Playing the Scientific Game and the Impact on Society – Complementary Medicine: an Insider’s Perspective

(I’ve written a letter to the Vice-Chancellor of Western Sydney University (WSU) in June 2015 covering some of my concerns that I had, and still have, regarding the National Institute of Complementary Medicine. Below you can read this letter, albeit in a somewhat shorter version (a much shorter and edited version you can find here). The response from WSU on all of my letters, and subsequent shorter versions, was simply:

“The University repeats its response in my letter to you 10 November 2015, that is to say:

  • the proposed publication (as revised) makes a number of assertions that are baseless and again those assertions are unsubstantiated by any evidence;
  • the proposed publication (as revised) contains commentary that appears to be defamatory.

The University does not wish to receive any further communications from you.  As previously advised, it is a matter for you whether to publish the article, and a matter for any publisher to decide whether it is worthy of publication.  That said, the University reserves all of its rights as against you and/or any publisher.”

This was followed by bestowing an honorary fellowship upon the NICMs main sponsor.)

The letter:

1. Introduction

Professors in science, fully supported by a university, endorse and defend the use of water as a scientifically proven treatment of disease! [a1,a2] As if all scientific principles, logic and ethics have left the building. Let us dig a bit deeper and ask another question! What is the golden rule and main objective of the academic world today? Is it making processes more efficient at universities so that scientists can come up with a real cure for cancer or end world hunger, and by so doing provide quality student training? Oh no, it is much simpler: “The higher the number of scientific publications the better” – not something one would expect of intelligent visionary people. The primary objective of scientists in the academic world has become the act of publishing. As such it is not new, but it is definitely increasing in importance. If you follow this golden rule you will become a top scientist. And then sometimes the general public will use statements such as “It is a scientific fact that…” – ouch. This intense and growing focus on scientific publications has led to some voices highlighting the difficulties, pitfalls and long-term impact being felt when scientific quality (and thus the quality of the scientist) is determined by means of the number of publications, number of citations, journal impact factors etc. [1,2,3] There are many numbers that academic administrators gave artificial importance to, and it is as if they manage to come up with a new “important” number every year. This can truly be called the “Scientific Game” and is best described with the well-known “publish or perish” mantra. Is playing this game harmless and maybe a clever way to keep (average) scientists busy?

There have also been many debates and reports dealing with the “scientific” field of Complementary Medicine (CM) – mainly regarding the questions of whether this is really “science” or just outright quackery; of whether universities can and should teach CM as a scientifically validated healthcare option; and if universities should be used as a vehicle to give scientific credibility to these, mainly, bogus medical treatments. [4,5]  Do you know, for example, that acupuncture supposedly works for just about every medical condition out there – from treating cancer and depression to enhancing memory and even fertility. With a bit of time and a lot of taxpayer’s money this will become scientific “fact” in the near future. [W1] Or is it maybe as Tom Hanks recently described it when he lashed out at the cancer quacks after his wife’s battle with cancer: “There’s a predatorily philosophy that happens where people find out that you have a certain illness, particularly cancer, and they will try and make money off of you ….”, and “…. there are people who are dealing and selling in false hopes.” [W2] The main question, however, is this: should universities, mainly funded by the taxpayer, produce “scientific evidence” for medical treatments or products that are pretty much ineffective and sometimes dangerous, and thereby knowingly mislead or harm the taxpayer?  This question can be asked of all medical research but in this manuscript it specifically deals with CM. The current scientific game, which focuses solely on a range of meaningless numbers, enables CM to grow and flourish at certain universities. In this manuscript I will give some inside information, as an analytical chemist and scientist, who worked (2012-2015) at the National Institute of Complementary Medicine (NICM), Western Sydney University (WSU), Australia, on these two aspects – the former enabling the latter – and the potential deleterious effect thereof on society. The end result is that professors in science, backed by a university, defend the use of water as a scientifically proven treatment of disease.

