The British Medical Journal for 10 December 2010 carried a real classic, Integrative medicine and the point of credulity (it is no longer behind pay wall).

The subtitle was

"So called integrative medicine should not be used as a way of smuggling alternative practices into rational medicine by way of lowered standards of critical thinking. Failure to detect an obvious hoax is not an encouraging sign "

The use of the terms "integrated medicine" or "integrative medicine" as a form of bait and switch has been discussed quite a lot on this blog (e..g. here and here).

Two common reactions when reading about various sorts of magic medicine are "You couldn’t make it up" and "If you believe that you’ll believe anything". One way to test just how much a true believer will believe is the spoof paper. This was used to devastating effect by Alan Sokal, to demolish the pretentious nonsense of postmodernism.

John C. McLachlan of Durham University put the idea to the test, with hilarious results. He responded to one of those spam emails that invite you to speak at a conference, in this case “The Jerusalem Conference on Integrative Medicine.”.

"I have discovered a new version of reflexology, which identifies a homunculus represented in the human body, over the area of the buttocks. The homunculus is inverted, such that the head is represented in the inferior position, the left buttock corresponds to the right hand side of the body, and the lateral aspect is represented medially. As with reflexology, the “map” responds to needling, as in acupuncture"

"Unfortunately, this novel paradigm may meet with closed minds and automatic rejection. Patience and understanding of “closed” mindsets is essential in order to advance this new discovery in a way commensurate with its importance."

The helpful diagram (above) explained all. Unbelievably, he soon got an answer.

Dear Prof. John C. McLachlan,

You have sent a proposal to the The (sic) Jerusalem International Conference on Integrative Medicine. We are happy to inform you that the Scientific Committee has reached it’s (sic) decision and that your paper has been accepted and you will be able to present your lecture.

The scientific committee?

How did universities come to employ the sort of brain-dead people who could take something like this seriously? No doubt they have nice suits and ties, but lack something between the ears.

London South Bank University recently advertised at a salary £66,000 to £74,000 "London South Bank University is delighted to announce this new full time post of Professor of Integrated Health and Traditional Chinese Medicine". This makes a heartbreaking contrast to brilliant postdoctoral fellows on short insecure contracts, doing wondeful science for half that pay.

There is too much intellectual corruption in universities and vice-chancellors defend it rather than root it out, If the London South Bank school of quackery wants to save some money in the presnt financial crunch, it’s obvious where they should start. More details on this when they respond to my Freedom of Information requests.

Follow-up

Jump to follow-up

I’m baffled. Why is it that beautiful, high quality blogs like Orac’s Respectful Insolence, wanted to be on a commercially-run site in the first place?

Scienceblogs is such a site and it recently caused a crisis when it accepted a paid PR piece by Pepsico (without warning its bloggers first). This was not to be with the obvious advertisements in the side bars, but published like any other blog, Scienceblogs is a commercial organisation, owned and operated by the Seed Media group. The response to the crisis by Adam Bly was leaked and can be read here. It is, in my view, not anything like good enough. One of the great beauties of the internet is that it is really quite hard to keep things secret.

ScienceBlogs was offensive enough even before Pepsigeddon. I go there to read Orac, not to be bombarded with adverts for phone companies and the very sort of quackery that Orac so eloquently exposes. Perhaps Americans are more inured to constant mendacious advertising through their TV and radio. Thank heavens for the BBC which makes (some) good programmes and never has advertisements.

Should people be paid to blog?

I have no objection to people being paid for work that they do. I have had occasional payments from newspapers (and the BMJ) for articles that they have commissioned. This makes a nice change. Scientists usually work for nothing but their salary, and that is how it should be. We write up our results in papers, and then, quite often, we pay the journal to publish our work, and then pay again to buy the journal in which it appears. [That, together with the crisis in peer review, is what persuades me that the current publishing system is broken, but that is a different story.].

We travel the world to give talks for nothing (well just occasionally a small honorarium). Not infrequently we don’t even get paid the full cost of travel.

And those of us who blog, mostly do that for free too. This site costs nothing but a few pounds a year for the domain name, and that comes from my own pocket [and a lot more of my time than I could have afforded when I was doing full time science).

I’m not grumbling about any of this. On the contrary, I enjoy the science and I enjoy the blogging. I am (or was) adequately paid. What more can one ask? The great virtue of not being paid is that you are behoven to nobody. The whole point of science, and the whole point of blogging, is to provide an independent opinion, your own opinion, on matters of science.

I’m only grateful that so many people seem to feel that some of the things I say are worth reading. I do it because it is interesting, it is fun, and it might even do a bit of public good.

Any hint that you may be selling a story on behalf of someone else is the kiss of death, both in real science and in blogging. It doesn’t have to be real, just the perception is enough to ruin your credibility.

To expect independent scientific views from Pepsi is whistling in the wind. Everyone knows about the hugely powerful lobbying by the food industry. The ruthlessness of the industry is, one might argue, counter-productive, because even if they were to produce a totally honest assessment of the evidence, nobody would believe it.

