Sara Stevens and the Ultra-Woo Allergy Test

I visited Sara Stevens of "The Complementary Health Team" in Blaby back in May. I've been incredibly slow to blog this, but just realised that blogging my letter of complaint in full would be much better than writing anything new.

Enjoy!

Dear Ms Stevens,

I visited your premises in Blaby on the 7th May 2009 around 5pm for what was sold to me as an “allergy test”.

Having thought about the tests I received, I have got quite suspicious of the methods used and am not convinced that they could work.

To summarise your methods:

• You took a homeopathic preparation of an allergen and put it into my left hand.
• I held it close to my stomach and outstretched my arm.
• You pushed my arm down.
• If my arm moved easily you deduced that I was allergic or sensitive to the preparation from which the homeopathic remedy was made. If not, you deduced that I was not allergic or sensitive.

The problems I am having difficulty overcoming are as follows:

• Homeopathic solutions are typically dissolved to the point where there is none of the original substance remaining. With no substance remaining, I see no difference whatsoever between the 35 preparations you presented me with. How could this work without a chemical difference between the solutions?
• With the preparations contained within glass phials, my body did not even come into contact with the pills. How could my body produce a reaction against a chemical it did not come into contact with?
• I can find no reliable evidence to suggest that coming into contact with an allergen near your stomach reduces your strength in a different part of your body.
• You merely pushed my arm down to subjectively measure the force. This is obviously a completely inaccurate way of measuring resistive force.

To summarise, you attempted to test me for an allergy by pushing my arm down while I didn’t touch a preparation that probably contained no trace whatsoever of an allergen. What evidence do you have to demonstrate that this test actually works?

Following the allergy test, you then gave me two further “tests”. The first, you claimed, was to assess the proportion of “bad bacteria” to “good bacteria” in my body. You did this by counting in tens (0, 10, 20 etc) up to 100 while repeatedly pushing down my arm. After assessing it was weakest between the times when you said “10” and “20”; you then pushed down my arm while counting between 10 and 20. From this, you deduced that my “Candia Level” as you called it, was 14%.

What evidence do you have to demonstrate that this second test actually works?

You then carried out a further “test” to find out what “good bacteria” I needed to buy to restore the balance. You did this by repeatedly pushing down my arm whilst pointing at descriptions of bacteria in a book. You then recommended I take “acidobifidus”.

What evidence do you have to demonstrate that this third test actually works?

I’ve read a fair bit about these tests online and opinion seems to be split. Practitioners of Applied Kinesiology appear to endorse the test, while the common consensus, including all reputable scientific studies, dismiss the practice as pseudo-science with no evidence that it produces accurate repeatable results.

If you do have good evidence that this test works, could you send it to me please? If you do not, I believe that you are operating an unfair commercial practice under the 2008 consumer protection regulations and would like a full refund.

If you do not have reliable evidence for this test, I assume you will from now on comply with the 2008 consumer protection legislation and discontinue your applied kinesiology service. Can you clarify if this is the case?

Regards,

Simon Perry

Skeptics with a "K"

Just a quick note to say I was on the Skeptics with a K podcast talking about the Chiropractic/colic campaign. This was the first time I've listened to the podcast. With the exception of my rambling, those Merseyside skeptics have done very well. Very funny discussion of Genesis at the beginning. I will now become a regular listener.

You can download the episodes here: http://www.merseysideskeptics.org.uk/category/podcast/. My interview is on #2.

Will Trading Standards now take on the General Chiropractic Council?

Sometimes the Trading Standards bodies I’ve written to get in touch with the GCC for more information. And, thanks to a trading standards officer in the Highlands, the GCC’s response is on the trading standard internal database. An officer in London who had received one of my complaints got in touch to ask about the evidence in their response.

I am extremely grateful that he did.

The GCC has been issuing a letter to Trading Standards officers considering action against Chiropractor practices. The letter appears to be deliberately designed to confuse trading standards officers and misrepresent the evidence – and it has managed to do that to great effect.

The text of this letter is available on DC Science blog.

Firstly, they include the text from their patient information leaflet:

Chiropractors mainly treat

• back, neck and shoulder problems
• joint, posture and muscle problems
• leg pain and sciatica
• sports injuries

You may also see an improvement in some types of

• asthma
• headaches, including migraine; and
• infant colic

So firstly there is some confusion here. If an improvement can be the result of chiropractic care, then why don’t they use it as a treatment?

“It is important to emphasise that the GCC doesn’t claim that chiropractors 'treat' asthma, headaches (including migraine) and infant colic. It is possible that chiropractic care may help to alleviate the symptoms of some of these conditions.”

What are they talking about? If chiropractic care can help to alleviate the symptoms, then it can be used as a treatment. The evidence throughout the asthma trials that they quote is clear: wherever the trials are properly blinded, it shows the treatment to be useless. I’ve been through the trials they’ve referenced for asthma: Brønfort in 1997 (note: I have not managed to find this paper – but the GCC’s letter acknowledges that this paper concludes that the treatment is ineffective), Brønfort et al 2001, Nielsen NH, Brønfort G, Bendix T. et al 1995 and Balon J, Aker PD et al 1998.

