Hot foul air

November 1st, 2008 by Ben Goldacre in alternative medicine, homeopathy, mondo academico, nutritionists, PhDs, doctors, and qualifications | 78 Comments »

Ben Goldacre
The Guardian
Saturday 1st November 2008

Guy Ritchie has cancelled Madonna’s order for tens of thousands of pounds worth of special Kabbalah water to fill their swimming pool. It’s always uncomfortable when we have to humour someone close to us in the name of avoiding conflict. Right now in Thames Valley University, for example, entire science departments must be feeling slightly embarrassed about their degrees in quackery. Because despite the refusal of all universities to openly disclose what they teach on these – uniquely their ideas must be shielded from critical appraisal – the leaks keep coming, and Professor David Colquhoun of UCL continues to archive the comedy on his website.

This latest batch of course notes from TVU sound more like religious evangelism than science. “Students and practitioners alike are frequently subject to negative expressions and even frank hostility from relatives… it is therefore best to be forewarned that your adherence to ‘alternative’ principles will be tested in these ways.” They talk about magical fields that cannot be detected by instruments, as if this were a personality flaw on the part of physicists, and so on.

This is not an isolated incident. The Centre for Nutrition Education and Lifestyle Management is headed by someone from Patrick Holford‘s Institute for Optimum Nutrition. You might be surprised to discover that there is a university BSc degree available from an institution where the front cover of the prospectus reads: “Caring for and Nurturing our future Evolution through the successful support of our genetic code”, but there it is, validated by Middlesex University.  What they offer is in fact a mixture of nutritionism and a self help method called “Neurolinguistic Programming”, which developed in the 1970s out of the New Age movement.

The University of Westminster have consistently failed to offer me or Colquhoun meaningful information about their degree courses. The University of Central Lancashire has turned down (several times) a request from David Colquhoun under the Freedom of Information Act to see the teaching materials used on their homeopathy BSc. But we do have – via David – an authentic leaked exam paper from the University of Westminster Homeopathy BSc degree course finals, asking questions about miasma.

Miasmatic theory originated in the Middle Ages and lasted until the middle of the 19th century, when diseases like cholera and plague were believed to be spread by foul air, known as miasmas. John Snow showed in 1854 that cholera was spread through contaminated water – nothing to do with “miasmas” – and Robert Koch discovered the micro organism that causes the disease in 1883. If you know someone with cholera then do try and get hold of a sample of their watery diarrhoea, you should be able to see Vibrio cholerae under a £14.99 microscope from Argos, if you borrow some stain from a friendly microbiologist. Make sure you wash your hands afterwards, and don’t bite your fingernails during the experiment.

In fact, the story that science can tell about cholera is well characterised and fiendishly fascinating. If you swallow some cholera bacteria, they shut down to pass through your murderously acidic stomach, and then, when they detect (from the changed chemical environment) that they are in your small intestine, they start producing curly whip-like tails. These rotate to propel the bacteria through the pasty mucus that lines your small intestine, and up against the intestinal wall, where they can thrive.

Once here, they again respond to their changed chemical surroundings, and stop producing the tails, and instead, start producing cholera toxin. This toxin pulls chloride ions across the bowel wall, and so water is drawn across with them, by osmosis, from your blood supply and into the passageway of your small intestine.

This happens on a massive scale: your small intestine is suddenly full of water, which flies out of your arse at a phenomenal rate, carrying the multiplying and thriving new generations of Vibrio cholerae bacteria out into the drinking water and so on to the next host, chillingly, perhaps your brother, perhaps your girlfriend – unless proper sanitation measures are in place.

Meanwhile, as this water flies out of you, dehydration rapidly begins to set in, and the only thing you can do to save your life is make sure you consume – almost continuously – the right mixture of dilute salt water and sugar, to replace the blood’s water and salts lost in the diarrhoea.

And fascinatingly, the single most successful evidence-based medical treatment in the history of humankind is something you’ve probably never heard of: the WHO rehydration recipe, used to treat people with diarrhoea, which has saved 3 million lives a year for the past two decades. In fact, diarrhoea kills more young children around the world than malaria, AIDS and TB combined.

You can fix yourself a pair of pints in your own kitchen following this deliberately memorable recipe: simply stir one level teaspoon of salt, and eight level teaspoons of sugar, into one litre (5 cupfuls) of drinkable water. Then sit back on your balcony, toast the fact that you don’t really have cholera, and savour the flavour of a drink that saves one child’s life every 11 seconds. Imagine being a part of inventing that. If I was going to teach anything on a science degree, it wouldn’t be miasma, and it wouldn’t be a secret.

