I have just sat through the an oral session for the evidence check on homeopathy, called by the House of Commons Science and Technology Committee. Well I wasn’t there in person, I watched it on the excellent video page. You can still see it if you are quick. Before I go on, aren’t we all glad they have reverted to a sensible name for this committee? Anyway, it was almost two hours very well spent. The transcript will be what endures for the public record, but that doesn’t capture all the body language and hesitation that attended so many of the answers to questions. I just want to pick out some bits that I think are worth our attention – in no particular order.

What astounded me more than anything was the staggering ignorance of Robert Wilson on matters of statistics. He was appearing for the British Association of Homeopathic Manufacturers, and was challenged on the evidence that homeopathy actually works. He launched a rambling discourse on sample size in clinical trials, stating categorically that most studies were too small (probably true), and that no study with less that 500 patients could be of any use. He seemed to be totally unaware of how sample sizes actually are calculated, and ignored the other factors such as expected differences, and variability. Only the number of patients mattered to him – one size fits all. This is not an esoteric subject, it is bedrock for anyone involved in life sciences. If he is the champion selected by the serried ranks of homeopathy companies, they can expect to lose their colours pretty quickly.

Wilson appeared in the first session, alongside representatives of the Royal Pharmaceutical Society of Great Britain (RPSGB), Sense About Science, and Boots, plus Dr Ben Goldacre of Bad Science fame. Everybody was asked whether they agreed that homeopathy works. Paul Bennett from Boots had to admit that there was no evidence, but regaled the committee with the mealy-mouthed flannel about customer choice that we have come to expect from his amoral employer. In summary, of the five witnesses, four said there was no evidence – and one of those was happy to carry on making money from gullible customers in the knowledge that they were being misled.

The second session was a bit more interesting. Dr Peter Fisher, director of the Royal London Homeopathic Hospital, was asked by the excellent Dr Evan Harris MP why the water used to prepare a remedy only retained the memory of that tincture and not everything else that had previously been dissolved in it. Fisher declared that the water was purified by double distillation, which removed all previous memories. Now this is an interesting hypothesis, and I am surprised that nobody picked him up on it. He is saying that double distillation resets the memory to zero, a claim that can readily be tested. We just need to prepare a standard remedy and divide it in half. One half we then double distil and use it to prepare a new remedy. We then give each remedy to patients in a clinical trial. There won’t be any difference of course, because neither group of patients will respond. If Fisher knows any other way of differentiating two remedies I’ll be avidly interested.

Another one that slipped through the committee’s net was a curious claim from Robert Mathie, research adviser to the British Homeopathic Association (BHA). He was reacting to criticism of high dilutions beyond Avogadro’s number, stating that many remedies were not so highly diluted and did have some remnants of solute. These had apparently been subject to tests, with positive results. Nobody seemed to remember the so-called `Law of Infinitesimals’, whereby potency increases with higher dilution. Is Mathie now repudiating this? But he got away with it.

One committee member was rather more sympathetic to homeopathy. Ian Stewart MP asked whether there was any evidence that homeopathy did not work, but nobody reacted to the essential silliness of the question. Had I been there, I would have said that I can’t prove that there is not a teapot orbiting the sun between Earth and Mars, but that there is no point in behaving as if there is (with apologies to Bertrand Russell). Such a question, from a member of the Science and Technology Committee, demonstrates a basis misunderstanding of science. The same member asked about evidence for harm from homeopathy, and nobody could provide any concrete examples. I would have mentioned Dr Marisa Viegas who in effect killed a heart failure patient by telling her to stop all drugs and take homeopathy. This was in the context of a question about regulation, and the committee should be told that the GMC only suspended Viegas for a year, and then struck her off because she still thought she was right. Sorry – I can’t give you a link for that case because it’s not on the GMC website (only goes back two years), but I have the minutes of the GMC hearing so email me if you would like it.

There was a lot of discussion about dangerous claims by homeopaths, particularly in relation to malaria prophylaxis. I would have liked to see Mathie pressed a lot harder on why no BHA member has been disciplined for making false claims. Bizarre belief systems always protect themselves from criticism by saying that they don’t support extremism, but they never actually keep their house in order by dealing with their own extremists. The result is of course more extremism.

