The Quality of Medical Science. What does this BMJ campaign tell us?

The next time a doctor tell you that a pharmaceutical drug or vaccines is safe, ask them to read the British Medical Journal's (BMJ) campaign "to produce better evidence".

And the next time you are told the conventional medicine is 'evidence based', and supported by medical science, tell them about the BMJ's opinion on the quality of that science.

What follows are passages taken direcctly from the BMJ website.  It concerns the BMJ's campaign to produce "better medical evidence" for such claims. What the campaign proves, without any doubt, is that the conventional medical establishment are aware of the situation that has led to so much patient harm over the last 70 years, and demonstrates that the BMJ, at least, are trying to do something about it.

     "The BMJ believes that the design, conduct, and reporting of healthcare research should better serve the needs of patients and the public: better evidence leads to better healthcare. To produce better evidence the BMJ aims to:

     • Expand the role of patients, health professionals, and policy makers in research and healthcare
     • Increase the systematic use of existing evidence for better decision making
     • Make research evidence relevant, replicable, and accessible for healthcare professionals, patients,
  and the public
     • Take a stand on financial interests by reducing questionable research practices, bias, and conflicts 
of interests.

What are the problems with current research evidence?

Patients are being let down by serious flaws in the creation, dissemination, and implementation of 
medical research. Too many research studies are poorly designed or executed. Too much of the 
resulting research evidence is withheld or disseminated only piecemeal. As the volume of clinical 
research has grown the quality of evidence has often worsened, which has compromised medicine’s 
ability to provide affordable, effective, high value care for patients. There are many problems. 
In our editorial launching the manifesto we describe the following:

     • Results from half of all trials are never published, and positive results are twice as likely to be 
published as negative ones.

     • 85% of research spending currently goes to waste.

     • Over four fifths (86%) of a sample of Cochrane reviews did not include data on the main 
harm outcome.

     • A systematic review of 39 studies found no robust studies evaluating shared decision making 
strategies.

     • The drug industry has been fined for criminal behaviour and civil infringements, but little 
happens to prevent such problems occurring again.

     • Despite repeated calls to prohibit or limit conflicts of interests among authors and sponsors of 
clinical guidelines, the problem persists.

     • A third of scientists report questionable research practices, including data mining for statistically 
significant effects, selective reporting of outcomes, switching outcomes, publication bias, protocol 
deviations, and concealing conflicts of interest.

     • More than one in 10 authors and reviewers has first-hand knowledge of inappropriate adjustment, 
alteration, or fabrication of data. More than one in 20 admits having lied in authorship statements.

These flaws have been known about for many years. I wrote about them in my E-Book, 
"The Failure of Conventional Medicine".  Ben Goldacre wrote about them in his book, "Bad Pharma". 

So it remains to be seen if the BMJ campaign will make any difference on this long-standing problem.

Should doctors recommend Homeopathy?

A doctor has recently published a bold statement about the value of conventional medical treatment. It is doing the rounds on the Linkedin.com website, the Natural and Integrative Medicine group. I quote it here in full.

As a retired physician I can honestly say unless you are in a serious accident, your best chance of living to a ripe old age is to avoid doctors and hospitals and learn about nutrition, herbal medicine and other forms of natural medicine unless you are fortunate enough to have a naturopathic physician available.

Almost all drugs are toxic and are designed only to treat symptoms and not to cure anyone. 

Vaccines are highly dangerous, have never, been adequately studied or proven to be effective and have a poor risk/reward ratio. 

Most surgery is unnecessary and most textbooks of medicine are inaccurate and deceptive. Almost every disease is said to be idiopathic (without known cause) or genetic-although this is untrue. In short our mainstream medical system is hopelessly inept/and or corrupt. 

The treatment of cancer and degenerative diseases is a national scandal. The sooner you learn this the better off you will be"

The dangers and lack of effectiveness of conventional medicine, and its huge and unacceptable costs, are not as well known as they should be. Our media is silent on all the health issues raised in the doctor's statement, although regular readers of this blog will be better informed.

What this doctor is saying, honestly, is that conventional medicine is not something anyone should seek, except perhaps in an emergency.

There does appear to be a move away by the conventional medical establishment that dominates the NHS from their slavish long-term slavish adherence to pharmaceutical drugs and vaccines. For example, exercise and nutritional guidance is being given more attention, as is the hitherto unquestioned trust in antipsychotic and antidepressant drugs in favour of counselling and psychological-based therapies.

And the British Medical Journal, (BMJ), one of the pillars of conventional medical establishment in Britain, has recently published an article, and conducted a poll, asking the simple question:

Should doctors recommend Homeopathy?

