A general record of my ongoing battle with all forms of nonsense.

Tuesday, 29 December 2009

Black Magic Psychic in Leicester


You may have thought that black "magic" was consigned to the Dark Ages or only manifested itself in faraway places such as Haiti. But a man in Leicester who goes by the name of Pandit Harinath Mukya claims he can not only diagnose spells put on you by others, but he can also cast spells to counter them.

I'm always interested in paranormal claims, but was particularly interested in Mukya (pictured), because most self-proclaimed psychics I have previously visited have come from a British cultural background.

It would be interesting to see similar claims originating from an Asian cultural background.

Having said that, I went along expecting readings similar to those I've experienced before – someone making a small amount of money providing simple readings, deluding their clients and themselves into believing their cold reading skills are genuine psychic ability.

What I found, at least to me, appeared very, very different. The entire interaction seemed as if it was designed to separate as much money as possible from the client.

Mukya's operation is run from a terrace house on Paton Street, off Narborough Road, in Leicester's West End.

Having phoned ahead to book a £10 consultation, I arrived to find the bay window decorated with posters advertising his services, and even an A-frame sign outside.

Inside, the front room of the house had been converted into a small shrine. The fireplace was decorated with religious paraphernalia, as was the table we sat at.

Religious posters covered the walls. By contrast, Mukya seemed remarkably unceremonious. He answered the door in jeans and a T-shirt, though he did add what I can only describe as a kind of religious scarf when he sat down.

Mukya's English was poor, but I could follow what he was saying. I was initially sceptical of the professionalism of this operation after he failed to predict my age shortly after I gave him my date of birth.

But it wasn't long before he demonstrated he was serious about this business.

Mukya told me that four of my friends were out to get me, that they were conspiring against me behind my back and this was bringing me bad luck. I had the impression that he was attempting to get me to trust him as the only friend who could help.

It wasn't long before we moved on to the question of money. He could help me but this was going to cost £350. He confirmed that this would take away any bad luck and bring me good luck.

He claimed it was important to start immediately, and asked me how much money I had with me. I opened my wallet to show him that all I had was £15. He suggested that we visit a cash point.

I told him that I didn't have that kind of money – I could only get £200. He said he would help me out, he would use some of his money.

He told me he was my friend – that he was there to help. At the end, he asked me to put all the money I had with me on to the fireplace and we performed what seemed to be some sort of Hindu-style prayer together. He gave me some nice red rice to put in my pocket and keep with me all the time.

Before I left, I confirmed with him that if I returned the next day with £200 all the bad luck would go away. I was there for less than 25 minutes. I was amazed how quickly he had progressed on to such significant money.

I came back the next day and told him apologetically that I could only muster £120. I wanted to drag out this payment as long as possible to enable me to discover more about the operation without parting with much money.

He assured me not to worry, he would help me by using some of his own cash. But we soon reverted back to how much money I could find. He asked how much I could bring the next day, and when I would be able to bring more.

He asked me to come back tomorrow and see how the pooja was going. A pooja is a kind of Hindu prayer or magic spell.

The visit lasted less than seven minutes and I left him with £120.

The third visit was the strangest. After a brief introduction, he immediately guided me upstairs, whereupon a second person started chanting. So far as I could tell, this person only began chanting when he heard us start to ascend the stairs. We entered a room where a man in religious dress was sitting next to a rug covered in what I can only describe as a variety of vegetarian sacrifices. There were a couple of large opened bags of turmeric powder in the centre with some other foodstuffs and the whole rug was circled with about 25 small apples.

This set-up appeared designed to convince me that my money was being well spent on the pooja rather than going straight into his pocket.

When we came back down he told me that he'd performed the same pooja three times already with three more to go and each time the sacrifices were thrown away and replenished. I found that hard to believe.

Again he asked for more money. He tried to convince me again of the costs, saying that they were sure to bring results. In the end, we agreed that I would come back next week with more money. He started hinting at this point that he would just be giving me the names of the people that were conspiring against me rather than removing the bad luck. Once again the consultation was brief. I was there for less than seven minutes.

On my fourth and final visit, I approached with the remaining £80 and looked forward to seeing the names of my four friends who were conspiring against me.

This time inconsistencies started to creep in. Initially, he had told me that he would be able to get the names of my enemies after I had ceremoniously thrown an item into moving water. Then it seems that he had forgotten this, and it no longer seemed important. Secondly, when he revealed the names of the four friends, it turned out that there were only three – and that two of them were not my friends after all, but people who simply knew of me.

The name of the friend was simply given as "John" with no surname. I think I know about 10 Johns.

It was then that the subject turned to money. In order to reverse the pooja, more money was required. I was told that some of the rituals could not be performed in this country for legal reasons and the man I previously saw upstairs had already flown out to India to begin the next stage.

I tried to push him to give me a price for this next stage but he flatly refused.

He did, however, appear to want to prepare me for significant costs. Obviously, if someone needs to go to India, I should be expecting a large figure.

But then he started telling me that the three people conspiring against me had already spent £28,000. The implication was clear – if they'd spent £28,000 I would need to at least match it.

I've visited a few other self-proclaimed psychics in Leicestershire and although I thought none of them demonstrated any real psychic ability, I did get the impression that they believed in what they were doing. I didn't once get that impression with Mukya.

I'm not sure how many people have gone through this operation, but even one person progressing to the next stage would be deeply concerning.

The rented house on Paton Street seems to be dedicated to this purpose, and full colour leaflets are being distributed as far as Oadby, so if nobody had paid money into the scheme, it is unlikely to be financially viable over a period of time.

I brought an audio digital recorder to each of my visits and the sound quality is crystal clear. The recordings have been passed on to trading standards.

The Difficulties with Psychic Photography

My recent article in the Mercury exposed a Leicester psychic attempting to scam a punter (well, me) out of a lot of money. We had a bit of an adventure trying to get a photo for the piece.

The Leicester Mercury sent along a photographer who I met at the end of the street a couple of minutes before my appointment. Our strategy was fairly basic: he'd hide behind a car across the road and I'd knock on the door. When the door was answered, I'd bend down to tie my shoelaces so he could get a clear shot of the guy over my head.

It didn't work. The guy was extremely cautious, first checking at the window before answering the door, and then staying way back in the house when he opened the door. Our photographer just couldn't get a clear shot.

I managed to get this quick shot below while inside. The psychic had asked if I could return for another appointment on Monday, and while I "checked my calendar" on my iPhone, I took this snap.

But we needed better quality for the paper. At this point, I owed him £80 for the fine "work" he'd done so far. To give our hidden photographer another chance, I told him I'd left my wallet in the car. As he opened the door so I could pop back and get it, the photographer tried again. Same problem; the guy was too far back in the house.

The photographer and I met up at the end of the street and hatched a second plan. The operation was being run from a terrace house. The street was one-way and with cars parked on both sides and there was only room for one car to drive down the gap in the middle. The plan was for me to drive back to the house and stop outside the house with the photographer following in the car behind. I'd stop to deliver the money and just when the psychic answered the door, the photographer would beep his horn to get me to move. I'd try and draw the psychic out by saying the cash was in the car. When he came out, the photographer would snap him from the car behind. Hopefully he wouldn't be noticed and our undercover photography mission would be complete.

It didn't work. As soon as I tried to draw the psychic out he got suspicious and hid back into the house, closing the door promptly.

I moved the car and pulled over at the end of the street. The photographer overtook and parked round the corner. A couple of minutes later, the photographer walked back towards my car and shrugged his shoulders to signal that he couldn't get the shot. At this point, I noticed the psychic had come out of the house and was walking towards my car. In a panic, I signalled to the photographer "that's him!". Our undercover photography mission lost some of its clandestine value when the photographer proceeded to take multiple pictures of him using a lens the size of a scuba tank from a distance of approximately two metres.

