Tom Salinsky

Part four is here.

TOM

I don’t think there is any evidence that a significant number of people are being harmed by choosing to go to alternative practitioners. There is undoubtedly a considerable morbidity and mortality arising from the side effects of drugs and the mistakes that happen in the conventional medicine system. Is the harm caused by inappropriate use of alternative medicine on the same scale?

Interesting. This is basically the Toyota defence isn’t it? “Until a lot more people are killed by our product, we don’t see the need to perform a recall.” Not really what I want my healthcare to be based on.

Your challenge to produce harm produced by alternative medicine “on the same scale” as that caused by evidence-based medicine does not make clear whether you want the same absolute number of corpses or the same level of morbidity per person treated. In either case, it is unlikely that I will be able to provide such evidence. In the first, less reasonable, case, despite my fears that alternative medicine fairy stories of miracle cures are distressingly seductive, it is obviously the case that almost everyone in Britain will be treated by conventional medicine at some point, but only a portion will seek alternative treatments. So even if they kill at the same rate, alternative medicine will be way behind. Even in the second, more reasonable, case, I doubt I will be able to meet this target since if someone is really sick and foolish enough to seek useless alternative therapies, it is likely that once they are at death’s door, they, or a relative, or someone will have the sense to take them to a proper doctor, and we can only hope they will be in time.

But just as we wouldn’t do without conventional medicine on the basis that a significant percentage of people who go into hospital will be killed simply because they went into hospital rather than because of the condition which brought them there, the question we should ask of homeopathic and other alternative remedies is not “what harm do they cause compared to other things in the world with the potential to do harm?” but “are they a net force for good?” or in other words “are we better off with or without them?” These calculations are not always easy to perform. Some people argue that the use of pesticides on fruits and vegetables contributes to deaths from cancer, and this is likely true. It is estimated that around 20 extra cancer deaths occur in the United States each year due to chemical pesticides. While this is a very small number (around 300 Americans die each year drowning in the bath by way of comparison), surely even 20 is too many. We should obviously get rid of these horrible carcinogens polluting our mealtimes. Alas, the immediate upshot of cutting back pesticide use would be to decrease farmers’ yields, which in turn would raise the price of their produce, which would in turn reduce the national consumption of fruits and vegetables, which would in turn increase the rate of cancers in the USA, probably adding 26,000 to the total (less the 20 who would no longer die because of exposure to pesticides). (Sources for these numbers on request).

So, let us ask what the harm caused by homeopathy is. I (and some of the commenters to this blog) have given you some examples of the horrendous consequences that can follow trusting that homeopathy will be efficacious in treating serious conditions. You say that you hope most people will have the sense to avoid magical treatments when their life is in danger, yet you seem quite sanguine at the prospect of people who are quite determined to erode this life-preserving common sense. Furthermore, the harm which homeopathy can cause is well-documented, by Simon Singh, through the campaign behind the “mass placebocide” or through this website dedicated to answering this very question. Note that Simon Singh makes the same connection that I do between homeopathy and mistrust of vaccinations. The body count due to recent refusals to vaccinate is easy to check.

Having agreed that harm from homeopathy is both possible and actual, we have to ask who it helps. Broadly, there are three kinds of people who might seek this kind of therapy.
• People suffering from serious conditions which require medical treatment. I am reassured that the Royal Homeopathic Hospital would refer these people, but still marvel at the cognitive dissonance required. Clearly, any people in this group run the serious risk of suffering quite unnecessary harm. For this group, the existence of alternative modalities is nothing but a negative. It will cause them to delay treatment.
• People suffering from self-limiting conditions which require little or no treatment in any case. These patients will not be directly harmed, except in the wallet. They will be spending money needlessly since their condition will improve on its own. This is a minor negative, but not in terms of health outcomes. It’s their money, you may argue, and they entitled to waste it however they please. Unfortunately, if they develop the belief that the alternative modality of their choice is effective in treating their minor self-limiting condition, then they may be more inclined to believe the more exotic claims made for this treatment and subsequently find themselves members of the first group. Thus, for this group also, the existence of alternative modalities is nothing but a negative.
• Finally, we come to the group which you have chosen to emphasise. Those suffering from chronic, non-life threatening conditions, for which no evidence-based treatment is offered or available. In a competitive marketplace, they are likely to get more sympathy from a quack than from a real doctor, and they may benefit in the short term from the (very powerful) placebo effect. They may even be permanently cured if they condition had no physical reality in any place (e.g. phantom limb sufferers or people who claim that mobile phone masts give them migraines). While I agree that some people in this group are made to feel better, I do not believe that this benefit is worth the cost, nor do I agree that the Royal Homeopathic Hospital (and other less scrupulous purveyors of fairy stories) is the best possible means of providing this kind of comfort. Relaxation techniques, improved diet, better trained GPs who understand the importance of providing emotional support to their patients and a better patient understanding of how psychosomatic illnesses affect us are all available and likely to be efficacious. You can probably add to that list.

So, no, I don’t believe that the harm done by homeopathy is on the scale of the harm done by conventional medicine. But conventional medicine does tremendous amounts of good which is absolutely unavailable anywhere else, whereas homeopathy does quite a lot of insidious harm, for only a little bit of good, almost all of which is available elsewhere.

Overall what makes me cross is big companies misleading people about important issues such as health. It isn’t just homeopaths who do this. Idiotic media celebrities like Gillian McKeith do the same thing. So do some drug companies. But lying to the general public about health is unlikely to have a positive effect on society, and institutions like the Royal Homeopathic Hospital, whether or not they cause harm themselves, make the lies of the unscrupulous so much more convincing. Campaigns like 1023 aim to provide more accurate information as a corrective to this – to help ensure that people do know that they need to be in hospital with severe chest or abdominal pain.

