Is it fair to compare "Alternative Facts" with "Alternative Medicine"

I came across this “meme” on Facebook today:

“The very concept of alternative medicine exists to create a double standard where the rules of science and evidence are stood on their head specifically to manufacture the result that is desired by cranks, charlatans, snake-oil salesmen, and self-proclaimed gurus. There is no alternative medicine. There is just medicine. Either it works or it doesn’t work.”
-Steven Novella

The inevitable retort was: but what about some “natural/traditional” medicines that have not been thoroughly studied. These might work. So, surely it’s an unfair comparison?

My response to that is this:

When people bullshit based on their gut feelings, they can also be right sometimes. It’s only when someone looks into it do we know whether it is actually fact or fiction. “Folk medicine” and natural products may have good (or bad!) effects but it is wrong to imply that they are medicine until we know whether/when they work.

In the same way that an opinion is not an “alternative fact”, a natural product that somebody thinks might do something is not “alternative medicine”.

Then, of course, there is the less generous - but even more apt - comparison of bare-faced lies with bare-faced fraudulent treatments like homeopathy - things demonstrably false that are being badged at truth under the label “alternative”.

I just hope that the war on “Alternative Facts” is more successful than the war on “Alternative Medicine”. The real problem with taking action based on made up stuff is that reality doesn’t care how well-meaning you are, or how much you want it to be true. Hopefully, America will not suffer too much at the hands of reality before Trump and/or his cronies realise this.

Avoiding measles vaccination does not just put children at risk of measles

If you know anyone who is still undecided about, or opposed to, vaccination, please point them to the latest evidence in the journal Science: Measles vaccine protects against other deadly diseases.

The first paragraph sums it up nicely:

“Measles kills about 140,000 people worldwide every year, but the millions of kids who have survived the disease aren’t in the clear. A new epidemiological study suggests that they remain susceptible to other infections for more than 2 years, much longer than researchers anticipated. The results bolster a hypothesis that the measles virus undermines the immune system’s memory—and indicate that the measles vaccine protects against other deadly diseases as well.”

Basically, it seems that the measles virus kills of large number of immune memory cells - the ones that give you a faster, stronger immune response to repeated infections. This means that even if measles itself does not kill you, there is a good chance that it will have “reset” your immune system to something approaching a newborn, removing a whole suite of previously acquired immunity.

This helps to explain why child mortality rates drop much more than would be expected following the introduction of measles vaccination (e.g. this study): not only are deaths from measles and direct measles-associated infections reduced, deaths from other infections are reduced too.

Even if you don’t care about herd immunity and your obligation to the rest of society, get your children vaccinated.

Yet another study debunks yet another vaccine/autism myth

As reported by ABC Science last week, a large study (roughly 95,000 people) has hammered another nail into the well-and-truly debunked vaccine-autism link.

In an accompanying editorial in [the Journal of the American Medical Association (JAMA)], Dr Bryan King, a doctor at the University of Washington and Seattle Children’s Hospital, says the data is clear.

“The only conclusion that can be drawn from the study is that there is no signal to suggest a relationship between MMR and the development of autism in children with or without a sibling who has autism,” writes King.

“Taken together, some dozen studies have now shown that the age of onset of ASD does not differ between vaccinated and unvaccinated children, the severity or course of ASD does not differ between vaccinated and unvaccinated children, and now the risk of ASD recurrence in families does not differ between vaccinated and unvaccinated children.”

Make no mistake: if you avoid vaccines in fear of autism, you are a misguided fool. If you spread this myth, you are an ignorant menace to society. This may sound harsh but people can really die if anti-vaxxers get their way.

Reference:

Jain A, Marshall J, Buikem A, Bancroft T, Kelly JP & Newschaffer CJ (2015): Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism. JAMA 313(15): 1534-1540.

Yet another lengthy investigation concludes that homeopathy is useless

Australia’s main body for health and medical research, the National Health and Medical Research Council (NHMRC), has recently conducted an extensive review of the “evidence for homoeopathy in treating 68 clinical conditions”. Predictably, it concludes “there is no reliable evidence that homoeopathy is effective for treating health conditions”.

