World (BBC Radio 4). This excellent science programme, presented by Quentin Cooper, had a discussion between me and David Peters ( listen to the mp3 file).
There was helpful intervention from Michael Marmot who had talked, in the first half of the programme, about his longitudinal population studies.
Marmot stressed the need for proper testing. In the case of
homeopathy and acupuncture, that proper testing has largely been done. The tests were failed.
The University of Westminster has, of course, gained considerable notoriety as the university that runs more degree programmes in anti-scientific forms of medicine than any other. Their lecture on vibrational medicine teaches students that amethysts “emit high Yin energy so transmuting lower energies and clearing and aligning energy disturbances at all levels of being”. So far their vice-chancellor, Professor Geoffrey Petts, has declined to answer enquiries about whether he thinks such gobbledygook is appropriate for a BSc degree.
But he did set up an internal enquiry into the future of their alternative activities. Sadly that enquiry seems to have come to the nonsensical conclusion that the problem can be solved by injection of good science into the courses, as reported here and in the Guardian.
It seems obvious that if you inject good science into their BSc in homeopathy the subject will simply vanish in a puff of smoke.
In 2007, the University of Westminster did respond to earlier criticism in Times Higher Education, but their response seemed to me to serve only to dig themselves deeper into a hole.
Nevertheless, Westminster has now closed down its homeopathy degree (the last in the country to go) and there is intense internal discussion going on there. I have the impression that Dr Peters’ job is in danger. The revelation of more slides from their courses on homeopathy, naturopathy and Chinese herbal medicine shows that these courses are not only barmy, but also sometimes dangerous.
Professor Chris Fowler
12:10 Educating tomorrow’s integrated doctors. Professor Chris Fowler, Dean for Education, Barts and The London School of Medicine and Dentistry
I first came across Dr Fowler when I noticed him being praised for his teaching of alternative medicine to students at Barts and the London Medical School on the web site of the Prince’s Foundation. I wrote him a polite letter to ask if he really thought that the Prince of Wales was the right person to consult about the education of medical students. The response I got was, ahem, unsympathetic. But a little while later I noticed that two different Barts students had set up public blogs that criticised strongly the nonsense that was being inflicted on them.
At that point, I felt it was necessary to support the students who, it seemed to me, knew more about medical education than Professor Fowler. It didn’t take long to uncover the nonsense that was being inflicted on the students: read about it here.
There is a follow-up to this story here. Fortunately, Barts’ Director of Research, and, I’m told, the Warden of Barts, appear to agree with my view of the harm that this sort of thing can do to the reputation of Barts, so things may change soon,
Dame Donna Kinnair
12:30 Educating tomorrow’s integrated nurses.
Dame Donna Kinnair, Director of Nursing, Southwark PCT
As far as I can see, Donna Kinnair has no interest in alternative medicine. She is director of nursing at Southwark primary care trust and was an adviser to Lord Laming throughout his inquiry into the death of Victoria Climbié. I suspect that her interest is in integrating child care services (they need it, judging by the recent death of ‘Baby P’). Perhaps her presence shows the danger of using euphemisms like ‘integrated medicine’ when what you really mean is the introduction of unproven or disproved forms of medicine.
Michael Dooley
12:40 Integrating the care of women: an example of the new paradigm. Michael Dooley, Consultant Obstetrician and Gynecologist
DC’s rule 2. Never trust anyone who uses the word ‘paradigm’. It is a sure-fire sign of pseudoscience. In this case, the ‘new paradigm’ seems to be the introduction of disproven treatment. Dooley is a gynaecologist and Medical Director of the Poundbury Clinic. His clinic offers a whole range of unproven and disproved treatments. These include acupuncture as an aid to conception in IVF. This is not recommended by the Cochrane review, and one report suggests that it hinders conception rather than helps.
12.40 Discussion
13.00 – 14.00 Lunch and Exhibition
15.30 Tea
Boo Armstrong and Get Well UK
16.00 Integrated services in action: The Northern
Ireland experience: what has it shown us and what are its implications?
