sCAM in the NHS - how these people think!

[Asolepius]

I am having an interesting exchange with the chairman of the NHS Trusts Association, Dr David Tod O.B.E., M.B.Ch.B.(Ed.), F.R.C.G.P., Dip.Crim.(Lon.). This is what he said when I asked him about the evidence base for the interesting practices his organisation is promoting at
the NHS Directory of Complementary and Alternative Practitioners :

"With regard to your second question, unless you can define "sufficient
body", as it would be reasonable to say that there can never be enough
evidence to confirm the efficacy of all treatments, and as all
treatments carry some element of risk, it would be presumptuous of
anyone to state that they are satisfied that there is ever a "sufficient
body of evidence" to entirely support any therapy's efficacy or safety.
It is for this reason that the Committee on Safety of Medicine was set
up and, more recent, of course NICE (National Institute of Clinical
Excellence)."

He should add to his qualifications a diploma in gobbledegook. Mind you he has agreed to delete dowsing and crystal therapy from the site - maybe someone else can take up the baton and get him to get rid of reflexology, aromatherapy and all the rest. Please form an orderly queue......

 

[Quasi]

Here his web site freely admitts there is no evidence:
"Group 3b covers other alternative disciplines which lack any credible evidence base such as crystal therapy, iridology, radionics, dowsing and kinesiology."
What the web site fails to mention is all of the negative information and data. Homeopathy is a total and utter failure, no mention of any of the negative clinical data going all the way back to 1842 ("Homeopathy and its Kindred Delusions" OW Holmes.) Further there are empirical proven statistical methods for significance. Maybe this guy should go back to school?

 

[Benguin]

I'd define 'any clinical evidence whatsoever' as a precursor to 'sufficient evidence'.

I find it frightening someone involved in such a senior level of the NHS is equivocating like that. He's basically saying that because there is always an element of risk and error in efficacy rates we should happily accept any treatment put forward on the shakiest foundations.

Have you asked him what criteria he would use to reject a treatment?

 

[Badly Shaved Monkey]

Les

A loathsome piece of doublespeak! It is worrying that someone in Todd's position should stoop to that.

For one thing he has conflated safety and efficacy. If a therapy fails on either then it should be excluded from medical practice.

He is right to say that nothing can ever be 100% safe, but any risk must judged against likely benefit. Risks cannot be judged in isolation. If a therapy does f-all then even tiny risks are unacceptable.

To defend sCAMs by saying that no medical practice has unassailable proof of efficacy is pretty slippery. For numerous sCAMs there is most certainly a "sufficient body" of evidence that they are nonsense and that should be enough to get them dropped by the NHS.

 

[Badly Shaved Monkey]

This is particularly offensive to read

"Homeopathy is a complementary therapy that can provide low-cost, effective treatments for a range of disorders that are often a continuous drain on NHS resources. Many disorders can be safely, cheaply and effectively treated by a professional registered Homeopath."

http://www.nhsdirectory.org/default.asp?Page=Homeopathy


"effective" twice in as many sentences. it makes me want to spit!

 

[Pragmatist]

I'm almost speechless! How on earth can they promote such outright crap!

I mean, I for one wouldn't have any problem with Osteopathy or something like the Alexander Technique, but RADIONICS for God's sake?!

O.K. it's obvious that if they are THAT uncritical that a direct approach is unlikely to work. So an indirect one is required. Personally I would start looking into the legal angle. Not with the intent of taking any legal action (although it might make some interesting test cases on the grounds of abuse of public funds promoting fraudulent practices). But rather in terms of liability for harm. Perhaps if they get enough calls/letters from people simply asking them what their liability is in the event that they are defrauded and/or harmed by a SCAMmer they will start to think twice and start worrying about it. They will of course deny any, but I think a case could be made of vicarious liability, or duty of care, failure to exercise due diligence etc. The trick would be to convince THEM that someone is likely to bring such a case, and regardless of whether they win or not, is prepared to carry it on for years with all the consequent publicity etc.

