Making misleading health claims online just got a little more problematic

I’ve developed several Google custom searches to make it easier to pick though the data and identify practitioners making misleading and potentially dangerous claims. These custom searches are like having a version of Google that limits itself to the websites of specific groups of alternative practitioners. They're not perfect - you'll get false positives as well as false negatives. But they do work very well.

Here are Google search engines limited only to websites belonging to members of:

• British Chiropractic Association
• Scottish Chiropractic Association
• McTimoney Chiropractic Association
• General Osteopathic Council
• Complementary and Natural Health Council
• Alliance of Registered Homeopaths
• Kinesiology Federation

You might find, for instance, that there are still some British Chiropractic Association members claiming to treat colic. Or you might find that some CNHC members are claiming they can treat ear infections by sticking a candle in your ear. Or maybe you’ll find a homeopath that is telling people that magic sugar pills can help with eczema.

Google's custom search system is far from perfect. It randomly seems to drop results, then pops them back in again. Text that is clearly found on many sites can't be found. But I expect this to improve over time as the indexing improves.

Despite these problems, if you're making misleading claims it’s now far more probable that you'll get caught. Fingers crossed that whoever finds them hasn't got FishBarrel installed.

Chiropractic Trade Organisations launch coordinated attack on General Chiropractic Council

A letter expressing no confidence in the General Chiropractic Council’s process, interpretation and proportionality in its regulation of the chiropractic profession has been written to the GCC. Its signatories are the chair of the McTimoney Chiropractic Association and the Presidents of the British Chiropractic Association, Scottish Chiropractic Association and United Chiropractic Association.

You can download the letter here.

It’s a long document, with 89 points of complaint to made against the GCC. The most interesting points from my first read were 35 to 38. The trade organisations are accusing the GCC (rightly in my opinion) of doing exactly what they are now accusing their members of.

They correctly point out that the GCC’s patient information leaflet was making similar claims to those Alan Henness and myself complained about. The GCC withdrew this leaflet after I reported them to the ASA in September last year.

They also point out that the GCC was well aware that these claims were being made for some time, from their 2004 survey of the profession, with over 57% of the profession claiming to treat asthma with a back rub, yet the GCC issued no guidance to the profession.

But these are problems that are only to be expected of the GCC. The GCC was set up by chiropractors in order to protect their profession, rather than by members of the public seeking protection from them.

The GCC only acted when they were cornered: their code of conduct states that claims must follow ASA guidelines, and the ASA clearly informed the GCC that these claims did not. They had no choice.

There’s a lesson here for other quacks seeking to regulate their own quackery. You can use people from your own profession to regulate, and they’ll prove themselves incompetent. Or you can use people to regulate your industry properly - and they’ll destroy it.

GCC extends complaints to cover all dubious claims

My complaints to the BCA focussed on claims to treat colic. I chose to just complain about colic claims for reasons of simplicity. It was easy to search the pages for one word and gather the evidence. When you’re submitting 55 complaints, it makes sense to go for the easiest method possible.

The GCC has now sent me copies of the responses to my complaints. What's interesting is that it appears that the GCC’s investigating committee has gone further than asked. They have manually gone through the Chiropractor's web pages looking for other claims.

Where they existed, the chiropractor will be investigated for those claims too.

I’m not sure of the GCC’s motivation is to make life easier for themselves in the knowledge that they will soon be needing to deal with Zeno’s 500+ complaints, or if this is a genuine attempt to properly regulate the profession. Either way, this is a positive step from the GCC and should be applauded.

A copy of one of the letters is below.

The General Chiropractic Council is knowingly and deliberately violating its own code of practice

The General Chiropractic Council is knowingly and deliberately violating its own code of practice and continuing to mislead the very patients it is meant to protect.

My previous post detailed how the General Chiropractic Council resolved my Advertising Standards Authority complaint against them informally. I also noted that as yet, the GCC has not removed their Patient Information Leaflet from their web site.

About a week after the informal resolution was made (but before it was published), I spoke to the ASA on the telephone about the fact that they were continuing to make these unsubstantiated claims. A concerned ASA voice told me:

"We would have hoped they would have taken this down by now."

