Tuesday, November 15, 2011

Homeopathy at Exeter University?

Earlier today, 15th Novemeber 2011, @Blue_Wode tweeted a link to a page on the website of the University of Exeter where the Staff Association is offering a discount for a homeopathy clinic ON IT'S CAMPUS!

http://www.exeter.ac.uk/staffassociation/benefits/homeopathy/

Now, we all know that homeopathy is bunkum, a form of so-called "complementary and alternative medicine" - SCAM, for short. I found this particularly surprising, given that the scourge of the homeopaths, Professor Edzard Ernst (@EdzardErnst) had recently "retired" from his post as Professor of Complementary and Alternative Therapy.

I decided to email various people within the University of Exeter to point this out and to ask them to act on this. As a university containing a medical school it really should not be in any way associated with the promotion - inadvertant or otherwise - of quack therapies. The web page makes many false claims of benefit that have typified those made on the websites of homeopaths. The Advertising Standards Authority has been deluged in recent months regarding complaints about homeopathy websites such that it has issued a temporary (hopefully!) moratorium on these complaints so that it can decide how best to deal with them. See http://www.asa.org.uk/Resource-Centre/Hot-Topics/Homeopathy-complaints.aspx for further information on this. This deluge of complaints has been made possible through the work of Simon Perry and his development of the browser plug-in "Fishbarrel" http://adventuresinnonsense.blogspot.com/search?q=fishbarrel

I sent this email at lunchtime to the Occupational Health department, the Chancellor (Floella Benjamin - the former children's TV presenter) and the Vice-Chancellor to ask them to act:-

"You may be aware  that homeopathy is being offered as a "Staff Benefit" by the University of Exeter. The reason I am aware of this is that this information is being spread through social networks by people who have serious concerns about this. It is particularly surprising that this "service" is being offered considering that the University had the only UK professor of "complementary and alternative medicine", the recently retired Edzard Ernst. Professor Ernst is well-known for his research and multiple publications on these "therapies" and has been very critical of homeopathy. The reasons for his criticism of homeopathy are based in the evidence - the evidence base clearly shows that at best homeopathy offers no benefit beyond placebo. To therefore be offering homeopathy as a staff benefit is actually doing the staff of the University of Exeter a great disservice by the promotion - inadvertent or otherwise - of quackery. You also have the Peninsula Medical School within your university, so again anything which promotes pseudoscience and quackery potentially harms the reputation of the University.

Please give serious consideration to withdrawing this so-called benefit and instead promote genuine evidence-based therapies for university staff."

I didn't expect a reply so quickly, but I must give kudos to Serena Horrell, manager of the Occupational Health department for replying within just a few hours:-

"Dear Paul,

I have picked up your email from our generic email account. I think the offer you must be referring to is the one being made by the Staff Association to its members, not one being made by ‘The University’ per se (more staff not being members, than those who are). As far as I am aware, the Occupational Health Service have never offered complimentary therapies (of any kind) and in the four years I have been post, this has remained the case, for the very reason/s you state (i.e. there is no evidence base for their use). 

I suspect the Staff Association see the use of complimentary therapies as something its members might value and are therefore offering these services to any members who might be interested (at a personal cost to each person who avails them self).  I fear there are a number of activities going on, in and around the university, that are neither evidence based nor have an established justification for their use, but, because all of the staff working at the university are adults, I expect they are being left to make their own decisions and judgements on these activities. If you have a real issue with this, you may wish to address the matter with someone representing the Staff Association direct.

Best wishes,

Serena.

Serena HORRELL, Mrs

Occupational Health Manager"

This is somewhat reassuring as it is clear that her department in no way supports or endorses homeopathy. However, the clinic is being held on the University campus and - inadvertantly or otherwise - it gives the impression that the University endorses the use of homeopathy. As suggested in her reply I have replied to Serena and copied it to the Staff Association (and also the Vice-Chancellor):-

"Dear Serena,

Many thanks for your prompt reply. It is extremely reassuring to know that your University does not endorse or directly supply homeopathic “remedies”. It does indeed appear that it is the Staff Association that is promoting homeopathy through a discount scheme. However, the link is readily accessible from the University website http://www.exeter.ac.uk/staffassociation/benefits/homeopathy/

This web page makes it clear that this “therapy” is provided at a clinic on the University campus, thereby indirectly suggesting that the clinic is endorsed by the University. Clearly, this should be unacceptable to an institution with science at its core. I have copied this reply to the Staff Association email address so that they can deal with it. Were it not for the temporary embargo on complaints about false claims of benefit made by homeopaths, I would report the page I linked to to the Advertising Standards Authority as the claims of benefit made on that page clearly breaches the advertising code of the Committee of Advertising Practice by making claims of benefit for homeopathy for which there is no evidence of benefit to support them. The Staff Association should immediately remove this page from the website and stop promoting this quack “therapy” before the ASA takes steps to deal with this in the same way as it is dealing with other homeopathy websites and their owners. The University should immediately distance itself from this promotion to prevent it being tainted by association, no matter how indirect that association may be."

So, will the University of Exeter take the necessary steps to disassociate itself from the promotion of homeopathy? We can but hope!

 


 

Friday, September 2, 2011

The EU and Homeopathy for cows

Recently an article appeared in the newspapers regarding a decision to spend EU (and hence UK taxpayers) money on homeopathy for cows. One version of the story was linked to on Twitter:-
http://www.telegraph.co.uk/earth/earthnews/8731706/Brussels-propose-spending-millions-on-homeopathy-for-cows.html
Needless to say, this sparked outrage on Twitter, with numerous comments on this, hashtagged with #ten23. Now, as has been more than adequately demonstrated on multiple occasions that homeopathy is nothing more than a placebo and an elaborate scam. Given the history of homeopathy it probably qualifies for the longest-running scam in medical history. That it has been around for so long says more about the inadequacies of science and medicine to counteract with evidence from properly-conducted high quality clinical trials. Early "successes" for homeopathy probably represented avoidance of ineffective and dangerous therapies as the clinical trial 200 years ago was not exactly a common method of investigation!
Why would the EU choose to spend money on homeopathy for cows? It seems that they have somehow been persuaded by pro-homeopathy pressure groups into believing that animals show benefit in trials of homeopathy as - surely - animals are immune from placebo effects. Hmm. OK. The animals themselves may not be influenced directly by placebos but the same cannot be said of those adminstering homeopathic "remedies" or observing their apparent effects. There is also the study of homeopathy in bovine mastitis, reported as positive in a deeply-flawed trial. For a critical appraisal of this trial and the cherry-picking of trials so characteristic of CAM supporters, see http://www.quackometer.net/blog/2010/09/can-homeopathy-cure-mastitis-in-cows.html
While I'm well aware of the faults of the EU, it does also do a lot of good - for example in improving consumers rights. However, I felt that I should write to my MEP's to see if this ridiculous decision could be changed. Here's the email I sent to them, via http://www.writetothem.com/ - thoroughly recommended as a way of contacting your elected representatives. Here's the email I sent them:-
"Dear Derek Vaughan, Kay Swinburne, Jill Evans and John Bufton,

I read with dismay an article on the website of "The Daily Telegraph"
today regarding a proposal to spend millions of pounds/euros on homeopathy for cows.
This is quite possibly one of the most ridiculous and absurd proposals I have ever heard of! Homeopathy, like every other form of so-called "complementary and alternative medicine", is quackery and charlatanism.
For information on this, I can recommend visiting the websites www.1023.org.uk and www.senseaboutscience.org You may also be aware of the conclusions of the House of Commons Science and Technology Committee in its Fourth Report "Evidence Check 2: Homeopathy" published in February 2010.
The conclusion is clear cut - homeopathy is a scam, no better than placebo. It should not be afforded any sort of respectability by endorsement from sources such as the European Parliament and the European Commission. I urge you to do everything possible to prevent this clear waste of European taxpayer's money."

