Ben Goldacre, The Guardian, Saturday 19 February 2011
For the past two weeks we’ve followed the government’s misuse of evidence on NHS reforms, remembering that they’re perfectly permitted to reform things with no evidence at all, like everyone else does, they just shouldn’t pretend to have evidence. On Thursday health minister Simon Burns appeared before a BMA meeting in London.
He tried to persuade a room full of nerds that the pathfinder initiative was a pilot scheme, to test the reforms before national roll out, even though this “pilot scheme” covers more than half of all the patients in England. Then he explained that doctors obviously don’t understand what the word “pilot” means. Then he explained that the evidence of what doctors say to him when he meets them is more reliable than good quality survey data.
Things get tricky when evidence collides with what people would simply like to crack on and do anyway. At midnight last night, the Medicines and Healthcare Regulatory Authority closed its consultation on how they should label homeopathy sugar pills without misleading the public. You may not think this is a difficult task, but politics makes it so.
To recap: homeopathy pills don’t work better than placebo dummy pills in trials. They are made by taking one drop of the original substance and diluting it in 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000, 000,000,000,000 drops of water, then taking one drop of that solution, which is now just water, and shaking it near some pills, which you then buy to treat an illness.
Current MHRA wording says: “a homeopathic medicinal product used within the homeopathic tradition for the treatment of [whatever condition]”. Homeopaths like this because it’s ambiguous. Their internal lobbying document (which I have helpfully posted on the internet for everyone to read), explains that this wording “avoids the need to prove the science” and so “allows us to practise as normal”.
Can the MHRA walk the line between evidence, politics, and clarity? Quack remedies are in their own world of silliness, but we are entitled to have higher expectations of regulators, since they themselves expect to be taken more seriously. Lacking optimisim, I have conducted my own consultation online. Here are the suggestions.
On instructions we have “take as many as you like”, since there are no ingredients. The proposed belladonna homeopathy pill ingredients label simply reads “no belladonna”, which is a convention the MHRA could adapt for all their different homeopathy labels. Other suggestions include “none”, “belief”, “false hopes”, “shattered dreams”, and “the tears of unicorns”.
For warnings we have: “not to be taken seriously”; “in case of overdose consult a lifeguard”, and “contains chemicals, including dihydrogen monoxide”. DHMO, of course, is a scary name for water, which became an internet meme after Nathan Zohner’s school science project. He successfully gathered a petition to ban this chemical on the grounds that it is fatal when inhaled, contributes to the erosion of our natural landscape, may cause electrical failures, and has been found in the excised tumours of terminal cancer patients.
These label suggestions are clear, unambiguous, and they do not mislead anyone. If you think they are funny, I invite you to notice that besuited people in your medicines regulator have just run a lengthy official consultation on how to label sugar pills so as not to mislead the public. People who claim to be serious should be serious.