MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

education

1 2 3 16

Today is the official publication date of my new book ‘DON’T BELIEVE WHAT YOU THINK‘. It is essentially a crash course in critical thinking. To give you a flavour, here is an excerpt from its preface:

… So-called alternative medicine (SCAM) is a complex and controversial subject. Many people pretend to be experts in SCAM, but few know even the basic facts about it. Many consumers talk about SCAM, but few can be bothered to look behind the smokescreen of misleading claims. Many feel emotionally attached to SCAM, but few manage to think rationally about it. Many religiously believe in SCAM, but few show concern about the evidence. Many are desperate for help, but few seem to mind getting ripped off…

Enthusiasts of SCAM tend to hope for less side-effects, symptom relief, a cure of their condition, improvements in quality of life, and protection from illness. Such high expectations are usually based on misinformation, often even on outright lies. The disappointing truth is that not many SCAMs are truly effective in treating or preventing disease, and that none is totally harmless. In fact, the dangers of SCAM are multi-fold and potentially serious:

  • harm due to adverse effects such as toxicity of an herbal remedy, stroke after chiropractic manipulation, pneumothorax after acupuncture (see chapter 3.2);
  • harm caused by bogus diagnostic techniques (see chapter 4.4);
  • harm of using materials from endangered species (see chapter 3.15);
  • harm through incompetent advice by SCAM providers (see chapter 4.5);
  • harm due to using SCAM instead of an effective therapy for serious conditions (see chapter 4.5);
  • harm due to the high costs of SCAM (see chapter 3.8);
  • harm due to SCAM undermining evidence-based medicine (see chapter 5.4);
  • harm caused by inhibiting medical progress and research (see chapter 5.1).

In this book, I address these issues in detail and explain how consumers get manipulated into believing things that are evidently wrong. Using plenty of real-life examples, I outline how the constant flow of misinformation, coupled with motivated ignorance, motivated reasoning, and cognitive bias can produce a form of wishful thinking that is detached from reality. In the interest of my readers’ health, I aim to correct some of these false beliefs and fallacious thought processes.

My book consists of 35 concise essays each of which addresses one commonly held belief about SCAM. The essays can be read as stand-alone articles; occasionally, this necessitates a degree of repetition which, however, is minimal. The text avoids technical jargon and is therefore easy to follow. For those who want to dig deeper into the scientific evidence, links are provided to numerous papers that might prove to be helpful. A glossary is added at the end to explain some terms that might be unfamiliar.

This book is meant to stimulate critical thinking not just about SCAM, but also in a more general way. Science deniers employ similar techniques no matter whether they focus on health, climate change, evolution or other subjects. Exposing their techniques for what they are is thus important.

  • They ignore the scientific consensus.
  • They cherry-pick their evidence.
  • They rely on poor quality studies, opinion and anecdotes.
  • They invent conspiracy theories.
  • They defame their opponents.
  • They point out that science has been wrong before.
  • They say, ‘science does not know everything’.

Critical thinking is the best, perhaps even the only protection we have from being fooled and, crucially, from fooling ourselves. If my book enables you to question nonsense, call out untruths, correct falsehoods, ridicule stupidity, and disclose fake news, it surely was worth the effort.

 

As so often in the realm of so-called alternative medicine (SCAM), the Australians are setting an example. The Australian Health Practitioner Regulation Agency (Ahpra) is the national organisation responsible for implementing the National Registration and Accreditation Scheme (the National Scheme) across Australia. Yesterday, the Ahpra have issued an important press-release. Here is an excerpt:

… While the vast majority of health practitioners are responding professionally to the COVID-19 emergency and focusing on providing safe care, Ahpra and National Boards are seeing some examples of false and misleading advertising on COVID-19.

During these challenging times, it is vital that health practitioners only provide information about COVID-19 that is scientifically accurate and from authoritative sources, such as a state, territory or Commonwealth health department or the World Health Organization (WHO). According to these authoritative sources, there is currently no cure or evidence-based treatment or therapy which prevents infection by COVID-19 and work is currently underway on a vaccine.

