DC quackery RSS feed

This page is devoted to giving publicity to assorted dubious, erroneous, nutty, or downright fraudulent claims about drugs and other sorts of treatment. It includes, but is not restricted to, so-called Complementary and Alternative Medicine (acroynym, SCAM). In particular, it is about the incursion of such ideas into universities. Lines on Homeopathy. Stir the mixture well Lest it prove inferior, Then put half a drop Into Lake Superior. Every other day Take a drop in water, You'll be better soon Or at least you oughter. Bishop William Croswell Doane (1832–1913), first Episcopal bishop of Albany (NY)

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More laughter

Faith

"A valuable ally in achieving a 'cure' and a dangerous enemy in assessing it"

He quotes Sir Peter Medawar thus.

"Exaggerated claims for the efficacy of a medicament are very seldom the consequence of any intention to deceive; they are usually the outcome of a kindly conspiracy in which everybody has the very best intentions. The patient wants to get well, his physician wants to have made him better, and the pharmaceutical company would have liked to have put it into the physician's power to have made him so. The controlled clinical trial is an attempt to avoid being taken in by this conspiracy of good will." (From Advice to a Young Scientist, published in 1979.)

Clinical experience

“Making the same mistakes with increasing confidence over an impressive number of years.”

Knight starvation

“Affective disorder that afflicts senior doctors . . . A progressive condition that deteriorates with the publication of each Honours Lisr and, in longstanding cases, can produce serious erosion of judgement and integrity.”

Education.

“Elitist activity. Cost ineffective. Unpopular with Grey Suits. Now largely replaced by Training.”

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Who needs data?

In praise of the data-free discussion. Towards a new paradigm

Eight years ago, when I decided to go full-time into complementary/alternative medicine (CAM) research, I was a narrow-minded and short-sighted man! Narrow-minded because I had been under the impression that data are an essential element in any scientific debate and short-sighted because I failed to realise how efficiently one can expand one's mind if only one manages to overcome science's obsessional insistence with data, facts and evidence. Today, after attending about 300 conferences on CAM, I have learned an important lesson and realised the true value and enlightened bliss of data-free discussions, meetings and other debates.

Their advantages are multifold. First, they are far less tedious. Under the old paradigm, one had to prepare, research, read and study for every presentation. Some speakers had to spend days, even weeks or months preparing a single lecture. The new CAM paradigm has made this so much easier. No more time-wasting preparatory work; one can now walk straight into the middle of the action and be part of it. The time thus saved allows one to extend one's scope of topics almost ad infinitum and to attend even more meetings and data-free discussions for the benefit of everyone.

Second, data can be frightfully intimidating and non-egalitarian. In the past, those with knowledge had a distinct advantage over those without. Under the data-free paradigm, all can join in and all are equal The less you are aware of the facts, the more light-heartedly you can go to work. Data are ever so patronising; they weigh you down and limit your freedom. Data-free debates, in contrast, can be such liberating fun!

Third, data do get in the way of our real aims in life. Data-free meetings are much more practical if you really want to achieve something quickly. All you need to do is to invite speakers who vaguely agree with your own views, let them talk at length and finally reach a groundbreaking, barrier-crashing consensus. If you want to be absolutely sure to succeed, invite a few VIPs to nod their wise heads along the way. Who on earth would dare to disagree with a consensus? Data-free discussion can be immensely productive.

Fourth, under the old paradigm, one set of data often opposed another set. Unavoidably, controversy ensued, people became emotional and in the end someone got hurt. Not so with data-free events! Where there are no data, there can be no disagreement. Here is the energy that will truly heal the medicine for the New Millennium. Data-free discussions provide the true basis for ubiquitous peace, love and happiness.

I, for one, am convinced -the bad old times when scientific meetings focused on data and evidence must be over once and for all. This is particularly true for CAM. The last thing we want is the slaying of our beautiful hypotheses by some nasty, ugly facts.

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Laughter, part 2: John O'Farrell writes

"It is the more pernicious drugs that the police should be concentrating on. I don't mean heroin or cocaine or ecstasy, I mean the real social menace: echinacea and arnica and all the herbal remedies that are sold at great expense and don't do anything whatsoever.

All over Britain traumatised children are being forced to take fish oil while the callous pushers in the health food shop buy another gold-studded collar for their rottweilers and laugh at the gullibility of the liberal middle classes. "Wanna score some more St John's wort man? It'll cost you, brother, this is good shit, I ain't cutting in no low-grade marigold." Armed police burst in. "This is a raid! Hand over your royal jelly!"

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The curious case of NADH and chronic fatigue syndrome

A recent Georgetown University Medical Center clinical pilot study among CFS patients reports that participants taking ENADA® were four times more likely than those taking a placebo to experience a reduction in symptoms. Please click on the links below for more information.

What this does NOT mention is that the huge column on the left represents eight people out of 26, and the tiny one on the right represents two people (out of 26)!

• Improves cellular energy [This, as it stands, is meaningless]
  
• Elevates mental clarity [There is no evidence that this is true]
  
• Promotes mental alertness and concentration [Again, there is no evidence that this is true]
  

Other sites that promote NADH heavily are Enada.com, and the Menuco Corporation, of which more below

The clinical trial referred to in all of these advertisements is Forsyth, L. M., Preuss, H. G., MacDowell, A. L., Chiazze, L., Jr., Birkmayer, G. D., & Bellanti, J. A. (1999). Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome. Ann.Allergy Asthma Immunol. 82, 185-191.

It is very clear from the letter below that this trial is flawed, but it is impossible to see exactly how flawed it is because the authors, in breach of all guidelines on such matters, have refused, for over a year, to make available the raw data that would allow a correct analysis to be done.

This reply from Professor Bellanti stands in contrast to his own statement in a recent report presented to Annual Meeting of American College of Allergy, Asthma and Immunology in which he says "We have recently demonstrated the clinical effectiveness of reduced nicotinamide adenine dinucleotide (NADH) in a group of 26 patients with CFS in a double-blinded, placebo-controlled, crossover study". There is no mention here (or in any of the advertisements) of the study being "preliminary" or "not definitive". (The measurement of 5-HIAA urinary concentration as a possible predictive marker of disease activity and therapeutic efficay of NADH in the chronic fatigue syndrome. Joseph A Bellanti MD; Linda M Forsyth MD; Ana Luiza MacDowell-Carneiro MD; Dawn B. Wallerstedt, MSN, FNP; Harry G Preuss MD and Georg D Birkmayer MD. PhD ).
This reply gives no reason at all for refusing to disclose the raw data, to allow others to check the conclusions. It does say that "there are various methods and points of view concerning statistical analyses", but does not (unsurprisingly) refer to anyone who thinks that a test of difference between two independent estimates of a binomial proportion is an appropriate way to analyse a cross over trial.

Financial interests

Latest news The case of the Bellanti paper was referred to the Georgetown University's Research Integrity Committee for review, in February 2001. That committee has reported that "no violation within the purview of the Code has been committed". In the light of the facts concerning (a) improperly analysed data, (b) non-disclosure of financial interest and (c) the refusal to allow independent analysis of the data, it seems the the University has a novel view of what constitutes research integrity!

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The homoeopathic treatment of myositis

I was asked by the producer of a television programme (QED) to look at a paper that claimed a beneficial effect of homeoepathic treatmemt of fibrositis (Fisher, P., Greenwood, A., Huskisson, E. C., Turner, P., & Belon, P. (1989). Effect of homoeopathic treatment on fibrositis (primary fibromyalgia) British Medical Journal 299, 365-366.).

It appeared from the paper that the crossover trial had been analysed incorrectly (each patient had been counted twice). The homoeopath, Peter Fisher, was kind enough to give me the raw data for re-analysis. When this was done no significant effects were found. Astonishingly, the British Medical Journal declined to publish the correction, but their rival, the Lancet, did so with alacrity (Colquhoun, D. (1990). Reanalysis of a clinical trial of a homoeopathic treatment of fibrositis. Lancet 336, 441-442.). [Get pdf]

Incidentally, the result of this exercise, despite the fact that it had been commissioned by the television producer, was entirely misrepresented in the final TV programme. The producer was evidently less interested in discovering the truth, than in giving the public what he thought they wanted, i.e. wishful thinking. In this he must have been successful, because the first letter that I received after the programme was from a lady in Fulham, who asked me to recommend a source of homeopathic flu jabs for her cat.

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The latest from Peter Fisher

Peter Fisher (Fisher, P. & Scott, D. L. (2001). A randomized controlled trial of homeopathy in rheumatoid arthritis. Rheumatology.(Oxford) 40, 1052-1055.)
This paper is remarkable in several ways. Fisher is a dedicated homeopath who has just been appointed homeopathic physician to the Queen. It is remarkable because he finds that placebo was, if anything, better than homeopathic treatment for rheumatoid arthritis, and has published it. However, what is really amazing is his conclusion.
"Over these years we have come to believe that conventional RCTs [randomised controlled trials] are unlikely to capture the possible benefits of homeopathy . . . . It seems more important to define if homeopathists can genuinely control patients' symptoms and less relevant to have concerns about whether this is due to a 'genuine' effect or to influencing the placebo response"

This last bit appears to me to be an admission from the UK's leading homeopathist that homeopathy has been based on an intellectual fraud. It is as near as you can get to admitting it is all placebo effect. Agreement at last!

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Fisher again

Sad to say, this statement is simply untrue.. For a summary of metanalyses, click here. (Thanks to Dr Simon Baker for this reference: see British Veterinary Voodoo Society): and see below

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Teaching that makes no sense

Alternative Therapies

It is unique in my experience for a teaching document to start with the warning that what follows may well be a load of nonsense. This beautifully-produced program starts with the statement “Please note that many of the statements/claims made concerning the therapies in this program are those of the practitioners of the therapies. The claims may or may not have a factual basis, and are not necessarily the views of the authors”. What follows consists of two things. Firstly the flights of fancy, meaningless statements, and downright fraud which are already available by the truck load on the internet. Secondly, there is a quite serious attempt to describe the principles of clinical trials. But these two aspects are never brought together. There is no attempt whatsoever to assess the truth of any of the statements and claims that are made. To that extent, the program is not about science at all.

The main topics are acupuncture, aromatherapy, chiropractic, herbalism, homeopathy, osteopathy and hypnotherapy. After describing what is claimed for them, an example of a clinical trial follows. This bit is done quite well if viewed as tutorial on clinical trial design, but it contributes nothing to the subject of the program. In the cases of chiropractic and homeopathy (though not aromatherapy) the results of the trial are assessed as positive, but there is no attempt at all to say whether this trial is typical, or whether the treatment is really thought to be effective.

In one particularly bizarre part of the acupuncture section we are invited to click to discover about the “classical Chinese theory” and the “Western scientific theory” of how acupuncture works [sic]. The former is the usual mumbo jumbo about “meridians” (not defined) and “energy” (not defined). But what really takes the biscuit is what is offered as the Western scientific theory: “Western science has shown that cells are influenced by patterns of electrons flowing through them (sometimes called ‘bioelectrons’)”. Funny –I always understood that currents were carried by ions –this is as nonsensical as the classical explanation. There is also a category named “other” that gives briefer details on 24 other “therapies” from crystal healing and Gerson therapy (one of the more unpleasant frauds) to reflexology and urine therapy. Brief, and totally uncritical, information is provided on what their proponents claim.

The program contains many quizzes to assess your knowledge of homeopathy, acupuncture etc. In order to do well on these tests you have to assent to all sorts of untrue, or often simply meaningless, statements. For example I was marked “wrong” because I failed to tick the box that says measles is “wholly treatable by chiropractic”. Is this a sensible way to teach pharmacology?

I take pharmacology to be the science concerned with what drugs do and how they do it. And I take science to be concerned with distinguishing truth from fiction. By those criteria, this program is concerned with neither pharmacology nor science. It is a disgrace to both.

Quality of content *
Accuracy of content *
Ease of installation ****
Ease of use *****
Quality of interface/navigation ****
Clarity of leaning objective * Value to teacher *
(*****Maximum)

D. Colquhoun FRS, A . J. Clark Professor of Pharmacology, University College London

Reply by Prof. Ian Hughes, University of Leeds

A great deal of money is spent by members of the public on a considerable variety of alternative or complementary medicines. Our current medical students will discover that many of their patients are experiencing or have considered this type of treatment. With increasing use of the Internet such patients will often be well informed (or misinformed) about alternative treatments and in a patient centred NHS will expect their medical practitioner also to be aware that alternatives exist. "No, I've never heard of it, I don't know anything about it but I'm sure it's useless" is not an answer which helps the partnership with the patient nor does it generate further confidences. A large number of patients, particularly those with chronic diseases, believe their circumstances are improved by alternative or complementary therapies and surely that is what it is all about. Patients expect their doctors to live in the real world in which alternative therapies do exist, are widely used and are perceived by individuals to be of real benefit. With regard to effectiveness it is too easy to take the stance that any trial with a positive outcome for an alternative therapy must, by definition, be a poor trial and be flawed. There is no need for the mechanism to be understood for a treatment to be effective. Can we really say we understand how antidepressants work? Nor is the lack of current acceptance an indicator of correctness. How long were purinergic nerves or helicobacter pylorii crying in the wilderness?

The "Alternative Therapies" program attempts to inform medical students about the variety of alternative therapies and the claims made for such treatments. It also attempts to equip medical students with the ability to judge evidence and come to their own conclusions rather than to adopt the prejudices of their teachers. It is for this reason that the program teaches about clinical trials, particularly on how to judge the quality of a clinical trial and the reliance that can be placed upon it. The reviewer has clearly not reached the section of the program in which this analysis is applied to six trials of different alternative therapies to illustrate how medical students should approach such evidence and make judgments. I would rather see my medical students able to form their own judgments (about evidence-based orthodox and alternative therapies) rather than simply adopt the views of their teachers. The reviewer's comment on the clarity of the learning objectives ("Who Cares?") is answered by student's repeated requests for such information when it is unavailable. Some teachers may not care about learning objectives though it would be normal to take these into account when reviewing a computer assisted learning program. Students however do value clear learning objectives which are perceived as improving the student learning experience as has now been appreciated by at least some of the units which scored poorly in the last QAA review process. Patient's expectations of medicine are changing and we should be equipping our medical students so they can communicate better with their patients, have knowledge about the real world and can practice evidencebased medicine while considering each patient as an individual. I do not claim the program achieves all these aims but it does provide information about what is claimed for Alternative Therapies and helps medical students to make their own judgments.

D.C. Replies:

Hughes makes my point perfectly.  Purinergic receptors were (rightly) in the wilderness while the evidence for them was weak, and they (again rightly) came out of the wilderness as soon as the evidence became strong.

His suggestion seems to be that "my medical students" should be given only the tools for assessment of evidence, but that any attempt by the teacher to try to assess the current state of the evidence is mere imposition of the prejudices of the teacher.  It is almost 'here is the library and here is how you do a t test -sort it out for yourself'.  This is as ludicrous an approach to teaching as I ever heard, but it does explain why the Alternative Therapies program is as it is.

[Get PDF]

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Regulating complementary medicine

Sir, Congratulations on your report on the deficiencies found in complementary medicine practitioners (Body & Soul, January 10). In the face of such evidence it is natural to ask for more effective regulation of this very profitable industry. But the question is quis custodiet ipsos custodes? This question has serious implications for the universities as well as for the public (and the industry).

The House of Lords report and the Government’s response to it pointed out that the first step was to find out whether the complementary treatment worked (better than a placebo). They recommended that the Department of Health should fund research on complementary medicine, the first priority being to find out whether each therapy worked.

The problem is that you cannot regulate properly an area when it is not, in most cases, known whether the product being offered has no effect above that of wishful thinking. This raises a serious question for universities, because it leads, naturally enough, to demands for better training. But how can a university run a course on a subject about which there is so little hard evidence?

Tragically (for their own reputation), some of the new universities are running three-year BSc courses in such subjects as complementary therapies. I’m quite happy to believe that nice smells produce good placebo effects, but aromatherapy is not, by any stretch of the imagination, science, and in my view it is not honest to award Bachelor of Science degrees in it.

The effect of such courses will be not to promote better regulation, but to give spurious respectability to an industry that, according to the Government, should (but does not) have, as its first priority, to find out what works and what doesn’t.

Yours faithfully,
DAVID COLQUHOUN,
A. J. Clark Professor of Pharmacology,
University College London,
Gower Street, WC1E 6BT.
d.colquhoun@ucl.ac.uk
January 10.
The Times
[Get PDF]

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Prince Charles' article, "We have become allergic to our western way of life. Complementary healthcare has a vital role to play in the 21st century",

This article drew several sceptical responses which were published under the heading The Placebo Response on the following Monday. These included the following (given here in its unshortened form ).

Prince Charles' article today was well intentioned, but it contained a huge inconsistency, He says, more or less rightly, that "there are 30,000 chemicals in products that we use which have never been tested". But then he advocates that the taxpayer should pay for a thousands of alternative treatments that are also almost all untested. Either you believe in evidence or you don't, but you really can't have your cake and eat it. And I fear that his account of clinical trials (selective, to put it mildly), and his suggestion that "modern computational techniques" can tell us how the human body will react to foreign chemicals (good or bad), are both pure wishful thinking. Would that life were so simple.
David Colquhoun

A question for constitutional lawyers?

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Give your opinion: protect your university from teaching mumbo jumbo!

These proposals will, in my view, have exactly the opposite of the intended effect. The reasons were given briefly in my letter above, and at greater (and more amusing) length, by Alice Miles in her comment in The Times (or get pdf version). The proposed 'regulation' will give the appearence of state-endorsed respectability to people who are selling untested products, without doing anything at all about their unjustified claims of efficacy.

Another effect of the proposed regulation will be to protect the herbal industry from the much stricter European regulation which might require the industry to provide evidence that its products actually work (not, on the face of it, an unreasonable thing to ask). This is no accident. The proposals arise from the recommendations of the Herbal Medicine Regulatory Working Group (click here). This group consisted almost entirely of representatives of the industry, including Michael McIntyre of the European Herbal Practitioners Association. Their web site makes it quite clear that the aim of the recommendations is to protect the industry from European legislation, rather than to protect patients.