 

[Deetee]

Quite a number of the links say "the information on this therapy is currently being revised", not just crystal and dowsing. However, you can link to national organisations through the "xxx in the UK" button.

Perhaps we could invent a spoof national organisation with a fancy looking web page or letter head supposedly about a particular sCAM therapy. Then ask the NHS directory if it can be listed under its links. If they agree, we then reveal all with a randi-type flourish, indicating how easy it is for snakeoilers to abuse this system and how open it is to potential abuse. Cue: egg on face of NHSdirectory

(or would it be illegal to try somethinglike this??)

 

[Deetee]

I have emailed them asking for a copy of the service level agreement for the commisioning of CAM therapies for GPs and PCTs.
I am interested to know how much of my tax is going towards this junk when patients cannot get valid therapies funded.

 

[Dragon]

Quite a number of the links say "the information on this therapy is currently being revised", not just crystal and dowsing. However, you can link to national organisations through the "xxx in the UK" button.

Perhaps we could invent a spoof national organisation with a fancy looking web page or letter head supposedly about a particular sCAM therapy. Then ask the NHS directory if it can be listed under its links. If they agree, we then reveal all with a randi-type flourish, indicating how easy it is for snakeoilers to abuse this system and how open it is to potential abuse. Cue: egg on face of NHSdirectory

(or would it be illegal to try something like this??)

Good idea - I doubt it would be illegal as it would be in the public interest. What about getting a journalist such as Ben Goldacre from the Guardian involved?


btw - If you're serious I suggest you don't discuss it any further here.

 

[Pragmatist]

Quite a number of the links say "the information on this therapy is currently being revised", not just crystal and dowsing. However, you can link to national organisations through the "xxx in the UK" button.

Perhaps we could invent a spoof national organisation with a fancy looking web page or letter head supposedly about a particular sCAM therapy. Then ask the NHS directory if it can be listed under its links. If they agree, we then reveal all with a randi-type flourish, indicating how easy it is for snakeoilers to abuse this system and how open it is to potential abuse. Cue: egg on face of NHSdirectory

(or would it be illegal to try somethinglike this??)

Now that wouldn't be a bad idea at all. And it wouldn't be illegal if it was set up carefully enough - make sure the truth is on record with a lawyer/the press first. Imagine a totally bogus therapy, bogus practitioners with fake names/qualifications/backgrounds, fake clinical trial results and so on. AND with a couple of national press/TV reporters involved as well. Take them to the point of no return - i.e. to the point where they actually hand over money and refer a genuinely sick patient and them blow them wide open with national publicity, headlines of "NHS funds fraud, endangers life of patient" etc., and then name and shame the actual people behind the trusts.

With enough careful preparation it could be a real killer sting.

 

[Asolepius]

This is Les Rose using my new handle of Asolepius (an old name resurrected for no better reason than nostalgia).

There's a bit more to this story. I also asked Dr Tod this question:

"Has the NHS satisfied itself that the listed practitioners are able to substantiate the claims they make about their practices?"

This is what he said:

"You are asking how the NHSTA qualifies the suitability of applicants to
the Directory. In selecting suitable professional independent
representative or voluntary organisations to work in partnership with,
we refer to those that are identified on the DoH website in the document
"Complementary Medicine Information Pack for Primary Care Groups" - June
2000.

"In categorising the therapies, the Association follows the
classification of the House of Lords Select Committee on Science &
Technology 6th Report 2000.

"Applicants must be members in good standing of one of the leading
professional bodies, for example The British Acupuncture Council, The
Association of Reflexologists, etc. In the case of Osteopaths and
Chiropractors, only practitioners who are registered with the GoSC or
GCC are accepted.

"Applicants must be fully qualified to the standard necessary for
membership of one of those leading bodies.

"Applicants are required to carry adequate and appropriate professional
insurance. Applicants are required to provide proof of their insurance
status.

"Applicants must provide details of qualifications held, where gained,
with relevant dates, etc.

"Applicants must provide information on which representative
organisations they belong to.

"Applicants must state how long they have been in practice.

