Hardly original, I know. But kudos to Martin for his entrepreneurial spirit in finding a way to charge £15 for the privilege of reading him repeat what his target audience already believe to be true.

The unique selling point of DMTH is, as one reviewer put it,

It names the players, the committees, the organizations, the networks, the back room people and the front men and women who provide a distraction and tie up resources while the bricks are put in the wall.

OK, the second half of that sentence is gibberish but you get the idea. It names names and Martin’s target readers have bought into his notion that knowing who their enemies are will help them in their endeavours to continue conning us into buying their soothing chit-chat and worthless cult therapies.

Apart from a heavy dose of the tired old ‘science as rival ideology’ line trotted by anyone whose faith in anything from quackery to creationism is undermined by a wealth of scientific evidence, DMTH is a book of many delights. Here’s an early example but similar can found on virtually every page. From page 15:

Those described in the pages of this handbook are often undemocratic, antisocial elements, greedy, culturally ignorant individuals who put their abstract scientific ideology, their own careers and the profits of corporations they defend ahead of the citizen’s needs or health care; many of them are members of disguised pharmaceutical lobby groups. At the centre of this operation, in Britain at least, is Dick Taverne…

It may strike readers that he already sounds more than a little insane. The best is yet to come but first, let me give an illustration of just how thorough Martin’s research was:

Of Zeno, who advertises his blog as  ‘the random thoughts of a skeptical activist’,  Martin writes,

Should read virtual sceptical activist. Why would a scientific Skeptic be proud of writing about random thoughts?

Of Alan Henness, Director of the Nightingale Collaboration, he writes,

Active organising skeptic and humanist campaigns, such as the one concerned with ending religious beliefs.

If you don’t know about the campaign that is “concerned with ending religious beliefs”, that would be because it doesn’t exist outside of Martin’s imagination. More to the point, it seems Martin hasn’t managed to work out that Alan Henness and Zeno are the same person even though this is stated this clearly on Zeno’s blog. Furthermore, even though Zeno has blogged the story extensively, Martin says nothing of Alan’s 500+ complaints about chiropractors, which resulted in hundreds of chiro websites removing the false and misleading claims that used to be on them and which was the inspiration for setting up the Nightingale Collaboration which, by the way, is described by Martin as “a group of maggots”.

There are several similar examples of Martin failing to reveal what his readers might think is worth knowing. All things considered, if Martin’s readers really want to know anything useful about their detractors, they’d probably be better off doing their own research.

Quackademic

I’d wager that the only place Martin J Walker’s body of work on his favourite topic is mentioned in the same sentence as the phrase “academic writing”, is in a book written by Martin himself. Et voila! From the preface of DMTH:

 One of the reasons my work stands out from much academic writing is that, until relatively recently, I was one of the only writers in the field who discussed named individuals.

One might infer that his work is, in fact, rather better than academic writing because he “discusses” named individuals. In DMTH, for example, he discusses Tracey Brown, director of Sense About Science, thus:

 Another amateur magician, she metamorphosed before our very eyes from a revolutionary communist to a close colleague of Dick Taverne, the great PR artist – now there’s a trick and a half!

That was one of the more benign of Martin’s “discussions” of a named individual and I think we can agree that it does indeed stand out from academic writing. In fairness, Martin doesn’t actually discuss people; he just writes stuff about them or, in the case of bloggers, about their blogs. Imagine reading my quackolades column (see lower left) in book form. That’s pretty much what reading DMTH is like.

Other examples of  Martin’s great exposé of quackbusters that stands out from academic writing  include:

Andy Lewis’ Quackometer “brings to mind the old feminist adage, many men are like children but without the wisdom”.

Crispian Jago is a “laddish pharma agent” who “has an imagination by-pass”.

Martin Robbins’ Guardian column is “yet another aspect of the illiberal Guardian and its fascistic war against freedom of choice in health care”.

“So what’s to say about this obsessed and bigoted old bloke Colquhoun — not much”.

And so it goes on and on and on. Usefully, the book does provide the urls of many skeptic blogs and websites and I’m sure there’s a good reason why Martin didn’t just put them all, together with the rest of the content of DMTH, on a website of his own, instead of asking his readers to buy it as a book. A website would have been much cheaper to fund. I mean, it’s not as if he had some reputable publisher who couldn’t wait to pay him for the book.

Ethics

An insight into Martin’s personal code of ethics and why he ­— unlike so many of his targets — has to resort to vanity publishing, is provided by a curious disclaimer included at the end of the preface. Entitled Perhaps an apology, it concedes the possibility that he may be doing someone or other an injustice in what he writes about them. It seems that in Martin’s world, it’s OK to write anything you like about people you don’t know, as long as you acknowledge somewhere that it might not be true.

The disclaimer includes this extraordinary sentence,

 While those I might have maligned, albeit slightly, can draw respite from consideration of the fact that any criticism is accepted only by the consipiracy theorist lunatic fringe. (sic)

Yes, I know it reads like an incomplete sentence but that’s just how Martin writes. Remove the word ‘while’ from the beginning and we are left with a suggestion that whatever he says about people he vilifies, they can console themselves with the knowledge that it is only going to be believed by loonies. Of course, we already know this but what a way to talk about his target readers! He goes on to suggest that the people he attacks will be proud to have been targetted by him. He’s flattering himself a bit there. Given Martin’s lack of status, I imagine most will be indifferent, though if I were Jack of Kent I’d be mortified at Martin’s description of him as a “seemingly honest blogger” when the only other people Martin is nice about are quacks and charlatans.

Here is some more from the preface:

Those described are first ‘quackbusters’ pure and simple i.e. those who attack manufacturers, users and practitioners of alternative medicines, pretending to a knowledge of science when they are actually involved in the tawdry business of enhancing corporate competitiveness.

The term ‘quackbuster’, is a term he is swift to reject, funnily enough. Several paragraphs are spent in consideration of the best epithet for, as he puts it,

the movement or the individuals so intent on untruthfully defending technological advance regardless of adverse reactions and unlooked for consequences.

‘Agents of industrial science’, ‘pharmalackeys’ (sic), ‘pharmamafia’ (sic), ‘enemies of promise’, ‘enemies of self-empowerment’ are all given an airing before he settles on the pithy ‘health corporatists’.

As someone who has never worked in science, health, pharmaceuticals or anything connected and whose only skeptic activity — apart from winding up quacks on this blog — has been to complain about some of the unconscionable claims made to my face by those who profit out of fake medicine, it comes as something of a surprise to find my own name in a chapter entitled Health Corporatists: individuals. It is accompanied by a sentence containing information about me which is irrelevant, innocuous and, as it happens, untrue. As this rather flattering nugget of misinformation can be read in Martin’s book and nowhere else — I certainly hadn’t seen or heard it before — I conclude that it’s one he fabricated himself because, well, he’s got my name and he had to write something.

But who cares? Martin obviously doesn’t know where to find the real dirt about me (phew!) nor about anyone else, judging by the drivel he writes about people I know. As I wouldn’t want anyone else to waste their money, I’d like to announce a special offer to readers:

As what he says about Ben Goldacre is a good illustration of the quality of argument in the book and another reason why it “stands out from much academic writing,” I’ll share some of it here.

Martin tells us that BG, “came from nowhere to take a prestigious columnist’s job at the Guardian” and that, “it was unclear why he had landed the job on the Guardian until it was disclosed by John Stone that he is the son of Oxford professor Michael J Goldacre”.

Apparently they thought it a secret. I wonder if they’ve discovered the much more interesting fact of who is Ben’s mother is. What does it have to do with Ben getting a Guardian column, anyway? This:

1. Michael J Goldacre once co-authored a study of a GlaxoSmithKline product (urabe-strain MMR vaccine).

Interestingly for one who claims  to “reference all [he] can and to be as academically honest as possible” (page xiv), Martin doesn’t give a reference for the study Michael Goldacre did for GSK but it’s easy enough to find and it turns out to be a study whose conclusion is unfavourable about the product and presumably the very opposite of what GSK were hoping for. Strangely, Martin doesn’t mention any of this.

2. Ben Goldacre wrote an article in the Guardian about MMR which went on to win an award sponsored by GlaxoSmithKline.

Note the common words that appear in 1. and 2. above: Goldacre and GlaxoSmithKline.  If you still don’t see how perfectly this explains how Ben got his prestigious column, then you’re probably not a member of the alternative therapy/anti-vax cult. If you were, the mere mention of GSK in the same sentence as each of the Goldacres would be all you needed.