The admirable European rules are, of course, being opposed the health fraud industry, and also by the Conservative Party (see below).

From the point of view of universities, the ominous part of the recommendations is the requirement for "training". If you do not want your university to end up running courses in herbalism etc. (what next? Astrology?), then express your opinion to the Department of Health now, by clicking here.

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Dr Detox

Olivia Stewart-Liberty (The Mail on Sunday, 18 April 2004)

If you are a pregnant, vegan teenager who eats no fruit and lacks a pancreas, there might just be some point in taking this load of overpriced junk. For anyone on anything like a normal diet it will do nothing to help you. They will certainly not help you to lose weight (apart from your wallet, which will lose weight fast). There is not the slightest reason to think they'll make you either happier or healthier. They may well make you feel worse, though it might be hard to say what was doing the harm since there are over 60 separate substances. The first thing to notice is that terms like “metabolic detox”, “liver cleanse” and “kidney support”: they sound good but they are just bits of fine-sounding mumbo jumbo that are used to shift quack medicines.

Many of the ingredients are simple amino acids (e.g. glutamic acid, glutamine, glycine, lysine, methionine), which you get by the bucket load when you eat anything that contains protein. Many others are standard vitamins and minerals that almost everyone gets in plenty from their diet –taking more of them does you no good at all, and may do harm. The remaining ingredients are mostly herbs, the therapeutic and toxic effects of which are largely unknown. The only good thing that can be said about the prescription is that the doses are mostly not so big that they would be expected to be toxic. Some substances like chromium picolinate are known to be potentially dangerous, (the dose of chromium is quite small, but it is not stated what form the chromium is supplied in). Selenium, zinc, iron, vitamins A and B6 are all known to be toxic in excessive doses, and the doses of vitamin A (and also vitamin C) are well above the recommended amounts, and that of zinc is high.

The “Digest-aid” consists mainly of digestive enzyme (probably of animal or bacterial origin –it is not stated). Unless you have pancreatic exocrine insufficiency, cystic fibrosis or chronic pancreatitis, you just don't need them.

Perhaps the most shocking of the prescriptions is the “Metabolic Detox”, for several reasons. Firstly the name is mumbo jumbo, and the amounts of the ingredients are not stated. Not may people are likely to recognize that Jethhi-Madh is the Hindi name for common or garden liquorice, or that cassia angustifolia is the Latin name for Senna (pods or leaves?), a rather old-fashioned laxative that might well account for patient's discomfort if given in a sufficient dose (the dose is unstated). The other ingredients, vidang, himej, ajwain are spices used in ayurvedic medicine which have never been tested for effectiveness or toxicity, and 'unaqua soddi chloredum' is nothing known in medicine (it sounds suspiciously like incorrect Latin for water-free common salt). Vidang and ajwain are herbs that are alleged to cure worm parasites, but they have not been tested properly. The last ingredient, 'niscot', is a mystery.

It seems that you reporter has been ripped off in a serious way. Why, it may be asked, is nothing done to protect the gullible public form such charlatans? There are two answers –one is loopholes in the law that allow outrageous claims to be made with impunity. The other reason is lack of will on the part of the government to regulate alternative medicine in the same way that conventional medicine is regulated. In order to sell a conventional drug, you must, reasonably enough, produce evidence that it is safe and that it does what is claimed for it. This process may be fallible, but it is a lot better than the regulations that the government are now proposing to apply to herbal medicines which do not require any evidence at all that the product actually possesses the effects that are claimed for it. That is a bit like saying, yes you may sell transistor radios, but it does not matter whether they work or not.

D. Colquhoun
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Pharmaceutical Industry, Clinicians and Money

Junket time in Munich for the medical profession - and it's all on the drug firms

How 'opinion leaders' among doctors are won over by cash on offer from the giants of the pharmaceutical trade

Business as Usual

Between two cultures: the expert clinician and the pharmaceutical industry

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Veterinary Voodoo

I reproduce here, the application form for this learned society. But before applying, read their stated aims.

Aims of the Society

1. To achieve a specialist listing for Voodoo practitioners in the RCVS Register. The syllabus and examination are now available for members wishing to work towards the the the diploma of VetMFVoo and the Fellowship award of VetFFVoo, to the standard approved by the Holistic Health Academy. We are confident of achieving specialist listing for holders of these prestigious accolades.
2. To achieve recognition as a Specialist Division by the BVA. Sadly, there is at present no indication that the BVA, unlike the RCVS, is supportive of magical systems of medicine. However, should there ever be any suggestion that the Association is becoming open to the concept of embracing magical thinking within the Specialist Divisions, the BVVS will immediately apply for recognition.
3. To achieve equal academic representation for Voodoo Medicine in all UK veterinary schools in which other branches of Sympathetic Magic are taught within the undergraduate course.

Latest news. A "homeopathic vet", Mr John Hoare, has made a formal complaint to the RCVS. He alleges that making disparaging remarks against veterinary surgeons who practise homoeopathy may bring the profession into disrepute.  Perhaps Mr Hoare is a bit lacking in the sense of humour department?  Does he think the Vet Voodoo society is serious? 

Can this be the same John Hoare, of Lyme Regis, who was reported in the Daily Telegraph as believing that animals are affected by the phases of the moon? "I am not surprised that the moon affects animals - and people for that matter. After all, we are mostly made up of water and the moon affects the tides."  Wow!

Any reasonable person would, of course, think that it was Mr Hoare's magic that brought the veterinary profession into disrepute. But the complaint may yet do good if it forces the RCVS to stop vacillating about quackery.

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Elsevier's new 'scientific' journal

EXPLORE: The Journal of Science & Healing

"It is an interdisciplinary journal that explores the healing arts, consciousness, spirituality, eco-environmental issues, and basic science as all these fields relate to health."

Acupuncture/Acupressure • Ayurveda • Biofeedback • Botanical or Herbal Medicine • Chiropractic • Consciousness • Creative Therapies • Diet/Nutrition/Nutritional Supplements • Environmental Medicine • Holistic Medicine/Nursing • Homeopathy • Indigenous Medical Practices • Manual Therapies • Mind-Body Therapies • Naturopathy • Osteopathic Medicine • Qigong/Tai Chi • Touch Therapies • Spiritual/Transpersonal Healing/Prayer • Tibetan Medicine • Traditional Chinese Medicine • Yoga

But how much science?

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Florida State University turns to quackery?

An FSU professor. Albert Stiegman, has predicted the future campus map.

Governers vote against quackery

"The Florida Board of Governors voted 10-3 Thursday to deny Florida State University's request to build a chiropractic school."

"However, the passage of the bill for the chiropractic school by the Legislature seemingly bypassed the Board of Governors."

In the end, reason won.

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Francis Wheen's top 10 modern delusions

In the USA and Canada, this book is called Idiot Proof: Deluded Celebrities, Irrational Power Brokers, Media Morons, and the Erosion of Common Sense, and you can buy it here

The dimming of the Enlightenment A longer synposis by Wheen

Click here for a synopsis, Francis Wheen's Top 10 Delusions . I'll reproduce only two here.

George W Bush thinks so, as do Tony Blair and Osama bin Laden and an alarmingly high percentage of other important figures in today's world. After September 11 2001 Blair claimed that religion was the solution not the problem, since "Jews, Muslims and Christians are all children of Abraham" - unaware that the example of Abraham was also cited by Mohammed Atta, hijacker of the one of the planes that shattered the New York skyline. RH Tawney wrote in Religion and the Rise of Capitalism that "modern social theory, like modern political theory, developed only when society was given a naturalistic instead of a religious explanation". In which case modern social and political theory would now seem to be dead.

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UK government funds CAM research

Both the House of Lords report on Complementary and Alternative Medicine, and the Government's response to it, state clearly “. . . we recommend that three important questions should be addressed in the following order:”. (1) does the treatment offer therapeutic benefits greater than placebo? (2) the treatment safe? (3) how does it compare, in medical outcome and cost-effectiveness, with other forms of treatment? These recommendations seem admirable, but they have not been followed. The money has gone, almost (if not completely) to projects that address the second and third questions, before it has been established that the treatments have anything other than a placebo effect. This interesting case is debated in Debate: UK government funds CAM research (Focus on Alternative and Complementary Therapies , 8, 397-401 (DC's bit, pp 400-401)). [Get PDF of whole debate]

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Conservatives for quackery

The admirable European rules (see above) to limit the fraud that can be perpetrated by the "nutritional supplement" industry are now in danger. [BBC News]

The Food Supplements Directive, approved by EU governments in 2002, is designed to tighten controls on the growing market in products sold under the health food heading - natural remedies, vitamin supplements and mineral plant extracts. Under the new rules, only vitamins and minerals on an approved list can be used in supplements. There will also be restrictions on the upper limits of vitamin dose.

The case was brought by industry groups the British Health Food Manufacturers Association (HFMA), National Association of Health Stores (NAHS) and Alliance for Natural Health (ANH) ahead of the law change in August. UK companies were supported by the Conservative Party and actress Jenny Seagrove, star of the TV mini-series Woman of Substance.

Shadow (Conservative) Health Minister Chris Grayling added: "This is not the final ruling, but I am confident we are in a position where we're close to winning the battle to scrap this controversial measure, which would have banned hundreds of vitamins from our shelves."

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Tony Blair supports quackery and fraud

Many papers report that Tony Blair spoke to EU leaders this month, to oppose the very sensible and modest European Food Supplements directive ( for example The Independent, 20 June, 2005).  This directive is a small move to prevent the most fraudulent claims for 'food supplements' and to prevent sale of those that are actually dangerous. It would, for example, prevent the sale of Viridian Trace Mineral Complex, which contains Manganese, Selenium, Boron, Copper, Vanadium, Chromium and Molybdenum. And a good thing too.

Does Tony Blair really believe the new age nonsense of supplement salesmen? Given his notorious defence in the House of Commons, of the teaching of Young Earth Creationism, at the taxpayers' expense, one can believe that he does. Given, also, his apparent difficulties in distinguishing truth from fiction in the matter of the Iraq war, one can believe his capacity for self-delusion approaches even that of George Bush. On the other hand, Blair has made sensible noises about climate change (even if the action has, so far, been limited). Perhaps, in the matter of quackery, he is under the influence of his wife, Cherie Blair, whose dabblings in the mystical leave Nancy Reagan's astrologer in the shade. Much h as been written about this (Libby Purves, in The Times is pretty good, as is Nick Hume ). But my favourite is the following account, quoted from Francis Wheen's wonderful book, “How Mumbo-Jumbo Conquered the World: A Short History of Modern Delusions”

Even the no-nonsense Margaret Thatcher was a devotee of mystical "electric baths" and Ayurveda therapy. But she was a mere dabbler compared with more recent inhabitants of Downing Street. Cherie Blair found her devout Catholicism no impediment to flirtations with New Age spirituality - inviting a feng-shui expert to rearrange the furniture at No 10 and wearing a "magic pendant" known as the BioElectric Shield, which has "a matrix of specially cut quartz crystals" that surround the wearer with "a cocoon of energy" to ward off evil forces.

The catholicism - if not Catholicism - of her tastes was further demonstrated in 2002 by the revelation that she employed a former member of the Exegesis cult, Carole Caplin, as a "lifestyle guru". Through Caplin, the prime minister's wife was introduced to an 86-year-old "dowsing healer", Jack Temple, who treated her swollen ankles by swinging a crystal pendulum over the affected area and feeding her strawberry leaves grown within the "electro-magnetic field" of a neolithic circle he had built in his back garden.

It was long assumed that Tony Blair, who wears his Christianity on his sleeve, did not share his wife's unorthodox enthusiasms. But that was before he and Cherie had a "rebirthing experience" under the supervision of one Nancy Aguilar while holidaying on the Mexican Riviera in the summer of 2001. The Times's detailed account of the prime ministerial mudbath is worth quoting at some length:

"Ms Aguilar told the Blairs to bow and pray to the four winds as Mayan prayers were read out ... Within the Temazcal, a type of Ancient Mayan steam bath, herb-infused water was thrown over heated lava rocks, to create a cleansing sweat and balance the Blairs' 'energy flow'.

"Ms Aguilar chanted Mayan songs, told the Blairs to imagine that they could see animals in the steam and explained what such visions meant. They were told the Temazcal was like the womb and those participating in the ritual must confront their hopes and fears before 'rebirth' and venturing outside. The Blairs were offered watermelon and papaya, then told to smear what they did not eat over each other's bodies along with mud from the Mayan jungle outside.

"The prime minister, on holiday just a month before the 11 September attacks, is understood to have made a wish for world peace. Before leaving, the Blairs were told to scream out loud to signify the pain of rebirth. They then walked hand in hand down the beach to swim in the sea."

Although Mayan rebirthing rituals are not yet available in Britain through the National Health Service, some of Cherie Blair's other peculiar obsessions have already been adopted as official policy. In January 1999 the government recruited a feng-shui consultant, Renuka Wickmaratne, for advice on how to improve inner-city council estates. "Red and orange flowers would reduce crime," she concluded, "and introducing a water feature would reduce poverty. I was brought up with this ancient knowledge."

Two years later, the government announced that, for the first time since the creation of the NHS, remedies such as acupuncture and Indian ayurvedic medicine could be granted the same status as conventional treatments. According to the Sunday Times, "The inclusion of Indian ayurvedic medicine, a preventative approach to healing using diet, yoga and meditation, is thought to have been influenced by Cherie Blair's interest in alternative therapy." An all too believable suggestion, since Cherie was a client of the ayurvedic guru Bharti Vyas and officiated at the opening ceremony for her holistic therapy centre in London.

The swelling popularity of quack potions and treatments in recent years is yet another manifestation of the retreat from reason and scientific method. According to a 1998 survey by the Journal of the American Medical Association, the use of homeopathic preparations in the United States more than doubled between 1990 and 1997. In Britain, by the end of the 20th century the country's 36,000 general practitioners were outnumbered by the 50,000 purveyors of complementary and alternative medicine - some of whom receive the seal of royal approval.

The Queen carries homeopathic remedies with her at all times. Princess Diana was a devotee of reflexology, the belief that pressure applied to magical "zones" in the hands and feet can heal ailments elsewhere in the body. Prince Charles has been a prominent champion of "holistic" treatments since 1982.

Most alternative therapies, homeopathy included, are closer to mysticism than to medicine. This may explain their appeal to the British royal family, whose survival depends on another irrational faith - the magic of hereditary monarchy, so fiercely debunked by Tom Paine and other Enlightenment pamphleteers.

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Europe gets it right, but not very

The European Court has decided to tighten rules on the sale of vitamins and minerals. [BBC News]

The ruling is, thank heavens, a small step towards reducing the mega-fraud perpetrated on a gullible public by the 'supplements' industry. But only a very small step. Very little will end up being stopped. It is not legal to sell washing machines that don't work, yet even with this ruling it will remain legal to sell medicines (dishonestly labelled as 'supplements') without producing any evidence at all that they work.

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Académie de Médecine condemns homeopathy

Homoeopaths are ripping off state, say French physicians

"COULD 20 million French people be wrong, and the Prince of Wales, David Beckham and Bill Clinton? France’s most august medical authority yesterday dismissed homoeopathic remedies in a damning report."

"Alternative medicine is flourishing around the world, but the Académie de Médecine, an advisory body of distinguished physicians, has upset practitioners and the homoeopathic industry by saying that they subscribe to mumbo jumbo."

"In the latest episode of a 200-year-old quarrel over the treatment of illness with minute doses of natural medicines, the academy urged the state to stop subsidising homoeopathy through the national health service.". The report said

"Homoeopathy is a method dreamed up two centuries ago, based on prejudices that were devoid of any foundation. It has survived as a doctrine completely outside the remarkable scientific movement which has been transforming medicine for two centuries."

"Homoeopathic treatments should not be viewed as medicines because they were not subject to clinical testing and no proof of their effectiveness was required, it said, adding that it was an aberration for the state to pay 35 per cent of patients’ fees for consultations with homoeopaths."

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The Melchizedek Method

This notice appeared recently in the window of my local “health food shop”. I've seen plenty of lunatic stuff, but this has to take some sort of record. It is a random jumble of words, designed, as usual, to extract money from the gullible. For a bit more about Melchizedek click here (fraudulent nonsense) or here (history) .

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Two trials of acupuncture

The Daily Telegraph recently published two reports about acupuncture. One said it worked. The other said it didn't work.

Acupuncture has a genuine ability to relieve pain, scientists have found.

The other report was

Acupuncture is no better at reducing migraines than fake treatment, researchers say today.

A study involving more than 300 patients found the healing method did reduce headaches, but only by the same amount as placing needles at non-acupuncture points.

Unfortunately the Daily Telegraph's reporters did nothing to help the confused reader. No comment was made on the apparent contradiction. In this particular case, there is an obvious explanation.

The first (favourable) article was said to be published in Nature, though in fact it was published in Neuroimage (Pariente J., White P., Frackowiak , Richard S. J. & Lewith G. Neuroimage, 25. 1161 - 1167, 2005). Presumably the reporter had picked it up from a rather uncritical synopsis on the news site, nature.com. It was conducted on 14 patients with painful osteoarthritis. Contrary to the first line of the Telegraph's report ("Acupuncture has a genuine ability to relieve pain"), the work did not measure pain at all. In fact the summary of the paper says

“The three interventions, all of which were sub-optimal acupuncture treatment, did not modify the patient’s pain.”

What the paper actually did was to use positron emission tomography (PET) to measure 'activation' of certain parts of the brain when needles were inserted. Some parts were activated more by having acupuncture needles piercing ths body than by 'stage-dagger' needles which retracted and did not pierce the body. I have no criticism of these findings: my purpose here is to explore the apparent contradiction between this trial and another.