Now, response times can vary from a few hours to a few weeks, depending on who you email and when. Within ten hours, I received an automated response from the office of Kay Swinburne (Conservative) promising to respond within six weeks. Ok, it's summer holiday time, she may be truly busy - I'll just have to wait. Just a few hours later, still less than twelve hours later, I received the following response from of John Bufton (UKIP):-


Dear Dr Morgan, 
Thank you for contacting Mr Bufton MEP regarding yet another example of how the EU is wasting our money
We agree completely that it is not the role of a "free trade organisation", to use our hard earned taxes to subsidise anything - whether it is quackery or not. 
We would not be happy for our taxes to be used by the EU to subsidise the huge pharmaceutical industries of Europe (which I should add here are responsible for more deaths in one day across the EU than 
Homeopathy in a decade - not that I could find any evidence of Homeopathy killing any of its patients). 
Until we leave the EU, the un elected bureaucrats in Brussels will continue to use our money on hair brained schemes, and there is nothing that MEPs can do about it.
Sincerely
   Nathan L Gill  PA to John Bufton MEP 

Err? What the fuck? As if this response in itself wasn't bad enough, the email bore a 2 megabyte PDF file entitled "The EU...Have I Been Lied To".
So, not only do I get a somewhat crackpot response but I also get a recruitment drive document for UKIP. To say I am not a fan of UKIP would be understating the matter. So I have emailed back:-

Dear Mr. Gill,
Thank you for your prompt reply.
I am glad that you agree that the EU should not be involved in any way in the promotion of such quackery. I am, however, disappointed by some of the patently ridiculous remarks that you subsequently make in this email regarding pharmaceuticals and homeopathy. I agree that the EU should not be subsidising pharmaceutical companies. It is also, of course, true that patients suffer adverse effects from medications. Sometimes these are very serious, life-threatening and (rarely) fatal.  I seriously question your statement regarding the number of deaths that are attributable to adverse drug reactions. Could you please tell me where you get your figures from? You should be aware that there are many sites on the internet which spread misinformation and downright lies about medicines, but there are reliable sources such as the Food and Drug Administration (USA) and the MHRA (UK).
As for your statement regarding homeopathy, I’m sorry to say that it is disappointing that you seem unaware of the deaths and serious harm that has resulted from people using homeopathy instead of real medicine. Perhaps the most shocking example of this is the story of Penelope Dingle in Australia - http://www.heraldsun.com.au/opinion/learn-from-this-tragedy/story-e6frfhqf-1225881062712  Reading the Coroner’s report is particularly harrowing http://www.safetyandquality.health.wa.gov.au/docs/mortality_review/inquest_finding/Dingle_Finding.pdf
Several other examples can be found at http://whatstheharm.net/homeopathy.html
There is a key difference between medicines and therapies properly licensed and used as compared to homeopathy and other forms of so-called “complementary and alternative medicines” (CAM) – efficacy. The available evidence is clearly that homeopathy and other CAM modalities are either no better than placebo or are actually worse than placebo (i.e. harmful). When deciding about the use of medicines a risk-benefit analysis is conducted. As homeopathy and CAM modalities have no benefit, the risk-benefit analysis is clearly all risk and no benefit.
Finally,  may I say that I do not agree with your politics and overall views of the EU and European Parliament. They are no different in their stupidities than the UK Parliament and its Members, for example Nadine Dorries MP. We need our elected representatives to act sensibly, act in accordance with available evidence and not use these instruments of government to further their own personal agendas. I believe that the UKIP is at best misguided in its overall views. Ultimately, you will be held accountable through the ballot box."
Let's see if I get any response to this and also whether the other MEP's for my area respond.

Sunday, August 21, 2011

NHS. No choice for Marjorie (allegedly)

Someone I follow on Twitter recently posted a link to this blogpsot that originated from someone writing as the Alliance of Registered Homeopaths. The story is one of an elderly lady with arthritis. The post claims that at one time she was able to get funding on the NHS to see a homeopath but no longer can. It says that at one time her Primary Care Trust, The Bournemouth and Poole PCT, did provide funding for patients to see homeopaths but no longer do so. The blog claims that this is a scandal in denying the patient the right to choose which type of treatment she gets. It claims that the patient won't use conventional (i.e. real) medicines because of adverse effects.

Ok, I can well understand that adverse effects can be serious and intolerable. Non-steroidal anti-inflammatory drugs (NSAID's) have well-documented adverse effects such as upper gastrointestinal tract bleeding (which can be life-threatening). On the other hand, they are very effective. However, the nature of this patient's illness and the decision by the PCT to not fund homeopathy for it is somewhat irrelevant. Homeopathy is bunk. The House of Commons Science and Technology Committeee have stated that it should not be funded on the NHS. This view was taken having fully examined the evidence concerning the efficacy of homeopathy and concluding that it is no more than placebo, with any placebo benefit accruing from the consultation process. Essentially it is a form of psychotherapy. I fully support the scientific evidence-based decision not to fund homeopathy on the NHS. I also support moves to get rid of homeopathy services that still (perversely, in my opinion) exist within the NHS and indeed any form of "medicine" that does not have evidence to support its use. That therefore includes pretty much the whole gamut of so-called "complementary" and "alternative" therapies.

However, the main point of my post here is that the blog has a comments section, much like any other blog. I wrote a comment expressing my sympathy for the patient (Marjorie) and her pain but supporting the decision of the PCT not to fund homeopathic "treatment" for her. Homeopathic "remedies" consist of highly-diluted "solutions" of substances that are supposed to - in higher concentrations - produce the symptoms the patient is suffering from. This is one of the "laws" that the inventor of homeopathy, Samuel Hanhnemann, proposed. This is not a "law" in the same way that we have a law of gravity because it is unproven. Scientifically, the "laws of homeopathy" are nonsensical. So, as part of my criticism to the blogpost, I referenced the evidence showing homeopathy to be no more than placebo, including the meta-analysis by Shang in The Lancet in 2005 and the website of the 10:23 campaign. After posting, the comment was last seen "awaiting moderation". It's not appeared on this blog. I wrote a second comment asking what had happened to my first comment - no sign of it now! I wish I'd saved them for insertion here. I've just posted another comment:-

"Two comments posted in response to this diatribe so far, neither appears to have passed moderation. Why is that? Is it that you won't permit critical comments to be posted here? Is it that your argument really has no substance to it in the same way that a homeopathic remedy has nothing in it?"

This comment "...will be visible after approval". Hmm. Like the other two are visible (not). Of course it may be that they're just a bit slow moderating and approving comments. On the other hand, they may be using filters to screen out words and phrases they don't approve of. Or it may be that someone is reading them and deleting them. I guess that we'll have to wait and see! If the comments don't appear in the next few days, we'll have our answer. 