No surprise there, but hopefully another nail prepared for the coffin of homeopathy, should drug stores develop of conscience and/or people ever stop getting taken in by utter crap.

The figures are scary, though. According to the news.com.au:

Australians spend almost $4 billion a year on complementary therapies like vitamins and herbs and almost $10 million on homeopathic remedies.

That's $10 million wasted. $10 million dollars that could have been spent on actual medicine. And I shudder to think how much of that $4 billion is wasted on complementary therapies with zero benefit, or worse - probably most of it. To put that figure in context, it is over five times the entire NHMRC 2013/14 budget of $771.2 million for health/medical research funding.

Perhaps the most revealing part of the article was the response of the homeopaths themselves:

However, Australian Homeopathic Association spokesman Greg Cope said he was disappointed at the narrow evidence relied on by the NHMRC in its report.

“What they have looked at is systematic trials for named conditions when that is not how homoeopathy works,” he said.

Homoeopathy worked on the principle of improving a person’s overall health and wellness, and research such as a seven-year study conducted in Switzerland was a better measure of its usefulness, he said.

I’m sorry… what‽ Homeopathy is based on the (utterly discredited) 200-year-old notion that “substances that produce symptoms in a healthy person can be used to [effectively] treat similar symptoms in a sick person”. This is not the principle of “improving a person’s overall health and wellness”, this a principle of targeting specific named symptoms with specific substances. Specific substances that are then diluted far beyond the point that any molecules (or “memory” thereof) remains in the solution (which is then often dropped onto a sugar pill), but specific substances that cause specific symptoms nonetheless.

Mr Cope is right about one thing, though: homeopathy does not work by treating named conditions. Homeopathy does not work.

Don't be an April fool - get (your kids) vaccinated

If there’s one thing that irks me as much as Homeopathy, it’s the anti-vaccination crowd. Therefore, I think that posts like the recent “Dear parents, you are being lied to” at Violent metaphors, deserve as much publicity as they can get. It's a well structured piece, heavily laden with links for further reading, with a heartfelt plea:

In only one respect is my message the same as the anti-vaccine activists: Educate yourself. But while they mean “Read all these websites that support our position”, I suggest you should learn what the scientific community says. Learn how the immune system works. Go read about the history of disease before vaccines, and talk to older people who grew up when polio, measles, and other diseases couldn’t be prevented. Go read about how vaccines are developed, and how they work…

As Professor Simon Foote wrote around a year ago, Parents have a moral obligation to children. Make no mistake about it, failing to vaccinate puts both your children and the children of others at risk. (And not just children.) As the Jenny McCarthy body count reports, preventable deaths in the US alone have exceeded 1300 since 2007, with 100 times that number of preventable illnesses. Whilst not the sole cause, anti-vaxxers must take a share of the responsibility for this.

Like Jennifer Raff at Violent metaphors, I’m sure that some of those opposing vaccination and/or advocating “parental choice” are doing so with the best of intentions. However, good intentions are no defence against disease and anti-vaxxers across the spectrum should take a long, hard look at themselves and ask whether their reasons for opposing the overwhelming global medical and scientific consensus are worth endangering even one life.

If you're not sure, I highly recommend reading the whole article. And if that’s too tame for your tastes, there is also the classic “Angry scientist finds an uneducated internet comment and delivers an epic response…”, which has a slightly less nuanced (but also informative) correction of some anti-vaxxer lies.

Support the Glasgow Skeptics in their fight against quackery

As some of my previous posts have indicated, I am not a great fan of Homeopathy. It is based on flawed principles that have been demonstrated to be wrong, it violates the Laws of Physics and it puts people at risk of harm and even death. It is quackery of the highest order and an embarrassment to a supposedly advanced post-Enlightenment society.

Sadly, however, we have a pro-Homeopathy MP on both the Commons Health Committee and Commons Science and Technology Committee. Furthermore, although not promoted on the NHS Choices website, this proven sham remedy is still available on the NHS despite having no evidence that it works other than as a placebo (what with them being nothing more than sugar pills).