Other than sharing health information from authoritative sources, registered health practitioners should not make advertising claims on preventing or protecting patients and health consumers from contracting COVID-19 or accelerating recovery from COVID-19. To do so involves risk to public safety and may be unlawful advertising. For example, we are seeing some advertising claims that spinal adjustment/manipulation, acupuncture and some products confer or boost immunity or enhance recovery from COVID-19 when there is no acceptable evidence in support.

Advertisers must be able to provide acceptable evidence of any claims made about treatments that benefit patients/health consumers. We will consider taking action against anyone found to be making false or misleading claims about COVID-19 in advertising. If the advertiser is a registered health practitioner, breaching advertising obligations is also a professional conduct matter which may result in disciplinary action, especially where advertising is clearly false, misleading or exploitative. There are also significant penalties for false and misleading advertising claims about therapeutic products under the Therapeutic Goods Act 1989.

Patients and health consumers should treat any advertising claims about COVID-19 cautiously and check authoritative sources for health information about COVID-19, such as state, territory and Commonwealth health departments.

As always, patients and health consumers should ask their practitioner for information to support any advertising claims before making decisions about treatment. Patients and health consumers should receive accurate and truthful messages so they can make the right choices about their health.

Many of my posts during the last weeks have dealt with this problem. The sad truth is that charlatans of all types are trying to exploit the fear of consumers during the current crisis for making a fast buck. This is despicable, unethical, unprofessional and possibly criminal.I do hope that the authorities of other countries follow the Australian example.

Yesterday, it was announced that Prince Charles, a long-time advocate of so-called alternative medicine (SCAM), has been taken ill with the corona virus. Since then, I have been inundated with messages about this fact. Many thought that, because Charles and I have a bit of history (details here), I might now ‘have a cup of tea and a malicious smile on [my] face thinking about it’, as someone put it on Twitter. Others made sarcastic comments suggesting that he will be fine because of all the help of the homeopathic cult.

I cannot join these sentiments. On the contrary, I sincerely wish him well – not because he is royalty, but because I wish everyone well who has been infected with this virus.

And I honestly do not think that Charles will be popping homeopathic placebos to save his life. Whenever a member of his (usually pro-homeopathy) family had fallen seriously ill in the past, they very quickly sought the help of the very best evidence-based medicine could offer. Charles’ present illness will be no exception, I am sure. If his infection becomes serious, he will have the benefit of everything modern scientific healthcare has to offer.

When he recovers – and I do hope he does – he will have plenty of time to think. Chances are that he never before had been afflicted with a killer disease. This should make him see things from an entirely new perspective. He must realise that so-called alternative medicine (SCAM) is an option only as long as one is healthy. Once the battle for saving a life is on, real medicine must save the day.

I am a born optimist, and therefore I hope that Charles on his sick-bed might even think a little further. He might realise that a health crisis, like the current corona pandemic, regularly brings out the charlatans who are trying to flog their wares or services to the unsuspecting public. On my blog, I have discussed some of these irresponsible rogues:

With a bit of luck, Charles might even reflect that his past endorsement of these quacks has been less than helpful; in the present crisis, it might even cost lives. Charles, I hope, will thus reconsider his attitude towards medicine, heaven knows, he might even become an outspoken advocate fro EBM!

So yes, I am an incurable optimist. Yet, I realise, of course, that Charles might not have any of these insights. That would be regrettable, but it does not deter me from wishing him a speedy recovery:

GET WELL SOON, CHARLES!

I have almost got used to seeing that any health crisis brings the worst out of charlatans. In the present pandemic, this has been true for SCAM merchants such as the:

homeopaths,

colloidal silver crooks,

TCM practitioners,

orthomolecular quacks,

Unani-salesmen

and, of course, the chiropractors.

Perhaps one can even forgive such behaviour on an individual level – sadly, it seems to be a human trait to turn every misery into a business opportunity. But when professional organisations behave in this manner, I have less understanding.

