In doing so, the reports say she revealed that that her own son was autistic. She wants to raise awareness of autism and hoped the charity, which she is a patron of, would use the money to help other parents.

But the Quackometer’s alarm went off. The claims being made looked very questionable. Just exactly who are IPAN and what do they do?

For a start, IPAN do not appear to be targeting children with a diagnosis of autism. Instead, they claim that they can spot certain behaviours in 3 month old babies that may be a precursor to autism. They claim that if left untreated, autism will develop. They claim that they use a ‘psychodynamic’ method “that deals exclusively with emotions’ to correct these problems. They claim that they want parents to know that ‘autism is preventable’.

These are extraordinary claims and I see no good reason to believe they are true.

Autism is a range of developmental problems characterised by poor development in social interaction, communication and behaviour. In order for a diagnosis to be made, a child needs to get to the stages where a child’s development can be seen to be slower than normal. Three months is well before the age when a doctor would want to consider a diagnosis. Diagnosis is not made until a child is at least 2 or 3 years old. Children do vary in their rate of development, and development can slow down and speed up. Claiming that definitive signs can be spotted at a very early stage is highly questionable.

The treatments offered by IPAN also appear to be away from mainstream thought. IPAN links to another organisation at www.infantmentalhealth.com called the Parent Infant Clinic. Here, babies as young as 2 months, are treated with psychotherapy by practitioners “specializing in the emotional and mental health of infants”. The Parent Infant Clinic says it uses psychoanalytic tools to “gives us the ability to understand emotions and family dynamics”.

Psychotherapy is common in France as a treatment for autism. Sometime it reaches extreme levels which have been criticised by the Lancet as being cruel. Routinely, parents are seen as the cause of autism by providing poor interactions with their children.

Treatment is intensive at the clinic – with commitments required from the parents of many weeks. Parents of ‘pre-autistic’ children can expect “36 hours of therapeutic treatment per week for around three weeks”. They ‘talk’ to the infant using ‘psycho-dynamic skills’ and work with the parents and siblings ‘to understand their inner world’.

A number of references are cited to support the claims, mostly written by Stella Acquarone – who happens to be the Director of the Parent-Infant Clinic.

Indeed, Melanie Sykes is reported to say “It is very expensive so the charity raises money for people who cannot afford to put their children through the therapy.”

So, what are the concerns? If IPAN and the Parent Infant Clinic are not correct then something terrible is happening.

As a parent of a 2 month old baby myself, I can say that of course we are always watching our child’s development and naturally we are concerned that things progress as they should do. For some parents, that worry could get out of hand and then they could easily be sucked into believing their child is suffering from ‘pre-autistic’ symptoms. They could then embark on a course of treatment that would be very time consuming, hugely expensive and disruptive of normal family life.

How would they know that the programme had been effective? Since no accepted diagnosis has been made, then a normal development cannot be seen to be a success. Why could that normal development not have happened anyway? If there are developmental problems with a child and this therapy is not effective, then the parents may be denied the chance to access mainstream advice and help having been drawn into the world of psychotherapy.

Indeed, a closer reading of the Melanie Sykes article reveals that indeed her own child has not yet had an official diagnosis of autism, but that she believes her seven year old has been helped by the clinic. Having been told by the clinic that there were problems, and after some extensive therapy, her child’s speech progressed rapidly. I am sure you can see the problem here.

The newspaper articles in the Sun and Mail are misleading by leading with the headlines about Sykes having a child with Autism when no such diagnosis has been made. They are also being careless by not making clear that the treatments being discussed are not mainstream and would be disputed by experts in the field.

As we saw with the Observer Burzynski fiasco, the media easily falls for stories about charitable giving for children with illnesses with celebrities doing their bit to help. It is an area that needs special care, as those selling unconventional and unproven treatments can easily slip under the petticoats of charity and collect large amounts of money for their own private clinics.

Related posts:

1. Life’s 4 Living: Audiokinetron and Lumatron Nonsense A bit of a ding dong has started up over at HolfordWatch after they questioned some of the activities of a charity called Life’s 4 Living. There is now a...
2. Broccoli for Brains Last Friday, saw Trevor McDonut’s ‘Tonight with’ programme showcase Patrick Holford’s ‘Food for the Brain’ charity and its involvement with a school. The school apparently saw lots of improvements with...
3. Chinese Whispers – MMR and the Press Just a few days before Andrew Wakefield appears before the GMC disciplinary body on charges of misconduct, a front page article in the Observer makes fresh claims of links between...

Online reviews of products and services can often be misleading as you do not know anything about the reviewers motives and depth of experiences. More often than not, I find myself wondering if reviews say more about the reviewer than the product. So, it’s good to see independent consumer organisations such as Which? systematically review and rate competing products.

One thing did strike me though, and that is that Which? tend not to focus on dodgy health product claims. I had put this down to simple commercial reasons. When you write a bad review of a bogus toaster which has a tendency to burst into flames, or a pushchair that happily chops off babies fingers, you are unlikely to get cancelled subscriptions from people who own those products. But those who have bought into the cult-like beliefs of much alternative medicine are going to get angry, upset and believe Which? is now in cahoots with Big Pharma.

So, I am very pleased to see that Which? have done some great investigative journalism into nutritionists. The results are shocking.

Well, they will not be shocking to you if you have been reading stuff like Ben Goldacre’s Bad Science.

Nutritional therapy is a form of karaoke medicine. The practitioners go through all the motions of looking like they know about science, diet and health, but what they actually do is spout painful nonsense. Sometimes dangerous nonsense.

Which? sent five of their reporters undercover to pose as patients. They visited a total of 15 nutritional therapists. The reporters posed several health issues such as having breast cancer, suffering from long lasting fatigue or having problems conceiving.

Out of the 15 therapists, 6 of them gave advice that Which? scored as a ‘dangerous fail’. This included advice to delay radiotherapy treatment and instead try to cure the cancer by cutting sugar out of the diet. Another advised the reporter not to report feeling unwell to their GP as they would not understand the diet they were to be placed on.

A further 8 therapists gave advice classed as a ‘Fail’, including offering quack diagnostic tests such as Hair Mineral Analysis and Iridology. One woman was told she could not conceive as she was suffering from a ‘leathery bowel’.

Twelve of the consultations resulted in patients being sold vitamin and mineral supplements costing up to £70 per month. In general, Which? said,

Most therapists over-simplified symptoms and failed to recognise important ‘red flag’ symptoms requiring proper medical attention. Their medical explanations, understanding of how the body works and their knowledge of vitamins and minerals was also poor. One therapist told Mark that weight had nothing to do with type 2 diabetes and another told Helen that alcohol is not a risk-factor for breast cancer.

Out of the 15 Nutritional Therapists visited, only 1 gave ‘Borderline Pass’ advice.

Which? is now demanding the government properly regulate the sector. Their Executive Director, Richard Lloyd said,

We found some shocking examples of irresponsible advice given by nutritional therapists. Our research shows that not only were they a waste of money, but some of their recommendations could seriously harm people’s health.

This is largely a self-regulated industry where anyone can set up and practice as a nutritional therapist, meaning there is no real protection for consumers. While the majority of the therapists Which? visited were registered with the industry body, BANT, our findings show that it is failing to police these practitioners effectively.

“Which? wants the government to take action to stop nutritional therapists putting people’s health at risk.

There is a huge danger in advocating ‘better regulation’ for practitioners of superstitious and pseudoscientific therapists. In short, regulating nonsense just results in legitimising nonsense.

Nutritional Therapists claim to be regulated right now. BANT, the British Association for Applied Nutrition and Nutritional Therapy, claims to have a code of conduct and regulate practitioners. BANT did not respond to Which? when challenged about these results. That is, I believe, because Nutritionists see this type of advice as good advice. Nutritional Therapists have cult-like and conspiratorial beliefs that mean they think mainstream doctors know nothing about nutrition and are covering up ‘natural’ health cures to protect pharmaceutical company interests.

And while they look to the money obsessed evils of Big Pharma, BANT specifically allow kick backs from vitamin pill sales to their customers. No wonder this survey saw so many being sold.

Of course, there is a proper statutory regulator for those wanting to give dietary advice in a clinical setting. The Health Professions Council regulates dieticians – it is illegal to call yourself a dietician without being registered. In contrast, anyone can call themselves a nutritionist regardless of training or affiliation with any so-called regulator.

Several government attempts have already been tried to create regulators for quack therapies. Ofquack, or the Complementary and Natural Healthcare Council, was set up by Prince Charles and funded by the Department of Health. The CNHC have been limping along for years now and have failed to persuade many nutritionists to be their regulator.

The CNHC (http://www.ofquack.org.uk)  have also been a complete failure in understanding how they need to protect the public. They have decided that they cannot make their registrants to stop making misleading claims. They also appear to have a problem finding fault in their members if they have been trained to believe their own misleading claims. As such, Ofquack are incapable of protecting the public from the sort of problems raised by Which? Nutritionists are trained to believe all sorts of nonsense about diet. Regulating them without considering whether what they believe to be true is giving them a fig leaf. Clearly any form of voluntary regulation would fail.

But what of statutory regulation? That has problems too. Chiropractors have also been statutorily regulated. But as another placebo therapy, regulation has not stopped them making very serious bogus claims over the years. It was only when the chiropractors decided to sue Simon Singh for pointing this out that all this came to public attention. Since then, the British Chiropractic Association has been humiliated and their regulator, the General Chiropractic Council exposed as a chocolate teapot.