In general, it surprised me that nobody wondered why we were having this debate about evidence at all. The homeopaths were stating that there is good evidence, and their opponents, led by the redoubtable Edzard Ernst, stated the opposite. We don’t have any such debate about the majority of orthodox drugs. It is usually as clear as the nose on your face whether a drug is effective or not, even though the impact of that on clinical practice might need more clarification. What we have with homeopathy is an elusive spectre of supposed efficacy which evaporates in the cold light of day.

Do look at the written submissions. Mine is there, but frankly the response from sceptics has been pretty pathetic – in terms of numbers not quality. Where were you all? The usual exponents of smokescreen science are there, notably the sociologist Clare Relton who loves splitting hairs about words. I need to steel myself to read Milgrom’s. Interestingly, the Prince’s Foundation takes pretty much the same line as Boots.

Well, I am looking forward to Monday’s session, with Professor Kent Woods of the MHRA, and Mike O’Brien MP and Professor David Harper from the Department of Health. How they defend what they have done with licensing will be an education. I don’t mean what they say (that will be the usual obfuscation), but their facial expressions will be a picture.

I write this in the departure lounge of Delhi International Airport, awaiting my flight home after visiting various hospitals around India. This is the third time I have done this, so I feel at least slightly qualified to write about health care in this vast country. It’s a nation of huge contrasts. I don’t for a moment think that there is free and equal access to health care for all, and there is in fact a two-tier system based on public and private hospitals. I don’t intend to focus on that, but on something quite different. I am constantly lectured by the alternative medicine fraternity, to the effect that traditional medicine has passed the test of time. It has been around for thousands of years (no doubt true for some of it but by no means all), and people know what works without all this reductionist science.

On that basis, and with India having spawned some of the longest established traditional `treatments’, I should have been seeing Indian folk medicine ruling the health care roost. But I didn’t. True, there was the odd ayurvedic medicine shop, always on one of the tatty high streets, but not to anywhere near the extent that such outlets are springing up in British towns. Indeed I made a point, as a distraction from the stress of being driven through chaotic traffic, of scanning the streets for evidence of traditional medicine, but saw hardly any. The nearest to any kind of penetration into modern life was the `Indian Ayurvedic Research Centre’, which looked quite neat and set in modest grounds. Outnumbering the traditionalists by a long chalk were many specialist clinics among the shops, very candidly emblazoned with what they did. There were lots of dental and orthodontal clinics, bone and joint clinics, and my favourite was `Piles and Fistula Clinic’. They don’t mince their words.

I spent a day and a half at the St John’s Medical College and Research Centre in Bangalore, a vast teaching hospital. Regrettably it is a Christian organisation, but although there were nuns floating about there was no evidence of praying as a therapeutic practice. The hospital and college are literally crammed into a 140 acre site. There are no landscaped grounds, as all available space is stuffed with buildings. Inside, it is bursting at the seams with sick people getting proper treatment for their ills. There was no evidence of traditional medicine inside either, and it seemed to contain all the specialities of any modern hospital in the developed world. OK, it wasn’t glittering and beautifully designed. It was dark and looked shall we say functional. I am sure though that every bit of it was being pushed to the limit to deliver modern health care. I could not help contrasting this with one or two American hospitals I have visited. One cancer department had a full time holistic nurse.

Now if traditional medicine really could deliver just a fraction of the health care that I saw going on at St John’s, I should have been seeing big ayurvedic hospitals, but I didn’t. The truth is that most people in India, and I am told in China as well, turn to modern scientific medicine when they are really ill. Now don’t anybody tell me that this is all because of a conspiracy between `big pharma’ and orthodox doctors, who apparently collude to prevent ancient wisdom from reaching the people. The truth is that most people are able to distinguish truth from fiction, given the evidence, and that is why Indians are voting with their feet. They mostly realise that it’s really ancient bollocks not wisdom, and that age doesn’t add any credibility to it.

I have followed on and off the case of Dale and Leilani Newman who killed their daughter Kara. They did this by refusing to allow treatment for her diabetes. Kara was eleven years old. Her parents are Christians, who believe that the only treatment for illness is prayer. They and their friends prayed as she lay on the floor, and watched her die.

These killers were convicted, and have now been sentenced. They must each spend one month in jail every year for the next six years, but not at the same time. Before I comment on the sentences, let’s think about what they did. It is beyond credibility that they were so ignorant as to be unaware that children only avoid death from diabetes by the use of proper medication. They must have known that millions of diabetic children are successfully treated that way, and do not die prematurely. That is not to say that there are no risks, even when treatment is given, but the risks are massively reduced compared with no treatment, which is usually a death sentence.

