Landmark decisions for homeopaths

giveway

This is a bleak day for homeopaths; but a victory for consumer choice

Today sees the publication of two long-awaited adjudications by the Advertising Standards Authority (ASA).

One is the second of the ASA's 'master' homeopathy complaints, intended to set the precedent for future claims about homeopathy.

But this is no ordinary complaint about a homeopath making a few silly claims: it is an upheld adjudication against the Society of Homeopaths (SoH), the UK's most prominent homeopath membership organisation, boasting over 1,400 members.

The other is the revised adjudication of H:MC21's advert in New Statesman in 2010 after their appeal of the first ruling.

Although these rulings are not what homeopaths might have hoped for, they set the precedent for claims the ASA will and will not accept in adverts for homeopathy and the standard by which all others will now be judged.

Homeopaths now have the opportunity to finally fall into line and abide by the same rules as everyone else. The Society of Homeopaths have taken the lead by removing their What can homeopathy help? web page (cached).

But first, a look at these two crucial adjudications.

Second's out...

A long time ago, we suggested that our supporters submit complaints to the ASA about claims made on homeopathy websites. To cut a long story short, the ASA sent letters to these homeopaths (letter 1, letter 2 and letter 3) and then produced detailed guidance on advertising homeopathy services. After considering the matter, they also decided to investigate two 'master' complaints to examine all the evidence and to set a precedent for others to follow.

The first of these was Steve Scrutton Homeopathy and the ASA ruled that his website breached their CAP Code on four counts and stated:

The web pages must not appear again in their current form. We told Steve Scrutton to ensure he held robust evidence when making claims in future, and to ensure that he did not offer, in a marketing communication, specific advice on, or treatment for, conditions for which medical supervision should be sought. We advised him to contact CAP Copy Advice for advice on amending his marketing material.

You can judge for yourself whether his website now complies and you could also check his Twitter feed — also regarded as marketing communications by the ASA.

We have been waiting for the ASA's final adjudication and it is published today.

This complaint was not submitted by us, so we had no idea which website was was being investigated; we now know it was the website and a Tweet of the Society of Homeopaths and the ASA identify themselves as challenger of the claims.

At the start of this week, we noticed that the Society of Homeopaths deleted their web page titled What can homeopathy help? (cached). We now know why.

It used to make all sorts of claims about homeopathy, the 'growing body' of evidence for its efficacy and listed several medical conditions:

To date, conditions for which the majority of clinical trial findings have been positive include:

  • Allergies and upper respiratory tract infections
  • Ankle sprain
  • Bronchitis
  • Childhood diarrhoea; chronic fatigue
  • Ear infections
  • Fibromyalgia
  • Hay fever
  • Influenza
  • Osteoarthritis
  • Premenstrual syndrome
  • Rheumatic diseases
  • Sinusitis
  • Vertigo

The ASA asked for evidence to support these claims — and found it wanting; not measuring up to the high standards we expect and deserve from a body charged with protecting the public from misleading claims.

All in all, the ASA investigated 16 points — the 14 conditions specified and two points about discouraging medical treatment — and upheld all of them, ruling that the SoH breached the CAP Code on no less than 35 counts.

One interesting point is that they supplied some evidence not written in English. When asked to provide translations, the SoH didn't provide translations when requested.

For one claim, the SoH provided evidence for Boiron's Oscillococcinum product, claimed to help with flu symptoms. What is interesting is that Oscillococcinum is classed as an unlicensed homeopathic 'medicine' in the UK and as such, we understand, it can only be prescribed by medical doctors. We also understand it is illegal to advertise it.

The adjudication is thorough, describing how the SoH responded and what evidence they supplied to substantiate the claims made — it is well worth reading in full.

Overall, it is a resounding defeat for all homeopaths as well as the leading homeopaths' trade body; but it also is a resounding victory for consumer protection.

Pseudo science from the 18th century

The other adjudication published today is the end of a long saga that started in 2010 when H:MC21 (Homeopathy: Medicine for the 21st Century) placed a full-page advert in the New Statesman. It attracted six complaints to the ASA. The ASA considered the complaint as 12 separate points and examined the evidence provided by the advertiser to substantiate their claims.

The ASA published their adjudication on 15 October 2011, upholding seven of the 12 points.

The points they didn't uphold included ones that denigrated Prof Edzard Ernst and the House of Commons Science and Technology Select Committee for their Evidence Check report on homeopathy. But that wasn't because they had not been denigrated by the advert, but simply because they did not fall within the categories of those protected from denigration under the ASA's CAP Code.

There were a couple of other more minor points that weren't upheld: we think they should have been upheld, but we felt that because it had already taken 12 months to investigate, it wasn't worth pursuing any further and wasting yet more of the ASA's time.

However, the main claims made by H:MC21 were about the the 'success' of homeopathy. They did provide lots of information about homeopathy and their beliefs about Evidence-Based Medicine and Randomised Controlled Trials, but didn't provide the necessary standard of evidence required by the ASA to substantiate the claims about homeopathy.

This should not have been unexpected: the ASA's standards for substantiation are very clear and well-known, so there can be no excuse for not understanding whether evidence is likely to meet the ASA's standards.

However, having not been provided with adequate evidence, the ASA upheld most of the points, ruling the ad breached the Code on no less than 20 counts.

Appealing

As is their right, the advertiser requested that the case be referred to the Independent Reviewer, Sir Hayden Phillips. They supplied him with an 18-page document detailing the minutiæ of the ASA's handling of the case and what they believed was wrong with it as well as a copy of an article from the Radio Times and information from the British National Formulary about paracetamol.

