HealthWatch members know that if companies make misleading claims they could be in breach of the EU’s Consumer Protection against Unfair Trading Regulations. However experience with other types of health-related products suggests that bringing a prosecution is almost impossible in practice (see below). The BMA and AMRC have written to the Health Secretary Andrew Lansley with suggestions for reducing the potential for harm from private screening tests. HealthWatch will watch with interest to see what action results
Mandy Payne
Reference
1. The full BMA/Academy statement can be viewed at: http://www.bma.org.uk/health_promotion_ethics/genetics/jointstatementhealthtests.jsp
Note: Sense About Science’s booklet, “Making Sense of Screening” is about screening in general and is available to download free of charge at: http://www.senseaboutscience.org.uk/PDF/MSOScreening.pdf
David
Colquhoun is a professor of pharmacology at University College London who has
devoted his career to researching the nature of the molecular interactions that
cause single ion channels to open and shut. But HealthWatch members will know
him better as an outspoken critic of pseudoscience through his popular blog
and website DC's Improbable
Science (http://www.dcscience.net), which is for many of us a first port
of call for informed analysis when health non-science is in the news.
Last year he famously obtained a Freedom of Information judgement to require the University of Central Lancashire to release details of their BSc course in homeopathy.The eighteenth HealthWatch Award will be presented at the 2010 HealthWatch Open Meeting and AGM, to be held on Thursday 28th October. Further details will be sent to members in due course.
As you’ll have read in the last issue of the HealthWatch Newsletter, the old Trades Descriptions Act has been overtaken by the 2008 EU Consumer Protection Regulations and any attempt to contact the Office of Fair Trading (OFT) direct is now blocked by Consumer Direct (CD) who do their best to shield the Trading Standard Officers from tedious complaints by members of the public expecting protection from those who make false claims for health products. HealthWatch members will have read about my difficulties penetrating the screen that CD sets up between the public and the TSOs. I thought the battle was over when I was recently given the phone number of a senior TSO in our local area (Herts), but I was too optimistic
John Garrow
Emeritus Professor of Human Nutrition
University of London
Editor’s note: The Office of Fair Trading website is at: http://www.oft.gov.uk/
The Prince’s Foundation for Integrated Health (FIH) has closed its doors. An announcement appeared on the FIH website on the 30th April 2010 which said, “Whilst the closure has been planned for many months and is part of an agreed strategy, the Trustees have brought forward the closure timetable as a result of a fraud investigation at the charity. The Trustees feel that The Foundation has achieved its key objective of promoting the use of integrated health.” Four days before the surprise closure, two former officials at the Prince’s Foundation had been arrested on suspicion of fraud and money-laundering, with an estimated £300,000 unaccounted for in the charity’s books.
See: http://www.fih.org.uk/media_centre/closure_of_fih.html and http://www.guardian.co.uk/uk/2010/apr/26/prince-charles-aide-homeopathy-charity-arrested
The Health Secretary Andrew Lansley announced in June that the government will set out new measures to protect NHS whistleblowers. Detailed proposals are awaited but measures will include unequivocal guidance to NHS organisations that all their contracts of employment should cover the rights of staff to raise concerns in the public interest.
See: http://www.dh.gov.uk/en/MediaCentre/Speeches/DH_116653
Finland, Germany and Portugal don’t do it, Spain might consider it, while France and Ireland like a doctor to be involved. A survey of 14 European countries and the US has looked at the extent to which patients are encouraged to report adverse drug reactions (ADR). Direct reporting by patients results in faster and more accurate accumulation of knowledge of ADRs than can be achieved if only health professionals are allowed to submit information. One of the report’s authors is Dr Andrew Herxheimer, past HealthWatch committee member.
Download report at: http://www.haiweb.org/10052010/10_May_2010_Report _Direct_Patient_Reporting_of_ADRs.pdf
It is surprisingly difficult to find out how research funders decide what research to fund. Now the James Lind Alliance has launched an online resource that should help patients, clinicians and the groups that represent them to ensure that research is grounded in what matters to them jointly. The JLA Guidebook is drawn from experience of patient/clinician partnerships in a wide range of conditions and gives step-by-step advice for establishing effective Priority Setting Partnerships and for identifying and prioritising treatment uncertainties. It includes templates for questionnaires, draft agendas, terms of reference as well as links, publications and other resources.