Important Note:

In the article above, I failed to distinguish satisfactorily between the fantastical miasmatic theory of disease in the middle ages and the fantastical miasmatic theory of disease as meant by some homeopaths, two equally fantastical theories (note) about the causes of disease. This will make the homeopaths fizz like a bag of wasps.

Now this distinction may, to you, feel a bit like those mediaeval philosophers’ heated debates about the number of angels that can fit on the head of a pin, but we must respect the belief systems of others, and more than that, accuracy is important. I’ve already let the Readers’ Editor know about this important error and will keep you updated on the progress of my complaint about my own work.

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! ++++++++++++++++++++++++++++++++++++++++++

78 Responses

  1. John said,

    November 5, 2008 at 5:46 pm


    I much admire Singh but I think he is being a little bit too po-faced in that article. Whatever Brown says he is doing he is obviously misdirecting the audience/participant and that is very much part of his act. I do recognise that stage magicians do not bend the laws of physics when they do things which are seemingly impossible.

    Organisations which use NLP as part of sales training have found improvements in the performance of their sales force. As a sales director for an IT company I can quantify this. However I would agree that in this respect NLP is probably not much different to a well-recognised sales methodology like the Huthwaite Groups SPIN. Most sales forces seem to improve performance post any sort of sales training – which is probably just the result of them refocusing their attention.

    I never for a second realised that NLP might be taught as a therapeutic technique nor that there was such a thing as a NLP therapist. Other than directing a discussion I do not see the applicability of this – other than (I suppose) it is good to talk.


    Maybe Brown isn’t using NLP. I just made that assumption based on the comments by the psychologist in one of his shows.

    Ditto my comments above about NLP having some therapeutic value.

    And I agree that much (all ?) magic, illusion etc is a SOTBO once you know how it is done. The joy of prestidigitation is that most of us civilians cannot work out how it is done – ever. I asked a military surgeon once if brain surgery was easy and he replied “it is if you know how to do it”. Either that or Paul Daniels can actually bend time and space.

    So it probably has some uses when stripped of its woo-ness. I will repeat my previous assumption that it is merely “smart aleck clever dick bastard verbal gameplay” and has little use beyond that.

  2. warhelmet said,

    November 5, 2008 at 7:15 pm


    “NLP has a number of compelling principles at it’s base which are consistent, well-reasoned, but often awfully difficult to get across lucidly.”


    I suggest that you go along to Take a look at the entry on NLP. It’ll explain some of the above comments on NLP better than I can. I’ve actually tested it on NLP adherents and they say it’s surprisingly balanced.

  3. indigochild said,

    November 5, 2008 at 11:32 pm

    I don’t want to be rude in any way, but that article is a shallow, limited response, full of misunderstandings, fuzzy thinking, and bordering on being openly hostile, without addressing a single substantive point presented in the early literature, opting instead to critique sales information.

    This is of course, because the author has likely not read any of it and/or is not interested.

    Which is fine, but you can’t seriously post it as a refutation, because it puts into sharp relief a complete lack of willingness to tackle the subject matter.

  4. jonathanhearsey said,

    November 6, 2008 at 1:48 pm

    Hang on a minute…..

    Do you not need to put aquagarde and oxyshock in Kabbalah water?

    If this is the case then I’m gonna get me some for the hot tub. UK water goes green and stinks without the chems!


  5. RobDur said,

    November 6, 2008 at 2:23 pm

    I’ve got to agree partially with indigochild; what annoys me most about ‘theories’ such as NLP is that at their heart there are often good ideas: I’m working with a lot of Greg Bateson’s work right now and though he went a bit cuckoo towards the end of his life, a lot of his ideas are pretty decent (btw, though Bateson used ‘the map is not the territory’ a lot, the phrase actually originates with Alfred Korzybski). Similarly whilst an insistence that we can ‘read body language’ is nonesense, the idea that a lot of communication is pre-consciously spread through the body in a non-structured way is a pretty good one.

    It’s like the dodgy poststructuralist cultural theory ideas which simplified ‘understandings’ of quantum physics to start to argue for interperative contingency in politics and literature… the problem is the misuse of decent ideas and the combining of contradictory theorists or theories – such as Freud and Bateson mentioned at – not necessairliy the ideas themselves.

  6. RobDur said,

    November 6, 2008 at 2:33 pm

    The point of the above being that if you attack ideas and theories that are used in a dodgy way ad hominem, you risk losing what is decent out of these ideas in the first place.

