A startling lack of critical self-appraisal

July 27th, 2007 by Ben Goldacre in bad science, craig sams, hate mail, stifling criticism | 52 Comments »

One for the small print maybe, but I think this is culturally quite interesting, because to me it tells a small part of the story on how you can maintain a belief system by avoiding appraisal of your ideas.

As you will remember, Craig Sams, a confectionery millionaire, recently wrote an article which I suppose you’d have to describe as an “attack” on me. This was close to what I’m hoping for – which is an attack on my ideas – and I genuinely wish he’d engaged with any single one of my criticisms of McKeith and the wider nutritionism industry. As I have said many times: there’s nothing I like better than people engaging in a discussion about ideas, and criticising mine. If you haven’t read Sams’ article already I’d highly recommend it for sheer enjoyment.

What interested me most about his piece was that this was the first time his billion dollar industry has even come close to engaging meaningfully with any of the key concerns that people have about pseudoscience in their promotional activity, rather than holding their heads in the sand and pretending that everyone who dislikes them is in the pay of the devil.

At first in emails it seemed like Sams was up for having a chat about all of this stuff, which I thought would have been interesting and constructive, for an unedited mp3 podcast, but then he suddenly changed his mind a month later and started sending me (and others) some pretty bizarre and angry emails. I will be nice and not print those in public.

So then I got on to the trade magazine which published it, Natural Products, to offer them a piece, explaining my position, defending myself against the slightly odd claims, and outlining the concerns that people have about their industry. I rather hoped this would move things on a little from the “dolphins-good-thalidomide-bad” world view that seems to dominate discourse within the trade.

The medical literature, as you will know, is full of critical self appraisal. In fact, if there is one crucial feature which distinguishes medicine from quackery, and from hysterical populist criticism of medicine, it is that long, strong, justified, and brutal tradition of critical self-appraisal.

The British Medical Journal is probably the most important medical journal in the UK. It recently announced the three most popular research papers from its archive, according to an audit which assessed their use by readers, number of times they were referenced by other academic papers, and so on. Every single one of these papers was highly critical of either a drug, a drug company, or a medical activity, as its most central theme.

The top scoring paper was a case-control study which showed that patients had a higher risk of heart attack if they were taking the drugs rofecoxib (Vioxx), diclofenac, or ibuprofen. 10.1136/bmj.330.7504.1366. At number 2 was a large meta-analysis of drug company data, which showed no evidence that SSRI antidepressants increase the risk of suicide, but did find weak evidence for an increased risk of deliberate self harm 10.1136/bmj.330.7488.385. And in third place was a systematic review which showed an association between suicide attempts and the use of SSRIs, and critically highlighted some of the inadequacies around the reporting of suicides in clinical trials 10.1136/bmj.330.7488.396.

www.bmj.com/cgi/content/full/334/7593/554-a

Such critical self appraisal is startlingly absent from the academic and commercial CAM literature, on the other hand. I think that’s a shame, and I think it’s partly responsible for them indulging some rather silly ideas, and exposing themselves to justified public mockery.

If you’re interested, this is how the Natural Products trade journal dealt with me offering them responses to their criticisms and concerns. I thought I was pretty patient and good humoured, you might disagree, but either way, one day a very bored medical historian might just use it in a passing footnote.

On Fri, Jun 8, 2007, Ben Goldacre < ben@xxx> wrote:
hi jim,

as you know you recently published a rather personal attack on me, by craig sams, which didn’t really address any of my criticisms or ideas about the role of pseudoscience in nutritionism and alternative therapies. i am always very keen to encourage a free exchange of ideas, and craig sams had set a time to meet to discuss these in an (unedited) interview, but he seems to have now decided not to engage in a discussion after all.

i think it might be useful – i’d shy away from saying appropriate – if i wrote something for your magazine, perhaps addressing some of the drearier ad hominem attacks, but also and more usefully setting out why it is that people become concerned about the rather free and easy use of inaccurate scientific information in your industry to sell their products. i’m assuming you pay contributors for their work, perhaps we could negotiate that.

do please let me know as soon as possible, i do feel that the reluctance to engage in meaningful discussion is one of the root causes of so much unnecessarily woolly thinking in what could otherwise be a very valuable and constructive industry.

ben

Ben Goldacre Thu, Jun 14, 2007 at 6:53 PM
Reply-To: ben@xxx
To: editor@naturalproductsmagazine, assistant@naturalproductsmagazine
hi there

did you get my previous emails? maybe you could reply to this one just to let me know that you did?

thanks,

ben

Jim Manson Thu, Jun 14, 2007 at 8:08 PM
To: ben@xxx
Hi Ben

Yes I did get it and apologies for not getting back to you before now.

I’d be very interested in publishing something along the lines you suggest. But since this may well throw up a bit of political crap could we have a quick chat on the phone to discuss what form your piece might take?

Is there a number I can get you on? My mobile is 07768 xxx and office number is 01273 xxx.

Jim

Ben Goldacre Thu, Jun 14, 2007 at 8:15 PM
Reply-To: ben@xxx
To: Jim Manson

heh

seriously tho, i really don’t think that printing someone who disagrees with you is likely to throw up political crap, and the fact that it might is [suppresses sanctimonious voice] the, er, problem, and the reason there is so much woolly thinking around in your world.

literally trapped in hospitals for a week now but totally on email, what crap, and what sidestepping did you have in mind?

Jim Manson Fri, Jun 15, 2007 at 7:34 AM
To: ben@xxx

Ben

Crap probably wasn’t the wisest choice of words in the circumstances (Freudian even?).

