The Three Amigos

OK, I’m a bit slow in commenting on the second oral evidence session of the House of Commons Science and Technology Committee. At least the delay has allowed me to get my thoughts in order – and to calm down. I have seldom seen three people looking less comfortable. They all knew they were on the rack, and I might have expected them to be a bit better prepared. They had the air of someone going to the dentist – something unpleasant, not overwhelmingly important, and to be got out of the way as quickly as possible. Well I hope they will realise that there is a bigger picture than they one they thought they were painting. Again I won’t cover the entire sorry episode, just the bits where I hope I can add some context.

We had Professor Kent Woods, chief executive of the regulatory body the MHRA, Mike O’Brien QC MP, minister responsible for the Department of Health, and Professor David Harper, chief scientist at the Department Health. All were asked what the evidence was for homeopathy. Seldom have I seen such wriggling and squirming. Nobody wanted to answer the question. Woods instead wittered on about 10% of the population using homeopathy, which wasn’t the question at all. The terrifyingly tenacious Phil Willis MP tore into Harper, repeatedly reminding him that he was the chief scientist and he should know. The dental analogy turned out to be very apt, as getting a straight answer was harder than pulling teeth. Eventually, as if confessing to an embarrassing personal habit, they all agreed that there is no reliable evidence. But O’Brien in particular clung to the placebo effect, which exposed his soft underbelly to Dr Evan Harris’ fangs (sorry, I can’t seem to resist teeth today). It was cringingly amusing to see a barrister tied up in knots on the ethics of knowingly using placebos. He was expertly backed into a corner by Harris when he admitted that he would not be happy as a patient to be given a placebo when his doctor knew it to be ineffective. Would it be ethical if the doctor thought it wasn’t a placebo? But then the doctor would be wrong – and thus not competent. Nice one Evan.

O’Brien tried valiantly to divert the flak to the professional bodies, not entirely without justification. As it happens I have it in writing from the Royal College of GPs that they do not approve the use of homeopathy, but have they ever told their homeopath members that? No, they like their membership fees too much. The questioning then turned to the more lunatic fringe of homeopathy (as if any of it is sensible). Kent Woods was emphatic that the MHRA had stamped on the products claiming to prevent malaria, and had them withdrawn from the market. Yes they did, but only after a TV programme exposed the scandal – which he had conveniently forgotten.

The NHS pilot scheme for patient budgets then came under fire, with O’Brien peeping nervously over the parapet. He explained that, if a patient wanted to spend their budget on homeopathy, it would need the agreement of their GP and of the primary care trust. Now this is interesting, as I have done some research on what PCTs spend on homeopathy. It seems that spending, which may be up to one million pounds a year, is largely confined to PCTs that have a homeopathic hospital on their doorstep. If there’s no quack hospital round the corner, nobody gets sent halfway across the country to take sugar pills – and that applies to nearly three quarters of PCTs.

The smoking barrels then swung back to Woods, who had to defend his agency’s exercise in double standards on the matter of homeopathy licensing. The committee chairman Phil Willis set Woods up for the fall, by referring to the MHRA’s analysis of the MLX312 consultation. This reported `overwhelming support’ for the proposals to allow labels bearing therapeutic claims. Willis then read out a list of the various organisations who had objected, as well as the ones which completely misunderstood the whole thing. Woods replied that “there has been very little objection to the scheme….”. One has to wonder what news media he reads. I happen to know that he had face to face interviews with certain parties who were highly critical. He said he would have to remind himself of the details of the consultation, but I would have expected someone in his position to have a better memory. His recall is no better regarding his own agency’s publications. When asked whether a purpose of the new rules was to enable the expansion of the homeopathic industry, he said no, and in any case there had only been one new licence issued so far under the new rules. Yet the explanatory memorandum for the scheme, issued by the MHRA, states:

Although the development of national rules by Member States under the 2001 Directive is optional, failing to introduce the scheme would inhibit the expansion of the homeopathic industry. Sections of the homeopathic industry are discontented with the current situation.

He also forgot to mention that the existing licences of right will expire under the new rules, and companies will be forced apply for new licences. They are just very slow at doing this.

The section on regulation of practitioners engendered the expected waffle about the useless schemes being set up by the Prince of Wales favourite lobby group. O’Brien was economical with the truth about the funding of all this. The Prince’s Foundation received £1 million from the Kings Fund and £900,000 from the Department of Health (as I found out via a Freedom of Information request) to develop a scheme which the Society of Homeopaths still hasn’t joined. Money well spent? Judge for yourself.

So are these three captains of health care worthy of holding their positions? I don’t think so. In particular Woods should consult a neurologist about his memory loss.

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9 Responses

  1. For anyone who doesn’t want to go through the trauma of watching the video, an uncorrected transcript of the session is available:

    http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/uc45-ii/uc4502.htm

  2. To be honest Mojo, you can still feel the squirming just reading the transcript!

  3. Mike O’Brien’s repeated response, that there is a significant lobby, is astounding. He says that there isn’t enough evidence to justify him cutting the funding. Surely it should be the other way round, the evidence has to be there to justify funding!

    What I was waiting for someone to ask him is what kind of evidence would he need to have to justify it? Would it need the pro-homeopathy lobby to disappear completely? He seems to understand that the evidence does not show any efficacy for homeopathy beyond the placebo effect, so clearly he’s not talking about evidence here in that sense, I wonder what evidence he means?

  4. Thanks for a very nice summary.

    I was most appalled by Harper. The other two were professional politicians and bureaucrats doing their job as they think fit.

    I could never in my most depressive moment have imagined that our chief scientist could be so ill prepared for cross-examination and so incompetent: he had no clue about systematic reviews to provide an unbiased summary of the evidence, or the possibility that critical appraisal of individual trials can assess their quality and risk of bias.

    O’Brien made one “argument” that no-one seems to have picked up on. In his thinking it would be illiberal to stop funding for homeopathy. But, this is to perpetuate a postcode lottery of availability, which I would be very curious to hear him defend — provided his defence was in plain English. Either a technology should be available to all, or it should be available to none (or it should be available in a research trial, but this does not apply to homeopathy).

    • Thanks for your point about the postcode lottery – I am currently writing up the PCT data in full and that’s an important aspect.

      I am as appalled by Woods as I am by Harper. Woods is a pharmacologist. He got the job because of that. He is supposed to know about scientific evidence.

      • Woods gave me the impression that he knew very well what the evidence is, while Harper seemed, not only to have not bothered to find anything out, but to be incapable of doing so.

        Woods was being a good bureaucrat: he has probably been told by the politicians to make it possible for the MHRA to register homeopathic medicines, and he has done that with marvellously precise language, that manages to evade the questions “Does it work?” and “Is it ethical?”. Although his bureacratic skills have to be admired, his ethics and values are detestable.

  5. I just corrected some `who said what’ errors, after reading the transcript. I am rashly assuming that the stenographers are right and I was wrong!

  6. […] There is a good account of the third SCITECH session by clinical science consultant, Majikthyse, at The Three Amigos. […]

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