  7. warhelmet said,

    November 6, 2008 at 5:39 pm

    No, it’s not posted as a refutation, it’s posted as a better articulation of some of my concerns than I can manage at the moment. And it is reflective of the skeptic community attitudes towards NLP. Also, I wanted people to read it because I do think that it adds something to the debate.

    Bear with me.

    I’m not actually as daft to base my opinions purely on an article that I read on Skepdic. But as a consumer of therepeutic services, it is important to me that the type of therapy I am purchasing can be shown to have some efficacy – beyond the anecdotal. It is important to me that it is grounded in a rational framework that I can understand. It is important that that framework is in tune with how my rational framework is constructed. I want the therapy to work with my mindset to achieve the goals I want rather than attempt to change my mindset.

    This is not to underplay the role of the therapist.

    But for me, when looking at the evidence I can lay my hands on, NLP does not fufill my criteria as a therapy that I should purchase.

    Whilst NLP does share some concepts with CBT, CBT has been proven to be effective. Humanistic approaches, especially the Rogerian CCT have a strong attraction to me because some of the reasoning mirrors the way that I think. My past experience of the client centred approach was very positive.

    Which is all very nice.

    But we are talking therapy. Although I do not think that NLPt is the therapy of choice for me, I do appreciate that others might find it useful. And the fact that UKCP recognise it as an experimental form of psychotherapy suggests that there is at least some acceptance of NLPt. But, you are not going to find a psychotherapist who has not been trained in other therapeutical approaches as well. Same for properly qualified counsellors.

    I’m a computer sciencist. In CS there is something called “duck typing” – the rationale of which is that if it looks like a duck, waddles like a duck and quacks like a duck, then it is a duck.

    I’ve come across the term “Human Potential Movement” in the past. I’ve seen it used to describe a number of different New Age philosophies that revolve around unlocking the extra-ordinary potential that exists in all human beings, but from a more secular than spiritual development. I had a friend who was into this sort of thing. Most of them pedal vaguely plausible psychobabble but deliver nothing. If they did, there would be loads of people out there achieving superhuman things with their unlocked potential. Some of them smell like cults. It’s woo.

    It is the point at which Grinder and Bandler started making claims for NLP beyond the realms of therapy and raking in lots of dollars from seminars and pop books, that NLP starts doing the duck thing. It starts to look like Human Potential stuff. It is woo.

    If you want to distingush between NLPt and NLPother, that’s fine by me.

    But the “Caring for and Nurturing our future Evolution through the successful support of our genetic code” BSc, what is it teaching? I doubt very much that is is NLPt. I bet it does woo. Hence the concern over the BSc status of the degree – ignoring the nutrionism.

    There is even more, but too far off topic.

  8. indigochild said,

    November 6, 2008 at 6:34 pm

    I was going to point out in my earlier post, and neglected it, was that the assertion made in the skepdic article about the reading of body language was somewhat disingenuous, because there is a notion of calibration in NLP that requires you to check whether or not your intuitions about the connection between body language and internal states are true, which is about as much as you can reasonably do, I think.

    Many mud has been thrown. I figured if I was going to argue in favour of NLP not being bad science, I might as well do it thoroughly. ta.

  9. thom said,

    November 6, 2008 at 8:47 pm

    Robdur, Indigochild: I agree that NLP has some interesting ideas – some with an impressive intellectual pedigree (some not). The link to Chomsky is, I think, mostly woo. NLP involves no formal analysis of grammar and at best is using his terms in a ‘inspired by Stephen King short story’ kind of way.

    The links to Freud, Erickson and hypnosis are more substantial. However, just because they borrowed some nice ideas doesn’t make it a good therapy and there is sadly no evidence that NLP is better than, say, Psychodynamic counselling.

    I’s also add that NLP clearly isn’t science – it is a therapy. CBT is not a science. It too is a therapy. What differs between CBT and NLP is the extent of the evidence base in terms of the scientific rationale for the theory and the scientific evaluation of the therapy.

    My own personal view is that clever ideas are interesting and important, but sometimes over-rated in science. It is is pretty easy to come up with clever ideas. What is hard is expressing them in a form that is useful, testable and then following through by actually publishing them and testing them. I should add that my evidence for this is almost entirely anecdotal. I have loads of what I think are good ideas – most turn out to be rubbish (but a few have ended up as published work or led to publishable experiments).

    Having said that I think there can be dangers in contagion from slagging off one thing on its intellectual antecedents. However, I think Chomsky and Freud are safe from this line of attack.

  10. indigochild said,

    November 6, 2008 at 10:59 pm

    I assure you, if you find a copy of The Structure of Magic I, you can see laid out formal analyses of language structures, including transcripts of actual therapeutic encounters columned with notes specifying which part of the model is being used, and why, and to what effect.