Anyone who has been involved in the battle against junk medicine knows that one is always accused of being a shill for Big Pharma. Of course the purveyors of junk medicine are not very good at checking their facts. If they were, they’d be in a more honest job.

Bhopal report blocked by Seed Magazine

The interesting thing about this sort of kerfuffle is that it brings new facts out of the woodwork.  In today’s Guardian, Gala Vince wrote ‘This isn’t the first time Seed has sacrificed editorial independence‘ A piece she wrote about one of the major shameful disasters of the 20th century, the Bhopal catastrophe, was not published by Seed, because it might have endangered advertising income from the Dow Chemical Company (they are the nice folk who made Agent Orange and Napalm). There is no doubt about this, because Vince quotes an email from Seed that told her.

“As for Bhopal, it’s a cautionary call on our part as we’re in the midst of advertising negotiations with Dow”

This sort of behaviour is much scarier than taking paid blogs from Pepsico, if only because it was secret at the time. The wonderful thing about blogs is that it isn’t secret now. It shows that, notwithstanding their fine words, Seed is not serious about scientific independence if it endangers their income.

Science and commerce don’t mix

Seed pay their contributors per page view, though I haven’t yet been able to discover how much (will anyone tell me?)

Most of the people who write for Scienceblogs do not rely on what they get paid by Seed for their bread and butter. Many of those I like best are practising physicians and surgeons. No doubt they are far richer than I have ever been. In my view they should leave Scienceblogs right now, before they lose any more credibility. Several already have.

If anyone doubts the corrupting effects of commercial interests in medicine, listen to this year’s Sense about Science lecture by Fiona Godlee (editor of the BMJ). The podcast has appeared on The Guardian’s web site. And if you are interested in the corrupting effects of commercial pressures in the alternative medicine industry there are plenty of sources in the links at the bottom of the right hand sidebar.

Or just read the admirable Orac, lately (I hope) of Scienceblogs.

Follow-up

Interesting. I got a direct message from one blogger on Twitter, in answer to my question about how much Seed pays bloggers.

“Seed pays peanuts: I usually get $100 – $200/ month, depending on # of page views. It goes up in increments of $25 per 10,000 extra visitors”

That’s a bit more than I’d guessed, but hardly a significant contribution to the pay of most people who write for them.

This week’s edition of Nature Neuroscience carried a paper with the title “Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture“.  The paper was not without interest, but it tells one nothing about acupuncture in humans. 

The mice had their paws injected with rather unpleasant stuff called Complete Freund’s Adjuvant. This makes them inflamed and sore, so they are unusually sensitive to pain.  When the mice were pierced with human-sized needles, and the needles rotated, they responded a bit less to painful stimuli.

The newspaper reports of this paper were even worse than usual.

The worst of the lot was Richard Alleyne, in the Daily Telegraph: “Acupuncture does work as it stimulates a natural pain killer, scientists find“.

Fiona McCrae in the Daily Mail was marginally better, with “Let’s get straight to the point, acupuncture DOES ease pain“. At least she manages to include a brief critical comment from Edzard Ernst.

Even the usually-excellent Ian Sample in the Guardian was unusually gullible with “Acupuncture may ease pain by triggering release of natural painkiller“. The subheading did say the study was done in mice not man, but there was no critical comment and, as in the other reports, no attempt to summarise what’s known already about acupuncture. 

Worse still, it wasn’t just the newspapers.  There were similar poor reports in Science magazine, in Scientific American, and even the Nature news blog left a lot to be desired.

When this sort of misreporting occurs, it often seems to come from the press release (another case documented here).  Many journalists never get any further than the press release, Here is Nature‘s press release.

The title, and the first sentence, are tendentious, to put it mildly.  The false assertion that "Acupuncture can relieve many kinds of pain" misrepresents entirely the current state of the evidence.  A lot has been written about acupuncture, not least on this blog, but the current position can be summed up roughly as follows. 

1. It has been found time and time again that no difference can be detected between real and sham acupuncture in blind comparisons, and
2. a non-blind comparison between acupuncture and no-acupuncture usually shows some advantage for the acupuncture, but the effect is small, transient and very variable.  A recent review from the Nordic Cochrane group concluded the effect was barely big enough to be clinically significant. 

The odds are that acupuncture is no more than a theatrical placebo.

The press release should have made all this clear, but failed to do so. But then the paper itself also failed to make the context clear.

The abstract of the paper starts "Acupuncture is an invasive procedure commonly used to relieve pain."  The second paragraph starts "Although the analgesic effect of acupuncture is well documented, little is understood about its biological basis".  It is simply not true that "analgesic effect of acupuncture is well documented".  It is not.  Try reading Barker Bausell’s excellent book, “Snake Oil Science” if you want to know about the strength of the evidence. 