This is typical of the standard of “argument” throughout the book. The only people who might be persuaded of whatever message Martin is giving — which, in this example, seems to be that there is something sinister and big pharma-related about Ben getting a column in a newspaper — are those who will believe anything they like the sound of. That’s how they become quacks in the first place, remember.

Martin also makes the claim that Ben Goldacre accepted payment for the use of his name “to help to sell processed food.” Seriously, it’s on page 29. You may be wondering what kind of evidence is produced to support this outlandish allegation. The answer is none. It is, like so much in this book, something that Martin seems to have pulled out of his arse.

Libel

Which brings me neatly to the only other thing worth highlighting in the book. From the preface, again:

In England particularly, [discussing named individuals] causes many problems. The other side know that they have the funds, experience and lawyers to begin legal actions that can tie up writers, researchers and practitioners for years, while WE are always strapped for cash and most lawyers will run miles, unsuitably dressed, rather than shake my hand.

Don’t bother billing me for a new irony meter. Instead, let’s take a moment to remind ourselves of the libel actions taken by quackbusters against quacks, anti-vaxers, vitamin-pill pushers and suchlike. Um…anyone got a list? Because Martin hasn’t.

OK. Now, how about libel actions taken by those people against quackbusters? Here are a few recent ones that spring to mind:

1. Matthias Rath, vitamin entrepreneur and, in my opinion, probably one of the most evil people alive, sued Ben Goldacre for libel but, after a year, dropped the suit and was ordered to pay costs. Unfortunately, due to the litigation, the chapter on Matthias Rath was omitted from the first edition of Ben’s book but he made it available for free on his website,  so there is no excuse for not reading it and finding out just how evil Rath is.

Given Martin’s spirited support of the food supplement industry’s right to con people into buying supplements that they don’t need on the grounds of allowing “individual freedom of choice in health matters” (page 241), Rath is the kind of person Martin presumably sees as a good guy.

2. The disgraced Andrew Wakefield sued Brian Deer for libel, only to abandon his claim and end up paying Deer compensation. The court report reveals that, having filed a suit against Deer, Wakefield then sought a stay of execution of the suit and, while it was on hold, used it as a way of threatening others with similar action.

Wakefield — the man whose fraudulent paper resulted in anti-MMR hysteria, falling take-up rates and made measles endemic again in the U.K — is, of course, one of Martin J Walker’s heroes. Brian Deer, who earlier this year received a British Press Award  in recognition of his Sunday Times investigation into the Andrew Wakefield MMR-autism fraud, is Martin J Walker’s nemesis.

3. Edited 15.11.11 to draw attention to Andy Lewis’ latest blog post on this very topic. Three threats of legal action from three different quacks in attempt to gag this blogger because he told the truth about them. Shame on you Society of Homeopaths, Joseph Obi and Robert Delgado. You’re no better than crooks.

4. The BCA sued Simon Singh but eventually dropped their case when it became obvious they were going to lose.

Now read this from DMTH page 18:

The corporate science lobby ran a campaign to change the libel laws headed up by Singh. The campaign was started after Singh wrote a deprecating article in the Guardian about chiropractors. This campaign was important to the science lobby because they needed to be free of the constraints of libel law so as to be able to attack in the most outrageous manner anyone who has different beliefs from them.

When I first opened DMTH, I imagined I would be reading the sincerely-held views of someone delusional. Reading the above paragraph disabused me of that notion. Nobody can be that delusional. Brian Deer says Martin is a liar for hire. I agree. From Brian’s article (but do read the whole of it, it’s well worth it):

 The most startling array of particularly nauseating falsehoods were authored by a now-64-year-old failed graphic artist who calls himself “Martin J Walker”. He lives penniless in Spain, but in July 2007 surfaced in London at mammoth hearings, triggered by my investigation, of a GMC “fitness to practise” disciplinary panel. He claims to be some kind of “health activist” and “writer”, but although generally of no consequence, is a relentless peddler of smear and denigration, with a track record of latching onto the vulnerable. These he beguiles, like he’s their new best friend, and then he tries to sell them self-published junk books, or better-still, have them give him money.

“I am 60 next year and I have been and am now, utterly broke and also in debt to various people for relatively large amounts of money,” he explained in a private email not long before he spotted in the Wakefield case what he thought was a financial opportunity. “I am not a writer to whom agents and publishers have ever paid the slightest attention.”

So, Martin J Walker has no reputation as a writer to live up to. His self-published books are funded by donations from people who want to read what he writes, regardless of whether it accurately reflects reality, because it fits in with the standard quack fantasy about anyone who challenges the claims made by quacks, anti-vaxers and vitamin pill pushers. As such, Martin has no power to influence anyone who matters, which is why — in spite of the many malicious falsehoods contained in the book — he’s unlikely to find himself on the receiving end of legal action. My understanding is that for a libel suit to have a chance of success, the libel has to be likely to be damaging. Who’s going to be damaged by anything written in a self-published book by an under-achiever?

Which is why I’m happy to give Martin’s book a bit of publicity. I hope it helps him pay a few bills.

There are heartfelt testimonials on various internet fora from people she has helped — mostly CFS sufferers who hadn’t been helped by the NHS and who were desperate enough to turn to a private doctor with a  website containing some highly questionable assertions about a range of health issues. I’ve no reason to doubt the sincerity of the stories of recovery from grateful patients. Those telling them demand to know why the only doctor who has actually helped them is being investigated by the General Medical Council (GMC) and faces losing her licence.

Yesterday Dr Myhill attended a hearing of the GMC’s Interim Orders Panel in connection with two complaints made about her. The first complaint, by a group of doctors, was filed in June 2009 and apparently concerns Dr Myhill’s recommendation on the strength of one blood test that a young patient with a neurological disease, whom she had not met nor seen the medical notes of, be administered B12 and magnesium sulphate injections

The second complaint was filed a few weeks ago. The complainant, who posts on the Bad Science forum under the name of ‘Jonas’, started a thread over there with the announcement that he’d made a complaint about a range of recommendations Dr Myhill makes on her website. These, Jonas argued, are contrary to national guidance and safety limits and so may place people at risk. The recommendations are in connection with nutritional supplements, heart disease, contraception, breast cancer diagnosis and vaccines. None of this complaint appears to be about treatment relating to CFS, with the possible exception of the vitamin supplements.

The purpose of yesterday’s hearing was to decide whether any interim order should be placed on Dr Myhill pending the full hearing of the complaints. The worst case scenario for her would have been suspension for up to 18 months. The panel were not required to decide on matters of fact but on whether Dr Myhill was acting within her competence and expertise as a physician and whether there might be a need to protect the public in any way. They concluded that she probably wasn’t and there probably was.

Dr Myhill is now forbidden from prescribing any prescription-only medication and has been ordered to remove from her website content relating to the following:

• The medical management of cases relating to cardiology, or cardiovascular disease including; chest pain due to ischaemic heart disease; acute coronary syndrome; heart failure; or pulmonary embolus;
• The treatment of asthma;
• The treatment, testing, identification, diagnosis or management of breast cancer;
• The use of hormonal contraceptive medication;
• The pharmacological management of primary or secondary prevention of vascular disease;
• Any immunisation or vaccination;

They have also placed a range of restrictions on her with regard to seeking employment. See the hearing transcript and full verdict here.

Naturally, Dr Myhill will be very distressed as will her supporters. I’m not sure to what extent the CFS sufferers might be affected by her inability to prescribe prescription-only meds; I’ve seen speculation that it will have a catastrophic effect while they will be largely unaffected by the changes to her website.

I fully accept that CFS is an identifiable condition and that it can have a life-shattering effect on sufferers, a couple of whom I have known. (I recommend an account from Margaret Nelson’s blog: ME and me and the Daily Mail.) I have no opinion on the causes of CFS because I haven’t read enough about it. I am aware of some of the conflicting ideas about these. Indeed, I am aware there is conflict over the very existence of the syndrome. At one end of the spectrum seem to be arch cynics calling it a fake disease adopted by malingerers; at the other end are sufferers who take furious exception to anything that they rightly or wrongly interpret as implying their condition is pyschosomatic.

