Well, once more, a leaked email landed in my inbox. And we also have an ‘official’ press release. And it shows a profession, if I can call it that, that is immature, confused and irresponsible. No big surprises.

So, first the leaked email. From Jayney Goddard. Much of it speaks for itself.

The ASA Meeting of Friday 29^th July

Dear Colleague,

First of all, a huge thank you to the hundreds of you who were so kind to respond to our email last week.  I am emailing now to let you know how the meeting went.

As you’ll be aware, in attendance were Dr Rob Verkerk and Meleni Aldridge from the Alliance for Natural Health and Dave Hawkins and I represented The Complementary Medical Association.   The ASA side was led by Vena Raffle – Head of Investigations – and a group of other ASA and CAP staff.

We went to the meeting with several items on our agenda. We wished to discuss the following points:

The nature of the communications received by practitioners from the ASA

Whether the ASA is perceived by practitioners to be a “legal” entity with “legal powers”.

The scientific competence of the ASA to be able to understand the specific issues involved in CAM (and should they not have expertise in our area we wanted to offer assistance from established CAM/Science experts)

We wanted to clarify the use of true patient testimonials on advertising and websites

On the first matter: It is deeply shocking to see just how many practitioners had received letters from the ASA and how these letters had provoked such deep distress.  We continue to look into the ASA communications with practitioners – so don’t hesitate to send us your response to our first email – if you have not yet done so. Rest assured that any communications on this matter are held in the strictest confidence.

As a result of the amazing and positive response from our profession, I was able to take just short of 80 emails to the meeting – the only reason that I didn’t take more was because of the time frame – it wasn’t possible to print more than that.

I put it to the ASA that the large number of emails I had bought with me demonstrated conclusively that the ASA communications to practitioners are perceived to imply threat – and have provoked anxiety and distress.  Furthermore, that practitioners generally believed – based upon the communications they had received from the ASA, that the ASA is a ‘legal’ body with legal powers. The ASA denied that their letters cause any anxiety or distress and are not threatening.  We found this odd as the dossier I took with me demonstrated conclusively that this is not the case.The ASA did not comment regarding the impression they give of being a legal or governmental body.

Dr Rob Verkerk questioned the ASA and CAP regarding their understanding of science, research and CAM.  This led to a discussion about the procedures that the ASA take when investigating a health advertising related complaint.  The ASA and CAP representatives explained that they have no scientific background at all and certainly no knowledge of complementary medicine and that they are just ‘doing their job’.  They are simply ‘experts’ in making judgements about adverts.  They explained that the procedure is the same whether they are “looking into a complaint about roofing and guttering or complementary medicine”.

We asked the ASA what would happen (i.e. what the investigative procedure would be) if a practitioner did supply supporting evidence to back up their claims of their discipline’s efficacy – following a complaint. The ASA responded that this had not yet happened – that ‘no one has yet submitted evidence that they needed to examine’. We found this odd as we know that practitioners have submitted evidence for their disciplines.

On the basis that the ASA and CAP told us that they do not have any knowledge of our field at all, we offered to assist them by providing a science/CAM expert.  They declined this offer of help.  We have grave concerns about the ASA’s ability to make judgements about research in our field.

Regarding the use of testimonials in advertising, this appears to be a very subjective matter, with the ASA deciding how to adjudicate based on the overall impression – or ‘feel’ that they get from the advert. We believe that there is much room for improvement in this area – as this process ought to be objective – and not simply based upon how each adjudicator ‘feels’ on a given day. Again – we’d like your opinion about this.

We suggested in parting that the ASA might like to open a dialogue with a wider audience – and suggested that perhaps they might like to come to “camexpo” in October – where we could hold a round-table discussion with them.  The CMA and the ANH will discuss the possibility of this with “camexpo” as both our organisations are members of the “camexpo” Advisory Board.

Obviously there is much more work that needs to be done although we feel that incredibly valuable points have been raised in this first meeting.  We would appreciate your feedback on the points raised and the ASA responses to them.