Friday, August 19, 2011

Vodafone UK and my consumer rights saga


Ok, so this has nothing to do with science or medicine, but I think it’s quite important that people do not allow companies supplying consumer goods to deny them their rights under UK and European law.
Back in mid-January 2010, I finally took the plunge and ditched my Samsung Omnia Windows Phone and upgraded to an iPhone. I went for the 3GS 16Gb model in black. I bought it with an 18 month contract with Vodafone. It was the dog’s proverbials. Without doubt the user interface is streets ahead of the Windows phones (although Android has subsequently shown itself to be pretty good). Everything was great until late May this year, some 16 months into the 18 month contract. The wi-fi started malfunctioning. It could connect to my home router if I was right next to it or a short distance away in line of sight. Beyond that, or move out of the room, the signal would be dropped. Even if less than 5 metres away, if you put a wall in the way, bye bye wi-fi.

Off I trotted to my local Vodafone store. They weren’t that helpful. They said I could send it off for Vodafone to repair, but it would cost £150. The reason for that is that Vodafone give  a standard 12 month guarantee with the iPhone. After that, you have to take out the Apple Care plan. Hmm. Clearly a basic failure to understand UK and European consumer law – more of this later. They did suggest I try the nearby Apple Store to see if they could do anything. To be fair to the Apple Store, they had a look at the phone, but basically there was little they could do, other than offer to supply a new handset for £139 (notice that this is less than the Vodafone repair charge). The Apple Store member (I think) did open the phone and reattached a loose wire, but he thought this was unlikely to be a successful fix. He was right. I declined the handset replacement offer as I was sure that consumer law meant that I had rights beyond Vodafone’s one-year guarantee.

I first emailed Vodafone on 25th May:-
“I have had an iPhone 3GS since January 2010 on an 18 month contract. A few days ago, the wi-fi stopped working. A local Vodafone store was unhelpful, suggesting that I go to the nearby Apple store. The staff were helpful and diagnosed a loose or broken wi-fi connection. The staff member confirmed this and was able to reattach a loose wire. However, he thought it was likely to only be a temporary solution as the wi-fi signal reception was very weak. It has now ceased working again.

I went into the Cardiff Vodafone store (St. David's Centre) this morning - the staff member in store advised me that the phone was out of warranty and that I would be best seeing if the Apple store could do anything. I explained that the warranty is supplementary to my statutory rights under consumer law (Sales of Goods Act) and that there is a reasonable expectation that a phone sold with an 18 month contract should be of sufficient durability to remain fully functional for at least the duration of the contract. The staff member was unwilling or unable to accept this argument and confirmed this with the store manager. He stated that they could send the phone off for repair but that there would be a £150 charge for this. I expressed my view that this was not acceptable under consumer legislation and said that I would take it up directly with Vodafone.  My son made contact earlier today via Twitter to @vodafoneUK who gave me this email address.

The major issue here is how do I get a working iPhone? I am unable to send the phone off for repair just at the moment (as I am away on holiday next week) and I believe that the upgrade option for my phone doesn't take effect until early July. I am also concerned and disappointed that the Vodafone store staff are either unfamiliar with consumer legislation or are unwilling to comply with it. As I see it, the situation is clear:-

1.  The phone is broken and needs repair

2.  There is a reasonable expectation that a mobile phone sold with an
airtime contract should be of sufficient durability to at least work until
the end of the contract time.

3.  Consumer rights legislation (mainly the Sales of Goods Act) entitles me
to a free repair or replacement in view of the short time since purchase
irrespective of any guarantee or warranty offered by either the vendor or
manufacturer at the time of purchase.

4. The legal position is that it is the vendor's responsibility to provide
the repair or replacement, not the manufacturer's.


The link below takes you to the Consumer Direct website so that you can see what Vodafone's responsibilities are in this matter:-



I look forward to your prompt response in this matter.


Yours sincerely,


Dr. Paul Morgan”


Now, I would think that this is fairly straightforward and clear. In terms of consumer law, my contract is very clearly with Vodafone. There is an expectation under law that goods should be fit for purpose and of sufficient durability. As this phone was sold to me with an 18 month airtime contract, the very least I should expect is that the phone would last at least for the 18 months of the contract.
There was a slight complication in that the phone contract is in my wife’s name – she had got the previous Omnia phone for me as a present and had set up the contract. I therefore had to get my wife to email the contract details to Vodafone and give me authority to discuss contract details with them. This was only a minor hassle and soon sorted out. However, while this was being sorted out, I received this message from Vodafone:-
“Hi Paul,
Thank you for getting back to us.
So we can discuss the account details please ask your wife to email us on this address with the 'WRT135' code in the subject line. She would need to provide her name, number, date of birth and address including postcode for us to pass security. We can then either discuss this with her or she can authorize you to speak on her behalf.
Until then I can give you some general advice, it does sound as if the phone in question has hardware damage. Your Vodafone warranty lasts for the life of the contract so if the phone is still in commitment we would be able to send it for a free of charge repair.
Without passing security I'm afraid I cannot be anymore (sic) specific. I look forward to hearing from the account holder soon so we can resolve this for you both.
Thanks
Holly
Web Relations Team”
“Oh, good” I thought. It seems that Vodafone Customer Services understand consumer law rather better than the shop staff. After we came back from a week’s holiday, we got the authorisation for me to discuss account details and begin the process by which the phone would be sent off to Vodafone. This took rather longer than necessary, as despite giving them all the details of the phone by email on a number of occasions, it took a further week to get the postage bag and instructions from them. I cannot understand why the staff at Vodafone Customer Services simply didn’t read the details from the emails I sent them!
Eventually, the phone was sent off. I expected that I would receive a repaired phone or a  replacement in due course. As part of their repair service, Vodafone offer an on-line repair status checker. Well, that’s the theory anyway – it never worked. By now, it’s mid-July, around six weeks after I first reported a fault. This was pretty poor in my opinion. However, worse was to follow.
I received a phone call while in work (and busy at the time). The call was barely audible, but basically the person on the phone was saying that the phone was out of warranty and therefore they wanted to charge me £150 for a repair! I tried explaining to the person on the phone from the repair centre that this was not what I had been led to believe from email correspondence or was the case under UK and European consumer law. This was a pointless exercise. I told him in no uncertain terms that I expected the phone repaired or replaced free of charge and returned to me at the earliest opportunity. I didn’t expect this to yield a positive result – I was right. I received an email from Vodafone basically stating the same as the person on the phone had said:-
“Hi Paul
I have just checked the repair status of this and I can see that the repair team have tried to call and have left a message of the nature of that call.
To let you know that the repair team have identified that this is an out of warranty repair and that this would be a chargeable service to be repaired. The amount to repair this is a set fee and this is £150.
If you can let us know what you would like to do and then we can either arrange for this to be completed or returned.
Thanks
Martin
eForum Team”

