The Quackometer

Further documents have been published after the House of Commons held its enquiry into the evidence base for government policy on homeopathy. There are some real treats in there, but I am most concerned about new evidence from the Medicines and Healthcare Products Regulatory Agency (the MHRA) on how they test the public’s understanding of the labeling of homeopathic products.

The new document was submitted to the enquiry after Professor Kent Woods (pictured) was challenged over how the regulator allows homeopathic products to make claims on their labels when it is known that these claims are false. The concern is that a customer could walk into Boots the Chemist and see two products for, say, hayfever and be unaware that the homeopathic product has no active ingredient, is just a sugar pill and will not help the relief of any symptoms. Clearly, this is a very unsatisfactory situation, where the medicines regulator is charged with ensuring medicines are safe and do what they claim but appears to wave homeopathic products through without regard to these principles. The public are being badly misled by the people charged with protecting them.

In the enquiry, Evan Harris MP asked a very pertinent question of Professor Woods,

Do you think that people reading that will think that it works for symptomatic relief of those minor conditions, or do you think that label that you have read out - and please feel free to read it out again - would make the average person think, which is the truth, as far as you are concerned, that there is no evidence of efficacy backing it up. Which of those two do you think is most likely, for the average person?

At is issue is the question of how far the MHRA go to ensure that the public are not being misled by the labeling they authorize on homeopathic products.

Professor Woods response was,

Well, fortunately, by law all packaging and patient information leaflets are subjected to user testing to ensure that they are comprehensible to the man in the street, and indeed that seems to be a very straightforward statement of the reality. This is a homeopathic medicinal product used within the homeopathic tradition for the symptomatic relief of sprains, muscular aches and bruising or swelling after contusions. That is what it says and the user testing is part of the approval of that leaflet, has the labeling been tested on the average man in the street.

This did not satisfy the MP, Dr Harris,

Sadly my question was not "What does it say? Has it been tested?" My question is, and maybe it is the result of this testing and you need to tell me, does the average person think that that label suggests that it is going to be useful for the symptomatic relief of those indications?

This is an important question. Does the MHRA care if the public are misled by homeopathic labeling or not? What do people make of the labels?

The new documents posted on the House of Commons web site shed light on this question.

It is worth reporoducing the test questions that are used to establish what people make of the labeling on a homeopathic product:

Three rounds of user testings were carried out with ten participants in each testing. Twelve questions relating to the key safety messages were asked and were designed to assess whether the respondent was able to find the information, understand it and use the information. The questions asked were as follows:

1. Can you tell me the name of this medicine?

2. What does the label say that this medicine is for?

3. If you take too much of this product (overdose) what does the label tell you to do?

4. Is there any advice on the label for women who are pregnant or breast feeding?

5. What does the label say is the active ingredient in this medicine?

6. If you have missed a dose of this medicine, what does the label tell you to do?

7. Once you have opened your medicine, how does the leaflet tell you that you should store it?

8. This medicine contains Arnica Montana 30C. What are the other ingredients in this medicine?

9. How many pillules are there in the Clikpak container?

10. This medicine contains lactose and sucrose which are types of sugar. If you have an intolerance to some sugars, what does the pack tell you to do before taking this product?

11. How many pillules does the pack say that you should take in a dose and how many times a day should you take them?

12. The pillules in this medicine are contained in a plastic Clikpak to help protect them. What instructions does the label give you as to how to dispense the pillules from the Clikpak?

These questions fail to address the central concern that labeling homeopathic products for the relief of specific symptoms is going to mislead patients into thinking that there is reason to believe this is true and that there is evidence to back up the stated claims. In my opinion, the MHRA is complicit in supporting a fraud on the public.

Question 2 is quite insidious in my view. It tests to see if the subject understands the medicine is targeted at specific conditions, when there is no evidence to suggest that the medicine can help. What would the answer to the question mean? Question 5 implies there is an active ingredient in the pill. If the test subject answered ‘Arnica’ would the MHRA conclude that the patient has been deceived by the packaging or has just read the label and concluded that it is telling the truth?

Question 8 explicitly states that the pill contains “Arnica Montana 30C”. Only someone with a good understanding of the nonsensical production methods of homeopathy would appreciate that this means that the pill does not contain any Arnica (it has all been diluted away). What would the average customer on the street conclude? In the original hearing, Professor Woods states that the labeling is designed for people who believe in homeopathy,

To begin with the fact that this is a homeopathic remedy, we are making provision for a group of people who believe in homeopathic remedies and, therefore, the first thing to establish is that this particular remedy is recognised by homeopathic practitioners as a homeopathic remedy. That is the essence of what we are trying to prove.

This is simple nonsense, as the products are likely to end up on the shelves of Boots where people may simply misread ‘homeopathic’ as ‘natural’ rather than ‘batshit magic pseudo-medicine’, the wording that ought to be on the label.

The MHRA appear to completely miss the point over homeopathy. As I have written before, they fail twice over. Firstly, they endorse misleading labels on homeopathic products and fail in their primary mission to “ensure that medicines and medical devices work.” Secondly, they appear to be blind to the blatant abuses that do go on in the creation of homeopathic medicines where claims are made explicitly and implicitly without even seeking MHRA approval.

The mistake that all regulatory efforts from this government has made is to attempt to regulate alternative medicines as if they were medicines. They are not: they are pseudo-medicines and need a different style of thinking. Trading Standards should take a more leading role in prosecuting misleading claims as they would with any other consumer product. The MHRA need to stop feeling they need to treat homeopathy as if it were medicine and give special dispensations in the claims that they can make. As with any other medicine, homeopathy should only be allowed to make claims if they can back them up with sound evidence.

I understand that there are some efforts within the MHRA to look into the issues I have raised with them. It has been several months since I last heard from the investigating officer involved. My first enquiry took 17 months for a response. In the meantime, I hope the the upcoming publication of the House of Commons Evidence Check report into homeopathy will be severely critical of them for presiding over a regulatory regime that endorses the homeopathic trade in misleading the public.

Labels: 10:23 campaign, homeopathy, MHRA, regulation

 

The Eighteenth Century in England was the Golden Age of Quackery, with London being a world capital for mountebanks, charlatans and other practitioners of irregular medicine. Consumers in Georgian England had access to an unparalleled selection of medical entrepreneurship from regular doctors, lay quacks, foreigners with exotic elixirs, and even preachers such as John Wesley (as we saw a few weeks ago). So popular were these various tonics and treatments that it has been claimed that many newspapers would have gone bankrupt without the advertising revenues from quacks. Indeed, the proprietor of the Reading Mercury, used his proud organ to sell his own Fever Powders.

This thriving market was in stark contrast to many continental countries where quacks were often hounded out of both their establishments and their countries. Samuel Hahnemann, founder of homeopathy, and Mesmer, inventor of animal magnetism, were both forced to leave their home towns in search of more accepting jurisdictions. London was often the home for the displaced medical salesman.

The reason for this open market in quackery can be traced to the rather weak position of the regular physicians guilds and societies who failed to gain a real monopoly on the healing arts. The three main establishment bodies, created in the Tudor period, were the Royal College of Physicians, who looked after university educated medics, the Barber-Surgeons, and the Society of Apothecaries, the forerunners of the pharmacists. These bodies gave licenses to practice and prosecuted those who transgressed. However, Roy Porter, in his book Quacks, describes how this authority was systematically undermined.

Under Elizabeth, James I and Charles I, a fairly tight lid was kept on medical pretenders. However, after the civil war, the various trade guilds were too closely associated with royal patronage and Charles II, in a twist of irony, managed to exploit the new zeitgeist to his own ends. He used his newly restored royal powers to subvert the licensing scheme by shamelessly issuing his own medical patents that gave nostrum sellers exclusive rights to peddle their powders. This practice grew rapidly under Charles II and subsequent monarchs. Anyone could create a new quack concoction. They simply had to register their unique ingredients with the patent office. Importantly, they did not have to provide any evidence of any sort that their medicine actually worked. The license then gave them exclusive rights to peddle their cures and access to the courts to prosecute anyone who copied them.

This licensing essentially emasculated the power of the medical societies to stamp on quackery. A double standard was created and the quacks exploited their royal blessing to the full. As Porter describes,

…quacks could actually bask in official approval of a kind, much to the faculty's fury… All these state interventions were represented by empirics [quacks] as tokens of royal blessing, the highest of all testimonials.

‘By Royal Appointment’ was the stamp of approval on these ‘licenses to kill’ as they were called at the time.

The effect of these patents on the public were not medicinal but commercial. Before Charles II, the quack was typically a foreign mountebank, dressed in a ‘zany outfit’, and set up a market stall to sell a few bottles of their elixir. With a patent, the business turned into an industry of mass production with household brand names, marketed effectively in the newspapers, and selling in quantities of millions. Quackery blossomed on the emerging consumer society, and the undermining of the medical establishments created a thriving free market for medicine in England. Many became very rich on the back of their patents and the Crown enjoyed a healthy income from the levied stamp duty.

Charles II was interesting, not for only creating a legal framework for quackery, but for also for taking a very personal interest in unorthodox medicine. Indeed, Charles was to become the de facto head of the lay medical trade. He entertained in his court characters such as the Irish spiritual healer, Valentine Greatrakes (also known as ‘the Stroker’) who claimed he could cure all manner of diseases by laying his hands upon them. Even more wonderfully, Charles revived the practice of laying his own Royal hands on the sick in order to cure them of diseases such as scrofula (a manifestation of TB). More commonly, Charles would use Touch Pieces, coins he had handled and then given to the sick in order to minister his healing gifts. In 21 years, he ‘touched’ over 91,000 people.

Now, in the 17th and 18th century, it would be quite possible to argue that the King’s licenses merely created a level playing field amongst medical practitioners, destroying the vested interests of an Oxford and Cambridge educated elite, and gave the people what they wanted: their consumerist right to have their choice of cure. Indeed, the doctor and the quack both had little to offer the seriously ill person at the time and almost all practices would be judged as quackery by modern standards. Today, we are lucky to be one of the first generations to live in an age of scientific medicine, where we have a deep understanding of the causes of many illnesses and the tools to measure which treatments actually work and are safe. Medical regulation becomes meaningful now that we have objective standards by which we can judge competency and skill. It is therefore rather incredible that this 17th Century Royal tale appears to be replaying itself in the 21st Century.

Prince Charles, heir to the throne, is the modern day head of British alternative medicine. He has set up a campaign and lobbying organisation called the Foundation for Integrated Health, which promotes the wider acceptance of quackery in British life – he calls it ‘integration’. Charles prefers magic homeopathic sugar pills to magic coins. Both though are equally as ridiculous.

He promotes his own elixirs, through another company of his, Duchy Originals. In order to do so, he lobbied the Department of Health as part of their enquiry into allowing more lax regulation for herbal medicine. He obtained one of the first licenses from the MHRA and launched his Duchy range of herbal tinctures. I complained to the Advertising Standards Authority about them and they found Duchy Originals to be making misleading and untruthful claims.

Much more worrying than these ridiculous potions is that fact that Prince Charles is directly involved in trying to establish new double standards in the regulation of medicine in the UK. Just has his namesake did, he is attempting to create new backdoors to allow mountebank practitioners to practice medicine without any of the ethical demands placed on real doctors. His Foundation was given money by the Department of Health to establish the Complementary and Natural Healthcare Council (more commonly known as Ofquack). This body offers voluntary regulation to a range of quack practitioners. There is no need for these practices to have any evidence base – the CNHC will just certify they have been well trained in their nonsense and give them the Royal and governmental stamp of approval.

Not satisfied with this, he is now lobbying the government to provide even more regulatory protection to herbalists. This has been planned for the best part of a decade now with the government trying to work out how to best protect the public by the dangers posed by unproven herbal remedies. Unfortunately, they appear to be going along with the idea that the way to do regulate pseudo-medicines is the same way you regulate real medicine. The much derided Pitillo Report recommended that Herbal Medicine practitioners be statutorily regulated and have protected title. The report made the fundamental mistake in that assuming a well trained herbal practitioner was a safe practitioner. However, it has never been explained how a training in nonsense can be considered a competent training. Indeed, Professor Colquhoun has exposed how such training is positively dangerous.

Nevertheless, the Prince’s Foundation has leapt on this report with relish. They are pushing hard to allow herbalists to have their own protected status. Matters have now come to head after the same College of Physicians having come out strongly against such regulatory moves. They say,

Statutory regulation of herbalists and Chinese medicine practitioners is ‘completely inappropriate’ and will put patients at risk. “Herbal and traditional medicine which are largely or completely of unproven benefit should be regulated in terms of consumer protection.”

The fear is that such regulation will not prevent the public from being exposed to dangerous practices, but instead give pseudo-medicine a false veneer of respectability and acceptance.

The Prince’s Foundation has not taken the College’s intervention lying down. They have accused the physicians of “washing their hands” of protecting the public. Of course, this is not true. They have stated that such protection should come through existing consumer protection laws, not through state recognition of their status. In other words, herbalists should be prosecuted for making misleading claims or importing dangerous concoctions. Interestingly, Dr Michael Dixon, one of Prince Charles's chief apologists, views the disagreement in 17th Century terms of the College trying to protecting a ‘trade monopoly’ as doctors. He fails to recognise that, in the 21st century, monopoly in medicine should come through evidence and reason, not regulation or commercial success. Dixon points out that herbalist do cause deaths through inappropriate and dangerous concoctions but offers no evidence to suggest that this was from an ‘uneducated’ minority. Irresponsible and deluded education in alternative medicine is the problem, not the solution.

The Foundation accused its detractors of “abandoning the public to quackery”. Professor George Lewith, another prominent proponent of unproven treatments, says,

Failing to introduce statutory regulation will amount to a Quack’s Charter. It is the incompetent and the irresponsible we need to stop. Not the well-trained, dedicated herbalists who put their patients first.

It is difficult to see how he could be more wrong. Introducing new regulation will indeed be a quack’s charter. How can using existing regulation to stamp out misleading and dangerous quackery be a ‘quacks’ charter’? Prince Charles’s friends need to show how recognising herbalists training will protect the public when it is likely that it is this very training that presents the clearest risk by indoctrinating students with nonsensical ideas about medicine, science and evidence.

Lewith’s aversion to the uncomfortable truths of medical science is made clear by his statement that “Those who oppose statutory regulation should consider the needs of the public and patients first, rather than the status of medical professionals or impractical notions about so-called science.”

The problems with statutory regulation are laid out very clearly on the dcscience web site from a rather good submission to the Department of Health. The Prince’s Foundation has yet to answer any one of these important criticisms and instead resorts to the usual quack trick of misdirection and obfuscation.

Prince Charles’ meddling represents one the greatest threats to the control of dubious medical practices since his namesake’s very similar personal interference. It is clear he wants to create a new golden age of quackery where modern scientific medicine is forced to compete (‘integrate’) with irrational nonsense, where the distinction between evidenced interventions and quackery is blurred by obfuscating regulation. History shows that creating double standards and allowing unfettered free markets in medical practices results in the exploitation of the public by deeply deluded or unscrupulous quacks. Pretending that freedom to practice, after licensing based on nothing more than unevidenced assertion of competence, protects people from harm is so obviously wrong. Let us hope that the government learns the lessons of history and ignores their current meddling Prince.

Labels: Prince Charles, regulation

 

In a recent submission to the House of Commons Evidence Committee on Homeopathy, the Society of Homeopaths proudly assert that,

The Society has long been committed to the highest standards for homeopathy, having run a voluntary regulatory system for the last 30 years and a course recognition process for the last 15 years. Further, it was the first homeopathy organisation to institute a Code of Ethics & Practice. Members must meet the stringent standards of competence for clinical and administrative practice set by the Society. Consequently our members are trained to very high academic and professional standards.

