How do you regulate Wu?

February 20th, 2010 by Ben Goldacre in bad science, herbal remedies, regulating nonsense | 80 Comments »

Ben Goldacre, The Guardian, Saturday 20 February 2010

You might have read the case of Ying Wu this week: a fully qualified traditional chinese medicine doctor operating out of a shop in Chelmsford who for several years prescribed high doses of a dangerous banned substance to treat the acne of senior civil servant Patricia Booth, 58, reassuring her that the pills were as safe as Coca-Cola. Following this her patient has lost both kidneys, developed urinary tract cancer, had a heart attack, and is now on dialysis three times a week. Judge Jeremy Roberts gave Wu a two-year conditional discharge, saying she did not know the pills were dangerous and could not be blamed, because the practise of traditional Chinese medicine is totally unregulated in Britain, a situation which he suggests should be remedied.

This sounds attractive, and has been loudly welcomed by alternative therapists, who see regulation as the path to legitimacy. It’s worth noting, in passing, that we do already have systems in place for dealing with dangerous substances (these pills are banned), false claims on the high street (like the regional Offices of Fair Trading, who chose not to use their powers here), and people prescribing treatments which have both powerful effects and dangerous side effects (like doctors, who make bad calls with sufficient frequency already that it seems a bit wishful to want shortcuts around that training).

But special regulation for alternative therapists raises one very simple problem: it’s very hard to regulate practitioners who make claims based on faith more than evidence. In such a situation, what is your yardstick for whether a clinical decision was reasonable?

Current attempts at regulation have exposed these contradictions. The Complementary and Natural Healthcare Council (or OfQuack, as they are affectionately known) has a Code of Conduct which forbids alternative therapists making claims without evidence. Blogger Simon Perry complained about every single reflexologist on the register, on the day they joined, if they were claiming to treat things like arthritis, infertility, babies with colic, and so on. All were told off, but the CNHC decided that fitness to practice was not impaired, because their reflexology expert said that the practitioners would have honestly believed their claims to be reasonable, since they would have been trained to believe that they could treat these diseases.

So is the training the problem? The government’s review into regulation of alternative therapists has recommended that it should be compulsory to have a university degree in alternative therapies, and that universities should run such courses. And what is taught on these courses? You cannot know, because the universities have gone to shameful lengths over many years, to the point of multiple appeals at the highest level with the Information Commissioner, to keep the contents of these science degrees a closely guarded secret.

Myself and Professor David Colquhoun of UCL have obtained occasional course materials from students themselves, who thought they were going to be taught the scientific evidence base for alternative medicine, and have been dismayed by what they found. You can see why the universities wanted to hide them. Handouts from the Bachelor of Science degree in Chinese Medicine at Westminster University, for example, show students being taught – on a science degree – that the spleen is “the root of post-heaven essence”, “Houses Thought (and is affected by pensiveness/over thinking) ” and is responsible for the “transformation of qi energy”, “keeping the muscles warm and firm”.

“Marrow helps fill the brain”. “Sin Jiao assists the Lungs ‘dispersing function’, spreading fluids to skin in form of fine mist or vapour (so it helps regulate fluid production…)”. We also see the traditional anti-vaccine spiel, as students are taught that vaccination is a significant cause of cancer.

One lecture by Niki Lawrence on “Herbal approaches for patients with cancer”, meanwhile, discusses the difficulties of the Cancer Act, which was specifically designed to protect patients from the more dangerous extremes of alternative therapists’ self-belief. “Legally you cannot claim to cure cancer” it begins, on a slide headed “Cancer treatment and the law”. “This is not a problem because: ‘we treat patients not diseases’.” Niki then romps on to explain that Poke root is “especially valuable in the treatment of breast, throat and uterus cancer”, Thuja occidentalis is “indicated for cancers of possible viral origin, eg colon/rectal, uterine, breast, lung” and Centella asiatica “inhibits the recurrence of cancer”.

It is a tragedy that someone has contracted a fatal condition and is on dialysis. What worries me is that when you try to slot the square peg of fanciful over-claiming and faith-based medicine into the round hole of serious regulation and university teaching, you create more problems and confusion than you started with.


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80 Responses



  1. fluffy_mike said,

    February 20, 2010 at 1:43 am

    medicines don’t kill, rappers do

  2. Jake said,

    February 20, 2010 at 2:29 am

    Rappers don’t kill, musicians do.

  3. SDByers said,

    February 20, 2010 at 5:26 am

    How do you regulate Wu?

    Simple answer: You can’t without looking like a fool.

    The only way to do it is to rule that ALL clames made are backed up by evidence, kind of like real medicine.

  4. anewcombe said,

    February 20, 2010 at 6:20 am

    “Honestly, your honour, I didn’t know heroin is bad for you.”

    “OK, be good for 2 years”
    Judges are amazing!

  5. AmbroseChapel said,

    February 20, 2010 at 6:37 am

    > backed up by evidence, kind of like real medicine

    Hilarious. Oh, wait, you weren’t joking.

  6. Andrej Bauer said,

    February 20, 2010 at 7:11 am

    In Slovenia we have a new law that regulates “healers”. It says that a healer must have at least a high-school degree in medicine (I don’t know what the US or British equivalent would be, but this school is enough for someone to become a nurse). As an additional requirement, anyone who practices homeopathy, chiropractics, or osteopathy must have both a degree in homeopath/chiropractics/osteopathy and a university degree in medicine. Needless to say our healer are not too happy about this. I personally think it’s a pretty good way to regulate alternative medicine.

  7. toumai said,

    February 20, 2010 at 7:41 am

    Thank, Ben. Hearing the news at the time I couldn’t quite believe that Ms Wu had walked free like that. Surely healers have *some* kind of duty of care? And surely ignorance has never been a defence in the eyes of the law? (“Sorry, yer honor, I hadn’t read me Highway Code so had no idea a blue arrow meant one way” “Please don’t kill anyone again. But you didn’t know, so off you go.”). There are, as you say, several areas under which prosecution might have been sought.
    As for the “degrees” in alternative meds … surely any degree *used* to be about pushing boundaries in the latest studies and interpertations – even for “dead” subjects, like classics. Since when did rote digestion of rubbish – kept secret – become acceptable? Who on earth validates these courses? And how can they sleep at night?

  8. DevonDozer said,

    February 20, 2010 at 8:41 am

    Yes, it’s daft, but look at the ‘victim,’. Here we have a ‘senior civil servant’ – presumably a person paid a lot of money by tax payers to shuffle bits of paper around and, we are told, to travel first class. At 58, she was educated when the state system taught science and maths to a reasonable level.

    I have no sympathy for her. If she was stupid enough to fall for wu then why should the taxpayer fund a health service to try and put right the damage she has caused to herself? And what are we doing having people like that on the public payroll?

    I agree completely with the fundamental attitude here towards Bad Science, but the libertarian in me struggles with solutions that simply bind us all in more rules, regulations and beaurocracy. We need less of that, not more. A response based on exposure of the nonsense for what it is and an emphasis on personal responsibility would have more appeal.

    Great blog though. Keep on with it as your career blossoms :^) .

  9. Ant said,

    February 20, 2010 at 8:55 am

    So the health service shouldn’t treat people who do daft things? If that’s the case, I shouldn’t have seen a single one of the patients on my A&E shift last night, because they all in some way or another did something to make themselves ill.

    People fail in all kinds of ways, it makes them ill and medics and the health service clean up the mess because sooner or later we all do something really stupid and need that help. Whether its people taking alternative therapies, the kids in gangs getting stabbed, the alcoholics and the smokers or the rock climbers falling off.

  10. blueporcupine said,

    February 20, 2010 at 9:03 am

    “fitness to practice was not impaired, because their reflexology expert said that the practitioners would have honestly believed their claims to be reasonable”

    Unbelievable. Assuming this is the sort of “loophole” that would routinely be available to alternative practitioners, I can’t see further regulation being any use. The instinct to create more legislation/regulation/quangos when things go wrong is dangerous in the abstract, as well as clearly pointless in this case. But I expect the judge thought he was being kind and understanding to hippies, which is normally what judges get slated for not doing.

  11. BGray said,

    February 20, 2010 at 9:05 am

    @toumai

    It’s only ignorance of the law that isn’t a defence. Ignorance of the facts can be, and often is, a defence. If I give you something that I think is safe, then I can’t be convicted of a poisoning offence because I have no intent to administer a noxious substance.

    You’re right that there’s probably a duty of care (I think there’s even caselaw on this point), but that relates to civil proceedigs in tort, while this is a criminal case. She’d probably also have a claim in contract.

