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

Friday, 27 November 2009

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

When the Complementary and Natural Healthcare Council (CNHC) decided to start letting in reflexologists, I started sending in complaints about them on the same day that they joined for claiming to treat disease with magic foot massages.

The CNHC has now upheld my complaints, asked the reflexologists to stop making unjustifiable claims, and informed me of their intention to contact all registered members to issue advice to all registered practitioners.

Oh, and they formally placed on record their thanks to me for "bringing this matter to their attention".

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 my little project. By searching for practitioners on the CNHC web site each day I could find out who joined. I actually wrote a computer program to do this as it takes multiple searches to get all the results. I would then manually check their web sites to see what was being claimed. If they made any unjustifiable claims, 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.

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.

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.

26 comments:

Paul said...

The only thing I'm left with after you have set out what you've done with such clarity is... how come no-one else ever noticed this before? No matter: you've done it now.

Looks like you've fed CNHC its own tail. Please blog again when they have shut themselves down or imploded in a puff of smoke.

Martyn Norris said...

Nice work xx

Kevin Kunz said...

Sad your only aim seems to be to deny others services they desire because you need to defend your rather narrow world view. I love skeptics but only open minded skeptics. Your mind seems to have slammed shut.

I feel sorry for you that you are so destructive rather than constructive. Your point is well taken that here are many claims made that are not supported by research And they should stopped.

But there is plenty of fine high quality CAM research. And there are many fine practitioners who are interested in the welfare of their clientele.

Your goal seems to be some kind of power trip aimed stopping CAM. You won't do it. I doubt you will even slow it down. We won't be shut down nor will we implode in a puff of smoke.

My heart goes out to you if this is your life. It seems very futile.

Anonymous said...

@ Kevin Kunz

Liar. Lying liar with pants on fire.

http://www.msnbc.msn.com/id/31190909/

$2.5 billion spent studying CAM. None of it works. So stop lying.

Dr J said...

@ Kevin Kunz

I think that protecting vulnerable sick people from false health claims is a marvellously constructive activity.

Would you be happy if, for example, you were persuaded to invest money at a certain rate of interest, only to find later that you did not actually earn any interest? Would you decry someone who warned you in advance as "destructive"?

I do not doubt that many CAM practitioners are interested in the welfare of their clientele - though I think that your choice of wording is instructive, as a doctor I prefer to refer to my "patients" - but we know where the road paved with good intentions leads, if those good intentions are not backed up by good hard fact. And sadly, the high quality CAM research is largely unsupportive of its claims, whereas the research claimed as "proof" by many advocates of CAM is mostly flawed and demonstrates, to be charitable, poor understanding of the nature of reliable scientific evidence.

Finally, could you quote where anyone is seeking to deny anyone any service? I can only see a desire that the choice of service should not be based on unreliable claims.

Sad to say, but as you imply that you are a CAM practitioner, it is hard not to wonder if the destruction you are most concerned about is of your advertising claims.

Anonymous said...

Bravo.
What do you call people who take money from gullible people by telling them lies? Fraudsters? Con artists?
I think "telling them to stop lying" is very mild - they should be thrown in prison.

Anonymous said...

@Kevin:

He is only stopping people from lying. Why do you feel threatened by being unable to claim you have evidence when you have none?

What sort of choice is it if you are being lied to?

Sili said...

Someone needs to put you up for a knighthood.

And get Chuckboy to deliver it.

Simon Taylor said...

Congratulations, but I suspect that the CNHC will find that its rules become a little more flexible as it starts to eat it's own tail.

@KevinKunz
How dare you suggest that the viewpoint that there is no evidence for much of CAM is a closed minded viewpoint. I would suggest that your own view is the closed minded one. Read the Cochrane reviews on Complementary Medicine..they couldn't be any clearer.

We would all love it if it turned out that Reflexology et al could do all the things they claim. Unfortunately there's no evidence, so who's the closed minded person?

As for the point that people want these therapies, this would be fine if it didn't stop them choosing evidence based therapies, and also be fine if no-one was making any money from promoting therapies which lack evidence for their efficacy. It's just all a bit dodgy and inevitably attracts patients who have discovered that evidence based medicine might not have a solution for their illness and are attracted by the web of lies suggesting that there is help available from CAM. As far as we know there isn't any evidence.

@Kevin Kunz
Your line 'I love sceptics but only open minded skeptics' is beautifully comical, it's like 'I love girls but only female ones'

It's not possible to be skeptical without being open minded, I think you've missed the point. However no worries.... all your learning issues are easily addressed. Just go back to school and get an education before you start spouting off your nonsense on this or any other blog. I know it's soemtimes difficult working out who to believe, but only a little bit of research will lead you in the right direction. Good Luck!

Jon Bray said...

Tim Minchin has a lovely saying which I'm sure he wouldn't mind me repeating here. "If you open your mind too far, your brain'll fall out".

