Fake medicine and AIDS denial are ‘charitable’

[BPSDB] Richard Wilson wrote this about a registered charity that is actively promoting AIDS denial.

This reminded me that, last year, I wrote to the same Charity Commission to complain about Frontline Homeopathy, which collects funds to promote homeopathy as “as an effective, low cost primary health care system” in developing countries. I got this reply. The Commission’s criterion is ‘charitable’, which apparently has nothing to do with ‘true’ or ‘effective’.

Thank you for your request.

The Commission’s policy on registering charities who pursue practices which constitute alternative and complimentary medicine was made following our Decision on the application for registered charity status from the National Federation of Spiritual Healers. Please see the link below for more details (you may need to scroll down to see the specific case and our findings).

www.charitycommission.gov.uk/tcc/issueguidesum.asp

I trust you will find this useful.

Perhaps this is matter for another campaign by bloggers?

Beware the spinal trap

Image via Wikipedia

[BPSDB] Along with many other blogs and magazines, I am reproducing, below, Simon Singh’s article on chiropractic, which led to his being sued for libel by the British Chiropractic Association. The full story can be found here. The point of the publication is to show support for Singh in his fighting the libel case. Please sign the statement at Sense About Science, if you haven’t already done so.

It is true, as Singh writes below, that chiropractors make claims for treatments for which there is little or no evidence of their effectiveness, but there are definite risks associated with chiropractic.

Beware the spinal trap

Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results – and can even be lethal, says Simon Singh.

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.

I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.”

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.

If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

Simon Singh is a science writer in London and the co-author, with Edzard Ernst, of Trick or Treatment? Alternative Medicine on Trial. This is an edited version of an article published in The Guardian for which Singh is being personally sued for libel by the British Chiropractic Association.

Update: The above article was modified by removing the words complained of by the BCA. However, the BCA has published these words itself , so you can form your own opinion on whether the original article could damage the reputation of the BCA or not.

Follow-up to Homeopathy Awareness Week

[BPSDB] There was no follow-up to the letter published prominently in the Guardian on 13 June 2009, on which I have commented before. I have followed this up with a letter to the paper’s Readers’ Editor. I actually wrote on two different issues, so this is an extract from the letter.

On Saturday 13 June you published prominently a letter from three physicians (Dr Lewith et al). This consisted of an unfounded claim (see http://apgaylard.wordpress.com/2009/06/15/false-positives/) about evidence for the effectiveness of homeopathy, in which the signatories appear to have a direct financial interest.

I expect that there were many letters (including my own) in rebuttal of this claim, but none appeared in the paper. It appears to me that homeopaths and their supporters get an easy ride in the paper (outside of Dr Ben Goldacre’s columns) despite the fact that it is to medicine pretty much what astrology is to astronomy.

For information, this is the public information on the involvement of the three signatories with homeopathy:

Dr George Lewith

Dr Michael Dixon

Dr Peter Fisher

They all use the weasel word “integrative” or “integrated”, which has come  to be a warning sign for serious bullshit whenever it is associated with the word “medicine”. Homeopathy is fake medicine. It imitates the protocols and procedures of medicine (but not necessarily the ethics), while the theory behind it, and the remedies themselves, are as empty of real content as the magic in the Harry Potter books.

Homeopathy Awareness Week: The facts of life

[BPSDB] Here’s a description of the process for producing a homeopathic remedy, as described on Wikipedia:

…homeopaths use a process called “dynamisation” or “potentisation” whereby the remedy is diluted with alcohol or distilled water and then vigorously shaken by ten hard strikes against an elastic body in a process called “succussion”. … During the process of potentisation, homeopaths believe that the vital energy of the diluted substance is activated and its energy released by vigorous shaking of the substance.

… A 2C dilution requires a substance to be diluted to one part in one hundred, and then some of that diluted solution diluted by a further factor of one hundred. This works out to one part of the original solution mixed into 9,999 parts (100 × 100 -1) of the diluent. A 6C dilution repeats this process six times, ending up with the original material diluted by a factor of 100^-6 = 10^-12. Higher dilutions follow the same pattern. In homeopathy, a solution that is more dilute is described as having a higher potency, and more dilute substances are considered by homeopaths to be stronger and deeper-acting remedies. The end product is often so diluted that it is indistinguishable from the dilutant (pure water, sugar or alcohol).

