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.