Synogenes.com

The recent figures say it all:
- 37% of the 132 NHS health care trusts still have contracts with homeopathic services

- 200,000 people are treated annually on the NHS using homeopathic remedies

- 55,000 appointments with homeopaths are paid for by the NHS each year

There are some signs that the position is improving and that GPs are finally getting the message that medieval magic is not the way to go... Spending on these quack cures has dropped from £593,000 in 2005 to a still lamentable £321,000 last year.

But of course, it's big business... something like £40 billion per year is spent worldwide on alternative therapies. And that's despite more than twelve authoritative and exhaustive studies which have shown repeatedly that there is no evidence to support them.

The latest exposé is the recent book by Simon Singh and Edzard Ernst: Trick or Treatment - Alternative Medicine On Trial. The former is a well-known science writer who has a doctorate in particle physics, and the latter is a man of unusual background. He is now a Professor of Complementary Medicine though he trained as a physician, picking up a PhD on the way, and he has specialised in the clinical investigation of alternative medicines. Not only does he understand the world of alternative medicines, but he has the scientific rigour to investigate them thoroughly... which has made him the scourge of the alternative therapy world.

He has conducted several dozen systematic trials and over a hundred clinical reviews. In the course of his studies he exposed the assumption that alternative therapies were free of potential harm, identifying among other things that around 13% of acupuncture patients suffered side effects, that chiropractic spinal manipulation carried a risk of rupturing the arteries in the neck leading to strokes, and perhaps most irritatingly, that the flagship remedy of homeopaths, Arnica, has no more than a placebo effect in dealing with post-operative pain, bruising and swelling.

His results were so thorough and conclusive that he has been rewarded with no fewer than thirteen scientific awards, and two visiting Professorships. He is someone to take seriously when considering complementary medicine.

He argues convincingly that £500 million of NHS funding ought to be spent other than in selling water to gullible patients.

It is interesting that so many people, in the face of overwhelming evidence to the contrary, still adopt an uncritical attitude to the peddling of medieval remedies. Some considerable time ago, Theodor Adorno looked at astrology to try to understand the psychology of people who have irrational beliefs(The Stars Down To Earth).

He came to the conclusion that it was largely about the need for an abstract authority figure and where the individual had something of a rebellious streak, rather than trusting their own thinking, they delegate it to another abstract authority, which is opposed to convention. In doing so, we convince ourselves that we are being different, not accepting the status quo, and that we are asserting our individuality. In practice we are taking the very easy route of abnegating our responsibility to think for ourselves. (Adorno went on to argue that this sort of thinking predisposes people to acquiesce in authoritarian politics... but that's another story.)

It certainly seems that there's more than a hint of this type of psychology in the pandering to alternative medicines. But surely, it's about time that those working in medical roles should have the confidence to acknowledge the gains made during the Enlightenment rather than leading their gullible patients back into the dark ages.

Edvard Ernst - resume

Simon Singh

When someone provides yet another whacky alternative therapy claiming anecdotal evidence of its success, we think of the placebo effect.

What's a placebo?
A placebo is a fake medicine used in double-blind trials so that the person treated doesn't know if they've been given real medicine or not. It's double-blind because even the doctor/therapist doesn't know if they've handed over the real medicine.

This sort of trial is carefully designed to eliminate bias. Neither doctor nor patient knows if the medicine is real and it won't be revealed until the results are in. That rigorously enforced impartiality is crucial to establishing scientific results and it means that anyone can reproduce the same trial with the same degree of objectivity - the results can be checked by anyone. Of course that's infinitely more sound that accepting probably biased anecdotal evidence: anecdotal evidence usually comes from people who have paid not inconsiderable sums for the cure and therefore they have a psychological predisposition to agree that it was effective. Double-blind trials eliminate this bias, anecdotal claims rely on it.

Of course, if people are suffering from an ailment and some alternative remedy provides relief based on the placebo effect, then surely that's better than not having it? Certainly for those individuals who react to the suggestion of treatment in this way, they are better off but it is not so clear cut.

The placebo effect is unpredictable
Unfortunately only around 30% of us are susceptible to a placebo effect and it is not possible to identify in advance which of us are. Not only that but at different times those who are susceptible might be a different 30%. And since placebos typically don't take effect immediately, it's rather difficult at any one time to determine if there is an effect or not.

Placebo effects do not persist and sometimes tail off even during the course of a trial.

Ethically dodgy?
There are ethical and legal problems as well with any suggestion of using placebos for therapy or treatment. One obvious issue is that where there is no clear mechanism for treatment, a patient may justifiably be suspicious of fraud - if someone is charging for a cure and the cure turns out to be auto-suggestion, they are likely to be disatisfied.

But there's also the potential for the supression of genuine clinical symptoms with patients claiming cure when there is no real cure at all.

With the diminution of placebo effect over time, unscrupulous or simply ill-informed amateur therapists may exploit the situation to argue for repeat custom.

What constitutes treatment and cure?
Medical authorities generally require a treatment to show an improvement greater than that attributable to placebo alone. In other words, it has to be shown that there is a measurable effect over and above that which is shown in the case of placebo.

So even if anecdotally some patients getting alternative medicine therapies report that they feel better, that cannot be used as evidence of its efficacy nor can it be accepted that the individual is actually getting real treatment even in terms of the placebo effect. It doesn't mean either that the placebo effect will continue.

