Challenging misleading healthcare claims

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What They Don't Tell You

questionmarkMany of you will be aware that a new monthly magazine called What Doctors Don't Tell You is being sold in various retail outlets including WH Smith and many supermarkets.

We were dismayed to see that the magazines carry many adverts for products and services that we believe are making questionable claims, which could mislead the public.

There is, of course, a responsibility on all advertisers to comply with the Advertising Standards Authority's CAP Code and this publication and its advertisers are no exception.

In view of the seriousness of many of the claims being made, we have submitted complaints to the ASA about a number of adverts found in the first and second issues.

In the September 2012 issue, we counted a total of 37 ads, with 34 in the October issue. Some of these are duplicate ads for the same service or product.

We have submitted complaints about 26 adverts.

We believe this may be the greatest number of complaints submitted to the ASA for a single publication.

We'd like to remind our supporters that the ASA only need one complaint to investigate an advert — additional complaints about the same ads only places an unnecessary burden on the ASA and will not change the outcome. We believe we have covered the vast majority of questionable claims, so we would suggest there is no need for anyone else to submit any further complaints.

It is, of course, up to the ASA to investigate and decide whether or not any of the ads we've highlighted are in breach of the CAP Code and to rule accordingly.

We will let you know the outcome of our complaints in due course and we will, of course, be monitoring all future issues for similar questionable claims.

04 October 2012

Still Being in Stillness

Late last year, we reported that the Advertising Standards Authority (ASA) had adjudicated on the Being in Stillness (BIS) website, which was one of the three websites in our 'master' complaint about the promotion of craniosacral therapy (CST).

The ASA identified ten points in our complaint and upheld them all.

Independent Review

ReviewBIS asked that the adjudication be reviewed by the ASA's Independent Reviewer, Sir Hayden Phillips.

There are just two grounds for a review: the person requesting the review must be able to establish that a substantial flaw of process or adjudication is apparent, or show that additional relevant evidence is available.

The details of requests for review are not published, so all we know is that the request was rejected by Sir Hayden, presumably because the request met neither of these grounds.

While a review is in progress, the ASA removes the adjudication from their website. It has now been republished.

Second complaint

Meanwhile, we noted that, in spite of the adjudication, the website remained much as it was. Additionally, some new text had appeared denying that the website contained any claims; rather, that it carried a "a genuine description" of the experience of many practitioners and clients of craniosacral therapy together with the standard protestation that the scientific method can't be applied to complementary therapies and that "the mention of certain conditions is not intended to imply or guarantee a 'cure' for those conditions; nor any others; and nothing in this website is intended to discourage you from seeking medical advice where applicable".

Further text argued that CST works with "our underlying vitality" and supports "our body's innate healing and self-repair" (though no explanation of how it does this was provided). Thus, it was claimed that CST "may be of help with almost any situation", specifying a long list of conditions that included depression, M.E., recurrent infections, digestive problems, menstrual disorders, tonsillitis, asthma, autism and babies' colic.

There was also a claim that CST may be useful in supporting older people in their various ailments and women through pregnancy and childbirth.

So we submitted a second complaint and the adjudication on this is today published on the ASA's website.

As expected, our complaint was upheld on both counts: that the claims implied that CST was effective in treating the conditions named and that people could be discouraged from seeking essential treatment.

Response

In response, BIS had argued that the website doesn't state that CST can treat conditions, in fact, it states that they do not guarantee a cure for any ailment. They held the view that visitors to the website will not see the anecdotal claims as objective and capable of substantiation.

The ASA, however, considered that the text implied that a cure was at least possible through CST, even if not guaranteed. They also considered that claiming to work with "the whole person rather than conditions" and with "many different situations and conditions" followed by a list of medical conditions did indeed imply that CST could treat those conditions and that this could discourage readers from seeking essential treatment for them.

The full adjudication is quite lengthy but worth reading as an illustration of how some practitioners think they can avoid compliance with the advertising regulations and how the ASA sees right through them.

Responsibilities

Like it or not, all advertisers have a responsibility to abide by the CAP Code and ASA adjudications. It is the level playing field that ensures that the public are not misled by advertising and the ASA provide an independent means for claims to be challenged and for advertisers to present their evidence for their claims. Responsible advertisers know that and are happy to abide by the Code and adjudications, even if the result is not what they might have liked.

We note that the list of conditions and the other claims the ASA has deemed misleading have now been removed from the craniosacral page on the BIS website (for comparison, the page we complained about is cached here) and we welcome this. However, the page now contains a longer section on the ASA and its decision and tries to argue that CST does not lend itself to scientific investigation.

