Our health care regulators cannot differentiate between a health care profession and a pseudo-medical cargo cult.
The Professional Standards Authority has accredited the Society of Homeopaths as a holder of a approved voluntary register of health-care practitioners. The PSA have announced in a press release that,
Patients and the public can have confidence in the Society of Homeopaths’ voluntary register which has been vetted and approved by the Professional Standards Authority.
There are many reasons why the PSA should not have done this. The PSA is charged with overseeing the statutory and voluntary bodies that regulate health and social care professionals in the UK. It is supposed to give assurance to the public that high standards are met and they are being appropriately protected from the untrained, the unscrupulous and the incompetent. The PSA they “do this to promote the health, safety and well-being of users of health and social care services and the public.” By accrediting the Society of Homeopaths they have clearly demonstrated they are not fit for purpose and are incapable of protecting the public. If the PSA can give the rubber stamp of approval to an organisation that promotes one of the most egregious forms of quackery around, then it can accredit pretty much anyone.
See my previous blog post: Ten Reasons why the Society of Homeopaths Should not Receive PSA Accreditation
The PSA give lots of detail about their decision to accredit and it is worth looking at this in depth. The first hurdle the Society had to jump was to convince the PSA that they “held a register for people in health and/or social care occupations.” I had argued that it was not possible to consider homeopaths working in a health profession as members of the Society of Homeopaths have no knowledge, training or practices that can diagnose or successfully treat illness. Whilst their intention is to act as health care providers, their beliefs make them systematically incompetent and a threat to the well-being of those they practice on. The PSA stated,
The Panel noted Call for Information submissions arguing that homeopathy is without a basis in evidence and not a health care practice, therefore unable to meet this Standard. The Panel noted that it is not its role to determine the efficacy of a therapy but to decide whether the Accreditation Standards are met.
Whilst one might accept that their role is not to review the evidence base for any practices of the registrants, it is reasonable to expect the PSA to evaluate if the applicants are telling the truth. The PSA noted,
The Panel noted the basic definitions of homeopathy provided in the application and on the Society’s website: ‘a system of medicine which involves treating the individual with highly diluted substances, given mainly in tablet form, with the aim of triggering the body’s natural system of healing’. The Panel considered that these could satisfy the definition of healthcare.
It is not true that homeopaths use highly diluted substances – mainly because there are no active substances in the remedies they dish out. The remedies are ritualistically diluted such that the remaining product is free from any active ingredient. There is also no reason to believe that such ritualistic preparations trigger any sort of healing process. If the Society had claimed they shook bags of bones to improve a persons imuju it would have been just as meaningless and equally unworthy of acceptance of being a healthcare practice. Homeopaths are not healthcare professionals. They are practitioners of pseudo-medical beliefs – quackery. This is the consensus view of science and the PSA has no need to determine the efficacy of this nonsense therapy.
Is it merely sufficient for people on a register to claim they are healthcare professionals? Has the PSA no duty to test that claim?
The PSA noted that a director of the Society had been directly in partnership with Andrew Wakefield during the MMR scandal. They also noted that homeopaths were associated with anti-vaccine views. However, they accepted assurances from the Society that a statement on their website makes it clear they do not endorse homeopathic vaccines. I doubt the PSA have read the statement though as it gives mixed and misleading messages. It states that “Currently there is no homeopathic alternative to vaccination or anti-malarial drugs which has been proven beyond doubt to be clinically effective”. What it ought to say is that there is no reason whatsoever to believe that homeopathy could be alternative to vaccinations at all. It goes on to state misleadingly that “There is some research evidence to suggest that homeopathic medicines may be effective in preventing serious disease: therefore homeoprophylaxis can be an ethical option under certain special clinical circumstances”. These are dog whistles to committed antivaccinationists and homeopaths.
For further advice on homeoprophylaxis under special clinical circumstances, please contact your homeopath or homeopathic pharmacist.
The PSA go on to reject the idea that the Society should not be accredited because it practices pseudoscience. The PSA say,
The Panel noted that questions of efficacy are outside the remit of the AVR scheme. The Panel noted that the Society affirmed its commitment to public protection through its policies and activities, providing for the public to be safer through seeing a Society registrant than seeing a practitioner who did not sign up to its standards.
The idea that you can tell pseudoscience by examining “questions of efficacy” is a serious misunderstanding of pseudoscience. Standard medical treatments may not be effective and clinical trials will help resolve such questions. But homeopathy is based on nonsense. Clinical trials do not add to our understanding that magic cannot work. We can reject homeopathy simply by examining its basic claims. The Civil Aviation Authority will not wait to see if a alleged flying carpet can gain an airworthiness certificate before rejecting it for public transport operations.