 

2. The number game: publish or perish!

Over the past 10 or so years I have witnessed these numbers grow in importance to a level where it can only be described as all-encompassing.  Every single thing we do as scientists is mirrored against these numbers. Or, should I rather say, that chasing these numbers dictates every single thing that we do. We simply became slaves of our own CVs with the simple golden rule of the higher your numbers the better your chances. Unfortunately this leads to a large amount of junk being published, not only reporting bad science, but usually scientific results that does not have any impact on society whatsoever. We do whatever we can to get anything published, moving from the one journal to the next (starting with the journal with the highest impact factor) in what can only be described as “journal-hopping”. Journal-hopping can sometimes take years, which means that during this time the researcher/student is not actively involved in doing research in the laboratory. And yet we are forced to publish just about everything because it is not about science, training students or the general public – it is about the act of publishing. Your job and your future career depend on it. There is a large body of literature available that describes the “publish or perish” mantra in great detail with one downside the subsequent increase in scientific misconduct (falsification, fabrication and plagiarism).

The real purpose and focus of a university should be student training and scientific research resulting in a positive impact on society – and these two aspects go hand in hand; the one cannot function without the other. If this is the focus, everything else will fall into place. Normally with an increase in quantity comes a decrease in quality and some may now argue that we have the peer review system in place in order to ensure scientific integrity and quality, and that junk do not get published – a.k.a. the gatekeepers for scientific quality. Does this system work? My experience tells me otherwise and luckily I am not alone. [6,7] Clearly there will be differences in how the scientific game is being played in different scientific fields and in different countries. At NICM all effort and resources go into creating an image that NICM is scientifically excellent in all aspects, specifically referring to all these (high) numbers, but without performing good independent scientific research.

Most academics know that we have a problem but no one really wants to discuss this issue because it cannot easily be solved – it is just too complex. And after all, if you are ahead with your numbers, why would you want to solve it anyway? There is, however, one publication that made me realise how futile, dangerous and inefficient the academic system is due to this fixation on playing the scientific number game. The title is simple and to the point, “Why most published research findings are false”, with one of the main conclusions being “…claimed research findings may often be simply accurate measures of the prevailing bias.” [8] And this is why there are apparently scientific publications out there that “scientifically validates” homeopathy and related CM. In a similar way that scientists sold the idea to the general public that smoking tobacco is harmless a number of decades ago.

3. Complementary medicine: How science is being practiced at NICM

3.1 NICM’s general approach

I applied for the position at NICM with an open mind believing that there are indeed some CM’s with merit which should be investigated. After joining NICM at WSU I very soon realised, within mere weeks, that I found myself in wonderland. A case of self-plagiarism was my first clue but after witnessing how science is being practised at NICM and after being probed as to where my allegiance lies, I realised that I am in for a rough ride. For example: I had to warn a student about (the possibility of) self-plagiarism simply because the only difference between six publications were the names of the compound and the herb tested. [9-14] Even though these publications have very little, if any, scientific impact or impact on the community, it does show intend. Can these results be trusted? And this under the watchful eye of a professor! The students are not to blame here but the blame should be squarely on the senior author – it is his job to explain this to students and of course lead by example, and this is clearly not the case.  I tried to convince NICM management, especially the senior author, of this for about 2 years, but stopped after a new PhD student presented a PhD proposal containing the exact same approach. All I could do was to ask the student to please include some novelty into her project. For NICM it is about the number of papers. High quality student training and research? No way!

As a scientist at NICM you will either have to convert to become a fellow believer or they will stop you dead in your tracks – and as a member of the public, they might even stop your life. Do whatever you can to put a positive spin on CM by innovative experimental designs, report only positive findings (or make a neutral result sound positive), claim that CM is save to use and that it is cost effective, and then use phrases like “we are building the body of evidence for CM” and “we are doing evidenced-based scientific research”. The question of bioavailability and in vivo efficacy, or the complete lack thereof, is rarely, if ever, addressed. As such the research approach in CM has been very well documented and discussed. [4,15]

