“Now Look What You’ve Made Me Do”

June 12th, 2006 by Ben Goldacre in adverts, africa, bad science, dangers, herbal remedies, homeopathy, times | 27 Comments »

Poor old Susan Clark, previously a regular Bad Science target when she was writing “What’s The Alternative” in the Sunday Times, she is now in a position of total safety at The Observer.

Apparently in the past the poor thing has had such a hammering for her advice on malaria medication, that now her readers have to suffer. Actually it’s all my fault. No hang on. It’s your fault for encouraging me. I hope you all feel very very very guilty.

observer.guardian.co.uk/woman/story/0,,1792154,00.html

Two months ago I took the anti-malarial drug, Malarone, for two weeks, at the end of which my tongue felt as if I’d just burnt it and the inside of my lips felt dry. The feeling went away after a month but now it’s back. Do you think they’re linked and what should I do?

[Susan Clark replies]:

“I often think if herbal and nutritional supplements came with the same alarming long list of recognised and unpleasant side-effects as many prescription drugs they might then actually deserve the suspicion with which they are so often treated.

“You need to check the data sheet supplied with the drug to establish that these sensations could be side-effects but even if they are, I have had such a complete hammering in the past for suggesting any kind of alternative (including homeopathic and herbal remedies) to prescription drugs for malaria that I am afraid you will have to persist with this medication and instead, try to deal with the possible side-effects which, for a small number of people taking them can also include nausea and vomiting.”

The complete hammering to which she refers is, I believe, here:

www.badscience.net/?p=211


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27 Responses



  1. Ben Goldacre said,

    June 12, 2006 at 11:41 am

    Actually, I’ve just noticed, Clark is very keen on promoting a company called “Victoria Health”.

    They have had 6 references in the Observer since the public electronic records began (these records go back, albeit patchily, to the late 19th century). Here are those results:

    browse.guardian.co.uk/search?search=www.victoriahealth.com&N=

    * Observer, Sunday June 11 2006
    * Susan Clark

    * Observer, Sunday May 14 2006
    * Susan Clark

    * Observer, Sunday April 9 2006
    * Susan Clark

    * Observer, Sunday March 12 2006
    * Susan Clark

    * Observer, Sunday February 12 2006
    * Susan Clark

    * Observer, Sunday January 15 2006
    * Susan Clark

    This seems to me like rather a lot for one company to be promoted, but I don’t read the glossies very much so I might be wrong. Is there any data on how frequently different alternative therapy columnists promote a given product or vendor over time? It would be interesting to see if any statistically significant patterns emerge, and then see if this is related to the market share of the business being promoted, the range on offer, relationship with/personal preference of the columnist, or any other possible factors.

  2. sockatume said,

    June 12, 2006 at 11:48 am

    “I often think if herbal and nutritional supplements came with the same alarming long list of recognised and unpleasant side-effects as many prescription drugs they might then actually deserve the suspicion with which they are so often treated.”

    It’s kind of hard for something with no effect to have a side-effect.

  3. Ithika said,

    June 12, 2006 at 12:02 pm

    “It’s kind of hard for something with no effect to have a side-effect.”

    There’s always the deleterious effect it has on your wallet and your ability to tell reality from fantasy.

  4. rvcx said,

    June 12, 2006 at 12:12 pm

    Listing side-effects would be absolutely catastrophic for all categories of placebo drugs. Wouldn’t they be just as likely to cause side-effects as to reduce the original complaint? How does patient belief in multiple effects affect each individual impact? Is there a single “total placebo effect” for a treatment which must be divided among all symptions, does increasing the number of claimed effects increase the total, or does a collection of effects just distract the patient from the main placebo effect they are trying to achieve? (I use “distract” quite literally, as psychology is clearly the primary delivery mechanism for placebos.)

    Does anyone actually do this kind of useful research on placebo treatment, or are all “alternative treatment” funds still directed to demonstrating that they are not placebos?

  5. ACH said,

    June 12, 2006 at 1:08 pm

    Re Ben’s comment (1). I’ve just seen a link over on the forum to Emma Mitchell’s column from the Grauniad on 10/6/06. She’s also recommending Victoria Health products. Maybe the Observer/Guardian group has shares?

  6. Michael Harman said,

    June 12, 2006 at 1:48 pm

    rcvx refers the question of side-effects from hoeopathics. That’s caused me to think about how homeopathics are produced. I know that one starts off with a solution of the active principle, and then goes through a sequence of dilutions and succussions (shakings), and the potency of the stuff is supposed to increase with each dilution and succussion.