Now for some real science, what you learn in chemistry at school. A ‘mole’ of any substance – for water 1 mole is 18 grams – contains approximately 6 × 10²³ molecules of the substance, that’s 6 followed by twenty-three zeros (6 × 10²³ is called the Avogadro constant).

That seems an awfully large number of molecules, but if you carry out the homeopathic dilution you soon reduce the concentration of the substance to effectively nothing. Suppose you start the homeopathic preparation with about a tenth of a mole of the active ingredient in 100 ml, by the time you have a 12C remedy (diluting by 100 twelve times) there is only, on average, approximately one molecule in every 100 ml. Homeopaths typically use 30C or even 200C solutions. Once you get to those dilutions, there is absolutely no chance of finding any of the original remedy in a sample. Such a homeopathic remedy consists only of the inert basis substances (water, alcohol, sugar, chalk etc.) that are used for making the dose or pill, like the placebos that clinicians use in tests.

Kate Chatfield of the Society of Homeopaths was asked by a House of Lords Select Committee:

“Is it possible to distinguish between homeopathic drugs after they have been diluted? Is there any means of distinguishing one from the other?”

She replied:

“Only by the label.”

Exactly.

Nevertheless, homeopaths still claim that the dilution process somehow makes a “remedy” more effective, even hinting at danger if the “strong” remedies fall into untrained hands. How this happens appears to be magic, the same way magic happens in the Harry Potter books. A few more scientifically-minded homeopaths have tried to come up with a pseudoscientific explanation called “memory of water”, but they have yet to put even a proper theory to this name, let alone find any evidence that it exists.

For the sake of argument, let’s just assume that the homeopaths are right, and that succussion does turn the material that you started with into an effective “remedy”. By the homeopathic “principle” that “like cures like”, the homeopathic solution should produce the symptoms of the disease that the “remedy” is used to treat.

In practice, even the very purest available water contains parts per trillion or parts per billion of numerous impurities. These chemical substances are in the water because the world we live in is made out of chemicals (they are not necessarily man-made pollution). Typical impurities would be common ions like sodium, chloride (that is, salt), calcium, magnesium,  iron and sulphate. There are likely tens of thousands of impurities in the form of molecules and ions at this level or lower. We don’t expect homeopathic “remedies” to be prepared with water this pure, which is expensive water used for chemical analysis and other experiments in labs requiring high accuracy. We happily drink water with higher levels of impurities than this – at those levels they have no significant affect on the human body.

So, even if a homeopathic “remedy” is prepared with the very purest available water, there may still be something like 10¹² (1,000,000,000,000) molecules each of numerous impurities in a 30C or a 200C remedy and this level cannot be reduced. Of those molecules, some molecules of each impurity have been through the whole dilution/succussion cycle, so the impurities have been “potentised” too. So a homeopathic “remedy” ought actually to deliver the effect of many thousands of uncontrolled chemical substances. Fortunately it doesn’t – imagine drinking potentised Epsom salts. That’s because the whole idea of “potentising” is nonsense.

Even worse, if homeopathy were true, it would be potentially one of the most polluting industrial processes. Suppose the homeopath dilutes a commercial 6C “remedy” to 30C for a patient, each time diluting 1 ml to 100ml. Each stage generates 99ml of by-product, each more “potentised” than the next. That’s 24 × 99 ml, almost two and a half litres of stuff that supposedly will induce symptoms, and more than enough for treating the most hypochondriac of patients. It’s even worse for a 200C remedy – you would have almost 20 litres to dispose of.  How much of this strong magic water is flushed away and finds itself back in our water supply?  Fortunately, you could drink a lot of 200C and the only symptom you would get is a strong desire to pee.

The homeopathic manufacturer Helios has a catalogue that is good for a laugh. It consists mainly of lower “potencies” that your friendly local homeopath can make into “remedies” for you. Helios’s Excrementum can, for example, presumably does actually contain a small amount of dog shit. Sooner you than me. Marc Abrahams has more about this.

Yes. Be aware  of homeopathy. It’s homeopathetic nonsense.

I want to do something really dangerous

[BPSDB]There is this piece of flimflam on the web site of Neal’s Yard (the unethical selling company):

In more severe, acute situations the 200th potency (200C) may be administered once – this should not be repeated. Unless you have some knowledge and experience of Homoeopathy it is best to leave administration of 200th potency remedies to a qualified practitioner and remedies of higher potency than 200C should never be taken without first seeking the advice of a qualified homoeopath.