Impact on society – not something that scientists always keep in mind. As scientists we have an obligation towards the taxpayer as we are basically public servants tasked with teaching and training our youth, and to use the knowledge and experience that we have gained to the benefit of the general public via the research that we do. At NICM, taxpayers’ money is not only used to aggressively play the number game but NICM is also knowingly misleading the general public. Yet NICM has achieved something remarkable enabling them to continue on this path. Based on the number of papers, impact factors, citations and income from the CM industry, NICM was ranked according to the Excellence in Research in Australia (ERA) in 2012 as “well above world standard”. NICM received the highest possible ERA rating of 5. That the director served on a ERA panel might have something to do with this, but nevertheless, all my attempts to obtain the data that was used by the ARC to rank NICM failed. Neither the ARC nor the research office at WSU, nor NICM could provide me with this data. I therefore became increasingly concerned that science has been hijacked by people who understand the scientific game extremely well and play the game exceptionally well – hence our high ERA rating – in order to give credibility to (mainly) bogus treatments and thereby potentially harming the general public.

How does NICM manage to mislead everyone? There are countless examples: In NICM’s newsletter of June 2015 they proudly report on: “New research confirms efficacy and safety of chondroitin sulphate for osteoarthritis”. A citation is given and one would expect that it refers to the results – but it does not. They cite a general publication on osteoarthritis. The publication reporting the original results included an additional important paragraph that NICM just did not include: “We identified a lot of studies in which unsound methods were used to assess the effects of chondroitin. For some outcomes, there was not enough data. In some studies, whose methodological quality was better, chondroitin showed no improvement in pain…” [16] Report anything that shows some positive result (even if the word slightly is used excessively to describe the results) and do not report anything negative. Why? Most people only read the title and when a scientific publication is cited only the title appears. So make sure your title is overly positive even though the results are at best questionable. And importantly, the general public believes that science, as reported by the scientist, is based on facts.  And there goes the sales figures!

NICM employs a large number of people, funded by the taxpayer, focusing on nothing else but to increase our numbers, improve our image and improve and protect the image of the CM industry. They employ people to create and maintain this amazing facade that we focus on doing independent scientific research – which we don’t. They do extensive marketing and branding of the institute, they lobby politicians, [W3] they approach celebrities (think here of a member of the British Royal family) to become patrons or spokespeople to further the interests of the CM industry. Why? To give NICM and CM more credibility [a3-a5] (credibility is earned by producing good unbiased scientific results – something that is very difficult, if not impossible, to achieve in the field of CM). They involve themselves with the regulatory agencies and even act as chairperson for many years on the “CM evaluation committee” for the Therapeutic Goods Administration (industry regulating industry). [W4] They lobby the CM industry and receive funding from them as well as commercial contracts. [W5] [a6,a7] [17]

They target external (inter)national eminent scientists who publish a large number of papers every year and they try to sell them dual affiliation – some fall for it while others do not. [a8,a9,a10] They set up collaborations with Chinese companies and universities and manage to include a signing of a Memorandum of Understanding during the Australian-China Free Trade Agreement signing. [W6] And the purpose of this? They want to use Australian citizens as guinea pigs for testing ancient Traditional Chinese Medicine – much of it unproven and ineffective and some outright dangerous – just to make a dollar. How? Use acupuncture because it has been shown to cause no side-effects (and efficacy?) and then sneak in TCM’s. [a11,a12,a13] They plan everything and every possible scenario in the finest of detail in order to maintain the image of NICM and the CM industry and they have no problem with simply misleading the public while doing this. For example: A large amount of funding was recently received from the Jacka Foundation of Natural Therapies in order to establish a Chair position at NICM. [a14] This position has not yet been advertised and already a number of people worked on pre-selecting possible candidates, while others worked on all possible questions from journalists that might be asked and, of course, the “correct” answer that should be given. [a15,a16] The answer to the question of whether NICM have any possible candidates in mind is simply “no”. Why not just be honest? Because NICM cannot run the risk of employing another real scientist and they have to do everything they can to ensure that they hire a fellow believer.