The government appears to be convinced that the public can be protected by ensuring that the practitioners of pseudomedical treatments have had proper, accredited training. Setting up the Complementary and Natural Healthcare Council (Ofquack) is predicated on that only people who have met standards of training can be registered.

I would suggest that the exact opposite is true. That training in irrational beliefs is likely to create a more dangerous practitioner.

To highlight my concerns, I want to discuss some course notes that arrived in my post. They were sent to me by a homeopath (let me call her P) who, after a great deal of reflection, had become quite concerned about what and how she had been taught.

The notes consist of a course outline, handouts and hand-written notes and describe a series of lectures on treating cancer with homeopathy. All the courses were given by the same lecturer, let’s call him homeopath H, at a college that was one of the first accredited by the Society.

First of all, it is quite a shock to see that a homeopathy college is giving lectures on treating cancer with homeopathy. Let us remember that homeopathy is just a chat and sugar pills. One would have thought that the best a homeopath can do is be supportive of their customer when going through difficult treatments – basic tea and sympathy. We would expect the homeopath to comply with the Society’s Code of Ethics and ensure that they have a “sound, open, co-operative and professional relationship” with their customer’s GP and act within “the bounds of their legal and ethical responsibilities and competencies”.

However, my previous investigations of homeopathy in the UK would suggest the exact opposite is true; that the Code of Ethics is a mere unenforced fig leaf and that homeopaths are trained to have a huge antipathy towards real medical practitioners. Furthermore, what homeopaths say to the outside world is quite different from what they say to each other.

These course notes are a horrifying example of this. Breathtaking in their stupidity, arrogance and cruelty.

At the centre of the lectures is a detailed case history and video of the treatment of a patient with cancer. Patient J appears to be refusing to speak to his GP anymore and H starts off by advising the patient to eat organic brown rice and drink spring water “to detox as quickly as possible”. Right from the word go, the homeopath puts their customer on a very restrictive diet for nonsensical reasons.

It gets much worse.

The lectures describe the homeopath’s responses to the progression of J’s illness and why different sugar pills are selected. And it is worth remembering this as you read the notes. No matter what justifications are given for each pill selection, J will have been given just plain sugar pills: the only difference being what might have been written on the labels.

A word of warning is given to the students on the course:

It is illegal to treat cancer. Treat patients who happen to have cancer

So, the lecturer understands that as homeopaths, advertising and offering to treat cancer would be breaking the law. Never mind. Use some weasel words in a shallow attempt to circumvent such inconveniences. Now, before I go on, I would say that I fully understand and could support genuine complementary therapies helping people with cancer cope with the emotional trauma of their disease and treatments. This is not what we see here though. We see nothing complementing a patient’s treatment and nothing about just happening to treat people who may have cancer. These notes describe a direct attempt to rid J of their cancer, no matter what word trickery H tries to pull.

Indeed, the antipathy to real treatments is clear in the notes. It is even suggested that it might be the chemotherapy (Rx) that kills patients:

It is the Rx that kills them. When people choose only to be treated homeopathically – have to have strength of character to see it through - pressure from allopaths and family.

It is not clear who has to have the ‘strength of character’. No doubt the patient must have their beliefs reinforced that homeopathy will save them, but also that the homeopaths must not buckle and allow the patient to return to real treatment.

Doctors are described as ‘allopaths’, the derogatory term used by the creator of homeopathy for those that did not adhere to his methods. From its inception, homeopath was never intended to be a complementary medicine to anything. It was designed as a complete system of medicine in its own right – suitable for everything and everyone. (The Society of Homeopaths still describes its methods as such on its home page.) Worse, Samuel Hahnemann saw the cause of many diseases as being due to treatments from ‘allopaths’. These beliefs obviously continue into current courses.

The students are told that,

Cancer in unvaccinated people tends to be in older people.

Another, near universal dogma amongst homeopaths are that vaccinations are ineffective and are actually the cause of many illness. Most see a conspiracy amongst ‘allopaths’ to keep us ill and in need of their drugs. The implication in these notes is that unvaccinated people are healthier and do not get cancer until later in life. These cancers, we are told, are slower growing and due to ‘psora’ (mythical homeopathic causes of illness), not vaccines, and these types of cancer ‘don’t kill them’.

If homeopathy is so good, then homeopaths are going to need good excuses for why their treatments fail. Homeopathy has had two hundred years to come up with good excuses. Again, allopathic drugs can destroy a patients ‘vitality’. H tells his students,

Not everyone has the vitality to deal with tumours – some people reabsorb – some people form calcification around it.

For those patients who kill themselves, “most people who commit suicide have been on antidepressants.”

The lecture notes are full of details about what homeopathic remedy can be used with what cancer symptoms. You can see similar sorts of nonsense on popular homeopathy web sites, such as hpathy. Along with these remedies, there are lots of unevidenced and irrational assertions about the nature of cancer, such as,

Breasts are the seat of mothering and there is usually a mothering issue in breast cancer.

When pain continues it is usually because we are denying something. When we deal with issue, pain goes away.

These ‘emotional’ issues are important for homeopaths as they see this as being ‘holistic’. We must not think that in describing these emotional states homeopaths are attempting to treat specifically these states – no, treating these emotions is indistinguishable from treating the disease. The direct implication is if that a sugar pill remedy can counter ‘mother issues’, the breast cancer will go away.

The remedy selection also contains advice for how to treat patients who have refused to go it alone with homeopathy and are also being treated in a hospital. There are remedies to ‘strengthen the kidneys’ after chemotherapy and bizarrely,

Potentised MRI can be used after scans.

Quite what this means is at first a little difficult to fathom. However, homeopathy is not just about diluted herbs. This is an example of an one of the more bizarre remedies where an ‘intangible’ essence is captured, usually by holding some vial in the vicinity of what you wish to make a remedy from, and then carrying out your magic dilution. You can find remedies made from ‘mobile phone’, the ‘light from venus’ and ‘antimatter’. Here, the MRI scan has been capture to counteract the bad effects (whatever they are) from an MRI scan.

It gets much worse.

At some point during the treatment of J, it became clear that he had TB and that this was being treated by a dreaded ‘allopath’ with their poisonous cocktail of drugs.

The lecture notes describe the drug regime that J was on. H makes it clear that TB is a notifiable disease.

Now has TB – TB notifiable disease.

So have to have Rx by law – or can be sectioned.

TB is notifiable because it is contagious and dangerous, killing about half of untreated infected people. Very effective treatments now exist, but it takes a long time on a cocktail of drugs which can have side effects.

In the notes, H appears to conspire with the patient to only take rifampicin, which can colour urine red, and another drug which may show up in a urine test, to convince the doctors that the treatment regime was being adhered to. In place of the real therapy, J is given more homeopathy and vitamin pills. (H, the lecturer, also runs an online vitamin store.)

P’s notes simply say, “This was illegal – [H]’s conscience dictated what he did.”

You may be shocked by this and quite rightly. Taking only part of the drug regime can lead to very bad complications, such as drug resistance. Such actions stand a high chance of killing someone with TB. But, even within the world of homeopathy, such actions are explicitly forbidden by the code of ethics. We can only ask, just what does this code mean when a homeopaths ‘conscience’ so easily overrides it?

J did not get better, as you might have guessed. The case study documents the terrible pain, fear and inevitable deterioration experienced by someone essentially untreated for cancer. Eventually, J declines further homeopathic help and dies some time later.

Now, all I have here is one student’s notes from a lecture series that happened over a decade ago. The college that this took place in has since changed hands. The lecturer is now running another accredited college and has since been made a Fellow of his registration body for services to homeopathy.

But this is not the only evidence to suggest that serious disconnects are manifest between the stated code of ethics of homeopaths and the actual practice of homeopaths in their training. Blogger ‘land tim forgot’ has documented his concerns about the Allen College of Homeopathy and their approach to cancer. Again, shocking stuff. Edzard Ernst has been reported in the BMJ talking about how the Society of Homeopaths appear to break their own code of ethics on their web site by posting “speculative," "misleading," and "deceptive" statements.

Can we really trust homeopaths to police themselves? The answer is a resounding ‘no’. They have failed to stop the extremes in their trade that threaten lives. They refused to condemn the homeopaths caught out handing out sugar pills to prevent malaria. When the WHO issued a statement saying homeopathy should not be used for the treatment of HIV/Aids, they resorted to misleading bluster. And it appears to be not just a fringe that have dangerous views. Fundamentalist approaches to homeopathy are taught as mainstream. In discussions with P, she tells me homeopathy in the UK has become dominated with a dogmatic approach to issues and that those that might question lecturers are bullied into silence.

Homeopathy in the UK has become a pseudomedical cult where the novitiates are quickly taught not to question, where conspiracy theories about Big Pharma are used to ensure external criticism is ignored and where irresponsible practices are taught as heroic actions.

All homeopaths need is blind and ignorant faith. One line in the cancer notes chillingly stood out,

If you do not understand what is going on – trust and wait. Homeopathy is the ability to trust and wait.

And in the meantime, their patients are being denied life saving treatments. Their fears about medicine are being turned into a distrust of doctors. Their autonomy is being replaced with false hope. Their chances for a longer life are being replaced by conspiratorial fantasy. This is not complementary medicine. It is the despair of our capacity for irrationality and delusion.

Labels: homeopathy, regulation, Society of Homeopaths

 

Last week, a comment piece in the Guardian asked, “Should there be freedom to mislead?”. It is an interesting question. Should the State intervene and try to regulate scientific truth? In a free society, should people not be free to hold untrue beliefs? In the context of pseudomedical beliefs, what role should regulation play in preventing untruthful claims to be made about treatments and how far should the state go in protecting people?

Several writers tried to answer the question.

HE Barber takes the stance that if people want to take quack medicines and bogus therapies they should be free to do so. The difficulty is where people cannot be expected to carry out rational deliberation or have informed consent. Children represent a group of people that should be protected from misleading claims.

The philosopher Julian Baggini takes a similar stance with the approach of caveat emptor – buyer beware – where people should not expect the state to take responsibility for preventing them being defrauded. However, he argues that we cannot be expected to be able to check every claim we face on the high street and that we should not tolerate people making ‘brazenly’ false claims leading to profit. He argues that we are all ‘vulnerable people’ when we rush into a chemist with a headache. We simply do not have the time or means to search PubMed for the best studies to support our purchase.

Adam Rutherford argues that it is unfair to allow quackery like homeopathy to compete with real medicine on different rules. The homeopathic pills on the shelves of the pharmacy are not subject to the same stringent rules for proof as the drugs alongside. However, real protection can only come if people develop critical skills and can “smell the honk of a shyster a parsec away; a nation of skeptics, where the norm is to confront assertions, and ritually demand parsimonious explanations.”

There is, of course, merit in all these views and they are not incompatible. It is daft to pretend we can legislate away the daftness of quackery or protect people totally from pseudomedical beliefs. Like religion, such beliefs appear to tap deeply into some people’s psychological needs irrespective of their empirical merits.

What regulation does get introduced though needs to be compatible with the true nature of those beliefs and the potential harms they pose. I believe the biggest problem with current approaches to legislation is that it tries, at some level, to falsely mirror and imitate the legislation of real medicine. It is like trying to regulate carpet manufacturers with legislation designed to ensure the airworthiness of aircraft just in case the carpet might fly. Pseudomedicine and medicine are two different things with different balances of benefits and dangers to people. Any regulation around them should reflect that reality.

Different countries take quite different approaches to the problem. In the UK, we appear to be taking the convoluted approach of attempting to replicate the structures and regulatory bodies we have for medically trained professionals for alternative medicine. There are currently consultations ongoing for the statutory regulation of acupuncturists and herbalists. The belief is that somehow we can protect people by ensuring that practitioners have been properly trained, neglecting the obvious fact that it is their training that is indeed a threat to people.

Sweden has taken an interesting approach by making it illegal for children under the age of 8 to be treated by CAM practitioners. It also stopped pregnant women being treated with CAM. This would appear to be a pragmatic compromise between allowing adults to make their own mistakes and protecting those who are unable to make any sort of balanced decision. It is the sort of law that may have prevented the recent tragic death of a baby in Australia at the hands of her homeopath parents.

However, Swedish quacks have not taken too kindly on this restriction of their trade. It would appear the Swedish homeopaths, Svenska Akademien för Klassisk Homeopati, took offense at this (translation) and took their case to Geneva. The UNCRC responded in June thus:

The Committee notes that complementary and alternative medicine (CAM) is a recognized field of medicine both in Europe and globally. To this end, the Committee is concerned that the State party prohibits the use of CAM for examination, treatment and care of children below eight years of age as well as pregnant women and women in labour and it is concerned that such a prohibition challenges the rights of all individuals in the State party, including children, to choose a method of treatment and that it might deprive them of their right to the highest attainable standard of health.

The Committee recommends that the State party consider reviewing and amending existing legislation to ensure that all children, without distinction of age, have access to CAM examination, treatment and care and can enjoy their right to the highest attainable standard of health.

The UNCRC have made the fundamental mistake here in trying to equate quackery with real medicine. They have made the assumption that being seen by a quack will lead to the ‘highest attainable standard of health’ and not pose substantial risks to the child. Quite how the committee noted that CAM is a ‘recognised field of medicine’ is not clear as by definition these pseudomedicines are not recognised. There is also no clear understanding how the child, or even unborn infant, can exercise their right to choose their methods of treatment.

It is a confused and muddled statement that does not show any understanding of the nature of the problem and the way in which this Swedish law protects people from the muddled, delusional and dangerous views of people like homeopaths.

I would hope the Swedish parliament, in bringing this law in the first place, is a little more enlightened than most and ignores this naive request.

Labels: regulation

 

Appearing on the Society of Homeopath’s web site is a report that a member has been struck off their register. This is the first instance that I am aware of where the self-regulating body has taken the step of removing someone from their register regarding matters of their practice.

(Yes, SoH has removed people before and you can see a report on the same page, but this looks as if it was an offence concerning more to do with ‘relationships’ with a customer, rather than as a result of their direct practice.)

So, Ms. Alex Christie RSHom has been removed from the register. She is of course still free to practice and will simply be relieved of having to pay SoH her subscription fees. She may well join one of the other 'regulators' or just continue to practice without registration in her work at Neal’s Yard Remedies.

What was Ms Christie’s offence? The Society do not make this clear. There is no press release about this. No statement to warn the public about the nature of the problem. No reminder to homeopaths about the boundaries of what they should be doing.

What we do get is a list of rules that Christie has supposedly broken. We can see that she broke the rule that said that:

A competent homeopath identifies those occasions when a patient’s condition is:

• Beyond the present limits of their clinical competence and expertise
• Likely to receive more immediate, effective benefit from another form of treatment
• Showing signs and symptoms suggestive of an underlying condition which requires referral for investigation and other medical diagnosis

Of course, the problem with this rule is that homeopaths are systematically incompetent. By believing rather arrogantly that sugar pills are a ‘complete system of medicine, suitable for everyone’, as the Society describes homeopathy, then naturally we might see few expressed limits on competence. Indeed, we see wild claims that sugar pills can cure everything from hay fever, autism to cancer. One might jest that a client is ‘likely to receive more immediate, effective benefit from another form of treatment ‘ when they are simply ill. This rule, if honestly applied, could strike off any homeopath at any time for making claims that cannot be justified.

Given that homeopaths actually believe their sugar pills work magic, then it is difficult to see how a panel of homeopaths can decide that another homeopath is practicing beyond their expertise. The Society of Homeopaths has held conferences of homeopathic treatments for AIDS and shows no signs that this might be dangerous and murderous nonsense. Their directors believe sugar pills can replace childhood inoculations and even replace vaccines for dangerous third world diseases. Whatever Christie did, she must have really upset someone within the Society.

