Enforced Quackery: Day 7

So, I wondered how long it would be, and it seems the answer is "about 6 weeks". The question? 'How long is it possible to be taught by homeopaths without hearing some nonsense about quantum mechanics?"

Day 7 consisted of a visit to the London Homeopathic Hospital. Just for added irritation value, this is on Great Ormond Street, and one has to (I am reliably informed) walk past the famous hospital where they actually do real medicine in order to get there. There was a meeting with a GP who is also a homeopath. He seemed to be the most sensible of the pracitioners they'd come into contact with so far - coming pretty close to Ben Goldacre's ideal of "ethical bullshit". He gives homeopathic remedies to patients because they seem to help, and doesn't worry about why - he was quite willing to admit that the mechanism is very probably the same mechanism as a placebo... but he made the fairly valid point - if I can give these people pills that make them feel better, why not do it? And who cares how they work?


Of course, then he was asked about how he thinks they work... while admitting that a placebo effect was a possibility, he then spouted the traditional nonsense about what he thought the mechanism might actually be, invoking the "memory of water", and something called "non-linear quantum mechanics". Now, I'm no expert, but I distinctly remember reading something about non-linear quantum mechanics fairly recently, it was this paper which no-one who isn't studying Complexity Theory should bother reading. It says that if quantum physics is non-linear, this should in theory allow us to build quantum computers which solve NP (and even #P) problems in polynomial time. It also says:

Such non-linearity is highly hypothetical: all known experiments confirm the linearity of quantum physics to a high degree of accuracy.

That's right the explanation for the extremely macro-level phenomenon of really really tiny water molecules somehow managing to remember that they once came into contact with significantly less tiny arnica molecules has something to do with the fact that the superposition principle of quantum mechanics - which has to do with things which are a lot tinier than water molecules, might possibly be violated in some cases (even though no-one has ever actually seen this happen).

This is classic bullshit. Essentially the argument goes: homeopathy works, and we don't really know why. I don't really know how quantum mechanics works either, so surely it must have something to do with that. It's not science, and it's certainly not an important part of a medical education.

Once again, there were complaints made to the people in charge about the fact that there hasn't been nearly enough patient contact (although apparently they did see a few during this session). Once again, the reason given was that the "medical practitioners" were worried about what the future doctors might say to their "patients". Again, a promising sign that they've not been brainwashed, but surely if they're not going to be allowed to see patients, then they're not going to be able to observe Medicine in Society.

Enforced Quackery: Day 5

Day 5 consisted mostly in a visit from a herbalist. Well, I say a herbalist, she seems mostly to have worked in Marketing for A Vogel - the "educational" material from this session consists of no less than 9 advertising leaflets from that company along with three or four studies which find that herbal medicine is just as effective as conventional medicine at treating certain illnesses (more cherrypicking? I don't know - maybe these medicines actually are as effective as the artificial counterparts). I would post links to the leaflets, but I can't seem to find them online, and I'm not sure I really want to give them even more free advertising. They were also given a free sample of one of the products (I think it was Echinacea throat spray).

Now, I am not a medical student, and my girlfriend has only been one for just over a year, but we're both pretty sure that it is not standard practice to invite representatives from drug companies to give a brief talk to students about how awesome their company's products are (if it is, we're pretty sure it shouldn't be). And can only imagine the reaction from the Alt. Med community if it were widely reported that Big Pharma had been having friendly one-to-ones with students in which it passed out free samples of it's products, and leaflets explaining how ibuprofen was way better than arnica for treating a sore ankle.

Anyway - the other thing to come out of day five was more details about the assessment for the module. There will be an essay on the case study from day 4, and my girlfriend has also chosen to write an essay on "The role of homeopathic medicine in the health service" (or some very similar title - it might be the role of homeopathic medicine in society, which I guess is slightly more pallatable). If anyone's still reading this, she'd be very grateful for suggestions on how it might be possible to write an essay about that, to be marked by a homeopath, without being intellectually dishonest.

Day 6 was today - I'll post something about that as soon as I've spoken to her.

Enforced Quackery: the literature

As I've already noted, one of the pieces of "evidence" that they were given to read about homeopathy was this, with the somewhat ridiculous title of "An Overview of Positive Homeopathy Research and Surveys".