Next the PSA looked at issues of risk and concluded the “Society had demonstrated understanding of risks relevant to the occupations it registers and was found to have appropriate controls in place.” They understood the biggest risk from homeopathy can from the divertinon conventional diagnosis and treatment away from patients. The PSA believed that “this risk is mitigated by the Society’s educational and conduct requirements”. Alarmingly, the PSA accepted that the training in Anatomy and Physiology, Pathology and Disease for a homeopath was sufficient for them to be able to diagnose and recognise their own competencies. This shows a staggering lack of insight into what homeopaths are: they believe and are trained in pre-scientific, vitalistic views of disease and health. Many reject germ theory and believe ‘miasms’ are the basis of disease and health. Homeopathic training is a systematic training in incompetency and to think they can diagnose illness to the extent that they can mitigate such risks is absurd. In addition, homeopathic principles reject the very notion of conventional diagnosis and believe that all they have to do is take a detailed case history of symptoms. The PSA have been ridiculously naive in this area. This naivety is enhanced because they acknowledge the Advertising Standards Authority have criticised the Society for “discourag[ing] essential treatment for conditions for which medical supervision should be sought”. The fact that the SoH have cleaned up their web site does not mean this is not a systematic problem within homeopathy.
The PSA looked at whether the Society could inspire public confidence in the running of its register. They noted,
The Panel considered a concern raised about a YouTube link posted by the Society’s former Chair on Twitter, entitled ‘Homeopathy for Health in Africa – HIV/AIDS – Finding the Genus Epidemicus’ and whether this could impact the public’s confidence in the Society’s ability to manage its register. The Panel noted that the AVR team as part of its due diligence had confirmed the former Chair had posted the link after stepping down from that position but was still a registrant of the Society. The team suggested that posting this link did not appear to be in breach of the Code of Ethics and Practice or the ASA’s adjudication decision.
So, let’s be clear. A registrant and former director is suggesting that magical pills can treat HIV in Africa but this should not be a cause for concern about the Society running a register with such people in it. Just what would it take for people to be concerned about such a register?
Next the PSA looked at the defined knowledge base for homeopathy. It again stated that “accreditation does not validate the efficacy of a particular therapy” but was happy to accept that “scientific research of homeopathy is an ‘active and growing field’”. It obviously does not concern the PSA that this evidence base is overwhelmingly negative for homeopathy. The PSA also showed both a lack of understanding of medicines regulation and homeopaths prescribing and manufacturing habits. Most homeopathic remedies are classed as unlicensed medicines. It is illegal for a homeopath to dispense such remedies. Many homeopaths manufacture their own remedies most often with magical electrical machines. To think that there is not a supply chain of these unlicensed remedies that goes through homeopaths is again a position of the utmost naivety.
I could go on.
It is worth noting that the Call for Information from the PSA on the accreditation of the Society gained 18 responses. Only two were positive. This is a set back for all those concerned about the public health impact of quackery such as homeopathy. The PSA have completely failed to ensure their fundamental purpose of public protection has been fulfilled. If the PSA were effective, the ability for quacks to influence public health would be diminished, but as the PSA itself acknowledges, “Accreditation should result in increased referrals to the Society’s registrants.” By rubber stamping the Society of Homeopaths, it is likely that more misleading health advice and pseudoscientific treatments will be carried out.
This failure has come about due to the near universal practice in healthcare regulation of failing to understand the nature of quackery and to ignore the risks that quacks pose. Indeed, Earl Howe made this position clear in the House of Lords,
My Lords, the Government have no plans to change the membership of the council of the Professional Standards Authority. The authority is required under the Health and Social Care Act 2012 to set standards for organisations holding voluntary registers for health and social care occupations, and accredits those which meet these standards. It is not required to make a judgment on the beliefs and practices of individuals registered with the organisations that it accredits.
It is not all bad news though. I know that at least one homeopath has already jumped ship from the Society to join an alternative non-accredited register after being dismayed buy the Society for not standing up to the regime imposed on them by the ASA where claims of efficacy cannot be made. Given that the Society has to renew its accreditation annually it might now have to be a lot better at enforcing its codes of practice. That is, if you spot a homeopath claiming something dodgy or selling something they should not be selling, you should make a complaint to the Society of Homeopaths. Before now, that would have been an utter waste of time.
The PSA report reveals that the Society of Homeopaths are down to a membership level of 1250 homeopaths. They have not been publishing this figure for quite some time. It is possible that this accreditation, although a battle I did not want them to win, may well end up being hubris after all.