Warmest wishes

Jayney

Jayney Goddard

President, The Complementary Medical Association

Central to the complaint from Jayney, apart from the ‘distress’ being caused, is that somehow the ASA do not have competence to judge the claims being made by homeopaths, acupuncturists and so on.

It is something of an odd claim and completely fails to understand hoe the ASA operate. They do not have hundreds of specialists in the background who are experts on all fields of advertising, including cosmetics, builders, food, electronics and health. The ASA operate in a very simple way – they expect advertisers to hold robust evidence to substantiate the claims they make. The onus is on the advertiser to hold the relevant specialist information, not on the ASA to hold that information. If a complaint is made against an advertiser then they will be asked to supply that evidence. The ASA can then assess the nature of that evidence – and call in specialist advice if needs be.

However, for health complaints, the ASA do indeed have guidelines as to the nature of that evidence. For example, they have very strict rules governing the use of patient testimonials, as these are not good indications of the effectiveness of any treatment.

(I do like the invitation to CAMExpo – a forum where it would be harder to find a greater number of unsubstantiated claims under one roof.)

The Alliance for Natural  Health have issued their own press release on the meeting.

Although quite long, it is perhaps safest to reproduce it all here so that it cannot be ‘removed’.

CAM LEADERS QUESTION THE COMPETENCE OF UK MEDIA WATCHDOG TO ASSESS CAM-RELATED COMPLAINTS

The Advertising Standards Authority (ASA), the UK’s media industry watchdog and self-regulator, has brushed off concerns raised by complementary and alternative medicine (CAM) leaders at Alliance for Natural Health International (ANH-­Intl) and The Complementary Medical Association (The CMA) over its scientific competence to adjudicate complaints against CAM advertisers.

In a meeting at the ASA’s London office on Friday, 29th July, ANH-Intl representatives Dr Robert Verkerk and Meleni Aldridge, and Jayney Goddard and Dave Hawkins from the CMA, were told by senior ASA Head of Investigations, Vena Raffle, “You don’t need to worry. This is what we do. We deal with advertising complaints in all areas from roofing to guttering. We can’t be experts in everything, but we work to standards across all areas.”

In the meeting, Dr Verkerk drilled the six ASA representatives over their respective backgrounds and skillsets. Despite somewhat defensive and indirect responses from the ASA, it seemed that none of the relevant staff possessed scientific qualification. Concerns by the CAM sector over the ASA’s approach have escalated as of 1st March 2011, when the ASA expanded its remit to cover the Internet. Additionally, the ASA appears to have accepted the highly controversial approach taken by the European Food Safety Authority (EFSA) toward health claims, one that has resulted in the rejection of some 80% of general function claims for foods and food ingredients submitted for evaluation.

“Evaluating the extremely complex processes that occur when practitioners and patients interact is not something that we think can be done by a non-scientist”, stated Dr Verkerk after the meeting. “Human metabolism is complex enough, yet you have another dimension of complexity when you’re looking at the practitioner–patient relationship”, he continued. Many claims made by CAM practitioners, assert ANH-Intl and The CMA, are the result of many decades of clinical experience, and are not necessarily limited to what can be found in the peer-reviewed literature, which tends to be both very limited and reductionist in nature.

Commenting on the non-transparent procedure used by the ASA, Dr Verkerk stated: “I was astounded to find that the ASA appeared to have no comprehensive and transparent system of evaluation. It evaluates complaints in isolation, using only the evidence given to them by the advertiser. The ASA also told us that no practitioners had given evidence in response to a complaint, whereas both ANH-Intl and the CMA are aware of evidence having been submitted.”

The CMA and ANH-Intl both believe that the future practice of CAM will be increasingly eroded if the ASA continues with its current heavy-handed policy. This includes sending threatening letters to CAM practitioners who, according to the ASA, appear to have breached the ASA’s British Code of Advertising, Sales Promotion and Direct Marketing (The CAP code).

Jayney Goddard said, “We have asked our members how they feel when they get a letter from the ASA and many feel threatened and intimidated, with some being concerned that they may be sent to jail if they don’t comply. It’s not surprising that some practitioners feel they have no option but to shut down their practice.”