The whole paper is written with the underlying premise that acupuncture works, and all that needs to be done is to explain why.  How the paper got past the referees in its present form beggars belief. 

Journals like Nature Neuroscience, like it or not, have a certain prestige. Of course, the prestige is exaggerated, and like all journals, it has some good papers and some poor ones. With that prestige comes responsibility to ensure that press releases are accurate. But one often has the impression that press releases are written with the aim of getting wide press coverage, and prestige for the journal, rather that as critical evaluations of the science.  This is one such case.

Martin Rees said today, in his first Reith lecture, that "science is organised scepticism".  It should be, and in the long run, it is.  This paper is an exception and sadly it isn’t alone.

Other commentaries on this paper

There have already been some excellent commentaries on blogs.  As so often, the best bloggers are sharper than the scientific journals.  If it were not for the fact that my comments on Twitter got some criticism from Nature, I wouldn’t have bothered to add to the following excellent analyses.

Ed Yong, in the Discover site was quick off the mark with A biological basis for acupuncture, or more evidence for a placebo effect?. This provides more detail than I’ve given here. It also has an intriguing postscript.

“PS: The paper notes that the authors have no competing financial interests that might have affected their work. However, it is worth noting that one of the co-authors, Jurgen Schnermann, is married to one Josephine Briggs. Briggs is the director of the National Center for Complementary and Alternative Medicine [NCCAM], an institute that has had its fair share of controversy in the past.”

NCCAM is, of course the branch of the US National Institutes of Health that has spent over a billion dollars of US taxpayers’ money without coming up with a single good treatment.  This is rather fascinating, because the report in the Telegraph ends with a laudatory comment from, ahem. Dr Josephine Briggs.

Dr Josephine Briggs, director of the National Centre for Complementary and Alternative Medicine at the National Institutes of Health in the US, said: “It is clear that acupuncture may activate a number of different mechanisms.

“This carefully performed study identifies adenosine as a new player in the process. It is an interesting contribution to our growing understanding of the complex intervention which is acupuncture.”

James Cole at the Stuff and Nonsense blog has another take on the same work, under the ironic title Acupuncture Works, Say Scientists

At Respectful Insolence, Orac gives a superb and thorough account. Read it: When what an acupuncture study shows is much more interesting than what acupuncture believers think it shows.

Follow-up

Jump to follow-up

Balance in reporting | Call You and Yours | Report on regulation | Cancer video

In the wake of the report by the Science and Technology Committee (STC) on the lack of evidence for homeopathy, and the Chinese medicine poisoning, the BBC carried at least three very bad reports. Being a strong supporter of the BBC that saddens me. 

Nevertheless it has to be said that the BBC does not always do very well on science reporting.  Too many of the reports are anonymous -you don’t know who to blame or who to write to.  Worse still, the BBC’s reports on its web site usually fail to link to original sources. This is unforgiveable: the ability to link to sources is the huge advantage of the web over print media.

The problem of balance in media reports

The question of balance is important. Ofcom imposes an obligation that reporting should reflect  the balance of viewpoints. Section 5 of Ofcom’s broadcasting code says (emphasis is mine).

“Section 5: Due Impartiality and Due Accuracy and Undue Prominence of Views and Opinions”

“To ensure that news, in whatever form, is reported with due accuracy and presented with due impartiality.”

“Meaning of “due impartiality”: “Due” is an important qualification to the concept of impartiality. Impartiality itself means not favouring one side over another. “Due” means adequate or appropriate to the subject and nature of the programme. So “due impartiality” does not mean an equal division of time has to be given to every view, or that every argument and every facet of every argument has to be represented.”

The BBC Trust has a very similar definition of "due impartiality".

It seems to me that in practice producers tend to use "equal time"  too much, and that this often gives a quite misleading impression of the state of play of informed opinion.  Nevertheless, inappropriate use of “equal time” is so common that it would not be worth a formal complaint. This post concerns cases of very unequal time,

Somebody said recently, it is as though after an air crash one gave equal time to the air accident investigator and a representative gravity-deniers association.  That is scarcely an exaggeration of what happened on the BBC after the STC’s report. 

Worse still, far more time was given (especially on ‘Call You and Yours’) to the viewpoint that any scientist, indeed any informed person, would regard as quackery.

This post gives details of three examples of highly partial reporting and it is the basis of complaints to the BBC. But since complaints to the BBC about science reporting rarely get far, a complaint
is being sent also to Ofcom.

(1) Call You and Yours: a platform for herbalists

You and Yours is often quite a good programme, They did an excellent job on a "snoring remedy" which I had unearthed.  But on Tuesday 23 February they did a "Call You and Yours" phone-in programme which was badly researched and highly partial. 

The presenter, Julian Worricker, didn’t know enough about the topic to ask the right questions, though I’d guess that the blame for the poor quality must lie more with the person who decided that the only "expert" on the programme was a herbalist, and with the people who screened the phone calls.

