Is a degree in homeopathy a sick joke?
By Richard Tomkins
Published: May 23 2009 01:32 | Last updated: May 23 2009 01:32
A couple of years ago The TaxPayers’ Alliance, a lobby group which campaigns for lower taxes, published a report claiming that £40m of public money was being wasted each year on daft degree courses at universities. Although the government had previously undertaken to squeeze out these so-called Mickey Mouse degrees, the alliance said it had identified no fewer than 401 “non-courses” that lent the respectability of scholarly qualifications to non-academic subjects.
Top of the Alliance’s list was a three-year BA honours degree in outdoor adventure with philosophy offered by University College Plymouth St Mark & St John. Others included courses in equine psychology at the Welsh Horticultural College, in lifestyle management at Leeds Metropolitan University, in martial arts and adventure tourism at Derby University and golf management at the UHI Millennium Institute in the Scottish Highlands.
EDITOR’S CHOICE
More from Reportage - Nov-24Critics say such courses risk cheapening the value of a university education by blurring the distinction between the kind of learning that requires serious scholarship and that which requires none. Others say this is just snobbery – and that such new courses are a great deal more practical than degrees in classics or medieval history, say.
For Professor David Colquhoun, however, this is all a bit of a sideshow to a more important issue. An eminent scientist and a pharmacologist at University College London, Colquhoun has been waging a six-year war against a particular subset of such “non-courses” identified by the Alliance. His campaign specifically targets science degrees in complementary and alternative medicine such as homeopathy, naturopathy and nutritional therapy, subjects he condemns as quackery and anti-science.
In fact, says Colquhoun, his position is quite different from that of the lobby group. “What they didn’t do, in my view, was to distinguish between the degrees that are in honest, if not very intellectual, subjects and those that are based on new-age gobbledygook. If it’s thought that the only way to get more plumbers is to offer a BSc in plumbing, I wouldn’t really object. Plumbing, golf management and so on are quite honest occupations – not very intellectual, perhaps, and no one’s going to mistake them for nuclear physics, but they’re legitimate occupations and they do what they say on the label. The degrees I object to are those that are in subjects that aren’t true, and that’s largely restricted to various forms of quackery.”
In a sense, it is a mirror image of the debate that has raged in the US over whether intelligent design should be taught alongside evolutionary theory. But, except among scientists and academics, the row over degree courses in alternative medicine has attracted far less attention. It is largely a war that has been waged over the internet – notably through Colquhoun’s Improbable Science website, but also via Ben Goldacre’s Bad Science blog and others such as The Quack-ometer, which sets out to debunk quack cures.
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There are no published statistics on the availability of British university degree courses in complementary and alternative medicine, but using the online course search facility offered by UCAS, the Universities and Colleges Admissions Service, it is possible to find 42 universities offering a total of 84 courses in subjects such as reflexology, aromatherapy, acupuncture and herbal medicine, all beginning this September. Of these, 51 are courses leading to BSc degrees, meaning graduates will be entitled to assert that they are scientifically trained to the highest standards.
All these BSc courses are run by new universities, the former polytechnics and other educational institutions that were given university status in 1992 as part of the government’s drive to widen access to university degrees. These former polytechnics still tend to emphasise vocational training, and by providing these courses, they are responding to an upsurge of public interest in alternative medicine. Arguably, they are also responding to a financial incentive: popular courses bring in more students, and the more students a university has, the more funding it gets.
But why has alternative medicine become so popular? In Britain, the Queen has long espoused homeopathy, and Prince Charles actively campaigns for complementary medicine. (“He’s an absolute bloody menace on this,” according to Colquhoun.) But on a broader front, the trend also coincides with what some have dubbed “the Endarkenment”: a swing of the pendulum away from the rationalist values and scientific thinking of the Enlightenment and back towards the type of thinking more characteristic of an age of religion and superstition.
The trend has provoked an attempt by scientists and others to stem the rising tide of twaddle, gobbledygook and mumbo-jumbo. Colquhoun has taken a particular interest in trying to stop universities awarding BSc degrees in complementary and alternative medicine, using freedom of information legislation to try to get access to course literature. To Colquhoun (“72, dammit, and still doing science”), any university offering a BSc course in homeopathy might just as well be offering BSc courses in witchcraft or astrology. “There isn’t much one can do about high street homeopaths as long as they stay within the law,” he says. “It’s quite a different matter when universities start to teach students that amethysts emit ‘high yin energy’ and so on. That sort of nonsense corrupts the university and corrupts science itself.”
