A general record of my ongoing battle with all forms of nonsense.

Friday, 27 November 2009

[Original] The CNHC wishes to place on formal record their thanks to Simon Perry

Having taken some very fine advice from someone I greatly respect, I now realise that this article wasn't very good. Well, it was rubbish. I've rewritten it here without taking 14 paragraphs before I get to the point - so read that one instead.

The Complementary & Natural Healthcare Council, or CNHC, started its operation of registering practitioners at the beginning of 2009. Its stated key purpose is to:
“protect the public by means of regulating practitioners on a voluntary register for complementary and natural healthcare practitioners.”
Practising evidence-based medicine has some difficult constraints. Firstly, you need to be able to show your intervention to be effective. It’s considered unethical to just make up ideas ad-hoc and market them as an effective medical intervention. Secondly, in order to avoid a repeat of the thalidomide disaster, you need to be able to demonstrate that your intervention is safe.

But all this is very difficult. It requires a lot of training. It means you can’t get your products and services to market without checking them. But what if there was a way we could avoid the hassle of checking the evidence for efficacy? What if there was a way we could practice without checking our interventions were safe? What if instead of going through the trouble of medical training, we could take a part-time evening course at a local college and be guaranteed a pass because the course content consists of no actual knowledge?

Welcome to the world of Complementary Healthcare.

Now I don’t think I’m the first person to point out that if you are going to regulate any type of healthcare, then the fundamental points you need to cover are (i) ensuring interventions work, (ii) ensuring interventions are safe, and (iii) ensuring practitioners are adequately trained.

But this is already subject to statutory regulation. It’s what we call medicine. The whole point of Complementary health is that the practitioners can’t be bothered with all that.

What on earth does the CNHC intend to regulate?

The CNHC’s Code of Conduct, Performance and Ethics states:
15. You must follow CNHC guidelines in relation to advertising your services
Any advertising you undertake in relation to your professional activities must be accurate. Advertisements must not be misleading, false, unfair or exaggerated. You must not claim that your personal skills, equipment or facilities are better than anyone else’s.
If you are involved in advertising or promoting any other product or service, you must make sure that you use your knowledge, healthcare skills, qualifications and experience in an accurate and professionally responsible way. You must not make or support unjustifiable statements relating to particular products or services. Any potential financial rewards to you should be made explicit and play no part at all in your advice or recommendations of products and services that you give to patients, clients and users.
The key line in that paragraph is:
You must not make or support unjustifiable statements relating to particular products or services.
Now have I missed something here? The whole point of Complementary health is that you can make claims of efficacy without justification. Don’t get me wrong, I personally believe justification to be extremely important. My point is simply that the regulatory body is exclusively for practitioners who don't share this view.

So I started a little project. The CNHC’s web site allows you to search for practitioners. Each day, I would look at which new practitioners had joined, check their web sites and report them if they made any unjustifiable claims. If they did, I reported them via the CNHC’s complaints procedure. I knocked these complaints out in a few minutes – quick enough to get the point across but so hastily that I failed on my first complaint to correct a copied & pasted spelling error and even added my own grammar hiccup at the end.
The ad suggests that reflexology is suitable for treating babies with colic, IBS and arthritus. She also claims to have experience in treating fertility issues. There is no reliable evidence to suggest that reflexology is capable of treating this issues.
But even with the bad English, it was sufficient to make the point: if the CNHC is going to regulate healthcare then it needs to deal with the question of efficacy.

I intended to send these in every day as new members joined. My persistence lasted about 5 days – it takes time and is very boring work. I drew it back to looking every week, but by that time there were so many members that the task of checking was daunting. In total, I think I only complained about 14 practitioners.

These were the first complaints that the CNHC has received. At this time of writing, I believe I am the only person ever to have complained to the CNHC.

Yesterday I received a call from the Maggie Dunn, the CNHC’s Chief Executive Officer to update me on the status of my complaints.

The CNHC had received evidence from the practitioners to defend their claims. They had also been in touch with the Advertising Standards Agency. The investigative committee met on Tuesday 24th November to discuss the cases.