Surely, though, homeopaths like to claim that homeopathy is absolutely safe if done properly – the one thing that homeopaths and the reality-based community agree on?

In the real world, we know perfectly well that a properly prepared 200C homeopathic remedy is exactly the same as a 30C or 400C remedy of the same remedy or any other remedy – it contains absolutely nothing of the original substance used to prepare it. (Even if it was prepared with the purest available water, however, it will still contain trace amounts of tens of thousands of other chemical substances that pass through our bodies every day.)

I’m sure this must have been done before, but I’d be happy to take any 200C or higher “potency” remedy under controlled conditions to find out why it is a risky business as Neals Yard claims. Presumably, I should start to experience symptoms related to the remedy (under the principle of “like cures like”).

“Under controlled conditions” would mean that I wouldn’t know what remedy I was taking, but someone would have to ensure that the homeopath didn’t cheat. Perhaps this could be made more of a scientific trial by having a sufficiently large number of us, none of whom knows which is having a homeopathic remedy and which is having an inert pill or water. And the samples would be blinded before administration – in other words, the person who prepared the samples would also not know who was getting what.

Perhaps homeopaths will object to this on the ground that it would be unethical to administer a strong remedy to someone who is not sick, but I’m a willing volunteer, and will endure great danger in the cause of science…

If anyone is willing to collaborate on this, please contact me.

Added 19 June: jdc325 pointed out that there is a 2004 video of a meeting of Australian sceptics taking an overdose of homeopathic sleeping pills.  The pharmacy assistants (around 3m40s into the video) gave dumb advice which was good for a laugh.

You ask, they don’t answer: Neal’s Yard Remedies

[BPSDB]The Guardian invited online readers to ask questions of Neal’s Yard, the self-described “ethical” skin and body care products firm. You can imagine the sort of questions people would want to ask. The comments thread is funny (and not at all insulting, unless you think that questioning someone’s assertions is in itself offensive). I expect Neal’s Yard thought they were going to get questions like “What homeopathic remedy should I take for my psoriasis?”

(I originally posted that the comment thread appeared to be taken down – whether there was a problem or not, it seems to be back. My own archive is now removed.)

Added later: it’s now been reported in the thread that Neal’s Yard have now backed out of answering questions.

Neal’s Yard have corrupted the word “ethical” to mean selling quack remedies and misleading information on health. They are as ethical as an untrained plumber doing defective work for an unwitting vulnerable person. (No intentionality necessarily intended here, of course: the untrained plumber may genuinely believe he is doing his victim a favour.) But in this case, Neal’s Yard seem to be dodging the questions the same way cowboy plumbers do when confronted by TV investigators.

Analysing the chiropractors’ statements

[BPSDB]There seems not to have been much comment on the press statement by the British Chiropractic Association on 7 May about the libel case against Simon Singh. This appears to be highly misleading. It reads in part:

In April 2008 Simon Singh published an article in the Guardian newspaper and on Guardian Online in the course of which he wrote that:

“the British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.”

The BCA asked Dr Singh to retract his allegations because they are factually wrong, defamatory and damaging to the BCA’s reputation. Dr Singh refused to do so.

In July 2008, the BCA issued libel proceedings against Dr Singh. He defended his position and the case has been continuing.

At a hearing on 7 May 2009 in the Royal Courts of Justice before Mr Justice Eady, Dr Singh’s submissions that what he published was not defamatory and that it was fair comment were roundly rejected by the Judge. Mr Justice Eady held:

1. that what Dr Singh had published was defamatory of the BCA in exactly the way the BCA had claimed; and

2. that Dr Singh’s allegations were not comment but were serious defamatory allegations of fact against the BCA.

Dr Singh’s application for permission to appeal to the Court of Appeal was refused by the Judge. Dr Singh has indicated, however, that he proposes to challenge that decision at the Court of Appeal and he now has three weeks to lodge that challenge.

Mr Justice Eady ordered Dr Singh to pay the BCA’s costs of the hearing within 28 days.

After the hearing BCA President Dr Tony Metcalfe said, “The BCA brought this claim to preserve its integrity and reputation. I’m delighted that the Judge has vindicated the BCA’s position.”

The trial will conclude later this year.