Medical opionion is divided but those who claim some degree of expertise, while disagreeing over precisely what it is and the likely causes, do apparently agree that the syndrome exists. Prof Simon Wessely is beyond the pale for some sufferers because of a perception on their part that he doesn’t allow the possibility of a physiological cause (edit: see comment below from Prof Wessely); Emeritus Prof Malcolm Hooper takes a contrary view to that of Prof Wessely. In a paper published last year, Dr Myhill summed up these two positions thus:

• Hypothesis (A) the metabolism of people with CFS is normal, but the fatigue and other symptoms are due to psychological factors.
• Hypothesis (B) there is a metabolic dysfunction with the result that not enough energy is being produced.

Sliding off the edge of reason at the angry sufferers end of the spectrum are the conspiraloons who see the GMC investigation into Dr Myhill as a ‘witch-hunt’, a view Dr Myhill shares. Unfortunately, the real and very important issues raised by the latest complaint are getting drowned in the the sea of nonsense spewed out by this vociferous group.

These are some of the reasons and views I have collected from different people who subscribe to the witch-hunt hypothesis:

• There are other people, procedures, practices and meds that harm people;
• This is the umpteenth complaint to the GMC about her;
• The complainant is anonymous;
• She helps people;
• She harms nobody;
• None of the previous complaints has come from patients and nor does this one;
• A person who genuinely had an issue with the website would complain to the  owner in the first instance

Let’s consider these in turn:

‘What about the other people, procedures, practices and meds that are harming people?’

The argument that if one cared about people’s health, one would be targetting things that really harm it, is made repeatedly by some of those supporting Dr Myhill so I’ll deal with it briefly. The fact that people have complained about Dr Myhill doesn’t mean they don’t care about anything else or that they are doing nothing about anything else. The only thing of importance we know about the complainants is that they made these particular complaints. Anything else is speculation and not an argument.

It’s the same point that gets made repeatedly to skeptics. “I wish you could find a space in your evidently caring heart for the thousands and thousands who die each year at the hands of ’scientific’ medicine, or don’t those matter?” said one commenter on this blog. In the interests of balance, I’ve been told, I should blog more about what they want to read and less about what I want to write. As if there weren’t enough people writing about the wrongs of scientific medicine already and as if my writing about it as well is going to make any difference to anything.

Anyway, back to the witch-hunt:

‘This is the umpteenth complaint to the GMC about her.’

There have been a number of previous complaints about Dr Myhill. These have all happened since she left the NHS and moved to private practice in 2000. I understand that all or most of these previous complaints concerned her recommendations on prescribing thyroid hormones. (I’m getting my information from her defence statement; I stand to be corrected if I’ve misunderstood.) The point is that these earlier complaints seem to be about something different from the latest two, which are different again from each other, though the common denominator is the allegation that some of what Dr Myhill says and does is potentially harmful.

Whereas, to a disinterested party, the fact that there have already been several complaints against her might set off alarm bells, to her supporters the important thing is that these previous complaints were unsuccessful. That there should be yet another complaint when there have been several unsuccessful ones already, confirms their darkest suspicions: Dr Myhill is being deliberately targeted by the GMC, who will use any excuse to stop her helping people. That previous unsuccessful complaints should serve as reason enough not to consider any more is a very curious argument, yet to her supporters it makes perfect sense. Look at the petition, for example,

We the undersigned wish to register our strong objections to the GMC (General Medical Council) over the witch hunt campaign to discredit Dr Sarah Myhill. This is the 6th time that Dr Myhill has been subjected to such a hearing and enough is enough!

That is one of the most idiotically-worded petitions I’ve ever seen and I don’t think I would sign a petition for someone I supported if it was worded like that.

Let’s say, for example, somebody I know and love keeps getting arrested and questioned for various crimes but none of the allegations stick. The sixth time he’s arrested I’m definitely thinking, ‘This isn’t fair. They’re just picking on him — what have they got against him? Who benefits from his conviction? They’ve never been able to prove anything against him — he’s obviously innocent’. This is somebody I know and love, right? I’m allowed, in my distress, to be irrational in my thinking.

Once I think about starting petitions and campaigns, however, I hope I’m going to run it past someone more objective than I’m capable of being in the circumstances. Hopefully I’ll realise that, even if he was innocent before, that doesn’t mean he’s innocent now; if a complaint has been made it still has to be investigated and an argument like ‘enough is enough’ isn’t, well, enough to not investigate it.

To an objective bystander like me, the idea that GMC members themselves are conducting a witch-hunt seems a bit silly. If someone submits a complaint, they can’t just say, “Flaming Norah! Not this woman again. Look, we’ve already thrown out a number of complaints about her already so let’s not waste time on any more.”

A bit more plausible is the idea that the complainants themselves are conducting a witch-hunt: a bunch of people don’t like someone so they take turns to make vexatious complaints to the employer, regulatory body or whatever. But why would they target a doctor that helps people and harms nobody? This is where we get the full chorus of cacophonous loony tunes.

After ‘Jonas’ announced on the Bad Science forum that he had complained about Dr Myhill, a vitriolic thread was started on Phoenix Rising, a ME/CFS forum, apparently for the purpose of hissing and spitting at posters on the Bad Science forum. The PR thread contains the usual nonsense about Big Pharma paying ‘shills’ to post on internet fora as well as some less than complimentary comments about Bad Science posters in general. The thread also contains this post on page 3:

As far as I am concerned this is Goldacre on a further a self destruction course. He is providing amo for the proposal I have made to report him and his website to the GMC. They have already set a precedent by taking a case against Dr Myhill. So let the junk and attacks continue on his site, save them, don’t reply and let them build their own case against themselves. We will just have to forward to the GMC. If this is not putting patients at risk as Dr Myhill was so pathetically accused I don’t know what is.

Thankyou Ben Goldacre for being the author of your own misfortune, yet again!!!

Can one fault the reasoning here? Ben Goldacre owns a website with a discussion forum and, athough he rarely posts there himself, he is responsible for everything said on it including any unpleasant comments about Dr Myhill, whether or not he personally expresses an opinion.

The idea that Ben Goldacre is somehow responsible for the latest complaint against Dr Myhill doesn’t stop with the Phoenix Rising ME/CFS forum. Take, for example, About.com’s Thyroid Disease Blog, authored by one Mary Shomom.

It is precisely because doctors like Sarah Myhill use successful approaches that are not part of the narrowly prescribed dogma that they are successful — but it seems that to the GMC, results and healthy, satisfied patients are less important than conformity.

So the GMC’s decision to pursue a case against Dr. Myhill raises a key question: who is the GMC actually trying to protect?

That is clear. The doctors on the GMC want to put her out of business. She is not part of the NHS, and she takes an integrative, holistic approach to treatment — which is an anathema to the old school NHS doctors. The GMC members are selfishly protecting themselves — their financial interests and their “status-quo treatment is best” egos — rather than protecting the health and safety of patient.

Have we got that straight? NHS doctors don’t like the “integrative, holistic approach to treatment”, so they want to ruin someone practising it outside of the NHS. There simply aren’t enough people queuing for treatments and using up the NHS’ finite resources already so they must stop those people from going to Dr Myhill after the NHS has failed them and bring them back and offer them more of the expensive but ineffective treatments they’ve tried already. Right, gotcha. I’m sure that is indeed why the complaints against Dr Myhill were made.

That Ben Goldacre is an NHS doctor who owns the Bad Science website is enough for Mary Shomom to write one of the most burningly stupid and gratuitous attacks on him I’ve ever seen. To show just how badly the stupid burns, here’s one sentence:

One also has to wonder whether Goldacre himself is actually the one who anonymously sent the complaint letter about Dr. Myhill as a publicity stunt to help sell books and get more media attention for himself.

Of course, writing an anonymous letter is exactly what you would do if you wanted publicity. Gah!

In the comments beneath the post (which include, by the way, some excellent comments in defence of Ben) we see evidence that the stupid is infectious in this gem:

The timing of this attack on Myhill from Goldacre’s site is interesting.

Goldacre doesn’t let on that he is “a member of the Royal College of Psychiatrists, and is a research fellow at the Institute of Psychiatry, King’s College London.” (Wikipedia). “Trust me I’m a psychiatrist” doesn’t sound so good, does it?

