Monthly Archives: March 2009

Professor David Colquhoun is a professor of molecular pharmacology at University College London. Since starting his blog – now at http://dcscience.net/ – several years ago, to protest between the merger of Imperial College and UCL, he has gone on to blog about the perils of alternative medicine, the importance of science, and education.

Aged 72, he is especially famed in the blogosphere for his campaigning zeal – after which several universities have closed their doors to students of complementary medicine. I spoke to him recently in the first of an occasional series of short interviews I will post on this blog.

Prof Colquhoun, your specialist interest is, I believe, in ion channels. Were you ever tempted by a non-scientific career?

I never wanted anything but science. It seemed to be the most honest and independent of jobs. You could pursue your own ideas and tell the truth as you saw it, without pressure to be “corporate man”. Both are less true than they used to be, and being an independent investigative journalist suddenly seems attractive.

One of the criticisms of modern healthcare is that we “overmedicalise” people and then “overmedicate”. Meantime, there are lots of complaints from academics that medical students aren’t getting as much pharmacology teaching as they used to. Is pharmacology an overbearing part of healthcare today ?

Pharmacology in healthcare is a curate’s egg, good in parts. Antibiotics and anaesthetics (local and general) have been boons to mankind. Other classes of drugs, though not curative, have done a great deal of good, for example for high blood pressure and for epilepsy. Progress, though imperfect, is being made for cancer and Aids. The treatment of pain remains far less satisfactory than one would wish. In diseases of the brain, there has been less success, and some abuse. Antidepressants and anti-anxiety drugs seem to have limited success and to have been over-prescribed, partly as a result of heavy and exaggerated advertising by drug companies.

You are obviously an enthusiastic and effective blogger. Tell me about how you got started – and about your success with “non-academic” departments of alternative therapies?

It started when Imperial College tried to take over UCL in 2002,  It was seen generally as Richard Sykes (Rector of Imperial) taking takeovers one step too far, as the financial press thought he had done in merging GlaxoWellcome and SmithKlineBeecham. Almost everyone apart from our provost thought it was just silly to merge two universities that were rather far apart and already each very big.  People were saying nothing could be done, so I decided to start a webpage and collect signatures. We got a lot of them, but what really made the difference was that people started sending me the reports of meetings that I put up on the web before they’d been censored by the senior management team.  The crunch came when two separate people forwarded to me an internal e-mail giving and account of an Imperial Senate meeting at which Richard Sykes was reported to have said: “I know I said that there won’t be redundancies. Of course there will, but don’t worry they won’t be from Imperial.”  Within minutes it was public knowledge and the whole daft idea collapsed a couple of days later. That experience made me realise that the web could be an enormously powerful instrument for democracy.  We are always being told that scientists must engage with the public and suddenly there was a way to do it. After the Imperial fiasco ended I was bitten by the bug, and kept on with three separate webpages, one on politics, chronicling the follies of the Bush-Blair era, one on education and religion and one on quack medicine.  They are all different aspects of what I like to call the age of endarkenment.

And alternative therapies are presumably a big part of that?

I do feel quite strongly, as a pharmacologist, about the absurd sorts of quack medicine that have become so popular in recent years.  I see their popularity as being an aspect of the age of endarkenment, an abandonment of reason in favour of mysticism and wishful thinking.  It would be lovely if you could cure malaria with a homeopathic pill, the medicine that contains no medicine.  But you can’t.  A surprising number of homeopaths claim you can and people who do so pose a danger to public health.

As long as the High Street homeopaths and crystal healers limit themselves to minor self-limiting conditions, they do little harm. They merely help to lighten the wallets of the worried well.  It is quite a different matter when they start to penetrate universities and real medicine.   But they have been surprisingly successful at doing both of these things.  Most universities are far too jealous of their intellectual reputation to go in for degrees in mumbo jumbo, but at least 16 of the modern (post-1992) universities give bachelor of science degrees in anything from homeopathy to naturopathy, subjects that are not only not science, but which are actively anti-science.  And although this sort of thing has been roundly criticised by just about every scientific society, the medical establishment has remained silent. Hardly a word of criticism has come from the RCP, RCGP, BMA or the RPSGB (the Royal College of Physicians, the Royal College of General Practicioners, the British Medical Association and the Royal Pharmaceutical Society of Great Britain). The Medical and Healthcare products Regulatory Agency (MHRA) has hindered rather than helped.  They seem to be overcome by a sort of stifling political correctness that prevents them from making a clear distinction between what is true and what isn’t.  Much the same can be said for the Department of Health.

How have you managed to get universities to review their “alternative medical” courses? One has shut down since you’ve taken on the task…

The vice-chancellors of universities who run degrees in subjects like homeopathy seem to me to be far more culpable than the homeopaths themselves. The homeopaths may be deluded but many of them really believe what they say.  Vice-chancellors, by and large, cannot possibly believe it, which is, no doubt, why they never answer letters that ask them to justify what they are doing.  They are clearly ashamed of what they are doing because they use all sorts of flimsy excuses to avoid revealing what is actually taught on these courses.  But this is where the freedom of information provided by the web comes in useful.  When someone sends me a set of slides from the University of Westminster that teach that amethysts emit high yin energy, I can spend a few minutes on my laptop in front of the TV and half an hour later the world knows what nonsense they are teaching.  That sort of thing, combined with newspaper articles and behind-the-scenes lobbying, seems to be bearing fruit.  One university – Salford – has shut down its activities in quack medicine altogether. [The official reason given was that it was for "strategic and financial reasons".] Another – Central Lancashire – is conducting what looks like a serious review, and has already closed its first-year homeopathy entry. Westminster University (the biggest sinner in this area) has also had a review but it was internal and so far has come up only with conclusions that won’t work.  It isn’t easy for a vice-chancellor to close courses. What can he/she say?  Yes, we have been teaching nonsense for years so we are stopping it?   That’s the truth of course, but it’s expecting too much of human nature that any VC would say it in public.

