The Northern Ireland NHS Alternative Medicine ‘Trial’

Various news sources and pro alternative medicine web sites have been telling us this week that a trial involving NHS GPs in Northern Ireland has shown that referring patients for homeopathy, reflexology, acupuncture and other CAM has highly successful outcomes. I see this as nothing short of an attempted fraud to extract NHS money for traders in quackery. Let me explain.

For example, the Princes Foundation for Integrated Health tells us, “It has demonstrated that integrating complementary and conventional medicine brings measurable benefits to patients’ health”. This is a deeply misleading statement and it does not take much to understand why. To do so, let us imagine another experiment.

In our imaginary world, the Apple Marketing Board approach the NHS and ask for £200,000 to do a study to show the truth behind the statement “An apple a day keeps the doctor away”. The Minister, being particularly fond of apples, agrees and the study begins. A group of doctors, who are also apple eaters, agree to send selected patients for apple therapy. They will treat them as normal, give them advice and drugs, or refer them as they normally would, but also offer to send them to receive a daily apple from an apple therapist. Patients who also like apples agree and they are tested to see how they feel now, in the doctor’s surgery, and how they feel a few months later after they have taken their normal medicine and also eaten their daily apple.

It is not difficult to predict the outcome of this test. Undoubtedly people will report being better months after their initial visit to the doctor. People go to their GPs when their health is bad. Through the natural progression of illness, or through the effectiveness of conventional treatments, people will undoubtedly report being better at a time in the future. Even people with chronic conditions will, on average, report feeling better as the first measurement in the GP office was taken when it is very likely symptoms were bad. (People with chronic illnesses do not go to their GP quite so much when their symptoms are not too bad.) Some patients may even experience a placebo effect from the obviously pleasant and indulgent experience of feeling special and being given apples.

Only a fool would conclude that any reported improvements were due to apple therapy. From this study, we have no way of comparing apple eaters with people who did not eat apples. Simply proclaiming health improvements is not enough as that is what we would expect without any apple intervention. We would also expect GPs to largely be happy and patients to be happy with their apples as they selected themselves into the trial as they were predisposed to enjoying apples. We cannot conclude that all people would be similarly so grateful. We might quite rightly conclude that the whole thing is a PR stunt by the Apple Marketing Board.

But this sort of result is exactly what we see in the Northern Ireland study. There has been no scientific publication of the study. Instead, the groups behind the study have commissioned a market research company to compile lots of meaningless tables and graphs for them. And the obedient market research company has produced a report that shows that, basically, people get better after visiting their doctor and that they quite like the indulgence of alternative medicine.

Alternative medicine groups are now ecstatically happy. This should not be a surprise to them as they were in control of events all the way along. What is quite remarkable about this so called study is that the money to conduct the trial was given to a lobby group for promoting the inclusion of alternative medicine in the NHS. It is difficult to imagine any other area of government where a group with large vested interests was given permission to promote their business, under the guise of science, using tax payers money. Independent, this report is not.

Peter Hain, the then Northern Ireland Secretary and supporter of quackery, gave the money (£200,000) to an outfit called GetWellUK. GetWellUK, run by Boo Armstrong, is a private company specifically set up to be, in their words “the best supplier of complementary healthcare to the National Health Service.” Only a fool would think any dispassionate appraisal would come out of such a lobby group. Indeed, at the time, Professor David Colquhoun pointed out that the project was a farce,

At the end of the “pilot scheme” there will have been no proper assessment of the effectiveness of the treatments. We shall be none the wiser.

And that has come true. The analysis has come from a market research company called SMR, run by a chap called Donal McDade. It is not a scientific analysis. It is at best a customer satisfaction survey. At worst, it is a set of graphs and figures that will please SMR’s clients – GetWellUK – so that they can use it for misleading PR.

The report avoids all the important questions. Primarily, it would be useful to know if the therapies were effective. On that matter it is silent. It asserts that the therapies provided significant health gains and produced economic savings:

Given the evidence of health gain documented by patients, GPs and CAM practitioners, it is recommended that DHSSPS and the project partners explore the potential for making CAM more widely available to patients across Northern Ireland. Not only has this project documented significant health gains for patients, but it has also highlighted the potential economic savings likely to accrue from a reduction in patient use of primary and other health care services, a reduction in prescribing levels and reduced absenteeism from work due to ill health.

There is absolutely no evidence in the 146 pages of guff in this report to make that assertion. It is pure wishful thinking.

Of course, patients were going to report their pleasure with the therapies. People do tend to enjoy the pampering of alt med. But that does not mean that quackery is effective or economically efficient. I would love my GP to send me to a weekend country spa resort after each visit to her, and undoubtedly I would feel great about it. My health would improve no end – at least that is what I would tell the market researchers. But this is not France.

