The Quackometer

Professor Jayney Goddard is the president of the Complementary Medical Association (CMA), "the world's largest professional membership body for complementary medicine" and has been elected a Fellow of the Royal Society of Medicine. She studied homeopathy at Imperial College for five years and has won numerous awards. According to various sites, she is "considered to be among the world’s leading experts in complementary and integrated medicine."

Impressive stuff. No wonder she was invited onto today's The Wright Stuff to debate with Simon Singh on the subject "Homeopathy: A Waste of Money". Indeed, Jayney Goddard is a regular guest on the show and boasts an impressive appearance list in other shows, including being resident 'Expert' on Discovery TV. But Jayney appeared to state a number of surprising factual errors and have some over optimistic interpretations of the research literature (and I will come onto these). How could such a eminent expert make such mistakes? I thought a little background research might be in order.

So, President of the CMA, "the world's largest professional membership body for complementary medicine". What is the CMA? Well, the CMA web site does not appear to be what I expected. It offers some articles, sells a few books and food supplements and offers marketing services for members. Looking at Company House records, the CMA is registered address is Chase Bureau Services, a supplier of 'off the shelf companies' and other company secretarial services. So, no 'head office' for the CMA then. The web site for the CMA is registered to a private individual with an address given in a residential block of flats in Wandsworth. I'm disappointed. The CMA is not sounding so grand as I first thought. However, the CMA does usefully offer viewers of the Wright Stuff options to buy products that Jayney mentions on air. It looks to me like Jayney Goddard is president of a shop.

So, what about being Professor Jayney Goddard? We are told that Jayney was "recently awarded a Professorship from Mahendra Sanskrit University in Kathmandu, Kingdom of Nepal". The university was set up to promote the Sanskrit language in Nepal. However, when I tried to contact the University to find out more about Jayney's Professorship, I found their website is permanently down. Unfortunately, it would appear that in 2002, a hoard of women Nepalese Maoist rebels reduced the University 'to cinder' and destroyed all the ancient Sanskrit texts, University buildings, furniture, and all university records. The rebels had previously planted a 'crude but powerful bomb' there too. It is not clear if Jayney Goddard makes frequent visits to fulfil her Professorial duties.

And what of these claims to have studied homeopathy at Imperial College? The University is one of Britain's most prestigious degree level teaching and research institutions. It does not offer a degree in homeopathy. Elsewhere we are told that her qualifications are "diploma in hypnotherapy and is a Licentiate of the London College of Classical Homeopathy". No qualifications from IC then? This is a puzzling one.

And finally, Jayney says she has been elected a Fellow of the Royal Society of Medicine. What does it take to become a Fellow of the Royal Society of Medicine? The answer looks to be about £356 for a London resident. You can join online. I filled in the form and elected myself to become a Regional Fellow for £287. Bargain! Le Canard Noir, Fellow of the Royal Society of Medicine. Magnificent! My mum will be so proud. It looks like Jayney could become a Fellow as her 'presidency' of the CMA is obviously a 'senior management' role in healthcare.

There is so much more on Jayney's CV that we could explore. But enough for now.

So, what of these errors she made on the Wright Stuff? Simon Singh was arguing that the totality of scientific evidence for homeopathy showed that it was ineffective and a placebo based therapy - unsurprising given that it is just plain sugar pills. Jayney tells us though that 'outcome trials' are the way to measure homeopathy. These trials almost always give you positive results for homeopathy - they are just not very good as they do not compare homeopathy against any control group. It is impossible to know if the effect was caused by homeopathy or it was just people getting better on their own. Simon argues this, so Jayney went into animal experiments and this is where she lost the plot.

There is just some research printed recently, I think it was actually in Immunology which is one of the worlds leading scientific journals and it showed that mice exposed to something causes Chagas disease (guffaws) ... these mice were treated homeopathically, prior to being infected. It was a properly run double blind placebo controlled trial - the gold standard that Simon is actually talking about - and what actually happened was the untreated mice died, the mice that were treated did not get the disease.

Wow. But is it true? Well, no.