Tellingly, we are told that Christie broke the rule that says “When dealing with cases of a serious and possibly terminal nature, ensure that the patient is fully aware of the advisability of keeping their GP informed of their condition.” Homeopaths are renowned for denouncing modern medicine. Their founder, Samual Hahnemann, defined homeopathy in opposition to medicine and indeed blamed medicine for chronic illness. This paranoia and hostility is openly evident still on homeopathic discussion forums. Homeopaths are in denial of two hundred years of medical progress.It is no wonder that members might give misleading advice to their clients.

What is quite remarkable about this is that the Society of Homeopaths has received lots of complaints over the past year or so about homeopaths blatantly breaching their code of ethics, giving dangerous advice about their magic versions of vaccination and selling sugar pills as a malaria prophylactic and all these have been met with stonewalling, obfuscation and a refusal to recognise the problem.

So, why act now? That is a bit of a mystery. We know that the Society want to hand over their regulation activities to the Health Professions Council. Perhaps they are trying to appear to carry out what they say they carry out.

Perhaps thought there is more to this story that will reveal itself over time and that this move is tactical. That would be my bet. We shall surely find out soon.

Labels: regulation, Society of Homeopaths, SoH

 

This is an open letter to all homeopaths in the UK.

It has been a bit of a surprise to me to learn that the Society of Homeopaths is wanting to lobby the Health Professions Council to include homeopathy within its regulation remit. As such, you will receive protected title (only registered homeopaths will be able to call themselves that) and be held against a code of standards and ethics.

Why do you want to do this? I can guess some of the reasons.

Homeopathy has always battled to be recognised – both as a science and as a healing profession. Deep within the homeopathic mindset is a belief that you hold a valuable principle of healing, if not the fundamental theory of healing. Over two centuries you have battled to gain acceptance and validation against what you see as a hostile (even conspiratorial) medical profession. You call the medical profession allopaths and define yourselves in opposition to your own picture of them.

Undoubtedly, you see that statutory regulation will put yourself at least on a par with doctors. You will no longer legally be invisible in the healing professions. But there are other more economic reasons too. Being statutorily registered will make it easier to gain referrals from the huge source of cash that is the NHS. It will also make it easier to get payments from private health insurers. You won’t have to pay VAT, although I doubt many of you make enough to have to worry about that. Universities have recently said that they will not teach BSc courses to train homeopathic practitioners unless they achieve statutory regulation.

So, the prize appears to be huge. Recognition, financial gain and the secured future of your profession through accredited education. The Society of Homeopaths can free itself of the tedious burden of having to pretend to regulate you and instead become something like the BCA and concentrate more on trying to sue its critics.

But what of the cost? Such rewards will come at a price – and I am amazed that the Society of Homeopaths believes you will wish to pay that price.

First, before we look at what this might all mean for homeopathy, I would suggest that the path to Statutory regulation will not be easy. I am sure you are aware that there are many people who think such a step would be absurd, myself included. Homeopathy has failed in two hundred years to make any progression in showing that it is nothing other than a inert treatment based on pre-scientific and magical thinking. The basic science to show that your principles are true is not there. My own simple challenge to homeopaths to demonstrate their fundamental propositions has not been taken up in 85 weeks. More damningly, in the two hundred years since homeopathy was invented, our scientific understanding of medicine, chemistry and physics has moved on enormously and it clearly shows that homeopathy is not just implausible but is utterly contradicted by everything we know about the world. Homeopathy lies outside of reason and science. It is a pseudo-medicine and is just a placebo therapy. It is just not tenable to hold any other position.

To gain statutory regulation, you will have to demonstrate that it is indeed possible to have meaningful standards in education and training for a pseudoscientific subject. That is not impossible – the current government has on the whole failed to see the problem with regulating absurd treatments. It is funding Ofquack, the Prince Charles backed Complementary and Natural Healthcare Council, as a voluntary regulator for a rag bag of quack practitioners. The government does not appear to see that upholding such people to high degrees of training and competence is problematic when such people believe in absurdities. I would suggest though that the HPC may well be tougher judges than Prince Charles.

So, onto the costs. In order to appreciate what such regulation might mean for homeopaths it is worth looking at what it has done for other statutorily regulated alternative medicines. Chiropractic would be a good example.

The regulation of chiropractic was not without its controversy. The Society of Homeopaths claim that 65% of its members support the route to such regulation. The Society of Homeopaths only represents 65% of homeopaths, so we can only be sure that 42% of homeopaths support such a route. Even then, this survey was taken in 2006 and a lot has changed since then. I would be very surprised if this support has grown. Are the majority of you in favour of this move? Chiropractors were also split when the Chiropractic Act was brought in. Many saw it as an attempt to control their practice and restrict what they could do. Chiropractic philosophy appears to embrace a libertarian stance and many resented passing control of their work to people who may not share their beliefs and views. Some were worried that the move had conspiratorial overtones of the medical community trying to suppress an alternative to them. There were quite a few who refused to be registered and had to cease calling themselves chiropractors and instead called themselves simply spinal manipulators or even the grand sounding osteomyologists.

Over a decade later, the political infighting still continues. Many resent that the McTimoney Chiropractors were let into the exclusive regulated club. McTimoney is seen as a chiropractic heresy where bones are not cracked so violently and training takes place through part-time courses. It is not seen as being real chiropractic and the practitioners as being undertrained – through cheaper courses. It represents a threat to the chiropractors who will have invested well over £40,000 in fees for their training at one of the other two ‘real’ chiropractic colleges.

The General Chiropractic Council, the regulatory body, appears to be popularly despised by the ordinary chiropractor. It is seen as heavy handed in its regulation, costly and not in tune with chiropractors’ needs (to be left alone). It has no duty to promote chiropractic but only to protect the public and enforce its code of conduct. It is also increasingly dominated by lay representatives – chiropractors are getting a smaller voice in its running. Much of this resentment has been well documented on the chiropractic blog chiropracticlive.com.

When the British Chiropractic Association decided to sue Simon Singh for criticising the lack of evidence base for the treatments it was promoting, I doubt they understood the difficulty they would be putting their members in because of the very fact that they were statutory regulated. The ensuing debate has exposed the non existent foundations of much of chiropractic care and this has led to an unprecedented number of complaints being made to the GCC about chiropractors misleading the public on their websites for the effectiveness of the treatments they offered. There are now perhaps 20-30% of the entire chiropractic profession undergoing statutory complaints procedures which could result in the loss of their registration and their ability to practice.

The mistake the government and chiropractors made in accepting statutory regulation was allowing it to go ahead before chiropractors could demonstrate that they were not simply a vestigial remnant of Victorian back cracking quackery. Now, chiropractors find themselves being held to the highest forms of professionalism and practice without an evidence base for pretty much anything they do. It is now possible that chiropractic in the UK will not survive the current onslaught of professional complaints and trading standards investigations being pursued against them. What will come out the other side is pretty much anyone's guess, but I am pretty sure it is not a situation that the majority of chiropractors would have wished for in their quest for recognition.

And this is what I find extraordinary about the attempt by homeopaths to join the HPC. At present, the nightmare that is happening to chiropractors cannot happen to homeopaths. Despite what you say, you have had the freedom of living without any form of genuine regulation. The Society of Homeopaths has never ruled against a homeopath for the way they practice when when faced with clear breaches of the code of ethics. Homeopaths have been free to indulge in whatever delusions they fancy without fear of sanction. You have claimed to treat malaria and AIDS and have done so without a single voice of censure from within the lay homeopathic trade. You have no idea what it is like to be regulated and to be subject to a real code of ethics and practice. I suggest you pop along to your nearest chiropractor to find out what it is like.

And I must say that chiropractors have it fairly easy. Their treatments (at least for lower back pain) have an air of plausibility and some evidence for effectiveness. Homeopaths lack these luxuries of plausibility and reliable evidence for anything. What makes your situation worse is that your belief set is acutely in conflict with those who will become your statutory medical colleagues. You regularly undermine public healthcare messages about childhood inoculation and believe your sugar pills are an alternative. You show no sense of boundaries for what you can reasonably hope to achieve and make claims to be a superior treatment for everything from asthma and swine flu to autism and cancer. Do you really believe you could continue with your alternative beliefs in a statutory world? And they are alternative. Whilst you denounce the side effects of real medicine as being avoidable by homeopathy you pitch yourself against the medical world. And I doubt that a regulated profession could last long with such rhetoric.

Homeopaths. You have never had it so good. And you do not realise it. You are pretty much free from any constraint on what you say and do. You may moan about the continuous criticism you get from people like me – but that is the worst you have to suffer at the moment – criticism. If by some fluke you do manage to achieve full regulation, expect your cosy world to come crashing down very fast. Your quest for regulatory recognition will be hubris. It took over fifteen years for the chiropractors to realise they had been practising on borrowed time. Your regulatory nemesis will come much quicker.

Labels: British Chiropractic Association, chiropractors, CNHC, Complementary and Natural Healthcare Council, homeopathy, regulation, Society of Homeopaths, SoH, the law

 

The pharmaceuticals are deliberately included to make it work. People think they are getting something completely herbal but it contains up to four times the dose of pharmaceuticals found in legally prescribed medicinal products. Often, such marketing claims about the supposed natural ingredients in these unlicensed products are simply an attempt to divert the consumer's attention away from very low manufacturing and ethical standards.

It might be tempting to dismiss this as an exceptional case where the herbal product required adulteration in order for it to rise to the occasion. However, some independent research has been done into measuring the levels and frequency of adulteration in herbal medicines and the results are rather startling. Bandolier, the Oxford evidence based healthcare information journal, reports that a literature survey would suggest that adulteration was widespread and that “Chinese herbal medicines may work because of the adulterants.” Surveys reported conflicting levels of adulteration, from US reports of 7% to reports showing nearly all samples containing adulterants. Bandolier conclude that  “in the absence of better information, we should assume that Chinese medicines are adulterated.” A review by Edzard Ernst concluded, “that adulteration of CHMs [Chinese herbal medicines] with synthetic drugs is a potentially serious problem which needs to be addressed by adequate regulatory measures.”

Alarming stuff. And of course, if your are lucky enough to have got from your Chinese herbalist some unadulterated herbs, then you are still left with the problem that you are about to take an unquantified amount of probably pharmacological active ingredient, mixed in with many other compounds that may or not be good for you, in a way that has not been tested for safety or efficacy and without any recourse should the herb not work or even harm you. And at the same time, your condition and herb taking is not being monitored by a qualified health worker.

Fraud in Chinese Medicine does not appear to be restricted to herbalism. It is not just adulteration that distorts our view of Chinese Medicine. Claims of efficacy can also be subject to fraud. One interesting review is by Kevin W Chen, Ph.D., M.P.H. of the University of Medicine and Dentistry of New Jersey. The review is into a branch of TCM called QiGong. Qi is the mysterious life-force that binds together so much of so called Traditional Chinese Medicine. QiGong was really invented in the last fifty years, but it has spawned a lot of research in China. Despite Kevin Chen being a True Believer, his review is interesting because it paints a fascinating picture of the nature of research in China into TCM. 

The review (An Analytic Review of Studies on Measuring Effects of External Qi in China) describes the various methods used to research Qi. However, the author notes that there are few randomised controlled studies and the field does not tend to replicate any results. As you might expect, there is complete publication bias with no negative results being considered worthy of publication.  Thus, any spurious results stand without independent confirmation. The reasons for this are interesting. Chen describes the “deliberate deception by qigong healers and in the research conducted by special interest groups that are determined to find positive outcomes”. There is a complete lack of discussion of “potential covariates that may affect the results”: positive results are assumed to be due to Qi.

Rivalry between different research teams drove bias,

Few double-blind randomization methods were used in these exploratory studies, which may greatly discount the results or conclusions, because experimenter effect and measurement bias might all become part of the observed results, especially when the specific qigong schools sponsored the research and tried to prove their own styles of qigong to be most effective.

Ten years ago, a review by Vickers et al looked at the question “Do Certain Countries Produce Only Positive Results? A Systematic Review of Controlled Trials”. They looked specifically at thousands of acupuncture trials and noted that “No trial published in China or Russia/USSR found a test treatment to be ineffective.” Even in England, “75% gave the test treatment as superior to control.” Not publishing negative results massively distorts our view of the efficacy of treatments; it can make ineffective treatments look effective, and that is not good. Pharmaceutical companies are guilty of publication bias too, but not on the scale of Chinese researchers.

Tang, Zhan and Ernst (1999) wrote a paper on “Review of randomised controlled trials of traditional Chinese medicine”. They saw a list of similar problems over all TCM. They concluded that “the quality of trials of traditional Chinese medicine must be improved urgently.”

Misleading people about acupuncture has a long history. Since, the first diplomatic contacts with communist China with Nixon, reports emerged of major operations being undertaken with acupuncture being used as an anaesthetic. What was not reported was the massive levels of patient sedation and local anaesthetic. Even the BBC were fooled and, in turn, fooled their audience when Kathy Sykes broadcast her programme, Alternative Medicine, that claimed to show that “acupuncture was used instead of a general anaesthetic during open heart surgery in China”. After a complaint and an appeal to the BBC, it finally admitted that it had misled the audience over acupuncture.

Why should Chinese Medicine be associated with so much fraud? I find this alarming. For the best part, I believe that most people working in alternative medicine are simply naive and deluded, and only harm people through omission and a negligence in not doing enough due diligence over their own beliefs. The examples I report here go somewhat further than this. China, being a nationalistic and totalitarian regime, will not produce the strongest incentives to produce honest and open research and industrial methods. Accountability will be low and  the rewards for producing ‘success’ high. Examining the research and claims of Chinese medicine in the UK is naturally made more difficult by language.

But what is more alarming is that there are signs we are approaching the regulation of much of Chinese Alternative Medicine in the belief that we simply need to uphold standards of training and ensure that traders are of ‘good character’. This will do little to stop adulterated products arriving in the UK or false and misleading claims being made by practitioners. Even unadulterated products present significant risks to customers. At the heart of the regulatory problem is a double standard. Real medicine is tightly regulated. Only a few qualified people can prescribe and dispense. There are professional regulators with teeth and drug companies are not allowed to advertise to the public and make misleading claims in their literature. Somehow, we allow herbalists to imply all sorts of unproven claims. They do not have to provide proof of efficacy or safety. There is no follow up and monitoring of side effects. We do this under the mistaken belief that Chinese Medicine is “traditional, natural and safe”. None of this is true. It is a business based on fraud, misleading claims and dangerous practices. I rarely say this sort of thing, but there is a strong case to be made to make the dispensing of herbal medicines illegal.

Labels: regulation, Traditional Chinese Medicine

 

The Professional Conduct Committee has seen that treatment plans are exploitative when they are constructed around a diagnosis that leads patients to believe they are more seriously ill than they are, with the intention to promote undue dependence on chiropractic care. Some treatment plans, as shown by the evidence heard by the Professional Conduct Committee, were formulated without any adequate assessment or reassessment of patients’ needs. Going hand in hand with this approach was the routine X-ray of patients without justification. The images were used as sales tools further to pressurise patients to accept treatment.

They speak of a few cases:

This year the Professional Conduct Committee heard evidence in one case that also demonstrated a blatant disregard for patients’ safety and wellbeing. Amongst other things, patients, including a child, were exposed to ionising radiation for no other reason than to use X-rays to pressurise patients to sign up to long contracts of care. The individual concerned showed no insight, understanding or remorse for what
he had done and was removed from the Register.

During another Professional Conduct Committee hearing, a respondent chiropractor admitted that he had routinely X-rayed nine out of 10 adult patients. Upon considering an audit of nine patient records, the Professional Conduct Committee was of the view that there was no justification for those patients to have been exposed to ionising radiation.

