On 1st May 2011, we entered the brave new world of the European Union’s Traditional Herbal Medicinal Products Directive (THMPD), so it’s not surprising that herbal medicine has been getting more press than usual in the UK of late. Some of the stories in national newspapers and on their websites have been woefully inaccurate or biased, while other media coverage of the THMPD has been far more positive in intent.
A well-known propaganda tactic employed by groups with a position to push – most definitely including the enemies of herbal medicine and of natural healthcare in general – is to place a bunch of stories in the media that support their position, at a time leading up to or coinciding with a major event. The propagandists’ power is greatly increased by the ill-informed chatter of the skeptic blogosphere (skeptocracy?) that reliably cranks into action at the same time. We can see this happening, as clear as day, with the full imposition of the THMPD, so we thought we’d take a critical look at one of the most obvious examples.
David Colquhoun has made a name for himself on his blog, DC’s Improbable Science. In his day job, he is Professor of Pharmacology at University College London, but his first love these days appears to be attacking natural healthcare in all its forms. Unlike Professor Edzard Ernst, for example, Colquhoun doesn’t even bother dressing up his views in scientific clothing, but goes straight for the jugular with blog posts like The Science Museum promotes anti-science in a disgraceful exhibit (about a display of alternative healthcare modalities), Yet more nonsense foisted on students by Edinburgh Napier University (about reflexology) and Government lends credence to quacks and charlatans (about statutory regulation of herbalists and acupuncturists).
His current focus is on pressuring universities to close courses on alternative medicine, because he thinks they’re nonsense – but more on that totalitarian tidbit another time. On an appropriate date, 1st April 2011, Prof Colquhoun wrote a post entitled Why does the MHRA refuse to label herbal products honestly? Kent Woods and Richard Woodfield tell me. It turns out that Prof Colquhoun’s stance on the THMPD is that it doesn’t go far enough: “The Traditional Herbal Registration (THR) scheme allows herbal medicines that are registered on this scheme to be sold if they are safe, and have been in use for 30 years. There is need to supply any information whatsoever about whether they work or not”. Colquhoun does not believe that traditional use means anything – like Ernst, he thinks it’s all a remnant of the dark ages – so he disregards the EU’s outwardly sensible decision to take it into account when developing the THMPD. He’d like to see notices on labels that say things like “There is no evidence that this product works for the indications mentioned” or "Clinical trials have shown this product to be ineffective for xxx”. His assertion is most likely based on the meta-analyses produced by Ernst’s group, of which more here.
No matter that no non-European herbal products are being registered, that very few herbal species are being used as the basis for products, that the products gaining THRs may be extracted with acetone and stuffed full of nasty excipients and cannot anyway be guaranteed as safe – the THMPD isn’t doing enough damage to herbal medicinal products. We need silly little labels as well! To make a tiresomely obvious point, putting similar labels on orthodox medicines would lead in some cases to wording like, “This product has a low chance of working in any particular individual but may cause serious side effects and possibly death”. Surely, the point here is that people will try herbal medicinal products, and if they work – everyone has different constitutions, after all, an obvious point that orthodox medicine can’t get its head around – they will buy more. If they don’t, they won’t – simple. No need for silly labelling.
Colquhoun then suggests his grand labelling wheeze to another old friend of ours, Richard Woodfield, Head of Herbal Medicine Policy at the Medicines and Healthcare products Regulatory Agency (MHRA). Apparently, there is no specific legal bar on distorting the market by needlessly telling people that herbal products don’t work, even if they might well do depending on the individual, but it’s not something the MHRA is interested in. “Under the previous Administration when the [THMPD] scheme was set up there was a strong policy of avoiding gold plating of European legislation – and this would clearly be a case of gold plating”, said Woodfield.
If the UK’s, and specifically the MHRA’s, implementation of the THMPD isn’t a case of taking an EU Directive, covering it in gold plate, encrusting it with diamonds that spell out “I LUV THE EU”, draping it in a fur coat and finishing it off with a pair of Manolo Blahniks, we don’t know what is. But of course, to Colquhoun, “The European law is obviously designed to encourage the herbal industry by disguising the lack of evidence for the herbs”. He really appears to believe that, “The government is pressing [the MHRA] to support the herbal industry, and big business usually wins over regulators (as with banks)”! He should have asked us – we could certainly point him at some herbal companies who are most definitely not being helped by the MHRA. However, we have to agree with Colquhoun on one thing: the government is helping “big business”, in the form of the larger companies (often pharmaceutical companies) producing Western phytopharmaceutical-type products, with their extracts and excipients. Such enterprises are doing very well under the THMPD, at the expense of smaller, innovative companies, and especially those catering to non-European herbal traditions.