After a couple of seconds, the photographer realised that he had just been photographing a professional fraudster who most likely was not going to be particularly happy about having his picture taken. Looking around, the only clear route for escape was to jump in the passenger seat of my car. However, being equally worried myself, the doors of my car were firmly locked.

For about 5 seconds the I kept trying to unlock the doors while the photographer prevented me from doing so by franticly pulling on the handle. Eventually he got in and the psychic ran off.

We got a nice, clear shot:
(reduced quality for web publication)

Thursday, 10 December 2009

Trust Boots

This is a repost of my article in the Leicester Mercury. I wanted to repost it here so I could fix the messed up text. When they copied and pasted it they lost all the formatting and most importantly the scientific notation. I've fixed it below.
“Trust Boots” is the tagline that has been offered by the high street pharmacist since 2005. According to Boots’ 2006 Corporate Responsibility Strategy, “Everything we do that builds trust is good for our business; anything which could compromise it, a risk we can't afford to take.” So have Boots shown themselves to be worthy of our trust?

On the shelves of their pharmacy on Gallowtree Gate in Leicester you will find a small section devoted to homeopathy. Many people I meet are confused about exactly what homeopathy is – some thinking it is simply a type of herbal or natural medicine.

Allow me to explain.

The first principle of homeopathy is what they call the “law of similars”. Homeopaths look for a chemical that produces a similar symptom to the disease they aim to treat. For instance, caffeine causes you to stay awake, so homeopaths may decide to use this in a remedy to treat insomnia. Another example is hay fever. Hay fever causes runny eyes and so do onions – so some homeopaths will treat hay fever with a preparation of onions. I realise that all this may sound a little bit unconventional, but please bear with me – in a moment it’s going to sound even more so.

Turning a chemical such as onion juice into a homeopathic preparation involves a process of “dilution” and “succussion”. To create the centesimal or “C” remedies they sell at Boots, the homeopath takes one drop of the chemical and mixes it with 99 drops of water (dilution). In centuries past, this was then banged against a leather covered board or book, often a bible, although in modern times the shaking is often done by machine. This shaking is called "succussion". This is now a 1C homeopathic preparation. It contains 99% water and 1% “active ingredient”.

To turn this into a 2C remedy, the process is repeated. One drop of the solution is taken from the 1C remedy is mixed with 99 drops of water and then shaken. The 2C remedy now contains 99.99% water and 0.01% “active ingredient”. Repeat the process again to create a 3C remedy at 0.0001%, and so on. Homeopaths believe that the higher the level of dilution, the more powerful the remedy.

Many homeopaths will use the solution directly, but Boots and many others prefer to sell homeopathy as pills - or pillules as they call them. One pillule is meant to contain the equivalent of one drop of homeopathic solution.

We can calculate approximately how many molecules of “active ingredient” get into the one drop that makes it into the pillule. A drop of water contains about 1,700,000,000,000,000,000,000 molecules. Scientists write this as 1.7x1021. That’s a 17 with 20 zeros after it. Boots sell remedies at 6C and 30C. A 6C remedy will contain around 0.0000000001% “active” ingredient – which works out at about 1.7 billion molecules of active ingredient. But what about when we dilute this further? By the time you get to 10C, there are only 17 molecules of active ingredient left. And at 11C, you only have about a one chance in 6 of finding a single molecule.

The branch of Boots on Gallowtree Gate in Leicester display a guide, provided by the manufacturer, that states a Bryonia 30C remedy “Relieves the symptoms of a dry painful cough, pressure and dehydration headaches” and that a Kali Bich 30C remedy “Soothes the symptoms of sinusitis”.

30C. I already explained that at 11C, you only have about a one in 6 chance of finding a single molecule of active ingredient. At 12C, there is only about one chance in 600 that you will find a molecule and at 13C just one chance in 60,000. By the time you get to 30C, you have more chance of winning the National Lottery jackpot five weeks in a row than you do of finding a single molecule of active ingredient.

Or think about it this way: how much water would you need to contain one molecule of active ingredient at 30C dilution? According to my calculations, the body of water would weigh 5 billion times more than the planet you are standing on. If you want that in pillule form, you'd need to buy 6x1038 pillules (a 6 with 38 zeros after it). At Boots' retail prices, that would cost you 35 trillion trillion trillion pounds. That's a rather expensive molecule.

These pills do not contain any active ingredient.

To my way of thinking, homeopathy is entirely implausible, but science is incredibly open-minded to seemingly implausible ideas. Ideas such as Einstein’s theory of general relativity and quantum theory are utterly bizarre, but once they were demonstrated to be true with fair tests then scientists accepted them.

Testing for a pill is essentially simple. Take a large number of people with a particular disease and randomly divide them into two groups. Give one group the pills you want to test and the other group some placebo pills that don’t contain anything. Neither the patient nor the researchers working with them can know which patients were given which pill. After an agreed period of time count how many people in each group got better.

So what do the trials show? Actually, that’s a little complicated. Some of the poor quality trials where the patients were told which drug they were getting, or had very small sample sizes showed an effect. But those effects could easily be down to the placebo effect or random variation due to the small sample sizes.

But when the experiments are done properly with larger numbers of patients, the vast majority do not show homeopathy to be any better than a placebo. A quick search of Cochrane articles leads us to reviews of homeopathy for the treatment of dementia, chronic asthma and attention deficit/hyperactivity disorder. They all end in similar conclusions: “No evidence that homeopathy is effective in treating dementia”, “Until stronger evidence exists for the use of homeopathy in the treatment of asthma, we are unable to make recommendations about homeopathic treatment.” and “Overall the results of this review found no evidence of effectiveness for homeopathy for the global symptoms, core symptoms or related outcomes of attention deficit/hyperactivity disorder.”

But what do they tell you in Boots? When I popped into their Oadby branch and asked about homeopathic treatment, the pharmacist tried to politely steer me away from the homeopathic remedies citing the lack of evidence. Fair enough.

But a pharmacist at the Gallowtree Gate branch was not so off putting. Despite a couple of points in the conversation where I felt she certainly gave the impression that she did not believe in homeopathy, she was still happy to say things that I would never expect to come out of the mouth of professional pharmacist, by explaining that homeopaths “don't just treat the condition, they look at the whole person” and “If you want absolutely spot on accurate treatment you need to see someone who is a qualified homeopath."

Boots' professional standards director Paul Bennett was asked about homeopathy at a parliamentary science and technology sub-committee on the 25th October: "Do they work beyond the placebo effect?" He replied, "I have no evidence before me that they are efficacious and we look very much for the evidence to support that."

I think it's unlikely that Boots don't know where to look for medical evidence. So what we're being told by Boots' professional standards director is that they've looked around, found evidence - but he hasn't found any that show homeopathy to work.

He was asked to clarify with the line, "You sell them, but you don't believe they are efficacious?" He replied, "It's about consumer choice for us."

If it is about consumer choice, I personally believe that Boots should be ensuring that their consumers are properly informed to make a choice. Their labels should clearly state "the best evidence shows that these products work no better than placebos." But their labels don't say that. The information on their shelves makes claims such as "Relieves the symptoms of a dry painful cough." Selling this quackery may well be about consumer choice. Making these claims of efficacy is most certainly not.

Is this likely to lead you to “Trust Boots”?

Saturday, 5 December 2009

GCC extends complaints to cover all dubious claims

My complaints to the BCA focussed on claims to treat colic. I chose to just complain about colic claims for reasons of simplicity. It was easy to search the pages for one word and gather the evidence. When you’re submitting 55 complaints, it makes sense to go for the easiest method possible.

The GCC has now sent me copies of the responses to my complaints. What's interesting is that it appears that the GCC’s investigating committee has gone further than asked. They have manually gone through the Chiropractor's web pages looking for other claims.

Where they existed, the chiropractor will be investigated for those claims too.