The conviction of this couple indicates that the court agreed with my argument that they could not have been ignorant. What alternative explanation exists? The court did not find that they were mentally ill. So we are left with the scenario of two people of sound mind and adequate education, knowingly taking action that killed their daughter. Kara was not starved and beaten to death in the manner of Victoria Climbié or Baby P. But she still suffered terribly and died. The praying was just as bad as the starving and beating. Those responsible for the fates of Victoria and Peter (as we now  know his name to be) were punished with the full force of the law, and rightly so. Kara’s parents however have been required to take what amounts to an annual vacation. Yet again religion is handled with kid gloves.

The judge said the Newmans were “very good people, raising their family, who made a bad decision, a reckless decision”. Their lawyer said “My clients just happen to have a belief that is very outside of our social norm.”

No, no, no. These people are killers. They would almost certainly do it again, to their other three children. If they could, they would probably do it to other people’s children. They are a danger to society. I think the case raises questions as to what we mean by ‘of sound mind’. Mental illness is conventionally divided into the neuroses, where patients are aware that they are ill, and the psychoses, whose victims have no insight into their condition. On that basis, the Newmans are psychotic, in that they display lethally aberrant behaviour but insist that they are right. They purport to communicate with a fictional being. I am not sure whether this takes the form of hearing voices, but if so that is a cardinal sign of psychosis. Yet I would put money on my claim that they would most likely pass all the standard tests of psychosis and be declared perfectly sane.

So I really don’t know what to make of the Newmans. Perhaps there has been insufficient research into the deleterious effects of religious doctrine on the mental state of its adherents. But I am sure of one thing. They are not good people, if one judges them by the outcome. Richard Dawkins famously said:

Normally good people do good things, and bad people do bad things, but to get good people to do bad things, you need religion.

There can be no better example than the Newmans. They might have been good once, but religion has made them bad. Any other parents who kill their children will immediately have their other children taken away and put into care. Indeed they can be taken away for far less than that. Yet here they get a fatherly pat on the back from the judge, and a lecture on what God really wants them to do. I have a challenge for the judge. This presumably is the loving god who killed 200,000 people in the 2005 tsunami, and more recently killed at least another thousand in an earthquake and another tsunami. Explain that if you can.

Finally, I realise that the Newmans are Americans, which some might say (ungenerously) explains all. Although religious madness is more common in the USA than in the UK, we Brits still operate on the basis that faith must be respected, whatever its flavour. For me the worm turned a long time ago. There is nothing admirable about believing the unbelievable, and look where it can take us when we do.

Sadly I am a pretty sporadic blogger (classic car ownership is to blame), but again I am driven to add my feeble voice to the case brought by the British Chiropractic Association against Simon Singh. I have known Simon for a couple of years, and been impressed not just by his searing intellect, but by his rock solid integrity.  As half the world seems to know, the BCA is suing Simon for the following article which appeared in The Guardian newspaper last year.

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.

I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.”

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.

If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

Now this version has been slightly sanitised, because a man sitting on a bench in 18th century costume decided on the meaning of certain words, in disregard for the actual meaning which Simon explained in the article. He then twisted the knife in the wound by refusing leave to appeal. Now Simon has had his request to overturn that refusal refused by another fancy dress artist, despite some 13,000 people signing up to a statement requesting reform of the English libel laws. One is driven to consider whether the courts are being vindictive.

Well there are far more eloquent advocates for Simon than I, so I will leave this piece with a challenge for the BCA. I charge its officers with selectively citing `evidence’ in support of spurious claims for the efficacy of chiropractic for colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying. There are no absolutes in science, and it’s very well established as to what is solid evidence in health care. The stuff that the BCA described as a `plethora’ is not, and they can sue me if they want. Me and the other 50-odd bloggers out there.

Simon has made it very clear as to what he meant by `a jot of evidence’, and I am going to do the same. A `jot’ is not a case report or even several case reports. Neither is it a poor quality trial. These are not `jots of evidence’ because they tell us nothing. In dramatic contrast, the best quality evidence about for example chiropractic in asthma tell us that……yes you guessed it, it does absolutely nothing at all. Yet these self same high quality trials were not included when the BCA published its `plethora of evidence‘ – which was comprehensively demolished in the BMJ.