The programme was billed as being a reaction to the case of a Chinese medicine practitioner who poisoned a patient, and to the publication of the report of Science and Technology Select Committee which damned homeopathy.

The programme can be heard here (at you own risk of bursting a blood vessel) Download mp3 file (43.6 Mb)

The major mistake was that the only "expert" on the programme was Michael McIntyre who is chair of the European Herbal & Traditional Medicine Practitioners Association. McIntyre is a well known advocate of alternative medicine, who constantly fudges the need for proper evidence. He is very keen to increase the respectability of herbalists (like all alternative practitioners, he is desperate to be accepted as a real doctor). In fact McIntyre doesn’t even represent all herbalists. . He failed to mention, and the presenter apparently didn’t know, that 2553 herbalists (as of 24 Feb) signed a petition that opposes the sort of pseudo-regulation the McIntyre wants so desperately.

"We the undersigned strongly object to the Government’s proposals to statutorily regulate herbalists and change section 12(1) of the 1968 Medicines Act."

Not to mention this was a serious error on the part of the researchers for this programme.

This was a programme about alternative medicine in which the ONLY expert was a notorious alternative medicine advocate. It was one of the most highly biassed programmes I have ever heard from the BBC. McIntyre most certainly does not represent the views of science or medicine, as shown, for example, by the submission from Sense About Science, the Academy of Medical Royal Colleges, the Institute of Biomedical Science, the Medical Research Society, the Medical Schools Council, the Physiological Society and the Royal College of Pathologists. The opinion of these not insubstantial people was not mentioned anywhere in the programme.

Here is a summary of the main points in the programme. It shows the bias very clearly. Furthermore the people who selected the phone calls seemed to pick almost all people who advocated alternative medicine.

(1) A lengthy anecdote relating a miraculous “cure” of fibromyalgia with homeopathy. No challenge or alternative interpretation was offered.

(2) A pharmacist (for heavens sake) who said she’d "seen results" from homeopathy and didn’t care whether or not it was placebo. She wasn’t challenged on the problem of lying about whether or not is placebo.  We’ve had cause before to worry about the quality of advice given my pharmacists.

(3) Another long anecdote from a nurse (!) claiming to have been "cured" if fibroids by acupressure and cupping. No challenge or alternative interpretation was offered.

(4) Then some emails read out, mostly pro-quack. Only one claiming no effect (in asthma) but that was an anecdote too. Mostly more miracle cures.

(5) Michael McIntyre has the first of several long speeches. advocating more research. There was an advertisement for his web site "promotes best practice" (allegedly). He talks quite seriously about "reflexology" and so on, as though it were real subject (it isn’t; its "principles" are made-up fantasies).

He said. "We need more research in how complementary medicine works".  Notice the inbuilt assumption that it does work. This is directly contradicted by the fact that the USA has spent over a billion dollars on CAM research and come up with not a single useful treatment.  Why did the researchers and the presenter not know about this, and challenge McIntyre?  Once again, the programme researchers seem to be Incompetent.

(7) A caller was mildly critical of fact the Norwich council can’t to anything about claims made by TCM shops (actually Trading Standards could, but generally don’t, but this wasn’t pointed out to the caller).

(8) A caller from Somerset makes the good point that alternative medicine becomes just medicine once it is shown to work.

(9) Michael McIntyre is challenged about evidence, and gives a lengthy speech about why proper RCTs aren’t necessary. They are necessary, but he isn’t challenged. Plus the usual excuse about lack of money for trials.  What about that billion dollars?

(10) The Somerset caller says why restrict yourself to herbs? Good point, but no response.

(11) McIntyre gives another long speech in which he propagates the myth that the impurities in herbal medicines are in some way helpful, or synergistic, This is the only justification that herbalists have for giving impure drugs, but there isn’t the slightest evidence to think it’s true. McIntyre should have been challenged about this, but wasn’t.

At no point was McIntyre challenged about the danger of giving drugs (herbal or otherwise) in unknown doses, as herbalists do. He should have been challenged.

(12) Worker (unspecified) in NHS psychiatry says placebos were used to get patients off drugs. The presenter misses the point by asking if the placebos should be paid for by the NHS. The question he should have asked is about ethics of deceiving patients, but presenter did not do this.

(13) A blatant advertisement from a "health food store" in Barnoldswick. The owners are "pharmacy technicians" (since most pharmacists seem to have difficulties about evidence,
this can’t be regarded as a high qualification). They plug the supplements (almost all unnecessary, a few dangerous) that they sell.

(14) McIntyre again. Says something more or less sensible about drug interactions.

(15) By this time I’d emailed and got in a quick bit about the valuelessness of anecdotes, but was .cut short before I could talk about regulation.

(16) McIntyre defends anecdotes, predictably enough. This time the presenter did raise a good point about how anecdotes should be verified by proper tests but McIntyre again evades the main point that most herbs have not been properly tested, and isn’t challenged.