So on the 6th October I emailed the GCC to ask their intentions:

"I notice that despite your informal resolution with the ASA, that the text still appears on your patient information leaflet here: http://www.gcc-uk.org/files/link_file/WhatCanI_142_5(Web-Version).pdf

Are you intending to take down or change this leaflet?"

And on the 8th, I received a reply in the post:

I emailed the ASA by email to get their take on this:

"I contacted the GCC following my finding that they had not removed the Patient Information Leaflet from their web site. I had a rather surprising reply from them this morning. They said that they will take it down in reasonable time - and suggested that this would happen once they had taken the time to re-write the document and translate it into several languages.

This is shocking. Surely it makes sense for them to take it down now if it breaches ASA standards - or not at all if it doesn't. Surely while they are re-printing they should not be continuing to distribute the material?

Can you clarify the ASA's position on this?"

And the ASA's reply was fairly clear:

"We’d normally expect an advertiser to implement the changes as soon as is 'reasonably practicable' (bearing in mind the time involved in printing new leaflets).

However, if it’s a leaflet on a website then it should be taken down as soon as possible."

So the ASA (rather unsurprisingly) agrees with me that it is unreasonable to continue to make unsubstantiated claims solely on the grounds that you haven't got around to writing and translating anything honest yet.

Based on the informal resolution and the above text from letters and emails, I can't draw any conclusion other than:

• The Chief Executive of the GCC is fully aware that its Patient Information Leaflet violates ASA guidelines.
• The Chief Executive of the GCC is aware that this leaflet is continuing to be made available on their web site.
• The Chief Executive of the GCC is in no rush to do anything about it.

How can the GCC be expected to regulate the chiropractic profession when it knowingly and deliberately violates the very guidelines it is meant to be enforcing?

I think it's time for a complaint against the GCC itself.

Hopefully they'll take my complaint seriously, clean up the regulatory body, start properly regulating the chiropractors and move towards a future of evidence-based chiropractic.

Then I can get back to my game of World of Warcraft.

General Chiropractic Council to Change Patient Information Leaflet

My complaint to the Advertising Standards Authority about the General Chiropractic Council’s Patient Information Leaflet has now gone through the ASA’s process.

The ASA has managed to deal with my complaint as an “Informally Resolved Complaint” rather than pushing it through to a formal adjudication.

This is a very interesting outcome.

What this means is that the General Chiropractic Council has withdrawn the claims as soon as they were approached and asked the ASA’s guidance in how they can make their advertising comply. There is an important point to note here: if the General Chiropractic Council believed they had the evidence to back up the efficacy of using chiropractic as a treatment for asthma, headaches, migraine and infant colic – then they simply could have produced it.

The ASA would have assessed this for them free of charge and either upheld the complaint asking them to remove the advertising, or not upheld the complaint. There is only one reason for backing off from the complaints: the GCC must have appreciated that that they simply do not currently have the evidence.

This is a significant change, and has huge implications for the circa 600 complaints currently being handled by the GCC.

By backing off and removing their claims before the ASA investigates, the GCC is acknowledging that even their loosely worded, slightly ambiguous leaflet (text below) is in breach of ASA guidelines.

There is some evidence, though more research is needed, that you may see an improvement in some types of:
• asthma
• headaches, including migraine
and
• infant colic.

If the GCC believes this loosely worded text to be in breach of ASA guidelines, then they must also believe that every complaint made to the GCC surrounding this subject is valid.

Am I being too optimistic in anticipating a vast number of guilty verdicts against chiropractors in the forthcoming months?

It also brings up a second potentially interesting outcome. If you’ve been following this blog, you will be aware of the letter that the GCC sent to Trading Standards in defence of their members. The advice given in that letter includes the exact text within the patient information leaflet that I complained about.

Will the GCC now follow that letter up with another saying that they are now withdrawing that claim? I will be putting that question to them.

Perhaps I'm being a bit optimistic – especially considering that more than a week after agreeing to informally resolve the complaint, the patient information leaflet remains on their website in its original form.

I am now beginning work on my second ASA complaint about the same Patient Information Leaflet.

While you're in the mood for chiro woo, I highly recommend Zeno's post on his recent ASA complaint - published at the same time.