In that context, this press release by the INTERNATIONAL CHIROPRACTORS ASSOCIATION seems revealing:

March 16, 2020 (Falls Church, VA) In these challenging times associated with the COVID-19 Pandemic, the International Chiropractors Association (ICA) is issuing a statement reaffirming chiropractic as an essential healthcare service. Everyone is under extraordinary levels of stress.

Chiropractic Services represent an essential and necessary component of the health care program of millions of patients of all ages and all walks of life in the United States and worldwide. Timely and consistent access to chiropractic care is essential to the maintenance of the health and wellbeing of this patient population, particularly during times of stress.

The association encourages jurisdictions at all levels to acknowledge and respect that chiropractic is an essential healthcare service even during a pandemic.

It is important to recognize that as of mid-March 2020, there are no recognized cures in conventional medicine or alternative health approaches for COVID-19. There are no vaccines, no drugs, no natural remedies, no alternative therapies that have been tested and the outcomes peer reviewed to meet any evidence-based standard. The public has the right to seek their own pathway to health and well-being. For millions of Americans, that pathway includes regular chiropractic care. For individuals such as those recovering from injury or suffering back pain, chiropractic care is essential on their road to recovery.

ICA President, Stephen P. Welsh, DC, FICA stated, “While Coronavirus-19 has everyone’s attention, it cannot be forgotten that health promotion and non-opioid pain management through chiropractic adjustments of the subluxation is essential and should not be curtailed or restricted because of this pandemic. With churches, schools, restaurants, museums being closed, the ICA reminds authorities that the offices of doctors of chiropractic should be treated no differently than the offices of medical doctors – as an essential health care service.”

Did I state that I have less understanding for this? To be honest, I feel slightly sick reading the press release!

The ICA state that one of their objectives is to ‘promote the highest professional, technical, and ethical standards for the doctor of chiropractic while safeguarding the professional welfare of its members and the public.’ I highly recommend that the ICA take a step back and inform themselves what professionalism and ethics really mean.

The objective of this analysis was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain. The researchers employed a retrospective cohort design for analysis of health claims data from three contiguous US states for the years 2012-2017.

They included adults aged 18-84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain. Two cohorts of subjects were thus identified:

  1. patients who received both primary care and chiropractic care,
  2. Patients who received primary care but not chiropractic care.

The total number of subjects was 101,221. Overall, between 1.55 and 2.03 times more nonrecipients of chiropractic care filled an opioid prescription, as compared with recipients.

The authors concluded that patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase.

Similar findings have been reported before and we have discussed them on this blog (see here, here and here). As before, one has to ask: WHAT DO THEY ACTUALLY MEAN?

The short answer is NOTHING MUCH! And certainly not what many chiros make of them.

They do not suggest that chiropractic care is a substitute for opioids in the management of spinal pain.

Why?

There are several reasons. Perhaps the most important ones are that such analyses lack any clinical outcome data, and that comparing one mistake (opioid-overuse) whith what might be another (chiropractic care) is a wrong apporoach. Imagine a scenario where half to the patients had received, in addition to their usual care, the services of:

  • a paranormal healer,
  • a crystal therapist,
  • a shaman,
  • or a homeopath.

Nobody would be surprised to see a very similar result, particularly if all of these practitioners were in the habit of discouraging their patients from using conventional drugs. Or imagine a scenario where half of all patients suffering from spinal pain are entered into an environment where they receive no treatment at all. Who would not expect that this regimen does not dramatically reduce the risk of filling an opioid prescription? But would that indicate that zero treatment is a good solution for managing spinal pain?

The thing is this:

  • If you want to reduce opioid use, you need to prescribe less opioids (for instance, by re-educating doctors to do as they have been told in med school and curb over-prescribing).
  • If you discourage patients to use opioids (as many other healthcare professionals would), many will not use opioids.
  • If you want to know whether chiropractic is effective in managing spinal pain, you need to conduct a well-designed clinical trial.

Or, to put it simply:

CORRELATION IS NOT CAUSATION!