(17) More emails. A man who takes sage for sore throats. One says "of course homeopathic remedies are placebos but placebos work"; "homeopathy is an extraordinary system for industrialising
the placebo effect, but used by responsible practitioners it has a valuable place". Once again the ethics of deceiving patients with hocus pocus in order to elicit a placebo effect was not raised.
And one caller raised the usual red herring about dogs responding. This, yet again, went unchallenged.  Why wasn’t it pointed out that it is the human who reports the state of the dog who has the placebo response?

(18) Then on to regulation. The researchers and presenter seemed to be quite unaware of the near-unanimous opinion of scientists and also of the Royal College of Physicians, that regulation in the form
proposed by the Pittilo report will be ineffective, and will do more to harm patients than to safeguard them.  There is more than one way to regulate, and this uninformed intervention was especially
unwelcome at a time when the government is considering the question.

(19) Lady with MS said that acupuncture didn’t do her any good at all, but she didn’t like to tell the acupuncturist. But the obvious conclusions were not drawn.

(20) Presenter asks McIntyre leading question "it does work for some and not for others ". No hint there that the ones it "works for" might be the ones who were going to get better anyway. McIntyre himself actual pointed out that some forms of MS (‘relapsing’) undergo spontaneous remissions but of course fails to draw the obvious conclusion that any. He apparent effect of acupuncture could well have been a spontaneous remission. He went on to say (without any evidence) that "acupuncture may help". He relied on the standard line that "more research needed", but failed to mention the vast amount of research that has already been done which shows that acupuncture is probably little more than a theatrical placebo. See, for example, the Nordic Cochrane Centre review and Barker Bausell’s book, Snake Oil Science.

(21) An email points out that anecdotes are no substitute for proper tests. McIntyre then misquotes Sir Michael Rawlins(chair of NICE). He claimed, as most quacks do, that Rawlins had endorsed anecdotes as an acceptable form of evidence in his lecture. This is not what he said at all. In fact Rawlins was referring to treatments that had already passed RCTs and saying that they should be followed up in the wider population of patients to see if they lived up to their initial promise. This interpretation of his words was published in the BMJ after I’d checked it was correct with Rawlins himself.

In the same lengthy speech McIntyre claimed "There really isn’t any dummy acupuncture". This is absolutely untrue, but was not challenged. Huge ingenuity has gone into devising retractable ‘stage dagger’ acupuncture needles, as well as trials that use real needles inserted in the "wrong" positions. One of the most consistent findings in CAM research is that sham acupuncture is not distinguishable from "real" acupuncture. McIntyre, needless to say, didn’t mention this, He should have been challenged but wasn’t.

(21) Declan Naughton (Kingston University) advocates greater "regulation". "If we have trained herbal practitioners" it will make it safer for everyone. Thw revelation of what is actually taught on these degrees shows that, on the contrary, they endanger patients, He claims that use of purified antibiotics leads to problems with drug resistance. There isn’t the slightest reason to think that resistance has anything to do with purification, This was a red herring but went unchallenged. I notice that Naughton has published in Medical Hypotheses, a journal for wild speculations that is not peer-reviewed

(22) Donald Kerr a TCM practitioner, supports McIntyre in looking for statutory regulation. "like the GMC". He is not challenged on the extent to which real medicine and TCM have a sound basis. Like most alternative medicine advocates, he goes for the usual diversionary tactic of criticising western medicine which he refers to as "prescriptive medicines" [sic]

(23) London herbalist Michael Simmons. His web site claims that "Medical Herbalists are trained in the same diagnostic skills as orthodox doctors b". This is simply not true, The fact that herbalists claim it is true mereyl shows how they endanger patients.

(24) Marc Seale, chair of the Health Professions Council (HPC) now appears. he says one very interesting thing "things like false advertising would be dealt with by the regulator". He also acknowledged that there is a strong feeling among scientists and physicians that statutory regulation would give a "false sense of legitimacy " to the area. This latter point was entirely missed by the programme and that seems like another example of incompetent research. But Seale still doesn’t seem to understand the problem, as outlined here and in a joint submission from Sense About Science, the
Academy of Medical Royal Colleges, the Institute of Biomedical Science, the Medical Research Society, the Medical Schools Council, the Physiological Society and the Royal College of Pathologists. This submission opposed regulation of the sort favoured by McIntyre and Seale, but wasn’t even mentioned. Once again, all the speakers were on the same side.

(25. Back once again to McIntyre, who lamented that after ten years of trying, he still hadn’t achieved statutory regulations for herbalists (to the joy of 2500 herbalists), That is simply because they have not fulfilled the requirements for statutory regulation, as laid out in the House of Lords report (2000). That was not mentioned either.  Agani the researchers appear not to have done their job properly.

(26) The presenter, Julian Worricker, refers to Prof. Edzard Ernst as a “divisive figure in this field”. That is a highly partial way to refer to the person who has done more than any other individual to bring together objectively the evidence for the effectiveness of alternative medicine.  Ernst has every scientist and every informed person behind him. 

