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Black is white.. day is night.. less is more.. nothing is everything (yes, homoeopathy again)

July 15, 2008

One of the more reliable sources of online laughs recently has been the comments thread following a ludicrous letter criticizing the rather wonderful Professor Edzard Ernst that appeared in the Times Higher Educational Supplement a couple of weeks back.

The letter was penned by Michelle Shine, a London homeopath. Shine is criticizing Ernst for applying critical appraisal to CAM therapies (well, she would, wouldn’t she?).

Apparently, in Michelle’s view, this is not what a Professor of Complementary Medicine should be doing. He should be “giving leadership”…

Hmm. You might think this is precisely what Ernst is doing. He is leading by example, demonstrating to the “CAM community” that, if they really want to be integrated with the mainstream of medicine, they have to adhere to the same standards of evidence we demand for other treatments.

Sounds like leadership to me.

It also sounds like what academics are supposed to do - serious investigation, critical analysis, and trying to get to the root of what works, and what doesn’t - and how what does work, works.

But apparently that isn’t leadership (according to Michelle). Or what a Professor of Complementary Medicine is supposed to do (according to Michelle).

Professor and PR - they both begin the same way? Errm?

From the tone of her letter, Michelle Shine thinks Ernst’s job is not to study CAM. Rather, his job is to promote it. We can infer, I think, that this means uncritically promote it, which is what homeopaths like Michelle do for homeopathy. As many different Bad Science bloggers have recounted, the non-medical homeopaths mostly think that homeopathy is an “entire self-consistent healing philosophy”, and can treat anything, from asthma to major depression to cancer to HIV/AIDS. Oh, and it can prevent malaria as well [not] [1].

Rather more shamefully, Michelle Shine implies that by studying CAM, rather than promoting it, Ernst is “betraying” the ideals of the person who funded the Exeter Complementary Medicine Chair - the late building magnate Sir (John) Maurice Laing (1918-2008).

Shine writes:

“Sir Maurice Laing originally funded the chair that bears his name at the Peninsula Medical School in Exeter because he was passionate about CAM. His wife, Hilda, had suffered for years from tuberculosis and was cured of this serious disease through the use of a CAM discipline, very possibly homoeopathy.

There is a significant body of high-quality scientific research supporting homoeopathy, which can now be added to more than 200 years of case histories - all of which verifies homoeopathy as a valid system of medicine.

Consequently, Ernst’s “interventions” on behalf of homoeopathy/CAMs must be causing Sir Maurice to turn in his grave.”

Why the THES printed this snide personal attack at all escapes me.

Apart from anything else, it is not true. Even the bit that implies Laing must have wished he had hired a PR man.

A quick google through the THES archive reveals an obituary for Laing, published earlier this year. The piece includes quotes from Edzard Ernst’s reminiscences at a Memorial Service for Laing.

“Interestingly, while much of the research carried out by Professor Ernst was at odds with Sir Maurice’s strongly held belief in the value of alternative medicine, [Sir Maurice] never pulled the plug on the post, instead stumping up yet more money when it was needed.

After ten years, the £1 million endowment ran out and Professor Ernst turned to him for more funding after promises of money from other sources fell through. Sir Maurice sent a cheque in the post for another £500,000, made out in his name.

“It took him no time at all to comprehend and respect that I had no plans to promote anything and was devoted to scientifically testing these treatments,” Professor Ernst said. “He began to hear from numerous sources that I was not sufficiently supportive of the field, but he kept encouraging me to do the rigorous science.”

Which suggests that Laing, unlike Michelle Shine and her homeopathic friends, understood that University Professors are supposed to be serious scholars, and also that establishing something as a viable treatment in medicine requires evidence that it works.

Last week Edzard Ernst responded directly in the THES to Shine’s jibes. His response is worth reproducing in full.

“In our book Trick or Treatment? Alternative Medicine on Trial, Simon Singh and I evaluate the evidence for or against some 40 alternative therapies. We stress that several are backed by encouraging evidence while others are not.

In the case of homoeopathy, we conclude that “there is a mountain of evidence to suggest that homoeopathic remedies simply do not work”, which should not be surprising because they “typically do not contain a single molecule of any active ingredients”.

Homoeopaths have reacted by stating that:

  • we misrepresent data
  • we are bought by big pharma
  • I was fired by the General Medical Council
  • I am a bad scientist, a fraud and a quack.

Now Michelle Shine has added to this long list of insults and lies by claiming that I am “falling short of (my) job remit” and that I cause Sir Maurice Laing (who endowed my chair) “to turn in his grave” (Letters, 3 July).

During many meetings, Sir Maurice encouraged me to conduct the most rigorous research possible, regardless of what it might find. Shine points out that my remit is to “speak for complementary medicine to government, the public and within the university”. But this is precisely what I have done during the past 15 years, publishing about 1,000 articles in medical journals. However, to speak “for” a subject does not mean telling untruths. We all seem to have got used to homoeopaths misleading the public, but British scientists and academics are bound to insist on the best evidence available to date.”

So Ernst is a man of integrity, as was Sir Maurice Laing.