    “Regulation” in some form might be good here as it would provide a very good basis to determine the standard of care practicioners owe their patients. This will make it easier for people injured as above to claim for negligence. It may even force them to behave themselves, knowing that if they deviate from the strict line (as with the reflexologists), they risk being sued.

  12. BGray said,

    February 20, 2010 at 9:09 am

    @blueporcupine – That wasn’t a judge making that decision; it was a quack self-regulatory body. It also isn’t a “loophole” necessarily as the courts can still declare it negligent (Bolitho v City & Hackney HA; Re Herald of Free Enterprise)

  13. Mojo said,

    February 20, 2010 at 10:13 am

    @BGray

    ““Regulation” in some form might be good here as it would provide a very good basis to determine the standard of care practicioners owe their patients.”

    If the “standard of care” expected includes treatments that are worthless or harmful (however sincerely believed in), it isn’t going to do much good.

    “That wasn’t a judge making that decision; it was a quack self-regulatory body. It also isn’t a “loophole” necessarily as the courts can still declare it negligent (Bolitho v City & Hackney HA; Re Herald of Free Enterprise)”

    In other words, regulation would be pointless and unnecessary.

  14. le canard noir said,

    February 20, 2010 at 10:19 am

    The judge in the Wu case missed a golden opportunity. A stiff sentence could have changed the alternative medicine industry overnight.

    Actually, it might take a few cases like this before the penny drops in Wu land. Quacks are characterised by a wonderful lack of insight. The homeopaths would see a conspiracy not an enforcement of the law, for example.

  15. Ian said,

    February 20, 2010 at 11:10 am

    I can’t believe the judge let her get away with this. 2 minutes on Google was enough for me to find out that in 2007 the MHRA described Xie Gan Wan as “contain(ing) aristolochic acid, a naturally occurring toxin that has been reported in the medical literature to cause cancer and kidney failure in humans.”

    It doesn’t need regulation, just for anybody prescribing a medicine or treatment to be liable for making reasonable precautions to find out whether it is safe. If somebody with no knowledge of Chinese (or any other kind) of medicine can find this information so easily then it isn’t asking too much of somebody claiming to practise medicine to find it.

    @ le canard noir – ironically homeopaths would appear to be the only alternative therapists who would not need to do much research. As long a they don’t prescribe too many sugar pills to a diabetic patient they should be pretty safe!

  16. pberry said,

    February 20, 2010 at 11:41 am

    As Ben points out early on in the article, there are already sufficient means to keep the more absurd fringes of woo in check. The only thing preventing more complaints or investigations is apathy. From what I can gather it seems to be falling to the anti-quack bloggers to do most of the awareness raising and campaigns. So be it.

    Of course, the biggest and most powerful form of regulation is customer choice. If people don’t want your sham product/therapy they won’t buy it and whole swathes of alt med would just quietly implode without a source of income. A good way of reinforcing the fact woo is at best marginal and at worst dangerous is to cut off its reservoirs of legitimacy such as degree courses.

    Keep up the fine work.

  17. Dr Jim said,

    February 20, 2010 at 12:47 pm

    In the law isn’t it the case that ignorantia juris non excusat (ignorance of the law is no excuse)?

    Should the same principle not stand for quacks who injure people with known dangerous treatments?

  18. SteveGJ said,

    February 20, 2010 at 12:51 pm

    It seems to me that any organisation or person selling medications or therapeutic treatments of any sort must be legally obliged to demonstrate that the treatments are safe. This to be enforced by criminal sanctions. Not too difficult for the homeopaths of course, but given the witch’s brew of many Chinese herbal remedies, that is going to be much more difficult.

    In addition, any claims to the efficacy of any treatments which are not backed up by evidence from proper tests should carry a clear statement to that effect. Should such a notice be omitted, the the seller should be liable to civil remedies. Having such a notice on the web sites of various bodes representing homeopaths and chiropractors (for one) would surely be a good thing. It might also sweep up some of the peddlers of super-foods, de-tox and cosmetics who make unfounded claims.

    Of course something rather like this already applies to conventional medicine, but I see no reason why the rules should be any different for unconventional treatments.

    Of course, there are lots of grey areas, but clearly alternative therapies should not be unregulated, but it must be done in a way that doesn’t give the appearance that there unevidenced claims are valid in any way.

    nb. it’s not exactly key to the message, but this made me wince.

    “Myself and Professor David Colquhoun of UCL”

  19. lowercase said,

    February 20, 2010 at 2:41 pm

    as with all belief systems legislating against alternative medicine just isn’t viable, that way the thought police lie. imho, we should teach the dangers of placing unreasonable weight behind unsubstantiated ideas in schools. but due to the unreasonable weight everyone from the quacks to the religious place behind their nonsense no government will ever have the balls to do this. we need a second enlightenment, until then the idiots will continue to believe rather than think.

    on a less pleasant note, does anyone else find something amusingly darwinian about idiots dying because of their dumb faiths? or is it just me

  20. the lab pharmacist said,

    February 20, 2010 at 2:44 pm

    A step in the right direction for pharmacists!

    www.pjonline.com/news/information_herbal_homoeopathic_products_society_website

    John Jolley asking for a statement that there is no evidence to support homeopathic medicines use, and that the Council should have a definitive policy on homeopathy. Yay!

    Let’s wait and see if ethics wins over commercialism.

  21. muscleman said,

    February 20, 2010 at 3:00 pm

    @lowercase

    Since the ‘patient’ is 58 I would say the horse has already bolted in a Darwinian case. It only counts as selection prior to reproduction, the grandparent hypothesis notwithstanding.

  22. Jeesh42 said,

    February 20, 2010 at 3:15 pm

    I’ve often wondered how you can teach a university course on something that has no rationale to it. It seems to me like every CAM lecture is necessarily collecting together a bunch of made-up words that you then have to learn the arbitrary meanings of – impossible to *teach* and impossible to *learn*.

  23. lowercase said,

    February 20, 2010 at 3:34 pm

    @muscleman

    hehe, true true, although it was intended as a more general statement. plus i’m sure i’m not the only one that allows a little leeway applying the term beyond it’s strictest definition. i reckon the darwin awards probably don’t disqualify post-menopausal women or those with a similar lack of reproductive abilities.

  24. Psythe said,

    February 20, 2010 at 3:42 pm

    Maybe it should be illegal to practice as an alternative therapist (or for that matter go on a course in alternative medicine) unless you have already done a medical degree?

    That way practitioners would have a choice of treatments – and should be more aware of potential dangers of any treatment. The training would also teach them how to look for evidence of efficacy, making it less likely they would recommend homeopathy etc instead of allopathy, at least in cases where there was a useful allopathic treatment.

    It would also make it amusingly tough for those who teach courses in such therapy :-)

    In this case, whether or not a criminal case is brought there should be a civil case, preferably well publicised, to bring the practitioner and the practice into disrepute.

  25. the rim groper said,

    February 20, 2010 at 4:54 pm

    per SDByers: “The only way to do it is to rule that ALL clames made are backed up by evidence, kind of like real medicine”.

    If only… real medicine is guilty of making many unfounded claims and it is no surprise to discover that iatrogenic harm is just as easily witnessed within ‘real medicine’.

    per toumai: “Since when did rote digestion of rubbish – kept secret – become acceptable? Who on earth validates these courses? And how can they sleep at night?”

    I know of several embryo medics who qualified merely by dint of rote learning. When you see the sheer volume of people hurt every year by qualified medical intervention, it begs the question; what does qualified medic mean, apart from being a holder of MB BS?

    If you retain any independent clinical judgement then you can count yourself extremely fortunate. The NICE guidelines are effectively diktat and woe betide any clinician who does not whole-heartedly support the nonsense emanating from that arm of government health policy.

    NICE is a highly prescriptive body, which requires an excellent rationale for countermanding its orders, lest the MDU abandon you after it all goes horribly wrong.

    The judgement seems to be perverse. Try getting a clinician to the same point after the patient has been harmed. Experimentation on live patients is what should outlawed. Whether it be initiated by the exponents of complementary medicine or by the supporters of the medical orthodoxy.

  26. twaza said,

    February 20, 2010 at 5:12 pm

    Are GPs that different from practitioners of woo?

    One aspect of this case that horrifies many people is the opinion that:

    Wu’s “fitness to practice was not impaired, because their reflexology expert said that the practitioners would have honestly believed their claims to be reasonable”.

    The British Medical Association in 2009 provided similar guidance to GPs. In terms of this guidance, to be “safe” from legal consequences should something go wrong, a GP has to have belief, not evidence, that the therapy is efficacious.

    GPs can “safely” refer patients to registered osteopaths and chiropractitioners — which might be a strong motivator for herbalists and other unregulated complementary and alternative medicine practitioners to be regulated.