(27) McIntyre again. He misrepresents Ernst’s views and misrepresents the strength of the evidence for the efficacy of herbal medicines, which are mostly untested.. But he is not challenged.

McIntyre goes on to misrepresent the BMJ Clinical Evidence paper which, he says, shows that 46% of all treatments are not proven to be effective. It is hard to be believe that McIntyre is really unaware that a large proportion of those that were not shown to be effective are CAM treatments, herbal medicine and the like. Professor John Garrow has pointed this out (see, also Healthwatch)

“It is true they chortle, but they have got their facts wrong. The 46% of treatments which are not proven to be effective is 46% of all treatments for 240 common conditions – and very few are used in the NHS. The great majority are treatments used by alternative practitioners. “

If McIntyre was not aware of this he should have been, If he was aware of it he was being less than honest. In any case the programme’s researchers should have been aware of it and McIntyrere should have been challenged. He wasn’t.

(28) A bizarre phone call from someone who seems to think that real medicines are not labelled with their ingredients

(29) Seale is asked if alternative medicine can be regulated like real medicine   He says they’ll check degrees. If the checking is done properly, he’ll find endless dangerous made-up material like that revealed here. No degrees on TCM would pass and the whole edifice would collapse.

(30) Another presenter says "it all depends on peoples’ experiences which side they are on".. No!  That is simply not true. Well it may have been be true of the phone callers, but is both misleading and untrue in general, The divide is actually between those who are aware of, and care about, evidence and those who do not.  Some people actually take the questions seriously, but this comment reduced the discussion to the level of the life style section in a downmarket women’s magazine. One expects more of the BBC.

(31) McIntyre pleads that herbal medicines must be all right because they are used widely on continental Europe. This non sequiter went unchallenged.

(32) Seale says we must wait for Department of Health consultation on Pittilo recommendations. Quite right. For the sake of patient safety, one must hope that the Department of Health will listen to the evidence, and not implement them, despite McIntyre’s success in putting one side of the story on this programme.

(33) McIntyre laments the fact that Europe is bringing in some very sensible regulations about herbal medicine.  Again he had free rein to air the views of some (not all) herbalists, with nobody there to support these sensible measures.

(2) Guilty plea in Chinese herbal ‘cancer’ case

This BBC web page gave a very unbalanced account of the case for and against statutory regulation< of traditional Chinese medicine. It simply echoed the (uninformed) view of the judge that "more regulation is necessary" but it was apparently quite unaware that the form of this regulation is at present under consideration by the Department of Health.

The vast majority of scientific and medical opinion is against the particular form of statutory regulation recommended by the Pittilo steering group, and the author of this anonymous report should have been aware of that.  Why was there no reference to the submission from Sense About Science, the Academy of Medical Royal Colleges, the Institute of Biomedical Science, the Medical Research Society, the Medical Schools Council, the Physiological Society and the Royal College of Pathologists? These are bodies whose views should not have been ignored, as also the individual submissions here and here. It may be acceptable for a judge to be unaware of this powerful body of opinion. It is not acceptable for BBC reporters to ignorant of it.

The web page does now contain a short statement from Sense about Science which goes a small way to redress the imbalance,  That was inserted only after a phone call to the BBC from a member of parliament.

(3) Woman claims that homeopathy cured her cancer

On February 23rd 2010m the BBC showed a an utterly irresponsible item. A homeopath, Gemma Hoefkens, claimed to have been cured of cancer by taking homeopathic sugar pills. There was nobody to point out the utter impossibility of this claim, just some not-very-probing questions fromt the presenter.

Hoefkens promoted her own web site during the interview.  It is illegal under the Cancer ACt 1939 to claim to be able to cure cancer and this video must come very close to breaking that law.  Some interesting inconsistencies in Hoefken’s account have been pointed out on the Ministry of Truth web site . This was a new low point in science reporting.

Follow-up

This complaint has been sent to the BBC. But the Ofcome web site says

“However, we cannot consider complaints about accuracy in BBC TV and radio news or complaints about impartiality in BBC TV and radio programmes. These complaints have to be dealt with by the BBC.”

This seems to preclude any independent outside adjudication. Not good.

Mark Henderson wrote a nice piece about impartiality in The Times (Feb 4 2010), “Science Matters: The BBC’s balancing act“. He expresses views that are, in many ways, similar to mine.

Jump to follow-up

Yes, it’s that most boring of non-medicine topics, homeopathy, again.  At lunchtime on Thursday I got a call from a Times journallst, Fay Schopen, to ask if I could do 500 words on the Science and Technology Committee’s Evidence Check report on homeopathy. Bang goes another evening.  The (im)balance was provided by Sara Eames, President of the Faculty of Homeopathy.  As always the media insist on treating the matter as though it were an even argument.  It’s not.  The version I bashed out was three times the length they wanted, and it was skilfully pruned to length by Fay Schopen for the published version.  Here is the original. longer, version, for what it’s worth.