One such NHS-funded travesty is the Glasgow Homeopathic Hospital. The Glasgow Skeptics are understandably saddened by this threat to Reason in their backyard and have set up a petition to NHS Greater Glasgow and Clyde to withdraw funding for Glasgow Homeopathic Hospital:

The Deputy Chairman of the junior doctors committee of the British Medical Association (BMA) has called homeopathy “witchcraft” and “nonsense on stilts”, whilst the BMA conference declared in 2010 that homeopathy has “no place in the modern health service”.

The NHS Choices website states that “there is no good-quality evidence that homeopathy is effective as a treatment for any health condition”, whilst the BMA's director of science and ethics, Dr Vivienne Nathanson, has said that “the funding of the homeopathic hospital should stop”.

It is therefore requested that NHS Greater Glasgow and Clyde withdraw funding for Glasgow Homeopathic Hospital.

You can sign the petition at change.org, here. They deserve the support of all right-minded individuals who want publicly-funded medicine to be evidence-based.

(Sadly, thanks to "Bad Pharma" not even medicine that appears to have evidence for efficacy is necessarily any good. If we cannot even dump the stuff that is proven to be crap, how can we hope to clean up the more complex mess of biased evidence?)

Are anti-vaxxers worse than Homeopaths?

Vaccination has hit the news again recently following an outbreak of Measles in Swansea. Sadly, indications are that this might be the direct result of successful lies and scaremongering by the fraudulent Mr Andrew Wakefield (not "Dr", since he got struck off “dishonest, unethical and callous” behaviour) at the end of the '90s, which caused a lot of parents to avoid giving the MMR jab to their kids. (And he's not finished.)

I don't generally go in for naming-and-shaming on this blog but if you are not familiar with Mr Wakefield's awful behaviour - and he still somehow seems to have supporters - I suggest you read this informative infographic by Darryl Cunningham, "The Facts In The Case Of Dr. Andrew Wakefield", or the more in depth expose by journalist Brian Deer. Not only did Wakefield fabricate data but he also had direct financial interests in seeing the MMR vaccine withdrawn. Bizarrely, far from being disowned by the anti-vax and alternative health community as a fraud and a miscreant, he has been embraced as a champion and hero of the cause.

Anti-vaxxers come in three main flavours, as far as I can tell. First, there are the snake-oil salesmen, who are actively trying to raise funds and/or sell alternative medicine through their scaremongering. These are the worst of the set because they pretend to be campaigning for truth when really they are putting people at risk by spreading lies to line their own pockets.

Second, there are the conspiracy theorists. These are deluded - often by the snake-oil salesman - into thinking that there is some giant conspiracy across science and healthcare professionals to lie to the public because we're all in the pocket of big pharma companies. (It is particularly ironic when these people support the likes of Andrew Wakefield, who was paid to discredit the MMR vaccine!) The tragedy here is that I suspect they are occasionally right about specific cases but, like the boy who cried wolf, who is going listen to them when blanket opposition to vaccination is so patently absurd? (I suspect this group also includes those who have been unfortunate enough to have a child suffer a rare condition or reaction and are looking for something more sinister than bad luck to blame.)

Lastly, there are those who are in favour of living a more "natural" lifestyle and who have sadly been suckered in by the more militant anti-vaxxers in online forums and the like. They may not fully buy into the whole "vaccines are evil" conspiracy, but they have been sufficiently brainwashed regarding the perceived dangers of tried-and-tested vaccines - and dulled to the very real dangers of not being vaccinated - that they avoid vaccinating their own children. This last camp includes the author of the recent "Comment is free" column in the Guardian, "Why I wish my daughter had been vaccinated". I hope more people read it. The evidence is clear. Vaccination is one of the most important medical innovations in history and has saved countless lives. As the article points out, people can only afford to be so complacent about it in the 21st Century because it has been so successful.

