It has been quite a while since I managed to find time to blog sadly. Too many irons in too many fires. But this particular event is worth a bit of a chuckle.
As an NHS Audiologist specialising in Tinnitus and a Skeptic I don't take too kindly to nonsensical exploitative treatments wherever I find them (low level laser therapy, I'm looking at you...). But I have never had to deal with them in my own workplace, until now that is.
While sitting down to a quick sarny and some admin one of my colleagues rushed in to my office waving a leaflet. She had found this, along with dozens of its fellows, scattered around the staff canteen. This was advertising a very long list of woo, all being delivered by the same individual through the offices of our Occupational Health Department. One of the treatments on offer was Ear Candling, which I have looked at before on here 'Hopi' Ear Candles, but in brief - pointless and dangerous.
I called up the OH department and they confirmed that this was indeed advertised through their office.
This brought up a number of questions in my mind.
1) How DO these individuals manage to gain specialities in multiple treatment modalities?
2) What evidence base is being employed to permit this treatment on NHS staff?
3) Who was getting a kick back from this?
Number one is easily addressed by looking on the internet. Given sufficient spare time and cash it would be quite simple to become an expert in:
Homeopathy
Reiki
Reflexology
Candleology
Aromatherapy
Stone Massage
Aura Manipulation
etc etc.
Indeed if you tried hard enough you could paper a reasonable sized office in official looking certificates of complementary treatment modalities.
For number 2 there was no evidence base suggesting efficacy or safety of treatment, they were completely unaware of any potential harm.
Having identified who I was and my speciality (Chief Audiologist and Hearing Therapist) I explained in detail why it was that I was deeply unhappy with such a moronic and dangerous practice being offered in my Trust. I also provided (via email) all the research literature I have examining the claims & harm of ear candling (Ernst, Seeley, etc). The person I was speaking to clearly came from a woo sympathiser perspective but was suitably swayed by my talk of 'employing evidence based medicine' and my willingness to take it further if necessary. As it happened the practitioner was in the hospital that day and agreed to withdraw ear candling from her list of offered therapies
I failed to receive a satisfactory answer to number three and will continue to pursue this. I would hope that the trust is at least receiving some benefit from this therapists direct access to staff and accommodation.
What do you think, is it ok for a health service that demands evidence based practice from all it's Doctors, Nurses and Allied Health Professionals to simultaneously advertise treatments that have a implausible mechanism of action and strong evidence of active harm?
Monday, 13 September 2010
Friday, 16 April 2010
BCA gives up case against Simon Singh
So here is his original article in full.
The fight for libel reform is not over, please sign the petition found here:
http://www.libelreform.org/
Simon Singh
The Guardian, Saturday 19 April 2008
Article history
This is Chiropractic Awareness Week. So let's be aware. How about some awareness that may prevent harm and help you make truly informed choices? First, 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 they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.
I can confidently label these treatments as bogus 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 Professor 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.
Bearing all of this in mind, I will leave you with one message for Chiropractic Awareness Week - 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.
• This article was taken down in June 2008 following a legal complaint from the British Chiropractic Association (BCA) but was reinstated on 15 April 2010 after the BCA discontinued its libel action against Simon Singh
-- Post From My iPhone
The fight for libel reform is not over, please sign the petition found here:
http://www.libelreform.org/
Simon Singh
The Guardian, Saturday 19 April 2008
Article history
This is Chiropractic Awareness Week. So let's be aware. How about some awareness that may prevent harm and help you make truly informed choices? First, 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 they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.
I can confidently label these treatments as bogus 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 Professor 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.
Bearing all of this in mind, I will leave you with one message for Chiropractic Awareness Week - 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.
• This article was taken down in June 2008 following a legal complaint from the British Chiropractic Association (BCA) but was reinstated on 15 April 2010 after the BCA discontinued its libel action against Simon Singh
-- Post From My iPhone
Friday, 2 April 2010
Current Workload
I'm currently working on:
1 article for BAA magazine for the BSA
1 of series of articles for the BTA magazine 'Quiet' on CAM treatments
Re-writing the Tinnitus Update for Audiologists for the BTA
Developing the national Quality Evaluation Tool for Advanced Adult Rehabilitation
Two lectures for the European Tinnitus Course
Research programme for DEFRA
Developing www.sheffieldindustrialhearing.co.uk
Seeing patients privately at www.hearingtherapy.net
NHS workload.
Feel tired just looking at it!
Also just filmed a segment on Tinnitus for The One Show which should be coming out on week of 19th April.
