The Quackometer

I had to share this with you. Following on from my recent Quack Word 'Doctor' blog, I came across the Royal College of Alternative Medicine (RCAM) , a Dublin based - well, I'm not sure quite what it is...

What caught my eye was just the shameless aggrandisement of the site. It is quite hilarious, if not a little repetitive at times. Calling yourself 'Doctor' is somewhat pompous when all you have done is paid for some international postage. However, the man behind RCAM has absolutely no shame and titles himself as the:

Distinguished Provost of RCAM (Royal College of Alternative Medicine) Professor Joseph Chikelue Obi FRCAM(Dublin) FRIPH(UK) FACAM(USA) MICR(UK)

Wow! Probably, just Joe to his mates. Naturally, when you Google the qualification FRCAM(Dublin), there is only person who appears to revel in this achievement. I'll leave the rest as an excercise for the reader.

The distinguished provost looks like he is just another pseudoscientific nutritionist, his spin being "Nutritional Immunomodulation". This is obviously a lot more clever than Patrick Holfords mere 'Optimum Nutrition', but having only one 'omnipill' is probably a poorer commercial decision that Patrick's vast range of supplements.

Obviously, Professor Obi has had a few problems with what probably amount to bewildering comments about his site as the legal threats and press releases concerning his 'ethical' responses to criticisms cover more space than anything else. 'Ethical' is a favourite word on the site.

The most recent press release states,

7th September 2006 : The Distinguished RCAM Provost , Professor Joseph Chikelue Obi FRCAM(Dublin) FRIPH(UK) FACAM(USA) MICR(UK) has formally accepted appointment as Chief Professorial Examiner for the Doctor of Science (DSc) programme in Evidence Based , Alternative Medicine (EBAM) of a highly respected International University in one of the British Commonwealth Protectorates.

This new qualification is primarily aimed at Medical Graduates , Physicians, Surgeons, Pharmacists, Dentists , Osteopaths , Chiropractors , Opticians , Wellness Consultants , Herbalists , Acupuncturists , Naturopaths , Healers, Podiatrists , Chiropodists , Scientists , Healers ,Therapists, Homeopaths , Chinese Medicine Practitioners and Nurses wishing to ethically upgrade their current Qualifications in Alternative Medicine over an exceedingly intensive 12 - 36 month period of study.

British Commonwealth Protectorates? Could that be Dublin?

I really have no idea what this organisation is all about. But it looks like it could be getting quite big soon...

RCAM currently has International Vacancies for One Million (1,000,000) 'Foundation Fellows' ('Movers and Shakers') ; who will independently play a highly pivotal role in diligently mentoring (and regulating) it's future Global Membership.

So if you really think that you seriously have what it takes to become a 'Leader' in Alternative Medicine , then (perhaps) RCAM may definitely be exactly what the Doctor ordered for you.

One million. That's a lot of quacks! And they are just to mentor (and regulate) the wider quack membership! This man has ambition.

The Big J really hates real doctors. This is his most recent press release...

RCAM would like to warmly commend the various Chieftans of the National Health Service of the United Kingdom for ethically and appropriately ignoring utterly misguided calls (from a rather amusing Group of thirteen Clinical Yestermen) to compel Hard-Working (and Tax-Paying) British Citizens to additionally pay for Life Enhancing Alternative Medicine Interventions out of their very own pockets - rather than get such treatments free via the NHS. RCAM would like to also categorically state that such exceedingly flawed 'G-13' demands that the National Health Service of the United Kingdom expediently abandon Alternative Medicine altogether (in total favour of Conventional Medicine) be diplomatically treated with the very utmost contempt which such unguarded verbal flippance duly deserves ; as none of these 13 'Eminent UK Scientists' behind such calls has professionally attained Globally Acceptable Fellowship Qualifications in Alternative Medicine and as such cannot be deemed competent enough to make such sweeping 'Shilly-Shally' statements about the noble independent specialty of Alternative Medicine.

