What a week for quackery!

Phew! This has been a spectacular week or so for alternative medicine.

Firstly, we had the Landmark ASA ruling on asthma and colic. Then we have the spectacle of some of its major proponents being tortured and exposed before the House of Commons Science and Technology Sub-committee looking into the evidence (or lack of it) for homeopathy. Skepticat tells it far better than I could, but the admission by Boots of the absence of evidence for homeopathy and that they just sell the stuff  ‘cos their customers want to buy it has been described as a Ratner moment.

That was Wednesday; but today was another significant day for the regulation of quackery.

How does Simon Perry find the time?

As well as complaining about chiropractors to the GCC and Trading Standards, running a business, writing a column on skepticism for his local paper, Simon Perry has found time to complain about reflexologists. Why reflexologists? The Complementary and Natural Healthcare Council (CNHC) — also known as OfQuack — opened their doors to welcome in reflexologists at the end of August. As soon as they appeared on OfQuack’s website, Simon started checking any claims made on their websites and sent in complaints to the CNHC (the first they have received) under their complaints procedure. He tells the full story in his blog post The CNHC wishes to place on formal record their thanks to Simon Perry.

They have today upheld all 14 of Simon’s complaints and told the reflexologists concerned to remove the claims Simon complained about, which included infantile colic, IBS and arthritis.

What is interesting is that the CNHC consulted the Advertising Standards Authority for advice. I have no doubt the ASA would have advised them that there was no acceptable evidence for the claims made. No surprise there then to Simon or I, but you have to wonder whether this was news to the CNHC. It certainly shouldn’t have been.

Setting an example

So, as a direct result of Simon’s complaint, the CNHC is going to draw up guidance on what can and what cannot be claimed by reflexologists.

But there’s more. They also promised:

  • CNHC will tell practitioners to remove claims they cannot justify.
  • CNHC will conduct a review of evidence base for regulated therapies.
  • CNHC will contact all registrants to instruct them not to make claims without justification.
  • CNHC will contact complementary health course providers and authors to instruct them not to make claims without justification.

Since they seem to be following the guidance of the ASA, this will seriously curtail the claims their members can now make, because the ASA will only accept peer-reviewed evidence of — wherever possible — robust, applicable, double-blinded, randomised, controlled trials as substantiation for any claims made. (For example, see here, here and here.) All AltMed practitioners have to obey much the same ASA rules as chiropractors when they advertise.

One of the few ASA adjudications involving a reflexologist was as a result of a complaint by the General Chiropractic Council against an ‘Alternative Treatment Centre’ — in Simon’s home town of Leicester! My irony meter just broke…

This CNHC decision really is a great breakthrough in ensuring their members do not make claims that mislead the public.

However, we will have to wait to see exactly how rigorously they carry out these promises or whether they try to lower the bar in terms of the quality of evidence required to justify a claim. One thing they can be pretty sure of is that if they do not put robust and scientifically-based guidance in place and actively and rigorously enforce it and be seen to enforce it, they will again feel the force of Simon’s skeptical pen.

Protecting the public

Regulation — statutory or otherwise — should be all about protecting the public. The CNHC have touted for business on the premise that being able to display the CNHC logo (not Kitemark®) will also be a major benefit to their registrants’ businesses:

The quality mark provides an independent indication of quality to those wishing to use complementary and natural health services. You will also be able to use the quality mark on websites, promotional literature and elsewhere as confirmation to the public that you meet the standards set by the CNHC. By using the CNHC quality mark you are demonstrating to members of the general public and other healthcare providers that you conform to national standards of practice in your work.

Registration with CNHC will be seen as the gold standard for complementary healthcare practitioners. Members of the public will quickly be able to confirm that a complementary healthcare professional has met CNHC’s standards for safe practice. Other healthcare professionals will also use the register as a mark of quality when considering referrals to a complementary healthcare professional.

Now it seems that they can add something about a guarantee of efficacy for all claims made.

I wonder what, say, a reflexologist will now have to say on their website, advertising material or directly to the customer? Perhaps:

Reflexology feels nice and may relax you, but there is no evidence that it will affect/treat/cure/help/prevent any medical condition whatsoever and we do not and cannot claim or imply otherwise. In fact, the alleged method of action has no basis in medicine, physics, chemistry or biology. Reflexology is not a substitute for proper medical treatment. If you have a medical condition or are worried about your health, you should consult a registered medical doctor.