Boo Armstrong of Get Well UK with a team from the NI study
I expect that much will be made of this “study”, which, of course, tells you absolutely nothing whatsoever about the effectiveness of the alternative treatments that were used in it. This does not appear to be the view of Boo Armstrong, On the basis of the “study”, her company’s web site proclaims boldly
“Complementary Medicine Works
Get Well UK ran the first government-backed complementary therapy project in the UK, from February 2007 to February 2008″
This claim appears, prima facie, to breach the Unfair Trading Regulations of May 2008. The legality of the claim is, at the moment, being judged by a Trading Standards Officer. In any case, the “study” was not backed by the government as a whole, but just by Peter Hain’s office. It is not even clear that it had ethical approval.
The study consisted merely of asking people who had seen an alternative medicine practitioner whether they felt better or worse. There was no control group; no sort of comparison was made. It is surely obvious to the most naive person that a study like this cannot even tell you if the treatment has a placebo effect, never mind that it has any genuine effects of its own. To claim that it does so seems to be simply dishonest. There is no reason at all to think that the patients would not have got better anyway.
It is not only Get Well UK who misrepresent the evidence. The Prince’s
Foundation itself says
“Now a new, year long trial supported by the Northern Ireland health service has . . . demonstrated that integrating complementary and conventional medicine brings measurable benefits to patients’ health.”
That is simply not true. It is either dishonest or stupid. Don’t ask me which, I have no idea.
This study is no more informative than the infamous Spence (2005) ‘study’ of the same type, which seems to be the only thing that homeopaths can produce to support their case.
There is an excellent analysis of the Northern Ireland ‘study’ by Andy Lewis, The Northern Ireland NHS Alternative Medicine ‘Trial’. He explains patiently, yet again, what constitutes evidence and why studies like this are useless.
His analogy starts
” . . . the Apple Marketing Board approach the NHS and ask for £200,000 to do a study to show the truth behind the statement ‘An apple a day keeps the doctor away’. The Minister, being particularly fond of apples, agrees and the study begins.”
16.30 Social enterprise and whole systems integrated care. Dee Kyne, Sandwell PCT and a GP. Developing an integrated service in secondary care
Dee Kyne appears to be CEO of KeepmWell Ltd (a financial interest that is not mentioned).
Peter Mackereth, Clinical Lead, Supportive Services, Christie Hospital NHS Foundation Trust
I had some correspondence with Mackereth when the Times (7 Feb 2007) published a picture of the Prince of Wales inspecting an “anti-MRSA aromatherapy inhaler” in his department at the Christie. It turned out that the trial they were doing was not blind No result has been announced anyway, and on enquiry, I find that the trial has not even started yet. Surprising, then to find that the FIH is running the First Clinical Aromatherapy Conference at the Christie Hospital, What will there be to talk about?
Much of what they do at the Christie is straightforward massage, but they also promote the nonsensical principles of “reflexology” and acupuncture.
The former is untested. The latter is disproven.
Parallel Sessions
Developing a PCT funded musculoskeletal service Dr Roy Welford, Glastonbury Health Centre
Roy Welford is a Fellow of the Faculty of Homeopathy, and so promotes disproven therapies. The Glastonbury practice also advertises acupuncture (disproven), osteopathy and herbal medicine (largely untested so most of it consists of giving patients an unknown dose of an ill-defined drug, of unknown effectiveness and unknown safety).
Making the best of herbal self-prescription in integrated practice: key remedies and principles. Simon Mills, Project Lead: Integrated Self Care in Family Practice, Culm Valley Integrated Centre for Health, Devon
Simon Mills is a herbalist who now describes himself as a “phytotherapist” (it sounds posher, but the evidence, or lack of it, is not changed by the fancy name). Mills likes to say things like “there are herbs for heating and drying”, “hot and cold” remedies, and to use meaningless terms like “blood cleanser”, but he appears to be immune to the need for good evidence that herbs work before you give them to sick people. He says, at the end of a talk, “The hot and the cold remain the trade secret of traditional medicine”. And this is the 21st Century.
Practical ways in which complementary approaches can improve the treatment of cancer. Professor Jane Plant, Author of “Your life in your hands” and Chief Scientist, British Geological Society and Professor Karol Sikora, Medical Director, Cancer Partners UK
Jane Plant is a geologist who, through her own unfortunate encounter with breast cancer, became obsessed with the idea that a dairy-free diet cured her. Sadly there is no good evidence for that idea, according to the World Cancer Research Fund Report, led by Professor Sir Michael Marmot. No doubt her book on the subject sells well, but it could be held that it is irresponsible to hold out false hopes to desperate people. She is a supporter of the very dubious CancerActive organisation (also supported by Michael Dixon OBE –see above) as well as the notorious pill salesman, Patrick Holford (see also here).