The second, unfavourable, report was of a much bigger study, 302 patients with migraine headaches. It was published by Linde et al. (Journal of the American Medical Association. 2005 293(17):2118-25). This study concluded

“Acupuncture was no more effective than sham acupuncture in reducing migraine headaches although both interventions were more effective than a waiting list control. ”

These two studies were on quite different conditions, used different methods, and very different numbers of patients. But suppose we take them at face value, are they not contradictory? No, not necessarily, because they used quite different sorts of control group.

The study that was reported as showing that acupuncture worked compared patients that had real acupuncture with patients who had treatment with "stage dagger" needles that appeared to pierce the skin but did not.

The study that was reported as showing that acupuncture did not work (Linde et al.) used a different sort of control group, acupuncture needles that pierced the skin but were inserted in the wrong places (as defined by the 'principles' of acupuncturists). No difference was found between 'real acupuncture' and control.

There is nothing incompatible about these two studies if one adopts the view that piercing the skin with a needle can produce a physiological response that makes the patient feel that other sorts of pain are less painful, but that it does not matter where the skin is pierced. The latter hypothesis means, of course, that all talk about "meridians"` and "energy flow" that acupuncturists use, is no more than mumbo jumbo.

Dr Lewith is quoted as saying, of the negative study, "This is a badly conceived study that just adds more confusion to the debate because it uses non-site specific acupuncture as a control." Quite on the contrary, the Linde study seems more interesting to me, because it unveils the mumbo jumbo of meridians (at least for the particular points used in this study). Dr Lewith may find this conclusion unpalatable, but it is the obvious implication of this pair of studies.

Another study confirms that the principles of acupuncture are nonsense

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Prayer does not work

An unusually big clinical trial (748 patients) of the efficay of prayer was published in The Lancet (July 2005). The same study tested also “music, imagery and touch” (MIT) therapy.

748 patients undergoing percutaneous coronary intervention or elective catheterisation in nine USA centres were assigned in a 2×2 factorial randomisation either off-site prayer by established congregations of various religions or no off-site prayer (double-blinded) and MIT therapy or none (unmasked). The primary endpoint was combined in-hospital major adverse cardiovascular events and 6-month readmission or death.

371 patients were assigned prayer and 377 no prayer; 374 were assigned MIT therapy and 374 no MIT therapy. The factorial distribution was: standard care only, 192; prayer only, 182; MIT therapy only, 185; and both prayer and MIT therapy, 189. No significant difference was found for the primary composite endpoint in any treatment comparison.

Neither masked prayer nor MIT therapy significantly improved clinical outcome after elective catheterisation or percutaneous coronary intervention.

Well, there's a surprise.

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Pharmaceutical companies behaving badly

Try these.

The Truth About the Drug Companies. Marcia Angell M.D., Random House, 2004 (ISBN 0-375-50845-3)

Smith R (2005) Medical journals are an extension of the marketing arm of pharmaceutical companies. PLoS Med 2(5): e138.

Horton R (2004) The dawn of McScience. NewYork Review of Books 51(4): 7—9.

It is common enough to hear criticism of the big drug companies by people in alternative medicine. That is not surprising -they are both chasing the same pool of money (yours). The interesting thing about these three sources is that they are not written by CAM people, nor by conspiracy theorists, nor my revolutionary marxists. They are written by people who, until recently, were editors of very well known medical journals. Marcia Angell was formerly Editor in chief of the New England Journal of Medicine. Richard Smith was until 2004, editor of the British Medical Journal, and Richard Horton was editor of The Lancet. They know what they are talking about, and if they are worried, we should be too. Smith starts thus.

  “'Journals have devolved into information laundering operations for the pharmaceutical industry', wrote Richard Horton, editor of the Lancet, in March 2004 [1]. In the same year, Marcia Angell, former editor of the New England Journal of Medicine, lambasted the industry for becoming 'primarily a marketing machine' and co-opting 'every institution that might stand in its way' ”

Doctors may not be as uninfluenced by the advertisements as they would like to believe, but in every sphere, the public is used to discounting the claims of advertisers. The much bigger problem lies with the original studies, particularly the clinical trials, published by journals. Far from discounting these, readers see randomised controlled trials as one of
the highest forms of evidence.

For a drug company, a favourable trial is worth thousands of pages of advertising, which is why a company will sometimes spend upwards of a million dollars on reprints of the trial for worldwide distribution.

The evidence is strong that companies are getting the results they want, and this is especially worrisome because between two-thirds and threequarters of the trials published in the major journals—Annals of Internal Medicine, JAMA, Lancet, and New England Journal of Medicine—are funded by the industry

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The end of homeopathy

That is the title of the Editorial in The Lancet (336, 690, 2005(, in the issue in which a new evaluation is published. The editorial says

“That homoeopathy fares poorly when compared with allopathy in Aijing Shang and colleagues' systematic evaluation is unsurprising. Of greater interest is the fact that this debate continues, despite 150 years of unfavourable findings. The more dilute the evidence for homoeopathy becomes, the greater seems its popularity.
For too long, a politically correct laissez-faire attitude has existed towards homoeopathy, . . . ”

“Going one step further, the Swiss Government, after a 5-year trial, has now withdrawn insurance coverage for homoeopathy and four other complementary treatments because they did not meet efficacy and cost-effectiveness criteria.”

“Surely the time has passed for selective analyses, biased reports, or further investment in research to perpetuate the homoeopathy versus allopathy debate. Now doctors need to be bold and honest with their patients about homoeopathy's lack of benefit, and with themselves about the failings of modern medicine to address patients' needs for personalised care.”

Full text from sciencedirect.com (if you have access: if not email me). Or download the pdf file here.

The paper itself draws the following conclusion.

Interpretation Biases are present in placebo-controlled trials of both homoeopathy and conventional medicine. When
account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic
remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the
notion that the clinical effects of homoeopathy are placebo effects.

Other reports on 16 August 2005.

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Sutherland on Trudeau

John Sutherland, until recently, was Lord Northcliffe Professor of Modern English Literature, here at UCL, and a visiting professor at the California Institute of Technology. Judging by his column in The Guardian, 29th August 2005, he is also a pretty good pharmacologist. How's this for delusional behaviour?

“America loves "how to" books. Typically they are about how to be a better American: richer, thinner, happier, sexier, and more beautiful. For the past few weeks the how-to charts have been headed by a book which has provoked more controversy than anything since The Anarchist's Cookbook instructed America's disaffected youth how to make Molotov cocktails.

Kevin Trudeau's book, Natural Cures "They" Don't Want You To Know About, offers, for a mere $25 (£14), "natural cures for more than 50 specific diseases" - including cancer, heart disease, bad breath, gout, male erectile dysfunction, obesity, dandruff, multiple sclerosis and gloom.

Buy this book, Trudeau promises, and "never get sick again". That's not quite accurate. Buy this book together with products that have included coral calcium on Trudeau's website, www.naturalcures.com, and subscribe to his email newsletter (lifetime subscription $499) and then enjoy eternal health. Just because it's natural, doesn't mean it's free.

Mr Trudeau has no medical, pharmaceutical or therapeutic qualifications. He did, however, spend two terms in Federal prison for credit-card fraud. In his book, he admits that "I have made major mistakes in my life. I have paid my price and I have turned my life around."”

. . . .

“It would be easy to dismiss Trudeau's ability to separate the great American public from their hard-earned dollars as confirmation that there's one born every minute and somebody else eager to profit by it. But the runaway success of Natural Cures also bears witness to genuinely troubling aspects of the American healthcare system. It has been estimated that some 50 million citizens have no health insurance. For these desperate people, who fall sick like everybody else, "natural cures" are all they can afford.”

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Cherie Blair and new age nonsense. The Independent seems to be a bit confused.

The Independent for 30th August 2005 carried yet another story about Cherie Blair's weird beliefs (the new age ones, not the religious ones): Witchcraft and nail clippings: the weird world of Cherie Blair?.

“Even by the standards of the alternative therapies said to be used by Cherie Blair, submitting her husband's toenail clippings to a health guru's pendulum is taking her alleged New Age obsession to a higher level.”

All good stuff, such as you might expect from an intelligent newspaper. All good, that is, until in another part of the same paper you come to Chakra power . This article, by Jane Feinmann, is as fine a piece of new age nonsense as anything Mrs Blair could manage. The subtitle of this appallingly misleading bit of journalism is "Western science has finally proved the value of Eastern medicine."  I have news for Ms Feinmann.  Western science, and indeed any sensible educated person, has no time for nonsense like this.

“My therapist at the Kailash Centre of Oriental Medicine (clients include Tara Palmer-Tomkinson, Meg Mathews and Geri Halliwell) is Momo Kovacevic, a bio-energy practitioner from Sarajevo, who claims to have an inherited gift. His mother was a psychic and his sister and brother have some of his power. He says he is able to feel people's pain and anguish and knows exactly where and how to draw out negative energy and replace it with positive.”

Prince Charles and the Smallwood report

Prince Charles, never shy of using his wealth to promote his views, commissioned a report on The Role of Complementary and Alternative Medicine in the NHS. The report was published on 9 August 2005. [Get the report here]

The report says the evidence that CAM works is slim, and simply passed the buck.

“Our principal recommendation therefore is that the Health Ministers should invite the National Institute for Health and Clinical Excellence (NICE) to carry out a full assessment of the cost effectiveness of the therapies which we have identified and their potential role within the NHS in particular with a view to the closing of  'effectiveness gaps'.”

The report, therefore, does NOT recommend that more CAM be made available on the NHS, contrary to widespread misreporting of its conclusions. Even the normally very reliable BBC News got this wrong. That judgement was passed on to NICE.

Play DC's (short) interview on BBC News24 (5.30 pm, 6 Oct, 2005) [Play the .wmv file]

The report was written by an economist, Christopher Smallwood. The style is curiously schizoid: clearly the author would love to say that CAM would make a wonderful contribution to the NHS, yet he is smart enough to realise that the evidence is very poor. Neither does the report address at all, the central dilemma of CAM. So does it tell us anything other than the well-known views of its sponsor?

The answer to that is, very little. It goes over the old ground about evidence, and the lack thereof, in a reasonably competent way, with the help of 'expert advice'. The problem with expert advice, especially in a field like this, is knowing which 'experts' to choose. The list of Interview summaries does not contain a single pharmacologist (clinical or otherwise), nor does it contain any statistician. Eight of the 10 names are deeply committed to CAM and/or make their living from it. The only exceptions are Professor Peter Littlejohns (National Institute for Clinical Excellence (NICE), and Dr John Appleby (Chief economist of the Kings Fund). Otherwise there is not a single respectable scientist among the 'experts'. Take a couple of examples. Evidence was given by Professor David Peters (University of Westminster) and Professor Nicola Robinson (Thames Valley University). These two institutions, are, sadly for the reputation of the new universities, among those that have been most prominent in allowing goobledygook nonsense to masquerade as science. A few details will be found in the next section.

It is, I suppose, a trubute to Smallwood that despite the views of his sponsor, and despite the very unbalanced group of people from whom he took evidence, he nevertheless concludes (albeit somewhat reluctantly) that not enough is known about benefits to do a cost-benefit analysis. The buck is simply passed to NICE, who will, presumably, come to a similar conclusion.

“Universities” that offer BSc degrees in subjects that are not science: fraudulent or mickey-mouse?

Universities are meant to be places where truth can be separated from fiction, free from commercial and superstitious influences. They have not always done this very well, but it is a fine aspiration.

That makes it particularly sad that a handful of the new universities are now offering Bachelor of Science degrees in subjects that are not science at all. This is one aspect of the central dilemma of CAM. At a time when the ex-polytechnics are struggling to establish a reputation as serious academic institutions, they are heading firmly in the opposite direction.

The new universities have been much-mocked for offering degrees in subjects like Golf Course Management (e.g. Bournemouth, Lincoln). While it is true that there is little relationship between the intellectual content of such courses and that of a B.Sc. in Physics, Golf Course Management is not dishonest. I dare say it is useful for some people. As far as I know, there is not yet a B.Sc. in plumbing, but it would be just as intellectual, and a lot more useful than golf.

What is truly disgraceful is not so much that degrees are being offered in subjects with little intellectual content, but that degrees are being offered in subjects that have negative intellectual content. Degrees in subjects where the words have no discernable meaning at all, but are pure mumbo jumbo.

It is true that the sceptic might say that degrees in theology from our oldest universities have a long tradition of doing precisely that. Personally, I have much sympathy with that view, and that's one reason why I prefer to work at UCL, which does not do it. But no university has ever offered a bachelor of science degree in theology. Nobody pretends that religion is a subject that is amenable to the methods of science. Consider a couple of examples.

Take a typical exposition of the 'principles' of acupuncture.

• "There are 14 major avenues of energy flowing through the body. These are known as meridians".
• The energy that moves through the meridians is called Qi.
• Think of Qi as "The Force". It is the energy that makes a clear distinction between life and death.
• Acupuncture needles are gently placed through the skin along various key points along the meridians. This helps rebalance the Qi so the body systems work harmoniously.

I suppose, to the uneducated, this language sounds a bit like that of physics. But it is not. The words have no discernable meaning whatsoever. No respectable university could subject students to this sort of mumbo-jumbo, pretending that it is science.

Here is another, equally nonsensical, example.

Reflexologist believe that sensitive and trained hands can detect tiny deposits and imbalances in the feet. And by working on these points the reflexologist can release blockages and restore the free flow of energy to the whole body. it is believed that nerve endings are unable to transmit their impulses because of crystalline deposits that build up and block their pathway. Reflexology is believed to clear these crystalline deposits.

Incredibly, it is possible to find places that offer B.Sc. degrees in subjects like homeopathy that bear no relationship to science whatsoever. Hapless students are taught this nonsense

“The School has developed the widest range of complementary therapy courses in Europe. The BSc (Hons) Health Sciences degrees in herbal medicine, homoeopathy, nutritional therapy and therapeutic bodywork and the Traditional Chinese Medicine: Acupuncture course were the first named degrees of their kind in the UK. They have recently been supplemented by a new pathway in naturopathy.”

Amusingly enough, their courses are promoted in much the same way as quack medicines, by means of personal testimonials. In similar vein the University of Lincoln says

“Complementary Medicine BSc (Hons) - Lincoln
This exciting and innovative degree programme will give you an appreciation of the orthodox western model of health and illness as a foundation to your complementary medicine studies in either western herbal medicine or traditional Chinese acupuncture.”

Another institution at the forefront of promoting gobbledygook in the name of acience, is Thames Valley University, whose brochure offers aromatherapy, reflexology and shiatsu massage as though they were science (B.Sc (Hons)). If a B.Sc. is too much for you, Thames Valley University also offer a short course in homeopathy, which is described thus.

“Would you like to know how to treat your relatives and friends for colds and flu, injuries, travel illnesses, pre-exam stress and acute emotional difficulties? These are just some of the conditions that can be treated with Homeopathy medicine and which will be covered in the course.”

(The suggestion that homeopathy can cure colds and flu is false, and in the light of the possible imminence of a severe flu epidemic, the suggestion that flu can be treated is, arguably, verging on being wicked.)

The University of Salford also offers Complementary Medicine and Health Sciences, BSc (Hons) , among other sorts of mumbo jumbo.

“If you complete all of the homeopathy modules in the degree you will be able to apply for entry into year two of the four-year part-time homeopathy professional training programme at the North West College of Homeopathy in Manchester. You will also receive a certificate in Homeopathic First Aid.”

What will be offered next? B.Sc. degrees in Black Magic and the Casting of Spells? Astrology? Why not? They would be little different from things on offer already. There would be no objection to teaching homeopathy etc as part of the history of ideas, or as a sociological phenomenon. What is deeply objectionable, if not downright fraudulent, is to label them as science.

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University of Maryland Medical Center promoting quackery

This one is a serious indication of how far universities have acquiesced in delusional thinking. The University of Maryland Medical Center has (or perhaps had) a good reputation in medicine. It isn't a second rate ex-polytechnic. Yet now their website has a whole section devoted to "Alternative / Complementary Medicine". The wording of the articles there is slightly more circumspect than the average high street "healthfood" store, but the effect is just the same, In fact it is worse, because the bad advice comes from what seems like an authoritative source. Try looking under prostate cancer: there you will find the following.

Red Clover (Trifolium pratense)
In one report, a 66 year old man who took red clover every day for a week prior to having a prostatectomy for prostate cancer showed reduced signs of cancer in the diseased prostate tissue.

This might (or might not) be a suggestive lead for some good experiments. But to post it on a site that purports to give medical advice is, in my view, totally irresponsible.

Dr Stephen Barrett, of Quackwatch (recommended) searched the Maryland site with Google and found articles that promote homeopathy for about 300 health problem. Try it for yourself. Barrett comments "Most of the bad articles also include unsubstantiated recommendations for dietary supplements and herbs".

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Homeopathy on the NHS in Bristol: Dr Spence's paper

On 21 November, Dr David Spence appeared on the BBC's Today Programme. He was being interviewed about a report that, he said, provided evidence for the effectiveness of homeopathy. In fact it does nothing of the sort.

Dr Spence's paper was published in the Journal of Alternative and Complementary Medicine. It is not really research at all. They simply asked 6544 patients who had had homeopathic treatment whether they felt better or not. Half the patients (50.7%) said they were 'better' ot 'much better'. A further 20% said they were 'slightly better'. The patients who had homeopathic treatment were not compared with anything whatsoever!

This is reported in a straighforward way. What is quite ludicrous is the stated conclusion of the paper:

"The study results show that homeopathic treatment is a valuable intervention".

Papers like this do not add to human knowledge, they detract from it. By reverting to pre-enlightment forms of argument, they mislead rather than enlighten. To make matters worse, this work was done at public expense, by the Directorate of Homeopathic Medicine, United Bristol Healthcare, National Health Service Trust, Bristol, United Kingdom.

What on earth is a respectable hospital and medical school, like those in Bristol, wasting money with this sort of mediaeval hindrance to medical knowledge? We are truly living in an age of delusions.