I’m not sure of the GCC’s motivation is to make life easier for themselves in the knowledge that they will soon be needing to deal with Zeno’s 500+ complaints, or if this is a genuine attempt to properly regulate the profession. Either way, this is a positive step from the GCC and should be applauded.

A copy of one of the letters is below.

Wednesday, 2 December 2009

Homeopathy Maths Quiz: My Answers

Here are the answers to my previous maths quiz. At the end, I've added some notes including an argument showing the "memory of water" idea spouted by homeopaths to be invalid.

1. What is the probability of there being a single molecule of active ingredient in a 30C homeopathic remedy? Assume no contamination and pure water.


Molar mass of water = 18.01528 grams.
1 drop of water approx = 0.05 grams.
=> 1 drop of water = 0.05/18 = 0.0027 moles
=> 1 drop of water = 6 * 10^23 (Avogadro constant) * 0.0027 = 1.66*1021 molecules

Number of molecules in a 30C preparation:
= 1.7x1021 (molecules in a drop) / 10030 (level of dilution) = 1.7*10-39

As this is less than one, it is the probability of finding a molecule.

Answer: 1.7*10-39

2. What is the probability of winning the National Lottery 5 weeks in a row. You get one ticket per week of course.

There are 6 balls drawn out of 49 and you can pick 6 numbers.

Probability that your 1st number will match any one of the 6 drawn = 6/49
Probability that your 2nd number will match any one of the remaining 5 drawn = 5/48
Probability that your 3rd number will match any one of the remaining 4 drawn = 4/47
Probability that your 4th number will match any one of the remaining 3 drawn = 3/46
Probability that your 5th number will match any one of the remaining 2 drawn = 2/45
Probability that your 6th number will match any one of the remaining 1 drawn = 1/44

Probability that all 6 match = 6/49 * 5/48 * 4/47 * 3/46 * 2/45 * 1/44 = 7.15 x 10-8

Or, about 1 in 14 million.

Probability of winning 5 weeks in a row = (7.15x10-8)5 = 1.87 x 10-36

3. Which is more likely?

Comparing 1.7*10-39 and 1.87 x 10-36, you can see that winning the national lottery 5 times in a row is about 1,000 times more likely.

Unless of course, there was some contamination during the process.

4. How much would it cost to buy enough pills that you'd expect to have one molecule of active ingredient? Note: At Boots, they're about £5 for 84 pillules.

To get one molecule, you'd need 10030 water molecules (1060).

Molar mass of water = 18 grams.

1060 molecules would therefore weigh 18x1060/6x1023 = 3.0 × 1037 grams

One drop of water weighs approx 0.05 grams

So you'd need 3.0 × 1037 / 0.05 = 6 x 1038 pills

At £5 for 84, that will cost 5/84 * 6 x 1038 = £3.57 * 1037

A Trillion is 1012. Trillion Trillion Trillion = 1036

So that's about 35 Trillion Trillion Trillion pounds.

Other Notes

David P made a good point when he pointed out that the mother tincture may not be pure. Obviously the mathematics above assumes it is.

Another point I realised while I was doing this is that there is another argument here against the "memory of water" bollocks" spouted by homeopaths.

At 12C, there are no molecules of the mother tincture remaining. So the only molecules in the final preperation that could have been in the same mix as any of the original ingredient must come out of this mix.

So by the time you get to 24C, there are not only no molecules of original ingredient left, but there are no molecules of water that have ever been in the same mix as the original ingredient left.

Even the water has memory argument therefore breaks down at dilutions beyond 24C. At best, homeopaths would need to argue that water not only has memory, but that water is capable of passing this memory on.

Are homeopaths going to come to the conclusion that a 30C remedy works because the water contains the memory of a rumour passed on by other water molecule that remembers the mother tincture?

Tuesday, 1 December 2009

A quick maths quiz

Here's a quick maths quiz. Post your answers, ideally with your working and I'll be able to see how well they compare to mine.
  1. What is the probability of there being a single molecule of active ingredient in a 30C homeopathic remedy? Assume no contamination and pure water.
  2. What is the probability of winning the National Lottery 5 weeks in a row. You get one ticket per week of course.
  3. Which is more likely?
  4. How much would it cost to buy enough pills that you'd expect to have one molecule of active ingredient? Note: At Boots, they're about £5 for 84 pillules.
I'll post my answers tomorrow.

Friday, 27 November 2009

The CNHC wishes to place on formal record their thanks to Simon Perry

When the Complementary and Natural Healthcare Council (CNHC) decided to start letting in reflexologists, I started sending in complaints about them on the same day that they joined for claiming to treat disease with magic foot massages.

The CNHC has now upheld my complaints, asked the reflexologists to stop making unjustifiable claims, and informed me of their intention to contact all registered members to issue advice to all registered practitioners.

Oh, and they formally placed on record their thanks to me for "bringing this matter to their attention".

The CNHC’s Code of Conduct, Performance and Ethics states:
15. You must follow CNHC guidelines in relation to advertising your services
Any advertising you undertake in relation to your professional activities must be accurate. Advertisements must not be misleading, false, unfair or exaggerated. You must not claim that your personal skills, equipment or facilities are better than anyone else’s.
If you are involved in advertising or promoting any other product or service, you must make sure that you use your knowledge, healthcare skills, qualifications and experience in an accurate and professionally responsible way. You must not make or support unjustifiable statements relating to particular products or services. Any potential financial rewards to you should be made explicit and play no part at all in your advice or recommendations of products and services that you give to patients, clients and users.
The key line in that paragraph is:
You must not make or support unjustifiable statements relating to particular products or services.
Now have I missed something here? The whole point of Complementary health is that you can make claims of efficacy without justification. Don’t get me wrong, I personally believe justification to be extremely important. My point is simply that the regulatory body is exclusively for practitioners who don't share this view.

So I started my little project. By searching for practitioners on the CNHC web site each day I could find out who joined. I actually wrote a computer program to do this as it takes multiple searches to get all the results. I would then manually check their web sites to see what was being claimed. If they made any unjustifiable claims, I reported them via the CNHC’s complaints procedure. I knocked these complaints out in a few minutes – quick enough to get the point across but so hastily that I failed on my first complaint to correct a copied & pasted spelling error and even added my own grammar hiccup at the end.
The ad suggests that reflexology is suitable for treating babies with colic, IBS and arthritus. She also claims to have experience in treating fertility issues. There is no reliable evidence to suggest that reflexology is capable of treating this issues.

But even with the bad English, it was sufficient to make the point: if the CNHC is going to regulate healthcare then it needs to deal with the question of efficacy.

Yesterday I received a call from the Maggie Dunn, the CNHC’s Chief Executive Officer to update me on the status of my complaints.

The CNHC had received evidence from the practitioners to defend their claims. They had also been in touch with the Advertising Standards Agency. The investigative committee met on Tuesday 24th November to discuss the cases.

They decided that my complaints were indeed covered by paragraph 15 of the code of conduct. All fourteen of my complaints were upheld. The practitioners will now be told to stop making these claims.

Sadly however, the CNHC decided that fitness to practice was not impaired because the unjustifiable claims were not made deliberately. The CNHC has a number of “Profession Specific Boards”. Someone from the board relating to reflexology had advised the investigative committee that it is likely the practitioner had been trained to believe that they could treat these diseases.

Now while I do not find it at all surprising that the practitioner was trained this way, I still take issue with this decision. If a practitioner has undergone training that tells them they can treat specific diseases for which there is no evidence then the practitioner has not undergone proper training. An untrained or poorly trained practitioner is surely unfit to practice.

What’s more positive however, is what else the CNHC now plans to do. It makes no sense for the CNHC to allow new registrants to join, only to be immediately reported by me. Instead, I’m told, the CNHC will now look at the evidence and provide advice in advance.

The evidence review will go beyond reflexology; it will extend to all of the disciplines covered by the CNHC.