In light of this adjudication, we now hope that other craniosacral therapists will review their own websites to make sure they are on the right side of the ASA's CAP Code and their guidance on craniosacral therapy. We also hope that the CST trade bodies take responsible action to help and encourage their members to do the same.

If they are still in any doubt about what they can and cannot say, there is always the ASA's free Copy Advice service.

01 August 2012

Accrediting nonsense

accredited homeopath

Our response to the CHRE's Accredited Register scheme

Last time, we asked for your help in making sure the Council for Healthcare Regulatory Excellence (CHRE) didn't allow alternative therapy organisations on to its new Accredited Registers scheme. We believe this could pave the way for alternative therapists to claim they are 'officially accredited' or 'Goverment accredited', particularly if they display the schemes 'quality mark'.

We believe this would simply mislead the public into thinking these therapies are legitimate and have a Government seal of approval.

Many of you wrote to the CHRE and sent us a copy of your submissions. Our thanks to everyone who did and we hope the CHRE will take note.

accredited crystal healerWe also submitted our response. We wrote it with several aims in mind. Firstly, since the CHRE oversee a number of statutory regulators of health care professionals (as well as chiropractors and osteopaths), we wanted to make sure that they knew what they would be getting into and what the implications might be for their credibility and that of legitimate health care professionals.

We highlighted the reason many occupations are considered alternative is that they do not have robust evidence to substantiate what they do and the claims frequently made about them by their practitioners and trade bodies. Another common feature is that they frequently have no plausible mechanism of action — as exemplified by homeopathy and crystal healing.

Additionally, we illustrated that, even though many alternative therapies are, in themselves, fairly harmless, there are indirect harms and risks that need to be considered. These include a frequent disdain or even outright antipathy for the many health professionals — particularly medical doctors — whose statutory regulator falls within the CHRE's remit and we drew attention to the distrust of vaccines by many alternative therapists.

We also highlighted many of the clauses in the standards proposed and how they needed to be strengthened so the public are better protected.

You can read our full submission here, but we concluded:

1. We strongly recommend that the CHRE do not allow onto their Accredited Register any organisation whose registrants provide alternative therapies that do not meet the basic requirements of having a robust evidence base or that does not have an assessment of safety that ensures that the public will be properly protected.

We believe that to do so would be detrimental to:

  • the CHRE’s reputation;
  • public confidence in the CHRE and its regulated professions;
  • public health and safety;
  • the reputation of other Accredited organisations.

2. We strongly recommend that the standards ensure that the public are given independent and unbiased information about the evidence base for treatments.

3. We strongly recommend that the standards ensure that the public are given independent and unbiased information about the risks associated with treatments.

This scheme is supposed to be up and running in November and we'll let you know when the CHRE publish their final eligibility criteria and standards.

Holland & Barrett update

As a result of further information we received from our supporters about point-of-sale advertising for homeopathic products in Holland & Barrett stores, we decided that writing to their head office wasn't sufficient to get this issue resolved once and for all.

It appears that some store managers have been told by their head office that there was nothing wrong with the advertising, despite the MHRA's previous ruling on our complaint.

So, we have submitted another comprehensive complaint to the MHRA, including many of the photographs of the POS advertising you sent to us.

It will no doubt take the MHRA some time to deal with this, but we are confident of the outcome. We'll let you know in a future newsletter.

Kensington High Street London 25-6-12

Holland & Barrett, Kensington High Street, London

23 July 2012

Help us again, please!

Saffron Walden 1Back in December 2011, we reported that our complaint to the MHRA about point-of-sale advertising for Nelsons homeopathic products found in Holland & Barrett had been upheld.

This was advertising that included therapeutic indications when a condition of the registration of those homeopathic products is that they are not allowed to have indications.

According to the MHRA, Holland & Barrett withdrew the advertising from their stores and agreed to review the information on their website. While they have corrected some of the information on their website, we still think some is not correct and we will be contacting the MHRA again.

However, more than six months later, it seems that some Holland & Barrett stores have yet to remove this prohibited advertising.

Camb GraftonIn May, one of our supporters told us that the Holland & Barrett store in Saffron Walden only removed the advertising after she wrote to them pointing out the MHRA's ruling. She has since spotted the same point-of-sale advertising in other Holland & Barrett stores in London, Cambridge, Saffron Walden, Bury St Edmunds and Stortford.

There are hundreds of Holland & Barrett stores up and down the country and we'd like your help again.

We think this is a matter for Holland & Barrett's head office to sort out once and for all and would like to ask our supporters to check any Holland & Barrett stores they happen to be passing. If you see point-of-sale advertising, please This email address is being protected from spambots. You need JavaScript enabled to view it., telling them when and where you saw this advertising and refer to the MHRA's decision. But please keep it polite and factual and if you are unsure whether what you saw was prohibited, just ask them to check their advertising.