Download the paper and see for yourself [ Spence DS, Thompson EA, Barron SJ. J Altern Complement Med. 2005, 11, 793-8. pdf file, 74 kb].

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Now the University of Pennsylvania medical school succumbs to mumbo jumbo.

Thanks to Michael White (Professor and Chair, Department of Pharmacology & Physiology, Drexel University College of Medicine, Philadelphia), who has written to me saying, inter alia,

"similar nonsense goes on in our institutions of higher learning (and not only in California!)". "The University of Pennsylvania ("America's first School of Medicine") has entered into an agreement with the Tai Sophia Institute of Applied Healing Arts to collaborate ".

So another real medical school has decided to forget science and throw in its lot with the delusional age. The University of Pennsylvania press release reads thus.

The University of Pennsylvania School of Medicine and the Tai Sophia Institute for the Applied Healing Arts of Laurel, Maryland, have signed an affiliation agreement to collaborate on education, research and clinical activities in complementary and alternative medicine.

Three initiatives relating to medical education, clinical activities, and the monitoring of the quality of herbal medicines and herbal products are initial targets for the program. The initiatives will include the creation of a Master's Degree in Complementary and Alternative Medicine, to be offered by the Tai Sophia Institute and developed in collaboration with Penn School of Medicine faculty. “This degree program is one of the first of its kind in the nation,” states Alfred P. Fishman, MD, Senior Associate Dean for Program Development at Penn's School of Medicine and co-director of the collaboration.

So, no mention there of finding out whether the mumbo jumbo produces benefits. What exactly is the Tai Sophia Institute? It isn't easy to tell when institutions use words that have no discernable meaning, but try their 'instititional values'.

“All members of Tai Sophia Institute's community – faculty, staff, administration, and students will

• Operate from a Declaration of Oneness, a unity with all creation.
• Use nature and the rhythms of the earth as a guide in teaching our students and each other.”

So the usual new age gobbledygook. The values go on "Continue our learning in the presence of each other, acting not as truth-tellers but as guides for self-discovery.". Aha, "not as truth tellers". You can say that again.

You could also try the Tai Sophia bookstore. Here you can buy such gems as "Hidden Messages in Water". Here's the description.

“Here is an eye-opening theory demonstrating how water is deeply connected to people's individual and collective consciousness in its ability to absorb, hold, and even retransmit human feelings and emotions. Using high-speed photography, he found that crystals formed in frozen water reveal changes when specific, concentrated thoughts are directed toward it. Emoto believes that since people are 70 percent water, and the Earth is 70 percent water, we can heal our planet and ourselves by consciously expressing love and goodwill.”

What on earth was the University of Pennsylvania thinking about when it associated itself with such pathetic twaddle? Is it that their senior people are so in the grip of the delusional age that they no longer care what's true and what isn't? Or did they just spot a good chance to make money from the gullible public?

It is particularly sad to see such respected places as U Penn fall to this level.  Somehow one is a little less surprised to see Creighton University is at it too.  Where? I hear you say.  "Creighton is a Jesuit university, rooted in the Catholic tradition", in Omaha Nebraska.  Perhaps that goes some way to explaining why they seem to have no difficulty in believing the impossible.

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The noni juice scam

The supply of fraudulent claims for "health foods" is endless, and normally I don't bother with them here. My concern is largely to protect Universities from becoming caught up in them (as shown on this page, many universities have already gone down that dishonest path). I became caught up in the Noni-juice business because I found that it was being marketed from the village where I live, on the basis of quite extraordinarily dishonest claims (includung alleged benefits in cancer).

I was instrumental in getting the Hertfordshire Trading Standards Department to shut down a local noni juice marketing organisation. I have a dossier on the dishonest literature which they were distributing then. The promotional web site used then (http://www.essential-energies.com/) was closed down, though I notice that the site is now back to life, operating from the same address, but this time it is marketing miracle shampoo!)

It recently came to my attention though, that noni-juice is still being marketed door-to-door in my area (possibly from the same address?) though it has vanished from the web. I know this because they tried to recruit my son as a salesman. He was given a booklet ('Doctor to Doctor. Clear answers to your patients' questions abouit noni', 2004) which purports to give medical advice about its use. This booklet is written by the impressive sounding "Dr Neil Solomon MD, PhD". A little further investigation shows that Neil Solomon gave up his US Medical Licence in 1993, after admitting to sexual malpractices with his patients. He is quoted on the site noni.worldwidewarning.net, and there you can find much interesting information on the dishonest promotion tactics used by the noni juice promoters.

"I admit that for at least the past 20 years, I have used my position as a physician to instigate a wide range of sexual relations with at least eight woman patients. This conduct included acts of sexual intercourse, as well as other explicit sex acts. These activities took place in my medical office during patient visits, as well as in other locations. I admit that I engaged in sexual misconduct with my patients during the physician/patient relationship. I admit that I engaged in this conduct with multiple patients over the same time period." -- Neil Solomon, October 27, 1993 (see it here)

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Bad advice on the internet

“Online referral directories listing e-mail addresses of UK homeopaths, chiropractors and general practitioners and private websites were visited. All addresses thus located received a letter of a (fictitious) patient asking for advice about the MMR vaccination. After sending a follow-up letter explaining the nature and aim of this project and offering the option of withdrawal, 26% of all respondents withdrew their answers. Homeopaths yielded a final response rate (53%, n = 77) compared to chiropractors (32%, n = 16). GPs unanimously refused to give advice over the Internet. No homeopath and only one chiropractor advised in favour of the MMR vaccination. Two homeopaths and three chiropractors indirectly advised in favour of MMR.”

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Homeopathy: a relict ot the past

This is a contribution to a debate in Edzard Ernst's journal, Homoeopathy: relic of the past or medicine of the future? (Marking Samuel Hahnemann’s 250th anniversary). It proposes that homeopathy is but one example of a wider fashion for delusional behaviour. Here are a couple of quotations.

“Arguably, these are all signs of a culture in which truth matters little (but money matters a lot). Ronald Reagan had his astrologer and allegedly the Blairs took their son to a pendulum waver rather than having him immunised (not to mention some really creative delusions when it comes to interpretation of intelligence reports). We have a royal family that are devoted to homoeopathy and talking to trees. With leaders like these perhaps it is not surprising that delusional behaviour has flourished for a quarter of a century.”

“With luck, the present fashion for not using your brain, in both East and West, will soon come to be seen as a brief hiccough in the course of human progress. Then homoeopathy and its kindred delusions will pass into history.”

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Ernst comes out against homeopathy

The UK's only professor of alternative medicine, Edzard Ernst of Exeter, has come out very clearly against homeopathy in Trends in Pharmacological Sciences (2005 Get the PDF).

“Homeopathy is a popular but implausible form of medicine. Contrary to many claims by homeopaths, there is no conclusive evidence that highly dilute homeopathic remedies are different from placebos. The benefits that many patients experience after homeopathic treatment are therefore most probably due to nonspecific treatment effects. Contrary to widespread belief, homeopathy is not entirely devoid of risk. Thus, the proven benefits of highly dilute homeopathic remedies, beyond the beneficial effects of placebos, do not outweigh the potential for harm that this approach can cause.”

See also "Professor savages homeopathy" Observer (18 Dec, 2005).

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Big Pharma and unethical trials

In December 2005, the financial journal, Bloomberg Markets (hardly a revolutionary organisation) has published a lengthy investigative report which contends that "the clinical trial drug industry is poorly regulated, riddled with conflicts of interest, and sometimes deadly."

Download the full report (pdf file, 758 kb)

The problem arises for the privatisation of drug testing. (See also, Marcia Angell's book, above.) The big companies distance themselves from the methods used to do the testing, but they pay the testing companies, who are therefore far from being unbiased. Here are a few quotations from the report.

These medical success stories mask a clinical drug trial industry that is poorly regulated, riddled with conflicts of interest— and sometimes deadly. Every year, trial participants are injured or killed.

Pharmaceutical companies sponsored 36,839 new clinical trials from 2001 to ’04, six times more than in the period from 1981 to ’85.

In 1991, 80 percent of industry-sponsored drug trials were conducted by medical faculty at universities, with protection for participants provided by the school’s own oversight boards, according to the New England Journal of Medicine. Now, more than 75 percent of all clinical trials paid for by pharmaceutical companies are done in private test centers or doctors’ offices, according to CenterWatch.

The U.S. Food and Drug Administration, the principal federal agency charged with policing the safety of human drug testing, has farmed out much of that responsibility to a network of private companies and groups called institutional review boards, or IRBs. The IRBs that oversee drug company trials operate in such secrecy that the names of their members often aren't disclosed to the public. These IRBs are paid by Big Pharma –just like the testing centers they're supposed to be regulating.

The oldest and largest review company is Western IRB, founded in 1977 by Angela Bowen, an endocrinologist. WIRB, an Olympia, Washington-based for-profit company, is responsible for protecting people in 17,000 clinical trials in the U.S. The company oversaw tests in California and Georgia in the 1990s for which doctors were criminally charged and jailed for lying to the FDA and endangering the lives of trial participants. No action was taken against WIRB.

“The FDA's backbone has been Jell-O, ” says Michael Hensley, a former FDA investigator. “The FDA stopped enforcing the rules years ago.”

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The Open University now teaches quackery

The Open University is a great institution. Its first vice-chancellor was Walter Laing Macdonald Perry. Before he took that job, he was professor of Pharmacology in Edinburgh (and one of my Ph.D. supervisors). He must be turning in his grave at the new OU course, K221 - Perspectives on Complementary and Alternative Medicine.

The course description sounds harmless enough, " This course provides an accessible but rigorous introduction to complementary and alternative approaches to health.".  But just how rigorous is it?  The game is given away when you see that the "experts" seem mostly to be true believers, people who make their living from alternative medicine. How can such people be expected to the merits of the systems of beliefs that are the basis of their livelihood?   It is rather like having a rigorous discussion about the existence of god in which all the course tutors are priests. Take some examples.

The bit about Testing Therapies is by Elaine Weatherley-Jones, She is in clinical practice as a homeopath. And as you might expect the three pages on the web about 'testing therapies' are highly partisan and selective.  Try these quotations.

“In homeopathy, the vital force is said to be responsible for maintaining health, combating disease by recruiting the body's natural tendency to cure itself. In the homeopathy model, disease occurs when the vital force is not working efficiently to keep the balance of health.”

“. . . in The Manual of Conventional Medicine for Alternative Practitioners: "The essence of alternative medical thought is that there is a vitalistic principle behind and encompassing any physical object", explaining that "vitalistic" means that there are "objects which are non-physical in part or whole". The vital force of homeopathy and qi of TCM are non-physical – it's impossible to see them, no matter how powerful an electron microscope was used. Qi and the vital force are ideas that are put forward to explain how the body heals itself.”

"Vital forces"? Which century are we living in? If this were offered as social studies, perhaps it would not matter, but the Open University is offering this course as part of a B.Sc. degree. Then we get the usual weasel words about the impossiblity of testing empirically whether alternative medicines (CAM) produce an effect, regardless of how they work. That is the important question. After all we are pretty vague about how some conventional drugs work. In a mind-boggling passage we are told that it is impossible to test CAM against a placebo, but quite possible to test CAM against an orthodox treatment.

“. . . when Belon and his colleagues reported research in 2004 in the journal Inflammation Research, they showed that ultra-high dilutions of histamines (which are proteins involved in allergic reactions and causes, for example, inflammation of the breathing tubes in asthma) are active in influencing human cell activity. ”

Histamine (there is only one), is not a protein? This is meant to be a university course! Belon, of course, is a committed homeopath. This passage conveniently ignores the fact that his experiments have been repeated at least twice by respectable scientists, and they find no such effect. Surprisingly enough, they find that no drug gives no response. Amazingly, it seems that the OU would have us think otherwise.

The rest of the course seems to be much the same. The dispassionate expert on Herbal medicine is a herbal practitioner who makes his living from it, and is just as uncritical as one might expect in that circumstance. Unlike Weatherley–Jones, though, he does come clean (more or less) about the lack of evidence as to efficacy of herbal remedies (though that evidently does not deter him from practising the subject).

“ . . . it is this growing popularity which answers the question of whether acupuncture has a place in the modern world.”

Is it not obvious that the long persistence, and popularity, of an idea cannot possibly be used as an index of truth? One merely has to think of the long-persistent and popular ideas about the 'one true god'. Clearly at most one of these can be true. The history of medicine is replete with popular and persistent ideas that turned out to be untrue. Take nux vomica. For hundreds of years conventional medicine regarded strychnine as a 'tonic'. That persisted right up to the 1950s. But it became apparent that it just did not work, and strychnine, and the very word 'tonic', vanished from the vocabulary of rational medical people. You won't be surprised to find, though, that is still widely touted by fraudulent herbalists.

It could be argued that the course is intended as sociology rather than science, though the course description does not say so, and the course can count towards a BSc. Even as sociology though, it would seem better if the viewpoint of the tutors was rather broader.

The course books

I have now obtained copies of the three course books that were used for K221 last year.. They are indeed written largely as sociology not as science.  But it is a highly biased sort of sociology, as one might have expected from the commitments of the authors.   Although there are occasional references to lack of evidence, this does not seem to deter the authors from their relentless pursuit of the 'integration' of CAM into medical practice.  A superficial reading by a naive student might give an impression that the books are a "rigorous introduction to CAM".  The more sophisticated student is likely to see them as subtle, even insidious, propaganda. I won't claim to have read all three books. Opening almost any page makes obvious their not-very-hidden agenda. Here are a few examples from CAM: Structures and Safeguards (eds. Geraldine Lee–Treweek, Tom Heller, Hilary MacQueen, Julie Stone and Sue Spurr).

Chapter 5 (Homeopathy: principles practice and controversies) contains a ludicrously biased account ot the affair of Jacques Benveniste (see here and here). There is no mention of the fact that his results were disproved at the time, and at least twice since, I know of only one group that has claimed similar results, and that group, like Benveniste's, contained committed homeopaths. There is no mention of Beneveniste's two Ignobel prizes. There is no mention of the fact that after he left France in disgrace, he went on to claim that the properties of the alleged memory of water could be sent by email, a claim so absurd that it has not persisted even within CAM.

This chapter uses the standard CAM trick of redefining the word efficacy.  Rather than its usual meaning of having an effect greater than placebo, it is conveniently redefined to mean, roughly, 'patients say they feel better', 

“Although the issue of whether or how homeopathic remedies 'work' is a major bone of contention for medical scientists, the fact that they perceive that the remedies do work makes it attractive to many orthodox medical practitioners.”

So that's OK then. Don't trouble yourself with what's true.

Chapter 1 of 'CAM: Structures and Safeguards' has the title "Knowledge, names, fraud and trust", and is by Geralidine Lee-Treweek. It is a fine example of relativism -almost post-modernist in style. This is a discussion of knowledge in which the words 'true' and 'false' barely appear. The student who lent me the book has scribbled in the margin "If it is not true and right –then it is not knowledge". Pass the student, fail the tutor. (in fairness, it has to be pointed out that the student passed with distinction, despite her scepticism.)

So does Open University course K221 really give you a "rigorous introduction to complementary and alternative approaches to health. " No it seems that it does not. Here are some more reasons.

A student who has successfully completed course K221 has told me that

• “It was very anti-science and anti-orthodoxy in places”
• “I had several 'discussions' with her [OU tutor] in our online tutor group, some about her anti-vaccination stance and the fact that she was happy to give homeopathic anti-malarials to travellers.”

The argument that homeopaths at least do no harm (see above) seems to be destroyed by their advocacy of policies that will lead to more children getting measles, and which will contribute to the spread of malaria. There is an ultimate irony in OU tutors preaching against vaccination. Walter Perry, the first vice-chancellor of the OU, before he was my supervisor in Edinburgh, had been Director of Biological Standards at the Medical Research Council's labs. In that job he had responsibility for introduction of polio vaccine in UK. That effectively eliminated the scourge of polio.

This is not what a real university should be doing, as part of a B.Sc. degree.

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BBC2 series on Alternative Medicine

BBC2 TV showed a much-advertised series on alternative medicine. The programmes seem to be linked with the dubious Open University course described above.

The programmes are presented by Kathy Sykes, who is professor of the public understanding of science at Bristol Univerity. She has done some excellent work in that area, for example, in the Rough Science TV series.

The first programme: acupuncture

The first programme, on acupuncture, was shown on 24th January, 2006. The programme did not start in a very promising way. Just lots of testimonials from happy patients, the staple diet of all snake oil salesmen. They are watchable, of course, but don't do anything at all to promote public understanding of what constitutes evidence.

There is, of course, little doubt that sticking needles into your body can produce physiological responses. Two things remain uncertain.

• Just how useful are these responses in helping particular conditions?
• Is there anything at all in the mumbo jumbo of meridians and chi?.

With a big flourish we were shown “a 21-year-old Shanghai factory worker undergoing open-heart surgery with only the needles to control her pain”. It turns out that this was a sham. The patient was doped on opiates and local anaesthetics. The needles were mrely cosmetic. Why were we not told?

The apparently contradictory trials reported above suggested that, at least the alleged principles of acupuncture are nonsense. The programme concentrated on a trial by Berman (Ann Intern Med. 2004, 141, 901-10 ) which used 'sham acupuncture', with 'stage dagger needles', on osteoarthritis of the knees. In this sort of trial there is no actual penetration, and the sham needles are placed on the places dictated by the mumbo jumbo. This procedure was justly criticised by a subsequent letters in the same journal (Ann Intern Med 2005, 142, 871).

Another large study was ignored by the TV programme altogether. This was by Linde et al. (Journal of the American Medical Association. 2005 293(17):2118-25). This study concluded

“Acupuncture was no more effective than sham acupuncture in reducing migraine headaches although both interventions were more effective than a waiting list control. ”

As pointed out above, this study is, in many ways, much more interesting than Berman's, because the control group did not have 'sham acupuncture'. Needles were really inserted, but they were inserted in points that have nothing to do with the mumbo jumbo of meridians. The fact that the controls were much the same as the treated group suggests that, whatever effect the needles produce, it doesn't matter much where they are inserted. The only obvious interpretation of this is that the 'principles' on which acupuncture is based are so much nonsense (and, therefore, it is not a subject that can possibly be taught in a university).