I am not going to accuse the BCA of deliberately lying, because I don’t know what goes on in their fuzzy heads. I am saying that, as self-proclaimed health care professionals, they have a duty to know what evidence is, and to present it fairly. They are clearly not doing that, but whether they are misleading by accident or design I will leave you to decide.

Coming into this story as late as I am, I don’t have much to add, other than to draw attention to the far more erudite offerings of others. If somehow you have not heard that chiropractors would rather issue legal threats than solid evidence for what they do, here’s a quick summary.

Firstly, the indefatigable Professor David Colquoun was invited to write a guest editorial in the New Zealand Medical Journal alongside two articles critical of the practices of chiropractors – especially their use of the title `doctor’. No need for me to repeat the story here, just read it for yourselves. The riposte from the editor of the journal has gone down as a classic – “Let’s hear your evidence not your legal muscle”.

Hot on the heels of that, our foremost science journalist Simon Singh PhD MBE, is being sued by the British Chiropractic Association (BCA) because of an article in the Guardian in which he called into question the evidence for several claims the Association is making. There is an ongoing and intelligent discussion of this on the James Randi forum. From here you will be directed to a galaxy of blogs which analyse the issue in detail.

All this has taught me a lot about the English legal system, which for defamation claims is pretty notorious for being very unfair to the defendant. I thought I knew a bit about it, having been threatened with libel myself. I used the justification defence and the whole thing went away. So I am not going to offer David or Simon legal advice, but perversely I rather relish the opportunity to test in public the claims which chiropractors make. Of course it’s not pleasant for the defendants, but I would reassure them that these cases rarely get to court. Let me confess that several years ago, and in my ignorance, I consulted a chiropractor myself. Like most people do today, I considered him to be a genuine health care professional. Having studied the evidence, I know better now. I have several friends who use chiropractors, and the curious thing is that no matter how much I talk about the lack of evidence they still keep paying for more treatments.

As you might have guessed from from the long gap between my posts, I started this one a while back and put it on the back burner. But I am now moved to update it and request your help – not for me, but for Simon Singh. I won’t repeat the full details so ably set out by Jack of Kent, but I do want to comment on the ruling by Mr Justice Eady. I am reminded of what a lawyer told me years ago (not a lawyer I particularly liked), that the law has nothing to do with morals. I have since then formed the opinion that the prime objective of the legal system is to ensure that the lawyers get paid, and that everything else is secondary. The odd thing is that, to any person of reasonable intelligence, science and the courts should both be interested in the same thing, namely evidence. It is obvious to said person of reasonable intelligence (indeed even to the less intellectually endowed) that Simon’s article is primarily about whether the BCA’s claims as to the efficacy of chiropractic in the treatment of these conditions is supported by evidence. The judge has thus divorced the case from the consideration of the evidence, and centred it on a pedantic interpretation of a word, notwithstanding Simon’s clear and precise explanation in his following paragraph of what he actually meant. The frightening thing is that Eady is a leading libel judge and gets most of the major cases.

But enough of my meanderings. This case has caught the attention not only of the scientific community, but also of other professions who are worried about free speech. I was one of the first 100 signatories to a statement asking the government to review the libel laws. There are now 4000, but we need more. Please go to Sense About Science and sign up. You will see that you are in very good company.

My good friend David Colquhoun alerted me to the bizarre material being taught to science students at Thames Valley University. So in my capacity as a science writer (perfectly true) I asked the Vice Chancellor Professor Peter John for a statement. I phoned his office and explained that I was enquiring about material was being taught in his Faculty of Health and Human Sciences. No reply. I phoned again. A message was politely taken again but there was still no reply. So I sent the following letter:

4^th November 2008

Dear Professor John

As a freelance science writer with an interest in evidence based medicine, I have called your office twice asking for a statement about some of the degree courses offered by your Faculty of Health and Human Sciences, without so far receiving a response. Let me illustrate the question with examples. I have seen some of the teaching material for the Bachelor of Science course on Nutritional Medicine, and the following is an extract:

1.4 Relationship to Science and the Limitations of Orthodox Methods

However, the subject of Wholistic Nutrition transcends the area of human understanding for which science, alone, is appropriate. The reason is that it is ‘vitalistic’. It recognises the presence in all life forms including the human body, of subtle (or ‘etheric’) energy forces not easily measurable by the physicist’s equipment. It shares that position with the ‘energy medicine’ disciplines such as homoeopathy, traditional acupuncture and spiritual healing. It follows an approach to those subtle energies that is embodied in the discipline and philosophy of naturopathy.