Such situations are bound to occur when you attempt to regulate nonsense. You don’t stop the nonsense being believed and practiced, and any attempt to clear it out would quickly result in the end of the regulator.

So what to do? It is worth pointing out the vast gulf between Dieticians and Nutritionists. Should statutory regulation of some sort be placed over nutritionists, we would essentially have two regulators for people who wish to offer healthy eating advice to the public based on very different worldviews and attitudes to evidence.

I feel it worth repeating some words I wrote several years ago when I was writing about Patrick Holford.

So, we have two worlds in the UK. Worlds with very different views on how food and diet affects our health and how we can manipulate diet to improve our health.

The first world is typically populated by scientists and dieticians. They take an evidence-based approach to understanding food and are cautious in coming to conclusion where there is insufficient data. They work in clinical practice, in hospitals, universities and on an NHS wage. They advise on good, affordable and understandable diets, and treat patients who are sick and need careful advice on their road back to health. They concentrate on the overall diet and not on an obsession with nutrients. They are regulated under law, have transparent and meaningful governing bodies. They are accountable for their actions and can be struck off if they fail in their duties. They promote their work in science journals. They share their canteens with nurses, surgeons, medical students and doctors.

The second world is populated by lawyers, accountants and journalists that have undertaken a career change. Younger students enter independent nutrition colleges and need little scientific training to do so. If they don’t get training, they add ‘Dr’ to their name anyway and get a contact with Channel 4. They selectively pick evidence that suits their alternative philosophies and learn to be suspicious, if not downright hostile, to science and medicine. They work in private practice and sell food supplements, questionable allergy tests and hair mineral analyses. They confuse allergy and intolerance, and fetish on vitamins and minerals, whilst advising clients to remove whole food groups from their diets. They sell their business to the worried well and poke around in their poo. They are not statutorily regulated and so lack that accountability. They promote their work in newspapers and magazines. They share their Richmond bistro with reflexologists, personal trainers, homeopaths and TV producers.

One way out would be to include the words ‘Nutritionist’ or ‘Nutritional Therapist’ in exactly the same legislation as exists for Dieticians. Nutritionists would require the same education, standards of professionalism and approach to evidence. This would essentially immediately criminalise the second  group and ensure the public are never confused about the two groups.

Such a move would be very heavily resisted by the nutritionists of course. They would not want to abandon their unevidenced and whacky beliefs about vitamin pills. And I suspect, the government would have no appetite to increase the burden of legislation on them.

I fear, that although this Which? report has been very good, it may well hasten government action towards mere legitimisation of dangerous health beliefs through ill thought through regulation. And that will not be in consumers’ interests.

*************************************************************************************************

David Colquhoun, who helped advise Which? on this report, has also written about their findings here.

Related posts:

1. Nutritional Therapists Fail to Join Ofquack The Complementary and Natural Healthcare Council, Ofquack, is having an appalling start to its life. Needing 10,000 people to join its register in the first year to break even, it...
2. Alleged Victim of Oxford Nutritionist ‘Detox Diet’ wins £810,000 Barbara Nash is a nutritionist based near Oxford. Dawn Page was overweight and sought the advice of Nash. It is alleged she was put on a ‘detox diet’ which included...
3. Andy Burman Resigns From Ofquack Andy Burman, Chief Executive of the British Dietetic Association, appears to have resigned his post from the Complementary and Natural Healthcare Council (Ofquack). This news follows my recent criticism...

Written by Stephen Pritchard, the Readers’ Editor, the response attempts to justify its coverage and blames bloggers for “aggression, sanctimony and a disregard for the facts”. It is a disgraceful and self-serving response. Pritchard claimed their story was one of “courage and generosity”. No it was not. It was a story of exploitation of courage and generosity. The Observer still fails to understand this.

First of all, and let’s get this out of the way, as Pritchard himself admits, he has a conflict of interest. His son plays in the band Everything Everything which held a benefit gig to raise money to send a sick child to the Burzynski clinic. The original article was written by the Uncle, Luke Bainbridge, of the poorly four year old who also happened to have been the Music editor for the Observer. This involvement with such an emotive issue should have required more dispassionate voices at the paper to respond.

The response fails to address the serious concerns raised about the article, and instead appears to attack those concerned for insensitivity and a lack of understanding. This is incredible. I have found almost without exception, the dozens of blog posts written about this story to be compassionate, insightful and targeted at those who should have known better – not the families of cancer sufferers – but those promoting the clinic, raising money for untested treatments, and the clinic itself.

When I first broke the story of the Observer’s coverage, I received around about 4,000 views of that story on that day. After the Burzynski Clinic tried to threaten my family, and the story went viral, I have received close to 200,000 page views. Within that readership, if a few have acted insensitively, I am appalled, but I am not surprised. I understand someone tweeted a family attending the clinic – very poor judgement – but hardly representative of the wave of sympathy that has been extended to people in this appalling situation.

I also must say that I have been contacted on twitter  by one family attending the Burzynski clinic. The writer claimed to be harassed by the blogs and asked me to stop. I have never written about this family and do not intend to. But, the fact that I have been highly critical of ‘her choice of doctor’ appears to her that I am harassing her. Of course, I do not intend to. Nor do I want a public debate with her. I can fully understand that the decision to go to Texas has resulting in huge emotional and financial investment and created a hope for the future. The public debate needs to be had with those who wittingly or unwittingly support this clinic and make the huge payments possible.

But as one twitter user this morning asked, “I wonder if the Observer will be doing article on the difficulty the Nigerian Royal Family have getting money out of country?” That remark is not as flippant as it may appear. When we see people making bad decisions, or decisions based on misleading or incomplete information, are we to remain silent and see them come to harm? No one likes it being pointed out to them that they may have been misled. And no one wants their hopes taken away. But to write a ‘human interest’ story about their journey into misadventure without pointing out the dangers in their decisions is not “human interest”, but complicity in misinformation.

The article fails to get to the nub of the concerns with Burzynski. First and foremost, the dubious ethics of charging parents of terminally ill children, hundreds of thousands of dollars, to enroll them in trials for a treatment that has failed to demonstrate any good evidence that it may be effective over 30 years. Burzynski is running a private clinic. He sells anti-aging creams, vitamins and supplements. He is under investigation by the Texas Medical Board. These are a few of the many red flags that ought to raise deep concerns. Even if he is on to something with his antineoplastons, he is asking the terminally ill to provide the investment funds for his research programme. His patients are taking all the risks, both with their health and wealth. He is reaping rewards whether he is right or not. Such actions go against the fundamentals of medical ethics.

Pritchard justifies the approach by saying “the point that is being lost in the vitriol that is flying around the internet” is that the treatment provides some hope for the parents.” My original article suggested that it was cruel to raise false hope. The costs involved are not just financial, but carry pain and risks for those being treated. In any medical treatment decision, there are benefits and risks. At some point, a balance needs to be struck. A glimmer of hope cannot be a full justification. Ken Murray has written recently how doctors tend to take fewer and less aggressive treatments at end of life. They better know the balances of risks and benefits, and can better decide on the trade offs between quality and quantity of life. When we come to terminally ill children, the issues are different. Their decisions are made for them. The balance tends to shift towards an all out attempt to give quantity of life over other factors. Straws are clutched at and these decisions may not always be in the child’s best interest. It is these perfectly natural and desperate decisions that unscrupulous or incompetent people may trade off.

I do not know the answers. But these discussions need to be had. And they need to be had in the context that there are peddlers of miracle cures out there, that may appear genuine to a desperate eye, but offer nothing but anguish, false hope and bankruptcy.

The Observer’s response not only failed to look at these issues, but took issue with those people that tried to. Most disgracefully, they attacked the 17 year old blogger, Rhys Morgan, for saying in his Guardian CiF article about libel threats from Burzynski, that the family had researched Burzynski on the internet. The family appeared to take issue with this and the Guradian has amended the article to say “The family has asked us to make clear that members of the family completed a long and thorough period of research across a wide range of conventional and alternative treatments, both in the UK and abroad, before approaching the clinic.”

Is this the justification for calling bloggers like Rhys, “aggressive, sanctimonious and having a disregard for the facts?” You should read Rhys’s blog and articles and decide for yourself. The response also failed to note how Rhys had been threatened by representatives of Burzynski by sending him pictures of his house. This is not science and medicine, but gangersterism. Let me remind you, Rhys is still at school. If there has been aggression against children, it has not come from bloggers.

The article leaves several assertions still unchallenged. They claim that “[we] know it is unproven, but there are other families in this country who were told by their hospital that their condition was terminal and nothing could be done for them, but were then treated at the clinic and survived.”

This is a misleading statement and may encourage other down this dangerous path. All we have is a few case reports from Burzynski that do not bear much scrutiny (read this oncologist’s summary). This is the sales pitch of the clinic, not evidence of effectiveness.  One blogger looked at all the media coverage of fund-raising for Burzynski and said, “In fact, every single patient that I have found in media coverage of Burzynski for the past 10 years, with a sole exception, is dead.”

