Thursday, July 9, 2009

UCLAN CAM Review - Full Report

UPDATE: July 15. The report of the UCLAN working party review of complementary medicine, as approved by the Academic Board last Thursday, has now been published. For the moment it is only on the staff intranet but I assume it will be public soon. UCLAN staff can find it at

UPDATE: July 17. David Colquhoun has now posted the full report and his own analysis of its conclusions.

Here is my section-by-section commentary on the report of the UCLAN working party review of complementary medicine.

Section 1: Introduction

The review is framed as a response to "concerns expressed by some colleagues within the University" but it never explains what those concerns were/are. I would have liked to have seen responses to my seven specific complaints, which I set out here exactly as they were submitted to the review team.
  1. Homeopathy is nonsense. There is no reason to think it could work. There is no good evidence that it works better than placebo for any condition. There is plenty of evidence that it does not work. To teach otherwise is to lie to our students, and to train them to lie to their patients.
  2. Homeopathy is not science. It is not even non-science, it is anti-science because its laws contradict the dose-response relationship and ignore the Avogadro limit. It invokes a mystical energy known as the “life force” which cannot be detected scientifically. Its advocates disparage the scientific method and ignore or distort the results of scientific analysis.

  3. Homeopaths have been caught out many times giving dangerous advice, promoting worthless remedies, claiming to be able to prevent serious diseases, disparaging scientific medicine and so putting patients at risk of serious harm or even death. Are UCLAN homeopaths guilty of this? If they are not, why are they so secretive about what they teach?

  4. The Society of Homeopaths is not a fit body to participate in degree validations. UCLAN should have no dealings at all with a body which fails to enforce its code of conduct when members give dangerous advice, and which resorts to legal threats when criticised for this.

  5. Chinese herbal medicines are complex mixtures of substances, few of which have been tested for safety or efficacy, and which may carry significant risks of harm. It is unethical for anyone at UCLAN to be involved in giving Chinese herbal preparations to patients until they have been properly assessed for safety and effectiveness.

  6. Acupuncture may have some effects but they are certainly small (at best) and have nothing to do with Qi, meridians, yin & yang or non-existent “organs”. Such notions are unscientific and should not be taught as science. The same applies to many other nonsensical forms of CAM which UCLAN and associated colleges promote, including Bach flower remedies, cupping, moxibustion, auriculotherapy, therapeutic touch and astrological medicine.

  7. Proper scientific testing of CAM is certainly possible if researchers are properly trained in the scientific method, but UCLAN’s CAM courses appear to contain virtually nothing about research design or statistics. Where there is genuine science content, it is often directly contradicted by the CAM content. This is unacceptable.

Nevertheless, I am delighted that UCLAN did take my complaints seriously, and I welcome this report. As you will see below, some of my points have been addressed, but some are still outstanding.

Section 2: Context

This short section mentions the "wider debate and controversies" around CAM, but again does not mention any specific examples. I would have like them to acknowledge the sterling efforts of David Colquhoun, for example, to force the disclosure of teaching materials, and the resulting embarassment when it was revealed that Westminter's CAM students are being told things like "Amethysts emit high yin energy" (UPDATE: July 17. DC has now posted a copy of the evidence he submitted to the review committee). Instead, the debate is described in rather dry fashion as relating to four themes: evidence/efficacy of CAM, suitability of CAMs as topics for university courses, the nomenclature of CAM degrees (specifically whether they should be called science), and the ethical/economic impact of CAM upon society as a whole.

Section 3: Method

The report explains that the review included a literature review (a list of papers is included later on, showing that some poor sod actually read much of Lionel Milgrom's epic series of inane quantum metaphor papers, which feat surely deserves a medal), some commisioned reports (which I would very much like to know more about), the preparation of a paper on the ethics of CAM by one of the reviewers (which I will also try to obtain), face-to-face meetings with interested parties (me included) and written evidence from a variety of individuals and groups.

Section 4: Consideration of Themes

Now we get to the meaty stuff! Each of the themes identified in section 2 is taken up in turn.

Section 4.1: Efficacy

Disappointingly, the reviewers decided that efficacy was outside their remit, due to the "volume and diversity of views". I think this was a mistake, since it undermines all their later comments about the importance of patient autonomy, which is only possible when patients are given adequate information on which to base their decisions.

Section 4.2: The Role of Universities in Society

I found this section unbearably waffly. There are lots of worthy statements about the importance of "critical thinking" but with no specific examples of what this means in practice it is impossible to say whether CAM students really develop these skills. There are lots of vague claims about the importance of "diversity" and of students being exposed to challenging ideas and debates, but, having ducked the efficacy question, there is no acknowledgement that some ideas have been completely discredited. Would the team argue that astronomy students must be taught astrology? Biologists, creationism? Would they really benefit from such "diversity"?

Somehow, this conclusion leads to the first recommendation in the report: that UCLAN should provide some postgraduate research scholarships to "suitably qualified" staff and students, with multidisciplinary supervisory teams, to "facilitate development of a broad range of research skills" and "contribute to the generation of knowledge in CAM". Fair enough, I suppose, although it would seem very unfair if scarce resources were diverted into CAM at the expense of other disciplines. There are certainly some CAMs where more research would be useful (if it is of high enough quality) and I would be happy to help develop these projects. I would draw the line at homeopathy, however, which has already been studied in quite enough detail to know that it is useless. Ho hum.

Section 4.3: Nomenclature.

Not much to argue with here! I do accept that defining "science" can be tricky, and that disciplines differ widely in exactly how "Sc" a BSc or MSc should be. My big problem with CAM degrees is that they are often antiscience, not just non-science, so I am very pleased with the recommendations here: that CAM degrees should be simply named "Bachelor with Honours in X" and called B (Hons) rather than BSc (Hons); and that there should be increased multidisciplinary input to CAM teaching so as to "facilitate greater exposure to subject expertise and different paradigms".

Section 4.4: Ethics

This is another somewhat waffly section, which takes two pages to explain that if you ignore the question of efficacy, there is no ethical reason not to teach CAM. However, the reviewers do note the need for patients to be protected from "lack of professional regulation, poor product quality assurance and inadequately trained practitioners". They therefore recommend that UCLAN should refrain from offering any CAM courses "until such disciplines have achieved statutory regulation status".

There are different ways of looking at this. One could say it is just passing the buck. It could also been seen as circular, since one major aspect of regulation is training of practitioners. Alternatively, one could look at the current level of disarray among CAMs regarding regulation: the dismal failure of the CNHC to attract members in any number (only a few massage therapists have joined so far) and the current implosion of the General Chiropractic Council following the ill-advised attack on Simon Singh, and conclude that most CAMs will never get their act together to meet the necessary standards.

Could this be the end of CAM courses at UCLAN? Watch this space...

Tuesday, July 7, 2009

The Ancient Wisdom of the East

Enthusiasts for alternative medicine always seem to stress how old their ideas are, as if "traditional" medicine was a good thing. They also love to denigrate "Western" medicine (even homeopaths do this, and their particular quackery was invented by a German). I have never understood why Eastern traditions are held in such regard in this context. Would you really want medical care from someone who does not accept germ theory, or who doesn't know that blood circulates around the body? Yet people still shell out a fortune for Traditional Chinese Medicine (TCM), despite the fact that there is bugger-all evidence it actually works. Most of these people - indeed, most customers for all types of CAM - are wealthy, educated women who really should know better. But what they are buying is a strangely sanitised version of the real thing, an airbrushed, bowdlerised, Disneyfied tradition with one missing ingredient. Animals! So here are two stories from this week that show just how wise and wonderful the real Eastern medicine can be.

Huyet Linh

The first article was in Private Eye's "Funny Old World" column (Eye 1239), having originally appeared in The Vietnam Nation back in February. It describes the work of the men who hunt "huyet linh", a Vietnamese folk remedy that...
" believed by many people in the northern mountain provinces to have medicinal properties. They often use it in the belief that it strengthens the health of pregnant women, facilitates childbirth and prevents post-natal diseases."
Men too take
huyet linh, to boost their sexual health and give them increased stamina. To find it, our hunters embark on dangerous expeditions into the deep jungle of Thung mountain. They live for days in caves, sleeping wrapped in leaves to hide their human scent, eating only dried food and risking death or injury clambering through the rocks and trees.

The men are following a troop of monkeys, looking for females of child-bearing age, yet it is not the monkeys themselves that they are interested in. It is something the monkeys leave behind...
"After three days of walking along bumpy, snaking paths, and climbing up and down slippery caves, Voong looks a decade older than his actual age. His arms, legs and faces are covered with bruises and scratches. However, he blossoms into a smile of contentment when looking at his indigo haversack full of pieces of blotting paper darkened with monkey menstrual fluid."
Yes folks, it's monkey blood! The hunters earn millions of dong collecting drops and clots left behind by menstruating females. Mmmmm, dig that crazy oriental wisdom! Still, at least the monkeys are unharmed by this particular quackery. Another Asian forest animal is not so lucky.

Slow Loris

The slow lorises of Indonesia are an endangered species, mostly because they are illegally caught and sold as pets. In Japan, a slow loris will set you back at least $1,500 (according to a BBC report from 2007)...
"The pet shops advertise them, and they're very popular to Japanese ladies," says Masayuki Sakamoto from the Japan Wildlife Conservation Society. They're easy to keep, they don't cry, they're small, and just very cute."
They are also the planet's only poisonous primate. Incredibly, they store their poison in their elbows, which they then suck in order to inflict a toxic bite. For this reason, pet lorises have often had their teeth ripped out by the unscrupulous traders. This is cruel, of course, and also means that the lorises might find it much harder to survive if they were rescued and returned to the wild. Animal rescue charities are now studying their toothless lorises to work out how badly it affects them.

Pet traders are not the only enemy, however, for it turns out that lorises are also prized for their (you guessed it) medicinal and spiritual properties. That brings me to my second Eastern wisdom story this week: today's Grauniad report that...

"...luckless lorises frequently find themselves roasted alive over wood fires while eager people catch the supposedly life-giving liquor that drips out. Bits of their bodies are used in traditional medicine. And legend has it that villagers anxious about traffic safety need only bury a loris beneath a new road to keep it free from accidents"
The Grauniad is coy about what the benefits of loris juice are supposed to be, but a quick web search found this on the Care for the Wild International website:

Use in Traditional Medicine

Almost all body parts of slow lorises are used in Traditional Chinese and Khmer Medicine in Cambodia, China, Lao PDR, and Vietnam; to a lesser extent also in India and Indonesia. Use of:

  • Fur: in Traditional Asian Medicine believed to support wound healing; in Indonesia locally worn as amulet to ward off danger.
  • Eye-balls: as love potion
  • Flesh: to cure epilepsy
  • Meat: to cure stomach ailments or asthma
  • Whole body: in alcohol: used as “energy drink”

  • In Britain, mainstream providers of TCM tend not to go for the whole tiger-penis rhino-horn monkey-period nonsense. For example, my friends at the Northern College of Acupuncture are keen to stress that they do not use any endangered animals. But if ancient oriental wisdom can be so obviously, ridiculously moronic when it comes to rare animals, why would anyone credit it when it comes to more mundane ingredients? The whole thing stinks of economic expediency. They know that their market consists of air-headed muppets who would run a mile if they thought anything cute and fluffy was getting the chop on their behalf. Pathetic! Take a look at this loris, hippies. This poor wee fucker is the true face of your ancient Eastern wisdom.