One of the recommendations made in the recent government Evidence Check was that homeopathy should have to be approved by NICE before being made available on the NHS. Do you think it would get NICE approval? On what grounds? If it wouldn’t, why should it be made available at no cost to patients when other more efficacious drugs are only available privately?

JOHN

I think the argument along the lines of ‘how many more people have to die before you admit I am right?’ is a bit over the top.

I think there are two areas where we are out of synch with each other. They concern the concepts of ‘health beliefs’ and ‘risk management’. I also have a problem with your relentless positivism. Science and logic and common sense are very valuable but there are other powerful forces that govern human beliefs and actions and they need to be understood rather than dismissed as simply foolish.

Risk management. Doctors deal with this every day. We are constantly having to decide whether to advise a patient to take a particular drug which has potential for good and for harm. This can be quantified to some extent. We can say, trials show that if you take aspirin your risk of a heart attack will be cut by X percent over ten years. There is also a risk that you will have a cerebral haemorrhage but the risk is much less so the odds are in favour of taking it. Often, when presented with this information, people say: but I’d rather not take any risk!  But this is impossible. It seems to be a hard concept to grasp. The other problem is that you can’t guarantee that taking the drug will have any benefit for that individual. The effect is only measurable on the population as a whole.

Health Beliefs. You argue that ‘the placebo effect’ can be more safely produced by doctors taking more time, being kind and sympathetic, being trained in psychology etc. But some people’s health beliefs are very physically based. They have very fixed ideas that only by swallowing a pill or having needles or massage or whatever can their bodily pains be relieved. Trying to argue people out of this is usually a waste of time. Often it’s based on personal experience or family traditions.

But I still think that for the overwhelming majority of people will be guided by conventional medicine when there is a really effective treatment available. I have yet to meet a patient who said, no, I’ll just have homeopathy etc. when it was a matter of life or death, or when I said, try this, we can really help you.

Maybe one can’t justify alternative medicine being paid for out of taxation or insurance. But I don’t think it will stop those people who believe in it from getting it privately if they have to. I don’t believe it should be banned by law because a few rather idiosyncratic people may wrongly choose it instead of conventional medicine when conventional medicine is in a position to prolong their lives or relieve their suffering.

That would be an abuse of their human rights. better to ban smoking if you must ban something. Or alcohol? Though, that has been tried.

And now I really have had enough of this subject. By all means have the last word. But after that,  can we talk about something else? How about euthanasia?

TOM

This seems a good place to end the conversation, as we are moreorless in agreement! I agree with everything you say about risk management and almost all of what you say about health beliefs.

I agree that for some people a physical intervention such as a pill, or a series of carefully placed needles, is required to trigger the placebo effect. You can’t argue someone in or out of the placebo effect – it isn’t a product of conscious decision-making.

I also agree that attempting to ban alternative medicine would not make it go away, any more than prohibition stopped people from drinking. Even regulating advertising of alternative medicine only encourages those who sell it to seek editorial promotion instead, which is more convincing than advertisements in any case.

So what do I want? Well, essentially just what you want – for everyone in the world to understand the difference between the claims made by evidence-based medicine and the claims made by magic-based medicine and so make informed health decisions. It’s just that you see very few people who get this wrong coming through your surgery and I read lots of blogs and listen to lots of podcasts which detail case after case, so we have formed very different views as to the scale of the problem. No doubt each of us has a somewhat skewed perspective.

The one area where I would be tempted to disagree would be on the subject of my “relentless positivism”. I am well aware that forces other than science and logic govern human beliefs and actions. However, I submit that to better understand these forces in an objective manner, the only option is to study these very forces with the tools of science and logic. But that’s not really what is under discussion here.

I imagine we’d boringly agree about euthanasia. Human dignity, relieving suffering and patients’ wishes all sometimes trump “first do no harm” but great care must be taken in exercising this option. Is that roughly your view too?

Doctor Who Series 5 Episode 6 - The Vampires of Venice

As usual, this review contains spoilers. Read with care.

So, Toby Whithouse, the writer who gave us School Reunion, the Doctor Who story in which The Doctor, his companion and her boyfriend infiltrate a mysterious school which is actually the operational base for a group of aliens disguised as humans, is back with a Doctor Who story in which… ah.

As full of familiar tropes as this was, the repetition isn’t the biggest issue and the first thirty minutes seemed rich, lush and full of witty lines. Arthur Darvill makes Rory a doofus boyfriend who is entirely different from Noel Clarke’s Mickey Smith, and the notion of sending Rory and Amy on a date is a lovely one (although Amy being the most important person in the universe seems to have taken a back-seat since the end of the last episode). Croatia, standing in for Venice looks absolutely fantastic, and Jonny Campbell’s camera prowls atmospherically around the architecture, costumes and actors. Murray Gold’s score may have been his finest to date – I particularly liked his new Doctor’s theme rescored for sonorous strings – and the supporting cast added gravitas and weight counterpointing the wit of the regulars.

But around the time that Isabella is fed to the fishes, freeing her father up to make a Noble Act Of Self-Sacrifice – yup, there it is – and especially following that NAOSS which firstly follows a second almost identical running through stone corridors waving torches at vampire girls sequence, and secondly effectively removes the major threat with almost twenty minutes to go, it all starts to seem a bit uneventful. At this point, the one-liners start undermining the jeopardy rather than counterpointing it. Rory’s fight with Francesco is terminally unexciting because of the constant wisecracking, and the stately camerawork is not suited to what should have been a fast-cut combat sequence. Further, Amy’s exploding Francesco with her compact makes no sense whatsoever – very disappointing given that the rest of the fish/vampire/alien business had been if not thoroughly worked out, then at least given some care and attention.