Colquhoun obviously thinks he’s on to something with his assertion that no evidence exists to show herbal medicines work. He makes the point over and over again in a couple of BBC TV news interviews hosted on the same blog page – in fact, it’s basically his only point of debate. Incidentally, the debate took place between two pharmacists, one of whom (not Colquhoun, in case you’re wondering) somehow specialises in herbal medicine: not an herbalist in sight, and certainly no-one familiar with the true implications of the THMPD. Such is the standard of balanced reporting on the BBC these days.
Also hosted on the same blog page is a Radio 5 Live interview between Prof Colquhoun and an herbalist, Michael McIntyre of the European Herbal and Traditional Medicine Practitioners Association (EHTPA). Colquhoun introduces the interview by misrepresenting the BMJ Clinical Evidence statistics in order to make McIntyre look dishonest. He states that “a large proportion” of the treatments considered to be of unknown effectiveness, currently standing at 51% of the overall total of around 3000 modalities (46% of 2500 when Colquhoun wrote the text), are alternative or natural treatments, whereas it is blindingly obvious that the entire project is mainly concerned with orthodox therapies. Some, indeed many, alternative therapies are undoubtedly included in the 51%, but far more of that proportion consists of orthodox treatments. What is more interesting about the Clinical Evidence figures is that only 11% of the 3000 are unequivocally known to be beneficial, a figure that would reduce further if the proven natural remedies – acupuncture for low back pain, for example, the effectiveness of which has been demonstrated using ‘generally accepted’ research methods – were discarded.
Anyway, the interview is fascinating for the way in which Colquhoun behaves. His entire tone is hectoring and aggressive, and he continually speaks over McIntyre, to the extent that the interviewer intervenes more than once to allow him to say his piece. “Which particular herbal medicine do you regard as having the best effectiveness?” asks Colquhoun of McIntyre. “If you had any confidence in any of them, you would name the best one!” Whichever way one looks at it, this is a meaningless and inflammatory question: for a start, individualised herbal medicine treats the patient and not the disease (“New Age baloney”, quoth Colquhoun); and even in the realms of herbal products, just as with orthodox medicines, there can never be a single ‘best’ product as disease conditions are not directly comparable and individual response will differ. Even trials that directly compare treatments only look at the therapy options for a single condition. But, of course, it is a tricky question to answer without looking evasive, which was probably the intention.
Having said that, we think that McIntyre did a great job of sounding sensible and reasonable against a man determined to forcefully push a particular point of view, regardless of his opponent’s arguments – have a listen and see what you think! (And compare what you hear with Colquhoun’s summary of the interview).
But why is any of this important? Isn’t all this bickering merely a fringe pursuit, of interest only to the small percentage of people who spend time reading skeptic blogs? Unfortunately not. The skeptics are few in number and extreme in ideology, but they have huge influence because they reflect the views and vested interests of the ‘establishment’, including the pharmaceutical industry and orthodox medicine. Without exception, the ownership of all forms of media is concentrated in very few hands, and these people also have extensive holdings in industry: pharmaceuticals, chemicals, pesticides, bio-engineering, etc. No wonder, then, that the voices promoting these technologies are those that get the most airtime!
If you are interested in how the fringe obsession of a very few people can quickly become national campaigns that threaten freedom of choice, even in education, please compare this blog post by Prof Colquhoun to this latest campaign from the increasingly fascist Nightingale Collaboration. And if you want to learn more about the connections between the skeptocracy, medicine, industry and government, a good place to start is Martin Walker’s new book, Dirty Medicine: The Handbook (ANH-Intl review coming soon!).
When the distortions and ignorance of a few obsessives can potentially lead to the closure of respected academic courses, something has clearly gone terribly, terrifyingly wrong. The skeptic movement loves to present itself as taking forward the banner of rationality and ‘science’, but in reality, it has absolutely zero to do with science as a method – rather, it has become an ideology that affects us all. Enough is enough.
Updated: 14 Jun 2011
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