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What is complementary and alternative medicine? Simply put, it’s anything that’s not conventional. that includes homeopathy, acupuncture, herbal medicine, aromatherapy, reflexology, traditional Chinese medicine, naturopathy, nutritional therapy, chiropractic, osteopathy, Ayurveda, colonic irrigation, hypnosis – the list goes on and on. In the main, these therapies are rooted not in science but in folk knowledge, custom or spiritual beliefs. Others were the invention of visionaries such as Samuel Hahnemann, the German physician who came up with homeopathy in the late 18th century, or D.D. Palmer, a Canadian-born magnetic healer who founded chiropractic in America at the end of the 19th century.
A big difference between conventional and alternative medicine is that the former is predominantly evidence-based: its gold standard is the double-blind randomised controlled trial, in which half the patients are given an experimental treatment and half are given a placebo, and neither doctor nor patients know who is getting which. In contrast, wide areas of complementary and alternative medicine remain untested, and, even where evidence does exist, it is often thin or disputed. Where evidence is absent, advocates tend to cite patient testimonials. Such anecdotes may be persuasive, but they are not evidence. There is no way of knowing whether these people would have recovered anyway, whether something else cured them, or whether it was the placebo effect – often quite powerful – of being given a treatment they believed in.
How to make a homeopathic tincture
To make their preparations, homeopaths first mix raw extracts with alcohol to form a tincture that becomes the basis of the dilution process. They believe that the more dilute a tincture is, the stronger its effect. To make a common 30C dilution (where C stands for 100), one drop of tincture is diluted in 100 parts of water; then one drop of that dilution is diluted in another 100 parts of water; and so on, 30 times. So, at the end of the process, the dilution is one part in 100 to the power of 30 or one part in 1,000,000,000,000,000,
000,000,000,000,000,
000,000,000,000,000,
000,000,000,000,000 – so weak that, according to the charity Sense about Science, the chance of its containing even one molecule of the original ingredient is less than the chance of winning the National Lottery five weeks in a row.
After each dilution, the liquid is vigorously shaken, in a process called “succussion”. Homeopaths believe that this process imprints the “memory” of the healing substance on the water, so it does not matter if no actual molecules remain. If this were so, critics point out, water would also retain the memory of all the other substances on the planet with which it had ever come into contact, and drinking just a glass of it would be a treatment for almost every condition imaginable.
Even Colquhoun concedes that not all alternative medicines are bogus. Herbal medicine, he says, is plausible to the extent that many pharmaceutical drugs contain versions of substances found in plants. “Of the common ones,” he says, “St John’s Wort is said, on some plausible evidence, to be good for mild depression, but the evidence is that it’s no more effective than conventional anti-depressants. The other very common one is echinacea: there’s some evidence that it may reduce the duration of your cold by about six hours. Even if that’s right, it’s such an entirely trivial effect that it’s barely worth having.”
What of the rest? Although many people imagine that acupuncture is a panacea for ailments that conventional medicine cannot cure, it is surrounded by mystic mumbo-jumbo about “qi” and “meridians” and a growing evidence base suggests that, beyond the placebo effect, its efficacy is limited to a small number of uses, such as pain relief in arthritis of the knee. Chiropractic, which involves manipulating the spine, may be useful in treating back pain (though probably no more so than physiotherapy, massage or light exercise), but is rooted in D.D. Palmer’s mumbo-jumbo about “vertebral subluxations” interfering with the body’s “innate intelligence”.
For scientists, among the most implausible of alternative medicines is the Queen’s favourite, homeopathy, because there is no known scientific basis on which it could work. The idea is to take a substance that triggers symptoms in healthy people and use an extremely diluted dose of it to treat the same symptoms in an unhealthy person – for example, using an extract of raw onion, which causes healthy people’s eyes to water, to treat someone suffering from flu or hayfever. Against science and logic, homeopaths believe that the weaker the dose, the stronger the effect on the patient, and they typically dilute their tinctures to the point where, in practice, not even a single molecule of the original ingredient is likely to remain. “One thing every scientist would agree on,” says Colquhoun, “is that homeopathy is garbage, and it’s therefore very offensive to us that people are offered BSc degrees in it.”