Karol Sikora, formerly an oncologist at the Hammersmith Hospital, is now Dean of Medicine at the University of Buckingham (the UK’s only private university). He is also medical director at CancerPartners UK, a private cancer company.
He recently shot to fame when he appeared in a commercial in the USA sponsored by “Conservatives for Patients’ Rights”, to pour scorn on the NHS, and to act as an advocate for the USA’s present health system. A very curious performance. Very curious indeed.
His attitude to quackery is a mystery wrapped in an enigma. One was somewhat alarmed to see him sponsoring a course at what was, at first, called the British College of Integrated Medicine, and has now been renamed the Faculty of Integrated Medicine That grand title makes it sound like part of a university. It isn’t.
The alarm was as result of the alliance with Dr Rosy Daniel (who promotes an untested herbal conconction, Carctol, for ‘healing’ cancer) and Dr Mark Atkinson (a supplement salesman who has also promoted the Qlink pendant. The Qlink pendant is a simple and obvious fraud designed to exploit paranoia about WiFi killing you.
The first list of speakers on the proposed diploma in Integrated Medicine was an unholy alliance of outright quacks and commercial interests. It turned out that, although Karol Sikora is sponsoring the course, he knew nothing about the speakers. I did and when I pointed this out to Terence Kealey, vice-chancellor of Buckingham, he immediately removed Rosy Daniel from directing the Diploma. At the moment the course is being revamped entirely by Andrew Miles. There is hope that he’ll do a better job. It has not yet been validated by the University of Buckingham. Watch this space for developments.
Stop press It is reported in the Guardian that Professor Sikora has been describing his previous job at Imperial College with less than perfect accuracy. Oh dear. More developments in the follow-up.
The role of happy chickens in healing: farms as producers of health as well as food – the Care Farm Initiative Jonathan Dover, Project Manager, Care Farming, West Midlands.
“Care farming is a partnership between farmers, participants and health & social care providers. It combines the care of the land with the care of people, reconnecting people with nature and their communities.”
Sounds lovely, I wonder how well it works?
What can the Brits learn from the Yanks when it comes to integrated health? Jack Lord, Chief Executive Humana Europe
It is worth noticing that the advisory board of Humana Europe includes Micheal Dixon OBE, a well known advocate of alternative medicine (see
above). Humana Europe is a private company, a wholly owned subsidiary of Humana Inc., a health benefits company with 11 million members and 22,000 employees and headquarters in Louisville, Kentucky. In 2005 it entered into a business partnership with Virgin Group. Humana was mentioned in the BBC Panorama programme “NHS for Sale”. The company later asked that it be pointed out that they provide commissioning services, not clinical services [Ed. well not yet anyway].
Humana’s document “Humana uses computer games to help people lead healthier lives” is decidedly bizarre. Hang on, it was only a moment ago that we were being told that computer games rewired your brain.
Day 2 Integrated health in action
09.00 Health, epidemics and the search for new solutions. Sir Michael Marmot, Professor of Epidemiology and Public Health, Royal Free and University College Medical School
It is a mystery to me that a distinguished epidemiologist should be willing to keep such dubious company. Sadly I don’t know what he said, but judging my his publications and his appearence on Natural World, I can’t imagine he’d have much time for homeopaths.
9.25 Improving health in the workplace. Dame Carol Black, National Director, Health and Work, Department of Health
This is not the first time that Dame Carol has been comtroversial.
9.45 Integrated health in focus: defeating obesity. Professor Chris Drinkwater, President, NHS Alliance.
The NHS Alliance was mentioned above. Enough said.
10.00 Integrated healthcare in focus: new approaches to managing asthma, eczema and allergy. Professor Stephen Holgate, Professor of Immunopharmacology, University of Southampton
10.15 Using the natural environment to increase activity. The Natural England Project: the results from year one. Dr William Bird and Ruth Tucker, Natural England.