If you have tried or have heard of a CAM treatment for Tinnitus that you're curious about I'd love to hear from you,
-- Post From My iPhone
1 article for BAA magazine for the BSA
1 of series of articles for the BTA magazine 'Quiet' on CAM treatments
Re-writing the Tinnitus Update for Audiologists for the BTA
Developing the national Quality Evaluation Tool for Advanced Adult Rehabilitation
Two lectures for the European Tinnitus Course
Research programme for DEFRA
Developing www.sheffieldindustrialhearing.co.uk
Seeing patients privately at www.hearingtherapy.net
NHS workload.
Feel tired just looking at it!
Also just filmed a segment on Tinnitus for The One Show which should be coming out on week of 19th April.
If you have tried or have heard of a CAM treatment for Tinnitus that you're curious about I'd love to hear from you,
-- Post From My iPhone
Thursday, 1 April 2010
Simon Singh wins his Bogus Adventure vs the BCA
In a wonderful decision delivered at 9.30 this morning the three most senior judges in the country have overturned the previous ruling on meaning in the case of Simon Singh vs the British Chiropractic Association.
Mr Justice Eady had ruled that Simon's use of the word 'bogus' was a statement of fact and inferred that the BCA was knowingly promoting ineffective treatments. Today it has been decided that he 'erred in his approach' and that it was clearly an opinion piece supported by evidence. This allows Simon to use the far more reasonable 'fair comment' defence rather than having to prove that the BCA were knowingly dishonest. The BCA have already produced a statement available from their website. It remains to be seen whether or not they have any appetite to persue their case when faced with such a defence.
I certainly know of chiropracters who claim to cure Tinnitus, as well as practitioners of traditional Chinese medicine. Whilst I'd love to see their evidence I'd rather not go through a libel case. I may well look into a literature review in the future with CAREFUL commentary....
Of course this is only the beginning of the reform of our frankly ridiculous UK libel laws but there are apparently strong hints within today's ruling that change may be starting to happen.
Congratulations to Simon on this historic victory for science and common sense.
-- Post From My iPhone
Mr Justice Eady had ruled that Simon's use of the word 'bogus' was a statement of fact and inferred that the BCA was knowingly promoting ineffective treatments. Today it has been decided that he 'erred in his approach' and that it was clearly an opinion piece supported by evidence. This allows Simon to use the far more reasonable 'fair comment' defence rather than having to prove that the BCA were knowingly dishonest. The BCA have already produced a statement available from their website. It remains to be seen whether or not they have any appetite to persue their case when faced with such a defence.
I certainly know of chiropracters who claim to cure Tinnitus, as well as practitioners of traditional Chinese medicine. Whilst I'd love to see their evidence I'd rather not go through a libel case. I may well look into a literature review in the future with CAREFUL commentary....
Of course this is only the beginning of the reform of our frankly ridiculous UK libel laws but there are apparently strong hints within today's ruling that change may be starting to happen.
Congratulations to Simon on this historic victory for science and common sense.
-- Post From My iPhone
Tuesday, 30 March 2010
Slight Change of Focus
It has been brought to my attention by a kind friend that posts on this blog have been rather few and far between. This has been for a number of reasons, chief of which is time.
When I set out to produce this blog my intention was to make it a resource for Tinnitus patients and professionals to enable them to review the evidence base for Tinnitus treatments and decide for themselves about their efficacy. To that end each post required I perform as thorough a literature review as possible, summarise each paper and write a conclusion. I still intend to do this when I get the chance but it is just not practical to do this regularly.
Alongside my NHS work I have a private practice at www.hearingtherapy.net, an industrial hearing assessment and rehabilitation business www.sheffieldindustrialhearing.co.uk, write regularly for the BTA Quiet magazine, sit on the British Society of Audiology council and chair the professional development committee of the British Academy of Audiology. I am currently engaged in a research programme funded by DEFRA and developing the national Quality Evaluation Tool for Tinnitus and writing the Tinnitus info leaflet for Audiologists for the BTA. So, quite busy.
To this end I shall be publishing more frequently on here but with less time intensive pieces making up the majority of posts. My hope is to encourage more active discussion both in the comments and in the forum available here. I will be creating a separate page so that the evidence-based posts can be easily found.
Thanks for your interest and patience,
Tim
When I set out to produce this blog my intention was to make it a resource for Tinnitus patients and professionals to enable them to review the evidence base for Tinnitus treatments and decide for themselves about their efficacy. To that end each post required I perform as thorough a literature review as possible, summarise each paper and write a conclusion. I still intend to do this when I get the chance but it is just not practical to do this regularly.