RCAM therefore publicly advises the General Public to lawfully go about their normal Wellness-Seeking Behaviour as usual - without any unwarranted prejudice or fear resulting from such highly self-serving, morally unethical , abjectly crude , totally unprofessional, utterly unstatesmanly, morbidly barbaric, wantonly uncivilized, profanely undemocratic and unspeakably sacrilegious perpetual affronts on the therapeutically formidable institution of Alternative Medicine.

Now, I do not have 'Globally Acceptable Fellowship Qualifications' in Santa Clause Studies to know he does not exist. But hey. I must be a morbidly barbaric and profanely undemocratic, unethical duck.

So, struggling around the acres of pomposity I find one place where Prof Joe might be making some money. You can call him to seek his wisdom, after pre-booking an hour's slot (and handing over your credit card) for a mere 300 Euros. Alternatively, you can pay by the minute on the contact line for a trifling $10 per minute.

Its going to cost you $20 just for Joe to say Hello and to read out his numerous titles, qualifications and names. Not bad 'ethical' work.

Labels: Professor Joseph Obi, qualifications, titles

 

UPDATE 8th February 2007

Well, six months after first posting this entry, the complementary IT team at Dr Wendy's support organisation have made a few spelling corrections. I thought this might happen soon, as this entry became the most widely read entry on the site. I guess it was being passed round a bit - thousands of times.

So, it looks like, after much speculation, Wendy's services are not complimentary, or free, but indeed complementary. Looks like the team also believes the word 'complementary' deserves capitalising, whereas 'medicine' does not. Read into that what you may. Anyway, for posterity, the wayback machine has preserved the original site here. And you can compare it with now.

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I've just had a comment pointing out that Dr Wendy Denning only scores 1 Canard on the quackometer. Strangely, I had just flicked over to her new Channel 5 series, "The Diet Doctors".

The person leaving the comment said that Dr Wendy deserved a much higher score. In addition, anyone describing themselves as a 'nutritional expert' also needs a good look over just to see what quackery they are up to. (More on that in later blogs). Dr Wendy was also apparently responsible for pushing that useless Christmas-cracker piece of tat, the QLink pendant, on the poor, hapless Daily Mail reporter, Sarah Stacey, who wrote the all time highest scoring newspaper quack article ever. Also, Dr Wendy got her nutritional qualifications from Patrick Holford's Richmond based, made-up college, the Institute of Optimum Nutrition.

So, I decided to investigate a little further. Why had the Quackometer scored Dr Wendy so low?

Well, I found the answer rather quickly and it has opened up a whole new field of organic broccoli for the quackometer to sort out. It appears that Dr Wendy is not into complementary medicine (medicine that complements real medicine) at all. Her web site tells us that she is into complimentary medicine - repeatedly - some seven times at least. Is that going around paying her patients compliments and saying how nice she thinks they would look in her green jacket? Or does complimentary mean she is giving away her nuggets of 'holistic' medical wisdom for free?

Apparently, No. A quick check of her web site reveals she charges £225 for 90 minutes in her clinic, of which, she will guarantee to show up for half-an-hour, obviously to pay all the right compliments to you for handing over your credit card.

So, the answer is obvious. The quackometer only scores those practitioners into complementary medicine. Those who just pay flattering tributes to their patients do not deserve scores on the quackometer.

An insight to quacks then. To get around the quackometer, the answer is simple. Spell everything wrong. Learn a tip from the email spammers: e.g. _V_I_A_G_R_A. Just how many spelling variations of osteopathy, acupuncture and gullible can you come up with?

It looks like I am faced with a big task. To catch the Dr Wendys of this world I am going to have to expand the quack dictionaries enormously with every possible spelling variant. Hell. There is so much good telly I am going to miss over the next few weeks.

Ho Hum.

Just what do they teach them at medical school these days?

Labels: diets, nutritionist, qlink

 

UPDATE 12/2/07

Congratulations to Ben Goldacre and the crew at Bad Science for getting Dr Gillian McKeith banned from using the title 'Dr'. In today's Guardian she is fully exposed as a Menace to Science. The Advertising Standards Authority have agreed that her use of that cheaply acquired title is thoroughly misleading.