10.30 Panel discussion
10.45 Coffee
Self help in action
11.10 Your health, your way: supporting self care through care planning and the use of personal budgets. Angela Hawley, Self Care Lead, Department of Health
11.25 NHS Life Check: providing the signposts to
integrated health. Roy Lambley, Project Director, NHS LifeCheck Programme
This programme was developed with the University of Westminster’s “Health and Well-being Network”. This group, with one exception, is separate from Westminster’s extensive alternative medicine branch (it’s mostly psychologists).
11.45 The agony and the ecstasy of helping patients to help themselves: tips for clinicians, practices and PCTs. Professor
Ruth Chambers, FIH Foundation Fellow.
11.55 Providing self help in practice: Department of Health Integrated Self Help Information Project. Simon Mills, Project Lead: Integrated Self Care in Family Practice, Culm Valley Integrated Centre for Health, Devon and Dr Sam Everington, GP, Bromley by Bow.
The Culm Valley Integrated Centre for health is part of the College Surgery Partnership, associated with Michael Dixon OBE (yes, again!).
Simon Mills is the herbalist who says “The hot and the cold remain the trade secret of traditional medicine” .
Sam Everington, in contrast, seems to be interested in ‘integration’ in the real sense of the word, rather than quackery.
Integrated health in action
How to make sense of the evidence on complementary approaches: what works? What might work? What doesn’t work?
Dr Hugh MacPherson, Senior Research Fellow in Health Sciences, York University and Dr Catherine Zollman, Bravewell Fellow
Hugh MacPherson‘s main interest is in acupuncture and he publishes in alternative medicine journals. Since the recent analysis in the BMJ from the Nordic Cochrane Centre (Madsen et al., 2009) it seems that acupuncture is finally dead. Even its placebo effect is too small to be useful. Catherine Zollman is a Bristol GP who is into homeopathy as well as acupuncture. She is closely connected with the Prince’s Foundation via the Bravewell Fellowship. That fellowship is funded by the Bravewell Collaboration, which is run by Christie Mack, wife of John Mack (‘Mack the Knife’), head of Morgan Stanley (amazingly, they still seem to have money). This is the group which, by sheer wealth, has persuaded so many otherwise respectable US universities to embrace every sort of quackery (see, for example, Integrative baloney @ Yale)
The funding of integrated services
14.15 How to get a PCT or practice- based commissioner to fund your integrated service. A PCT Chief Executive and a Practice-Based Commissioning lead.
14.30 How I succeeded: funding an integrated service. Dr John Ribchester, Whitstable
14.45 How we created an acupuncture service in St Albans and Harpenden PBC group. Mo Girach, Chief Executive, STAHCOM
Uhuh Acupunture again. Have these people never read Bausell’s
book? Have they not read the BMJ? Acupuncture is now ell-established to be based on fraudulent principles, and not even to have a worthwhile placeobo effect. STAHCOM seem to be more interested in money than in what works.
Dragon’s Den. Four pitchers lay out their stall for the commissioning dragons
And at this stage there is no prize for guessing that all four are devoted to trying to get funds for discredited treatments
- An acupuncture service for long-term pain. Mike Cummings Chair, Medical Acupuncture Association
- Manipulation for the treatment of back pain Simon Fielding, Founder Chairman of the General Osteopathic Council
- Nigel Clarke, Senior Partner, Learned Lion Partners Homeopathy for long term conditions
- Peter Fisher, Director, Royal Homeopathic Hospital
Sadly it is not stated who the dragons are. One hopes they will be more interested in evidence than the supplicants.
Mike Cummings at least doesn’t believe the nonsense about meridians and Qi. It’s a pity he doesn’t look at the real evidence though.
You can read something about him and his journal at BMJ Group promotes acupuncture: pure greed.
Osteopathy sounds a bit more respectable than the others, but in fact it has never shaken off its cult-like origins. Still many osteopaths make absurd claims to cure all sorts of diseases. Offshoots of osteopathy like ‘cranial osteopathy’ are obvious nonsense. There is no reason to think that osteopathy is any better than any other manipulative therapy and it is clear that all manipulative therapies should be grouped into one.
Osteopathy and chiropractic provide the best ever examples of the folly of giving official government recognition to a branch of alternative medicine before the evidence is in.