Vitalism is the notion that life in living organisms is sustained by a vital principle that cannot be explained in terms of physics and chemistry. This vital principle, often called “the life force”, is something quite distinct from the physical body and is responsible for much that happens in health and disease.

Bearing mind that this is offered as a science degree, in a faculty of science, I would appreciate your comments on the scientific basis for these statements about vitalism. The author of this material does not consider that science is appropriate for Wholistic Nutrition, so I am wondering why this course is offered as a science degree.

I also note that the University offers BSc courses in homeopathy, and again I would be grateful to know how this correlates with scientific knowledge about ultra-dilute solutions and their clinical effects. I write for a number of bioscience-related journals, so I am unable to say in which one my findings will be published, but I always avoid one-sided arguments so for this reason I do hope to hear from you soon.

Well you can guess what happened – nothing at all. So I phoned yet again, and was told that I would be hearing from the relevant Head of School. Needless to say I didn’t, so I wrote again:

9^th January 2009

Dear Professor John

I wrote to you on 4^th November 2008 requesting a statement about some of the degree courses offered by the Faculty of Health and Human Sciences. I have not received a reply to that, and I have repeatedly telephoned your office to ascertain your position regarding my request. One of your assistants did indicate that a statement would be forthcoming, but later on I was told that the request had been referred to the relevant Head of School. I have still not heard anything.

If you are not prepared to provide me with a statement then please say so, and I will not bother you again. But please understand that I am giving you the opportunity to defend a position which many people consider anomalous, and that whatever the outcome of my request I propose to publish it. Please do not interpret that as threatening, as it is simply within my remit as a freelance science writer.

The deathly silence was maintained, so I phoned Professor John’s office again on 21^st January. His PA asked me to email the second letter and she would put it in front of him. As of today, 1^st February, there has been no reply of course.

Now how hard is it for John to email me and say “I am not prepared to give you a statement”? I think his silence speaks far more loudly than anything he might have said. My interpretation is that he cares not a jot for the truth in science, and only cares about selling degree courses which attract the gullible. It is worse than selling snake oil, because he is busily building a generation of people who can’t tell truth from fiction, and that’s a heinous crime against society.

But I have one more thought. All these students who are taught about vitalism, medicines with no medicine in them etc, presumably get interest-free student loans backed by the government. So yet again it’s your money and mine that is being used to further the cause of anti-science. Why do we put up with this?

Science publishing is big business. Ask Robert Maxwell – or rather you should have asked him when you had the chance. He started his business empire by siphoning off Germany’s scientific discoveries after World War 2 and publishing them in a stable of journals under his newly acquired Pergamon Press banner. The world is hungry for knowledge, and people who discover what they think is new knowledge are desperate for an audience. I am of the opinion that however ludicrous your claim, you can get it published somewhere in the world, and probably in a `peer reviewed’ journal.

The other week I wearily noted the announcement that the BMJ Group has taken over the journal of the British Medical Acupuncture Society. The Group seems inordinately proud of its first foray into complementary medicine – no doubt because they can already hear the ring of the cash register.

But they are light years behind the big boys in publishing pseudo-science. Stand up anyone who hasn’t heard of Elsevier. Nobody? I thought not. Now how many of you think it’s a pukka science publisher? Well think again, because prominent in its portfolio is Homeopathy, a supposedly peer reviewed journal. Its editor in chief is the Queen’s homeopath Dr Peter Fisher. I haven’t taken much interest in this journal until a colleague pointed out a particularly irritating paper by Relton et al. My letter in reply is to appear in the January issue, with a response by the authors. I can’t wait. I’m told my letter was reviewed by Dr Fisher his very self. Have a look at the other papers appearing in Homeopathy, and be amazed at how much can be said about nothing – literally.

It doesn’t stop with fantasies about the memory of water. How about the journal Chaos, Solitons and Fractals? Actually the journal itself may well be genuine, but it is edited by Mohammed S. El Naschie, who has published 322 papers on numerological subjects which frankly I am not qualified to distinguish from gibberish. But others are so qualified, so I will leave you to read what they say. My point is not really about the gibberish, it’s about peer review or the abuse of it. You see, El Naschie has published this astonishing output in his own journal! This reminds me of the celebrated creationist Michael Behe, who had claimed that his work was peer reviewed. In fact the publication was his own book, and he eventually admitted that he did the review himself. But even if a journal claims independent peer review, what does that mean? In the case of Homeopathy, clearly the reviewers will mostly be other homeopaths. A peer is by definition someone at the same level as the author; in other words, it could be someone just as stupid as the author. Perhaps that’s a qualification in this case.

