Editorials Christmas 2009: Years Like This

Secret remedies: 100 years on

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b5432 (Published 15 December 2009) Cite this as: BMJ 2009;339:b5432
  1. David Colquhoun, research professor
  1. 1Department of Pharmacology, University College London, London WC1E 6BT
  1. d.colquhoun{at}ucl.ac.uk

    Time to look again at the efficacy of remedies

    In the linked feature (doi:10.1136/bmj.b5415), Jeffrey Aronson describes how the BMA, BMJ, and politicians tried a century ago to end the marketing of secret remedies.1 They didn’t have much success. Forty years after their endeavours, A J Clark (professor of pharmacology at University College London and later at Edinburgh) could still write, “the quack medicine vendor can pursue his advertising campaigns in the happy assurance that, whatever lies he tells, he need fear nothing from the interference of British law. The law does much to protect the quack medicine vendor because the laws of slander and libel are so severe.”2 Clark himself was sued by a peddler of a quack cure for tuberculosis for writing that: “‘Cures’ for consumption, cancer, and diabetes may fairly be classed as murderous.” Although he fought the libel case, impending destitution eventually forced him to apologise.3

    Clark’s claim in 1927 that: “some travesty of physical science appears to be the most popular form of incantation”4 is even truer today. Homoeopaths regularly talk nonsense about quantum theory, and “nutritional therapists” claim to cure AIDS with vitamin pills. Some of their writing is plain delusional, but much is a parody of scientific writing, in a style that Ben Goldacre calls “sciencey.”5 It reads quite plausibly until you check the references.

    One hundred years on from the abortive efforts to crack down on patent remedies, we need to look again at the efficacy of remedies. Indeed the effort is well under way, but this time it takes a different form. The initiative has come largely from an “intrepid, ragged band of bloggers” and several journalists, helped by scientific societies. It hasn’t been helped by the silence of the BMA, the royal colleges, the Department of Health, and a few vice chancellors.. Even the National Institute for Health and Clinical Excellence (NICE) and the Medicines and Healthcare Products Regulatory Agency (MRHA) could be helping more.

    The response of the royal colleges to the resurgence in magic medicine that started in the 1970s looks to me like embarrassment. They avoided the hard questions by setting up committees (often populated with known sympathisers) so as to avoid having to say “baloney.” The Department of Health, equally embarrassed, refers the hard questions to the Prince of Wales’ Foundation for Integrated Health. It was asked to draft “national occupational standards” for make believe subjects like “naturopathy”6).

    Two recent examples illustrate the problems. Take first the Pittilo recommendations for statutory regulation of acupuncture and herbal and traditional Chinese medicine.7 8 The Pittilo report recommended official recognition by statutory regulation and entry by honours degree. But you cannot start to think about a sensible form of regulation unless you first decide whether or not the thing you are trying to regulate is nonsense. This idea, however, is apparently lost on the Department of Health and the authors of the Pittilo report. Fortunately, consultation on statutory regulation has attracted many submissions that point out the danger to patients of appearing to give official endorsement to treatments that have no proper evidence base. The Royal College of Physicians seems to have experienced a major change of heart: its submission points out with admirable clarity that the statutory regulation of things that don’t work endangers patients (though they still have a blind spot about the evidence for acupuncture, partly as a result of the recent uncharacteristically bad assessment of the evidence by NICE). Such enlightenment doesn’t extend to the Prince of Wales, who made a well publicised intervention on behalf of herbalists after the public consultation closed.9

    Glossary10

    • Acupuncture: a rather theatrical placebo, with no real therapeutic benefit in most, if not all, cases

    • Herbal medicine: giving patients an unknown dose of an ill defined drug, of unknown effectiveness and unknown safety

    • Homoeopathy: giving patients medicines that contain no medicine whatsoever

    The other example concerns the recent “evidence check: homeopathy” conducted by the House of Commons Science and Technology Select Committee (SCITECH). Oliver Wendell Holmes said all that needs to be said about medicine-free medicines in his 1842 essay, Homeopathy and its Kindred Delusions11 So it is nothing short of surreal to find the UK parliament still discussing it in 2009.

    The committee’s proceedings are worth watching, if only to see the admirably honest admission by the professional standards director of Boots that they sell homoeopathic pills without knowing whether they work.12 But for pure comedy gold, there is nothing to beat the final session. The health minister Michael O’Brien was eventually cajoled into admitting that there was no good evidence that homoeopathy worked but defended the idea that the taxpayer should pay for it anyway. The chief scientific advisor in the Department of Health, David Harper, was not so straightforward. After some evasive answers the chairman, Phil Willis, said, “No, that is not what I am asking you. You are the department’s chief scientist. Can you give me one specific reference which supports the use of homoeopathy in terms of government policy on health?” One is tempted to quote Lewis Carroll “but answer came there none.” There were words, but they made no sense.

    Then at the end of the session Harper said, “homeopathic practitioners would argue that the way randomised clinical trials are set up, they do not lend themselves necessarily to the evaluation and demonstration of efficacy of homeopathic remedies.” Earlier, Kent Woods (chief executive officer of the MHRA) had said, “the underlying theory does not really give rise to many testable hypotheses.” Why not? The hypotheses are testable, and homeopathy—because it involves pills—is particularly well suited to testing by proper randomised controlled trials.13

    It isn’t hard to do better than that. “Imagine going to an NHS hospital for treatment and being sent away with nothing but a bottle of water and some vague promises,” wrote the Sun’s health journalist Jane Symons recently.14 “And no, it’s not a fruitcake fantasy. This is homeopathy and the NHS currently spends around £10m on it.” It isn’t often that a Murdoch tabloid produces a better account of a medical problem than anything the Department of Health’s chief scientific advisor can muster.

    Notes

    Cite this as: BMJ 2009;339:b5432

    Footnotes

    • Feature, doi:10.1136/bmj.b5415
    • Competing interests: DC held the AJ Clark chair of pharmacology at UCL from 1985 to 2004.

    • Provenance and peer review: Commissioned; not externally peer reviewed.

    References

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