Ok, now it was time to get serious. I did some digging around on the Internet to check out my rights fully under UK and European consumer legislation. There are several key pieces of legislation, of which the most important is European Union Directive 1999/44/EC. This directive was designed to harmonise consumer rights across the EC. The booklet “Your rights as a consumer - How the European Union protects your interests”, published in 2007, spells things out pretty clearly. The section on product guarantees is explicit, stating on page 7 :- “A two-year guarantee applies to the sale of all consumer goods everywhere in the EU”. Now, this may be something you were unaware of. Having said that, the next question to ask is “has this directive been fully implemented in UK law?”. Yes. There are several pieces of UK law that apply when it comes to consumer rights. The most important piece of legislation is the “Sales of Goods Act”, originally dating from 1979. This clearly states that goods must be as described, of satisfactory quality and fit for purpose – this means both their everyday purpose, and also any specific purpose that you agreed with the seller (for example, if you specifically asked for a printer that would be compatible with your computer). The Act also makes it clear that your claim in respect of faulty goods is against the vendor of the goods, not the manufacturer. In terms of a consumer item being “fit for purpose”, the Act also includes a definition of durability. This will, of course, vary from item to item. For example, a television may be expected to last for, say, 5 years. This doesn’t mean, however, that if your TV breaks down within five years of purchase that you can get your money back or a brand new replacement set – there are time limits as to when a vendor has to do this, but this may not be explicit. Typically, three or four weeks for most consumer items is regarded legally as “reasonable”. Within that time frame you can reject the item and claim a full refund. You may decide, however, that you want a repair or replacement. The choice here is that of the vendor – you cannot choose a replacement. Thinking about this, twice I have had a VCR (different brands bought from different retailers) break down after almost a year of use. One retailer gave me a brand new replacement, the other gave me a full refund. Both these retailers went beyond their legal obligations, so kudos to them both. For the record, it was Argos who gave me a replacement and Amazon who gave me a refund. Either of them could have offered a repair or a partial refund to cover the fact I had benefitted from a period of use of the items – this is called “recision” or “recission”, essentially, the unmaking of a contract.
Anyway, more about the enactment of EU Directive 1999/44/EC. Much of what is in this directive had already been dealt with in UK law by the Supply of Goods and Services Act 1982 and the Sale and Supply of Goods Act 1994. The final piece of legislation was the  Supply of Goods to Consumers Regulations 2002. The EU confirmed in a communication dated 24th April 2007 that UK law had fully enacted the directive with effect from 31st March 2003. See Annex I for details on this.
I therefore felt confident that I was entitled to a repair or replacement with a mandatory two year guarantee on all consumer items sold within the EU. So, I had to press my case further. I emailed back to Vodafone:-
“Clearly, then, you have failed to read the email chain. The phone is on a contract and is expected - by the terms of the Sales of Goods Act – to at least last for the term of the contract. Please see the attached message, which clearly states “Your Vodafone warranty lasts for the life of the contract so if the phone is still in commitment we would be able to send it for a free of charge repair.” The 18 month contract began (I believe) in January 2010 and the fault was reported to you on 25th May (see attached email). That it took so long to get the phone to you for repair is not my fault but Vodafone’s.
Finally, irrespective of any 12 month guarantee offered by Vodafone or Apple with regard to this product, may I remind you of your obligations under European Union Directive 1999/44/EC.  The phone was approximately 16 months old at the time of reporting the fault – well short of the two year guarantee that this legislation provides as a minimum standard. This directive covers consumer goods across the EU.
Put simply, the statutory rights imparted to me as a consumer is that I am entitled to a two-year guarantee under EC legislation. I would also expect the Sales of Goods Act to offer additional protection in terms of a reasonable lifespan of such a consumer device – this legislation, for example, says that a television set should be expected to last at least 5 years without a fault developing. I don’t know if anyone has set a lifespan for mobile phones yet, but 3 or 4 years would not seem unreasonable.
Please, therefore, and at no charge to me, repair (or replace) and return the phone as soon as possible. I expect to receive it back within the next few days. Failure to do so will result in Vodafone rendering themselves liable to legal proceedings. Furthermore, I will find it necessary to cancel any and all contracts with Vodafone and switch all Pay-as-you-go phones within the family from Vodafone to another network provider.
I await your prompt positive response.”

I don’t think I could have been any clearer, but still Vodafone Customer Services tried to deny me my rights. Next, I received a text from Vodafone saying that the phone had been dispatched back to me. “Hurrah!” I thought, they’ve finally decided to comply with the law and send me my repaired or replaced phone back to me. I received an email from someone saying they would look into the matter regarding the non-functioning repair section on the website:-
“Hi Mr Morgan,
I completely understand why you are feeling so frustrated by this however, there is little that we can do at this moment in time as is down to the repaired centre to get the handset repaired as soon as possible.
Can I ask when it was you sent the handset away and also what is the SID job number for your repair?
If you can let me know I will be able to chase the repair centre for an update for you on Monday however, as long as the fault is caused by anything other than physical damage or moisture damage then this will be repaired free of charge under the manufactures warranty as per the legal requirements.
The repair will also be completed within a "reasonable timescale" this is how the time that it will take is defined under EU and UK consumer legislation.
James
Web Relations Team”

“Hurrah!” I thought again. By now, the date is 15th July. Never mind, I’ll soon be back in possession of my iPhone. During its absence, I’d been using a Samsung Galaxy Android handset, which is OK but I far prefer the screen and interface of the iPhone. What I’d failed to realise from that email was the use of the term “manufacturer’s guarantee”. I really should not have been surprised when the phone arrived back unrepaired as I had not authorised a repair and paid them £150. I also received another email:-
“Hi Paul,
I have tried to call both numbers on the account this afternoon however was unable to get an answer. I have looked into this email chain including the emails you have attached in your reply. [Not sure she did!]
You include an email from me before the account details had been confirmed where I said we insure phones for the life of the contract.
This is true for all phones except the iPhone range as Apple only provide a manufacturer warranty of 12 months from the moment the phone is activated with iTunes. If you wish to extend the warranty you need the Apple Care Protection Plan:
http://www.apple.com/support/products/
Due to our agreement with Apple and their 12 month warranty we are unable to extend this and as you did not take out the Apple Care Protection Plan the £150 charge for fixing the handset will still apply.
If you do not want to pay this then the phone can be returned to you in the state we received it, alternatively our engineers can fix the phone for the fixed £150 fee.
I know this is not what you wanted to hear however we have no way to override this process; the 12 month warranty is standard for all Apple devices and is not specific to Vodafone contracts.
Please let us know what you would like to do, you can also contract (sic) our warehouse with your decision. If there are any other questions let me know. Alternatively if you would like another call from us just let me know the best time and number to call on.
Thanks
Holly
Web Relations Team”
Now I was starting to get really aggravated. This was the same “Holly” who had sent me the first email (reproduced above) which stated that the Vodafone warranty lasted for the life of the contract (even though this is less than the EU-mandated two years). This seems to me to be a case of reneging on an agreement already made.
On Monday 18th July, I rang Vodafone and, after a little hassle from the person who answered the phone to me, eventually managed to speak to a Customer Services Manager, Trish Rudd. I’m not convinced that she fully understood the legal situation. Nevertheless, we agreed that if I could supply a copy of that first email from Holly, then I could get a replacement handset and then she would arrange for the account to be reimbursed for the repair cost. I emailed back:-
“I have had a telephone conversation with Trish Rudd in Customer Services today regarding the iPhone having been returned unrepaired in spite of the clear statement below (email of 3rd June) that the repair would be carried out free of charge. Vodafone itself seems to be unclear as to the duration of the warranty and relationship to contract lengths for the iPhone and other handsets sold by Vodafone. There seems to be either confusion within Vodafone regarding consumer law as enshrined in both UK and European consumer law or an attempt to disregard these laws. However,  we have come to an agreement that I will pay upfront for a repair or replacement (fixed cost £150) and Vodafone will then credit that sum of money to the contract. I will be taking a copy of the email below to a local Vodafone store so that the repair/replacement can either be undertaken via that Vodafone store or by my local Apple store. The contract number is below in the email dated 26th May.
Dr. Paul Morgan”

