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Critical evaluation of the use of alternative therapies as clinical treatments

12 December 2014

Professor David Colquhoun has applied his extensive pharmacological, statistical, and analytical skills to assessments of the validity of public policies on the use of alternative therapies as clinical treatments. His evidence-based arguments have supported the closure of university courses in these subjects and helped ensure the accuracy of NHS information.

Professor David Colquhoun (UCL Neuroscience, Physiology & Pharmacology) has spent his academic life studying the mechanisms of how drugs act on receptors, a field to which he has brought a particular expertise in and commitment to the rigorous use of statistics for the proper analysis of all types of data. This expertise has been brought to bear on the results of wide-ranging activities, from clinical trials to epidemiological studies, but also in assessing the proposed pharmacological effects of alternative medicines such as reflexology and homeopathy.

The number of bachelor and masters degrees in subjects such as reflexology, aromatherapy, acupuncture and homoeopathy has halved since 2007, from more than 40 to 21. Many of the surviving courses are under review… The closures are partly the result of a campaign led by Dr David Colquhoun, professor of pharmacology at University College London. - The Daily Telegraph

The principles behind such therapies are not derived from scientific experimentation and analysis, and their teaching is neither scientifically informative nor clinically relevant, yet until recently a number of UK university courses existed in these subjects. Professor Colquhoun conducted extensive critical investigation of these courses, identifying important disadvantages to allowing universities to offer degrees in these subjects. As well as conferring unearned credibility upon them, those disadvantages included the potentially serious effects of promoting such therapies as medicine and of allowing ever-greater numbers of 'qualified' individuals to profit from the non-medical - and sometimes dangerous - treatments that they entail.

His detailed evaluation allowed Professor Colquhoun to make a strong, evidence-based case to the Information Commissioner and an Information Tribunal against the provision of BSc and masters courses in these topics. His efforts led to the widespread closure of such courses in universities across the UK, as the Telegraph reported in 2012.

Indeed, degrees in naturopathy, reflexology and aromatherapy have now vanished from British universities, with prospective students apparently returning to more 'traditional' degrees such as physics and chemistry. Professor Colquhoun's research has also had an important influence on the provision of NHS information about the effectiveness or otherwise of alternative therapies which, he argues, have no positive impact at all beyond a placebo effect, and may do clinical damage. Their use as a serious treatment option in place of evidence-based medicine can therefore damage patients' health whilst incurring unnecessary financial costs.

In light of this, the Department of Health was considered to have "failed the general public" (David Mattin, ex-NHS Choices editor) when, in 2012, it prevented accurate information about homeopathy from appearing on the NHS Choices website. A new page on that website, replacing a previous statement that "homeopathy is not part of mainstream medicine", lent unjustified credibility to homeopathy, and Professor Colquhoun campaigned heavily for the restoration of the more accurate information. His campaign was successful and the NHS Choices website was quickly changed to acknowledge that:

"A 2010 House of Commons Science and Technology Committee report on homeopathy said that homeopathic remedies perform no better than placebos, and that the principles on which homeopathy is based are 'scientifically implausible'. This is also the view of the Chief Medical Officer, Professor Dame Sally Davies."

A similar story is emerging around the National Institute for Health and Clinical Excellence (NICE) guidelines for low back pain, which currently recommend manual therapy (including chiropractic) and acupuncture - techniques now thought to be ineffective. The medical and scientific community's criticism of these guidelines has been documented and publicised by Professor Colquhoun via his popular blog, DC's Improbable Science, helping prompt reconsideration by NICE of the back pain guidance.

The blog also encourages and helps equip a wide public readership to critically assess evidence, an important skill in a media-dominated culture wherein scientific findings are inflated and oversimplified for the sake of a headline. By explaining concepts such as causality, randomisation and statistical significance, blog posts go beyond simply critiquing media reports to arm readers with the tools they need to evaluate evidence for themselves. Several hundred posts have generated more than 7,000 comments, with the most read post, "Acupuncture is a theatrical placebo: the end of a myth", receiving more than 36,000 page loads. More general posts on the misinterpretation of statistical tests of significance have proved almost as popular: they led to a full paper that explains, in part, the problems of irreproducibility in some sorts of science. The blog as a whole has received more than 3.9 million hits; it featured on the Times 100 best blogs list in 2009 and won the Good Thinking Society UK Science Blog Prize in 2012.

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