    But how exactly is this done? One presumably starts with a beaker of the initial solution, pours a bit into a bottle, and succusses it. Do you then empty the beaker, wash it out, pour the bottle into it, top up with 100 times of pure water, and repeat the process? There will presumably be traces of the previous contents left in the beaker. But logically (as far as logic has any place in this matter), one might suppose that a little bit of low potency stuff won’t affect the higher potenty stuff.

    But then wehat happens to the beaker (and bottle) at the end of the procedure? I suppose the bottle may get sent out to be sold to the patient; but I gather that it may instead be used to pour over a batch of sugar pills. So we have a beaker, and quite possibly a bottle, which have traces of high-potentcy stuff on/in them. (And don’t tell methat every single homeopath, since the system first began, has exercised such scrupulous care than no single homeopath since time began has ever ever ever made a mistake and re-used the same beaker or bottle.)

    What would happen if by some mischance they got re-used? As soon as they get filled, they’ve got a highly dilute solution of the last batch of stuff already at maximum potency, and that now goes through several more cycles. It must finish up with absolutely GINORMOUS potency. There would be no need for anyone to actually take it; it would be eating its way out of the bottle if it merely passed near someone. And how would the patent react to such super-duper-extra-blowyourballsoffifouevensniffit strength stuff?

  7. Dr Aust said,

    June 12, 2006 at 2:14 pm

    Of course, herbal medicines can, and do, have side-effects: e.g. photosensitivity (a bad rash when you go out in the sub) in some people taking St John’s Wort for mild depression. There have been quite a few cases of serious adverse effects from certain Chinese traditional remedies.

    Homeopathy should theoretically have no side-effects, since there is nothing in it.

    Note, though, a sugar tablet or tincture of homeopathic water is just as likely to have what I think of as “false positive side-effects” as a real drug. Point here is that if you are unfortunate enough to have some unexpected health problem at the same time (more or less) as you start taking a tablet (herbal or prescription) you might want to report it. But it could just be a coincidence (e.g. you ate a dodgy curry and got terrible acid stomach / the runs at the same time as you started on St Vitus bladderwort, or on statins. You blame the pills rather than the prawn Bhuna.

    One point of having reporting of what people think might be side-effects ot prescription drugs (“please report anything unusual”) is to allow an assessment of whether the side effects are sufficiently “consistent” to make the regulators think it is a real side-effect of the pills. But statistically a certain fraction of what is reported as side-effects MUST be unrelated to the drug.

    Snag- in the UK with unlicensed herbal medicines you buy in Boots there is no-one for you to report it to. So these medicines don’t have the long list of side-effects largely, I would suggest, because they are unregulated and there is no reporting. This is one reason why herbal medicines are regulated in other countries. If you take St John’s Wort in Germany it will have come from a medical practitioner and be treated like any other medicine. Actually, the more reputable a supplier of a herbal formula (serious suppliers with quality control and testing of product content, again more common in Europe) the MORE likely there is to be a proper side-effects leaflet in with your (e.g. again) St John’s Wort tablets. The more bogus the product the less info.

    My friends who studied medicine in Germany often tell me how absurd they think it is that the herbal remedy sector is unlicensed in the UK, especially given the huge profits it generates for people like Boots.

    Another point is whether people BELIEVE that the things will have side-effects – back to good old perception or “health beliefs”. If you believe your herbal formulations don’t have side-effects, you won’t attribute those stomach cramps to the herbs.

    Talking of perception, sSaw a hilarious Alt Med piece in one of the Sundays a week or two back. “Alt Med cured my bad back when the Dr couldn’t”.

    Turned out the osteopath (or other alt person) told the guy to get up out of bed and keep mobile. This is of course the current mainstream NHS wisdom, evidence-based even, for back pain. The writer’s GP may have been a dingbat (although it wasn’t clear whether he had been ordered to stay in bed or had just decided that bed rest was the “medical” treatment for his back pain) but exercise is hardly an “alternative therapy”. It must be one of the commonest things GPs recommend to their punters.

    Perhaps what this tells us (again) is that the patient is more likely to TAKE UP exercise if told to by a stern Alt Therapy Guru (at 100+ quid/hr) than if told to by their GP. Bring back James Robertson Justice and medical paternalism, eh?