Learned Lion Partners is a new one on me. It seems it is
part of Madsen Gornall Ashe Chambers (‘MGA Chambers’) “a grouping of top level, independent specialists who provide a broad range of management consultancy advice to the marketing community”. It’s a management consultant and marketing outfit. So don’t expect too much when it comes to truth and evidence. The company web site says nothing about alternative medicine, but only that Nigel Clarke
“. . . has very wide experience of public affairs issues and campaigns, having worked with clients in many sectors in Europe, North America and the Far East. He has particular expertise in financial, competition and healthcare issues. “
However, all is revealed when we see that he is a Trustee of the Prince’s Foundation where his entry says
“Nigel Clarke is senior partner of Learned Lion Partners. He is a director of Vidapulse Ltd, Really Easy Ltd, Newscounter Ltd and Advanced Transport Systems Ltd. He has worked on the interfaces of public policy for 25 years. He has been chair of the General Osteopathic Council since May 2001, having been a lay member since it was formed. He is now a member of the Council for Healthcare Regulatory Excellence”
The Council for Healthcare Regulatory Excellence is yet another quango that ticks boxes and fails absolutely to grasp the one important point, does it work?. I came across them at the Westminster Forum, and they seemed a pretty pathetic way to spend £2m per year.
Peter Fisher is the last supplicant to the Dragons. He is clinical director of the Royal London Homeopathic Hospital (RLHH), and Queen’s homeopathic physician, It was through him that I got an active interest in quackery. The TV programme QED asked me to check the statistics in a paper of his that claimed that homeopathy was good for fibrositis (there was an elementary mistake and no evidence for an effect). Peter Fisher is also remarkable because he agreed with me that BSc degrees in homeopathy were not justified (on TV –see the movie). And he condemned homeopaths who were caught out recommending their sugar pills for malaria. To that extent Fisher represents the saner end of the homeopathic spectrum. Nevertheless he still maintains that sugar pills work and have effects of their own, and tries to justify the ‘memory of water’ by making analogies with a memory stick or CD. This is so obviously silly that no more comment is needed.
Given Fisher’s sensible condemnation of the malaria fiasco, I was rather surprised to see that he appeared on the programme of a conference at the University of Middlesex, talking about “A Strategy To Research The Potential Of Homeopathy In Pandemic Flu”. The title of the conference was Developing Research Strategies in CAM. A colleague, after seeing the programme, thought it was more like “a right tossers’ ball”.
Much of the homeopathy has now vanished from the RLHH as a result of greatly reduced commissioning by PCTs (read about it in Fisher’s own words). And the last homeopathy degree in the UK has closed down. It seems an odd moment for the FIH to be pushing it so hard.
Follow-up
Stop press It is reported in the Guardian (22 May 2009) that Professor Sikora has been describing his previous job at Imperial College with less than perfect accuracy. Oh dear, oh dear.
This fascinating fact seems to have been unearthed first by the admirable NHS Blog Doctor, in his post ‘Imperial College confirm that Karol Sikora does not work for them and does not speak on their behalf‘.
Today brings a small setback for those of us interested in spreading sensible ideas about science. According to a press release
“The BMJ Group is to begin publishing a medical journal on acupuncture from next year, it was announced today (Tuesday 11 November 2008).
This will be the first complementary medicine title that the BMJ Group has published.”
And they are proud of that? What one earth is going on? The BMJ group is a publishing company which says, of itself,
“Our brand stands for medical credibility. We are one of the world’s best known and most respected medical publishers.”
Well perhaps it used to be.
They have certainly picked a very bad moment for this venture. In the last year there have been at least five good books that assess the evidence carefully and honestly. Of these, the ones that are perhaps the best on the subject of acupuncture are Singh & Ernst’s Trick or Treatment and Barker Bausell’s Snake Oil Science. Both Ernst and Bausell have first hand experience of acupuncture research. And crucially, none of these authors has any financial interest in whether the judgement goes for acupuncture or against it.
Here are quotations from Singh & Ernst’s conclusions
“Reliable conclusions from systematic reviews make it clear that acupuncture does not work for a whole range of conditions, except as a placebo.”
“There are some high quality trials that support the use of acupuncture for some types of pain and nausea, but there are also high quality trials that contradict this conclusion. In short, the evidence is neither consistent nor convincing – it is borderline.”
