The random thoughts of a sceptical activist

Zeno

Homeopathy regulation: there’s nothing in it

Is ‘homeopathic’ an accurate description of self-regulation?

The Advertising Standards Authority (ASA) are paragons of efficiency and professionalism. They may well have a lot to deal with at the moment, but that does not stop them investigating complaints thoroughly and responsibly. They take the business of regulation seriously and have a well-deserved reputation for being fair, independent and impartial.

That’s how a regulator should conduct its business if they are to be seen as thorough and effective, particularly where there is a need to protect the public from those who would prey on their trust, ignorance or vulnerability.

The ASA have an advantage over the trade bodies that parade their Code of Ethics as banners of respectability to entice the public to believe their members are being properly regulated. The ASA operate at arms length from those who fund them: those who decide on whether an advert is legal, decent, honest and truthful treat all complaints equally, regardless of who the advertiser is or who the complainant is.

It’s a pity the same cannot be said for the ‘regulators’ of purveyors of ‘alternative’ therapies.

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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?

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The end of an era

Professor Edzard Ernst recently announced his retirement as Director of the Complementary Medicine Research Group. What does this mean for him and for the future of critical research into the evidence for alternative therapies?

I interviewed Prof Ernst to find out.


Professor Edzard Ernst is critical of many sorts of complementary therapies. But his views of what works — and what doesn’t — are informed by critical examination of the evidence.

Many of his detractors would have us believe otherwise and see any critical examination of their pet therapy as a biased attack. Nothing could be further from the truth as anyone who understands the scientific process would understand.

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Is there a Doctor in the clinic?

There are a lot of doctors out there, but it can be difficult to know which are properly qualified and registered medical practitioners and who are, well, just quacks.

It’s not really that much of a problem for most of us. If we’re feeling unwell, we make an appointment with our GP. If there is any doubt about their status, you can always verify they are registered with the General Medical Council (GMC) by checking their List of Registered Medical Practitioners (LRMP).

But there are so many other ‘doctors’ out there. Ignoring The House Doctor®The Car Doctor and others who have obviously got nothing to do with health, there are many who certainly like to give the impression they are proper doctors — and I have no doubt some of them think they really are.

Take homeopaths, for example.

A simple search of the business directory yell.com shows a large number of homeopaths using the title Dr. Of course, some of them are also medically qualified and on the GMC’s LRMP, but you don’t have to look far to find examples of non-medically qualified homeopaths calling themselves Dr. Again, I have no doubt many of them think they really are doctors and some may well have qualification that entitles them to prefix their name with Dr, but no one should be in any doubt of what they are.

In the UK, Dr is not a protected title: anyone with a suitable qualification can call themselves Dr so-and-so. This is in stark contrast to, say, chiropractors, which is a protected term and its use by anyone not registered with the General Chiropractic Council is illegal under the Chiropractors Act 1994.

Things, thankfully, are a bit stricter when it comes to advertising services to the public.

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Taking the strain

The General Chiropractic Council‘s occasional News from the GCC publication rarely makes interesting reading. It’s usually a mish-mash of stuff only of interest to chiropractors.

But there is an occasional interesting item or two.

The latest issue discusses the apparent ongoing debate between the Advertising Standards Authority (ASA) and the GCC:

The ASA Committee of Advertising Practice (CAP) – the debate goes on

The latest issue we’ve flagged up to the team at CAP relates to claims to treat minor sports injuries.

Its AdviceOnline in respect of osteopathy and physiotherapy states that CAP has accepted that they may claim to help minor sports injuries, but there is no mention of this for chiropractic. In respect of physiotherapy, CAP goes on to state that

“At the present time, CAP is unlikely to ask to see evidence for the treatment of minor conditions.”

We’ve asked CAP to confirm that it would take the same approach to any claims made by chiropractors about minor sports injuries. As ever, we’ll keep the profession in touch with progress.

We have the situation where the GCC  — the statutory regulator for chiropractors, who frequently claim to be a primary health-care profession — is asking the ASA — the voluntary advertising regulator, funded through a levy on advertising spend — to add minor sports injuries back onto their list so their registered chiropractors can make claims about it!

Let’s see if we can help answer the GCC’s query.

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Out with the old…

When I submitted my complaints about claims made on chiropractic websites in June 2008, a fundamental requirement regulating what chiropractors could claim — firmly embedded in their Code of Practice — was that they only advertise consistent with guidance issued by the Advertising Standards Authority (ASA).