So, of course, with this agreement made I went into Cardiff city centre, armed with a printout of the relevant email. I took these to one of the Vodafone stores where one of the assistants duly noted the details of the email onto the account. They didn’t have any replacement handsets for me to buy but suggested I try the Apple store. They did have replacement handsets for £139, so I bought one. Interestingly, the assistant (I think they call them “Geniuses”!) said that Apple did not repair iPhones but replaced them with handsets as a flat rate repair. This raises some interesting questions, which I will deal with later. The most important thing now was that I had a working iPhone. Phew! All I had to do now was email off my receipt from the Apple store and await the refund.
“Further to my discussion with Trish Rudd on Monday 18th July, I took a printout of the emails into the Vodafone store in Cardiff (St. David's 2 Shopping Centre) and the assistant in store has noted these details on the account. As they were unable to sort out a repair or exchange before the weekend, I went (as discussed with Trish Rudd) to the Apple Store in Cardiff, where they exchanged the handset for £139 (less than Vodafone wanted to charge for a repair!). The account number is xxxxxxxxx/x. The phone number is xxxxxxxxxxx.
I attach the receipt from the Apple Store as proof of this transaction. I would be grateful for the money to be credited to the account at the earliest opportunity.
Best wishes,
Dr. Paul Morgan”

Wrong – again. More delays, obfuscation and stone-walling was to emanate from Vodafone Customer Services. I was now less than one week from going on the main family summer holiday – two weeks in Cyprus. I faced the prospect of going away with the issue unresolved – this would have been aggravation I could do without. I responded to the second email from Holly :-
“Please see the note on the account from Trish Rudd. Please also try to understand Vodafone’s obligations under European consumer law, EC Directive 1999/44/EC. I attach a copy of the guidance document and the EC Directive for you to save any further confusion on the matter. It would be greatly appreciated if Vodafone did not continue in its efforts to escape from its legal obligations in this matter.
Dr. Paul Morgan”.

Next I get a response from another person at Vodafone Customer Services:-
“Hi Paul,
I’ve checked the account for you, I can see that you have also been speaking to customer services direct and the Vodafone Store. The outcome of this was that you were dealing with this direct with apple. Can you please confirm if this is correct?
Further to Holly’s email I can confirm that your warranty was with Apple. They provide a 12 month warranty with all of their phones. When we send an iPhone off for repair it is sent to Apple direct. I understand your frustration with this however any disputes that you have with the warranty that Apple provide need to be taken up with Apple direct.
Best wishes,
Amanda
Web Relations Team
Vodafone UK”.

So, another person at Vodafone trying to deny me my rights. I was not best pleased, to put it mildly! My response was hard line and detailed:-
“For goodness sake!!!!! PLEASE READ WHAT TRISH RUDD HAS PUT ON THE FILE!!!!! You clearly do not understand consumer law and  you do not understand what is VERY CLEARLY stated in the agreement between myself and Trish Rudd. The deal is remarkably straightforward to understand. You – that is, Vodafone, are the retailers of a product (an Apple iPhone) purchased on a contract. My contract is, therefore, with Vodafone because you (Vodafone) are the retailer/vendor of the product. Any contract that Vodafone has with Apple is irrelevant to your contract with me. This principle is made very clear in the Sales of Goods Act 1979. The following is taken from the website of “Which
“When you buy goods you enter into a contract with the seller of those goods. Under the Sale of Goods Act 1979 goods must be:
           'as described',
           'of satisfactory quality', and
           'fit for purpose' – this means both their everyday purpose, and also any specific purpose that you agreed with the seller (for example, if you specifically asked for a printer that would be compatible with your computer).
Your claim is against the retailer who sold you a faulty item, not the manufacturer.”
The key phrase here is “fit for purpose”, for the act includes a definition of durability. If an item is sold with a contract associated with the use of that item (in this case an airtime contract), then at the very least the purchaser of the item is entitled to expect that the item in question will last in a fully working condition for the duration of the contract. Had the fault resulted from misuse of the product, then I would not be making this claim against Vodafone.  In this specific case, the airtime contract is/was for 18 months, the phone was purchased in January 2010 with this contract as you can see from the attached email re: order no. xxxxxxxxxxxx. The fault was initially reported to Vodafone on May 25th this year, only 16 months from purchase. That it has taken so long to deal with this matter is the fault of Vodafone, not me. Irrespective of this, the fault was reported within the period of the original contract. These facts are clearly documented in the emails and are not a matter of debate. Because the iPhone purchase was dependent on the taking out of an airtime contract, this makes its purchase a “conditional sale” as the phone could not have been purchased at that time for the price charged without that airtime contract.
I hope this is clear enough for you!
Subsequent legislation adds to consumer rights:-
Supply of Goods and Services Act 1982
Sale and Supply of Goods Act 1994
Supply of Goods to Consumers Regulations 2002
European Union Directive 1999/44/EC applies to the sale of consumer goods within the European Union and is enshrined within these laws. Please read the attached file “European Consumer Directive.pdf”, which is from the “Official Journal of the European Communities”. The relevant statement is on Page 2 in Paragraph 17:- “whereas Member States may also provide for a limitation on the period during which consumers can exercise their rights, provided such a period does not expire within two years from the time of delivery; whereas where, under national legislation, the time when a limitation period starts is not the time of delivery of the goods, the total duration of the limitation period provided for by national law may not be shorter than two years from the time of delivery;”. This is further clarified in Article 5.
Also attached is document “CSD 2007 EN final.pdf”, which is the official communication from the Commission to the Council and the European parliament. Finally, I attach the file “Your rights as a consumer.pdf”, published by the European Commission. This booklet makes it very plain and clear in the section on product guarantees on page 7 (the 9th page of the pdf file) – this very clearly states that “A two-year guarantee applies to the sale of all consumer goods everywhere in the EU.”
It really cannot be any clearer! Whatever guarantee that Vodafone offers does not preclude or replace consumer rights under UK and European law. The continuing stone-walling attitude that is further re-iterated in your email below is not acceptable. Vodafone has to conform to consumer legislation. In this case, not only was the fault with the iPhone reported to Vodafone within the 18 month contract but well within the two years guarantee that EC1999/44/EC provides for.
It is clear from the string of correspondence that Vodafone staff either do not know or understand consumer law or are being directed by superiors who either themselves do not understand consumer law or are seeking to escape Vodafone’s legal obligations. None of these possibilities is acceptable.
The conversation I had on Monday with Trish Rudd, while not entirely satisfactory, provided both parties with a solution to this situation that does not in itself recognise my consumer rights but does ensure that the replacement handset I now possess solves the problem with the clearly-stated agreement that the costs incurred in getting a replacement handset from my local Apple store (as Vodafone were unable to supply a replacement handset) would be reimbursed by Vodafone by crediting that sum of money to the Vodafone account. You should also be aware that Apple do not repair iPhones but always supply replacement handsets. In this case, a black 16Gb iPhone 3GS, the cost as receipted was £139 – less than the £150 cost that Vodafone quote for a repair. The net result of this is that Vodafone is now obliged to credit £139 to the Vodafone account xxxxxxxxx/x.
Please do not try to renege from this deal. I will be going on holiday soon, returning on Monday 8th August. Failure to refund the costs incurred by me by that time will result in legal action being taken against Vodafone. Furthermore, the ongoing contract between us will be terminated, affecting another handset (my son on 07xxxxxxxxx) on the contract and all Vodafone pay as you go phones currently in possession by my family (my wife, 2 other children and my in-laws) will also be switched to another mobile phone network. Your behaviour in this matter is wholly unacceptable and does not show Vodafone in a good light. I would find it impossible when discussing mobile phone networks with others to recommend Vodafone as this episode leaves me with nothing but bad opinions of Vodafone.
Time is now of the essence in you fulfilling your obligations to refund £139 in this matter by August 8th 2011.”

