Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
Universities
This letter appeared in the Times on Friday 30 January, 2009. It was prompted by the news from the University of Salford, but its main purpose was to try to point out to the Department of Health that you can’t hope to regulate alternative treatments in any sensible way while continuing to push under the carpet the crucial question of which ones work and which don’t.
| Sir
We would like to congratulate the vice-chancellor of the University of Salford, Professor Michael Harloe for his principled decision to drop “all the University’s programmes associated with complementary medicine within the School of Community, Health Sciences & Social Care”. This includes their “Homeopathy in Practice” degree. It is also encouraging that the University of Central Lancashire recently closed its BSc in Homeopathy to new students, and announced a review of all its activities in alternative medicine. Although universities are now taking sensible actions, government policy in the area of regulation of alternative medicine is in urgent need of revision. In May 2008 the Steering Group chaired by Professor Pittilo recommended to the Department of Health that entry into acupuncture, herbal medicine and traditional Chinese medicine should “normally be through a bachelor degree with honours”. But, in the same month, new regulations on Unfair Trading came into effect. One of the 31 commercial practices which are in all circumstances considered unfair is “falsely claiming that a product is able to cure illnesses, dysfunction or malformations”. One part of government seeks to endorse unproven and disproved treatments, at the same time as another part makes them illegal. The reason for this chaotic situation is simple. The Department of Health, and the Medicines and Healthcare products Regulatory Agency (MHRA), have consistently failed to grasp the nettle of deciding which treatments work and which don’t. That is the first thing you want to know about any treatment. Vice-chancellors seem now to be asking the question, and the government should do so too. The ideal mechanism already exists. The question should be referred to the National Institute for Health and Clinical Excellence (NICE). That was recommended by a House of Lords report in 2000, and it was recommended again by the Smallwood report (commissioned by the Prince of Wales) in 2005. Now it should be done. Sir Walter Bodmer FRCPath, FRS, FMedSci, FRCP (hon) FRCS(hon) Professor David Colquhoun, FRS Dame Bridget Ogilvie , AC, DBE, FRS, FAA, Professor Dame Nancy Rothwell, FRS, FMedSci, FRCP (hon) |
(Actually, the Times removed the qualifications of the signatories, but left the titles!)
An earlier, longer, version of the letter tried to preempt the obvious criticism by including, as the second paragraph, this passage.
“It makes no sense to offer Bachelor of Science degrees in subjects that have no scientific basis. Not only is homeopathy scientifically absurd, but also the best quality clinical trials show that it is not distinguishable from placebo. From the point of view of the patient, there is nothing wrong with placebo effects. Conventional drugs benefit from them too. There is everything wrong with surrounding the placebo effect with mystical mumbo-jumbo and awarding degrees in it.”
Universities drop degree courses in alternative medicine
In the same issue, there was a related article by the Times’ education editor, Alexandra Frean: Universities drop degree courses in alternative medicine..
“Universities are increasingly turning their backs on homoeopathy and complementary medicine amid opposition from the scientific community to “pseudo-science” degrees.
The University of Salford has stopped offering undergraduate degrees in the subjects, and the University of Westminster announced yesterday that it plans to strengthen the “science base” content of its courses after an internal review which examined their scientific credibility.
Both universities are following the lead of the University of Central Lancashire, which last year stopped recruiting new students to its undergraduate degree in homoeopathic medicine.
The decisions by Salford and Westminster open a new chapter in the fierce debate about the place of awarding of Bachelor of Science degrees in subjects that are not science.”
The article ends thus.
“Other universities are more robust in their defence of their courses
Ian Appleyard, principal lecturer in acupuncture at London South Bank University, said that acupuncture should be studied for the very reason that it was not well understood from the standpoint of Western scientific medicine. Acupuncture had been used by a significant proportion of the world’s population for thousands of years.
“Recent large-scale clinical trials such Haake and meta-analysis from reputable institutions such as The Cochrane Collaboration, have shown that there is evidence to support the therapeutic benefits of acupuncture treatment for back pain and migraine,” he said.”
Uhuh, it seems that Ian Appleyard has been reading the misleading BBC report on the recent trials. In fact they show precisely the opposite of what he claims. The fact that advocates of alternative medicine can misinterpret the evidence so badly is, I guess, at the heart of the problem.
What’s happening at the University of Westminster?
Westminster has regularly been labelled as the University that has more quackery courses than any other.
It is also the only university for which we have much idea about what is taught. The university, like all others, has tried to keep secret what they teach. That itself shows that they aren’t very proud of it. But a surprising amount has leaked out from Westminster, nonetheless. The set of “vibrational medicine” slides, including “Amethysts emit high Yin energy”, have caused much hilarity. The Westminster “miasmatic” examination question gets some laughs too, after it was published in Nature. The set of homeopathic materia medica notes that have come into my possession are pretty good too (coming on line soon).
Recently it emerged that the University of Westminster had followed the example of the University of Central Lancashire (UCLAN), and set up a review of its activities in alternative medicine. But unlike UCLAN it was kept secret, and as far as one can tell, it asked for no input from critics.
Well the outcome of this review turned up in my mail recently. Click the picture to read the whole letter from the Vice-Chancellor.
There is no doubt that the outcome, so far, is rather disappointing. Here are some quotations from this letter, with my comments interleaved.
“The Audit was Chaired by Professor Alan Jago and carried out its review using a comprehensive evidence base”
Alan Jago is a pro- vice chancellor, and formerly from Westminster’s School of Architecture and the Built Environment, so no specialist knowledge there.
“The panel made a number of recommendations to me as a result of their Audit. Many of these recommendations concern the University’s processes for review and validation of courses and these will be passed to the Pro Vice Chancellor responsible for Quality to consider.”
Uhuh, sounds like box-ticking again When will universities learn that validation procedures are, on the whole, not worth the paper they are written on.
“The overarching aim of these actions then is to strengthen and make more explicit the ‘scientific’ nature of the Integrated Health undergraduate degrees.
In order to do this we will:
Strengthen learning outcomes particularly in discipline and clinical modules to reflect the science outcomes embedded in the courses.
Revise course specific regulations to explicitly identify that the core health sciences modules have to be passed to complete a degree of the BSc Scheme.
Strengthen the final year project offer to provide more scientific projects through working with Biosciences staff.
Strengthen the scientific/academic qualifications of staff through development
of existing staff and appointments where they become available.”
This seems to me to be whistling in the wind. Remember, we are talking about “bachelor of science” degrees in things like homeopathy and naturotherapy. These are things that are not science at all. In fact they are antiscience to their core.
If you were successful in raising the increasing the scientific level of the staff, many of the subjects they are meant to be teaching would vanish in a puff of smoke.
Certainly the responses of the Westminster staff to earlier enquiries (here, and here) showed little sign of scientific thinking.
And I wonder what Westminster’s admirable biomedical scientists think about taking on homeopathy students for projects?
“I am certain that this work will place Complementary therapies courses in an extremely strong position to meet the external challenges of the future.
I’m sorry to say, Professor Petts, that the scientific community is not likely to share your certainty.
Remember, Peter Fisher is on record as saying that there is not enough science in homeopathy to justifiy offering a BSc degree in it (watch the movie). He is the Queen’s Homeopathic Physician, and Clinical Director of the Royal London Homeopathic Hospital But Westminster still seems to know better.
It seems, so far, that Westminster has missed a chance to change for the better.
Follow-up
Times Higher Education published a pretty pathetic report on the Westminster audit. They did ask me for comments but then failed to publish most of them. I suppose a magazine like that is so dependent on advertising that they can’t afford to upset the authorities. Nevertheless, do they really have to be quite so bland?
I hear that the internal audit has made everyone at the University of Woominster Westminster more nervous and that staff and students have been advised not to share teaching material with people outside the university. Having seen some of them, I’m not surprised they are ashamed of them.
Congratulations to the vice-chancellor of the University of Salford, Michael Harloe.
Times Higher Education announced on 15th January 2009 Salford to shut complementary medicine BSc.
“The University of Salford is to stop offering undergraduate degrees in acupuncture and complementary medicine because they are no longer considered “a sound academic fit”.”
This is the first time that a University has decided to stop teaching quackery altogether. The university’s press officer told me (22 January 2009)
| “all the University’s programmes associated with complementary medicine within the School of Community, Health Sciences & Social Care will be run out. This includes the Homeopathy in Practice programme. “ |
| Salford, before it became a university, was home to the great L.S. Lowry |
Salford’s Peel building, where L.S.Lowry worked |
“Managers concluded last year that the BSc traditional Chinese medicine and other degrees with a complementary medicine element “cannot really be held to be a good fit with the strategic direction of the school, and resource and energy would be better directed elsewhere”.
There are more than 70 students registered on the Chinese medicine degree course.
The university will continue to offer these subjects at postgraduate level, as short courses and as part of continuing professional development programmes. Traditional Chinese medicine work will also be linked to the university’s allied
health professions courses.”
Another report appeared in the Manchester Evening News: “Needle over acupuncture course”. “A UNIVERSITY has scrapped a course in acupuncture and aromatherapy branded `anti-science’ by critics.
Salford University said the three-year degree in traditional Chinese medicine didn’t fit with the `strategic direction’ bosses want to adopt.
The move is part of wider cuts which will see 150 teaching and support staff jobs axed.”
One of their students raised the question that the university must dread.
“First-year student Gary Leese, who is organising a petition, said: “Why did the university launch the course if they didn’t think it was good enough?”
The comments left by the readers of the Manchester Evening News were mostly very sensible. The first to come in, from someone with the beautifully Lancastrian name, Gladys Rowbotham, said “Some common sense at last!”.
A brief report appeared also in the Manchester Confidential
Why now?
This is rather an interesting development. On 19th April 2007, I sent a Freedom of Information request to Salford to ask for course validation documents for their courses in Homeopathy and in Traditional Chinese Medicine. I also asked for course materials for specified courses. This request was even less successful than usual. Not only were the course materials refused (as they always are), but, unusually, the validation documents were refused too. The excuse for this was more pathetic than usual too. They claimed it would cost more than £450 to email a few documents and powerpoints, and claimed exemption under Section 21 of the Freedom of Information Act, “Information Reasonably Accessible to the Applicant by Other Means”, rather than the more usual excuse (Section 43, “Commercial interests”).
It was never explained what “other means” were meant to be available. Perhaps they thought I should pay £3000 in fees and enrol for the course?
On 6th April 2007, Times Higher Education (THE) ran an opinion piece “Credible endeavour or pseudoscience?“. In this, I wrote, as follows.
“Clearly the buck stops with university vice-chancellors who award the degrees. Two weeks ago, after the publication of my opinion article and a special report on university homoeopathy courses in the journal Nature , the BBC tried to get one of the vice-chancellors to defend themselves. They did not succeed. Letters to vice-chancellors on this go unanswered. Requests to see course materials have repeatedly been refused. The QAA is exempt from the Freedom of Information Act. Teaching materials and the names of examiners are kept secret. This I find incomprehensible and indefensible.”
After this appeared, I was sent by the University of Salford a copy of Michael Harloe’s defence of their position at that time, as sent to THE. It relied heavily on validation by the Quality Assurance Agency. But the QAA is merely a box-ticking organisation that would give top marks to a course in astrology, given a sufficient mound of paperwork, as I pointed out in Nature, “Their own rules prevent them from doing anything useful”.
The statement also said that the courses teach critical thinking about alternative medicine. But it has been pointed out over and over again that what alternative medicine advocates lack, above anything else, is any faculty of critical self-appraisal.
One has to have some sympathy with a vice chancellor who is put on the spot and forced to defend courses in which he probably does not really believe himself. Perhaps it is not surprising that letters so often go unanswered. What can they say? There really is no answer that doesn’t leave the hapless VC with egg on his face.
If there is one lesson from this, it is not to be discouraged if you get no answer from a vice-chancellor. It has probably been read and may well get acted on eventually. Shutting down a course is no easy matter. It takes time.
I said the buck stops with the vice chancellor. Professor Harloe has grasped the nettle and done the right thing. Let’s hope a few more now follow his excellent lead..
What does this mean for the Pittilo report?
The gamma-minus Pittilo report (see also. The Times) recommended more degrees in alternative medicine, but there seems to be something of a trend developing in exactly the opposite direction.
The University of Central Lancashire has closed the first year entry to its “BSc” in Homeopathy, and announced a review of all its activities in the area of alternative medicine. Now we have Salford. There are stirrings among the good scientists even at the University of Westminster which has a new Dean and VC.
This rather absurd situation has arisen because of the adamant refusal of the government, and of a dozen or more quangos, to grasp the nettle of whether or not the alternative treatments work. Time and time again, the one important question that you want to know about any sort of treatment, namely, is it effective, has been pushed under the carpet.
The sort of absurd political correctness that leads to the fraudulent conjurers known as ‘psychic surgeons’ being referred to as a “profession” by the Department of Health has obscured reality. Even the MHRA was persuaded to allow misleading labelling of homeopathic and herbal “remedies”. thus betraying its job. In its own words “The MHRA is the government agency that is responsible for ensuring that medicines and medical devices work, . . .”.
There is a lesson here. You can’t go on avoiding reality for ever. One consolation is that, in the end, it is the universities who are leading the way, albeit slowly.
All we need now is for the Department of Health, the MHRA and the endless box-ticking quangos to wake up too.
I’m perfectly happy to think of alternative medicine as being a voluntary, self-imposed tax on the gullible (to paraphrase Goldacre again). But only as long as its practitioners do no harm and only as long as they obey the law of the land. Only too often, though, they do neither.
When I talk about law, I don’t mean lawsuits for defamation. Defamation suits are what homeopaths and chiropractors like to use to silence critics. heaven knows, I’ve becomes accustomed to being defamed by people who are, in my view. fraudsters, but lawsuits are not the way to deal with it.
I’m talking about the Trading Standards laws Everyone has to obey them, and in May 2008 the law changed in a way that puts the whole health fraud industry in jeopardy.
The gist of the matter is that it is now illegal to claim that a product will benefit your health if you can’t produce evidence to justify the claim.
I’m not a lawyer, but with the help of two lawyers and a trading standards officer I’ve attempted a summary. The machinery for enforcing the law does not yet work well, but when it does, there should be some very interesting cases.
The obvious targets are homeopaths who claim to cure malaria and AIDS, and traditional Chinese Medicine people who claim to cure cancer.
But there are some less obvious targets for prosecution too. Here is a selection of possibilities to savour..
- Universities such as Westminster, Central Lancashire and the rest, which promote the spreading of false health claims
- Hospitals, like the Royal London Homeopathic Hospital, that treat patients with mistletoe and marigold paste. Can they produce any real evidence that they work?
- Edexcel, which sets examinations in alternative medicine (and charges for them)
- Ofsted and the QCA which validate these exams
- Skills for Health and a whole maze of other unelected and unaccountable quangos which offer “national occupational standards” in everything from distant healing to hot stone therapy, thereby giving official sanction to all manner of treatments for which no plausible evidence can be offered.
- The Prince of Wales Foundation for Integrated Health, which notoriously offers health advice for which it cannot produce good evidence
- Perhaps even the Department of Health itself, which notoriously referred to “psychic surgery” as a profession, and which has consistently refused to refer dubious therapies to NICE for assessment.
The law, insofar as I’ve understood it, is probably such that only the first three or four of these have sufficient commercial elements for there to be any chance of a successful prosecution. That is something that will eventually have to be argued in court.
But lecanardnoir points out in his comment below that The Prince of Wales is intending to sell herbal concoctions, so perhaps he could end up in court too.
The laws
We are talking about The Consumer Protection from Unfair Trading Regulations 2008. The regulations came into force on 26 May 2008. The full regulations can be seen here, or download pdf file. They can be seen also on the UK Statute Law Database.
The Office of Fair Trading, and Department for Business, Enterprise & Regulatory Reform (BERR) published Guidance on the Consumer Protection from Unfair Trading Regulations 2008 (pdf file),
Statement of consumer protection enforcement principles (pdf file), and
The Consumer Protection from Unfair Trading Regulations: a basic guide for business (pdf file).
Has The UK Quietly Outlawed “Alternative” Medicine?
On 26 September 2008, Mondaq Business Briefing published this article by a Glasgow lawyer, Douglas McLachlan. (Oddly enough, this article was reproduced on the National Center for Homeopathy web site.)
“Proponents of the myriad of forms of alternative medicine argue that it is in some way “outside science” or that “science doesn’t understand why it works”. Critical thinking scientists disagree. The best available scientific data shows that alternative medicine simply doesn’t work, they say: studies repeatedly show that the effect of some of these alternative medical therapies is indistinguishable from the well documented, but very strange “placebo effect” ”
“Enter The Consumer Protection from Unfair Trading Regulations 2008(the “Regulations”). The Regulations came into force on 26 May 2008 to surprisingly little fanfare, despite the fact they represent the most extensive modernisation and simplification of the consumer protection framework for 20 years.”
The Regulations prohibit unfair commercial practices between traders and consumers through five prohibitions:-
- General Prohibition on Unfair Commercial
Practices (Regulation 3)- Prohibition on Misleading Actions (Regulations 5)
- Prohibition on Misleading Omissions (Regulation 6)
- Prohibition on Aggressive Commercial Practices (Regulation 7)
- Prohibition on 31 Specific Commercial Practices that are in all Circumstances Unfair (Schedule 1). One of the 31 commercial practices which are in all circumstances considered unfair is “falsely claiming that a product is able to cure illnesses, dysfunction or malformations”. The definition of “product” in the Regulations includes services, so it does appear that all forms medical products and treatments will be covered.
