Challenging misleading healthcare claims.


Who are you?

Although we have access to experts in many different fields, the Nightingale Collaboration consists of just Alan Henness and Maria MacLachlan.

Where do you get your funding from?

The Nightingale Collaboration was initially set up with funding from science writer Dr Simon Singh, but we now receive no funding.

We would stress that we receive no money from any commercial companies, including pharmaceutical companies.

Why are you making complaints?

There are rules and laws in place to protect the public from being misled.

When misleading claims are made, members of the public are denied the ability to make a fully informed choice in their healthcare decisions.

While some organisations actively ensure their rules are adhered to, most rely on members of the public to bring possible breaches to their attention. We are making resources and advice available to anyone who wants to use them to help reduce misleading claims and we will be conducting our own campaigns.

What do you mean by 'misleading' claims?

Misleading claims are those that either state or imply that a particular healthcare treatment is effective when there is no robust scientific evidence for that claim.

Who are you to decide what's misleading and what is not?

We don't decide.

When we find claims we believe may be misleading, we submit complaints to an organisation that oversees that advertising or healthcare therapy. This could be the Advertising Standards Authority, Trading Standards, a statutory or voluntary regulator — all of whom enforce standards, whether mandatory or not.

Also, many professional trade bodies have codes of conduct that their members are supposed to follow. We want to ensure these are comprehensive, robust and rigorously enforced so that misleading claims are not made.

Allopathy (conventional medicine) kills thousands. Why are you focusing on CAM?

We focus on misleading claims in healthcare promotion to the general public in the UK.

Most misleading claims that appear in advertising aimed at the general public are in promotions for complementary and alternative therapies and products. If there are misleading claims in advertising for conventional medicine, then we believe these should be challenged too and the resources we make available on this site should help people to do that.

CAM is safe and has no side-effects, so why not just leave them alone?

The reason many (but not all) CAM therapies are safe and have no direct side-effects is because they have no physiological effects at all, other than a placebo effect.

However, some CAM therapies are dangerous: eg some herbal preparations contain an unknown dose of an ill-defined drug, of unknown efficacy and of unknown safety. Quite a few are also contaminated or are adulterated with real pharmacological drugs.

However safe a therapy is on its own, misleading claims may delay or dissuade people from seeking proper and possibly urgently needed medical advice and treatment. Such misleading claims exploit their lack of experience or knowledge.

If you have a medical condition or think that you might or are worried about your health, consult your properly medically qualified General Practitioner. In the UK, doctors can be found on the General Medical Council’s List of Registered Medical Practitioners.

Surely people should be free to choose CAM if they want?

Yes. But that choice has to be fully informed, particularly about the lack of good evidence for, or implausibility of, a product or therapy. We don't have a problem with fair and balanced advertising of claims, but in CAM advertising, these seem to be the exception.

But it's been used by many people for years/centuries/millennia — surely it must work?

Popularity or how long it's been used is no guarantee that it works and is safe.

After all, we now know that many of the treatments people believed in for centuries were ineffective and some were dangerous. Bloodletting, for example.

But it worked for me!

Perhaps it did. Perhaps it didn't. Perhaps you would have got better anyway. How can you be sure?

We understand that many people do perceive an improvement in their condition after they've used a particular therapy and this may lead them and their practitioner to attribute their recovery to that therapy. However, there are many other possibilities.

arrowgreenSee this article Why Bogus Therapies Seem to Work for a good list of why it may have appeared to work for you.

When it comes to people's health, we need to be as sure as we can be that a treatment is safe and likely to be efficacious. That's why it's necessary to conduct trials on them and strive to ensure that the trials are as neutral as possible and as robust as possible, so that we can rely on the results and understand what is and isn't effective and what is and isn't safe.

But lots of trials have been done and they are positive. How can you dismiss these?

Yes, there are many trials that show, for example, that homeopathy is effective. But if you take the best of those — the most rigorous and unbiased — and look at those results, they show that homeopathy is no better than a placebo.

The question is down to what is considered good evidence.

There are frequently several problems with the way trials on CAM are conducted. At a minimum, they should be designed to reduce as much as possible any bias — unintentional or otherwise — by everyone, including those conducting the trial and those taking part. Unfortunately, it is frequently found that trials on CAM are low quality and have a moderate or high risk of bias. This means that their results must be considered suspect.

Until a therapy has been tested using robust methodology, we consider it irresponsible for practitioners to use no more than anecdotal evidence to back up a claim that their therapy is effective. To do so is misleading and prevents a member of the public making an informed choice.

How do you know science won't catch up and produce the evidence?

We can only rely on what we currently have evidence for; we cannot try to second-guess what might happen in the future, so this cannot be used to justify making claims for which there is currently no good evidence.

How do I volunteer?

We're not looking for volunteers at the moment, but anyone can challenge misleading claims in health care promotion simply by following the advice we give.

Where does the name Nightingale Collaboration come from?

Florence Nightingale is well known for her commitment to using robust evidence to decide what worked in improving healthcare. As the first woman to be elected to the Royal Statistical Society, the Nightingale Collaboration acknowledges her great legacy.

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