  8. Dr Aust said,

    June 12, 2006 at 2:16 pm

    PS I meant “go out in the sun”, of course. Blame my typing. Wasn’t suggesting St John’s Wort makes people drive submersibles

  9. Sociology Boy said,

    June 12, 2006 at 2:45 pm

    Susan Clark? Victoria Health? Surely that can’t be the same Susan Clark that has a series of columns (called ‘What Really Works’, natch) published on, er, www.victoriahealth.com? Have a look at the wisdom that is contained here: www.victoriahealth.com/vh2/contents/genericPage.csp?pageID=1204

    Can’t imagine that there would be a conflict of interests between her work in the Sunday Times and flogging tat through Victoria Health, but there you go.

  10. Sociology Boy said,

    June 12, 2006 at 2:52 pm

    Sorry, did I say Sunday Times above? I meant Observer, and of course her columns on the Victoria Health website were written prior to her time there.

  11. Ben Goldacre said,

    June 12, 2006 at 3:05 pm

    no, hang on sociologyboy, that is odd… i think susan clark might also have mentioned Victoria Health a few times in her sunday times column… wait a minute… in fact… she recommended Victoria Health more times than i can even be bothered to count, somewhere between 34 and 46 according to google.

    www.google.co.uk/search?num=100&hs=RQn&hl=en&client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&q=+site%3Awww.timesonline.co.uk+%22victoria+health%22+susan&btnG=Search&meta=

  12. Dr Aust said,

    June 12, 2006 at 3:17 pm

    Nice one Sociology Boy

    Plus ca change….

    The “What really works” tag had me laughing. I read one of her columns at random and found it touting Lemon Balm as a therapy for “low mood or melancholia”. This was a response to someone who had taken Prozac but wanted a herbal remedy.

    According to La Clark lemon balm “performed well in double-blind, placebo-controlled University research trials”. This looked suitably impressive and caught my eye so I had a look on medline. There ARE two or three small trials, all done at one unit in Newcastle. But they actually say nothing about low mood/melancholia, instead indicating that the stuff might help with mild anxiety, or help you concentrate. Not quite the same thing as treating depression.

    I really can’t believe what some of these people get away with. Can they sleep at night? Probably after a strong draught of Lemon Balm, KavaKava and Valerian.

    This is actually a mild example of Alt-Healthery, since at least it is based on something vaguely scientific, however minimal.

    It all just testifies to the credulousness of the public, fed by the voluminous mystification (can I say that?) of all the Alt Health columnists and pundits. The public seem to want desperately to believe in magic bullets for curing disease or keeping you healthy, only they want to have “natural” ones instead of “Drugs”. A fascinating (if depressing) phenomenon.

    Diet is another good example of Alt Health mystification. One of my more trenchant medical buddies has taken to joking that he is going to write a dietary advice book (a la Poo Lady) containing the evidence-based info about diet and health, and retire on the proceeds. The trouble is that apart from the old nostrums (“Eat lots of fresh produce” “At least five portions of fruit and veg a day” “Avoid processed foods” “Try and cook with unsaturated fats” “don’t eat too much red meat”) there isn’t much to say. But of course if people really hoisted in that the sensible advice on diet

    (i) is already dispensed by mainstream healthcare people; and
    (ii) could probably go on one side of A4 paper

    then the whole Alt Health industry would risk going down the pan.

  13. raygirvan said,

    June 12, 2006 at 3:23 pm

    Further machinations: I notice Victoria Health has a special relationship with the Mail on Sunday’s YOU magazine. See Victoria Health and YOU.

  14. pseudomonas said,

    June 12, 2006 at 3:30 pm

    Well, according to the Victoria Health website: The information and products contained within this website are not intended to diagnose, treat, cure or prevent diseases.

  15. Dr Aust said,

    June 12, 2006 at 3:42 pm

    Dontcha just love a blanket disclaimer?

    Without labouring the point (oh well, I’ll just go ahead and labour it, why not….) the Alt Health people get to have their cake and eat it. If your doctor misdiagnoses you, or gives you the wrong treatment, you can sue him/her, and s/he can get struck off and lose their livelihood.

    If you go to an Alt Health practitioner with a condition that is eminently treatable by conventional medicine, they are mostly under no professional obligation whatsoever to tell you so (unregulated, again). Instead they can charge you whatever you are prepared to pay for Bach Flower Remedies, Primal Scream therapy, Homeopathic tinctures, Laying On Of Hands etc.