    Here are the relevant sections in full:

    “GPs may delegate treatment to complementary therapists who are not registered with a statutory regulatory body. In doing so, they remain responsible for the treatment given and would bear some liability should the patient come to any harm. Whether GPs are prepared to delegate treatment in these circumstances would therefore depend principally upon their knowledge of, and belief in the efficacy of, the therapy and their personal knowledge of the competence of the individual therapist.”

    “GPs can safely refer patients to therapists who are registered as doctors, dentists or nurses with the GMC, GDC or Nursing and Midwifery Council (NMC) respectively, because these professionals would be fully accountable for their actions and the patient could seek legal redress against them in the event of an accident. Health Professionals registered with the Health Professions Council, Osteopaths regulated by the General Osteopathic Council (GOsC) and chiropractors, regulated by the General Chiropractic Council (GCC) are similarly regulated and GPs should carry no responsibility for the actions of such Health Professionals other than for the decision to refer.”

    The guidelines are available here:

    www.bma.org.uk/images/refcomtherap0406_tcm41-190153.pdf

  27. twaza said,

    February 20, 2010 at 5:15 pm

    ARE GPS THAT DIFFERENT FROM PRACTITIONERS OF WOO?

    One aspect of this case that horrifies many people is the opinion that:

    Wu’s “fitness to practice was not impaired, because their reflexology expert said that the practitioners would have honestly believed their claims to be reasonable”.

    The British Medical Association in 2009 provided similar guidance to GPs. In terms of this guidance, to be “safe” from legal consequences should something go wrong, a GP has to have belief, not evidence, that the therapy is efficacious.

    GPs can “safely” refer patients to registered osteopaths and chiropractitioners — which might be a strong motivator for herbalists and other unregulated complementary and alternative medicine practitioners to be regulated.

    Here are the relevant sections in full:

    “GPs may delegate treatment to complementary therapists who are not registered with a statutory regulatory body. In doing so, they remain responsible for the treatment given and would bear some liability should the patient come to any harm. Whether GPs are prepared to delegate treatment in these circumstances would therefore depend principally upon their knowledge of, and belief in the efficacy of, the therapy and their personal knowledge of the competence of the individual therapist.”

    “GPs can safely refer patients to therapists who are registered as doctors, dentists or nurses with the GMC, GDC or Nursing and Midwifery Council (NMC) respectively, because these professionals would be fully accountable for their actions and the patient could seek legal redress against them in the event of an accident. Health Professionals registered with the Health Professions Council, Osteopaths regulated by the General Osteopathic Council (GOsC) and chiropractors, regulated by the General Chiropractic Council (GCC) are similarly regulated and GPs should carry no responsibility for the actions of such Health Professionals other than for the decision to refer.”

    The guidelines are available here:

    www.bma.org.uk/images/refcomtherap0406_tcm41-190153.pdf

    (PS WordPress does not let me comment from Chrome.)

  28. twaza said,

    February 20, 2010 at 5:17 pm

    PPS
    Wordpress did accept my comment from Chrome, but complained that it could not, which is even more irritating.

  29. lowercase said,

    February 20, 2010 at 5:53 pm

    @the rim groper

    your point seems to be that real medicine is flawed, yes it is, that’s why we have scientific method to improve it. the issue with alternative medicines is not their flaws but their complete lack of any basis in reality. also, what’s mostly wrong with nice is governmental influence rather than anything to do with the fact that it’s a medical body.

  30. skyesteve said,

    February 20, 2010 at 8:16 pm

    @Ant – absoultely right. A few years ago the BMJ banned the use of the word “accident” in its pages (though I’m not sure if the ban still holds) on the basis that, with the exception of natural disasters, everything else had a reason for happening and, therefore, the term accident was redundant.

    @the rim groper – the guidelines of NICE/SIGN are just that – guidelines (NOT protocols). They are, however, based on a thorough review of the evidence by and large (at least that was my experience working on one of the SIGN guideline groups some years ago though I know there is some controversy about NICE from time to time). However, there is no obligation for any doctor to follow them to the letter – provided of course they have better evidence to back up their case should it ever come to a court of law. Then, of course, there also the Bolam principle…

  31. jweirmccall said,

    February 20, 2010 at 8:26 pm

    - The rim groper (love the name by the way)

    “Experimentation on live patients is what should outlawed.”

    I feel you need to clarify this slightly. Do you mean anything which does not have incontrovertible evidence should not be carried out on anyone? If so how do you propose gaining that knowledge in the first place? Or should we settle with our current knowledge for fear of causing more harm then good?

    Given that the NICE (or SIGN in Scotland) guideligns are written by a committee of prominent doctors and nurses based on the current evidence base I am confused by your disdain for them considering your accurate stance
    that poorly evidence based medicine causes much harm to many people.

  32. jweirmccall said,

    February 20, 2010 at 8:27 pm

    *guidelines* of course :P

  33. Sili said,

    February 20, 2010 at 8:48 pm

    I thought they were regulated already. Isn’t that what the GMC is for?

    Or are they practising medicine without a license? I though that was a punishable offence.

  34. the rim groper said,

    February 20, 2010 at 8:52 pm

    per lowercase:

    “your point seems to be that real medicine is flawed, yes it is, that’s why we have scientific method to improve it. the issue with alternative medicines is not their flaws but their complete lack of any basis in reality. also, what’s mostly wrong with nice is governmental influence rather than anything to do with the fact that it’s a medical body.”

    Where to begin… scientific method? Does the phrase cholesterol/heart disease hypothesis have any resonance for you? Yes, real medicine is deeply flawed and when juxtaposed with the alternative medicines, it would appear to be no contest. Scratch the surface though and you will begin to find much that is awry in the world of real medicine.

    As previously noted, the judgement appeared perverse. All that was necessary was to judge the miscreant as if she were a qualified physician, for she held herself out as offering the power to cure disease. Her failings were legion. The stupidity of her patient was also contributory. How far society has to go to protect people from their own stupidity is where the debate begins. I don’t care if people want to endanger their own lives and I remain unconvinced that the issue requires the attention of the legislature.

    NICE… what an execrable body: not a repository of excellence and clinical best practice underlined by evidence-based medicine. Just another mealy-mouthed arm of the government, who appear to occupy their place in order to impose healthcare by fiat.

    I don’t agree that the administration of so-called alternative medicines is necessarily without any basis in reality. Snake oil is always going to be snake oil and many people who do believe in the healing powers crystals, light, colour, astrology, qi, acupuncture and shiatsu, do so without any evidence but their own certain belief. It is but a very short step to current medical practice, where you may note a really positive physiological response to a placebo… prescribed for any number of ills that ought to be self-limiting and yet they hang around for years. It is probably far more to do with the secondary benefits of being unwell than it being a failure of the clinician to understand the disease process presented and treat it appropriately.

    When Williams noted a woman with dropsy in 1776 and then noted her recovery after the administration of digitalis purpurea, it prompted him to examine the properties of the Foxglove. Today, you will know that specific ancient alternative medicine remedy as digoxin. The local people were already using the plant for this specific use without the intervention of medical science. The basis in reality had existed before Williams investigated the phenomenon and discovered the properties of the plant.

  35. Andy Graham said,

    February 20, 2010 at 9:47 pm

    I suspect that it is more difficult to apportion blame here than has been considered the case in many of the above posts. While I do not agree with the extreme views of @the rim groper with regard to the medical establishment, it is certainly the case that medics, and scientists in many disciplines, take some information (particularly printed information) at face value. Think of all of the text books you’ve ever read. You can’t work everything out from first principals; there isn’t the time.

    One would hope that proper medics are shielded to some extent from bullshit by their training in the appraisal of information and its sources. I understand this to be part of what Ben does. As a result we would hope to avoid the worst of this nonsense within the field of genuine medicine. Nonetheless, we need systematic reviews in order to identify the results of poor research which have seeped through the cracks and become standard practice. As Ben has written more than once, the field of antidepressant medication provides one such case.

    But what of less well trained people? If no one ever taught you about evidence or tuned your bullshit detector, how would you know? Moreover, if they instead filled your head with nonsense about chakras or Chinese herbs, all the while appealing to the ancientness of the wisdom, wouldn’t it all seem terribly authoritative?

    It seems to me that this Chinese herbal medicine practitioner, and no doubt many of her colleagues, was trained in just this way. She then went and applied her training by (legally) plying her trade and prescribing her remedies. Admittedly she got it wrong even by the lax standards of her own weird profession, but it hardly seems that she would have received the kind of training which makes a medical doctor culpable for prescribing the wrong quantity of morphine. Her individual culpability is then further mitigated when you consider that all of the daft practices in which she received training is legal, encouraged and (in the case of homeopathy if not Chinese herbs) even NHS funded! If it’s all bollocks why is it allowed to continue?!