The House of Lords’ report in 2000 tended to give acupuncture the benefit of the (very considerable) doubt that existed at the time the report was written. Since that time there have been a lot of very well-designed trials of acupuncture.
Now it is quite clear that, for most (and quite possibly all) conditions, acupuncture is no more than a particularly theatrical placebo. Perhaps that is not surprising insofar as the modern western practice of acupuncture owes more to Chinese nationalistic propaganda that started in the time of Mao-Tse Tung than it owes to ancient wisdom (which often turns out to be bunk anyway).
The BMJ Group has decided to endorse acupuncture at a time when it is emerging that the evidence for any specific effect is very thin indeed. Well done.
The journal in question is this.
Acupuncture in Medicine is a quarterly title, which aims to build the evidence base for acupuncture. It is currently self-published by the British Medical Acupuncture Society (BMAS).
One good thing can be said about the Society and the Journal. That is that they don’t espouse all the mumbo-jumbo about ‘meridians’ and ‘Qi’. This, of course, puts them at odds with the vast majority of acupuncture teaching. This sort of internecine warfare between competing sects is characteristic of all sorts of alternative medicine. But that is just ideology. What matters is whether or not sticking needles in you is actually anything more than a placebo.
British Medical Acupuncture Society (BMAS)
The British Medical Acupuncture Society (BMAS). is “a registered charity established to encourage the use and scientific understanding of acupuncture within medicine for the public benefit.”. The phrase “encourage the use” suggests that they do not even envisage the possibility that it might not work. Their web site includes these claims.
Acupuncture can help in a variety of conditions:
- Pain relief for a wide range of painful conditions
- Nausea, especially postoperative nausea and vomiting
- Overactive bladder, also known as bladder detrusor instability
- Menstrual and menopausal problems, eg period pains and hot flushes
- Allergies such as hay fever and some types of allergic rashes
- Some other skin problems such as ulcers, itching and localised rashes
- Sinus problems and more
Presumably the word “help” is chosen carefully to fall just short of “cure”. The claims are vaguely worded, but let’s see what we can find about them from systematic reviews. It appears that the BMAS is being rather optimistic about the evidence.
BMJ Clinical Evidence is considered reliable and is particular interesting because it is owned by the BMJ Publishing Group.
Low Back Pain (chronic) Acupuncture is listed as being of “unknown effectiveness”.
Dysmenorrhoea Acupuncture is listed as being of “unknown effectiveness”.
Osteoarthritis of the knee. Acupuncture is listed as being of “unknown effectiveness”.
Psoriasis (chronic plaque) Acupuncture is listed as being of “unknown effectiveness”.
Neck pain “Acupuncture may be more effective than some types of sham treatment (not further defined) or inactive treatment (not further defined) at improving pain relief at the end of treatment or in the short term (less than 3 months), but not in the intermediate term (not defined) or in the long term (not defined)”
Headache (chronic tension-type) Acupuncture is listed as being of “unknown effectiveness”.
What about the greatest authority, the Cochrane Reviews?
Cochrane Reviews
Low back pain The data do not allow firm conclusions about the effectiveness of acupuncture for acute low-back pain. For chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and “alternative” treatments. The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low-back pain. Because most of the studies were of lower methodological quality, there certainly is a further need for higher quality trials in this area.
Chronic asthma. There is not enough evidence to make recommendations about the value of acupuncture in asthma treatment. Further research needs to consider the complexities and different types of acupuncture.
But most of the vaguely-worded claims made by BMAS have not been the subject of Cochrane reviews. The obvious interpretation of that is that there is not enough evidence to make it worth writing a review. In which case, why does BMAS claim that acupuncture can “help”?
Bandolier is another excellent source of high quality information, This was their view in September 2006
“Large, high-quality randomised trials of acupuncture have been published since the reviews. In fibromyalgia, chemotherapy-induced nausea and vomiting, breech presentation, tension headache, and migraine, all were negative compared with sham acupuncture. One in osteoarthritis of the knee, had statistical improvement over sham acupuncture at three months, but not later. Both large trials and this review of reviews come to the same general conclusion; that over a whole range of conditions and outcomes acupuncture cannot yet be shown to be effective.”