And where does the Jacka Foundation get their funds? They own property in Melbourne, one of the world’s most expensive cities, and now they use the rental income to buy a scientific department at WSU [W7] And WSU is of course very happy with these funds because it improves their numbers. But money vs safety? Money unfortunately comes first. NICM happily provided laboratory space to an adjunct that can only be described as of a very advanced age and completely immobile – truly a safety disaster waiting to happen. Why? Because this person is apparently “loaded” and they are expecting an inheritance soon. This person’s safety and the safety of the other laboratory users do not matter, as long as there is a slight chance of some money coming in. [a17,a18] And if NICM (and WSU) treats its own people like this, just imagine how they will treat the general public. It is concerning when the executive of NICM is advised by an external consultant not to take on a project dealing with the quality control of an illegally imported product, and yet they still try and take on the project with the simple argument that if NICM performs the analytical work according to the book, then the rest does not matter. [A19] If someone dies then NICM cannot be blamed. Strong advice not to involve ourselves with illegal products luckily stopped this project, but it reflects how NICM’s hunger for money far outweighs the safety of the general public.

NICM is nothing more than a university department providing unbalanced scientific “evidence” for the CM industry, making a dollar by doing so, and enhancing the image of CM and the “world-class” top scientists at NICM. They do this in a very clever way. One way is to quantify known compounds in a CM product simply because this constitutes scientific research and this approach can only give a positive result [W8] and lead to a “scientific” stamp of approval. One of the main critiques (also by the World Health Organisation) against the use of medicinal herbs is the lack of quality control (and of course efficacy etc). This is well known criticism and in a presentation given during my interview, I clearly stated that the problem is not a lack of analytical methods to quantify compounds in herbs but a lack of our ability to be in control of the quality. I failed to convince NICM management and to this day NICM is developing methods to quantify compounds in herbs with the claim that they are addressing the criticism as given by the WHO. In vivo safety and efficacy also does not really matter. Asking numerous times that toxicity should be investigated for one such product, keeping in mind that one of NICM’s priorities is: “…elucidates safety, efficacy and cost effectiveness of complementary medicine and translates this into policy and practice”, nothing happened. [W9] Testing for toxicity has not even been discussed in any of the project meetings. [a20] A statement was even made that in vitro toxicity testing suffers from false positive results, so why bother. If this specific product show toxicity or not does not really matter, but the reluctance to test for toxicity is against NICM’s own priorities. Asking the question if they will be confident to give this product to their own children did however make them think for a second – but only for a second. In other words they design experiments that will give positive results and they really do not have safety and efficacy of these products in mind.

3.2 Impact on society

In order to maintain and strengthen this massive and complex network you need to employ a lot of people, all of them paid by the taxpayer. NICM received $2.15 million from the taxpayer in 2015 (excluding industry and foundation contributions), most of which goes to salaries. Discussing my growing ethical concerns with NICM and WSU in 2013 only resulted in NICM’s budget being increased in subsequent years. As a scientist you know that you are in trouble when you raise your concerns, which include the selling of false hope to desperate people and generally misleading the public, to which the Director responds with, “but everyone is doing this.” And in all of this, especially with the continued support of WSU, you do not really need to do independent scientific research and student training. Almost all of NICM’s resources are being spent on growing and maintaining this massive complex network of lobbying and propaganda for the CM industry – and admittedly, NICM is doing it brilliantly. Any criticism from anyone – it is simply laughed off. “We bring in lots of money from industry”, “We are top scientists – just look at our numbers”, “The university is fully behind us so we do not understand what your problem is.”

The following example epitomises the whole problem: The National Health and Medical Research Council (NHMRC) of Australia recently published a report on Homeopathic treatments and they found that there is no evidence for their efficacy whatsoever. [W10] We should now, as a trusted institute, discourage the general public from using homeopathic treatments, as the NHMRC report concluded that: “People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness”. NICM should therefore endorse this finding. After all, on our publicly available information pamphlet, we stand for, “In pursuit of better health for Humanity”. Yes, we should test claims of companies and advise the general public that they are being misled by ineffective or potentially dangerous medications or treatments, as is clearly the case with homeopathic treatments. NICM’s response to the NHMRC report was however quite different and can only be described as rejecting their findings by playing the scientific number game. [W11] NICM welcomed the NHMRC report but states, “Randomized controlled trials of homeopathy were not systematically and independently reviewed. Laboratory and animal studies were also excluded. No homeopathic expert was appointed to the NHMRC Review Panel” and “This conclusion is consistent with many, but not all, international reviews of homeopathy”. No citations were given to provide the public with the missing “scientific evidence” for NICM’s claimed efficacy of homeopathy and therefore this statement can only cause confusion amongst the public.