The CNHC will then be contacting all registrants to explain what they are allowed, and not allowed, to claim.

I confirmed with Maggie that this advice will not solely relate to advertising. I was told that the advice will make clear that practitioners are not permitted to make these claims within the day to day interactions with their clients.

I also expressed a concern to Maggie over the training received by the practitioners. There are undoubtedly many courses out there teaching that reflexology is an efficacious treatment for many diseases. Would the CNHC be doing anything about these courses?

Maggie told me that as a regulator, the CNHC sees it as their duty to get in contact with alternative health course providers and authors. Given the nature of my original complaint, I expect this will enforce the view that claims must be justifiable.

What would a course on reflexology consisting only of justifiable claims cover exactly? How to spell reflexology?

This is so important, and so surprising I feel I need summarise in bullet points:
  • CNHC will tell practitioners to remove claims they cannot justify.
  • CNHC will conduct a review of evidence base for regulated therapies.
  • CNHC will contact all registrants to instruct them not to make claims without justification.
  • CNHC will contact complementary health course providers and authors to instruct them not to make claims without justification.
It is my view that adhering to the CNHC’s guidelines will make it impossible to practice complementary medicine.

Could this the end of the CNHC? It would be hugely ironic if forcing its members to act ethically became the cause of its demise.

Finally, Maggie told me that the investigations committee had decided that they wished to “place on formal record their thanks to Simon Perry for bringing this matter to their attention.”

You’re welcome.

[Original] The CNHC wishes to place on formal record their thanks to Simon Perry

Having taken some very fine advice from someone I greatly respect, I now realise that this article wasn't very good. Well, it was rubbish. I've rewritten it here without taking 14 paragraphs before I get to the point - so read that one instead.

The Complementary & Natural Healthcare Council, or CNHC, started its operation of registering practitioners at the beginning of 2009. Its stated key purpose is to:
“protect the public by means of regulating practitioners on a voluntary register for complementary and natural healthcare practitioners.”
Practising evidence-based medicine has some difficult constraints. Firstly, you need to be able to show your intervention to be effective. It’s considered unethical to just make up ideas ad-hoc and market them as an effective medical intervention. Secondly, in order to avoid a repeat of the thalidomide disaster, you need to be able to demonstrate that your intervention is safe.

But all this is very difficult. It requires a lot of training. It means you can’t get your products and services to market without checking them. But what if there was a way we could avoid the hassle of checking the evidence for efficacy? What if there was a way we could practice without checking our interventions were safe? What if instead of going through the trouble of medical training, we could take a part-time evening course at a local college and be guaranteed a pass because the course content consists of no actual knowledge?

Welcome to the world of Complementary Healthcare.

Now I don’t think I’m the first person to point out that if you are going to regulate any type of healthcare, then the fundamental points you need to cover are (i) ensuring interventions work, (ii) ensuring interventions are safe, and (iii) ensuring practitioners are adequately trained.

But this is already subject to statutory regulation. It’s what we call medicine. The whole point of Complementary health is that the practitioners can’t be bothered with all that.

What on earth does the CNHC intend to regulate?

The CNHC’s Code of Conduct, Performance and Ethics states:
15. You must follow CNHC guidelines in relation to advertising your services
Any advertising you undertake in relation to your professional activities must be accurate. Advertisements must not be misleading, false, unfair or exaggerated. You must not claim that your personal skills, equipment or facilities are better than anyone else’s.
If you are involved in advertising or promoting any other product or service, you must make sure that you use your knowledge, healthcare skills, qualifications and experience in an accurate and professionally responsible way. You must not make or support unjustifiable statements relating to particular products or services. Any potential financial rewards to you should be made explicit and play no part at all in your advice or recommendations of products and services that you give to patients, clients and users.
The key line in that paragraph is:
You must not make or support unjustifiable statements relating to particular products or services.
Now have I missed something here? The whole point of Complementary health is that you can make claims of efficacy without justification. Don’t get me wrong, I personally believe justification to be extremely important. My point is simply that the regulatory body is exclusively for practitioners who don't share this view.

So I started a little project. The CNHC’s web site allows you to search for practitioners. Each day, I would look at which new practitioners had joined, check their web sites and report them if they made any unjustifiable claims. If they did, I reported them via the CNHC’s complaints procedure. I knocked these complaints out in a few minutes – quick enough to get the point across but so hastily that I failed on my first complaint to correct a copied & pasted spelling error and even added my own grammar hiccup at the end.
The ad suggests that reflexology is suitable for treating babies with colic, IBS and arthritus. She also claims to have experience in treating fertility issues. There is no reliable evidence to suggest that reflexology is capable of treating this issues.
But even with the bad English, it was sufficient to make the point: if the CNHC is going to regulate healthcare then it needs to deal with the question of efficacy.

I intended to send these in every day as new members joined. My persistence lasted about 5 days – it takes time and is very boring work. I drew it back to looking every week, but by that time there were so many members that the task of checking was daunting. In total, I think I only complained about 14 practitioners.

These were the first complaints that the CNHC has received. At this time of writing, I believe I am the only person ever to have complained to the CNHC.

Yesterday I received a call from the Maggie Dunn, the CNHC’s Chief Executive Officer to update me on the status of my complaints.

The CNHC had received evidence from the practitioners to defend their claims. They had also been in touch with the Advertising Standards Agency. The investigative committee met on Tuesday 24th November to discuss the cases.

They decided that my complaints were indeed covered by paragraph 15 of the code of conduct. All fourteen of my complaints were upheld. The practitioners will now be told to stop making these claims.

Sadly however, the CNHC decided that fitness to practice was not impaired because the unjustifiable claims were not made deliberately. The CNHC has a number of “Profession Specific Boards”. Someone from the board relating to reflexology had advised the investigative committee that it is likely the practitioner had been trained to believe that they could treat these diseases.

Now while I do not find it at all surprising that the practitioner was trained this way, I still take issue with this decision. If a practitioner has undergone training that tells them they can treat specific diseases for which there is no evidence then the practitioner has not undergone proper training. An untrained or poorly trained practitioner is surely unfit to practice.

What’s more positive however, is what else the CNHC now plans to do. It makes no sense for the CNHC to allow new registrants to join, only to be immediately reported by me. Instead, I’m told, the CNHC will now look at the evidence and provide advice in advance.

The evidence review will go beyond reflexology; it will extend to all of the disciplines covered by the CNHC.

The CNHC will then be contacting all registrants to explain what they are allowed, and not allowed, to claim.

I confirmed with Maggie that this advice will not solely relate to advertising. I was told that the advice will make clear that practitioners are not permitted to make these claims within the day to day interactions with their clients.

I also expressed a concern to Maggie over the training received by the practitioners. There are undoubtedly many courses out there teaching that reflexology is an efficacious treatment for many diseases. Would the CNHC be doing anything about these courses?

Maggie told me that as a regulator, the CNHC sees it as their duty to get in contact with alternative health course providers and authors. Given the nature of my original complaint, I expect this will enforce the view that claims must be justifiable.

But what would a course on reflexology consisting only of justifiable claims cover exactly? How to spell reflexology?

This is so important, and so surprising I feel I need summarise in bullet points:
  • CNHC will tell practitioners to remove claims they cannot justify.
  • CNHC will conduct a review of evidence base for regulated therapies.
  • CNHC will contact all registrants to instruct them not to make claims without justification.
  • CNHC will contact complementary health course providers and authors to instruct them not to make claims without justification.
It is my view that adhering to the CNHC’s guidelines will make it impossible to practice complementary medicine.

Could this the end of the CNHC? It would be hugely ironic if forcing its members to act ethically became the cause of its demise.

Finally, Maggie told me that the investigations committee had decided that they wished to “place on formal record their thanks to Simon Perry for bringing this matter to their attention.”

