Regulating nonsense

David Colquhoun’s frustration — and indeed anger — is palpable. And understandably so.

He brilliantly covered Monday’s announcement by the Department of Health (DoH) of their consultation into the regulation of “acupuncture, herbal medicine, traditional Chinese medicine and other traditional medicine systems”.

This consultation is the DoH’s response to the infamous Pittilo Report, which saw the light of day just over a year ago.

I won’t go into the report or the consultation at the moment, but urge you to read what David says about it. Suffice to say I agree with David when he urges:

It is very important that as many people as possible respond to it. It’s easy to say that the consultation is sham. It will be if it is left only to acupuncturists and Chinese medicine people to respond to it. Please write to them before the closing date, November 2nd 2009.

In his conclusion, David says:

But if the government were to accept the recommendations of the Pitilo report it would be seen, quite rightly, as being anti-scientific and of posing a danger to the public.

…and he quotes from the blog on the FT by GP Margaret McCartney:

This report would, if implemented, create lots more nonsense exam papers funded by a lot more public money – and would produce practitioners without the absolutely crucial skill of how to assess evidence and reject or use it appropriately.

I never thought I’d quote The Sun, but their piece today says:

HERBAL medicine and acupuncture face new Government controls, health minister Ann Keen announced earlier this week.

“Patient safety is paramount,” she says adding that the Government wants to introduce safeguards to ensure anyone offering the alternative remedies meets “professional standards of care and safety”.

It sounds sensible but it’s actually a charter for licensed quackery.

Unlike doctors, herbalists and acupuncturists won’t have to provide proof their treatments work.

Anything that gives an official seal of approval to alternative medicine is bound to increase its credibility and popularity. And that is why regulation is far from sensible.

As Britain’s leading expert on alternative medicine, Professor Edzard Ernst points out: “If you regulate nonsense, it is still nonsense.”

Says it all, really, in nice simple language everyone can understand.

However, I want to mention the announcement of this consultation on the website of the Prince’s Foundation for Integrated Health. Their release on this was titled: Regulating complementary therapies: a critical consultation. Of course, Prince Charles’ lot think this is the best thing since sliced organic bread (available from all upper class supermarkets — other, more affordable, alternatives are also available).

It quoted their medical director, Dr Michael Dixon:

There is good evidence for herbal medicine, acupuncture and Chinese medicine in the treatment of some conditions but, as in all healthcare, these therapies require properly trained practitioners.

Strange wording: “There is good evidence for… …in the treatment of…” The Advertising Standards Authority is not so keen on such woolly weasel wording and no doubt would take that to be a claim of efficacy. They would require decent scientific evidence for any such claims.

However, Dixon appears to think there is more than a jot of evidence for these woo treatments. Of course, some herbal potions are pharmacologically active — sometimes a tad more than you might have expected, but let’s not forget the the NICE fiasco on — amongst other AltMed therapies — acupuncture. (More information on acupuncture can be found on the excellent evidence-based medicine website, EBM-First.)

Dixon states that: “these therapies require properly trained practitioners.” But how do you train someone in nonsense? No, the answer isn’t to teach gobbledegook in our Universities, doling out Bachelor of Science degrees in woo.

He goes on to say:

Statutory regulation will demand high standards of practice. It will enable the public to identify qualified practitioners, and to feel confident of good quality, safe treatment.

Well, that’s debatable. The consultation report certainly talks about the problems with adulterated herbal potions and the difficulties that gives regulation but note that it doesn’t say anything about evidence of efficacy for any of these woo therapies. Heaven forbid that they should have to provide scientific evidence — plethora or otherwise. Although I’ve not yet read through all of the DoH’s consultation (there’s a lot of it!), willingness to enter into a discussion on the efficacy of these treatments would appear not to be on the agenda.

However, that will not stop many of us from giving the thorny topic of efficacy at least passing mention when we submit our considered responses…

What statutory regulation of yet more quackery will do is enhance its perceived standing in the eyes of the public: “if it’s regulated by the Government, it must be OK”. What we don’t need are more quacks calling themselves “a primary health-care profession“. That does not protect the public.

AltMeds — including the FIH — talk incessantly about increasing consumer ‘choice’; but the public’s choices are reduced when quackery is covered in a veneer of statutory respectability.

The FIH subtitled their release: “a critical consultation”. A critical response to the consultation is certainly something they can rely on.

6 thoughts on “Regulating nonsense”

  1. It's always about the safety, never about the efficacy. So long as the clinic is clean and the clinicians are clean and the implements are clean or the "remedies" not adulterated, then it gets a tick.

    If you ultimately suffer or die as a result of not getting you ailment properly checked out and "treated", it won't be the fault of the safe, clean, qualified alternative practitioner who never promised to be able to heal you of anything.

  2. How should we regulate woo though? It's a tricky question.

    I suppose, in the case of homeopathy, it could be argued that we don't need to. But even here, there have been cases of "remedies" sold as "homeopathic" that – it transpired – actually contained ingredients.

    But we can't realistically ban people from paying other people to rearrange their chakras (or whatever), so what do we do?

    We can, I suppose, insist that products (eg "herbal medicines") list their true ingredients and chemical breakdown and do not include dangerous levels of toxic substances at the "prescribed" dosages; but all that is only part of the problem.

    In the case of (say) chiropractic which employs potentially dangerous manipulations (to be fair, it should be mentioned that complications from chiropractic are mercifully rare) how do we ensure that such manipulations are carried out as safely as possible? We are forced to consider attempting to regulate training courses and exams which are largely complete nonsense – with all the absurdities that such a course of action implies.

    As I say, "It’s tricky"!

  3. Prosecution, not regulation.

    That ought to the simple message here. There are laws already in place that, if properly enforced, would protect the public from the dangers inherent in these trades.

    At present, they are rarely enforced. Trading Standards Offices need specialists who can deal in such issues. Regulating quacks will result in greater danger as it cloaks them in respectability that they have not earned.

  4. I used to believe that some sort of regulation – one that ensured some level of hygiene/safety/insurance – would help ensure the public were protected from the worst of the quacks, but I'm coming round to the position that there should be no statutory regulation of any of them.

    All that happens is that any 'official' endorsement is lauded over the unknowing public and no one is any better protected. Indeed, the public is probably less safe.

    As Le Canard Noir says, there are laws already to protect the public from adulterated herbal potions, misleading advertising, etc. All we need is for them to be properly enforced.

    Schroedinger: I'm not convinced that listing an analysis of herbal potions would help much – it may not even be possible given the variability and complexity of the source plants. Would the consumer be any the wiser as to the risks?

    No, proper protection of the public, not regulation of quacks is the answer, but it is tricky.

  5. I wonder what would happen if advertising any sort of efficacy, implicit, explicit or even vague beyond belief, was banned? In other words, put a "ban" on advertising health services as if they were just competing businesses.

    We (in Oz) don't see our local GP advertising that he can treat a vast range of illnesses (I'm not even sure if he's allowed to these days) yet alternative practitioners seem to live to advertise. They hold expos, they're in the classifieds, the Yellow Pages and all over the web making all manner of fanciful claims as to how they can "assist" your healing.

    An advertising ban might prove worthwhile.

  6. Regulation of Woo-Bullshit should follow the regulation of any contractual claims.

    If 'what was promised in return for consideration' was not delivered, then the supplier is liable.
    If said supplier is offering claims that are untenable, or even fraudulent, then the offer of contract is itself a prima facie actionable offense.
    No extra laws are required.

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