The actual dilemma here appears to be; given the only real benefit shown to complementary medicine is via the placebo effect, is it wise or fair to ban practitioners from lying to their clients, thus denying them the only benefit they may get from the treatment?

This is only really applicable for those conditions for which conventional medicine is ineffective or for minor ailments such as sprains which get better by themselves but for which conventional remedies such as aspirin may have uncommon but dangerous side effects; UK government regulation fortunately stops licensing of homeopathic 'remedies' or prophylaxis for serious conditions such as HIV/Malaria.

Robert Carnegie rja.carnegie@excite.com said...

Re denying others services they desire... is being lied to a service? Being told you'll be better after a foot rub? Or that you'll feel better? Maybe you will feel better, feeling is so arbitrary. But isn't reflexology the one where each of your actual internal organs or body regions is associated with an actual region on the foot? On the sole of the foot? That's got to be rubbish or I'd feel vastly different whenever I wear different shoes. Of course there's the famous case history of the man who periodically woke up with his shoes still on from yesterday and a terrible headache, but he assumed he was just allergic to leather.

Kevin Kunz said...

Closed minded skeptics are easy to come by. Have you actually looked at the research involving reflexology or are you just very intuitive knowing what is right and wrong without actually researching it.

You assume all CAM practitioners are frauds. They aren't. You assume we are liars we are in genral very good people. Yet your poster you calls me a liar doesn't have the guts to do it without being anonymously. Pathetic and childish.

Name calling and opinions aren't really a replacement for the facts. The fact is that there are a number of controlled evidenced based studies on Medline.There are fMRI's, doppler sonograms and other high tech investigations.

I don't try to pretend to be a doctor so they are my clientele and not my patients. And btw they aren't all sick therefore theydon't qualify to be called patients.

I have a very smart clientele. They are actually far from gullible. They know when to see the doctor and they know when it is appropriate to see me. One of my clients said, "When I go to the doctor I don't know what I will feel like. When I go to you I always know I will feel better. That is what I pay for.

Dr. J you make a lot assumptions about me that aren't true. The only claims I make is that reflexology works in the nervous system and that every function and structure that reflexology effects can be explained.

I am concerned about the claims that are made about reflexology and have called out people for making those claims. I have gone to the extent of having my lawyer send cease and desist letters when they use my name to promote these claims.

You have made your judgements all ready regarding reflexology. I can't open your mind. It is your world view and you will defend no matter what I say. You see the foot as some type of inert object that isn't really wired into the nervous system. You don't see it as a sensory organ that has a direct impact on the ANS. You don't see that the feedback from the foot alters the feedforward going out from the brain to reset the tone or tension level of the body. You don't see that the feet are intimately connected by known neural pathways into internal organs and that the demands of locomotion and survival demand this intimate relationship. You don't see that survival depends on information sharing between each and every body part.

Movement intelligence depends on clear communication between all parts of the locomotive system, the brain and the internal organs for integrated activities such as locomotion.

I have seen research studies such as kidney doppler sonograms showing that when you work on the reflex area on the foot it causes an increase in blood flow to three arterial feeds to the kidneys. Why hasn't the medical community at least taken a look are this study to see if they can help kidney patients and cut costs at the same time? It was a double blind randomized controlled study done to NIH standards.

You would think the medical community would be quite excited by this. It could help a lot of people.

Dr. J I am ignoring these other people because they are name callers and opinionated rather than factual. What if you had the facts rather than intuitively assuming "facts"? Would you be capable of changing your mind?

Dr. J could you open your mind to the idea that the feet are a participant in the adaptation that take place in response to stress? Could you open your mind to the fact the feet contribute to the overall health of the body? Could you open your mind to the fact that stress is not just an general adaptive syndrome but also quite local, specific adaptations to stress?

I do feel sad for people that think the only way to deal with people that don't agree with their worldview is extinction. But let me be clear. Stripped away all the hype and claims about reflexology and you still have a physiological circuitry that is quite useful. Believe or not we are here to stay. And stay we will.

Simon said...

@Kevin Kunz

Yes, I've looked for trials. Didn't find any that pointed me to the belief that reflexology is efficacious for treating any disease though.

Can you put in links please?

Yes - you can change my mind if you have evidence.

Anonymous said...

Excellent work! Keep it up!

@kearneykd

Kevin Kunz said...

Great Simon. Give me a bit. I am working today. But I will post what I can.

pvandck said...

Sadly however, the CNHC decided that fitness to practice was not impaired because the unjustifiable claims were not made deliberately.

They were made by accident?

pvandck said...

Might it be that Kevin Kunz (what a fabulously appropriate name) might have a vested financial interest in ripping people off because they are credulous and vulnerable?

Daniel said...

Kunz, I know I speak for many when I say I can't wait for your evidence.

However, I anticipate that it might be a very, very long wait. I'll put my feet up in the meantime...

Anonymous said...

I am a reflexology sceptic - but my mind is open enough to use google.