I also sent another email as I seemed to be dealing with two different conversation threads with people at Vodafone who were either unaware of each other or failing to communicate which other:-
“I am surprised that you do not have access to the other emails regarding this account and reference number WRT135. They have a reference number of #6498761. I have emailed back with this reference a short while ago with a very clear explanation of the situation and what I expect from Vodafone. This whole sorry saga suggests that internal communications within Vodafone are sadly disjointed. For a communications company, this is unbelievably poor. I may well be writing to the CEO of Vodafone.
The phone number is 07xxxxxxxxx (it is in the email below!)
Pin is xxxx
Address is xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx.

Time is now of the essence in dealing with this matter. As stated in my earlier email, Vodafone have until August 8th to resolve this matter to my satisfaction.

Dr. Paul Morgan”

Further messing around by Vodafone on Thursday 20th July:-
“Good afternoon Dr Morgan,
Many thanks for those details. I've just tried to call you but was diverted straight to voicemail so I've left a message.
I have taken a look at the account and cannot see any notes where we've agreed to refund the £139 charge for the replacement handset.
I can see we have advised you on a number of occasions that the iPhone is no longer in warranty and that any repairs would be chargeable. I can see the notes from Trish confirming you've been into the store but there is nothing that indicates a refund is due to you.
As has been advised, Apple offers an extended warranty option by the name of Apple Care. This extends the warranty by 12 months and we're unable to override this agreement.
Therefore I'm unable to credit and refund the applicable charge.
Kindest regards,
Lee
eForum and Web Relations
Vodafone UK”

Another person at Vodafone trying to deny me my consumer rights. My reply was pretty blunt:-
“Lee,
Have you actually looked at the file and seen what has been put on the file by Trish Rudd following my conversation with her on Monday? Have you spoken to Trish Rudd? Read the email “Re:FW: iPhone 3GS broken wifi – WRT135[#6498761]” and take note of the sentence in the message from Holly which says “Your Vodafone warranty lasts for the life of the contract so if the phone is still in commitment we would be able to send it for a free of charge repair.” This is the statement which is the basis of the working solution I have agreed with Trish Rudd.
Have you looked at the message thread with the subject heading WRT135 [#6498761]?
Have you looked at whatever the assistant from the Cardiff St. David’s 2 Vodafone store logged on the account file on Monday?
Does anyone within Vodafone ever actually communicate with anyone else?
Do you understand the clear obligations that Vodafone have under UK and European consumer law, as detailed in the email I sent yesterday with the heading “WRT135 (#6498761) Time is now of the essence”? It is attached for your information.
I have had enough of the stone-walling from Vodafone “customer services” (I can only presume that this is an oxymoron). As I have made clear in yesterday’s emails, it is Vodafone who are responsible for the consumer guarantee, a guarantee which, under UK and European consumer law is a minimum TWO YEAR guarantee. My contract is with Vodafone, not Apple.
TIME IS NOW OF THE ESSENCE IN THIS MATTER.
You (Vodafone) have until August 8th (when I return from holiday) to refund the money in question. Failure to do so will result in legal action being taken against Vodafone for the money in question and costs incurred in prosecuting the case.
Yours, with extreme anger,
Dr. Paul Morgan”

Despite this very clear message, further stone-walling was the result from Vodafone:-
“Good Afternoon Dr Morgan,
 Thank you for your reply.
 I have read through your reply, and consulted with Lee, with reference checking if you were offered the refund of the £139.00 by cross referencing the notes in question. As Lee as stated, the notes do not support what you are asking us to do with regards to reimbursing the £139 charge levied by Apple.
 I have also asked a Team Manager to look over the details of this case, to ensure that the information I am giving is correct, in accordance to our policies and Terms and Conditions. I am sorry to say the response that Lee supplied still stands. Apple do only supply a standard one year warranty with their devices, with any 2nd year covered by a separate Apple Care Policy that is paid to Apple. The contract you have with ourselves is an Airtime contract, with the device been given to use with the contract, but no (sic) purchased from ourselves.
If you are not happy with this response, you do have the right to escalate this, which is done through a Team Manager.
 Regards
 Trev
eForum Team”

Err? I thought I had escalated this to a Team Manager when I spoke to Trish Rudd. Did she not put on the file what was clearly agreed in our phone conversation on the previous Monday? Or was this latest Vodafone staff member also failing to understand consumer law or deliberately trying to put me off? I will never know. Did this person also not understand that the phone was actually bought from Vodafone? Money was paid for the handset and the original purchase receipt had been sent to them by email. However, if he thought I would be put off or cave in, he was sadly mistaken. My response:-
“Dear Trev,
You clearly need to escalate this through a Team Manager and even higher within the Vodafone organisation, as its seems that people at your level are simply unable to appreciate not only the agreement I made with Trish Rudd, but also the legal obligations placed on Vodafone by UK and European consumer law, as I have very clearly shown you in the various emails and attachments I have provided Vodafone with. I will make it very clear for you once again and reattach the document “Your rights as a consumer”, published by the European Commission which summarises their directive EC 1999/44/EC, which has been enacted into UK consumer law.
1.         UK and European consumer law provides for a TWO YEAR guarantee on ALL consumer goods sold in the EC.
2.         As enshrined in UK consumer law, my contract is with Vodafone, not Apple. Any contract Vodafone has with Apple regarding the supply, maintenance and repair or replacement of iPhones which develop faults within this two-year guarantee period is not my problem as it is a commercial arrangement between the two companies and has no bearing whatsoever on my rights as a consumer under UK and European consumer law.
3.         As I have made it abundantly clear what Vodafone’s legal responsibilities are under UK and European consumer law on several occasions, I have had enough of the stone-walling and denials by various staff members of Vodafone UK. Time is of the essence in making the refund of the cost of replacing the faulty handset, as agreed with Trish Rudd. Vodafone UK has until Monday 8th August to conclude this matter to my satisfaction by acknowledging its legal obligations and refunding my £139. Failure to do so will result in legal proceedings being instituted against Vodafone UK.
I will be writing to the Chief Executive of Vodafone UK, Mr. Guy Laurence to express my total disgust with this behaviour of the Vodafone staff I have been dealing with and to ensure that he is fully aware of the legal obligations under UK and European consumer laws. Whether the position expressed by Vodafone staff is simply one of ignorance of consumer law or one of a deliberate policy to fob customers off under the guise of a Vodafone “guarantee” which does not comply with UK and European law is something I believe he needs to investigate and deal with accordingly.
To describe me as a disappointed Vodafone customer would be grossly understating my position.
Dr. Paul Morgan”