 

A new appointment in the realm of so-called alternative medicine (SCAM) has just been announced:

Friends of Science in Medicine (FSM) President, Assoc Professor Ken Harvey MB BS (Melb), FRCPA, AM congratulates Professor Jon Wardle, nurse and naturopath, with postgraduate qualifications in public health, law and health economics, on being appointed to Southern Cross University’s (SCU) Maurice Blackmore Chair of Naturopathic Medicine in Lismore. Professor Wardle has also been appointed as Foundation Director of the National Centre for Naturopathic Medicine (NCNM) funded with $10 Million from the Blackmore Foundation set up to sponsor research into ‘complementary medicine’.

Vice Chancellor, Professor Adam Shoemaker BA (Hons), PhD (ANU), researcher in Indigenous literature and culture, said the benefits of basing the NCNM at Southern Cross were enormous, “Being in a region like the Northern Rivers of New South Wales means we have brilliant local networks in this field. We are also supported by a local community who, like the University, are really receptive to trying new things in order to create a healthier future”.

Professor Harvey comments, “Professor Wardle certainly has challenges ahead. The Northern Rivers region is the anti-vax capital of Australia and some naturopaths advise against vaccination. Degree courses in naturopathy such as the Torrens Bachelor of Health Science (Naturopathy) degree, include studies of homeopathy, iridology and flower essence therapy. None have scientific evidence of efficacy”.

FSM has long argued that health care should be based on scientifically sound research, published in peer-reviewed journals of accepted standing. FSM is equally concerned about medical practitioners offering unproven and often exploitative treatments as it is about complementary medicine practitioners. Professor Harvey said, “some naturopaths practicing in Lismore, associated with SCU, work at clinics that use unverified laboratory tests to make dubious diagnoses and recommend treatment programs that lack evidence of efficacy”.

Professor Harvey (and FSM) conclude that there is an urgent need for evidence-based science to be applied to naturopathy. They trust that Professor Wardle will emulate Professor Edzard Ernst, Foundation Professor of Complementary Medicine at Exeter University, by applying accepted scientific standards to the evaluation of naturopathic interventions.

The March 24 opening of the NCNM in Lismore will feature a panel discussion on the future of health care with guest speakers: Professor Kerryn Phelps AM, former President of the Australasian Integrative Medicine Association, Marcus Blackmore AM, naturopath and Executive Director of Blackmores Ltd, which markets vitamin and herbal products, and Professor Jon Wardle. FSM hopes that the panel will discuss some of the issues raised above.

Sounds exciting, but is Wardle up to the job?

Judging from his publication record, he is certainly a naturopath through and through. He has published lots of papers; as far as I can see most of them are surveys of some sort or another. Many leave me somewhat bewildered. Two examples must suffice:

No 1

Objectives: To explore the recommendations of naturopathic medicine for the management of endometriosis, dysmenorrhea, and menorrhagia, drawing on traditional and contemporary sources.

Design: Content analysis.

Setting: Australia, Canada, and the United States of America (USA).

Subjects: Contemporary sources were identified from reviewing naturopathic higher education institutions’ recommended texts, while traditional sources were identified from libraries which hold collections of naturopathic sources. Sources were included if they were published from 1800 to 2016, were in English, published in Australia, Canada, or the USA, and reported on the topic. Included sources were as follows: 37 traditional texts; 47 contemporary texts; and 83 articles from naturopathic periodicals.

Results: Across included sources, the most reported disciplines were herbal medicine, clinical nutrition, mineral medicines, homeopathy, hydrotherapy, and chemical-based medicines. Herbal medicines were extensively reported from all sources for the management of endometriosis, dysmenorrhea, and menorrhagia. Clinical nutrition was only recommended from contemporary sources for all three conditions. Mineral medicines were mentioned in both traditional and contemporary sources, but were only recommended for dysmenorrhea and menorrhagia. There were limited recommendations for homeopathy and hydrotherapy treatments in all conditions across all sources. Chemical-based medicines were only mentioned for dysmenorrhea and menorrhagia, and recommendations ceased after 1922. Recommendations for endometriosis were not present in any of the traditional sources, across all reported disciplines.