It is true that not all vaccines are 100% safe for 100% of people, and some of the stabilisers and adjuvants (immunity boosters) can have risks associated with them - which is why all new vaccines go through intensive testing, clinical trials and monitoring (as MMR has). These are not generally what the scaremongers are talking about, however, as they are generally not just opposed to new and unproven vaccines (indeed, they often promote their own unproven remedies) but instead trot out the same set of busted myths as a basis for opposing vaccination in general. These common myths are explained in "Six myths about vaccination – and why they’re wrong" from a great Australian site that I will be visiting again, The Conversation. (But you will still find them repeated.)

There is a small but genuine minority of people for whom vaccination is not possible, usually due to an allergy or immune deficiency of some kind. These people - along with the other small minority for whom vaccination fails - are wholly dependent on "herd immunity" to keep those nasty diseases at bay. This is the very real phenomenon where a sufficient proportion of the population is immune such that the disease is unable to take hold and spread.

By refusing to get their children vaccinated and discouraging others from doing so, anti-vaxxers are weakening the effects of "herd immunity" and out-breaks such as the current (and frankly embarrassing) UK measles outbreak in Wales are the result. You are not just endangering your own children, you put the children of others at risk, and that is just not fair. It's a bit like people who think that speed limits or the Highway Code do not apply to them. You can get away with such behaviour for a while so long as everyone else is following the rules because they are keeping you safe with their diligence. Whether born of ignorance or not, it's selfish, pure and simple.

But what if you are worried that you are one of those - or might be - with a genuine bad reaction to vaccination? Don't you have the right to avoid that risk?

No. First, bad reactions to vaccines are both rare and even more rarely as bad as getting the disease you are being vaccinated against. We tend to forget that because, ironically, vaccination has been so successful that incidents of these nasty diseases are themselves rare. Yes, you might be the unlucky one to experience a bad reaction - but you might equally be the unlucky one to get the life-threatening disease if there is a lack of herd immunity. Second, because of herd immunity, people with known bad reactions to vaccination should be even more pro-vaccination! Without the ability to get protection themselves, they are relying on the civil responsibility of others.

I've blogged a few times about Homeopathy, a sham treatment of sugar pills or water with no scientific basis nor evidence for efficacy that (shamefully) is still offered on the NHS in some places. Most homeopathic treatments are targeted at fairly innocuous conditions and are usually sold alongside real medicine, so the main damage done is to your finances (and maybe your pride once you realise you've been scammed). Apart from the diversion of funds from legitimate treatments, however, the damage done to third parties by Homeopaths is minimal.

"First, do no harm."

These words, attributed to Hippocrates, nicely sum up the essence of the "Hippocratic Oath" that (ethical) practitioners of medicine generally swear to. Anti-vaxxers, in contrast, put innocents at risk, including those who have not embraced their twisted and deviant message of lies. For that reason I think, yes, they are worse than Homeopaths - at least if you buy into the hogwash of Homeopathy, you are usually only harming yourself. (Sadly, that's not always the case and reliance on homeopathic treatment can kill children too. I think the effects on society are smaller, though. That said, the lesser of two evils is still evil.)

Save the Pangolins!

The picture on the right is a pretty shoddy one I took in the Royal Ontario Museum in Toronto (more on that later) to remind me to write a post about pangolins because I think they're great. (There's a better Wikipedia photo by Valerius Tygart, below, of a tree pangolin). This is not really what I had in mind but it will do until I get to write a proper one, as there is currently a Care2 petition to the Prime Minister of Vietnam to crack down on the illegal trade in pangolins. It's not just rhinos that are endangered due to the supposed healing qualities of their body parts. (Pangolin scales, like rhino horns, are nothing more exotic than keratin - like finger nails.)

I'm not sure how much good these things do but the Thai Prime Minister vowed to end the ivory trade last month following a large WWF campaign, so it can't do any harm. Look at this guy and tell me that the world wouldn't be diminished without him* - then sign the petition:

*In the interests of full disclosure: (a) the tree pangolin shown is not one of the two threatened species - the Sundra pangolin and the Chinese pangolin - in Vietnam, and (b) I don't know if it's a he.