All these papers reach the same conclusion: the SMT (Spinal Manipulation Therapy) is ineffective in the treatment of asthma.

So what are they talking about when they say “You may also see an improvement”? Well the key word, I think, is “see”. While the trials they listed all reached the unanimous conclusion that SMT is ineffective in the treatment of asthma, Brønfort et al, 2001 (a pilot RCT) also found that the patients reported that their life had got better. But the paper did not compare this patient-rated outcome measure between SMT and control group. And the paper even states that “observed improvements are unlikely as a result of the specific effects of chiropractic SMT alone”.

So perhaps what they mean is that if you get chiropractic treatment for asthma, then you might think it did some good, however:

• Objective measures will show that you haven’t been helped, and
• You would have thought you’d been helped if you’d undergone a sham procedure too, and
• This information came from a pilot study and is therefore not particularly reliable.

When the GCC lists this paper as evidence, they only mention that “the children rated their quality of life substantially higher and their asthma severity substantially lower.” The GCC completely neglected to mention that this study concluded that SMT is ineffective in the treatment of asthma.

They then go on to list 3 more papers that they say “appear to echo the evidence levels outlined in the paragraphs above”:

a. Nielsen NH, Brønfort G, Bendix T. et al 1995. Chronic asthma and chiropractic spinal manipulation: a randomized clinical trial. Clin Exp Allergy Jan;25(1):80-8
b. Balon J, Aker PD et al 1998. A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. NEJM 339 (15): 1013-1020
c. Brønfort G , Evans RL, Kubic P, Filkin P 2001. Chronic pediatric asthma and chiropractic spinal manipulation: a prospective clinical series and randomized pilot study. JMPT 24(6):369-77

But they fail to give any further information about these trials. Why? Why have they not quoted the conclusions, or sent the trial papers on along with their letter?

Why has the GCC not clearly stated that all of these papers conclude SMT to be ineffective in the treatment of asthma?

Why did the GCC list 4 papers that all concluded that SMT is ineffective in the treatment of asthma – but still state “although some clinical trials had positive results there is insufficient data to make strong statements about efficacy”?

Why has the GCC failed to reference the largest and best reported study of the use of SMT in treating infant colic?

How would the General Medical Council react if our GPs started advertising that they were willing to provide ineffective treatments for asthma?

Would they jump to the defence of those GPs?

Would they write letters deliberately designed to confuse Trading Standards?

Would they wait for a member of the public to issue a specific complaint about a specific practitioner before taking any action?

Would they publicise on their web site that “you may also see an improvement” if this ineffective treatment is used?

I think not.

The GCC is meant to be the body designed to regulate the chiropractic profession. With its actions, it has proven itself not only utterly incompetent, but it is actually protecting the very actions it should be regulating against.

The Trading Standards officer I spoke to yesterday was very much of the opinion that Trading Standards should be tackling the General Chiropractic Council directly. I am not sure if this is within their remit, but personally I am now shifting my focus in this direction.

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.

STOP THE CAMPAIGN - Edinburgh City Council has got evidence that chiropractic is an effective treatment for colic

But they won't tell me what it is.

The result of my original burst of 80 odd trading standards complaints has been hugely positive. Most offices have responded with business advice that the trader should remove the claims and for the large part they have done so.

But interestingly, my complaint to Edinburgh City Council about Health for Life has so far resulted in a dead end.

Since your last e-mail I have contacted Health for Life regarding the treatment of colic. They have provided me with sufficient evidence to support their claims regarding the use of chiropractic for those with colic. In light of this, Trading Standards will not be taking any further action in this matter.

So, quite reasonably, I asked if I could see this evidence.

I regret that I am unable to provide details of the evidence and substantiation provided as this information has been obtained using powers provided for the discharge of my duties.

But this evidence is clearly important, so I wrote to Health for Life themselves:

Dr. Paul Homoky,

I recently made a complaint against you to Edinburgh Trading Standards regarding claims to treat colic using chiropractic on your web site.

I have been told by Edinburgh trading standards that you have provided evidence and substantiation to back up your claims. However, they are unable to pass this evidence onto me.

The importance of this evidence cannot be underestimated. I have made a large number of similar complaints to both trading standards and the GCC and have more ready to send out. Over 100 practices have already changed their advertising material. If there is good evidence in favour of this treatment that I previously missed, it is critical that I withdraw these complaints with immediate effect and apologise to those affected - therefore allowing children access to an efficacious treatment that is currently being denied to them.

If this evidence does not exist, it is important that I continue my campaign to ensure more children are not subjected to a pointless and potentially risky intervention.

But without seeing the evidence, I can only presume that Edinburgh Trading Standards has made a mistake in evaluating the quality of evidence on offer.

I hope you appreciate the importance and will be able to send me details of the relevant studies.

Many thanks,

Simon Perry.

I look forward to their response.