Goldacre is supervised by Simon Wessely, who has built a career arguing CFS and GWI are psychiatric conditions, the opposite of what Myhill thinks. Now it’s turning out they are real physical ailments, not just maladaptive beliefs, so the shrinks are lashing out wildly at anyone in reach, as their ship sinks.

It has never before occurred to me that Ben Goldacre is ashamed of being a psychiatrist. I wonder who held a gun to his head and forced him take it up? Next time I hear Ben repeat his favourite catchphrase, “Trust me, I’m a doctor,” I’m going to call him on it. But the most important thing here is the uncovering of the Goldacre-Wessely connection. Wessely, remember, is despised by some CFS sufferers. The latest complainant is a registered user on the website forum that Ben owns. Voila! A link between Wesseley and the complainant is established and it’s obvious Goldacre is a key player — maybe even the instigator — of this evil mission to destroy Dr Myhill. As Mary Shomon says,

A quackbuster is a quackbuster — and in the end, quackbusters are NOT on the side of wellness or truth.

Note to readers: In case you missed it, every bit of my paragraph above is sarcastic. It’s what happens to me when I read things that are unutterably and irredeemably stupid and that would be my description of the “arguments” that there is some ulterior motive — and someone other than Jonas — behind the latest complaint against Dr Myhill.

The fact of the matter is they haven’t a clue why anyone would bother complaining about someone so wonderful and they are desperately making stuff up. The thought that people might complain because they genuinely think that she is giving dangerous advice and they are genuinely concerned about the effects this could have on people’s health, doesn’t enter their thick heads!

‘The complainant is anonymous.’

Anyway, whoever complained had better not walk out alone at night, or so one blogger would like him to fear. That would be Rita Pal, who presents herself as a heroic NHS whistle-blower, which she may well be, I’ve no idea. I only know that what she writes about the latest complainant makes her sound like a complete nutjob. First she — like Shomon and numerous other commenters — labours under the misapprehension that the complainant is anonymous.

Perhaps the big girls blouse will fight like a real man and stop “hiding behind the skirts of the GMC”. Of course, identification is really easy really, we get the IP, we get the internet company and we get the address. It is about a 48 hour job if I put my mind to it…There will be no problems in outing Dr /Mr Anonymous. After that, we will do what was done to Dr Tim Woodman. The matter was faxed to all local papers, to every PCT and posted on the internet. In the end, Timbo became depressed. I can’t help it if some doctors make vexatious complaints then can’t sustain it.

Then she offers to give advice to anyone who wants to make complaints about — you guessed it — Ben Goldacre to the GMC.

Just to remind Ben — I don’t like him messing with my friends…So far two of my friends have gone down due to the Bad Science Forums. Either Ben controls it or he doesn’t. The choice is his. I though am highly pissed off — and not a lot of people like it when I lose my patience.

Oh get over yourself, you silly moo! (The deliciously ironic title of this piece, by the way, calls the Bad Science forum ‘crackport farm’.)

Let’s remind ourselves that the complainant only posted on Bad Science after he’d submitted the complaint and after Dr Myhill had commented on it on her own website. The Bad Science forum is just a place where skeptics hang out, a bit like an on-line SitP but without the guest speakers. Instead, everyone who registers, regardless of whether they are good, bad or ugly, can say pretty much what they like. It’s called ‘free speech’. The suggestion that the complaint arises from the Bad Science forums or from anyone other than the complainant doesn’t stand up to a nanosecond’s scrutiny.

Good tip about the IP addresses though, Rita. Obviously, I have the IP addresses of all the lovely people who leave their quackolades on this blog. I’m sure a quick email to their internet service companies will secure their names and addresses for me in a jiffy. Beware when you answer your front door, losers. [/more sarcasm]

It’s time to nail this one: the complainant isn’t anonymous. The complainant’s name and address are known to the GMC, while we can infer from what Dr Myhill says in the letter she sent to supporters on 9th April  that she knows his name.

However, on the basis of this unsubstantiated complaint by an anonymous complainant (I am told his name but not who he is), the GMC have decided that “there is a potential risk to public safety”.

In her defence statement Dr Myhill elaborates:

I do understand and respect the complainant’s request for anonymity and have no desire to know his name or whereabouts. However I did wish to know whether he was acting out of personal concerns or if he was acting for a third party. I wanted to know this because in the past other practitioners of nutritional medicine have been harassed by investigative journalists.

On the Bad Science forum, Jonas mentions he’s a junior health professional.So if Jonas is a doctor or a nurse or a physiotherapist or a dietician, or even if he is an investigative journalist representing other interests, it makes what difference, exactly? None. What matters is whether the complaint has any merit, regardless of who filed it. (Edit: according to the hearing transcript Jonas is a UK registered Clinical Scientist.)

Dr Myhill’s supporters do her no favours by banging on about this being an anonymous complaint but, unfortunately, they are taking the lead from her in this as in everything else about the case. Dr Myhill has already made much of the original post Jonas made on the BS forum. She quotes from it on her webpage: ‘Our anonymous complainant has announced himself on the internet’ and again in her defence statement. In case her supporters had missed seeing it, she read it out in her speech to them outside the GMC yesterday. This can be seen on youtube, nearly five minutes in. “And I quote from what he put online verbatim!” she says, angrily, before reading out some of the post and making clear from her tone her contempt for its contents.

Notably, what is missing from each of her accounts of Jonas post, is the actual substance of his complaint, i.e. the links to the pages on her website that contain the (allegedly) harmful recommendations he has complained about. These have always been quite visible in the post and there would have been little point in his posting without them. They are what his complaint is all about, what he is inviting other posters to comment on and they are what the GMC is being asked to look at. Yet they are ignored by Dr Myhill, who appears to think there is some advantage to be gained by quoting the rest of his post ad nauseum and theatrically describing the GMC’s position on the complaint as

Setting my opinion against an anonymous observer and coming down on the side of anonymity.

And perhaps there is, if the intention is to divert attention away from the substance of the complaint and vilify the GMC by implying the complaint they have agreed to investigate is frivolous, unsubstantiated and anonymous.

‘Dr Myhill helps people, harms nobody and no patient has complained.’

Outside the GMC premises in Euston Road yesterday, dozens of Dr Myhill’s supporters gathered, some of them holding placards saying they owed their life to her, all of them angry at the way she is being treated. Many more supporters have posted vivid accounts on the internet of the desperation that drove them to turn to Dr Myhill and of the improvements they’ve made since being treated by her. Behind much of the anger at these complaints lies the fear that someone who is helping people who’ve suffered horribly with CFS may lose her licence and won’t be able to continue helping them or help others who are suffering.

I am not qualified to comment on the treatments Dr Myhill gives to CFS patients or to anyone else. Let’s just say, for the sake of argument, that Dr Myhill has stumbled upon a treatment regime that really does help many sufferers. It would indeed be a terrible thing if she were not able to help them anymore. I am already desperately sorry if the restrictions placed on her yesterday mean that ill people will suffer.

I am equally sorry if anyone suffers as a result of misinformation on her website. I know it can be difficult to imagine that someone to whom you feel indebted can be guilty of anything but I’m sure you’re not too blinkered to acknowledge that the fact that she might be doing some things right doesn’t preclude the possibility that she’s doing other things wrong.

Hand in hand with the argument that she helps people, is the one that she’s done nobody any harm and none of the complaints against her comes from patients. I have to wonder if they are being deliberately obtuse when they say this. This is what Jonas says,

The complaint does not focus on matters of opinion that I may not agree with. It clearly identifies specific examples where, according to national guidance and safety limits, patients may be being placed at risk. It does not mention anything about any financial aspects of Dr Myhill’s practice. It does not target her approach to diagnosing/managing specific conditions such as thyroid disease or CFS.

The complaint focuses on what I consider to be specific examples of dangerous practice that are a risk to patient safety.

I can’t see a way of putting it any clearer. If someone can point to specific examples of advice given that contravenes national guidance and safety limits, these having been determined by the weight of scientific evidence available, how can it be wrong to complain about it?

I’ve heard a range of responses to this question, from ‘the complainant is wrong; the website content is scientifically supported’ to ‘the national guidance is wrong and Dr Myhill is right’ to ‘some of the stuff is quackish but it doesn’t post a significant risk to health’.