This NICM statement made me realise that NICM is actively misleading and potentially harming the general public. Does NICM investigate homeopathic treatments? No they don’t simply because, as stated by the director, homeopathy is too controversial! In other words if you investigate homeopathy you will in all likelihood get a negative result – and that is not something that NICM wants.

The premier flagship CM Institute in Australia and WSU supports the use of Homeopathic treatments. Why? It boils down to this: If NICM receives a large amount of funding (>$5 million over a number of years) from the Jacka Foundation of Natural Therapies, which actively supports and promotes the following as effective medical treatments: “Energy and Subtle Healing, Homeopathy, Hypnotherapy, Meditation, Planetary and Human Ecology, Reflexology, Acupuncture, Acupressure, Alexander Technique, ……… (a very long list but very interesting), [W12] one will start to understand the somewhat predictable response from NICM to the NHMRC report. If NICM fully supports the findings of the report, this foundation will stop or decrease their funding and in the long run that will be the end of NICM. Can we call this a blatant conflict of interest? Is this legal? Does it break a consumer law? Does this constitute scientific misconduct? As a scientist I am now supposed to defend these treatments – but by doing that I will knowingly be misleading the public and potentially cause serious harm or even death.

This is the main problem with playing the number game – it gives scientific credibility to these un-testable, ineffective and dangerous treatments. We do not even have to study any of these above-mentioned treatments and yet whatever we publish gives credibility to these treatments. When you count the number of papers, impact factors, citations and industry income and you punch that into a computer, the computer spits out another number which means “well above world standard”. Really?

4. Taking on NICM and the fate of whistleblowers

What happens if these ethical concerns are explained or discussed with colleagues at NICM? A very blank expression and maybe even a hint of shock, and an immediate reference to our ERA 5 rating. How can I possibly have these concerns if we are rated well above world standard and our scientific outputs are reviewed by the world’s top scientists? The scientific game and the resulting ERA 5 rating are basically used to silence any criticism or concerns. Unfortunately there are people who know the scientific game well, they play it aggressively and they truly believe in it. They really believe that these numbers mean that they are great scientists and that the science they do is therefore of the highest quality. There is no support for independent scientific research – and honestly, if you can manage to reach the highest echelons of the scientific system by playing the number game, who would bother to do dirty old independent science in the laboratory? And this is the damage that the scientific game is doing – it enables “scientists” and industries selling bogus products to get away with it.

Some may ask if I have done enough to try and solve this problem. I have raised my concerns with NICM and that led to nothing other than sidelining myself – I had to withdraw from specific projects and publications (and yet they still named me as a co-author), which caused a lot of tension. I have raised my concerns with the WSU management, which also led to nothing. Since 2013 I have tried to move to other departments at WSU but there was no real interest or assistance from WSU – simply because moving me would have been an admission of guilt. I did however realise that by me leaving, the problem will not be addressed and I will knowingly allow the general public to be harmed. This realisation came to me when I was called by a Paediatrician who suspected CM (from a well-known Australian supplier) to have caused severe poisoning in a 4-year-old girl. Thus by keeping quiet I will indirectly be responsible for putting the general public at risk (the girl luckily recovered after her herbal treatment was stopped). So I fear that people may die because of the game that is being played at NICM and at WSU. This is the main point that I have raised with the Vice Chancellor of WSU, without much happening (this unedited manuscript was sent to him along with additional information). [a21] The response, after a number of weeks and after a number of email exchanges, was simply, “…. nor any of the information you have provided to date, support your assertions concerning NICM”. With this response and noticing that NICM is receiving more support and taxpayer money from WSU, simply meant that my time was up. The only option left was to expose NICM internally, with the hope that they will draw their swords on each other, and not use it on me. Unfortunately the latter happened and that led to my demise.