I’m not sidestepping anything in particular. But I do think the personal attacks (which have travelled in both directions by now anyway) are a distraction from the real issue – the polarisation of the debate which is preventing meaningful discussion. So all I was going to say is can you make the points you want to make without dwelling on particular ‘personalities’?

Either way, does this have to be confrontational before it gets going?

Jim

ps I’m out of the office today but picking up emails over the weekend.

Julia Brandon Fri, Jun 15, 2007 at 9:13 AM
To: ben@xxx
Hi Ben,

Please accept our apologies. We did indeed receive your first email, and on having discussed the options this end, I thought Jim (the editor) had already replied to you. Jim is out the office today, but we will be in touch with you next week to discuss options.

Thanks for getting back in touch, and prompting us into action!

Kind regards

Julia

Ben Goldacre Fri, Jun 15, 2007 at 1:57 PM
Reply-To: ben@xxx
To: Julia Brandon

hi jim,

it goes without saying that i want to address the issues, but one of the issues is ad hom attacks, and i think you’ll agree as an editor it is entirely reasonable to expect me to respond to those. they also form a part of the story about the rhetorical style of the natural products scene, and the phenomenon of people dodging legitimate criticisms. i’m not aware of writing ad hom attacks on sams (other than a few pretty moderate and relevant comments in an online blog).

it also goes without saying that much of what i have to say is going to be very challenging for many of your readers, that’s the point, and best crystallised with reference to specific cases – specifically characters such as mckeith, sams, and holford – and i would very much hope that you would be able to publish these criticisms of their ideas, and the things they have said. if you are not, then that again exemplifies the problem, of course.

i think you would be rather surprised by the number of friends i have in the health food and organic world, and moreover by the large number of emails i get from people who feel very embarrassed by the way that pseudoscience and ad hom are used to market their products.

Jim Manson Mon, Jun 18, 2007 at 7:09 AM
To: ben@xxx
Cc: Julia Brandon

Hi Ben

It doesn’t actually surprise me that you have supporters in the natural and organic sector (I even know some). But that could be that they don’t conform to the knackered stereotype sometimes bestowed on them!

Re crystallising your points with references to Patrick Holford, Gillian McKeith and Craig Sams, hasn’t this already been done via a national newspaper (sometimes with entire columns devoted to the subject) – PH (12 references), GK (23)?

I’d still prefer to publish something that concentrates on the issues and gets us away from the current personalised as well as polarised debate. But if the references to the ad hom stuff can be reasonably contained, well then let’s do something.

Re dates and rates: We’re just going to press with a combined summer issue (bit like the Beano), so don’t have space available until our September issue. Re rates, well, they not great (£160-180 ptw).

Alternatively we could always set up an interview. Or a head-to-head with someone like Dr Rob Verkerk at the Alliance for Natural Health?

Jim

Ben Goldacre Mon, Jun 18, 2007 at 4:36 PM
Reply-To: ben@xxx
To: Jim Manson
Cc: Julia Brandon

hi jim

i think you might be confusing criticising peoples ideas with criticising them as people. i certainly dont want to get into non-specific “this kind of claim kind of gets made with kind of not very much kind of evidence”. i’m offering you a critique of the unnecessary use of pseudoscience with concrete examples from the leaders in the field, and a discussion of the unhealthy climate in which science is used as a promotional tool for show, and where there is no possibility of ideas undergoing critical appraisal.

it is this environment in which bad ideas flourish. this is also of course relevant to the genuinely ad hom critique of my work made by craig sams, in which he addressed none of my criticisms, engaged in a bit of personal abuse, and accused me of doing things i havent done. that is a relevant part of the story of how science and ideas are used in the industry. he is after all one of the movements leading lights and of course your columnist.

i would remind you that the three most highly referenced studies in the BMJ last year where, in order, on the dangers of vioxx, the dangers of paroxetine, and the dangers of SSRIs. critical self appraisal is an integral part of medicine. with the greatest respect, if you find that hard to allow in the pages of your trade publication, then that is yet another symptom of the problems i am proposing to write about.

b

Ben Goldacre Mon, Jul 2, 2007 at 2:13 PM
Reply-To: ben@xxx
To: Jim Manson
Cc: Julia Brandon

hi jim/julia,

it’s been two weeks now, and i’ve not heard back from you. perhaps if you feel uncomfortable printing an interesting comment/feature on the problems with using pseudoscience in the industry you represent it might be easier for you to simply give me right of reply to the inaccuracies in your ad hominem attacks on me personally. do let me know what form that would take, and how many words, although i think it would be less interesting and informative for your readers,

many thanks,

ben

Ben Goldacre Thu, Jul 26, 2007 at 2:52 PM
Reply-To: ben@xxx
To: Jim Manson

just to let you know i’m writing about this as part of a wider project on how the alt med industries are undermined by their own resistance to critical self appraisal, let me know if you dont want your emails quoted,

b

Jim Manson Fri, Jul 27, 2007 at 2:48 PM
To: ben@xxx

Hello Ben

I’m perfectly happy to be quoted personally. But then, unless you are going to be very selective about what you quote, I don’t really see that my comments demonstrate the alt med industry’s “resistance to critical self appraisal”.

I ought however speak with my employer. How imminent is the ‘wider project’?

Jim

Ps I’m going to email you one or two further thoughts on this later

Jim Manson Fri, Jul 27, 2007 at 4:13 PM
To: xxxxx; ben@xxx
Carsten

This from Ben Goldacre yesterday. He doesn’t give any clues about what the ‘wider project’ might be. I imagine if he does quote me he’ll do so very selectively. Any thoughts?