GetWellUK do not address the question of effectiveness for one simple reason. We already now how effective the treatments being considered are. Homeopathy is pseudoscience, magical thinking and a placebo. Acupuncture appears to be nothing more than a theatrical placebo too with limited evidence of any real effect. Reflexology is just plain nonsense and little more than a foot massage with some mumbo jumbo thrown in. Chiropractic and Osteopathy are useless for everything but lower back pain, and then no more so than a conventional (and cheaper) options. But of course to discuss these things, would be destroy the value of this report as propaganda.

It is difficult to forgive GetWellUK for this as there is a precedent here. In the Spence study of 2005, the customers of a homeopathy clinic in Bristol, were asked to rate their experiences. It was a simple customer satisfaction survey but written up as a test of the medical effectiveness of homeopathy. The report was berated for its unscientific approach and for its use as commercial propaganda. The Northen Ireland team must have known the weakness of such an approach. Or was there aim simply to produce good PR so they could push their quack agenda into the NHS?

And the PR is showing some signs of working. The survey got a free ride in the GP magazine Pulse. It also attracted a comment from a Pulse journalist who demanded that Professor Edzard Ernst hand over his £10,000 prize as it was now clear that homeopathy ‘worked’. The journalist simply showed himself to be a fool. The Ernst-Singh prize has simple winning conditions that are far from met in this shabby report.

No doubt the various quack pressure groups will be using this to promote their agendas. If this was a building firm bidding for a government contract, no doubt submitting such a misleading report would ensure they were barred from future tenders and maybe even prosecuted for fraud. But this is alternative medicine. It is not socially acceptable to call a fraud a fraud when it deals with quackery. And behind all of this, of course, funding GetWellUK, is our future head of state Prince Charles.

Michael McGimpsey, the Health Minister in Northern Ireland, has now had this report on his desk for quite a few months. The government web site describes this as an ‘independent report’ . It is anything but. Let us hope he has the wisdom to see through this charlatanism and let the report get buried under a mound of more pressing issues.

23 comments for “The Northern Ireland NHS Alternative Medicine ‘Trial’

  1. Anonymous
    February 23, 2009 at 7:54 am

    Please,please,please sign my government petition against precisely this sort of lunacy at “petitions.number10.gov.uk/quackery”.The NHS cannot afford to provide tried and tested treatments let alone woo.

  2. Blue Wode
    February 23, 2009 at 9:59 am

    Great post.

    For those who may be unaware, Boo Armstrong of Get Well UK was recently announced runner-up in Courvoisier’s Future 500 competition. She said…

    Quote:
    “Achieving recognition and publicity through Courvoisier Future 500 is a potential springboard…Perhaps someone reading this over breakfast will reflect on how complementary therapies have helped them, and try to help our mission. It is in everyone's interest to have a healthy and sustainable health service.”

    More:
    http://www.guardian.co.uk/courvoisier500/the-final-five

    …however, it’s unlikely to be in Ms Armstrong's interest to pay close attention to the conclusion of the most up-to-date systematic review on the cost effectiveness of complementary therapies in the UK:

    Quote:
    “Prospective, controlled, cost-effectiveness studies of complementary therapies have been carried out in the UK only for spinal manipulation (four studies) and acupuncture (two studies). The limited data available indicate that the use of these therapies usually represents an additional cost to conventional treatment.”

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17173105

  3. David Allen
    February 23, 2009 at 10:33 am

    Much though I enjoy the comments of le canard and appreciate the need for a ‘totally against anything that isn’t prescribed’ whatever the validity, point of view they lose something by always opposing everything.

    Rarely is one view totally right all the time and another totally wrong.

    It is always a useful excercise for non-believers, whether that be to do with the efficacy of a non prescriptive based treatment or the existence of the afterlife to establish for themselves the criteria that might need to be satisfied in order to quell their scepticism.

    If you try this you will find it an impossible task as at some time there will be a need to move the goalposts again in order to maintain a true belief in absolute opposition.

    Generally the process is to establish an hypothesis then do ones dammdest to disprove it not the other way round.

  4. zeno
    February 23, 2009 at 12:54 pm

    David

    Some decent results from good quality trials that showed an effect greater than placebo would do the trick!

    However, I wouldn’t have thought it was necessary to continually state that that is all that is required: it’s obvious, isn’t it, and I don’t think any goalposts are moving.

    I’m sure I speak for many when I say we avidly await for good evidence that all the world’s ailments can be cured by sugar pills or the like. (Oh, and some kind of semi-plausible mechanism for it working would be nice too.)

    Do you really think that sceptics want disease and suffering to continue when there was a magic cure to it all?

    However, looking at the best evidence available so far, through unbiased eyes, leaves a whole load of AltMed stuff…shall we say, somewhat wanting.

  5. Sean Ellis
    February 23, 2009 at 2:43 pm

    Once again, this kind of lax verification makes a mockery of the medical certification process. As usual, here is a link to the CNHC safety petition, and as a public service, a clickable link to Julia Lightfoot’s quackery petition mentioned in the previous comment.