    The UK, and much of the wider world, is responsible for the poor woman on dialysis. We tolerate untrained people prescribing unproven remedies to an unsuspecting public for no better reason than that we do not wish to offend. Statistics can be made to tell the truth of any medicine, given a sufficient sample size, and so there is no valid excuse that “we can’t know if it works or not”. Indeed, many quack remedies have already been through clinical trials and proven ineffective (or even harmful). Only medical doctors should be legally permitted to prescribe or treat illness. Anyone else found doing so should be prosecuted.

  36. JQH said,

    February 20, 2010 at 11:02 pm

    The depressing fact is that the woos pushing these quack remedies really do believe them. Regulation is therefore pointless. The law needs to be changed so that all medical treatments are tested for efficacy and side effects. Those which are not so tested should be banned.

    As an aside, can you imagine how the alt.med community would be shrieking if a Big Pharma product had side effects like cancer, kidney failure and heart attacks? Why are they so silent now?

  37. jwm said,

    February 20, 2010 at 11:48 pm

    JQH: Our medicines can cause all of those. Its just we know the risk of harm when balancing it against potential for benefit which the alterative community sorely lack, and always will, because, as mentioned above with regards to digoxin, when we find anything that is as/more efficacious than our current meds, it stops being alternative, and becomes conventional medicine. Conventional medicine does not come with the proviso that it cannot occur naturally and must come from a vat.

    Rim groper:
    The cholesterol-heart disease hypothesis is a pretty poor example of a medical fallacy. In fact, the main debate is in the realm of the dietician/nutritionist ‘is eating fat bad for you’. Most medical textbooks advise low salt diets and exercise, proscribing no other advice regarding intake other than to balance it with exercise. No mention of avoiding animal fats etc, although this is an area of ongoing research. In the medical realm the debate is actually over the role of raised cholesterol in heart disease rather than there being no link which numerous studies have shown. Is it cause (currently looks unlikely) or a marker of the process causing heart disease (more likely). And how can this process have been a bad thing when it yielded statins which reduce risk of heart disease (albeit not by the originally intended mode of reducing cholesterol).

  38. jwm said,

    February 20, 2010 at 11:55 pm

    Rim groper:
    Also, you seem to have answered my question regarding the source of your disdain with regards to NICE (an admittedly imperfect body) with more disdain. Is the hatred merely visceral or based on something communicable?

  39. skyesteve said,

    February 21, 2010 at 12:40 pm

    @the rim groper – you use the example of Digitalis (the foxglove) as a symbol of how modern medicine has little more to offer than a herbal ancestor but I’m afraid I have to beg to differ. We do use digoxin today – but the reason we use that and not some ground up foxgloves is because we can control (and vary) the doseage and we can give the helpful chemical whilst simultaneously reducing the side effects. With ground up foxgloves you can’t accurately control the dose nor can you get rid of the side effects caused by this poor control and by other chemicals in the foxglove extract. The same could be said, for example, with chewing willow bark instead taking an aspirin tablet.
    In fairness, in contrast to other comlimentary therapies, I actually have some time for herbalism because it can at least demonstrate a logical physiological basis and may, in the right hands, be as effective as “modern” therapy for some conditions – for example, the use of St John’s wort as compared to SSRIs in mild to moderate depression (although perhaps that’s a poor example given that both may not be much better than placebo…)

  40. muscleman said,

    February 21, 2010 at 3:21 pm

    @the rim groper

    Do you have any idea how powerful a drug digitalis is? get the prescription even slightly wrong and you have a dead patient. This is why we moved from grinding up foxglove flowers and made digitalis chemically so we can sure of its potency and that it has no other contaminants that might lower or potentiate that (which a herbal preparation cannot). Also those on digitalis are monitored closely including various physiological and biomarkers to ensure they are on the right dose. No herbalist has either the knowledge to do any of this or access to the support staff, equipment and methods.

    Medicine is currently engaged (and has been for over a decade) on the project Evidence Based Medicine. Everything is up for testing including things like are bandages necessary and good? Nothing is beyond testing. Yes, it is taking time and in many cases getting good evidence will be difficult. But medicine the world over is doing this, right now as we blither. I have been to seminar talks where this is described and talked to clinicians involved (I am a humble biomedical scientist with no medical quals). I have talked to and listened to talks by PhD students and medics doing MD/PhD’s on just those questions. People engaged in studies that are extremely unlikely to set the world on fire but which are necessary, good and need to be done, so they dedicate themselves to do it.

    Meanwhile homeopaths, chiropractors, herbalists et al whinge when we ask for RCT’s of their claism that they don’t have enough money. Yet the companies that make for eg homeopathic preps make huge profits and could easily fund a number of sufficient RCT’s every year (like Big Pharma does) to test the efficacy of their preps. Yet they don’t, because it is against their business model to find out that they don’t work. There are strong national regulatory bodies that talk internationally that insist that Big Pharma do the necessary before they get a license and many drugs fall by the wayside. Why should altmed get a free ride when Pharma are doing it right (finally, regulation is never perfect, but its better than nothing).

    Your comparisons between altmed and modern medicine are ignorant and you cherry pick only what you want to see and ignore the real differences.

    In one of Mark Thomas’s vox pop evenings recently in one place it was held that homeopaths etc should be allowed to practice if and only if they agree not to seek modern medical assistance under any circumstance. How many do you think would stay in business if that rule were adopted? Be honest now.

    Altmed is like ‘organic’ food and ‘wholefoods’ and greenwash, simply stuff for people to differentiate themselves from hoi polloi and pretend they are going the extra mile to ‘look after themselves’, to be holier than thou. But when the crunch comes they scuttle off to their GP and demand to see an NHS specialist (unless they have a BUPA policy and even then).

  41. WestEast said,

    February 21, 2010 at 3:30 pm

    Ben

    Until now I enjoyed your articles, media interviews and lectures – and while I appreciate the Brand “Goldacre” is about standing on a soapbox – your latest comments on what Chinese Medicine Students are tought are a tad sloppy, literal and underresearched. On the positive side, it was right that Wing Xu was brought to court for prescribing unlicensed products that contained a banned and known nephrotoxin and carcinogen – it was really regrettable that the judge played by the letter of the law and did not offer “punishment” for “prescribing” an unlicensed product. There fact of life is that in every profession there are poor practitioners and what else can be done other than use the blunt tool of regulation? However I was dismayed by your literal and unresearched comments about the content of Chinese Medicine courses – the smallest amount of research would have revealed that you can’t literally interpret the teaching of Chinese Medical Tradition by superimposing a Western philosophic perspective – the two traditions stem from a fundamentally different logic base, Western from Cartesian logic, Chinese from Taoist philosophy – which means that the description of “internal organs” such as Spleen & liver in Chinese Medicine Tradition are not akin to those in the Western Medicine – it’s simply a way of describing the philosophy in terms almost metaphorical terms – yes it’s challenging and confusing for those trained in Western to continually remember to switch logic bases – but understanding the stem route and a little of Chinese Medicine tradition allows you to broaden your perspective and hold both logic systems at once – there are different ways of understanding the world, no one logic system is “right” and no-where is this better understood than in China where Western & Chinese Medicine operate in an intergrated way – the Chinese being very pragmatic will switch between the two – choosing that which they feel is appropriate or more suitable – hospitals have floors of Western and Chinese practitioners working together and referring patients to and fro’. If you want to learn a little more, I suggest you ditch the covert type operations with your Professor friend and go to Amazon – there are plenty of standard Chinese Medicine text books for sale that are used for undergraduate study – suggest you might like to read Ted Kaptchuk “Chinese Medicine – the web that has no weaver” or Giovanni Maciocia – “the Foundations of Chinese Medicine” – these will provide the basic understanding to being able to interpret the undergrads notes and you could then compose an informed piece which I am sure we’d all look forward to!

  42. Mojo said,

    February 21, 2010 at 7:05 pm

    “…the description of “internal organs” such as Spleen & liver in Chinese Medicine Tradition are not akin to those in the Western Medicine – it’s simply a way of describing the philosophy in terms almost metaphorical terms…”

    Are you saying that when Chinese Medicine uses terms like “liver” or “spleen” it doesn’t actually mean “liver” or “spleen”? Why use the words for specific organs with specific functions when you mean something else?

    Why not just say what you mean?

  43. SimonW said,

    February 21, 2010 at 8:49 pm

    I also don’t understand why this person effectively got off.

    A lot of it is will to enforce the law, rather than the law. Most of these Chinese herbalists would appear to be flouting the 1968 Medicines Act.

    But yes a quick Google for the product name shows a warning in hit 4.

    The product was banned in 1999, I doubt it has been sitting in a shelf for 11 years, so someone has been importing it and distributing it illegally. Did the MHRA investigate this aspect I wonder? I doubt this is the only such product they are dealing in which is dangerous.