    To what extent this derives from Chomsky’s work, I cannot say, not having studied it in anything like the requisite depth.

    At the core, in terms of scientific validation, there is a problem, namely this. Scientific validation requires that tests be repeatable, and conditions be controlled.

    If you take it to be understood that your consciousness is incapable of tracking every process of your body, and every sensory input simultaneously, not to mention how they are interrelated, both the conditions of repeatability and control become, in the context of interpersonal communication, literally impossible.

    So in what way can a general scientific study be formulated? Is the scientific microscope even suitable for a subject that can look back through it and see a huge eye peering at it, and think to itself, “What the fuck are you looking at?”?

    Take for example, the Id, the Ego, and the Super Ego. Nowhere, in any description, anywhere, is there an indication of how an Id smells, or where it does it’s shopping. It’s a model, an idea about ideas. It’s not true. You’ll never meet an Id in a supermarket, or see one on a swing, but that a councillor can carry one around in his or her head, and compare people to it doesn’t seem to phase anybody! Doesn’t this strike you as odd? It’s a label on something that has no internal or external reality, until you start to categorise things accordingly.

    Final word from me, (because I’m becoming aware of the impoliteness of carrying on a long conversation in the threads of Ben’s blog), the ideas of Chomsky or Freud are not immune from criticism, but only if you can point out something that would be more true, or at least more useful. Chomsky said recently that if he believed now what he believed ten years ago, he would assume the field were dead, which it probably would be, had he studied homoeopathy at the University of Westminster.

    The word “adherence” gives me the chills.

  11. warhelmet said,

    November 7, 2008 at 11:11 am

    Measureable outcomes.

  12. Dudley said,

    November 8, 2008 at 1:38 pm

    Anyone calling on Derren Brown as a witness in favour of NLP would be well advised to look at his book, esp pages 172-186. He talks about the training he received, demolishes the theories behind NLP, and mentions that he was given a license to practise as an NLP therapist after just four days of seminars.

  13. indigochild said,

    November 8, 2008 at 8:38 pm

    “Tricks of the Mind”, and as Derren Brown writes on page 186:
    “As I have suggested, if we remove from the NLP equation the grinning, flaccid course-junkies, delusional flower-fairies and ridiculous tactile businessmen, and some of the taken-as-read wild claims made by NLPers at all levels, there are some sensible enough tools and techniques from that world which are worth knowing about, as long as you don’t become a True Believer.”

  14. Robert Carnegie said,

    November 9, 2008 at 1:25 am

    Did anyone notice when “cholera virus” slipped into the thread? And that one was explained in the article. Or is that why you don’t need antibiotic for it…

  15. Robert Carnegie said,

    November 9, 2008 at 1:27 am

    …presumably there is a substantial difference between the theories of homeopathic miasma and mediaeval miasma? Although that firstly requires that the theory of homeopathic miasma is in fact substantial. Don’t know about that…

  16. warhelmet said,

    November 9, 2008 at 1:54 pm

    I would guess that homeopathic miasma becomes more miasmic the more it gets diluted.

  17. metascrawl said,

    November 20, 2008 at 12:14 pm

    As an undergraduate at Westminster on a proper degree (well, English Literature) this is the most depressing article I’ve read in ages.

  18. jms1917 said,

    November 27, 2008 at 8:04 pm

    For all those vegetarians, vegequarians, piscatorians and other inhabitants of the planet Vega. Animals have no rights.

    Rights have consequent responsibilities. A cat has no rights beacause, however well you may treat it, it will never respond by treating a mouse – or any other creature on the planet – any better.

    We may have a duty to treat animals well, but we cannot have any contract with them.

  19. jms1917 said,

    November 27, 2008 at 9:22 pm

    To: Mehitabel-III

    I have a friend from California who writes in the same way you do. I can never work out what she’s saying either.

    As you suggest, it may be a difference between the British and American education systems, but, though stream of consciousness may work for William Faulkner, it doesn’t work for you.

    Would you try to be a bit clearer, please? Sentences would be handy.

  20. jms1917 said,

    November 27, 2008 at 9:42 pm

    The “placebo effect” is itself bad science. It is in fact no effect at all, it’s a control.
    Improvements in any patient that are normally attributed to the “placebo effect” are more likely due to:
    Spontaneous improvement, fluctuation of symptoms, regression to the mean, additional treatment, conditional switching of placebo treatment, scaling bias, irrelevant response variables, answers of politeness, experimental subordination, conditioned answers, neurotic or psychotic miss-judgment, psychosomatic phenomena, misquotation, etc.