This crucial point was ignored by the TV programme. A big fuss was made of a functional magnetic resonance experiment, staged for TV, that showed that the effects on brain 'activation' are different for superficial needling and for real needling. There is nothing in the least surprising in the observation that have a needle pushed into you affects the brain, but it really does not help at all in answering the important questions. Incidentally that experiment had already been done anyway.

In summary, the first programme, failed to give a fair assessment of current knowledge about acupuncture, and failed to consider the important questions of what sort of controls are appropriate, and whether talk of meridians means anything whatsoever. Sadly, I can't agree with the boast that "It's the deepest investigation into the efficacy of alternative medicine ever attempted on TV".  Let's hope the second programme is a bit more critical.

The second programme: healing

The second programme (31st January, 2006). I liked this programme much better than the first, even if it left the crucial questions unresolved.

The programme started with a healing meeting by the notorious Benny Hinn.  The meeting had all the mass hysteria of a Nuremburg rally, though no mention was made of the fact that this (very rich) man's financial malpractice had been revealed by a CBC TV programme.  On the right is his receipt for £3347 for two nights at the Lanesborough hotel in London (that did not include $1700 he gave in tips). The lovely Ghanaian lady who cleans my office and lab every morning gives gives money to this mega-rich man because "he needs it to preach the gospel".

Kathy Sykes did, though show a pretty healthy degree of scepticism about the people who pretend to photograph "auras" and other imaginary "force fields". She visited the "Center for Frontier Medicine in Biofield Science" at the University of Arizona. The National Institutes of Health provided $1.8 m of US taxpayers' money for this project which seems not to do real research at all. After seeing a demonstration of the "Gas Discharge Visualization", GDV, or Kirlian camera, given by a very gullible Dr Melinda Connor, Sykes comments that this 'research'

“is not so much trying to find the evidence for 'healing energy', but is rather working on the basis that there is one”

In other words, the 'research' is a con. Once again (see above) we see money given by well-intentioned governments diverted form the purpose for which it was given.  For more first class boloney on 'imaging', see for example, Biofield Sciences in Exeter (UK)  and 'electro-crystal therapy'.  The list is endless.

Kathy Sykes went on to show several interesting experiments on placebo effects. For example sham healers (played by actors) do at least as well as 'real' healers.  And sham knee surgery may be as effective as real surgery, though the programme failed to mention the obvious possibility that this could mean nothing more than that real knee surgery is itself pretty ineffective.  As so often in this series, the producers failed to talk to the right people.

She concludes "healing does not work beyond placebo".

So I'm right with her, though it would have been better if there had been a more critical mention of the fact that not all placebo effects are real.   Many probably depend on the natural fluctuations in the intensity of the patient's condition.  Anything can 'cure a cold', because you recover from a cold in a few days anyway, 

Sykes concludes, speaking of the placebo effect, "I want to see that power properly harnessed -we'd be mad not to".  But that, disappointingly, was the end of the programme.  That point is where the problems begin.  How do you harness the placebo effect?  How do you justify lying to the patient in order to maximize the effect?  How do you train the 'healers'? Are they themselves to believe the same lies, or are they to be trained in the art of deception?  As pointed out in a recent review of the neurobiology of placebos (Colloca and Benedetti, 2005)

"For example, the assertion that placebos, fake therapies, fresh water and sugar pills could positively affect the brain biochemistry in the appropriate psychosocial context might lead to a dangerous justification for deception, lying and quackery".

These are the central dilemmas of sCAM, as listed at the top of this page. The programme did nothing to solve them, or even to draw attention to them.

The link with Open University Course K221

The blurb on this programme on the Open University/BBC site concludes

“So, could the power of the mind explain the benefits people experience from healers? And have healers tapped into this power somehow? The conclusion throws new light on all healing processes, and has a surprising and inspirational message for every practitioner and patient.”

But what is to be done about this "inspiration"? Nothing is said about that.  The TV programme was immediately followed by voice-over that advertised an Open University pamphlet, which is publicity for their course K221. That course, judging from what is posted on the web, is run by true believers who are a lot less sceptical than Sykes. She says that she did the voice-over but has not yet been shown the contents of the course.

The third programme: herbalism

Oooh dear. The third programme was, in my view, by far the worst. Hardly a single critical voice was heard. Despite the odd word of reservation, the programme left the impression of being an advertisement for the herbal medicine industry. Did the BBC not think of asking a pharmacologist?  In my view, this programme was a disservice to human knowledge.  Let's look at some of the details.

The programme once again starts with dramatic testimonials from satisfied customers. No hint is given to the viewer of the total unreliability of such testimonials. References, in awed voice, are mad to "a vast body of ancient knowledge that herbalists draw on".  No mention of the superb track record that 'ancient knowledge' has for turning out to being dead wrong.  It was 11 minutes into the programme before the question of evidence was even mentioned and then we had a herbalist wandering through a field. At 13 minutes, the herbalist, Simon Mills, was interviewed -he rattled on about dampness. marshy conditions. "There are herbs for heating and drying". Sheer gobbledygook. And still no discussion of evidence.

Sutherlandia At 18 minutes "To get another view I'm going to a country where herbs are claimed to have dramatic effects". Off to Africa to spend a good 10 minutes on Sutherlandia, a totally unverified treatment for AIDS.  Why spend all this time (and licence-payers money) to end up with the conclusion that clinical trials have not been done yet, and we have no real idea whether it works or not?  A search of Pubmed for Sutherlandia and AIDS produces a mere five papers.  Mills et al. Nutrition Journal 2005, 4:19 write as follows.

"Despite the popularity of their use and the support of Ministries of Health and NGOs in some African countries, no clinical trials of efficacy exist, and low-level evidence of harm identifies the potential for drug interactions with antiretroviral drugs."

(and one of the authors on that paper is from the Canadian College of Naturopathic Medicine: hardly likely to have a bias against herbs). The comments made in the programme about AIDS were irresponsible and potentially dangerous: they could kill people..

It took until almost half way through the programme, before we got round to the question of whether any of these claims are true. Very impressive to learn that the Nazis pushed herbal medicine, but totally uninformative (or does it mean that herbalism appeals to nutters?). We are shown the German herbal bible, but again it is pointed out that it contains no evidence about their efficacy. So no further forward yet.  Then we are introduced to chromatography: very pretty, but still no evidence about whether herbs help people.

At 9.34 pm we are last get round to some evidence. Or do we? Not yet, just another personal testimonial about the the wonders of St John's Wort. St John's Wort (Hypericum) is an interesting case, because there is at least some evidence that it works, though certainly not enough for it to be described as a "superherb", as Sykes did.  Of course depression (like knee surgery -above) makes a pretty good case for herbalists, because conventional antidepressents are so very unsatisfactory themselves.  It doesn't take much to do better than Seroxat (Paxil, paroxetine).  At 9.38 pm we get the first actual numbers. And very selective numbers they are too. The view presented in the programme was desperately over-optimistic about the wondrous effects of St John's wort.  Consider the recent review by Linde et al. (2005 Brit J. Psychiatry, 186, 99-107) (read it yourself -download pdf file).  The conclusion was as follows.

“Current evidence regarding Hypericum extracts inconsistent and confusing. In patients who meet criteria for major depression, several recent placebo-controlled trials suggest that Hypericum has minimal beneficial effects while other trials suggest that Hypericum and standard antidepressants have similar beneficial effects. ”

And another trial, again not mentioned in the programme, was published in Journal of the American Medical Association, 2002, 287, 1807 – 1814) [download the pdf file]. This paper was interesting because it compared placebo, St John's Wort and sertraline (Zoloft, a drug of the same class as Seroxat).  All three were indistinguishable (on the two primary outcome measures).  So St John's Wort was as good as Zoloft, but only because Zoloft was no better than placebo either.  The paper concluded thus.

“This study fails to support the efficacy the efficacy of H. perforatum [St John's Wort] in moderately severe major depression. The result may be due to low assay sensitivity of the trial, but the complete absence of trends suggestive of efficacy for H. perforatum is noteworthy.”

Why were we not told about trials like these?

At 9.43 pm, almost three quarters of the way through the programme, we are eventually told that ginseng, echinacea and evening primrose oil do not work. What took so long?

9.46 pm. Off to South Africa to look at research in Johannesburg on Sutherlandia by Carl Albrecht (more of him below). Some impressive stuff about flavonoids but no results. Flavonoids can't be absorbed, but, aha, it contains saponins too. Perhaps they allow the flavonoids into cells. Well perhaps. But this is not information, it is idle speculation.

At 9.51, we get back to brain imaging, this time at Imperial College. Professor Sykes seems to be excessively impressed by brain imaging. We are then treated to more idle speculation about how ginko might help in Alzheimer's disease. Dr Warner is running a clinical trial to find out whether ginko really helps. But there were no results yet. In that case why not wait until there is a result, before telling us all about it?

We are told that herbs now "have to go through rigorous quality standards".  It was NOT made clear that the standards don't include anything about the herb actually doing anything useful.  The standards may give some protection against your being poisoned.  They do nothing at all to guarantee you'll be helped. 

The conclusions

"What's really impressed me is the way that different ingredients from particular herb can combine together and have really powerful effects on us humans. So I believe that herbs are going to play a key role in medicines of the future"

"What started as an ancient wisdom may just might provide new medicines that will help us all live longer, fuller lives"

These statements are quite outrageous!   The first statement has no basis whatsoever.  It is sheer idle speculation.  It could be true, but there is no reason to believe it is.

The second statement is content-free.  Yes, it "may just" do that. On the other hand it may not.

The web site for the third programme. (7th February, 2006, 2100-2200) concludes thus.

“So, what's their secret? Working with fellow scientists, Kathy discovers that plants contain much more than a single – or even two or three – active ingredients. They are enormously complex chemical cocktails that have medicinal properties modern pharmaceuticals simply can't reproduce.”

Stop press: on Saw palmetto (one of the “superherbs” of the TV series)

The New England Journal of Medicine, for February 9th 2006 (354, 557 – 566), reports a clinical trial of "Saw Palmetto for Benign Prostatic Hyperplasia". This is what they say.

“Saw palmetto is used by over 2 million men in the United States for the treatment of benign prostatic hyperplasia and is commonly recommended as an alternative to drugs approved by the Food and Drug Administration.”

“In this double-blind trial, we randomly assigned 225 men over the age of 49 years who had moderate-to-severe symptoms of benign prostatic hyperplasia to one year of treatment with saw palmetto extract (160 mg twice a day) or placebo.”

“Conclusions. In this study, saw palmetto did not improve symptoms or objective measures of benign prostatic hyperplasia.”

I hope that the BBC, the Open University and Prof Sykes now appreciate the folly of judging treatments before the results are in.

Three pharmacological ideas are relevant. None of them were mentioned in the programmes.

Evolution of plants

Naturalness

Here are some products of nature. That doesn't mean they are good for you.

Lead, uranium, radon, arsenic, thallium, strychnine, cyanide (in Sorghum and Prunus species),
Stinging nettles, poison ivy, yew, deadly nightshade, castor beans (ricin), tobacco, curare, foxglove, fly agaric, (muscarine), death cap (amanita phalloides), . . ..

Foxgloves, heart failure and blological standards

Here is a bit of relevant pharmacological history.

The 24th edition of Martindale's Extra Pharmacopoeia (1958) describes Digitalis Leaf (B.P., I.P.), also known as Digit. Fol.; Digitalis; Foxglove Leaf; Feuille de Digitale; Fingerhutblatt; Hoja de digital. It was defined as "the dried leaves of Digitalis purpurea (Scrophulariaceae)." At that time it was sometimes prescribed as Prepared Digitalis (BP), which is "Digitalis leaf reduced to powder, no part being rejected, and biologically assayed the strength being stated in units per g. For therapeutic purposes it must be adjusted to contain 10 units in 1 g."  Sometimes foxglove leaf was prescribed as Tincture of Digitalis (B.P., I.P.). “It may be made from unstandardised leaf, the tincture being subsequently biologically assayed, or it may be made from prepared digitalis, using a quantity containing 1000 units per litre, by percolation or maceration, with alcohol (70 %). It contains 1 unit per ml. I.P. allows also 1 unit per g. Dose: 0.3 to 1 ml. (5 to 15 minims). ”

Although these preparations are now totally defunct, they were still better than the sort of thing that is now advocated by herbalists.  Why? They were betterr because they were standardised.

Foxglove leaves contain several chemical compunds that are useful in certain forms of hear failure.  But the margin of safety is quite low.  Take a bit too much and it kills you not cures you. One batch of foxglove leaves will contain different amounts of active compounds from the last batch, and that endangered patients. 

From the 1930s onwards, pharmacologists developed methods of biological assay that overcame this problem.  An international standard digitalis leaf sample was established. Every new batch had to be assayed against this standard, and diluted to a fixed level of biological activity.   This ensured that each batch of digitalis powder had the same biological potency as the last batch.  It was a great pharmacological advance in its time.  But of course it did involve the use of animals for the biological assay.

All this was solved when the active principles were purified from the foxglove leaves.  There was no longer any need to uses animals for biological assays. The right amount of pure digoxin or digitoxin could be weighed out.

Herbalists want to go back to pre-1930, impure and unstandardised leaves. In this case, and all others I can think of, there is not the slightest reason to think that the impure mixture in the leaf is any better than the purified active principles. Of course there could be such cases. But that is all idle speculation, something we saw only too much of in the TV programmes.

Postscript. Some reviews of the TV programmes

• There has been some lively discussion of the BBC2 series on a forum of the James Randi Educational Foundation, on the BBC2/Open University site, on Ben Goldacres's Badscience site, and at ebm-first.com.

• The Times TV critic was unenthusiastic.

  “So having started out as a sceptic, Sykes ended the programme chirruping, like a born-again Christian, about how herbs contain complex combinations of chemicals that scientists cannot yet reproduce”

• Simon Singh writes in the Daily Telegraph (14 Feb., 2006): "Did we really witness the 'amazing power' of acupuncture?

  “A BBC series on unorthodox therapies was devoid of scepticism and rigour, says Simon Singh.”

  “Although the second programme was indeed a rational look at the placebo effect, the other two episodes were little more than rose-tinted adverts for the alternative medicine industry.”

  “For example, the scene showing a patient punctured with needles and undergoing open heart surgery left viewers with the strong impression that acupuncture was providing immense pain relief. In fact, in addition to acupuncture, the patient had a combination of three very powerful sedatives (midazolam, droperidol, fentanyl) and large volumes of local anaesthetic injected into the tissues on the front of the chest.
  With such a cocktail of chemicals, the acupuncture needles were apparently cosmetic. In short, this memorable bit of telly was emotionally powerful, but scientifically meaningless in building a case for acupuncture. ”

  “This TV series pretended to be scientific and had the chance to set the record straight, but instead it chickened out of confronting the widespread failure of alternative medicine. ”

• Advertisers cash in. Sadly, but predictably, the programme on herbalism has already been exploited by vendors of unproven treatments. While it is true that the programme did not actually assert that this herb cured AIDS, it certainly left the impression that it was good stuff.  Here is an example: "As seen on BBC2"

  “In South Africa, BBC 2 TV presenter, Professor Kathy Sykes learnt of the herb Sutherlandia, which is being touted as a new weapon in the fight against HIV and AIDS.”

  “It is with thanks to programmes such as Alternative Medicine shown on BBC 2 on Tuesday 7th February, and the work carried out by Professor Kathy Sykes that medicinal herbs can receive the acknowledgement they truly deserve, and this knowledge be passed on to the general public.”

  “Bioharmony Sutherlandia is available from Revital Ltd in 60 x 300mg tablets for £19.99rrp. ”

• A groundbreaking experiment ... or a sensationalised TV stunt?

  Simon Singh, in The Guardian (25 March 2006) followed through with some more details on the BBC2 series. It's not only pharmacologists who were unhappy about it. So were several of the people who advised the BBC and/or appeared on the programme.

  “But this week scientists involved in the series have complained that elements of the programmes were misleading, the production team was uninformed, and scientists were used as "marionettes" ”

  At the end of the first programme a "hugely ambitious" imaging experiment was shown with an enormous flourish. The outcome was, roughly speaking, that pushing needles into yourself produces a signal in the brain. Good heavens! Who'd have thought it? Even George Lewith, normally an apologist for CAM, was critical.

  “The interpretation of the science in this particular programme was not good and was inappropriately sensationalised by the production team. I think all of us on the experiment felt like that.”

  “The experiment was not groundbreaking, its results were sensationalised and there was insufficient time to analyse the data properly and so draw any sound conclusions. It was oversold and over-interpreted. We were encouraged to over-interpret, and proper scientific qualifications that might suggest alternative interpretations of the data appear to have been edited out of the programme.”

  Edzard Ernst, professor of complementary medicine at Exeter University, and the main consultant for the series says:

  "The BBC decided to do disturbingly simple storylines with disturbingly happy endings. But none of these stories is as simple as they presented, nor do they have such happy endings. Even when the evidence was outright negative, they somehow bent over backwards to create another happy ending. "I feel that they abused me in a way. It was as if they had instructions from higher up that this had to be a happy story about complementary medicine without any complexity, and they used me to give a veneer of respectability."

  The BBC, thus far, remain unapologetic

  "We take these allegations very seriously and we strongly refute them.We used two scientific consultants for the series, Prof Ernst and Dr Jack Tinker, dean emeritus of the Royal Society of Medicine, both of whom signed off the programme scripts."

