How hard it is to see the mote in one’s own eye

The ability of people in a position of responsibility to be blind to biasses and canards never ceases to amaze me. On 4th June last the Royal Society of Medicine hosted a symposium on `Integrated Oncology’. This was originally a three-day event, organised jointly by the RSM and the Prince’s Foundation for Integrated Health, until the latter sank into its own financial Sargasso Sea. I and certain others wrote to the Dean of the RSM as follows:

16th July 2010

Dear Dr Misselbrook

An Open Letter

We have noted with concern that the RSM hosted a symposium on `Integrated Oncology’, originally organised in collaboration with the Prince’s Foundation for Integrated Health, on 4th June 2010. The programme was hardly scientific, and all the speakers are well known supporters of complementary and alternative medicine (CAM). However we were gratified to see that two whole days devoted to “The Seven Levels of Healing”, a concept which does not appear to have been subjected to any proper research, were dropped from the programme. Nevertheless, the programme seemed to assume mistakenly that scientific and empathic medicine are mutually exclusive. Genuinely compassionate care includes giving patients the right information about treatments that work, based on evidence rather than intuition.

The original alignment with the Prince’s Foundation for Integrated Health (FIH) seems to have been ill-advised. This organisation has operated for years as a lobby group for CAM, and has used public and charitable money to further the personal aims of the Prince of Wales. Examples are £135,000 for a misleading patient guide, and almost £2 million for a regulation scheme that excludes evidence based practice. The organisation has now announced that it is to close, and its stewardship of donated funds is currently undergoing intense scrutiny (reference). All this seemed to present an opportunity to cancel the symposium, rather than to go ahead with a reduced programme.

What matters to members of this Society is surely the best health care for patients, and that means compassionate and evidence based medicine. The FIH chose to sidestep that, and instead to pander to fashion and wishful thinking, while drawing in learned societies in order to lend credibility. We call upon this Society not only to make clear what standards it expects of its Members and Fellows, but to lead by example.

Yours sincerely

[Majikthyse]

with

Professor John Garrow MD PhD FRCP FRCPE, Emeritus Professor of Human Nutrition, University of London, and HealthWatch member

Professor David Colquhoun FRS, Professor of Pharmacology, University College London

John Illman, medical journalist

Professor Raymond Tallis FRCP FMedSci DLitt LittD FRSA, Emeritus Professor of Geriatric Medicine, and HealthWatch member

Caroline Richmond MSc, obituary writer, and HealthWatch member

Dr James May, General Practitioner, and HealthWatch chair

Mr Keith Isaacson FDS MOrth RCS Eng, Consultant Orthopaedic Surgeon, and HealthWatch member

Dr Simon Baker MA VetMB PhD MRCVS, Veterinary Surgeon

Professor Edzard Ernst MD PhD FMed Sci FSB FRCP FRCP (Edin), and HealthWatch member

Dr Susan Bewley MD FRCOG MA, and HealthWatch member

Dr Ashley Simpson BA(Hons) MBBS, and HealthWatch member

Dr Simon Singh PhD, Science Writer

Professor Michael Baum MB FRCS ChM MD FRCR, Professor Emeritus of Surgery & Visiting Professor of Medical Humanities, University College London, and HealthWatch member

CC: Professor Robin Williamson PRSM

Reference

Booth R. Arrests prompt questions about oversight of Prince’s charities. The Guardian 27th April 2010. Available at http://www.guardian.co.uk/uk/2010/apr/27/prince-charles-charity-arrests (accessed 9th June 2010)

I received a reply dated 27th July. Some of my fellow signatories have encouraged me to do a blog post on this matter, so here it is. Firstly, below is Dr Misslebrook’s reply, which I don’t regard as confidential as our letter was headed `An Open Letter’.

Thank you for your letter of 16/7/10 re the recent meeting on “Integrated Oncology” on 4/6/10.

The RSM has 58 semi-autonomous Sections, each fully responsible for its own programme and each run by its own Section Council within the Section Regulations of the RSM. This meeting was not a Society Conference planned by myself, but was a Hypnosis and Psychosomatic Medicine Section meeting. This Section’s name makes its concerns clear. The RSM puts on about 430 conferences and meetings annually allowing for both breadth and depth, and this meeting illustrates one particular aspect of that breadth.

My function as Dean with respect to Section meetings is to ensure that they are educationally fit for purpose. This does not necessitate that I should personally agree with the agenda of each talk, rather that the presentation and the speakers are in accord with the aims and objectives of the meeting. For a Section whose remit is Psychosomatic Medicine this particular programme seems quite to the point.

The RSM campaigns neither for nor against CAM. This meeting makes no suggestion that CAM should in any way replace orthodox medical care. I agree with you that compassionate care includes giving patients information about treatments that work, however the days when we can ignore our patients’ own belief systems are over. We need to work with our patients, and if this means working alongside CAM in some cases then so be it.

You state that we have “aligned” ourselves with the Prince’s Foundation for Integrated Health. This is not the case. We regularly hold joint meetings with many other bodies without any inference that our views must coincide. One of the central functions of the RSM is to promote dialogue both within medicine and between medicine and society as a whole. This does not make any given presentation the official view of the RSM.

There is a certain irony in my defence of this meeting. My own view that CAM generally functions as a placebo is a matter of public record.’ The RSM stands up strongly for science in medicine but we do not see it as our role to enforce a rigid biomedical orthodoxy. I may not agree with some of the speakers at this meeting but I would defend their right to speak and the audience’s right to critically examine their views.