    You might describe this as “odd”.

  16. pseudomonas said,

    June 12, 2006 at 3:51 pm

    It’s great the way that you can avoid all the trading standards / advertising standards regulation if you persuade a columnist to spout guff about your quacksalvery rather than taking out and advertisement directly.

  17. Ben Goldacre said,

    June 12, 2006 at 4:16 pm

    pseudomonas: i think that’s an incredibly good general point, the columnists make the dramatic claims and the adverts remain neutral. this is at it’s most obvious with the vitamin ads, esp glucosamine, where all the ads ever tend to mention is the dose, the newspapers do the rest of the work for them.

  18. Dr Aust said,

    June 12, 2006 at 4:35 pm

    Found my way from Emma Mitchell’s columns to the website of the Nutritional Therapy Council (NTC) at

    www.bant.org.uk/bant/jsp/index.faces

    – she recommended it in one Guardian column as a way to find a nutritional practioner in your area.

    ..anyone know anything about this lot?

    The BANT website looks quite official, with links to “Training” and stuff about “qualified nutritional practioners” and even a Complaints Procedure, so they seem to be trying to look official and self-regulating / respectable. The list of “Training Institutions” is all small natural health colleges, plus the Westminster University School of Integrated Health.

    I know David Colquhoun on his website at

    www.ucl.ac.uk/Pharmacology/dc-bits/quack.html

    gets particularly exercised about Universities setting up “Alt Health” degrees. Can’t remember if he’s had a go at Westminster

  19. tom p said,

    June 12, 2006 at 4:35 pm

    Another thing that marks Susan Clark out as stupid and dangerous and actively harming the morons who read her and take heed of her advice is this line “I am afraid you will have to persist with this medication and instead, try to deal with the possible side-effects “.

    If she had the slightest brain or sense or compassion, she would tell the poor sod to go and see their doctor and tell them what has happened. The doctor could then prescribe a different medication.

    Hopefully, the doctor would then inform the MHRA of this side effect, but it’s frankly unlikely given the low low reporting rates of adverse drug reactions by doctors

  20. Ben Goldacre said,

    June 12, 2006 at 4:37 pm

    A Quantitative Analysis Of The Frequency With Which One Company Is Promoted, And By Whom, In UK National Newspapers

    Dr Ben Goldacre*
    Bad Science Research Institute,
    www.badscience.net
    tips@badscience.net
    *Corresponding Author

    Introduction.

    Susan Clark is an alternative therapy columnist who yesterday made a barbed attack on her critics. It has been noted that she promotes one company, Victoria Health, with some regularity. It was unclear what the background frequency of this company being promoted in newspapers was.

    Methods.

    Since I couldn’t be bothered to cycle to the Guardian and go through all the newspaper archives systematically, I had a quick look at each newspaper’s archives through publicly available resources, as a pilot study.

    Results.

    Victoria Health are promoted in the following newspapers and circumstances:

    # You magazine (with which they have an explicit commercial relationship)

    # by Susan Clark (dozens and dozens)

    # by Emma Mitchell in the Guardian. [anybody know if she has a relationship with them?]

    From this brief survey, several interesting negative findings also arose. No mention of Victoria Health could be found in other newspapers. Specifically, there were:

    # no mentions in the Express:

    www.google.co.uk/search?num=100&hl=en&client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&q=+site%3Awww.express.co.uk+%22victoria+health%22+&btnG=Search&meta=

    # no mentions in the Independent:

    www.independent.co.uk/search/simple.do?publicationId=55&includeSectionId=38&xsuccessUrl=index.jsp%3FtemplateName%3Dresult&xerrorUrl=index.jsp%3FtemplateName%3Dresult&searchEngineName=lucySearch1&includeSubSections=true&pageLength=25&articleType=news&sortString=by_date_desc&maxRows=500&searchString=%22victoria+health%22

    # no mentions in the Telegraph:

    www.google.co.uk/search?num=100&hl=en&client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&q=+site%3Awww.telegraph.co.uk+%22victoria+health%22+&btnG=Search&meta=

    # no mentions in the Daily Mail (from google alone) except once briefly in the context of an explicit commercial relationship:

    www.google.co.uk/search?num=100&hl=en&client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&q=+site%3Awww.dailymail.co.uk+%22victoria+health%22+&btnG=Search&meta=

  21. Dr Aust said,

    June 12, 2006 at 4:39 pm

    Re. Pseudomonas’ comments:

    Presumably the columnists are “geared” to writing positive stories: “you could try this” “This might do some good” “read this helps” etc etc. Harder to say “nothing you can do expect eat healthy and take exercise”, they would just keep repeating themselves.

