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.