  This is the same Jack Tinker who, as Chairman of the Ethics Committee of the Dr Foster organisation, also approved their "COMPLEMENTARY therapists Guide 2004", and the utterly uncritical complementary practioner directory. The 'Dr Foster' organisation is a commercial business that supplies "management information", "market research services", "marketing services" and "information for the public". Let's hope their services in conventional health care are a bit more critical than their evaluation of CAM. Their "Guide to [CAM] therapies" repeats all the usual pseudo-scientific gobbledygook in a totally uncritical way.

  Singh's article ended with some quotations from this site, concerning Sutherlandia and AIDS, with the remark made above, highlighted: "Comments about Aids were irresponsible and potentially dangerous".

• Science accuses BBC of medical quackery

  Lois Rogers, in the Sunday Times for 26th March, reports on the same topic. “Ernst yesterday released the contents of a letter that he has written to Martin Wilson, the series producer, criticising him for promoting “US-style anti-science”. He said he felt “abused” by the programme makers: “It was as if they had instructions from higher up that this had to be a happy story about complementary medicine without any complexity, and they used me to give a veneer of respectability.”  ” “This is no longer a fringe game played by new age people,” said Colquhoun. “It is beginning to erode intellectual standards at real universities.”

Later a letter appeared in defence of the programmes. This is dealt with below.

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London quackery: The Royal London Homeopathic Hospital

It's about time I dealt with the health fraud on my own doorstep. University College London Hospitals (UCLH) is not part of UCL, but is a National Health Service Foundation Trust.  The trust is responsible for eight hospitals: University College Hospital, The Middlesex Hospital, Hospital for Tropical Diseases, National Hospital for Neurology & Neurosurgery, Elizabeth Garrett Anderson & Obstetric Hospital, Eastman Dental Hospital, The Royal London Homoeopathic Hospital and The Heart Hospital.

These are all (but one) absolutely first class teaching hospitals, with responsibility for clinical teaching for UCL medical students. The one blot on the landscape is the Royal London Homeopathic Hospital. This hospital was acquired by UCLH in April 2002. Why on earth is a respectable NHS trust promoting quackery? The UCLH web site says

“The merger enables closer collaboration between complementary therapies and conventional medicine to provide better care for NHS patients. The merger co-incides with the government's commitment to integrate complementary and conventional care within the NHS, where there is evidence of the effectiveness of complementary therapies.”

Notice that the crucial proviso in this statement.

“. . . where there is evidence of the effectiveness of complementary therapies.”

That would be fine If there were evidence of effectiveness, but there is next to no such evidence. Why does UCLH brush this inconvenient fact under the carpet?

The Trust actually has an absolutely first class way of assessing the effectiveness of treatments that are used within UCLH. It is called the Use of Medicines Committee,   All NHS Trusts are required to have such a committee, and UCLH's committee was singled out for praise after a visit by the Parliamentary Select Committee on Health, in their 4th report.  These committees are required to obtain good evidence that a proposed treatment works, and their evaluations may be more stringent than those of NICE.

“ During the inquiry, we visited University College London hospital to hear about its Use of Medicines Committee. We were incredibly impressed with its drug formulary, which is used not only by the hospital trust but by the nearby primary care trusts. Because members of those trusts are on the committee, it is also well accepted by the GPs in the area.”

So does the UCLH formulary contain homeopathic and herbal products? If so they will have bypassed entirely the high standards of evidence that are required by the Use of Medicines Committee for any other sort of medicine. If these standards were applied to homeopathic and herbal treatments, the Royal London Homeopathic Hospital would have to close down, because few of these alternatives to medicine would pass an evidence-based assessment. Presumably UCLH Management has foreseen this, and would rather adopt a double-standard than deal with the political fall-out that would result from applying rules of evidence to alternative medicine.

A fine example of the abuse of language: Homeopathic podiatry

The UCLH web site says (somewhat ungrammatically): "The Royal London Homoeopathic Hospital is celebrating the first decade of its Marigold Clinic which provides complementary treatment of homeopathic podiatry. "

“ Dr Peter Fisher, RLHH Clinical Director, said: "It is an honour for the hospital to host the Marigold Clinic which has been tremendously successful. The Royal London Homoeopathic Hospital has a history of acting as a test bed for NHS innovation. The complementary cancer service and acupuncture are just two examples of therapies the RLHH has been the first to introduce on the NHS. I foresee the same thing happening with homoeopathic podiatry. It's time has come, current reforms and patient choice are working in our favour." ”

To describe as "innovation" a reversion to a totally discredited 19th century bit of delusional thinking, is a usage that defies belief. See, for example, here and here.

It is embarrassing to a real university like UCL to see a conference, sponsored by RLHH, on 'Improving the success of homeopathy' branded with a logo that looks very like UCL's own (old version) logo. The title carries the assumption that there is something to be 'improved'. The conference dealt not only with marigold for bunions, but also HIV/AIDS

What does the Royal London Homeopathic Hospital cost you, the taxpayer?

Guess what? Nobody knows. But with the help of the Freedom of Information Act 2000, I have been able to make some good guesses.

For a start, at least £18 million has been spent on refurbishing the RLHH. The recurrent costs are not so easy to discover. By use of the Freedom of Information Act 200, this is what I discovered.

The direct cost of running the RLHH is £3.379 million per year of which £3.175 million per year are paid by the NHS. Approximately 75% of the direct costs are for salaries.These are the salary cost of staff working at the RLHH. The staff are medical, nursing, pharmacy, administrative and managerial, and ancillary. The balance of cost is for purchase of drugs, laboratory tests, use of patient beds in other Trust hospitals, building and office running costs.

As well as this, the NHS pays also for indirect services, but nobody seems to know the cost of these (and still less, their value). Indirect services are those not charged directly to the RLHH and will include the following. Payroll, payment and income services, accountancy, recruitment , training, personnel, governance and clinical audit, R and D management and governance, medical and nursing education, training and professional support, communications, I.M. and T., estates maintenance management and planning, catering, cleaning, security, insurance, depreciation, payment of public dividend. These sevices are supplied by the Finance Directorate, Workforce Directorate, Chief Nurse Directorate, Capital Investment Directorate, IM and T Directorate, R and D Directorate, Governance Directorate, Directorate of Corporate Sevices, Communications Directorate.

For the UCLH Trust as a whole, indirect costs amount to 39.2 percent of direct costs. If that proportion applies to RLHH, then the total annual cost of RLHH would be £4.7 million.

That sounds to me like a lot of money for a placebo effect.

The RLHH is 97.7 percent homeopathic

Their web site lists eight consultants, all described as "homeopathic consultants" and a ninth has been added recently, Dr H. Roniger.  Thus it seems that Lord Winston made an error of fact when he defended the RLHH in the House of Lords by saying " My Lords, perhaps I may be allowed to break with tradition and come to the assistance of my noble friend. Is it not the case that the national homeopathic hospital conducts perfectly normative medicine and is it not justified in doing that, irrespective of the efficacy or otherwise of homeopathy, which I believe is only a small part of its practice?"

This is the breakdown of prescribing at the RLHH (audit taken August 2004, provided under the Freedom of Information Act). It refers to the number of items dispensed, not their value (which I am still trying to discover).

NB: Creams are herbal or homeopathic.

And the cost of CAM in Glasgow

A freedom if Information Act request elicited the following costs. Much of the information I asked for is not even recorded.

The cost of the Glasgow Homoeopathic Hospital.

The running costs for the Homoeopathic Hospital were:
2004/05 £1,658k
2005/06 £1,881k

The cost of all CAM services at Baillieston Health Centre There is no record of any specific costs associated with CAM incurred at Baillieston Health Centre.There was many years ago a Baillieston Childrens' Homoeopathic Clinic but this service was subsumed into the new Glasgow Homoepathic Hospital. That hospital opened in 1999 at a total capital and building cost of £2,780,189.The total cost came from the New Homoeopathic Hospital Endowment Fund. 3) The cost of CAM provided by GPs or any other part of the Trust. There is no record of specific costs associated with GPs or others employed by the NHS Board providing complementary and alternative medicine. If homoeopathy, hypnosis, acupuncture or any other form of complementary medicine is provided it is not as a costed, discrete service.

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Quackery at Georgetown University

Georgetown University (yes, them again, see above) run a "Master of Science" (yes, that's right, science): "Complementary and Alternative Medicine Program. MS in Physiology".

“In Fall 2003, we introduced the first CAM-oriented, science-based MS program at a US Medical Center.”

“With the tremendous public interest in complementary & alternative medicine (CAM), we anticipate the need for scientists and physicians trained to understand the basic principles of both Western biomedicine and CAM modalities”

Which 'basic principles' of CAM? The 'basic principles' of things like homeopathy and acupuncture are just pseudo-scientific gobbledygook. There is nothing comprehensible to learn.

The CAM MS in Physiology is designed for students who fit into any of several categories in terms of background and eventual career placement: * Those interested in a research career (often with further training at the doctoral level) in a CAM-related area * Students wishing to pursue a career within the CAM industry * Those interested in administrative or regulatory affairs careers related to CAM within the public sector * Practioners or potential practitioners of CAM modalities seeking basic science education relevant to their practices * Those who wish to have a strong understanding of CAM modalities while pursuing a career in medicine

The sort of people it is designed for, those "wishing to pursue a career in the CAM industry", makes a nonsense of the claim that the course is scientific. If it were, the graduates would certainly not wish to work in such a dishonest industry.  Georgetown University does describe itself as "Catholic and Jesuit", but surely that does not preclude a bit of honesty?

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Scientific malpractice: the cloning fraud

The New York Times (17 January 2006) published a beautiful spoof that illustrates only too clearly some of the bad practices that have developed in real science (as well as in quackery). They show, only too clearly, that competition, when taken to excess, leads to dishonesty.

The spoof is, of course, based on the fraudulent papers by Korean cloner, Woo Suk Hwang, which were published in Science, in 2004 and 2005.  As well as the original fraud, this sad episode exposed the practice of 'guest authorship', putting your name on a paper when you have done little or no work, and cannot vouch for the results.  The last ('senior') author on the 2005 paper, was Gerald Schatten, Director of the Pittsburgh Development Center. It turns out that Schatten had not seen any of the original data and had contributed very little to the paper, beyond lobbying Science to accept it. A University of Pittsburgh panel declared Schatten guilty of "research misbehavior", though he was, amazingly, exonerated of "research misconduct". He still has his job. Click here for an interesting commentary.

One Last Question: Who Did the Work? By NICHOLAS WADE In the wake of the two fraudulent articles on embryonic stem cells published in Science by the South Korean researcher Hwang Woo Suk, Donald Kennedy, the journal's editor, said last week that he would consider adding new requirements that authors "detail their specific contributions to the research submitted," and sign statements that they agree with the conclusions of their article. A statement of authors' contributions has long been championed by Drummond Rennie, deputy editor of The Journal of the American Medical Association, and is already required by that and other medical journals. But as innocuous as Science's proposed procedures may seem, they could seriously subvert some traditional scientific practices, such as honorary authorship. Explicit statements about the conclusions could bring to light many reservations that individual authors would not otherwise think worth mentioning. The article shown at left from a future issue of the Journal of Imaginary Genomics, annotated in the manner required by Science's proposed reforms, has been released ahead of its embargo date.

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NHS takes up Cherie's magic magnets cure

It's not just homeopathy. The Sunday Times, (26 February, 2006) reports that the National Health Service has fallen for another scam.

 “IT COULD be called the Cleopatra Effect. Magnetic therapy, which has held the rich and powerful in thrall from ancient Egypt to modern Downing Street, is about to be made available on the National Health Service.

NHS accountants are so impressed by the cost-effectiveness of a “magnetic leg wrap” called 4UlcerCare that from Wednesday doctors will be allowed to prescribe it to patients.”

This is nicely timed to coincide with an Editorial in the British Medical Journal, by Finegold & Flamm (2006) (click to download pdf file). The editorial title was "Magnet therapy. Extraordinary claims, but no proved benefits". They conclude

“Patients should be advised that magnet therapy has no proven benefits. If they insist on using a magnetic device, they could be advised to buy the cheapest – this will alleviate the pain in their wallet,”

For example, Carter et al,, 2002 found no detectable effect of magnet therapy for treatment of wrist pain Attributed to Carpal Tunnel Syndrome (30 patients,double blind, careful controls). Winemiller et al., 2003 (Journal of American Medical Association, 290, 1474–78), found no benefit of magnets vs sham-magnets in treatment of plantar heel pain in 101 patients.

Magnets are said to be one of Cherie Blair's several curious and irrational beliefs. It is alleged, according to the Daily Telegraph, that “Cherie Blair did not allow her youngest child, Leo, to have the controversial MMR vaccine and instead asked a New Age healer to wave a "magic" pendulum over him”. A few more examples are documented here and here.

The accountants at the Prescription Pricing Authority have decided that the "the magnets will save money on bandages and nurses’ time by healing the wounds." I dare say they could save even more money by removing all effective treatments.

The evidence in favour of the magnetic treatment all seems to come from a Dr Nyjon Eccles. The Sunday Times describes him as an "NHS GP in north London", but elsewhere he is described as "Founder, CEO and Medical Director of the Chiron Clinic" in Harley Street. A look at their web site shows that they offer a full range of alternative scams. Cancer patients can get

“LYMPH DETOXIFICATION - This is achieved by non-invasive scalar, oxygen-fed light beam therapy. This helps to detoxify the tissues by assisting the body in dissolving lymph blockages and restoring normal lymph flow using the Nobel quantum scalar technology coupled with oxygen for remarkable healing potential.”

This is total gobbledygook, designed to take advantage of the desperate.

The only real evidence to be provided by Dr Eccles that the device works is a small (26 patients) double blind trial that has not yet been published in a peer-reviewed journal, and which suffered from a number of problems (dropouts, outliers). What, I wonder, does NICE think of evidence like this?

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More on magnets and the PPA

In the discussion of magnets on the Badscience site, a Michael King says that 4ulcercare will be included in Part IX of the Drug Tariff because it meets the criteria of the Prescription Pricing Authority (PPA). I presume this Michael King is Director of Planning and Corporate Affairs at the PPA, though he does not say so.

Michael King says

“There is no judgement offered about whether a product in the Drug Tariff is more (or less) efficacious than any other, or the placebo effect.”

The criteria for inclusion in Part IX of the Drug Tariff () include, in section 10 iii, “They are cost effective”

Will he please explain how a device can be cost-effective, if it is ineffective (relative to placebo)?

What the PPA says

Michael King has replied to my question by email (1 Mar 2006).  He says

“The cost-effectiveness threshold for inclusion in the Drug Tariff is met if the 'effectiveness' of the device, as seen in data submitted by the manufacturer in support of the application, exceeds its cost to the NHS. ”

Sadly this is still ambiguous. It seems to suggest that that whatever data are submitted by the manufacturer are taken at face value, without any attempt to evaluate their quality. So I phoned King to ask if this was the case. He was helpful, but he said that it was not the case. He told me that the data were subject to some sort of low level evaluation, short of the sort of evaluation that NICE would do. This seems to contradict his earlier statement (above) that inclusion in the Tariff implies no judgement about whether a device is better than a placebo.

King said also that listing in the Tariff

". . . is not a licensing decision nor a recommendation akin to the outcome of a NICE review"

The problem is, of course, that listing is seen as a recommendation by the public, by the Daily Mail, and certainly by the manufacturer.

One thing, at least, is clear in this case. Whatever evaluation was done, it was done very badly. But in order to try to find out exactly what evaluation was done, and by whom, I'm having to resort to the Freedom of Information Act.

Watch this space.

What NICE says

Fraser Woodward (Communications Manager, National Institute for Health and Clinical Excellence (NICE)) writes as follows.

 “The test of "cost effectiveness" applied by the PPA when determining whether or not a device should go on the tariff is very different to the way cost effectiviness is assessed by NICE”

That is pretty obvious, but how is the public meant to know that, when they hear that the NHS has declared a treatment to be 'cost-effective', that statement can mean two entirely different things according to which part of the bureaucracy the statement comes from?

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Submit homeopathy to NICE

I have just discovered that anyone is free to suggest a topic to be referred to NICE ( National Institute for Health and Clinical Excellence). Just click here and fill in the form. I have just suggested that homeopathy as a whole be referred to NICE. The objection is likely to be that there is not a suffciently good evidence base for NICE to deal with it. That, of course, is exactly why NICE should deliver a verdict. To say otherwise is to perpetuate the existing double-standard. I tried to counter this argument in the comment section.

The best chance of success is probably for them to get a flood of requests –DO IT NOW!

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The cost of the Chiron Clinic

The "evidence" for the effectiveness of magnetic treatments of leg ulcers was mentioned above all appears to come from a Dr Nyjon Eccles of the Chiron Clinic in Harley Street (see above). According to emails in my possession, a patient wrote to the Chiron clinc as follows.

“I have been troubled with leg ulcers for some time now, and nothing seems to help them. The Daily Mail said that you have a treatment that uses magnets that might help. ”

The reply from Dr Eccles said

“Thank you for your query. I am sure we can help you. You are right, a combination of the 4Ulcercare magnetic device with key nutrients should help resolve the problem.

“Cost of consultation is £135. The 4 Ulcercare can be prescribed now as you know and nutrients are likely to cost around £30 for a month's supply.”

So, no more expensive than a real consultant phsyician. But it does seem a little odd that the need for magnets, and the cost of nutritional supplements could be determined so precisely before the patient, who "suffered from leg ulcers" had been seen.

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Magnets and the Freedom of Information Act 2000. Can you believe this?

In an attempt to discover how the PPA managed to calculate the cost-effectiveness of magnetic treatment of leg ulcers, I lodged with them a request under the Freedom of Information Act 2000.

The result beggars belief.

“I am writing to advise you that following a search of our paper and electronic records, I have established that the information you requested is not held by the Authority.”

The PPA say that they retain no copies of anything related to their recent decision. The Department of Health is now being asked for the same information.