Alongside my NHS work I have a private practice at www.hearingtherapy.net, an industrial hearing assessment and rehabilitation business www.sheffieldindustrialhearing.co.uk, write regularly for the BTA Quiet magazine, sit on the British Society of Audiology council and chair the professional development committee of the British Academy of Audiology. I am currently engaged in a research programme funded by DEFRA and developing the national Quality Evaluation Tool for Tinnitus and writing the Tinnitus info leaflet for Audiologists for the BTA. So, quite busy.
To this end I shall be publishing more frequently on here but with less time intensive pieces making up the majority of posts. My hope is to encourage more active discussion both in the comments and in the forum available here. I will be creating a separate page so that the evidence-based posts can be easily found.
Thanks for your interest and patience,
Tim
Saturday, 30 January 2010
10:23 Boots Homeopathy Campaign
Following on from the excellent open letter to Boots from the Merseyside Skeptics there is a national campaign running today to shame Boots into doing the right thing.
Approximately 300 people around the country are taking part in a group homeopathic 'overdose' using 30C preparations of arsenic, nux vomica etc. Of course as this is a homeopathic preparation at 30C there are no actual molecules of the advertised substance in the pills so we are at no risk. The pills are made of sucrose & lactose so other than a mild sugar rush or potential lactose intolerance these pills are capable of producing no effect on the human body.
Why does this matter? Well apart from being misled by the nations favourite chemist there is the concept of opportunity cost. This is the potential delay caused by relying on an imaginary treatment rather than an effective one. At the mild end this may simply prolong suffering. More serious is the possibility of someone relying on homeopathy entirely rather than conventional medicine, missing out on accurate diagnosis and potentially allowing a condition to move from treatable to untreatable. There are documented cases of people dying, or allowing their loved ones die because of their faith in alternative medicine.
The placebo effect is very real and is certainly capable of producing positive effects in the human body. If someone is deriving benefit from homeopathy, reiki healing or ear candling that's wonderful provided they are at no risk and are informed about the true nature of the treatment they are choosing. The principle behind the 1023 campaign (1023 relates to Avagadro's number) is that we all deserve to have accurate, honest information about our healthcare. That Boots is choosing to lend their enormous credibility to a completely unproven treatment harms both themselves and their customers. Boots representatives in open session in parliament have admitted that they only sell homeopathic treatments because there is a demand for them, not because there is any evidence of their efficacy. If today's campaign fails to shame Boots into doing the right thing we can at least hope that the media coverage may reduce the demand through educating the public, making the business case for homeopathy less enticing.
-- Post From My iPhone
Approximately 300 people around the country are taking part in a group homeopathic 'overdose' using 30C preparations of arsenic, nux vomica etc. Of course as this is a homeopathic preparation at 30C there are no actual molecules of the advertised substance in the pills so we are at no risk. The pills are made of sucrose & lactose so other than a mild sugar rush or potential lactose intolerance these pills are capable of producing no effect on the human body.
Why does this matter? Well apart from being misled by the nations favourite chemist there is the concept of opportunity cost. This is the potential delay caused by relying on an imaginary treatment rather than an effective one. At the mild end this may simply prolong suffering. More serious is the possibility of someone relying on homeopathy entirely rather than conventional medicine, missing out on accurate diagnosis and potentially allowing a condition to move from treatable to untreatable. There are documented cases of people dying, or allowing their loved ones die because of their faith in alternative medicine.
The placebo effect is very real and is certainly capable of producing positive effects in the human body. If someone is deriving benefit from homeopathy, reiki healing or ear candling that's wonderful provided they are at no risk and are informed about the true nature of the treatment they are choosing. The principle behind the 1023 campaign (1023 relates to Avagadro's number) is that we all deserve to have accurate, honest information about our healthcare. That Boots is choosing to lend their enormous credibility to a completely unproven treatment harms both themselves and their customers. Boots representatives in open session in parliament have admitted that they only sell homeopathic treatments because there is a demand for them, not because there is any evidence of their efficacy. If today's campaign fails to shame Boots into doing the right thing we can at least hope that the media coverage may reduce the demand through educating the public, making the business case for homeopathy less enticing.