We think that is the best way to make Holland & Barrett take notice and ensure the misleading advertising is removed from all their stores.

However, if you prefer, you can always have a chat with the store manager and hand him or her one of our information sheets — or just leave one next to the advertising.

And don't forget to let us know how you get on.

accredited homeopathAccredited Homeopath?

Or how about Accredited Crystal Healer? Accredited Iridologist? Accredited Colonic Irrigator?

We are finalising our response to the consultation by the Council for Healthcare Regulatory Excellence (CHRE) on its Accredited Registers scheme.

As we pointed out in our last Newsletter, this could pave the way for alternative therapists to claim they are 'officially accredited' or 'Goverment accredited'. They will, after all, be entitled to display a 'quality mark'.

We believe this will simply mislead the public into thinking these therapies are legitimate and have a Government seal of approval.

The CHRE (which will be renamed the Professional Standards Authority for Health and Social Care later this year) do say that being admitted to their Accredited Register:

…will not be an endorsement of the therapeutic validity or effectiveness of any particular discipline or treatment.

However, particularly given the level of interest shown by many alternative therapy trade bodies, we do not believe that the eligibility criteria and standards proposed by the CHRE are sufficiently stringent and robust to prevent alternative therapy organisations applying and achieving the status of an Accredited Register.

We believe that the public will be misled and may even be put in danger by the accreditation of alternative therapies for which there is no robust evidence base and for which there are safety issues or for which safety hasn't been properly assessed.

We also believe that potential customers will not be given all the (unbiased) information required with which to make informed choices and exercise informed consent.

The consultation ends on Tuesday 19 July, so only a few days left to help — but more than enough time. Click here to find out how.

Sensible CNHC advertising advice

We've not said much about the Complementary and Natural Healthcare Council (CNHC). They have members from a wide variety of alternative therapies (or 'disciplines' as they call them). This includes reflexologists and we're pleased to see that the CNHC are advising their members to heed the Advertising Standards Authority's adjudications on our three reflexology master complaints and their new guidance on reflexology.

In their July (Issue 32) Newsletter (the link to this newsletter on their website is wrong, but we have our sources!), the CNHC say they have written to all their registered reflexologists:

The [ASA's] CAP Compliance Team has asked CNHC to draw to your attention to:

  • three rulings by the Advertising Standards Authority (ASA) in respect of advertising by reflexologists, which have implications for all reflexologists
  • the latest CAP copy advice with regard to reflexology, in light of these three rulings

The detailed rulings and the advice can be read on www.copyadvice.org.uk/Ad-Advice/Advice-Online-Database/Therapies-Reflexology.aspx

It's also important to understand that the CAP Compliance Team pro-actively monitors advertisements, as explained on www.cap.org.uk/Compliance/Monitoring.aspx

Please check the wording of your websites and publicity materials to ensure that all of your advertising complies with the CAP Advertising Code. The easiest and safest way to describe your reflexology practice is to use the reflexology descriptor that CNHC has agreed with the CAP Copy Advice Team. This is available here and can be downloaded by all CNHC registered reflexologists by logging into the Resources section of MyCNHC. We also recommend that you use CNHC's Advertising Guidance which you can find on our website here: CNHC Advertising Guidance

This is very welcome: although many alternative therapists are responsible and will already be abiding by the rules, it does no harm to remind them and ensure they are aware of what they can and can't claim.

The CNHC's Therapy Descriptors have been agreed with the ASA for all their regulated therapies and they are devoid of the many misleading claims frequently being made by alternative therapists. They provide very responsible guidance that keeps on the right side of the CAP Code.

We hope all CNHC therapists — and non-CNHC therapists — will take note and ensure all their advertising complies with this very sensible advice.

We also hope the CHNC ensures its members abide by it.

Website

We had a small glitch on our website a few weeks ago. This was caused by migrating it to a new bigger, faster, better server, which gave some warning messages that were displayed on the page. This has now been resolved and we apologise for any inconvenience.

06 July 2012

We need your help!

The new Government register could be a way for unproven and disproven therapies to gain undeserved recognition. Help us make sure it's not abused.

not_accredited

Last time, we mentioned the consultation by the Council for Healthcare Regulatory Excellence (CHRE) on their Accredited Register scheme that will be launched in November. This scheme will:

…set standards for organisations that hold voluntary registers for people working in health and social care occupations and we will accredit the register if they meet those standards. It will then be known as an 'Accredited Register'.