One down...

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Yes, I know. This is surprising quack word, but let me explain.

I'm not really writing about the word 'Doctor' but about titles and qualifications in general. More specifically, it is about using titles and qualifications, however acquired, to provide a sense of authority to healing claims when sound evidence is lacking.

'Trust me, I'm a Doctor.'

Quacks lack evidence for the effectiveness of their treatments or theories and so rely on a number of other techniques to convince you of their worth, including testimonials, anecdotes and baffling pseudoscience. However, one of the surest giveaways of quackery is the flaunting of titles and qualifications. The quack will proudly put 'Dr' before their name and 'PhD' afterwards. Normally, one or other of 'Dr' and 'PhD' will do. This is an 'appeal to authority'. It is solely there to impress. The quack is setting themselves up as a respected authority on a subject and so there is no need to look any further at any real arguments or evidence in favour of what they are saying.

Now of course, evidence-based medicine, and science in general, is full of Doctors, PhDs, Professors and diplomas. The difference is that, in general, these titles are not always flaunted. Look at any scientific paper in a prestigious journal like Nature and you will see just names and no titles. The authority of the paper comes from the strength of the argument and the rigours of the experiment, not the qualifications of the authors.

Qualifications do count, of course. They are part of the apprenticeship of science. But once the years have past, they become increasingly irrelevant. Look at how doctors tend to revert back to Mr/Ms etc as they become more experienced and advanced in their careers. Their reputation for excellent work is what matters, not their past exam success.

If you are still not sure, why not try a little experiment for yourself? Next time you are in a book shop, go and visit the popular science section. It is probably quite small, near the back and you may need a shop assistant to help you. Now look at the books and see how many titles you can spot on the covers. Names like Richard Dawkins, Steven J Gould, Hawkins, Dennett, Penrose and Pinker ought to leap out. All luminaries in their fields, but not a qualification in sight. If you look inside at the brief biography, you may spot the odd professorship mentioned alongside their stated appreciation of their family. Their titles, qualifications and awards are insignificant in the face of their arguments. If you do find a title, it is likely to be of a little known author.

Now go back towards the front of the shop until you end up in the 'Mind, Body, Health and Spirit' section. This won't be hard to find. It will be three to four times the size of the science section. In a bad bookshop, the science books might be mixed up with it. However, the actual useful contribution to human knowledge on those shelves will fit in a small shoe box. A waste of trees. Now look for qualifications. It won't take you long. They will be printed in huge, silver, embossed letters on the spine and cover. Looking at the Amazon best sellers at the moment we see names like Dr Gillian McKeith Phd, Doreen Virtue PhD, Jeffrey E. Young PhD and Dr Wayne Dyer. If the author hasn't got a title themselves, then they will get a forward written by someone who has and that will appear in big letters. Those embossed letters count for everything. Noel Edmonds is missing a trick here.

But surely these people must know what they are talking about? You can't just lie about your qualifications?

Well, you don't need to lie, but there are a number of ways of getting round the three to fours years of library work, fine tuning of experiments, paper writing, seminar giving, thesis writing, thesis re-writing, and tortuous examinations - all on a pittance of pay - that are the staple of postgraduate degrees, if you want to start earning big quack bucks fast.

Let us count the ways...

1. Swap Subjects
You could have mistakenly done all the hard work above only to find out that being a geologist does not make as much money a selling bucket loads of useless vitamin pills. I've written about this before. Even though you are now a nutritional 'expert' there is no need to make it clear that your PhD was in geology, economics or bongo playing. Flaunt those letters after your name!

2. Join a 'New University'
The massive expansion in higher education in the UK, and probably elsewhere in the world, has resulted in a deluge of former polytechnics, colleges and furniture shops now calling themselves universities. Even better is that, in the mad dash to attract students and, hence attract funding, the hard subjects of physics and chemistry have been dropped due to the difficulty of persuading students to take them. Far better to offer courses in homeopathy, nutrition and Madonna. Set yourself up as Professor of Reiki Studies and bingo, you're off.