The following supposed climax never really has any power or energy and is apparently composed entirely of offcuts from previous episodes. As dark clouds of alien energy pour out of the Globe Theatre the Calvierri School, the Doctor has to climb Alexandra Palace The Empire State Building The Palazzo and rewire the Adipose Parthenogenesis Saturnynian Tsunami machine before finally looking up and seeing the skies clear of Sontaran gas storm clouds.

And this invites the nitpicking. Why do most of the Calvierri girls turn into vampires, but Isabella just gets a bit light-averse and Amy is entirely unaffected? What kind of vampire story is this when being bitten by a vampire is something you can just shrug off and carry on? Why does the Doctor make such a big deal of Rosanna not knowing Isabella’s name, but nobody notices that she calls him “Doctor” without ever having been introduced? Why does her clothing disappear when her filter fails (suggesting it is illusory) but then we see her taking off much of it before jumping into the lake (suggesting it is real)? Who’s going to mop up all the murderously hungry man-fish still in Venice’s lakes? Who thought it would bring this story to a rousing conclusion to have the chief villain obediently kill herself, saving the Doctor, our hero, from having to lift a finger?

Even more than the misguided Victory of the Daleks, which was ill-conceived but cheerful nonsense from very early on, this is a spectacular missed opportunity. Thirty minutes of creeping suspense, genuinely funny lines, strong character work from regulars and new cast members alike and rich visuals, which get thrown away not in an RTD-style whirl of bewildering last minute plot resolutions but in an excitement-free, drama-light, that’ll do muddle.

Compare the entirely pointless rewiring of the tsunami machine here to the almost identical scene at the end of Partners in Crime. Whithouse just has the Doctor pulling the plug on some bit of whizzy set-dressing and ends the threat there-and-then. RTD builds the tension by having the machine first neutralised, and then not, and then uses the renewed threat to build structure and character by having Donna produce the urgently-needed second capsule to the Doctor’s total delight. If you’re going to re-use an old sequence you have to do it better than the people you’re copying, not give us a watered-down version.

Two stars.

Doctor Who Series 5 Episode 5 "Flesh and Stone"

Right, all that election fuss and bother over with, let’s see if I can marshal some thoughts about Flesh and Stone before Vampires in Venice airs. As usual, beware spoilers!

Basically, this was fantastic. Building on the adventure and derring-do of the first part, moreorless wrapping up the villainy with a denouement that was mostly carefully-set-up-and-then-hidden-from-view-plotting and just a little bit RTD-style-magic-hoover-which-suddenly-appears-and-sucks-all-the-badness-away, then dropping some delicious hints about what the end of the series might hold and then having the companion trying to jump the Doctor on the eve of her wedding! What larks!

Not only that, but Moffat finally gives a major speaking character a proper death. The demise of Iain Glen’s stoic bishop is one of the finest deaths the series has given us, brilliantly freaking out Doctor and viewer alike, incorporating everything that’s wonderfully terrible about the Angels and providing a real, tangible sourness, which perfectly complemented things like the comfy chair gag.

And the much-talked-of fairy tale imagery really went into overdrive here with an extended sequence of Amy, eyes tight shut, wandering through a forest, dressed in red, while frozen monsters lurk behind every tree – how weird that the statues, freaky because we never see them move, become even more freaky when we do some them move!

As unbothered as I am by a companion with an honest libido, I’m equally unbothered by the last five minutes being an extended tease for the next episode – it’s a feature of the fifth series which I enjoy and I can’t think why it wasn’t included at the end of the badly-underrunning Victory of the Daleks. I’m faintly bothered by the previous five minutes largely being a tease for the end of the season, however. Moffat is asking a lot of viewer loyalty here, just as the summer kicks hold and the ratings start to dip. Still, it’s a different show than it was in 2005 and TV is a different thing now than it was in 1989. American shows like Lost, 24, Battlestar Galactica and The Wire have proven that an audience will follow a continuous narrative over many weeks, but I still worry that season arcs need to be all-or-nothing and that this piecemeal approach will not garner new viewers, as much as it might please the stalwart ming-mongs. On which subject, just what is happening around 17 minutes in as the Doctor comes back and pleads with Amy to “remember”? If you look closely, there’s a heck of a clue that all is not what it seems in this scene.

Finally, let us note that this is the last Moffat script of series 5 until the two-part finale. RTD was widely criticised for his cavalier rewriting of scripts credited to others, but an analysis of the DWM favourite story poll indicates that these stories are precisely the ones which are likely to be the most popular. RTD’s own scripts may have suffered from not having had that extra pair of eyes to spot flaws, burnish up dialogue and strengthen plotting. Rare scripts not by RTD or Moffat which did not have RTD’s input tended to fall flat, such as Matthew Graham’s widely-derided Fear Her or Helen Raynor’s Daleks in Manhatten (written while RTD was sick). (For a full analysis of this, see here, if you really must.)

We don’t know whether Moffat is rewriting other people’s scripts in the same way, but he’s certainly working very closely with other writers. So far, Gatiss’s script is the only one which has attracted anything other than general praise, either from me or from the Whogosphere in general. We wait with interest to see what Messrs Whithouse, Nye, Chibnall, Curtis and Roberts can conjure from their typewriters as well as to see what will happen on 26.06.2010.