    The MHRA is ineffectual compared to it’s US counterpart. This became apparent watching only thyroid medication issues, where the US regulators issued a fair few recalls and warnings, where as the MHRA issues one warning on thyroid medication in the same period of interest to me which was notified to them by the manufacturer. Of course it is conceivable the European medications were better than the US, although since some were the same manufacturers and same factories so I find this unlikely explanation of the difference. I didn’t do a statistical test to tell if the difference was significant, but as my statistician friends tell me most times you can tell without doing the maths.

    Whilst I think people have a duty to check what they put into their own bodies, the law exists to protect those who can’t (on in this case presumably didn’t).

  44. Bhoddhisatva said,

    February 21, 2010 at 9:50 pm

    WestEast:
    Until now I enjoyed your articles, media interviews and lectures – and while I appreciate the Brand “Goldacre” is about standing on a soapbox – your latest comments on what Chinese Medicine Students are tought are a tad sloppy, literal and underresearched. . snip . However I was dismayed by your literal and unresearched comments about the content of Chinese Medicine courses – the smallest amount of research would have revealed that you can’t literally interpret the teaching of Chinese Medical Tradition by superimposing a Western philosophic perspective – the two traditions stem from a fundamentally different logic base, Western from Cartesian logic, Chinese from Taoist philosophy – which means that the description of “internal organs” such as Spleen & liver in Chinese Medicine Tradition are not akin to those in the Western Medicine – it’s simply a way of describing the philosophy in terms almost metaphorical terms – yes it’s challenging and confusing for those trained in Western to continually remember to switch logic bases – but understanding the stem route and a little of Chinese Medicine tradition allows you to broaden your perspective and hold both logic systems at once
    Oh so teaching that “2+2 does not equal 4″ is OK as long as it’s symbolic, culturally relevant or ancient … what a load of tosh!
    Just because something’s been done for years and has lots of florid prose and semi-mystic description does not make it right.
    Trepanning, blood letting and human sacrifice was done for tens of thousands of years, but that doesn’t make it right.
    Logic is logic, garbage is garbage, and superstitious quackery is just that.

  45. Bhoddhisatva said,

    February 21, 2010 at 9:54 pm

    Rim Groper: I too have a real gripe with the dietary fat/blood serum lipids and CVD.
    Have you read Malcolm Kendrick’s book – “The Great Cholesterol Con”?

  46. progjohn said,

    February 22, 2010 at 8:32 am

    No-one should be allowed to sell or prescribe any substance or intervention that claims to have health benefits without being able to show evidence that it works and is safe. This should apply in exactly the same way to everything from bio yoghurts to cancer drugs, whether the source is a friend who does healing or an NHS hospital.
    This will give us some problems given that the “evidence based medicine” project still has a long way to go, but how can anything less be acceptable?
    I believe that health products are in a different category to other fringe beliefs and should be treated differently, let palm readers and doswers rip fools off to their hearts content but we need protection from quacks whose cures are at best useless and at worst dangerous.

  47. timbp said,

    February 22, 2010 at 9:45 am

    1. This judgement looks wrong, on the information given.
    Wu prescribed high doses of a “banned substance”. If the substance is banned, obtaining it was (should have been) difficult enough that she would know it was banned. Even if she didn’t then find out more about the substance and why it was banned, it would be hard to claim ignorance.
    I suspect she did not prescribe high doses of a banned substance, but instead prescribed high doses of a traditional remedy that happened to contain high doses. Assuming it was imported, not made on the premises, Customs and Quarantine (replace with your UK equivalents) clearly also did not know the medicine contained a banned substance, so there was no indication to the practitioner that there was a problem with the remedy.

    2. I am related to a judge, and am biased in favour of judges.
    But my judge relation has told me that 90% of judges are idiots.
    He has also said 99% of lawyers are idiots, so I guess the people picking judges are doing a good job!

    3. The article says she prescribed a banned substance. I have suggested she prescribed a remedy that contained a banned substance. Which is true?
    I think my interpretation fits better with the judge accepting that she did not know the pills were dangerous.

    4. Does traditional Chinese medicine have a “first do no harm” ethic?
    if not, is it medicine?

    5. If the practitioner was really ignorant (and a judge has said she was), then perhaps her school should be sued.
    How can any training body graduate someone so ignorant of the possible adverse effects of her treatments?

    6. Many comments seem to assume, or at least portray, doctors as only prescribing drugs that have been proven effective (or proven not dangerous).
    But consider hormone replacement therapy (HRT).
    Good for acute symptoms of menopause.
    WHI trial was stopped early because of increased adverse events (breast cancers, and others).
    Many doctors were prescribing HRT while the trial was taking place. They were prescribing without supporting evidence. They were following theory, and their theory was our [Western science] dominant theory.
    The WHI HRT trial was stopped early, and people still argue about what it means. And, I suspect, there are still doctors prescribing long-term HRT to post-menopausal women.
    Judge right now: Are any of these doctors guilty of malpractice?

    7. Does the UK regulate surgical methods?
    In Australia, drugs have the usual hurdles (plus a cost-benefit vs other drugs to get on PBS), and medical devices have some sort of regulation (so rarely mentioned that I can’t right now find any info on it). But, as far as I know, any surgeon at any time can try a new technique. A patient consents for a particular problem to be fixed surgically (personal experience: I don’t recall the hospital consent form specifying the surgeon, and possible methods were never mentioned), and it is up to the surgeon as to how the problem is fixed.

  48. Symball said,

    February 22, 2010 at 11:03 am

    Very simple to sort out- make it an offence to practice alternative medicine (or regular for that matter) without suitable liability insurance. That way if you do make any ‘mistakes’ such a s prescribing remedies that even a cursory search reveal are harmful, then ignoring reports of side effects, you can at least be sued for damages.

    of course insurers wouldn’t touch any of the self taught nutjobs with a bargepole, leaving the responsible practitioners to carry on in peace.

  49. biscuit said,

    February 22, 2010 at 11:04 am

    Ben, I love your work. But I’m always astounded by your sheer lack of understanding of chinese Medicine. I ma currently doing a BSc in Acupuncture.

    We are taught all of the ‘mumbo jumbo’ about the ‘spleen and liver but it is very clearly stated throughout the course that the ideas are theoretical and only make sense in the paradigm of TCM.

    We also have three modules on biomedical patho-physiology which clearly goes through the actual functions of the Spleen etc. We also have two modules on Research and are constantly reminded to evaluate the reliability of evidence-based research.

    I think the actions of the herbalist are abhorent and completely agree that ALL medicine, should be tested under the same strict legislation. It astounded me when I discovered this is not the case and fully back your campaign to have this done.

    but Ben, to strengthen your arguements and to make them heard by TCM practitioners (many of whom would agree with your concerns) you really need to up your knowledge of how CHinese Medicine theory is understood. I urge you to read The Web that has no Weaver as an accessible starting point. At the moment you sound very ignorant.

  50. Groinhammer said,

    February 22, 2010 at 11:04 am

    @WestEast
    “…you can’t literally interpret the teaching of Chinese Medical Tradition by superimposing a Western philosophic perspective – the two traditions stem from a fundamentally different logic base”.
    One logic base would suggest that body parts or dried whole specimens of endangered species used as – in the loosest possible sense of the word – ‘medicine’ to elicit a placebo effect is morally reprehensible.
    The other logic base derives from the Mao school of Let Them Eat Cake.

  51. Groinhammer said,

    February 22, 2010 at 11:09 am

    @biscuit
    Are you also taught all of the ‘mumbo jumbo’ of Acupuncture as well?

  52. B.Serious said,

    February 22, 2010 at 11:34 am

    The main point to understand in this case is that it would not have happened had Statutory Regulation been in place for herbalists, as the herbal profession has been calling for for 15 years and which the govt promised way back in 2001 and reiterated only recently:

    “Herbalists to face strict regulations
    a government report says there is an urgent need to protect the public. It recommends that anyone offering the treatments should be required to register with a regulator, who will require new practitioners to take a degree in their subject. Those who fail to keep the regulator’s code could be struck off, while those operating without a licence would be prosecuted.”
    Daily Telegraph 14 Jun 2008

    The DoH has just conducted the THIRD public consultation regarding this, with all three having been massively in favour (circa 98%) of regulation, and with the most recent receiving 6000 responses, the most ever received for a public consultation.

    It is highly doubtful that Ms Ying Wu is a doctor or a herbalist, but it is impossible to say with accuracy as she was not a member of the professional association which provide voluntary regulation for herbalists in the UK (the best thing we have in place until Statutory Regulation comes about).