Table 33. & 34. X-rays

Chiropractors were asked:

a) For what percentage of your patients is an x-ray justified?
b) Do you take x-rays of your patients?
c) Do you refer patients direct for imaging?
d) Do you refer patients for imaging via GPs?
e) Do you interpret the x-rays?

Table 33. a) X-ray justified?
Number of Range chiropractors

0%	9	1%
1-20%	525	61%
21-40%	99	12%
41-60%	51	6%
61-80%	47	6%
81-100%	34	4%
Didn’t specify	89	10%

 
Table 34. b, c, d, e) X-rays

	B	C	D	E
Yes	294 (34.43%)	499 (58.43%)	568 (66.51%)	593 (69.44%)
No	542 (63.47%)	306 (35.83%)	246 (28.81%)	241 (28.22%)
Didn’t specify	18 (2.1%)	49 (5.74%)	40 (4.68%)	20 (2.34%)

Clearly, the majority of Chiropractors are X-raying fairly regularly and some are performing it routinely. There are undoubtedly practitioners out there that believe wholeheartedly in the concepts of subluxations and use X-rays to try to find their mysterious problems.  One comment in the Survey noted this 'fundamntalist' approach to their art,

Labels: chiropractors, regulation, Simon Singh

 

Today sees the long awaited launch of the government backed Ofquack, better known in some circles as the Complementary and Natural Healthcare Council (CNHC). Ofquack is the "national voluntary regulator for complementary healthcare practitioners" and was set up by Prince Charles' Foundation for Integrated Health and funding from the Department of Health. You can find their sparkly new website at http://www.ofquack.org.uk/.

It has been quite a long road getting here. The quackometer reported on the newly emerging regulator's woes this time last year when I described it as a dead duck. The CNHC had grand ambitions to be the one-stop-shop regulator for all complementary therapists - a single register that the public can check to see if their chosen quack professional was 'legit'. The House of Lords, in a 2000 report, said that such a move was desirable. It has been a dismal failure.

The reasons for this are many, but principally stem from the daft decision by the Department of Health to put the set-up of the new body in the hands of Prince Charles. This is a man with a blind faith in all sorts of wooly alternative health ideas and no critical ability to appraise the problem rationally. His sycophants have assured that Ofquack has been set up so that it presents little challenge to his beliefs.

So, Ofquack is not quite dead, but it is moribund. They state that their aim for 2009 is to register 10,000 practitioners. My guess is that they will achieve a tenth of that. Of all the forms of quackery that were supposed to be regulated by the CNHC only massage therapy and nutritional therapy are included in the fold. The other large quack trades, such as homeopathy, aromatherapy, reflexology and reiki have not been cooperative and enthusiastic in their wish to be regulated. The homeopaths, for example, have flatly refused to take part and their current fake regulatory bodies, such as the Society of Homeopaths, are desperately trying to be seen as their own effective regulators - a role they fail dismally at.

So, will the massage therapists and nutritional therapists flock to the fold of Ofquack? Well, massage therapy is a small trade - it does not include the vast majority of massagers that you might find in luxurious hotels, sports centres, or dodgy rooms above a betting shop in the less salubrious suburbs of Birmingham. Massage therapists are the massagers left over who somehow believe that a good rub down can clear your body of toxins or something. Not a happy ending.

What of the nutritional therapists? I somehow doubt they will be rushing to join. They stand to lose a great deal by being independently regulated. Currently, their own regulator BANT allows them to get away with all sort of sharp practice. BANT changed their code of practice under pressure from Vitamin pill companies to allow BANT members to take kick backs on the sale of pills. This is a cosy and profitable arrangement that I am sure would be threatened if Ofquack decided to apply some more ethical standards to their registrants. Nutritional therapists also make money from dodgy diagnostic tests, such as fake allergy testing and hair mineral analysis, which has been described by the American Medical Association as "an unproven practice with potential for health care fraud." I am sure practitioners would wish to stay with a 'regulator' who is in on the scam.

So, even if some quacks decide to join so that they can use the new 'kite mark' on their advertising, will Ofquack work? I doubt it. The central problem is that the Complementary and Natural Healthcare Council appear to be horribly confused about what they are supposed to be protecting the public from.

Today, one of the chairs of the CNHC said on the BBC web site (Alternative therapy 'crackdown') that Ofquack would "would clean up the industry used by one in five people." She "estimated thousands of clinics may go out of business in the process." (See Maggie Dunn talk about Ofquack here).However, the BBC were quick to point out the flaw here when they said "It will not judge clinics on whether therapies are effective, but rather on whether they operate a professional and safe business." However, there is an inherent contradiction here that you cannot assess if a therapy is 'professional and safe' if you do not also take into account if the therapy is effective. And here we have the fatal flaw in the whole idea of the Complementary and Natural Healthcare Council.

Let's imagine a few scenarios. Someone complains to Ofquack that a nutritional therapists is using hair mineral analysis to diagnose 'mineral deficiencies' and using this as a basis of selling huge numbers of expensive supplements and then is taking a kick back on the sales in the form of commissions. Hair mineral analysis does not diagnose dietary deficiencies. The whole basis of the transaction is fraudulent and yet is very common in nutritionist circles. What would Ofquack do? They would probably consult their therapy specialists who advice them if such a practice was within the training of a therapist. And the answer would be 'yes'. Patrick Holford's Institute of Optimum Nutrition in London trains students in such dodgy practices. The course is underwritten by the University of Bedfordshire. Is the practice safe? Well no direct harm has occurred, although the indirect harm is that someone believes their diet is deficient when it probably is not, and they are left with the belief that they have to buy 'specially formulated' vitamin and mineral supplements to avoid dreadful health effects. Could Ofquack protect the public from these dubious practices without asking 'is the therapy effective'?

A second scenario - based on real life. A customer is brain damaged by a nutritional therapist who told their customer that the needed to diet by drinking lots of water and removing salt from their diet. Again, this sort of advice is routine. This year, Barbara Nash, a nutritional therapapist, was sued and paid out £810,000 in a settlement for compensation for such a course of action? How would Ofquack respond to such a complaint? Clearly they would have to take into account that such advice is batty and dangerous. But to do this they have to rely on their 'panel of experts' from the various quack trades. In the Barbara Nash case, none of the nutritional therapy bodies spoke out and condemned her actions. People like Nash are constantly told that they have good training and are professional. As Ben Goldacre argued in the guardian,

After completing the rigorous training at the "College of Natural Nutrition", anyone would naturally believe themselves to be appropriately qualified, and able to give advice confidently. Nash's confidence in her own abilities seems entirely congruent with that world view.

Membership of Bant carries such privileges as "a listing in the Bant Directory of Practitioners, which is available to the public and entry on the Bant website" and "acknowledgement of professional status by the Nutritional Therapy Council". So endorsed, Nash would once again have perfectly reasonable grounds for a strong faith in her own abilities

The big fear here is that if any therapist would join Ofquack, they now would have government backed endorsement of their 'abilities and professionalism', even though everything they think they know is nonsense - and sometimes dangerous nonsense.

The Barbara Nash affair took its first scalp at Ofquack. In my blog, I laid part of the blame on the British Dietetic Association for not doing enough to educate the public about the difference between quack nutritional therapists and properly qualified and regulated Dietitians. It transpired that Andy Burman, Chief Executive of the BDA, was actually on the board of directors of the CNHC. You can see from comments on my web site the sheer anger of dietitians over the fact that their Chief Executive was openly helping to promote quack alternatives to their profession. Dieticians have to spend a lot of their time disabusing patients of the nonsense they have been told by nutritionists. Very soon after, Andy Burman resigned from the CNHC board of directors.

So, even if quacks start joining the Complementary and Natural Healthcare Council there will soon be huge stresses applied. The first upheld Advertising Standards complaint, or any other action that requires Ofquack to judge if a therapy is effective will result in their current structures unable to cope and their members frightened to death. Quacks are used to cosy arrangement with their current trade bodies who act as regulators. They know they could never be struck off for doing their normal quack business. But Ofquack, being a government body, and with a large lay team acting as judges, may sooner or later have to let reality into their decisions. The whole edifice will then collapse.

So what is to be done? Well, the first thing is that setting up voluntary regulators that rubber stamp quack training and practices only legitimises irrational, fraudulent and dangerous practices. It will risk giving extra undeserved standing to nonsense and will not protect the public from delusional and/or deceitful actions.

The whole thing has been a huge waste of money. The hundreds of thousands of pounds given by the government to set up this body would have been much better spent on training Trading Standards Officers in the issues of alternative medicine. As Professor David Colquhoun argues, the new Trading Standards Laws that came into effect last May have probably made much of alternative medicine illegal. "The gist of the matter is that it is now illegal to claim that a product will benefit your health if you can’t produce evidence to justify the claim." The law is clear: “falsely claiming that a product is able to cure illnesses, dysfunction or malformations" will be illegal. And as alternative medicine ceases to be alternative as soon as there is good evidence of efficacy, a lot of quacks could be in trouble.

What is standing in the way of people being prosecuted for making false health claims is the appropriate expertise within Trading Standards to evaluate the claims and initiate the appropriate prosecutions. There appears to be a situation evolving where there could be a large clash of government policy. It is likely Trading Standards will start prosecuting registered members of the Complementary and Natural Healthcare Council. Now, that will be a sight to watch.

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


Update

As always, satire is the most efficient way of telling the story.

The excellent Daily Mash runs with the headline...

COMPLEMENTARY THERAPISTS TO BE REGULATED BY WITCH DOCTOR

Papa Limba said his first task as chairman of the Complementary and Natural Healthcare Council would be to identify which therapists were righteous shamans and which had the bad juju.

...

Limba said: "There are many frauds and not everyone has as strong a connection to the serpent god Demballa as they like to make out."I place my hands on their head and if their spirit vibrates to the rhythm of the ocean I give them a sticker to put in the window. If not I rub them with the mashed root of the banyan tree and we never hear of them again."He added: "Once a year I shall visit them and cast my chicken bones on their consulting room floor. If they are still there a week later I report them to health and safety."

And there is the heart of the problem. How are Ofquack going to certified 'well trained' practitioners when their training is in nonsense?

Labels: CNHC, Complementary and Natural Healthcare Council, ofquack, regulation

 

I am well aware that this blog may suffer from a distinct availability bias: I only really comment on and criticise forms of quackery that are easily accessible to me. As such, I may give the impression of highlighting the worst aspects of alternative medicine in the UK when actually I am only commenting on those areas that interest me and I can easily research (i.e. Google). Occasionally, I get glimpses into vast new hinterlands of quackery, unexplored and largely inaccessible. Horse owners appear to be awash with nonsensical beliefs. Even Chinese herbalists on the high street have gone unexamined because their web presence is small and unassuming.

By contrast, homeopaths have been thoroughly raked over, primarily because they crave the recognition and respectability that institutions, regulatory authorities, scientific-looking journals and conferences give them. They desire to be seen, not just as equals, but as superiors to conventional doctors, and to wear the mantle of science, even though they denigrate it when it contradicts them (as it always does). This provides a wealth of material that can be mocked, prodded and played with. But it may not represent a fair snapshot of what abuses go on in the outside world.

Here's a story that may well have escaped my attention. DM Digital TV is a Manchester based TV company (Sky Channel 802) that broadcasts in Urdu to the Pakistani population of the UK and abroad. Ofcom, the UK broadcasting regulator, has fined the TV station £15,000 for making unsubstantiated and potentially dangerous medical claims. The programme in question (Health is Wealth) was all about a homeopath called Dr Professor Mohammed Jamil Jilu ("Dr Jamil") who made several amazing claims about the ability of homeopathy to cure cancer, diabetes and hepatitis. The complainant to Ofcom thought the programme was just a platform for the promotion of Dr Jamil's homeopathy practice. Dr Jamil does not appear to have much of a web presence and does not appear to be a member of any of the pretend homeopathy regulators in the UK. Apparently, Dr Jamil is registered in Pakistan. One wonders what meaning their code of ethics has.

It turned out that Dr Jamil did in fact pay to have the programme made and so not only did the programme fall foul of the Ofcom code of practice on medical claims, but also on sponsorship and the Cancer Act of 1939. DM digital claimed in its defence that it was not the only broadcaster who carried the programme and that the programme would have met regulatory guidelines in Pakistan. It also pleaded that it was a small company (20 people) and that a large fine could seriously damage it. They also appeared to believe that Dr Jamil's testimonials regarding his ability to cure cancer were sufficient mitigation. It looks as if the TV station was operating without any regard to the broadcasting regulations whatsoever. It may have been hoping it was under the radar and was unnoticeable to the regulators. Its compliance officer did not even see the programme before broadcast.

Ofcom has regulatory teeth. It is able to impose quite heavy fines. Awareness of availability bias is quite strong with some regulators. For example, the Advertising Standards Authority, although it has significantly less power, does actively monitor foreign language channels to help ensure its reach is not limited by its own accessibility bias. It does not wait for complaints from the public, but actively seeks out problems in areas that may otherwise go unnoticed.

In contrast, the homeopathic self-regulators in the UK are completely passive. They take no role in ensuring their members act responsibly. They will have nothing to say about this case. Even when complaints are made to them, their actions are to brush aside. Self regulation is a failure. Ofcom had this to say about the seriousness of the case,

[T]he case involves significant potential harm to some viewers. A homeopath, who was not medically qualified, was permitted to give medical advice on air to an audience in the UK about how to treat extremely serious conditions such as cancer, hepatitis and diabetes. The Committee was concerned that this kind of advice would resonate with any members of the audience who may be suffering from these diseases and so would be vulnerable. In the Committee’s view there was a material risk that broadcasting the sort of unsubstantiated claims made by Dr Jamil may lead some viewers to buy his advertised products without taking proper medical advice – so causing either a delay in treatment or a failure to seek treatment at all. The seriousness of the breach of Rule 2.1 was compounded by the fact that the programme’s presenter did not challenge Dr Jamil’s claims at any stage.

No doubt, the homeopathic community will not see a problem as their own availability bias precludes reason, evidence and truth.

Labels: DM digital TV, regulation

 

The Society of Homeopaths have recently had their 30th Anniversary Annual General Meeting and Conference at Leicester University. Lots of pop and cake were undoubtedly consumed. Various guest speakers were there talking nonsense and various 'breakout' sessions allowed homeopaths to share their delusional experience with each other.

One session will be on "Perils and pitfalls in practice" given by Patricia Moroney the current Professional Conduct Officer. She says,

There will be an opportunity for you to assess the professional conduct issues that arise in a variety of situations. The workshop will be a fun and interactive way to engage with The Code of Ethics and Practice.

Now, undoubtedly 'Trish' has been having some fun with the code of ethics over the past year. A few months ago, the Society of Homeopaths produced the first documented expulsion of a member ever. The Quackometer has repeatedly criticised SoH for not taking action against members who obviously flout their rules and not being transparent and accountable in their approach to professional conduct. Could the Society be listening?


The Society claim in their Review of 2007 to have made only one formal investigation,

During 2007, The Professional Conduct Department responded to over a hundred logged telephone calls, letters and emails from members and the general public. Many of the queries arose from misunderstandings or lack of information. The majority were resolved swiftly through means of advice or where necessary mediation. During 2007 the department conducted one Adjudication Panel hearing. The complaint was upheld.

That is surprising given the fact that many bloggers have sent in complaints about members, fellows and directors of SoH who are blatantly breaching the Society rules. My own efforts to complain are well documented on this site. One complaint resulted in SoH taking legal action against me rather than address my concerns.

e.g. See

Homeopaths Through the Looking-Glass
The Society of Homeopaths: Truth Matters
Society of Homeopaths breach own Code of Ethics on website
Patricia Moroney Pwned

and so on.

