D.H. stands for Quacks

Ever heard of the Department of Health (DH)?

Of course you have.

So, as an organisation managed by the Departmental Board that work within the boundaries set by Ministers, is it safe for me to assume you would trust their judgement when making decisions about healthcare?

Well then, maybe you will be surprised to hear that they are proposing a professional registration scheme that will allow practitioners of traditional medicine to have the DH’s seal of approval, despite these practitioners lacking any medical training.  The problem lies not only with the misleading implication that such practitioners appear of equal pedigree to qualified practitioners of evidence-based medicine; the lacking of medical training also means they increase the possibility of misdiagnosis and/or ill-advised treatment strategies, which could lead to dangerous drug interactions and even death. [Edit: for an example of the latter, please see this article].

So who are these regulations for?

They are for practitioners of traditional medicine systems including Traditional Chinese Medicine, Herbal Medicine and Acupuncture, awarding accreditation simply on the practice of “traditional methods”, rather than evidence.

Why is the DH proposing such regulations?

Department of Health, Whitehall

Apparently the scheme is being designed to attend to the DH’s concerns about practitioner’s English fluency, criminal records and hygiene.  That sounds reasonable enough, however, there are already schemes that adequately assess these.

Basically, the scheme sets to regulate every important aspect of good practice except evidence of medical training.

Presently, there are similar professional accreditation and regulations already in place for alternative medicine practices, such as chiropractic and homeopathy, which have contributed to their successful introduction into university curriculums.

How did the idea of this new scheme come about?

Well, it all began in 2008 when the late Principal and Vice-Chancellor of The Robert Gordon University in Aberdeen, Professor R. Michael Pittilo, compiled a report (well-known as the Pittilo report), verbosely entitled “Report to Ministers from The Department of Health Steering Group on the Statutory Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and Other Traditional Medicine Systems Practised in the UK”.  In a nutshell, the aims of this report were to make recommendations for regulating these traditional medicines, in-keeping with current health policies to protect the health of the public.

In August 2009, the Department of Health launched a joint consultation (which closed mid November 2009) on the Pittilo report to collate all respondents’ verdicts on if and how these traditional medicines could be regulated.

What was the response?

In October 2009, a number of professional bodies, including Sense about Science, the Royal College of Pathologists, the Academy of Royal Medical Colleges and the Institute of Biomedical Sciences, pulled together and submitted a response to the consultation.  Each body agreed with the report as far as protecting the public, however, they did not support the proposal of any professional regulation of traditional medicines that lack scientific evidence proving their treatments work.  This response included the invaluable work of David Colquhoun, who investigated the alarming truth about the alternative medicine university courses and whose blog (DC’s Improbable Science) included details of the consequences of the proposed DH scheme.  Collectively, each party’s main fear focussed on how a regulation by the DH, would give the impression to patients that the traditional medications have as much efficacy as evidence-based treatments, which are proven to work beyond placebo.

What happened next?

A statement was made in February 2010 by the (then) Health Secretary Andy Burnham, in which he announced:

Emerging evidence clearly demonstrates that the public needs better protection, but in a way that is measured and does not place unreasonable extra burdens on practitioners.

I am therefore minded to legislate to ensure that all practitioners supplying unlicensed herbal medicines to member of the public in England must be registered with the Complementary and Natural Healthcare Council (CNHC).

I believe that the introduction of such a register will increase public protection, but without the full trappings of professional recognition which are applied to practitioners of orthodox healthcare.

Now read the last paragraph again.

How much would you trust an unlicensed practice that was “without the full trappings of profession recognition”?  If these practitioners advertised this real truth about their service, together with the lack of evidence of efficacious medicines, would you still want to use them?  I’ll hazard a guess and say you wouldn’t.

The Pittilo report itself was rejected and, after his death, came the removal of the “Introduction to Homeopathy” that was being taught at his university.  Despite the original report being rejected, it clearly influenced the introduction of the new DH’s proposed scheme described above.

So what is being done about it?

On Wednesday 8th September, while scientists – the nation over – were digesting that speech by Vince Cable, I joined Voice of Young Science (VoYS) – who are part of the independent charitable trust Sense About Science – and Dr Evan Harris, at the launch of the campaign, to protest against the proposed regulations scheme from going ahead.

VoYS School of Old Wives' Traditional Medicine

To raise awareness of the potential damaging effects that this new scheme could have on patients, VoYS created a stunt called “The School of Old Wives’ Traditional Medicine” whose motto is “Cui testimonio opus est“, or in other words “Who needs evidence?”.  The stunt aimed to echo the problems with the DH’s proposed scheme, which essentially provides their seal of approval to practitioners who lacked evidence-based medical training.