Well this is pretty much as I predicted, except that the Silly Party won. I think this is largely due to the number of votes cast.

To be fair to me, my prediction wasn’t quite as bad as that. With all 649 contested seats now having returned results (the Thirsk and Malton election will be re-run on 27 May following the death of a candidate) the final results are in fact 306 / 258 / 57. This means that about 30 seats I thought would go to the Lib Dems actually went to the Tories, outside my self-declared margin of error of 20. My prediction for Labour was pretty much spot-on, however, and so is what I called the overall narrative of the result. The Conservatives are the biggest overall party, but neither party has enough for a stable government without help from the Lib Dems.

However, the stunning collapse of Lib Dem vote (in terms of seats won) also means that the third party is a slightly less significant force when it comes to the Making of Kings, since now even with a stable Lib Dem coalition, Labour still can’t pass the 326 seat winning line without help from other minority parties. This may explain Cameron’s eager overtures compared to Brown’s rather more subdued approaches as each of the two parties with the most support in the country, and the most seats in the House of Commons effectively beg permission to govern of the party who came third. Ain’t democracy grand?

It may also be instructive to compare the actual result to the exit poll released at 10:00pm last night. This mighty exercise – for the first time a coproduction between Sky, ITV and the BBC was generally derided by pundits on its unveiling. None of the Party spokespeople wheeled in front of the cameras by any of the broadcasters had anything good to say about the poll, all proclaiming that it would be hopelessly incorrect and that it was pointless to speculate. However history will show that it was stunningly close. Off by just one for the Conservatives, three for Labour and two for the Lib Dems. Kudos to the real pollsters who actually know what they’re doing.

Finally, no matter how this all shakes down over the next week or so, I think the real losers in this election are the Lib Dems. True, the Tories did not win the outright majority they hoped for, but they are the largest party by a substantial margin and could probably hold a minority government together if they strike a couple of deals here-and-there. A good result by any standard. But nor was this a rout for Labour. The strength of the core Labour vote not only held the Tories back from the brink of victory but also curbed the Lib Dem surge. After three terms in office, and having survived a punishing recession, this is a very good showing. The Lib Dems however had their most lavish and successful exposure on the stage of British politics since their inception and yet not only failed to capitalise on it, they actually lost seats.

Of course, you can also interpret these results as a damning of our first-past-the-post electoral system. My thoughts on that are best left to another post. For now, with the rest of the country, I wait to see what the result of the result will be.

PS – come and see Horse Aquarium tonight at the Hen and Chickens 9:30pm to take your mind off this mess. Three improvisers, your suggestions, one hour, lots of laughs.

Following my stunning lack of success with the Oscars, I am determined to do at least as well, if not worse, when it comes to the General Election. Based on a thoroughly unscientific method of looking and some recent polls, and letting gut feeling do the rest, here’s my prediction of the numbers of seats each of the major parties will win tomorrow…

Conservative: 275

Labour: 250

Lib Dems: 85

While I would not be a bit surprised if these numbers turn out to be quite badly wrong, I would be quite alarmed if the overall narrative changed significantly. That is to say, I am fairly confident that…

• The Conservatives will win the most seats
• But will not win an overall majority (on the figures above, they are short by around 50 seats)
• The Lib Dems will not crack treble figures (or if they do, not by much)
• Despite having an increased share of the vote
• And they will become the kingmakers in the new Parliament.

Or to put it another way, my figures are plus-or-minus about 20.

Both because this kind of outcome will shine a harsh light on our first-past-the-post-elect-your-local-constituency-MP-directly system, and because they rarely shut up about it (except when tactical voting boosts the number of seats they can win) the Lib Dems will be in a tremendously strong position to make electoral reform a key part of any coalition deal they might make. This in turn means a deal with Labour, not the Tories, even though Nick Clegg is basically a Tory at heart, since the Tories will never agree to electoral reform (nor could they stomach an alliance with such a Eurofriendly party).

Electoral reform almost certainly means the end of decisive victories in the House of Commons (as well as an end to directly electing your local representative) and so every general election henceforth will deliver the same outcome – of the three main parties, the one with the fewest elected representatives, becomes the party which decides who will govern.

And remember, when this happens, the Lib Dems told you it was in the name of democracy!

Oh, and in the mean time, .

Part three is here.

TOM

Muddy waters? Not at all!

You say that you don’t see complementary/placebo medicine as competing with scientific medicine. However, not all placebo practitioners see it that way. Many peddlers of placebo cures directly attack what they sometimes term “allopathic” medicine as causing harm, arranged to make money for “big pharma” or who-knows-what other ills. Here’s a quick sampling of web pages and opinions which it took me about two minutes to find.

“Antibiotics kill bad as well as healthy bacteria. This results in weakening of immune system. Homeopathic medicines strengthen the immune system by building resistance to sickness. They do not disturb or hamper digestive system.”
http://www.otherhealth.com/research-scientific-validity-homeopathy/9877-modern-medicine-allopathy-homeopathy.html

“Allopathy’s strength lies in intervention. When you need a shot of penicillin, you need a shot of penicillin. When your body needs insulin, no therapy other than insulin injections will do. If surgery is required, then surgery is the solution. Allopathy’s weakness lies in the simple fact that removing the symptoms of a disease does not necessarily remove the cause of the disease. Its greatest weakness is that many of its cures are killing people. One reason many people have left conventional medicine for healthier alternatives is that death is not an acceptable side effect.”
http://www.mnwelldir.org/docs/therapies/what_is.htm

“[The World Health Organisation] wants to remain ignorant about AIDS, because it is under the control of the big Multinational Companies manufacturing the so–called HIV–detection kits and the highly toxic drugs like AZT, which products they must sell by any means to make the big bucks.”
http://www.wonder-cures.com/art8.htm

Now, it’s easy for you and me to dismiss these as the ravings of cranks, and indeed you then say “you think most people are aware that they [evidence-based and alternative medicine] are different in conception”. Presumably you think this is important. If people are aware that antibiotics are a sensible (although not a guaranteed) treatment for pneumonia but that homeopathic remedies are unsuitable, then they will steer clear of them – despite the fact that they are readily available.