The article consisted of Peter Fisher, director of research, Royal London Hospital for Integrated Medicine, arguing for "Yes", and Edzard Ernst, emeritus professor, University of Exeter, arguing for "No".

Such BMJ polls have sometimes attracted as many as 500 votes, although most barely attract 100 votes. This particular poll attracted over 5,000 votes!

Homeopathy is always capable of provoking a good discussion!

The result has surprised many homeopaths, including myself, who expected the rabid 'homeopathy denialists' from Sense about Science, and conventional doctors, would come out in large numbers to support the "No" vote. However, the "Yes" vote won, convincingly.

Yes: 3,193 (62%)
No: 1,944 (38%)
Total votes cast: 5,137

So the tide certainly seems to be turning. Conventional drugs and vaccines are proving to be so dangerous that doctors are increasingly unable to prescribe them, and so ineffective there is little point doing so.

Meanwhile, the pharmaceutical companies seem entirely intent on maximising their profits, and continually lie about the safety and effectiveness of their products. Their regular corruption and fraudulent activity, their apparent inability to keep themselves out of court, must be deeply nauseating to supporters of conventional drug-based medicine.

And as evidence of drug harm begins to filter through, patients are increasingly looking for safer and more effective medical therapies.

The time for more choice in health care is on its way in Britain. Perhaps the NHS is now being forced to recognise that will no longer be able to support the conventional medical monopoly it has been running for much longer.

BBC News, Big Pharma - and an outbreak of honesty?

Could this be an outbreak of (very welcome) honesty within the BBC News service? Hitherto, their reporting of health issues has been lamentable, apparently only willing to publish the 'good' or 'positive' news about pharmaceutical drugs, and quite unwilling to tell its listeners, viewers and readers, any of the 'bad' or 'negative' news.

This morning, on its Today programme, the BBC reported that a BMJ (British Medical Journal) editorial had attacked the 'long-existing habit of the pharmaceutical and science community' to publish only selectively (that is, the good bits) about the clinical trials on new drugs. This, by itself, is an amazingly refreshing outbreak of honesty from the Conventional Medical Establishment! But to listen how the BBC dealt with this, listen to the broadcast at:

http://news.bbc.co.uk/today/hi/today/newsid_9671000/9671074.stm

You will hear in the short clip that two examples are given of this Big Pharma practice, which has been going on for decades, largely without comment or concern from the BBC, or indeed, the mainstream media generally:

1. Tamiflu - about which Roche has apparently been refusing to publish data, and
2. Vioxx - where evidence about its link to heart attacks has been suppressed by the drug company.

Apparently, the BBC asked the drug companies to comment - but they declined! However, Professor Colin Blakemore said, presumably in their defence:

What journal will publish boring results?

Indeed, he appeared to assume that the public only wanted to hear the 'good' news, and certainly for as long as I can remember, this is all the BBC has wanted to report too.

Blakemore, perhaps mirroring the attitude of the entire conventional medical establishment, appears to have been more concerned about the need to 'entertain us' rather than ensuring, and safeguarding, the health of patients!

However, despite this unusual but welcome display of BBC honesty, it is also clear that they did not know how to ask searching and relevant questions on the issue. Indeed, they did not appear to recognise the importance to us all of this issue.

* How many pharmaceutical companies are failing to publish the full evidence about their drugs?

* On what basis are Big Pharma companies allowed to withhold important clinical information? Is this being done in order to sell more drugs? And if so, can this be in the interests of the health of patients?

* Are the Drug Companies being held fully accountable for any consequences to patients of the drugs they manufacture and sell? (Drug companies are being sued in the USA for the damage they cause patients, but not, it would seem, in this country).

* How many pharmaceutical drugs, and indeed which ones, are currently being prescribed without the full clinical information being known to medical personal and patients?

* How many patients are at this moment taking pharmaceutical drugs about which full information remains unknown? And what action will now be taken by the medical authorities to obtain this information?

* How long has the government, the NHS, and MHRA been aware of the practice? If the medical establishment has known about it, why has nothing been done? And if it did not know, is there a need to re-examine the basis on which pharmaceutical drugs been sanctioned, approved and prescribed to patients?

* Are local doctors and GPs aware of this practice? Are they, indeed can they be, fully aware of the impact any drug has on their patients?

Clearly, the BBC are more adept at criticising and attacking those people who are aware of the dangers of Big Pharma drugs, and who are looking for 'non-drug alternatives' to the medicine being offered to us within the current NHS-ConMed monopoly.