Of course, what reflexologist would want to work under such restrictions? They’ve been making unfounded claims for years and may be reluctant to start working to EBAM (Evidence-Based Alternative Medicine)? Even the thought of that was a million miles away just yesterday!

Will they now desert the CNHC in droves or reluctantly fall in with their new rules? We will have to wait and see.

Taking the lead

However, there are more serious implications.

If the CNHC do fully carry out their promises, we will be in the ludicrous and untenable position of the CNHC, being a voluntary, non-statutory regulator (although set up with £900,000 of public money) enforcing and regulating to far higher standards than the statutory regulator of chiropractors, the General Chiropractic Council.

Surely the General Chiropractic Council (and the General Osteopathy Council) now have no option but follow suit and issue similar robust, scientifically-based guidance to all its members and to the various colleges that train chiropractors.

At least, because the GCC’s Code of Practice explicitly states that all chiropractors MUST comply with ASA guidance, their job is easier — they already have the guidance in place. Now all they have to is start enforcing it.

If only they had done their job properly when they were set up, there would have been no need for my 524 complaints.

With the CNHC as a model regulator that now only accepts robust scientific evidence for claims made, where does that leave the Government’s desire to statutorily regulate all sorts of quackery as outlined in the Pitillo report and consultation?

It’s been a grim week for AltMed indeed, but a great week for science and for the protection of the public from misleading claims: this is one skeptic who also wants to formally record their thanks to Simon Perry!

7 thoughts on “What a week for quackery!”

  1. Thanks for this.

    I have trouble with these statements:
    “the ASA will only accept peer-reviewed evidence of — wherever possible — robust, applicable, double-blinded, randomised, controlled trials as substantiation for any claims made.”
    “CNHC will conduct a review of evidence base for regulated therapies.”

    In the first case, “wherever possible” leaves the door open to poor studies. What is their expertise? Also, quacks have their own “peer-reviewed” magazines and, when one is a quack one’s peers are quacks; i.e., incompetent to perform proper review.

    Furthermore, their understanding of blinding and controls (etc.) is substandard. For example, I recently reviewed “controlled, blinded” study where the control was not at all like the treatment and the blinding was only with respect to the person who collected the subject’s reports and entered the data.

    The statement by CNHC is similarly dubious because it is a quack organization and if they don’t always submit to the ASA, they are going to allow a lot of quackery. But, hey, they already do. If the CNHC cracks down, they may lose a lot of business (by which I mean their subscribers).

    So, it’s great that they upheld Simon’s objections; but how long and well will they do that? It is nice to see some quackery being limited.

  2. I don’t think CNHC will be around long enough to ‘regulate’ anything. The maths go something like this:

    Total funding £800,000 to £900,000 – Now almost all spent.
    Annual running costs approx. £350,000.
    Quacks who parted with £30 to join = less than 1500 in first year
    Total annual income approx £45,000
    No more funding after last £127,000 in April 2011.

    If they double their customer base in the next year they will STILL be going into the red to the tune of £250,000 PA

    No wonder the Department of Health don’t want the CNHC performance indicators released.

  3. JJM

    I was saying that there may well be some cases where RCTs are not the best way to determine whether or not a claim can be substantiated. However — particularly for quackery — the ASA has been pretty good at rejecting anything that isn’t robust, including studies only published in quack comics.

    Of course, many advertisers have tried to sway the ASA with poor quality evidence and OfQuack may well not go as far as the ASA might (but at least they seem to have consulted the ASA). Whether they go far enough is something we’ll need to look at once they start publishing anything. I would assume that, even if they don’t publish anything themselves, they will keep the DH informed so FOIA requests will be important.

    They are being watched closely and they know it.

    OfQuack got a mention on Monday at the House of Commons Science and Technology Select Sub-committee. After the less than impressive performances from the witnesses, I wonder if we could be in the situation where the Government continues to fund homeopathy on the NHS, but its ‘regulator’ doesn’t allow any claims for effectiveness to be made because there is no evidence for them?

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