So, the unlucky recipient of a Society of Homeopaths reprimand was a Mr David Evans of the North West College of Homeopathy.

What events resulted in this investigation?

We do not know.

All we know is the list of rules he was supposed to have broken. These range from "avoid disclosing any information concerning a patient to a third party without the patient’s written consent" and "Maintenance of appropriate records" to rather more disturbing rules such as "Maintaining appropriate boundaries Homeopaths, are responsible for avoiding exploitation of their patients financially, emotionally, sexually; or in any other way." and "Where a patient, student, or supervisee is expressing feelings towards the homeopath, tutor, or supervisor which cause problems for the maintenance of professional boundaries and the professional- for whatever reason- is unable to resolve the situation in an acceptable manner the professional relationship is to be ended"

The Society do not tell us what the defendant was supposed to have done wrong. Perhaps it is a new parlour game. Look at the list of rules breached and imagine the story that led to the hearing. What fun.

And what is the result of the hearing?

The Panel recommended to the Board of The Society of Homeopaths that Mr. David Evans be expelled from The Society with immediate effect. The Board ratified the recommendation of the Panel to be effective from 11th March 2008.

Now, the whole debate about regulation is how the public are best protected against dangerous practices and people who should, perhaps, not be in positions of trust. Is the Society of Homeopaths capable of fulfilling this role? What has the effect of this ruling been? To my best knowledge, the only effect has been the removal of the letters RSHom from the web site of the place where the subject of the investigation works.

So far, I have been complaining that organisations never use their code of ethics to protect the public from harm. Now that they have tried to do so, we are confronted with the obvious futility, uselessness and deceptive nature of the whole facade.

Such is the weakness of voluntary self-regulation. The government see this as the way forward for all of alternative medicine by setting up Ofquack, the new 'federal' register of all alternative healers. Just like the Society of Homeopaths, the code of ethics for Ofquack will be more about putting a veneer of professionalism on the indefensible rather than protecting the public.

Labels: regulation, Society of Homeopaths

 

The Advertising Standards Authority is one of the few regulatory bodies in the UK regularly prepared to tackle the untruthful and unsubstantiated claims made routinely in the alternative health industry. It is also one of the weakest regulatory bodies in the UK. Nothing could highlight that more than how Life Healthcare (trading under the url http://www.reverseageing.com/) dealt with an investigation.

Life Healthcare had made an advertising leaflet for a product called Thyroid Support Formula and had a heading on the front page that stated "New Scientific Studies Prove That There Is Hope, Read On, and You'll learn the Secrets That Your Doctor Might Not Be Telling You about an Under-Active Thyroid". Particularly worrying was the claim that,

But the truth is that conventional medicine does not have the best testing or treatment methods for an under active thyroid. Just because your test results have come back negative for an under active thyroid doesn't mean you don't have it.

A complainant to the ASA expressed concerns that a leaflet from Life Healthcare was

potentially harmful because it discouraged people from seeking proper medical treatment or from following the advice of their doctor

and doubted that,

the claims made in the ad for the product's efficacy could be substantiated

The ASA took a look a the advertisement and also challenged Life Healthcare if they had proper authorisations to market their products and whether the testimonials and photos included in the ad were genuine.

So, pretty serious charges. How did Life Healthcare respond? They didn't. They completely ignored requests by the ASA to explain themselves. The ASA upheld all complaints and said,

The ASA was concerned by Life Healthcare's lack of response and apparent disregard for the Code, which was a breach of CAP Code clause 2.6 (Non-response). We reminded them of their responsibility to respond promptly to our enquiries and told them to do so in future.

Their action was,

We told Life Healthcare not to repeat the claims in future advertising. We urged them to seek guidance from the CAP Copy Advice team before advertising again and asked CAP to inform its members of the problem with Life Healthcare.

I, for one, am not convinced that this direction will be adhered to.

Life Healthcare appears to make a business from evading legal restrictions on its practice. The from page of its website informs us,

With draconian EU legislation pending for the UK marketplace your right to buy optimum dose nutritional supplements may be limited, and some ingredients may no longer be available. Fortunately as we are based outside the EU (in the Channel Islands), Life Healthcare can continue to supply these high potency supplements that may have to be withdrawn from the UK and Europe in the coming months and years.

The current weakness of consumer protection laws in the UK will indeed be strengthened in the next few weeks as vastly improved consumer trading legislation comes into force. Whether this makes any difference to companies such as Life Healthcare remains to be seen.

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

Postscript

It would appear that fleeing to the channel island might not be the get out of gaol free ticket Life Healthcare hope for. Yesterday in parliament, the Minister for Health Dawn Primarolo, responded to a question asking what the Government was doing about such loopholes. She replied,

The FSA continues to work with the Ministry of Justice, the Department responsible for the Crown Dependencies, and the administrations in the Crown Dependencies regarding implementation of the food supplements directive and Nutrition and Health Claims Regulation to prevent trade in food supplements that would be illegal in the United Kingdom.

Labels: ASA, regulation, vitamins

 

Part of the wonderful new world of regulated alternative medicine is the insistence that all registered practitioners undergo Continuous Professional Development. Just like in real professions, quacks will be expected to attend a certain number of hours per year in keeping their skills up to date and learning about the latest developments in their field.

The Prince of Wales and his new Complementary and Natural Healthcare Council are right behind this initiative and, with the government, there are going to be lots of shiny new 'training standards' for their members. Existing non compulsory 'regulators', such as the Society of Homeopaths also insist in Continuous Professional Development.

So, what do we expect homeopaths to learn? The latest meta analyses and why scientific results do not support homeopathy? Basic chemistry lessons and why no atoms means no effect? No.

Let me show you an example. This evening, homeopaths can earn on of their CPD certificates by going to a talk in St Albans given by Myriam Shivadikar. The talk is entitled, MEDICAL ASTROLOGY FOR HOMEOPATHS.

Every ancient civilisation used astrology for forecasting events, promoting health and in the prevention of disease. The alchemists used astrology and based prescriptions on the patient’s planetary constitution. As a physician, we need to understand patients in order to treat them. The best physician can predict a disease before it occurs- Why wait for a person to get sick?

This simple yet effective system of astrology is based on ancient wisdom using Planetary Cycles and popularised by Robin Murphy. You do not need to have prior knowledge of ‘Western Astrology’ to use this system.

Western Astrology? I thought 'Western' was bad and allopathic? Fortunately, you do not need prior knowledge of anything before attending this course. Trainees need not have prior knowledge of the differences between their arse and their elbow.

What new skills will homeopaths pick up?

• Your constitutional 3 main planets based on your date and time of birth

• The 7 sacred planets

• 7 year cycles – How to predict and prevent diseases.

• Diseases and remedies associated with each planet

Marvelous. This is for real. Adults appear to believe this stuff.

The event is being put on by Gala Homeopathy (slow load). Gala appears to specialise in charging homeopaths to attend events in exchange for their CPD certificates. In a few weeks, you can hear a talk by Lionel Milgrom who believes quantum mechanics explains homeopathy. It's utter nonsense of course, but the homeopaths lap it up. You can also learn about Live Blood Analysis, a technique that I have discussed recently and has been described as 'High-Tech Hokum' and a 'money making scheme'.

This event simply demonstrates that the whole approach of regulation by 'box ticking' is deeply flawed. The Complementary and Natural Healthcare Council (Ofquack) appears to believe that simply ensuring that homeopaths and other quacks are properly trained will protect the public. The important question is; what are they being trained in? No one wants to address this question. All Ofquack will be doing is endorsing nonsense. Once you have accepted that it is quite alright to accredit training in the nonsense foundations of most alternative medicine you loose the ability to sensibly decide what is good training and bad training. Offering training in delusion can only make quacks more efficient at fleecing their customers and engaging in meaningless or even dangerous practices.

I now think that the only way to tackle regulation of alternative medicine is by using prosecution under trading standards legislation. Everything else appears to legitimise the nonsensical, deluded and even fraudulent. Fortunately, despite the best efforts of Prince Charles and the many bodies representing alternative medicine, this is going to be the regime we will get. Time will tell if it is effective.

Labels: BPSDB, Natural Healthcare Council, ofquack, pseudoscience, regulation

 

Some years ago, a well meaning but utterly deluded friend gave me a book entitled Natural Remedies For Your Cat by Christopher Day. It is a slightly disturbing tome that appears to recommend homeopathic remedies for pretty much everything - from fleas to gunshot wounds.

Rational cat lovers might find this book pretty disturbing. In many ways, it is a classic homeopathy text. It sees homeopathy as verging on the panacea, has a brief disclaimer telling owners to seek veterinary help and has a chapter on feline vaccination.

A cat's immune system is a very finely poised and delicately balanced yet powerful entity in the daily battle for life and health. (...) Deaths, severe illness and chronic mild illness have all been recorded as following closely on vaccination. (...) There is an alternative to conventional vaccination but it has not been efficacy-tested on laboratory animals. No proof of efficacy therefore exists. However, many breeders, show people, cat lovers and catteries now feel strongly that the alternative is as effective as, and, safer than, conventional vaccination.

Christopher Day is not some soft-headed amateur pet healer. Day is a fully qualified vet and paid up member of the Royal College of Veterinary Surgeons. Recently, his name has been popping up a few times. A friend in the pub said she was going to see him about a troubled horse that was clearly in a lot of pain. As tactfully as possible, I suggested that he had slightly unorthodox ideas and another vet might be more appropriate. I was told that "he was a qualified vet" and that "holistic approaches appeal to me because they ultimately have the patients best interest at heart". Apparently, they do not fob you off and they take their time. Fortunately, Christopher Day turned out to be far more expensive than 'mainstream' vets.

I have also been pointed towards him by a few homeopaths with the idea that a vet practicing homeopathy is somehow proof that it works. Animals do not know about the placebo effect, apparently. We shall explore this canard a little more shortly.

There is something important going on here. Day runs the 'Alternative Veterinary Medicine Centre' in Oxfordshire. He describes himself as a 'holistic vet' and offers the following treatments,

Homeopathy : Herbs : Acupuncture : Moxibustion : Aromatherapy (Essential Oils) : Tissue Salts : Bach Flowers : LASER : Magnet Therapy : Chiropractic Manipulation : Nutrition : Crystals : Ultra-Sound : Physiotherapy : Positive Health : Holistic Medicine : First-Aid : Preventive Medicine

His site says that he specialises in alternative medicine but does not shun conventional medicine "per se". Apparently, "it is our pleasure not to have to resort to it very often".


It is difficult to imagine a medical doctor who used homeopathy using such language. Indeed, Peter Fisher, the director of the London Homeopathic Hospital, can be quite circumspect and modest when talking about the capabilities of homeopathy. It is not possible to imagine a doctor writing books like this, offering clinics like this and eschewing conventional treatment without getting into trouble with regulations. In the human medical world, such total embracing of the alternative worldview is almost exclusively the reserve of your non-medically qualified private practitioner.


Bizarrely, if a lay homeopath were to set up a practice to treat animals without a veterinary qualification, they would be breaking the law. Homeopaths may practice freely on humans, but not on cats, budgerigars and whippets. Chris Day himself tells us on his web site that,

The Veterinary Surgeons Act 1966 was put in place to regulate the treatment of animals. Under its provisions, it is basically only veterinary surgeons who may legally diagnose, prescribe, advise on the basis of a diagnosis and perform surgery on animals.

There are exceptions to this. Various massage like 'manipulative therapies' are allowed but should be overseen by a vet. The RCVS web site says,

All other forms of complementary therapy in the treatment of animals, including homoeopathy, must be administered by veterinary surgeons. It is illegal, in terms of the Veterinary Surgeons Act 1966, for lay practitioners however qualified in the human field, to treat animals. At the same time it is incumbent on veterinary surgeons offering any complementary therapy to ensure that they are adequately trained in its application.

What does it mean for a homeopathic vet to be "adequately trained in its application"? Since homeopathy is a pseudoscience and without scientific justification, rational or adequate evidence base, how can you be "adequately trained" in it? The idiocy of this position does not go unnoticed within the veterinary field and has been beautifully spoofed by the The British Veterinary Voodoo Society.

The problems of allowing "adequately trained" homeopaths to have free reign on animals is that homeopathic thinking is diametrically opposed to accepted standards of care. Homeopathy is not a complementary therapy that works alongside real medicine. It is, and always has been, strictly alternative. Homeopathy is a 'complete system of medicine' that is in opposition to the principles of science-based thinking about health. One of the characteristics of homeopaths is to denigrate real medicine. It is how they differentiate themselves and how they appeal to people who feel they have been let down by conventional care.

The latest handbook for homeopathic vets, the Textbook of Veterinary Homeopathy (Saxton, J. & Gregory, P. Beaconsfield Publishers, Beaconsfield, Bucks UK. 2005) has this to say about mixing homeopathy with conventional treatments...

There is little doubt that most orthodox drugs impede the action of homeopathic remedies. This is not surprising when one considers that the action of most of these medicines is in direct contradiction to that of homeopathy; anything which suppresses a reaction of the body will act counter to homeopathy, and considering the subtle energetic nature of homeopathic medicine it is only logical that such powerful drugs as corticosteroids or NSAIDs will antidote its effects.

and,

Perhaps the most important issue here is to be aware that any orthodox Medication may interfere with the action of a homeopathic remedy and to take account of this in prescribing these medicines. Ideally, all orthodox medication should be stopped prior to commencing treatment with homeopathy.

This book was written by two vets, John Saxton and Peter Gregory, who are members of the Royal College of Veterinary Surgeons and Fellows of the Faculty of Homeopaths.

So, at least, homeopathy is a big no go for the amateur vet. The Animal Society of Homeopaths would be an illegal organisation. But, veterinary homeopathy is a strange beast. For a start, homeopathy relies on the concepts of 'like cures like'. A substance that causes symptoms in the well can cure the ill. And yet, homeopathic 'provings' are done on humans. Do these translate to animals? All animals? We know different substances can affect different species in wildly different ways. How does my cat's response to Sepia differ to mine? I think that maybe I am taking the principle too seriously. Homeopathy also prides itself on the time spent in consultation with their customers in order to come up with a 'holistic symptom picture' and an 'individualised' remedy. It is this consultation that gives a talking-therapy-like benefit to customers, not the pill iteself. Does Christopher Day spend an hour in a field talking to a herd of cows about foot and mouth and their feelings about the disease, the stresses in their lives, and their hopes for the future, before dropping a vial of plain water in their communal trough? Maybe not.

As far as I can see, Christopher Day is a genuine character who believes that homeopathy is a useful way of treating sick animals. It is my opinion that this is a deeply misguided belief as homeopathy is nothing but a pre-scientific magical belief system based on totally implausible premises and with an evidence-base that is far too weak to suggest that anything real is going on. In such circumstances, one would expect that a regulatory authority would have something to say about this, in order to protect the welfare of animals, prevent owners from wasting money and to protect the professional image of veterinary surgeons.

So, who is regulating animal homeopathy? Day is a member of three organisations. He is a member of the RCVS - he has to be in order to practice. He is a Fellow of the Faculty of Homeopaths, the club reserved for medically trained homeopaths (both doctors and vets) and so can carry the designation VetFFHom. Indeed, he is listed as the Veterinary Dean of the Faculty of Homeopaths. Day is also a member BAHVS, the British Association of Homeopathic veterinary Surgeons. Indeed, Day was for 25 years the Secretary of the BAHVS. Out of all these organisations, who is making sure homeopathy is being practiced responsibly and in the best interest of the welfare of animals?

