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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.
We 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.
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.
Holland & Barrett, Kensington High Street, London
23 July 2012
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.
In 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 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.
Or how about Accredited Crystal Healer? Accredited Iridologist? Accredited Colonic Irrigator?
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.
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.
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
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.
…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.
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.
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?
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
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.
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
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:
…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.
And another one…
There'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
A complaint submitted to the Advertising Standards Authority (ASA) 17 months ago has finally been resolved.
A leaflet entitled, Podiatry & Chiropody Marigold Clinic, found in the 'pharmacy' area of the Royal London Hospital for Integrated Medicine (RLHIM) — previously named the Royal London Homeopathic Hospital — claimed that:
Marigold Therapy is a research based medicine which provides gentle, effective treatment for foot problems.
Marigold Therapy is an integral part of homeopathic podiatry, comprising of specially formulated medication applied topically in conjunction with conventional podiatry treatment.
We understood from this that conditions were treated by topical treatments (creams or ointments) called 'Marigold Therapy' and this was confirmed by the Marigold Therapy website (cached), which points out that Marigold Therapy refers to a range of products that have been:
researched and developed over the past 35 years
…by Dr M Taufiq Khan who founded the RLHIM's Marigold Clinic in the early nineties. The family tradition continues with M Taufiq Khan's son, M Tariq Khan, now Director and Consultant Podiatrist (cached) at the clinic.
The Marigold Clinic specialises in the treatment of foot disorders including:
- Athlete's foot
- Corns, Callosities and Fissures
- Dry eczema
- Skin ulcers
- Verrucae and Viral Warts
- Epidermolysis Bullosa
- Pachyonychia Congenita
Bones and joints
- Bunion and other bone and joint conditions including gout
- Post-operative complications
- Sports injuries involving the feet
- Thickened, dry, brittle, psoriatic and eczematic nails
- Fungal infection
The Marigold Therapy website claims that:
the safety and efficacy of Marigold Therapy have been demonstrated through extensive clinical use in podiatry clinics and numerous studies and in randomised, double blind, placebo controlled trials
…but no references are given for any of these studies and simply lists three locations where these studies were allegedly conducted.
For this reason, we complained about the RLHIM leaflet to the ASA, challenging whether the efficacy claims made for Marigold Therapy to treat the medical conditions listed could be substantiated. When we did so, we pointed out that this leaflet was also available as a pdf download and in their 'interactive hospital service guide', though this was several months before the ASA extended its digital remit to include marketers' own websites.
It should have been a simple matter for the RHLIM or Tariq Khan to provide copies of the 'randomised, double-blind, placebo-controlled trials demonstrating the safety and efficacy of Marigold Therapy' as claimed for it on the Marigold Therapy website. In fact, he helpfully lists some studies he's co-written on the RHLIM's website: of the eleven listed, two specifically mention marigold therapy, five mention thuja and all but one are co-written by father and son. It's not clear whether these studies are the 'numerous' ones referred to nor whether the journals they are published in are peer reviewed.
After 17 months, the RLHIM has agreed with the ASA that the leaflet must be withdrawn and changes made before it is used again. So, instead of an adjudication, the University College London Hospitals — trading as The Royal London Hospital for Integrated Medicine — just get a mention in the ASA's list of informally resolved cases.
But what's important is that the leaflet with its misleading claims has now been removed from their website and pages 36 and 37 of the latest RLHIM service guide are no longer there.
Even though the misleading leaflet has had to be withdrawn, there are quite a few loose ends here and we hope to return to this at a later date, but you might like to read more about the Marigold Clinic in a blog post written by Prof David Colquhoun a few years ago: Conflicts of Interest at the Homeopathic Hospital.
Then there are all the other leaflets about the other treatments on offer at the RHLIM…but those will have to keep for later.
Thanks to all 190 of our supporters who responded to our Red Tape Challenge Survey!
This fantastic response helped us formulate our reply to the Red Tape Challenge and we were able to include many of your comments.
You can download a pdf of our full response here.
It is clear that it is highly misleading for the medicines regulator to be lending legitimacy to homeopathic non-medicines. Unfortunately, regulation of homeopathic 'medicines' is mandated by EU Directives, but we can see no need for these to be regulated by the medicines regulator. We have recommended that the Government review 'right-touch' regulation of these products and asked that they consider a more appropriate body.
It is also clear that current regulation is not working to protect the public because it allows the labelling of homeopathic products to mislead consumers. We have recommended that this be reviewed so that consumers are able to make fully informed choices.
When it comes to the regulation of herbal products, the situation is more complicated because some traditional herbal products can have pharmacological effects and can interfere with conventional medicines. It is appropriate that some measure of protection is afforded to consumers by good and effective regulation.
However, the current regulations do not work to protect the consumer because of the double standard of the lax herbal regulation compared to the far more stringent Marketing Authorisation required by conventional medicines: herbal products are not required to demonstrate efficacy and the current regulations are certanly not burdensome. We have recommended that the Government looks at more appropriate regulation.
Like the labelling of homeopathic products, the labelling required by the traditional herbal regulations also does not work to allow consumers to make informed choices.
For further details, please read our full response.
Thanks again for all your support.
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- The end of homeopathy on the NHS in Bristol?
- NHS Homeopathy: 20 years of decline
- Nelsons Homeopathic Pharmacy #2
- The different faces of the Society of Homeopaths
- The growing pains of osteopaths
- Diluting misleading claims - ASA update
- NHS homeopathy in Scotland - on a shoogly peg
- Homeopathy on the NHS: at death's door
- Rubbing salts into the wounds of homeopathy
- About The Nightingale Collaboration
- How to find out who owns a website
- Advertising Standards Authority
- How to submit a complaint to the ASA
- Finding deleted and changed webpages
- The decline of homeopathy on the NHS
- Making a complaint
- Landmark decisions for homeopaths
- WDDTY #2 - The Second Wave
- NHS Lanarkshire to end referrals to Glasgow Homeopathic Hospital