The two groups representing CAM consider the ASA’s approach, in conjunction with that of the anti-CAM skeptic group, the Nightingale Collaboration, to be akin to a “witch-hunt” against CAM practitioners.

“If the basis of adjudications was transparent and took into account the full gamut of evidence, we would not be so concerned,” added Jayney Goddard, “but what we have here is an independent watchdog that appears incompetent to evaluate the field of CAM. Not only that, but the ASA is now dealing with a greatly increased level of complaints from the over-zealous, CAM-skeptic Nightingale Collaboration. Practitioner–patient relationships can’t, unfortunately, be evaluated in the same way as roofs and guttering.”

The ANH-Intl and The CMA aim to encourage the ASA both to increase the transparency of its evaluation and adjudication methods, and to expand the type of evidence that can be used to substantiate specific claims. The two organisations urge CAM practitioners not to simply ‘roll over’ when challenged by the ASA, but to attempt to justify their claims with the best and broadest range of available evidence.

So, as well as claiming the ASA is incompetent to assess the claims of quacks, it is also claiming that there is a lack of transparency here. I am not sure how they have arrived at this conclusion. What extra elements do they require in order for the ASA to be more transparent in what they do?

There is an obvious question that Goddard and the ANH need to ask themselves. The ASA is a widely respected body, fully supported by all major advertisers as a cheap and light handed way of ensuring UK advertising is ‘legal, decent, honest and truthful’. If the ASA can be accepted as adjudicating on claims as diverse as double glazing to vitamin pill benefits why are they incompetent when it comes to homeopathy and herbalism?

Verkerk appears to believe that the answer is in something to do with the “extremely complex processes that occur when practitioners and patients interact”. However, the ASA are not going to adjudicate on the alleged mechanisms by which, say, homeopathy works, but on whether or not there is robust evidence to substantiate claims that such ‘extremely complex’ processes actually have specific effects on people. That is no different from any other form of treatment – and the ASA are quite happy to look at adverts where there is undoubted complexity in mechanisms in mainstream health claims. If I go to a homeopath expecting my child’s asthma to improve, the ASA will want to see evidence that asthma symptoms are alleviated under homeopathic care.

Their request to ‘expand the range of evidence’ and to include their own people in assessing claims is also misconceived. Expertise is required to help assess health claims. Practicing homeopaths, herbalists and acupuncturists cannot be considered experts as their beliefs are clearly false. What does it mean to be an expert in something that is not true?

I also find it incredible that the quacks have not worked out that the ASA’s lack of direct statutory powers is also a very good thing. It allows advertising claims to be managed without recourse to the courts at every opportunity. It is in advertisers very best interests to use the ASA as a resource to check what is legal and to accept their judgements when they are made so that legal action does not follow.

And that is what could and will happen. If a homeopath refuses to work with the ASA, then the next steps do involve criminal proceedings. Instead of denouncing the ASA as incompetent and threatening, they should be cooperating fully to ensure they are not subjected to more serious sanction.

In all, it shows a group of people seriously out of touch with reality. The quack world has enjoyed decades of nearly no regulatory interference. What regulation does exist is never enforced. Slowly, they are being dragged into a world where people are held to account for the claims they make and the actions they take. That is something they are not used to. And that is why it is bothering them so much.

UPDATE 7/8/11

The ASA have now published the ‘threatening’ letters that they sent to homeopaths. Scary stuff…

Related posts:

1. The Advertising Standards Authority Seeks to Destroy Complementary Medicine–Apparently This time, Jayney Goddard, who calls herself the President of The Complementary Medical Association, is calling on homeopaths and other quacks to provide evidence for her to take to the...
2. How to become a Daytime TV Expert: The Jayney Goddard Story Professor Jayney Goddard is the president of the Complementary Medical Association (CMA), “the world’s largest professional membership body for complementary medicine” and has been elected a Fellow of the Royal...
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She has been circulating an email asking for evidence that the ASA has really hurt the feelings of people who make livings from selling superstitious and pseudoscientific forms of treatments. And hurting people’s feelings is bad.