You’re welcome.

Tuesday, 24 November 2009

Oooops, they've done it again

As you may know from one of my previous posts, I recently reported the General Chiropractic Council to the Advertising Standards Authority for making the following claims in their patient information leaflet:
There is some evidence, though more research is needed, that you may see an improvement in some types of:
• asthma
• headaches, including migraine
and
• infant colic.
The ASA asked them to remove this claim if they don't have the evidence to back it up, and they agreed to do so.

So it's strange that the GCC considered it a good idea to continue to use the following text into their careers leaflet:
There is some evidence, though more research is needed, that you may see an improvement in some types of:
• asthma
• headaches, including migraine
and
• infant colic.
Yes, you're right; it's exactly the same.

Following a second complaint from myself, the ASA has administered an appropriate second slap and the GCC has now removed the claims.

Thursday, 19 November 2009

The GCC Is Avoiding FOIA Requests

On the 6th October 2009, I sent two Freedom of Information Act Inquiries to the General Chiropractic Council. At this point in time, the GCC had just finished its resolution with the Adverting Standards Agency and as a result of this it became known to me that the GCC had commissioned a review of the evidence for the use of chiropractic in the treatment of various diseases that were not related to the spine.

The first request asked them to hand over all communications between the GCC and the ASA.

My second request simply asked:
  • Has the GCC commissioned a review of evidence concerning the effectiveness of chiropractic in the treatment of colic or other diseases?
  • If so, please provide me with copies of all communications surrounding the commissioning of this review.
  • Please provide the final specification detailing how the review is to be performed.
The GCC’s previous behaviour, and especially their response to questions from Trading Standards officers, has clearly demonstrated that they are not interested in regulating the profession of chiropractic, but instead of protecting the interest of practitioners.

I was obviously interested in how they were planning to perform this review, for instance had they agreed the criteria for inclusion and perhaps more interestingly if there had been an attempt to sway the outcome of the trial during the commissioning phase.

I received a reply from Paul Ghuman the next day confirming receipt and asking me to confirm if my request for communications between the GCC and the ASA related to my complaint made about the GCC’s Patient Information Leaflet. I quickly clarified that this was the case.

It took until the 2nd November until I received a response. They were more than happy to respond to the first request, but the second was completely avoided. They acknowledged that they had commissioned a review, but gave no details.
2. Please note that the current request needs to be defined more clearly in the respect of the information required. For example, it could be that the request is for who approved/agreed the final specification or who made the decision on reviewers. I need more clarification in respect of what information it is that is being requested.
Now they could have asked for this on the 7th October when they responded to my first FOIA request. Why did they wait until the 2nd November to ask this question? If I am not being clear enough, that should be obvious enough from the first time they tried to find the information.

I replied to clarify:
To clarify on (2), I assume the GCC has outsourced the evidence review to a scientist, group of scientists, research group or elsewhere. I also assume that in order to find a supplier for the research you may have contacted several organisations/people.

I am looking for copies of all communications to and from those organisations/people that are relevant to the review - both those that were commissioned and those that were considered.
Is that clear? Any questions just ask.
Since I replied, now 2½ weeks ago, I have emailed Paul Ghuman to chase up, phoned him twice and left a message and emailed Margaret Coats.

No response.

The GCC is acting very much like they’ve got something to hide.

Friday, 13 November 2009

Edzard Ernst shows Society of Homoeopaths break their own code of conduct

In this excellent article in the BMJ, Zosia Kmietowicz interviews Edzard Ernst on the Society of Homoeopaths breaking their own code of conduct. Similar observations were made on Gimpyblog back in 2007. Apparently they didn't learn too much from that then.

Homoeopath society breaks own ethics code by making speculative claims on website, says expert Zosia Kmietowicz

The Society of Homeopaths is in breach of its own code of ethics by posting "speculative," "misleading," and "deceptive" statements on its website, claims a leading UK expert in complementary medicine.

Edzard Ernst, professor of complementary medicine at the Peninsula Medical School in Exeter, identified numerous statements on the society’s website that he claimed could be seen as contravening the code. He was writing in the International Journal of Clinical Practice (doi:10.1111/j.1742-1241.2009.02249.x).

The code of ethics, which runs to 23 pages, sets out the rules that the society expects its members to abide by. These state that advertising should not make claims to "cure named diseases" or be "false, fraudulent, misleading, deceptive, extravagant or sensational." It adds that "all speculative theories will be stated as such and clearly distinguished."

However, a review of some members’ websites showed a series of violations of the code that led Professor Ernst to scrutinise the society’s own website.

Despite there being no good clinical evidence to substantiate such claims, says Professor Ernst, the society’s website carried statements claiming that homoeopathy can help with various symptoms and illnesses, including fever, sore throat, toothache, arthritis, eczema, asthma, anxiety, insomnia, chicken pox, erectile dysfunction, and prostate problems.

"In my view, they [the statements] do ‘expressly or implicitly’ claim ‘to cure named diseases,’" writes Professor Ernst. "If this is so, they violate the SoH’s [Society of Homeopath’s] own Code of Ethics."

He concludes, "If the SoH wants its members to behave ethically it should evaluate its own website carefully and deliberate whether it is responsible for a professional organisation to make health claims which are not supported by the current best evidence."

Professor Ernst told the BMJ that advertising by members of the Society of Homeopaths "should be more than lip service to evidence based medicine, otherwise it is confusing and potentially harmful."

Paula Ross, the society’s chief executive, said she was grateful to Professor Ernst for highlighting his concerns and that the society would be investigating the concerns and making amendments "where appropriate."

BMJ 2009;339:b4605

Friday, 23 October 2009

Why making large numbers of complaints about chiropractors was the right thing to do

I've been criticised recently for making large numbers of complaints against chiropractors for making unsubstantiated claims to treat colic. Criticism has come from comments on my blog, from posts and comments on Lanigan's blog, and from the Shadow Minister for Mumbo-Jumbo David Tredinnick MP.

The justification for my complaints is simply that there is no evidence that chiropractic is an effective treatment for infant colic. For the purpose of clarity, I'd like to add that there is also no evidence that chiropractic can help alleviate the symptoms of infant colic.

But some criticism has pointed out that I'm not suggesting an alternative treatment, and while no evidence-based treatment for infant colic exists, it makes sense to use a treatment with no evidence for its effectiveness.

I will now explain why this position is wrong.

What do we mean by "no evidence"? We mean, simply, that there is no sensible reason to believe that a given intervention is effective. There is no evidence that bathing your child in tomato juice is an effective treatment for infant colic. There is no evidence that hanging your child upside down for two hours a day is effective in alleviating the symptoms of infant colic. These might sound like strange things to suggest, but that's my point: there is no evidence base for these being effective. Chiropractic, as an intervention for treating colic, is no different in this respect.

I am aware that chiropractors do use chiropractic as a treatment for colic, but this isn't a reason to suspect it may work.

Some chiropractic colleges teach that chiropractic is effective in treating colic, but this isn't a reason to suspect it may work.

Some chiropractors notice that symptoms of colic appear to subside after chiropractic treatment. But this is equally consistent with the hypothesis that it is ineffective: we know that symptoms subside over time without treatment anyway.

Until there is a valid reason to suspect that chiropractic may be effective in treating colic, chiropractic as a treatment stands equal beside bathing your child in tomato juice and hanging your child upside down.

But chiropractic takes it one stage further. Because despite the fact that there is no evidence to suggest that bathing your child in tomato juice is effective, nobody has ever tried to look for the evidence. With chiropractic, the evidence has been searched for. Double blind trials have been performed. And they have failed to show it is effective.

If there are three hypotheses, all without evidence for them and one where evidence has been looked for but not found, then that one is clearly the least plausible hypothesis.