In actual fact, the trial has not taken place, so the BCA has not been in the slightest degree “vindicated”. All the judge has done is issued a perverse ruling on the meaning to be placed on Dr Singh’s words, so that in order to win the case he has to prove something that he apparently did not mean in the first place. It also means that the case no longer has any bearing on the real scientific issue, which is whether the evidence that these treatments are effective exists.

However, the BCA seems to have quietly and implicitly conceded that what Dr Singh wrote is true, as they have removed the offending document (checked on 19 May 2009), with the claims that Dr Singh complained of,  from their web site. It remains true so far that the BCA has not produced “a jot of evidence” for this claim, and from the fact that they went to law rather than produce the evidence leads me to conclude that the evidence does not exist. I think it is also a reasonable inference that if the BCA makes the claims in future without producing the evidence, then it is doing so in the knowledge that the evidence does not exist.

I have looked through the publicly-accessible part of the BCA web site, to the greatest extent I could, and it does not appear to repeat the claims elsewhere. As regards children, the material on the web site consists of claims so vague that they would be difficult to challenge (as in a video on pregnancy and children), general good advice on posture and activity, and scare statistics on back pain. In fact, if you looked through those specific materials, you would find it difficult, if not impossible, to know exactly what a chiropractor does, except that they claim to have some sort of knowledge of the causes of back pain.

As it’s hidden behind a log-in, I have no way of knowing what information the BCA has passed on to its members. If it has told them the same as in the press statement, then it is misleading its members. It should at least make it clear to them that it cannot support the claim that it originally made about treating childhood ailments.

I have been looking at a few chiropractors, selected because they are local to me. One of them makes very serious claims on her web site about the effectiveness of chiropractic in the treatment of specific conditions, including some referred to by Dr Singh. I have contacted the practice, and am waiting for someone to get back to me. Otherwise, the general impression that I get of the public front of chiropractic is vagueness. I hope to post more on this later.

Simon Singh and the back quacks

[BPSDB]I’d like to support Simon Singh in his current legal difficulties but I have no intention to join Facebook. (I did start signing up once but I read the terms and conditions and changed my mind.)

If there are some who don’t know what this is about, Dr Singh is a victim of the broken libel laws of England. He wrote an article criticising chiropractors for the following claim by the Brtish Chiropractic Association (BCA): “There is evidence to show that chiropractic care has helped children with the following symptoms: Asthma Colic, Prolonged crying, Sleep and feeding problems, Breathing difficulties, Hyperactivity, Bedwetting, Frequent infections, especially in the ears”.  Dr Singh and his colleague Edzard Ernst studied the evidence thoroughly and found none that supported the claim.

However, the BCA did not withdraw the claim (although the original leaflet is no longer on the BCA website) and did not produce any evidence for the claim. Instead, it sued Dr Singh for libel.

The BCA has put out a highly misleading statement. The BCA has not been “vindicated” as the trial has not yet taken place (and may yet not happen). It is important to remember that damages in a libel case are awarded as compensation for loss of reputation. The BCA has not been awarded damages, only costs of the hearings so far.

What has happened is that the judge has put an obstacle in Dr Singh’s way by insisting that, to win his case, he must prove something that he didn’t mean in the first place (and apparently, even the BCA did not claim that he meant it). He has to prove that the BCA dishonestly promotes unproven treatments. Jack of Kent has further details from a lawyer’s point of view.

The English libel law is a litigant’s delight, but reputation is not only a matter of the law. It is likely that the BCA will come to regret its actions. The fact is that they made the claims about chiropractic (even though they have taken the document off their web site) and they have failed to provide any evidence to support them, opting for legal action instead. Suppose that the BCA  had come forward with evidence. I am sure that Dr Singh would have withdrawn his criticism graciously, and if he had not, there might then have been grounds for a libel action.

As it is, going straight to law (or threats of legal action) without first publicly answering criticism may well become widely thought of as a distinguishing mark of the quack, especially when the matter is one of scientific evidence. See Quackometer and the Society of Homeopaths,  David Colquoun and Ann Walker, and Ben Goldacre and Matthias Rath – if you follow these issues through, you will see that the quacks lost in each matter. A legal ruling can offer only a monetary remedy, but trying to suppress criticism sets in process a whole series of consequences which may never have been intended.

And as far as I’m concerned, the BCA has demonstrated its lack of integrity, and also why you should never touch a chiropractor with a bargepole – or, rather, never let them touch you.