How does it help this vital distinction between evidence-based and placebo medicine to be maintained if placebo medicine shares shelf-space with evidence-based cures in Boots? If NHS doctors provide imaginary treatments on request? If evidence-based medicine is offered side-by-side with placebo medicine, as birthing pools are provided side-by-side with epidurals in maternity wards? How can the lines not be blurred in patients’ minds? And do you not share my concern about the possibility of harm once these lines are successfully blurred? This is where the muddy waters really are, I believe.

Yes, there is no market for herbs on broken legs, but there is a big market for homeopathy which is no more magical, but which presents a more credible face to the western world. Homeopathic pills look like medicines (which partly accounts for their effectiveness, although studies show that saline injections – a more impressive intervention – can be even more effective in pain relief for example) and so they appeal to a moderately medically-literate audience. But that appeal depends on blurring the distinction which you identified. And it works – the market for homeopathy in the UK is estimated at £30m annually (£4m on the NHS). For complementary medicine as a whole it is £1.6bn. That’s a lot of money to spend on magic.

I agree, that if it were the case that all promoters of homeopathic medicine (and other placebo interventions) were eager to direct their patients towards evidence-based interventions for more serious or urgent situations (regardless of the inevitable cognitive dissonance that this requires), then they would do considerably less harm. But your personal experience of this kind of co-operation happening in China or on the NHS doesn’t change the fact that it is not the norm. When researchers visit high street homeopathic vendors, they are prescribed useless sugar pills as a malaria prophylaxis and told not to bother with evidence-based immunisation. When patients visit websites for information about homeopathy, they may read information which presents evidence-based medicine as a cure which is worse than the disease. When practitioners of placebo medicine are criticised in the press, they often attempt to silence their critics by legal means, as happened recently to Simon Singh, heedless of the fact that open scientific debate is essential for determining best options for patient care.

The upshot of all of these behaviours could be and is that patients die who might well have lived had they not been fed this misinformation. The further consequence is that it becomes easier for evidence-free attacks on mainstream medicine, such as the anti-vaccination campaign, to take hold in the public consciousness. This seems to me like far too high a price to pay for the temporary alleviation of chronic pain in some patients, or the illusion of relief from self-limiting conditions for others.

We know that pneumonia kills, but that it can be effectively treated by antibiotics. We know that a lot of people are unaware of the fact that homeopathy is a useless treatment for pneumonia, because homeopathic treatments are readily available, and if no-one thought they would be effective, market forces would ensure that – like herbs for broken legs – they would be nowhere to be found. People who believe that homeopathic remedies will treat their pneumonia will likely die. Homeopaths have a strong vested interest in maintaining this belief. Homeopathic pills in Boots and the presence of an institution such as the Royal London Homeopathic Hospital are very effective in helping to maintain this belief.

Your initial question to me was “why are you so cross about this?” My question to you is “why aren’t you?”

JOHN

The reason I am not cross about it is that I don’t think there is any evidence that a significant number of people are being harmed by choosing to go to alternative practitioners. Do you know of any?  Its true that these advertisements appear to be very misleading, but I think people have enough sense to know  that they need to be in hospital with severe chest or abdominal pain and that they need a surgeon for a broken leg.

They go to the alternative practitioners only when they have discovered that they have the kind of symptoms which are painful or distressing but not due to any disorders that conventional medicine can help except by support and the doctor’s continuing interest  and concern. Sadly,  that may be more forthcoming from a homeopath.

And, as I have said there is something about these  miracle cures that has a very strong appeal to human nature. I’m not sure that one can or should legislate against it unless you can show that harm has resulted on a significant scale. What is significant? Well, there is undoubtedly a considerable morbidity and mortality arising from the side effects of drugs and the mistakes that happen in the conventional medicine system.   Is the harm caused by inappropriate use of alternative medicine on the same scale?

Doctor Who Series 5 Episode 4 - The Time of Angels

Note: this review contains spoilers throughout.

The first two-parter of the season has been, since 2005, something of a graveyard slot. Aliens of London, Daleks in Manhatten and The Sontaran Stratagem all struggled to accumulate fans with Rise of the Cybermen, while not so widely disliked, still seen as one of the revived series’ weaker entries (maybe it benefited from sharing a season with the very controversial Love & Monsters and the generally derided Fear Her). After the very significant wobble last week, Time of Angels needed to pull something out of the bag.

This is also the point where the season starts hitting its stride (although these were the first episodes filmed!). Four episodes in, we can start to get a sense of what “The SmithMoffat years” are going to be like. A couple of themes are emerging here. One, slightly odd, one is floating outside the TARDIS. Currently, three out of four stories have featured such scenes, starring the Doctor, Amy and now River Song.

