Ofquack, or the Complementary and Natural Healthcare Council (CNHC) (www.ofquack.org.uk), has been approved as an Accredited Voluntary Register by the Professional Standards Authority (PSA).
So now, craniosacral therapists, ear acupuncturists, reflexologists and reiki healers can claim to be covered by similar professional standards as doctors and nurses. This development is deeply worrying. It aims to protect the public from risks associated with such practices, but it will do not such thing. Indeed, by providing unwarranted credibility to quacks, it puts the public at greater risk from therapists who believe absurd, unproven and dangerous things about health.
But let’s step back. I was wrong about Ofquack. In January 2008, I called Prince Charles’ new initiative a Dead Duck. The CNHC was set up to be an umbrella voluntary regulator that would oversee many types of pseudoscientific and superstitious health practices and give them the sort of legitimacy that would allow them to be employed by the NHS or paid through insurance.
I thought it would fail for two reasons: firstly, squabbles within and between the various therapies would mean that there would be great distrust and reluctance to join the new register; and secondly, they would never reach their goal of 10,000 registered members and so be financially unviable.
So, how did they manage to survive for over five years and become accredited by the PSA? That is a question of two parts. They survived very simply: by not being a regulator. Awareness of them amongst the public is near zero – they have not spent the money required to be visible. Despite, misleading claims and unethical practices being rife, in five years, only two complaints came from clients of practitioners. One was resolved without an investigation and the other was not deemed to be serious enough. There have been probably several hundred complaints in total though about misleading advertising, but these have come from activists concerned about the very nature of regulating absurdity. These complaints have never resulted in any practitioner being investigated despite endemic and deeply worrying, misleading claims being made. I predicted back in 2008 that if Ofquack ever did start investigating its members it would collapse very quickly. It has a toothless squawk where members would simply leave in their droves if they thought membership threatened their beliefs and livelihood. Remember, this is a voluntary register. Membership allows practitioners to put a sticker in their window. As soon as the costs and risks outweigh the benefits of that sticker, they will be off. Even without active regulation, the CNHC only ever managed to attract half the members it said it needed.
The second part of the question: how did they manage to get accredited by the PSA? The answer to this is even more disturbing. The simple answer is that the PSA do not give two hoots as to whether any of the therapies covered by Ofquack have any merit whatsoever. The therapies are quackery and the PSA turns a blind eye. They have adopted the pathological box-ticking mentality that appears to believe that as long as a practitioner can show they have been well trained in sticking pins in the homunculus that resides in our ears, then that is good enough to protect the public. There appears to be no recognition whatsoever that accrediting practitioners who are deeply misled about the causes of disease and their treatments can lead to harm if a customer were to believe them.
The Professional Standards Authority claim to work to “Right-touch Regulation“. The first principle of this is that they “identify the problem before the solution” and that they “check for unintended consequences”. Accrediting quack regulators is a solution that fails to grasp the central of problem of regulating nonsense: it is still nonsense that harms those who believe. The unintended consequences of regulating quackery is that it is putting lipstick on a pig, or more likely, putting a hog in armour. It may mislead some people into thinking they are dealing with something that they are not. And if any member ever ends up being struck off a quack voluntary register, it has no consequences for anyone. The quack is still free to practice and mislead. Those harmed are still harmed. As a rule of thumb, all attempts to professionalise quacks, just make their actions consequence free. By being covered by a ‘professional register’ it is more likely that real consequences, such as investigations by Trading Standards or even the Police, will be less likely as ‘these things are best left to the regulator. A dangerous situation indeed.
And the practices covered by Ofquack are at worst indistinguishable from life threatening frauds. Let’s look at Cranosacral therapy. The CNHC tells us that,
Craniosacral therapists work with the presence of subtle rhythmic motions that are expressed within the body (particularly the head, spine and pelvis). The free and balanced expression of these subtle motions is related to our state of health and vitality.
In a typical session the client will lie (or sometimes sit) clothed on a treatment couch. The therapist makes contact by gently placing her/his hands on the client’s body and uses a light touch to tune into the subtle motions taking place. The therapist can evaluate if there are any imbalances within the body and use a range of non-invasive therapeutic skills to relax and thereby promote self-healing within the client.