They decided that my complaints were indeed covered by paragraph 15 of the code of conduct. All fourteen of my complaints were upheld. The practitioners will now be told to stop making these claims.

Sadly however, the CNHC decided that fitness to practice was not impaired because the unjustifiable claims were not made deliberately. The CNHC has a number of “Profession Specific Boards”. Someone from the board relating to reflexology had advised the investigative committee that it is likely the practitioner had been trained to believe that they could treat these diseases.

Now while I do not find it at all surprising that the practitioner was trained this way, I still take issue with this decision. If a practitioner has undergone training that tells them they can treat specific diseases for which there is no evidence then the practitioner has not undergone proper training. An untrained or poorly trained practitioner is surely unfit to practice.

What’s more positive however, is what else the CNHC now plans to do. It makes no sense for the CNHC to allow new registrants to join, only to be immediately reported by me. Instead, I’m told, the CNHC will now look at the evidence and provide advice in advance.

The evidence review will go beyond reflexology; it will extend to all of the disciplines covered by the CNHC.

The CNHC will then be contacting all registrants to explain what they are allowed, and not allowed, to claim.

I confirmed with Maggie that this advice will not solely relate to advertising. I was told that the advice will make clear that practitioners are not permitted to make these claims within the day to day interactions with their clients.

I also expressed a concern to Maggie over the training received by the practitioners. There are undoubtedly many courses out there teaching that reflexology is an efficacious treatment for many diseases. Would the CNHC be doing anything about these courses?

Maggie told me that as a regulator, the CNHC sees it as their duty to get in contact with alternative health course providers and authors. Given the nature of my original complaint, I expect this will enforce the view that claims must be justifiable.

But what would a course on reflexology consisting only of justifiable claims cover exactly? How to spell reflexology?

This is so important, and so surprising I feel I need summarise in bullet points:
  • CNHC will tell practitioners to remove claims they cannot justify.
  • CNHC will conduct a review of evidence base for regulated therapies.
  • CNHC will contact all registrants to instruct them not to make claims without justification.
  • CNHC will contact complementary health course providers and authors to instruct them not to make claims without justification.
It is my view that adhering to the CNHC’s guidelines will make it impossible to practice complementary medicine.

Could this the end of the CNHC? It would be hugely ironic if forcing its members to act ethically became the cause of its demise.

Finally, Maggie told me that the investigations committee had decided that they wished to “place on formal record their thanks to Simon Perry for bringing this matter to their attention.”

You’re welcome.

9 comments:

Sean Ellis said...

Will they be applying this standard retrospectively to those practitioners who have already joined?

Johnnie said...

Exceptional!

Simon said...

@Sean Ellis
That's what they tell me. They are contacting all registrants and instructing them not to make unjustified claims.

Warhelmet said...

Very interesting. I suppose that it's the result of the innate contradiction at the heart of the CHNC - how can you regulate something that is mostly faith-based?

It does make you wonder what statutory regulation of CAM would look like initially. I suspect that if the Society of Homeopaths get thier way and homeopathy is regulated by the HPC there would be a bloodbath.

gimpy said...

This is good. The FIH, backers of Ofquack, make claims that are not borne out by the evidence for all manner of quackeries. I wonder how the impending contradiction with what the CNHC allow will be dealt with?

evileyemonster said...

It's simply a shame that efficacy should even be a debatable subject.

Politics and Science rarely mix well.

Badly Shaved Monkey said...

What a lovely piece of work, Simon.

I duly serve notice that I may need to quote the following paragraph widely and frequently;

"if you are going to regulate any type of healthcare, then the fundamental points you need to cover are (i) ensuring interventions work, (ii) ensuring interventions are safe, and (iii) ensuring practitioners are adequately trained.

But this is already subject to statutory regulation. It’s what we call medicine. The whole point of Complementary health is that the practitioners can’t be bothered with all that."

Zeno said...

Any idea when they will publish the decisions on their website?

Simon said...

@Zeno, they said some time this week.