    It’s counting thing again. Come on people, stick with the arithmetic.

  21. HypnoSynthesis said,

    January 9, 2009 at 11:06 pm

    NLP? Just to be clear, I’m a hypnotherapist, and so I’ve had a lot of exposure to an awful lot of different NLP practitioners and trainers, etc., over the past 15 years. But I’m also something of a “skeptical” hypnotist, if you can imagine that -I basically believe that suggestion, and related factors, explain many of the effects of talking therapy. However, NLP is largely pseudoscience and the people who promote it are predominantly the kind of people you wouldn’t buy a used car from, to be blunt. It’s not New Age? The last time I saw Richard Bandler he was doing some hybrid of NLP and Tantric Chakra therapy, and his trainers were teaching an NLP model of Remote Viewing (clairvoyance). One of the other main US trainers does Hawaiin Huna chanting NLP to summon spirits. NLP is based on Chomsky? It’s a classic example of taking big words from the world of theory and trying to blind people with academic jargon to cover the fact that the actual claims are totally unfounded, and patently absurd. Research on NLP? As far as I understand it no peer-reviewed research has been published on NLP in about 20 years, because a series of different systematic reviews published in the 1980s undermined its key claims and killed off interest in studying it further. NLP is modelled on expert therapists? That’s a myth created to market the workshops by the people who made it all up in the first place. Even if you consider Fritz Perls (!) to be some kind of expert, NLP bears only the most tenuous relationship to his work. As for Milton Erickson, read what Erickson’s colleage and friend Andre Weitzenhoffer, professor of psychology at Stanford, says about NLP, it’s claims to be based on Erickson’s work are “fanciful and absurd.”

  22. mirelle said,

    February 9, 2009 at 4:26 am

    To control the pain we must first go to the doctor because we can give him what is appropriate and what we need, such as oxycodone that I take is a medicine used to counter the pain of my back pain for years, but This was the prescribing doctor, I take it in moderation because I read in is a pill that causes anxiety, and if you can not control it can affect your nervous system, we must always know what the physician and thus avoid setbacks …

  23. neukoln said,

    March 20, 2009 at 6:50 pm

    I find this thoroughly depressing. I have an interest in Nutritional Medicine which was awoken by the popular book by medical practitioners Davies and Stewart (

    It is a shame that it appears that what are promoted as ‘academic’ programmes in Nutritional Medicine espouse gobbledigook about vital energy etc. There are thousands of research papers on the effects of vitamins, minerals, amino acids (positive, negative, neutral). Why can academic programmes not focus on these – and arm nutritional practitioners/therapists with facts rather than the sort of stuff than puts them in the same class as crystal healers? It’s very depressing.

  24. psychgradmum said,

    August 28, 2009 at 8:43 pm

    This appears with the banner “improve your chances of migrating to Australia – study natural medicine” have a look at the course outlines and guides – it’s quite enlightening!

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  27. Diodorus said,

    April 13, 2011 at 2:06 am

    I’m afraid Snow’s 1854/1855 studies didn’t actually demonstrate (at any rate to the satisfaction of his contemporaries) that cholera was spread through tainted (‘poisoned’) water, because not all other factors (esp. sewers, a local plague pit) then considered possible causes had yet been eliminated in the Broad Street outbreak. Snow didn’t bother to criticise these theories, but they had to be tested and disproved separately by others. He was also unsure he’d included all and only all the right cases, since at the time ‘Asiatic cholera’ was counted as just one of a whole family of cholera-type illneses, diagnosed through symptoms only, that might be put down on a death certificate (cholera bilosa, English cholera, cholera malgna, etc.). In general, the same data might support the miasma theory and the ‘poison/animalcule’ theory, e.g. where victims lived and died in houses prone to flooding (e.g. as in Oxford, where low-lying houses did in fact have a higher rate of mortality from cholera). Good, solid data might point to the weather as subsidiary cause, by increasing incidence and duration of miasmatic airs (cf. Farr’s work on London). Finally, Snow didn’t deny the miasma theory generally, only claimed that it was wrong for cholera; but he didn’t have much of an alternative (‘Lots of tiny invisible animals? In water? What have YOU been drinking?’). Of course, he was right, broadly (sorry) speaking); but being right ain’t the same as being seen to be right, and being right about the vector isn’t being right about the cause.

  28. Nutritionist Birmingham said,

    April 14, 2012 at 11:07 am

    I think they must have a hidden agenda for comments like this. I’m interested in Nutritional Therapy and wish people would give it a chance.