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Edzard Ernst, co-author of Trick or Treatment? Alternative Medicine on Trial, is a curious figure – a professor of complementary medicine who rails against alternative medicine. Born and trained in Germany, he left a post at the University of Vienna in 1993 to become Britain’s first professor of complementary medicine at Exeter University. But if advocates of alternative therapies had hoped that their field was at last to receive the recognition it deserved, their hopes were to be cruelly dashed: for Ernst emerged not as an advocate of complementary medicine, but as its scourge.
“I believe in scientifically investigating the subject,” he says. “If I was a scientist in gynaecology or neurology or whatever, I wouldn’t be against it nor would I be in favour of it; I would just research it. When doing research, as we’ve been doing here for 15 years, you come to certain conclusions. And when you’ve published 1,000 papers, as we have, you come to certain over-arching conclusions. And if that combines with approaching retirement [he is 61], you get a bit lippy about it.”
Ernst is not saying that all complementary medicine is twaddle. But, based on the evidence of his research, he is sure a lot of it is. “We’re dealing with a whole range, from the effective to the definitely ineffective, and in the middle there’s a large proportion of ‘don’t know’,” he says. He estimates that only 5 per cent of treatments offered by complementary and alternative medicine are supported by evidence. “And even that figure”, he says, “is almost certainly too optimistic.”
So, as a university professor in complementary medicine, does he think BSc courses in complementary medicine should be removed from the curriculum? “I’m almost entirely with David Colquhoun on this one,” he says. “To have a BSc in homeopathy is a contradiction in terms. There’s no science to homeopathy. If you wanted to teach it in a scientific way, then you would need to teach the history of homeopathy, the principles of homeopathy and the evidence for homeopathy. And at the end of such a course you would have generated an anti-homeopath.”
The problem with BSc courses in complementary and alternative medicine, he says, is that they are not taught in a scientific way. “There’s no critical thinking, even in the type of course where there could perhaps be some science. Herbal medicine, for example, is complicated pharmacology with lots of interesting facets that one could teach in a scientific way. But I’m not aware of any course that’s being taught in a scientific way.”
Criticisms such as this seem to have stung the University of Westminster, which has the largest number of BSc degree courses in complementary medicine and which even runs a clinic at its New Cavendish Street campus in London’s West End offering the public treatments such as homeopathy and aromatherapy. In January, the university announced that it was strengthening the science base of its courses after completing an academic review. An internal memorandum leaked to Colquhoun spoke of the need to show that the university was delivering on its “promise of a science-based training”.
Westminster said it had no one available to discuss its courses with the Financial Times. But at eastern England’s Anglia Ruskin University, which offers BSc degree courses in aromatherapy and reflexology, Sue Lord, programme leader for complementary medicine in the faculty of health and social care, is happy to explain why a science degree is justified. Students, she says, are required to study anatomy and physiology, they have to understand the composition of the oils they are using, how they are absorbed into the skin and how they may react with whatever else the patient may be taking.
Lord rejects the suggestion that the teaching is uncritical: there is a sizable research component, she says. However, she acknowledges that “we’ll never be able to please the scientists, because we can’t use conventional scientific research methodology to look at complementary medicine.” Double-blind randomised control trials are all very well when testing something straightforward like a new drug, she says, but don’t lend themselves to testing the effects of aromatherapy, where there is a complex interplay between many different factors: the effect of the oil massaged into the skin, the effect of the aroma on the brain, the therapeutic effect of the massage itself, the patient’s willingness to see an improvement and so on. “The research is there,” she says, “but it’s the kind of research that the scientists will probably dismiss because it’s not the kind of black-and-white research that you can use for some of the things you do in science.”
. . .
George Lewith, professor of health research at the University of Southampton’s medical school, is also director of the Centre for Complementary and Integrated Medicine, a private practice with clinics in Southampton and London’s West End, so it is no surprise that he is ready to speak out in support of complementary therapies. In fact, Southampton University – a member of the elite Russell Group – does not offer degree courses in complementary medicine, but Lewith defends the idea of offering them in principle, on the basis that, done properly, they produce better-trained practitioners. “Without the new universities’ involvement we might be faced with the quackery we saw in the 1940s and 1950s, when these people were outside medicine and were practising in an alternative fringe culture,” he says. “That was much more dangerous.”
But is it right that students are being taught how to practise medicine for which no solid evidence base exists? “We do it all the time in conventional medicine!” Lewith counters. Certainly, he says, people with serious or life-threatening illnesses receive treatments that are evidence-based. But at primary care level, in the GP’s surgery, it’s a myth that general practice is wholly, or even largely, evidence-based. Most patients have low-level conditions such as flu, back pain or allergies for which no single, evidence-based, effective treatment exists.