Another is recycling. I grumbled that much of both The Eleventh Hour and Victory of the Daleks was reused from earlier episodes, often early RTD episodes. Here we have Mr Steven Moffat hubristically giving us a double sequel to his very well-received Blink and his not-quite-so-rapturously greeted Silence in the Library two-parter. And yet despite very overtly recycling Professor Doctor Song and the Angels, finally this starts to feel genuinely fresh, energised and galvanised.

It helps that this is an adventure in the truest sense of the word. The threat in The Eleventh Hour was rather intangible, and part of the point of that story was to show the new Doctor effortlessly swatting a fairly feeble opponent. The Beast Below, for all its virtues, was a story about concepts and the moments of supposed jeopardy, mainly involving the Smilers, were the weakest aspects. Victory of the Daleks gave us Daleks which barely exterminated anyone, preferring to stage an impromptu fashion show for their mortal and defenceless enemy rather than gun him down. What’s satisfying about The Time of Angels is that by the time we get to that heavily-trailed cliffhanger speech, the Doctor and Amy are in All Sorts Of Danger.

But it’s not all scares. The pre-titles sequence is very Moffaty, and entirely implausible but artfully constructed and brilliantly paced, putting the viewer just far ahead enough to feel clever (and able to follow it) but not so far ahead that it feels predictable and boring. Cheeky jokes at the series mythology are always welcome, especially when they are played as brightly as Smith, Gillan and Kingston play them here. And if it seems early on as if that woman from ER is reading script pages from that David Tennant episode about the shadows, while on the set of Earthshock, that nagging feeling of overfamiliarity is extinguished entirely once we descend into the caves and the shoes start dropping one-by-one. The Angel on the videotape is not just an image… Amy is turning to stone… the statues only have one head… All beautifully mounted by director Adam Smith and played with total conviction by the entire cast – fuck me, that’s Iain Glen, that is! Only the Weeping Angels taking Bob’s voice seemed to bring back unwelcome memories of Silence in the Library (oh and that cartoon Graham Norton reprising the opening moments of Rose).

And it’s partly the grace notes that elevate this script – these aren’t Eric Saward’s stock mercenaries; they’re a bishop leading an order of gun-toting clerics. River Song is not just a flighty archaeologist with an extensive shoe budget, but an escaped criminal of some kind. And double extra bonus points for “the crash of the Byzantium” being one of the “have we dones” from Silence in the Library. Who knows what “picnic at Asgard” will turn out to be?

It’s always dangerous to judge a two-parter on the basis of part one, but Flesh and Stone would have to be ghastly to drag this episode down, and if it’s great – or even good – then this story could be one of the all-time classics.

Provisional rating: four-and-a-half stars.

Part two is here

TOM

I’ll keep this as brief as I can.

Parts of your reply misrepresent my position slightly. I’d like to clear up any misconceptions.

I don’t equate evidence with certainty. Absolutely, we can be less sure than we would ideally like that a given intervention will be effective in a given case, but we always have an evidence base on which to make such judgments – even if the best we can say is “this is a wildly experimental treatment which stands as good a chance of curing your cancer as it does of killing you on the spot, but we’ve run out of other things to try – what do you say?” If this is a lottery, it’s one where we can often buy an awful lot of tickets.

Thus, I continue to insist that everything is split into two categories. A physician can recommend a treatment because there is evidence to suggest that it will be effective or can ignore the evidence which shows that a treatment is no better than placebo and prescribe it anyway. A physician can honestly tell a patient that the evidence is inconclusive, or dishonestly claim results which are not supported by data of any kind.

The other slippery issue is that of false claims. You approve of the wording on the Homeopathic Hospital’s website regarding Iscador, but I’m not sure you are looking at this website the way a patient might. Here’s a page from a website all about Iscador.

Here we read that “one of the primary functions of Iscador^® is that it stimulates parts of the immune system that can slow the growth of cancer cells”. This, as we know, is rubbish. On the same website, there is a link to a single study, published in a Complementary Medicine Journal which purports to show a significant benefit to cancer sufferers using this preparation. However, as we have already seen, a review of all the available literature shows that overall there is no good evidence that Iscador has this effect. This is the usual pattern. Evidence-based (or science-based) medicine which reviews all the available evidence, and people with a pill to sell (herbal or pharmaceutical) who pick only the studies they like and ignore the rest.

Now consider the effect on a patient who may have seen these other claims made for Iscador’s magical cancer-healing powers, coming across Iscador on a National Health Service website. It isn’t the details of the mode of action that stick in the mind – it’s the key message MISTLETOE CURES CANCER. And this message is reinforced, not contradicted, by the product’s availability through an apparently prestigious and trustworthy source. So while the NHS might stop short of actually saying “mistletoe cures cancer”, it ends up delivering that message just the same.

It is at least partly for this reason that the Ten23 campaign is targeting Boots. When homeopathic preparations are seen side-by-side on the shelf with active pharmaceuticals in the country’s largest and most-trusted pharmacy, it is almost inevitable that patients will get the wrong impression (this is reinforced by dire warnings on the sides of the bottles). So, it becomes impossible to clearly send a message that homeopathy will not cure your cancer, is not a suitable defence against malaria, will not cure your child of eczema and so on, and the result is that people believe the hype, and sometimes that belief turns out to be deadly.

My feeling is that placebo cures possibly do have a role in treating chronic conditions such as back pain, may even have a role in treating minor self-limiting conditions although this is more likely to be simply a waste of everyone’s time,* but are a danger as soon as they are let near anything remotely life-threatening. With a powerful lobby that can’t bring itself to say “for god’s sake get proper medicine if you feel really poorly,” the only answer is to try and destroy the credibility of these interventions as much as possible, or stand by as greedy corporations and misguided practitioners continue heedless of the harm they cause.