There are billions and billions of possible things you could do to a small child that might be effective in alleviating the symptoms of infant colic. Only a tiny fraction of them will work. It is completely unreasonable to suggest that any one of those billions of possible treatments may work without some sort of evidence. If you've looked for evidence that one of those billions of treatments works and failed to find it, then it is completely irresponsible to promote it as a treatment - especially, when like most interventions, it is not 100% safe.

With my complaints, I am not trying to deny patients the right to try whatever they want as a treatment. What I am trying to prevent is a group of people profiting by telling their patients that their treatment is effective when there is not only no evidence - but there is actually evidence to the contrary.

Tuesday, 20 October 2009

Form letter to your MP

OK, sorry - I've hashed this out in 10 minutes. It's rough, but it needs to go out now so tough.

Go to http://www.writetothem.com/, fill out your postcode to find your MP. Copy and paste this letter in. Send it.

Quick, do it NOW.

Thanks.

Dear ???????,

Tomorrow there is a debate in parliament on the subject of libel reform.

English libel laws are being used to stifle scientific debate in the UK, to the point where many scientists are not bothering to make their opinions heard. Those that do criticise others are being heavily punished for doing so.

Medical doctor and journalist Ben Goldacre was recently involved in a libel battle following his criticism of a vitamin salesman who claimed that anti-retroviral drugs were ineffective in treating AIDS and offered his vitamins as an alternative. Despite the fact that Goldacre won, they still came out of it £150,000 poorer. The science author Simon Singh is going through a similar situation right now.

In 1961, the German paediatrician Widukind Lenz criticised the drug Thalidomide. By this time, at least 10,000 children had been born with birth defects. If he, and all other scientists since, had refused to make their criticism known for fear of legal action, the deformities may still be continuing today.

If we put a stop to criticism, we not only put an end to our ability to know which of our current treatments are effective and safe, but we also make it impossible to evaluate the treatments of the future.

We must do everything we can to reform our uniquely repressive English libel system.

The future health of everyone in this country and the world depends on it.

Yours,


Saturday, 10 October 2009

The General Chiropractic Council is knowingly and deliberately violating its own code of practice


The General Chiropractic Council is knowingly and deliberately violating its own code of practice and continuing to mislead the very patients it is meant to protect.

My previous post detailed how the General Chiropractic Council resolved my Advertising Standards Authority complaint against them informally. I also noted that as yet, the GCC has not removed their Patient Information Leaflet from their web site.

About a week after the informal resolution was made (but before it was published), I spoke to the ASA on the telephone about the fact that they were continuing to make these unsubstantiated claims. A concerned ASA voice told me:

"We would have hoped they would have taken this down by now."

So on the 6th October I emailed the GCC to ask their intentions:

"I notice that despite your informal resolution with the ASA, that the text still appears on your patient information leaflet here: http://www.gcc-uk.org/files/link_file/WhatCanI_142_5(Web-Version).pdf

Are you intending to take down or change this leaflet?"

And on the 8th, I received a reply in the post:


I emailed the ASA by email to get their take on this:

"I contacted the GCC following my finding that they had not removed the Patient Information Leaflet from their web site. I had a rather surprising reply from them this morning. They said that they will take it down in reasonable time - and suggested that this would happen once they had taken the time to re-write the document and translate it into several languages.

This is shocking. Surely it makes sense for them to take it down now if it breaches ASA standards - or not at all if it doesn't. Surely while they are re-printing they should not be continuing to distribute the material?

Can you clarify the ASA's position on this?"

And the ASA's reply was fairly clear:

"We’d normally expect an advertiser to implement the changes as soon as is 'reasonably practicable' (bearing in mind the time involved in printing new leaflets).

However, if it’s a leaflet on a website then it should be taken down as soon as possible."

So the ASA (rather unsurprisingly) agrees with me that it is unreasonable to continue to make unsubstantiated claims solely on the grounds that you haven't got around to writing and translating anything honest yet.

Based on the informal resolution and the above text from letters and emails, I can't draw any conclusion other than:
  • The Chief Executive of the GCC is fully aware that its Patient Information Leaflet violates ASA guidelines.
  • The Chief Executive of the GCC is aware that this leaflet is continuing to be made available on their web site.
  • The Chief Executive of the GCC is in no rush to do anything about it.
How can the GCC be expected to regulate the chiropractic profession when it knowingly and deliberately violates the very guidelines it is meant to be enforcing?

I think it's time for a complaint against the GCC itself.

Hopefully they'll take my complaint seriously, clean up the regulatory body, start properly regulating the chiropractors and move towards a future of evidence-based chiropractic.

Then I can get back to my game of World of Warcraft.

Tuesday, 6 October 2009

General Chiropractic Council to Change Patient Information Leaflet


My complaint to the Advertising Standards Authority about the General Chiropractic Council’s Patient Information Leaflet has now gone through the ASA’s process.

The ASA has managed to deal with my complaint as an “Informally Resolved Complaint” rather than pushing it through to a formal adjudication.

This is a very interesting outcome.

What this means is that the General Chiropractic Council has withdrawn the claims as soon as they were approached and asked the ASA’s guidance in how they can make their advertising comply. There is an important point to note here: if the General Chiropractic Council believed they had the evidence to back up the efficacy of using chiropractic as a treatment for asthma, headaches, migraine and infant colic – then they simply could have produced it.

The ASA would have assessed this for them free of charge and either upheld the complaint asking them to remove the advertising, or not upheld the complaint. There is only one reason for backing off from the complaints: the GCC must have appreciated that that they simply do not currently have the evidence.

This is a significant change, and has huge implications for the circa 600 complaints currently being handled by the GCC.

By backing off and removing their claims before the ASA investigates, the GCC is acknowledging that even their loosely worded, slightly ambiguous leaflet (text below) is in breach of ASA guidelines.

There is some evidence, though more research is needed, that you may see an improvement in some types of:
• asthma
• headaches, including migraine
and
• infant colic.

If the GCC believes this loosely worded text to be in breach of ASA guidelines, then they must also believe that every complaint made to the GCC surrounding this subject is valid.

Am I being too optimistic in anticipating a vast number of guilty verdicts against chiropractors in the forthcoming months?

It also brings up a second potentially interesting outcome. If you’ve been following this blog, you will be aware of the letter that the GCC sent to Trading Standards in defence of their members. The advice given in that letter includes the exact text within the patient information leaflet that I complained about.

Will the GCC now follow that letter up with another saying that they are now withdrawing that claim? I will be putting that question to them.

Perhaps I'm being a bit optimistic – especially considering that more than a week after agreeing to informally resolve the complaint, the patient information leaflet remains on their website in its original form.

I am now beginning work on my second ASA complaint about the same Patient Information Leaflet.

While you're in the mood for chiro woo, I highly recommend Zeno's post on his recent ASA complaint - published at the same time.

Saturday, 12 September 2009

The dodgy posters in Leicester Highcross TCM shop

I went into the Traditional Chinese Medicine place in Leicester's Highcross centre today and took photos of all the posters on display. In total there are 20 photos of 31 posters or signs.

See if you can count how many of these 31 posters are not breaking the Consumer Protection Regulations.

If you can't read the text, click on the image for higher resolution.

A
B
C

D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V

Friday, 11 September 2009

The public isn't interested in why the GCC is trying to mislead Trading Standards

I received the GCC's response to my Freedom of Information Act Inquiry yesterday evening. The GCC avoided responding to almost every point. You can read the full text of their response here and here.

Two points stand out. Firstly, I was very clear in asking for all previous versions of the document, yet they only returned the final version without specifically stating that it was the only version.

Secondly, and more interesting is their response to my request for copies of internal communications discussing the content of the letter.