    If she had been a member of a professional association, or if Statutory Regulation had been in place:
    Her medical qualifications would have been checked
    She would have had professional medical insurance
    There would have been an appropriate complaints procedure
    She would have know that the herb in question was banned over 10 years ago
    She would have been obtaining herbs from an authenticated supplier with appropriate Quality Assurance in place

    It is the governments failure to follow through with its promise of regulation that is at fault and to blame in this case. The judge is absolutely correct to highlight the need for regulation to protect public safety.

    Regulation has nothing to do with efficacy or status (there are other measures for that which form no part of this argument), it is purely a means of protection for the public by creating teeth for legal process.

  53. AC said,

    February 22, 2010 at 11:51 am

    This person was charged under the Offences Against the Person Act, which is a Victorian law – the same one that gives us “grievous bodily harm with intent to wound” aka GBH and other snappy offences.

    On that basis the judge appears to think that this law, which was designed for people poisoning their husbands, mainly could be stretched to cover this offence. It’s not really about the judge, but about the choice of the CPS to choose this offence. If you kill someone by doing something stupid or reckless, that’s gross negligence manslaughter. Since this victim didn’t die, presumably that wasn’t open to the CPS and they couldn’t find a criminal offence that dealt with reckless poisoning.

    As others have said, civil law remedies in contract and tort might well be available.

  54. AC said,

    February 22, 2010 at 11:53 am

    > On that basis the judge appears to think that this law,
    > which was designed for people poisoning their husbands,
    > mainly could be stretched to cover this offence

    EDIT: Ont that basis the judge appears to think that this law, which was mainly designed for people poisoning their husbands, couldn’t be stretched to cover this offence

    sorry…

  55. Ben Goldacre said,

    February 22, 2010 at 12:14 pm

    the herbal medicine fans who say that i have misrepresented or cherry picked the contents of BSc courses in alternative medicine should take their arguments to the obsessively secretive UCLan, Westminster and the rest. they refuse to be open about the contents of their courses. what i have seen in leaks has been damning. if they wish to be taken seriously they must stop acting like MI5 over an undergraduate course.

  56. biscuit said,

    February 22, 2010 at 1:19 pm

    Ben, How about finding out the bases of TCM from another source; I recommend ‘The Web that has no Weaver’ as a good readable introduction into the basic concepts. As well as a chapter on the difficulties between the integration of bio-med and TCM.

    I fully admit taken out of context it sounds absurd, I am anatural sceptic, and struggled not to dismiss it all off hand but as I learnt more I understood that the as a whole paradgim it makes sense. We are they clearly taught that these ideas are not accurate as fact but serve a purpose to explain the empirical responses to treatment.

    Out of interest have you contact Salford and Leeds?

    The institutes shouldnt be so closed as it only adds to suspicion but perhaps, theya re worried that you will take snippets of the course totally out of context as you did in the above article. Hence my request that you endeavour to gain a better understanding. And try and read the book fully rather than ‘cherry picking’ before ripping it to shreds in your affable manner!

  57. Happy Camper said,

    February 22, 2010 at 1:43 pm

    “DevonDozer said,
    I have no sympathy for her.”
    That’s outrageously harsh. She lost her kidneys because someone who she thought was a medical professional gave her pills and said they would make her better. My cousin lost both his kidneys and died at the age of 23. She’s on dialysis 3 times a week. Have a heart. It’s not like she was train dodging for fun.

    “Here we have a ’senior civil servant’ – presumably a person paid a lot of money by tax payers to shuffle bits of paper around”

    You don’t know that. She could have been a hard-working and industrious credit to the public sector. Supposing for a moment that she was the very worst and most lazy employee of all time, she still surely wouldn’t deserve to suffer a heart attack and develop cancer. The punishment wouldn’t fit the crime.

    It would be nice if people knew better than to take quack medicine, but they don’t – look at how popular horoscopes are. Most people have neither the time nor inclination to research every little thing. I propose that anyone selling anythig that makes definite claims, like ‘cures colic’, must submit it to a randomised controlled trial, double blind, etc etc, and if it passes they can claim it, if it fails they can’t.

  58. Actuary said,

    February 22, 2010 at 2:50 pm

    biscuit –

    I’m an Asian and have read some of the Chinese philosophy behind the traditional medicine. All very interesting stuff but Chinese philosophy is just that, philosophy. It’s not empirical science and if the “qualified” Chinese medicine practitioner had no idea how toxic the pills she was giving to the patient, that surely means that she was not qualified to prescribe any medicine.

    To those people who would say “Western medicine does harm too”, the problem is that it was KNOWN to be HARMFUL. While ignorance may be a legal defence, it’s not a defence for the so called medicine she practised.

    The problem with the Eastern traditional medicine is that it has not advanced since the middle ages, because it does not open itself to the empirical science. Same with all the alternative medicine. On one hand you have continuously developing Western medicine, and the other hand dead tradition which has not done any research other than 2000 years ago when someone ate some berries (which is not true, but I’m being flippant).

    My grandmother goes to her relative who is a traditional medicine practitioner for a spot of acupuncture for her chronic condition, frankly for a spot of TLC. When she gets cold she goes to a proper doctor. My grandfather was an acupuncturist but again, he goes to Western medicine doctor. Asians I find do not sprout the nonsense about “toxic western medicine” – traditional medicine is taken when there is no hope or for general well being like vitamin tablets.

    Spare me the wisdom of the East rubbish. The answer does not lie in history. We wouldn’t have improving longevity if that’s the case.

  59. the rim groper said,

    February 22, 2010 at 4:46 pm

    per lowercase:

    “your point seems to be that real medicine is flawed, yes it is, that’s why we have scientific method to improve it.”

    Cholesterol apparently causes heart disease and dietary cholesterol raises your ‘bad’ cholesterol fraction according to conventional scientific method – 50 years worth of utter nonsense… feel free to explain this to me, while my fingers tap out a mindless rhythm, waiting for your enthusiastic explanation as how your much vaunted scientific method has improved upon this catastrophic failure to admit the wrong-headedness inherent in isolating a molecule that is vital to life and trying to expunge it while caring not at all for the consequence of other substances within the mevalonate metabolic pathway…

    per skyesteve: The inception of NICE was supposed to provide a national repository of the best evidence-based medical knowledge and clinical practice that was available to clinicians and I supported that move back then. TA094 was the technical appraisal that arose out of consultation and became the background to the guidelines for prescribing statins to the nation. The pharmaceutical companies that produce statins were also invited to make their comments in the discussions (presumably because some idiot thought they should be included as stakeholders!) concerning statin prescriptions.

    I think it is clear to all that this should never have been permitted. Drug companies having an input into national prescribing policies for the products they want to be prescribed? Corruption at the highest level, would be the polite way to express such avaricious drug peddling.

    Bolam is a convoluted and complex piece of tort law which is unlikely to provide a defence to the clinician who does not follow the crowd or the dicta that is handed down by NICE.

    per jweirmccall:

    glad you like the name. ^_^

    “Experimentation on live patients is what should outlawed.”
    I feel you need to clarify this slightly. Do you mean anything which does not have incontrovertible evidence should not be carried out on anyone? If so how do you propose gaining that knowledge in the first place?”

    I am sorry for not being clear. What is wrong with the science is that much of it is worthless. Junior clinicians finding meaningless research projects to complete so that their CV looks better. The pharmaceutical company sponsored advertorials which pass for peer-reviewed clinical research and are little more than exercise in data manipulation to secure a marketing advantage of competing products.

    My disdain for NICE derives form them taking the advice from drug companies as to what the national prescribing policies for the said drug ought to be. If the drug was any good and if it had been independently assessed in RCTs which had not been tainted by drug company sponsorship, then I might adopt a different viewpoint. The medical profession are currently in thrall to big pharma and it is detrimental. Drug company provided date does not go any distance along the pathway to counting as evidenced-based medicine, in my book.

  60. biscuit said,

    February 22, 2010 at 8:25 pm

    Actuary

    A few points on your response:
    1. I wholeheartedly agree with you that to handout any form of medicine a practitioner should be fully qualified and legislated against. I think the ruling made by the Judge was wrong because in my opinion a person that hands out medicine be it herbal or other should be pharmacetagoly and medically trained. For her to fail to recognise that they may have been a link between her patients failing health and her pills is abhorent.

    2. TCM has been formed almost purely on empirical evidence, and is still evolving on empirical evidence.
    It is rooted in Daoism and to some point confucionist idealolgy, but so too has biomedicine been rooted in Positivist theory (and further back Christianity and paganism) which has held it back with it’s ridgidity. This is lessening with a wider understanding of the use of Qualitive research but still can result in some of the poor treatment received by patients especially in the field of mental health.