It is unlikely that the Observer will respond with a better article. They have form for not backing down when they report dubious alternative medicine claims (MMR). It would have been nice for future parents of very poorly children to see the Observer cover the risks of choosing such unconventional routes. But instead, they will see a myriad of well researched, compassionate and thoughtful articles on blogs when they do research on the internet, as they undoubtedly will. And that unfortunately, makes the Observer redundant. And in a time when newspapers are struggling to cope in the digital age, I cannot see how that is a good thing.

Related posts:

1. Dr Hilary Jones Promotes Questionable Burzynski Clinic on TV There is a stark and inexplicable difference in how the mainstream media and bloggers have been covering the Texas based cancer clinic of Dr Stanislaw Burzynski. There has been an...
2. Burzynski in Court: Patient treated like a ‘Cash Machine’ Dr Stanislaw Burzynski has some problems. His forthcoming hearing with the Texas Medical Board has been widely publicised.  It would now appear that he has more immediate concerns. According to...
3. The Burzynski Clinic Threatens 17 Year Old Blogger I have been hinting that Burzynski has been threatening other prominent UK bloggers. Well, that blogger has now gone public. Rhys Morgan Rhys Morgan is a 17 year old schoolboy...

Rhys Morgan

Rhys Morgan is a 17 year old schoolboy from Wales. He has a keen interest in quack remedies, having been exposed to many through his own health problems with Crohn’s Disease. He hit the headlines on the BBC last year for exposing the bizarre world of a quack cure called Miracle Mineral Solution, that had been touted to fellow Crohn’s sufferers.

Rhys not only blogged about this dangerous form of quackery, but lobbied Cardiff City Council to persuade them to get the Trading Standards Authority involved. For his efforts, the James Randi Educational Foundation awarded him him the Grassroots Skepticism prize at the London Hilton Metropole. The BBC reported that Rhys would go onto tackle more ‘miracle cure’ web sites.

The Blog Post

So, Rhys wrote about (see here) the Texas based clinic of Stanislaw R. Burzynski, M.D., Ph.D who offers a urine based therapy as a cure for cancer. In his article, Rhys discussed Stan Burzynski’s “antineoplaston therapy”. He highlighted the recent examples in the press of where a teenager in Ireland with a brain tumour was having €120,000 raised for him to be sent to the Burzynski clinic, and also the case of a young mother in the UK whose family was trying to raise £95,000 to be sent to America “as the NHS does not fund this treatment.”

The problem is, as Rhys noted, is that antineoplaston therapy is considered an unproven treatment based on a hunch. Burzynski has been conducting continuous clinical trials on his therapy. Indeed, it would appear that the only way to get treatment is to enrol in a trial – and then pay for the trial yourself. The results of these trials have not convinced other researchers. The American Cancer Society states that “Most cancer specialists believe there is insufficient evidence to recommend use of antineoplastons.” They note that even alternative medicine enthusiasts are wary of this treatment with Dr Andrew Weil saying, “I see no reason for any cancer patient to take this route.”

Rhys’s article is thoughtful but direct. Of the patients he mentioned, he says, “I hate the idea of taking away someone’s last hope. Even though this is false hope, I still hate taking it away.” But he fears that misleading desperately ill patients is even worse. I too share a contempt for those who seek to take huge sums of money off the dying by offering vain hopes through unproven cures. I get family members writing to me on this web site after loved ones have been dragged into quack cures during their last months, wasting money that surviving families really need and wasting time that could have been better used being close to those you love.

It is therefore no surprise that Rhys noted Burzynski conviction for fraudulently claiming money from an insurance company and hence saying “I take no issue with calling Stanislaw Burzynski a quack and a fraud.”.

The Threat from Burzynski

A few weeks ago, Rhys received an email from a Marc Stephens who stated that his post and tweets were “in violation of several state and federal laws.” and that he “immediately cease and desist in your actions defaming and libeling my clients.”

The letter gave Rhys a bit of a lecture of US law on libel seemingly unaware that they were talking to a 16 year old school boy who was not resident in the United States. The letter ended with the threat, “ I suggest you remove ALL references about my client on the internet in its entirety, and any other defamatory statement about my client immediately, or I will file suit against you.”

“GOVERN YOURSELF ACCORDINGLY.”

You might have seen similar threats elsewhere.

Rhys is a bit of a smart chap. But receiving this is not pleasant. It could have threatened his entire wealth of a few hundred pounds in a savings account. Furthermore, it offended his sense of justice and ethics to take down an article that he felt was entirely justified on the basis of a broad threat that failed to identify anything that was factually incorrect. Instead, Rhys noted the rather odd statement in the letter that “Every comment you made in your article is highly incorrect.” He knew this was not true.

A quick bit of Googling by Rhys revealed that Marc Stephens did not appear to be a lawyer but was employed by the Burzynski Clinic for the purposes of Marketing and Sponsorship.

Rhys responded saying that he had to finish school that day before he could do anything. Stephens responded asking Rhys to “Please forward the notice to your parents if you are actually in High School. This is a very serious matter. “ and then demanded that Rhys “provide a public apology to Dr. Burzynski and his patients and post it on your websites, and social media sites.”

All very odd behaviour.

So what to do?

Rhys has many good friends. He contacted myself for help. He spoke to Simon Singh who had been through a two year ordeal when the now totally discredited British Chiropractic Association tried and failed to sue him for defamation. He got some good advice.

Taking down his blog posts appeared to be a sensible thing to do in order to show good will whilst the problem was explored. That goodwill has not been extended back. So, Rhys has now republished and added a commentary. You had best read it.

My take

Rhys is a bit of an hero. With his campaigns to close down the dreadful Miracle Mineral Cure, he has undoubtedly helped many very poorly people from being duped into taking dangerous quack medicines.

You know what? It is just likely that at 17 years of age, Rhys Morgan has already saved more lives by simply speaking out than Burzynski has in three decades with his fixation on his “antineoplastons.”

Related posts:

1. The Burzynski Clinic Threatens My Family. Tonight, the entertainer Peter Kay will be performing the first of two special sell-out gigs in Blackpool to raise funds for a very poorly four-year old girl with brain cancer....
2. Burzynski Clinic Issues a Statement What to make of the press release issued by the Burzynski Clinic? Well, the good news is that Marc Stephens, the PR man who threatened my family, has had his...
3. The False Hope of the Burzynski Clinic Yesterday’s Observer contained a full page, heart breaking story of a 4-year old girl, Billie Bainbridge, who has a inoperable and rare form of brain cancer, Diffuse Intrinsic Pontine...

It is difficult to know precisely what has happened. But there now appears to be no trace of its existence.

Previously, only a few years ago, the British Homeopathic Association were boasting of five NHS hospitals dedicated to homeopathy. It now only lists three. We know that Tunbridge Wells closed after West Kent PCT withdrew funding. So, what happened to Liverpool?

Of the remaining three hospitals, it is now difficult to call them dedicated homeopathic hospitals. The Royal London Homeopathic Hospital changed its name to the Royal London Hospital for Integrated Medicine to reflect the fact that homeopathy was becoming less important as fewer referrals were occurring and other forms of quackery were taking over, such as acupuncture, aromatherapy, reiki and reflexology. This week we learned of the closure of the Glasgow NHS Homeopathic Pharmacy within the “Centre for Integrative Care” formerly known as the Glasgow Homeopathic Hospital. At Glasgow too, it would appear that the authorities are declining to fund homeopathy, and so to survive, they to are taking referrals for other ‘integrated’ therapies.

In recent years, it has always been a stretch to call the clinic in Liverpool a Homeopathic Hospital. It was once a proud and important institution that could trace its origins back into the first half of the Nineteenth Century. In reality, the hospital really closed in the 1970’s as it was merged as part of an NHS reorganisation. But vestigial remnants held on within the NHS and continued the name of the hospital by holding a clinic at the Old Swan Health Centre, a GP clinic. That clinic now makes no mention of homeopathic services.

My guess is that the remaining champions of 19th Century superstitious therapies within Liverpool have now retired or moved on. (If you can confirm this I would be grateful).

It is tempting to think of the NHS homeopathic services as being rather benign and maybe even useful places for people with chronic illnesses who can have a nice chat, a cup of tea and leave with a vial of harmless (and useless) sugar pills.

If Liverpool was offering that, then it was also offering much more troubling services. The Old Swan Health Centre was also offering superstitious treatments for cancer. I reported how the clinic had been offering the mysticism of Rudolf Steiner in the form of injection of mistletoe extracts. (Archived NHS information here.) Steiner thought that mistletoe was like a cancer on trees, so using the homeopathic principle of ‘like-cures-like’ he thought mistletoe would be a cure for cancer. Just two years ago, Liverpool NHS PCT was still offering this insane treatment.

The past year or two have been hard for the Old Swan as PCTs in the area debated withdrawing funding for referrals for homeopathic treatment. Despite the ‘grassroots’ Friends of North West Homeopathy putting up a fight, and kindly in association with Weleda, the $300m Steinerist company who makes mistletoe injections, it would appear that their efforts have been for nothing.

So, we should welcome the eventual quiet fizzling out of this tiny corner of delusion with the NHS. Not only does homeopathic thinking directly threaten peoples’ lives, it undermines peoples’ understanding of science and medicine by offering a worldview that believes there are alternatives to evidence based medicine that closed minded doctors somehow ignore.  That is a harmful worldview that leads to all sorts of pain.