But to return to the opening question, this post is part of a concerted effort across the net to draw attention to the abuse of science by Elsevier. The attitude of this unjustifiably respected publisher is just the same as that of the UK’s post-1992 universities – it’s all about sales and nothing to do with truth. It’s a disease that is spreading across science publishing, as the BMJ Group demonstrates, and I and many others are not prepared to watch it happen while doing nothing.

I’m not sure if people with bizarre beliefs sometimes go out of their way to make an exhibition of themselves, or if they just don’t care. Here we see Dr Michael Dixon OBE, resting his hand on an invisible hat worn by another man.

Ah – I see I have misunderstood, now that I know the context. This comes from the charity CANCERactive, whose mission is to

provide all people, regardless of age, colour, sex, race, creed or financial status, absolutely all the information available on cancer, its causes and possible treatments, so that they can make more informed personal choices and thus increase their odds of beating the disease.

All the information? Wow, that’s ambitious. So somehow this charity has collected together the entire output of the worldwide medical literature on cancer? I’m impressed. But wait, there’s more. In addition to all this scientific stuff, there’s a wealth of information of a somewhat unscientific nature. Indeed there is a decided emphasis on the unproven, which apparently makes this

The most trusted source of information on holistic therapies and prevention in the UK.

How that statement can be verified seems obscure, but the more I look at this site the more I realise that evidence is the last thing the charity will consider. I will leave you to roam through the gibberish to be found here, but I will start you off at the page called Complementary Therapies for People with Cancer. Here you will find the usual evidence-free claims about how these therapies work, but I really want to draw your attention to the impressive list of references. I don’t have time to analyse the whole lot, but in the section on homeopathy there is the statement:

There has been some research into homeopathy that does show benefits in certain conditions including chemotherapy induced stomatitis, radiodermatitis, and general adverse events from radiotherapy.

Six references are given for this claim. Let’s look at the first one, which is from my good friend Edzard Ernst and colleagues. You will find the abstract on PubMed. Did they find that homeopathy shows any supportive evidence? Well this is what they said:

Our analysis of published literature on homeopathy found insufficient evidence to support clinical efficacy of homeopathic therapy in cancer care.

The most trusted source of information on holistic therapies and prevention in the UK? Do me a favour please – if you trust this stuff you could well die sooner. They pick out references to make their case look stronger and then reverse what the authors have said. Yes, I know these are defamatory statements but there is even more extreme material on the site. The thoroughly discredited Vega testing receives fulsome praise, and this article even endorses the notorious Dr Hulda Clark who fled from the USA to escape a charge of practising medicine without a licence.

There is not much new about all this you may well observe, and I agree that the web is replete with dangerous and misleading material on cancer. But what astonishes me particularly about CANCERactive is the support it receives from people who should know better – its patrons. OK, there is the usual dog and pony show of celebrities, and we don’t expect them to know anything, but what are highly respected oncologists doing here? Does Professor Karol Sikora support the Gerson Diet? Does Professor Trevor Powles OBE endorse Vega testing? Do they know how their names are being used to lend support to quackery?

Thus I am brought back to how this piece got started. Dr Michael Dixon OBE chairs the NHS Alliance, and you will find his profile here. He is close to the Prince of Wales, so don’t be surprised if another gong comes his way one day. Presumably striking silly poses in public is one of the qualifications. Maybe I should run a caption competition for this delightful picture – what do you think?

I know I’m not the first to criticise Boots for its shameless exploitation of health fads and fancies, but I happened across what it calls its `Corporate Social Responsibility’ policy. With regard to `Our Marketplace’, they say that:

Central to the success of our Group is the trust in which Alliance Boots is held by our customers and wider stakeholders. We aim to reflect integrity and stewardship in everything we do.

How do these fine words sit with some of the products they are selling? I thought I would find out. Thus I marched into my local Boots store and homed in on the substantial `Alternative Therapies’ shelves. The conversation I had with the pharmacist in charge is detailed further down this post, so I won’t duplicate it here, but after that fruitless exchange I fired off an email to the Alliance Boots website, asking how the sale of homeopathy and Bach Flower Remedies could be called socially responsible. In fact that department never responded at all, and simply passed my email to Boots Customer Care, who replied thus:

Thank you for taking the time to contact us regarding your concerns over the retail of Homeopathic and Alternative remedies available in store.

