Simon Singh was in Kingston on Monday night speaking to the Kingston Humanist Society. As all the skeptics I have challenged refuse to debate me in public, I thought I would go down and give a clinicians explanation of Evidence Based Medicine to a physics scientist. (more of that in my next blog post)
What really surprised me was Simons explanation of how he got together with Edzard Ernst “The first Professor of Complementary medicine in the UK, “who according to Simon knows everything there is to know about CAM”.
In January 2006 The BBC aired a programme on acupuncture presented by Professor Kathy Sykes. Simon Sing showed a clip from the programme which opens with a woman having open heart surgery, apparently using just acupuncture to supress the pain. The presenter tells the viewer “as the surgeon begins, the success of the operation depends not just on his skill, but on the power of acupuncture”. Here’s a link to the relevant segment of the programme: http://www.youtube.com/watch?v=t-dWMpuYnwQ
According to Simon Singh the open heart surgery was in fact performed with anaesthetic, the patient was receiving three powerful conventional sedatives — midazolam, droperidol and fentanyl — along with large volumes of local anaesthetic injected into her chest, all of which rendered the acupuncture merely cosmetic. This is what Simon Singh and Edzard Ernst have to say about the procedure in the book they wrote “Trick or treatment”, they state; “the patient had received a sufficiently large dose of conventional drugs to mean that the acupuncture needles were a red herring , probably playing nothing more than a cosmetic or psychological role. They described demonstration as “a deception” on the viewers.
What shocked me was the nonchalant manner in which Simon informed us that professor Edzard Ernst was in fact an advisor to the programme makers on this “deception”. This was of course before they began working together on Trick or Treatment.
It is a few years since I read “Trick or Treatment” promising us the “truth about acupuncture” and other CAM, but I didnt recall reading about this error of judgment on Ernst part in the book, which for me brings his credibility into question. Nor have I been able to find reference to his involvement in a book claiming to be seeking the truth about complementary medicine.
The programme was aired on January 20 2006, yet it was March 25 before Ernst made his apparent concerns public, possibly in the light of much criticism of the BBC series on alternative medicine and Simon Singh having approached him.
On March 25 Ernst states, Having seen the finished programme, he wishes he had not had his name attached to it. Remember this is two months after the programme had been aired. Ernst refuses to answer whether he was paid to advise on this programme. Simon told us that Ernst assured him that he considered jumping ship but decided it was better to remain part of the project and be able to “reel in the excesses” of the BBC production team and presumably get paid for his efforts.
Below is part of Simon Singh’s original response to the programme in the Telegraph:
A BBC series on unorthodox therapies was devoid of scepticism and rigour, says Simon Singh
“Scotland’s Herald television reviewer, Ian Bell, was stunned when he saw “a 21-year-old Shanghai factory worker undergoing open-heart surgery with only the needles to control her pain”. It seemed to be one of the most amazing bits of television this year, but did he really witness the amazing power of acupuncture or was he, like the rest of us, misled?
The three-part BBC series Alternative Medicine, presented by Kathy Sykes, was supposed to be a rigorous scientific examination of the claims of alternative therapies. Although the second programme was indeed a rational look at the placebo effect, the other two episodes were little more than rose-tinted ads for the alternative medicine industry.
For example, the scene showing a patient punctured with needles and undergoing heart surgery left viewers with the strong impression that acupuncture was providing immense pain relief. In fact, in addition to acupuncture, the patient had a combination of three very powerful sedatives (midazolam, droperidol, fentanyl) and large volumes of local anaesthetic injected into the chest.
With such a cocktail of chemicals, the needles were merely cosmetic. In short, this memorable bit of television was emotionally powerful, but scientifically meaningless in building a case for acupuncture. I have spoken to several experts who say that the procedure was neither shocking nor impressive, but it was unconventional because the Chinese surgeons seemed to have used a higher level of local anaesthetic to compensate for the lack of general anaesthetic.
When I put this to Professor Sykes, she replied: “The suggestion that the operation could have taken place without the acupuncture and it would have been fine is an interesting idea and might possibly be the case.”
Even though the television commentary was technically accurate, by omission and emphasis, viewers were left with a false impression. Everyone I have spoken to, including Ian Bell, believed they had witnessed acupuncture providing major pain relief, so they felt misled when I explained what was really going on.
Of course, recent scientific studies have hinted at tentative evidence that acupuncture might provide limited pain relief, but this is still far from proved and many other studies have shown that acupuncture is nothing more than a placebo. However, the programme makers seemed to have focused on whatever positive evidence was available and then added a dollop of impressively irrelevant heart surgery to cast acupuncture in the best light”.