Let’s remind ourselves what the ASA are really doing. Last night, I wrote about how the ASA investigated one of the UK’s largest homeopathic pharmacies that had been selling ‘remedy’ kits for travellers to prevent them catching fatal diseases. These kits do not work and by promoting such things, and denigrating real vaccinations, they put people’s lives at risk. If a few feelings are hurt upon the way then so be it.

Goddard claims she is meeting the ASA this Friday. She is taking along an advertising executive called David Hawkins who she describes as “a multi-award winning advertising and brand creation genius”. (Prizes for anyone who can detail these awards).

Also along for the ride is Dr Robert Verkerk and Meleni Aldridge from the Alliance for Natural Health. The ANH is an industry lobby group who work mainly for food supplement companies and spend much of their time lobbying the EU and governments to give such retailers an easy legislative life. They do this, of course, under the banner of ‘health freedom’ and people’s choice to ‘alleviate suffering’ through ‘natural health choices’.

It may be worth – just for the fun of it – going back a few years to when I first wrote about Jayney Goddard.

She had been appearing on TV – debating with a certain Simon Singh – about whether Homeopathy was a waste of money. She was very impressive and had lots of ‘research’ at her finger tips. She sounded too impressive and her online  list of qualifications, awards and distinctions were too good to be true.

Jayney had been describing herself as having a “Professorship from Mahendra Sanskrit University in Kathmandu”. She was “the world’s largest professional membership body for complementary medicine” and has “been elected a Fellow of the Royal Society of Medicine”. She “studied homeopathy at Imperial College for five years and has won numerous awards”.

A little digging revealed that the Mahendra Sanskrit University  had been destroyed by Maoist rebels many years before. It also became clear that being a Fellow of the Royal Society of Medicine required little more than a cheque for a few hundred pounds, and that, of course, Imperial College had never taught homeopathy. Indeed, the University, I understand, wrote to Goddard to stop her making these claims.

All very impressive stuff.

It would also appear that Goddard is well known to the ASA as someone complained about her last year for advertising what appeared to be a very dodgy multi-level marketing scheme with very misleading claims. Well worth reading about on Sceptical Letter Writer’s blog. The ASA found that her company, Magic Bullet TV Ltd, had misled with its advertising and made unsubstantiated claims. Note, that Jayney does not mention her own direct experience with the ASA in her email below.

Anyway, that leaked email in full…

Dear Colleague,

I am writing to you regarding an extremely important issue that directly affects all of us who are in any way involved in complementary medicine and natural healthcare.

As I am sure you will be aware, many practitioners of a variety of disciplines have received letters from the Advertising Standards Authority which notify them about complaints raised about their advertising (particularly on websites etc.).  This ‘anti-natural healthcare’ campaign is being run by a selection of well organised groups who are committed to destroying our profession and seem, to all intents and purposes, to have enlisted the help of the ASA to do this.

Over the last few weeks I have been contacted by countless practitioners who have felt that these letters have been extremely distressing.  This is of course, totally unacceptable.

I am meeting with the ASA this Friday to address this situation and various regulatory matters – and before I do so I need your help – as soon as possible please:

If you have received an ASA letter please could you tell me the following:

Please tell me in your own words whether (based upon the letter you received) you believed that

a)      the ASA is a legal body – with legal powers?

Please respond Yes or No

b)      whether you felt that the letter you received was in any way alarming or threatening?

Please let us have your comments

c)       whether you felt that you are being blackmailed in the letter you received by the threats of ‘sanctions’ and ‘bad publicity’

Please let us have your comments

(We will, as mentioned above, be raising other regulatory issues in the meeting too and we will report back on these in due course).

Please rest assured that any responses to my questions will be treated with the utmost confidence and your identity will not in any circumstances be divulged to the ASA – or any other body.

If you have not received a letter from the ASA yet – but you know someone who has please would you be so kind as to pass this email on to them.