3. Do a Cheap Correspondence Course through an Unaccredited American College.
This might involve a little work and at least cost you a fair amount of postage, but at least you will be able to defend yourself in a court of law that you are entitled to the letters after your name. Sometimes called the "looneyversities", these institutions often dole out pretty useless awards for little more than a fee. Proper academic standards are rarely upheld and are not subject to academic review by the usual authorities.

Paul McKenna PhD sued a journalist for saying his doctorate was not real. I quote from the Guardian:

Central to the case is an article published in October 2003 headlined "It's a load of doc and bull", in which Lewis-Smith wrote that McKenna's first PhD, awarded by La Salle university in Louisiana, was a sham. "I discovered that anyone could be fully doctored by La Salle within months (no previous qualifications needed)," he wrote, just so long as they could answer the following question correctly: 'Do you have $2,615, sir?'" This followed a number of articles dating from 1997 in which, among ther things, the columnist calls McKenna a "non-doctor", a "dildo" and compares him to Dr Crippen, the notorious murderer executed in 1910 for killing his wife.

In fact, La Salle university was not as it seemed: in late 1996 the former president, Thomas Kirk, admitted to the FBI that it was not officially accredited; the following year he was jailed for five years for fraud. McKenna told the court he knew nothing of the fraud when he enrolled for a doctorate in hypnosis in June or July 2005. While he admitted the revelation had "devalued" the qualification, he insisted he did not believe it rendered it "bogus"

The judge found in favour of Dr McKenna noting that "Mr McKenna was not, in my judgment, dishonest and, for that matter, whatever one may think of the academic quality of his work, or of the degree granted by La Salle, it would not be accurate to describe it as "bogus". So there. The title 'Doctor' is not protected, meaning anyone can pretty much call themselves this. The quality of any degree behind the title is irrelevant.

Perhaps, the most celebrated case in the UK is that of Dr Gillian McKeith PhD. Her credentials have been scrutinised by a number of observers, including the Sunday Mail with an article entitled Is Channel 4's latest food guru Dr Gillian really a Quack and a danger to our health? Perhaps the funniest analysis was done by Ben Goldacre in the Guardian who looked into her professional memberships that included the American Association of Nutritional Consultants (AANC). Dr Goldacre applied for the same membership for his recently deceased cat, Henrietta. It cost him just $60.

The qualifications of Dr Gillian have been well explored and I will give a reference shortly. It is fair to say though that she does have qualifications that everyone respects. They are in languages, business and marketing. All things she does very well and her education has obviously paid off.

Dr Gillian McKeith PhD is not afraid of legal challenges either, although sometimes they take a more 'out-of-court' route. If you Google "Dr Gillian McKeith PhD" you will find the following wording on the first page:

In response to a legal request submitted to Google, we have removed 1 result(s) from this page. If you wish, you may read more about the request at ChillingEffects.org.

Fortunately for posterity, I know the page concerned. You can find it here. This page is essential reading for all Gillian fans.

4. Start your own Institution or University and award Yourself Titles and Awards
Arguably the hardest work, but it can have big payoffs. The main one being that you can charge other people to get similar awards.

This is most often done in the US. The Beatles guru, Maharishi Mahesh Yogi, set up his own university so that lots of 'research' could be done on Transendential Meditation.

The UK has its own examples, including Patrick Holford BSc, DipION, FBant. Patrick is one of those people who you will have found in the Healthy Living section of the bookshop, in between 'Angel Healing' and 'The Photographic Kama Sutra'. Patrick styles himself as the "leading spokesman on nutrition, food, environmental and health issues".

Once again, Patrick's BSc was in psychology, not nutrition. His significant qualification in health matters is the DipION awarded by the Institution of Optimum Nutrition which was set up as a 'charitable and independent educational trust ' by none other than Patrick Holford himself. Hire a few rooms in some managed office space in Richmond, London and you can have an International Headquarters. Even better, get one of those new universities (say Luton) to accredit your course and you can expect a stream of fresh new students. Nevermind that the most recent official quality review of Luton (now Bedfordshire) concluded:

As a result of its investigations, the audit team's view of the University is that: limited confidence can be placed in the soundness of the University's current and likely future management of the quality of its academic programmes and the academic standards of its awards.