Jim


++++++++++++++++++++++++++++++++++++++++++
If you like what I do, and you want me to do more, you can: buy my books Bad Science and Bad Pharma, give them to your friends, put them on your reading list, employ me to do a talk, or tweet this article to your friends. Thanks! ++++++++++++++++++++++++++++++++++++++++++

52 Responses



  1. Ben Goldacre said,

    July 27, 2007 at 5:58 pm

    well, it’s a trade journal, you know, the guys in a difficult position. he’s there to sell, as they all are.

  2. rob said,

    July 27, 2007 at 6:14 pm

    “I imagine if he does quote me he’ll do so very selectively” – says it all about the way they see this debate! It’s about winning points and twisting words, not about the science.

  3. Ben Goldacre said,

    July 27, 2007 at 6:20 pm

    er, yeah, that was a bit funny, given i was only ever planning to just bung it up quickly online. i’m going to do something more narrativey with various examples i have of this kind of thing later, but i’m religious about transparency and linking to primary sources, no selective quoting here.

  4. raygirvan said,

    July 27, 2007 at 7:04 pm

    Of related interest: Bad plant science, the saga of Craig Sams’ inaction regarding a 100% false statement on his website, repeated in a number of articles he has written for nutritional magazines and forums.

    As part of a macrobiotic horror story portraying various harmless vegetables as toxic “nightshade plants”, he has repeatedly written that the various alkaloids in the Solenaceae family are nicotine going under different names.

    He’s even admitted it’s a mistake, but I take the failure to correct it promptly and publicly as another example of the lack of a critical appraisal system in this territory.

  5. Stuu said,

    July 27, 2007 at 7:13 pm

    I’d be rather surprised if Ben manages to get an article; if the woos start allowing critical appraisal of their ideas, then their world will likely start crumbling. If you allow someone to demonstrate how all your reasons for suggesting some weird thing are essentially bullshit, it makes it harder to sell your pills/quack therapy/peculiar ideas.

  6. Dr Aust said,

    July 27, 2007 at 9:22 pm

    I think David Colquhoun might quite enjoy writing something for “Homeopathy”

    intl.elsevierhealth.com/journals/homp/default.cfm

    – taking the homeopaths to task for their lack of critical self-appraisal, or perhaps analysing statistically why many of the results they claim as being “positive” for homeopathy are actually random occurrences that they go on to cherry pick.

    I would be rather surprised, though, if Peter Fisher and his editorial board

    intl.elsevierhealth.com/journals/homp/board.cfm

    – ever ask DC to do it.

  7. evidencebasedeating said,

    July 27, 2007 at 9:42 pm

    Never mind, Ben.
    How about trying another ‘journal’ that may be receptive to your measured debate?

    I recall that the ‘Institute of Optimum Nutrition’ rag was keen to engage dietitians to ‘comment on the management of X disease’, so that ION Key Stage 1 ‘nutritionists’ could ‘learn from the different approaches to nutrition’, ie RDs will provide the scientific rationale that is beyond the knowledge of the ION ‘lecturer/practitioners’.

    Indeed, you would be welcome – I’m sure – to debate with Patrick the relative merits of his surreal approach t nutrition, seeing that they actually ‘encourage debate…with a unbiased and nonpatronising view’ –

    “Taking an unbiased and non-patronising view, Optimum Nutrition provides academic information presenting this in a feature-style, offering an educational yet enjoyable read.

    Optimum Nutrition’s new section ‘Taking Sides’ covers conversations, sometimes controversial, between two bodies with opposing views. The next issue will be a discussion between nutritional therapist Anthony Haynes and the Soil Association”

    www.ion.ac.uk/journal.htm

    Bring it on :)

  8. gadgeezer said,

    July 27, 2007 at 9:56 pm

    Didn’t Michael Baum write an excellent piece denouncing homeopathy in the Daily Mail a few months back?

  9. calvin said,

    July 27, 2007 at 10:13 pm

    McKeith may well be a phoney, but she’s done far less damage than the real doctors who over prescribed antibiotics for decades helping to create things like MRSA. I bet these doctors were just as smug and self certain as you Ben. One wonders what blunders of orthodox approved medicine will blight the lives of future Britons?

  10. bootboy said,

    July 27, 2007 at 10:20 pm

    “she’s done far less damage than the real doctors who over prescribed antibiotics for decades helping to create things like MRSA.”

    So, let’s get this straight. If we had removed all real doctors from the world and replaced them with phoneys like McKeith, for the last few decades, we’d all now be living to 200? Or am I failing to get your point?

  11. bootboy said,

    July 27, 2007 at 10:41 pm

    Oh sorry.

    Did you read the article?

    “The medical literature, as you will know, is full of critical self appraisal. In fact, if there is one crucial feature which distinguishes medicine from quackery, and from hysterical populist criticism of medicine, it is that long, strong, justified, and brutal tradition of critical self-appraisal…..”

  12. calvin said,

    July 27, 2007 at 11:17 pm

    The hysterical populist criticism of medicine couldn’t have anything to do with the fact that the NHS currently owes £3.9bn in compensation for medical negligence? Let’s put the boot into homeopathy though eh!

  13. gadgeezer said,

    July 27, 2007 at 11:59 pm

    Interesting. Say, for argument’s sake, that a fair amount of the compensation involves no-fault agreements concerning birth-injuries – an area that medicine deals with but not homeopathy. So, would that be like saying that, road hauliers associations, end up paying out far more for motorways accidents than (say) 95 year-old drivers, so the latter are safer drivers? Overlooking, for the sake of argument, that the 95 year-olds don’t drive on the motorway.

  14. rueroy said,

    July 28, 2007 at 12:21 am

    I don’t know what kind of evils Jim Manson may be responsible for in the wider world, but he comes over quite well in this e-mail correspondence.