After thousands of years of acupuncture (or at least almost 40 years in the West) there seems to be very little to show for it.
The journal: Acupuncture in Medicine
What about the journal in question? Like all journals devoted to alternative medicine, it claims to be evidence-based. And like all journals devoted to alternative medicine it suffers from a fatal conflict of interest. If this journal were ever to conclude that acupuncture is a placebo, it would destroy the journal and the livelihoods of many of the people who write for it.
Scanning the first three issues of 2008 shows that it is very much like other alternative medicine journals. Most of the papers don’t address the critical question, is it a placebo. And most papers end up rather limply, with a statement along the lines “acupuncture may be useful for ***. More research is needed.”
The editor in chief of the journal is Dr Adrian White, and its editor is Michael Cummings. White is quoted by Ernst in the Guardian in 2004.
“We need to provide hard evidence to support what we all see in our clinics every day: that the modern approach to acupuncture works, and is highly relevant to the new, patient-centred NHS.” .
That means the answer is assumed in advance. That just isn’t science.. ‘We know the answer, all we have to do now is get some evidence’.
Why should the BMJ Group want to do a thing like this?
The press release says
Commenting on the move, BMJ and BMJ Journals Publishing Director, Peter Ashman, said “The journal is a good complement for our existing portfolio of journals and we’re certain that the Society’s members and other subscribers will appreciate the benefits of the decision the BMAS has made on their behalf.”
He continued: “The BMAS is ambitious for its journal to grow and flourish and we’re looking forward to working with the Society to develop an editorial and commercial strategy which will achieve the aims of BMAS and those of its members, while reaching out to the wider global community interested in this fascinating area of medicine.”
Yes, you got it. Money. The same motive that causes some vice-chancellors to bring their university into disrepute by awarding BSc degrees in subjects that are not only not science, but which are oftenly openly anti-science.
Conscience doesn’t seem to bother these people, so let’s put the problem in purely cash terms.
Both the BMJ Group and the vice-chancellors will have to decide whether the cash they gain is sufficient to counterbalance the corrosive effects of their actions on their own reputations.
Follow-up
Only a couple of days later, two new trials show acupuncture is no different from sham controls for helping IVF pregnancy rates. James Randerson in the Guardian writes thus.
“Acupuncture aimed at improving IVF success rates is widely offered by fertility clinics in the UK. In the first of the studies, researchers in Hong Kong split 370 women receiving IVF into two groups. One group received real acupuncture before and after having an IVF embryo implanted into their uterus. The other had the same procedure, except the treatment used retractable needles that did not penetrate the skin.”
“Of the 185 who received the sham treatment, 91 achieved a clinical pregnancy (foetal heartbeat identified using ultrasound) and 71 had a successful delivery. This compared with 72 clinical pregnancies in the true acupuncture group and 55 live births. The differences between the groups were not statistically significant.”
“In a second study, researchers in Chicago used a similar design in which 124 women received true or sham acupuncture. The control group had their skin punctured by real acupuncture needles, but not at genuine “Qi-lines” on the body. In the true acupuncture group, 43.9% achieved a clinical pregnancy, compared with 55.2% of the women given the sham treatment. “
The original paper for the first study can be seen here.
The Times today has given s good showing for my comment piece. It gives the case against following the advice of the Pittilo report. It simply makes no sense to have government regulation of acupuncture, herbal medicine, traditional Chinese medicine until such time as there is evidence that they work. It makes even less sense to have BSc degrees in them. The Department of Health should have more sense that to use the Prince of Wales as its scientific advisor.
Let’s hope that the recent example set by the University of Central Lancashire is the start of trend for vice-chancellors to appreciate that running such degrees brings their universities into disrepute.
I can only apologise for the dreadful title that The Times’ sub-editors put on the piece, My original title was
A bad report for the vice chancellor
The Pittilo report to the Department of Health will endanger the public and corrupt universities. There is a better way.
I like that much better than “Regulate quack nedicine? I feel sick”.
But, oh dear, the picture that I sent them is on the left, but what appeared is on the right. Spot the difference.
 |
 |
Well now, at least, I can feel I have something in common with Isambard Kingdom Brunel.
Follow-up
It so happens that Professor Pittilo wrote a letter to Times Higher Education this week. I fear that it provided a yet more evidence that he hasn’t really quite got the hang of evidence.