Download from http://www.JLAguidebook.org
Understanding Uncertainty is an engaging website that seizes on figures given in news stories of all kinds and applies statistical analyses. Among the health issues considered are screening tests: for HIV, breast cancer and terrorist tendencies; while in “2845 ways to spin the risk” an interactive demonstration lets you explore the way “risks can be ‘spun’ to look bigger or smaller, how medical treatments can be made to seem useless or to be wonder cures, and how lifestyle changes might look worthwhile or not worth bothering with.” Worth a visit.
Go to: http://understandinguncertainty.org
On
June 15th the Medical Journalists’ Association held a meeting to discuss
“Libel law reform: What every medical journalist should know”. Attendance
was extended also to members of HealthWatch, Sense about Science and the Guild
of Health Writers. The chairman was John Illman, and the three invited speakers
were Simon Singh (the science writer and author who was sued for libel action
by the British Chiropractic Association, but he won), Peter Wilmshurst (the
cardiologist who is currently being sued by a US medical device manufacturer)
and Tim Smith, an expert in libel law.There was an audience of about 60, mostly medical journalists. A show of hands indicated that the large majority had experience of being sued for libel, or threatened with legal action if they did not apologise and withdraw some defamatory publication. Apart from Peter Wilmshurst I saw only two other clinicians in the audience.Accounts of the legal battles of Singh and Wilmshurst are available elsewhere [1,2].
The complexities of English libel law, though ably explained by Tim Smith, are beyond my understanding. What I learned was that it is amazingly easy and inexpensive to enter a claim of libel in the High Court in London, that if the litigants win the defendants are charged eye-watering costs, and even if the defendant wins he is still substantially out-of-pocket in the end.
Just to confirm that I had correctly understood the italic note above I asked the platform party if they could quote any libel action, in the English court in the last decade, in which a winning defendant had come out of the trial without having lost a substantial amount of money. None of the experts could remember such an event
John Garrow
Emeritus Professor of Human Nutrition
University of London
References
Magic
and superstition have been declining since the time of the Reformation in the
UK [1]. By the 1940s and 50s there was little sign of it expressing itself in
alternative medicine. However, from the 1970s complementary and alternative
medicine (CAM) grew rapidly in popularity [2], becoming the large scale industry
it is today. The question arises why, given the expansion of effective modern
medicine in the last 80 years, is there a renewed enthusiasm for irrational
beliefs about medicines? Is it simply a matter of failing scientific education,
or are wider cultural forces at work?It is well (if crassly) said that, “culture eats strategy for breakfast”. A narrow focus on “the public understanding of science” may prove to be insufficient to counter the cultural torrent. It is worth noting that it is not clear to what extent such informed rationalism contributed to the earlier decline of magic. Keith Thomas, the Welsh historian and author of Religion and the Decline of Magic, writes, “One cannot simply attribute the change to the scientific revolution. There were too many ‘rationalists’ before, too many believers afterwards, for so simple an explanation to be plausible.” [3]
A clue to our current cultural condition lies in the predictable response given by a user of CAM when confronted with the evidence for its ineffectiveness: “Yes, but it works for me.” Today, sadly, “me” seems to trump reality. This observation corresponds with the analysis of another British historian, the late Roy Porter, regarding the resurgence of alternative medicine. “Flexibility, permissiveness, variety, self-discovery have assumed greater status in our culture of self-enhancement or narcissism.”[4]
The roots of our modern Narcissism [5] arguably lie as far back as the first modern philosopher Rene Descartes. His famous assertion, “Cogito ergo sum” (I think therefore I am), was an attempt to provide a foundation for certain objective knowledge. Since it is only possible to be completely objective if you stand outside the system, the cost was to philosophically remove the subjective observer from reality. The problem with this is that such god-like objectivity isn’t ours to be had. We do not stand outside reality; we are an integral part of it. Descartes had thus, entirely unwittingly, created a monstrous subject. But the consequences of this philosophical move would take centuries to work out in the day to day lives of ordinary people. Is this too abstract? Please bear with me.
Subsequently we have experienced the Industrial Revolution, which has arguably had a bigger impact on our social existences than any other revolution before or since. The previous integration of home and work life was broken up into private and public spheres. The public work world is the impersonal world of faceless bureaucracy where people become numbers in the system, whereas the private home world is where we feel that life has meaning and significance. Unfortunately medicine itself has been bureaucratised. Doctors (and I include myself) have had to largely stop visiting patients at home, and expect them to come to see us in a health centre or hospital. Yet it is in the private world of home where individuals feel known personally and make decisions for themselves—what colour wall paper, whether to write a novel or buy a Nintendo. Indeed consumerism is another impact of the industrial revolution—we buy things not because we really need them, but because advertisers and social pressures make us feel that we ought to have them.