Related posts:

1. Liverpool NHS PCT Drops Supernatural Cancer Claims from Website Six weeks ago I wrote about how Liverpool Homeopathic ‘hospital’ was advertising that it offered cancer treatments based on the supernatural beliefs of mystic Rudolf Steiner. Observing that mistletoe grew...
2. Any Willing Quack. Liverpool PCT look to Commission Homeopathic Services I do not have a crystal ball. And I have no idea how the current farcical reorganisation of the NHS will end up. But last September, I was worrying...
3. Are There Any Homeopathic Hospitals in the UK? The publication of the report of the House of Commons Science and Technology Committee Evidence Check into Homeopathy has resulted in a lot of misinformation about how much public...

The ratchet on NHS homeopathy continues to turn. It would appear that the homeopathic pharmacy at the Glasgow Homeopathy Hospital has been closed.

A note to local GPs is reminding them that they have no obligation to fill the hole left by this closure by prescribing homeopathy if patients ask for it.

The Glasgow Local Medical Committee notes that there has been a sudden surge in requests from patients to prescribe homeopathic sugar pills after they have been unable to get them at the hospital.

The Glasgow Homeopathic Hospital began its life as a homeopathic dispensary in 1880. According to the historian of homeopathy in the UK, Peter Morrell, the hospital grew rapidly in the 1930’s and finally moved to its current location, at the Gartnavel General Hospital Site, in 1999.

After spending millions on the designer facilities at Gartnavel, the running costs have been around £2 million per year. But now, the hospital appears to be in almost certain terminal decline.

Scottish commissioners have been refusing to pay for patients to be referred to the homeopaths and the BMA has called for all health boards to stop funding. Certainly spelling eventual doom was the decision to stop paying for doctors to be trained in homeopathy at the hospital.

Closing their own pharmacy was undoubtedly a way of saving precious cash. However, without patients being able to access their sugar pills immediately, the ability for doctors to play at homeopathy is being squeezed. As the note to GPs makes clear, they are under no obligation to fill the gap. The letter states,

GPs have no obligation to prescribe homeopathic remedies where they do
not feel competent or trained to do so or if they do not believe them to be
therapeutic.

The fact that a GP agreed to refer a patient to the Homeopathic hospital
does not oblige the GP to issue a homeopathic remedy.

However, if a GP wishes to prescribe a homeopathic remedy, a prescription can
be written in the normal way.

Patients will now be dependent on GPs feeling confident they can ethically and competently write a homeopathic prescription. What is a shame is that the letter still panders to the idea that you can obtain competence by being trained in homeopathy. A trained homeopath is no more able to get their sugar pills to work than a trained astrologer is able to predict the future. It is a training in delusion.

Most GPs will know this and so patients may be in a tight spot.

Outside of the NHS, sourcing homeopathic products looks likely to get harder and harder. On Monday, the medicines regulator, the MHRA, stated that it had told Boots the Chemist to remove all point of sale material describing claims for homeopathy. Boots had been breaking the law regarding making unlicensed and unfounded claims for the sugar pills. Without such point-of-sale material, it is difficult to see how homeopathy on the High Street can be profitable as it will now rely on customers being confident in the esoteric knowledge about what each remedy is supposedly for. Boots almost certainly was relying on customers being confused into thinking that because they were ‘reputable’ and that the sugar pills were sold next to genuine medical products that they actually worked and were not superstitious nonsense. (You can check on your own local Boots with the help of this letter from the Nightingale Collaboration.)

Over the coming months, we are likely to see greater pressure on the MHRA to clamp down on the widespread ignoring of the law by retailers of homeopathic products. I would not be surprised if we saw some business failures of the few homeopathic product manufacturers in the UK.

But back to the NHS. What the Glasgow Homeopathic Hospital does is wrong. And so its troubles are to be welcomed. The British Homeopathic Association, the lobby group for doctors stuck in the intellectual black hole of homeopathy, states that Glasgow focuses on helping people with chronic fatigue syndrome. Now, whilst it is true that mainstream medicine has few answers for this condition, this does not justify funnelling such patients into the hands of doctors who think sugar pills are the answer.

No doubt, the hospital will be able to claim patients are very satisfied with their offering. But this is problematic on two counts. Firstly, I have no doubt that the staff at Glasgow offer good care – but care is not the same as treatment. And secondly, CFS is a hard to understand condition where some patients can be violently opposed to the idea that their illness may have a psychological component. Researchers have been abused and received death threats for publishing studies that challenged popular ideas that the illness is caused by a virus.

No doubt patients may find some affinity with the homeopathic hospital that offers a pill for their ill and in doing so is ‘taking them seriously’. But such an approach may actually be further medicalising CFS patients and could be reinforcing harmful beliefs.

Homeopaths claim to treat ‘the whole person’. This is a lie. This is not patient-centred medicine. It is dogma-centred pseudo-medicine. No matter who walks through the door, a sugar pill will be waiting for them. Or rather, it would have been. And that is a step in the right direction.

Related posts:

1. 10:23, Homeopathy and the Shame of the Pharmacy Profession This Saturday, hundreds of people, in many cities,  will be demonstrating outside Boots the Chemists about their selling of homeopathic remedies. Each volunteer will be taking a homeopathic ‘overdose’...
2. That’s It for Tunbridge Wells Homeopathic Hospital Reported today in Pulse, Campaigners look to have lost their fight to save a leading homeopathic hospital, in a landmark case that accelerates the treatment’s deepening crisis over NHS funding.West...
3. Boots Giving Away Worthless Therapies Thanks to Lee Warren, the Purple Magician, who saw this in King’s Cross, London. Trust Boots to be complete idiots. Double Idiots. ...

There are many aspects of this new bill that look likely to shift the balance in the situations I describe below. In particular, the new draft bill requires a test of ‘serious and substantial harm’ to be shown. Public interest defenses are to be strengthened and requirements made that alleged defamatory words be read in the context of the article and not on their own.

I welcome the recognition that costs are a serious issue here. In urging changes to the law, I am not calling for an end of the ability for people in alternative medicine to sue for libel (as many have tried to mis-characterise). It may well be that I get things wrong. I want to ensure there are quick, affordable and sensible ways that people can settle problems. (The first one is a requirement that concerned people write to me with their complaint – something that often does not happen).

There is still much to do. Most importantly, it is vital that the draft bill gets included in the Queen’s Speech. A well balanced libel law that has fast and inexpensive remedies will benefit everyone – with the exception of those who cannot bear scrutiny and wish to silence public debate with intimidation and threats.

The Impact of Libel Laws on Bloggers

Introduction

1. The following case studies are examples of how current libel laws have personally affected me and my blogging activities.

2. My name is Andy Lewis and since 2006 I have been writing a regular blog at quackometer.net. The subject matter of my blog is an examination of superstitious and pseudoscientific health beliefs (often known as Complementary and Alternative Medicine), the potential harms that such beliefs can hold and the role of authorities and regulators in mitigating such potential harms.

Case 1: The Society of Homeopaths

3. In August 2007, I wrote a blog post entitled The Gentle Art of Homeopathic Killing. The subject of the post was to examine the role of the Society of Homeopaths in regulating its members. A year before, the BBC Newsnight programme had investigated homeopaths in the UK who appeared to be offering dangerous advice to travellers to malarial areas. In particular, there was concern that it was routine for homeopaths to suggest homeopathic sugar pills could protect against serious travellers’ conditions. Despite finding many examples, the Society of Homeopaths did not take any action against its members who were exposed by the programme.

4. I had concluded that despite the Society having a Code of Ethics that prevented its members from acting in certain ways, this code was never upheld and that homeopaths were free to practice as they saw fit. As such, such as code might give false assurance to the public that homeopaths were under appropriate scrutiny when they were not. In order to test this, I examined a particular member’s claims and how they might be breaching the Society’s Code of Ethics. The homeopath concerned was advertising that they could treat childhood asthma in the UK, and had been to Kenya to work at a clinic specializing in the homeopathic treatment of malaria, TB and HIV – activity that I suggested were likely to put lives at risk.

5. The first I knew that there was a problem with this post was on the 4^th of October when I was contacted by my web hosts, Netcetera, alerting me that they had received a letter from the solicitors of the Society of Homeopaths (Howes Percival) requesting that they considered my post defamatory and that Netcetera should remove it. Netcetera say they have a policy of first asking the author to ‘come to an agreement’.

6. I immediately wrote an email to Paula Ross, the then Chief Executive of the Society of Homeopaths, asking her to clarify the nature of their complaint and to explain why they viewed the article as defamatory. I wrote “If you could tell me urgently what the wording is that you feel is incorrect, defamatory or not fair comment I will examine it immediately and will ensure a friendly and swift resolution of this matter.”

7. The Society did not reply to me. Instead, Howes Percival wrote to Netcetera again saying that the letter to ask for clarification was “inappropriate” and that all correspondence should go through “the firm”. I was included in the email and this was my first communication from the solicitors. At no point here or subsequently did the Society clarify the nature of its concerns or allow me any possibility to address them. The letter repeated the demand that the ‘material be removed’ and pointed out to Netcetera that Godfrey vs Demon showed that Netcetera would be liable for the material hosted on its sites. The threat was made that if the post was not removed by the 11^th then ‘our client will have no option but to take immediate legal action against Netcetera and the Website’.

8. As neither I nor Netcetera were given any chance to address the concerns and, as the alternative was the suspension of my account by Netcetera, I had no option but to remove the material.