The emails are considered to be exempt under S36 of the FOIA because the disclosure of the information would, or would be likely to, inhibit the free and frank exchange of views for the purposes of deliberation. The GCC considers it is important that an exchange of views can take place between relevant parties to allow for proper space for deliberation without the exchange being made public. Additionally, the GCC needs to be able to think through the implications of particular options and consider how to properly approach the trading standards offices. Consequently, the public interest test has been applied by the "qualified person" at the GCC and the decision was that the public interest in withholding the information outweighed the public interest in disclosure and therefore it was considered appropriate to rely on FOIA s36 in this case.

Now the only way I can see this inhibiting the free exchange of ideas is if those ideas are not in the public interest. If those ideas included strategies for deliberately misleading trading standards by misrepresenting evidence, then you'd expect that the free exchange of those ideas may be inhibited. But then I'd have thought that inhibiting those ideas was very strongly in the public interest.

But if the ideas exchanged were how best to represent the evidence and how important it is to be honest with trading standards, then it is important that these ideas are not inhibited. But then honest ideas that are genuinely intended to help the public are not likely to inhibited by the prospect of them being made public.

Now I am willing to accept that some of the GCC's staff may have been less than complimentary when referring to me in their internal communications. And I don't have a problem with that.

Paul Ghuman of the GCC, I make you an offer to protect your staff from embarrassment. Pop those communications over to your lawyers at Capsticks and let them know what you want to remove. Then ask them to send the censored copy to me, declaring that nothing material to the decision making process was removed.

If you'd prefer not to do this, I'll ask my MP to send the next request for information. He has been very helpful before when I have been campaigning against quackery.

His next open bureaux is at 5pm on the 18th September.

Wednesday, 2 September 2009

Quick Update on the Chiropractic Stuff

Just a quick post to keep you up to date. Firstly, thank you to everyone who signed the letter to Trading Standards. Once I got to 500 signatories I sent it off, reporting 56 chiropractor practices. The sites have started to change. 12 have completely removed the claims, and another 5 have diluted what they are claiming - not ideal, but I'm not sure we can do much better right now.

So we're looking at 39 remaining. Not bad when we started with 160.

I'm still keeping an eye on these complaints, but for now my focus has changed the GCC. The organisation has done nothing to make sure its members are not practicing quackery. It promotes chiropractic for babies with colic and asthma in its patient information leaflet, and it has been actively defending its members from the Trading Standards complaints I've been making.

Having received a copy of their leaflet, I have now reported the GCC to the Advertising Standards Authority. The complaint has been slightly stalled when they questioned if I should be submitting the complaint as coming from Skeptics in the Pub. I'm not sure why that is relevant - and Skeptics in the Pub doesn't even exist as a legal entity, but I'm sure we'll work out the details soon. The ASA have made some very good decisions recently so I'm looking forward to seeing them deal with this.

My letter is below.

New Complaints
Advertising Standards Authority
Mid City Place
71 High Holborn
London
WC1V 6QT

To Whom It May Concern:

I have attached a copy of a leaflet entitled “What can I expect when I see a chiropractor?”. This leaflet is published by the General Chiropractic Council and used to promote the chiropractic profession. The GGC’s address is:

General Chiropractic Council
44 Wicklow Street
London
WC1X 9HL

020 7713 5155

My complaint is that this leaflet breaches the following ASA standards:
3.1 Before distributing or submitting a marketing communication for publication, marketers must hold documentary evidence to prove all claims, whether direct or implied, that are capable of objective substantiation. Relevant evidence should be sent without delay if requested by the ASA or CAP. The adequacy of evidence will be judged on whether it supports both the detailed claims and the overall impression created by the marketing communication. The full name and geographical business address of marketers should be provided without delay if requested by the ASA or CAP.
The claims I would like to focus on in this leaflet are as follows:
There is some evidence, though more research is needed, that you may see an improvement in some types of:
asthma
headaches, including migraine and
infant colic
First I would like to focus on asthma. The statement “There is some evidence, though more research is needed, that you may see an improvement” is misleading. The evidence from trials quoted by the GCC themselves in a letter they recently wrote to trading standards (available at http://www.dcscience.net/gcc-response-to-TS-050609.pdf), they cited the following:

Brønfort concluded in 1997 that there is moderate evidence (Level B) that SMT is a non-efficacious therapy for chronic to moderately severe asthma in adults. There was insufficient data (Level D) to draw conclusions about the efficacy of spinal manipulative therapy (SMT) for other respiratory diseases (including childhood asthma)
I was not actually able to find this paper. However, you can see from the above that the GCC acknowledge that the conclusion of this paper is that the treatment was ineffective.
In 2001, Brønfort et al ( see c. below) concluded that after three months of combining chiropractic SMT with optimal medical management for childhood asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower. The observed improvements were thought unlikely to be as a result of the specific effects of chiropractic SMT alone, but other aspects of the clinical encounter that should not be dismissed readily.
This is a misrepresentation of the study’s findings to make it appear that the outcome was positive (study is attached with this letter - Bronfort2001 asthma.pdf). In fact, the study also concludes that there were “no important changes in lung function or hyperresponsiveness at any time.” In addition, the patient rated outcomes were not even compared between the control and treatment groups. Even the GCC admits in their abstract above “The observed improvements were thought unlikely to be as a result of the specific effects of chiropractic SMT alone”. My conclusion from this evidence is that if you go for a chiropractor for asthma then you might think you’ve got better, but (a) if you had received the sham treatment you may have thought that too, and (b) objective measures will show you wouldn’t have got any better.

In their letter, they also list the following studies:

a. Nielsen NH, Brønfort G, Bendix T. et al 1995. Chronic asthma and
chiropractic spinal manipulation: a randomized clinical trial. Clin Exp
Allergy Jan;25(1):80-8
(see Nielsen1995.pdf)

b. Balon J, Aker PD et al 1998. A comparison of active and simulated
chiropractic manipulation as adjunctive treatment for childhood
asthma. NEJM 339 (15): 1013-1020
(see Balon1998.pdf)

c. Brønfort G , Evans RL, Kubic P, Filkin P 2001. Chronic pediatric
asthma and chiropractic spinal manipulation: a prospective clinical
series and randomized pilot study. JMPT 24(6):369-77
(Bronfort2001 asthma.pdf)

These studies all come to the conclusion that this treatment does not work.

Study (a) concludes:
The results do not support the hypothesis that chiropractic spinal manipulative therapy is superior to sham spinal manipulation in the management of pharmaceutically controlled chronic asthma in adults when administered twice weekly for 4 weeks.
And study (b):
In children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit.
I have already described study (c).

I have also attached “Spinal manipulation for asthma: A systematic review
of randomised clinical trials, E. Ersnt, 2009.” (09-000 SM4Asthma.pdf). Which states within its conclusion:
Systematic reviews often conclude that ‘‘more evidence is needed’’. In this particular instance, however, I am not convinced that more studies of spinal manipulation should be funded with public money. The current evidence is clearly not positive, not even encouraging. If clinicians or organisations nevertheless imply (as they do) that spinal manipulation is an effective therapy for asthma, the onus is on them to fund, conduct and publish rigorous trials that demonstrate this claim to be true.
By making the statement “There is some evidence, though more research is needed” I believe that the GCC is being misleading. This statement implies that there is a mixture of positive and negative findings and we don’t really if it works or not. In reality, the evidence from RCTs overwhelmingly suggests that this treatment is ineffective.

I have also attached “Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials, E. Ernst, 2009” (09-000 SM4InfantColic.pdf). As you can see from the text, the best evidence studying the use of chiropractic in the treatment of colic is also negative.

I would like to confirm that I have no commercial interest in the outcome of this investigation.

Yours sincerely,




Simon Perry.

Monday, 31 August 2009

Sara Stevens and the Ultra-Woo Allergy Test

I visited Sara Stevens of "The Complementary Health Team" in Blaby back in May. I've been incredibly slow to blog this, but just realised that blogging my letter of complaint in full would be much better than writing anything new.

Enjoy!