The Quest for “Dr” Paul Homoky’s Secret Evidence

Following my previous post about how Edinburgh City Council now has secret evidence that Chiropractic is an effective treatment for colic, I have been pursuing two different routes to try and get at it. The importance of this evidence – like any evidence of clinical efficacy - cannot be overestimated.

Firstly, I sent the following FoI request to Edinburgh city council:

Hi Lynsey,

I am really quite confused about what has happened over my complaint, and really want to get to the bottom of it. Hence this FoI.

1. What are City of Edinburgh Council Trading Standards' criteria for sufficient evidence when assessing a claim to be able to treat disease?

2. Would City of Edinburgh Council Trading Standards accept simple case histories as adequate evidence when assessing the efficacy of a treatment to treat a self-limiting disease?

3. Would City of Edinburgh Council Trading Standards accept unpublished studies as adequate evidence when assessing the efficacy of a treatment?

4. What training do City of Edinburgh Council Trading Standards' Enforcement Officers receive to ensure they can adequately assess the validity of studies testing the efficacy of a medical treatment?

5. What is City of Edinburgh Council Trading Standards' policy for dealing with trading standards complaints where an assessment of the evidence falls outside the expertise of the enforcement officers?

Many thanks,

Simon Perry

I also contacted “Dr” Paul Homoky, asking for this evidence (see last post). I have now received his reply:

Dear Simon,

Thank you for your email. I’m afraid I won’t be sending you any information. I am far too busy helping patients to improve their health through natural, safe techniques and to help educate the public regarding prevention and lifestyle management. You and your colleagues have already sent an unreasonable complaint to the Edinburgh council and General Chiropractic Council without having even met or talked with me and discussed our approach. If you had done so, or even examined my website properly, you would have learned that we do not treat colic, nor do we claim to treat it on our website or in the clinic. We deal with spine and nervous system complaints, the treatment of which sometimes has a positive effect on other conditions too.

We are a reputable clinic with great success and happy clients. I do not have anything to prove to your sceptics society. Our mode of therapy is chosen specifically because it is safe and effective. I wonder if you have applied the same rigorous analysis to a wide range of medical treatments which are provided by medical doctors on a daily basis—many of which are proven to be ineffective, unnecessary and/or carry a high risk of negative outcome.

My new wife and I have had our first baby, and we would like to enjoy his beautiful entry into the world. Please do not send any further emails to me. I was happy to provide details to the Edinburgh Council as they requested, but this is, quite frankly, our business and not yours. I have taken the time to write this email to you because I believe you deserve a response. If you have any further questions regarding chiropractic care of the spine and any of its researched effects, please direct them to the British Chiropractic Association.

I wish you and your sceptics society well. I am a sceptic too—we have much in common.

Best wishes,

Paul Homoky, B.Sc., D.C.

Chiropractor

I don't think it is correct to say that he does not claim to treat colic. From what I can make out of the wording, he seems to say they don't treat colic, but colic is caused by misalignment of the spine and they treat misalignment of the spine. That would seem to imply that they treat colic, even if indirectly. The text on his site is as follows:

But chiropractic isn’t a treatment for colic! If vertebral subluxation is present, interfering with the proper function of any part of the body, restoring proper nervous system control allows the body to heal. This can happen regardless of age and regardless of what the symptoms are called.

So “Dr” Paul Homoky has decided to keep the evidence secret. All UK chiropractors are bound by the GCC’s code of conduct, which includes:

E1.4 must avoid conduct which may undermine public confidence in the

chiropractic profession or bring the profession into disrepute, whether

or not such conduct is directly concerned with professional practice.32

Now publicising irrelevant evidence, or evidence that has already been publicly debunked, is likely undermine public confidence in the chiropractic profession so it may be that this is his reason for not providing it. However, should the evidence be strong, it would of course undermine public confidence in the profession if he refused to provide it.

I will take up “Dr” Paul Homoky’s suggestion and ask the BCA if they are aware of this new evidence.

After my last post, Felix_the_Mac commented on why I had not asked Edinburgh City Council to provide the evidence for a second time within my FoI request. In reality, this might work. But I don’t think that’s the best approach. Once I finally get hold of the evidence, it’s likely to make for one amusing blog post and die away.

But in all likelihood I’ll get refusal after refusal. And that means I can drag this out for months.