9. I was paying Netcetera £10 per month to host the Quackometer and various other sites I had constructed for friends and an elderly persons’ charity.

10. A number of people had heard about my predicament and as soon as they saw my post had been removed, found copies in the Google cache and reposted my article on their own web sites. Within a few days, over 64 copies had been reposted over the web after support from such people as Ben Goldacre from the Guardian and the blog of Professor David Colquhoun FRS.

11. This support, whilst welcome, was also disconcerting as it was very unclear how such multiplication of any alleged libel would be viewed by the courts should the Society wish to pursue me.

12. As of today, the phrase “The Gentle Art of Homeopathic Killing” returns 20,900 hits on Google.

13. The Society of Homeopaths wrote to the Guardian after Goldacre’s article was printed. It is worth quoting the relevant parts as it is the only place where the thinking of the Society is explained:

The Society of Homeopaths took the content of the 2006 BBC Newsnight programme on malaria very seriously and responded via press statements and media interviews promising action if it were required. We contacted the programme makers directly to ask for their evidence that any Society members had given dangerous or misleading advice to members of the public. They were unable to provide a single example. The Society’s professional conduct procedures cannot be invoked without a specific complaint, an alleged offender or any evidence. In these circumstances, The Society was unable to investigate a specific case. Nevertheless, as a further precaution, we reissued our Guidelines on advice for the prevention of malaria and sent a copy to every member within a day of the programme being aired.

The Society instructed lawyers to write to the Internet Service Provider of Dr. Lewis’ website because the content of his site was not merely critical but defamatory of The Society, with the effect that its reputation could have been lowered. Dr Lewis, in his article, stated as fact highly offensive comments about The Society and it is for that reason that The Society decided it had no option but to take action. The very crude abuse posted on various websites and e-mailed to The Society since our action suggests that these bloggers/authors are not people who are interested in a real debate on the basis of either science or the public good but who simply want to attack homeopathy, for the very sake of it.

14. This episode came to an end when I obtained emails from the BBC Newsnight team that came from the Society of Homeopaths showing that the above statements were very misleading. The Society had acknowledged receipts of transcripts of the undercover conversations with their members, including a Fellow of the Society of Homeopaths. It was simply not true that the Society was unable to investigate any cases, and indeed in the Society of Homeopaths Newsletter (Winter 2007) they told their members that ‘the researchers identified three of our members”.

Case 2: Professor Joseph Chikelue Obi FRCAM

15. Joseph Obi, or as he prefers to style himself, Distinguished Provost of RCAM (Royal College of Alternative Medicine) Professor Joseph Chikelue Obi FRCAM(Dublin) FRIPH(UK) FACAM(USA) MICR(UK), used to be a doctor in the UK until he was struck off by the GMC after serious professional misconduct at South Tyneside District Hospital in 2003. He was alleged to have had inappropriate relationships with psychiatric patients, failed to care for patients, and was being investigated by the police for “taking thousands of pounds of a 58 year old woman”.

16. I wrote two blog posts in 2006 about how this was one of the most extreme examples of how people in Alternative Medicine use questionable titles and qualifications to enhance their credibility. Obi is a Professor of an organization that he invented – the Royal College of Alternative Medicine – which in reality is a post box in Dublin. Obi was selling ‘Fellowships’ of the College for many thousands to other people so they too could designate themselves with the letters FRCAM.

17. Once again, the first I knew there was a problem was when Obi sent an email to Netcetera. It contained the threat,

Further to our Previous Warnings , we wish to (once again) remind you that Quackometer.net (which you Host and Register) has still been flagrantly violating our Statutorily Registered Trademarks (and Copyright) – despite Multiple Warnings. Please therefore note that (unless you urgently remedy the situation) you will soon be liable to the Tune of US$10,000,000 (Ten Million Dollars) per day ; effective the 21st of December 2009.

18. It was difficult to see this as anything other than a joke. Merely writing about a trademarked name does not constitute a violation of trademark or copyright. But a few weeks later, Netcetera received much more official looking letter from someone called Tanja Suessenbach,

Dear Sirs,

Re Defamation

We advise Professor Dr Obi and the Royal College of Alternative Medicine. We are informed that you host the Quackometer`s website (copy evidence enclosed). Our clients hereby give you formal notice that they are determined to sue you directly for the highly defamatory contents contained on the website should you fail to immediately shut down the website and delete all of the defamatory material relating to the Royal College of Alternative Medicine, Professor Dr Obi and our clients` lawfully registered Trademarks.

In case the defamation continues beyond 12 noon on Monday the 21st of January 2008, we are instructed to hold you fully liable to the tune of £1 Million (One Million Pounds) per day , together with additional punitive damages relating to the many months during which the defamatory material had and has been globally accessible via your server.

Kindly note that Google has already blocked the highly defamatory material from appearing on its search engines in the Republic of Ireland, and is currently in the process of extending the ban to other countries.

Please find enclosed photocopies of the two RCAM Trademarks and a copy letter of Good Standing from the Company Registration Office in Ireland, as well as copies of these highly defamatory articles. Please provide an undertaking that no further reference concerning Professor Dr Obi and/or the Royal College of Alternative Medicine is going to appear anywhere within the Quackometer`s website.

Looking forward to hearing from you.

Yours faithfully,

Tanja Suessenbach LLB, LLM

19. It was apparent that Obi had indeed managed to get Google Ireland to remove links to my site.

20. It was also clear that Suessenbach was not a solicitor, but a ‘legal letter writer’.

21. I wrote to Suessenback asking her to clarify the nature of the complaint. I received no response.

22. Netcetera, meanwhile, had been receiving threatening phone calls telling them that legal proceedings were about to begin and asking me to seek urgent resolution with Obi (which was impossible as no correspondence was being returned) or Netcetera would have no choice but to suspend my account.

23. It is worth noting Netcetera’s view on their predicament:

We do not judge one way or the other as a company as to the veracity of content, although as individuals we have our own thoughts of course.

Unfortunately as far as the law is understandable, a request to take down a site for defamation requires us to do so unless we want to risk ending up in court defending something in which we as a company have no interest. Our policy at present is to pass on such requests to the site owner, and ask them to reconcile any differences with the complainant, perhaps taking off content in the meantime.

24. I took down the articles, but stated I would re-instate them if Obi and Suessenbach continued to refuse to engage with me.

25. Having received no response from Obi or Suessenbach, I reinstated my pages. On the 18^th of January 2008, Netcetera suspended the Quackometer website stating I had breached their terms and conditions and citing my account had been “inappropriately used”. The nature of this inappropriateness was not explained to me.

26. Within days, the Quackometer was back online, this time being hosted by Positive Internet. They wrote to me in an email entitled “Your lilly-livered Hosting Company” and offered to host my site for free.

27. One year later, in December 2009, Obi again threatened Positive Internet along similar lines stating that I was violating trademarks. Positive responded to me that “his legal theories sound about as rigorous as his medical ones.” And that was the end of it.

Case 3: The Osteomyologist

28. In April 2008, I wrote about how the ASA had adjudicated against an alternative health practitioner by the name of Robert Delgado at the Optimum Health Centres in North Finchley. My post was substantially about how statutory regulation of practitioners could be sidestepped by changing the name of what you do. Despite it being illegal to call yourself a chiropractor without being registered by the GCC, a number of practitioners sidestep this by calling themselves ‘spinal therapists’ or Osteomyologists.

29. Calling himself Dr Delgado, the Osteomyologist had been found by the ASA to be producing advertisements that lacked substantiation and truthfulness. They also found that in calling himself ‘Dr’ that this was likely to mislead the public into thinking he was a registered medical doctor.

30. Osteomyology is not a genuine medical speciality. It was a term coined in 1992 for chiropractors and osteopaths who refused to be regulated by the then new statutory regulatory framework. Changing the name of what they did removed them from the scope of legislation. My post, entitled Registered Osteomyologist, Robert Delgado, found Guilty by the ASA. So What? highlighted that this left such practitioners with no regulatory framework to protect the public from them in the event of a problem. The ASA may have seen a problem, but they hold no sanction other than telling advertisers not to repeat their claims.

31. I received a letter from a solicitor acting for Delgado stating that they viewed my post as defamatory and that I should remove it immediately. In particular, they stated that as I had used the word ‘guilty’ in my title post that this could imply that Mr Delgado was criminally prosecuted.

32. I replied that I made it quite clear in my article that it was the ASA that had ruled on the complaint and that at no point do I suggest that criminal activity was involved. I asked for details of any other wording that Delgado thought were misleading untrue or inaccurate and that I would be happy to address them. And as a token of good faith that I would immediately change the title of my article to Registered Osteomyologist, Robert Delgado, Gets Knuckles Rapped by the ASA. So What?

33. The solicitor wrote back and failed to answer any of my questions asking for details of the words being complained of. Instead, the threat was repeated that unless the whole post was taken down, legal action would start for substantial damages.

34. After consideration, I felt I had no option but to comply. I felt satisfied to myself that my article was factual and honest opinion, but I had no confidence in how courts would interpret words like ‘guilty’. As the amount of money involved could soon get very high, I felt I had no option but to remove the post.

Conclusions

35. In reforming libel law, I will be looking for changes that allow me to feel confident that an honest, public discussion of controversial areas where there are potential vested interests involved need not expose me to arbitrary legal threats that could financially ruin me. The health of democracy requires ordinary citizens to be able to participate in public debate without fear of capricious and crippling harms.