Not so much a ‘wake up call’, having pro-homeopathy MP David Tredinnick on the Commons science committee is the stuff of nightmares

Sadly, the recent kerkuffle over the portrayal of homeopathy on the NHS Choices website and the government's flagrant disregard of scientific advice on culling badgers may well just be the tip of an iceberg that the good ship Great Britain is sailing towards, full speed ahead.

Apparently, the Conservatives want to be the Republican Party so much that they have elected science-illiterate MP David Tredinnick to both the Commons Health Committee and Commons Science and Technology Committee. The problem? In the words of Miriam Frankel in her recent piece, ‘Wake up call’: Q&A with pro-homeopathy MP David Tredinnick, this is a man who "thinks the moon influences human behaviour and believes that homeopathy works."

As a scientist, the piece does not make happy reading.

"I’ve come onto this committee as someone who wants to see it take a broader view of science. I don’t believe that science is about defending the status quo: it’s about pushing boundaries. It’s really significant that I got onto this committee and I think it should be a wake-up call to those in the scientific community who don’t want to explore alternatives."

This doesn't sound too bad until you realise what the alternatives are that he wants to consider: homeopathy, acupuncture and herbal medicine.

"I think there are some good, double-blind placebo-controlled trials that have been conducted by the Integrated Healthcare Hospital, formerly the Royal London Homeopathic Hospital. But there’s also an enormous amount of evidence available through the observation of patients, so we shouldn’t ignore that. The other thing is that is very safe and very inexpensive. It should be more widely available on the NHS. And we should be teaching people to use simple homeopathic kits to stop unnecessary visits to doctors’ surgeries."

What?! Have you even read the House of Commons Select Committee (Science and Technology Committee) Evidence Check for Homeopathy? It's "safe and very inexpensive" because it doesn't contain any active ingredients! It has been explored by science. What possible motive do scientists and doctors have for not promoting homeopathic medicine if it actually worked? Not knowing how it works? We don't know how Paracetamol works but we use that.

It gets worse:

"I think that if the sun has an impact on our lives and the moon has an impact on the tides and cycles, it is logical to suggest that it might have an impact on other aspects of our lives as well. It’s accepted that at certain times certain people’s behaviour gets more extreme at the full moon—that’s, I think, scientifically proven. Hormonal reactions to increased positive ions in the air—the full moon effect—can cause hyperactivity, depression, violent behaviour, etc."

No, David, that's unscientific crap. You're right that science is about "pushing boundaries" but the way we push those boundaries is by ruling out the hogwash, like homeopathy and "the lunar effect". It is most certainly not by promoting hearsay and anecdote as a basis for policy or a way to determine efficacy.

Someone made a petition to remove David Tredinnick from the House of Commons Science and Technology Committee but it's been rejected because "E-petitions cannot be used to request action on issues that are outside the responsibility of the government". Hmmm. I'll feel another letter to my MP coming on.

h/t: Rachel Nesbitt at the Society of Biology.

Another small victory in the fight against quackery but the NHS is yet to dilute its shame to Homeopathic concentrations

As blogged recently by Rachel Nesbitt at the Society of Biology, NHS Choices website becomes ‘neutral’ on homeopathy, the NHS Choices website had recently diluted its stance on the inefficacy of homeopathic 'treatments' in response to lobbying.

Happily, in response to a deluge of disgruntled comments, the original text has now been replaced and the site now begins:

"Homeopathy is a 'treatment' based on the use of highly diluted substances, which practitioners claim can cause the body to heal itself.
A 2010 House of Commons Science and Technology Committee report on homeopathy said that homeopathic remedies perform no better than placebos, and that the principles on which homeopathy is based are 'scientifically implausible'. This is also the view of the Chief Medical Officer, Professor Dame Sally Davies."

It's still not all good news, though. As the website explains further down the page:

"It is available on the NHS?
The Department of Health does not maintain a position on any particular complementary or alternative therapy, including homeopathy. It is the responsibility of local NHS organisations to make decisions on the commissioning and funding of any healthcare treatments for NHS patients, such as homeopathy, taking account of issues to do with safety, clinical efficacy and cost-effectiveness and the availability of suitably qualified practitioners.
Homeopathy is not available on the NHS in all areas of the country, but there are several NHS homeopathic hospitals and some GP practices also offer homeopathic treatment."

