May 3rd 2017, 18:14
Complementary and alternative medicine (CAM) groups could soon lose their tax-advantageous charitable status in the UK unless they can demonstrate that the therapies they represent benefit the public.
It's the test for every group that's a charity. For some, like Oxfam and Christian Aid, it's easy to demonstrate that their work benefits the public, and you might think the same would apply to alternative therapy groups as well.
But the Charity Commission has been faced with a legal challenge, engineered by the self-appointed scourge of all things alternative, Simon Singh (whose own groups, the Good Thinking Society and Sense About Science, both enjoy charity status).
That means the burden of proof becomes tougher. Anecdotal accounts of how a therapy has helped someone simply won't do, nor will a properly conducted trial if it's been published in a second-division medical journal.
What the Charity Commission is looking for are 'robust' (that loathsome word du jour) trials that have been published in prestigious medical journals, and it mentions The Lancet and British Medical Journal by way of examples.
The commission's approach is safe, but naïve. Surprisingly few medical trials are robust, even when they're published in leading journals, as two new reports have made clear. One was prepared by Dr Tim Errington, an immunologist at the University of Virginia, who has become so concerned about fraud and spin in science—and medical studies in particular—that he's created The Reproducibility Project, so named because the ability to reproduce somebody else's results is one of the cornerstones of science.
He took a look at five medical trials—including one for a cancer treatment—that had been published in medical journals so prestigious they would make even the Charity Commission swoon. He spent two years going over their methods, their analyses and their conclusions, and was able to fully reproduce the results of only two of them. Two others were 'inconclusive', and the fifth was impossible to replicate.1
"It's worrying because replication is supposed to be a hallmark of scientific integrity," said Dr Errington.
Similar worries are being raised in the UK. Retraction Watch has been set up to monitor fraud in medical research, and its findings are alarming: in the past five years, there have been at least 300 allegations of fabrication, inaccuracy and plagiarism reported at 23 of the 24 research-led universities the group investigated.2
Medical breakthroughs—the kind beloved by national media—are the most common type of fraud, and there has been a 10-fold increase in these over the past decade, says Retraction Watch. Worse, industry watchers reckon only a tiny fraction of fraudulent research is ever exposed.
Why does it happen? There are commercial pressures from drug companies that pay for research and expect to see their new drug pass with flying colours, and there are pressures from universities and research centres that are dependent on grants and funding, and wish to be seen as the reliable 'go-to' place to deliver the results everyone wants.
The prestigious journals are keen to publish this kind of research too. If they can be the publisher of major, and exciting, research, their publication will rise even higher in the consciousness of the medical community.
Finally, there's the human factor. The researcher needs to make his mark and put his name to that breakthrough piece of research that changes the landscape of medicine.
As Dame Ottoline Leyser, director of the Sainsbury Laboratory at Cambridge University, summarizes the problem: "It's about a culture that promotes impact over substance, flashy findings over the dull, confirmatory work that most of science is about. Everyone has to take a share of the blame. The way the system is set up encourages less-than-optimal outcomes."
The controversy has even reached the doors of the Houses of Parliament. The science and technology committee at the House of Commons has launched an inquiry into scientific integrity. "Where research has been found to be fraudulent at a later point, it has a big impact on the public," said committee chairman Stephen Metcalfe.
It does more than that, of course. It means treatments can be recommended and drugs prescribed that aren't effective and may even be dangerous; it means that doctors and patients can be duped by commercial interests dressed up as science.
The nuances of these arguments are no doubt lost on the Charity Commission, and probably elude Mr Singh as well, who will continue to use the heavy cosh of science to beat the world into a shape that satisfies only him.
eLife, 2017; 6: e23383