ISPs and their role in Libel

36. Current interpretation of libel law makes ISPs an easy target and weak link that can easily be attacked should someone wish to remove critical material from the web.

37. ISPs are typically paid a few pounds per month by bloggers and have no incentive to defend their users against claims that might mount to hundreds of thousands of pounds. Even trivial claims might start amounting significant costs should a complainant start legal action.

38. ISPs are treated as if they are publishers of materials rather than being the infrastructure on which the web works. There is no clear hierarchy of responsibility in the digital publishing world. It should not be possible to threaten an ISP unless all reasonable effort has been made in resolving the matter with authors and editors of materials.

39. Requests to ISPs to remove material should be a last resort and the management of an ISP needs to be confident that the request is genuine and has complied with reasonable steps with the author or site owner. Doubt in an ISPs liability will ensure that an ISP will always act to minimise its exposure to risk at the expense of the publisher of the material.

Nature of Libel

40. At present, libel laws are being used simply to remove unfavourable material from the web. The costs involved with defending a claim mean that it is irrational to maintain resistance in the face of such a threat for most people.

41. Those who seek to use libel law should be required to show that significant and serious damage has occurred. However, given that a individual is usually unable to start to defend against a threat given even a small chance of chance of significant losses, the law should be clear that a solicitor cannot act unless they are confident that the claim is not trivial and that comprehensive details of the exact nature of the offending words and the nature of the harm is clearly offered.

42. A blogger should be able to feel confident that a trial cannot proceed unless the complainant has undertaken appropriate pre-trial protocols in attempt to resolve the dispute before a trial can start. This would help to remove the Damoclesian threat that is at the centre of the chilling effect of current libel law. Such a protocol would ensure that there is a duty to contact the authors of the material in preference to any other party that may be involved in the chain of publication, that the nature of the complaint is made clear and that simple and fast remedies are offered that do not involve attempts to silence beyond the scope of the complaint.

43. Authors should be able to feel confident that they have a right to fair comment regarding matters such as public safety, public health, science, policy and politics. The free expression of debate regarding public interest should weigh substantially against any particular reputation, especially if that is a commercial reputation.

44. Authors should also be able to feel confident that arbitrary definitions or usages of words cannot detract from comment that is substantially true.

http://qako.me/kl01zD “Malaria advice ‘risks lives’”, By Meirion Jones, BBC Newsnight

http://qako.me/kcAlFb Ben Goldacre’s Blog: Appendix: Andy’s incredibly polite email to the Society of Homeopaths

http://www.guardian.co.uk/science/2007/oct/20/homeopathy Threats – the homeopathic panacea

http://www.dcscience.net/?p=171 Society of Homeopaths: cowards and bullies

http://qako.me/tertruthmatters The Society of Homeopaths: Truth Matters

http://qako.me/terDrObi Shamed Doctor Probe – The Chronicle

http://qako.me/ltxZDE ASA Adjudication on Optimum Health Centres

http://qako.me/jK2HsO The Times: Back off: Handle with care

http://en.wikipedia.org/wiki/Osteomyology

Related posts:

1. Unanswered Questions Just in case you were wondering, here is the letter I wrote to the Society of Homeopaths, asking them just why they were so upset about me. This letter was...
2. Why Libel Laws Must Change Let me tell you a few stories about how I have nearly stopped blogging. Some of these stories you may know; others I have not talked about before. The...
3. Netcetera are Recreant Milquetoasts and Poltroons. Positive Internet Stand Tall. So, the Quackometer has been up and running for 24 hours now and most systems have been restored. A bit more to go though. For the technically inclined, this...

The advert appeared to be calling for more NHS funding for homeopath whilst giving misleading information and denigrating critics of this quackery.

In the Telegraph, Christine Odone wrote about her old magazine sinking to plugging nonsense,

The pages once graced by George Orwell and George Bernard Shaw now feature a catalogue of factoids about the adverse side-effects of conventional drugs and the NHS’s wrong priorities.

Professor Edzard Ernst, one of the academic researchers attacked in the advert, responded with an article in New Statesman,

Rarely had I seen an advert so inaccurate and borderline libellous in a respected publication. The advert, which appeared to breach the British Code of Advertising, was by a lobby group called Homeopathy: Medicine for the 21st Century (H:MC21).

It contained unjustified attacks on myself and colleagues, including statements that gave a dangerously false impression of homoeopathy’s therapeutic value.

I complained about this advert to the Advertising Standards Authority and encouraged others to do so. I specifically complained about each statement made in the advert to ensure the fullest adjudication was made. Five other complaints were received.

It has taken almost a year for the ASA to adjudicate on the advert and the reasons for taking so long are worth exploring. Their deliberations are now published.

In total, twelve specific issues were looked into by the ASA. The ASA upheld seven of these points as breaking the British Code of Advertising Practice.

Most importantly, the ASA ruled that,

1. The homeopaths could not supply sufficiently robust evidence to to show that homeopathy was superior to a placebo and there was a lack of evidence to support claims of efficacy.
2. That the much touted Spence study of patients at Bristol Homeopathic Hospital did not show that patients’ improvements was directly relate to homeopathic treatment.
3. That the homeopaths were misleading people when they claimed more trials of homeopathy were positive rather than negative.
4. That the recent Cuban leptospirosis homeopathy trial could not show that reductions in disease were attributable to homeopathic treatment.
5. There was no evidence that homeopathy could treat chronic disease and that increasing funding for homeopathic treatment would result in increased benefits.
6. That the homeopaths claims that charity Sense About Science relied on ‘propaganda stunts’ and had ‘no scientific credibility’ could not be substantiated and was misleading.
7. That claims that Ernst and Singh’s Book Trick or Treatment was ‘scientifically flawed’ was the the opinion of HMC21 and this did not in itself substantiate this claim.

A number of points were not upheld, most significantly that the denigratory attacks against Professor Ernst and Evan Harris did not fall within the British Code of Advertising list of parties that you could not denigrate (It would appear, according to the ASA, that academics and MPs are fair game, but producers of competing products are not.)

It has taken almost a year to conclude this. And the main reason is that H:MC21 fought tooth and nail on each point, never letting an interim judgement go by without challenge. And there were many interim judgements.

Indeed, the amount of material thrown at the ASA must have been huge. I have written about some of the peurile and voluminous material used against Ernst and Singh by a central member of this lobby group.

Now, the Society of Homeopaths are very clear about how their members should behave. Their code of ethics states,

38 All advertising must be published in a way that conforms to the law and to (the guidance issued in the British Code of Advertising Practice).

39 Professional advertising must be factual and not seek to mislead or deceive, or make unrealistic or extravagant claims. Advertising may indicate special interests but must not make claims of superiority or disparage professional colleagues or other professionals. No promise of cure, either implicit or explicit, should be made of any named disease. All research should be presented clearly honestly and without distortion, all speculative theories will be stated as such and clearly distinguished.

It is quite clear that the authors of this advert have ignored the BCAP, have not been factual, have been misleading, have made claims of superiority, have disparaged other professionals and made implicit and explicit promises of cure for named diseases.

One would have thought that the authors would be immediately removed from their register.

Who was behind this advert?

The founder of the H:MC21 lobby group was William Alderson. At the time of publication, Alderson was a director of the Society of Homeopaths and was Chair and Treasurer of H:MC21. But very quickly that changed. When it became clear that a director was likely to be subject to intense scrutiny by the ASA, his name disappeared from the list of directors. Soon after, Companies House showed that his directorship had been terminated. Whether he was pushed or decided to step aside is not clear.

He also stopped his official roles at H:MC21. Although his LinkedIn profile still lists him as a “Special Consultant”.

If the Society of Homeopaths do decide to take action, then now it will not be against one of their own directors. But, as we know, the Society do not enforce their code of conduct, so I doubt Alderson will need to worry

At present, many more homeopaths are now being scrutinised by the ASA. This is as a result of the Nightingale Collaboration’s campaign to highlight how widespread misleading claims are about homeopathy on practitioners’ web sites.

The ASA has been inundated and has asked that further complaints are not made until progress is made. Last month, the ASA issued specific guidance to homeopaths on how to comply with the CAP code. In that guidance, they state,

To date, the ASA has have not seen persuasive evidence to support claims that homeopathy can treat, cure or relieve specific conditions or symptoms. We understand this position is in line with other authoritative reviews of evidence.

We therefore advise homeopathy marketers to avoid making specific claims of efficacy for treatments where robust evidence is not held to substantiate them.

The ASA have a job ahead as there are many homeopaths who have refused to comply with these instructions and continue to make specific claims. Indeed, even the Society of Homeopaths maintain a list of conditions that it believed homeopathy can help, in apparent breach of these CAP guidelines and even its own code of conduct. I expect many homeopaths will be defending their delusions as hard as H:MC21 has done.

It would appear the homeopaths do not care to much about what the ASA have to say. Why is this?

The ASA is not a statutory body, but an industry funded self-regulator. As such, it has been largely successful in ensuring that advertising in the UK is legal, decent and truthful. It has managed to regulate advertisers without involving criminal sanctions which would be costly and damaging to all involved. Indeed, because of the ASA, a CEO of a company might be sent to prison for misleading their investors in the City, but is very unlikely to even get a fine for misleading their own customers in an advert.