The vaccination pages

For all I know, there may be some truth in all of these responses. But I also believe there is substance to Jonas’ complaint and I defy anyone to actually examine the pages complained about (if they are still there) and say that there isn’t. I’ve limited my reading of Dr Myhill’s website to a few articles, mainly those on immunisation which, for reasons I won’t go into, is something I feel rather strongly about. What I’ve read is, in my humble opinion, indefensible.

On 18 April jdc wrote a blog post criticising Dr Myhill’s web article entitled, MMR vaccination — should my child have it? The following day the content of that page had been removed and replaced by this notice:

Update April 19th 2010

I have received several emails from authorative sources who tell me my information on vaccinations is out of date. Thank you very much for getting in contact! This page was originally based on a lecture which I attended in good faith!

I am grateful for new information that I will incorporate as soon as reasonably possible!

This would have seemed a very positive and gracious response, were it not for the fact that she directs readers to her main article on vaccinations: Vaccinations — good or bad? (See pdf here.) Someone influenced by the opinions expressed in this article wouldn’t have their child immunised against anything. The fact that she includes a ‘recommended schedule’ for some vaccinations at the end of the article doesn’t mitigate the strongly anti-vax message and (what I believe to be) misinformation throughout the rest of it.

In the speech she wrote for her supporters yesterday, Dr Myhill made this controversial claim.

Lynn Gilderdale who died from ME aged 28 had her ME triggered by a BCG vaccination.

Lynn got the BCG jab at age 14. How does Dr Myhill know that Lynn’s ME was triggered by the BCG vaccination? When she actually delivered the speech, Dr Myhill helpfully departed from the script, just very slightly. (See the youtube vid at 2:50)

Lynn Gilderdale who died from ME aged 28; her mother tells me her ME was triggered by a BCG vaccination.

Spot the difference? How can it be ethical to present the opinion of a grieving mother as if it were an established fact? (Let’s not bother talking about Lynn’s death “from ME” actually being death from an overdose of morphine in an assisted suicide. Her mother was acquitted of her attempted murder.)

Amongst Dr Myhill’s recommendations, by the way, are that babies receive no vaccinations before six months and are kept at home. Is this advice — which is, I’m sure, much appreciated by mothers whose live-in nannies can be persuaded or coerced into staying at home with the baby for six months  — an example of the “holistic approach” revered by Mary Shomon and others?

As Dr Myhill evidently sets so much store by anecdote, here’s one from me.

My first baby got his BCG jab in November 1984 at eight weeks of age. This was followed, shortly after, by the DPT — the latter, I would add, accompanied by huge anxiety on my part, thanks to anti-vax scaremongering at the time about the whooping cough vaccine. His sister got the same jabs two and a half years later.

Their father worked long hours leaving me to spend twelve hours of every day with the two of them and no help from anyone else. We lived in a small flat. If, in the interests of protecting their health, I hadn’t been able to take them both out to toddler groups, friends’ homes and suchlike, I’d have ended up killing both of them and myself, probably.

When the MMR was launched after a year in which 16 children in England/Wales had died of measles, I was banging on the door of the clinic to get it for my two. Fortunately they, like every one of their similarly immunised friends, grew into strong, healthy adults who — unlike me — never knew the miseries of feeling ill and lonely and missing weeks of school because of a series of loathesome infectious diseases, which left some children of my generation with permanent disabilities and others dead.

On the basis of my anecdotal experience, I’m tempted to recommend that all children get all the jabs my children had, starting with the BCG at eight weeks, though you may as well stick with what the NHS is saying nowadays.

I don’t intend to spend any time on what else I think may be wrong with Dr Myhill’s site. A lot of it is coming down anyway and there is another thread on BS where people are posting on this very topic, which brings me to a final argument from Dr Myhill’s supporters and from Dr Myers herself:

Why couldn’t the complainant just complain directly to Dr Myhill about the content of the website?

I have some sympathy with this. It would have given her the opportunity to either convince the complainant that all the website content is sound or to change the content so that it is accurate. Jonas, however, points out that:

These complaints date back to at least 2001 and yet she still continues to practise in the same way and offer the same inaccurate information that attracts all of this adverse attention? She could quite easily continue to help the CFS patients, to whom she is quite clearly a benefit, without promoting such misguided and dangerous practices.

This is precisely why I chose to complain to the GMC as I felt that personal communication would simply be futile. Why would she listen to a junior health professional with only a few years experience when she has repeatedly resisted multiple challenges from her senior peers over the course of 10 years? We would probably still be debating the intricacies of thyroid function assessment many years later whilst her dangerous information continued to mislead patients and risk their safety.

This, as an argument, I find altogether more persuasive than any of those presented by her supporters, most of which aren’t arguments at all. The most intelligent post from a CFS sufferer — and one whose calm reasoning contrasts starkly to many that I’ve seen — was posted by a newly registered poster at BS. Here it is in full, with bold added:

I feel a little silly now, although not altogether regretful, to admit that a couple of years ago I took the ATP test on Dr Myhill’s site and then took to ‘prescribed’ supplements including injecting B12 and Mag. Although reading through the ‘inaccuracies in Dr Myhill’s website’ thread has made me feel very naive for doing so. At the time I was so ill, and so desperate to find a/. a diagnostic test and b/. some kind of treatment, that I know in my heart of hearts that I put aside my analytical thinking for the sake of hope.

And that’s the point, when you are ill and looking for information and hope you try and find any authority to give it to you. For me, it did me no harm (apart from financial (which in so small matter actually)), in fact it helped, but that’s not the point — what if I had been a patient with lung cancer believing that medical treatments wouldn’t work and supplements would? Or a mother who now believed that putting my baby on her side (rather than her back) is good protection for cot death?

I think it is such a shame that we (as the ME community) can’t see that the complaint is about the inaccuracies in the website that a Doctor shouldn’t be putting forward, and not an attack on the validity of the illness. The problem is that it is very hard to want to see the flaws in Dr Myhill when she is one of the only doctors out there offering actual treatment for ME/CFS (founded, unfounded, or er..otherwise). We want to believe! We want hope, and that sometimes blinds you to really being unbiased when looking into to these things.

Which is why this forum and others like it are important.

I hope that Dr Myhill is able to continue helping CFS sufferers, that her pioneering work is fruitful and justifies the loyalty her supporters feel for her.  As for the possibility that they might stop thinking about themselves long enough to see the truth of the complaint about the website — after reading Dr Myhill’s speculation over why the GMC have imposed such “fierce and inappropriate sanctions“, I won’t be holding my breath.

Edited to add: I’ve just become aware of an old thread on facebook on Dr Myhill that makes for interesting reading.

You may be wondering what possessed me to spend a day listening to a bunch of quacks talking piffle. Having done it, I’m wondering the same. The best I can say is that I went for the same reason I once consented to an examination by a chiropractor, wore a niqab and gave birth at home (not all at the same time) and why I might yet have a reiki massage and do the alpha course: I wanted to see what it was like. I saw it as part of the rich tapestry of out-of-the-ordinary experiences that life has to offer. What could be more bizarre than to sit listening to “top PhD research scientists” talk about one of the loopiest of all quack therapies as if there was a serious chance it could revolutionise health care systems in the developed world?

The conference, organised by the very scary Jayney Goddard of the Complementary Medical Association, was promoted thus:

Jayney Goddard ‘Homeopathy is nothing more than placebo! It doesn’t work and homeopaths are cynically ripping off vulnerable people!’ We’ve all seen these ridiculous headlines. So, if you are as fed up as we are of hearing this constant nonsense, do come along to the 2010 “Scientific Research in Homeopathy” Conference. This is a not-for-profit event that will give you the proof you need to effectively counter these arguments.

Jayney opened the conference with the declaration that, “Homeopathy is weird. We know it works but we don’t know how,” and promised us speakers “at the zenith of their profession.”

Are you ready?

Lionel Milgrom

Call me naive, but when I go to conferences I expect to hear professional presentations in keeping with the theme of the event.

I’d never seen or heard Dr Milgrom perform live before and I initially mistook him for some cocky little barrow boy from Billingsgate market who’d wandered in by mistake. But, according to the conference website, he’d had a “a long career as an academic research scientist”. Blimey, as Milgrom would probably say, he certainly kept his scientific credentials well-hidden during the hissy-fit he gave in lieu of a presentation.