Finally, you are a noted pipe-smoker: ever thought you should give it up?

Often. But no pipe, no algebra.   Sad, isn’t it.

 

I was talking to a composer a few weeks ago. “This stuff doesn’t really exist except when it’s played,” he said, pointing to his score with heavy despair. “Whereas you’ve got a job where you can actually see that you are doing something good.” He couldn’t understand that my protests to the contrary were genuine: doctors cannot always be sure that they are making a positive difference.

Medical history is stuffed with examples of bad practice – lobotomy for just about anyone with a mental health problem, tonsillectomy for most people with a sore throat, bed rest for everyone with low back pain. I may exaggerate, but only a little. Even now, we don’t seem to appreciate the value of analysing what we are doing.

The US Senate has just passed a bill putting $1.1bn into research aimed at identifying which medical treatments work and which don’t. This sounds like a good idea, but of course not all research is created equal. Regular readers will be aware, for example, of the conflicts surrounding the Department of Health recommendation that all over-65s receive a flu vaccination. Some evidence supports vaccination, some indicates that it does not improve mortality rates. What to believe?

The remainder of the article can be read here. Please post comments below.

The MB ChB medical degree confers a Bachelor’s degree only. True doctorates are PhDs. However, I am guilty of having the title of “Dr” on my bank card. This was only because I thought it might help me get a (larger) overdraft when first out of medical school. But otherwise, at the hairdressers, school gates, and in the world at large, I am Mrs Married. At work, I generally introduce myself without title and then explain what my job is — ie, a GP. On aircraft, I am most definitely Mrs and will always offer to mind the children while my medical husband answers the call for “any doctor on board?”.

In other words, I can’t quite explain why some people seem to get joy out of calling themselves “Dr” at every opportunity – it’s unnecessary and rarely useful to oneself. But it may be useful for patients. I have pondered this as I have observed signs outside chiropractors premises with “Dr” in front of all the names, and dental surgeries too.

The background to this is one of increasing confusion and blurring of identities of many people who work in healthcare with potentially confusing titles (nurse practitioner, nurse consultant, specialist practitioner, house officer, Foundation Year 1, Foundation Year 2, specialist trainee, etc). Of course, other healthcare workers may have a PhD but not a medical degree and be correct in calling themselves Dr (certainly technically more correct than Bachelor medics using the title). But surely the crux is in making sure patients, who probably have more important things on their minds, have a clear idea about who is who?

The medical colleges and the General Medical Council have been rather quiet on this topic. But the Advertising Standards Authority recently reached a couple of interesting judgments. First, against Wigan Chiropractic Clinic. The advert the clinic placed was found to be misleading, in that it implied that the chiropractors were medically qualified by describing them as doctors. (“Who can a Chiropractor treat? Our Doctors are well experienced at treating everyone.”) There were more complaints also upheld about the clinic, but more on that later.

The other recent judgment made by the ASA was that against a dental surgery  where the dentist had advertised his practice using the title “Dr” before his name. The ASA said that “the title ‘Dr’ before a practitioner’s name should not be used in ads unless the practitioner held a general medical qualification, a relevant PhD or doctorate (of sufficient length and intensity) or unless the similarities and differences between the practitioner’s qualifications and medical qualifications were explained in detail in the ad”.

The use of medical titles shouldn’t be about prestige (and it’s debatable whether ‘Dr’ confers any) or snobbery, but accurate information for patients and colleagues.

The BMJ have got a good personal view written by Emeritus Professor Michael Oliver. It’s entitled “Let’s not turn elderly people into patients” and is based on the Prof’s own experience of healthcare.

I suspect there are a fair amount of doctors both in hospitals and general practice who sometimes talk, over coffee, about whether or not their medication does any good at all and in fact just does harm – or maybe I just associate with medics who are as cynical as I am. The trouble is that this attitude may be cynical, but is often correct. All medicines have side effects. Medication used for preventing cardiovascular disease is increasingly commonly used in more people – especially, as the Prof says, in older people, 75+ - yet the margin of possible benefit may be small. Sure, if people want to take medicines and have been properly and fairly advised about them, fine. But all too often, standardised protocols are applied with such rigour that the person’s opinions about their options aren’t highly prioritised.

I doubt that there has ever been a golden age in medicine, but the current obsession with clinical guidelines, and the GP contract and hospital targets which prioritise political targets over clinical ones are dreadful. What is worse is that the medical “profession” seems to have given up objecting and has more or less accepted them.

I am pleased to see that PatientPak (“introducing the world’s first antisuperbug kit”) have been admonished by the Advertising Standards Authority . I wish I had been able to mention it in this piece for the BMJ before it went to press….

Margaret McCartney’s Blog

This blog is no longer updated but it remains open as an archive.

A forum on healthcare policy and professional issues, by Glasgow-based GP and FT Weekend columnist Margaret McCartney.

FT Blogs