But the ASA only works because of the fear of adverse publicity from ASA adjudications, peer pressure from other advertisers, and fear of sanction from their own trade bodies.

In large companies, there will be marketeers and PR people weighing judgments between the capacity for an advert to increase sales and its capacity to harm their credibility, customer goodwill and their share price.

But homeopaths do not suffer from these pressures. Most homeopaths are small traders and an ASA adjudication is likely to go unnoticed by their clients, and will almost certainly be ignored by the wider media. Homeopaths’ peers share their mind-set of hostility to outside authorities that threaten their beliefs, and so an adjudication might even be seen as a badge of honour by their peers. And a homeopath’s trade body has no intention of bringing sanctions when the trade bodies themselves break the CAP guidelines.

Just as the Press Complaints Commission did not have the peer support of other newspapers to manage the excesses of the trade, so too the ASA does not have the support of other alternative therapists in order to police the claims of alternative medicine. The PCC is finished after the phone-hacking scandal. It has been seen to be toothless and craven. A tougher regulator is needed and will emerge. And so too, it is possible that the mass of homeopathy complaints will expose the weaknesses of the ASA in ensuring misleading quack medicine advertising is not published.

That is, unless they get tough very soon, and get the co-operation of other authorities who have real teeth –such as Trading Standards and the Medicines Regulator. This is within their powers and they should not hesitate. How many homeopaths will persist in their obstinacy when a criminal record is on the cards? A few well chosen examples could be made that could clear up this problem very quickly.

It is a shame that the very British style of low key regulation, that appears to work so well for most of industry (bar a few budget airlines – who also relish being bad boys), may be damaged by the cults of alternative medicine. The problem arises as authorities treat these cults as serious businesses that can be regulated as normal rather than deluded and dangerous fools, or worse, deceptive charlatans. The ASA works because regulators and business share a common world view. This is not the case with homeopaths and other pseudoscientific therapy cults.

Whether Trading Standards and the MHRA have what it takes to manage these claims remains to be seen. So far, their track record has been abysmal. The ASA have shown their credibility in assessing claims, but have not been able to easily enforce adjudications with such advertisers by striking the necessary fear and shame. A partnership is required. Watch this space.

Related posts:

1. The Homeopaths and the Advertising Standards Authority It is now the end of the Nightingale Collaboration’s first month of operation. This newly formed organization was set up to “challenge misleading claims in healthcare advertising”. In particular, TNC...
2. Desperate Homeopaths Look what just appeared in my inbox. It a communication that appears to have gone out to most homeopaths in the UK, both medically trained and lay, about the current...
3. Patrick Holford’s Advertising Standards Poor Patrick Holford. Doing business has its ups and downs and, alternative nutritionist and pill salesman Patrick, has his own fair share of business successes and failures at the moment....

This is a murderous practice. People will die if they are told that homeopathy is a ’side-effect free’ way of treating or preventing these diseases. People will die if they are told that homeopathy is an effective medicine.

Very often it is their members who are involved by either volunteering at these clinics or donating money. The Society has responded to these criticisms with bluster and obfuscation. A typical statement from them might read as,

The Society of Homeopaths, the UK’s largest register of homeopaths with 1,500 members, does not endorse the use of homeopathic remedies with a view to preventing serious tropical diseases such as malaria and yellow fever.

These are hollow words. Recently, the Society held their annual seminar in York where they invited Jeremy Sherr to talk. Sherr is one of the most notorious homeopaths in Africa (read about him on gimpy’s blog.) He has no shame in promoting his sugar pills amongst some of the most vulnerable people in Africa. For this, Sherr is lauded and treated like a god by UK homeopaths. The Society used the seminar to raise funds for Sherr, being helped along by Helios pharmacy and Lockton’s Insurers.

This is how Sherr promotes his clinic. It is not easy watching.

Like Abha Light in Kenya, Sherr’s clinics need to be shut down. These deluded zeolots want to ensure that homeopathy is “gonna go everywhere in Africa”. They tell people with HIV that sugar pills can treat their conditions.  ‘It is a good medicine with no side effects’.

According to their enlisted rapper ‘Rhymes B’, “Homeopathy is the only medicine that God wants.”, and that you should “Take it for malaria and gonna feel alright”.

The song lyrics tell people that homeopathy is ‘made naturally from natural plants.’ It does not mention that those plants do not treat illness and that in any case all traces of them have been removed by the homeopathic process of massive and repeated dilution. Homeopathy is just sugar pills and water.

It makes explicit claims that a person with HIV will see their CD4 count improved. “For malaria is not a problem. For HIV not a problem either”. These are murderous words that will kill people.

Sherr will not listen to his critics. Western homeopaths, deeply deluded and besotted with this individual, can only obfuscate and mislead whilst actively supporting him. If he is not stopped soon, then homeopathy might well take a deep grip within African countries and just be one more massive burden that this continent has to carry.

Related posts:

1. Homeopathy Awareness Week, 14 – 21st June 2009 Are you a journalist or presenter looking for someone to discuss Homeopathy Awareness Week? Then please get in touch. The Society of Homeopaths are promoting “Homeopathy – a natural approach...
2. A Letter to David Bellamy Dear Professor Bellamy, I am writing to you to ask for your help as Patron of the British Homeopathic Association. But first I must say that I am somewhat...
3. Homeopaths Find The Solution – Hire PR Consultants. Under the banner of One Vision, One Voice you can watch the conference as it used a PR Consultant to brainstorm a set of ‘themes’ for how homeopathy should...

In this season’s newsletter from the Homeopathy Research Institute, Dr Peter Fisher, Clinical Director of the NHS Hospital, the Royal London Hospital for Integrated Medicine, writes an essay on how homeopathy research may be being unfairly appraised due to the ‘plausibility bias’ of scientists.

Fisher makes a case that “Negative plausibility bias obstructs a fair
evaluation of the evidence around homeopathy”. That is, that views that homeopathy appears to be ‘impossible’ clouds the judgements of people when reviewing scientific studies into the effects of homeopathy. Indeed, Fisher claims that some trial data for homeopathy has similar levels of evidence to mainstream treatments, but that the lack of a “plausible
theoretical framework” means that the these trials have little impact on medical practice.

The article is written for homeopaths as a summary of a paper that Fisher co-authored where they discuss the impact of their concept of ‘plausibility bias’ on how the trials of homeopathic treatment of upper respiratory tract infection. The authors make a case that “the same level of supporting clinical trial evidence should be accepted for all scientific developments”.

Fisher quotes Chaplin, a researcher into the Memory of Water,

If a lower level of proof is set for hypotheses that fit prior beliefs then we bias our view of science in favour of such beliefs and may be easily misled.

To back up this claim, Fisher adds,

‘Inherent implausibility’ is a poor guide to future understanding.  History is littered with examples of ideas that at one time appeared highly implausible but are now accepted as fundamental truths: the Copernican revolution and quantum physics are well –known examples.

Now, before I show why that last statement is a confusion, it is worth looking at this charge that sceptics of homeopathy, like myself, have a negative bias against the clinical results of homeopathy because we have no ‘plausible framework’ for how it might work. Indeed, this is a common charge laid against critics that because ‘we don’t know how it works, does not mean it does not work’.

There are several confusions here and many a big conflation. But the argument that we should treat all treatments the same has a superficial appeal. Surely, as dispassionate scientists we should not ‘load the dice’ against treatments that we may find problematic for some reason?

It is of course nonsense. Even if you held this view about homeopathy, it is not how you view your everyday beliefs. We all work on the natural assumption that if a claim is unlikely then we will need extra evidence to change our minds.

Let’s imagine a hypothetical homeopath sat at home in front of the telly.

In rushes their five year old son saying that they have seen a dog in the garden. The homeopath’s belief prior to this event is that there are no dogs in the garden. They do not own one. However, should the homeopath now change their mind when this new piece of evidence comes along? Their five-year-old does make up stories sometimes, but it could be true. Let’s say 50-50 for now. So it is worth investigating further and so, the homeopath gets up and wanders out into the garden where they see a bush rattling as if a large creature is in there. Should the homeopath upgrade their beliefs about the number of dogs in the garden? It would be wise to do so. It is not clear what else could be disturbing the bush so much. So the homeopath investigates further and finds next-door’s Fido, who has escaped and is burying a bone in the bush. The homeopathy is now 100% certain that there is a dog in the garden and can act appropriately.

The plausibility of the claims and the nature of the evidence allows the homeopath to rapidly upgrade their confidence in their child’s hypothesis that there was a dog in the garden.

Now consider a second example. This time the child rushes into the house claiming there is a tiger in the garden. This being Southern England, the plausibility of there being a tiger in the garden is near zero. Not impossible, but near zero. So, the homeopath will not hedge their bets and call the police to send a marksman, but will probably wander out with their child asking what stories they are making up now? But a bush is seen rusting too. This is the same level of evidence we had for the dog, but the homeopath is not going to treat the claims identically because the prior probability of it being true is quite different. As it turns out, the escaped tiger turned out to be a toy. And coincidently, Fido was after his buried bone in the bush. So, no tiger. It was a preposterous children’s invention.

We naturally appraise claims and evidence on their plausibility. The new facts would have to fit in with what we already know about the world. The world is not capricious. If a claim flies in the face of what we know, we do not change our mind until the evidence is overwhelming.