So it isn’t that homeopathy on the NHS is itself prescribed in a cavalier or life-threatening way, rather that this activity is an enabler, enhancing the credibility of others with fewer ethics or less regard for evidence, and also fuelling the fires of hysterical media coverage of things like Andrew Wakefield’s infamous MMR paper. Is public demand for medicalised quick-fixes a good enough reason to accept this corrosion of public standards of evidence? I don’t think it is.

You asked the excellent question – can you have medicine without quackery? I don’t know if you can. But I do know that mainstream medicine has no business flattering the quacks.

One final question for you. Many churches pray for people with life-threatening illnesses and many people feel happy that people are praying for them. What if this were offered as a service on the NHS? Is government-sponsored prayer also something you would endorse?

* Caveat – when I have a sniffle, I’m perfectly well aware that no matter what I do it will probably last 3-4 days, but I prefer Lemsip to a homebrewed hot lemon drink because the fact that Lemsip tastes a bit medicine-y makes me feel better. The placebo effect is also present with pharmaceutical interventions of course.

JOHN

I don’t see complementary medicine (or if you prefer ‘placebo medicine’) as competing with scientific medicine. I think most people are aware that they are different in conception and that for some major illnesses or accidents only science will deliver. Very few people put herbs on broken legs these days. There would be no demand for it on the NHS.

Whether there would be a demand for prayers for healing on the NHS I don’t know but it might catch on and save a lot of money currently spent on visits to A and E.

When I was in China last year, I was interested to see that some of the hospitals and clinics we visited  had Western scientific medicine  and TCM ( traditional Chinese Medicine) departments running side by side. The patients chose which one to go to, but if the doctor they went to initially thought they had got it wrong they were cross-referred to the other wing.  So the two approaches can co-operate.

That’s all I  have to offer for now. I hope I have muddied the waters a bit so you can get to work clearing them again.

Doctor Who Series 5 Episode 3 - Victory of the Daleks

Please note: this review contains spoilers throughout

This was probably the episode I was looking forward to the most – Winston Churchill! The Daleks! Mark Gatiss! What could go wrong? Er, quite a bit.

The set-up is gorgeous. The Doctor and Amy arrive in a wonderful and wonderfully-realised location – Churchill’s wartime bunker. A nervous young radio girl fears for the safety of her man. Soldiers push tin representations of their forces around a map. Then, up pops Bill Patterson, looking remarkably like Bill Pertwee in that tin hat, and unveils his “Ironsides” – obedient, polite tea-making, union jack-sporting Daleks, whose awesome firepower Churchill eagerly endorses.

So, we’re all set for a nifty retread of Power of the Daleks, with a (fairly) newly-regenerated Doctor having to desperately convince a group of trusting humans, isolated in a claustrophobic location that the docile metal pepperpots in their midst are actually the most lethally antagonistic force in the universe.

And then, about 15 minutes in, it all starts to unravel.

To be fair, it goes along at a fair clip, and a lot of the flaws I’m about to dwell so lovingly on, were not immediately apparent to me. And, to be even fairer, accusations of nonsensical plotting can also be levelled at The Beast Below, but my reaction to Beast, was that – despite lapses in logic – I was carried away by the big emotions, the wonderful symbolism of those FORGET and PROTEST buttons and the sheer charming oddness of it all. But what little there is to like in Victory is shopworn and underpowered.

Almost as soon as the Daleks are unmasked, which itself happens a bit too quickly and easily, they remove themselves from the action, and they and the Doctor repair to a much more spacious, far less interesting location. So, the gullible humans who bring these murderous creatures into their lives never remotely pay the price for this foolishness. Where Dalek succeeded so brilliantly in demonstrating how effective a killing machine even a single Dalek could be, Victory contents itself with just telling us how mean they are, but they only ever actually off two nameless squaddies.

So, now we’ve robbed the story of all its atmosphere and power, we can learn the Daleks’ plan. They possess something called a Progenitor, which makes Daleks (out of what?), but which can only be ordered so to do by other Daleks (why?), in which category the current Daleks do not qualify (why not?), so rather than reprogramming it the not-quite-Daleks lay a trap for the Doctor, whose identification of these Daleks will be proof enough for the Progenitor (but it wouldn’t take the word of an android Doctor, which might have been a simpler plan given that these Daleks are pretty nifty android-builders) whereupon the Progenitor builds things which look a bit like Daleks, but which perfectly-clearly aren’t. What!?

Throughout this muddled Dalek info-dump, the Doctor does very little except to wave a jammy dodger at them, which is a nice touch in a story which is pretty short on them, but he doesn’t really do very much.

Meanwhile, the real heart of the story is supposed to be in Bill Patterson’s capable hands (or hand). And Patterson does make a decent fist (sorry) of the plight of the Dickian android Bracewell who believed himself to be a brilliant human inventor. But again, the plotting destroys not only any sense that there might be in this idea, but drains out most of the drama too, since Bracewell instantly and obediently changes sides to fight the Daleks, with barely a hint of regret or internal conflict.

But we aren’t done with Patterson just yet. The Daleks can use Bracewell’s energy supply as a bomb, which will if detonated, crack the planet open like an egg. Rather than detonate it straight away, despite being safely in orbit, they elect to set a rather long timer, which gives the Doctor and Amy just time enough to remind him of a lost love, and the recollection of this implanted memory prevents the detonation from taking place, for reasons which are never made clear.