Neither the Dean of the School of Science and Health, nor any other Professor included in this specific conversation even bothered to ask what my problems with NICM were. [a22] And this tells me only one thing: they are all in on this and they are completely happy to maintain the status quo. But because I do not want to falsely accuse anyone of anything I’ve send (a month after I left WSU) this manuscript to the directors of NICM for comments. This resulted in me receiving a letter from the WSU management calling what I’ve written as “baseless to say the very least”, without any scientific comments (I cannot use the WSU affiliation and the statement about the missing reference in NICM’s newsletter is not their fault). They want to know if NICM has broken any rules or regulations. If not, then they are allowed to continue to promote water as a cancer treatment!  And importantly WSU reserves all of its rights against me – for whatever that means. [a2]

5. Conclusions

How is it possible that a professor in science and a university can promote and defend the use of water as a scientifically proven treatment for disease? I do hope that I have managed to give an adequate answer to this question. The steady growth in the use of CM and the number of courses offered in CM at universities around the world is the result of a scientific system in need of urgent reform. And yet NICM is not entirely to blame here; they are only masterfully using the deficiencies of the current scientific system to enable them to prosper and the general public to suffer (health-wise as well as financially). CM is by no means the only scientific field that is potentially damaging to society and there are other fields of science that are also guilty, to some degree. One important question, that needs to be asked. Is NICM breaking any laws? No they do not (excluding self plagiarism and naming academics as co-authors on manuscripts without those people even knowing about it – but WSU will just brush this aside as unimportant), and they are extremely careful not to break any laws – they spend a lot of time and resources to stay within the legal framework. It is not illegal to serve on different advisory boards or to lobby politicians, to pre-select potential new employees and unfortunately it is not illegal to sell water to cancer patients. You do however need to spend a huge amount of resources to be able to continue to legally sell water (and other useless interventions) to cancer patients making the primary focus of WSU, to be a distinctively student-centred and a vibrant research led University, at NICM impossible to attain.

As long as WSU support NICM with taxpayer’s money, NICM will continue to lobby regulators, politicians, doctors, health care insurance companies etc. in order to maintain the current rules regulating CM but also to eventually relax the rules governing CM. So we can be sure that not only is water legally being sold as medicine, but with time, other CM medicines will also legally enter the market. They are currently pushing very hard to get TCM’s over the line. Anyone that opposes this and wants to break this vicious cycle will be sued by WSU/NICM, simply because they are currently not breaking any rules – that I know of. This cycle can therefore only be broken if the taxpayer decides that enough is enough. Hence a public awareness campaign will probably be the only approach that might have a chance of success. Worst case scenario, NICM and WSU will maintain the status quo, go into an aggressive damage control mode (they already started), use the number of citations that this paper will attract to increase their own numbers and obviously get rid of any (future) trouble makers, and importantly they will continue to promote and defend water, and other CM’s, as validated treatments for disease. Best case scenario: Public outrage, full investigation of NICM and a return to support and practice of real science at WSU leading to a real positive impact on society.

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Websites (accessed on 30/10/2015)

[W1] http://nicm.edu.au/clinical_trials

[W2] http://www.news.com.au/lifestyle/health/health-problems/tom-hanks-lashes-out-at-cancer-quacks-after-his-wifes-battle-with-breast-cancer/story-fneuzlbd-1227583490898

[W3]http://nicm.edu.au/__data/assets/pdf_file/0005/846473/150223_House_of_Representatives_Hansard_2.pdf#page=142

[W4] http://nicm.edu.au/about/people/researchers/professor_alan_bensoussan

[W5] http://nicm.edu.au/about

[W6]http://www.uws.edu.au/newscentre/news_centre/more_news_stories/china_connection_to_build_bridge_to_better_health_in_australia

[W7] http://www.jackafoundation.org.au/index.php/about-us.html

[W8]http://researchdirect.uws.edu.au/islandora/object/uws%3A11202/datastream/PDF/view

[W9] http://nicm.edu.au/about/objectives_and_priorities

[W10]https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam02_nhmrc_statement_homeopathy.pdf

[W11]http://nicm.edu.au/__data/assets/pdf_file/0006/670740/Homeopathy_statement_May_2014_DRAFT_4.pdf

[W12]http://web.archive.org/web/20140621155715/http://jackafoundation.org.au/index.php/about-natural-therapies

[W13] http://nicm.edu.au/research/lab_research

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