At that time, the General Chiropractic Council‘s Code of Practice that was in effect was the 8 December 2005 version and the relevant clause was C1.6. Let’s put it fully in context:

Chiropractors must justify public trust and confidence by being honest and trustworthy.

C1 Chiropractors must act with integrity and never abuse their professional standing.

Specifically chiropractors:

C1.6 may publicise their practices or permit another person to do so consistent with the law and the guidance issued by the Advertising Standards Authority. If chiropractors, or others on their behalf, do publicise, the information used must be factual and verifiable. The information must not be misleading or inaccurate in any way. It must not, in any way, abuse the trust of members of the public nor exploit their lack of experience or knowledge about either health or chiropractic matters. It must not put pressure on people to use chiropractic.29

______________________

29 For example, by arousing ill-founded fear for their future health.

This clearly mandates chiropractors to ensure any advertising complies with ASA guidance, remembering that ASA guidance includes the CAP Code, other guidance and their adjudications.

In prosecuting my complaints, the GCC inexplicably forgot all about the requirement to be consistent with ASA guidance and came up with some arbitrary standard of evidence for compliance. The Professional Conduct Committee begged to differ even with that and effectively allowed any old evidence to be used to substantiate chiropractors’ claims. To understand the whole story, see Humpty Dumpty regulation.

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Active ingredients: still none (hopefully)

While some of us were composing our considered responses to the MHRA’s consultation on homeopathy, supporters of the magic sugar pills panicked and urged friends and homeopaths to flood the MHRA with their ill-considered responses.

This orchestrated campaign was leaked last night and gave us all a good laugh.

It was obvious the writer of the original email either hadn’t read the MHRA consultation document or was just unable to understand it and her email no doubt scared many a homeopath to write desperate emails to the named official at the MHRA. Of course, everyone is perfectly entitled to respond and make their views known. It does help, though, if you have some basic understanding of the regulatory framework and what issues the MHRA was consulting on.

The panic email contained many errors, including this gem:

The practice of homeopathy by lay homeopaths is at stake, and if the MHRA changes the wording to the document mentioned below, we will …not be allowed to practice any longer.

The originator of the email appears to be the Administrator at a ‘school’ of homeopathy, so you would have thought she might have better understood the consultation.

Her assertion is — like homeopathy — nonsense: homeopaths are not about to be stopped selling their products. The consultation is about ending the privileged position some homeopathic products were inexplicably granted 30 years ago and about the warning labels on some of them. Of course, I have no idea why homeopaths would want to maintain the status quo…

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Active ingredients: None

That’s what all homeopathic ‘medicines’ should say on their labels because that is precisely what they contain: no active ingredients.

Saying anything different is misleading the public.

For various unfathomable reasons, we have the Medicines and Healthcare products Regulatory Agency (MHRA) regulating a non-medicine and a non-healthcare product. They don’t really even regulate homeopathic products. Not in any way that properly protects the public.

In fact, they do the opposite: they give these sugar pills and potions the legitimacy of having MHRA licence numbers — just like real medicines — and ‘Government approval’. This misleads the general public who are unaware that homeopathy isn’t some ‘alternative’ or ‘complementary’ system of medicine. It isn’t a system of medicine at all.

The MHRA are currently asking the public about some aspects of their regulation, including what wording should be on some homeopathic products and this is an ideal opportunity to tell them what we think.

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Pseudo science down on the farm

I liked Yeo Valley yoghurt, particularly their vanilla one. Big pots of the stuff didn’t last long.

They are organic, but this isn’t why I used to buy it. I just liked the rich, creamy taste.

Yes, I used to buy it.

On Twitter yesterday, @GhostOMichael, a follower of @RhysMorgan, tweeted a link to a page on Yeo Valley’s website (cached) that I found worrying: it told how Yeo Valley ‘treat’ their cows with homeopathy. (That page has disappeared and has been replaced with this one. Thanks to Jaxxson for pointing it out.)

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Humpty Dumpty regulation

The phrase Humpty Dumpty chiropractic cropped up in a Google Alert a few days ago. It was the fitting title of an editorial (cached) in the December 2010 issue of Clinical Chiropractic, which discussed the slippery and nebulous meaning of vertebral subluxation complex (VSC).

For those who don’t remember their childhood, in Lewis Carroll’s Through the Looking Glass, Humpty Dumpty is discussing the meaning of words with Alice. HD remonstrates:

‘When I use a word,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’

Such equivocation is typical of on-line conversations with chiropractic supporters discussing the VSC, but it applies elsewhere as well.

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