Just look at that!
| One of the 31 commercial practices which are in all circumstances considered unfair is “falsely claiming that a product is able to cure illnesses, dysfunction or malformations” |
Section 5 is equally powerful, and also does not contain the contentious word “cure” (see note below)
Misleading actions
5.—(1) A commercial practice is a misleading action if it satisfies the conditions in either paragraph (2) or paragraph (3).
(2) A commercial practice satisfies the conditions of this paragraph—
(a) if it contains false information and is therefore untruthful in relation to any of the matters in paragraph (4) or if it or its overall presentation in any way deceives or is likely to deceive the average consumer in relation to any of the matters in that paragraph, even if the information is factually correct; and
(b) it causes or is likely to cause the average consumer to take a transactional decision he would not have taken otherwise.
These laws are very powerful in principle, But there are two complications in practice.
One complication concerns the extent to which the onus has been moved on to the seller to prove the claims are true, rather than the accuser having to prove they are false. That is a lot more favourable to the accuser than before, but it’s complicated.
The other complication concerns enforcement of the new laws, and at the moment that is bad.
Who has to prove what?
That is still not entirely clear. McLachlan says
“If we accept that mainstream evidence based medicine is in some way accepted by mainstream science, and alternative medicine bears the “alternative” qualifier simply because it is not supported by mainstream science, then where does that leave a trader who seeks to refute any allegation that his claim is false?
Of course it is always open to the trader to show that his the alternative therapy actually works, but the weight of scientific evidence is likely to be against him.”
On the other hand, I’m advised by a Trading Standards Officer that “He doesn’t have to refute anything! The prosecution have to prove the claims are false”. This has been confirmed by another Trading Standards Officer who said
“It is not clear (though it seems to be) what difference is implied between “cure” and “treat”, or what evidence is required to demonstrate that such a cure is false “beyond reasonable doubt” in court. The regulations do not provide that the maker of claims must show that the claims are true, or set a standard indicating how such a proof may be shown.”
The main defence against prosecution seems to be the “Due diligence defence”, in paragraph 17.
Due diligence defence
17. —(1) In any proceedings against a person for an offence under regulation 9, 10, 11 or 12 it is a defence for that person to prove—
(a) that the commission of the offence was due to—
(i) a mistake;
(ii) reliance on information supplied to him by another person;
(iii) the act or default of another person;
(iv) an accident; or
(v) another cause beyond his control; and
(b) that he took all reasonable precautions and exercised all due diligence to avoid the commission of such an offence by himself or any person under his control.
If “taking all reasonable precautions” includes being aware of the lack of any good evidence that what you are selling is effective, then this defence should not be much use for most quacks.
Douglas McLachlan has clarified, below, this difficult question
False claims for health benefits of foods
A separate bit of legislation, European regulation on nutrition and health claims made on food, ref 1924/2006, in Article 6, seems clearer in specifying that the seller has to prove any claims they make.
Article 6
Scientific substantiation for claims
1. Nutrition and health claims shall be based on and substantiated by generally accepted scientific evidence.
2. A food business operator making a nutrition or health claim shall justify the use of the claim.
3. The competent authorities of the Member States may request a food business operator or a person placing a product on the market to produce all relevant elements and data establishing compliance with this Regulation.
That clearly places the onus on the seller to provide evidence for claims that are made, rather than the complainant having to ‘prove’ that the claims are false.
On the problem of “health foods” the two bits of legislation seem to overlap. Both have been discussed in “Trading regulations and health foods“, an editorial in the BMJ by M. E. J. Lean (Professor of Human Nutrition in Glasgow).
“It is already illegal under food labelling regulations (1996) to claim that food products can treat or prevent disease. However, huge numbers of such claims are still made, particularly for obesity ”
“The new regulations provide good legislation to protect vulnerable consumers from misleading “health food” claims. They now need to be enforced proactively to help direct doctors and consumers towards safe, cost effective, and evidence based management of diseases.”
In fact the European Food Standards Agency (EFSA) seems to be doing a rather good job at imposing the rules. This, predictably, provoked howls of anguish from the food industry There is a synopsis here.
“Of eight assessed claims, EFSA’s Panel on Dietetic Products, Nutrition and Allergies (NDA) rejected seven for failing to demonstrate causality between consumption of specific nutrients or foods and intended health benefits. EFSA has subsequently issued opinions on about 30 claims with seven drawing positive opinions.”
“. . . EFSA in disgust threw out 120 dossiers supposedly in support of nutrients seeking addition to the FSD’s positive list.
If EFSA was bewildered by the lack of data in the dossiers, it needn’t hav been as industry freely admitted it had in many cases submitted such hollow documents to temporarily keep nutrients on-market.”
Or, on another industry site, “EFSA’s harsh health claim regime”
“By setting an unworkably high standard for claims substantiation, EFSA is threatening R&D not to mention health claims that have long been officially approved in many jurisdictions.”
Here, of course,”unworkably high standard” just means real genuine evidence. How dare they ask for that!
Enforcement of the law
Article 19 of the Unfair Trading regulations says
19. —(1) It shall be the duty of every enforcement authority to enforce these Regulations.
(2) Where the enforcement authority is a local weights and measures authority the duty referred to in paragraph (1) shall apply to the enforcement of these Regulations within the authority’s area.
Nevertheless, enforcement is undoubtedly a weak point at the moment. The UK is obliged to enforce these laws, but at the moment it is not doing so effectively.
A letter in the BMJ from Rose & Garrow describes two complaints under the legislation in which it appears that a Trading Standards office failed to enforce the law. They comment
” . . . member states are obliged not only to enact it as national legislation but to enforce it. The evidence that the government has provided adequate resources for enforcement, in the form of staff and their proper training, is not convincing. The media, and especially the internet, are replete with false claims about health care, and sick people need protection. All EU citizens have the right to complain to the EU Commission if their government fails to provide that protection.”
This is not a good start. A lawyer has pointed out to me
“that it can sometimes be very difficult to get Trading Standards or the OFT to take an interest in something that they don’t fully understand. I think that if it doesn’t immediately leap out at them as being false (e.g “these pills cure all forms of cancer”) then it’s going to be extremely difficult. To be fair, neither Trading Standards nor the OFT were ever intended to be medical regulators and they have limited resources available to them. The new Regulations are a useful new weapon in the fight against quackery, but they are no substitute for proper regulation.”
Trading Standards originated in Weights and Measures. It was their job to check that your pint of beer was really a pint. Now they are being expected to judge medical controversies. Either they will need more people and more training, or responsibility for enforcement of the law should be transferred to some more appropriate agency (though one hesitates to suggest the MHRA after their recent pathetic performance in this area).
Who can be prosecuted?
Any “trader”, a person or a company. There is no need to have actually bought anything, and no need to have suffered actual harm. In fact there is no need for there to be a complainant at all. Trading standards officers can act on their own. But there must be a commercial element. It’s unlikely that simply preaching nonsense would be sufficient to get you prosecuted, so the Prince of Wales is, sadly, probably safe.
Universities who teach that “Amethysts emit high Yin energy” make an interesting case. They charge fees and in return they are “falsely claiming that a product is able to cure illnesses”.
In my view they are behaving illegally, but we shan’t know until a university is taken to court. Watch this space.
The fact remains that the UK is obliged to enforce the law and presumably it will do so eventually. When it does, alternative medicine will have to change very radically. If it were prevented from making false claims, there would be very little of it left apart from tea and sympathy
Follow-up
New Zealand must have similar laws.
Just as I was about to post this I found that in New Zealand a
“couple who sold homeopathic remedies claiming to cure bird flu, herpes and Sars (severe acute respiratory syndrome) have been convicted of breaching the Fair Trading Act.”
They were ordered to pay fines and court costs totalling $23,400.
A clarification form Douglas McLachlan
On the difficult question of who must prove what, Douglas McLachlan, who wrote Has The UK Quietly Outlawed “Alternative” Medicine?, has kindly sent the following clarification.
“I would agree that it is still for the prosecution to prove that the trader committed the offence beyond a reasonable doubt, and that burden of proof is always on the prosecution at the outset, but I think if a trader makes a claim regarding his product and best scientific evidence available indicates that that claim is false, then it will be on the trader to substantiate the claim in order to defend himself. How will the trader do so? Perhaps the trader might call witness after witness in court to provide anecdotal evidence of their experiences, or “experts” that support their claim – in which case it will be for the prosecution to explain the scientific method to the Judge and to convince the Judge that its Study evidence is to be preferred.
Unfortunately, once human personalities get involved things could get clouded – I could imagine a small time seller of snake oil having serious difficulty, but a well funded homeopathy company engaging smart lawyers to quote flawed studies and lead anecdotal evidence to muddy the waters just enough for a Judge to give the trader the benefit of the doubt. That seems to be what happens in the wider public debate, so it’s easy to envisage it happening a courtroom.”
The “average consumer”.
(3) A commercial practice is unfair if—
(a) it contravenes the requirements of professional diligence; and
(b) it materially distorts or is likely to materially distort the economic behaviour of the average consumer with regard to the product.
It seems,therefore, that what matters is whether the “average consumer” would infer from what is said that a claim was being made to cure a disease. The legal view cited by Mojo (comment #2, below) is that expressions such as “can be used to treat” or “can help with” would be considered by the average consumer as implying successful treatment or cure.
The drugstore detox delusion. A nice analysis “detox” at .Science-based Pharmacy
Herbal medicine is, unlike homeopathy, not ridiculous, It is merely Pharmacology, as practised up to circa 1900. Whereas good trials have now shown acupuncture to be sham and homeopathy to be a placebo, there has been very little good research on herbs.
Most herbalism could fairly be described giving to sick patients an unknown dose of a substance with unknown efficacy and unknown safety.
How odd, then, to visit the Royal Society of Medicine to be greeted thus.
Just look at the words!
“Traditional Chinese Medicine (TCM) has developed over thousands of years”
That’s partly true
“and provides a comprehensive and systematic understanding of the natural world and the treatment of the human body.”
and that is total nonsense. TCM provides no understanding and virtually none of it is known to be useful for treating anything.
| Another poster at the RSM exhibition provides some of the explanation. What on earth, one wonders, do they mean by “making efforts to modernise TCM “? So far, the idea of modernising TCM doesn’t seem to include any great effort to find out if it works. Much of the promotion of TCM seems to be not so much ‘ancient wisdom’, but modern nationalist propaganda by the Chinese government. |
 |
The history is fascinating, but you won’t learn it from the posters on display at the exhibition.
“The Daoguang emperor though it [acupuncture] was a barrier to medical progress and removed it from the curriculum of the Imperial Medical Institute,”
“By the start of the twentieth century, acupuncture was extinct in the West and dormant in the East. It might have fallen out of favour permanently, but it suddenly experienced a revival in 1949 as a direct result of the communist revolution and the establishment of the People’s Republic of China. Chairman Mao Tse-tung engineered a resurgence in traditional Chinese medicine, which included not just acupuncture but also Chinese herbal medicine and other therapies ”
“His motivation was partly ideological, inasmuch as he wanted to reinforce a sense of national pride in Chinese medicine. However he was also driven by necessity. He had promised to deliver affordable healthcare .. . . ”
“Mao did not care whether traditional Chinese medicine worked, as long as he could keep the masses contented. In fact, his personal physician, Zhisui Li, wrote a memoir entitled ‘The Private Life of Chairman Mao’, in which he quoted Mao as saying”
“Even though I believe we should promote Chinese medicine, I personally do not believe in it. I don’t take Chinese medicine.” “
Singh & Ernst Trick or Treatmant, page 46.
Or, as put more succinctly by Shapiro
“You would never know that TCM was fashioned in the twentieth century, as we shall see, from a ragbag of therapies in post-revolutionary China.”
Rose Shapiro, Suckers, how alternative medicine makes fools of us all.
Why is the Royal Society of Medicine allowing such mendacious posters? As it happens, I and a friend were visiting the RSM to see their Academic Dean, with a view to finding out why the RSM had failed to take any public position on alternative medicine. The answer appeared to be money, and that was the answer to why the TCM exhibition was being held on their premises too. The Dean no more believed in TCM than we did, but, well, they need the income. He pointed out (looking suitably sheepish) that the address given for the exhibition was not the RSM, but Number 1 Wimpole Street (that, of course, is also the address of the RSM).
Ah, so that’s OK then.
It has to be said that the RSM isn’t alone in its spineless attitude. Both the British Medical Association (BMA) and the Royal College of General Practitioners (RCGP) have failed to make any clear condemnation of mystical medicine. This is in stark contrast to just about every relevant scientific society (here is a summary).
It is a mystery to me why much of medicine should still be dominated by a mindset that seems to have lagged 200 years behind every other science. Perhaps medicine is just too complicated.
UCL Hospitals’ skeleton in the cupboard
Make no mistake, University College London Hospital is top class. The UCLH Trust. runs seven hospitals All but one of them are excellent. But in 2002 the Royal London Homeopathic Hospital was acquired as part of the UCLH group, to the intense embarrassment of UCL scientists.
Let’s start with the good bit. Usually I don’t like anecdotes, so just think of this as a vote of thanks, not evidence.
A personal history of UCH
I owe UCLH a lot personally. On December 13th 1984, my wife had
a subarachnoid haemorrhage when she was seven months pregnant. After misdiagnosis at St Peter’s Hospital, Chertsey, she was moved to UCH and diagnosed very quickly. The next day she had neurosurgery to pin an aneurysm at the Maida Vale Neurosurgical Hospital, part of the UCLH group (it no longer exists). The surgeon, Alan Crockard, came out of theatre after five hours, looking rather tired and said “it was adhered to the optic chiasma on one side and about a millilmetre from the pituitary on the other. It was a bit tricky but I think we got it”.
| After a week in intensive care, under heavy sedation, Margaret’s blood pressure was not low enough and they decided to deliver the baby. At about 4 pm on a snowy Christmas Eve, a team of neurosurgeons and a team of obstetricians gathered and soon after, Andrew Stuart Colquhoun emerged in a small incubator to be whisked off in an ambulance to the Special Care Baby Unit at UCH (run, at that time, by Osmund Reynolds).. Christmas day was spent in the hospital, with Margaret’s mother. Andrew weighed 1.4 kg at birth, but by Christmas day he had pulled out his ventilator himself, and was doing fine. He was so tiny that it was a couple of days before I dared to hold him. The Unit had racks of doll-sized clothes, knitted by volunteers. | 
Andrew (at 9 days) and Dad. Jan 2, 1985. Click for album.. |
Once Margaret was well enough, she was given a side room in a neurosurgical ward with a cot for Andrew by her bed, an arrangement that gave the neurosurgical nurses some fun. They were in UCLH continuously until 27th April before Margaret had recovered enough to go home, [Full photo album here]
Now they are both fine.and Andrew is 6′ 7″ (200.5 cm)..
It is episodes like this that make one very proud of the NHS. Heaven knows what it would have cost in the USA.
Margaret & Andrew, with carer, Anna, June 2, 1985 |
Andrew playing cricket in Bangladesh, Feb 2005. |
But now the the less desirable side of UCLH
Herbs and homeopaths at UCLH
| Recently I was sent the UCLH Annual Review 2007 – 2008. There was a lot of good stuff in it and worth a read despite there being too much hyperbole and too many pictures of men in dark suits. But buried among all the high tech stuff, what do we find but an advertisement for 1900-style pharmacology in the form of the herbal clinic at the Royal London Homeopathic Hospital, accompanied by a load of utterly inaccurate information from the TV botanist, David Bellamy. Take, for example, the claim about Devil’s Claw for osteoarthritis. Even alternative medicine advocates said “The authors concluded that there are insufficient high-quality trials to determine the safety and efficacy of Devil’s Claw (Harpagophytum procumbens) in the treatment of osteoarthritis, and that definitive trials are needed.”
Reading between the lines, I’d guess that the opening of this clinic has a subtext. It is well known that funding for homeopathy has dried up (partly as a result of our letter to NHS Trusts that appeared in the There have been problems before with the herbal activities at the RLHH before (see Conflicts of Interest at the Homeopathic Hospital). It appeared that the Khans, who run the Marigold homeopathic podiatry clinic (no, seriously, it is real) were largely prescribing a herbal product that was made by their own company. without even the hospital trust, never mind the patients, being made aware of it. In normal medicine this would be regarded as a rather serious offence, but as far as I know, nothing was ever done about it. |
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The ethics of alternative medicine are truly one of life’s great mysteries.
Reading further in the annual review, we come to the page about the RLHH. The homeopathy side must really have run down because it seems to have diversified into selling cosmetics and groceries. That sounds like desperation.
Good heavens, they sell “chemical-free sun cream”. One wonders what it can be made of, if not chemicals. This is the language of low-grade advertising agencies, not what one expects from an NHS hospital trust.
But next to this there is a much more interesting item. Just look at the last sentence.