    The point that it all goes wrong seems to be at:

    Jim: But since this may well throw up a bit of political crap could we have a quick chat on the phone to discuss what form your piece might take?

    Ben: seriously tho, i really don’t think that printing someone who disagrees with you is likely to throw up political crap …

    Jim is in a delicate situation, Ben presumably has a mixed (at best) reputation amongst the CAMmers and, although he later retracts it a bit, that sounds like a pretty good example of “political crap”.

    If he was the editor of a respected medical journal then Ben’s response would be appropriate. However, he’s not, and so small steps should be encouraged, rather than going in all guns blazing and seizing on the first admission that his industry might not be up to the standards of self-criticism that we’d like it to.

    Jim’s suggestion of a phone call seems like a great way for him to satisfy himself that he isn’t going to commission an article that will degenerate into a slanging match.

    As my girlfriend keeps telling me, I think that it’s important to know which battles are worth fighting.

  15. calvin said,

    July 28, 2007 at 1:26 am

    “So, would that be like saying that, road hauliers associations, end up paying out far more for motorways accidents than (say) 95 year-old drivers, so the latter are safer drivers? Overlooking, for the sake of argument, that the 95 year-olds don’t drive on the motorway” Gadgeezer

    Yes it would be like saying that. Road safety is important and addressing road safety by scrutinizing 95 year olds who generally don’t drive too much, when you could be scrutinizing lorry drivers who tend to drive much more often in far more dangerous circumstances would be ridiculous. Your point being?

  16. zooloo said,

    July 28, 2007 at 2:42 am

    It is true that medical practitioners have made mistakes. Those mistakes are recognised and resolved.

    The difference with the quacks is they simply ignore any criticism whatsoever and continue in their folly.

    Saying “Well they’ve made mistakes too” doesn’t mitigate.

  17. BSM said,

    July 28, 2007 at 8:04 am

    “Your point being?”

    I think Ben’s line “dolphins-good-thalidomide-bad” may be relevant here.

    Do you really not see that the relevant response to Ben’s piece would be to cite examples where the CAM or popular nutrition industry had shown a useful degree of self-critical appraisal?

    It is always revelaing that when invited to engage in a mature appraisal of what they do, the only thing that CAM advocates ever come up with is the usual whinges about conventional treatments that operate in areas of medicine that CAM dare not even tackle.

    So, to keep this thread on-topic, perhaps you can produce a single good example of a CAM believer applying some critical faculties to their pet therapy. I’ve looked for years and never found one, but I’d love to be surprised.

  18. evidencebasedeating said,

    July 28, 2007 at 10:57 am

    Calvin, you certainly live up to the namesake!
    but no more ad hom for you to snipe at in the ‘traditional’ genre, but I must take issue with your comment

    “The hysterical populist criticism of medicine couldn’t have anything to do with the fact that the NHS currently owes £3.9bn in compensation for medical negligence? Let’s put the boot into homeopathy though eh!”

    Remind me how one can ‘successfully sue for damages’ if one is ‘treated’ negiligently by Mckeith, Holford, or a homeopath?

    (just in case you wish to argue the latter, absence of ‘active’ treatment for a treatable condition is as ethically corrupt as ‘incorrect’ treatment – and would certainly get a real Allied Health Professional struck off).

    Answer – you can’t.

    McKeith argues in the small print akin to ‘this info is nothing more than nebulous entertainment, so if you follow it without MEDICAL advice you’re a moron; Holford is ‘Fellow’ of an organisation of which over half the ‘ethics’ committee (what a laugh) are ION acolytes and the remainder are businessmen and related (ker-ching!!) and one which meets ‘behind closed doors to gossip the issues of self-delusion), and homeopaths are divided as to what they actually ARE. Just read anything by Dr Peter Fisher of the London Homeopathic Hospital, who frequently confuses the ‘efficacy’ of herbal remedies to justify the homeopathic approach…(vastly different practices. Herbs are ‘dirty’ medicines with an armoury of synergystic and

    But never mind. If you choose to follow the weird and wonderful – feel free. Perhaps you will never need to interface with ‘evil’ NHS clinicians such as Ben and myself. But at some stage you will recognise the delusion that these are parallel health approaches with similar morals and ethics. The alternative world doesn’t have any. Well, not that they realise.
    ker-ching!

  19. evidencebasedeating said,

    July 28, 2007 at 11:02 am

    yawn

  20. calvin said,

    July 28, 2007 at 12:02 pm

    evidencebasedeating

    “Remind me how one can ’successfully sue for damages’ if one is ‘treated’ negiligently by Mckeith, Holford, or a homeopath?”

    Come off it! When McKeith or the homeopaths are involved in a scandal like Thalidomide or illegal baby organ transplanting you might have a valid point, but in the present time (although I’m sure you could dig up some atypical cases) homeopathy probably provides a valuable service to conventional medicine by diverting hypochondriacs away from the NHS.

    “just in case you wish to argue the latter, absence of ‘active’ treatment for a treatable condition is as ethically corrupt as ‘incorrect’ treatment – and would certainly get a real Allied Health Professional struck off”

    Would “absence of active treatment” apply to hospital waiting lists? Waiting times for operations seem to be of far more concern to the British public than the scandals of homeopathy. Motes and Beams ring any bells?

  21. pv said,

    July 28, 2007 at 12:19 pm

    Calvin, the reason you know that antibiotics have been over-prescribed in certain parts of the world is because the medical establishment told you so.
    The reason the NHS pays compensation is because it can be held to account.
    Practically all of the multi-billion dollar industry known as CAM is a money making scam (legalised fraud) and is accountable to no-one. It panders to ignorance, abuses the vulnerable and diverts people from seeking proper advice and more likely effective solutions for serious medical conditions. In many ways the CAM industry is lethal and certainly costs the NHS much more when cases are only referred after they become chronic.