The research was done, but not published in Immunology. It was published in the in-house comic of the Faculty of Homeopaths, Homeopathy - a rag with as much scientific integrity as the Beano. The paper, "Effects of homeopathy in mice experimentally infected with Trypanosoma cruzi ", did not say that the untreated mice died or that the treated mice did not get the disease. It reported that more mice died in the control group but that this was not statistically significant. But the main criticism would be that the statistical certainty of effects were low (only p<0.05) and that multiple measurements were being made in five groups that would undoubtedly result in many false positives. If Professor Jayney Goddard thinks this is the best evidence for homeopathy, then we can be pretty sure it does not work. What is certain, is that this TV show was not the right forum for discussing p-values.

But Jayney went on to discuss homeopathy for childhood diarrhoea. She talks of trials 'all over the world, in developing countries' where children with diarrhoea have been treated with homeopathic medicines and also placebos and Jayney claims that the children who have been treated homeopathically had shorter periods of diarrhoea. Jayney tugs the heartstrings and tells us that the poor children of Burma, after the recent cyclone, could benefit enormously from such treatment. Undoubtedly, it is the sceptic scientists like Singh who get in the way of saving the children. Again. Is this true? Again, no. Diarrhoea and homeopathy is really just one researcher's passion - Jacobs. She has been involved in a number of trials in places such as Nepal and Nicaragua. Individually, these trials did not show a strong significant effect for homeopathy. But when Jacobs did her own meta analysis on three trials, she claims to be able to show a statistically significant effect. Jacobs suggests that "larger sample sizes be used in future homeopathic research to ensure adequate statistical power".

As meta analyses go, doing your own analysis on just three papers that you have been involved with is not really showing multiple independent confirmation of your result and is unlikely to be sufficiently self-critical of the work and take adequate precautions usually found in competent meta-analyses. Tellingly, Jacobs did go on to do another larger trial in Honduras in 2006. The conclusion was,

The homeopathic combination therapy tested in this study did not significantly reduce the duration or severity of acute diarrhea in Honduran children.

Showing his own biases, the paper did not discuss the possibility that homeopathy could not work, but rather that the homeopathic pills had been stored incorrectly and so on.

In discussing the Chagas and diarrhoea trials, Jayney Goddard misled her TV audience. It would have taken half an hour for Singh to untangle that lot, even if he had the relevant papers to hand. Given the the show host was acting like a moron pretending him and his friends did not need protection in malarial areas, Simon Singh did not have a chance of getting clear science across.

The most telling moment came when one of the other guests asked,

Simon, you've got trials that prove your case, Jayney, you've got trials that prove your case, which makes it very difficult for us to know where the truth lies.

Well, if Simon's colleague, a real professor of complementary medicine from Exeter University, Edzard Ernst, had come on, then perhaps there could have been a rational and fruitful discussion about the role of homeopathy in the NHS. But instead of Professor Ernst, we had to have a Professor from a long-since burnt down Nepalese Sanskrit University who runs a web site selling homeopathic books and pills. That, in my opinion, creates the obvious confusion shown on this show.

Labels: BPSDB, homeopathy, Jayney Goddard

 

In a recent post, I described how Neal's Yard Remedies had withdrawn their Malaria homeopathy pills. Their press release said,

as this is obviously a contentious issue which is causing customer concern, we have decided to withdraw the product, Malaria Officinalis 30c from sale with immediate effect.

I described this as bullshit, just like the rest of their press release. The much more likely cause was that they were being investigated by Trading Standards and the MHRA - the medicines regulator in the UK - after a BBC investigation had 'stung' one of their branches.





Well today, the MHRA have issued their own press release, which I will reprint here...

The Medicines and Healthcare products Regulatory Agency (MHRA) has clamped own on a homeopathic remedy intended to be viewed as a treatment or preventive for malaria sold by the cosmetic chain, Neal’s Yard Remedies. The MHRA has received confirmation from the company that the remedy, Malaria Officinalis 30c, will be removed from sale immediately.

All homeopathic remedies are classed as medicines and require prior authorisation by the MHRA before being placed on the market. The MHRA was concerned that no record of an authorisation had been given for Malaria Officinalis 30c and therefore concluded that it was an offence to sell, supply or to advertise this product which had not been authorised.

David Carter, Head of the Borderline Team at the MHRA said, “This product was clearly intended to be viewed as a treatment or preventive for malaria, which is a serious and potentially life-threatening disease. We regard the promotion of an unauthorised, self-medicating product for such a serious condition to be potentially harmful to public health and misleading. We are pleased that Neal’s Yard Remedies have complied with our request and removed this product from the market.”