Unlike, one is forced to conclude, many homeopaths.

In the meantime, the comments thread below Shine’s letter has featured, over this last fortnight, a selection of bad science people (supporting Ernst, and pointing out the falsehoods in Shine’s letter) and of homeopaths giving Shine their vocal support.

One homeopath who showed up is William Alderson:

William trained at The London School of Classical Homoeopathy. He had originally sought homeopathic treatment out of desperation, but it was not simply the success of the treatment that convinced him of the importance of homeopathy. When he read Samuel Hahnemann’s Organon of Medicine and discovered that this was a medical system with a sound scientific basis, he determined to find out more, and ultimately to train as a homeopath himself. (emphasis mine)

Goodness. As William Alderson’s bio reveals, he is a man of many and varied talents. Unfortunately, the ability to tell whether something has a “sound scientific basis” is clearly not among them.

I especially had to laugh when I read Alderson’s comment that:

“The effects of [homeopathic] potentised remedies are highly implausible only if you limit your scientific approach to that of chemistry, and if you rigorously use an inappropriate test. If a wider range of scientific investigatory techniques are used, and if appropriate tests are used, then the results have the chance of according with the clinical evidence - 200 years of clinical evidence.”

Ho hum. And day is night, and black is white. At least in William Alderson’s homeopathic parallel universe (homeoverse?).

A brief recap. It has been repeated ad nauseam that, for homeopathic remedies to have biological actions, one would have to explain how “no molecules” can do more than “some molecules”. “Potentised” means, or course, “diluted with shaking, which shaking is believed by homeopaths to impart magical healing properties”. Following the dilution, there are no molecules of “remedy substances” left. None.

For this potion to do something, one would also have to explain how water magically “remembers” having once had something dissolved in it, when that stuff is not there any more. Water molecules “jostle” one another on a molecular scale at such a speed that any “space” left by a substance that was once there would be gone in a matter of a picosecond (a millionth of a millionth of a second) at the very most, and probably much quicker.

In addition, absolutely no credible science exists to show that a homeopathic remedy is distinguishable from pure water. James Randi famously offered a million dollars to anyone who could credibly demonstrate a “paranormal phenomenon” (homeopathy would qualify, see the noted Horizon programme a few years back), while Edzard Ernst and Simon Singh have recently offered ten thousands pounds of their own money to anyone who can show by any scientific method that homeopathic remedies are distinguishable from water.

No claimants have shown up to claim Ernst and Singh’s prize, and Randi still has his million bucks.

Finally, the homeopathic canard about “sceptics don’t use proper tests” (put another way: “Double blind trials to test our healing power? No fair!”) has been magisterially debunked by Ben Goldacre in his definitive pwning of homeopathy, and in many other places too.

So everything - everything - in Alderson’s ringing statement is…. well, frankly, rubbish.

As an academic used to correcting students’ misconceptions, I thought I ought to re-phrase Alderson’s statement to make its breath-taking ludicrousness a bit clearer. Or better still, I will correct it along the lines of a student project report or thesis, to make it clear what Alderson is really saying:

Key:

Bold black for Alderson’s original words

Blue for the new edits to clarify the meaning

Red for deletions

“The effects of potentised remedies are highly implausible only if you limit your scientific approach to that of using all the known laws of physics, chemistry and biology, and if you rigorously use an inappropriate test the same established tests proven over decades of experience to be the best way to test medical treatments.

If a wider range of scientific and pseudo-scientific investigatory techniques are used, including techniques that are inadequately controlled and or/spurious, and if inappropriate tests are used that do not rigorously exclude experimenter, observer and reporter biases, then the results have the chance of coming out apparently positive - according with the subset of the available “clinical evidence” that we homeopaths like to bang on about, namely 200 years of anecdotes, famously the least reliable kind of medical evidence there is. We will ignore the more rigorous clinical evidence that does not suit our a priori belief-based position, namely all the blinded trials and meta-analyses that demonstrate that homeopathy is simply an elaborate placebo.”.

Incidentally, it is not terribly surprising that William Alderson has appeared to fight Shine’s corner, as they seem to be close associates. Both are, or have been, associated with a recently set up charity HMC21, or “Homeopathy: Medicine for the 21st century”. Michelle Shine, according to this homeopathy website, was formerly Chair of the group, while William Alderson is the secretary.

HMC21 says its purpose is to:

“promote homeopathy, and to defend the right of people in the UK to choose homeopathy as a therapy within the National Health Service”

Obviously the way to do that is for people like Michelle to accuse Edzard Ernst of being dishonest, and for Alderson to back her up with 42-carat nonsense.

Let’s hope their squeakings are treated with the derision they deserve.

Are you listening, Vice Chancellors?

And… is it too much to hope that the Vice Chancellors of those Universities offering “B.Sc. degrees” in Homeopathy and other belief-based nonsense might be reading these exchanges in their THES? And getting a reminder of the difference between scholarship and education on the one hand, and promotion and pseudoscience on the other?