Technology’s relationship with the “self” is ambiguous. Certainly the successes of technology contributed to the decline of magic as society gained some control over the contingencies of nature, which rendered people powerless against disease and disaster [6]. However, more recently all-pervasive technology has given the illusion that it is the only place to look for answers. Porter described the “growth of the therapeutic state and the medicalized society”. If one is subject to anxieties despite technology then it is not clear where else to look for answers. The paradox here is that anxieties have been rising in recent decades at the very time that technology and success in medicine has taken hold. Porter documented this as the “doing well, feeling bad” syndrome.[7]
Psychologically we have the advent (with thanks to Carl Jung) of existential self-psychology[8]. Visiting the self-help section of a book shop is the best way of understanding this phenomenon. It invariably neighbours the philosophy section but in a separate section with alternative medicine books. It seems the problems of life can be solved by focusing on the needs of the self. However, the self is properly defined in its relations to the external world, so that to look to the self to solve the problems of the self is to ignore reality, and—it must logically follow—to end up losing the self.
Narcissus was a man famed for his beauty and proud of it. He glimpsed his reflection in a pool and fell in love with himself, not realising that it wasn’t reality but an image he was looking at. As a result he didn’t eat or drink and, pining for himself, he wasted away. It is a powerful myth which seems to have very modern resonances. The self is something which should not be the focus of our attentions. If it is, we will waste away for want of reality. Reflections are insubstantial and ephemeral, like a change of clothes, so that by trying to understand ourselves, we understand ourselves less and less.
So we turn to astrology to tell us about ourselves, and we can’t stop looking in mirrors or searching photos for ourselves, as if to check we are still there. Reality is redefined as what impacts me existentially, and so we seek intensity of feelings over profundity of truth and reality. We immerse ourselves in physical sensations; bungee jumping and drug taking, or eating disorders and deliberate self-harm. Our culture is therefore ripe for CAM. The therapists often come to your home, or operate from theirs; there is an emphasis on sensory experiences: aromatherapy, whale music, massage, light touch or needle insertions. Even more significant is the focus that CAM therapists give to the “history” of the “self”, either by asking questions about trivialities like one’s favourite colour, making connections between quite unrelated subjective symptoms or by appearing to magically divine information about the self by cold reading. All of this is designed to make the self central and reassure the self that it is really real.
It would be wise for promoters of evidence-based medicine to be aware of these realities. An excessively mechanistic or reductionist philosophy, which treats people as machines or as numbers in the system, risks feeding into these narcissistic drivers. If doctors are tempted to exchange a good bedside manner for an effective medicine (as Porter suggested they are), then they should think again. Although randomized controlled trials are required to randomize patients in large numbers for the purposes of research, it would be a mistake for clinicians to treat individuals as numbers.
I remember one consultant telling me that he sees himself as a mechanic trying to fix the machine. But people need to be treated holistically as subjects embodied in reality, not as abstract objects, or free-floating narcissistic selves.How do we break the spell of the self? CAM therapists make a category error. “Holistic” medicine should not mean treating the self apart from reality. Rather, it is the humble recognition that doctors, patients and effective therapies each form a part of reality. Doctors and health care professionals need to concentrate on caring for others, and seeing curing as a means to caring for the whole person. Any attempt to treat people as objects for the purposes of “objectivity” is more likely to be part of the problem than the solution. Our addiction to the reflection of ourselves is going to be a hard habit to break, and the solution is not simply better scientific education.
James May
GP Principal, Kennington, London
Chairman of HealthWatch
References
Many
enthusiasts of CAM, it seems to me, have a view on the nature of evidence which
fundamentally differs from the dominant view in mainstream medicine. Let me
explain. Imagine a treatment for which virtually no reliable evidence exists.
Take crystal therapy as an example. You may think crystal therapy is nonsense.
But enthusiasts of this treatment will quickly explain that there is no evidence
either way.And they are, of course, right—not a single clinical trial of crystal therapy has ever been published. So is it fair to say that there is “no reliable evidence”?