    3.I think your sweeping generalisation about ‘Asians’ is surely based on terrible research…to make such statments on the back of knowing some Asian people is hardly going to pass muster on this site!

  61. jwm said,

    February 22, 2010 at 8:30 pm

    Rim groper:

    Thanks for the info about NICE. Im dissappointed, although not surprised that pharma have infiltrated every aspect of medical existence. However your puritanical approach to evidence based medicine, while providing for a level to which to aspire, is impractical, and discounting all evidence will cause more harm than good.

    “Cholesterol apparently causes heart disease and dietary cholesterol raises your ‘bad’ cholesterol fraction according to conventional scientific method”

    Since this statement is based on evidence, what really happened was that a hypothesis was created that fitted the results of an original study, whih was then further analysed with larger studies with more statistical power and disproved – Surely the very process of scientific method, no? As stated earlier, you’ll stuggle to find modern medical textbooks advising low fat diets. A quick look in Kumar and Clark (the medical bible for medical students everywhere) reveals the only dietry advice to be to avoid excessive salt intake.

    “feel free to explain this to me, while my fingers tap out a mindless rhythm, waiting for your enthusiastic explanation as how your much vaunted scientific method has improved upon this catastrophic failure to admit the wrong-headedness inherent in isolating a molecule that is vital to life and trying to expunge it while caring not at all for the consequence of other substances within the mevalonate metabolic pathway…”

    Ah, I’d best let the diabetics know that their being misled in the advice they’ve been given regarding lowering their levels of a crucial component in the kreb cycle.

  62. ICanDoScienceMe said,

    February 23, 2010 at 1:03 am

    @biscuit

    I find it hard to believe that you are a “natural skeptic” when you clearly believe in the “paradigm of TCM”. It is quite simply total rubbish. Any passing success is due to an accidental stumbling upon a potent natural active ingredient NOT a validation of the “paradigm”. To assert anything else is to make a mockery of modern medicine.

    When TCM has a huge literature of “Daoist” – drug halflife, metabolic pathway interaction, gene expression effects, quantitative genomics, etc to prop up the mysticism then perhaps serious scientists will sit up and take real notice. Until then the people who can’t do real science will divert attention from the real work by playing “doctor” and sticking needles in energy flow lines… /sigh

  63. Martin said,

    February 23, 2010 at 3:32 am

    “…reassuring her that the pills were as safe as Coca-Cola. Following this her patient has lost both kidneys, developed urinary tract cancer, had a heart attack, and is now on dialysis three times a week.”

    So is Coca-Cola going to sue? :)

    I’m very open to the idea that anyone who wants to provide any form of ‘medicine’ has to have a medical degree from a certified body (and not one bought off the internet like Ben’s dead cat). Once they have this they can go off and learn their speciality. Don’t medical specialists (eg, dentists, surgeons, etc) have to do this? Why should homeopaths, nutritionists, etc get special treatment?

    Conventional medicine doctors also have insurance, so Symball’s idea of requiring alternative therapists to hold liability insurance is reasonable. If they want to be judged by conventional medical standards (which they do, despite what they say, why else are they pointing to the ‘trials’ they perform) then they have to meet conventional medical standards.

    And to those above who dislike extra regulation, I quite agree. I’d prefer that we didn’t have to introduce regulation to prevent venal, greedy parasites from preying on the weak and vunerable, but if you took that to it’s logical conclusion then we wouldn’t have to outlaw burglary because no-one would do it.

  64. B.Serious said,

    February 23, 2010 at 9:54 am

    Ben Goldacre said:
    the herbal medicine fans who say that i have misrepresented or cherry picked the contents of BSc courses in alternative medicine should take their arguments to the obsessively secretive UCLan, Westminster and the rest. they refuse to be open about the contents of their courses. what i have seen in leaks has been damning. if they wish to be taken seriously they must stop acting like MI5 over an undergraduate course.

    Thats just not true though is it Ben?

    Please show a modicum of journalistic integrity. As you know full well, the Westminster documents that have been much cited were obtained under the Freedom of Information act and despite that fact that they were taken out of context and ridiculed, Westminster have made available the rest of their curriculum. The UClan course is no longer running.

  65. elvisionary said,

    February 23, 2010 at 12:39 pm

    @BGray

    I’m not a lawyer, but I believe under English criminal law the mens rea test for most forms of GBH, ABH or assault is “intentionally or recklessly”. So you don’t need to prove intent if you can show recklessness.

    If someone is prescribing a substance without bothering to find out that it’s banned and highly dangerous, that sounds pretty reckless to me.

  66. Ennui said,

    February 23, 2010 at 1:20 pm

    I remember taking chinese medicine for acne when I was 15. It didn’t do anything. I only took one bottle, but now I’m worried about my health :-(

  67. AC said,

    February 23, 2010 at 1:38 pm

    @elvisionary

    You’re right that “reckless” is relevant to ABH, GBH and the like, but that wasn’t (I understand) the offence charged. In any event, even if it had been and the ‘reckless’ point was made for those offences, they would also have to have shown assault and/or battery (i.e. physical violence or the threat of it). In this case there was no such threat – indeed there was an assurance of no harm.

    The offence charged was, I believe, one of the admistering offences. The Offences Against the Person Act 1861 contains two “administration” offences.
    Section 23: “Whosoever shall unlawfully and maliciously administer to or cause to be administered to be taken by any person any poison or other destructive or noxious thing, so as thereby to endanger the life of such person, or as thereby to inflict upon such person any grievous bodily harm, shall be guilty of an offence.”

    And Section 24: “Whosoever shall unlawfully and maliciously administer or cause to be administered to or be taken by any other person any poison or other destructive or noxious thing, with intent to injure, aggrieve, or annoy any such person, shall be guilty of [an offence].”

    But here the test isn’t recklessness, its whether it was “unlawful” and “malicious”. In this case it appears that it wasn’t malicious as there appears to have been no deliberate evil intent. Recklessness can come into “malicious” but the caselaw generally relates to cases where something untoward was planned but a different and more serious effect occurred. Here nothing untoward was intented, apparently.

    An improvement to the law in this respect was suggested in the late 1990’s – presumably it came to nothing or we wouldn’t be having this discussion.

  68. MedsVsTherapy said,

    February 23, 2010 at 2:17 pm

    “I urge you to read The Web that has no Weaver as an accessible starting point. At the moment you sound very ignorant.”

    Yes, Ben quite ignorant. You must read these amazing works. Also recommended: “The symptom that has no pathophysiology.” “The cure to which no patient is seeking.” “The healer who receives psychosurgery from the patient’s brain waves.” “The vital sign that does not indicate some parameter of vitality.” “The influence of the remote stars upon your personality.” “How I received the donated liver of a chocolate lover, and darned if I don’t like chocolate now.” “Lower-class people have skulls with more pronounced areas of Acquisitiveness, and that is why they steal.” “All is actually nothing, and nothing is actually all, so why is the government trying to redistribute nothingness?.” “We are all one, so give me our money right now.” “What is the sound of one girl shopping?” “Don’t but this book.” And, “How the Elephant Man’s Mother Was Scared By an Elephant When She was Pregnant With Him, Causing His Elephantitis.”

    All classics, Dr. Ben. You must read. You sound quite ignorant unless you have read my favorites, and also believe them.

  69. elvisionary said,

    February 23, 2010 at 4:06 pm

    @AC – thanks for that. Sounds like the law needs updating…

  70. Gunga said,

    February 23, 2010 at 9:35 pm

    Educate a Canadian….
    Do you not have legislation that prevents prescribing?
    The Regulated Health Professionals Act (RHPA) in Ontario lists the medical professionals who can prescribe ANYTHING…..I, for example, as a registered reflexologist, am legally prevented from prescribing something as simple as increasing water intake to “flush the system after a treatment”. Even prescribing further treatment or a particular frequency of treatment is forbidden by the RHPA. I will admit, there are a number of my colleagues who don’t even know of the existence of the RHPA and they often (whether in ignorance or in blatant defiance of the Act) prescribe, treat specific conditions, and diagnose. All are forbidden by the RHPA unless you are one of the specific health professionals listed in the RHPA.
    I agree that there is a great deal of charlatanism out there but please, keep in mind that not all of us are crackpots. I, and other practitioners like me, see our services as an adjunct to mainstream medicine not as a replacement. There are some of us who even dedicate our own time and funds to develop and participate in evidence based research in the true spirit of the scientific method and will denounce elements of our practice even in the face of being rejected by our colleagues. We don’t claim to cure cancer. We do, however, see the benefit of any treatment that limits the devastating effects of chemo so the patient can complete a pharmacological treatment that has been proven to cure that cancer. We recognize the dangers of treating patients with thromboses….and we don’t treat them. We wont claim and have yet to prove we cure chronic pain, but we can help some patients deal with the constipation caused by pain meds without the need for pharmaceuticals.
    In short, laws need changing and practitioners of every description and discipline should be accountable. Patients should be encouraged to contact legislating bodies to make complaint and should be encouraged to use the colleges to search for practitioners with good credentials and no limitations on their licenses. When non-regulated practitioners, like myself, are educating their patients, I see it as part of my best and ethical practice to encourage the patient to contact my professional association for any information about the profession and background on me.