    The thing about science is that it is transparent and open to all. Anyone capable of doing so can check it, add to it, correct it… It isn’t true just because it’s written in a book by some authority figure. It is true or not because it can be verified. This applies to evidence based medicine too, whose practitioners in the UK have to be registered and are legally accountable. The pharmaceutical industry is also legally accountable.
    All of this is in complete contrast to the quackery known as CAM, where everything is anecdotal and defers to authority (magic books), where nothing is verifiable (because it’s not allowed), where everything is by and large opaque and secretive, and where no-one is accountable to anyone for anything.

  22. gadgeezer said,

    July 28, 2007 at 12:41 pm

    You misunderstood the point which was that you can’t use the sums of money paid out in compensation to judge efficacy – which is rather what you were doing in your “hysterical populist” blah blah.

  23. Ambrielle said,

    July 28, 2007 at 1:14 pm

    calvin, “Its potential for harm could be reduced to acceptable levels with a minimum of regulation.”
    I’m interested in what you propose would be appropriate regulation. I also think you underestimate the harm caused, not least by the amount of wasted money the NHS spends on CAM. I also don’t see that it’s an ‘either/or’ situation. Of course we want to get rid of bad medical practice/ineffective or harmful medicines. It shouldn’t stop us from demanding that the CAM industry provide evidence for theirs thousands of assertions, and to stamp out those which simply don’t stand up to scrutiny.

  24. calvin said,

    July 28, 2007 at 1:56 pm

    “You can’t see it, can you? Absence of REPORTED effect does NOT mean ‘absence OF effect’”

    Neither does it mean that there is a presence of effect. I’m sure that there have been some instances in which CAM has had seriously bad consequences for sick people, that’s why it needs to be regulated. I’m equally sure that the amount of harm being done compares favourably to the amount of harm caused by the many blunders of conventional medicine, and that the medical establishment is reacting mainly to an intrusion on its territory rather than from any great regard for the public. For some individual members of the fraternity of conventional medical practitioners taking aim at CAM is simply an outlet for their overbearing smugness.

  25. JQH said,

    July 28, 2007 at 2:41 pm

    Calvin, as has been said before: the reason you know about conventional medicine’s blunders is due to conventional medicine monitoring what it does and being open about the results.

    CAM kills people with its lies. CAM practicioners like that twittering moron Sue Young tell people their doctors will likely kill them and encourage their patients to avoid conventional medicine. In South Africa, CAM is rife and untold thousands have died as a consequence of the lack of effective medicine.

    Have a think about that if you’re not just trolling.

  26. rongraves said,

    July 28, 2007 at 3:06 pm

    I haven’t looked at this thread for some hours and, hey, Calvin’s arrived. So much anger – so many words – so little point.

  27. banshee said,

    July 28, 2007 at 3:27 pm

    Have to agree with other correspondents, Calvin – the premise that CAM therapy may cause little harm is not a rationale to expend resources upon it in the first place.

    Nor is it a rationale to replace or add in to allopathic therapies.

    Enhancing feelings of well being is one thing, claiming curative functionality is quite another.

  28. calvin said,

    July 28, 2007 at 4:50 pm

    “Calvin, what precisely is your point? What would you like to see changed in the practice of “conventional” medicine?”

    My point is that all of the many blunders of conventional medicine ignored on this website are also attributable to “bad science”, Mr Goldacre isn’t interested in bad science; he is simply opposed to the unconventional. I’m concerned about the harm being done by bad medical advice and practice wherever it comes from; I’m seeing most of it in conventional medicine. You seem to be saying that it’s okay to get bad results if you pay lip service to the proper methodology. Frankly, I think that it’s a joke bitching about the absurd “Dr” Gillian McKeith, when conventional medicine provides the public with an institutionally incompetent organization like NHS24.

    “Calvin – the premise that CAM therapy may cause little harm is not a rationale to expend resources upon it in the first place”

    That’s true.

  29. IanWac said,

    July 28, 2007 at 6:56 pm

    Odd really.
    I’m so vain, and so keen for patients to absolutely love me that I’d do anything for them to get better. No, really I would. I’d quite happily indulge in quite a bit what I’d previously regarded as mumbo jumbo if it really worked – although of course I’d read up pretty carefully to make sure I understood it first. In truth, if this stuff worked, I wouldn’t just use it, I’d want to own it. Like I do when prescribing antibiotics. Which I try to do as little as possible, because in my reading and self criticism – and trying to find out if there is anything more to do for my patients – I’ve found out that overuse can be quite bad. (But they can be quite good if, for example, you’ve got pneumococcal sepsis.)

    Incidentally, where did the “illegal baby organ transplanting” come from? If you’re referring to the Van Velzen Alder Hey years, you probably need to read the Redfern report again. Or perhaps for the first time. www.rlcinquiry.org.uk/

  30. calvin said,

    July 28, 2007 at 10:09 pm

    “re. thalidomide scale problems – it looks like “Treatment with beta carotene, vitamin A, and vitamin E [pills] may increase mortality.”

    Really! I can just see how this story broke in the media, “line up the presses, we’ve got a scandal as big as Thalidomide on our hands…..hold on it involves alternative practicioners…shit!…looks like we’re gonna have to bury it” Whatever j!

  31. j said,

    July 28, 2007 at 11:35 pm

    you’re right, of course, Calvin. One should always completely trust the media’s interpretation of statistics, and if they don’t see the significance of particular figures, that means these figures are not relevent. *I hope the sarcasm comes across in print*.