Conclusions: The findings of this article provide insights into the documented historical and contemporary treatments within naturopathic medicine for endometriosis, dysmenorrhea, and menorrhagia. While philosophical principles remain the core of naturopathic practice, the therapeutic armamentarium appears to have changed over time, and a number of the original naturopathic treatments appear to have been retained as key elements of treatment for these conditions. Such insights into naturopathic treatments will be of particular interest to clinicians providing care to women, educators designing and delivering naturopathic training, and researchers conducting clinical and health service naturopathic research.

No 2

Complementary and alternative medicine (CAM) is an increasingly prevalent part of contemporary health care. Whilst there have been some attempts to understand the dynamics of CAM integration in the health care system from the perspective of conventional care providers and patients, little research has examined the view of CAM practitioners. This study aims to identify the experiences of integration within a conventional healthcare system as perceived by naturopaths. Qualitative semi-structured interviews were conducted using a purposeful sample of 20 practising naturopaths in South East Queensland, Australia to discuss their experiences and perceptions of integrating with conventional medical providers. Analysis of the interviews revealed five broad challenges for the integration of CAM according to naturopaths: competing paradigms between CAM and conventional medicine; co-option of CAM by conventional medical practitioners; the preservation of separate CAM and conventional medical worlds by patients and providers due to lack of formalised relations; negative feedback and biases created through selective or limited experience or information with CAM; and indifferent, reactive and one-sided interaction between CAM and conventional medical providers. Naturopaths support the integration of health services and attempt to provide safe and appropriate care to their patients through collaborative approaches to practice. The challenges identified by naturopaths associated with integration of CAM with conventional providers may impact the quality of care of patients who choose to integrate CAM and conventional approaches to health. Given the significant role of naturopaths in contemporary health-care systems, these challenges require further research and policy attention.

So, is Jon Wardle up to the job?

The answer obviously depends on what the job is.

If it is about publishing 100 more surveys that show nothing of much value and are essentially SCAM-promotion, then he ought to be fine. If it is about rigorously testing which SCAMs generate more good than harm, then ‘Houston, we have a problem’!

The website of this organisation is always good for a surprise. A recent announcement relates to a course of Thought Field Therapy (TFT):

As part of our ongoing programme to explore prospects for improved healthcare, the College is pleased to announce a course on TFT – a “Tapping” therapy – independently provided by Janet Thomson MSc.

In healthcare we may find ourselves exhausting the evidence-based options and still looking for ways to help our patients. So when trusted practitioners suggest simple and safe approaches that appear to have benefit we are interested.

TFT is a simple non-invasive, technique that anyone can learn, for themselves or to pass on to their patients, to help cope with negative thoughts and emotions. It was developed by Roger Callahan who discovered that tapping on certain meridian points could help counter negative emotions. Janet trained with Roger and has become an accomplished exponent of the technique.

Janet has contracted her usual two-day course into one: to get the most from this will require access to her Tapping For Life book and there will be pre-course videos demonstrating some of the key techniques.  The second consecutive day is available for advanced TFT training, to help in dealing with difficult cases, as well as how to integrate TFT with other modalities.

How much does it cost (excluding booking fee)?  Day One only – £195; Day Two only – £195 (only available if you have previously completed day one); Both Days – £375.

When is it?  Saturday & Sunday 7th-8th March – 09:30-17:30

What, you don’t know what TFT is? Let me fill you in.