The list of targets was predictable enough: Edzard Ernst, Richard Dawkins, David Colquhoun, Michael Baum, Simon Singh and Ben Goldacre all came in for a tongue-lashing as did the Sense about Science charity, with a special mention for the charity’s founder, Lord Taverne: “Dick by name, dick by nature,” spat Milgrom, to approving sniggers from the audience. But the main target for his venom was Evan Harris. “I’ve always voted Lib Dem before,” he snivelled, “but I never will again.” He announced that he’d written to Nick Clegg requesting that Evan be censured — “and I really hope he is!” See gimpyblog for a look at the letter.

It seemed a curious decision to kick off a purportedly serious conference about homeopathy and scientific research with a session that was little more than a rant about “the new fundamentalism”, as Milgrom describes the growing opposition to the unethical promotion and public funding of scientifically unsupported therapies. It also seemed curious that he should give a presentation that, as far as I can see,  was virtually identical to the one he gave at the first such conference two years ago (available here or, for anyone who’d prefer to read the same old guff in article form, try here). As an update on his last rant, we’d been promised a “critique” of the article by Michael Baum and Edzard Ernst on the truth about homeopathy, but nothing that could reasonably described as a critique took place.

It will come as no surprise that Milgrom gave the usual quackish misrepresentation of what was happening in the BCA v Simon Singh libel case (in spite of Jack of Kent’s hilarious post about him last year), sneered at the 10:23 event and at skeptic bloggers in general. And, of course, he called the meta-analysis by Shang et al (the one that reveals homeopathy to be the biggest cock and bull story since the virgin birth) the “best example of bad science worthy of Ben Goldacre”, which is what he said last time (see apgaylard), and which is, of course, nonsense. There were a few criticisms of the Shang paper but these have been more than adequately answered and, anyway, they had no effect on the truth of Shang’s conclusions. Milgrom is not the type of quack who would let the truth get in the way of good story, however.

If anyone’s interested in any of the…ahem…‘scientific’ content of Milgrom’s slot, I suggest you go and read Andy Lewis’s superb article about what he said at the previous conference and if that isn’t enough for you, I can recommend Shpalman’s collection of articles on Milgrom. As far as I’m concerned, he’s a waste of space and I’m not going to waste any more of my time on him.

19.4.2010: Edited to add link so you can read Milgrom’s rant now published on some quack website. Don’t all rush.

Alex Tournier

The demeanour of this charming Frenchman couldn’t have been more of a contrast to that of the horrendous Milgrom. Not only did he not slag anyone off but his was one of only two presentations at the conference that contained some science and it is rather sad that someone so well qualified is wasting their time on homeopathy. Dr Tournier is a biophysicist and a research fellow for Cancer Research UK. He is also chair of the Homeopathy Research Institute.

I don’t propose to say much about the content of his presentation because, although I took copious notes, I don’t have a copy of the slides he used. (Copies of all the presentations were promised to attendees; none have so far materialised.) Even with the slides, I found his argument difficult to follow and it was even more difficult to take him seriously after he’d introduced his session with probably the daftest remark made by any of the speakers during the entire day, which is that the principle of like treating like — the ‘Law of Similars’ — is “pretty uncontroversial”.

Say what?

It isn’t the first time I’ve heard a quack from a scientific background mention vaccines in the same breath as homeopathy and, coming from people like that, I can’t see the comparison as anything other than dishonest. I know a lot of homeopaths say things like, ‘homeopathy works by stimulating the body’s own healing power’, but they’re just stupid. That’s not an explanation!

Surely the ‘treat like with like’ — sympathetic magic — idea is every bit as controversial as the ‘more dilute = more potent’ nonsense. (The latter is what Alex Tournier described as the ‘Achilles heel’ of any theory of homeopathy, when really it’s just the part that most easily lends itself to ridicule.) The ‘Law of Similars’ has always been a huge stumbling block to acceptance as far as I’m concerned and I still await answers to the questions about it I have posed several times already in previous posts.

Tournier soon made his second ludicrous and dishonest assertion of the day, which was that homeopathy’s detractors never pick up on the similarity of the high dilutions principle and hormesis. Oh, good grief! I may not have a PhD in biophysics but even I know the difference between something and nothing.

Another reason why I didn’t expect to be blown away by Tournier’s presentation is that I’d read Gimpy’s analysis of what he said last time. To quote Gimpy,

…he indulges in the familiar deceit, misinterpretations and hypocrisy of homeopaths when it comes to evaluating scientific approaches to homeopathy

Exactly.

Anyway, as I can’t bring Tournier’s presentation to you, I’ll just c & p what he said in the pre-conference information and move on. (I’d skip it if I were you.)

There is presently no accepted scientific theory of how the high-dilutions involved in homeopathy might carry any physical effect, let alone a therapeutic effect. Several lines of enquiry have been followed over the years with little success. There is currently a great need for a testable theory of high-dilutions, such a theory might be that of Quantum Coherence Domains (QCDs).

Giuliano Preparata (1942-2000), an Italian theoretical physicist at the university of Milan, hypothesised the presence of QCDs in room temperature condense matter. QCDs emerged out of Preparata’s extension of Quantum Electro-Dynamics to include interactions with external Electromagnetic (EM) fields. In the case of water these hypothesised QCDs would be small volumes of water each one acting as a single quantumly coherent entity.

These QCDs have interesting properties in terms of a potential explanation of the phenomena linked to high-dilutions. These QCDs are predicted to capture the EM fields present at the time of their creation. This process could, in principle, capture the specific EM signature of any given substance. The serial dilution/succussion process involved in homeopathy could then be seen as a way of propagating QCDs around a sample (through succussions or, equivalently, vortexing) and eventually removing all trace of the original substance (through dilutions).

QCDs are currently being investigated as a potential explanation of a number of anomalous behaviours reported in experiments investigating solvation effects. In the context of high-dilutions a number of experiments have already reported some effects, although not in a fully reproducible way.

I will present an overview of the theory of QCDs and how, when applied to homeopathy, it offers a framework through which many of the observed phenomena can be investigated and potentially explained.

Kate Chatfield

Chatfield’s name will be familiar to anyone who’s been following David Colquhoun’s campaign against quackademia (snigger). She still leads an MSc course at Uclan but it’s only in homeopathy by e-learning, which would explain why Chatfield, who described herself as a “philosopher not a scientist” is considered qualified to take it.

Obviously, as she’s not a scientist, her session wasn’t remotely connected to science. Instead she promised, in her session, to address the question of whether it is unethical to prescribe homeopathy. Chatfield, a homeopath, concluded that it isn’t. Fancy that.

Steven Cartwright

How lucky am I that Azneo has produced a very nice wee blog post on the same presentation — right down to the quote from Sir Arthur Conan Doyle — given by Cartwright at another venue! Before you click on the link, allow me to indulge in a bit of blatant well-poisoning.

I’m sorry but I just have to share with you some bits from an article by the same Dr Steven Cartwright that was published in The Homeopath magazine in 1996.

Cartwright had several years experience as a homeopath and four years involvement in shamanism, when he travelled to Peru to learn about the shamanic healing practices of a tribe of Amazon Indians. He “knew intuitively that there were important connections between shamanism and homeopathy”.

My favourite bit is his description of how a shaman deals with a sick person who comes to see him and how it may take several visits before the shaman ‘sees’ what is wrong with the person.

The shaman would say that the spirits have shown him. And in that moment of ‘seeing’ the cure takes place. The singing that follows, the plant infusions that are given, all help; but unless the shaman has ‘seen’, no cure can take place.

This all sounds fair enough, doesn’t it? We are talking about a primitive people living in the Amazon rainforest, after all. I don’t suppose too many of them get the chance to go to university, unlike Steven Cartwright who, according to his conference profile, gained his PhD from Edinburgh University and spent many years as a research biochemist at Oxford University before discovering homeopathy. He continues:

The parallels with homeopathy were unmistakable. A patient can come several times to the homeopath, but only when we ‘see’ the nature of the patient’s sickness, only when we understand, can and does, cure take place…For the shaman it is the spirits who help him to ‘see’. The homeopath has only symptoms to help him or her to ‘see’. And intuition.

Now here’s the bit that made my jaw drop:

For those of us who do not follow the way of the shaman, there is a symbolic system above all others which is so versatile and which tells us so much about a patient and their state of being, including their heredity, even before they tell us their story, that it is invaluable as an aid to coming to the meaning of sickness; and that symbolic system is astrology. Astrology gives us access directly at the level of meaning, rather than manifestation, and that, to my mind, is its great value.