I wonder if this could possibly have anything to do with the fact that Michael Baum and I visited the Trust headquarters in August 2006 to propose that the RLHH might be turned into a centre of supportive and palliative care? It would be nice to think so. But it seems they haven’t gone nearly far enough yet. If all they do is replace the waning homeopathy We know they are under pressure from their royal patrons, but that, in a constitutional monarchy, is simply not acceptable. |
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Michael Baum is a cancer surgeon who has taken a particular interest in palliative and supportive care. He is someone whose views should be taken seriously. He is also the author of the magnificent “An open letter to the Prince of Wales: with respect, your highness, you’ve got it wrong” Here is a quotation from that letter. The UCLH Trust should bear it in mind.
| The power of my authority comes with a knowledge built on 40 years of study and 25 years of active involvement in cancer research. I’m sensitive to the danger of abusing this power and, as a last resort, I know that the General Medical Council (GMC) is watching over my shoulder to ensure I respect a code of conduct with a duty of care that respects patients’ dignity and privacy and reminds me that my personal beliefs should not prejudice my advice. Your power and authority rest on an accident of birth. Furthermore, your public utterances are worthy of four pages, whereas, if lucky, I might warrant one. I don’t begrudge you that authority and we probably share many opinions about art and architecture, but I do beg you to exercise your power with extreme caution when advising patients with life threatening diseases to embrace unproven therapies. There is no equivalent of the GMC for the monarchy, so it is left either to sensational journalism or, more rarely, to the quiet voice of loyal subjects such as myself to warn you that you may have overstepped the mark. It is in the nature of your world to be surrounded by sycophants (including members of the medical establishment hungry for their mention in the Queen’s birthday honours list) who constantly reinforce what they assume are your prejudices. Sir, they patronise you! Allow me this chastisement. |
Follow-up
The photo album chronicling the birth of my son, is really just for family and friends, but at least one blog picked up on the wider significance.
It may be only post-1992 universities that run degrees in nonsense, but you can find plenty even in the highest places. Like St Bartholomew’s (founded in 1123). That well known source of misleading medical advice, The Prince’s Foundation for Integrated Health (FiH), published last March, “Teaching integrated health at Barts and the London“. This consists of an interview with two members of staff from what is now known as the Barts and The London School of Medicine and Dentistry (SMD)..
| Dr Mark Carroll BSc (Hons), PhD, FHEA is Associate Dean (Education Quality) in the Centre for Medical Education (SMD), specialising in all aspects of quality assurance in the SMD |  |
| Prof Chris Fowler BSc MA MS FRCP FRCS(Urol) FEBU is Dean of Education |  |
They say they are dubious about alternative medicine, but rather keen on integrated medicine. Seems odd, since the latter is really just a euphemism for the former.
After seeing the FiH posting, I wrote to Carroll and Fowler to get more information.
From Carroll 20 March
We are at an early stage in the planning process for the “Integrated Health & Wellbeing” strand in our new MBBS curriculum. I can send you our ideas (attached). Much will depend on whether we can make a new appointment of someone who can lead on the planning
From Fowler 25 March 2008
Our discussions with the PFIH [Prince’s Foundation for Integrated Health] have only progressed to the stage of indicating an indicative curriculum for integrated health. We don’t have the sort of detail that you are asking for at present. We are hoping that they will work with us to get someone to champion the development.
. . .
Your views would be welcome
So I sent them some views on 26 March (read them here). I also said “I find it quite astonishing that a respectable medical school should feel it appropriate to have parts of its curriculum in the hands of the Prince of Wales.”. It seems, though, that only one sort of view was wanted. On 27 March. Fowler wrote
“I find your insinuation unnecessary and insulting. We have been working on a serious response to the GMC’s requirement that we teach medical students about the range of options available to patients. It is fatuous to suggest that the Prince of Wales is personally involved in any practical sense. The Prince’s Foundation for Integrated Health is an important stakeholder and I think that it entirely reasonable both to talk to them and to seek funding to help us to develop an area that is deficient in our current provision.”
Uhuh, not a very nice response to a rather moderate letter. Lesson 1: never trust anyone who uses the word “stakeholder”.
It does seem very odd that a medical school like Barts should turn to the Prince of Wales’ Foundation for advice on medicine. After all, the bad advice given by the “Patients Guide” is rather well documented (see also here). If messrs Fowler and Carroll were really unaware of that, I’d argue that they aren’t doing their job properly.
It seems that Barts, like Edinburgh, has over-reacted to pressure from the General Medical Council (GMC). Actually all that the GMC require is that
“They must be aware that many patients are interested in and choose to use a range of alternative and complementary therapies. Graduates must be aware of the existence and range of such therapies, why some patients use them, and how these might affect other types of treatment that patients are receiving.” (from Tomorrow’s Doctors, GMC)
There is nothing there about saying that they work. Certainly medical students need to be familiar with alternative medicine, given the number of theit patients that use it. That is a job I have done myself, both at UCL and at Kings College London. I’d argue that I am marginally better qualified to assess the evidence than the Prince of Wales.
Oddly enough, the bad education in Edinburgh came also from a Professor of Medical Education and Director of Undergraduate Learning and Teaching,
The result is manifested in two ways. Barts has a “Science in Medicine” course that has resulted in medical students being placed with homeopaths. And it has a Special Studies Module in Ayurvedic Medicine. Let’s take a look at them.
An Introduction to Ayurvedic Medicine
| The aims of this Special Study Module are “To introduce the concepts and principles which underpin Ayurvedic medicine. To introduce Year 1 and 2 medical students to the Ayurvedic approach to patient assessment, diagnosis and treatment”, and to “Critically evaluate the evidence base for Ayurvedic treatments and yoga therapy”. Just one small snag there. There is next to no evidence base to be assessed. |  Click to enlarge |
The module is given by Professor Shrikala Warrier, who is Dean of MAYUR: The Ayurvedic University of Europe. That sounds quite grand. But the web site of The Ayurvedic University of Europe is rather unusual for a university. It lists two courses but has no list of staff. Could it be that Professor Shrikala Warrier is the staff? Neither is it clear where Professor Warrier’s professorial title comes from. Her own private university perhaps?
The two courses it offers are B.Sc.(Hons) Ayurveda and B.Sc.(Hons) Yoga. It says that the course the “BA(Hons)Ayurvedic Studies is a three year programme of study developed in collaboration with Thames Valley University in London”. That’s odd too, because there is no mention of it on the Thames Valley University web site (and TVU is not in London, it’s in Slough). Elsewhere it is stated that the “programme has been validated by MAHE, which is also the degree awarding body”. MAHE is not explained but it appears to refer to the Manipal Academy of Higher Education, in Goa, India. That looks like a pretty good place. It does not offer degrees in Ayurveda, though there is a small Department of Ayurvedic medicine within the otherwise entirely conventional Kasturba Medical College-Manipal. Their first year physiology exam would tax our students.
Elsewhere we see the same address, 81 Wimpole Street, listed as The Manipal Ayurvedic University of Europe (a joint venture between The Manipal University and the Ayurvedic Company of Great Britain) Prof. S. Warrier, B.A.(Hons), M.A., Ph.D., MILT, Dean of Academic Planning.
If one checks Mayur Ltd at Companies House, one finds that it has two directors, Lady Sarah Morritt and Professor Shrikala Warrier. The company report shows that no accounts have been filed up to now and their 2008 accounts are overdue.
The business history of ayurveda is nothing if not tortuous. The London Gazette (May 2008) notifies us that
AYURVEDA HOLDINGS LIMITED (chairman Lady Sarah Morritt) was passed a Special Resolution: “That the company be wound up voluntarily.”
If you email the Ayurvedic University of Europe, the reply comes not from a University address but from unififiedherbal.com. That seems to be some sort of marketing company, at the same address, 81 Wimpole Street. But efforts to find out more about it from Companies House show that UnifiedHerbal.com was dissolved on 3 October 2006.
Several of the links are broken on the web site of Ayurvedic University of Europe, but one that does work is ‘products’. That takes you to the sales pages of http://www.drwarrier.co.uk/. That doesn’t look much like a university, but no prizes for guessing the address. Yes, it’s 81 Wimpole Street again. They will sell you all sorts of cosmetics, though Companies House lists Dr Warrier Limited, and tells us
Last Accounts Made Up To : 31/08/2007 (DORMANT) and
Next Return Due : 26/09/2008 OVERDUE. Their registered office is
at Harold House, Waltham Cross EN8 7AF.
From drwarrier.co.uk you can buy, for example,
The most commonly prescribed Ayurvedic formula. Triphala is an effective blood purifier that detoxifies the liver, helps digestion and assimilation, and reduces serum cholesterol and lipid levels.
Blood purifier? Detox? Where have we seen this sort of utter gobbledygook before? Or perhaps she can sell you some
Traditionally used for obesity and overweight, and reducing and preventing accumulation of cholesterol (LDL). Its anti-inflammatory and detoxifying actions help reduce arthritic pain and swelling.
There isn’t the slightest evidence for these effects in man. Hence, no doubt, the usual weasel words. “traditionally used for . . . ”
The sales department alone casts rather a large doubt on Prof Warrier’s ability to teach medical students how to “critically evaluate the evidence base for Ayurvedic treatments”.
It does seem a bit surprising that a top flight medical school should think that this is an appropriate place to educate its students.
Medicine in Society
The syllabus at Barts includes something called Medicine and Society. Page 5 of the second year Tutor Guide mentions “complementary therapies” as part of the course. There is little hint about what that means in practice.
It turns out that the alt med placements are at the Greenwich Natural Health Centre. Nothing is too barmy for them Acupuncture. Cranial Osteopathy, Craniosacral Therapy, Herbal Therapy, Homeopathy, Hot Stone Therapy and Nutritional therapy to name but a few of the preposterous make-believe stuff that is on offer.
Medical students are having to spend their time listing to stuff like this, on ‘hot stone therapy’.
“Hot stone therapy / massage is a kind of massage that uses treated volcanic rocks such as basalt and basinite that are believed to promote relaxation as well as eliminating negative energy within the client’s body, mind and soul.”
“These stones are carefully gathered and handcrafted for various sizes, shapes and weights according to what part of the body it will be use on.”
Or this, on ‘nutritional therapy’.
“Many of us lack the basic raw materials (from food and drink) to function at our best. Intensive farming, pollution, stress, stimulants and an over-reliance on processed foods are just some of the reasons for us being deficient in vital nutrients. As a result, we may develop serious degenerative diseases like cancer or arthritis.”
“Some clients may experience reactions like headaches, skin eruptions or bad breath during the first stage of treatment. These are quite normal and are due to detoxification, which is usually followed by a sense of well-being and increased energy.”
That must be about as close as you can get to claiming you can prevent cancer by taking vitamin pills. It is wrong and it is dangerous,
Sigh. What century are we living in?
According to Barts’ second year Tutor Guide, “Placement tutors are responsible for student assessment”.
What sort of grade will the student get if they tell their tutor in homeopathy or ‘Nutritional therapy’ that they are talking nonsense?
What do the students think?
Could the Ayurvedic course be the very same course that is referred to by a second year medical student on the Unprotected Text blog?
“When I found out my friend had been attached to a “doctor” in Ayurvedic “medicine” for the year I was horrified, as was she, and the school would not allow her to change claiming that the point is not to learn the medicine but its role in the multidisciplinary healthcare team.
I don’t believe that there is such a role.
The very fact that a student is forced to put up with this as a part of their education is appalling.”
A comment left on Unprotected Text by someone writing as ‘Barts Medic’ said
“I was HORRIFIED to hear that some of my friends have their medsoc placements
at such RUBBISH places too!last week, they were forced into a room one by room to be touched up (‘massaged’)
by the ‘doctor-person’ to HEAL them. she rubbed them all over, and CHANTED! WTF.if i was given a CRAPPY placement like that, i wouldnt turn up either”.
And there is an excellent statement about “holistic medicine” on Unprotected Text. Better, perhaps, than you’d get from the GMC.
“Holistic medicine is in fact a world away from homeopathy, although the two are often confused predominantly by homeopaths trying to validate their branch of “medicine”. Much of what is taught in medical school is in fact, holistic, and so it should be. The importance of mentality, or spirituality in medicine should not be used to excuse homeopathy.”
“That doesn’t seem to add up” is another blog that relates the experiences of another student who has been exposed to “Enforced quackery Day 1, “, “Enforced quackery Day 2“, “Enforced quackery Days 3 and 4“. He says
“. . .by the end of day 3 the students *still* hadn’t seen any patients and that, when confronted with this fact the person in charge is reported to have said that this was because she was scared of what the students might say to the patients… Apart from this being a massive insult to the professionalism of the students, it is at least an encouraging sign that they have not been very effectively indoctrinated.”
It seems that we shall soon have some more documentary evidence. It is truly impressive to find that Barts’ medical students are so bright and that they have the courage to speak up about it.
So there is one good thing. We have some very perspicacious medical students in London.
Pity that one can’t say the same thing of their teachers.
Follow-up
I have it on good authority that the unhappy students who were placed at the Greenwich Natural Health Centre were presented with one of the more absurd documents ever to be produced by homeopaths, “An Overview of positive homeopathy research and surveys“.
There is no need to argue about whether homeopaths cherry-pick the evidence. The selective use of evidence is announced proudly, right there in the title.
What excuse can Bart’s have for exposing medical students to such profoundly anti-educational stuff as this?
Later there appeared on the That doesn’t seem to add up blog, Enforced
Quackery – the literature. The unfortunate students who were pushed into a homeopathic placement were give a print out of a page from Sue Young’s homeopathic web site. It is merely a bit of phony history that attempts to link Pasteur with homeopathy.
Sue Young, incidentally, is a homeopath who has consistently breached the Code of Ethicsof the Society of Homeopaths by claiming to treat serious diseases, though needless to say the Society did nothing about it. She is also the person who wrote a wholly inaccurate account of the reasons why my blog left the UCL server (see alse here and here). She didn’t, needless to say, ask me, but luckily she was soon corrected on quackometer and in the Guardian.
Incidentally, the Unprotected Text blog continues to provide a fascinating student view on medical education. Students show more sense than their teachers not only about alternative nonsense but also about other gimmicks like ‘problem based learning’.
Today brings a small setback for those of us interested in spreading sensible ideas about science. According to a press release
“The BMJ Group is to begin publishing a medical journal on acupuncture from next year, it was announced today (Tuesday 11 November 2008).
This will be the first complementary medicine title that the BMJ Group has published.”
And they are proud of that? What one earth is going on? The BMJ group is a publishing company which says, of itself,
“Our brand stands for medical credibility. We are one of the world’s best known and most respected medical publishers.”
Well perhaps it used to be.
They have certainly picked a very bad moment for this venture. In the last year there have been at least five good books that assess the evidence carefully and honestly. Of these, the ones that are perhaps the best on the subject of acupuncture are Singh & Ernst’s Trick or Treatment and Barker Bausell’s Snake Oil Science. Both Ernst and Bausell have first hand experience of acupuncture research. And crucially, none of these authors has any financial interest in whether the judgement goes for acupuncture or against it.
Here are quotations from Singh & Ernst’s conclusions
“Reliable conclusions from systematic reviews make it clear that acupuncture does not work for a whole range of conditions, except as a placebo.”
“There are some high quality trials that support the use of acupuncture for some types of pain and nausea, but there are also high quality trials that contradict this conclusion. In short, the evidence is neither consistent nor convincing – it is borderline.”
The House of Lords’ report in 2000 tended to give acupuncture the benefit of the (very considerable) doubt that existed at the time the report was written. Since that time there have been a lot of very well-designed trials of acupuncture.
Now it is quite clear that, for most (and quite possibly all) conditions, acupuncture is no more than a particularly theatrical placebo. Perhaps that is not surprising insofar as the modern western practice of acupuncture owes more to Chinese nationalistic propaganda that started in the time of Mao-Tse Tung than it owes to ancient wisdom (which often turns out to be bunk anyway).
The BMJ Group has decided to endorse acupuncture at a time when it is emerging that the evidence for any specific effect is very thin indeed. Well done.
The journal in question is this.
Acupuncture in Medicine is a quarterly title, which aims to build the evidence base for acupuncture. It is currently self-published by the British Medical Acupuncture Society (BMAS).
One good thing can be said about the Society and the Journal. That is that they don’t espouse all the mumbo-jumbo about ‘meridians’ and ‘Qi’. This, of course, puts them at odds with the vast majority of acupuncture teaching. This sort of internecine warfare between competing sects is characteristic of all sorts of alternative medicine. But that is just ideology. What matters is whether or not sticking needles in you is actually anything more than a placebo.
British Medical Acupuncture Society (BMAS)
The British Medical Acupuncture Society (BMAS). is “a registered charity established to encourage the use and scientific understanding of acupuncture within medicine for the public benefit.”. The phrase “encourage the use” suggests that they do not even envisage the possibility that it might not work. Their web site includes these claims.
Acupuncture can help in a variety of conditions:
- Pain relief for a wide range of painful conditions
- Nausea, especially postoperative nausea and vomiting
- Overactive bladder, also known as bladder detrusor instability
- Menstrual and menopausal problems, eg period pains and hot flushes
- Allergies such as hay fever and some types of allergic rashes
- Some other skin problems such as ulcers, itching and localised rashes
- Sinus problems and more
Presumably the word “help” is chosen carefully to fall just short of “cure”. The claims are vaguely worded, but let’s see what we can find about them from systematic reviews. It appears that the BMAS is being rather optimistic about the evidence.
BMJ Clinical Evidence is considered reliable and is particular interesting because it is owned by the BMJ Publishing Group.
Low Back Pain (chronic) Acupuncture is listed as being of “unknown effectiveness”.
Dysmenorrhoea Acupuncture is listed as being of “unknown effectiveness”.
Osteoarthritis of the knee. Acupuncture is listed as being of “unknown effectiveness”.
Psoriasis (chronic plaque) Acupuncture is listed as being of “unknown effectiveness”.
Neck pain “Acupuncture may be more effective than some types of sham treatment (not further defined) or inactive treatment (not further defined) at improving pain relief at the end of treatment or in the short term (less than 3 months), but not in the intermediate term (not defined) or in the long term (not defined)”
Headache (chronic tension-type) Acupuncture is listed as being of “unknown effectiveness”.
What about the greatest authority, the Cochrane Reviews?
Cochrane Reviews
Low back pain The data do not allow firm conclusions about the effectiveness of acupuncture for acute low-back pain. For chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and “alternative” treatments. The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low-back pain. Because most of the studies were of lower methodological quality, there certainly is a further need for higher quality trials in this area.