According to Wiki, TFT is a fringe psychological treatment developed by an American psychologist, Roger Callahan.[2] Its proponents say that it can heal a variety of mental and physical ailments through specialized “tapping” with the fingers at meridian points on the upper body and hands. The theory behind TFT is a mixture of concepts “derived from a variety of sources. Foremost among these is the ancient Chinese philosophy of chi, which is thought to be the ‘life force’ that flows throughout the body”. Callahan also bases his theory upon applied kinesiology and physics.[3] There is no scientific evidence that TFT is effective, and the American Psychological Association has stated that it “lacks a scientific basis” and consists of pseudoscience.[2]

Other assessments are even less complimentary: Thought field therapy (TFT) is a New Age psychotherapy dressed up in the garb of traditional Chinese medicine. It was developed in 1981 by Dr. Roger Callahan, a cognitive psychologist. While treating a patient for water phobia:

He asked her to think about water, tap with two fingers on the point that connected with the stomach meridian and much to his surprise, her fear of water completely disappeared.*

Callahan attributes the cure to the tapping, which he thinks unblocked “energy” in her stomach meridian. I don’t know how Callahan got the idea that tapping on a particular point would have anything to do with relieving a phobia, but he claims he has developed taps for just about anything that ails you, including a set of taps that can cure malaria (NPR interview).

TFT allegedly “gives immediate relief for post traumatic stress disorder (PTSD ), addictions, phobias, fears, and anxieties by directly treating the blockage in the energy flow created by a disturbing thought pattern. It virtually eliminates any negative feeling previously associated with a thought.”*

The theory behind TFT is that negative emotions cause energy blockage and if the energy is unblocked then the fears will disappear. Tapping acupressure points is thought to be the means of unblocking the energy. Allegedly, it only takes five to six minutes to elicit a cure. Dr. Callahan claims an 85% success rate. He even does cures over the phone using “Voice Technology” on infants and animals; by analyzing the voice he claims he can determine what points on the body the patient should tap for treatment.

_____________________________________________________________

Yes, TFT seems utterly implausible – but what about the clinical evidence?

There are quite a few positive controlled clinical trials of TFT. They all have one thing in common: they smell fishy to me! I know, that’s not a very scientific judgement. Let me rephrase it: I am not aware of a single trial that proves TFT to have effects beyond placebo (if you know one, please post the link).

And Janet Thomson, MSc (the therapist who runs the course), who is she? Her website is revealing; have a look if you are interested. If not, it might suffice to say that she modestly claims that she is an outstanding Life Coach, Therapist & Trainer.

So, considering that TFT is so very implausible and unproven, why does the ‘College of Medicine and Integrated Healthcare’ promote it in such strong terms?

I have to admit, I do not know the answer – perhaps they want at all costs to become known as the ‘College of Quack Medicine’?

Today is a momentous and desperately sad day. Allow me therefore to deviate from my usual subject and write a very personal post (I promise, it won’t happen often).

This post is not about SCAM but about something that is even closer to my heart.

 

I first moved to the UK in 1979. The reason was simple, I had fallen in love with Danielle, the woman who now is my wife. I only stayed for about 3 years. However, as luck would have it, this short time would become the most formative period of my life, both privately and professionally. After a brief and unhappy stint as a doctor in a psychiatric hospital, I got a job under John Dormandy who opened my eyes to the wonderous world of science.

I nonetheless went back to Germany because I felt I had to complete my clinical training. In 1987, became a professor first in Hannover and then in Vienna. Even though the Vienna post was grand (to say the least), I soon became unhappy with it (no need to go into details here; if you need to know, read this or this). I thus started looking for other opportunities, ideally in the UK.

Why the UK?

It wasn’t because of the weather.

It also was not because of the food.

Nor was it because of the huge salary (the move roughly halved my previous income).

It was because of the beautiful memories. And it was because of my deep appreciation of the people. I had grown to admire their humour, their tolerance, their openness, their way of life, their way of dealing with problems, their politeness, their understatement, their honesty, their fair play.

Much has been written about my time at Exeter. Not everything was smelling of roses. But, on the whole and despite all the problems encountered, I had a really good time – mainly because my initial judgement of the people was being confirmed over and over again. I began to feel British and, in 2000, I became British. All my life, I had felt the burden of the recent German past weighing heavily on my shoulders. I had never managed to be proud of being a German. Now I was proud to be British, and I had a passport to prove it!