We recreated this scenario with a touch of fun.  Planted right outside the entrance to the DH, we assessed the competencies of members of the public at becoming an Old Wives’ Traditional Medicine practitioner.  This involved asking four multiple choice questions, which included:

Dr Evan Harris, ready to award Diplomas

Eating carrots can….

a) help you see in the dark

b) give you a nose like a snowman

c) give you psychic powers

The gimmick was that “Just like the proposed Department of Health scheme, we will not test your medical knowledge“.  It only took a few minutes and, with mostly correct answers, a diploma was awarded to the new graduate and their name was entered into the Register of Practitioners of Old Wives’ Traditional Medicine.

The Register of Practitioners

Quite a large number of people joined in:

Members of the public gathering to join in

 

 

 

 

 

 

 

 

 

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How did the pubic take to the campaign?

One participant very kindly blogged about his experience, you can find James’ blogpost here.

The labcoats and bright red rosettes were a great attracting feature to our stall.  We had such a great response from the public and it was most encouraging to see some of our supporters take their diplomas and then walk into the DH building behind us, to go to work.  One member of our team signed up Cambridge Liberal Democrat MP, Julian Huppert‘s parents to the VoYS school, as they passed by, while another chased Conservative Chancellor George Osborne and Lib Dem MP Danny Alexander half way down Whitehall.  Even the police got involved; and I mean in a good way!!

Getting a diploma was easy-PC (*ahem*)

Another diploma being signed

One member of the VoYS team was silently expecting there to be a presence of pro-alternative medicine groups, ready to sabotage our protest.  Luckily no one of that calibre showed up, which may either be because they had not heard about it, or, they recognised our campaign was not to attack the alternative medicines themselves, but only to prevent any accreditation from the DH.  All those that did take part did understand our message, with the exception of only one member of the public, who accused us of being a disgrace to the profession and made a hasty retreat, without giving us the chance to explain what we were doing.

This point now brings me to the importance of choosing the correct campaign approach.  Now, I would say that one person out of the hundred or so people we challenged in that hour, who failed to get the message or disagreed with the approach, was not a bad achievement.  However, when this Old Wives’ Traditional Medicine campaign was being promoted to gain support from fellow scientists, who adopt evidence based policies, it began to cause a stir on Twitter; and it was this tweet that started it all….

Where it all began....

When I first got the email from the co-ordinator of VoYS, Julia Wilson, asking for volunteers to help with the protest, I imagined a lot of tweets, about this campaign, would start to appear; but I barely saw any at all.  I tweeted using the #oldwivesmed hashtag as the email instructed, but there was hardly a jot even in this group.  I must admit, due to the lack of the usual support, I became very dubious about the whole campaign.  However, I still booked the time off work to go and help, just in case it was legitimate and I tweeted a couple more hashtag comments to see who else would be joining in.  It wasn’t until I read the above tweet and the subsequent flurry of concurring replies that I realised why twitter was all quiet on this front.

I questioned some of the people why they wouldn’t be supporting it and the general response was that although they do actually agree with what the campaign stands for, they were offended by the “Old Wives” focus; it made them feel uncomfortable, some said it was derogatory to our mother’s and grandmother’s, it was ageist, sexist and it also completely took away the real reason for the protest.  It was argued that a stronger impact would have been made if the tag had focused more on the becoming a doctor without any qualifications.  I do have to agree with that because it lost a lot of support, just through the tag choice.  I personally, however, did not take the “Old Wives” tag as an offence because, to me, it is a simple, light-hearted and extremely well-known term that has been used, inoffensively with no malicious intent, for many years.  A tweet even made reference to David Mitchell‘s Guardian column: “….’PC gone mad’ is along way from power – it’s still a minority party compared to ‘chauvinism gone senile’….”.  Most of the assailants of the tag were actually accused of being over-sensitive, by a number of people, and this prompted even more comments including this one:

Matters escalated quickly

Despite my commending feelings and the fact that I took part because I believed in the cause, this really does highlight the importance of choosing a knowledgeable, optimum campaign approach.  [Edit: an in-depth look into the effects of humour in science, written by Alice Bell, can be found here and is well worth a read].  I feel that, due to the lack of support from reputable people who are admired and who many people take guidance from, there was quite possibly a large proportion of people who either failed to receive the call for volunteers, or were just put off by the approach either directly or indirectly through others.  This completely diluted the potential volume of support.  This is a real shame because I imagine that most would agree with the reason for the campaign and it turned out to be a lot of fun, as well as a great turn out for participating members of the public.