On March 25th Edzard Ernst’s explained his involvement which were published by Simon Singh in the Guardian.
Edzard Ernst, professor of complementary medicine at Exeter University, was dismayed by the shortage of hard evidence. The main consultant for the series says: “The BBC decided to do disturbingly simple storylines with disturbingly happy endings. But none of these stories is as simple as they presented, nor do they have such happy endings. Even when the evidence was outright negative, they somehow bent over backwards to create another happy ending.
“I feel that they abused me in a way. It was as if they had instructions from higher up that this had to be a happy story about complementary medicine without any complexity, and they used me to give a veneer of respectability.”
Rationality
Prof Ernst, an experienced TV consultant, was disappointed by several sections of the series. The low point for him came last November, when he complained three times about the programme on faith healing, which he felt was creating a false impression. Having been ignored, he wrote to Martin Wilson, the series producer: “With any other subject this would simply be a false impression and an orgy in pseudo science, but with healing this cuts much deeper. Here we are touching on a very fundamental issue of rationality. If your programme undermines rationality in that unfortunate way, it does an enormous disfavour far beyond healthcare and promotes US-style anti-science.”
Having seen the finished programme, he wishes he had not had his name attached to it.
According to Prof Ernst, the fundamental problem was the production team’s lack of expertise and unwillingness to listen: “I would have expected that journalists doing a medical programme would be able to deal with medical evidence. But they were at a complete loss to understand the difference between an anecdote and real evidence. You need somebody on the team who is a scientist, particularly in the area that the programme is about. Also, there is no point having expert advisers if nobody is going to take on board what they say.”
Despite the criticisms, the BBC is understood to be considering commissioning a second series. A spokesman said yesterday: “We take these allegations very seriously and we strongly refute them. We used two scientific consultants for the series, Prof Ernst and Dr Jack Tinker, dean emeritus of the Royal Society of Medicine, both of whom signed off the programme scripts. It seems extremely unusual that Prof Ernst should make these comments so long after the series has aired.”
Simon Singh did not ask why Ernst did not insist on having his name removed from the programme and why his “mea culpa” was two months after the programme had been aired.The BBC never commissioned a second series, soon after Ernst and Simon Sing wrote their best selling book claiming to seek “the truth” about alternative medicine
I asked Edzard Ernst on Twitter on Tuesday why he had allowed his name to be associated with this TV Programme. He has been tweeting, but has not answered my question and presumably got Simon Singh to respond on his behalf: “Richard You already know why Edzard was associated with the acupuncture programme, I explained yesterday”
I then asked Ernst if he received money for consulting on this programme? Again Simon responded on Ernst’s behalf: “Richard trust me when I say, “Edzard Ernst is a man of integrity who was pragmatic about the best way to serve viewers”
I checked the book could not find a mention of Ernsts involvement with the programme in the chapter on acupuncture, or how he was exploited by the BBC. Perhaps it might be mentioned in chapter 6 “Does Truth Matter”There is a heading “Placebos – little white lies of fraudulent falsehoods”? Perhaps its mentioned there. No!
Perhaps its in “The top ten culprits in the promotion of unproven and disproven medicine”. 1Celebrities: Professor Ernst and his colleague Max H Pittler looked for articles published in 2005 – 2006 which involved well known people using alternative medicine. Yes this patient was a factory worker, so its unlikely to be under celebrity, but I thought Ernst might consider himself a bit of a “celebrity” who was anti CAM and might have included it. 2 Medical Researchers according to the book “There have been only a few shining examples of academics who have gone out of their way to highlight the contradictions, exaggerated claims and falsehoods within much of alternative medicine. It gives an example of such a person; Edzard Ernst, but no mention of the “deception”. 3Universities: No!
4 The Media: must be in there According to Ernst and Singh the media “tend to present an overly positive and simplistic view of alternative medicine. The way that alternative medicine is presented in newspapers, all to often flies in the face of the evidence” They even mention the “Misleading sequence that implied that acupuncture could act as a powerful anaesthetic for open heart surgery” again no mention of “Ernsts involvement or the way “he was taken advantage of”. I did not bother checking who the other culprits were, it is obviously something Ernst is not keen to talk about. You will have to read the book yourself to find that out if Ernst admits his failing in those sections.
Its a shame so few chiropractors have bothered to read this book which shows little understanding of the principles of “Evidence Based Medicine” as outlined by the likes of Archie Cochrane and David Sackett. This will be my next posting as part of a series of postings which finish on April the 12th when I turn this blog over to others as I move away from chiropractic and into Woo.