And as for the PSA, it is now clear they are worse than a chocolate tea-pot and a direct danger to public health. If I was a doctor, or other health care worker, I would be furious at the PSA for undermining public health through incompetent oversight. The PSA will no doubt claim that their accreditation is just a test to see if membership bodies can run a register. How the public perceive what they do though is of vital importance. It is most important that this accreditation is not seen as an endorsement of effectiveness. The PSA might be justified in their activities if, and only if, they could be sure that their rubber stamps were not perceived by the public as endorsements of quackery.
UPDATE 16th September 2014
The story hits the Times.
Harry Cayton, who declared as a conflict of interest that he used to work in a Steiner community, appears to believe that the question of whether homeopathy is useless or not is matter of opinion. He also thinks that even if people want a ‘competent’ homeopath then the government should have a role in endorsing that competency.For quackery, competency is just a measure of how well versed you are in that quackery. It says nothing about how effective you are, whether your claims can be justified or whether you pose a risk to the public. Indeed a well trained homeopath may well pose a bigger risk to the public as they may have a more distorted view of their own capabilities.
If we can’t win at this hurdle, the next step would probably be to see if we can collect evidence of the SoH, over the next year, blatantly flouting their duty of investigation of ethics breaches, and reporting every single one possible to the PSA.
Over a year ago, I complained to the SoH of several of its members’ web sites that were flouting its own Code of Practice. Those I recently checked were still flouting its CoP. Surely even the PSA must eventually take heed if it can be demonstrated that an organisation on its register knowingly does this?
And if the PSA reaccredit them despite this, encourage legitimate organizations to sue the PSA.
Well, this may be interesting. Since the supportable scope of practice of homeopathy is any condition where doing nothing is an appropriate treatment, any member on the register who claims to treat or cure any disease for which medical intervention is advisable (i.e. anything much more serious than rhinovirus) can and should be reported.
Also based on my reading of the PSA’s document, any endorsement of the College of Practical Homeopathy will necessarily have to stop, as this teaches germ theory denial.
Actually losing registration would be more embarrassing for the SoH than being refused it.
Endorsement of CoPH? The SoH doesn’t show them as a recognised course providers. The CoPH website doesn’t indicate that their courses are recognised by the SoH or anyone else for that matter.
As Mr Quack has pointed out:
” Earl Howe made this position clear in the House of Lords,
My Lords, the Government have no plans to change the membership of the council of the Professional Standards Authority. The authority is required under the Health and Social Care Act 2012 to set standards for organisations holding voluntary registers for health and social care occupations, and accredits those which meet these standards.”
In the case of the SoH it has been determined that it is competent to hold a voluntary register for persons occupied in providing ‘healthcare’.
Being ‘registered’ is meaningless in terms of judging professional competence as Quackometer has set out. The public must not be fooled by homeopaths claiming any other implication of the ‘register’.
As a Member of the Magic Circle I am proposing TMC creates a register and seeks PSA recognition for ‘persons who are occupied in providing magical entertainments in order to improve the health and well being of patients.’ A number of magicians do this, myself and Robin Williams (in film) included.
I share Mr Quack’s concerns at this nonsense. PSA is not fit for purpose, but for the present we must emphasise that SoH standards are very low, permitting quackery, possible fraud (by those who sell and claim that remedies have an effect without having any evidence they do) and deception of the public.
Magicians act with honesty and integrity. We say we are going to deceive people – and then we do!
They claim that they “do this to promote the health, safety and well-being of users of health and social care services and the public.”
How on earth can they achieve this goal when they recognise nonsense? Completely barmy, and if you read the PSA excuses they make zero sense in context of their stated mission.
Down from what?
I guess at one time it must have been 1251 BSM.
Oh, good. You’ve mastered integers.
As so often BSM you have jumped to conclusions. My ability to add the integer 1 on to 1250 to make 1251 does not show that I have mastered the negative integers. More evidence is required before you can say that I have mastered integers.
A very simple google search gives you an answer (might well be anecdotal considering the source) to your question ‘Down from what?
Hint Quackometer Blog post 2011.
Do you know how to google?
I’m happy to acknowledge that you may not have mastered integers. I withdraw my comment.
Some Homeopathic remedies are diluted to infinity according to:
Homeopathic remedies are diluted by a factor that must relate to an integer
eg 30c is diluted by 10^60 which is an integer.
Infinity is not an integer.
Therefore has Andy mastered integers or is he like me still learning?
Have you googled ‘Quackometer 2011 society homeopaths members’ yet?
First paragraph gives you a number for you to spin.
Currently, their public register has just 1,163 members. Maybe they’ve diluted some of them.
It means they have none of the original substance left. There is some finite volume by none of the substance so it is infinitely diluted. It isn’t strictly true, there is an extremely small chance it’ll contain a molecule of the original. However for all practical purposes it is since even in that unlikely scenario it would have no effect.
