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.
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
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
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.