When Cameron announced the ‘in/out referendum’, I was baffled by the sheer stupidity of the move. How could anyone want to get out of the EU? It never made sense to me. The EU had given us peace for decades and was a guarantor that we Europeans would never again start killing each other. Why was that not pointed out in the run-up to the referendum? Most families had lost sons in the last two European wars. Why did hardly anyone use such arguments? Why was the remain campaign fought so half-heartedly? The other side was campaigning with (mostly vile and primitive) emotions; why did we not use positive and ethical ones?

I remember being in tears when I heard the results of the vote.

I remember fighting tears when acquaintances asked my wife (she is French and has, like I, a British passport) and me: ‘are you now going to go home?

Since the referendum, I have observed in utter horror and bewilderment how the county that I now call my home has changed.

What happened to the tolerance that I so admired?

What happened to the openness of the people?

What about honesty and fair play?

What happened even to humour?

During our 8 years in Germany, my wife and I had to witness our fair share of xenophobia. I despised my fellow Germans for it. Now I see it in Britain, and I feel nauseous.

What is happening to the county I love?

What is pseudoscience and how can it be differentiated from science? This ‘demarcation problem’ has occupied many of our best minds and which nevertheless is largely unresolved. Two brave academics have recently published a paper aimed at providing organisations within the justice system with an overview of:

a) what science is and is not;

b) what constitutes an empirically driven, theoretically founded, peer-reviewed approach;

c) how to distinguish science from pseudoscience.

In it, they demonstrate that not all information which is presented as comprehensively evaluated is methodologically reliable for use in the justice system. Even though it does not really solve the old demarcation problem, I found their article important and informative and therefore take the liberty of quoting a brief excerpt here:

Organisations within the justice system do use empirically and theoretically supported approaches. However, some implemented approaches lack empirical evidence. In more perturbing cases, police officers, lawyers and judges may resort to pseudoscience – that is, bodies of information that may appear to be scientific but, in reality, lack the characteristics of scientific knowledge. … if members of the justice community are not advised about the publishing process then pseudoscientists can be fairly proficient at providing counterarguments. In addition, pseudoscientists can use several other fallacious arguments to achieve maximum support for their approaches.

For example, pseudoscientists might argue that their approaches are supported by a select number of articles, theses or books, and that they are reliable due to their acceptance by important organisations. However, if upon reading such literature it becomes apparent that there is no empirical or theoretical support, or that the steps leading to the conclusions are not thoroughly justified (be this methodologically or through evaluation), the implementation of their approaches remains merely destitute of vision. In addition, such reference to important organisations – often known as ‘name-dropping’–is detrimental by nature; doing so lends support to the notion that one might be unable to distinguish pseudoscience from science and may not understand the role that science plays in developing better professional practice.

Fallacious arguments from pseudoscientists can also address negative comments in a way that attempts to discourage further criticism from members of the scientific community. They can engage in legal threats and ad hominem attacks – that is, opposition to an argument ‘by questioning the personal circumstances or personal trustworthiness of the arguer who advanced it’. For example, if academics raise concerns regarding a particular pseudoscience without having attended its associated seminars, pseudoscientists might assert that the academics do not have the required understanding and that, as such, their criticism is of no value. If the academics had indeed attended the seminars, the pseudoscientists might instead suggest that their concerns are raised out of obscure or malicious reasons. Pseudoscientists might even state that they are criticised due to their revolutionary approach and refer to a quote dubiously attributed to the German philosopher Arthur Schopenhauer: ‘All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as self-evident’. However, as Sagan rightly points out,

the fact that some geniuses were laughed at does not imply that all who are laughed at are geniuses. They laughed at Columbus, they laughed at Fulton, they laughed at the Wright brothers. But they also laughed at Bozo the Clown.

As reported previously the NHS NATURAL HEALTH SCHOOL in Harrogate, is a service that offered a range of free complementary therapy treatments to patients and their relatives who are affected by a cancer diagnosis and are either receiving their cancer treatment at Harrogate or live in the Harrogate and Rural District.

This NHS school offered alternative treatments to cancer patients and claim that they know from experience, that when Complementary Therapies are integrated into patient care we are able to deliver safe, high quality care which fulfils the needs of even the most complex of patients.