The Faculty of Homeopaths, although quite outspoken about the excesses of non medically qualified human treating homeopaths, appears to welcome vets into their fold without question. The Royal College of Veterinary Surgeons appears to wash its hands and not want to interfere. We cannot expect BAHVS to take a meaningful role as their officers, like Day, hold the very beliefs that ought to be questioned. I see little evidence that suggests that anyone wants to tackle the inconvenient problem that homeopathy is a useless placebo therapy.

Of course, we hear that customer choice is what justifies the use of voodoo and homeopathy on animals. It would be wrong to restrict choice, when paying customers, like my friend in the pub, believe it helps their pets and farm animals. The big difference between animals and humans though is who is making the choice. The animals have no say and are silent in the matter. Choice can be such a weasel word and we should be suspicious when politicians use it. We usually do not want a choice of schools. We want our local school to be of a high standard so that we can send our kids their with confidence. We do not want a choice of hospitals. We would rather the closest and most convenient one for ourselves and our families was up to scratch. Choices like these is used to hide inequalities and injustices by people who will usually gain financially, socially or politically.

Giving people a choice between quackery and proper care for their animals hides a huge injustice. It adds no choice to owners since there are false options involved which actually detract from the animal owner's empowerment. The owner may well feel better for providing 'holistic' care to their animal. They may well feel superior and 'caring more' than leaving their animal to a standard vet, who may not be able to do too much. But, this is at the expense of the animal who may find it hard to tell us that the magic homeopathy water was ineffective. The owner, full of fresh expectations of improvement in their animal, interprets any sign to justify the expense of their 'alternative approach'. The usual thinking biases kick in such as post hoc reasoning after regression to the mean, wishful thinking and selection biases. Meanwhile, an animal may still be suffering.

Can it be justified to use a placebo on an animal? The debate about humans being given placebos is interesting. It is a valid discussion because placebos are a function of the recipients beliefs and a placebo may well do some limited good. In animals, such complex social and ritualised beliefs can only be marginal. The function of an animal placebo is to palliate the owner's anxieties and fears, not the animal's. This strikes me as unequivocally morally wrong.

Labels: animals, homeopathy, regulation, veterinary homeopathy

 

If you are worried about the activities of an alternative medicine practitioner, there is not an easy way to find the right authority who might look into it. The Advertising Standards Authority are very effective at investigating complex matters, but can only really rap knuckles and leave traders to carry on pretty much unharmed. Often, the only damage is an ASA ruling placed well down in the Google result list. The ASA can only also look into a narrow range of promotional material; they cannot touch web sites, for instance. Trading Standards have deeper powers and can criminally prosecute, but are not too well geared up to look into false medical claims. They are regional in their authority and have a shed load of complicated legislation to work within. The MHRA are probably quite rightly mostly concerned with the evils of Big Pharma. And the regulatory authorities that provide standards of behaviour and codes of ethics to alternative medicine practitioners are a hollow sham: can you find one example where a self-regulatory body has disciplined one of its members and documented the result?

But, the world of quackery is about to be shaken and I am being nice to them by giving them the 'heads up'. The infighting about how best to regulate homeopaths may well become moot as legislation being brought in will allow direct consumer redress against many practices that mislead.


The complexity of trading standards legislation is being largely swept away and replaced with generalised laws to clamp down on unfair sales and marketing practices. The act is a incorporation of an EU directive into English law and so will be applicable throughout the EU area.


The regulations will cover a whole raft of,

Misleading practices, like false or deceptive messages, or leaving out important information.

Now, a lot of alternative medicine is full of that. Have a look at David Colquhoun's blog about Boots and their new wonder drug, CoQ10. Within the act, there will be specific restrictions on certain practices. The ones I am going to be interested in are:

Falsely claiming accreditation
1. Faking credentials
Claiming to be a signatory to a code of conduct when the trader is not.
2. You’re not who you say you are.
Displaying a trust mark, quality mark or equivalent without having obtained the necessary authorisation.
3. Your endorsement is not real
Claiming that a code of conduct has an endorsement from a public or other body which it does not have.
4. Not being true to the terms of the endorsement
Claiming that a trader (including his commercial practices) or a product has been approved, endorsed or authorised by a public or private body when he/it has not or making such a claim without complying with the terms of the approval, endorsement or authorisation.

Specifically, if a alt med trader claims to be governed by a code of conduct and their behaviour does not comply, then they will be guilty. To me it looks like it is immaterial as to whether the governing body actually adjudictates on the traders compliance. That should be interesting, given the widespread practice of alternative medicine governing bodies not enforcing their codes of practice. It does look like it will be illegal for the providers of codes of practice to do so if it misleads the consumer.


Specifically, it will be an offense if,

• the trader has undertaken to be bound by a code of conduct (or code of practice), and indicates that he is bound by it,
  AND
  • the trader fails to comply with a firm and verifiable commitment in that code,

Next:

10. Scare tactics

Making a materially inaccurate claim concerning the nature and extent of the risk to the personal security of the consumer or his family if the consumer does not purchase the product.
That is a stock trick of the trade. What would Clarins make of this? Should homeopaths be telling their patients about the evils of medical science anymore? What about anti-vax advice from homeopaths?

20. Pyramid schemes
Establishing, operating or promoting a pyramid promotional scheme where a consumer gives consideration for the opportunity to receive compensation that is derived primarily from the introduction of other consumers into the scheme rather than from the sale or consumption of products.

There goes Reiki, where practitioners typically only make money by 'tuning' new recruits.


But most interestingly,

11. Over promise, under deliver
Falsely claiming that a product is able to cure illnesses, dysfunction or malformations.

Now, what is going to be interesting is to what extent words like 'cure' are interpreted. The good news is there is going to be a 'man on the Clapham omnibus' principle here. What are the 'reasonable expectations of the average consumer' when they engage with a trader. It does not matter is a weaselly homeopath uses words like 'treat' - if it is reasonable that the customer expects to get better after the specific treatment then the homeopath could well find themselves on the wrong end of a guilty verdict.


The courts are going to demand that traders are going to be able to substantiate their claims. And we have a good idea of what they will make of anecdotal and testimonial based evidence.

It also looks like that there will be no need to establish there is an intention to deceive. The trader will be expected to undergo sufficient due diligence about their claims. It will not be sufficient just to wander around with your head in La La Land to escape the law.

Traders will also not be able to give false or misleading information is "the typical consumer takes, or is likely to take, a different decision as a result." Such information concerns things like:

(a ) the existence or nature of the product
(b) the main characteristics of the product
(n) specification of the product

Will homeopaths be able to get away with saying things like 'contains small amounts of natural remedies'? Probably not. I am sure the list is endless.

Also, the use of titles and credentials is likely to come under scrutiny. It will be an offense to mislead about the 'nature, attributes and rights of the trader or his agent' which include:

(c) qualifications
(d) status
(e) approval
(f) affiliations or connections
(g) ownership of industrial, commercial or intellectual property rights, and
(h) awards and distinctions.

Wow. That could be fun.

The new regulations will come in to force in a few months. As always with new legislation, we will need to see how the act is interpreted and how effectively it is enforced. But it does look like it might be much simpler to complain about certain practices and seek action.

So, if you are running a web site where you imply you are a doctor and you are not, and you claim to part of a regulated profession and you are not, and you offer healing practices that mislead, then you probably need to rethink your business. And you had better be nice to me.

Labels: regulation, the law

 

We know it is going to be a fun year for watching Homeopaths. The fight is well and truly on for who gets to pretend to regulate the profession. The beleaguered Society of Homeopaths have today gone on the offensive for total and unyielding control.

The year started off with Prince Charles and the Foundation for Integrated Health announcing the arrival on the scene of the government backed Complementary and Natural Healthcare Council, or Ofquack. This was something of an ambush on the various factions of homeopaths. They have been fighting amongst each other, trying to poach members and accusing each other of dastardly crimes and not being true homeopaths, but on one thing they appear to be unanimous: their opposition to CNHC and 'federated regulation'. What this means is that they do not want to be regulated by non-homeopaths. Heaven forbid someone who does not 'understand' homeopathy, ever tell them what they can and cannot do.

But the CNHC know that the various groups' objections to Ofquack do not mean that individual homeopaths will object. There may well be advantages of being seen to be regulated by the Princes' organisation, not least of all that it might well be a lot cheaper then the subs that the SoH demand. So, CNHS have been ploughing on as if there is no problem and appearing in newspapers and on the radio telling the world that homeopaths are happy and ready to join.

No so fast.

Today, the Society of Homeopaths have upped their game and issued a press release to tell the world that they, and they alone, are ready to set up a single register. If the CNHC succeed, SoH may well cease to exist in a year or two. They are planning their counter attacks.

Consultation commences today on regulation of homeopaths.

The Society of Homeopaths resolves to divest regulatory framework from its membership organisation to create the UK’s first independent single register and regulatory body for homeopaths

The Society of Homeopaths, Britain’s largest professional association of homeopaths, today announced that it has begun a wide-ranging consultation as it prepares to launch the UK’s first independent single register and regulatory body for homeopaths. Following a recent meeting with the Department of Health, the Board of the 30 year old Society resolved to divest its self-regulation and governance arm from its membership and continuing professional development functions in order to create a first-class regulatory body, which will govern the professional practice of an
expanding number of homeopathy practitioners.

What this means is, at the moment, a bit confusing. First of all, what is new? SoH already have the largest single register and if it wasn't for those pesky, breakaway splitters, the Alliance of Registered Homeopaths, they would have a near monopoly. They make no mention of working with other homeopaths groups and so we must assume that it this is an initiative solely within the Society and aimed at wrong footing the CNHC. How will they get ARH splitters to join the new SoH backed register and not Ofquack? My guess is that SoH believe that ARH will fold quicker than a spineless internet service provider as soon as members stop renewing their subscriptions.

There is also the implication that they are doing this with the approval of the Department of Health. But we know we have to be dead careful with Society press releases. Things should not be taken at face value. We know that the Department of Health are planning to bankroll CNHC for the next year and so it is unlikely they are supporting both initiatives. We must assume that the Society mean exactly what they say: they had a meeting with the DoH and then they embarked on this initiative. Two unrelated facts. They might have well have said that they had a bowl of cornflakes, brushed their teeth, and then decided to divest themselves of their self-regulatory powers.

The press release then goes on to praise the high level of self-regulation within the Society of Homeopaths. Regular readers here will know how difficult that is to accept. Despite obvious, numerous and well documented breaches of their code of ethics, there is little evidence of the Society ever making any adjudications and disciplining any of their members. They say in press releases that they have a "transparent complaints process". Can you find a list of their cases considered on their web site? We know complaints have been made. Where is the transparency?

So what is going to happen? Well, it looks like there is going to be a consultation,

Commenting on the Board’s resolution and the consultation process, Chair designate, Jayne Thomas said: “Today marks an important watershed in our profession. The consultation is to be widespread. We are seeking the views of patients, other homeopaths, the many colleges and universities that train the professionals, other organisations in the homeopathy field and of course politicians from all parties.

The one group that is conspicuously absent is scientists and the medical profession. And in that we see that this is one more futile bit of gesture and power politics. This is about control of the profession and not about protecting the public. My guess is that my opinion will not be welcome at this consultation.

If protecting the public was paramount then any regulatory structure must take into account the quality of advice that is given out by homeopaths. Both the CNHC and SoH want to control training standards but neither want to take on the content of that training. We know there is a deep problem within the homeopathic community that their training makes them systematically incompetent. They are trained not to recognise and actively reject normal standards of scientific evidence. They are trained to accept unquestioningly the teachings of their founder Samuel Hahnemann as if it was revealed truth. And in doing so they pose a real danger to their patients that they will offer useless or even dangerous advice, and worse, they will undermine the relationship that they might have with their GP. The failure of the Society of Homeopaths to tackle the problem of members giving out dangerous anti-malaria advice effectively rules them out as a competent body in regulating the profession.

Professor Dame Joan Higgins, who set up the CNHC, suffers from the same problem. Professor Higgins has recently given a presentation reviewing progress and expectations. One slide notes that there has been 'press criticism' that CNHC will 'endorse quackery'. Well I never! How does she respond to this criticism?

FWG role was not to evaluate the effectiveness of CAM and it did not have the capacity to do so. Its task was to establish a regulatory structure to protect the public not to promote CAM. This does not mean that it was positive/negative about CAM. It did not take a view.

This statement is somewhat disingenuous in that no one would expect them to evaluate the effectiveness of CAM, or at least homeopathy. That evaluation has already been done. Homeopathy is the ritualised prescription of plain sugar pills for all illnesses. As such, it is pure placebo and the best clinical evidence to date suggest that this is just the case. It is not a hard problem to understand. In principle, it is perfectly possible to draw up a set of regulations that take this into account.

So, Professor Higgins also washes her hands of the rather inconvenient problem that homeopathy does not work as described but practitioners are too deluded to work competently within the boundaries set by that knowledge. Whilst we have all these fighting organisations struggling to come out on top as the pretend regulators of the profession, we will have no one prepared to protect vulnerable people from homeopaths who practice their 'healing art' without care as to what is true and what is not true.

I wonder what is going to happen next?

Well, the CNHC will be late in setting up. There are already signs of slippage. There has only just been an advert go out to look for a Chair of the body. For an organisation that has stated it is ready to go in April, that looks rather late. A new chair may not be up and running until mid Summer at the earliest.

It's all going to be a complete shambles.

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

Your contribution to the consulation can be made by sending thoughts to consultation@homeopathy-soh.org

Labels: Natural Healthcare Council, regulation, Society of Homeopaths

 

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 has involved a move from cuddly cotton wool children's Microsoft servers to grown up, open source, Apache/Unix servers where a missed semi-colon can kill faster than a homeopath dishing out malaria pills.

It's been a bit of a bother, but I have time in the evenings now after becoming a Wiidower. Mrs Canard Noir bought me a Wii for Christmas and I have barely used it. She is next to me hogging it at the moment, trying to get Laura Croft to shoot wolves. You should see her on Wii Boxing. It scares me.

So, I might as well blog.

Backstory: Professor Dr Professor Joseph Chikelue Obi FRCAM(Dublin) did not like some stuff I wrote that highlighted his bizarre behaviour and strange quackery. After a year or so, when the Google search results were displaying my site highly despite his best efforts to write so many third person articles about himself, he gets a professional letter writer, Ms Tanja Suessenbach, to threaten my web hosts, Netcetera, with legal action if they do not pull my site.

One would have thought they would have laughed it off. As was so beautifully put on Gimpy's Blog,

This isn’t the case of a credible individual holding a gun to the head of Netcetera in the form of a grievous and legitimate complaint it is a man in a chicken suit successfully robbing a bank while holding a giant inflatable banana and farting loudly.

But no, they asked me to remove the offending pages and 'seek agreement' with Obi. I did to avoid immediate suspension, but felt that Netcetera had put me in an impossible position of being completely unable to reach any sort of reasonable agreement with Obi. How could I? He had got what he wanted.

All I could do was dig up more info on Obi in an attempt to show Netcetera just how ridiculous he was. It was soon clear that his 'College' he set up in Dublin (Royal College of Alternative Medicine, RCAM) was a complete facade with some strange anomalies in its registration.

I wrote to Netcetera on the 30th of January,

David,

Thanks for getting back to me. I fully understand this is a difficult position for you. Netcetera want to get on with the business of web hosting rather than deal with rubbish like this. However, I feel that an important point is being missed. Obi made his claim of defamation without a shred of evidence to substantiate that. On your request, I asked for that evidence and you still asked me to take down the pages.

I hope that as a service provider you do not feel that it is acceptable for third parties to demand the removal of your customers’ content without having to back up their demand with good reasons. We will not get the evidence required to substantiate Obi’s claims.