What also isn’t clear is why the Doctor didn’t just bundle Bracewell into the TARDIS and remove him from any populated area. Now, there are many, many similar moments in Doctor Who stories, hence all of those Hartnell stories which feature the TARDIS trapped or falling off a cliff or lost in a bet. But it’s symptomatic of the plotting weaknesses in this story that Gatiss doesn’t bother removing the TARDIS from the Doctor’s control at this point, even though he had included a subplot of Churchill repeatedly trying to steal the TARDIS key!

Well, it wouldn’t have been exactly fair play to portray Churchill as a thief, you might argue; Churchill is one of the greatest tacticians and one of the most formidable orators in the world – we don’t want to see him portrayed as a selfish and foolish pickpocket who threatens the safety of the earth for the sake of getting one over on the Doctor. This is a good argument, but it would be stronger if Churchill’s skills in leadership and battle-planning had contributed anything at all to the story. Gatiss sets up and then ignores the promise of a wartime prime minister who will invite death into the heart of the British camp if it will give him a tactical edge. But as soon as the Daleks disappear back to their ship, Winston has no further part to play in the story. Previous “celebrity historicals” have tended to make their heroes’ talents key to the plot Shakespeare’s gift for language, Agatha Christie’s problem-solving skills, Charles Dickens’ humanity – but Victory of the Daleks just expects us to go “ooh, it’s Churchill” and not notice that the character with more screen time than anyone except the Doctor and Amy doesn’t actually do anything except recite catchphrases, and further ignore the fact that Ian MacNeice is far fatter and jowlier than Britain’s most famous PM.

Any moral conflict in Churchill is sidestepped, Bracewell is suitably appalled by the truth of his existence and everyone else is firmly on the side of the Allies and the elevation of the conflict from geopolitical to galactic is also entirely ignored, since the story features no Nazis. So, once Bracewell turns Spitfires into spaceships – by magic – the Doctor has the Daleks where he wants them, and FINALLY someone has to make a moral choice. The Doctor, inevitably chooses saving the Earth over eradicating the Daleks, but by this time, I’m too bored to really care, except to notice in passing that Russell T Davies did this exact same plotline with real emotion and tension in The Parting of the Ways.

By the time the Doctor is laboriously giving ticking time bomb planet-killer Bracewell time enough to escape so that the Daleks can zoom back and blow up the planet whenever they wish, I’m totally fed up with this episode. We learn that our radio girl’s chap has indeed been shot down, in what must have been a fossil left over from a previous draft, since it has no bearing on the rest of the story at all, and the Doctor and Amy depart leaving only another crack in reality behind.

I’m mildly curious as to why Amy doesn’t remember the events of The Stolen Earth, but I fear that the real legacy of Victory of the Daleks will only be this ghastly redesign of British television’s most iconic badguys. The rest is all just missed opportunities. Even Doctor Smith wasn’t given many opportunities to sparkle, although – bless ‘im – he did grab a couple with both hands.

Let’s hope the next episode will be doing something other than taking set-pieces and concepts from old stories and rehashing them. What’s the next one about again…?

Two stars.

Doctor Who Series 5 Episode 2 - The Beast Below

Note: this review contains minor spoilers throughout.

All the hoopla and 65-minute razzmatazz of the season opener out of the way, we can now settle down and begin to get an idea of what this new Moffat/Smith/Gillan Doctor Who might be going to be like. And the answer, from me at least, is pretty good. Despite being slimmed down to a more manageable 45 minutes this didn’t seem rushed to me (although it did to some viewers). We even took the time to neatly bookend the adventure with a pair of TARDIS scenes – the first playfully contrasting our expectations as viewers with Amy’s expectations as the Doctor’s new companion, the second leading in to next week’s adventure in the manner of a Hartnell story.

Whereas last week’s episode consisted of a lot of very strong concepts but didn’t stay still long enough to explore any of them, this week we got a simple and straightforward mystery with an elegant resolution, the clue to which was in that very first TARDIS scene – loved that moment when Amy suddenly looks up and sees the Doctor on the scanner. Add to this the immense fun of having the Doctor and Amy thrashing around on a giant tongue, a wonderfully brash performance from Sophie Okenedo as Liz Ten and the genuinely scary image of Amy’s tear-stricken face suddenly appearing on the screen to warn herself off asking any more questions, and you have a really satisfying slice of modern-day Doctor Who.

Satisfying, but not perfect. You’ll notice that the smilers, for example, are not mentioned. Heavily featured in trailers, well-designed and a creepy idea, but they’re grafted on to the mind-wiping, thought police, crying children, spacewhale plot rather artlessly, look silly once they stand up and get out of their booths, and fall over as soon as Liz Ten blinks in their general direction. And, unforgivably, they flubbed what should have been a wonderfully creepy shot of David Ajala’s head swivelling round – we join the shot too late to properly see his face. And I’ll dock more points for the children’s function being slightly muddled. If you don’t do well at school we’ll feed you to the Space Whale, which none of knows exists, because we’ve all chosen to forget, and which won’t eat children anyway, but we will make use of you as slave labour despite the fact that we don’t know we’ve enslaved a Space Whale. Did I turn two pages at once?

However, the Doctor and Amy continue to delight. Amy’s journey from learning the ropes, to screwing it up, to saving the day, to that lovely heartfelt hug, really anchored the episode, and Matt Smith, while perhaps more obviously finding his feet here than when playing the “still-cooking” version of Eleven last week, is shaping up to be a truly excellent time lord.

We could have done without a repeat of the “you look Time Lord” gag from Planet of the Dead and the whale brain looked a little Oodish to me, but otherwise this was fine, fine stuff. I am a happy fan today.

Four and a half stars!