-- Post From My iPhone
Location:Leeds
Thursday, 26 November 2009
Boots BS Baffles Brains - Excellent Open Letter from Merseyside Skeptics Society
An Open Letter to Alliance Boots
The Boots brand is synonymous with health care in the United Kingdom. Your website speaks proudly about your role as a health care provider and your commitment to deliver exceptional patient care. For many people, you are their first resource for medical advice; and their chosen dispensary for prescription and non-prescription medicines. The British public trusts Boots.
However, in evidence given recently to the Commons Science and Technology Committee, you admitted that you do not believe homeopathy to be efficacious. Despite this, homeopathic products are offered for sale in Boots pharmacies – many of them bearing the trusted Boots brand.
Not only is this two-hundred-year-old pseudo-therapy implausible, it is scientifically absurd. The purported mechanisms of action fly in the face of our understanding of chemistry, physics, pharmacology and physiology. As you are aware, the best and most rigorous scientific research concludes that homeopathy offers no therapeutic effect beyond placebo, but you continue to sell these products regardless because “customers believe they work”. Is this the standard you set for yourselves?
The majority of people do not have the time or inclination to check whether the scientific literature supports the claims of efficacy made by products such as homeopathy. We trust brands such as Boots to check the facts for us, to provide sound medical advice that is in our interest and supply only those products with a demonstrable medical benefit.
We don’t expect to find products on the shelf at our local pharmacy which do not work.
Not only are these products ineffective, they can also be dangerous. Patients may delay seeking proper medical assistance because they believe homeopathy can treat their condition. Until recently, the Boots website even went so far as to tell patients that “after taking a homeopathic medicine your symptoms may become slightly worse,” and that this is “a sign that the body’s natural energies have started to counteract the illness”. Advice such as this directly encourages patients to wait before seeking real medical attention, even when their condition deteriorates.
We call upon Boots to withdraw all homeopathic products from your shelves. You should not be involved in the sale of ineffective products, because your customers trust you to do what is right for their health. Surely you agree that your commitment to excellent patient care is better served by supplying only those products whose claims can be substantiated by rigorous scientific research? Or do you really believe that Boots should be in the business of selling placebos to the sick and the injured?
The support lent by Boots to this quack therapy contributes directly to its acceptance as a valid medical treatment by the British public, acceptance it does not warrant and support it does not deserve. Please do the right thing, and remove this bogus therapy from your shelves.
Yours sincerely,
Merseyside Skeptics Society
The Boots brand is synonymous with health care in the United Kingdom. Your website speaks proudly about your role as a health care provider and your commitment to deliver exceptional patient care. For many people, you are their first resource for medical advice; and their chosen dispensary for prescription and non-prescription medicines. The British public trusts Boots.
However, in evidence given recently to the Commons Science and Technology Committee, you admitted that you do not believe homeopathy to be efficacious. Despite this, homeopathic products are offered for sale in Boots pharmacies – many of them bearing the trusted Boots brand.
Not only is this two-hundred-year-old pseudo-therapy implausible, it is scientifically absurd. The purported mechanisms of action fly in the face of our understanding of chemistry, physics, pharmacology and physiology. As you are aware, the best and most rigorous scientific research concludes that homeopathy offers no therapeutic effect beyond placebo, but you continue to sell these products regardless because “customers believe they work”. Is this the standard you set for yourselves?
The majority of people do not have the time or inclination to check whether the scientific literature supports the claims of efficacy made by products such as homeopathy. We trust brands such as Boots to check the facts for us, to provide sound medical advice that is in our interest and supply only those products with a demonstrable medical benefit.
We don’t expect to find products on the shelf at our local pharmacy which do not work.
Not only are these products ineffective, they can also be dangerous. Patients may delay seeking proper medical assistance because they believe homeopathy can treat their condition. Until recently, the Boots website even went so far as to tell patients that “after taking a homeopathic medicine your symptoms may become slightly worse,” and that this is “a sign that the body’s natural energies have started to counteract the illness”. Advice such as this directly encourages patients to wait before seeking real medical attention, even when their condition deteriorates.
We call upon Boots to withdraw all homeopathic products from your shelves. You should not be involved in the sale of ineffective products, because your customers trust you to do what is right for their health. Surely you agree that your commitment to excellent patient care is better served by supplying only those products whose claims can be substantiated by rigorous scientific research? Or do you really believe that Boots should be in the business of selling placebos to the sick and the injured?
The support lent by Boots to this quack therapy contributes directly to its acceptance as a valid medical treatment by the British public, acceptance it does not warrant and support it does not deserve. Please do the right thing, and remove this bogus therapy from your shelves.
Yours sincerely,
Merseyside Skeptics Society
Subscribe to:
Posts (Atom)