Chronic asthma. There is not enough evidence to make recommendations about the value of acupuncture in asthma treatment. Further research needs to consider the complexities and different types of acupuncture.
But most of the vaguely-worded claims made by BMAS have not been the subject of Cochrane reviews. The obvious interpretation of that is that there is not enough evidence to make it worth writing a review. In which case, why does BMAS claim that acupuncture can “help”?
Bandolier is another excellent source of high quality information, This was their view in September 2006
“Large, high-quality randomised trials of acupuncture have been published since the reviews. In fibromyalgia, chemotherapy-induced nausea and vomiting, breech presentation, tension headache, and migraine, all were negative compared with sham acupuncture. One in osteoarthritis of the knee, had statistical improvement over sham acupuncture at three months, but not later. Both large trials and this review of reviews come to the same general conclusion; that over a whole range of conditions and outcomes acupuncture cannot yet be shown to be effective.”
After thousands of years of acupuncture (or at least almost 40 years in the West) there seems to be very little to show for it.
The journal: Acupuncture in Medicine
What about the journal in question? Like all journals devoted to alternative medicine, it claims to be evidence-based. And like all journals devoted to alternative medicine it suffers from a fatal conflict of interest. If this journal were ever to conclude that acupuncture is a placebo, it would destroy the journal and the livelihoods of many of the people who write for it.
Scanning the first three issues of 2008 shows that it is very much like other alternative medicine journals. Most of the papers don’t address the critical question, is it a placebo. And most papers end up rather limply, with a statement along the lines “acupuncture may be useful for ***. More research is needed.”
The editor in chief of the journal is Dr Adrian White, and its editor is Michael Cummings. White is quoted by Ernst in the Guardian in 2004.
“We need to provide hard evidence to support what we all see in our clinics every day: that the modern approach to acupuncture works, and is highly relevant to the new, patient-centred NHS.” .
That means the answer is assumed in advance. That just isn’t science.. ‘We know the answer, all we have to do now is get some evidence’.
Why should the BMJ Group want to do a thing like this?
The press release says
Commenting on the move, BMJ and BMJ Journals Publishing Director, Peter Ashman, said “The journal is a good complement for our existing portfolio of journals and we’re certain that the Society’s members and other subscribers will appreciate the benefits of the decision the BMAS has made on their behalf.”
He continued: “The BMAS is ambitious for its journal to grow and flourish and we’re looking forward to working with the Society to develop an editorial and commercial strategy which will achieve the aims of BMAS and those of its members, while reaching out to the wider global community interested in this fascinating area of medicine.”
Yes, you got it. Money. The same motive that causes some vice-chancellors to bring their university into disrepute by awarding BSc degrees in subjects that are not only not science, but which are oftenly openly anti-science.
Conscience doesn’t seem to bother these people, so let’s put the problem in purely cash terms.
Both the BMJ Group and the vice-chancellors will have to decide whether the cash they gain is sufficient to counterbalance the corrosive effects of their actions on their own reputations.
Follow-up
Only a couple of days later, two new trials show acupuncture is no different from sham controls for helping IVF pregnancy rates. James Randerson in the Guardian writes thus.
“Acupuncture aimed at improving IVF success rates is widely offered by fertility clinics in the UK. In the first of the studies, researchers in Hong Kong split 370 women receiving IVF into two groups. One group received real acupuncture before and after having an IVF embryo implanted into their uterus. The other had the same procedure, except the treatment used retractable needles that did not penetrate the skin.”
“Of the 185 who received the sham treatment, 91 achieved a clinical pregnancy (foetal heartbeat identified using ultrasound) and 71 had a successful delivery. This compared with 72 clinical pregnancies in the true acupuncture group and 55 live births. The differences between the groups were not statistically significant.”
“In a second study, researchers in Chicago used a similar design in which 124 women received true or sham acupuncture. The control group had their skin punctured by real acupuncture needles, but not at genuine “Qi-lines” on the body. In the true acupuncture group, 43.9% achieved a clinical pregnancy, compared with 55.2% of the women given the sham treatment. “
The original paper for the first study can be seen here.
Jump to follow-up: Brian Kaplan
| Obama wins! Bush and Blair have gone. Could this mark the beginning of the end of the fashion for believing things that aren’t true? |
Trinity College Dublin: the Phil. “Creationism is a valid world view”
This is the 324th year of the Trinity College Philosophical Society (known locally as the ‘Phil’). Its former members include Bishop Berkeley, Dean Jonathan Swift, Oscar Wilde, Bram Stoker, Samuel Beckett, and E.T.S. Walton . It was founded for “discourse of philosophy, mathematics, and other polite literature ”, and is now a debating society.
The motion was Creationism is a Valid World view. At the dinner before the debate, the students all dutifully stood as one of them recited long graces in Latin both before and after eating. All very Oxbridge. So I wasn’t optimistic. However I hadn’t taken into account the conformist tendencies of undergraduates. Notwithstanding the Latin graces, the result of the debate was very clear indeed.
Result. The Creationists were totally wiped out. Almost the only vote for the motion was a young born-again student, who made a desperately sincere speech.
I don’t need to give the details of what happened, because the opposer of the motion, Bob Bloomfield (of the Natural History Museum) has given an excellent account (The Discovery Institute send big guns to Ireland but only manage to fire blanks) on the Beagle project blog. Two of the proposers were Americans, from the Discovery Institute, and they said what you’d expect: nothing that would impress anyone with any education. I’ll settle for Bloomfield’s description of me as “charmingly irascible”. Irascible, moi? Well it would make anyone mildly irritated to have to spend time arguing about creationism in 2008.
Religion, all religion, seems to me to be boring and not a thing worth wasting good time on thinking about, but the rise of barmy fundamentalism has made it essential, if only so that genetics can be taught without accusations of racism, I’m entirely with Dawkins, I can’t prove that there is no god, and I can’t guarantee
that the bottom of my garden is free of fairies. Both questions merit about the same amount of time, though if pressed, I’d go for the fairies. They are, allegedly, rather better behaved than gods.
The 24th president of the USA said, when asked for his thoughts on evolution, said
“of course like every other man of intelligence and education I do believe in organic evolution. It surprises me that at this late date such questions should be raised”.
Woodrow Wilson, 1922
That, of course, was from a president who has been described as ” leading intellectual of the Progressive Era”.
How things have changed in the time of Tony Blair, George Bush and Sarah Palin. Very few people had such barmy beliefs in 1960, never mind 1922. My thesis is much the same as that of Francis Wheen in “How mumbo-jumbo conquered the world” Sometime around 1980, with the conjunction of Thatcher, Reagan and Khomeini it came into fashion to believe things that aren’t true, just because you wished they were (actually I’d put it a bit earlier than Wheen: arguably it started when the Beatles went to that guru), It was after that when suddenly people started to believe in magic medicine, religious fundamentalism. weapons of mass destruction, and, ahem, that the market would make us rich if only we would remove all the regulations.
Tony Blair defended in parliament the Emmanuel School which is run by a young earth creationist and used car dealer, Peter Vardy. The head of the school, Nigel McQuoid, features strongly on the web site of the Christian Institute, This curious organisation seems to be devoted largely to creationism, homophobia and the virtue of beating children (a search of the site for “corporal punishment” gives 43 hits). An essay by Burns & McQuoid says
“There are those who argue that Science and Christianity can be harmoniously reconciled . ; ;. We cannot subscribe to this view”
The former head of science (yes, of science) at McQuoid’s school, Steven Layfield, had an article on the Christian Institute web site. It vanished as soon as it got some publicity but you can read it at http://www.darwinwars.com/lunatic/liars/layfield.html.
Try this quotation.
“Note every occasion when an evolutionary/old-earth paradigm (millions or billions of years) is explicitly mentioned or implied by a text-book, examination question or visitor and courteously point out the fallibility of the statement. Wherever possible, we must give the alternative (always better) Biblical explanation of the same data.”
| These guys are really at the fruit-cake end of the religious spectrum. In contrast, the young anglican chaplain of Trinity, Darren McCallig, spoke against creationism, eloquently and sensibly. His religiousness did seem at times to be diluted almost to homeopathic extremes, but all the better for that. He seems to have a sense of humour too, judging by the poster for his services. |  click to enlarge |
There is, of course, a very healthy opposition to creationists in the USA too, I like particularly Gerald Weissman’s article “The facts of evolution: fighting the Endarkenment” (it may have been the first time that I saw the wonderful word endarkenment, which describes so well the last 30 years). It starts thus.
“Those of us who practice experimental science are living in the best of times and the worst of times, and I’m not talking about A Tale of Two Cities, but a tale of two cultures. “
Here are a couple of pictures of the meeting.
Chris Stillman (geologist)
Berlinski (left) Luke Ryder (speaking), Bloomfield, DC, Stillman (right)
And some pictures of Dublin here
James Joyce, TCD quadrangle and Molly Malone. Click to view
UCL homeopathy debate
This was organised by the UCL students’ debating society. The Darwin Lecture theatre was surprisingly full for this debate, but they weren’t all students. As usual on these occasions, the homeopaths tried to pack the audience, but this time they failed. That tactic is fair enough I suppose, but it means that the vote failed to tell us anything much about the opinion of students, beyond the fact that not many of them opposed the motion.
There are a few though. To the horror of some of our pharmacology and neuroscience undergraduates, a student society devoted to medicines that don’t work has been started at UCL, for the first time ever. Luckily, it seems to be a rather small society. I was fascinated to see that they are going to hear about the evidence base for complementary therapies, from George Lewith. I had occasion a while ago to look at Dr Lewith’s attitude to evidence: see Lewith’s private clinic has curious standards.
| The proposers were Simon Singh and me. Simon is author of, among other things, Fermat’s Last Theorem and Trick or Treatment. I thought he did an excellent job. Singh pointed out that, contrary to the view propagated by quacks, science likes wacky ideas, as long as you can produce the evidence for them He cited dark matter as an example. |
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The main opposer was my old friend Peter Fisher, homeopathic physician to the Queen. It was a pleasure to show the video of Fisher agreeing with me that there is not enough science in homeopathy to justify a BSc degree in it. Fisher, in his papers, strikes me as one of the most honest of homeopaths. He was “very angry” when homeopaths were caught out recommending their sugar pills to prevent malaria. But is his speech, he struck me as less than honest. He cherry-picked the evidence quite shamelessly as usual. And his suggestion that there was an analogy between the ‘memory of water’ and a DVD was disposed of ably by a physics student who spoke from the floor.
The results were too close for comfort, 65 for, 53 against and an amazing 37 abstentions,
Sadly we’ll never know how the students voted, because of the imported homeopaths.
| Dr Brian Kaplan was there. He had given the meeting some advance publicity, in a web posting that also kindly gave publicity to our 2006 letter to the Times. He didn’t like the letter, which is unsurprising given that it turned out to be more effective than we could ever have hoped (see also here). |  |
On the second row, getting very excited, was homeopath Grace Da Silva-Hill and her husband, She runs the ‘Healing with Grace’ business. On her web site she makes the ludicrous claim that
“Homeopathy will treat the cause of your health problem, not just alleviate your symptom”
She also says, inter alia, that
“Homeopathy is effective in treating a wide range of conditions such as: asthma, . . . “
In contrast, the Cochrane review says
“There is not enough evidence to reliably assess the possible role of homeopathy in asthma. “
I have been sent her account of the debate (a reply to a query from the ubiquitous Dana Ullman).
“Hello Dana, The debate, on monday 20th Oct., organised by UCL debating society, was poorly managed, and biased, attended mostly by students, who appear to have gone there to practice their debating skills. The motion was lost by 12 (65 for and 53 against), with 37 abstentions. Peter Fisher put on a good show, and so did his second, in comparison with the rather stale and poor presentation of Simon and Qulquoun (sorry, can never spell this). My husband Ken did a rather
good caricature of him, unfortunately can’t share it here. Pity there were not more homeopaths/supporters there. Kind regards,”
Uhuh. Well, I guess she would say that.
You can judge the critical faculties of Mrs Da Silva-Hill from a comment she left on a piece in the Daily Telegraph, ‘Homeopathy putting lives at risk with claims’. I quote from it verbatim.
“The public does not care about the research available, the public care about having their health problem sorted, where conv. medicine has failed,”
(I apologise for attributing to Mrs Da Silva in the original post a quotation from the Telegraph that appeared above her name but was actually written by somebody else. I apologise also for using a picture of her without permission.)
On the way out of the debate, I walked back to Euston Road with another homeopath, William Alderson, who had come all the way from Kings Lynn to cast his vote. He was earnest and sincere, the conversation was amicable but his idea of evidence was so different from mine that no progress was made. You can read more about Alderson on Dr Aust’s blog.
It’s fascinating stuff.
Follow-up
Dr Brian Kaplan has posted some splenetic comments on this post. I suppose the paranoid tone is an indication that we are winning, but I do wish he’d be a bit more careful about the facts. Let me correct some of them.
(1)Neither the letter of May 2006, nor its follow up in May 2007, was written under the NHS letterhead. The follow-up letter of May 2007 contained the words
“If you have not already reviewed your own trust’s provision, you might find it useful to consider, in conjunction with your Director of Public Health, the paper that we have enclosed which, while not a full review of the scientific position, has been used by other trusts to promote evidence based commissioning.”
The enclosed form was a sample commissioning letter which reproduced the NHS logo with a notice saying “insert your NHS logo here”. The accompanying letter made it perfectly clear that the enclosed form was simply an example to help those who wanted to save money and not an official NHS communication.
(2) Kaplan says I accuse him of lying to his patients, but his reference is to (an old version of) my Dilemmas at the heart of alternative medicine. It says nothing of the sort. I have said many times that I believe homeopaths are perfectly sincere, but they are just deluded. The reference to lying in the ‘dilemmas’ concerns how to get the maximum placebo effect when you know it is a placebo. Homeopaths have not reached that stage yet.
All this information has been available since May 2007. He should have checked.
I have always thought that our undergraduates had difficulty in expressing themselves clearly, in simple words. But they are models of clear thought compared with Christine Barry’s recent paper (Social Science and Medicine, 62, 2464-2657, 2006).
Barry’s work rivals Alan Sokal’s famous spoof paper, “Transgressing the boundaries: the Hermeneutics of quantum gravity”. Sokal’s paper opens as follows.
“There are many natural scientists, and especially physicists, who continue to reject the notion that the disciplines concerned with social and cultural criticism can have anything to contribute, except perhaps peripherally, to their research. Still less are they receptive to the idea that the very foundations of their worldview must be revised or rebuilt in the light of such criticism. Rather, they cling to the dogma imposed by the long post-Enlightenment hegemony over the Western intellectual outlook, which can be summarized briefly as follows:
that there exists an external world, whose properties are independent of any individual human being and indeed of humanity as a whole; that these properties are encoded in “eternal” physical laws; and that human beings can obtain reliable, albeit imperfect and tentative, knowledge of these laws by hewing to the “objective” procedures and epistemological strictures prescribed by the (so-called) scientific method.”
Compare this with the opening of Barry’s paper.
“Calls for ‘gold standard’ randomised controlled trial evidence, by both biomedical and political establishments, to legitimise the integration of alternative medicine into healthcare systems, can be interpreted as deeply political. In this paper, the supposed objectivity of scientific, biomedical forms of evidence is questioned through an illumination of the multiple rhetorics embedded in the evidence-based medicine phenomenon, both within biomedicine itself and in calls for its use to evaluate alternative therapeutic systems.”
and, later,
“I wish to problematise the call from within biomedicine for more evidence of alternative medicine’s effectiveness via the medium of the randomised clinical trial (RCT).”
“Ethnographic research in alternative medicine is coming to be used politically as a challenge to the hegemony of a scientific biomedical construction of evidence.”
“The science of biomedicine was perceived as old fashioned and rejected in favour of the quantum and chaos theories of modern physics.”
“In this paper, I have deconstructed the powerful notion of evidence within biomedicine, . . .”
Just one difference, though, Sokal’s paper was a spoof, which brilliantly exploded the pretentious nonsense of post-modernism. Barry’s paper, is, I very much fear, intended to be serious.
To make matters worse, this work was funded by the Department of Health.
Sokal’s story is told in his devastating book, “Intellectual Impostures”. Strongly recommended, if you want to retain your sanity. [Link to Amazon]. Here is a quotation from the book, concerning Jacques-Marie-Emile Lacan (1901 – 1981), a French psychoanalyst and psychiatrist.
[Jouissance = enjoyment; the word appears in French in the translations.]
In it the square root of -1 is related to erectile function in a piece of gobbledygook which shows an understanding of mathematics about as profound as Barry’s understanding of “the quantum and chaos theories of modern physics”.
It was a great delight to visit Amsterdam on 25 October to speak at a meeting off the Vereniging tegen de Kwakzalverij (Society against quackery). Unfortunately their excellent web site is in Dutch, so the best you can do at the moment is to use the Google translation, with its frequently hilarious renderings. Better translations coming soon, I hope.
| Symposium
Niet-reguliere geneeswijzen in de 21ste eeuw in internationaal perspectief Non-mainstream medicine in the 21st century in an international perspective |
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The Dutch society has 1800 members and is the oldest and biggest such society in the world. I very much hope that their web site will soon have an English version. That is only appropriate since the origin of the word quack is from the Dutch Kwakzalver. (Kwak=Chatterer, salesman, zalf = salve, ointment). (In contrast the noise made by a duck is simply described by the OED as being “imitative”, though the great Michael Quinion thinks the two usages may be connected.
