The random thoughts of a sceptical activist

The business of regulation

Simon Perry has been having an interesting email conversation with Maggy Wallace, Executive Chair of the Complementary and Natural Healthcare Council.

There have been a few emails back and forth — and it would be best to read the conversation before continuing — but I felt I needed to add my tuppence-worth:

 

Hi Maggy

I’ve been following your conversation with Simon Perry with interest and I’d like to respond to some of the points you made.

You said:

As a regulator you cannot honestly expect us to support a position as stated by you to the effect that ‘………..Genuine, honest training on reflexology must cover the simple truth that reflexology is not known to be effective for any condition.’

This is your opinion and in our view, is unsupportable as a statement.

Simon didn’t express an opinion and it’s entirely supportable. The scientific evidence on reflexology is clear: it is a nice foot massage, which some may find relaxing and stress-relieving, but nothing more. Any claims outside of that are not supported by the evidence.

You may not like the scientific evidence of course, but it is reinforced by the sheer implausibility of the claimed method of diagnosis and claimed mechanism of action for reflexology.

If you don’t agree with the scientific evidence, what do you base your assessment of reflexology on? What the professional associations tell you? Reflexology trade bodies? Your members’ websites?

You told Simon:

If we believed what you say to be true, and continued to regulate reflexology, we could be accused of misrepresentation and acting without integrity, both of which would be serious accusations indeed.

Belief doesn’t come into it – it’s what the evidence says. And I don’t understand why you think you might be accused of misrepresentation and acting without integrity.

Your members, in their advertising, whether in newspapers, leaflets or on the Internet, fall within the remit of the ASA, so surely you should be showing leadership by telling your members in no uncertain terms that they have a duty to abide by the CAP Code and dealing with any possible breaches swiftly and decisively? If you are unable to do that, you are not being a responsible regulator; you are not protecting the public nor acting with integrity.

I know you advised your members about this in January, but, when read alongside your therapy descriptors, the message isn’t very clear as is apparent by even a cursory glance at some of your members’ websites – many of your members are either confused by your pronouncements or are deliberately ignoring them.

Your Code of Conduct, Performance and Ethics For Registrants states:

Advertisements must not be misleading, false, unfair or exaggerated.

The ASA say:

We’re here to make sure that all advertising is legal, decent, honest and truthful

and that their rules:

…are designed to ensure that advertising does not mislead, harm or offend.

These seem to say much the same thing. Do you agree?

However, your ‘Therapy Descriptor’ for reflexology states:

Numerous disorders may benefit from reflexology depending on the specialism and expertise of your practitioner. Examples include pain, headaches, sinus problems, hormonal imbalances, back problems, stress and tension.

The ASA has this to say about reflexology:

Reflexology involves the massage of specific zones, usually of the feet, that are believed to correspond to areas or organs of the body. Neither CAP nor the ASA has accepted the efficacy of reflexology to treat or prevent illness and CAP understands that the clinical evidence is, at best, inconclusive. These claims, however, are likely to be acceptable: helps relax; improves mood; aids sleep; helps relieve tension and improves a sense of well-being. Practitioners should not refer to serious or prolonged medical conditions (Rule 12.2).

That’s not quite the same list as yours, is it? Why? And please note what they say about efficacy and evidence.

Regardless of your views on any of this, it’s the scientific evidence that the ASA will be using to determine whether claims made by your members are misleading or not.

You said:

CNHC is working with practitioners to ensure that they do not over-represent the efficacy of their therapies and do not make misleading medical claims

Sorry? ‘Over-represent the efficacy’? There is no efficacy for the majority of what your members practice. Can you explain why should it be wrong to censure claims that just ‘over-represent’ the efficacy?

And why, unless they are also a registered medical professional, regulated by one of the nine statutory regulators, do you think any of your members should be making any medical claims, never mind misleading ones? The ASA tend to take a dim view of this.

This will take some time owing to the numbers involved and the work and expense (and time lag) associated with changing web sites and advertising material.

I am pleased to see that you are at least doing something, but, as Simon pointed out, little substantive progress has been made in the last year and misleading claims are still being made by your members.

The ASA announced last September that their long-heralded digital remit extension would come into force on 1 March 2011. That six-month gap was a period of grace to allow advertisers time to change their websites. Why are so many of your registrants still making claims that cannot, by any stretch of the imagination, be considered to be in line with your ‘therapy descriptors’ never mind the ASA’s guidance?

We fail to see however, how driving people from our register – which will undoubtedly be the effect of further complaints – can be seen to be in any way acting in the interests of the public. The individuals will merely continue to practise without any means of calling them to account. Please tell me how you think this serves the public interest?

Can you tell me how you think allowing your members to make misleading health claims serves the public interest?

The CNHC is not there to simply have as many therapists on their register as possible. What the CNHC is doing at the moment is giving false legitimacy to unproven and disproven pseudo scientific therapies that, at best, do nothing but, at worst, could prevent or delay their customers seeking proper medical attention.

I note you state your key purpose is:

…to protect the public by means of regulating practitioners on a voluntary register for complementary and natural healthcare practitioners.

If the key phrase in that is not ‘to protect the public’, then what is? And how does allowing your members to make misleading claims fulfil that laudable aim?

Many of us can see no purpose for the CNHC other than to promote bogus therapies by giving them the false imprimatur of government-backed regulation. That makes it not fit for purpose: the purpose being, first and foremost, to protect the public.

But you are completely wrong in assuming that if you didn’t exist, there would be no way of calling errant therapists to account. There are other guardians of public safety and public interest that already do that, including Trading Standards, the ASA and the MHRA.

If they are the ones who more effectively protect the public, where will that leave the CNHC?

I look forward to receiving your reply, which I will post on my blog.

Best regards.

Alan

 

Update 01 June 2011

I got a reply:

Thank you for your letter which comments on the issues that we are currently discussing with Simon Perry, the contents of which have been noted.

Predictable.

7 Responses to The business of regulation

  • Can you report the CNHC to the ASA for making misleading claims about reflexology on their website? The CNHC’s business is, in part, getting money from reflexologists by persuading the public to use CNHC registered reflexologists. Their “therapy descriptor” is a promotion on behalf of CNHC registered reflexologists.

    There is no evidence to support “improve the blood supply to all areas of the body and promote the correct functioning of nerve impulses” which are both medical claims. Hormonal imbalances are serious medical conditions that should be treated by a medical practitioner, not a reflexologist, and headaches may include serious medical conditions.

  • Davidp said:

    Can you report the CNHC to the ASA for making misleading claims about reflexology on their website? The CNHC’s business is, in part, getting money from reflexologists by persuading the public to use CNHC registered reflexologists. Their “therapy descriptor” is a promotion on behalf of CNHC registered reflexologists.

    Now there’s an idea… ;-)

  • is there a list some where thats list the main alternative therapies and what conditions the ASA say they can advertise. i mean in one handy place, in a simple format that i can use a reference tool as i forget sometimes what they can and cannot say.

  • @nobby:

    The ASA’s CopyAdvice website is pretty good.

  • The bit about “driving people from our register” is astounding. They look dangerously close to saying that they don’t want to regulate their members because if they did they would be unable to regulate them.

  • Mojo said:

    Quite.

  • ty mojo, i am fully signed up to the copyadvice site and it is great. i was looking for a simple reference site really. maybe i am just being lazy (as usual) when i come to sites with multiple claims on them from different therapies

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