The list of organisations that have expressed an interest is growing and comprises many well-respected medical professions such as Cardiothoracic Surgical Assistants, Genetic Nurses and Counsellors and Anaesthesia Assistants.

Yet there are others, including homeopaths, acupuncturists, osteomyologists, anthroposophists, naturopaths, reiki-ists and even crystal healers. On top of that, there are several organisations that register alternative therapists of all flavours, including reflexologists, aromatherapists, bowen therapists, ear candlers, kinesiologists, stone therapists — just about the whole gamut of alternative therapists.

And, of course, the Complementary and Natural Healthcare Council (CNHC).

We don't know what the CHRE's attitude to alternative therapy organisations is, but we can easily see how alternative therapists, if they were to become CHRE accredited and entitled to display the Accredited Register's 'quality mark', could easily trumpet the accreditation and the mark as a symbol of legitimacy.

This does not enhance the protection of the public because it will simply confound informed consumer choice.

When is endorsement not endorsement?

The CHRE say that all they are doing is ensuring those organisations are committed to good practice in the way they operate. But even the best run register of practitioners of an unproven alternative therapy still leaves its members practising that unproven therapy on an unsuspecting public.

Also, since the idea is to have the registers online on the CHRE's website, they aim to make it easier for consumers to find practitioners.

However, they are at pains to point out that:

It will not be an endorsement of the therapeutic validity or effectiveness of any particular discipline or treatment.

But there is nothing in the draft standards that obliges organisations or their members to make this absolutely clear to their prospective customers.

Is it possible to endorse a register of practitioners of unproven therapies without being seen to endorse that unproven therapy?

We don't think so. And that is why this proposal is so dangerous.

Even if it is made clear, we believe it will not serve to protect the public. On the contrary, we believe being accredited by the CHRE — a statutory Government body — will simply and inevitably mislead the public.

Maintaining standards

Some of the proposed eligibility criteria and standards are interesting. To be eligible, an organisation must be able to:

…demonstrate that there either is a sound knowledge base underpinning the profession or it is developing one and makes that explicit to the public. (A.7)

There are some obvious problems with this. The first is that it talks about a 'knowledge base' but not an 'evidence base'. Homeopaths (or whoever) may well believe there to be a 'sound knowledge base' for their therapy, but it is really a scientifically unsound knowledge base. The danger here is that we don't know how the CHRE might want to interpret this criterion; we don't know if they will be disposed to allowing homeopathy to pass this test, so we have to make sure that this criterion is made far more robust.

But if a profession is just developing this sound knowledge base (and no doubt some alternative therapists might claim that), the question has to be asked how consumers can possibly be protected when subjected to a treatment by practitioners who haven't even yet got that 'sound knowledge base'?

One of the standards an organisation has to meet is:

C.2 The organisation promotes ethical practice

When it comes to unproven or disproven alternative therapies such as homeopathy, reiki and crystal healing, it cannot be ethical to subject a customer to these 'treatments', telling them it will align their chakras, balance your Qi, remove negative energy, that it's an 'energy' medicine that works holistically with your body's innate healing or that it works because of 'laws' invented 200 years ago, but which are entirely contrary to everything else we know about physics, chemistry and biology. Will they tell them there is no good evidence that it will help them?

Within the confines of the homeopathic, reiki or other make-believe 'paradigm', we have to worry that the CHRE might be tempted to accept that these are just different 'modalities'; different ways of looking at the body and different ways of healing, when they are all just pseudo scientific nonsense.

If the CHRE is to genuinely protect the consumer — and seen to be doing so — all such post-modern nonsense must be given short shrift and we need to ensure the CHRE have robust standards in place to rule out the possibility of alternative therapies ever being given the credibility that being CHRE-accredited will confer on them.

Another standard:

G.1 The organisation provides clear, helpful, easy to access information. It ensures that information provided by the organisation and by its registrants helps consumers to make informed choices and exercise informed consent.

An alternative therapy trade body may well provide clear, helpful and easy to access information, but is it credible to believe they will give their customers the information necessary for them to make truly informed decisions? Will they tell them it's not been independently tested and that there is no good reason to believe it can help/treat/cure/alleviate their condition?

Aims

One thing that must be remembered is that the CHRE aims:

…to promote the health, safety and well-being of patients and other members of the public and to be a strong, independent voice for patients in the regulation of health professionals throughout the UK.

They can't do this if they allow alternative therapies to hitch a ride and gain undeserved credibility; they need to protect patients and be seen to protect patients.

 

We've picked out just a few of the problems with the proposed standards, but there are many more that, depending on how they are interpreted, could allow many pseudo scientific, unproven or disproven therapies to be unleashed onto an unsuspecting public with the false imprimatur of Government accreditation.