The other document, when I finally dug it out, was a print out of this page. So far as I can tell the main idea of the page is the idea that homeopathy is a little bit giving people vaccinations, which I guess is true, for sufficiently small values of "bit" - homeopaths give people a really really tiny amount of something that causes a disease and this makes them better. It then seems to claim that Pasteur therefore stole the idea of vaccinations from homeopaths.

Now, I'm not in a position to judge the historical accuracy of the document (although I can't help but find it somewhat suspicious - that's probably because I'm biased). But again, that's beside the point. The real question is, how is this in any way relevant to the applications of homeopathy in modern medicine?

If I'd gone up to a lecturer in my calculus II course asking for help on solving partial differential equations and they'd given me a link to some website which explained that Liebniz stole his theory of the calculus from Newton*, I would not have been much impressed - and I'm not even sure that analogy is quite ridiculous enough to explain how useless this document is to a medical student who wants to know more about how homeopathy works in practice.

Day 5 was today - I'll have an update sometime before the end of the week.

* NB - I'm not knowledgeable enough to have an opinion about that debate either, but at least it's an actual historical controversy.

Enforced Quackery Days 3 & 4

I'll give a brief summary of day 3, and also the real reason I've finally gotten round to writing these posts. Basically, I don't really know what happened, my girlfriend was too ill to attend.

All I really know is that by the end of day 3 the students *still* hadn't seen any patients and that, when confronted with this fact the person in charge is reported to have said that this was because she was scared of what the students might say to the patients... Apart from this being a massive insult to the professionalism of the students, it is at least an encouraging sign that they have not been very effectively indoctrinated.

Day 4 consisted almost entirely of a 1/2 hour meeting with a patient (finally!) - details of which it would probably be inappropriate to publish - suffice it to say that it was rather a sad story.

Anyway, as I was saying, my decision to actually post this stuff (which I've been meaning to get round to for weeks) was prompted by an email I received this morning from a rather more prominent (and consistent) blogger than me, David Colquhoun (I hope I spelled that right), who has now picked up on the story. His email asked about how things have been going at the GNH, so I'm going to pass on the documents (when I find them) to him, and let him take the story from here.

Day 5 is this Tuesday, if there's anything interesting, I'll try to post sometime before Christmas...

Enforced Quackery Day 2

Sorry for the delay in writing this - I got caught up doing actual work, and the girlfriend missed one day of her quackery training through being ill (presumably through not taking the arnica that she was given on the first day...). I'll try to catch up all the posts in the next few days.

First, as pointed out in the last post, the girlfriend told the "teacher" exactly what she thought of homeopathy (it's nonsense, it doesn't outperform placebo in proper blinded studies, etc.). She was challenged to bring in some evidence for her views (oops!) I was all for just taking Ben Goldacre's book, but the girlfriend thought taking something with "Bad Science" on the cover might be a bit too antagonistic, so we looked up some references and she took some metaanalyses instead. Needless to say, these were ignored.

She was then given some documents to take home and peruse as "evidence" that homeopathy works. The first of these genuinely astounded me. It was a document entitled (I kid you not) "An Overview of positive homeopathy research and surveys". (online here)

This document is published by the "European Network of Homeopathy Researchers". A network which has practically zero presence on the web apart from having authored this document, and which is sponsored by the European Council for Classical Homeopathy, but let's forget about it's provenance for a second... an overview of positive research?

I'm sure anyone who is reading this doesn't need me to point out quite how ridiculous this idea is, but my girlfriend hadn't realised until I did, so I'm going to make it explicit here. Imagine I have a dice and I roll it 10,000 times, calling every set of 10 rolls a "trial". I then decide to publish only those "trials" which say that my dice is biased towards the number 6. There are going to be an awful lot of "trials" which give statistical support to this hypothesis (at the 95% level, approximately 50 of them) - does this mean my dice is biased?

It reminds me of the overcomplicated slogan I wanted to get put on a t-shirt once "Is homeopathy better than a placebo? 1 in 20 trials say YES with 95% confidence", and unfortunately confirms my hypothesis that homeopaths just wouldn't get it.

There are many, many more flaws in the document (several trials are repeated, most of them are flawed, the wrong figures are quoted from several) but it's hardly worth taking it to pieces when it's such a ridiculous thing to write in the first place.

There was also some other document about homeopaths having more sympathy for Jenner than the medical establishment at the time, or something like that... I didn't actually read it and I can't seem to find it - but I'll dig it out.

Not much else happened - still no patient contact. Yes, that's right, the "Medicine in Society" module where the students get to see how medicine is practised by real-life practitioners and by day two, still no actual medicine being practised.