The Lancashire Evening Post catches up with the UCLan story, two days after you read it here.
A reply from Professor Pittilo
This response to the op-ed of 29th August appeared as a letter
in the Times on Sept 2.
| Public health needs protection
Regulation of acupuncture and herbal medicine has been subject to much scrutiny Sir, Professor Colquhoun’s campaign to discredit our report (“Regulate quack medicine? I feel sick,” Aug 29) is in danger of placing public health at risk. He is entitled to challenge existing evidence for the effectiveness of complementary and alternative medicine (CAM) but fails to acknowledge the key recommendation from the steering group on the essential need to demonstrate efficacy, safety and quality assurance as a prerequisite for NHS funding. Professor Colquhoun dismisses CAM because of the absence of a rigorous scientific foundation and he asserts that to teach and practise it is unethical. Survey data consistently demonstrates very high demand for CAM with one report estimating that 22 million visits involving 10.6 per cent of the population in England alone occurred in 2008. This demand is one reason why his alternative model of trade law enforcement will not work. He may argue that these people are uncritical recipients of nonsense, but data from the Medicines and Healthcare products Regulatory Agency confirm that they are at significant risk from poor practice. It is essential that we protect the public by implementing statutory regulation alongside demanding evidence of efficacy. Professor Colquhoun’s resistance to the teaching of science to CAM practitioners will do little to help them to critically evaluate effectiveness. Professor Michael Pittilo Chair of the Department of Health Steering Group |
And Pittilo wrote in similar vein to Times Higher Education.
Science vital to health study28 August 2008 Your feature on some members of staff at the University of Central Lancashire attacking science degrees in complementary and alternative medicine (“Staff attack science degrees in alternative health”, 7 August) raises a number of concerns. It is up to any university, taking account of the expert views of staff and external peer review, to determine the appropriate title and award for any degree. It is encouraging to note from the feature that new courses The recent report to Ministers from the Department of Health Steering Group on the Statutory Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and other Traditional Medicine There is no doubt that courses that provide a solid scientific foundation will greatly assist CAM practitioners in establishing evidence-based practice. It would be most unfortunate if the reported resistance to degree titles led to those wishing to practise acupuncture or herbal medicine receiving less hard science than they might have. To say that acupuncture and herbal medicine degrees have no academic justification appears arrogant in the extreme. Although it is certainly true that some content may not be scientific, this does not invalidate the legitimacy of these courses at degree level, a fact borne out by their successful validation in a number of universities. R. Michael Pittilo, Principal and vice-chancellor, The Robert Gordon University. |
This one got excellent responses from Kevin Smith (University of Abertay, Dundee), and from Peter J. Brophy (Professor of veterinary anatomy and cell biology University of Edinburgh). This was my comment to THE
There are a few very obvious responses to Professor Pittilo’s letter
For many alternative therapies the “philosophy” is simply incompatible with science. One obvious example is homeopathy. On Mondays and Wednesdays (science days) the students will be required to learn that response increases with dose. On Tuesdays and Thursdays will be taught the opposite. But for the exam they must reproduce only the latter (nonsensical) idea because their aim is to get a job as a homeopath. That makes nonsense of the idea of a university.
This seems to constitute a recognition that the evidence is still very inadequate. The time to start degrees, and the time to give official government recognition, is after the evidence is in, not before. What happens if you start degrees and then find that the subject is so much nonsense? Well, that has already happened in several areas of course. But the people who accredit the course and who act as external examiners just happen to be fervent believers in that nonsense, so all appears to be well (to bean counters anyway).
There is, as it happens, a great deal of evidence now about acupuncture, but the authors of the report do not seem to be aware of it. I recommend Barker Bausell’s book on the topic. If students are educated science, like what constitutes evidence, and our current understanding of words like “energy”, they would have to disavow the subject that there are supposed to training to practise
No, it is not a matter of arrogance, just a matter of careful attention to the evidence. Attention to evidence was notably absent in Prof Pittilo’s report, perhaps because his committee consisted entirely of people who earn their living from the subjects they were supposed to be assessing.
I have had the misfortune to have waded through a mound of such validation documents. The one thing they never consider is whether the treatment works. Sad to say, these validations are not worth the paper they are written on. |