Dear Mr Colquhoun Re: Freedom of Information  I refer to your request under the above legislation, which I received on 27 February 2006 for information about “I should like to see all documents and correspondence that relate to the decision of the PPA to approve the buying of the magnetic device '4ulcercare' (and other magnetic devices, if any)”. I am writing to advise you that following a search of our paper and electronic records, I have established that the information you requested is not held by the Authority. Under the act I have a duty to advise and assist you and with regard to that duty you need to be aware that documents and correspondence in respect of applications for listing of appliances in Part IX of the Drug Tariff are supplied to the Authority for the purposes of making a listing decision and following the addition of an item to the Drug Tariff (or its rejection) all information is returned to the Department of Health. It would seem, therefore, that your request would be more appropriately addressed to the Department of Health. You can make an FOI request to them by sending an e-mail to dhmail@dh.gsi.gov.uk and marking it “Freedom of Information”. If, however, you would like me to do this for you, please get back in touch and I will action accordingly. . . . Yours sincerely Gordon Wanless Project Manager (Information Security and Data Protection)

In response to a second Freedom of Information request I was sent a document that gives some procedures for handling applications, including the making of paper files and spreadsheets. Paragraph 6.5 says

“6.5 Once the application has been accepted or rejected . . . the file can then be closed and set to the Department of Health . . .”

It says nothing about destroying all copies, emails and spreadsheets.  But Mr Wanless tells me "I did check it out by discussing it with the dealing department and I can confirm that it does appear to be the case (i.e. that the electronic records are deleted). The e-mails are printed out and kept in the paper file and then deleted also".  It seems that the PPA keeps no records of its activities whatsoever.  Very curious.

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Magnets and more Unfreedom of Information

Well this beats everything. Following the advice of the PPA, I re-submitted my request under the Freedom of Information Act to the Department of Health (DoH), which is where the PPA claimed to to have sent very single bit of information concerning their decision to make magnetic ulcer treatment available on the NHS.

When I mananged to decode the result (the DoH seem incapable of sending legible emails) this is what they said.

Trade secrets in magnets? They are one of the oldest scams of the health fraud industry! Are the DoH really so enthusiastic to protect these non-existent trade secrets? (The company whose trade secrets the DoH are so eager to protect are under invesitgation by the Office of Fair Trading!) Or is the DoH merely colluding to cover up the cockup at the PPA?

Either way, the Freedom of Information Act 2000 has yet to prove it's worth the paper it's written on.

Why not write to your MP to ask them to approach the DoH about this absurd misuse of the Act?

I have requested an internal investigation by the DoH. Next the appeal goes to the Ombudsman.

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Misleading advertising of magnets. Office of Fair Trading acts

A major problem in stopping CAM fraud is the generally toothless attitude of the Advertising Standards Authority and of the Office of Fair Trading. Not this time though. The OFT Press Release reads thus.

“The OFT is seeking an injunction preventing publication of advertisements making the following claims about the company's products:

• the products have a therapeutic effect, caused by a specified physiological mechanism, due to the magnets they contain
• the therapeutic effect of the products, due to the magnets they contain, is clinically proven or established by scientific trials, or is widely accepted in the scientific or medical communities
• unqualified claims the products have a therapeutic effect and/or that wearing products containing magnets will always produce such an effect, due to their magnets
• that products magnetise or ionise water as a result of the magnets they contain. 

Magno-Pulse Limited contends that the advertisements are not misleading and has refused to stop publishing adverts making these kinds of claims. Accordingly, the OFT has issued proceedings so the courts can decide the matter. Magno-Pulse Limited has indicated it intends to defend the proceedings.

Christine Wade, Director of Consumer Regulation Enforcement said:

"Where advertisements claim products have therapeutic effects it is important they do not mislead consumers. The OFT is asking the High Court to decide if Magno-Pulse Limited’s advertisements are misleading."

It cannot have escaped the attention of the PPA (above) that this action makes them look pretty foolish.
Let's hope the High Court is not fooled.

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Alternative Medicine series: dirty tricks at the BBC?

Following the article by Simon Singh in the Guardian ((25 March 2006), two letters appeared on April 1, 2006. The first, from Prof. Edzard Ernst, confirmed that he felt the BBC had ignored and misrepresented his advice.

The second letter defended the BBC. It was unequivocal in its support of the entire series of programmes, and its appearence surprised me.  In the light of all that has been written, one might have hoped that the BBC would listen and learn from its mistakes. The letter has ten signatories.

But all is not what it seems. Contrary to appearances, this letter was actually written by the BBC who also compiled the signatories (it seems to have been the responsibility of Kim Creed, of BBC Factual Publicity).

• One of the signatories. Dr James Warner, had never seen the letter until after it was published, and tells me that "[I] substantially do not agree with the sentiments expressed therein. Indeed, we had to resist attempts by the programme makers to sensationalise our work". The Guardian has published a correction.

• Six other signatories tell me that their approval was limited to the way their own contribution was treated, and was not intended as approval of the whole series. One commented " I've obviously been naïve, and I am very fed up with this whole thing". Another says " I suppose I (foolishly by the sounds of things) extrapolated from my own programme and experience, without considering the wider implications of the concluding sentence".

• Only one of the eight signatories whom I've asked has actually seen all three programmes, as they were transmitted. This makes it rather odd that they should appear to endorse so unequivocally the whole series.

• One of the signatories, Carl Albrecht, gives his address as "University of Johannesburg", but oddly the BBC forgot to mention that Dr Albrecht is co-owner (at least until very recently) of the South African Company, Phyto Nova, that makes, promotes and sells the untested herb, Sutherlandia, for treatment of AIDS (see, for example, here). He is, therefore, highly biassed. He is also exceedingly controversial. One of his strongest critics has been Stuart Thomson, Director of the Gaia Research Institute, hardly an organisation that is biassed against "natural medicines". Albrecht is indeed a very curious choice of advisor for a programme about science.

• Three of the signatories (Berman, Cummings and Albrecht) are heavily committed to CAM, and so unlikely to be critical of anything that favours it, even apart from financial interests in the outcome. Brian Berman even has is own an entry in Quackwatch. So several of the signatories are pretty much committed in advance. Asking them if they endorse the programmes is about as informative as asking a group of priests if the endorse god.

• It gets worse. This morning, 6th April, I heard from Andrew Vickers, of the Memorial Sloan-Kettering Cancer Center, New York. This is what he says.

  “I didn’t sign this letter ”
  “I was shown the text of the letter but didn’t fully agree with it and told them so. I said something along the lines that the series didn’t do “full justice to the subject matter” (how could it possibly?) but that what they did was fair and reasonable within the constraints set by the medium. You are also right to point out that my comments only go so far as the acupuncture episodes (which I saw) rather than the other two shows (which I did not). No doubt had I been shown a final version for signature I would have also pointed this out.”

The BBC brought us superb programmes like Life on Earth and Planet Earth.  They bring us superb news (I'm listening to the incomparable John Humphrys on the Today Programme right now). They have suffered unjustly at the hands of spin-meisters like Alastair Campbell and the execrable Hutton Report (If the Hutton Report had been an undergraduate essay, it would have scored alpha-plus for collection of evidence and gamma-minus for ability to connect evidence to conclusions).

How ironic it is, then, to see the BBC behaving in this case like spin artists.  Deny everything, and, if necessary, falsify the evidence.

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Big Pharma invents diseases to sell drugs?

This is not a new story. There was much about it in Marcia Angell's book. But now a set of essays has appeared in the journal PLOS Medicine (part of the Public Library of Science, freely available to everyone. Read them here. Ben Goldacre's Badscience column has, as usual, some good sense on this topic too,

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Boots the Chemists, homeopathy and education

Boots the Chemists is a very big business in the UK. There are 1,450 Boots stores in the UK, employing over 68,000 people. At one time they were sufficiently ethical not to deal in homeopathy. But no longer.

When asked for evidence that the things they sell actually work, the Boots help desk is astonishingly coy, as related here (thanks to ebm-first.com for giving publicity to this report).

When 'a friend' asked Boots about their 'Alternatives Hayfever Relief Tablets', the answer came, after some delay, "This is a homeopathic product, further information on homeopathic products is available from the Nelson company who make this particular product for Boots. " This company has been making homeopathic products for many years and may well be able to help you further. You may also find general information about homeopathic medicines in reference books in the public library". The email address that they gave me for Nelson's did not work, and writing to another Nelson's address produced no reply at all. Clearly any letter that contains the word "evidence" arouses suspicion and is simply deflected.

Dangerous advice from Boots: a small sting. I have been into several Boots stores, sought out the most senior pharmacist that I can find, and asked them the following question. "I have a 5 year old son who has had diarrhoea for three days now. Please can you recommend a natural remedy". The response was interesting. In every case but one, the pharmacist reached for a copy of the Boots pamphlet on homeopathy, and thumbed through it, while desperately, but unsuccessfuly, trying to retain an air of professional authority. Then one or another homeopathic treatment from the booklet was recommended. In only one case out of six did the pharmacist even mention the right answer (GP and rehydration). One pharmacist, who turned out to have qualified in Germany, was very insistent that homeopathic treatment was inappropriate and that I should should start rehydration and take the child to the GP. The other five, including one who had an impressive-looking badge saying "consultant pharmacist", did not even mention rehydration.
Conclusion The education of the pharmacists was clearly insufficient for them to give reliable advice. On the contrary, their advice was downright dangerous.

Miseducation by Boots the chemists

Boots also run an "educational" web site for children, the 'Boots learning store'. Click on the section for 'pupils', and then '16+' and you find their education about alternative medicine (do their pharmacists do this course, I wonder?). The slide show that follows is an insult to human intelligence, “‘POTENCY‘ is the term used to describe the dilution of a remedy. The weaker the solution the more potent the medication.”

Then follows a totally misleading slide about enzymes.  

There is nothing wrong with the enzyme bit, but the analogy with homeopathy is baseless and misleading. Enzymes don't work when there are no molecules present.

But in the next slide, enzymes and catalysts are forgotten anyway, This is how it works.

This meaningless mediaeval gobbledygook about 'vital forces' is being peddled as 'education' by the biggest retail pharmacy chain in the UK. What hope is there for kids?

But there is more. Now for the exam. If you click on the 'teacher' section you can download the students' notes and the test. The 'Student Notes' include the following direct claim that homeopathy can cure diseases.

Now take the test, Here is question 1, and the answer.

I suppose that if the educators at Boots classify Hahnemann's provings as a 'clinical trial' it goes a long way to explain the quality of their learning store, and the quality of the advice given by their pharmacists.

Postcript: "Nurses and pharmacists are to be given greater powers to prescribe drugs"

The foregoing history does not give one much confidence in the government's latest money-saving wheeze. [BBC]

“The latest measures mean nurses and pharmacists will be able to prescribe treatments for more serious conditions such as heart disease and diabetes - traditionally the domain of GPs.

Health Secretary Patricia Hewitt said: "Nurse and pharmacist independent prescribing is a huge step forward in improving patient accessibility to medicines from highly skilled and well trained staff."

And Chief Pharmaceutical Officer Dr Keith Ridge added: "For pharmacists, this is the dawn of a new era. It will help transform the public's perception of pharmacy and the services they deliver to patients.”

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Dutch doctor struck off for use of complementary medicine

Another case. In 2004 two doctors working in private practice and treating their patients with complementary medicine were found guilty of serious professional misconduct by the General Medical Council. Edzard Ernst comments “The GMC seems to be reminding us that the integration of complementary medicine has to be based on scientific evidence; otherwise it is in danger of amounting to professional misconduct” (see details here ).

Unfortunately a great deal of such professional misconduct is still being funded by the NHS.

And another, in 2003. [see BBC]

“Dr Michelle Langdon risked the health of an 11-month-old girl and failed to get proper consent before using homeopathic medicine, the GMC's professional conduct committee decided on Thursday.

Dr Langdon, a partner at the Brunswick Medical Centre in Camden, north London, treated the baby's stomach infection by using a "dowsing" ritual to select a remedy, the hearing had heard.

She was found guilty of serious professional misconduct and banned from practising medicine for three months.”

A bit of “serious professional misconduct” does not seem to have prevented Dr Langdon from being a committee member of the British Society for Integrated Medicine. Their Founder President, Dr Julian Kenyon, writes thus, in their newsletter (Feb 2006)

Yes indeed? When can we look forward to some prosecutions? (At least you can't be prosecuted for using kids' fonts.)

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Aromatherapy in Scotland

Aromatherapy on NHS for patients with brain injuries was the title of an article in the Edinburgh Evening News, 21 April 2006. It said

“NHS Lothian has agreed to fund the aromatherapy after patients said their health improved after receiving treatment.” “A survey conducted by ECAS [an Edinburgh–based charity] found that half the patients questioned after an aromatherapy treatment reported improvements in joint mobility.”

On 28th April, they published my response.

In fact ECAS is, in general, a throughly admirable charitable organisation. But in this case, they seem to have misunderstood what constitutes evidence, and not thought about the dilemmas of CAM.

More CAM in the Lothian NHS area: the Dalkeith Medical Practice.

A good friend (and ex-postoc) of mine, when his young son had a fever, took him to the local GP. As a good scientist he was horrified to be offered an unsolicited homeopathic treatment, Belladonna 6C. His letter of protest elicited a reply from Dr Wolfgang Walter (14 Dec 2001) that was astoundingly condescending. For example he wrote

What seems even more amazing is that he admitted with no obvious embarrassement that there was no reason to believe that his prescription worked.

Dr Walter seems since then to have moved to Bristol, another area with more than its fair share of homeopaths, but the homeopathic head of the practice, Dr Michael S. WIlson, is still there.

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The NHS Trusts Association and CAM

The NHS Trusts Association says very little about itself on its web site, apart from saying that its Chief Executive is as Dr David Tod OBE FRCGP. It appears, though, to be devoted largely to promoting mediaeval mumbo jumbo within the NHS. Its web site consists largely of the The NHS Directory of Complementary and Alternative Practitioners

“Working in partnership with the online health and lifystyle magazine Complementary alternatives we have been able to make this invaluable resource accesible to all. ” [sic]

This lifestyle magazine (oops. NHS guide) is not content with the usual suspects, acupuncture, homeopathy etc, but also lists such totally barmy frauds as crystal therapy, radionics and iridology. It listed for me 24 'crystal therapists'. Are these really available on the NHS?

Just in case you are feeling a bit sceptical (!), the site kindly tells you how crystal therapy works.

“They do however assess the condition of the bio-magnetic field of a client before choosing appropriate crystals to help bring it back into balance and harmony. Since the state of the bio-magnetic field relates to and influences the state of the physical body, this process will help activate, support and often accelerate the natural self-healing processes.”

This utterly unsupported claim is written in the usual pseudo scientific language. It is an insult to any educated person, and it is being propagated by what sound like am official NHS source. In fact I am assured that the 'NHS Trusts Association', despite its impreesive name, has no official status at all. It seems that here is nothing to stop professional/academic bodies which work with the NHS using ‘NHS’ in their name, NHSTA has not got a .nhs.uk web site and does not show the NHS logo (rules about this are here).

“The NHS Trusts Association (formerly the Association of Primary Care Groups & Trusts, APCGT) held its inaugural meeting in Westminster on 27th April 2000, attended by the press and addressed by senior members of the Department of Health.
The meeting unanimously approved the Constitution and appointed Dr David Tod OBE FRCGP Chief Executive. The NHS Trusts Association’s membership is now approaching 70% of PCTs, with new members joining on a regular basis.”

The NHS Alliance appears to be in the same category. It is not an official NHS organisation (its address is not .nhs.uk) but it is used by its chairman, Michael Dixon, to spread propaganda for alternative medicine. Official or not, it features strongly on the Department of Health web site.  More of this soon.

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Passive smoking

This is a topic that I have kept well away from, because I have an obvious vested interest: "no pipe, no algebra". But the topic does make an interesting example of the effect of political correctness on people who are otherwise impeccable in there attitude to evidence. Tim Luckhurst writes about this in The Independent (2 May, 2006).

“On Desert Island Discs in 2001, Sir Richard Doll, the man who proved the incontrovertible causal link between active smoking and lung cancer, said: "The effect of other people smoking in my presence is so small it doesn't worry me."

He was right not to fret. One of the largest studies of the health consequences of secondary smoking was published in the British Medical Journal in 2003. It tracked the health of 118,000 Californians over four decades in a rigorous attempt to identify a causal relationship between environmental tobacco smoke (the scientific term for secondary smoke) and premature death. It concluded: "The results do not support a causal relationship between ETS and tobacco-related mortality." ”

The paper in question is 'Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98', James E Enstrom and Geoffrey C Kabat 2003, BMJ, 326, 1057. The publication was followed by a torrent of abuse, more reminiscent of religious zealotry than of science. The responses have been analysed in an article in Public Understanding of Science (2005, 14, 5–23) by Ungar and Bray, 'Silencing science: partisanship and the career of a publication disputing the dangers of secondhand smoke' [download pdf].

I don't know what the final answer will be about the risks of passive smoking, but as a pharmacologist, the higher levels of damage reported seem barely credible, bearing in mind that

“Reputable research shows that a non-smoker inhales between a 500th and 1,000th of the toxins inhaled by the smoker himself.”

It does seem that it is not only big drug companies, and deluded homeopaths, who are happy to distort evidence for their own purposes. Well-meaning zealots can do it too. That is just as scary.