The placebo effect is really the psychological noise which masks the identification and treatment of real medical symptoms. It has to be removed before it is possible to relate treatment to identifiable causes and without that, we have no basis for expecting the treatment to be successful. So using the placebo effect as treatment is a non-starter.

Unfortunately we can't treat people with placebos because it doesn't treat anything, it simply masks the symptoms. That's a shame because it would be very cheap to treat everyone with placebos for the many ailments they present with. Understanding how the placebo is used in double-blind trials shows why evidence is necessary as the basis for relating the treatment to the diagnosis and not simply heresay.

Here's a little puzzle to see whether we really understand the significance of accuracy.

A patient goes to a doctor and after explaining the symptoms, the doctor thinks it might be illness X, for which, fortunately, there is a test. He explains that the test is 90% accurate, that is 90% of the test results are right but 10% of them are incorrect.

The patient agrees to undergo the test and a couple of weeks later the patient gets the bad news that the test was positive saying he has illness X. Now the question - should he believe the results? Is he really likely to have illness X?

Intuitively we all say of course he is likely to have the illness, because the tests are 90% accurate.

But, we are missing a vital piece of information. How many people in the population actually suffer from illness X? Since I'm making up the problem I happen to have that statistic to hand and it turns out that at any one time, there is an incidence of 2 in 1000 of the population suffering from illness X.

Now let's do some simple sums.

Let's assume there are 10,000 tests done. We know that given our statistics, twenty of them will have illness X.

Since the test is 90% accurate, 18 of them will be told correctly that they have illness X, and 2 of them will be told incorrectly that they don't.

Now let's think about the rest, the other 9980 people who in fact don't have the illness at all.

For 10% of them, the test will return incorrect results so 998 of them will be told incorrectly that they have illness X. The remaining 8978 will be correctly told that they don't have it.

Lets add up the results:
Told they have illness X: 1016
Told they don't have illness X: 8984

Number who actually have the illness: 20

Probability that someone told they have it really does: just under 2%.
Probability that someone told they don't have the illness really doesn't: a touch over 90%.

This might seem like a catch question but it's an illustration of why statistical information has to be examined very carefully. It's remarkably easy to jump to conclusions without enough information.

If it's any consolation, this test is regularly applied to journalists, scientists, academics, etc, and most of them get it wrong too.

Incidentally, that's why there has to be so much rigour and exactitude in conducting medical tests for illnesses, especially rare ones. Reliability has to be very very high to justify diagnostic conclusions. A test accuracy of 90% with an uncommon illness is almost useless! So although it sounds impressive, we are really comparing it with how we'd feel in a test we'd completed ourselves - if we scored 90% we'd feel quite pleased. Science and especially medicine has to have very much higher standards.

Although the news that the University of Central Lancashire has suspended its BSc course in Homeopathy, the fraudulent sale of water as a medical treatment, is very welcome, the reasons are pretty appalling.

There is no absolutely no doubt that homeopathy is a fraudulent practice - that's been established after more than fifteen years and hundreds of scientific studies and reviews. There is not one shred of evidence that it is in any way effective other than as a placebo - and you always get the placebo effect for free with any treatment. So it's a fraud and a university, an institution supposedly offering higher learning, is disgracing itself pretending to offer a science degree in it.

Unfortunately, the University of Central Lancashire is not acknowledging the real nature of homeopathy. It's suspending the course because they can't get enough bums on seats.

According to the Guardian, Kate Chatfield and Jean Duckworth blamed the suspension of the course on low application numbers. But they said "Fortunately our masters course is thriving and we have been asked to focus upon this area and homeopathy research for the time being." In other words, those deluded individuals who have committed their time and money to studying a fraudulent methodology by signing up to the course, can continue doing so and still end up with a Master of Science degree.

That not only seriously undermines the value of possessing a Masters degree for all those scientists who have done serious scientific work, but also deludes the possessors of the fraudulent ones into thinking they are actually practising science.

When we can't distinguish between the scientific qualifications of those who have consistently and rigorously adopted a controlled scientific approach from those who believe fairy stories about water having a memory, the whole basis of science degrees is undermined.

No surprise then that many scientists, including Professor Colquhoun of University College, London have been so scathing. It remains a disgrace that 400 years after the scientific enlightenment, we have university departments peddling medieval magic as if it were science.

It's good news that the Lancashire BSc in Fraudulent Therapy has been suspended but disgraceful that so-called scientists do not have the intellectual honesty to admit that the courses they are offering are bogus, non-scientific, and based on belief in magic. They are putting their very suspect university positions before honesty and integrity. Shame on them!

If a science degree is worth anything, it is because of it's basis on the open, tested, evidenced, reliable, and rational scientific method in which results are openly presented and challenged, theories are put to the test, hypotheses disproved, and evidence is critically assessed. Knowledge of how the world works, whether we're talking about geology or neurology, astronomy or dermatology, is hard won - it takes work, gathering observations, assessing evidence, being willing to throw out theories that can't be backed by repeatable evidence.

Scientists earn their reputation not just through their intellectual and practical skills in obtaining those theories and evidence, but through their integrity in being prepared to acknowledge when the evidence contradicts them. Those running the courses in homeopathy in the University of Central Lancashire give us every reason to doubt both their integrity and their honesty.