Due to the highly organised nature of the wide ranging attacks on our profession it is now time for us all to work together to address these issues – the wellbeing of our clients depends upon our being able to offer our valuable treatments. If we are unable to advertise – then complementary medicine and natural healthcare is in grave danger.

I will let you know how the meeting goes.  I anticipate that this will probably be the first of several meetings – however, present at this first one will be representatives from The Complementary Medical Association (The CMA) including Dave Hawkins (formerly Planning Director of the world’s largest advertising agency and who has worked extensively with the Code of Advertising Practice Committee and the ASA throughout his career), Dr Robert Verkerk and Meleni Aldridge from the Alliance for Natural Health (ANH) and myself.

Lastly – let me finish by thanking you in advance for your help in this matter – it is a crucial time for our profession.  (I’d also like to apologise if you’ve received this email more than once forwarded from other people – it simply means that friends and colleagues of yours are on the ball and believe that you may be able to help with this extremely important issue).

Warmest wishes

Jayney Goddard

President, The Complementary Medical Association

PS Time is of the essence – so please can you respond to me ASAP!

Related posts:

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2. Quacks Denounce ASA as Incompetent and Threatening Last week I reported that a top quack delegation was visiting the Advertising Standards Authority to tell them that they were being very mean to quacks by asking them not...
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Impressive stuff. No wonder she was invited onto today’s The Wright Stuff to debate with Simon Singh on the subject “Homeopathy: A Waste of Money”. Indeed, Jayney Goddard is a regular guest on the show and boasts an impressive appearance list in other shows, including being resident ‘Expert’ on Discovery TV. But Jayney appeared to state a number of surprising factual errors and have some over optimistic interpretations of the research literature (and I will come onto these). How could such a eminent expert make such mistakes? I thought a little background research might be in order.

So, President of the CMA, “the world’s largest professional membership body for complementary medicine”. What is the CMA? Well, the CMA web site does not appear to be what I expected. It offers some articles, sells a few books and food supplements and offers marketing services for members. Looking at Company House records, the CMA is registered address is Chase Bureau Services, a supplier of ‘off the shelf companies’ and other company secretarial services. So, no ‘head office’ for the CMA then. The web site for the CMA is registered to a private individual with an address given in a residential block of flats in Wandsworth. I’m disappointed. The CMA is not sounding so grand as I first thought. However, the CMA does usefully offer viewers of the Wright Stuff options to buy products that Jayney mentions on air. It looks to me like Jayney Goddard is president of a shop.

So, what about being Professor Jayney Goddard? We are told that Jayney was “recently awarded a Professorship from Mahendra Sanskrit University in Kathmandu, Kingdom of Nepal”. The university was set up to promote the Sanskrit language in Nepal. However, when I tried to contact the University to find out more about Jayney’s Professorship, I found their website is permanently down. Unfortunately, it would appear that in 2002, a hoard of women Nepalese Maoist rebels reduced the University ‘to cinder’ and destroyed all the ancient Sanskrit texts, University buildings, furniture, and all university records. The rebels had previously planted a ‘crude but powerful bomb’ there too. It is not clear if Jayney Goddard makes frequent visits to fulfil her Professorial duties.

And what of these claims to have studied homeopathy at Imperial College? The University is one of Britain’s most prestigious degree level teaching and research institutions. It does not offer a degree in homeopathy. Elsewhere we are told that her qualifications are “diploma in hypnotherapy and is a Licentiate of the London College of Classical Homeopathy”. No qualifications from IC then? This is a puzzling one.

And finally, Jayney says she has been elected a Fellow of the Royal Society of Medicine. What does it take to become a Fellow of the Royal Society of Medicine? The answer looks to be about £356 for a London resident. You can join online. I filled in the form and elected myself to become a Regional Fellow for £287. Bargain! Le Canard Noir, Fellow of the Royal Society of Medicine. Magnificent! My mum will be so proud. It looks like Jayney could become a Fellow as her ‘presidency’ of the CMA is obviously a ’senior management’ role in healthcare.

There is so much more on Jayney’s CV that we could explore. But enough for now.