De Kwakzalver, Jan Steen (1626-1679) Rijksmuseum Amsterdam. Click to enlarge
The Quack doctor, Jan Steen (1626-1679). Click to enlarge
Translations of some key parts will be posted here soon. My talk was about Support for alternative medicine in government and universities in the U.K
The meeting started with the announcement of the winner of the Meester Kackadorisprijs.
The Master Kackodoris prize
The Meester Kackadorisprijs is awarded to individuals or institutions who promote quackery and who should know better (the quacks themselves are never nominated). The short list for the 2008 prize included the vice chancellor of the Free University of Amsterdam
| Prof. dr. Lex Bouter, rector magnificus Vrije Universiteit
The vice-chancellor was on the short-list for the prize because of his part in a recent paper, “Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis.” (Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, Bouter LM, Brit Med J 336, 545-9) [Available free] |
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This paper has been cited all over the world, but it seems not to have been very good. See for example the magnificent analysis of it in “Yawn, still one more overhyped acupuncture study: Does acupuncture help infertile women conceive?” . See also the Cochrane review (it could all be placebo). The fact that the vice-chancellor appears to have been only a ‘guest author’ anyway does not count as an excuse. The large number of citations received by this paper should, incidentally, be seen as another nail in the coffin of attempts to measure quality by citation rates.
In the event, vice-chancellor Bouter did not win the Kackodoris prize this year. In a speech at the start of the symposium, it emerged that he had been narrowly beaten by the Dutch Christian Radio Association for its assiduous promotion of quackery.
The chair of the Dutch society, Cees Rencken, is doing a great job. I hope that it will soon be better known outside the Netherlands.
And it’s time we had a UK equivalent of the Kackadoris prize. There will be no shortage of worthy candidates.
Frits Van Dam (Secretary) and Cees Renckens (Chair) of VtdK
(photo: Sofie van de Calseijde)
Some pictures of Amsterdam
(meetings photos: Sofie van de Calseijde)
Follow-up
Thames Valley University is one of those shameful institutions that offer Bachelor of Science degrees in homeopathy. They don’t stop there though. They’ll teach you several other forms of make-believe medicine. Among these is “nutritional medicine”. This is taught at the Plaskett Nutritional Medicine College which is now part of Thames Valley University.
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Everyone is for good nutrition of course, but ‘nutritional medicine’, or ‘nutritional therapy’ pretends to be able to cure all sorts of diseases by changes in diet or by buying expensive nutritional supplement pills. It has no perceptible relationship to the very important subjects of ‘nutrition’ or ‘dietetics’. Nutritional therapy is very firmly part of alternative medicine, in other words it is largely quackery. If you don’t believe that, read on.
The subject of nutritional therapy was in the news recently because of Matthias Rath. He is the person who is reponsible for the death of many Africans because of his advocacy of vitamin pills for the treatment of HIV/AIDS. He didn’t just (mis)treat people, but also played a role in persuading the recently departed Thabo Mbeki, and his health minister (“Mrs Beetroot”) to abandon effective therapies for AIDS sufferers. See reports in The Guardian, by Ben Goldacre, and here,
I’ve written a lot about the penetration of quackery into universities, and I thought I’d seen the worst with ‘amethysts emit high yin energy‘. But, as Goldacre said, let me tell you how bad things have become. .
Recently I came into possession of a lengthy set of notes for a first year course on “The Holistic Model of Healthcare”. The notes are from the 2005 course at Thames Valley University, They are not signed, but appear to have been written by Dr Lawrence Plaskett himself. . You can download the whole set of notes here.
Here are a few choice quotations. The basis of them is pure vitalism. They read like a throwback to the dark ages. Little comment is needed. They speak for themselves.
1.3 What do Orthodox Dieticians know about Food and Health?
Dieticians working in the National Health Service and private clinics and hospitals are usually well trained in the basics of the subject, though they too have an entirely orthodox slant. By and large they seem to accept the general view of most of the medical profession that nutrition does not affect illness much. Hence, they restrict themselves to designing diets required by the doctors for whom they work – usually for specified narrow purposes, such as low fat diets, low sodium diets etc. Such diets are, indeed, important in the hospital management of certain diseases (once these have become established) but they represent extremely limited horizons. Much that is in the basic and essential training of alternative nutritional practitioners is missing from the training of dieticians. As a result, most hospital diets are not very good for health judging from the parameters that will be set down in the following Sessions
Well, it is true that real dietitians prefer not to base their practice on mediaeval vitalism. That is what marks them out as professionals.
1.4 Relationship to Science and the Limitations of Orthodox Methods
However, the subject of Wholistic Nutrition transcends the area of human understanding for which science, alone, is appropriate. The reason is that it is ‘vitalistic’. It recognises the presence in all life forms including the human body, of subtle (or ‘etheric’) energy forces not easily measurable by the physicist’s equipment. It shares that position with the ‘energy medicine’ disciplines such as homoeopathy, traditional acupuncture and spiritual healing. It follows an approach to those subtle energies that is embodied in the discipline and philosophy of naturopathy.
Vitalism is the notion that life in living organisms is sustained by a vital principle that cannot be explained in terms of physics and chemistry. This vital principle, often called “the life force”, is something quite distinct from the physical body and is responsible for much that happens in health and disease.
Naturopathy is a relatively modem term for an ancient concept (dating back to 400 BC). This concept embraces the notion that the body is inherently self-healing and that it is the practitioner’s job to stimulate and support this process. Each patient is recognised as having a unique life experience and a unique genetic inheritance. All diseases are seen as one and as attempts by the body to purify itself of toxins. Treatment focuses on causes rather than on symptoms and always addresses the whole person. The wise words of Hippocrates (often called the Father of Medicine) express some of the main tenants of naturopathic thought. He said:
- It is only nature that heals and wherever and whenever possible nature should be given the opportunity to do so.
- Disease is only an expression of purification.
- All disease is one.
- Let food be your medicine and medicine be your food.”
Hence, most ‘alternative’ nutritionists see conventional nutrition. as being rather rigid and unmoving. Hence, they also see it as very limited. This happens because orthodox nutritionists tend to be locked into science alone. They fail to grasp the significance (or the reality of) the subtle energies and they reject the philosophy of vitalism. It is generally the view of ‘alternative’ nutritionists that understanding these things is a major step to healing the patient.
“Understanding” vitalism sounds more like a way of harming patients than healing patients.
1.5 The Pressure of the Orthodox model
Almost everyone who takes steps towards ‘alternative’ medicine experiences a backlash from others around them who have not been able to make the same conceptual change. Patients wanting to settle into an ‘alternative’ approach can be subject to negativity from their doctors (and as a result many patients do not ask the doctor’s opinion). But students and practitioners alike are frequently subject to negative expressions and even frank hostility from relatives
who can understand only orthodox, symptomatic treatment. It is therefore best to be forewarned that your adherence to ‘alternative’ principles will be tested in these ways.
The “Life Force” gets capital letters, like God, But what is it? Pure fantasy.
2 THE LIFE FORCE
2.1 What does our Energy Consist of?
At the root of most hoIistic therapies lies the belief that all life is animated by a subtle force. We call this the Life Force. You either believe it or you do not. It cannot exactly be proved at the moment and the belief is not in accord with the yardsticks that we call ‘scientific’, The belief is a little akin to the belief in God or in spirits or ghosts, and yet at the same time it is not,
because the Life Force is by no means so remote from us. It is not necessarily difficult for an agnostic to accept the Life Force. The writer was once asked for a definition of the Life Force and wrote:” The Life Force is that non-material. non-physical force that animates all life forms and distinguishes them from non-living matter. It Is seen as a determining Force, not as a mere accompaniment to the phenomenon of Life. That is, it determines whether Life can exist or not. It determines the physical form that a life form takes: by its quality and its strength it determines the health, vigour and vitality of the life form. Hence it determines our freedom from, or our susceptibility to illnesses, and our general ability to come through and to recover from Life’s stresses and traumas.”
A bit later it gets even better, when we get to astral travel and even survival after death. Truly bonkers.
The postulate of a subtle Life Force makes a natural connection with such topics as out of body experiences, astral travel and even survival after death. This happens because the subtle Life Force appears by its very nature to be “life within a different medium” and if life can exist in
a different medium, then why should it not exist quite independently of the physical body?
So what’s the evidence?
2.2 Evidence Concerning the Life Force
Since our ‘usual’ human senses only work through the medium of the human body we can only expect to detect the Life Force or other subtle forces, through their interactions with matter. It is clear that these interactions are themselves subtle and sensitive because one level or state is impinging upon another. It is postulated that they are not entirely of our world, not physical, only detectable with physical apparatus under special conditions.
Often they are described as “that which science cannot see”. Not surprisingly, therefore, when investigators come forward convinced that they have a phenomenon that demonstrates the Life Force. the physicists, looking at it with a steely scientific eye, are not usually ready to accept the conclusions claimed. Hence, we have several delicate phenomena that are often claimed to be manifestations of the Life Force, yet not accepted as such scientifically.• The experiments done by Harold Saxton Burr on the “Fields of Life”.
• The experimen1s performed on detecting and measuring “Electrodynamic fields”
• The phenomenon of “Capillary dynamolysis”
• Homoeopathic effects.
• The Chinese ‘energy pulses’ at the human wrists.
From experience it is clear that many students will simply accept the Life Force as ‘obvious’. Some will say they have always known about it. Others are able to accept the concept now as a reasonable principle. Others perhaps (though we have rarely come across it) will never accept the Life Force. If that occurs, it seems a shame, for it removes some of the excitement from wholistic nutrition, . . .
What’s said about the homeopathic evidence?
2.6 Homoeopathic Effects
It is not until Nutritional Medicine students have qualified and got into practice that they usually employ any homoeopathy as an adjunct to their therapy in anything other than a first-aid role. That is because homoeopathy is a complex training in its own right and a quite separate discipline. However, any demonstration of the effectiveness of homoeopathic medicines at potencies higher than 12C is evidence for the existence of the subtle etheric energies. Such remedies have been diluted beyond the point at which the last traces of material substance derived from the Mother tincture, have been removed, leaving only the residual energy associated with the original material.
Of course the notes go on to misrepresent the clinical trials which actually show that homeopathy is mere placebo.
2.9 Toxic Effects upon the Life Force
The Life Force is generally seen as an abundant ebullient and beautiful manifestation of Nature’s energy. Although some forms of acupuncture take in the concept of a form of polluted Life Force called Aggressive Energy”, that idea is not shared much by other whoIistic disciplines. We are left for the most part with the idea of a rather perfect form of energy.
In Western Naturopathic thought, the enemy of the Life Force is toxicity. The Life Force inhabits a potentially perfect physical body. The main threat to the integrity of that body consists of the body’s own metabolic wastes, if they are not properly cleared out. Plus environmental toxins that gain access to the body from outside, or that are generated in the bowel. In that way the bowel gains a high level of importance in Naturopathy and ‘”Nature Cure”.
The Life Force, then, with its almost holy purity, is in danger of being inhibited, dampened down and threatened by what amounts to some entirely physical dirt that gains access to that temple of the soul the human body. Whilst in Traditional Chinese Medicine impurities in the mind, emotions or spirit are just as important as physical impurity, it is naturopathy that focuses upon the actual physical sewers of the body.
Aha, that’s it. Holy water.
The inability of naturopaths in the past to identify specific toxins or to point with sufficient exactitude to the ways in which they can be removed, has been the Achilles Heel of the naturopaths in trying to represent their views in the past to orthodox doctors or medical scientists.
And it still is. The alleged toxins have never been identified, still less removed. Detoxification is a myth of downmarket women’s magazines and profiteering spas. And, of course, of some Bachelor of Science degrees.
2.10 Nutritional Effects upon the Life Force
2.10.1 Bulk nutrients
Next comes the consideration of the bulk nutrients – the protein, carbohydrate and fat. These are our source of biochemical energy and we obviously starve without them. Their purity is crucial. If they have been chemically modified or damaged by toxic interactions, then they will entrain toxicity and also be hard to break down. Even at best, their digestion and assimilation costs energy, which may well be both biochemical and subtle.
What “toxic interactions”? This is all sheer fantasy.
2.10.3 The micronutrients
When you practice [sic] nutritional therapy in a naturopathic setting, being aware at the same time of the on-going biochemistry, you become critically aware of the role of the micronutrients in a way that the classical naturopaths were not.
Biochemical reactions will flow better when they are present in the correct balance. Therefore the minerals have a key interaction with the Life Force. Without the right minerals the Life Force can be conceived of as pushing forward to achieve high activity in the body, yet being blocked through the chemical composition not being correct. If you apply the minerals in this situation, there may, indeed. be a surge forward of the energy.
Whatever that may mean.
3 THE EBULLIENCE OF THE LIFE FORCE: STOPPING THE ROT AND STARTING TO RECOVER
3.1 The Horror of Deterioration: The Chronic State
All that has gone before has already shown that the grassroots of deterioration in the physical body are:
- Weakened Life Force
- Nutritional Deficiency and Imbalance
- Toxic Attack
If nutritional error or deprivation are the more strongly implicated primary cause, then the Life Force struggles with an unbalanced physical body, getting the tissue biochemistry to work at full integrity is impossible; hence. the body’s detoxification system becomes incompetent and the body’s toxic burden may rise steeply. At the same time the Life Force ails.
So, focusing as we do now upon elimination of toxins (the very nub of classical naturopathy), we perceive that it is a process that depends upon a good strong Life Force and also upon adequate nutrient intake. Therapies that directly stimulate the Life Force (homoeopathy, acupuncture and spiritual healing) therefore make an indirect, though real, contribution to toxic elimination through increasing the Life Force or otherwise improving its health and balance.
So according to this, all CAM is much the same. That idea will provoke bitter internecine warfare.
3.5 The Law of Cure
We have above depicted the move from relative health to chronic illness as a downward path. Equally, the route back from the edge of the abyss of chronic illness is one of revitalisation and detoxification. The idea of the ‘route back’ was spotted years ago by the homoeopath, Constantine Hering, and has become known as ‘Hering’s Law of Cure’.
The Law further embodies the notion that toxins, and therefore symptoms, tend to move outward from within as recovery or cleansing occurs. This is fully in accord with the classical naturopath’s idea. Toxins close to the surface of the body are conceived to be most likely on their way out. The skin is an eliminatory organ and toxins at or near the skin level are not so much of a threat to well being. Naturally, the patient may well be horrified at the disfiguring
rash that may be seen by all. Nonetheless, the patient is seen to be far better off than when having these toxins deep within the body, held, perhaps within essential organs that are becoming progressively damaged.
This sounds increasingly like a ‘do-nothing’ approach (much like homeopathy then).
3.6 Suppression
Boils used to swell up into a red sore and then burst. Very bad ones, or carbuncles, might be lanced to cause the pus (morbid matter) to run out. These days, boils and carbuncles tend to occur much less than formerly, presumably because of the lower Life Force of the population and the generally suppressive medical culture. The chances are that they get treated with an antibiotic long before they get a chance to come to a head and burst. Such treatment is suppressive in the strictly naturopathic sense of the word. The same is absolutely true with regard to bringing down artificially the temperature during a fever, whereas ‘sweating it out’ is the natural thing to do.
More of the do-nothing approach.
4.2 How lridology Helps us to See Toxic Foci
As mentioned above, toxic foci (deposits) in the body show up in the iris of the eye. The iris is arranged so as to encompass a complete ‘map’ of the body. with all the organs and systems laid out upon it. Hence the location of a toxic deposit in the iris shows the iridologist its position within the body. The toxins may appear as colours, spots. blobs and smears in particular
places in the iris, or as darkened areas.
Now iridology, another sort of fantasy medicine, creeps in.
5.5 What Place for Immunisations?
Here we shall restrict ourselves to saying as little as possible. We shall. indeed, make no recommendations. However. the classical naturopaths and homoeopaths have all been of one voice in condemning the use of morbid diseased matter for injection into the human body to prevent disease. It was not, they said, a proper procedure. There has also been much disagreement about how effective such measures are. Of course, whenever there is danger of infection. it is wrong to do nothing. At least you should use the homoeopathic equivalent treatment. As to the effectiveness of those methods, that is beyond the scope of this course.
As to the personal view of the writer, it is that the natural therapists who have declared thernselves on this topic in the past are probably right. They have maintained that immunisation is just another form of toxin and an especially potent one capable, on its own, of sparking a downward spiral into ill health in susceptible people. As to what extent that effect might be balanced by benefit, that is an unresolved argument. The writer does not use immunisations himself.
Well there is a surprise. Just like almost every other quack, the writer would endanger the whole population by opposing immunisation.
The quiz
The notes contain a number of questions, and, more interestingly, model answers are given at the end. Here is one example.
Question. Why do some patients respond well to very little treatment?
Answer. The size of the toxic burden, the strength of the Life Force and micro nutrient status strongly influence a person’s response to treatment. Therefore a person with a low toxic burden, high micro nutrient status and strong life force should respond well to very little treatment.
Or, to put it differently, echinacea cures your cold in seven days, when otherwise it would have taken a week.
Conclusion
We’ll always have crackpot ideas about medicine, at least until real medicine gets much more effective than it is now. For example, in low back pain, the cause is usually not known, the treatments are only palliative, and it isn’t very effective palliation either. The big difference between real medicine and crackpot medicine, is that in real medicine you aren’t allowed to invent the answer when you don’t know it.
No doubt the author of these fantasy notes was entirely sincere in his delusions. But how can any self-respecting vice-chancellor tolerate having this sort of stuff as part of a Bachelor of Science degree? Professor Peter John, vice-chancellor of Thames Valley University is not a scientist. His background is in education. But you don’t need to be a scientist to see what nonsense is being taught as science in his university.