It is important to choose a qualified craniosacral therapist who has undertaken all the necessary training to understand the theory and practice of Craniosacral Therapy.
The thing is, all this is made up gobbledygook. It is pseudoscience at its best. There are no ‘subtle rhythms’. It is plain delusion. All this may not matter, but such therapists routinely offer this nonsense to new born babies. They scare mothers that ‘birth trauma’ can be corrected by treatment. “The compressive forces experienced during birth as a result of the passage through the pelvis and the tight fit in the birth canal can cause imbalance in a baby’s system, even in natural and apparently problem-free births”. They then tell the mothers that such therapy can treat colic, asthma, autism, depression and many other conditions that are potentially dangerous and life threatening.
The regulatory regime now in force works under the assumption that a craniosacral therapist who has been well trained is a safe therapist. Whereas the reality is that they are able to better execute on their delusions. The Training Dilemma in alternative medicine was pointed out to the PSA before they approved Ofquack. It is obviously something that does not concern them.
But getting accreditation has not been plain sailing for Ofquack, mainly thanks to the activities of the Nightingale Collaboration. As Ofquack stated,
From the outset there have been groups that have attempted to work in opposition to CNHC and of course not everyone supports the notion that people want to use complementary therapies, or that there needs to be a regulator. However, the fact is that large numbers of people do use complementary therapies and where they do – as originally stated by the House of Lords in 2000 – it is better that there is somewhere that people can rely on to find practitioners who are properly trained, qualified and insured.
The Nightingale Collaboration have been challenging that assumption. In the Summer, they submitted 100 complaints about the advertising claims of members. The claims ranged from Hypnotherapists claiming they could treat Irritable Bowel Syndrome to a ‘Healer’ treating cancer. This delayed the application from the CNHC to the PSA. As they state in their conditions of accreditation, Ofquack have not been following their complaints procedure and have been trying to go through an “informal procedure” to get the members to quietly change their websites. The PSA have insisted that Ofquack adopt a single procedure and that the outstanding 110 complaints go through this formal prodedure in order to ratify their accreditation. The CNHC have until the end of October to do carry this out.
Ofquack have a real dilemma over this. It will not be easy for them to make these complaints disappear with a quiet word in the right ears. The PSA have insisted as a condition of accreditation that these complaints are handled formally. But to investigate these claims will raise shivers through their membership who want to see them as their legitimising friend and passport to business. Fortunately, at the helm of the CNHC is Margaret Coates, who was formally the CEO and Registrar at the General Chiropractic Council. The GCC have famously resided over a regulatory regime for chiropractors that has allowed absurd and seriously misleading claims to go unchecked for decades. As a result of similar mass complaints to the GCC, and under her leadership, the GCC underwent the largest number of healthcare complaints in regulatory history in the UK with hundreds of chiropractors being investigated for making false claims. In order to carry out the investigations, the GCC had to remortgage its premises, and now chiropractors have to pay the highest statutory fees of any group of health care workers. The Chiropractor’s membership bodies passed a unanimous vote of no confidence in the GCC under her leadership. What will happen to Ofquack?
I understand that news of this was not met with joy at the Annual CAM Expo in London where the CNHC were speaking. One good thing that may come of this is that indeed accreditation may put large strains on relationships with their members. Another area where Ofquack may now find it more difficult to appease their members is their relationship with the Advertising Standards Authority. Ofquack have stated they are working to get the ASA to accept lower standards of evidence for quack therapies in advertising. The ASA are almost certain to have nothing to do with this. In doing so, the CNHC show their true colours. Instead of protecting the public by holding their members to the highest standards of evidence when making advertising claims, they are working on behalf of their members to try to get more misleading forms of evidence accepted. The public interest is not a consideration here.
We will have to see where all this goes. Ofquack may well struggle to maintain members if they cannot bring home the goods on advertising standards or if they start to discipline and remove members from the register. What the PSA does is more concerning. Could they be foolish enough to allow homeopaths to become accredited? The Society of Homeopaths are indeed seeking such accreditation. This would undermine all pretence to public protection in health regulation in the UK as it would be giving a stamp of approval to some of the most deluded and dangerous quacks out there.