This has not gone too unnoticed. The Sunday Telegraph posted an article entitled "Is this the worst university in Britain?".

The Institute's philosophy is one of nutritional therapy, treating disease through what you eat, as highlighted by the quote on the front page of its web site:

"The Doctor of the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition"
Thomas Edison, c 1870

So Thomas Edison not only invented the light-bulb but was a pioneering nutritionist. It's a shame that the rest of science has not yet caught up with his thinking and adopted this in the way we have adopted the lightbulb. Maybe it is because the lightbulb is based on sound science and is useful?

Does any of this matter? Well, people do take Mr Holford seriously. He has been associated with comments that Vitamin C is better than AZT in the treatment of AIDS, where the evidence for that has been very poor. This is burning issue in South Africa now where the Health Minister believes you can treat HIV with potatoes. Someone is dying there every two minutes of HIV and AIDS. Also, the general public take him seriously. He last came to my attention when researching the QLink trinket that is sold as a way to stop 'harmful' EMF disrupting your life energy thingumajigs. He sells them on his website and provides this most fantastic endorsement:

There are many gadgets out there promising to protect you from electromagnetic radiation and give your energy a boost. I've investigated many and did not find any stacked up. The one exception is Q Link. The scientific proof is deeply impressive and that's why I wear one. I recommend you do the same.

So, all the other EMF pendants are quackery and nonsense, Patrick, except the ones you sell?Presumably, Patrick will be setting up an Institute of Optimum Quantum Physics as well now.

So why do the likes of Dr Gillian and Patrick see qualifications as so important to them? The key here is to see that they are both nutritionists and both sell food supplements of one form or another. The problem in selling these things is convincing people they need them; basic nutrition for most people is not hard. It's common sense - eat a balanced and varied diet, eat your greens and don't overindulge too often. Not much of a market for superfoods and vital supplements there. If, however, you make all this sound very complex, stress the importance of eating at an 'optimum', throw in some pseudoscience to make it sound like you know this stuff deeply, flaunt your qualifications and make it all sound too hard for the individual to keep track off, then you just might create a market for your overpriced alfalfa extract.

Dr Canard Noir Bsc(Hons.), PhD

Labels: Ben Goldacre, nutritionist, Quack Words, titles

 

Yes, sometimes I do get filled with self-doubts, usually in the night. It soon passes. But you see, there is just so much quackery out there that any rational and honest thinker must fully entertain the idea that they have got something horribly wrong. After all, the sceptic should always be challenging their own assumptions. Is the black duck guilty of close-minded, self-dissembling and narrow thinking?

Now, in the UK , the body responsible for policing medicines (the MHRA), has recently given an endorsement to the homeopath scammers to keep pushing their sweeties as if they were medicines. Under pressure, the MHRA has handed them a nice get-out-of-gaol-free card. How can I be so sure I am right when such august bodies are against me?

The MHRA is extending their exemption to homeopaths to enable them to make claims of efficacy without any proof that they actually work. This is in direct contradiction with the MHRA's stated goals:

So, the MHRA appears to be simply abrogating its responsibility to ensure that medicines work by allowing the quack community to get away with its usual trickery.

The sweetie pushers have already leaped into these new opportunities by packaging up their chocolate-free smarties as cures for hay-fever, colds and the like, which will sit next to the aspirins, antihistamines and paracetamols in places like Boots. They have been able to get these new products to market so quickly as there was no expensive R&D involved, no extensive clinical trials, no licenses to submit and no new manufacturing processes to set up. They just needed an inexpensive skateboarding graphic designer to sit at their mac and redesign some packaging for the same old little sugar pills that undoubtedly come out of one huge bucket. I can hear the laughter in the board room of Nelson's from here.