Perhaps he didn’t know what is going on. Well, he does now.
Follow-up
Thanks to Ben Goldacre for the link from his miniblog.?
Thames Valley University and their degree in “Nutritional Medicine”
Why? Why do they pretend it’s science? Why don’t they just call it “some stuff we made up”
It seems that validation committees often don’t look beyond the official documents. As a result, the validations may not be worth the paper they are written on. Try this one.
One of the best bits of news recently was the downfall of Matthias Rath. He’s the man who peddled vitamin pills for AIDS in Africa, and encouraged the AIDS denialists in the South African government. Thabo Mbeki and his Health Minister, Mrs Beetroot, have gone now, thank heavens.
Rath was one of the best illustrations of the murderous effect of selling ineffective treatments. The fact that nobody in the “nutritional therapy” industry has uttered a word of condemnation for this man illustrates better than anything one can imagine the corrupt state of “nutritional therapy”. The people who kept silent include the British Association of Nutritional Therapists (BANT).
It might be surprising, then, to find the Northern College of Acupuncture proudly adding a course in alternative nutrition to its courses in acupuncture (now known to be a theatrical placebo) and Chinese herbal medicine (largely untested and sometimes toxic). It might be even more surprising to find the boast that the course is validated by the University of Wales. It seemed a good idea to find out a bit more about how this came about. Thanks to the Freedom of Information Act, some interesting things can be discovered.
Polly Toynbee’s superb article, Quackery and superstition – available soon on the NHS, written in January 2008, mentioned diplomas and degrees in complementary therapies offered by, among others, the University of Wales. This elicited a letter of protest to Toynbee from the Vice-Chancellor of the University of Wales, Professor Marc Clement BSc, PhD, MInstP, CEng,CPhys,FIET. He invited her to visit the university to see their “validation and monitoring procedures (including the University’s very specific guidelines on health studies disciplines”.
So let’s take a look at these validation procedures and guidelines.
The validation process
The Northern College of Acupuncture submitted a 148 page proposal for the course in October 2007. The document has all the usual edu-bollocks jargon, but of course doesn’t say much about clinical trials, though it does boast about an unblinded trial of acupuncture published in 2006 which, because of lack of appropriate controls, served only to muddy the waters. : This submission was considered by the University’s validation committee last December.
|
The whole validation document is only four pages long [download it]. The most interesting thing about it is that the words ‘evidence’ or ‘critical’ do not occur in it a single time. It has all the usual bureaucratic jargon of such documents but misses entirely the central point.
Does that mean that the University of Wales doesn’t care about evidence or critical thinking? Well, not on paper. Two years previously a short document called Health Studies Guidelines had been written by Dr Brian Spriggs (Health Studies Validation Consultant, since retired) for the Health Studies Committee, and it was approved on 21 April 2005. It starts well.
“Degrees in the Health Studies field are expected to promote an understanding of the importance of the scientific method and an evidence-base to underpin therapeutic interventions and of research to expand that base.”
It even goes on to say that a BSc degree in homeopathy is “unacceptable”. Don’t get too excited though, because it also says that acupuncture and Chinese herbal stuff is quite OK. How anyone can imagine they live up to the opening sentence beats me. And it gets worse. It says that all sorts of rather advanced forms of battiness are OK if they form only part of another degree. They include Homeopathy, Crystal therapy. Dowsing, Iridology; Kinesiology, Radionics, Reflexology, Shiatsu, Healing, and Maharishi Ayurvedic Medicine.
Dowsing? Crystal therapy? Just let me remind you. We are living in 2008. It is easy to forget that when ploughing through all this new age junk.
The Validation Handbook of Quality Assurance: Health Studies (2007) runs to an astonishing 256 pages [download the whole thing]. On page 12 we find the extent of the problem.
“The University of Wales validates a number of schemes in the Health Studies field. At the current time we have undergraduate and/or postgraduate degree schemes in Acupuncture, Animal Manipulation, Chiropractic, Herbal Medicine, Integrative Psychotherapy, Osteopathy, Osteopathic Studies, Traditional Chinese Medicine and Regulatory Affairs, both in the UK and overseas.”
That sounds pretty shocking. Further down on page 12, though, we find this.
“Degrees in the Health Studies field are expected to promote an understanding of the importance of the scientific method and an evidence-base to underpin therapeutic interventions and of research to expand that base. The mission is to promote and require the critical evaluation of the practices, doctrines, beliefs, theories and hypotheses that underlie the taught therapeutic measures of the discipline.”
They are indeed fine words. The problem is that I can detect no sign in the submission, nor in its consideration by the validation committee, that any attempt whatsoever was made to ensure that the course complied with these requirements.
The only sign of concern I could detect of any concern about the quality of what was being taught came in a minute to a meeting of the Health Studies Committee meeting on 24th April 2008.
“Members received a copy of an article entitled Quackery and superstition available soon on the NHS which appeared in The Guardian newspaper in January 2008, and a copy of the Vice- Chancellors response. Members agreed that this article was now historical but felt that if/when the issue were to arise again; the key matter of scientific rigour should be stressed. The Committee agreed that this was the most critical element of all degree schemes in the University of Wales portfolio of health studies schemes. It was felt it would be timely to re-examine the schemes within the portfolio as well as the guidelines for consideration of Health Studies schemes at the next meeting. The Committee might also decide that Institutions would be required to include literature reviews (as part of their validation submission) to provide evidence for their particular profession/philosophy. It was agreed that the guidelines would be a vital document in the consideration of new schemes and during preliminary visits to prospective Institutions. “
The Press Office had passed Polly Toynbee’s article to them. Curiously the Health Studies Committee dismissed it as “historical”, simply because it was written three months earlier. That is presumably “historical” in the sense that the public will have forgotten about it, rather than in the sense that the facts of the matter have changed since January. So, at least for the nutrition degree, Toynbee’s comments were simply brushed under the carpet.
After a few cosmetic changes of wording the validation was completed on 16th January 2008. For example the word “diagnosis” was removed in 43 places and “rewritten in terms of evaluation and assessment”. There was, needless to say, no indication that the change in wording would change anything in what was taught to students.
You may think that I am being a bit too harsh. Perhaps the course is just fine after all? The problem is that the submission and the reaction of the validation committee tell you next to nothing about what actually matters, and that is what is taught. There is only a vague outline of that in the submission (and part of it was redacted on the grounds that if it were made public somebody might copy ;it. Heaven forbid).
That is why I have to say, yet again, that this sort of validation exercise is not worth the paper it’s written on.
How can we find out a bit more? Very easily as it happens. Just Google. What matters is not so much formal course outlines but who teaches them.
The nutrition course
The title of the course is just “Nutrition”, not ‘Nutritional Therapy’ or ‘Alternative Nutrition’. That sounds quite respectable but a glance at the prospectus shows immediately that it is full-blown alternative medicine.
Already in July 2007, the glowing press releases for the course had attracted attention from the wonderfully investigative web site HolfordWatch. I see no sign that the validation committee was aware of this. But if not, why not? I would describe is as dereliction of academic duty.
“This pioneering course is unique in that it is firmly rooted in both Western nutritional science and naturopathic medicine and also covers concepts of nutrition within traditional Chinese, Japanese, Tibetan and Ayurvedic medicine.
This means that graduates will gain comprehensive understanding of both modern scientific knowledge and ancient wisdom concerning nutrition and dietetics.”
Ancient wisdom, of course, means something that your are supposed to believe though there is no good reason to think it’s true. In the end, though, almost the only thing that really matters about any course is who is running it. The brochure shows that all of the people are heavily into every form of alternative nuttiness.
Course Director and Tutor: Jacqueline Young nutritionist, naturopath, clinical psychologist and Oriental medical practitioner
Nutrition Tutors:
Elaine Aldred (qualified as a chiropractor with the Anglo European Chiropractic College, as an acupuncturist with the British College of Acupuncture and as a Western Medical Herbalist with the College of Phytotherapy. She recently also qualified in Chinese herbal medicine with the Northern College of Acupuncture.)
Sue Russell (3 year diploma in nutritional therapy at the Institute of Optimum Nutrition. She currently practises as a nutritional therapist and also works part-time as a manager at the Northern College of Homeopathic Medicine.)
Anuradha Sharma (graduated as a dietician from Leeds Metropolitan University in 2002 and subsequently completed a Naturopathy certificate and a post-graduate diploma in acupuncture).
Guest Lecturers include : Dr John Briffa, Professor Jane Plant, M.B.E. (a geochemist turned quack), and, most revealingly, none other than the UK’s most notorious media celebrity and pill peddler, Patrick Holford.
So much has been written about Holford’s appalling abuse of science, one would have thought that not even a validation committee could have missed it.
“The course has been created by Jacqueline Young“, so let’s look a bit further at her track record.
Jacqueline Young has written a book, ‘Complementary Medicine for Dummies’ [Ed: ahem shouldn’t that be Dummies for Complementary Medicine?]. You can see parts of it on Google Books. Did the validation committee bother to look at it? As far as I can tell, the words ‘randomised’ or ‘clinical trial’ occur nowhere in the book.
The chapter on Tibetan medicine is not very helpful when it comes to evidence but for research we are referred to the Tibetan Medical and Astrology Institute. Guess what? That site gives no evidence either. So far not a single university has endorsed Astrology (there is a profitable niche there for some vice-chancellor).
Here are few samples from the book. The advice seems to vary from the undocumented optimism of this
Well researched? No. Safe? Nobody knows. Or this
Mandarin peel prevents colds and flu? Old wive’s tale. Then there are things that verge on the weird, like this one
or the deeply bizarre like this
The problem of Jacqueline Young’s fantasy approach to facts was pointed out at least as far back as 2004, by Ray Girvan., who wrote about it again in May 2005. The problems were brought to wider attention when Ben Goldacre wrote two articles in his Badscience column, Imploding Researchers (September 2005), and the following week, Tangled Webs.
“we were pondering the ethics and wisdom of Jacqueline Young dishing out preposterous, made-up, pseudoscientific nonsense as if it was authoritative BBC fact, with phrases such as: “Implosion researchers have found that if water is put through a spiral its electrical field changes and it then appears to have a potent, restorative effect on cells.” “
and later
“Take this from her article on cranial osteopathy, riddled with half truths: “Sutherland found that the cranial bones (the skull bones encasing the brain) weren’t fused in adulthood, as was widely believed, but actually had a cycle of slight involuntary movement.” In fact the cranial bones do fuse in adulthood.
She goes on: “This movement was influenced by the rhythmic flow of cerebrospinal fluid (the nourishing and protective fluid that circulates through the spinal canal and brain) and could become blocked.” There have now been five studies on whether “cranial osteopaths” can indeed feel these movements, as they claim, and it’s an easy experiment to do: ask a couple of cranial osteopaths to write down the frequency of the rhythmic pulses on the same person’s skull, and see if they give the same answer. They don’t. A rather crucial well-replicated finding to leave out of your story.
That was in 2005 and since then all of Young’s “preposterous, made-up, pseudoscientific nonsense” (along with most of the other stuff about junk medicine) has vanished from the BBC’s web site, after some people with a bit of common sense pointed out what nonsense it was. But now we see them resurfacing in a course validated by a serious university. The BBC had some excuse (after all, it is run largely by arts graduates). I can see no excuses for the University of Wales.
Incidentally, thanks to web archive you can still read Young’s nonsense, long after the BBC removed it. Here is a quotation.
“Implosion researchers have found that if water is put through a spiral its ,field changes and it then appears to have a potent, restorative effect on cells. In one study, seedlings watered with spiralised water grew significantly faster, higher and stronger than those given ordinary water.”
The vice-chancellor of the University of Wales, Marc Clement, is a physicist (Department of Electrical and Electronic Engineering), so can he perhaps explain the meaning of this?
Selection committees for jobs (especially senior jobs) and validation committees for courses, might make fewer mistakes if they didn’t rely so much on formal documents and did a little more investigation themselves. That sort of thing is why the managerial culture not only takes a lot more time, but also gives a worse result.
It would have taken 10 minutes with Google to find out about Young’s track record, but they didn’t bother. As a result they have spent a long time producing a validation that isn’t worth the paper it’s written on. That makes the University of Wales a bit of a laughing stock. Worse still, it brings science itself into disrepute.
Follow-up
What does the University of Wales say? So far, nothing. Last week I sent brief and polite emails to Professor Palastanga and to Professor Clement to try to discover whether it is true that the validation process had indeed missed the fact that the course organiser’s writings had been described as “preposterous, made-up, pseudoscientific nonsense” in the Guardian.
So far I have had no reply from the vice-chancellor, but on .26 October I did get an answer from Prof Palastaga.
| As regards the two people you asked questions about – J.Young – I personally am not familiar with her book and nobody on the validation panel raised any concerns about it. As for P.Holford similarly there were no concerns expressed about him or his work. In both cases we would have considered their CV’s as presented in the documentation as part of the teaching team. In my experience of conducting degree validations at over 16 UK Universities this is the normal practice of a validation panel. |
I have to say this reply confirms my worst fears. Validation committees such as this one simply don’t do their duty. They don’t show the curiosity that is needed to discover the facts about the things that they are meant to be judging. How could they not have looked at the book by the very person that they are validating? After all that has been written about Patrick Holford, it is simply mind-boggling that the committee seems to have been quite unaware of any of it.
It is yet another example of the harm done to science by an unthinking, box-ticking approach.
Pharmacology. A Handbook for Complementary Healthcare Professionals
Elsevier were kind enough to send me an inspection copy of this book, which is written by one of the nutrition course tutors, Elaine Aldred. She admits that pharmacology is “considered by most students to be nothing more that a ‘hoop-jumping’ exercise in the process of becoming qualified”. She also says. disarmingly. that “I was certainly not the most adept scientist at school and found my university course a trial”.
The book has all the feel of a cut and paste job. It is mostly very simple (if not simplistic). though for no obvious reason it starts with a long (and very amateur) discussion of chemical bonding Then molecules are admitted to be indivisible (but, guess what, the subject of homeopathy is avoided). There is a very short section on ion channels, though, bizarrely, it appears under the heading “How do drugs get into cells?”. Since the author is clearly not able to make the distinction between volts and coulombs, the discussion is more likely to confuse the reader than to help.
Then a long section on plants. It starts of by asserting that “approximately a quarter of prescription drugs contain at least one chemical that was originally isolated and extracted from a plant”.. This cannot be even remotely correct. There are vast tables showing complicated chemical structures, but the usual inadequate
list of their alleged actions This is followed by a quick gallop through some classes of conventional drugs, illustrated again mainly by chemical structures not data. Hormone replacement therapy is mentioned, but the chance to point out that it is one of the best illustrations of the need for RCTs is missed.
The one thing that one would really like to see in such a book is a good account of how you tell whether or not a drug works in man. This is relegated to five pages at the end of the book, and it is, frankly, pathetic. It
is utterly uncritical in the one area that matters more than any other for people who purport to treat patients. All you get is a list of unexplained bullet points.
If this book is the source of the “scientific content” of the nutrition course, things are as bad as we feared.
We know all about the sixteen or so universities that run “BSc” degrees in hokum. They are all “post-1992” universities, which used to be polytechnics. That is one reason why it saddens me to see them destroying their own attempts to achieve parity with older universities by running courses that I would regard as plain dishonest.
Older universities do not run degree courses in such nonsense. Academics (insofar as they still have any influence) certainly would not put up with it if they tried. But nevertheless you can find quackery in some of the most respected universities, and it gets there not via academics but (guess what) via Human Resources. It creeps in through two routes. One is the “training courses” that research staff now have to do (the “Roberts agenda”). The other route is through occupational health services.
Quackery in training courses
It isn’t easy to find out what happens elsewhere, but I was certainly surprised to find out that UCL’s own HR department was offering a course that promised to teach you the “core principles” of Brain Gym and Neurolinguistic Programming, both totally discredited bits of psycho-babble, more appropriate to the lifestyle section of a downmarket.women’s magazine than a university. I gather that HR’s reaction after I brought this to light was not to ask what was wrong with it, but just to get angry.
In a spirit of collegiality I offered to run a transferable skills course myself. I even offered to do it for nothing (rather than the rumoured £700 per day charged by the life style consultants). I proposed a course in ‘How to read critically’ (subtitle ‘How to detect bullshit’). This seems to me to be the ultimate transferable skill. Bullshit occurs in every walk of life. My proposal was moderately worded and perfectly serious.
Guess what? Despite several reminders, I have never had any response to my suggestion. Well, I suppose that HR people now regard themselves as senior to mere professors and there is really no need to reply to their
letters.
Quackery in occupational health. Leicester sets a good example
If you work at a university, why not search the university’s web site for “complementary medicice” or complementary therapies”. If it is a real university, you won’t find any degrees in homeopathy, or in amethysts
that emit high yin energy. But some quite surprising places are found to be recommending magic medicine through their Occupational Health service, which usually seems to be part of HR. In fact at one time even UCL was doing it, but no soon had somebody sent me the link than it disappeared. As a matter of historical record, you can see it here (it had all the usual junk, as well as harmless stuff like yoga and pilates).
While looking for something else I stumbled recently some other cases. One was at the University of Leicester, a very good university (and alma mater to the great David Attenborough who must have done more to point out the beauty of science than just about anyone). But we find on their staff wellbeing site, alongside some perfectly sensible stuff, a link to complementary therapies.
The list of ‘therapies’ includes not only the usual placebos, acupuncture, reiki, reflexology, but, even more exotically, a fraudulent Russian device called SCENAR therapy. They have a nice leaflet that explains all these things in words that run the whole gamut from meaningless gobbledygook to plain wrong. Here are some examples from the leaflet.