More generally speaking, “no reliable evidence” can correspond to several different situations. There could be some evidence but it is too flimsy to be reliable, or there might be a few good studies but their results are contradictory, so the totality of the evidence is not reliable. And, more often than not, we have no trial data at all (as for crystal therapy).In conventional medicine, any of these three situations would mean that the treatment in question is characterised as unproven
Edzard Ernst
Professor of Complementary Medicine
Peninsula Medical School
Universities of Exeter & Plymouth
Keith
Isaacson, consultant orthodontist and HealthWatch Committee member, is pleased
that he now has another good reason to encourage patients to follow his adviceFor all my professional life I have been encouraging patients to be more enthusiastic about brushing their teeth, mainly for reasons of dental health. However, research recently published in the BMJ [1] gives me another reason to encourage my patients—tooth brushing has been linked to a lower incidence of heart disease.
It is already known that there is a link between cardiovascular disease (CVD) and periodontal disease [2]—a common chronic inflammatory condition, which in turn is linked with poor oral hygiene. Findings from this latest study using cross-sectional survey data from a large sample has further strengthened that link.
For years it has been known that coronary arteries can get furred up by atherosclerosis, a cause of heart attack. Some causes of atherosclerosis—smoking, obesity—are well established. But what is less widely known is that chronic low grade inflammation increases blood levels of some of a group of chemical markers which are also associated with atherosclerosis [3]. A common cause of chronic inflammation is periodontal (gum) disease, which in turn usually results from poor oral hygiene
Keith Isaacson
Senior Consultant Orthodontist
North Hampshire Hospital, Basingstoke
References
Les
Rose was dismayed by his experience when asked to review a homeopathy paper
for a clinical research journal. We reproduce this article from his Majikthyse
blog with his kind permission.I get invited to peer review papers for a few journals, and the process is usually well managed by the editors. I have had to recommend outright rejection on rare occasions, and one of those was quite recently. I was sent a manuscript by Evidence-Based Complementary and Alternative Medicine. I normally regard such review work as confidential, so I won’t identify the author.
However I have no compunction in identifying the journal as I have real concerns over this incident
Les Rose
Freelance consultant clinical scientist
Reproduced with the author’s permission from Les Rose’s Majikthyse blog. See: http://majikthyse.wordpress.com/ 2010/04/27/so-is-this-peer-review/
Lord Lester of Herne Hill, QC, a human rights lawyer and expert in international law, hopes his bill will encourage the government to act quickly on libel reform. “We need a simpler statutory public interest defence, which clearly applies to everyone and covers opinion as well as fact,” he wrote in the Times [2]. This is the first attempt in over a century to put forward a wholesale redraft of our libel laws.
The bill, which had its first reading in the House of Lords on 26th May, proposes clarifying the defences of justification and fair comment, to be renamed as “truth” and “honest opinion”. The bill will also require claimants to provide evidence their reputation was damaged by an alleged libel before they can bring a case forward (they don’t have to do this at present) and make corporations prove financial damage before they can sue. The bill is due a second reading in the Lords on 9th July.
Supporters of free speech in matters of science had already had cause for celebration in April. Shortly after the last HealthWatch Newsletter went to press, the British Chiropractic Association dropped their libel action against the science writer Simon Singh [3]. Commenting on the case that his solicitor says will cost him at least £20,000 plus more than a year’s lost earnings, which he will never recover [3], he told the Times, “My victory does not mean that our libel laws are OK, because I won despite the libel laws.” [4]
Mandy Payne
For more information about the Libel Reform Campaign go to http://www.libel reform.org
There
are two stages in someone becoming a Catholic saint. The first is beatification,
the second is canonization. Each stage, amongst other qualifications, requires
that a documented miracle be attributed to the individual under consideration.
In September this year, the Pope is due to come to England for the beatification
of Cardinal Henry Newman.The final judgement about the required miracle is decided by a Vatican panel, known as the Consulta Medica. Unlike the Bureau at Lourdes, who publish their findings widely, the Vatican keep a very tight control over the details of their cases. A recent study of Vatican miracles by Dr Jacalyn Duffin, a Canadian haematologist, reported that the Vatican Archives are kept sealed for the duration of the next six papacies [1]. She was unable to have access to any documents after 1939. In the Newman case, however, details in a document known as a Positio have been released to a handful of researchers with a specialist interest in Cardinal Newman.
Peter May
GP (retired), Southampton
Reference