I’ve since learned that astrology — sorry, I mean medical astrology — is considered quite appropriate for incorporation into the homeoquack’s armoury. I am so tempted to book a consultation with Steven Cartwright just to hear him talk about ‘Mars in Scorpio rising’ or some such twaddle.

You may be wondering why somebody like this was speaking at a conference that has the word ‘science’ in the title. The answer is that he’s been involved in “experimental work at the Cherwell Innovation Centre in Oxford aimed at developing assay systems for homeopathic potencies as well as demonstrating changes in solution on succession, which it is hoped will eventually lead to an explanation of the mechanism of action of homeopathy”.

Steven Cartwright, bless him, comes over as a really sweet and personable man but he doesn’t half talk some hogwash. Here’s a sample taken down verbatim from his session:

Has anyone here given a remedy and it hasn’t worked, then given the same remedy further down the line and it has worked? (Murmers of assent.)

What’s happening?

The indications are that potencies oscillate in their effectiveness over time…What if James Maddox and James Randi had come to Benveniste’s lab on a day when the strength of the potency was at its lowest? And if they’d come when the strength of a remedy was at a peak, I wouldn’t be standing here now because Benveniste would have won the Nobel prize and it would all have been sorted.

OK, go away and read that other blog now, if you’re interested enough in what Dr Cartwright has to say. (As an alternative, I’d recommend yesterday’s interesting post by Prof Stephen Curry: Homeopathy and the Structure of Memory.)

By the way, if anyone doesn’t know the story of Benveniste, you could do worse than watch the 2002 Horizon documentary on homeopathy, which is now on youtube. The advantage of this is you get to see and hear Benveniste himself talk and he’s dead sexy. Well, just dead now, of course. Milgrom’s in it too.

Edited to add: Or see the Bienveniste story told in cartoon strip here — superb!

Oliver Dowding

We have huge “constituencies” of satisfied users consistently proving beneficial outcomes. These are satisfied users who generally have four legs, but in some cases, only two, and all come from the animal kingdom. Whilst not widely practised in this country, there are a great many more animal users of homoeopathy than sceptics are prepared to accept.

Yes, I know. This extract from Dowding’s conference profile is just begging for ridicule. You’re right, Oliver, I do not accept. Just put me in touch with some of these four-legged “users” and let them tell me themselves how satisfied they really are.

There is more of the same on this website, which he directed us to.

This article is written from the experiences I had in keeping 500 head of dairy livestock for 14 years, whilst managing the farm under organic principles.  I was meeting many health challenges that they faced, which we primarily resolved with homoeopathic remedies.  The overriding outcome and opinion formed was that cows are not inherent liars or fraudulent creatures!  They have no axe to grind, nor a commercial position to maintain or enhance.

There’s not more much I can say about this former dairy farmer, who was yet another speaker at this so-called science conference who began his session by declaring he wasn’t a scientist, had no degree of any sort in fact but he had “spent a lifetime doing things”. Well, that’s nice to know.

Dowding was as sour as Cartwright was sweet. Allopathic medicine is failing on a big scale, he told us, and we need alternatives. I’m sure he knew he was singing (or, rather, reading his speech word for word) to the choir but that didn’t stop him.

Like Lionel Milgrom, he felt the need to have a cathartic rant at the usual suspects — mainly Ben Goldacre — but also at the more humble everyday folk who like to challenge the promotion of dangerous nonsense on the web under “ridiculous pseudonyms”. I can’t think who he means. Strangely, the one he chose to focus on was my friend, Margaret Nelson, who makes no attempt to hide her identity in making her brief comment on libdemvoice.org, which Dowding read out because it ends with this throwaway line:

Oh, and if Oliver’s use of homeopathic “treatments” for his livestock causes them any suffering, he’s liable to be prosecuted on animal welfare grounds because it’s not treatment at all.

Dowding, to my astonishment, then read out his entire response, which is nearly a thousand words long! How surreal was it to be at a conference supposedly about scientific research listening to Worzel Gummidge read out some squabble he’d had on the internet? Honestly, it felt utterly bizarre. I will add that I go to quite a few meetings and conferences and if the humanists and skeptics I hear at them behaved like some of these people did, I’d have nothing to do with them.

Anyway, Worzel said nothing that was worth reproducing here so I’ll move swiftly on.

Clare Relton

During the conference, two conflicting views were expressed on the state of scientific evidence for homeopathy. One view is that there is loads of good quality scientific evidence that homeopathy works (Milgrom) and the other view was that there isn’t (Relton — though, in fairness, she implied this rather than said it in as many words).

Milgrom repeated the lie that “there are many good quality scientific trials and meta-analyses showing that homeopathy can demonstrate clinically observable effects over and above placebo”. Relton, on the other hand, while stating that since 1945 there have been some 200 RCTs published on homeopathy and that a new one lands on her desk every couple of weeks, repeated the argument so beloved of altmed devotees, which is that “lack of evidence of effectiveness is not the same as evidence of lack of effectiveness”.

Indeed it isn’t and it’s a perfectly reasonable thing to say in relation to a therapy that — unlike homeopathy — is scientifically plausible but hasn’t been trialled extensively. When a treatment that — unlike homeopathy —  doesn’t flout any fundamental laws of physics but — unlike homeopathy — hasn’t been subjected to rigorous scientific testing, then of course we can’t know for certain whether it works or not.

Take, for example, the extract from the foxglove plant, digitalis, which was originally part of an old folk remedy for heart disease and which is still used by homeopaths “for people who are prone to heart and circulatory disorders. The remedy is considered particularly appropriate if symptoms are accompanied by a fear of death, or a fear that moving — especially walking — may cause the heart to stop beating”.

For more than two centuries digitalis (digoxin) was considered a life-saver by physicians practising orthodox medicine as well.

…doctors based their ideas on their clinical experience and intuition, and knew that digoxin saved lives. They could see it working. The 1997 trial showed that doctors had been wrong on this point for two centuries. People who took digoxin lived no longer than those who swallowed a placebo. That was not because it was less ‘natural’ than chewing on a foxglove, simply because the effect of the active compound on the human body was not as miraculous as intuition suggested.”

Druin Burch,Taking the Medicine p. 237

When it comes to a therapy that has been tested in a couple of hundred RCTs and when the better quality trials demonstrate an effect no better than placebo….well, if that isn’t evidence of lack of effectiveness, I don’t know what is.

But for homeopaths — or any other breed of quack for that matter — if the science tells us something we don’t like, then there is something wrong with the science. Clare Relton used her slot to talk about clinical trials — the subject of her recently completed PhD. She was the most engaging speaker at the conference and her presentation was the only one I found vaguely interesting, though not as interesting as her story of how she flunked science at age 13, got a “motley collection of GCSEs” yet ended up being employed by the NHS to provide homeopathic treatment and is now a research fellow at Sheffield. She said she found the fact that she now earns her living from science “intriguing” and, having heard her presentation, so do I.

She mentioned her extensive experience of treating menopausal women with homeopathy. As someone who’s spent the best part of a year finding out just how bad the menopause sucks and how it can ruin one’s social life, I had no trouble imagining how nice it would be to spend an hour in the company of this charismatic woman. I could envisage her listening intently, maybe even holding my hand as she nodded sympathetically. Then she would prescribe an individualised remedy — a remedy just for me — devised after careful consideration of everything from my food preferences to my phobias (for a list of questions used in homeopathic consultations, see here). I have not the slightest doubt that if anyone can cure my menopause, Clare Relton can. A series of appointments with her and I’m sure the hot flushes would lessen in frequency and eventually disappear altogether. Yep, I’m convinced of it.

Anyway. Dr Relton talked about perceived shortcomings of RCTs and about her pioneering work on a new trial design: Relton et al BMJ. 2010 Mar 19;340:c1066. doi: 10.1136/bmj.c1066. Rethinking pragmatic randomised controlled trials: introducing the “cohort multiple randomised controlled trial” design.

Here’s an extract from the article:

We have obtained ethical approval for and have conducted a pilot study of the cmRCT design. (Relton C. A new design for pragmatic RCTs: a “patient cohort” RCT of treatment by a homeopath for menopausal hot flushes. [PhD thesis] ISRCTN 0287542. University of Sheffield, 2009.)