Reflexology
“In the feet, there are reflex areas corresponding to all the parts of the body and these areas are arranged in such a way as to form a map of the body in the feet”
Reflexology has been shown to be effective for:
- Back Pain
- Migraine
- Infertility
- Arthritis
Well no, there are no such areas in your feet. That is sheer imagination. And reflexology has not “been shown to be effective” for any of those conditions. These claims for therapeutic efficacy are not only lies. They are also illegal.
“Reiki
Each hand position is held for a few minutes, and during this time healing energy will flow into you, balancing your energy system, releasing stress, soothing pain, and promoting your body’s natural ability to heal itself.”
This is sheer idiotic mumbo-jumbo. The “flow of healing energy” is totally imaginary. Such talk is offensive to anyone with half a brain. Insofar as they claim to heal anything, it is also illegal. The comes SCENAR.
“What is SCENAR?
SCENAR is an acronym for Self Controlled Energo- Neuro Adaptive Regulator. It is a reflex biofeedback device which when used by a qualified practitioner, can help to alleviate acute and chronic pain. It is licensed in the UK for pain relief but experience has shown that it is helpful in a wide variety of conditions.”
This is even more seriously nuts than the others. The term “licensed” means merely that it is electrically safe. It certainly does not mean that it works. Pubmed shows only three publications about the SCENAR device, all in Russian,
One sales site (apparently Russian) makes the following modest claim.
“A prime goal of the Russian Space Program was to provide space travelers with a portable medical device that would become their “universal medical assistant” in space. So from the beginning, the SCENAR was designed to replace an entire medical hospital, with all its staff, diagnostic and treatment facilities, even the pharmacy. A universal, non-invasive, portable regulator of body functions (among other things) was envisaged.”
The SCENAR device (right) looks like a TV remote control (perhaps it IS a TV remote control -we aren’t anywhere told in comprehensible terms what’s in the box. The Russian site sells also the rather baffling accessory on the right. The mind boggles.
SCENAR device |
Remote rectal-vaginal electrode for SCENAR |
How does this rubbish get onto the web site of a good university?
I presume that it is just another sign of what happens when universities come to be run by non-academics. No doubt the occupational health people are well meaning and kind, but just scientifically illiterate. What about the HR person in charge of them? They are not known for scientific literacy either (which would not matter if they stuck to their job). But perhaps they just didn’t notice. There is only one way to find out. Ask. So I sent this letter.on 10th September.
| Hello
I am a pharmacologist and I have a side interest in public understanding of science, alternative medicine.and medical fraud I was quite surprised when Google led me unexpectedly to your complementary therapies page at http://www.le.ac.uk/staffwellbeing/complementary_therapy.html There is, sad to say, a great deal of information on these pages that is simply not true. For example it has NOT been shown that reflexology has been shown to be effective in any of the conditions which you list, as far as I know To take only one more example from this page, the SCENAR device is an even more extreme example. It is well known to be fraudulent. and has been investigated by the Washington State Attorney General. This sort of thing is not what one would expect from a very respectable university, and it must be a great embarrassment to your excellent medical scientists. Apart from the many scientific inaccuracies (which greatly impede the efforts of those of us who try to improve public understanding of science), you are, I hope, aware that there is a legal aspect. Since May this year, new regulations have made it illegal to make claims for health benefits if evidence cannot be produced to show that the claims are justified. I would like to put it to you that many of the claims made on this page are not only immoral, but also illegal. I wondered whether you , or your HR department, would like to make any comments Best regards David Colquhoun |
I got an immediate and very sympathetic response from the Director of HR and a week later, on17th September, he wrote
“Hi David,
I have discussed the matter with my manager of Staff Counselling and Welfare and have agreed that it is probably safest that we remove the references to ‘complimentary’[sic] therapies from the site entirely.
Thank you for your helpful input and the recommendations for reading matter.”
So there is a lesson here. If you find this sort or stuff on your own institution’s web site, all that may be needed is a simple letter that points out what nonsense it is. Admittedly the HR man seemed rather more worried about whether the claims were illegal than whether they were true, but either way, it worked.
Only one little snag. As of 6 October the pages still have not been removed.
On the assumption that they eventually will be removed, I have kept copies of the Wellbeing page, of the Complementary Therapies page, and of the ‘explanatory leaflet’. They stand as part of a historical record that
shows, once again, what can happen when scientific matters get into the hands of HR. Fortunately Leicester University has an HR director who is willing to listen to advice.
Follow-up
Something seems to have gone seriously wrong. Despite the rapid response, virtually all the nonsense is still there on 13th October. It seems not to be so simple after all.
And despite several reminders, the advertisement for SCENAR ‘therapy’ is still on the University web site on December 14th. I know that no decision by HR can be made with fewer than 25 meetings and an awayday in Majorca, but this is getting ridiculous.
Alfred Joseph Clark FRS held the established chair of Pharmacology at UCL from 1919 to 1926, when he left for Edinburgh. In the 1920s and 30s, Clark was a great pioneer in the application of quantitative physical ideas to pharmacology. As well as his classic scientific works, like The Mode of Action of Drugs on Cells (1933) he wrote, and felt strongly, about the fraud perpetrated on the public by patent medicine salesmen. In 1938 (while in Edinburgh) he published a slim volume called Patent Medicines. The parallels with today are astonishing.
 
Alfred Joseph Clark FRS (1885 – 1941) |
 |
I was lucky to be given a copy of this book by David Clark, A.J. Clark’s eldest son, who is now 88. I visited him in Cambridge on 17 September 2008, because he thought that, as holder of the A.J. Clark chair at UCL from 1985 to 2004, I’d be a good person to look after this and several other books from his father’s library. They would have gone to the Department of Pharmacology if we still had one, but that has been swept away by mindless administrators with little understanding of how to get good science.
Quotations from the book are in italic, and are interspersed with comments from me.
The book starts with a quotation from the House of Commons Select Committee report on Patent Medicines. The report was submitted to the House on 4 August 1914, so there is no need to explain why it had little effect. The report differs from recent ones in that it is not stifled by the sort of political correctness that makes politicians refer to fraudsters as “professions”.
The problem
“2.2 The situation, therefore, as regards the sale and advertisement of proprietary medicines and articles may be summarised as follows:
For all practical purposes British law is powerless to prevent any person from procuring any drug, or making any mixture, whether patent or without any therapeutical activity whatever (as long as it does not contain a scheduled poison), advertising it in any decent terms as a cure for any disease or ailment, recommending it by bogus testimonials and the invented opinions and facsimile signatures of fictitious physicians, and selling it under any name he chooses, on payment of a small stamp duty. For any price he can persuade a credulous public to pay.”
Select Committee on Patent Medicines. 1914
“The writer has endeavoured in the present article to analyse the reasons for the amazing immunity of patent medicines form all attempts to curb their activity, to estimate the results and to suggest the obvious measures of reform that are needed.”
| Clark, writing in 1938, was surprised that so little had changed since 1914. What would he have thought if he had known that now, almost 100 years after the 1914 report, the fraudsters are still getting away with it? Chapter 2 starts thus. |
 |
THE LAW
The Select Committee appointed by the House of Commons in 1914 ‘to consider and inquire into the question of the sale of Patent and Proprietary Medicines’ stated its opinion in 28 pages of terse and uncompromising invective. Its general conclusions were as follows:
That the trade in secret remedies constituted a grave and widespread public evil.
That the existing law was chaotic and had proved inoperative and that consequently the traffic in secret remedies was practically uncontrolled.
In particular it concluded ‘”that this is an intolerable state of things and that new legislation to deal with it, rather than merely the amendment of existing laws, is urgently needed in the public interest.”
The “widespread public evil”continues almost unabated, and rather than introduce sensible legislation to cope with it, the government has instead given a stamp of approval for quackery by introducing utterly ineffective voluntary “self-regulation”.
Another Bill to deal with patent medicines was introduced in 1931, without success, and finally in 1936, a Medical and Surgical Appliances (Advertisement) Bill was introduced. This Bill had a very limited scope. Its purpose was to alleviate some of the worst abuses of the quack medicine trade by prohibiting the advertisement of cures for certain diseases such as blindness, Bright’s disease [nephritis] , cancer, consumption [tuberculosis], epilepsy, fits, locomotor ataxy, fits, lupus or paralysis.
The agreement of many interests was secured for this measure. The president of the Advertising Association stated that the proposed Bill would not affect adversely any legitimate trade interest. Opposition to the Bill was, however, whipped up amongst psychic healers, anti-vivisectionists and other opponents of medicine and at the second reading in March 1936, the Bill was opposed and the House was counted out during the ensuing debate. The immediate reason for this fate was that the Bill came up for second reading on the day of the Grand National! This is only one example of the remarkable luck that has attended the patent medicine vendors.
(Page 14).
The “remarkable luck” of patent medicine vendors continues to this day, Although, in principle, advertisement of cures for venereal diseases was banned in 1917, and for cancer in 1939, it takes only a few minutes with Google to find that these laws are regularly flouted by quacks, In practice quacks get away with selling vitamin pills for AIDS, sugar pills for malaria and homeopathic pills for rabies, polio anthrax and just about anything else you can think of. Most of these advertisements are contrary to the published codes of ethics of the organisations to which the quack in question belongs but nothing ever happens.
Self-regulation simply does not work, and there is still no effective enforcement even of existing laws..
“It has already been stated that British law allows the advertiser of a secret remedy to tell any lie or make any claim that he fancies will sell his goods and the completeness of this licence is best illustrated by the consideration of a few specific points.
Advertisements for secret remedies very frequently contain a list of testimonials from medical men, which usually are in an anonymous form, stating that ………….. M.D., F.R.C.S., has found the remedy infallible. Occasionally, however, the name and address of a doctor is given and anyone unaware of the vagaries of English law would imagine that such use of a doctor’s name and professional reputation could not be made with impunity without his consent. In 1899, however, the Sallyco Mineral Water Company advertised that ‘Dr. Morgan Dochrill, physician to St. John’s Hospital, London and many of the leading physicians are presenting ‘Sallyco’ as an habitual drink. Dr. Dochrill says nothing has done his gout so much good.
Dr. Dochrill, whose name and title were correctly stated above, sued the company but failed in his case. ”
“The statement that the law does not prevent the recommending of a secret remedy by the use of bogus testimonials and facsimile signatures of fictitious physicians is obviously an understatement since it is doubtful how far it interferes with the use of bogus testimonials from real physicians.”
Dodgy testimonials are still a mainstay of dodgy salesman. One is reminded of the unauthorised citation of testimonials from Dr John Marks and Professor Jonathan Waxman by Patrick Holford to aid his sales of unnecessary vitamin supplements. There is more on this at Holfordwatch.
The man in the street knows that the merits of any article are usually exaggerated in advertisements and is in the habit of discounting a large proportion of such claims, but, outside the realm of secret remedies, the law is fairly strict as regards definite misstatements concerning goods offered for sale and hence the everyday experience of the man in the street does not prepare him for dealing with advertisements which are not merely exaggerations but plain straightforward lies from beginning to end.
Scientific training is undoubtedly a handicap in estimating popular gullibility as regards nostrums. One imagines that no one today would be willing to spend money on pills guaranteed to prevent earthquakes but yet the claims of many of the remedies offered appear equally absurd to anyone with an elementary
knowledge of physiology or even of chemistry. A study of the successes and failures suggests that success depends chiefly on not over-rating the public intelligence. (Page 34)
This may have changed a bit since A.J. Clark was writing in 1938. Now the main clients of quacks seem to be the well-off “worried-well”. But it remains as true as ever that “Scientific training is undoubtedly a handicap in estimating popular gullibility as regards nostrums.” In 2008, it is perhaps more a problem of Ben Goldacre’s dictum ““My basic hypothesis is this: the people who run the media are humanities graduates with little understanding of science, who wear their ignorance as a badge of honour.”
Clark refers (page 36) to a successful conviction for fraud in the USA in 1917. The subject was a widely advertised ‘get fat quick’ pill that contained lecithin, proteins and sugar. The BMA analysis (in 1912)
suggested that the cost of the ingredients in a box of 30 tablets sold for 4/6 was 1 1/4 d. [4/6 meant 4 shillings and six pence, or 22.5 pence since 1971, and 1 1/4 old pence, a penny farthing, is 0.52 new pence]. He comments thus.
The trial revealed many interesting facts. The formula was devised after a short consultation with the expert of one of the largest drug manufacturers in the U.S.A. This firm manufactured the tablets and sold them to the proprietary medicine company at about 3/- per 1000, whilst they were retailed to the public at the rate of £7 10s. per 1000. The firm is estimated to have made a profit of about $3,000,000.
These trials in the U.S.A. revealed the fact that in a considerable proportion of cases the ‘private formula’ department of the large and well known drug firm already mentioned had first provided the formula for the nostrum and subsequently had prepared it wholesale.
Nothing much has changed here either. The alternative medicine industry (and it is a very big industry) is fond of denouncing the evils of the pharmaceutical industry, and sadly, occasionally they are right. One of the less honest practices of the pharmaceutical industry (though one never mentioned by quacks) is buying heavily into alternative medicine. Goldacre points out
“there is little difference between the vitamin and pharmaceutical industries. Key players in both include multinationals such as Roche and Aventis; BioCare, the vitamin pill producer that media nutritionist Patrick Holford works for, is part-owned by Elder Pharmaceuticals.”
And then. of course, there is the deeply dishonest promotion by Boots the Chemists of homeopathic miseducation, of vitamins and of CoQ10 supplements.
The manner in which secret remedies can survive repeated exposure is shown by the following summary of the life history of a vendor of a consumption [tuberculosis] cure.
1904, 1906: Convicted of violating the law in South Africa.
1908: Exposed in British Medical Association report and also attacked by Truth.
1910: Sued by a widow. The judge stated: ‘I think this is an intentional and well-considered fraud. It is a scandalous thing that poor people should be imposed upon and led to part with their money, and to hope that those dear to them would be cured by those processes which were nothing but quack remedies and had not the slightest value of any kind.’
1914: A libel action against the British Medical Association was lost.
1915 The cure was introduced into the United States.
1919 The cure was sold in Canada.
1924 Articles by men with medical qualifications appeared in the Swiss medical journal boosting
the cure.
Secret remedies have a vitality that resembles that of the more noxious weeds and the examples mentioned suggest that nothing can do them any serious harm.
Most of the time, quacks get away with claims every bit as outrageous today. But Clark does give one example of a successful prosecution. It resulted from an exposé in the newspapers -wait for it -in the Daily Mail.
There is, however, one example which proves that a proprietary remedy can be squashed by exposure if this is accompanied by adequate publicity.
The preparation Yadil was introduced as an antiseptic and was at first advertised to the medical profession. The proprietor claimed that the remedy was not secret and that the active principle was ‘tri-methenal allylic carbide’. The drug acquired popularity in the influenza epidemic of 1918 and the proprietor became more and more ambitious in his therapeutic claims. The special virtue claimed for Yadil was that it would kill any harmful organism that had invaded the body. A more specific claim was that consumption in the first stage was cured with two or three pints whilst advanced cases might require a little more. Other advertisements suggested that it was a cure for most known diseases from cancer downwards.
These claims were supported by an extraordinarily intense advertising campaign. Most papers, and even magazines circulating amongst the wealthier classes, carried full page and even double page advertisements. The Daily Mail refused these advertisements and in 1924 published a three column article by Sir William Pope, professor of Chemistry in the University of Cambridge. He stated that
the name ‘tri-methenal allylic carbide’ was meaningless gibberish and was not the chemical definition of any known substance. He concluded that Yadil consisted of :
‘About one per cent of the chemical compound formaldehyde.
About four per cent of glycerine.
About ninety-five per cent of water and, lastly, a smell.
He calculated that the materials contained in a gallon cost about 1/6, whilst the mixture was sold at £4 10s. per gallon.
This exposure was completely successful and the matter is of historic interest in that it is the only example of the career of a proprietary medicine being arrested by the action of the Press.
Clark goes on to talk of the law of libel.
“On the other hand the quack medicine vendor can pursue his advertising campaigns in the happy assurance that, whatever lies he tells, he need fear nothing from the interference of British law. The law does much to protect the quack medicine vendor because the laws of slander and libel are so severe.”
The law of libel to this day remains a serious risk to freedom of speech of both individuals and the media. Its use by rogues to suppress fair comment is routine. My first encounter was when a couple of herbalists
threatened to sue UCL because I said that the term ‘blood cleanser’ is gobbledygook. The fact that the statement was obviously true didn’t deter them for a moment. The herbalists were bluffing no doubt, but they caused enough nuisance that I was asked to take my pages off UCL’s server. A week later I was invited back but by then I’d set up a much better blog and the publicity resulted in an enormous increase in readership, so the outcome was good for me (but bad for herbalists).
It was also good in the end for Andy Lewis when his immortal page “The gentle art of homoeopathic killing” (about the great malaria scandal) was suppressed. The Society of Homeopaths’ lawyers didn’t go for him personally but for his ISP who gave in shamefully and removed the page. As a result the missing page reappeared in dozens of web sites round the world and shot to the top in a Google search.
Chiropractors are perhaps the group most likely to try to suppress contrary opinions by law not argument. The only lawyers’ letter that has been sent to me personally, alleged defamation in an editorial that I wrote for the New Zealand Medical Journal. That was a little scary, but the journal stuck up for its right to speak and the threat went away after chiropractors were allowed right of reply (but we got the last word).
Simon Singh, one of the best science communicators we have, has not been so lucky. He is going to have to defend in court an action brought by the British Chiropractic Association because of innocent opinions expressed in the Guardian.
Chapter 6 is about “The harm done by patent medicines”. It starts thus.