I'm not sure if this is a deliberate typo - the link at the top of the page reads "is it available..." rather than "it is available..." but, tragically, yes, homeopathy is available on the NHS in some places. With Jeremy Hunt as Health Secretary and pro-Homeopathy Conservative MP Tredinnick on the Commons science committee, I genuinely fear for any future hopes evidence-based science policies in general (badgers beware), and for the NHS in particular.

In case anyone is in anyone doubt as to the driving force behind promoting homeopathy, the final paragraph of the "is it available..." section reads:

"Homeopathy is usually practised privately and homeopathic remedies are available from pharmacies. The price for an initial consultation with a homeopath can vary from around £20 to £80. Homeopathic tablets or other products usually cost around £4 to £10."

That's right. £4 to £10 for some sugar pills. And if you think that homeopathy is harmless, the tell that to anyone duped into giving their child a homeopathic vaccine. (Their opposition to vaccines is particularly ironic, given that the only shred of science that comes even slightly close to homeopathy is that small amounts of a pathogen - an actual vaccine - can potentially give you protection. The mechanism is entirely different, though. (It's real, for one thing.))

If people want to take a placebo, that is their choice - and it might even still work if given explicitly as such - but hiding the fact that a 'treatment' is just a placebo is irresponsible. Promoting it in favour of actual treatments should be criminal. Thanks to the games played by big pharma, the battle for getting decent evidence-based medicine is hard enough. If we can't even stamp out something as obviously nonsense as homeopathy, what hope do we have?

The stupidity of poaching rhino and the wider importance of evidence-based medicine

Extinction - and danger of extinction - is sad whatever the cause but when the cause is motivated by sheer nonsense it is particularly upsetting. Black Rhino are critically endangered and under increasing threat from poaching because of their horns. (The picture is actually of Southern white rhino at Dublin Zoo, which are "near threatened" rather than endangered.)

The stupid thing is that the horns have no intrinsic value - they are just keratin, which is essentially the same material as hair and nails. It is only because traditional medicine in several countries value rhino horn so highly, that poaching is so lucrative. Rhino horn has no clinically proven benefits. You might as well grind up your toe-nail clippings. (Try spinning that as an aphrodisiac.)

I've moaned before about Homeopathy and the like but the importance of evidence-based medicine goes well beyond the obvious issue of efficacious treatment. Promoting any woo indirectly supports all the tragedies associated with extreme cases, including using endangered species in "traditional" medicine. If it really works, the chances are that we can work what it is that is actually having an effect - and possibly why - and try to find an alternative source. All the time we embrace ignorance, we embrace ignorant practices.

Are big pharma companies worse than homeopaths?

Ben Goldacre is well known for busting Bad Science and promoting evidence-based medicine. His latest book, Bad Pharma, goes beyond quackery and takes on Big Pharma, highlighting what are down-right dangerous practices in the industry. I haven't read the book but his recent article about it in the Business section of the Guardian, "The drugs don't work: a modern medical scandal", makes scary reading. You can also hear him talk about it in a recent Nature Podcast Extra.

It's common knowledge that Homeopathy is pure placebo and literally has no active ingredients. The danger of homeopathy is not that it will do you any harm - there is nothing in there to do any harm - but rather that people will be conned into using Homeopathy in place of treatments that could actually cure them. (Not all conditions can be treated effectively with a placebo and some drugs out there genuinely do work better than placebo.)

The same is not true of drugs. (Or herbal remedies for that matter.) They contain an active ingredient and therefore there is the very real potential for harm as well as the very real potential for an actual positive effect. It is therefore much worse to find out that Big Pharma companies are playing games with the clinical trials and evidence on which doctors base their treatments.