    If you need me to spell it out for you – if lots of people take, say, vitamin E pills over the relatively long term (they do) and these pills lead to a small increase in mortality (there’s pretty good evidence that they do) that will lead to a significant nuber of premature deaths.

    This is different from the vioxx or thalidamide scandals: for example, the risks for each person taking the pills are smaller, and there’s no clear company that’s responsible (or can get sued). However, large numbers of people taking pills with a small risk of death attached can lead to a significant number of premature deaths.

    I think it’s scandalous that many alternative practitioners still recommend these pills as a way to increase longevity and health – whether or not the media reports it.

  32. pv said,

    July 29, 2007 at 12:01 am

    Calvin (who seems to be revelling in being centre of attention) wrote:
    “I don’t see much difference between a company claiming that its products will improve your health and a company claiming that consuming their brand of junk food or fizzy crap will enhance your social life.”

    Well, Calvin, you are entitled to your opinion (and it is just your opinion), but I don’t see any junk food manufacturers claiming to be able to prevent malaria or cure any form of cancer. The consequences of taking a homeopathic prophylactic against malaria might be just a teeny bit more disastrous than finding out you don’t have more friends as a result of drinking Coca Cola. Pity you don’t define junk food, but whatever it won’t give you malaria although cancer might be caused by many things including genetic predisposition. And it won’t cause obesity in any way shape or form if you get enough exercise. In fact junk food is only harmful if that is all you eat. And it won’t make your teeth fall out if you clean them regularly. In fact I’d say you are completely wrong by comparing CAM to junk food.
    Anyway, it’s nice to see your arguing skills are so poor that you can justify the fraudulent practice of sCAM by simply saying “well, something else is bad”.

  33. calvin said,

    July 29, 2007 at 12:18 am

    “The consequences of taking a homeopathic prophylactic against malaria might be just a teeny bit more disastrous than finding out you don’t have more friends as a result of drinking Coca Cola”

    Could well be J, can you remind me what the homeopathic prophylactic against malaria is exactly, and how many people have died as a result of taking it?

  34. pv said,

    July 29, 2007 at 1:52 am

    Ben, I think the last email is very funny:

    “Jim Manson Fri, Jul 27, 2007 at 4:13 PM
    To: xxxxx; ben@xxx
    Carsten

    This from Ben Goldacre yesterday. He doesn’t give any clues about what the ‘wider project’ might be. I imagine if he does quote me he’ll do so very selectively. Any thoughts?

    Jim”

    It illustrates all by itself the problem of the CAM/quack mindset of these people. They are secretive and selective, and careful to print only what they agree with, and what agrees with them. What’s good for business. And they think everybody and everything behaves like them, including science and all scientists.

  35. j said,

    July 29, 2007 at 12:58 pm

    Could well be J, can you remind me what the homeopathic prophylactic against malaria is exactly, and how many people have died as a result of taking it?

    Firstly, I think you’ve got me confused with someone else.

    Secondly, as evidencebasedeating notes, if a ‘conventional’ medical practitioner recommends that a patient foregoes appropriate treatment (e.g. takes a sugar pill instead of an effective malaria prophylactic, when travelling to a high-risk area) they can be disciplined for this. Quite right, too: the effects of such recommendations can be very serious.

  36. raygirvan said,

    July 29, 2007 at 7:01 pm

    > calvin The point is …

    That comes down to a variant of the “something worse” fallacy: the idea that you shouldn’t bother about X because Y is worse and/or more prevalent. This is covering an area unaddressed by the existing malaria guidelines offered by the FCO and Department of Health. Ignorance is one thing, but actively prescribing non-functional preparations for a dangerous disease is criminal, and ought to be treated literally so.

  37. pv said,

    July 29, 2007 at 9:04 pm

    “The major cause of malaria infection among Britons is ignorance. You would rather put the boot into homeopaths than concentrate on informing the public.”

    Since homeopaths spend a great deal of time (in fact all of it) misinforming the public and promoting ignorance for profit then yes I am happy to condemn the lot of them. And I find your justification of their government supported quackery and legalised fraud, on the basis that “there’s something worse” as simply lacking in any perspective on anything.

  38. Robert Carnegie said,

    July 30, 2007 at 12:09 am

    I want to see the statement justified (or not) that “a tiny percentage” twice over of British malaria cases are homeopathic remedy users, when homeopathic products are sold in many high street stores – in fact I think that’s where the malpractice sting on homeopathy vendors was held. Homeopathy isn’t in the ghetto, it’s mainstream over-the-counter merchandise – I was about to write “medicine”, more fool me.

  39. hairnet said,

    July 30, 2007 at 7:13 pm

    Calvin, i totally agree with you that thalidomide was a bad thing, but are you sure that denouncing the entire premise of free at source medicine is then not-justified?
    Yes the medical negligence is absolutely huge but can you suggest a way we measure against the absolutely mahoosive medical benefit?

    CAM may do little harm but it does bugger all god AND costs desperate people a lot of money.

    QEF’ingD

  40. calvin said,

    July 30, 2007 at 7:26 pm

    My point is that people are contracting malaria whilst abroad. The role of homeopathic medicine in this is minor; the role of ignorance is major. The major amount of attention is being focused on homeopathy to the detriment of confronting the major cause, which is ignorance. This seems to me the same blame based approach adopted by bad office managers, which concentrates on kicking arses rather than solving problems.

  41. jodyaberdein said,

    July 30, 2007 at 8:00 pm

    Calvin,

    I wonder if you would care to comment on the Cochrane Colaboration’s recent review of the efficacy of mefloquine for malaria prophylaxis?

    www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000138/frame.html

    Secondarily, given your interest in microbial resistance to therapeutic agents, perhaps yout could enlighten us on how plasmodium falciparum has remained unable to overcome homeopathic prophylaxis/treatment in the last 200 years of exposure whereas it has quickly conquered any molecules it has actually been exposed to?