    An excellent discussion. One in which I am sure many holistic practitioners would not engage. Too bad.

  71. heavens said,

    February 24, 2010 at 12:48 am

    Do I have this straight in my mind?

    The British taxpayer forks over an enormous sum of money to these universities to run ‘alternative medicine’ programs.

    The British taxpayer then says, “By the way, what is it that you’re actually teaching in these classes?” and the university says, “It’s a secret,” or maybe “We just pay the instructors; we never bothered to figure out what they’re teaching.”

    To which the British taxpayer replies, “Oh, well, that’s fine, then” instead of the more rational response, which I suggest would sound a lot more like:

    “So — for all I know — you could be telling them to sacrifice chickens during a full moon, and you expect ME to keep PAYING for that? Fat chance, guys. I’m canceling those checks.”

  72. Colonel_Mad said,

    February 24, 2010 at 11:30 am

    Hey traditional Chinese medicine can cure AIDS didn’t you know….
    www.i-sis.org.uk/unravelingAIDS.php

    I love this site. Its full of loony’s coming up with all sorts of pseudoscience with an intensity only seen emenating from those with psychological disorders. Treat yourself to a peruse!

    I don’t know if its funny or worrying that the founder is apparently an Open University lecturer.

    Jonathan

  73. Colonel_Mad said,

    February 24, 2010 at 11:36 am

    PS apologies for my grocers’ apostrophe in that last post. Must be the ground up tiger claw I had for breakfast.

  74. Dr Spouse said,

    February 24, 2010 at 2:58 pm

    heavens: “The British taxpayer forks over an enormous sum of money to these universities to run ‘alternative medicine’ programs.

    The British taxpayer then says, “By the way, what is it that you’re actually teaching in these classes?” and the university says, “It’s a secret,” or maybe “We just pay the instructors; we never bothered to figure out what they’re teaching.””

    There is a slight problem with this tack: if alternative medicine teaching materials are going to be subject to FoI then so are all teaching materials at university level.

    These teaching materials are produced by academics – while universities would love to make academics produce easy-to-deliver teaching materials as part of their contract of employment, and then hand over those materials to contracted non-academic teaching staff, to save academic salaries, teaching materials are the IP of the academic staff that produce them. In general it’s not standard practice in academia to make teaching materials freely available.

    Academic staff are the teachers of the students on their courses who have themselves, or their sponsors, paid their course fees – they are not teachers of students at other institutions nor of the general public. If all academics are required to give their teaching materials to anyone who asks, they won’t be able to work those materials up into a book or prevent the university from making them redundant once they’ve created a course.

    Rather, since all degree level courses are accredited by a university and (should be) subject to external review and external examination, it’s the degree awarding bodies that should be scrutinised – degrees that are not rigorously taught and examined should be removed from the books of the university – where it’s not possible to teach something at degree level (or not possible yet, or the material should properly be part of another degree – so the herbs in Chinese medicine do have active ingredients, clearly, and when more is understood they’ll be part of a pharmacology or toxicology course) then that degree should be removed from the books.

  75. pv said,

    February 25, 2010 at 11:04 am

    biscuit, firstly your assertion that “TCM has been formed almost purely on empirical evidence, and is still evolving on empirical evidence”, is unsupportable tosh.
    www.quackometer.net/blog/labels/Traditional%20Chinese%20Medicine.html

    You also wrote:
    “I think your sweeping generalisation about ‘Asians’ is surely based on terrible research…to make such statments on the back of knowing some Asian people is hardly going to pass muster on this site!”

    You are addressing you comment to someone who has stated that they are Asian (not someone who might have met someone who knows someone’s mother’s father-in-law!) and that their grandfather was an acupuncturist who used “toxic” western medicine. There seems to be so much of Actuary’s excellent post that you haven’t bothered to read, or simply don’t understand.

    If I may say so it’s your own ramblings that don’t pass muster…

  76. outeast said,

    February 26, 2010 at 12:09 pm

    @ WestEast, Biscuit

    Claims such as ‘you can’t literally interpret the teaching of Chinese Medical Tradition’ and ‘the two traditions stem from a fundamentally different logic base’ are all well and good; hell, they may even be true. It may well be that [the translation of] ‘spleen’, say, does not in fact mean ‘the spleen’. Many disciplines have their own language, their own terminology and so on.

    But… at heart, and setting aside the psychosomatic aspects to illness (which any established and trusted medical tradition can alleviate through a meaning effect)alternative medical practices still deal with the corporeal body. When you treat an injury, or a viral disease, or a bacterial infection you are dealing with a physical problem. When you prescribe a medicine, you are providing the patient with chemical compounds they might not otherwise be exposed to. And so on. I see no reason that these physical interventions cannot be described in terms comprehensible to someone utterly ignorant of the ‘alternative’ tradition involved.

    You can say that an apparent claim such as “Sin Jiao assists the Lungs ‘dispersing function’, spreading fluids to skin in form of fine mist or vapour (so it helps regulate fluid production…)” is not as silly as it sounds because ”you can’t literally interpret the teaching of Chinese Medical Tradition’. Fair enough. But what does such a claim actually mean then – in terms a Western-educated person can understand? How can this be rephrased as a testable claim about the body? We’re may be dealing with a different ‘logic base’, but it’s the same human body with the same organs!

  77. Michael Grayer said,

    March 8, 2010 at 3:59 pm

    Having read “Foundations of Chinese Medicine” by Maciocia (well, part of it anyway, it’s a giant 1236-page tome), I’m unimpressed. My description of it is based on recall. It’s not available in many university libraries (in the Inform25.ac.uk consortium anyway), though curiously it is available at UCL and the Wellcome library, as well as a few ex-polys.

    It begins by introducing Western medicine as though it has remained completely unchanged since Aristotle, and continues by assigning a whole host of unmerited “philosophical” meanings to various permutations of Yin and Yang – essentially telling us nothing more than 2^3=8 and (2^3)^2 = 64. It has several references for its philosophical underpinnings, though alarmingly little in the way of evidential citations.

    Overall, it is what Douglas Adams might call “mostly harmless”, with no references to life-threatening diseases such as malaria, HIV or cancer (though that also means no explicit instruction to refer the patient immediately to a GP either). A couple of features did stand out as alarming though. Firstly, the only part of the text referring to vaccines suggests (with no evidence) a whole load of spurious links of vaccination with diseases such as autism (and the other usual candidates). Secondly, the section on diagnosis advises the reader to actively disregard the process of “cause and effect” and instead look for “patterns” – in other words, to rely on correlation rather than causation and to completely disregard confounding factors. This is where the book ceases to be a harmless, if boring, work of fiction and the implications of its advice begin to get more serious, especially given its de facto place as a standard “Chinese Medicine 101 and handy reference” book.

  78. Delster said,

    March 8, 2010 at 9:51 pm

    @Ian

    Re Homeopatist being safe
    “As long a they don’t prescribe too many sugar pills to a diabetic patient they should be pretty safe!”

    They can never give too many as the sugar contained is not diluted, ie 100% pure, and therefore would have no effect on a diabetic unless they actually failed to take one that was proscribed….

  79. Veronica said,

    March 14, 2010 at 5:31 pm

    Some of you commenting here have mixed up the function of NICE with the fnction of the MHRA.

    MHRA pronounces on the safety and efficacy of medicines, i.e. the risk:benefit ratio of taking them. NICE decides whether they represent value for money and therefore whether, however good they are, you and I should be allowed to have them on the NHS.

    I think this case stinks. Imagine the makers of thalidomide or Vioxx being able to get a conditional discharge on the basis that they have poisoned somebody but didn’t know what they were doing.

    It’s one rule for scientifically researched medical treatment, and another rule for woo.

  80. Ben Vail said,

    August 6, 2010 at 1:31 am

    @Veronica

    Intent is very important to our justice system, as it should be… It’s right that judges take this into account in deciding what’s the best outcome for those involved and society; Locking people up for honest mistakes is rarely going to help anyone, as those mistakes are not going to be made again. Ignorance of the law is not the same as strongly believing the consequences of your actions would be beneficial and not detrimental, :)

    A tragedy certainly, and regulation is needed, even if it’s just the improved application of regulation that already exists in regards to health claims and dangerous substances, but in my opinion, revenge is not the answer…

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