    “Negative results are always harder to publish than a good “this could be something” result”

    .. at last – a parallel between science and Alt Health!

  22. Dr Aust said,

    June 12, 2006 at 4:48 pm

    A palm to David Colquhoun, a very nice man (and a proper scientist) who long ago once attempted to teach me some statistics (the professional statisticians were unable to explain statistics in anything resembling English, sadly all too common a failing) . He has indeed had a go at Univs running Alt Med degrees. See:

    www.ucl.ac.uk/Pharmacology/dc-bits/quack.html#univ

    Go David.

    I have a slightly crazed vision of a Buffy’s gang-style crew of Alt Medicine Slayers. Ben isn’t really blonde enough for Buffy so perhaps he will have to be cast as Xander, plenty ofooprtunities for witty quips. David Colquhoun would be a shoo-in for the Giles role.

    Think I need to lay off the strong coffee in the afternoon.

  23. sockatume said,

    June 12, 2006 at 5:22 pm

    Michael Harman: Just to confuse the matters, I’d like to point out that potency supposedly decreases with dilution in homeopathy. Must be a real pain in the neck when it comes to managing their aqueous waste.

  24. tom p said,

    June 13, 2006 at 10:58 am

    Dr aust,

    There is somewhere for adverse reactions to herbal medicines to be reported – The MHRA. I should know, I was the herbals officer (for my level) there for a while.

    Also, herbals aren’t technically unlicensed, genuine traditional ones can just get an automatic license and don’t have to do anything to get it other than apply (well, I hink they have to show the quality of the product, but other than GMP there’s nothing).

    The one area where they are (in theory at least) regulated is in advertising. Herbal peddlers have to include an invitation to always read the product leaflet or similar (www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&nodeId=600), but rarely do.

    I’ve noticed that adverts for herbals in general almost always fail to comply with the lenient requirements in the blue book (available for download from the above link) and have started complaining to the MHRA (not that they seem to have done anything about it yet).

  25. tom p said,

    June 13, 2006 at 11:02 am

    Oh, and herbals are supposed to be regulated the same way all over the EEA under the Traditional herbal Medicines Directive (Directive 2004/24/EC amending, as regards traditional herbal medicinal products, Directive 2001/83/EC)

  26. Dr Aust said,

    June 13, 2006 at 11:28 am

    Hi Tom

    Thanks for correcting me – very interesting

    I had always assumed herbals were much more regulated in (say) Germany than in the UK mainly since (i) the Germans are into heavy regulation of the health sector (including CAM) than we are; and (ii) herbals are so widely prescribed there by doctors (e.g. St J’s Wort for mild depression)… so figured people selling herbals there would have to have much more stringent quality control and product info.

    I have noticed that here in the UK certain herbal formulations have much better info than others – e.g. for St J’s W again, Kira that Boots sell (which is made by Lichtwer Pharma, a big German company you probably know) has stuff like “equivalent to xx ug hypericin” and a full side-effects leaflet. But if I walk to the local Health Food superstore they have loads of different brands of SJW and a health-food salesperson who says “oh, this one is good” and sells me/you a bottle with minimal info.

    I would be interested to hear your views on the “comparability” of the regulations (if any) on product quality / included product info for mainstream pharmaceuticals and herbals.

    Going back to your original point, I would have predicted that adverse side-effect reporting would be less with (e.g.) herbals simply because they don’t come from the GP/hospital like mainstream stuff does, which provides a contact point and “avenue” for reports of side-effects of pharmaceuticals to go back to MHRA. Does your experience shed any light on this?

  27. Delster said,

    June 13, 2006 at 12:19 pm

    what gets me is how many people assume that herbal (ie plant derived) medicine is in the same catagory as homeopathy… ie totally ineffective.

    I’m not a pharmacist but off the cuff i can think of several medicines that are in general use and were derived from plants.

    To give a few – Asprin, Quinine and Curare. Asprin everybody knows about. Quinine is (or was…anybody?) an anti malaria drug and curare is a muscle relaxant, which is so effective it’ll relax you to death if your not careful, used in surgical prep.

    The main problem with herbal, as pointed out above, is quality control.

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