Legitimate, conscientious health care professionals, who care about public health and evidence-based medicine and who fall under the PSA remit should be outraged by all of this.
Follow Up 13/10/2013
David Colquhoun gives an in depth analysis at the absurd processes that led the PSA to approve the CNHC.
PSA seems to be just an auditor of procedure rather than quality, validity and veracity. This is not atypical. As a former HR Manager said to me once, “Investors in People – it’s all about the badge on the wall, not about actually investing in people.”
‘Legitimate, conscientious health care professionals, who care about public health and evidence-based medicine and who fall under the PSA remit should be outraged by all of this.’
I most certainly am.
I will press the BMA to review the situation, but don’t hold your breath. Too many GPs find it very handy to have practitioners on whom they can unload awkward customers. GPs and consultants are not rational scientists and seekers after the truth. They just want to care for patients, and if patients want pseudo-scientific care – so be it.
Politicians are in the same boat. Integrity and honesty is too expensive.
“GPs and consultants are not rational scientists and seekers after the truth. ”
Indeed, I am a scientist and yesterday a senior registrar made strenuous efforts to shoehorn data into fitting a preconceived hypothesis, sorry made an obvious diagnostic error and wouldn’t see it. Having supervised and taught research students I am well versed in recognising that process.
But never mind, I have some hypotheses of my own to test. If I’m right I will be happy to show the registrar how he could have arrived at that point from what I told him.
I’m new to this site and found it very informative. However, despite the argument you have put forward I believe the public will continue to use services ‘regulated’ by the CNHC. I have also been on to the PSA site to see how their accreditation scheme works.
From what I have read, surely having the CNHC put through the assessment of the PSA can only help to improve them. It will not improve the quality of their services – but PSA make it clear that they do not assess efficacy – it will though, improve other areas of weakness. Take the complaints from Nightingale; if it wasn’t for the PSA accreditation then these complaints would not be dealt with as efficiently.
The public, I fear, will always use unproven services but at least the CNHC with the help of the PSA are making the effort to improve they are regulated.
I think you are missing the point. The charge is here that this regime gives the appearance of regulation without there actually being any meaningful regulation. Note that not one member has gone through a formal investigation to dat as a result of them making misleading claims. The Nightingale action merely is a demonstration of this.
The CNHC have just been removed from the PSA’s list of AVR organisations and their panel decision notice has also been removed.
Have they not met the conditions and deadlines set by the PSA?
The CNHC website is still showing the AVR logo, but I wonder if that might also disappear.
Even if this is temporary, it could be very embarrassing for them.
Apparently, it’s just a website glitch…
I see the PSA and OfQuack got a mention in the House of Lords a few weeks ago when Lord Taverne asked: To ask Her Majesty’s Government whether they intend to appoint a scientist to the Professional Standards Authority.
“My Lords, the Professional Standards Authority has recently approved the registration of the Complementary and Natural Healthcare Council—which is known in scientific circles, quite justifiably, as Ofquack. It means, in effect, that craniosacral therapists, reflexologists and homeopaths can now claim to be covered by the same professional standards as doctors and nurses. In the past, the Department of Health has sometimes suggested that it will not take sides between evidence-based medicine, which is based on science, and complementary medicine, which is based on pseudo-science. Does the Minister not agree that the Department of Health should not be neutral between sense and nonsense?”
The PSA have certainly been having a lot of problems with their website this past week, but OfQuack are now being listed again.
People don’t mind purchasing magazines which degrade women, celebrate alcohol and drug cultures. Yet a publication that dare threatens the status quo of the medical profession and everyone is furious. Not all ‘quackery’is wrong. Would you include recommending a good diet, excercise, plenty of liquids, vitamin support as quackery? I wouldn’t these are sensible things that sensible people would try first without resorting to popping a pill. Homeopathy for me, this ones the jury’s out. As long as no one is claiming to cure cancer then what’s the harm. Placebo has been shown to be more effective for treating many things. This is an I necessary fight.