Professor Joan Higgins, Chair of the Federal Working Group on Complementary Therapies, is in charge of setting up the Natural Healthcare Council (Ofquack). From April, this will be a voluntary self-regulated body that will be tasked with protecting the public from the dangers of alternative medicine. The Professor wrote to the Guardian today to complain about Polly Toynbee’s straight talking article,
I am sorry that Polly Toynbee feels that the creation of a new regulator “gives non-science a new authority”. As a lay person, I am certainly not able to judge the scientific validity of these therapies and this is not what my working group (to which she refers) was set up to do. I would ask her to consider an alternative scenario. Complementary therapists have been in practice for many years. There is public demand for their services and there is no move to stop therapists offering their services to sometimes quite vulnerable people. If complementary therapy is not to be banned, is it not, therefore, wise to regulate it and offer the public some measure of protection and a body to whom to complain if things go wrong?
The problem is that the Professor is not the only person who is ‘certainly not able to judge the scientific validity of these therapies’. No one involved appears to want to tackle the inconvenient problem that most alternative therapies do not work. But without acknowledging this, how can a regulator protect the public? If a homeopath advises a mother that sugar pills can be used to ‘treat’ their child’s asthma will the homeopath be in breach of any code? Their training as a homeopath may be thorough, their professional conduct may be solid – but their medical advice is appalling. Who is going to set the standards of what is good practice? Who is going to guard the standards that Ofquack guard?
Professor David Colquhoun is tackling this problem and is using the Freedom of Information Act to get to the bottom of this. His most recent blog post on the (Un)-Natural Healthcare Council is hilarious.
Professor Colquhoun believes that the whole regulatory infrastructure is unnecessary and that a strengthening of existing legislation would suffice. I would tend to agree with him and I have commented on these pages about the shortcomings of Trading Standards and the Advertising Standards Authority in dealing with quackery.
However, there may be other options. The Financial Services Authority has created huge upheavals in banking and lending over the last decade. In short, they have forced anyone offering financial advice to conform to standards of disclosure and product information. Anyone offering financial services must make an initial disclosure to their clients outlining the nature of the service they are offering, the method by which they will receive payments and commissions, how the service provider is regulated and how to make a complaint. When recommending a financial product, the advisor must present a Key Facts Illustration (KFI) document that outlines in standard terms the features of the products, the risk associated with the product, and full costs.
I see merit in exploring this idea for alternative medicine. In fact, this would bring CAM practitioners more in line with their hospital colleagues – it is giving their clients the information required to make informed consent.
In the USA, California have already introduced a similar scheme: California Senate Bill SB577 . The reason for introducing this bill though was rather different. Before that, people like Homeopath Dana Ullman got arrested for practicing medicine without a license. The Bill allowed people to practice CAM but within a legally controlled framework. This is not the same as self-regulation. This is external regulation.
There are some pretty sound elements to it, like making it illegal to:
- recommend the discontinuance of legend drugs or controlled substances prescribed by an appropriately licensed practitioner.
- …shall disclose in the advertisement that he or she is not licensed by the state as a healing arts practitioner.
Importantly, they have to perform a disclosure:
(1) Disclose to the client in a written statement using plain language the following information:
(A) That he or she is not a licensed physician.
(B) That the treatment is alternative or complementary to healing arts services licensed by the state.
(C) That the services to be provided are not licensed by the state.
(D) The nature of the services to be provided.
(E) The theory of treatment upon which the services are based.
(F) His or her educational, training, experience, and other qualifications regarding the services to be provided.
(2) Obtain a written acknowledgement from the client stating that he or she
has been provided with the information described in paragraph
I would go further than that list. For example, any attempt to undermine this disclosure or denigrate or undermine a person’s GP or their advice would be an offense.
As I believe that the biggest threat to homeopathy is people finding out what it is. I would suggest that the CAM Key Facts Illustration contained two extra elements: the theory behind the therapy and whether it is supported by science and the evidence base for effectiveness of the treatment. Obviously, such statements could not come from the practitioner themselves. We are trying to protect people from their non-medically qualified practitioners delusions. The MHRA could possible provide such statements for each therapy in the same way that the Financial Services Authority provide sample paragraphs for inclusion in mortgage documents.
I see the challenges here are with how to enforce this sort of regulation. What is to be avoided is any sort of licensing as this implies government approval. Can we find a way to carry out licensing in a way that does not imply endorsement? For example, Oxford City Council licenses a sex shop on the Cowley Road, apparently. (Ben Goldare tells me there is one there.) This does not imply that Oxford approves of any the appliances found therein. Do we need licensing? Trading Standards does not need a list of licensed plumbers to enforce various regulations. Who would pay for the extra demands on local councils? Maybe Sue Blackmore’s proposals to Tax the homeopaths would be required in parallel.