For example, says Lewith, irritable bowel syndrome is one of the commonest conditions presenting itself to the general practitioner. “We have a variety of relatively ineffective treatments for it, some of which are slightly better than others. Probably the best treatment is an old herbal remedy called peppermint oil. Your GP will probably prescribe something – there’s a whole range of anti-spasmodics for the gut – but the evidence is flakey for many of these. There’s not a huge advantage over placebos for any of them.”
. . .
Does it matter if homeopathy is gobbledygook, as long as it works? Many people find homeopathy makes them feel better. This may be because of the placebo effect, or it may be because they would have felt better anyway, or it may be that homeopaths, without even knowing it, administer a form of psychotherapy along with their little sugar pills. Who cares, if it achieves the desired result?
The answer, says Colquhoun, is that it is ethically objectionable for doctors to lie to their patients about the efficacy of treatments, just as it is ethically objectionable for homeopathy students to be taught things that aren’t true. There are also risks: homeopathy may be harmless if used for the treatment of minor conditions that will resolve themselves anyway, but it can be dangerous if used, for example, in place of anti-malarial drugs, as some homeopaths have recommended. And many homeopaths voice opposition to MMR vaccinations, Colquhoun says.
Nobody, he continues, is trying to ban high street homeopaths as long as they do no harm and refrain from making false claims. “But the question is, who pays?” he says. “A holiday in Majorca or a bottle of Chanel No 5 may make people feel better but no one’s suggesting I should pay for them. At the moment, we’re paying for homeopathy in two ways: one is through the National Health Service and the other is by paying for university degree courses that ensure people are ‘properly trained’ in stuff that is just gobbledygook.”
In fact, strapped for cash and under pressure from the medical profession, many primary care trusts have virtually banned spending on complementary therapies – indeed, the Tunbridge Wells Homeopathic Hospital, one of five homeopathic hospitals run by the NHS, was forced to close at the end of March after the West Kent Primary Care Trust stopped paying for patients to be treated there. Colquhoun and his fellow scientists have also been encouraged by developments on the academic front. The University of Salford, for example, recently announced that it was winding down all its BSc courses in complementary medicine “for financial and strategic reasons, not in response to any campaign”, and as this article was being prepared for publication, it emerged that Westminster University had stopped recruiting to its BSc course in homeopathy.
But the struggle is far from over. To Colquhoun, the government appears extraordinarily reluctant to determine whether, or to what extent, complementary medicine actually works. “That’s why government policy about the regulation and funding of alternative medicine is in such chaos, because they insist on saying we must have proper regulation and training to protect the public, and that one way to protect the public is to have honours degrees in these subjects. But they will not grasp the nettle of first judging whether it’s nonsense. Because an honours degree in nonsense just gives you nonsense.”
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Mumbo-jumbo and barmpots: A glossary of Magic Medicine
Homeopathy: giving patients medicines that contain no medicine whatsoever.
Herbal medicine: giving patients an unknown dose of an ill-defined drug, of unknown effectiveness and unknown safety.
Acupuncture: a rather theatrical placebo, with no real therapeutic benefit in most, if not all, cases.
Chiropractic: an invention of a 19th-century salesman, based on nonsensical principles: shown to be no more effective than other manipulative therapies, but less safe.
Reflexology: plain old foot massage, overlaid with utter nonsense about non-existent connections between your feet and your thyroid gland.
Nutritional therapy: self-styled “nutritionists” making untrue claims about diet in order to sell you unnecessary supplements.
Spiritual healing: tea and sympathy, accompanied by arm-waving.
Reiki: ditto.
Angelic reiki: the same but with added “angels, ascended masters and galactic healers”. Excellent for advanced fantasists.
Colonic irrigation: a rectal obsession that fails to rid you of toxins which you didn’t have in the first place.
Anthroposophical medicine: invention of the mystic barmpot, Rudolf Steiner, for whom nothing whatsoever seems to strain credulity.
Alternative diagnosis: kinesiology, iridology, vega test, etc: various forms of fraud, designed to sell you cures that don’t work, for problems you haven’t got.
Any alternative “therapist” who claims to cure Aids or malaria: agent of culpable homicide.
Source: Professor David Colquhoun’s ‘Improbable Science’ blog
Copyright The Financial Times Limited 2009 |