I followed this up with an email to the CEO of Vodafone UK, Mr. Guy Laurence:-
“Dear Mr. Laurence,
Please see the attached emails exchanged between myself and Vodafone Customer Services in respect of an Apple iPhone 3GS which developed a fault 16 months into an 18 month contract. The contract is in my wife's name but I have full authorisation to discuss any and all details of the account.
UK and European consumer law provides consumers with a two-year guarantee on all consumer goods sold within the European Union, as set out in European Commission Directive EC/1999/44/EC. The Sales of Goods Act 1997 makes it clear that the consumer contract is with the vendor of the goods (in this case, Vodafone) not the manufacturer. The EC directive is enacted within subsequent UK consumer laws:- Supply of Goods and Services Act 1982 Sale and Supply of Goods Act 1994 Supply of Goods to Consumers Regulations 2002
As you will see from the various emails I have sent, I have attached copies of the clear, unambiguous documents supplied by the European Commission in which this minimum two-year guarantee on consumer goods is clearly spelt out, most easily understandable in the document "Your rights as a consumer". It really is as plain as that. Whatever customer support Vodafone offers to business customers is a different issue to its obligations to consumers. Whatever supply and maintenance arrangement Vodafone has with Apple is none of my concern and has no bearing whatsoever on Vodafone's responsibility to me as a consumer.
Whether the position taken by the staff of Vodafone customer services is one of deliberate obfuscation or one borne out of ignorance of your company's knowledge of consumer law (which I doubt as I assume you have a legal team to advise you on such matters), the net result is that there is an ongoing refusal to acknowledge my rights as a consumer under UK and European consumer legislation. I am therefore requesting that you take direct responsibility for sorting this matter out to my satisfaction. As you can see from the email correspondence, my patience with Vodafone Customer Services is at an end. I have stated that time is of the essence in resolving this matter to my satisfaction under UK and European consumer law. I will be away on holiday until Monday 8th August 2011. Failure to resolve this situation will result in legal proceedings being instituted against Vodafone UK.
Yours sincerely,
Dr. Paul Morgan”

I did receive a response back from another person at Vodafone on Sunday 24th July – the day we were departing for Cyprus:-
“Good Afternoon Paul,
Thanks for your email into the Web Relations Team.
I have now escalated this issue to my team manager. I’m afraid that they are not in the office today, however they will contact you via phone in the next 48 hours.
Thanks,
Espi
Web Relations Team
Vodafone UK”

It wasn’t necessary for the Team Manager to phone back. The office of Vodafone’s CEO came up trumps! Finally, a positive outcome! On Monday 25th July, I received this email:-
“Account: xxxxxxxxx
Dear Paul
Thanks for your email to Guy.  I've been asked to respond on Guy's behalf.
We will refund the £139 you paid to Apple.  This will be paid into the same account that is used for the Direct Debit, please allow 14 days for receipt of the funds.
I'm sorry that you've had to contact us more than once about this.  As a goodwill gesture I've also credited this month's bill (£45.99).
All the best
Andrew Woodvine
Directors' Office
For and on behalf of
Guy Laurence
Vodafone UK CEO
Phone: +44 8080 044477
Vodafone Limited, The Connection, Newbury, Berkshire RG14 2FN Registered in England No 1471587”

I was in Cyprus when this email arrived – thankfully, our hotel had free wi-fi (which I could connect to with my new iPhone!). This was a great relief and helped me relax finally. Ahhhh! It was good to be able to write an email to Mr. Woodvine thanking him for his intervention in this matter:-
“Dear Mr. Woodvine,
Thank you for your swift positive action in dealing with this matter. All I can say in response is a huge "Thank You". You have restored my faith in Vodafone. I am on holiday in Cyprus at the moment - your email has removed a significant stressor from my relaxation.
Best wishes,
Dr. Paul Morgan”

True to his word, the month’s bill was written off and £139 credited to my bank account.
This whole saga, despite the eventually satisfactory outcome still leaves a number of questions unanswered.
1.      Guarantees on consumer goods sold within the EU – how many consumers are aware of the Directive 1999/44/EC and what this means, i.e. a two year guarantee?
2.      How many companies selling goods to consumers are aware of this legislation? If they are unaware of this legislation, why?
3.      If they are aware of it, is there a deliberate policy of trying to deny consumers their legal rights by standing by the “traditional” 12 month guarantee that we’ve got used to?
4.      Is it the case that companies are not training their staff adequately in consumer rights? Or is this a deliberate ploy not to provide adequate training?
5.      Specifically for Vodafone, do the staff not know that iPhones are not repaired but replaced by Apple when faulty?
6.      Why is that Vodafone want to charge customers £150 to “repair” an iPhone when Apple will only charge £139 for the same replacement handset?

I’m sure there are many other issues that could be raised and questions that could be asked about the relationships between companies and their customers. 