So, Neal's Yard ethical bullshit has been exposed.



Now, I emailed their MD, Jonathan Hook, to ask if he supported the claims made by his unmedically qualified Medicines Director, Susan Curtis. In her book Homoeopathic Alternatives To Immunisation she describes how similar remedies could prevent malaria. Some of them are still for sale. No reply so far.



The book is still for sale on Neal's Yard's website. It continues to make alarming claims...

An invaluable guide for all trevellers[sic]. This book contains practical
information on preventing and treating major infectious diseases, including hepatitis, flu, measles and whooping cough.

Only the claim for malaria has now been dropped.

It looks like Neal's Yard has done the absolute minimum to avoid prosecution. This is shameful and is contemptuous of its customers. When is Neal's Yard going to come clean and do the right thing?

And let us not forget, Neal's Yard were only acting as resellers for Ainsworths. Are the MHRA going to anything about that company too?

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The BBC have now picked up on this story. "Firm 'misled' over malaria drug". Of course, it wasn;t a 'drug' they were selling, but a plain sugar pill.

Labels: homeopathy, Neal's Yard Remedies

 

Edzard Ernst has accused practitioners of alternative medicine of lying to their patients. In last week's New Scientist he gave an interview where he described his childhood experiences with homeopathy, and his subsequent medical and homeopathic training, and his work in the only German homeopathic hospital. His conversion to doubt has been slow and guided by the evidence. He now believes that homeopathy is nothing more than a placebo therapy. That is what the science says. According to Ernst, the continued popularity of homeopathy is essentially due to homeopaths lying to their patients about the state of research into the subject. If they told the truth, their businesses may collapse.

Now, Dr Brian Kaplan, a medically qualified homeopath, has taken exception to Ernst remarks and thrown down the gauntlet - pistols at dawn. Kaplan says,

I have met hundreds if not thousands of homeopaths in my career. Some have indeed believed in some strange things, some have been very naive indeed in my opinion, but I have never met a homeopath whom I thought was lying to his/her patients. They may have said things to patients that Ernst thinks is untrue but that is very different from lying which is the deliberately not telling the truth.

Now, for once, I would pretty much like to agree with Kaplan. I think few homeopaths are out-and-out liars. Lying is not the word for what homeopaths do. The actual word that is most commonly appropriate is 'bullshitters'.

To explore this issue, I would like to draw on the work of renowned moral philosopher and Professor Emeritus of Philosophy at Princeton University, Harry G. Frankfurt. In 2005, Frankfurt published an essay entitled On Bullshit. This groundbreaking work explores the philosophical meanings of bullshit, why there is so much around and how it differs from other sorts of untruths.

Frankfurt argues that bullshitting is not the same thing as lying, but both are an abuse of the truth. In his words,

It is impossible for someone to lie unless he thinks he knows the truth. Producing bullshit requires no such conviction. A person who lies is thereby responding to the truth, and he is to that extent respectful of it. When an honest man speaks, he says only what he believes to be true; and for the liar, it is correspondingly indispensable that he considers his statements to be false. For the bullshitter, however, all these bets are off: he is neither on the side of the true nor on the side of the false. His eye is not on the facts at all, as the eyes of the honest man and of the liar are, except insofar as they may be pertinent to his interest in getting away with what he says. He does not care whether the things he says describe reality correctly. He just picks them out, or makes them up, to suit his purpose.

Homeopaths are renowned bullshitters. They do not care about the truth. They are extremely reluctant to say anything definitive that can be proven wrong. They do not test their ideas themselves in any meaningful way. They will say anything to make themselves look plausible in the face of sincere criticism. Instead of addressing the concerns raised by Ernst, they bullshit about conspiracy theories about how pharmaceutical companies are funding people like him to discredit them. There is not a shred of evidence for this - but that does not matter - they just bullshit away.

We saw Neal's Yard Remedies this week after they were caught dishing out useless sugar pills to prevent malaria bullshitting for England. Their PR department will undoubtedly be winning PR bullshit awards over that attempt to get-out of-gaol-free.