Enforced Quackery: Day One

It was remarkably sensible. They students sat in with an osteopath and a homeopath. The osteopath was very respectful, a very nice friendly woman, and offered several pieces of fairly sensible advice - being exceedingly respectful towards one of the students when she found out that she was already a qualified physiotherapist.

The homeopath asked "does anyone know anything about homeopathy", and my girlfriend told her. She apparently went into quite a lot of detail about Avogadro's constant, the fact that every drop of water on the planet should already be a homeopathic remedy for everything and the fact that homeopathy just doesn't work. (To be fair, of course, as Ben Goldacre would say "it's a lot more complicate than that", but the pills don't work any better than any other sugar pills). The homeopath stood there, listened, thanked my girlfriend (I might need to come up with a codename if I'm going to keep doing this... or get her to let me use her real name) for her contribution and then went on to explain about what the various tablet do.

She told them all she'd give them some free arnica tablets next time (for general aches and pains, I believe) and offered to give a few of them medicine for various conditions if they hadn't cleared up in two weeks time, and then finished with an exhortation to "do some research about homeopathy". Her suggested source was the Society of Homeopaths website which I'm sure would offer a "Fair and Balanced" view. I'm going to give her a copy of Ben Goldacre's book,as well as a few of the better meta-analyses.

As for the (very helpful) point made in the comments about using the experience to learn about why people feel the need to go to these people for help instead of using medicine that actually works - yes, we've already talked about that - it is a good chance to see something that she probably won't get to see working in hospitals or on future ward rounds (although asking the patients tactfully why they aren't seeing a traditional doctor might be a challenge). Still, that's not the way the hospital treats it - they consider it an opportunity to watch real-life health professionals at work in the field. Also, I apologise about the comments I made about the qualifications of the psychotherapists at the Centre - I was not happy at the time, and it was unnecessary.

Anyway - the visit didn't go too badly, everyone was polite and, whilst I don't think she got much out of it, my girlfriend was slightly more happy than she expected to be - at least she got a chance to air her views. We'll see how things go next week when she'll have more contact with patients.

Enforced Quackery

My girlfriend is a second year medical student at a UK university (naming no names, as she seems to think she'll be punished if this gets out...) She does a module called "Medicine in Society", she has 11 full days observing real-life medical practitioners at work, more than half of her patient contact for the year. This year, she will be doing her placement at the Greenwich Natural Health Centre. Yes, it is as bad as it sounds.

Among other things, they offer "Holistic Aromatherapy", "Homeopathy", "Cranial Osteopathy", "Cranio-sacral therapy" (on reading the blurb on the website, I honestly can't see any difference between these particular two brands of woo) , and the Reiki Healing. Even when some of the treatments sound as though they might be sensible (Pyschotherapy, Relationship Counselling...) it turns out that some of the practitioners are the same people who do the Reiki healing. Although, to be fair, some of them do seem to be qualified psyhotherapists (not, note, qualified pychiatrists).

There doesn't appear to be a single person on the staff at GNH who is a qualified medical doctor (I haven't looked through the entire list, I'm willing to be corrected on this) and one woman proudly offers her qualifications as "BA Hons", "DipTch", which unless I'm mistaken is just a Bachelor's degree (in an unspecified (arts) subject) and a teaching diploma.

Anyway, that's enough trashing the place - obviously, it's a hotbed for woo, and they don't really buy into the whole "evidence-based medicine" thing. Fair enough, there's a time and a place for that sort of thing, as Ben Goldacre points out in his new book, there are probably more important things to worry about, but this is where the story gets silly.

On hearing that she was going to be sent to woo-central, and not really liking the idea, my girlfriend decided to ring up the School and ask if she could possibly be transferred to a placement where they did actual medicine. She was told in no uncertain terms that she could not, and that if she didn't attend all eleven days of woo-school, she couldn't possibly pass her second year. An extract from this conversation apparently went:

My Girlfriend: "But there's absolutely no evidence that any of it works, it's not based in science."
Office Lady: "That's a fair point, but..."

"but..."? But what? What "but..." could possibly justify forcing someone to waste 11 days and (approximately) £1000 of tuition fees on learning about treatments that can't possibly work? Possibly the scariest part about this is that the other twenty or so medical students who were sent on the same placement don't seem to have objected at all.

Anyway, today is day one of her placement. She's promised to take copious notes, and I'm going to write about them here.