Dear Ms Stevens,

I visited your premises in Blaby on the 7th May 2009 around 5pm for what was sold to me as an “allergy test”.

Having thought about the tests I received, I have got quite suspicious of the methods used and am not convinced that they could work.

To summarise your methods:
  • You took a homeopathic preparation of an allergen and put it into my left hand.
  • I held it close to my stomach and outstretched my arm.
  • You pushed my arm down.
  • If my arm moved easily you deduced that I was allergic or sensitive to the preparation from which the homeopathic remedy was made. If not, you deduced that I was not allergic or sensitive.

The problems I am having difficulty overcoming are as follows:
  • Homeopathic solutions are typically dissolved to the point where there is none of the original substance remaining. With no substance remaining, I see no difference whatsoever between the 35 preparations you presented me with. How could this work without a chemical difference between the solutions?
  • With the preparations contained within glass phials, my body did not even come into contact with the pills. How could my body produce a reaction against a chemical it did not come into contact with?
  • I can find no reliable evidence to suggest that coming into contact with an allergen near your stomach reduces your strength in a different part of your body.
  • You merely pushed my arm down to subjectively measure the force. This is obviously a completely inaccurate way of measuring resistive force.
To summarise, you attempted to test me for an allergy by pushing my arm down while I didn’t touch a preparation that probably contained no trace whatsoever of an allergen. What evidence do you have to demonstrate that this test actually works?

Following the allergy test, you then gave me two further “tests”. The first, you claimed, was to assess the proportion of “bad bacteria” to “good bacteria” in my body. You did this by counting in tens (0, 10, 20 etc) up to 100 while repeatedly pushing down my arm. After assessing it was weakest between the times when you said “10” and “20”; you then pushed down my arm while counting between 10 and 20. From this, you deduced that my “Candia Level” as you called it, was 14%.

What evidence do you have to demonstrate that this second test actually works?

You then carried out a further “test” to find out what “good bacteria” I needed to buy to restore the balance. You did this by repeatedly pushing down my arm whilst pointing at descriptions of bacteria in a book. You then recommended I take “acidobifidus”.

What evidence do you have to demonstrate that this third test actually works?

I’ve read a fair bit about these tests online and opinion seems to be split. Practitioners of Applied Kinesiology appear to endorse the test, while the common consensus, including all reputable scientific studies, dismiss the practice as pseudo-science with no evidence that it produces accurate repeatable results.

If you do have good evidence that this test works, could you send it to me please? If you do not, I believe that you are operating an unfair commercial practice under the 2008 consumer protection regulations and would like a full refund.

If you do not have reliable evidence for this test, I assume you will from now on comply with the 2008 consumer protection legislation and discontinue your applied kinesiology service. Can you clarify if this is the case?

Regards,


Simon Perry

Sunday, 16 August 2009

Skeptics with a "K"

Just a quick note to say I was on the Skeptics with a K podcast talking about the Chiropractic/colic campaign. This was the first time I've listened to the podcast. With the exception of my rambling, those Merseyside skeptics have done very well. Very funny discussion of Genesis at the beginning. I will now become a regular listener.

You can download the episodes here: http://www.merseysideskeptics.org.uk/category/podcast/. My interview is on #2.

Wednesday, 12 August 2009

Will Trading Standards now take on the General Chiropractic Council?

Sometimes the Trading Standards bodies I’ve written to get in touch with the GCC for more information. And, thanks to a trading standards officer in the Highlands, the GCC’s response is on the trading standard internal database. An officer in London who had received one of my complaints got in touch to ask about the evidence in their response.

I am extremely grateful that he did.

The GCC has been issuing a letter to Trading Standards officers considering action against Chiropractor practices. The letter appears to be deliberately designed to confuse trading standards officers and misrepresent the evidence – and it has managed to do that to great effect.

The text of this letter is available on DC Science blog.

Firstly, they include the text from their patient information leaflet:

Chiropractors mainly treat
  • back, neck and shoulder problems
  • joint, posture and muscle problems
  • leg pain and sciatica
  • sports injuries

You may also see an improvement in some types of
  • asthma
  • headaches, including migraine; and
  • infant colic
So firstly there is some confusion here. If an improvement can be the result of chiropractic care, then why don’t they use it as a treatment?

“It is important to emphasise that the GCC doesn’t claim that chiropractors 'treat' asthma, headaches (including migraine) and infant colic. It is possible that chiropractic care may help to alleviate the symptoms of some of these conditions.”


What are they talking about? If chiropractic care can help to alleviate the symptoms, then it can be used as a treatment. The evidence throughout the asthma trials that they quote is clear: wherever the trials are properly blinded, it shows the treatment to be useless. I’ve been through the trials they’ve referenced for asthma: Brønfort in 1997 (note: I have not managed to find this paper – but the GCC’s letter acknowledges that this paper concludes that the treatment is ineffective), Brønfort et al 2001, Nielsen NH, Brønfort G, Bendix T. et al 1995 and Balon J, Aker PD et al 1998.

All these papers reach the same conclusion: the SMT (Spinal Manipulation Therapy) is ineffective in the treatment of asthma.

So what are they talking about when they say “You may also see an improvement”? Well the key word, I think, is “see”. While the trials they listed all reached the unanimous conclusion that SMT is ineffective in the treatment of asthma, Brønfort et al, 2001 (a pilot RCT) also found that the patients reported that their life had got better. But the paper did not compare this patient-rated outcome measure between SMT and control group. And the paper even states that “observed improvements are unlikely as a result of the specific effects of chiropractic SMT alone”.

So perhaps what they mean is that if you get chiropractic treatment for asthma, then you might think it did some good, however:
  • Objective measures will show that you haven’t been helped, and
  • You would have thought you’d been helped if you’d undergone a sham procedure too, and
  • This information came from a pilot study and is therefore not particularly reliable.

When the GCC lists this paper as evidence, they only mention that “the children rated their quality of life substantially higher and their asthma severity substantially lower.” The GCC completely neglected to mention that this study concluded that SMT is ineffective in the treatment of asthma.

They then go on to list 3 more papers that they say “appear to echo the evidence levels outlined in the paragraphs above”:

a. Nielsen NH, Brønfort G, Bendix T. et al 1995. Chronic asthma and chiropractic spinal manipulation: a randomized clinical trial. Clin Exp Allergy Jan;25(1):80-8
b. Balon J, Aker PD et al 1998. A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. NEJM 339 (15): 1013-1020
c. Brønfort G , Evans RL, Kubic P, Filkin P 2001. Chronic pediatric asthma and chiropractic spinal manipulation: a prospective clinical series and randomized pilot study. JMPT 24(6):369-77

But they fail to give any further information about these trials. Why? Why have they not quoted the conclusions, or sent the trial papers on along with their letter?

Why has the GCC not clearly stated that all of these papers conclude SMT to be ineffective in the treatment of asthma?

Why did the GCC list 4 papers that all concluded that SMT is ineffective in the treatment of asthma – but still state “although some clinical trials had positive results there is insufficient data to make strong statements about efficacy”?

Why has the GCC failed to reference the largest and best reported study of the use of SMT in treating infant colic?

How would the General Medical Council react if our GPs started advertising that they were willing to provide ineffective treatments for asthma?

Would they jump to the defence of those GPs?

Would they write letters deliberately designed to confuse Trading Standards?

Would they wait for a member of the public to issue a specific complaint about a specific practitioner before taking any action?

Would they publicise on their web site that “you may also see an improvement” if this ineffective treatment is used?

I think not.

The GCC is meant to be the body designed to regulate the chiropractic profession. With its actions, it has proven itself not only utterly incompetent, but it is actually protecting the very actions it should be regulating against.

The Trading Standards officer I spoke to yesterday was very much of the opinion that Trading Standards should be tackling the General Chiropractic Council directly. I am not sure if this is within their remit, but personally I am now shifting my focus in this direction.