The advertiser also supplied additional new 'evidence' for their claims, including the oft-cited and oft-misrepresented 'Swiss Health Technology Assessment' on homeopathy. The report, titled 'Homeopathy in Healthcare', was no such thing of course, and no matter how many times it's pointed out that the Swiss Government had to declare that it was not an HTA and that it was published 'without any consent of the Swiss government or administration', it is still represented by many homeopathists as being the definitive, independent, neutral, authoritative report on the 'effectiveness, appropriateness, safety and costs' of homeopathy. It most certainly is not.

Since this report was not published until long after the advert, it cannot be used to substantiate any claims: advertisers must hold the necessary substantiation at the time they publish the advert. Despite this, the ASA examined the report and in their revised adjudication, concluded:

After seeking expert advice, we considered that 'Homeopathy in Healthcare' did not move the case forward in favour of the efficacy of homeopathy in treating medical conditions, in light of conventional standards for efficacy. We noted that proponents of the homeopathic approach often objected to conventional medicine's focus on RCTs as the gold standard for assessing efficacy, and instead they favoured other forms of measurement in their assessment, such as patient self-analysis and outcome studies. Nevertheless, we continue to expect claims, that a particular medicine or approach could be used to treat medical conditions, be substantiated with a robust body of evidence, consisting of RCTs conducted on human subjects, where appropriate. We did not consider the alternatives put forward, such as patient self-analysis or outcome studies, alone to be suitably robust to support efficacy. because 'Homeopathy in Healthcare' did not include robust evidence, of the type we considered necessary, we considered it was insufficient to substantiate the efficacy claims made in the ad.

Sir Hayden considered all the evidence and new submissions. He asked the ASA to re-open the case and consider a few points. This they did and made some minor changes to their original adjudication, mostly consisting of small amendments to the wording surrounding H:MC21's submission and some clarification, spelling and grammatical corrections. But it essentially remained the same, with the same seven points being upheld.

Coincidentally, the revised adjudication is also published today.

Maintaining standards

Aware of the impending outcome, H:MC21 organised a protest outside the ASA's offices and a lobby of Parliament last week, trying to make this protest not just about their advert, but about restrictions on choice in medicine and seemingly wanting the ASA to consider anecdotes over more robust evidence.

They claim the ASA is denying the public the choice of homeopathy for their healthcare. That's completely wrong, of course: the ASA is there to prevent the public being misled by claims made in adverts. This is, unfortunately, much needed, whether it's an advert for washing powder, cheap flights, yoghurt or homeopathy and the same rules apply to everyone.

Regardless of what homeopathists might want the ASA's CAP Code to say, the same rules have been there for years: advertisers should have been perfectly aware of the conditions they needed to meet to ensure they were compliant and their adverts were 'legal, decent, honest and truthful'.

The issue of consumer 'choice' is just a common trope. The real issue is simply whether the advertiser can properly substantiate the claims made. And by ensuring advertisers can substantiate the claims they make, consumers are protected from misleading advertising that would otherwise deny them from making a fully informed choice. We want consumers to be allowed to make that informed choice.

H:MC21 used the following as a slogan in one of their protest leaflets:

Don't let advertisers restrict your choice in healthcare

That's something we wholeheartedly agree with, but we suspect that's not quite what H:MC21 meant. It is advertisers who restrict choice by giving misleading information or omitting vital information.

The end of the road

We have little doubt that these advertisers will have pulled out all the stops to provide the ASA with the best, most convincing evidence for homeopathy available from anywhere, whether RCTs, pilot studies, customer satisfaction surveys, magazine articles (peer reviewed or not), published in any journal, magazine, newspaper, leaflet or comic, and consulted the best homeopathy experts the world over.

They will have known what was at stake here: the claims that homeopaths will from now on be now able to make on their own websites, in adverts in magazines, in newspapers, in leaflets and in banner and search ads on the Internet.

We think the ASA has been very patient throughout this tedious process — it must have been a mammoth task for them and no wonder it has taken more than two years. But it's at an end now.

They have carefully examined all the evidence provided to them, rightly applying the same standards as they do to other advertisers, and have come to a decision that is no different to what we have known for a long time: there is no evidence of a sufficiently high standard for homeopathy that substantiates any claims for any medical condition.

To now make any such claim will be a breach of the rules.

advice

Showing leadership

Homeopaths must now understand that they have to live up to their responsibilities and abide by the CAP Code, ASA guidance and rulings and stop claiming that homeopathy is effective for any medical condition or other misleading claims.

But no one should misunderstand or misinterpret any of this: no one is stopping any homeopath from practising — not us; not the complainants; not the ASA. This isn't about stopping anyone calling him/herself a homeopath, earning a living from homeopathy, selling homeopathic products and it does not stop anyone from visiting a homeopath or buying these products and services if that's what they want to do.

What this is about — and what this is only about — is ensuring homeopaths comply with the same rules all other advertisers have to abide by.

Additionally, the ASA did not ask us our opinion of the evidence; nor did we expect them to. The ASA are perfectly capable of assessing scientific evidence and making these decisions themselves.

Now that the ASA's position is settled, we look forward to all homeopathy advertisers realising that they have no choice any more but to live up to their responsibilities and comply with the ASA's rulings and guidance and cease making misleading claims. The ASA's free Copy Advice Service might be useful.

We hope homeopaths will follow the good example set by the SoH and that the other homeopathy trade bodies will quickly follow suit and boldly face up to their responsibilities, issue clear instructions to all their members that they must abide by the ASA's guidance. And they must enforce it. No ifs; no buts; no woolly weasel words; no disclaimers; no abdication of responsibilities.

The public has been misled for long enough. It's time to stop.

03 July 2013

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