So, what of these errors she made on the Wright Stuff? Simon Singh was arguing that the totality of scientific evidence for homeopathy showed that it was ineffective and a placebo based therapy – unsurprising given that it is just plain sugar pills. Jayney tells us though that ‘outcome trials’ are the way to measure homeopathy. These trials almost always give you positive results for homeopathy – they are just not very good as they do not compare homeopathy against any control group. It is impossible to know if the effect was caused by homeopathy or it was just people getting better on their own. Simon argues this, so Jayney went into animal experiments and this is where she lost the plot.

There is just some research printed recently, I think it was actually in Immunology which is one of the worlds leading scientific journals and it showed that mice exposed to something causes Chagas disease (guffaws) … these mice were treated homeopathically, prior to being infected. It was a properly run double blind placebo controlled trial – the gold standard that Simon is actually talking about – and what actually happened was the untreated mice died, the mice that were treated did not get the disease.

Wow. But is it true? Well, no.

The research was done, but not published in Immunology. It was published in the in-house comic of the Faculty of Homeopaths, Homeopathy – a rag with as much scientific integrity as the Beano. The paper, “Effects of homeopathy in mice experimentally infected with Trypanosoma cruzi “, did not say that the untreated mice died or that the treated mice did not get the disease. It reported that more mice died in the control group but that this was not statistically significant. But the main criticism would be that the statistical certainty of effects were low (only p<0.05) and that multiple measurements were being made in five groups that would undoubtedly result in many false positives. If Professor Jayney Goddard thinks this is the best evidence for homeopathy, then we can be pretty sure it does not work. What is certain, is that this TV show was not the right forum for discussing p-values.

But Jayney went on to discuss homeopathy for childhood diarrhoea. She talks of trials ‘all over the world, in developing countries’ where children with diarrhoea have been treated with homeopathic medicines and also placebos and Jayney claims that the children who have been treated homeopathically had shorter periods of diarrhoea. Jayney tugs the heartstrings and tells us that the poor children of Burma, after the recent cyclone, could benefit enormously from such treatment. Undoubtedly, it is the sceptic scientists like Singh who get in the way of saving the children. Again. Is this true? Again, no. Diarrhoea and homeopathy is really just one researcher’s passion – Jacobs. She has been involved in a number of trials in places such as Nepal and Nicaragua. Individually, these trials did not show a strong significant effect for homeopathy. But when Jacobs did her own meta analysis on three trials, she claims to be able to show a statistically significant effect. Jacobs suggests that “larger sample sizes be used in future homeopathic research to ensure adequate statistical power”.

As meta analyses go, doing your own analysis on just three papers that you have been involved with is not really showing multiple independent confirmation of your result and is unlikely to be sufficiently self-critical of the work and take adequate precautions usually found in competent meta-analyses. Tellingly, Jacobs did go on to do another larger trial in Honduras in 2006. The conclusion was,

The homeopathic combination therapy tested in this study did not significantly reduce the duration or severity of acute diarrhea in Honduran children.

Showing his own biases, the paper did not discuss the possibility that homeopathy could not work, but rather that the homeopathic pills had been stored incorrectly and so on.

In discussing the Chagas and diarrhoea trials, Jayney Goddard misled her TV audience. It would have taken half an hour for Singh to untangle that lot, even if he had the relevant papers to hand. Given the the show host was acting like a moron pretending him and his friends did not need protection in malarial areas, Simon Singh did not have a chance of getting clear science across.

The most telling moment came when one of the other guests asked,

Simon, you’ve got trials that prove your case, Jayney, you’ve got trials that prove your case, which makes it very difficult for us to know where the truth lies.

Well, if Simon’s colleague, a real professor of complementary medicine from Exeter University, Edzard Ernst, had come on, then perhaps there could have been a rational and fruitful discussion about the role of homeopathy in the NHS. But instead of Professor Ernst, we had to have a Professor from a long-since burnt down Nepalese Sanskrit University who runs a web site selling homeopathic books and pills. That, in my opinion, creates the obvious confusion shown on this show.

Related posts:

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