So, counter to what Martin Chaplin says that we ‘may be easily misled’ if we ask for greater evidence for ideas that do not fit in with our prior beliefs, the exact opposite is true. Indeed, we call people who too readily accept wild claims gullible, credulous and fools.

Science codifies this thinking into a statistical formula. Indeed, Peter Fisher, in his paper discusses the role of Bayes’ theorem on how we should change our mind in the face of new evidence. This statistical technique tells us that if we have a certain confidence in a belief, then when a new piece of evidence comes along, how much should we change our mind?

Fisher’s argument in his academic paper is a little different from the homeopaths’ report. In the paper, the authors fully acknowledge the role Bayesean analysis plays in affirming hypotheses. Their argument is simple though: that in order to apply Bayes properly, you need to understand the prior probability that your hypothesis might be true. In other words, in the absence of trial data, what confidence can you have that the claims of homeopathy are correct?

This is indeed a weakness of using Bayes theorem in real life. What probability would you put on there being a tiger in the garden? Tigers have escaped from zoos before, but it is quite hard to come up with a number. Some might think that for homeopathy it is more like asking the probability that there is a dinosaur in the garden. Is such a thing truly impossible? Or could some Jurassic Park like experiment make this a possibility one day?

However, for homeopathy, the situation is probably more like asking if there is a fairy or dragon in the garden. As Fisher quotes, “Accepting that infinite dilutions work would subvert more than conventional medicine; it wrecks a whole edifice of chemistry and physics”. Homeopathy is not really just implausible, it is impossible according to very well established principles of basic science.

Applying Bayes in this context, then indeed does become deeply problematic. But the problems run deeper than even Fisher appears to think. Whilst we might argue that the prior probability is zero on the basis of the impossibility of the claims, Fisher argues that the probability is finite – and indeed, larger than mainstream scientists would accept – and this is the source of the plausibility bias. We shall come onto this.

But first, back to the claim that science does occasionally support implausible claims. This would make the chance that homeopathy is true to be finite if indeed it is true that “History is littered with examples of ideas that at one time appeared highly implausible but are now accepted as fundamental truths”.

However, I would argue that the examples Fisher gives do not support this very well. (Indeed, an aside challenge is for anyone to come up with a good example where science eventually confirmed a genuinely implausible hypothesis. )

Fisher says that “quantum physics” is a good example. I do not agree. Quantum theory arose because experiments were turning up very strange results. In 1905 Einstein published a paper on the photoelectric effect that showed that this phenomenon could be explained if light behaved as if it consisted of discrete particles carrying specific energies. This was not implausible, but highly counterintuitive. The prevailing concepts of light involved it behaving as a wave. For it to behave as ‘quantised’ particles ran counter to what was seen in other experiments.  From Einstein’s early work came the full theory of Quantum Mechanics. Despite it being a highly successful theory, it still remained highly counterintuitive and indeed Einstein did not like what it appeared to be saying.

Science is often counterintuitive in that its results often appear to contradict what we think we know from everyday experience. Implausibility, however, is where a result appears that we thought was highly improbable due to well characterised principles.

The example of the Copernican Revolution also does not convince me that implausible theories are often found to be true. In 1543 it too might have appeared to be counterintuitive that the planets revolved around the Sun. But was it also implausible (or indeed impossible) in the same way the hypotheses of homeopathy are implausible? Homeopathy runs counter to current, well established science. The Copernican Revolution ran counter to Ptolemaic models of the Universe. But these were not well established scientific theories as we know them to day, but ideas that were based mainly on Greek authority and the insistence of the Catholic Church that the Earth was at the centre of the Universe. The Copernican Revolution was more of a move away from dogma than the triumph of a theory over its own inherent implausibility.

But even if you were to argue that there have been implausible ideas that turned out to be true, it naturally does not mean that implausible ideas will be shown to be true. An implausible idea is exactly that – and the number of implausible ideas that can quite safely be forgotten will always greatly outnumber those that turn out to be correct.

So, by appealing to the idea that we cannot dismiss homeopathy because other ideas that appeared to be crackpot eventually came good, Fisher is obviously on very dodgy ground. So, his main thrust is to push the idea that the implausibility of homeopathy is not well founded at all.

Fisher resorts to portraying the critics of homeopathy as refusing to accept the number of replications of basic experiments into homeopathy and the ideas of homeopaths as to how this implausibility might be overcome. We are back on familiar territory now as Fisher makes a number of well exercised misrepresentations.

The House of Commons Select Committee review of the evidence for Homeopathy comes under fire first. This is important as the Advertising Standards Authority use it to justify asking homeopaths to remove all health claims from their advertising and web sites.

Fisher states,

This report was heavily criticised, particularly for its failure to take evidence from a single patient who had experienced homeopathic treatment and from only one practitioner (me), while calling a number of well-known sceptics including representatives of Sense about Science, a lobby group which has campaigned stridently against homeopathy

It is not true that only one practitioner gave evidence or that patients were ignored. The report is an inch thick and full of the written evidence from many homeopaths, users and scientists. Oral evidence was only given by a select few, including homeopathic manufacturers – but all evidence was discussed in the report.

He continues to suggest that basic science is now replicating results that confirm a homeopathic action,

The best established method utilises the Human Basophil Degranulation Test – a test tube model of allergic response. The finding that homeopathic dilutions of histamine inhibit basophil degranulation has been verified repeatedly by different scientific teams.

A paper by Endler, publish in 2010 is used to support this claim,  Repetitions of fundamental research models for homeopathically prepared dilutions beyond 10-23: a bibliometric study.

Edler says of the Basophil experiments, “However, when comparing the studies in detail one must
conclude that no independent repetition trial yielded exactly the same results as the initial study, and methods always differed to a smaller or larger extent.”

This is hardly a statement that is going to lead to a conclusion that the Basophil experiments are capable of consitent replication. What is even more surprising is that Peter Fisher did not use another review that concentrated exclusively on the basophil experiment to back up is statement.

Madeleine Ennis published her review also in 2010 and concluded that,

The methods are poorly standardized between laboratories – although the same is true for conventional studies as described above. Certainly there appears to be some evidence for an effect – albeit small in some cases – with the high dilutions in several different laboratories using the flow cytometric methodologies. How much of the effect is due to artifacts remains to be investigated.

Again, inconclusive and in need of definitive work. This paper was published in Peter Fisher’s own journal Homeopathy. Why Fisher did not quote this is not clear. I note the Edler paper is more positive in its editorial.

Finally, Fisher tries to tell us that

Beyond this is the question of how these effects are mediated. Although the work is preliminary, many believe that ‘nanostructures’ in water may be involved. Supporters of this view include the Nobel Laureate, Luc Montagnier, who has published remarkable results supporting this hypothesis, although these await independent replication.

This is just gobbledegook. There is no coherent explanation that involves ‘nanostructures’ that can rescue homeopathy from the very deep well of impossibility. There are a number of fringe scientists and supporters of homeopathy who propose different entities that somehow survive the extreme dilutions to be the carriers of the homeopathic effect. But no one has describes how these structures themselves overcome the inevitable dilutions that prevent the original substances from ending up in the pill. Rather than solve any homeopathic mystery, so-called ‘nanostructures’ merely pile on new layers of implausibility.

We are treated to an appeal to the authority of the Nobel Laureate Luc Montagnier as a last gasp to present some plausibility. Montagnier, whose research does not mention homeopathy, has so far failed to publish any of his high dilution work in independent peer reviewed journals. Is it plausible that Montagnier is correct with his outlandish claims, or is it more reasonable to see a scientist who did his best work a quarter of a century ago and is now pursuing a folly as he approaches retirement?

Evidence based medicine is built on an important assumption: that the prior probabilities of treatments under test can be considered to be constant. That is why most of the time, no account is taken of the underlying mechanism, at and that the clinical trials can speak for themselves. It is assumed that any treatment being tested on humans has a reasonable chance of success and is not based on non-physical or anti-scientific thinking. But this assumption breaks down for superstitious and pseudoscientific forms of treatments where the prior probability may be exceptionally low. Fisher is asking us to ignore this problem and just run with evidence based medicine as if there were no issues with the absurdity of treatments.

But extraordinary claims require extraordinary evidence. And rather than it being mainstream scientists that are suffering from a plausibility bias when considering homeopathy, the reverse is true: homeopaths, ignore the science that suggests their treatments are impossible and ignore the highly plausible reasons as to why they may be tricked into thinking an inert treatment is effective.

Fisher is right to conclude that studies of homeopathy “may have limited impact on practice until a plausible theoretical framework is established”. What he cannot accept – because of his own plausibility bias – is the extreme unlikelihood of that ever happening.

Related posts:

1. Homeopathy Does Not Cause Side Effects in Cancer Patients The Cochrane Library has published a new review of the effects of homeopathy on cancer patients**. Its conclusion is that “there is limited evidence that homeopathic remedies ease the side...
2. My Sparrow Dead and Cold I have recently been rather drawn into the world of electrosenstivity and found that passions run high. But loudness of voices and strength of convictions rarely match closely to soundness...
3. Should Cochrane Call for More Research Into Homeopathy? The Cochrane Collaboration is an independent network of volunteers, funded only by donations, that collate systematic reviews of the evidence base for healthcare interventions. You can go online and view...