In addition, they also ran courses for alternative practitioners. Their reflexology course, for instance, covered all of the following:

  • Explore the history and origins of Reflexology
  • Explore the use of various mediums used in treatment including waxes, balms, powders and oils
  • Explore the philosophy of holism and its role within western bio medicine
  • Reading the feet/hands and mapping the reflex points
  • Relevant anatomy, physiology and pathology
  • Managing a wide range of conditions
  • Legal implications
  • Cautions and contraindications
  • Assessment and client care
  • Practical reflexology skills and routines
  • Treatment planning

I imagine that the initiators of the school are full of the very best, altruistic intentions. I therefore had considerable difficulties in criticising them. Yet, I do strongly feel that the NHS should be based on good evidence; and that much of the school’s offerings seemed to be the exact opposite. In fact, the NHS-label was being abused for giving undeserved credibility to outright quackery.

Therefore, I did something I do rarely: I filed an official complaint in September 2019.

What happened next?

Nothing!

I sent several reminders; and what happened then?

Almost nothing!

I got several assurances that a response was imminent.

And then I forgot all about it.

So, I was surprised to receive this email yesterday from the chief executive of the HARROGATE AND DISTRICT NHS FOUNDATION TRUST (I did not change or correct anything):

Dear Professor Ernst

Thank you for contacting our Chair about the Natural Health School and my apologies for the extended delay in replying to you.   We have reflected on the points you raised and I have set out a summary of this below in respect of the key issues.

  1. As a result of colleagues who set up the service having moved on to other posts outside of the Trust we have not been able to understand how the service was named.  However, I agree that the terminology “NHS Natural Health School” could be interpreted in a certain way and as such we have agreed it should instead be referred to as the Natural Health School only to avoid any interpretation that it has national NHS endorsement.  We will amend the information on the website and other material to reflect that the service is endorsed by the Trust.
  1. The service is hosted by HDFT, in that staff are employed by the Trust, but it is funded through charitable contributions.  No NHS resources are used in providing the school, or the complementary therapies which are provided to patients receiving treatment at the Sir Robert Ogden Centre.
  1. There is no intention to assert that the services provided (ie the complementary therapies) are treatment for cancer.  The ‘treatments’ referred to are complementary therapy treatments and are described as such.  They are focused on wellbeing concurrently to the medical treatment of cancer, and we are satisfied that this is clear in the current description.
  1. Whilst recognising the differences of views on the complementary therapy treatments, the service regularly secures feedback from patients and this has been positive and as such we continue to offer it to those patients who would wish to take it up.
  1. The school provides training to allow participants to achieve a qualification which is awarded at level 3 by the International Therapies Examination Council.

I hope this provides clarity on the context to the service.

Best wishes

… … …

___________________________________________________________________

I find this response more than a little unsatisfactory; here are just a few points I find worth mentioning:

  • As far as I can see, apart of the actual name of the school (it is now called ‘NATURAL HEALTH SCHOOL’), very little has changed. In particular, a NHS link is still implied in multiple different ways.
  • To claim that ‘we have not been able to understand how the service was named’ seems like someone is taking the Mikey.
  • So is the remark that ‘the terminology “NHS Natural Health School” could be interpreted in a certain way’.
  • The statement ‘there is no intention to assert that the services provided (ie the complementary therapies) are treatment for cancer’ is simply untrue; symptomatic treatment of cancer is still a treatment for cancer!
  • If the treatments are focussed on wellbeing, they nevertheless should be backed by evidence to show that they improve wellbeing. The label ‘complementary’ does not absolve a therapy from the need to be evidence-based.
  • There may be ‘different views’ on complementary therapies; yet, there is only one set of evidence – and that fails to support several of the treatments on offer.
  • Positive feedback from patients is no substitute for evidence.

I am not sure whether I should reply to the above letter. I take little pleasure in embarrassing chief excecutives.

WHAT DO YOU THINK I SHOULD DO?

 

 

1 2 3 16
Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories