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 https://staff.uclan.ac.uk/9930.htm

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...

4 comments:

Stu said...

Congratulations Mike, this is great and you should be very proud of all you have done to make it come this far,

Stu.

Dr* T said...

^ what he said.

Watching with interest :)

I'll put you on my blogroll - you might want to have a look at www.badscienceblogs.net - it's a pretty good aggregator of skeptical blogs and this one would fit right in!

T

apgaylard said...

I'd like to add my congratulations.

Your excellent post did raise a question in my mind: are they really saying that the ethics are OK if you set aside the (lack of) efficacy issue? If the report does this it strokes me as rash. This would ignore the "lying problem" you put in your question: surely teaching anti-science (or even just wrong) explanations for how these practises (don't) work would be an ethical problem even if they did?

Jhon said...

There are different ways of looking at this. One could say it is just passing the buck. It could also been seen as circular.

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Jhon
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