This situation surely cannot last long. The inherent contradictions in this rushed bit of legislation must surely show up sooner or later. One question I would like to know is this. If I suspect that a product has not been prepared homeopathically, but is labeled as such, what test could the MHRA inspectors apply to see if fraud has been at work? As we discussed recently, all homeopathic remedies end up identical. The 'active' ingredient has been diluted out of it. In most pills and solutions, not one single molecule of the stated ingredient is actually being bought by the consumer. No need to inform the consumer, no need to label carefully. One tub of pills is the same as any other. All have the same ingredients list - lactose. So, no test could tell an ordinary sugar pill from a 'legitimate' homeopathically prepared one. Could lorry loads of Far Eastern counterfeit homeopathic treatments flood our high streets? How would we know? Would we care? It would be illegal under these new laws, but it will just result in one set of quack activities being replaced by another.

So, with such huge forces against the likes of me, it is natural to have a little self-doubt now and again. I am not saying that I am cleverer than these people. The quackometer project is not supposed to be some fount of Delphic wisdom about which medicines work and which do not. No, the project and blog are about critical thinking, about not taking someones word for it when they make extraordinary claims. It's about scepticism when scepticism is required.

If a claim is made about healing that is in someway difficult to reconcile with the broader knowledge of medicine and science then there ought to be some pretty damn good evidence for it. When claims are continuously made without that evidence coming forward then we can justifiably call 'quackery!'. When pseudoscientific nonsense is presented instead of evidence. Quackery! When the best trials presented are small, poorly designed and badly controlled, and published in tame 'journals'. Quackery! When the best 'proof' given on a web site is just an overabundance of meaningless anecdote and testimonial. Quackery!

Homeopathy has had two hundred years to support its claims and the evidence to date is dismal. The science base presented is nothing more than mumbo-jumbo magical thinking. Quackery!

So, thanks to quackometer user, Jonathan Ramsay, who sent me an email about his side-business (Boffin Productions) of making greeting cards that take the piss out of such nonsense. Jonathan is a private tutor who is dismayed at the level of support found amongst his students for woo and quackery. The greeting card I liked the best demonstrated the central idiocy of homeopathy with instructions for homeopaths on how to make a cup of coffee. You can probably guess the theme. The strongest homeopathic coffee is indeed that prepared with no coffee in sight. There is probably some homeopathic idiot out there that would give a glowing testimonial about how wonderful this coffee is and what a kick it gives them in the morning.

It's Monday morning now and being a bitter, closed-minded conventionalist, I am off to get a proper, old-fashioned cup of allopathically prepared coffee.

Labels: homeopathy

 

A correspondent has made valid points about the quackometer that I should be careful to ensure that it only awards Canards to real quacks. A sentiment I share and I worry about how to achieve this. I was told to make sure I didn't get the 'good guys' who look into the effectiveness of alternative treatments. Fair enough - but this is a murky world, and telling the good guys from the quacks is not necessarily easy. For example, what makes a Good Homeopath? And can I adjust the Quackometer to go easy on them? Let's explore.

First, an an example. Professor Edzard Ernst of Exeter University in the UK is widely regarded as being fairly unique and well respected in the academic world for his work on the safety and efficacy of complementary medicines. A summary of his department's work so far shows that, for example, there is no evidence for the effectiveness of homeopathy, reiki and iridology, but evidence for some limited efficacy of acupuncture in nausea and also for massage. His work is well received by the broad scientific community and mainly attracts criticism from those practitioners of alternative medicine who don't like his results. I am pleased to say that the Quackometer awards Professor Ernst 0 Canards.

Professor Ernst is a pretty rare fish though. The universities in the UK are beginning to fill up with quack academics who do research into alternative medicine and most of them appear to be little more than apologists for quackery. Third rate universities are offering bonkers degrees in homeopathy and the like in order to fill their quotas, get their money from the government and the gullible students, and in doing so add to the air of respectability for this huge multi-million pound con. Poorly reviewed and tame journals are set up to publish miserable pieces of work that could be torn apart by a sixth form student who understands the term 'randomised, double-blind controlled trial'. (Tip: buy this book - Trisha Greenhalgh's How to Read a Paper.)