At Boots we take our responsibilities as the leading Pharmacy led Health & Beauty retailer very seriously and as part of this we pride ourselves on being able to offer all of our customers a choice of products that support them in their day-to-day lives.

I’d like to reassure you that we take product quality and efficacy very seriously and every product is thoroughly reviewed by our team of Nutritionists, Legal, Pharmacy and Formulation experts before it can be stocked within our Stores.

Boots also stocks a number of proprietary branded items that are popular with our customers. Many of the products that we offer to our customers are an alternative to prescribed medication, some of which have side effects that are difficult to manage. Guidelines currently exist which mean that Boots, as well as all other retailers, are currently unable to make claims on our Homeopathic products.

We take the concerns of all of our customers very seriously here at Boots and we thank you for the time you have taken to give us this feedback. Please be assured that I have shared your comments with the teams here in Boots for future product ranges that we may consider.

Well they don’t take some things seriously enough to answer a direct question with a direct answer. I was not taking this lying down of course, so had another go. In among a number of specific questions, I highlighted homeopathy:

I need to update my previous question. Last week I found on the shelf of my local Boots store `Boots Homeopathic Insomnia Tablets’. This product bears, quite legally, a product licence of right (PLR). I had not seen this before. It is obvious to anyone buying the product that it is intended to treat insomnia, and is therefore a claim. Such licences were granted in 1971 when the Medicines Act 1968 came into force. There was no requirement to submit data to support any claims when those licences were granted. You are therefore wrong when you say that homeopathic products do not carry claims – many of them do. In addition, you seem to be unaware of the regulations which became law in September 2006, which allow homeopathic products to make claims for `mild, self-limiting conditions’ (ie those that get better anyway). Again there is no requirement for homeopathic products to submit data in support of claims of efficacy – a situation that has caused huge controversy.

Now my primary point is not whether Boots is operating within the law, but how you can reconcile these activities with what you claim is social responsibility. Let me take homeopathy as an example. I took the insomnia tablets to the counter and asked for advice from the pharmacist. I asked what assurances she could give as to whether they would work. She started talking about the `like cures like’ principle of homeopathy, noting that the product contains coffee (which it doesn’t of course because it is diluted out of existence). She could not give me any assurance that this principle was scientifically valid. She also had to accept that there was no evidence from clinical trials to support the claim on the label. I then asked what her professional code of practice says about advice given to customers. She said that advice had to be factual. I pointed out the conflict between that, and the claim of the product she (as the responsible pharmacist) was selling, as well as what she had told me about how it was supposed to work. She then called in the store manager, who refused to answer any questions and referred me to Boots Customer Care – ie yourselves.

I need to make it clear that I will be publishing my questions to Boots, and your replies. If you choose not to reply, I shall publish that fact as well. So the best thing is if you send me a clear reply, addressing each of my direct questions with direct answers. Please note this point very carefully: anecdotal reports from customers, or sales figures, or any information other than properly controlled scientific studies, do not constitute reliable evidence. If they did, we would not bother regulating conventional medicines. So please don’t tell me how popular these things are – I already know that.

The reply contained the following comments about homeopathy:

The continued supply of Homeopathy products in our stores is supported by close regulation of such products by the MHRA, which is then substantiated by a number of professional bodies as being viable alternatives that appeal to our customers.

Your comments have been fully understood by us and I trust that you understand we’ve taken your concerns seriously. I feel that there is little more assurance that we can give you on this matter and of course we understand that your opinion is important to you. Thank you for the feedback you have given us.

Another exercise in how not to answer a question, so I gace it one last try:

Thanks for taking the time to reply, but you still don’t address my questions. I really don’t think you have `fully understood’ my comments, or you would have given me a direct answer. I will re-state my original question.

Do you consider that it is socially responsible to promote in your stores products for which there is no evidence to support their claims of effectiveness? Please give me a direct answer. The regulation of homeopathy by the MHRA is not relevant, as the national rules scheme enacted in September 2006 specifically excludes any requirement to demonstrate efficacy. Thus the MHRA’s regulation process has nothing to do with claims of efficacy so has no bearing on my question. Please tell me which professional bodies `substantiate’ the supply of homeopathic products in your stores. What do you mean by `substantiate’? On what evidence do they say that they are a `viable alternative’ – and alternative to what? My guess is that you are referring to professional bodies of homeopaths. If so, do you think these are objective and unbiassed sources of advice? Do you seek advice from independent sources such as The Cochrane Collaboration, or the UK’s only professor of complementary medicine?