Big Pharma, Homeopaths and woo merchants are all in the business of making money and so it is perhaps not surprising that they use some of the same tricks to sell their wares but what is surprising (to me) is the extent to which the law lets them get away with it and regulating authorities are apparently powerless to do anything about it. Although it does nothing to undermine the need for evidence-based medicine, it massively undermines the access to evidence-based medicine - if the evidence the doctors get access to is hidden or distorted then what's the point?

It's a pretty stark picture. Indeed, Ben Goldacre starts the book thus:

"Medicine is broken. And I genuinely believe that if patients and the public ever fully understand what has been done to them - what doctors, academics and regulators have permitted - they will be angry... I'm going to tell you how medicine works, just over the page, in one paragraph that will seem so absurd, so ludicrously appalling, that when you read it, you'll probably assume I'm exaggerating."

Before I get to that paragraph, I would say that there is at least one other group that will be (and are!) angry - other academics. I am one! I am angry as both a sometimes patient and a scientist. (And, when it comes to medicine, a member of the public!)

The reason this angers me as a scientist are two-fold. First, the trivially obvious reason: such flagrant abuses of methods that are supposed to provide objective evidence not only undermine public faith in medicine but they undermine faith in science as a whole. (Not, sadly, that non-medical science is immune to these abuses but they generally seem to get identified by other scientists, who are all skeptics by nature, and rarely have the same capacity for harm.) The second reason is that it is not just doctors and patients that use these data. There is a lot of effort being put into mining existing drug actions and side effects to identify novel treatments (e.g. "network medicine") - often by people who do not stand to make money from the discovery. The weakness with all of these approaches is that "rubbish in, rubbish out" and if the pharma industry is systematically sabotaging the data that the scientific community are using for such endeavours then a lot of good scientists are wasting valuable time and money, not to mention missing important connections that could result in genuine treatments.

But now for that paragraph. You can read the full paragraph using Amazon's Look Inside feature but here's a taster:

"Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don't like, they perfectly entitled [legally, not morally - RJE] to hide them from doctors and patients, so we only ever see a distorted picture of any drug's true effects. Regulators see most of the trial data, but only from early on is a drug's like, and even then they don't give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated in a distorted fashion..."

The rest of the paragraph - and, judging by the intro, the book - is not much cheerier. It's no wonder he says that Medicine is broken. When I am feeling brave, I think I will order a copy for my kindle.

Nevertheless, I think there is something worth pointing out or reiterating: this is a problem of implementation, not theory. It is not that drugs cannot or do not work - some do and we have well-designed and well-executed studies that show this. (Generally, the older ones, when Pharma was not so desperate or, perhaps, cynical and there was more low-hanging fruit.) It is not that medicine should not be evidence-based or that we do not have methods for gaining that evidence. This does most emphatically not mean that homeopaths and woomeisters were right all along. The fact that some of their conspiracy theories have a semblance or truth about them does not mean that their pseudoscientific nonsense suddenly gains merit.

I'm not really sure what can be done about this but the first step on the road to recovery is admitting that you are sick, and it certainly cannot be swept under the carpet. Part of me still hopes that Ben Goldacre's new book is an exaggeration (or, at least, concentrates on all the negatives) but can we really take that chance? However widespread the problem in terms of current drugs that are affected, we must make some changes to things that are clearly broken. Making the clinical trials process entirely independent of drug companies would be a start and forcing drug companies to publish all of their data from trials for analysis by independent experts seems like such a no-brainer that my mind still boggles a little at the revelation that it isn't so.

Should it be needed, it's just another indicator of the dangers of privatising health care. When the bottom line is money not effectiveness, you know you are in trouble.

The (lack of) evidence for Homeopathy

Yesterday, I mentioned the House of Commons Select Committee (Science and Technology Committee) Evidence Check 2: Homeopathy.

It's quite a long report, so I think it worth highlighting a few of the conclusions here:

54. We conclude that the principle of like-cures-like is theoretically weak. It fails to provide a credible physiological mode of action for homeopathic products. We note that this is the settled view of medical science.

61. We consider the notion that ultra-dilutions can maintain an imprint of substances previously dissolved in them to be scientifically implausible.

