Archive for April, 2010

Talking to my GP father about Homeopathy #4

Posted on April 30th, 2010 in Skepticism | 4 Comments »

Part three is here.


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.”

“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.”

“[The World Health Organisation] wants to remain ignorant about AIDS, because it is under the control of the big Multinational Companies manufacturing the socalled HIVdetection kits and the highly toxic drugs like AZT, which products they must sell by any means to make the big bucks.”

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?”


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?

So… what did I think about The Time of Angels?

Posted on April 28th, 2010 in Culture | No Comments »

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 LondonDaleks 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.

Talking to my GP father about homeopathy #3

Posted on April 19th, 2010 in Skepticism | 2 Comments »

Part two is here


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.


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.

So… what did I think about Victory of the Daleks?

Posted on April 18th, 2010 in Culture | 4 Comments »

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.

So… what did I think about The Beast Below?

Posted on April 12th, 2010 in Culture | No Comments »

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!

So… what did I think about The Eleventh Hour?

Posted on April 6th, 2010 in Culture | 4 Comments »

Matt Smith as Doctor Who

Doctor Who Series 5 Episode 1 - The Eleventh Hour

Note: this review contains minor spoilers throughout.

Rarely has 65 minutes of TV had so much to live up to. 18 months after Sir David Tennant announced he was stepping down, 14 months after Matt “who?” Smith was unveiled as his successor, ninety-odd days after his first handful of lines in the closing minutes of The End of Time, Matt Smith’s first full episode of Doctor Who is here.

But it’s not just Smith’s debut episode. For the first time in its history, the series continues but every one of the key creative people is new-in-role. New Doctor. New companion. New head writer. New producer. (Note for pedants, obviously every one was new in An Unearthly Child in 1963, and there was a similar clean sweep for Rose in 2005, but that was after a nine-year gap. When Barry Letts took over as producer in 1970, he inherited script editor Terrance Dicks, and his predecessor oversaw Jon Pertwee’s first story. Letts himself produced Tom Baker’s first story before handing over the reigns to Philip Hinchcliffe in 1974.) The big question, after the colossal popular success of the RTD stories, was how new would it be? How new should it be?

The opening sixty seconds is so 2005-2009 as to be almost self-parody. There’s Murray Gold’s bombastic score, there’s the TARDIS hurtling past London landmarks, there’s a bit of barely-necessary wirework. Then suddenly we get a weird, off-kilter version of the theme, accompanying titles which seem to move a bit too slowly (and be over with too quickly) and then suddenly everything has changed. The texture is richer, deeper, slower, darker. The phrase “fairy tale” has been enthusiastically bandied around by the production team and a definite hint of the Tim Burton’s pervades the whole piece.

Then, up pops Matt Smith, spouting a few rather Tennant-ish lines and suddenly the mix of old and new seems exactly right. Quick side-note. Almost as soon as David Tennant got into his stride, I suddenly realised how some of Eccleston’s more flippant lines should have sounded (especially in Rose, The Unquiet Dead, and – tellingly – The Empty Child). It struck me that Russell and co had been writing for Tennant since the off, whether or not they knew it. This makes SmithMoffat’s job even harder. David Tennant, in performance and writing, is the twenty-first century Who and the new version may be erring too much on the side of familiarity, whereas it might be better to establish some clear water first.

From this point on, the overall feeling was one of tremendous confidence, both in the swaggering Doctor recalling the deadly alien menace just to give it a proper talking to, and in the power and speed of the storytelling and reinvention of the series. Amy’s backstory is fascinating, a lovely blend of Russell’s emo-Who and Moffat’s timey-wimey games. Smith still sounds a little bit public-school but is authentically bonkers in a very refreshing way. There are jokes for adults (“get a girlfriend”) and jokes for kids – I’m apparently the only one who thought that the food scene was embarrassingly juvenile; sudden inexplicable changes of mind plus spitting out food will certainly appeal to six-year-olds but left me cold. And the new TARDIS is absolutely lovely, inside and out. And then, there’s blink-and-you’ll-win-a-Hugo clips of all the old Doctors to ensure total fangasm.

What leaves me slightly disappointed is the plotting – usually Moffat’s great strength over RTD. I appreciated the fact that we avoided the sometimes unsatisfactory forty-minutes-of-escalating-threat-followed-by-a-sudden-and-unlikely-resolution-in-the-last-five-minutes structure of so many stories in Series 1-4. Instead, Eleven is actively working to solve a clearly-defined problem from about a third of the way in. But my favourite of the self-contained episodes establish quickly what they are about and mine that key concept for all it’s worth – think Dalek, Father’s Day, Tooth and Claw, Blink, Midnight. The Eleventh Hour sprang giddily from concept to concept and badly needed a bit more focus, almost as if several different stories had been combined and put through a meat grinder – all the bits of a good story were there but (if you’ll pardon the horrible simile) in a pile of unrelated bits and pieces.

Okay… this is about the crack in Amelia’s wall and what lies beyond it. Oh, this about what you can see out of the corner of your eye. No, it’s about a ward full of coma patients chanting the same- wait, what’s Annette Crosbie doing there? Oh, it’s about Amy Pond and her imaginary raggedy Doctor friend. Oh, no, it’s a rerun of that Sarah Jane Adventures story with the Judoon. Or in fact Smith and Jones.

And that’s the last, slightly disquieting element of The Eleventh Hour – how familiar it all was. Where the feel and the cast were all shiny and new, many of the concepts were shopworn and second hand – not just the escaped convict from Smith and Jones but the laptop conference from The Stolen Earth, the relationship fractured through time from The Girl in the Fireplace, the “Earth is defended” speech from The Christmas Invasion (but without the sour punchline to give it dramatic weight), the coordinated global message to the sky from Last of the Time Lords, the hospital setting and chanting zombies from The Empty Child and the companion about to get married from – of course – The Runaway Bride. Doctor Who has always plundered other narrative forms, but Moffat stealing from himself and the previous five years this early in the run does not augur well.

For all that, I’ll give it four stars out of five. The story is only really good enough for three, but Matt Smith’s supple performance, Karen Gillan’s equally impactful presence, that gorgeous new TARDIS and those wonderfully scary CGI teeth combine to earn it one extra star. I assume and hope that the best is yet to come.

Next episode: The Beast Below.