  42. evidencebasedeating said,

    July 30, 2007 at 10:24 pm

    excellent, pv

    never seen this Mencken chestnut before. My favourite Mencken quote is:

    “There is always a well-known solution to every human problem–neat, plausible, and wrong”

    Works well when used to debunk surgeons prehistoric views on nutrition (eg ‘drip and suck’/ lets wait for bowel sounds etc etc )

    But this Mencken quote is just for Calvin, who is proof positive of the worring aspects of woo:

    “The most common of all follies is to believe passionately in the palpably not true. It is the chief occupation of mankind”

  43. calvin said,

    July 30, 2007 at 11:03 pm

    I wonder if you would care to comment on the Cochrane Colaboration’s recent review of the efficacy of mefloquine for malaria prophylaxis?

    It had the enticement of brevity. It says to me that malaria is a serious illness that is relatively easy to catch and for which the prophylactic measures are fairly dodgy and that anyone without good reason should stay out of malarial areas.

  44. pv said,

    July 31, 2007 at 12:48 am

    I brought up the subject of HOMEOPATHY as a prophylactic for malaria, which has all the advantages of being not just dodgy but 100% fraudulent because it is, and always has been, 100% useless.
    It has always been the case that there is no absolutely sure way to prevent malaria. This was explained to me before I went to Kenya in the late 1980s. However, in contrast to conventional prophylactics, to which resistance has been gained over time (depending on the geographical area), and new drugs are being tried (again depending on geographical area), homeopathic concoctions contain no active ingredient to which resistance can be gained.
    While a conventional drugs such as Pyronaridine, Mefloquine, Chloroquine and others, and newer drugs, or combinations of them afford some protection in areas where resistance hasn’t been acquired, homeopathy has never afforded any protection against anything, anywhere.

    And, Calvin, if you had a fraction of Mecken’s ability to reason clearly you might be formidable. But sadly you haven’t. :-)

  45. pv said,

    July 31, 2007 at 2:21 am

    “Even without a fraction I’m still more formidable than you.”

    Of course you are, Calvin. I’m sure you must be formidable at something.

  46. jodyaberdein said,

    July 31, 2007 at 2:01 pm

    Re: 30

    Broadly I’d agree with your interpretation, but perhaps you could have been a tad more generous in grouping the clear efficacy and side effects into an overall ‘dodgy’.

    Now for the next question: can you find us a similar piece of work from the CAM literature that reports on efficacy and serious adverse effects?

    Any thoughts on plasmodial resistance to homeopathy?

  47. calvin said,

    July 31, 2007 at 5:41 pm

    “Broadly I’d agree with your interpretation, but perhaps you could have been a tad more generous in grouping the clear efficacy and side effects into an overall ‘dodgy”

    Well, on reflection, that was unnecessarily polemical, but given that all I’m saying is that there is a lot of evidence that we need to do a much better job of informing the public about the general dangers of malaria, rather than indulging on an ego bolstering crusade against homeopaths, and the Goldacre hive-mind has gone ballistic, I think that I could be forgiven.

    Let’s get real; almost no one takes homeopathic remedies for anything serious as a first and only resort. The overwhelming majority of punters use these non-treatments for non-ailments like “stress” and “chronic fatigue” (try having a wee sit down now and again?).

  48. craigsams said,

    July 31, 2007 at 7:26 pm

    Dr. Goldacre mentions that I decided not to debate, so I am appending my email of June 8 by way of clarification. It is also true that I wrote to the Guardian asking them if they had the courage to publish the type of debate that their columnists conduct parallel to the Guardian website. It took them 9 weeks to say they would not. The Bad Science website contains anonymous descriptions of me that you can read for yourself. They are nonsensical, prejudiced, hateful and ill-informed.

    All this kerfuffle arises from a single point I made in my article – that doctors sometimes prescribe drugs that lead to addiction and other problems. I didn’t say they were a bunch of murderers – just that the pharmaceutical industry and the medical industry have made some serious mistakes. It’s regrettable that this has engendered so much anger, but I don’t regret saying it. It’s nothing particularly new. I admire the way that the NHS is embracing therapies such as tai chi, meditation, yoga, nutritional therapy, acupuncture and massage and am optimistic that we are seeing a more proactive approach to maintaining the nation’s health.

    I agreed to a discussion in the spirit of open debate but reconsidered after drawing Dr. Goldacre’s attention to the meaning of ‘twat’ and ‘schlong’ and the other irrelevant stuff he was publishing. He briskly averred that he knew exactly what they meant – he is the moderator of his website.

    So I wrote to him on the 8th June saying the following

    “I’ve read your website carefully, noted your commentaries and the sequence of the interspersion of your comments and those of your correspondents, reflected on the potential for useful discussion and concluded there is none.

    I have decided on a lifestyle that suits me very well and makes me very happy and very healthy and I don’t feel inclined to defend it against a mob of anonymous critics. There are aspects of my life that are public, anyone can google me or look at my website. I am not ashamed of my life, my ethics, my skin colour, my age, my wife and family, or my diet but you and your correspondents feel very strongly that I should be. I am no more ashamed of having enough money to be semi-retired at the age of 63 than I am of having lived in serious poverty and debt for most of my life whilst pursuing a business based on my ideals, however misguided you might think they are. I’ve always earned my income honestly and never as a salaried dependent of the State or the taxpayer or a corporation. I don’t think I’m a cunt, prick, fuckwit, child slave exploiter, corporate junk food peddler or sexist, but they and you do. That’s your business and your website provides yourself and them a forum to record your views. I can’t even begin to think of how or when to rebut or argue these views expressed by yourself and your correspondents, so I’d rather let you keep the conversation to yourselves.”