Now, without all the tags of the Old Wives’ Medicine, I hope this blog has helped you understand the serious message here.  [Edit: You can also listen here, at the Pod Delusion podcast, to hear the short interview with Dr Evan Harris at the protest.]

Please help the VoYS campaign to prevent the DH’s regulation scheme for giving accreditation to practitioners who have no evidence-based medical training.  Please help VoYS prevent the traditional medicine practitioners from treating patients with medications, not proven to work past placebo.

Would you like to show your support?

To find out what you can do to help, here are all the contact details you need:

Sense About Science 25 Shaftesbury Avenue London W1D 7EG
T: +44 (0)20 7478 4380

enquiries@senseaboutscience.org

[EDIT: There may just be time to sign the petition:

Call for clear, honest labelling about evidence on homeopathic products http://bit.ly/g6uojM ]

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Comments
4 Responses to “D.H. stands for Quacks”
  1. alicerosebell says:

    Nice post.

    Sorry, when I mentioned the “chauvinism gone senile” line I wasn’t meaning that to be directed at this campaign. I thought that was clear, but I must have articulated it badly. I was pointing out that these issues are more complex than a breezy dismissal of people just being oversensitive (i.e. what Ed said, as you quote). Really didn’t mean to direct that at you, so hope you didn’t think that was so.

    I think there are problems with taking a humourous approach to such serious campaigns. I also think there are a lot of advantages – clearly everyone on that demo had a lot of fun and I’m sure you got (good!) publicity because of it too. This is something I’d spent a lot of time thinking about (chapter of my PhD on humour in sci com) and I should have a post touching on this issues as part of the Guardian sci blog festival this week

    Really, for me it was the arrogant stance that most grated, the idea that laughing at ignorance is ok. I’m not a fan of SAS’s celeb science leaflets for the same reason. But again, I know some people love this and maybe the good publicity outweighs those who it alienates. If you haven’t heard them already, the SciAM podcasts on arguing with non-skeptics are interesting in this respect. You can probably guess which side of the debate I’m on, but I do appreciate the points raised by both sides and don’t pretend to know a definitive answer.

    • dellybean says:

      Thanks for your comment.

      Please do not worry about me taking any offence to anything you, or anyone for that matter, have said on twitter; my blogpost was merely highlighting the importance of choosing the correct campaign strategy and those tweets were just examples of what can happen. As you mentioned, some approaches do alienate some people, and these maybe outweighed by the greater number of people who welcome it; that may be so, however, in cases where the people who are alienated are those who a lot of people admire and look for their support in a campaign, the knock-on effect of subsequently alienating big groups of people, is truly detrimental to that campaign. This is how I felt at first (with #oldwivesmed) when I noticed hardly any support on twitter. Imagine the impact it had when no plugging of the campaign came from Dr Boynton, Frank Swain and yourself, for example, three reputable figures in the blogosphere….it was huge!! That was the point I wanted to get across: knowledgeable campaigning that is carefully thought through is extremely important for getting your message heard successfully.

      Thanks for your take on the whole matter, it’s really useful for future reference. Also, thanks for the link, I will check that out.

  2. Tamlyn Peel says:

    Hey, really good blog post covering both the main issue and other arguements.

    I was at the stunt too (the no-so-beardy bearded one) and was surprised at the furore beforehand over the choice of “Old Wives’ Medicine”, as it had never crossed my mind that it was in anyway sexist or ageist (especially as SaS is mostly women). But the whole thing has pointed out that you’ve got to be careful what you say and how you say it at the risk of alienating even people who agree with the main point you’re trying to put across.

    I think humour is really useful at getting people on side, and on the day almost everyone we stopped on the day got the joke (or if you’ve ever seen the clown army at demos they are truly hilarious – http://www.clownarmy.org/), but granted sometimes it can make you look like a smug git. Just watched this video from TAM which makes good points about how to engage people – http://blogs.discovermagazine.com/badastronomy/2010/08/17/dont-be-a-dick-part-1-the-video/

    I personally don’t think VoYS got it wrong (though Twitter tends to disagree) and although it was my first VoYS activity, I learnt a lot and I’m looking forward to getting involved next time. Maybe with just a little more thought as to how best to engage with people.

    (Oh and unforuntely you’re beaten to my favourite blog about the day by this gem from the Journal of Chinese Medicine: http://www.jcm.co.uk/drum-tower-archive/article/old-wives-tales-1126/)

    Tam

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