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The Royal College of Pharisees

Posted by Dr No on 26 March 2010

pharisee.jpgThat smuggest of colleges, the Royal College of Physicians of London, already infamous for its part in the MMC/MTAS disaster, has of late been cozying up ever more closely to the Department of Health, and its chief pongo, Sir Liar Liar Pants on Fire Donaldsong. Earlier this week it moved still closer, issuing an right-on report damning callous smokers who kipper their kids.

The report, featuring a cover photo of a prole caught in the hideous act of kippering a bairn, contains shocking figures and urgent recommendations in bountiful supply. Passive smoking, it estimated, caused children over 300,000 UK GP consultations and almost 10,000 hospital admissions every year, at a cost to the NHS of about £23.3 million. An alarming list of childhood illness caused by passive smoking includes old favourites such as asthma and wheeze (22,000 extra cases) and middle ear disease (120,000 extra cases), as well as the reliable media magnets meningitis (200 extra cases) and cot-death (40 extra deaths).

The report’s authors resisted a temptation to call for an outright ban on smoking (or kids for that matter), choosing instead to go for a rolodex of recommendations that included headline calls for a ban on smoking in any vehicle, and in public places where children are present.

Now - what could be wrong with a medical Royal College adopting an anti-smoking position? On the face of it, nothing – and Dr No is whole-heartedly against kippering kids. But the College’s recommendations call for significant inroads into personal freedoms – all naturally in the unimpeachable best interests of hundreds of thousands of kids. At this point, Dr No’s bullshit counter started to crackle away. For, just as a smoker has an unmistakeable air of stale smoke about them, so this report has about it an air of zealotry. And where there’s zealotry, more often than not there is fudge.

And sure enough there is. The first fudge is that the figures, alarming as they are, are estimates. Estimates, when it comes to veracity, are often found wanting – as we have seen only too clearly in Donaldsong’s recent estimates of the number of swine ’flu cases. So, naturally, Dr No turned to the full report to review the soundness of the estimates.

Here Dr No encountered more fudge. Although the College has released the headline figures, it has hidden the full report behind a £20 price tag. Obscuration is always irksome, and provokes suspicions – why place a bar before research which the zealots would have us believe is vital to the health of our children?

Dr No, needless to say, has no intention of making a gratuitous contribution to RCP funds - all the more so since the research was adequately, even generously funded, a point he will return to shortly – and so he turned to what is available. And found yet more fudge.

The conclusions and recommendations provide nothing in the way of science to back up the estimates; instead, they contain an emollient letter of welcome from Donaldsong, and more repetition and expansion of the headline figures and recommendations – but no useful references or data.

The College also provides a set of PowerPoint slideshows to support its case. Here again there is plenty of rhetoric, and precious little research – although slide three of Hubbard’s slideshow does contain three interesting bullet points about generating - generating? - the numbers:

• need to make a number of assumptions (oh, really, so what are they then?)

• provides approximate figures (how approximate? Are these figures estimates, guesstimates - or just plucked from the air?)

• at all stages tend to err on side of caution (as in, presumably, the precautionary principle ie ramp up the estimates until the eyes start to water)

But most notably – no science, just more fudge. And so Dr No is none the wiser about apparent paradoxes in the College’s claims - for example, that passive smoking causes 22,000 extra cases of childhood asthma and wheeze a year, when other – apparently contradictory – publicly available data show less passive smoking is temporally associated with more asthma. Childhood asthma prevalence has increased 2-3 fold over the last half century, while adult smoking prevalence – and so childhood exposure to passive smoking - has more than halved over the same period.

In times past, the RCP busied itself with the business of becoming and being a physician. It is not unreasonable for it to have a position on the important public health challenges of the day, but lately it has greatly increased its public health activity, and extended its reach into areas that properly belong not to medics and academics, but to politics and politicians. To Dr No’s eyes it appears that, like the Pharisees of long ago, the College doth protest its perfection too much in the face of its new-found God, the DoH. Could it be that there is a cozy ring of finance that runs through the College, the researchers, and the Government?


As a mere HNC student in Countryside Management if I presented ppt. like that I would fail! We are expected to back up our aims with robust evidence - and of course the quality of actual presentation is expected to be much higher too. It is indeed worrying!

So it is free to hear the Colleges biased views on the opinion, but twenty quid to hear a (dubiously) balanced report. If they were so firm on their science and the importance of the 'cause' then you would assume they would provide an electronic copy free of charge for those who can to scrutinise. Also Dr No, how does passive smoke cause middle ear infections?

Anon - good to hear they do things right in the Countryside, even if they don't in Regent's Park! Dr No suspects the College is so smug it thinks it can patronise the rest of us...certainly, those PPT presentations are a disgrace.

Interestingly, they have now published a 'FAQs issued in the aftermath of the report' - see here - but don't expect any lights to go on - it's just more of the same.

Hiding the 'research' behind a £20 price tag (is anybody really going to pay £20 for a 200 page A5 booklet?) smacks of dirty tricks. Donaldsong's recent no-booze-for-kids report was published free and in full on the web, and when Dr No looked at it - see here - he found little in the way of substantial evidence to support the CMO's claims. Given the similarity of the subject matter, and the CMO/RCP cozying up that has been going on recently, Dr No expects the RCP full report will also be long on wind and short on substance.

Somewhat bizarrely, it does appear from the RCP's website that the full report will be made available as a free download in due course - which of course raises the question of why not now - at the time the report is published, and the press coverage at its height? The only answer that Dr No can come up with is they want to have the headlines unsullied by the awkward lack of solid evidence; but be able to say - in due course - that they did make the full report available - a sort of variant on the 'good day to release bad news' trick.

M - its more middle ear disease, which includes infections, but also includes things like glue ear. Dr No is not a specialist in the area, but if there is an effect from passive smoking, which there may well be, even if he doubts the evidence for the magnitude of the effect, then he guesses it might act by mucking up Eustachian tube function.

It is nice to see someone else bothered by the science, or lack thereof. All too often lately the mainstream med societies have leaned on nothing but thin air to pronouce their edicts tot he rest of us. This looks like another one of those cases.

I detest bad science. It undercuts the times when science actually has something important to tell us.....

D. Willoughby - I couldn't agree more - it undermines science in general. There have been thousands of comments in the wider web from lay people rubbishing the RCP's pronouncements. As noted above, the CMO's pronouncements a few months ago on booze and kids had the same lack of substance in the backing science.

The other thing that worries Dr No is what he briefly referred to as the cosy ring of finance. The DoH is a major donor to the RCP, but - perhaps to avoid accusations of snouts in troughs - the 'research' sympathetic to the DoH's will is done at a remove, and is itself funded by some other organisation. But the researchers are hand in glove with the College and the DoH (and, as it happens, some 'interesting' commercial concerns). End result? The DoH gets the 'research' it wants; and the College gets gets the grants it wants...

Admin note - deleted the double post - hope that is OK.