David Colquhoun
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It is fashionable to think things are true for no better reason than you wish it were so. Anything goes, from fairies, crystals and Ayurvedic medicine (as advocated by Cherie Blair) to fooling yourself about WMD (as advocated by her husband).
The latest sign of this trend is a report to the Department of Health from Professor Michael Pittilo, Vice-Chancellor of the Robert Gordon University, Aberdeen. His May report - on acupuncture, herbal medicine, traditional Chinese medicine and the like - recommends that these therapies should have statutory regulation run by the Health Professions Council, and that entry for practitioners should “normally be through a bachelor degree with honours”. Consultation is supposed to begin around now.
Both of the ideas in the report are disastrous. The first thing you wanted to know about any sort of medical treatment is: “Does it work?” One of the criteria that must be met by groups aspiring to regulation by the HPC is that they “practise based on evidence of efficacy”. That evidence does not exist for herbal and Chinese medicine, which remain largely untested. For acupuncture the evidence does exist and it shows very clearly that acupuncture is no more than a theatrical placebo.
Placebos can, it is true, make you feel better; and if there is no better treatment, why not use them? That's fine, but it raises huge ethical questions about how much you can lie to patients, and how much you can lie to students who are training to use the placebos.
New Labour has often said that its policies are guided by the best scientific evidence, but the problem is that the answer you get depends on whom you ask. Pittilo's committee consisted of five acupuncturists, five herbalists and five representatives of traditional Chinese medicine (plus eleven observers). There was not a single scientist or statistician to help in the assessment of evidence. And it shows: the assessment of the evidence in the report was execrable.
Take one example, the use of a herbal preparation, Gingko biloba, for the treatment of dementia. On page 25 of the report we read: “There have been numerous in vitro and in vivo trials on herbal medicine... which have established the benefits of single ingredients such as gingko...for vascular dementia”. That is totally out of date. The most prestigious source of reliable summaries of evidence, the Cochrane Collaboration, says: “There is no convincing evidence that Ginkgo biloba is efficacious for dementia and cognitive impairment”. The NHS Complementary and Alternative Medicine Specialist Library (compiled by alternative medicine people) says: “The evidence that ginkgo has predictable and clinically significant benefit for people with dementia or cognitive impairment is inconsistent and unconvincing.” Since then another large trial, funded by the Alzheimer's Society, concludes: “We found no evidence that a standard dose of high purity Ginkgo biloba confers benefit in mild-moderate dementia over six months.”
The Government's answer to the problem is, as always, to set up more expensive quangos to regulate alternative medicine. That might work if the regulation was effective, but experience has shown it isn't. It makes no sense to regulate placebos, especially if you don't admit that is what they are. The Government should be warned by the case of chiropractors about the dangers of granting official recognition before the evidence is available. The General Chiropractic Council already has a status similar to that of the General Medical Council, despite it being based on the quasi-religious idea of “subluxations” that nobody can see or define. Recent research has shown it to be no more effective, and less safe, than conventional treatments that are much cheaper.
The problems that Professor Pittilo's recommendations pose for universities are even worse. You cannot have universities teaching, as science, early 19th-century vitalism, and how sticking needles into (imaginary) meridians rebalances the Qi so the body systems work harmoniously. To advocate that degrades the whole of science.
The vice-chancellors of the 16 or so universities who run such courses presumably do not themselves believe that vitalism is science, or subscribe to the view that “amethysts emit high yin energy”, so it is hard to see why they accept taxpayers' money to teach such things. Thankfully, the University of Central Lancashire abandoned its first-year homoeopathy course this week because of low numbers.
Fortunately there is a much simpler, and probably much cheaper, solution than Pittilo's: enforce the laws that already exist. It is already illegal to sell contaminated and poisonous goods to the public. It is already illegal to sell goods that are not as described on the label. And, since May 2008, new European laws make it explicitly illegal to make claims for any sort of treatment when there is no reason to believe the claims are true. At the moment these laws are regularly and openly flouted on every hand. Enforce them and the problem is solved.
David Colquhoun is Research Professor of Pharmacology at University College London. His blog is at dcscience.net
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