In this pilot, a large observational cohort of 856 women aged 45-64 was recruited and their outcomes measured. A total of 72 women reported frequent or severe menopausal hot flushes, or both. Of these 72 women, 48 were eligible for the trial treatment (NA) and 24 were randomly selected to be offered the treatment (nA). The outcomes of the randomly selected patients were then compared with the outcomes of those eligible patients not randomly selected (NA – nA) using both intention to treat analysis and CACE analysis.20 Patients were not told about the treatments that they were not randomly selected to be offered.

Now, here’s how she described to the conference audience, what she’d told the women selected to be offered the treatment:

There is a treatment that we think might benefit you but we are not sure. There doesn’t appear to be any risks because it is homeopathic, although there is not much evidence about it.

I don’t pretend to be any kind of expert in these matters but even I managed to spot a teensy-weensy problem with that scenario. We know by now (and, indeed, have known for more than 200 years) that the mere belief that a medical intervention is taking place can result in an improvement (or worsening) in some medical conditions. That’s why trials have control groups and why both groups are blinded. Isn’t comparing a group who know they are being treated to a group who know they aren’t, asking for bias? What am I missing here? I hope someone will be able to explain it to me — preferably someone who knows what they are talking about.

If you’re wondering why I didn’t pose this question to Dr Relton at the time, it’s because we were forbidden by Janey Goddard from asking questions in the sessions. The conference wasn’t an occasion at which conferring was encouraged until a brief all-speaker panel session at the end. Goddard said it was more “holistic” (yes, she really said that!) to save questions until the end of the day when, inevitably, there were too many — mostly daft — questions for the time allotted.

During her slot Relton also highlighted, with the help of the BMJ pie chart, “how little we know about the effectiveness of NHS-funded healthcare”. To her credit, she didn’t do what I’ve mostly seen quacks do with that pie-chart and claim that it refers only to conventional medicine when it fact it refers to all commonly used treatments including the one Dr Relton has spent years practising. She focussed very much on the 51% of treatments of unknown effectiveness (treatments “for which there are currently insufficient data or data of inadequate quality”) without mentioning the criteria on which treatments were included or left out so I’m not sure what point she was making. Funnily enough, she made no mention at all of the 13% of treatments of proven effectiveness and of the fact that homeopathy was not included amongst them.

Dr Rob Verkerk

Verkerk is a “compelling speaker who is also extremely personable,” said the pre-conference publicity. In fact, Verkerk, who has a PhD in something to do with agriculture comes across a dreary, whingeing and obnoxious gobshite, very much in the Milgrom mould. He is the Executive Director of the Alliance for Natural Health — whatever that is — and, like many of the presentations at this ‘Scientific Research in Homeopathy’ conference, his had nothing much to do with scientific research but, like Clare Relton’s session, focussed much more on dissing the methodology employed by scientific researchers because it doesn’t suit quack remedies.

He quickly endeared himself to the audience with a hilarious joke that went something like this: “It’s important to declare one’s biases and my bias is that I don’t like pharmaceuticals a lot”. His second bias is that he doesn’t like “corporate imperialism”. I’m sure you can work out one of his favourite themes from those two biases and his argument was so tired, I’m not even going to go there.

My interest was piqued when he informed us that “energy-based medicine” is central to some ancient tradition or other and that the only people who don’t understand it are orthodox physicians. But my hope that he was going to give some sort of explanation of this energy-based medicine was not realised, alas. Instead he told us his third bias is Ben Goldacre, whom he doesn’t think is a very good doctor or scientist. But then Dr Verkerk evidently doesn’t think that any doctor or scientist who considers the totality of available evidence for quack remedies and concludes that they are basically crap, is a very good doctor or scientist.

Verkerk talked about the difference between efficacy in the “ideal experimental world” and effectiveness in the “real world”. As every quack knows, the methods of research favoured by scientists tend to demonstrate a lack of efficacy in quack therapies and this, he whined, is mainly because scientific researchers ignore clinical experience, which isn’t what David Sackett intended at all. No, indeed! Then again, I don’t think he intended that clinical trials should be cherry-picked and the larger, better quality ones ignored. In his 1996 article in the BMJ, (which Verkerk mendaciously referred to as a “complaint” that clinical experience is being disregarded), Sackett said,

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

It follows that, as the best clinical evidence from systematic research of homeopathy shows it’s a crock, NHS funding for it should be withdrawn immediately.

Of course, Verkerk also had a go at Edzard Ernst. He went on about Edzard rather a lot, in fact. To give a flavour of what he said and the tone in which he said it, this is Verkerk reading from a systematic review of RCTs of individualised herbal medicine conducted by “Ernst and his chums”, in 2007.

“There is a sparsity of evidence regarding the effectiveness of individualised herbal medicine and no convincing evidence to support the use of individualised herbal medicine in any indication”…so says God! And it is utter rubbish! If only he was to look at what’s happening in a clinical environment…

If this conjures up a picture of a surly adolescent having a tantrum, I’ve succeeded in conveying my own impression of Verkerk’s session. If not, you might like to look at Verkerk’s written response to the same systematic review, in which he says pretty much the same thing and in the same way as he did at the conference.

Scientists like Prof Ernst have become so introspective over their worship of their reductionist methods that they fail to see how they do or don’t relate to the much, much bigger picture of how extremely complex and diverse natural substances interplay with even more complex and diverse genomes. This truly is an abuse of science.

Worship of reductionist methods? Enough already! I really can’t be bothered to transcribe the rest of what this guy said. Let’s just consider that the pre-conference publicity said the main purpose of Verkerk’s session was to “outline a potential way forward aimed at facilitating greater acceptance and uptake of homeopathy by mainstream medicine”.

This is what he said in conclusion:

It is time to park some of the thinking on efficacy. It ties up a huge amount of resources. If they want to do it, that’s fine, but the work is done so consistently badly and inappropriately that, most of the time, it’s not worth it…We need to be thinking about mechanisms but it’s not not the end of the line if we don’t have one. We need to focus on finding better tools to measure what is going in a clinical environment. We have to translate that patient experience and find better ways of translating what’s happening at a clinical level into a so-called scientific approach.

In other words, stop worrying about how it works; the way scientists do science sucks and we just need to find ways of making all our anecdotes look like convincing evidence. Clare Relton said pretty much the same thing — she just said it in a nicer way.

Conclusion

The conference has been described as a “huge success” but only, so far as I know, by the person who organised it. It’s not clear what criteria she is basing her judgment on but probably that people enjoyed it as a social occasion. One thing I can be sure of: not a single person left that conference equipped to “effectively counter” the arguments against homeopathy as a therapy or against its provision on the NHS.

Something I hoped to gain from the day was a better understanding of why people so passionately believed in such an implausible idea. Is there something more going on here (I mean psychologically, not with homeopathy) than the naive post hoc ergo propter hoc assumption?

I don’t think so.

I think we already know the factors that come into play: perhaps the most important one is that bad experiences with proper medicine make one more disposed to wanting any alternative to work, however batty it sounds. The apparently miraculous recovery of a loved one (or oneself) when nothing else had worked — as was the case with Relton’s son’s chronic ear infections, which hadn’t responded to antibiotics but got better after getting homeopathic treatment — can provoke an ephiphany and I use that word deliberately. The conversion to homeopathy is closer to a religious experience than it is to anything else, just as homeopathy is more like a religion or cult than it is like a proper health discipline. I don’t think faith in homeopathy can be explained by any new insight into the human condition that has thus far eluded us.

And, of course, once someone has invested days, months or years and a considerable amount of money to becoming a homeopath and especially once they’ve found they can make some sort of living out of it, their minds become resolutely closed to the possibility that they can be wrong about it. (By the way, in my usual spirit of open-minded enquiry, I wouldn’t mind doing this two-day beginners’ course at the Centre for Homeopathic Education, if only it didn’t cost £250. Any offers to fund me?)

Talking of money, I will say that if the conference had really lived up to the title and the promises, i.e. if it had really been about scientific research, if the speakers had really been top PhD scientists and at the zenith of their profession and if it had really equipped people to effectively counter what are really very simple arguments, then it would have been a fantastic bargain at £58.

As it is, the best thing I got out of it was a rather nice goody bag which, once I’d binned the contents, proved quite useful on my next trip to Sainsbury’s.