  6. ian quinn
    February 23, 2009 at 4:42 pm

    As the Pulse journalist, or in this instance blogger, in question, I should point out that I did not actually expect to get the £10,000, although it would be most welcome given the credit crunch.

    It would indeed be foolish to take the blog too seriously, as it was of course intended to be tongue in cheek, although it is clearly a debate which has strong views on either sides, if the facts are sometimes a tad debatable.

  7. Dr Aust
    February 23, 2009 at 5:34 pm

    Did you notice who was the first person on the comments thread on the Pulse article (i.e. not Ian Quinn’s comment), hailing the survey results and demanding a choice of Alt.Reality for all on the NHS?

    Answer is one of Gimpy’s Betes Noires, the reliably reality-free Steve Scrutton of the Alliance of Registered Homeopaths.

    Of course, Steve didn’t say over at Pulse that he was a homeopath.

  8. gimpyblog
    February 24, 2009 at 11:22 am

    Bête noire, Dr Aust? The man inspires laughter rather than fear.

  9. Dr Aust
    February 24, 2009 at 1:11 pm

    Yes, agree “bete noire” makes Scrutty sound a bit over formidable, rather than a figure of mockery.

    The odd thing about his Pulse comment was that as written it seemed to imply he had been trying to get homeopathic treatment for himself funded through the NHS. I always imagined homeopaths would be treating one another via some kind of barter system.

    I wonder what it feels like to be a conventional doctor treating a rabidly believing homeopath? I guess it depends rather on whether the “patient” has anything really wrong with them.

  10. Anonymous
    February 24, 2009 at 2:11 pm

    The Pulse article states:

    “Dr Anne McCloskey, a GP in Londonderry whose practice took part in the pilot, said … ‘Overall it was very positive. Our patients loved them, but the scheme wasn’t big enough to prove definite benefits. It should have gone on for longer.’

    Exactly. No Definitive Benefits.
    whatever the PR blurb dresses it up as, and no, there can be No Surrender as one commentator suggests – reconciling mumbo jumbo touchy feely feelgood factors as treatment outcomes is Bad Science

  11. Sceric
    February 24, 2009 at 2:30 pm

    as a “marketing guy” [spare me the scorn, as an engineer with an add-on degree in marketing and a tendency for the writing of the Graf of Sacher Masoch], I know ecactly hwo those studies are conducted and why: 1. for PR purposes [like in this case] 2. for improving your reaction/behavior/effectivness towards your customer. Used for point 2 (or 1 and 2), they make sense…for 1 alone, they are just good for the paper industry if printed …

  12. Le Canard Noir
    February 24, 2009 at 2:59 pm

    Well Sceric, the question is, who is the customer? I think, in this case, the Department of Health?

  13. Anonymous
    February 25, 2009 at 1:35 pm

    I fail to see anyway the survey would manage to contact patients who were not satisfied. As so well noted, the longer patients are away from the time of care, they will most likely have improved. Those who were not cured died or are out of contact in a nursing or rehabilitation facility, thus not interviewed.
    The point being that any casual survey will show wonderful results. Later one can do a meta-analysis on all these wonderful surveys and show very great significance levels. GIGO

  14. Sceric
    February 25, 2009 at 3:36 pm

    yeah, you’re right, that the actual customer would be the Department of Health. The results are crap anyway, as with most surveys of that kind, the poeple to respond are the ones that are satisfied. The disgrunteld ones wont waste their time on a survey (in a “real” survey you try in incorporate them or make a seperate survey with them directly after you p..them off)…so all in all, this thing isn’t even a good survey by marketing standards (bit probably it was cheap)

  15. Anonymous
    February 26, 2009 at 12:08 pm

    Nice try LCN but I think that people now are beginning to see through your one sided rants. Please keep going. You are Colquhoun could well be the best things for CAM ever.

  16. Le Canard Noir
    February 26, 2009 at 1:12 pm

    Thank you anonymous. I thought it was a nice try too. But I do think people are actually beginning to cotton onto quack tricks, such has this appalling abuse of public funds and propaganda.

  17. February 16, 2010 at 4:23 pm

    Nicely debunked, although I have a sneaking suspicion that CAM may be useful for doctors dealing with hypochondriacs (as mentioned by Jack of Kent at the recent London SITP). I wouldn’t be surprised if some doctors wanted to keep it on the NHS to provide a prescribable placebo…

    • Le Canard Noir
      February 16, 2010 at 4:33 pm

      Yes, it is an ineteresting question. Doctors may well want to be able to prescribe CAM for some patients. That does not mean that they should be able to do so. Ethical questions remain of course. I think I could be pursuaded either way, although I must admit leaning strongly in favour of not allowing doctors to tell fibs to patients just because it gets them off their backs!

Leave a Reply