You can see the level of Obi’s response here… http://www.professorjosephchikelueobi.com/

We have now waited long enough for either Obi or his ‘legal advisor’ to respond in a meaningful and constructive manner. That has not happened, not will it happen because his case is utterly groundless and he has achieved what he wanted to do - take down those pages. I therefore believe that it is entirely justified to re-instate
those pages and I intend to do so. I hope it will be with your consent.

Regards,

I heard nothing.

Then, last Monday, I got this email,

Thanks for your comments.

We do not wish to be in a position where we could be taken to court, and incur the loss of time and expense that would involve. Consequently Netcetera have decided to suspend the Quackometer website, with reference to our Acceptable Usage Policy, the first part of which is quoted below.

The full policy can be found on our website www.netcetera.im/SiteInfo/AUP/ “Acceptable Usage Policy This policy is subject to change, without alternate notice, so please check regularly for updates. This policy is in addition, and considered part of Netcetera’s Terms and Conditions. Netcetera will be the sole arbiter as to what constitutes a violation of this provision. 1) Web Hosting 1.1) Netcetera reserves the right to suspend or cancel a customer’s access to any or all services provided by Netcetera, where Netcetera decides that the account has been inappropriately used. Netcetera reserves the right to refuse service and /or access to its servers to anyone.”

We will prevent public access to the site as of noon today 18th February 2008. You will be able to access the content to be able to transfer it to another host if you so wish. We will hold the content available to you for 30 days, and then we will remove it from our servers.

Regards

So, that gave me 20 minutes to prepare for the collapse of the Quackometer.

On the face of it, it looks like Netcetera were unhappy about being taken to court over something that was not their argument. I think it is worse than that. If anyone there had slightly looked at the complaint (and remember, Obi and Suessenbach refused to respond to request to make clear their grievance), it would appear obvious that the complaint was groundless. Worse than that, the complaint was a blatant attempt to remove legitimate criticism from the web. Netcetera would have won and reclaimed any costs. They just did not want the bother - far easier to lose a customer than to defend their customers.

Positive Internet offered me free hosting after the Magic Watergate scandal. I had been dragging heals over this because of the large amount of work involved when I could have been harassing quacks. Positive are marvelous; you can read about them here. For me it is enough to say that they are the only Internet hosting provider with an entry on the Pilkipedia. Right now, I am aware that I have lost half my audience as they are now exploring the Pilkipedia. Damn, there goes another 50%.

So, for those of you left, I shall finish the story.

The consequences have been inevitable. Such a story spreads quickly and within hours the blogs start appearing. What is more, it starts hitting the mainstream IT sites such as ZDNet, where Rupert Goodwins starts his article by saying,

If you fancy running a controversial website, you might like to think twice before signing up with Netcetera for hosting purposes. The Duck's crime was to collate newspaper reports concerning one Joseph Chikelue Obi.
...
If you fancy doing some waterfowling of your own, do check whether your hosting contract says, as Netcetera's does, that you can be terminated without recourse and without reason. You might like to take your punt gun elsewhere.

The blogs started coming thick and fast too. No Nonsense! was one of the first of the block and described the lilly livered apology for a Web Hosting company, Netcetera. Twonilblankblank asked, "Would your webhost fuck you over?" JDC325 said, "and for all those web hosts out there, please remember: there’s a difference between defamation and criticism." Hawk/Handsaw said "Netcetera fold like a cheap suit"

The story hits the IT mainstream when a full feature makes one of the main stories of the day at El Reg. The Register reporter, Chris Williams, does some digging and phones both Netetera and Suessenbach. Netcetera do not want to play. Suessenbach tells El Reg that "We cannot speak as litigations are imminent." Scary.

Forums are now buzzing with Bad Science, UK Skeptics and the James Randi JREF covering it.

There are now way too many blogs and web pages covering this for me to mention them all (and I want to have a go on the Wii at some point). You can see a comprehensive list here. But some of my favourites are:

• Apathy Sketchpad - "Spineless Morons"
• GagWatch - "Netcetera promptly wet themselves"
• Thinking Is Dangerous - "Netcetera condemn themselves as pathetic caitiffs"
• PalMD on WhiteCoatUndergound - "What a bunch of bloody wankers!”
• Chemo Brain - "we’ll take your site off the internet if a total schmuck frightens us"
• Orac on Respectful Insolence - "outcry from the medical and skeptical blogosphere"
• MediaWatchWatch - Just check out the fantastic picture!

Other sites, such as The Bronze Blog and Paul Hutchinson’s Blog call for a boycott of Netcetera.

What does this mean? Were Netcetera right? At one level, I can sympathize with them. This is a fight they did not choose and could not gain anything from (although Positive will do well). The really big enemy is English Law that is just muddle, unfair and confused - firstly, with its heavy handed libel laws, and secondly, its inability to accommodate electronic media. A more sensible approach needs to be adopted here so that people with genuine grievances can have them heard and addresses whilst the flippant and mischievous can be harried away without fear.

But we should not let Netcetera off the hook. The fact that another host were prepeared to take me on and at their expense at least shows that it is not clear cut. For me, I had a contract with Netcetera and they broke it without giving good reason and relying on an unfair and unequal clause in their lobsided contract. Its all a bit fucked up.

And so, the last word ought to go to Mr Obi himself. What has he got to say? Well, "alighting from the back seat of an Extended Black Daimler Limousine at the start of a Whirlwind Alternative Medicine Tour", he says,

Alternative Medicine Strongman and Royal College of Alternative Medicine (RCAM) Boss, Professor Joseph Chikelue Obi , has today sent out his very best wishes to the Quackometer Blog Owner Andy Lewis, who is currently transferring his Internet Service Provider (ISP) Ports from Netcetera Ltd to Positive Internet Ltd.

That's sweet.

My fundamentally humble message to all Skeptic Internet Service Providers (out there) today is therefore extremely loud and exceedingly clear : Stop condoning the ruthless harassment of Alternative Medicine Practitioners - or be fully prepared to face the dire financial consequences of your actions !

Obi is truly a spokesperson for the whole alternative medicine movement.

Joseph, perhaps you would like to apply for this job?

Chief Executive Officer and Registrar,
COMPLEMENTARY AND NATURAL HEALTHCARE COUNCIL

£60,000 p.a. pro rata.
The new Complementary and Natural Healthcare
Council (CNHC) has been established to put in place a regulatory body for those complementary therapies which are not statutorily regulated, nor seeking statutory regulation. The main function of the new body will be to enhance public protection and confidence in the use of complementary therapists. The Council now wishes to appoint to the role of CEO/Registrar, as soon as possible.

You would certainly get my full support.

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

Update 23rd Feb

From The Wardman Wire and Humaniform I learn that the presitigous Bear-Faced Usmanov Award has been made to Mr Obi for "extreme efforts in closing down websites which are criticising you by threat without evidence". Also, The Double Headed Schilling is awarded to webhosts who roll over before such threats, has naturally been given to "internet hosting (sometimes) company Netcetera."

Check out the graphics depicting these awards to Netcetera.

(Usmanov, for the uninitiated, is a Russian oligarch, and part owner of Arsenal football club, who tried to suppress ex ambassador Craig Murray from writing alegations of Usmanov's 'colourful' past by threatening ISPs with legal action. Naturally, attempts at this sort of suppression, massively amplified the exposure of the allegations. One would have thought people would learn a lesson.)

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

Dr Aust sums up the mess very well on Respectful Insolence.

I hope he does not mind me reproducing it here...

Yes, the British law on this is a hopeless mess compared to the UK and Canada. The need for some sensible new legislation is clear, but British Govts are historically reluctant to do anything legislative that curtails lawyers' ability to trouser huge fees (such as in defamation lawsuits). Perhaps this is because so many British politicians are lawyers.

In the UK situation, if the plaintiff says to the ISP "this libellous thing about me is posted on your servers, take it down", then an ISP that doesn't take the stuff down becomes directly liable for the libel (Godfrey vs Demon internet). Furthermore, the longer the stuff remains up, the greater the potential libel damages "for accumulated damage to reputation" in a defamation suit - the longer the offending passage is up, the greater the potential harm to reputation, goes the reasoning. The ISPs almost certainly take the view that they are a more "attractive" libel suit target, as they are companies and hence clearly have assets, while the blog poster is likely to have no money to speak of. So the ISP has a large vested interest in caving in. This is why the "legal chill by threat to sue" types in the UK go for the ISP rather than the blogger.
All American bloggers should be duly grateful, methinks, for the judgement in Zeran vs. America Online, which effectively says "ISPs are not publishers".

In the UK, where the law conversely does see the ISP a a publisher, it comes down to whether the ISP is prepared to tolerate any potential liability, or even inconvenience, for the sake of some kind of principle.

When UCL was trying to boot David Colquhoun ff their servers following complaints and spurious libel threats, many of the people writing to the UCL Provost (including me) argued that as a University UCL had an overriding duty to protect free comment, and scientific accuracy, as part of its core purpose. But it is a bit harder to make that argument with a business or corporation, whose overriding obligation is presumably to maximize "shareholder value".

An interesting and unresolved question, with wide Internet implications, is to what extent a judgement under the silly UK law can be enforced in any other jurisdiction. In print libel cases there are suggestions that under some circumstances it can,
hence the phenomenon of "libel tourism" I referred to earlier.

You can read more Dr Aust here.

More updates (27th Feb)

The Skeptics Guide to the Universe
Rebecca Watson - The Skepchick - and Steven Novella, MD - Neurologica - discuss the Quackometer/Obi/Netcetera affair on the weekly Podcast
I hosted u a website, but I eated it
LOLquacks in an easy to understand synopsys of the Obi/Necetera Affair. A Must Read.
Quackometer vs Obi - Abusing Lawsuits to Silence Critics
Steven Novella discussed the implications of net censorship in light of the netcetera/obi affair.

Labels: BPSDB, Netcetera, Professor Joseph Obi, regulation

 

After yesterday's raids by the MHRA on suspect dodgy pill sellers and their 'Internet Day of Action', perhaps one of the largest profiteers from such schemes will get away with it.

Google has been quite happy to take money from triamazon.com to show adverts for the site and the hugely overpriced food supplement pretending to be a miracle cancer cure.

This is despite the fact that Google has a clear policy that it will not do such things. As part of its advertising terms it says that it will not take adverts for:

Miracle Cures
Advertising is not permitted for the promotion of miracle cures, such as 'Cure cancer overnight!'

Furthermore, by taking money for such adverts, Google will be in contravention of the Cancer Act of 1939 which says,

No person shall take any part in the publication of any advertisement—

containing an offer to treat any person for cancer, or to prescribe any remedy therefor, or to give any advice in connection with the treatment thereof

People do get prosecuted under the terms of this Act. Trading Standards have a duty to enforce it. However, as Trading Standards tend to be highly fragmented across local councils, none of them appear to want to take on the Google giant. I believe Westminster Trading Standards as their UK address is given as,

Google UK Ltd
Belgrave House
76 Buckingham Palace Road
London
SW1W 9TQ
United Kingdom
Phone: +44 (0)20-7031-3000
Fax: +44 (0)20-7031-3001

However, Westminster undoubtedly have many higher priorities making sure dodgy plumbers do not rip off senile old ladies who live on Buckingham Palace Road.

I have complained to Google before about similar issues and also to Trading Standards. Ignored, so far. Google should be policing their own noble 'do no evil' terms, and if they cannot they should be prosecuted where they flout the law. Perhaps the MHRA, as part of their Internet day of action, could tackle one of the largest advertisers on the web. Google has the power to make or break such companies. The MHRA ought to be concerned.

Labels: Google, regulation, triamazon

 

You know, I do not believe that most of the people that feature on this site are fraudsters. No, the truth is far worse than that - most homeopaths, reiki practitioners and herbalists actually believe what they say and that makes then particularly dangerous. But there are people whose motives are particularly hard to believe are just plain deluded. I fear 2008 is going to feature quite a number of more 'interesting' cases.

I have been keeping an eye on Andrew Harris and his site http://www.triamazon.com/ for six months or more. He also uses a site called http://www.thiskillscancer.com/. Apaprently, Triamazon is a,

NATURAL SCIENCE PROVEN SAFE NON-TOXIC product that is effective against many cancers and is also far superior to chemotherapy as it does not harm healthy cells.

Harris sells 'half a course' of 100 pills of Triamazon for about £250 a bottle from his home in Altrincham. He says,

Skeptics please see... The official independent "Research White Paper" on the proven effectiveness of selected Acetogenins, by clicking on this link below... http://www.iupac.org/publications/pac/2003/pdf/7502x0259.pdf

Clicking through to this paper reveals information about the synthesis of acetogenins. Nothing about clinical efficacy. The Alliance for Natural Health issued a warning saying that the pill was Graviola (Annona muricata). You can buy Graviola tubs for about £20 or less if you look.

Just about every day I have been getting Google alerts for triamazon as it has been advertised around the web on bulletin boards, chat rooms and in press releases. Typically, such messages say things like:

Andrew Harris an ex-cancer patient exposes the big pharma industry cover-up of a natural cancer killing miracle with astounding incriminating conclusive independent evidence available via a direct link to pubmed archives on his website. Andrew is the founder of www.thiskillscancer.com His strong entrepreneurial background in business, marketing, research and management is combined with his personal experiences in having gone through 14 lots of conventional toxic combination chemotherapy to actually surviving cancer through an alternative natural, non toxic, immune system boosting, cancer killing miracle.

Leaving aside the issue of whether triamazon can do anything for cancer, advertising cancer cures is illegal in the UK under the Cancer Act of 1939. Trading Standards are tasked with upholding this act and have been aware of Triamazon for many months now. Indeed, Andrew Harris has been aware of it too as his web site has, at times, appeared with a disclaimer that his site was intended for doctors only - an attempt to wriggle out of the Cancer Act's glare. It was not fooling anyone.

Yesterday, at 7.30 am a house in Sale was visited by Trading Standards, the MRHA and the Police and the raid seized 'quantities of an unregistered drug called Triamazon' and a 48 year old was arrested. The Medicines and Healthcare products Regulatory Agency (MHRA) have teamed up with police to take part in a number of dawn raids around the country as part of an 'Internet day of action'.

It has been slow, but it is good to see that existing legislation can deal with some of the worst sorts of quackery out there. Taking money from desperate and scared people in exchange for worthless pills, has to rank amongst some of the lowest scams imaginable.


If you see similar sorts of things on the web, the Consumer Direct site is a pretty good place to start.

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

The Mirror Now Cover this too:

Police swoop on cruel internet cancer "cure" pill conmen

Labels: regulation, triamazon

 

Professor Joan Higgins, Chair of the Federal Working Group on Complementary Therapies, is in charge of setting up the Natural Healthcare Council (Ofquack). From April, this will be a voluntary self-regulated body that will be tasked with protecting the public from the dangers of alternative medicine. The Professor wrote to the Guardian today to complain about Polly Toynbee's straight talking article,

I am sorry that Polly Toynbee feels that the creation of a new regulator "gives non-science a new authority". As a lay person, I am certainly not able to judge the scientific validity of these therapies and this is not what my working group (to which she refers) was set up to do. I would ask her to consider an alternative scenario. Complementary therapists have been in practice for many years. There is public demand for their services and there is no move to stop therapists offering their services to sometimes quite vulnerable people. If complementary therapy is not to be banned, is it not, therefore, wise to regulate it and offer the public some measure of protection and a body to whom to complain if things go wrong?

The problem is that the Professor is not the only person who is 'certainly not able to judge the scientific validity of these therapies'. No one involved appears to want to tackle the inconvenient problem that most alternative therapies do not work. But without acknowledging this, how can a regulator protect the public? If a homeopath advises a mother that sugar pills can be used to 'treat' their child's asthma will the homeopath be in breach of any code? Their training as a homeopath may be thorough, their professional conduct may be solid - but their medical advice is appalling. Who is going to set the standards of what is good practice? Who is going to guard the standards that Ofquack guard?