“The trade in secret remedies obviously represents a ridiculous waste of money but some may argue that, since we are a free country and it pleases people to waste their money in this particular way, there is no call for any legislative interference. The trade in quack medicines cannot, however, be regarded as a harmless one. The Poisons Acts fortunately prevent the sale of a large number of dangerous drugs, but there are numerous other ways in which injury can be produced by these remedies.”
The most serious harm, he thought, resulted from self-medication, and he doesn’t mince his words.
“The most serious objection to quack medicines is however that their advertisements encourage self-medication as a substitute for adequate treatment and they probably do more harm in this than in any other manner.
The nature of the problem can best be illustrated by considering a simple example such as diabetes. In this case no actual cure is known to medicine but, on the other hand, if a patient is treated adequately by insulin combined with appropriate diet, he can be maintained in practically normal health, in spite of his disability, for an indefinite period. The expectation of life of the majority of intelligent diabetics, who make no mistakes in their regime, is not much less than that of normal persons. The regime is both irksome and unpleasant, but anyone who persuades diabetics to abandon it, is committing manslaughter as certainly as if he fired a machine gun into a crowded street.
As regards serious chronic disease the influence of secret remedies may be said to range from murderous to merely harmful.
‘Cures’ for consumption, cancer and diabetes may fairly be classed as murderous, since they are likely to cause the death of anyone who is unfortunate enough to believe in their efficacy and thus delay adequate treatment until too late.
The phrase “‘Cures for consumption, cancer and diabetes may fairly be classed as murderous” made Clark himself the victim of suppression of freedom of speech by lawyers. His son, David Clark, wrote of his father in “Alfred Joseph Clark, A Memoir” (C. & J. Clark Ltd 1985 ISBN 0-9510401-0-3)
“Although tolerant of many human foibles, A. J. had always disapproved fiercely of quacks, particularly the charlatans who sold fraudulent medicines. During his visits to London he met Raymond Postgate, then a crusading left wing journalist, who persuaded A.J. to write a pamphlet which was published in an ephemeral series called ‘Fact‘ in March 1938. It was a lively polemical piece. . To A.J.’s surprise and dismay he was sued for libel by a notorious
rogue who peddled a quack cure for for tuberculosis. This man said that A.J.’s remarks (such as “‘Cures’ for consumption, cancer and diabetes may fairly be classed as murderous”) were libellous and would damage his business. A.J. was determined to fight, and he and Trixie decided to put their savings at stake if necessary. The B.M.A. and the Medical Defence Union agreed to support him and they all went to lawyers. He was shocked when they advised him that he would be bound to lose for he had damaged the man’s livelihood! Finally, after much heart searching, he made an apology, saying that he had not meant that particular man’s nostrum”
Talk about déjà vu!
On page 68 there is another very familiar story. It could have been written today.
“The fact that the public is acquiring more knowledge of health matters and is becoming more suspicious of the cruder forms of lies is also helping to weed out the worst types of patent medicine advertisements. For example, in 1751 a bottle of oil was advertised as a cure for scurvy, leprosy and consumption but today such claims would not be effective in promoting the sale of a remedy. The modern advertiser would probably claim that the oil was rich in all the vitamins and the elements essential for life and would confine his claims to a statement that it would alleviate all minor forms of physical or mental ill-health.
The average patent medicine advertised today makes plausible rather than absurd claims and in general the advertisements have changed to conform with a change in the level of the public’s knowledge.
It is somewhat misleading, however, to speak of this as an improvement, since the law has not altered and hence the change only means that the public is being swindled in a somewhat more skilful manner.
The ideal method of obtaining an adequate vitamin supply is to select a diet containing an abundant supply of fresh foods, but unfortunately the populace is accustomed to live very largely on preserved or partially purified food stuffs and such processes usually remove most of the vitamins.”
The first part of the passage above is reminiscent of something that A.J Clark wrote in the BMJ in 1927. Nowadays it is almost unquotable and I was told by a journal editor that it was unacceptable even with asterisks. That seems to me a bit silly. Words had different connotations in 1927.
“The less intelligent revert to the oldest form of belief and seek someone who will make strong magic for them and defeat the evil spirits by some potent charm. This is the feeling to which the quack appeals; he claims to be above the laws of science and to possess some charm for defeating disease of any variety.
The nature of the charm changes with the growth of education. A naked n****r howling to the beat of a tom-tom does not impress a European, and most modern Europeans would be either amused or disgusted by the Black mass that was popular in the seventeenth century. Today some travesty of physical science appears to be the most popular form of incantation.”
A.J. Clark (1927) The historical aspect of quackery, BMJ October 1st 1927
Apart from some of the vocabulary, what better description could one have of the tendency of homeopaths to harp on meaninglessly about quantum theory or the “scienciness” and “referenciness” of
modern books on nutritional therapy?
So has anything changed?
Thus far, the outcome might be thought gloomy. Judging by Clark’s account, remarkably little has changed since 1938, or even since 1914. The libel law in the UK is as bad now as it was then. Recently the United Nations Human Rights Committee said UK laws block matters of public interest and encourage libel tourism (report here, see also here). It is unfit for a free society and it should be changed.
But there are positive sides too. Firstly the advent of scientific bloggers has begun to have some real influence. People are no longer reliant on journalists to interpret (or, often, misinterpret) results for them. They can now get real experts and links to original sources. Just one of these, Ben Goldacre’s badscience.net, and his weekly column in the Guardian has worked wonders in educating the public and improving journalism. Young people can, and do, contribute to the debate because they can blog anonymously if they are frightened that their employer might object.
Perhaps still more important, the law changed this year. Now, at last, it may be possible to prosecute successfully those who make fraudulent health claims. Sad to say, this was not an initiative of the UK government, which remains as devoted as ever to supporting quacks. Remember that, quite shamefully, the only reason given by the Medicines and Health Regulatory Authority (MHRA) gave for allowing false labelling of homeopathic pills was to support the “homeopathic industry”. They suggested (falsely) that the EU required them to take this irresponsible step, which was condemned by just about every scientific organisation. But the new unfair trading regulations did come from the EU. After almost 100 years since the 1914 report, we have at last some decent legislation. Let’s hope it’s enforced.
Postcript
The back cover of the series of ‘Fact‘ books in which A.J. Clark’s article appeared is reproduced below, simply because of the historical portrait of the 1930s that it gives.
Follow-up
This post got a lot of hits from Ben Goldacre’s miniblog which read
- Prof David Colquhoun gets into a time machine and meets himself
A truly classic DC post.
Thanks, Ben.
Today is a good day for anyone who deplores dangerous confidence tricksters. In particular it is a good day for Ben Goldacre, and for the Guardian which defended him at potentially enormous expense.
| Matthias Rath, the Dutch (or is it German) vitamin salesman has dropped his libel action against the Guardian. He is the man who is, without doubt, responsible for many deaths form AIDS in Africa, as a result of peddling vitamin pills as cures. The action was taken after Goldacre said, in the Guardian, that Rath aggressively sells his message to Aids victims in South Africa that Rath vitamin pills are better than medication”. |  |
Here is some of what has appeared already today
Fall of the doctor who said his vitamins would cure Aids – from The Guardian, with a video of the villain.
Goldacre’s Badscience blog article on his victory .
Profile of Zackie Achmat – from The Guardian, Mr Achmat is the founder of the Treatment Action Campaign , instrumental in exposing Rath.
Extract from witness statements from the defence in the trial .
And a lot of publicity from Gimpyblog (“Ben Goldacre and The Guardian triumph over murderous Matthias Rath”), Holfordwatch , Quackometer and jdc325 blogs.
Then more in the Guardian the next day, Chris McGreal investigates the Rath Foundation
Nutritional therapist?
Let’s be clear about what the words mean. Nutritional therapists are not like dietitians, and they are not like nutritionists. Nutritional therapists are solidly in the camp of alternative medicine practitioners, Don’t
take my word for it. They say so themselves.
“For nutritional therapists (who practise Complementary and Alternative Medicine) optimum nutrition encompasses individual prescriptions for diet and lifestyle in order to alleviate or prevent ailments and to promote optimal gene expression through all life stages. Recommendations may include guidance on natural detoxification, procedures to promote colon health, methods to support digestion and absorption, the avoidance of toxins or allergens and the appropriate use of supplementary nutrients, including phytonutrients.”
They love to use imaginary words like “detoxification”, and, much more dangerously, they love to pretend that they can cure diseases by changes in diet. As long as you buy from them a stack of expensive “supplement” pills, of course. That means they are selling medicines, but by pretending they are selling food supplements they manage to evade the law that requires medicines to be safe and effective. That will not be so easy under new legislation though, and we can look forward to a few prosecutions soon.
Guess who runs an “Honours BSc degree” in Nutritional Therapy. No prizes for realising it is the UK’s leading university purveyor of woo.
The University of Westminster
On their web site we learn that the Course Leader is Heather Rosa, and the Deputy Course Leader is Val Harvey. Harvey qualified in the subject at the Institute of Optimum Nutrition, the private college run by none other than the famous pill-peddler, Patrick Holford, about whom so very much has been written (try Holfordwatch, or the masterly chapter in Goldacre’s Bad Science)
We don’t know much about what is taught on the Nutritional Therapy course because the University of Westminster has refused repeated requests to say (but watch this space).. One can only assume that, whatever it is, they are not very proud of it. It seems a little unlikely that they will go as far as Matthias Rath and claim to cure AIDS -we’ll just have to wait and see. Meanwhile we can get an inkling by looking elsewhere.
Course leader, Heather Rosa, pops up for example, on the expert panel of a web site called Supplements Compared.com. “Supplements Compared is designed to help you find the best dietary supplement product for your health needs.” And what sort of advice do you find there? Try the page that compares 10 brands of CoQ10 (that is the stuff I wrote about recently, in “Boots reaches new level of dishonesty with CoQ10 promotion” – their advertising was deemed improper by the ASA ). It isn’t a recommended treatment for anything at all, but you certainly wouldn’t guess that from what is written by the ‘expert panel’. The winners are, according to the ‘expert panel’, Boots’ CoQ10 and Holland and Barrett’s CoQ10. Winners? Perhaps the explanation for that comes elsewhere, under “How are we funded?”. “Manufacturers who are awarded “best product” and “worth a look” are given the opportunity to promote this fact throughout the site for an additional fee.”. Well well.
Deputy Course leader, Val Harvey has her own web site and business (I do hope thar Westminster does not pay these people a full time salary too). What can we glean from there? It has the usual scare tactics “Why
you are at risk?“. Never fear; buy enough vitamin pills and you’ll be saved.
Her home page makes some pretty drastic claims.
“Potential health benefits of your nutritional programme
An appropriate Nutritional Programme can benefit many conditions including:
Allergies
Arthritis
Asthma
Bloating, indigestion
Chronic degenerative diseases
Chronic fatigue, ME
Constipation, diarrhoea
Cystitis
Depression, mood swings
Digestive or bowel problems
Eczema, psoriasis, other skin problems
Food sensitivities
Frequent infections
Hormone imbalanceHypertension or elevated cholesterol
Irritable bowel syndrome
Low energy
Menopausal symptoms
Migraines, headaches
Parasitic and fungal infections
Pre-conceptual issues
Premenstrual syndrome (PMS)
Sinus congestion
Stress
Thrush
Weight problems
and many others ….
These are just some of the wide range of health problems that may be helped by nutritional therapy. Even those who consider themselves well and healthy may be able to enhance their physical and mental health, as well as their performance, including athletic performance, by improving their nutrition.”
There is, in my view, not the slightest bit of good evidence that swallowing vitamin pills can benefit most of these conditions.
But at least the list doesn’t contain AIDS, so is all this really relevant to the case of Matthias Rath?
Yes, I believe it is. The University of Westminster may well not support the views of Matthias Rath (they won’t say), but we have heard no choruses of protests about him from any nutritional therapists, as far as I’m aware. There is no mention of him at all on the web site of the British Association of Nutritional Therapists (BANT), the UK club for these people. BANT, by the way, has a rather curious code of ethics. It allows its members to take undisclosed financial kickbacks for the pills they prescribe to patients. If doctors were caught doing that they’d be struck off the register.
It is the existence of degrees in subjects like “nutritional therapy” that gives the subject a spurious air of respectability which allows seriously dangerous people like Rath to flourish with very little criticism. In an indirect way, the vice-chancellors who allow it to flourish (and Universities UK who do nothing about it) must bear some small part of the responsibility for the deaths of thousands of people from AIDS.
It is about time they did something about it.
Follow-up
ANH. The first reaction from the supplement-peddling industry comes from the Alliance for Natural Health on 16th September. It contains not one word of condemnation for Rath’s murderous activities. It’s hard to believe how low they will sink.
The Prince’s Foundation for Integrated Health remains totally silent about Rath. HRH’s concern for health seems to dry up if things don’t suit his views.
The British Association of Nutritional Therapists shows it’s total irresponsibility after a letter was sent to them to ask about their reaction. Their answer , on jdc325’s weblog was “The association has no opinion to offer on Dr Raths vitamin trials.”.
There have been some really excellent books about quackery this year. This isn’t one of them, because
 |
Nice dedication uh? |
it is about a lot more than quackery It is about the scientific method in general. and in particular about how often it is misunderstood by journalists. Abuse of evidence by the pharmaceutical industry is treated just as harshly as abuse of evidence by homeopaths and you get the low-down on both.
“More importantly, you will also see how a health myth can be created, fostered and maintained by the alternative medicine industry using all the same tricks on you, the public, which big pharma uses on doctors. This is about something much bigger than homeopathy.” (p.28)
Sir Iain Chalmers, a founder of the Cochrane Collaboration , co-author of the best lay text on evidence says: “Bad Science introduces the basic scientific principles to help everyone become a more effective bullshit detector”. And there is no more invaluable skill than being a bullshit detector.
Chalmers says also “Ben Goldacre has succeeded where the ‘public engagement in science’ organisations have so signally failed.” That is exactly right. ‘Public engagement’ has rapidly become bureaucratised, and at its worst, is no better than a branch of the university’s marketing department. This sort of public engagement corrupts as much as it enlightens. Goldacre enlightens, and he also makes you laugh.
In the introduction, Goldacre says
“You cannot reason people out of positions that they didn’t reason themselves into.” (p xii)
It’s a nice point, but the rest of the book makes a magnificent attempt to do just that.
There is quite a lot about medicine, of course, that’s his job, after all. But it isn’t all quackery by a long chalk Quackery is merely a good hook to hang the arguments on about how you distinguish what’s true from what isn’t. That’s partly because quacks make every mistake known to mankind (sometimes through ignorance, sometimes just to boost sales), and partly just because it is a topic that interests people, and with which they are bombarded every day I feel exactly the same. If I were to talk about the statistics of single ion channels, nobody would read it (big mistake -it’s fascinating), but if one can use the case of honey versus cough medicine to explain the analysis of variance, there is a chance that someone might find it interesting.
As much as anything, Goldacre’s book is about C.P. Snow’s two cultures. The chapters on the distortion and trivialisation of science in the media are just terrific.
“My basic hypothesis is this: the people who run the media are humanities graduates with little understanding of science, who wear their ignorance as a badge of honour. Secretly, deep down, perhaps they resent the fact that they have denied themselves access to the most significant developments in the history of Western thought from the past two hundred years.” Chapter 11, p. 207
“.. . . here is the information I would like from a newspaper to help me make decisions about my health, when reporting on a risk: I want to know who you’re talking about (e.g. men in their fifties): I want to know what the baseline risk is (e.g. four men out of a hundred will have a heart attack over ten years); and I want to know what the increase in risk is , as a natural frequency [not as relative risk] (two extra men out of that hundred will have a heart attack over ten years). I also want to know exactly what’s causing that increase in risk -an occasional headache pill or a daily tub full of pain-relieving medication for arthritis. Then I will consider reading your newspapers again, instead of blogs which are written by people who understand research , and which link reliably back to the original academic paper, so that I can double check their précis when I wish. ” (p. 242)
I detect some ambiguity in references to things that aren’t true. Sometimes there is magnanimity. At other times he is a grade one kick-ass ninja. For example
I can very happily view posh cosmetics -and other forms of quackery -as a special, self-administered, voluntary tax on people who don’t understand science properly (p. 26)
Of course nobody wants to ban cosmetics, or even homeopathy. But a lot of bad consequences flow from being over-tolerant of lies if you take it too far (he doesn’t). The lying dilemma and the training dilemma are among them. Some unthinking doctors will refer troublesome patients to a reflexologist. That gets the worried-well out of their surgery but neglects the inevitable consequence that Human Resources box-ticking zombies will then insist on having courses that teach the big toe is connected to the kidney (or whatever) so that reflexologists can have an official qualification in mystical mumbo-jumbo.
Is there anything missing from the book? Well inevitably. There are plenty of villains among the peddlers of nutri-bollocks, and in the media. But there isn’t much about the people who seem to me to be in some ways even worse. What about the black-suited men and women in the Ministry of Health and in some vice-chancellors’ chairs who betray their institutions and betray the public through some unfathomable
mixture of political correctness, scientific ignorance and greed? What about the ludicrous behaviour of quangos like Skills for Health? You have to wait right to the end of the book to hear about universities. But when it comes, it is well worth the wait.
“I’m not surprised that there are people with odd ideas about medicine, or that they sell those ideas. But I am spectacularly, supremely, incandescently unimpressed when a a university starts to offer BSc science courses in them.” (p. 317)
It’s almost worth buying Ben Goldacre’s book for that sentence alone.
This book is a romp through the folly, greed and above all the ignorance of much in our society. It’s deeply educational. And it makes you laugh. What more could you want?