    Regards

    Craig

  49. evidencebasedeating said,

    July 31, 2007 at 9:25 pm

    ‘Admiration’ for nutritional therapy as ‘pro-active treatment within the NHS’?

    Pur-leese, Mr Sams. How truly patronising – and, as it happens, nonsensical, prejudiced and ill-informed.

    So you think some microventure of a self-styled nut therapist ‘practicing’ her nutrition-lite (and invariably wrong, wrong, wrong) approach to vulnerable patients is a way forward?

    Absolute tosh. The NHS has been well served -virtually since its inception – by Registered Dietitians. Yes, we do ‘deal’ with the sick and dying to optimise quality of life. Yes, we also ‘do’ preventative medicine. Yes, we have a broad and deep knowledge base that allows us to qualify medical approaches and put dietary recommendations into context for the client.

    And no, unless you’re talking about the parallel beliefs of alternative medicine approaches such as TCM, nut therapists DON’T do nutrition properly. And the reason why people of your ilk choose to swipe at medics all the time is that is truly a result of your prejudice and business spin.

    Of course docs don’t ‘do’ acupuncture (unless they’re on Harley St). Chartered Physio’s do. Yoga or tai chi? often found in cardiac rehab or pregnancy classe, where they’re run by Registerd Nurses. So ‘docs’ don’t rate it? So what. the NHS patient management is truly multidisciplinary – holistic, you may say, in your preferred terminology….

    Unlike some ‘complementary’ therapies, though, nut therapists try their pretty little heads to understand the science, but its a bit tricky when all you have is a weekend course in detox, or have paid a few thou £ to undertake a course, that actually may just allow you access to a ‘proper’ course if you decide to train ‘properly’ later.

    Your health, wealth, and attitudes are all self-determined. As are mine. But my recommendations to others are based on objective science and permit my patients to decide their options based on informed decision making. Not messianic ‘follow me’ statements.

    Accept Doc Goldacres offer of debate. Your comments appear to confirm the criticism you state are wrong. Now is your chance for rational debate – why not take it?

    And perhaps revise how the NHS actually works before criticising it with faux opinions??

  50. pv said,

    August 1, 2007 at 11:14 pm

    “Unfortunately that only leaves the overall spin of calling a major food plant class a scary name, “nightshade foods””

    Ray this is one of the things Mr Sams is likely to get uppity about, if it is pointed out loudly and publicly that he is indulging in a bit of wilful deceit. It’s no different than Powe£watch, George Carlo and Mast (In)sanity referring to “radiation”. It’s an obvious and deliberate deception to hype up the scare factor, because they are all aware of the public’s perception of these words.
    But let’s not for get that Mr Sams is a businessman and it’s not his job to be neutral, especially about generating profits. And fear is without a doubt a good profit generator. But he is proud of everything he does, so everything is alright!

  51. twisted said,

    September 4, 2007 at 1:53 pm

    Not read come across your site before, but I felt this was worthy of comment:

    So, you’ve come on to this editor, saying you want to write a piece in response to someone else’s attack on you.

    He emails you back and says let’s talk and discuss it.

    You send him another email instead to tell him why he should publish whatever piece you decide to write.

    He comes back and continues to express interest in paying you to write a piece for him, but asks you to tell him it will not just consist of personal attacks.

    You come back to say, essentially, that it’s difficult to separate the message from the messenger, so you’d have to make some sort of personal attack in the piece.

    He comes back again and says that some of what you want to write about has already been written about, but says ‘let’s do something’ if the personal attacks element doesn’t take up too much space.

    You come back and make several points in outline of your proposal and then accuse him of not wanting to print your piece.

    He doesn’t respond, you say that’s because he’s not interested in self-appraisal and then offer to write another piece which would be a right-of-reply and then follow it by saying you’ll publish the email correspondence.

    ****

    I’m sorry, but this just makes you look like an idiot who doesn’t listen to other people or read what they say, which I’m sure isn’t the case.

    I have no truck with the alternative health industry, I’ve never read this magazine and I have no desire to.

    But to say this exchange represents an unwillingness to engage in self-appraisal is just nonsense. Maybe they don’t self-appraise, but this doesn’t demonstrate that.

    I can only hope that the annoyance you must have felt at being attacked personally must have clouded your judgement.

    Given the tone of your emails to this editor, I’m not surprised he suspected a stitch-up at the last. I would have been tempted to say “Send me 1,000 words and we’ll discuss it”, and if it had turned into a libellous piece that would have got him sued by his own columnist or several rich celebroquacks – plainly his concern – then I would have dropped it, although perhaps he was worried about kill fees.

    If you wanted a right of reply, you should have written it, not written about writing it. And to be honest, from your emails I fail to see how the second piece would be different from the first one you proposed. And (another and) if you really wanted a response, you have the man’s mobile phone number. You missed an opportunity to (a) get your message to the fluffy bunny brigade and (b) tax their industry for £160.

    Rest of the site is excellent. Keep up the good work in sticking it to the pseudoscience lot.

  52. diudiu said,

    December 21, 2009 at 5:54 am

    ed hardy ed hardy
    ed hardy clothing ed hardy clothing
    ed hardy jeans ed hardy jeans
    christian audigier christian audigier
    ed hardy t shirts ed hardy t shirts
    ed hardy uk ed hardy uk
    ed hardy bags ed hardy bags
    ed hardy hoodies ed hardy hoodies
    ed hardy mens ed hardy mens
    ed hardy womens ed hardy womens
    ed hardy kids ed hardy kids ed hardy kids

You must be logged in to post a comment.