More delightful results from the world of accredited voluntary registration, which is currently the only form of regulation for counselling and psychotherapy.
The UK Council for Psychotherapy was made an AVR by the PSA. Since then they had a complaint hearing for a psychotherapist who had sex with his client. He got a six month suspension and is now re-registered with them http://notsobigsociety.wordpress.com/2014/08/30/therapist-who-breached-sexual-boundaries-returns-to-psychotherapy-practice/
Admittedly they did recently strike off another psychotherapist who also had sex with a client, but he resigned his registration after the allegations were found proved, effectively striking himself off.
And of course, if you’re struck off by an AVR, it doesn’t mean you have to stop practising. It just means you’re no longer a member of that particular organisation.
Please don’t be silly Alan.
If the SoH had diluted the membership at 1250 then surely that would mean more SoH members not less?
Homeopathy is a royal pain in the ass that is, most alarmingly in the 21st Century, still heavily supported, and influenced by, Royal pains in the ass.
Professor Dame Sally Davies (Chief Medical Officer) was 100% correct in stating that homeopathy is “rubbish”.
Homeopathy as a medical science is used all across the world. Prominent countries are Germany, France, India.
You seem to state that all these countries have medical councils and governments that cannot differentiate between medicine and quackery?
Yes. That is probably true.
Why do you use “probably” with true?
Also, what does “canard” in your name stand for?
Sadly, there is some truth about what you say about its popularity. However, you have not provided any good evidence that homeopathy is a ‘medical science’.
There are two answers: no, they can’t differentiate; and yes they can, but there are political reasons for continuing to perpetuate quackery.
Of course they can differentiate. The Second Law of Thermodynamics is universal.
They choose not to do so to appease some voters and collect the VAT on the ‘remedies’ sold.
Do not confuse self-interest with scientific truth.
“They choose not to do so to appease some voters and collect the VAT on the ‘remedies’ sold.”
This statement is incorrect if converted to numbers and compared with votes and VAT of scientific medicine. I am sure the German Government understands the implication of homeopathic treatment as it values its citizen.
Not a ‘medical science’. just a quack treatment. The argument ad poopulum does not the truth make.
This can be said with more emphasis for the “scientific medicine”. Here the argument “ad populum” has larger meaning. And after years of development there is not one medicine on offer: only drugs.
Seeking PSA accreditation is an act of hubris on the part of the SoH. I’m not familiar enough (thankfully) with the internal politics of the SoH to know but I do wonder if their leadership had a mandate for seeking accreditation from members? And if so, what was the framework for the debate?
The Society of Homeopaths do follow consistant standards and procedures: they lie about the efficacy of their preparations (I won’t call them medicines or treatments, becuase they don’t qualify as either thing) at every opportunity
I got cured using Homeopathic remedies. It works
You are wrong and price yourself a gullible fool for presenting your fallacious inference in public.
I am embarrassed for you.
“pr[OVE] yourself a gullible fool”
Thank you, iPhone, for that.
The ironically-named Education Master declared:
“I got cured using Homeopathic remedies”
All you need to know about homeopathic “cure” is contained in this sentence from a recent letter to the Veterinary Times from veterinarian Ian Hart. Mr Hart wrote:
“I have, on many occasions, ‘cured’ histiocytomas by hte simple action of doing nothing at all and a worried that people might consider me to be a homeopath.”
I have never read such a selection of bigoted comments. If you don’t homoeopathy, don’t use it. Simple. Clearly you all have absolutely no idea how it works. There is no ‘belief’ about it. Horses (for example) and babies don’t have belief systems yet it works on them. To decry this method of treatment is to insult huge numbers of intelligent people in many countries who have benefited from its use (without side effects btw). Shame on you.
Please supply reliable references to back up your assertions and beliefs:
1) How homeopathy ‘works’.
2) That is works on (a) Horses and (b) babies.
3) That people have benefited from the use of homeopathy.
The horses’/babies’ owners will no doubt be anxious that their charges seem to be ill.
Horses/babies are sensitive to their owners emotions and will appear to be even more ‘ill’.
When then the owner gives a ‘remedy’ which the owner believes has a ‘healing power’, the owner’s anxiety abates, the horse/baby senses this and, assisted by natural remission,appears to improve.
That the owner then ascribes improvement to the remedy and does not understand the power of vicarious placebo effects is noted.
But until evidence is provided, as Andy Lewis requests, proponents for homeopathy need to return to the drawing board, do their homework, and join the critical thinking community with as much good grace as they can muster.
Misleading patients that homeopaths are a ‘healthcare profession’ in any meaningful sense is to be deprecated. In the twenty first century we really should be doing better.