70. In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos. The Government shares our interpretation of the evidence. We asked the Minister, Mike O'Brien, whether the Government had any credible evidence that homeopathy works beyond the placebo effect and he responded: "the straight answer is no".

77. There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious. Competition for research funding is fierce and we cannot see how further research on the efficacy of homeopathy is justified in the face of competing priorities.

82. We do not doubt that homeopathy makes some patients feel better. However, patient satisfaction can occur through a placebo effect alone and therefore does not prove the efficacy of homeopathic interventions.

101. We agree with Professor Ernst and the RPSGB. For patient choice to be real choice, patients must be adequately informed to understand the implications of treatments. For homeopathy this would certainly require an explanation that homeopathy is a placebo. When this is not done, patient choice is meaningless. When it is done, the effectiveness of the placebo—that is, homeopathy—may be diminished. We argue that the provision of homeopathy on the NHS, in effect, diminishes, not increases, informed patient choice.

109. When the NHS funds homeopathy, it endorses it. Since the NHS Constitution explicitly gives people the right to expect that decisions on the funding of drugs and treatments are made "following a proper consideration of the evidence", patients may reasonably form the view that homeopathy is an evidence-based treatment.

Conclusions

110. The Government's position on homeopathy is confused. On the one hand, it accepts that homeopathy is a placebo treatment. This is an evidence-based view. On the other hand, it funds homeopathy on the NHS without taking a view on the ethics of providing placebo treatments. We argue that this undermines the relationship between NHS doctors and their patients, reduces real patient choice and puts patients' health at risk. The Government should stop allowing the funding of homeopathy on the NHS.

111. We conclude that placebos should not be routinely prescribed on the NHS. The funding of homeopathic hospitals—hospitals that specialise in the administration of placebos—should not continue, and NHS doctors should not refer patients to homeopaths.

I'm not sure whether the NHS still funds it but I am sure that it shouldn't. It appears, however, that BUPA are no do know is that BUPA no longer do, at least for its "bupa Select" cover. Point six on their notification for change states:

6. Complementary medicine practitioners, homeopathy
 We no longer provide cover for homeopathic treatment.

Homeopathy: there's nothing in it.

UK Homeopathic manufacturers might have to sell their sugar pills as... sugar pills!

If I had to draw up a top three list of irrational nonsense that makes me fear a little for the future of humanity, Homeopathy would probably be on that list. It embodies everything that is wrong about "woo" - disproven bunk supported by liars spouting pseudoscientific nonsense in order to extract money from the gullible, credulous and/or desperate.

It should be illegal to pretend that sugar pills or water are medicine. Happily, it turns out, it is! In a great Guardian piece yesterday - Homeopaths offer to rebrand products as 'confectionery' - "The Lay Scientist" Martin Robbins reports that:

Under current UK law*, it is an offence for a lay homeopath to supply or sell unlicensed homeopathic medicines for which they do not hold a certificate of registration from the MHRA. Unlicensed remedies can only supplied by those with prescribing rights - medical doctors or registered pharmacists - and then only after a face-to-face consultation with the patient. Since very few homeopathic products are licensed, this means a huge swathe of Big Sugar's products are, in theory at least, not legal.

*The Medicines (Homoeopathic Medicinal Products for Human Use) Regulations 1994, as amended in 2005.

Furthermore, under the Human Medical Regulations Act, there is an obligation to enforce this law if a complaint is made - and, thanks to Simon Singh and friends, complaints are being made! It's still not clear to me how much actual fallout from this there will be but it's definitely a step in the right direction.

Martin Robbins ends his piece with this great line:

"I've got no problem with people buying and selling homeopathic remedies for their aches and sniffles. Just don't pretend it's a real medicine, and don't persuade people it can treat dangerous diseases. Is that really so much to ask?"

I hope not, Martin. I really hope not.

(And in case you are under the impression that Homeopathy might be effective, read the House of Commons Select Committee (Science and Technology Committee) Evidence Check 2: Homeopathy.)

[Edit: I was obviously having a brain-dead moment when writing this and erroneously called Martin Robbins, Tim. Doh! Sorry, Martin.]