Professor David Colquhoun is tackling this problem and is using the Freedom of Information Act to get to the bottom of this. His most recent blog post on the (Un)-Natural Healthcare Council is hilarious.

Professor Colquhoun believes that the whole regulatory infrastructure is unnecessary and that a strengthening of existing legislation would suffice. I would tend to agree with him and I have commented on these pages about the shortcomings of Trading Standards and the Advertising Standards Authority in dealing with quackery.

However, there may be other options. The Financial Services Authority has created huge upheavals in banking and lending over the last decade. In short, they have forced anyone offering financial advice to conform to standards of disclosure and product information. Anyone offering financial services must make an initial disclosure to their clients outlining the nature of the service they are offering, the method by which they will receive payments and commissions, how the service provider is regulated and how to make a complaint. When recommending a financial product, the advisor must present a Key Facts Illustration (KFI) document that outlines in standard terms the features of the products, the risk associated with the product, and full costs.

I see merit in exploring this idea for alternative medicine. In fact, this would bring CAM practitioners more in line with their hospital colleagues - it is giving their clients the information required to make informed consent.

In the USA, California have already introduced a similar scheme: California Senate Bill SB577 . The reason for introducing this bill though was rather different. Before that, people like Homeopath Dana Ullman got arrested for practicing medicine without a license. The Bill allowed people to practice CAM but within a legally controlled framework. This is not the same as self-regulation. This is external regulation.

There are some pretty sound elements to it, like making it illegal to:

• recommend the discontinuance of legend drugs or controlled substances prescribed by an appropriately licensed practitioner.
• ...shall disclose in the advertisement that he or she is not licensed by the state as a healing arts practitioner.

Importantly, they have to perform a disclosure:

(1) Disclose to the client in a written statement using plain language the following information:

(A) That he or she is not a licensed physician.
(B) That the treatment is alternative or complementary to healing arts services licensed by the state.
(C) That the services to be provided are not licensed by the state.
(D) The nature of the services to be provided.
(E) The theory of treatment upon which the services are based.
(F) His or her educational, training, experience, and other qualifications regarding the services to be provided.

(2) Obtain a written acknowledgement from the client stating that he or she
has been provided with the information described in paragraph

I would go further than that list. For example, any attempt to undermine this disclosure or denigrate or undermine a person's GP or their advice would be an offense.

As I believe that the biggest threat to homeopathy is people finding out what it is. I would suggest that the CAM Key Facts Illustration contained two extra elements: the theory behind the therapy and whether it is supported by science and the evidence base for effectiveness of the treatment. Obviously, such statements could not come from the practitioner themselves. We are trying to protect people from their non-medically qualified practitioners delusions. The MHRA could possible provide such statements for each therapy in the same way that the Financial Services Authority provide sample paragraphs for inclusion in mortgage documents.

I see the challenges here are with how to enforce this sort of regulation. What is to be avoided is any sort of licensing as this implies government approval. Can we find a way to carry out licensing in a way that does not imply endorsement? For example, Oxford City Council licenses a sex shop on the Cowley Road, apparently. (Ben Goldare tells me there is one there.) This does not imply that Oxford approves of any the appliances found therein. Do we need licensing? Trading Standards does not need a list of licensed plumbers to enforce various regulations. Who would pay for the extra demands on local councils? Maybe Sue Blackmore's proposals to Tax the homeopaths would be required in parallel.

Discuss.

Labels: David Colquhoun, Natural Healthcare Council, regulation

 

The ambush by the Prince of Wales on the various factions of Alternative Medicine by announcing the set up of the Natural Healthcare Council, Ofquack, is starting to have effects. In the Guardian yesterday, Polly Toynbee ran an article entitled, Quackery and superstition - available soon on the NHS. She argues that we should,

Labels: Natural Healthcare Council, ofquack, regulation, Society of Homeopaths

 

Prince Charles' Foundation for Integrated Health and its new regulatory quango, the Natural Healthcare Council (or Ofquack, as it is bound to become known), is due to launch in April. Ofquack is designed to be an 'independent self-regulatory body for complementary therapists.

In 2000, the House of Lords Science and Technology Select Committee looked into the regulation of non-medically trained health workers. It asked the Prince of Wales Foundation to look into setting up a body to mop up all the 'harmless' CAM therapies, such as reiki, massage, aromatherapy, yoga and homeopathy. Alternative therapies that have the potential to have real effects on people such as osteopathy, herbalism and acupuncture have already been statutorily regulated or are soon set to be. Ofquack, The Natural Healthcare Council, will not be a statutory body; it will be voluntary (for now) and will involve representatives from each 'discipline' and lay people to help self-regulate.

The idea behind setting up this new body is to attempt to provide protection to the public from exploitative or dangerous practices. The Quackometer believes the structure of the body will mean that it will be impotent to carry out this role. For this reason, I am disappointed that Ofquack is being set up in its present from and I would hope Prince Charles team, headed by Professor Dame Joan Higgins, would stop and think again.

However, I need not worry. As is becoming increasingly clear, large swathes of the alternative medicine industry want nothing to do with this initiative. This was totally predictable and the consequences are going to be hilarious.

Let's start with the Homeopaths. The Society of Homeopaths has issued the following press release following yesterday's report on Ofquack in The Times,

As the UK's largest membership association and regulator of homeopaths, The Society of Homeopaths supports the establishment of an independent single register and regulatory body for homeopaths. Indeed, a recent survey of its membership indicated that at least 65% would support statutory regulation for homeopaths.

Registered members of The Society of Homeopaths (identifiable by the designation 'RSHom') have a recognised professional qualification, comprehensive insurance and have agreed to abide by a strict Code of Ethics & Practice.

The Society of Homeopaths has yet to assess the suitability and standards of the Natural Healthcare Council for the purpose of providing regulation of homeopaths.

Paula Ross
Chief Executive

Now, as with all press releases from SoH, you have to take great care in interpreting what they are saying. Let me do that delicate task for you and sum up their thoughts...

"Over our dead bodies."

The Alliance of Registered Homeopaths has been a little more straight talking over Ofquack. Karin Mont of ARH, wrote in their in house rag, Homeopathy in Practice:

Federal Voluntary Self Regulation [Ofquack] is a recently introduced concept that is intended to bring a diverse group of complementary therapies under one central control. The homeopathy profession has been unanimous in rejecting federalisation as an option for regulation.

In other words,

"Over our dead bodies."

It's not just the homeopaths that are hostile to Prince Charles' new quackery club. The Reiki practitioners (wave their hands around to 'channel healing energy') set up their own regulatory committee to 'respond' to the development of Ofquack.

On their web site they now note,

Following a meeting in November 07, The RRWG has now formally withdrawn from the Federal Working Group set up by the Princes Trust for Integrated Health. The Group is considering its options and the way forward in January 2008.

Further explanation is given in a letter from Anthony Perry, Chair of the Reiki Regulatory Working Group. He explains that no-touch Reiki practitioners are looking for 'light touch' regulation. Central to this is the desire that,

We believe the Regulator should have an overriding duty to regulate the practitioners, but not the practices or therapies themselves, e.g. such as the teaching of Reiki in its many diverse forms.

So, in short: you may keep a list of our members, but don't dare tell us how to wave our hands around and who we can wave them over.

The aromatherapists are not quite so well organised. They too have set up a regulatory body, but it looks still-born. Their web site http://www.aromatherapy-regulation.org.uk/ appears to be down. For some insight, we must look at the few aromatherapy bloggers around.

Tony Burfield on the aromaconnection blog writes that the 'sky fell in' with the announcement of the set up of Ofquack. He thinks it will be an "an unmitigated disaster for CAM". Tony then goes into a lot of conspiracy theories, describing Sense about Science as 'sinister'. He clearly believes there is some sort of corporate conspiracy to control aromatherapists. Tony smells a rat.

But tellingly, he says,

Within aromatherapy, the low educational entry requirements & abysmal course standards set in UK colleges are a national joke, so setting minimum standards for practitioners will presumably be a great source of material for satirical magazines such as Private Eye. The profession is starved of finance, so no substantial evidence-based aromatherapy data-base exists as such - anything that does exist is likely to consist of published (so-called) aromatherapy studies by non-practising academics, rather than tapping the massive collective experience of everyday practitioners

One would have thought that aromatherapists could have done with all the friends they needed, but it looks like one more case of,

"Over our dead bodies."

Tony concludes with a prayer:

Please pray with us that Prof. Edvard[sic] Ernst is not promoted to a position of adviser or authority within the National Healthcare Council. Ernst is a Corporate Science sympathiser who is working undercover as Director of Complementary Medicine at Exeter University, & whose sole purpose seems to be to rip the soul out of CAM, armed only with a Corporate Science device called "the meta-analysis". Ernst's stature & reputation is such that it has even over-awed normally sensible Herbalgram staff who worship & reproduce his every utterance, & who apparently haven't noticed that now HE'S WORKING FOR THE OPPOSITION. Wake up!

I think we can see a full picture now amongst the various proposed members of Ofquack. There is deep suspicion that they will not be allowed to practice the way they wish to practice. Homeopaths do not even trust each other to regulate themselves with at least ten different registering factions looking after the interests of different beliefs. And worse, heaven forbid that a scientist like Ernst should get involved and apply some reason and evidence to their regulation. (Fortunately for Tony, I doubt Ernst will get invited to this little party. Charley and Edzard are not the closest of friends.)

We also see fear of conspiracies. Ofquack will receive government funding and this lays it open to charges of being controlled by the enemies of quackery. Users and practitioners of alternative medicine have a strong anti-establishment streak about them. Asking them to trust in Ofquack will be like asking wildebeest to use crocodile endorsed river crossings.

But the biggest problems lie in the arrogance and independence of each faction. The homeopaths are the worst. They see themselves as a 'complete system of medicine' and holders of the true keys to healing. Other healing practices are wrong or corrupt. To lump homeopaths in with the smell sniffers, the crystal danglers, the foot ticklers and the bendy yoga lovers would be a deep humiliation for them and a completely unacceptable loss of autonomy and status.

Over their dead bodies.

Labels: CNHC, Complementary and Natural Healthcare Council, ofquack, regulation

 

How should homeopaths be regulated? I am not sure I have made up my mind yet about what I would like to see and I am not convinced there is a perfect solution. However, I hope some debate has been kicked off by all the goings on last year, here and on various other blogs and forums. One thing I am pretty sure of is that homeopaths have pretty much ruled themselves out of the discussion. Adults only from now on.

And the reason for this is that they have had their chance - and a good shot at trying to regulate themselves. Indeed, this was the stated aim of the Society of Homeopaths last year. Two of their annual goals were:

To facilitate the smooth handover of Society regulatory processes to a new regulatory and registration body

and,

To uphold and review The Society’s professional standards especially in relation to the development of a new regulatory and registration body (NRRB)

They failed miserably at both.

The farce of creating a single homeopaths' single register is being documented at gimpy's blog. Squabbling about money made sure the register did not get off the ground. I believe this reflected deeper rivalry between the various homeopaths' groups based on philosophical differences and also just plain old human power struggles.

The Society also demonstrated that their code of ethics could not protect the public from the worst delusional beliefs of their members. Their utter two-faced failure to tackle the problems posed by members offering anti-malaria advice led to the Society being prepared to directly misrepresent their own actions to the papers. They were also last year promoting homeopathic intervention in HIV people in Africa. It is difficult to think of more exploitative, deluded and dangerous actions.

So, to start off - what are we trying to protect against? Ben Goldacre has been quite clear about the dangers of alternative medicine - bullshit. And that bullshit manifests itself in a couple of dangerous ways with homeopaths. Firstly, they may delay a customers access to effective treatment - in the case of serious illness this can be fatal. Secondly, they may present themselves as serious alternatives to real medicine. We have found this most shocking when homeopathic missionaries tell vulnerable African people with HIV that they can treat them. Homeopaths use the denigration of medicine as a standard marketing tool. Homeopaths stand out in the alternative medicine crowd in their anger and hostility towards real doctors and medical practices. It is how they define themselves and what makes them most dangerous to the public. They most definitely are not a 'complementary medicine'.

It is not that I want people to stop visiting homeopaths and other therapists. People often do get benefit from the self-indulgent friendly chat that a GP is just not in a position to offer. Homeopaths ought to be in a prime position to offer this as I have said before. However, in visiting a practitioner, we need to consider how the public may be protected against two main problems we find in quackery: being exploited financially, and being given inappropriate and dangerous medical advice.

One potential solution is coming from Prince Charles and his Foundation for Integrated Health. FIH is looking into setting up a Natural Healthcare Council that will offer regulatory functions to the broad church of complementary and alternative therapies. The Times reports that this new voluntary register should be established this year and,

will be able to strike off errant or incompetent practitioners. It will also set minimum standards for practitioners to ensure that therapists are properly qualified.

Their hope is that,

all practitioners will be forced to join or lose business as the public will use the register as a guarantee of quality. The council will register only practitioners who are safe, have completed a recognised course, are insured and have signed up to codes of conduct.

Funnily enough, the homeopaths appear to be deeply hostile to this move. "The homeopathy profession has been unanimous in rejecting federalisation as an option for regulation" reports the Alliance of Registered Homeopaths. But, as I have said, I am not really interested in what they think - their only motives in discussing regulation appear to be self-interest and survival.

So, will the chief tree-talker's ideas be a good move? Should Prince Charles' organisation be allowed to succeed?

I have some serious reservations.

Firstly, by what standards will the Natural Healthcare Council set for competence and training? Professor David Colquhoun has documented the training dilemma of alternative medicine by noting that most alternative therapies are based on nonsense ideas that have no scientific and objective merit. "It cannot be expected that a universities will provide a course that preaches the mumbo jumbo of meridians, energy lines and so on... Can any serious university be expected to teach such nonsense as though the words [of alternative medicine] meant something? ". Since, homeopaths cannot even agree amongst themselves what homeopathy is and what are its essential elements (not surprising, as it is not based on reality) then the Council risks either alienating large swathes of practitioners or being completely arbitrary in its criteria. Either will not protect the public. Setting education standards for homeopaths is like trying to accommodate Hogwarts into the National Curriculum.

Secondly, by what standards will practitioners be judged in handling complaints and when upholding professional standards? Should we uphold a homeopath to standards of homeopathy, aromatherapy, reiki or - heaven forbid - evidence and science? This is important. In deciding whether a homeopath has crossed a line of ethics in offering malaria prophylactics, who will judge them? If homeopaths are involved, the the public will not be protected as they have dangerous and delusional ideas about their magic sugar pills. However, if they are to be judged by the standards of best evidence, then no homeopath will join the organisation as they know that they cannot practice within their strongly held beliefs. In either case, the Council will fail to protect the public. You might think that homeopaths would be willing to disengage from their wilder healing fantasies in order to gain the credibility of the name of Prince Charles, but all my experience says that homeopaths are fiercely proud, angry and determined not to be constrained by any external forces (probably orchestrated by 'allopaths').

And if the Council do uphold the strongest standards and do this in a transparent and accountable way, will the UK suddenly be free from rogue practitioners? Well, no. My recent example of the the ASA upholding a complaint against Osteomylogist, Robert Delgado, showed that even statutorily registering complementary therapists has big loopholes. This non-statutory and voluntary registered body, the Natural Healthcare Council, will have even less power over practitioners.

But what it will achieve is that Prince Charles' name will give credibility to all sorts of unproven therapies and wacky non-medically qualified people to go out there and pretend to be healers. And at the same time, offer no guarantee of protection to the public.

I don't think this is the answer and I think it will even lead to a greater threat to the public.

Labels: Ben Goldacre, homeopathy, Natural Healthcare Council, regulation, Society of Homeopaths