I gladly signed the petition supporting one of your signatory’s recent campaign for the freedom of scientists to speak openly without fear of libel. I was delighted when he won. The freedom to speak and to be open to critical examination should apply to all.

With best wishes,

Dr David Misselbrook

Dean

i. Misselbrook D. Thinking about Patients. Basingstoke: Petroc Press 2001, page 164.

It’s interesting to see that his “function as Dean with respect to Section meetings is to ensure that they are educationally fit for purpose”. It isn’t clear what the purpose of this event was, but as there were no speakers from a sceptical or critical standpoint there could have been no intention to challenge any of the ideas presented. So I suppose it was fit for the purpose of misleading patients.

So what exactly is “working alongside CAM”? Misselbrook does not mention the matter of ethics. Does “working alongside” include properly informed consent, ie telling patients that the vast majority of CAM has no reliable evidence to support its claims? Or does it mean paternalistically staying silent on the matter?

Hmm… so “One of the central functions of the RSM is to promote dialogue both within medicine and between medicine and society as a whole”. There seems to have been little scope for dialogue at this event, when all the speakers were CAM supporters.

I wonder whether the RSM would be keen to host a meeting on say the folly of splinting broken legs. Don’t laugh, the evidence for most CAM is about as good as it is for letting fractures take their natural course. It beggars belief that the RSM could be so keen on “critical examination”, as we see in the last line of the letter, and not to notice that a programme has been engineered to avoid such a challenge.

I have no reason to suppose that Dr Misselbrook is not an excellent doctor and a charming chap, but it really would be refreshing to see some properly critical thinking going on in supposedly high places. It’s a matter of looking below the surface at what the implications are. I won’t be surprised to see all sorts of claims going around the net as to how the RSM supports CAM for cancer. What matters is not how the Dean sees it, but how the world at large sees it.

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7 Responses

  1. i was once told by someone in the know that the RSM is very devided regarding their activities on alternative medicine.some of its officers seem to be very worried about getting involved in quackery. what we have seen here could be the expression of an internal debate and struggle.viewed form this angle,it seems well worth complaining each time the RSM is promoting quackery.eventually,one would hope,this might strengthen the sceptic fraction within this organisation.

  2. The fact that the RSM sell their Fellowships for a few hundred pounds means that when I see someone saying they are a “Fellow of the Royal Society of Medicine” I assume they are a quack. The web provides many example of how their name is misused in this way.

  3. As an RSM member I have complained several times about people mis-using ‘FRSM’ and have had no response at all from the RSM. Several years ago an edict was issued saying that people could use FRSM after their names ‘provided there was no implication that this was an academic title’. What bollocks! Why else would anyone use such initials? There are no circumstances in which it would have this implication.

    But to the real susbtance of this posting, I too was very concerned about this meeting (there was a whacky one last September too) and I am completely pissed off with people who a) are in charge and b) should know better hiding behind ‘it wasn’t actually my idea’ excuses. The answers you received did not address the issues but skirted around them. This meeting had no place in the RSM calendar, even if it had been hosted by the section of tooth fairies and father christmas, or for that matter the section of Neuroscience.

    Misselbrook says ‘The RSM campaigns neither for nor against CAM. This meeting makes no suggestion that CAM should in any way replace orthodox medical care…’

    The RSM a campaigning organisation? What does that mean and where are its ‘campaigns directed?

    Then ‘
    The RSM stands up strongly for science in medicine but we do not see it as our role to enforce a rigid biomedical orthodoxy. I may not agree with some of the speakers at this meeting but I would defend their right to speak and the audience’s right to critically examine their views.’

    When I joined I thought I was belonging to a scientific organisation, promoting and discussing good medical practice and providing excellent resources for library and for meetings. No one is suggesting that people don’t have a right to talk about magic medicine if they want to, but is the RSM the place to do this. I think not.

    Although the FIH is defunct there is no real RIP as it is rising again as the College of Medicine, (does this have roayl approval ?) so will we see the RSM joining forces with quackery in an even more pseudo acadmeic guise?

    And of course taking the quacktitioner royal’s views to their logical conclusions, no one would intervene in anything at all: he says we should ‘work with nature not against it’ which , being interpreted logically, means not intervening at all when someone is ill. Just let nature take its course…………..

    • Thanks Lindy – sorry your comment arrived just after I went on holiday. Sombody should start a professional body that doesn’t have any commercial interests – I don’t know of one hitherto.

  4. The RSM recently put the name of John McTimoney (he of chiropractic fame) on their ‘Wall of Honour‘.

    The news item on the McTimoney website is:

    John McTimoney is honoured at The Royal Society of Medicine

    As I understand it you can put anyone’s name there – just hand over £2,500!

    You’re welcome to honour anyone who worked in the medical sector or healthcare field.

    You can add your personal comment about John McTimoney to a ‘virtual wall‘.

    • Thanks Zeno – what a dreadful fund-raising scheme this wall is. There should at least be some form of vetting of nominations. I have posted the following comment:

      This is astounding. Chiropractic is neither science nor medicine, it is a belief system based on imaginary ideas about how the body works. This entry dishonours both the Society and the genuine people listed here.

      But note the terms and conditions:

      7. The Royal Society of Medicine reserves the right to delete any contribution at its sole, unfettered discretion at any time without notice or explanation. The Royal Society of Medicine will reactively moderate all content posted to the site, and operates a takedown policy for any information deemed offensive.

      So don’t be surprised if it disappears quickly.

  5. An excellent comment!

    As you say, it may disappear sometime soon, but I’ve set up a ChangeDetection.com alert to notify me when the page changes:

    change log

    I’ll let you know if it is removed or if anything is added.

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