"Applicants are required to state whether they practise privately, in the
NHS, or both.

"Applicants are asked if they are prepared to work in the NHS.

"Applicants are required to state whether they are prepared to enter into
sessional working arrangements with GP surgeries under contract.

"Applicants are required to state whether they have any criminal
convictions other than motoring offences.

"This process is at least as rigourous (sic) as that currently undertaken for
practitioners of orthodox medicine when applying for jobs in the
National Health Service."

Can anyone spot anything in this discourse that actually answers the question? No prizes.......

 

[Benguin]

Who exactly is funding these people and what is their mandate supposed to be? I only hit the broken links when I looked.

 

[Badly Shaved Monkey]

Les

Since you probably already know, can you tell the rest of us to whom to write to put our complaints formally?

Edited to add:

Can we have a consensus view on which of these therapies can be rubbished completely e.g. not acupuncture perhaps. I think the starting point would be to make them accept that some are 100% fiction before moving onto others that are contentious but possibly with some grounding in reality. I'll betcha Dr Todd doesn't know the difference between an osteopath and a chiropracter and the fact they the latter believe all disease to result from their invented spinal malalignments.

 

[Asolepius]

....and this document , to which Tod refers, is a real beauty. I'd love to see what Bandolier would make of it. An amazing collection of drivel put together at public expense. Did someone mention untra vires not long ago?

Les Rose now masquerading as Asolepius.

 

[Asolepius]

Sorry for typo - I meant ultra vires!

 

[Asolepius]

Les

Since you probably already know, can you tell the rest of us to whom to write to put our complaints formally?

Snipped

Here is Tod's email as published on the NHSTA site:

David.Tod@nhsta.org.uk

 

[Benguin]

I'll betcha Dr Todd doesn't know the difference between an osteopath and a chiropracter and the fact they the latter believe all disease to result from their invented spinal malalignments.

Actually, that isn't true of many chiros. The ones I've spoken to regard that as an embarassing part of their background and a feature of american colleagues they'd rather not be associated with.

Any one using the term 'subluxation' can be safely consigned to the woo-bin. Osteos have a problem with the protection of their title ... Chiros do have legal protection, like acupuncturists.

Homeo is safe turf as it doesn't do anything, we know that. Other things involving smells, relaxation, massage may well reduce stress and provide short-term symptomatic relief. For that, they are fine and probably doing a service, it is any attempt to claim cures that needs addressing.

 

[Anders W. Bonde]

Les,

I just browsed through the Information Pack you linked to. I am utterly appaled and left speechless. That pack is but a pack of lies and conjecture. Why has no-one scientifically competent reviewed this document prior to public release? Whoever may have reviewed it is certainly scientifically incompetent and highly gullible. Absolutely shocking. ["Therapists believe this that and the other..."]. Don't they want evidence?

Words fail me. I thougt the creationist jerks in the US have way too much (any is way too much) influence on policy - in the UK (as in Denmark) it's the SCAMmers.

Welcome back, eye of frog, toe of newt...

 

[Pragmatist]

it is any attempt to claim cures that needs addressing.

Not just cures, don't forget bogus diagnosis. In many ways the bogus diagnosis is even more insidious, particularly if it allows a sCAMmer to lure someone completely away from properly qualified care.

 

[Asolepius]

Les,

I just browsed through the Information Pack you linked to. I am utterly appaled and left speechless. That pack is but a pack of lies and conjecture. Why has no-one scientifically competent reviewed this document prior to public release? Whoever may have reviewed it is certainly scientifically incompetent and highly gullible. Absolutely shocking. ["Therapists believe this that and the other..."]. Don't they want evidence?

Words fail me. I thougt the creationist jerks in the US have way too much (any is way too much) influence on policy - in the UK (as in Denmark) it's the SCAMmers.

Welcome back, eye of frog, toe of newt...

Note that Edzard Ernst isn't among the list of advisers. Apparently there has been some parliamentary debate on this topic and I'm just awaiting the Hansard citation. Apparently our Prime Minister participated - he of the great respect for evidence.