We have seen The Society of Homeopaths trying to bullshit their way out of similar accusations, issuing press releases that really did not appear to care if what they were saying was the truth. They claim to be consulting with the Department of Health over self-regulation. A freedom of information act request suggest otherwise.

We see their 'intellectuals' publishing papers on quantum mechanical explanations for homeopathy. It is utter bullshit of the highest order, but that does not matter, because the homeopaths lap it up.

When homeopaths, like Kaplan, only partially review the evidence for homeopathy, cherry picking the positive studies and ignoring the overwhelmingly disappointing, they are bullshitting. By continuously saying that meta-analyses are 'discredited' when they are not is just pure bullshit.

Bullshit may not cover all homeopaths abuses of the truth though. Some have seen Frankfurt's analysis of truth abuses as incomplete and in need of further revision and extension. It was therefore necessary for former Oxford Wilde Reader in Mental Philosophy and current Professor of Philosophy at the University of Miami to publish an essay entitled mindfucking.

McGinn's 2008 analysis notes that not everyone who engages in speaking without regard to the truth is a bullshitter. They may well be just telling stories, or singing a song, and is not making any claims to be either telling the truth or a lie. Defining a bullshitter cannot be done by just noticing a disregard for truth.

In examining the true nature of bullshit, we discover that in order to be a bullshitter you must intentionally represent yourself as competent and sincere and be trying to place this false belief in the listeners head that you are telling the truth. As such, a bullshitter is not completely indifferent to truth and falsehood as Frankfurt has suggested. We can see how homeopaths publishing papers on quantum mechanics gives the impression that they know what they are talking about in this area. There is the intention to come across as an authority. The fact that these papers are not published in quantum physics journals should set off loud alarm bells. There is no one in an alternative medicine journal capable of telling the authors that the paper is bullshit and so rejecting it.

But deeper into this new analysis of truth abuse comes the concept of mindfucking. Both liars and bullshitters are concerned with beliefs - that of what their listeners think. There are always two untruths for the liar and the bullshitter - the (possible) untruth of what is being said and the untruth of the belief in the listeners head that what is being said is sincere. The mindfucker, on the other hand, does not just care about their listeners beliefs and what the listener thinks of them, but about manipulating their emotions too. The intention is to disturb and abuse. The mindfucker seeks to raise emotions of alarm, confusion, insecurity, fear and hatred. At the very least, mindfucking is using emotion to manipulate thought.

And this is where we can see that homeopaths are most definitely mindfuckers. It is just not good enough to lie to you patients about the power of the pills. It is also not good enough to bullshit about evidence. Homeopaths find it necessary to fuck with people's minds. They tell them that the real enemy is their doctor. They scare them in one-sided stories about the harm that drugs and immunisations do. They tell them their medication will do them more harm than good. They talk incessantly about side-effects of drugs as if the actual effects of the drugs and the illness itself were secondary issues.

Is Kaplan guilty of a mindfuck in his criticism of Ernst? Instead of addressing Ernst's evidence of the ineffectiveness of the majority of complementary medicine, Kaplan accuses Ernst of ignoring the supposed lack of evidence behind conventional medicine. It is a mindfuck because it plays to the usual emotion of distrust in Big Pharma, it deflects from the issue and seeks to cause alarm about Ernst's motives. But of course, Ernst is Britain's only Professor of Complementary Medicine and it is a complete red herring to accuse him of ignoring a subject that he never intended to study. There are thousands of researchers in Britain studying and improving the evidence base of medicine and yet Kaplan wants to attack Ernst over it. The irony is of course is that Ernst is improving the evidence base of CAM - people like Kaplan do not like the answers coming out of his department. Let's fuck with people's minds instead.

So, I am not sure if Ernst is going to take up Kaplan's offer of a duel. My bets would be on the canny German. They still train people to duel there, you know. Kaplan has not made a case that a duel is necessary. Rather, it is up to Kaplan to state that homeopaths do not misrepresent the truth about the evidence base for homeopathy. If he is sincere about the truth, why is he not as concerned about his own profession as Ernst appears to be? Where is the condemnation of homeopaths running high street shops with dangerous beliefs about immunisations? Where is the concern that homeopaths do not practice within the knowledge of a sound evidence base?

I think Ernst was actually being rather kind in calling homeopaths liars. He should have called them all bullshitters and mindfuckers.

Labels: edzard ernst, homeopathy