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There's no remedy for the Prince of Quacks

This is the title of a piece by Francis Wheen in the London Evening Standard, 16 May 2006

“Prince Charles travels to Geneva next week to deliver the keynote speech at the annual assembly of the World Health Organisation. Some mistake, surely?” “The WHO describes Charles as the president of the Prince's Foundation for Integrated Health and "patron of a number of health charities". It omits to add that his views on medicine are barmy - and pernicious. ” “WHO delegates from 192 nations have plenty to discuss during their five-day meeting - HIV/Aids, sickle-cell anaemia, preparations for a flu pandemic, the eradication of polio and smallpox. Why waste precious time listening to the heir to the British throne, who has spent more than 20 years displaying his ignorance of medical science?” “The prince has never met a snake oil vendor he didn't like. A couple of years ago he urged doctors to prescribe coffee enemas to cancer patients, a suggestion which provoked this rebuke from Professor Michael Baum of University College London: "The power of my authority comes with a knowledge built on 40 years of study and 25 years of active involvement in cancer research. Your power and authority rest on an accident of birth." ”

The Prince’s Foundation for Integrated Health publishes Complementary healthcare: a guide for patients which is full of wishful thinking. For example, it tells the unfortunate patient that

“Homeopathy is most often used to treat chronic conditions such as asthma; eczema; arthritis; fatigue disorders like ME; headache and migraine; menstrual and menopausal problems; irritable bowel syndrome; Crohn’s disease; allergies; repeated ear, nose, throat and chest infections or urine infections; depression and anxiety.”

but says nothing at all about whether or not they work. That is just irresponsible.  And to describe pills that contain no trace of the substance on the label as ''very diluted" is plain dishonest .

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Use of ‘alternative' medicine in the NHS

This letter was sent to the chief exectutives of 476 NHS Trusts (acute and primary care trusts). It was the main headline in The Times, and the lead item on the BBC's Today Programme.

As soon as this appeared the phone started ringing. Michael Baum did an excellent job on the Today Programme, and on BBC Birmingham, BBC55, BBC world service, ITN news (interviewed for 20 minutes outdoor in the rain), Sky News live, and as well as all that he saw patients, and missed lunch while in the operating theatre. Michael comments " How was your day your Royal Highness? ".

Leslie Rose did  BBC Breakfast TV interview and various radio stations.

I did interviews for BBC News24, BBC1 News, Chanel 5 News, Sky news, the Jeremy Vine Show (radio 2), BBC Radio Solent, and wrote something for the Scotsman. Today it's Radio London at 10.35 pm and tomorrow, Radio Foyle (Derry).

Listen to the Today Programme 08.10 interview

John Humphrys, on the Today Programme, interviews Michael Baum (lead signatory on the letter), and Peter Fisher of the Royal London Homeopathic Hospital (For more on Peter Fisher, see here, and here, and here). Listen to the interview [mp3 file, 4.4 Mb]

Leslie Rose interviewed on BBC Breakfast TV. Watch the interview (Realplayer file).

Interview for Sky News.

The Jeremy Vine show interview (Radio 2)

The Late Show on BBC Radio London (24 May), host Stephen Rhodes, DC versus Gary Trainer: click to listen

Radio Foyle (N. Irelend) Talk show with Mark Patterson.  The local health food shop manager told me that 'arthritis is a build up of toxins in the body', and that glucosamine and chondroitin are herbal!  Click to listen

Michael Baum's 2004 Open letter. "An open letter to the Prince of Wales: with respect, your highness, you've got it wrong". Download pdf file.

Coverage in The Times, 23 May 2006. The front page headline.

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Prince of Wales Addresses World Health Organisation: good in parts

Prince Charles addressed the WHO in Geneva on 23 May 2006, The full text of his speech is on the WHO web site. Some bits of it I rather liked. Who could disagree with this bit.

“The state of our health reflects the food we eat, the exercise we take, the water we drink, the air we breathe and the quality of our housing and sanitation. I believe it also extends to our social needs and circumstances – the need to belong to a community, the need for meaningful work and daily purpose. The need in our lives for dignity and kindness, for self-respect, for hope and, above all, for harmony and, dare I say it, beauty. It encompasses the power of art, the healing properties of loving human relationships and the role of the human spirit. Human health is the sum of all these parts.”

“Beauty is truth, truth beauty,—that is all
Ye know on earth, and all ye need to know.”

The problem for me, is that talk of mysterious 'energy flows', 'auras', 'meridians', 'yin and yang', 'potentisation', and such like mumbo jumbo is, almost certainly, not true. And for me, that makes it ugly. Ugly and dishonest.

The speech, it has to be said, was relatively restrained. The Prince made pretty modest claims -nothing much beyond acupuncture for osteoarthritis of the knee, and St John's Wort for non-severe depression. There was no mention at all of homeopathy, reflexology or any other of the myriad variants of alternative medicine. Why, I wonder, was this? Has the Prince of Wales lost faith in homeopathy? Does he realise now that the evidence for its efficacy is appalling? If that is the case, then it would have been nicer if he'd said so.

The other interpretation is that he thought it expedient to suppress some of his more curious beliefs. If so, that would not be very honest. The impression given of homeopathy is very favourable in Complementary healthcare: a guide for patients, which is published by the Prince’s Foundation for Integrated Health (see above). So why not in his WHO speech? Surely something wrong there.

The speech also included the following words (you can see this bit on Sky News, together with a reply from me).

“in the ceaseless rush to “modernize”, many beneficial approaches, which have been tried and tested and have shown themselves to be effective, have been cast aside because they are deemed to be “old-fashioned” or “irrelevant” to today's needs. ”

All this shows that his idea of " tried and tested and have shown themselves to be effective" is very different from any idea of good evidence that would seem acceptable today.

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Follow-up after yesterday's letter and HRH's speech

Today, 24 May 2006, there is a lot of follow-up.

The Times

Several articles appeared on 24th May. "'Misrepresented' Charles refuses to follow his doctors' orders". by Andrew Pierce and Mark Henderson. They quote a statement from Clarence House.

"What the Prince is arguing for, and always has argued for, is for a combination of treatments where it is appropriate and where it is proven to work."

So, straight back to the question of what you mean by "proven". They also quote Michael Baum, thus.

“Professor Baum said that where the Prince’s remarks were not meaningless, they were wrong. "What the Prince calls the biophysical model of the body is infinitely more beautiful, not to mention more useful, than anything conjured up by the alternative wing,” he said. “The body is a beautiful orchestration of recognisable biological and physiological processes, which can be observed and understood." ”

And, from the House of Commons,

“Evan Harris, a Liberal Democrat member of the Commons Science and Technology Committee, said that the Prince was abusing his constitutional position by taking a controversial stance without allowing himself to be cross-questioned.”

Mark Henderson and Fran Yeoman also wrote "NHS must audit spending on alternative therapy, MPs say. Health officials admit they have no idea how much such treatment costs"

"The Department of Health admitted that it had no idea how much taxpayers’ money was being spent on non-conventional therapies.

Phil Willis, chairman of the Commons Science and Technology Select Committee, said the department had a duty to collect accurate information on the extent of NHS support. "

"All can seek these at their own expense, but this debate is ultimately about the use of taxpayers’ money, which only therapies that are proven to be safe and effective deserve."

The Royal Society

“The Prince’s speech came as the letter critical of alternative medicine was backed by the Royal Society, six of whose Fellows had signed it. Professor David Read, vice-president, said: "We share the concerns that some treatments labelled as complementary and alternative medicines have not been properly tested and are known to cause adverse effects, while others have no demonstrable benefits. We also support the view that patients should not receive misleading information about the effectiveness of complementary medicine." ”

The Daily Mail

Michel Hanlon wrote a magnifiently sensible piece in the Daily Mail. It starts thus.

"Let's be clear about this: there is no such thing as alternative trust medicine. There is medicine which works and medicine which doesn't. Anything which doesn't work is snake oil, and anyone who buys such stuff is either being duped, or has more money than sense."

The Guardian

Good pieces by Sarah Boseley, and, especially by Dylan Evans, whose "Crazy Medicine" concluded with a recognition of the dilemmas, thus.

“There is always the possibility, of course, that doing away with the crackpot theories that provide alternative therapies with some of their appeal may actually rob them of their effectiveness, by destroying the vital belief that enables these therapies to mobilise the placebo response. In such cases, we face a choice of a clearly ethical nature: to preserve the effectiveness of these therapies by perpetuating crazy theories, or to seek the truth at the risk of robbing some patients of their favourite therapeutic resources.”

Der Spiegel

The Scotsman (24 May 2006)

Lynday Moss, the Scotsman's Health Correspondent, wrote aboutou letter, and the WHO speech. She mentiond that "NHS Lanarkshire provides complementary therapies for cancer patients and their relatives, including aromatherapy and reflexology, at an annual cost of about £27,000.", followed up by an abbreviated piece that she asked me to write. The unabbreviated version follows.

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The backlash

The Society of Homeopaths has posted a response to the letter.

"In fact, there is considerable evidence to show that homeopathy is effective in the treatment of a wide range of illnesses, including a large study at the end of 2005, of the outcomes from 6,500 patients at the Bristol Homeopathic Hospital, over a period of six years, in which 75% reported improvement."

What a wonderful response! They have chosen to cite, in their own defence, quite the worst study to come out for years (see the commentary above).  It is precisely because homeopaths mistake things like the Spence study for evidence that we felt our letter was needed.

The Complementary Medical Association has posted a rather angrier response here.

“Baum and colleagues imply that these “Alternatives” are “unproven or disproven”. Again, sadly they are mistaken and really need to look at the research before they undertake a smear campaign such as this. ”

But the first bit of 'research' they cite is, astonishingly, the same Spence study. It is quite hard to conduct any sort of sensible dialogue with people whose understanding of the principles of inference is so rudimentary. Nevertheless, we'll keep trying.

The Daily Mail quotes Terry Cullen, chairman of the British Complementary Medicine Association, as saying that the group's stance was "frustrating". He said

"It's very frustrating that senior responsible people dismiss complementary medicine for the sole reason that it doesn't have the definitive scientific proof that other drugs have.

So we have it from the horse's mouth, After 100s, or even 1000s, of years there is still no good evidence.

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Can you tell the difference between homeopaths and witch doctors?

The answer is: witch doctors are not publicly funded within the NHS. Not so far, anyway

Dominic Lawson, The Independent, 26 May 2006 gave support to the letter (though I get very uncomfortable when I get branded as part of the establishment).

“Hence homeopaths believe - they really do -that the most effective remedy is one in which there is no longer a single molecule of the active ingredient in the water. However - please bear with me - the water has "a memory" of the active ingredient, and it is this which will cure the sufferer.

As the Australian Council Against Health Fraud remarks: "Strangely, the water offered as treatment does not remember the bladders it has been stored in, or the chemicals that may have come into contact with its molecules, or the other contents of the sewers it may have been in, or the cosmic radiation which has blasted through it." I suppose you might say that the medicinal water of the homeopath has a selective memory.”

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Christine Barry deconstructs evidence

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 briiliantly 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-Émile Lacan (1901 – 1981), a French psychoanalyst and psychiatrist. 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". [Jouissance = enjoyment; the word appears in French in the translations.]

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Pseudoscience and Postmodernism: Antagonists or Fellow-Travelers?

This an essay by Alan Sokal, published in Archaeological Fantasies: How Pseudoarchaeology Misrepresents the Past and Misleads the Public, edited by Garrett G. Fagan (Routledge, 2006), pp. 286-361. It is available on-line.

This is a wonderful essay. It could hardly be more relevant to the Barry paper. It explains why so much of the philosophy science has moved so far in a relativist direction that it has become barely distinguishable from CAM and astrology, apart from the more pretentious language of the former. Little wonder that it is almost entirely ignored by scientists.

Here are some quotations.

And finally

For a bit of fun, try the post-modern essay generator. Click the link at the bottom to generate a new essay in a moment. If you are worried about your RAE rating you could always try submitting one to a journal.

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Centre for Complementary and Integrated Medicine: economical with the truth?

Some interesting emails have come into my possession recently. They concern the Centre for Complementary and Integrated Medicine, which gives its address as Harley House, Brunswick Place (Formerly Upper Harley St.), London NW1 4PR (don't you just love "formerly Upper Harley Street"?).

This centre lists its doctors as Dr Nick Avery, Dr Mike Clark and Professor George Lewith.

Their web site claims "There are several approaches that we use in complementary medicine that may be of help to people with fibromyalgia. There is at least one positive clinical trial that indicates that homeopathy can help this condition."

An enquiry was sent to the clinic, as follows.

After some delay, a polite response came from Dr Avery.

But no mention there of a trial.  A second enquiry gave a fascinating result.

This paper must be the one that I was asked to check by the producer of a television programme (QED), (Fisher, P., Greenwood, A., Huskisson, E. C., Turner, P., & Belon, P. (1989). Effect of homoeopathic treatment on fibrositis (primary fibromyalgia) British Medical Journal 299, 365-366.).

But surely some mistake here? The problems with this paper have already been described above. Fisher et al. had made a naive mistake in their statistical analysis, and in fact the homeopathic treatment had no demonstrable effect whatsoever, a result that was published soon after in the Lancet: Colquhoun, D. (1990), Reanalysis of a clinical trial of a homoeopathic treatment of fibrositis. Lancet 336, 441-442.). [Get pdf]

So why does Professor Lewith cite the Fisher paper without mentioning that it provides no evidence at all?  Professor Lewith says that he was unaware of this history. That does seem odd for someone who is devoted to assessment of CAM (all you have to do is search for 'fibromyalgia and homeopathy' in Medline). Very baffling.

The AMI test and the Vega test

Dr Avery also sent "our information leaflet on Fibromyalgia". This document was rather interesting.

The Vega test and the AMI machine

What are these tests?  The Vega test is one of the older con tricks.  Dr Avery seems to be misinformed.  The Vega test does not measure "energetic imbalances" (whatever that means), it measures skin conductance. So it resembles the infamous lie detector (perhaps it should be tried on its advocates).  It has been the subject of several legal actions (listed here, by the Quackwatch site). Here are three of many examples.

• In 1985, the FDA notified a distributor that Vegatest devices could not be marketed as a medical devices without FDA approval (which they do not have).
• In 1990, the New Zealand Medical Journal described how a homeopathic physician had used a Vega device to diagnose allergies in three infants. In each case, the device was applied to the mother with the child on the mother's lap or roaming about the examining room. The doctor also diagnosed "miasms," which, if not removed, would prove fatal later in life. The Medical Practitioners Disciplinary Committee ordered that he be censured, pay a penalty of NZ$900 plus NZ$25,000 for costs and expenses, and follow certain standards of care for three years
• In 2002, the British Advertising Standards Agency concluded that a leaflet offering Vega testing as a "complete test for hidden problems" was misleading and advised the advertiser to withdraw it .

In 2003, the BBC did its own investigation.

“We sent Inside Out’s Chris Packham to three Holland and Barrett stores across the South to find out more. Chris took the Vega test in Newbury, Chichester and Farnborough, only to discover that his allergy results differed from store to store.

In total, Chris was sensitive to over 33 different foods, including staples like wheat, potatoes, milk, tomatoes, tea and coffee. But out of the 33 products, there was only two that all three testers agreed on - cheese and chocolate.

Chris was also advised by Holland and Barrett staff to take a total of 20 different vitamins and minerals. But again, the testers can’t seem to agree and all three testers advised different supplements.

It seems your allergies may not be determined by food alone, but also your location. ”

Professor Lewith told me, when I asked about the Vega test,

"I use it to help with homeopathic diagnoses, your next question of course is why on earth would you want to make an irrational diagnosis about a completely irrational subject."

Yes, indeed it is!

To make matters still odder, Professor Lewith has himself published a paper showing that the Vega test does not work.  Why, then, does he use it in his private clinic? The paper in question is in British Medical Journal, 2001;322:131-4. It concludes "Electrodermal testing cannot be used to diagnose environmental allergies."

The AMI machine is much less well-known. It presumably refers to "Apparatus for Measuring the Functions Of the Meridians and Corresponding Internal Organ". Again it is said the the mysterious and undefined "imbalances". The most likely interpretation seems to be that it just another galvanometer.

For a sane description of bizarre 'allergy tests', look here.

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Links to other interesting sites that deal with dubious claims and quackery

QUACKWATCH (highly recommended)

Health Watch (UK)

Sense about Science an independent charitable trust to promote good science and evidence in public debates.

ebm-first.com:  A nice site about the follies of CAM run by an Edinburgh housewife who has suffered from it

The James Randi Educational Foundation

Badscience.net Ben Goldacre's site, with text of his usually excellent Guardian column.

UK Skeptics' forum. A new UK forum

Sense about science

The National Council Against Health Fraud (USA)

ADbusters (see especially the spoof adverts gallery)

Science Jokes

The world of Richard Dawkins

The skeptic's dictionary

The skeptics' society

CrankDotNet: cranks, crackpots, kooks and loons on the net

The skeptics annotated bible

Francis Wheen's Top 10 Delusions

REASON Rationalists, Empiricists And Skeptics Of Nebraska

Some links to delusional sites that illustrate how the far the CAM lobby has penetrated the National Health Service

The NHS Alliance

NHS Trusts Association

The NHS CAM library

The Research Council for Complementary Medicine

The Prince’s Foundation for Integrated Health

How to use the RSS feeds.

There now feeds for several pages. They update automatically to show you the latest additions.

DC science RSS feed.

DC quackery RSS feed.

DC politics RSS feed.

DC religion and education RSS feed.

These feeds can be used to produce a list of titles of additions to these pages via any newsreader program. The two methods that I like are these

Use the Firefox browser. If an RSS feed is available, you'll see the red 'live bookmark' icon to the right of the web site address (in earlier versions it may appear in the status bar; bottom right).

Click on the icon, and save the bookmark. This will be a 'live bookmark'; it is a folder that contains links that update themselves automatically.

Another good way to use them is to go to http://www.netvibes.com and set up a page for yourself there. Right click on the RSS logo above, choose 'copy link location'. The on the netvibes page, click 'add content'. then 'add my feed', and paste the feed address into the upper box ('Enter an RSS/ATOM feed link :'). The link should read, for example, 'http://www.ucl.ac.uk/Pharmacology/dc-bits/dcpolitics.xml' for the politics feed.  You can set up links to BBC and newspaper sites similarly, whenever you see the RSS logo.

Hint for biologists.  You can make a similar self-updating Pubmed search by going to http://www.hubmed.org/, doing a search on the topics that interest you, right click on the 'FEEDS' button (top right) and paste that link into your netvibes page, as above.

© David Colquhoun

This page last modified 15 June, 2006 by David Colquhoun.