Saturday, July 9, 2011

Journey into skepticism

I discovered science as a primary school child. I was fascinated by the chemistry, physics and biology books and encyclopaedias that my parents had bought my older brothers. The discovery of the public library and realising that I could borrow books other than The Famous Five and The Secret Seven meant that I could explore science further, so that when I started studying science in school, I just lapped it up. It was a natural progression through science into medicine. Starting medical school in 1980, I underwent what was then the traditional format of medical teaching, with separate pre-clinical sciences and then the clinical studies. One of the most important areas that I was taught was that of critical appraisal. This subject enables you to read articles and papers published in journals and elsewhere to examine whether what was said is likely to be true. Without critical appraisal, statistics and statistical analysis is just a dull bore. Now, I'm not a statistician by any standard, but it does help you sort out the wheat from the chaff. Of course, this begs the question as to how many of these papers get through the peer review process to publication. I suspect the answer is that peer review was often weak and flawed. Nevertheless, it provides the foundation for evidence-based medicine (EBM).
Science provides the basis for just about every development that mankind has made in it's history. From the invention of the wheel through to TV's and computers, landing men on the moon - none of these would have happened without the application of scientific methodology. Science therefore provides us with the tools we need to judge whether, for example, a therapy is effective for a particular disease. You learn to understand how randomisation helps reduce the possibility of trial results occurring by chance. You also learn to understand and appreciate the limitations of evidence gathered by trial methodologies other than randomised double-blinded, placebo-controlled clinical trials. Increasingly, medicine will not accept any new treatments until sufficient evidence has accumulated to demonstrate that the benefits of a new therapy are not only genuine but also outweigh the risks that the new therapy might invoke. It's all about the risk-benefit analysis.
In the years since I qualified, the growth of computer technology and the Internet has made it much easier. In  particular, the development of websites dedicated to EBM, such as the Centre for Health Evidence and the Centre for Evidence Based Medicine give access to a multitude of tools to help with the critical appraisal of papers published in the medical journals.
So, I guess I've always been somewhat sceptical (with a "c") when it comes to accepting whether a paper was to be believed or not throughout my medical career. Even when papers are extensively peer-reviewed and critiqued, it can be difficult to be confident that one study can give the answer to the problem studied. For example, the world of critical care medicine got very excited about the publication in 2001 of a study of the practice of tight glycaemic control and its apparent impact on morbidity and mortality in critical illness. Despite this being a single-centre study and the majority of patients undergoing cardiac surgery, intensive care units across the world adopted the practice, including the one where I work. There's no doubt that the stress of critical illness will result in hyperglycaemia. However, treating the patient to achieve normoglycaemia is a risky business. In the scientific literature and at conferences, many intensivists raised concerns about the applicability of the practice, the risk of hypoglycaemia and the purported benefits. Subsequent studies failed to show the benefit from the original paper. The risk-benefit analysis swung very firmly back to risk. Those units that had rushed to adopt tight glycaemic control backed away from the practice. The lesson here is not to rush into changing clinical practice on the basis of flawed studies.
This sort of problem led to an even greater reluctance to believe the results of studies published in the journals. I'll admit that I rarely have time to read articles in the depth required to reveal flaws for myself, except when I am acting as a peer-reviewer (a few times a year). Fortunately, there are plenty of resources where I can find proper critical appraisals of articles which may change clinical practices.
So, why become a skeptic (with a "k")? In the past, I'd only been vaguely aware of some forms of so-called "complementary" and "alternative" medicines (CAM). Mostly, I thought they were a load of nonsense but in themselves not harmful as long as patients used them in addition to "conventional" medicine and surgery. Stories on patients suffering harm, or even dying, from reliance purely on some form of CAM seemed extremely rare and the result of such patients (or, disturbingly, their parents or partners) being mentally deranged. I even thought, naively, that the reporting of such stories would highlight the fallacy of trusting CAM.
The first stage in my journey occurred in 2010 when my son, Rhys, was diagnosed with Crohn's disease at the age of 15. My wife and I watched our son go from an active, intelligent, hardworking school student to someone who could barely struggle to get out of bed as his illness took a grip. Finally, after the penny dropped and tests confirmed the diagnosis, he was able to start effective therapy, although it still took some months for him to get well. He'd discovered the Internet some time previously and was spending his spare time getting into Facebook, Twitter, YouTube etc. and - most importantly as it turned out - blogs. As part of his GCSE English course work he had written an essay on CAM, so he sought advice from me about assessing evidence and did a lot of research on the Internet on the various forms of CAM. Let's just say he was largely unimpressed by the evidence of efficacy! When the diagnosis of Crohn's disease was made, he began searching for information on the disease, therapeutic options and the evidence of efficacy for various conventional and CAM treatments. Being intelligent and drawing on the knowledge gained in his essay-writing, he was easily able to work out (with little help from me) what was effective and what was not. He joined a web-based support group for people with Crohn's disease.
This led to the next step in becoming a skeptic. During my son's research into Crohn's therapies, he stumble upon a substance being marketed as "Miracle Mineral Solution" or "Miracle Mineral Supplement" - MMS for short. Importantly, he found that the FDA in the USA had essentially banned it as being dangerous, issuing this warning. Scary stuff! You would think that anyone reading the warning would avoid it like the plague. Err, no. The support group he joined had a lot of interesting discussions. However, there was also a lot of discussions on CAM. That was OK, though - he would just avoid all the crap and focus on trying to distill out the useful. That was until he found mentions of MMS in discussion threads. His response was to post a link to the FDA warning. This received support from some forum members but others were of the opposite view, even going so far as to attack him in the discussion. He found that a senior member of the forum seemed to be actively promoting MMS and to be offering medical advice regarding its use. When Rhys commented on this he was temporarily banned from the forum. He did not take this lying down! He tweeted about his experiences. He and others saved copies of the pages containing the offending and offensive forum posts, so that later editing would not erase what was said. He made a video of himself describing his experiences and finally started to write about them in a blog. The rest is history!
Rather than repeat what Rhys has been up to, read it in his own words on his blog. It is absolutely incredible what he has achieved in a relatively short space of time. Since then, Rhys and I have become involved with the Cardiff branch of "Skeptics in  the pub" (SITP) movement. Rhys has appeared on "Pythagoras's Trousers" on Radio Cardiff, Radio Wales, the ITV Wales news, BBC Radio 4 and BBC 1's "The One Show". He's also spoken at "ThinkCon 2011" (part of the Cambridge Science week) and at the Bristol SITP. He will be also be speaking at a Bath SITP in the near future.
Perhaps the greatest highlight, however, was being invited to attend the "TAM London 2010" meeting in October 2010. My wife and I were invited to accompany Rhys to the meeting. I was in London for a few days prior to the meeting as I was examining for the Royal College of Surgeons of England. Before my wife arrived with Rhys on the Friday evening, I was informed by the meeting organiser, Tracy King, that the organising committee had voted to award Rhys the prize of "Outstanding Contribution to Grassroots Skepticism". Needless to say, this came as a complete surprise to him on the Saturday.  Amongst others, we met James Randi himself, The Amateur Transplants and Tim Minchin.
The things I've learned from this process? Having previously thought of the CAM business as nothing more than a harmless irritation, I now realise that it's an industry populated by deluded fools and unscrupulous bastards only in it for a quick buck. If this was at no risk, then I would be happy to take the view of a fool and his money being soon parted. However, all too often, CAM is associated with significant harm, for example the Penelope Dingle case or vertebral artery damage following neck manipulation. Simply sitting back and feeling smug about not falling for this crap, it's time to get active and fight back against people who are peddling woo. I've also realised after some "interesting" debates with various cranks on social networking sites that it can be impossible to rid people of their delusions. It's far better to keep challenging them for their evidence so that anyone inquisitive about CAM can see what shite these quacks are peddling can see that they lack credible evidence to support their ridiculous claims. Sometimes it's better to ignore the constant stream of crap these people come out with - don't feed the trolls!
Hopefully, all this has made me take a more critical look at products that are being pushed to an often unsuspecting public. The ability to take action against woo-meisters through agencies such as the MHRA, Trading Standards and (most notably) the ASA has enabled anyone to challenge the claims made on websites. The ASA acquired the ability to act against false claims made on websites in March this year was a major advance in the anti-woo fight. To make it even easier to report false claims, mega kudos must go to Simon Perry for his development of Fishbarrel, a plugin for the Google Chrome web browser. I've also become hyper-critical of new publications in critical care journals.
I think the biggest challenge now is not to let skepticism be so all-consuming that it spoils your enjoyment of other aspects of life. It's still important to be able to suspend belief sometimes to enjoy television, films, the theatre, books, etc. You can take life too seriously and become so engrossed with demanding evidence for the efficacy of anything and everything that it detracts from a happy, balanced existence.
So, skepticism is important in so many ways but you mustn't let it become so all-engrossing that it stops you from enjoying life. I hope that I'm getting to that position. It can be really difficult to stop yourself from getting so deeply involved in something like skeptical activity that you find yourself pushing other aspects of your life aside to the detriment of the well-being of yourself and your family and friends. My advice? Be skeptical, particularly when it comes to issues that affect your health, wealth and happiness. Just take care to not to drown in obsession with demands for evidence of benefit when pure enjoyment in family, friends, food, books, TV, films, theatre are every bit as important. Enjoy!