Homeopathy Politics and Liberty

The more homeopathy denialists attack homeopathy, the more we should all ask the question - what is their venom all about. I wrote this initially in September 2011, and with the recent attack on Homeopathy by the Chief Medical Officer (February 2013), it remains relevant.

The latest attack comes from part of the Conventional Medical (ConMed) Establishment - the BMJ. Dr Brian Kaplan has written an apt response to this gratuitous attack - and I am blogging it here as it speaks so well about what is happening.

I agree with Brian completely - this is an attack on our liberty. And it is an attack supported and funded by the sectional, and vested interests of the Big Pharmaceutical companies.

"The denialists, detractors and critics of homeopathy were back in action this week.  In a critical letter to the BMJ protesting against the Government seeking advice (sic) from experts on the registration of homeopathic products. Referring to homeopathy as ‘naked quackery’ and ‘pseudoscience’, the letter was written by Susan Bewley (an obstetrician) ‘on behalf’ of a list of names including the usual suspects, Ernst, Baum, Rose etc.) It seems the letter section of the BMJ has become a popular forum for these doctors to spout their vituperative, amateur homilies on medical politics.

So let us look at the history of the politics of homeopathy in the UK. It is important to acknowledge that throughout its history homeopathy has been attacked for the same reasons: Dilutions, implausibility, quackery and now ‘pseudoscience’, ‘bad science’ etc.

19^th Century: Dr F. Quin studies homeopathy in Germany, brings it to the UK, treats the Prince of Wales and builds the London Homeopathic Hospital.  Several other homeopathic hospitals are built in England and Scotland.

1948: The NHS is formed and all the homeopathic hospitals are INVITED to become part of it. This is the reason why homeopathy (unlike aother forms of CAM) is so strongly integrated into the NHS. Homeopathic doctors and their benefactors had built hospitals staffed by doctors specialising in homeopathic treatment prior to the formation of the NHS.

1948-1990: Homeopathy becomes more and more popular both on the NHS and in private medicine. However the opposition movement becomes more determined to end NHS homeopathy. They attack on two main fronts: PR & Media and direct political attack. On the media front, The Guardian newspaper and the supposedly neutral BBC prove to be particularly useful allies to their cause but in the realm of official politics they suffer serious defeats.

December 2009 Political Defeat I: The denialists manage to get a Science and Technology Subcommittee to do an ‘Evidence Check’ on homeopathy. The controversial hearings (signed by very few of the MPs who were meant to take part in it), is addressed by Mike O’Brien the then Minister of Health in the Labour government. He famously describes the draconian anti-homeopathic suggestions of the Committee as ‘illiberal’ and makes it clear that GPs and local health authorities are best placed to decide if their patients should get NHS homeopathy or not.

July 2010: Political Defeat II: The report (with its authoritarian anti-homeopathic and anti-democratic  recommendations) passes to the new Coalition Government for consideration. The new Health Minister, Anne Milton thanks the S&T Committee for their work but then kicks all their reccomendations into touch. Her reasons for doing so are much the same as the Labour minister’s: GPs and localhealth authorities should be trusted to make the best decisions for their patients. An infuriated Michael Baum pores scorn on her in a well-publicised letter to the Lancet concluding with a condescending “Shame on you Minister!”  I was personally astonished by the aggressive, rant-like nature of this letter as Baum had only a few months before called for the debate on homeopathy to return to the ‘realm of polite disputation’.

So summing up:
Government under Labour: supported homeopathy on the NHS.

Government under Coalition: reiterated this support almost to the letter.

Head of State and family: are known to use and have used homeopathy for several generations.

The detractors, denialists and illiberal, wannabe Statist authoritarians  have tried to thwart GPs (rather than dissuade them which would at least be respectable) from referring patients for NHS homeopathy by insisting that their scientism trump due democratic process – but it hasn’t worked. Despite what Ben Goldacre writes in the Guardian, despite the letters to BMJ and Lancet, and despite inexplicable and inexcusable BBC bias against homeopathy, both Labour and Coalition Governments have seen fit to protect the significant minority support for homeopathy in the UK as well as the rights of British GPs to send their own patients for NHS homeopathy if they so wish. In doing so Government has so far managed to resist a serious, concerted attempt to undermine the democratic provision of health care in this country.

The attack on homeopathy has been a veritable Pandora’s Box of vitriol and bias that has certainly damaged British homeopathy by it’s sheer persistence and seemingly well-funded mass pressure at a PR level. It is heartening to know that at least at a pure political level, there has been unequivocal support by both Labour and the Coalition not only for homeopathy, but for something equally as important –  liberal democracy itself. Fortunately the last thing to come out of this particular Pandora’s Box was still Hope.