Thought for the day

Finally, before I sign off, I thought I would try my hand at writing an advertising blurb for HMC21, and for the many homeopaths who seems to be able to achieve a stunning level of unconscious quantum doublethink when it comes to their preferred brand of belief-based wibble.

“Don’t like the physical laws of this universe? Insist on being judged by the laws of a parallel one you thought up specially!

Choose Homeopathy now!”

Just don’t expect me not to complain if you are trying to spend my taxes on promoting your parallel reality.

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1. Over at his Thinking Is Dangerous blog, Dr* T recently celebrated the 2nd anniversary of the Simon Singh / Sense About Science BBC Newsnight investigation of homeopathic practitioners and pharmacies who recommended homeopathic malarial prophylaxis to people proposing to visit malaria-endemic countries. The anniversary has now triggered a series of other badscience bloggers to post comments about the British Royal Family’s favourite quackery. Enjoy.

From Cochrane reviews to celeb bowels: Holford bestrides the arena

June 8, 2008

Star UK Nutri-Guru Patrick Holford may not be an Honorary Professor any more, but he still likes to quote (or perhaps “cherry-pick”) science to help pitch his advice, books and supplements.

An example is on the extensive website dealing with the modestly-entitled “Holford Low-GL diet”, where he has a bit talking about a recent Cochrane review of Low Glycaemic Index (GI) / Low Glycaemic Load (GL) diets for weight loss. Somewhat oddly, since the review is about both, Holford’s site only talks about the study saying that low GL diets might help with weight loss (in fact, he manages to mention this a stunning seven times in under 200 words). I hope this omission of any mention of low GI diets is not coloured by the fact that Patrick promotes “low GL” schemes heavily as being far superior to “low GI” ones. Perhaps I will come back to this another time.

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Science (ish) AND celebrity testimonial! How splendid.

Directly under the link to the Cochrane review on Holford’s website is a link to the inevitable celebrity testimonial anecdote, where we are treated to the story of Z-list celeb and serial footballer-dater Danielle Lloyd’s dramatic loss of 10 lbs on the Holford diet.

Patrick tells us that poor Danielle was in a bad way when she consulted him:

“A diet of crisps, sweets, McDonalds and beer as well as lack of exercise had led to Danielle becoming her heaviest ever, and suffering from health problems such as poor digestion, lack of energy and severe premenstrual syndrome.”

Ah… so that was what all the Celebrity Big Brother 5 fuss was about…

Anyway, the food Patrick’s diet includes, if the daily menu listed for Ms Lloyd is representative, is perfectly sensible. Of course, this is not altogether surprising since there is rather less difference than you might think between a “detailed Low-GL weight loss diet plan” and the famously concise dietary advice from New York Times writer Michael Pollan that Holfordwatch like to quote:

“Eat food. Not too much. Mostly plants”

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But - Food is never enough for Nutritionistas

If sensible dietary advice was all that was on the table (lame pun), Patrick and the rest of the Nutri-gurus would not annoy me so much. As ever, though, the Nutritionistas cannot just leave it at that. You invariably need a whole load of add-on nonsense too, preferably at considerable expense (to you).

This pattern is followed for Danielle Lloyd. As Patrick goes on to tell us, after the inevitable York Laboratories “Food Intolerance” test

*sigh*

- and the equally inevitable resulting diagnosis of “dairy intolerance”

(PS - does anyone who has Patrick’s tests ever NOT get diagnosed with dairy intolerance?)

- Ms Lloyd is now much restored, thanks to, inter alia:

“[ supplemental] digestive enzymes, probiotics and a teaspoon of glutamine powder- which is like an MOT for your insides.”

Luckily, Danielle will not have to maintain this punishing regime because now that she has had her Holford Full Service Bowel MOT she can be kept roadworthy with some minimal (though not exactly cheap) routine nutritional maintenance:

“She will… not need these but will continue to take my Optimum Nutrition Pack”.

Which is one of Patrick’s cheaper supplements at a mere £ 1.25 a day. The advertisting tells us that this supplement is Taken on a daily basis by Patrick Holford himself”.

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A (proper) doctor writes

Dr Crippen over at NHS Blog Doctor has been blogging about nutritionists this weekend, and summarizes the mainstream medical and scientific view - and cynicism about the supplement peddlers - thus:

“There is nothing wrong with dietary advice and anyone out there wanting sound dietary advice need look no further than the British Dietetic Association which I frequently recommend to patients. There is nothing wrong with good nutrition either. Where most doctors part company with “nutritionists” is when they start to make extravagant and scientifically unfounded claims about the healing powers of particular nutritional regimens. Eat more “insert your favourite food” and you will have less chance of getting “insert your favourite cancer”. Odd diets are often supplemented by recommendations to take huge quantities of additional minerals and vitamins, and the really astute “nutritionists” will have internet web sites from where they sell plausible combinations of said vitamins and minerals.”

Of course, this doesn’t sounds like a description that could fit Patrick Holford…

…er…

No, surely not. Patrick truly bestrides the world of nutrition like a colossus. From Cochrane reviews to Micro-celeb tummy in one click of a mouse. Truly, mere words cannot do the man justice.