What we need our supporters to do

fence

We need you to make your voice heard and make the CHRE aware of your concerns about allowing alternative therapists into the Accredited Register scheme.

We would urge you to submit a full response to the CHRE, replying to all the criteria and standards you think need to be strengthened.

Alternatively, complete the survey the CHRE have helpfully provided that has the eight questions the consultation is seeking responses on or submit the questionnaire included in the consultation document and send it to them by email or post.

But if you don't have time for that, please just drop the CHRE This email address is being protected from spambots. You need JavaScript enabled to view it., saying that you think alternative therapists should not be allowed onto the Accredited Register, ideally giving brief reasons why.

If you do submit a response, please let us know, but remember the deadline for submissions to the CHRE is Tuesday 10 July 2012.

Your help is greatly appreciated!

14 June 2012

Regulation of health care professionals

Thirty-one different health professions consisting of over 1.4 million professionals (from medical doctors and nurses to osteopaths and chiropractors) are currently statutorily regulated and overseen by ten regulatory bodies:

collage…the regulators operate within a wide variety of legal frameworks which have been agreed and amended by Parliament in different ways and at different times over the past 150 years. A complex legislative landscape has evolved on a piecemeal basis resulting in a wide range of idiosyncrasies and inconsistency in the powers, duties and responsibilities of each of the regulators. There are currently seven separate Acts of Parliament and three Orders made under section 60 of the Health Act 1999 which govern 10 regulatory bodies. These have all been amended extensively by 16 Orders made under the Health Act 1999 and a range of Acts of Parliament over the last 10 years.

In essence, it's a nightmare to administer, confusing to the public and the Department of Health wants to simplify this tangled mess.

So, the Law Commission, the Scottish Law Commission and the Northern Ireland Law Commission published a joint consultation setting out their proposals to consolidate the various Acts and Orders into one, with variations for different regulators only where necessary.

But note that this is simply consolidating the regulations, not the regulators themselves so there was no direct proposal to merge or abandon any of the regulators. However, having regulators all set up under the one common Act may well make merging some of them easier in the future.

The lengthy consultation document covered numerous aspects of the current regulations and how the Law Commissioners proposed to tackle them. It also asked for views on several key questions.

There are many differences between the regulators in what their duties are, the way they are constituted, the requirements they place on their registrants and the way they run complaints and fitness to practice panels.

We took the opportunity to make recommendations on some aspects as they applied to chiropractors and osteopaths.

The consultation ended last Thursday and the Council for Healthcare Regulatory Excellence has published their response. You can read our response here.

And another one…

accreditedThere's another consultation currently in progress that interests us.

The Council for Healthcare Regulatory Excellence (CHRE) — to be renamed the Professional Standards Authority for Health and Social Care in November — is setting up a register of registers.

The CHRE's new duty to set up this register was part of the Health and Social Care Act 2012 and it will:

…set standards for organisations that hold voluntary registers for people working in health and social care occupations and we will accredit the register if they meet those standards. It will then be known as an 'Accredited Register'.

The CHRE is the 'regulator of regulators' who:

…scrutinise and oversee the work of the nine regulatory bodies that set standards for training and conduct of health professionals.

The nine regulators are the ones the Law Commissioners are wanting to bring together under one Act.

Sixty-six organisations and trade bodies that have a register of health professionals have already expressed an interest in this accreditation scheme but this includes homeopaths, crystal healers, reiki practitioners, acupuncturists, anthroposophists and various organisations that cover a variety of alternative therapies.

Even the Complementary and Natural Healthcare Council are interested in the scheme.

Of course, an organisation accepted by the CHRE will be able to say that their register is accredited by the CHRE and some may even claim to be accredited or even regulated by the Government. Members of those registers would also be able to display a 'quality mark' to show they are part of this Government scheme.

There are standards that will have to be met, but it is not clear that these standards and the eligibility requirements are rigorous enough to prevent it being taken advantage of by practitioners of therapies for which there is not a jot of evidence.

We believe that being a CHRE Accredited Register will lend unearned and undeserved legitimacy to many alternative therapies — this can only mislead the public.

Further details of the consultation can be found on the CHRE's website.

We will be submitting our own response but we encourage our supporters to let the CHRE know their own views.

The CHRE have made this easy by providing a short online survey of the eight questions the consultation is seeking responses on and we strongly encourage our supporters to complete this or submit the questionnaire included in the consultation document and send it to them by email or post.

The closing date for your response is 10 July 2012 and we'll publish our response once we've submitted it.

03 June 2012

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