One name that was offered to me was George Lewith and currently scores 6 Canards. Is this a reasonable score? Dr Lewith looks like an interesting character and may well share characteristics with Professor Ernst. He is a part time researcher at the University of Southampton's Complementary Medicine Research Unit. He has regularly appeared in print and in other media criticising some of the wilder claims of alternative medicine and published papers that show negative (as well as positive) results for alternative medicine experiments.

His main interests appear to be in acupunture and he has trained as an acupuncturist in China. Interestingly, he has tried to develop good ways of doing 'sham' acupuncture - the patient believes the needle has penetrated the skin where is in fact the needle is like a stage dagger. It withdraws into a sheath when pressure is applied. This is required in order to attempt blinded trials. How you blind the acupuncturist as well is another matter. Dr Lewith has published results showing that real physiological effects happen when you really stick needles in people. (Am I surprised? No. Does this give credibility to the claims of acupuncturists? Hardly. There is a long way to go from a real physiological response in people when you stick a needle in someone to proving all that stuff about meridians, blocked chi and curing everything from chronic pain and anaesthesia to constipation and drug addiction.)

So, interesting stuff from Dr Lewith. However, what is a little more difficult to get to grips with is that his day job is at a private alternative medicine practice in Southampton. Here a range of alternative medicine is offered to customers, including acupuncture, herbal medicine and homeopathy. Despite, Dr Lewith's many criticisms of alternative medicine, is he still practicing such techniques as part of his job? Does this mean he deserves his 6 Canards? How do you reconcile him being 'one of the good guys' with him just being one more alternative medicine practitioner.

Well, one way would be if he practiced within his extensive knowledge of the evidence for the effectiveness for such treatments. Maybe acupuncture for some nausea prevention and so on. But homeopathy? The best clinical evidence is that is provokes a placebo effect and nothing else. Science tells us it can have no other effect as we have discussed recently. So does a Good Homeopath just use their sugar pills to act as a placebo? Undoubtedly some people will benefit from a long consultation and a placebo. If you are undergoing a prolonged nasty conventional treatment or suffer from some difficult to cure chronic pain, then such treatments may alleviate psychological difficulties and so on. If so, it would be hard to condemn someone working in this way as a quack.

So, how do you tell a Good Homeopath from the quack? Now we are in trouble. The difficulty is that in order for a placebo to work, the patient must really believe that they are getting a treatment that is going to be useful to them. Long consultations, a 'holistic' and 'individualised', approach, careful prescription of the differently labeled sugar pills, all add to the air of the shamanic ritual that can lead to the hypnotic response of the placebo. So the Good Homeopath has to be a damn good liar to their patient. Any hint that they are just going though some mumbo-jumbo ritual and the deal is off. Herein lies the paradox. The Good Homeopath has to lie through their teeth, treat the patient as if they were just one more credulous sucker and go against all that new-fangled patient-doctor relationship stuff involving informed, consultative decision making that doctors are expected to do these days.

A doctor with a homeopathic practice cannot let slip that they know it is a placebo ever. Dr Lewith has written many times about the effectiveness of homeopathy for various treatments. Is this part of the charade? We cannot tell - that is the paradox. The Good Homeopath has to appear as indistinguishable from your common or garden quack in order for their placebo interventions to work.

My challenge to the Good Homeopath would be this: that in behaving as such, are you not adding to the air of respectability that we find on the pages of the Sunday supplements where such diligence may not be observed? I think that for this reason the Good Homeopath still needs a few quacks on the quackometer.

postscript:

The Good Homeopaths in the UK has received a body blow today and I am surprised they are not making a fuss. New legislation has come in that allows manufacturers of sugar pills to put claims about what they are 'good for' without any evidence to their efficacy. Yep, the makers can put their canards on their advertising and labels without any proof of what they say. This is not going to benefit the Good Homeopath who has to go through the long expensive trouble of providing the 'complex intervention' of the consultation for the placebo to kick in. Now, someone can just walk into Boots and pick up the 'right pills' for them. Big Pharma wins again.

I would be furious if I was a Good Homeopath.

Labels: homeopathy