Should the NHS fund homeopathy?

The problem with parliament is that there aren’t enough doctors in the House.  Or at least there are too many people who seem not to be able to make a critical distinction between what you’d like to be true and what actually is true (no, I’m not talking about Iraq but about something far less important). Perhaps the prime example is David Tredinnick (Cons. Bosworth) who claimed £700 on expenses for his efforts to link astrology and alternative medicine.

Luckily there are a few MPs who are not convinced that healthcare depends on the phase of the moon, and most of them are on the parliamentary Science and Technology Committee (STC).  That committee has been conducting ‘evidence checks’ in an effort to find out the extent to which government policy is based on good evidence.  Last Monday they published Evidence Check 2: Homeopathy.  The report restores ones faith in reason.  It concluded that there is no reason to think homeopathic pills have more effect than a placebo, therefore they should not be paid for by the NHS, and neither was more research justified. The report also criticised the Medicines and Health Regulatory Authority (MHRA) for allowing misleading labelling of homeopathic pills, and the Department of Health for failing the take notice of evidence.

Let’s get one thing straight. Homeopathy is very simple indeed.  The medicine (in dilutions beyond 12C) contains no medicine. Zero, zilch, nothing. That’s why it is a placebo.  Arnica 30C contains not a single molecule of Arnica.  It is like selling strawberry jam that has never seen a strawberry.  Yet Trading Standards officers can do nothing about this gross mislabelling because loopholes in the law allow advocates of magic medicine to get away with it.  It also involves the preposterous idea that the more you dilute a remedy the stronger it gets.  If you want to get drunk quickly, put a drop of whisky in the Atlantic Ocean and take a drop.  It is nothing sort of surreal that the matter is still being discussed after 200 years.

How did these absurd ideas ever take hold?  Around 1800, when homeopathy started, conventional medicine barely existed, and giving nothing was better than being bled and poisoned.  Bleeding patients had been standard medicine for hundreds of years in 1800 despite the fact that it killed people.  It went on so long because it depended on anecdotes, clinical authority and wishful thinking.  These are still the forms of evidence favoured by homeopaths, but real medicine has changed entirely now whereas homeopathy has remained stuck in 1800.

The problem is that homeopaths routinely misrepresent the evidence (if they didn’t they’d be out of business).  The report says

”We regret that advocates of homeopathy, including in their submissions to our inquiry, choose to rely on, and promulgate, selective approaches to the treatment of the evidence base”.

The Society of Homeopaths has the nerve to offer you “An overview of positive homeopathy research”. They quite blatantly omit the very much stronger negative evidence.  The only word for that is dishonesty. 

A favourite with homeopaths is a 2005 study in which 6544 consecutive patients were asked how they felt after homeopathic treatment and 50% said they felt better or much better.  That seems a surprisingly small proportion given that most of them would have been treated for minor self-limiting conditions, but we’ll never know because there was no comparison group at all.  As evidence, this is utterly worthless,

Two other defences are commonly offered by homeopaths.  One is patient choice.  The other is that it doesn’t really matter if it’s a placebo if it makes you happy.  Choice is fine as long as it’s informed choice.  If the homeopath said “these pills contain nothing, but you might feel better after taking them anyway”, that would be fine.  But homeopaths never say that.  In any case to deceive the patient into thinking they are being offered real medicine when they are not poses deep ethical problems, and the Department of Health has refused to grasp that nettle.  You might as well say that Chanel No 5 should be available on the NHS because it makes some people feel better.  At the moment we are in the absurd position in which a doctor is not supposed to give placebo knowingly and honestly, but can refer patient to a homeopath for a dishonest placebo.  The fact that the homeopath may genuinely believe in the magic is not a sufficient excuse. 
 
If homeopaths limited themselves to minor self-limiting conditions, they wouldn’t do too much harm.  But non-medical homeopaths (the vast majority, in the Society of Homeopaths) mostly have no idea of their limitations.  They believe they can prevent and treat treat malaria, AIDS, cholera, yellow fever, even cancer..  At this point homeopathy ceases to be a harmless joke but becomes more like culpable homicide. 

Recently two homeopaths in Australia were jailed for manslaughter after their own daughter died for want of proper treatment.  That is the sort of thing that happens you put your faith in magic medicine,

Homeopathy is on a par with talking to trees. No decent health service should pay for it.

Follow-up

Goldacre has lovely piece in the Guardian.

Homeopathy doesn’t work. But are the claims for other medicines any better?

Drug ads that don’t back up their claims show how dumb doctors can be about evidence and how lax regulation has become

After the Commons science and technology committee report this week, and the stupidity of “we bring you both sides” media coverage, you are bored with homeopathy. So am I, but it gives a simple window into the wider disasters in medicine.

He sounds as bored with homeopathy as I am. He points out that while 100% of claims made by homeopaths’ advertisements are untrue, it is also the case that 30 – 60% of advertisements by Big Pharma can’t be justified by evidence. Once again we see the similarity between the alternative industry and the regular industry (though the former still comes out worse).

