The transcript of oral evidence given during the fourth evidence session of the HoC Select Committee for Science and Technology’s inquiry into antimicrobial resistance is now available. Being of the concerned opinion that the membership of David Tredinnick is pejorative to the Committee, I was pleased to note that (it turned out) both witness panels for the fifth and final session held on Weds 12th March included the Chief Medical Officer, Professor Dame Sally Davies, in expectation that she would have little truck with Tredinnick’s CAM-inculcating agendum.
The Chair brought Tredinnick into proceedings fairly early on (@ 0935→), the bumbling humbugger immediately leading in with the billion-pound cost of new medicine development, citing Davies’s own recent book. This he considered preparative justification for raising, again, herbal medicines, pettily reminding Davies of her own previously admitted resort to tea tree oil (!), and with his exampling of myrrh and frankincense further convincing of his seemingly religious devotion to this theme.
As had others in previous sessions, Davies patiently and politely spelled out for him that plants/herbs have long been appreciated as sources of efficacious medicines… but that they require substantial work to precisely determine the testable active ingredient, rather than the haphazard administering of “soups of chemicals”. Hence the cost. However, Tredinnick apparently cannot see the point of bothering with this problematic, expensive, reductionist, scientific approach; rather, having himself used Traditional Chinese Medicine for years, he instead lauds the combinatorial administering of (up to 25 different) crude herbs:
“If we’re going to use herbal medicine, we have to look at it as it is usually used.”
Which, as Davies responded, can be dangerous and thus necessitates proper regulation. Not wanting or able to address that point, Tredinnick again, in blatant contravention of the role of this Committee, quickly segued into pseudoscience’s favourite time-waster – homeopathy:
“I wanted to ask you also… about the French studies on homeopathic medicine, which apparently show that where homeopathic medicine and allopathic medicine are used together, it increases patient satisfaction and it reduces the amount of allopathic medicine used… “
Tredinnick ought to be taken to task for resorting to the Hahnemann-neologised, meaningless term, ‘allopathic’. There is no such thing as ‘allopathy’: this nonsense contributes to the fallacy that homeopathy constitutes a valid alternative form of medicine. Interestingly, Tredinnick does not here mention the discredited ‘Swiss government-commissioned health technology assessment’ he enthusiastically – and erringly – cited during a previous session. Perhaps, then, he has since been advised of its invalidity as evidence. Instead, he invokes other (French) studies on “homeopathic medicine” as bolstering his belief that “… whatever the results… we really do need to look at all the potential treatments around, and that this is one of them…”, and on which, knowing these study documents had crossed her desk, he invited Davies to comment. Which she did – critically:
“… those studies… were not proof for use. But we do know that patients like to spend time with clinical staff and get benefit out of that interaction. And I am on record to this committee as talking about the value of the placebo response.”
Undeterred, Tredinnick considered appeal to popularity as constituting overriding argument that our government should fund it:
“Do you think it’s odd that in France and Germany there are four thousand homeopathically-trained doctors practising quite happily, treating patients with the support of their government, and that here we have perhaps five hundred but there’s very limited access on the health service? Do you think it’s strange that we’re out of line with those two European countries, without even addressing other countries in the rest of the world?”
Davies tellingly replied:
“Not at all. This is absolutely cultural. The French, as you know, use many of their antibiotics and other drugs anally; the Italians use many of them vaginally; whereas we’re apt to use them orally. Culturally, we practice medicine differently.”
Whether or not Davies was here, in effect, telling Tredinnick that, for all the good it does, you may as well stick homeopathic medicine up your…!!, she was certainly subtly informing him and the Committee that appeal to popularity/culture is not evidence, and is thus irrelevant to this inquiry and inadmissible for consideration.
But such logic is lost on Tredinnick, who continued his self-imposed remit of promoting ‘alternatives’ during the second panel session (@ 1030:40→). He again suggested that the previous Committee’s conclusions following the 2009 Evidence Check on homeopathy are voided by subsequent research – re-citing the French study in justification for his position that “we should be spending some of [the NIHR funding budget], and not none of it, on looking at alternatives…”. Citing the Health and Social Care Act emphasis on “patient choice… at the heart of the Health Service”, he reasoned:
“… surely it makes sense that… the Health Department tries to encourage people to go and use other treatments, first, and surely, if a … general practitioner believes in their clinical judgement that going to a herbalist or a homeopath is a good idea, we should support that because we’re trying to reduce the consumption of antibiotics.”
It makes no sense if there is no evidence that those other treatments work. Yet, Tredinnick persists in his belief that such untested or unproven alternatives do ‘work’. Despite welcome repeated referral to the need for evidence by Davies and other panel witnesses, he is apparently simply unreceptive to being informed that they do not. And so he maintains his efforts to get the Committee to concur on a recommendation that NHS funds – that’s our money – be frittered on them through misinterpretation of what is meant by ‘patient choice’. Although the resistance genie is largely out of the bag, the way to reduce antibiotic consumption is to prescribe them less. The ‘clinical judgement’ of a GP is questionable where that GP believes that passing the buck to a herbalist or (certainly) a homeopath is a ‘good idea’. ‘Patient choice’ properly applies between available efficacious treatments – popularity regardless. It is not about a fob-off non-choice between evidence-based and non-evidence-based treatments.
I cannot see from the Register of Members’ Interests that Tredinnick is actively lobbying on behalf of CAM representative bodies, or their associated industries. So I take it, then, that he is not. However, neither is he playing devil’s advocate. His activity on this (and the Health) Committee is, in my opinion, motivated primarily by his agendum – to bring about the recommendation that our Government spend our money on treatments lacking evidential basis. Hence, the Committee’s role – the consideration of evidence – is embarrassingly contravened by his membership.