I have the study, and have emailed the pdf. Here's the abstract:

Changes of Renal Blood Flow during Organ-Associated Foot
Reflexology Measured by Colour Doppler Sonography
Using colour Doppler sonography blood flow changes of the
right kidney during foot reflexology were determined in a placebo-
controlled, double-blind, randomised study. 32 healthy
young adults (17 women, 15 men) were randomly assigned
to the verum or placebo group. The verum group received
foot reflexology at zones corresponding to the right kidney,
the placebo group was treated on other foot zones. Before,
during and after foot reflexology the blood flow of three vessels
of the right kidney was measured using colour Doppler
sonography. Systolic peak velocity and end diastolic peak velocity
were measured in cm/s, and the resistive index, a parameter
of the vascular resistance, was calculated. The resistive
index in the verum group showed a highly significant decrease
(p £ 0.001) during and an increase (p = 0.001) after foot
reflexology. There was no difference between men and women
and no difference between smokers and non-smokers.
Verum and placebo group significantly differed concerning alterations
of the resistive index both between the measuring
points before versus during foot reflexology (p = 0.002) and
those during versus after foot reflexology (p = 0.031). The significant
decrease of the resistive index during foot reflexology
in the verum group indicates a decrease of flow resistance
in renal vessels and an increase of renal blood flow. These
findings support the hypothesis that organ-associated foot reflexology
is effective in changing renal blood flow during therapy.
Ó 1999 S. Karger GmbH, Freiburg
Fax +49 761 452 07 14 Accessible online at:
E-mail kargergmbh@aol.com http://BioMedNet.com/karger
www.karger.com
Manfred Herold,

Anonymous said...

@ Jon Bray:

It's from Terry Pratchett's Discworld novels originally.

Simon said...

@Anonymous, reflexology sceptic

Interesting, but (i) I didn't receive your email of the paper so I can't check it, and (ii) it's not relevant.

The complaints I made concerned claims to treat disease. This study merely concluded that more blood flows to your kidneys during the foot massage.

So assuming this trial was well conducted (which hasn't been established) - it still doesn't mean much.

Sceptic with a k said...

I found this interesting blog concerning reflexology research..

http://reflexologyresearchproject.blogspot.com/


It's quite a good read if you have a spare nanosecond.

Mary-Lou Stalin said...

http://www.reflexology-research.com/control.htm

Some quite astonishing claims on Mr. Kunz's site.

Not sure about the rigour or validity of the trials, mind.

As a layman, they don't ring true, but maybe someone of a more scientific bent can explain why that is.

Simon said...

Well I've read the first 4. The first wasn't blinded, the next two showed no effect and the last one didn't really say whether it worked or not.

Kevin Kunz said...

Actually these aren't here for propaganda. There are negative as well as positive studies. We have 168 for you to go through.

The kidney study is a double blinded randomized study done to NIH standards. It wasn't about whether improving arterial blood flow is a curative rather it was about the foot to body link. Have you read the whole study or just the abstract? Because this protocol was very cleverly done.

I am a little taken back that skeptics seem to be able to cross into other fields make judgment calls. Also I have run into a lot of you that read abstracts and then make decisions. Is that kosher? Or intuitive?

I have a biased in favor of reflexology or more to the point that our feet are a part of our nervous system and therefore can be used to influence the body's operating tempo.

Are you saying the feet are not a part of the nervous system and therefore have no influence over the body.

You are into software. Let me try this out on you. In order to react to our external environment we need an organized response. The nervous system is a schematic like circuitry in a CPU. We need to gather feedback from our surroundings. We also need a mediator, the brain to act as a type of processor. Then we need a systematic feeding forward of information to adjust to the wide variety of changes in the external environment. These muscle spindle organ dynamics are set at a certain operating tempo. New information say from the feet in the form of proprioceptive information such as pressure, stretch and movement is not only going to shift the muscle spindle organ dynamics but also shift the operating tempo of the internal organs. New demands require adjustments of fuel and O2.

Right? Or are you in the school that says that incoming sensory information is randomly processed? There is no neural matrix that ties into the muscles and into the ANS. Actually reflexology charts to us are somewhat reflecting the feedforward mechanism of the gamma efferent part of the nervous system. Stress after all is not simply global but acts locally as well.

Sorry about the research. It was kind of low priority as I didn't think you would accept the positive studies. But the skeptics always seem to be able to find negative studies. Curious.

I object to claims but with the popularity of reflexology it is going to happen. I don't believe for instance in those pads that are supposed to detox your body. But they stick a label on them of reflexology. Can't stop them.

But do you really think listing research is a form of making claims if in fact you list both positive and negative studies?

I think reflexology is quite astonishing. The feet are sensory/motor servo units that react to pressure, stretch, movement, touch, heat, cold and vibration.

After 40,000 years of sensory blindfolds- the shoe those senses are seriously impaired. A little TLC does cause a rapid change in both the ANS and the state of tone throughout the body.

Besides it is a great deal of fun.

Michael Kingsford Gray said...

I call POE on the Kunz.
But well done, nonetheless...