Michael Grayer (2 march 2010) , at nontoxic.org.uk has some trenchant comments about what the mainstream media call “balance”. What constitutes balanced coverage worries me too, and gave rise to a complaint to the BBC recently.

Jump to follow-up

What follows is mostly from the press release for the report of the Science and Technology Select Committee’s report on homeopathy.

Comments on their hearings can be found in Comedy gold in parliament and tragedy from Prince of Wales: editorial in British Medical Journal (Although published before Christmas, the comments on this editorial are still going strong in the BMJ).

It seems that the attempts of the British Homeopathic Association to misrepresent the evidence (as documented by Martin Robbins in the Guardian) were not sufficient to fool the MPs.

Committee chairman. Phil; Willis, said

"We were seeking to determine whether the Government’s policies on homeopathy are evidence based on current evidence. They are not."

The NHS As well as recommending, as expected, that NHS funding of homeopathy should end. the report also recommends that no more money should be spent on clinical trials of homeoapthy. The evidence is in and it doesn’t work

The MHRA The Medicines and Health Regulatory Authority (the MHRA) came in for strong criticism when it allowed registering of homeopathic products, and allowed highly misleading labelling of them (see for example, The MHRA breaks its founding principle: it is an intellectual disgrace, and The MHRA loses the plot, and Learned Societies speak out against CAM, and the MHRA). During the committee’s hearings, the CEO of the MHRA, Kent Woods, seemed to say that the labelling of Arnica 30C had been tested to ensure that it did not mislead the public. However evidence subsequently submitted by the MHRA showed that this was not the case. This, rightly. elicited strong criticism in the report

"The MHRA’s user-testing of the label for Arnica Montana 30C—the only product currently licensed under the NRS—was poorly designed, with some parts of the test little more than a superficial comprehension test of the label and other parts actively misleading participants to believe that the product contains an active ingredient.”

With scientific papers it is not acceptable to cut and paste the press release, but for a report of this sort, it summarises the main points succinctly.

The summary of the report

In a report published today, the Science and Technology Committee concludes that the NHS should cease funding homeopathy. It also concludes that the Medicines and Healthcare products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims without evidence of efficacy. As they are not medicines, homeopathic products should no longer be licensed by the MHRA. 

The Committee carried out an evidence check to test if the Government’s policies on homeopathy were based on sound evidence. The Committee found a mismatch between the evidence and policy. While the Government acknowledges there is no evidence that homeopathy works beyond the placebo effect (where a patient gets better because of their belief in the treatment), it does not intend to change or review its policies on NHS funding of homeopathy. 

The Committee concurred with the Government that the evidence base shows that homeopathy is not efficacious (that is, it does not work beyond the placebo effect) and that explanations for why homeopathy would work are scientifically implausible.

The Committee concluded—given that the existing scientific literature showed no good evidence of efficacy—that further clinical trials of homeopathy could not be justified.

In the Committee’s view, homeopathy is a placebo treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception. Prescribing of placebos is not consistent with informed patient choice—which the Government claims is very important—as it means patients do not have all the information needed to make choice meaningful.

Beyond ethical issues and the integrity of the doctor-patient relationship, prescribing pure placebos is bad medicine. Their effect is unreliable and unpredictable and cannot form the sole basis of any treatment on the NHS.

The report also examines the MHRA licensing regime for homeopathic products. The Committee is particularly concerned over the introduction of the National Rules Scheme (NRS) in 2006, as it allows medical indications on the basis of study reports, literature and homeopathic provings and not on the basis of randomised controlled trials (RCTs) – the normal requirement for medicines that make medical claims.

The MHRA’s user-testing of the label for Arnica Montana 30C—the only product currently licensed under the NRS—was poorly designed, with some parts of the test little more than a superficial comprehension test of the label and other parts actively misleading participants to believe that the product contains an active ingredient.

The product labelling for homeopathic products under all current licensing schemes fails to inform the public that homeopathic products are sugar pills containing no active ingredients. The licensing regimes and deficient labelling lend a spurious medical legitimacy to homeopathic products.

The Chairman of the Committee, Phil Willis MP, said:

“This was a challenging inquiry which provoked strong reactions. We were seeking to determine whether the Government’s policies on homeopathy are evidence based on current evidence. They are not.

“It sets an unfortunate precedent for the Department of Health to consider that the existence of a community which believes that homeopathy works is ‘evidence’ enough to continue spending public money on it. This also sends out a confused message, and has potentially harmful consequences. We await the Government’s response to our report with interest.”

Follow-up

A lot of people gave written about the SciTech report. The report of the Parliamentary Select Committee appeared. Evidence check homeopathy damned the policy of both the Department of Health and of the MHRA. The main job, apart from a few talk shows, was a visit to the BBC News Channel for an interview about it. Here it is.  The comment about  Chanel Number 5 seemed to go down well on Twitter.

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