Well they got the last word, for what it’s worth:

Thank you for your further email of 29 July.

Your comments and feedback have been fully understood and we respect that your opinion is important to you.

I believe there is little more assurance or comment that we can offer you, or comment any further from the previous emails that I’ve sent to you, that will resolve this matter to your satisfaction, and we now consider this matter closed.

I wonder if Boots really understands how much information is conveyed in their steadfast attempts to tell me nothing? Their last reply indicates that they have not the slightest idea of the difference between fact and opinion – or they choose not to know. Firstly, I was not expressing an opinion, I was asking direct questions, which they refused to answer. Secondly, I was stating facts, eg about the regulation of homeopathy, about which they are signally ignorant. Indeed I was not particularly looking for `assurance’, I was hoping for a direct answer to a direct question.

What can we conclude? I think it is that Boots has not the slightest intention of being `socially responsible’, if that conflicts with the need to make money by misleading customers about health care. But I just want to make one thing clear. I am not surprised when a company is venal, self-serving and unscrupulous; that’s disappointing but not unexpected. What is very much worse is when a company publishes high-sounding words as a pretence that it has a conscience, and refuses to engage in any kind of dialogue when asked what it means by that.

You might well be thinking that there is no point in ranting on like this if Boots and the like are not going to take the slightest bit of notice. But there is a point. If you read my first post here you will remember that I hope the blog will be a tool kit for those who want to make a difference, and support truth against falsehood. There was a good example recently, when the BBC removed its whole complementary medicine section from its website, as a result of multiple complaints by people who support evidence-based medicine. Over the last few years I have been increasingly encouraged by the good sense of a growing proportion of the general public. Boots is accountable to its shareholders as any company is, but it’s a public company and the trading of its shares is a public matter. Ethical investment portfolios have grown very fast over the last 10 years, which is something Boots should consider if it wants its share price to hold up. Meanwhile, you can do what I do and ask your local Boots pharmacist why they attempt to defend the indefensible. They may not see sense as quickly as the BBC did, but it’s worth trying.

The game is to see how long it takes to get banned from an alternative medicine or other irrational site. I tried it with www.mercola.com. I have been monitoring the site for some time, and the other week decided to see how tolerant Joe Mercola would be to someone telling the truth. So I created an account and submitted two comments about mobile phone radiation which Mercola says is potentially lethal. Much to my surprise, the comments passed moderation and appeared on the site. I am Asolepius on this site. So I tried again, this time commenting on an article about organic food. Again, my comment was published. But right now you are wondering why you can’t see it. The reason is that the very next day my account had been disabled, and the second and third comments deleted. So how long did it take me to get banned from a `natural’ health site? Three days and only three comments. Can anyone beat that? For a few days the comments still appeared when I searched on my user name, but they have gone as well now – someone has manually gone through the site and purged me.

Now I don’t suppose for a moment that Joe Mercola ever reads this blog, but of course the whole purpose of his site is to sell his vast range of questionable products, such as special cooking pots (because aluminium ones give you dementia), and his air tube mobile phone earpiece. Is he, or anyone else in that field, the slightest bit interested in defending their claims with rational argument? Of course not, they just delete adverse comments and ban anyone who challenges them. Go to the FDA site and search for `Mercola’. You get 88 hits. Maybe more by the time you read this. A lot of them are his crackpot lobbying of the FDA to promote his business, but he gets a steady stream of warning letters and enforcement actions, which he seems to wear as a badge of honour. Well there is no honour in blocking debate about what he does.

Contrast this with my policy here. I have published two comments so far (to posts here and here), dissenting from my views. I won’t block such comments, on one condition. I have to understand them. Now I know that English is not everyone’s first language, but it’s the language of this blog so you have to be able to express yourself clearly. I won’t publish comments that are unintelligible. The two adverse ones so far are not very clear so I gave them the benefit of the doubt, so in future by all means argue with me, but make your points clearly please.

Meanwhile I am not bothering with Mercola any more. I thought about starting up www.mercolawatch.com but it would be a full time job and I have to earn a living. It would be satisfying to point out to him the difference between sodium nitrate and sodium nitrite, but I would have to start up another account and life is frankly too short.