The chiropractor's web pages on colic are here and here. And if you're interested, City of Edinburgh Trading Standards can be found here:

City of Edinburgh Council
Services for Communities
Trading Standards
Chesser House
500 Gorgie Road
Edinburgh
EH11 3YJ

T 0131 469 5643
F 0131 469 5411

Chinese Medicine Allergy Tests in the Leicester HighCross Centre

Claims to be able to test for allergies using nothing but a lock of your hair should always be treated with suspicion, but especially so when the claims are made by a shop advertising Traditional Chinese Medicine.

But it’s always worth trying these things out, so a couple of us went along for a test. After a couple of weeks we both got our results with some added advice on which supplements we should be taking.

My results:

Low reaction to wheat, "pepper/spicy", nuts. Moderate reaction to dairy, caffeine, yeast. I could benefit from more chromium and valerian.

My friend's results:

Low reaction to Nightshade family, citrus fruits, salt, sweet, beet/cane sugar, house & dust mite. Medium reaction to dairy, orange and grass pollen. He could benefit from more Omega-3, Milk thistle herb and co-enzyme q10.

With the exception of dairy, our results were completely different.

Which is quite strange, since we both took in a sample of my hair.

I’ve written to the company to request an explanation and have not yet received one. Nor have they offered to refund the fee.

Please sign the letter to Trading Standards

UPDATE: We've now got 500 signatories and I'm preparing the letter to send off. Thank you for all your support.

You can sign the letter by filling out this form.

If you've visited this blog for the first time, here's a lightning-speed explanation: the evidence suggests that Chiropractic doesn't work as a treatment for colic, I made several complaints to trading standards about Chiropractors who were making this claim. Most trading standards offices have taken action, a few chiropractors are holding out. This last letter is to get those last few businesses to stop making unscientific claims about important issues of health. It will be mail-merged the details and claims made by approx 50 chiropractors.

While the names of signatories will of course need to be printed on the letters to Trading Standards, they will otherwise be kept private.

Please sign the letter.

The full text is below.

To Whom it May Concern,

We are writing to complain about [company name]. While it is up to you to establish whether this company is breaking the law, we wish to bring a possible infringement of The Consumer Protection from Unfair Trading Regulations 2008 to your attention.

This company makes the following claims on their web site [web site url to be inserted here]:

[copied & pasted claim]

This text clearly implies that the company in question is willing to use chiropractic to treat infant colic. There is no reliable evidence to support the belief that colic is caused by a problem with the spine, nor that chiropractic is effective in treating it. In addition, there is reliable evidence from a controlled trial that clearly shows chiropractic to be no more effective than placebo.

Below are listed the studies typically cited by chiropractors to show that chiropractic is an effective treatment for colic. We have included an explanation of the trial and the conclusion that can be drawn from it. The final study in the list is generally ignored by chiropractors making this claim; however, it clearly shows the treatment to be ineffective.

Study	Summary	Conclusion
1. Klougart N, Nilsson N and Jacobsen J (1989) Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases, J Manip Physiol Ther,12:281-288.	This study tracked 316 children with symptoms of colic during chiropractic treatment and showed that there was improvement in 94% of cases. However, this study failed to provide any evidence for or against the efficacy of chiropractic in the treatment of colic for the following reason: all children with colic improve over time. If all children improve from colic anyway, then showing that they improve after a certain treatment is unhelpful unless there is a control group not receiving treatment with which to compare them. This study contained no such group.	This is irrelevant. It is irrelevant because it cannot demonstrate that treatment improves recovery from the condition.
2. Mercer, C. and Nook, B. in the Proceedings of the 5th Biennial Congress of the World Federation of Chiropractic (1999)	This doesn't seem to have been published, so was not peer reviewed. As it seems to be almost impossible to get hold of the paper, there is very little that can be said. From the summary provided by the BCA, however, it appears that this was a simple observational study like the one above with no control group.	This is irrelevant. It is irrelevant because it cannot demonstrate that treatment improves recovery from the condition.
3. Wiberg J, Nordsteen J, Nilsson N. The short term effect of spinal manipulation in the treatment of infantile colic. A randomised controlled trial with a blinded observer. J Manipulative Physiol Ther (1999) 22:517-522.	This study was a randomised controlled trial comparing chiropractic with dimethicone in the treatment of colic. Without blinding between the two groups, it is likely that the placebo effect could play a major part in the outcome. The placebo effect is likely to be more pronounced with the chiropractic treatment as it is a more dramatic intervention. In addition, the system of measurement (asking parents to record crying hours) adds another potential bias. The parents who were keeping the diaries were were not blinded. Wiberg and Nilsson appear to concede this point themselves here: http://adc.bmj.com/cgi/eletters/84/2/138#124	This is inconclusive at best due to the lack of blinding, with the effects shown likely to be due to placebo and bias in record keeping.
4. Hayden & Mullinger (2006) Complementary Therapies in Clinical Practice (2006) 12, 83–90.	This study did not investigate chiropractic, but cranial osteopathy. Even so, this was a preliminary trial. Preliminary trials are of too small a scale to reach a conclusion. They are used only to see if it might be worth performing a proper trial.	This is irrelevant. It is irrelevant because it does not study chiropractic.
5. Hipperson AJ (2004) Clinical Chiropractic 11, 122 – 129.	This was merely a report of two case studies. This is irrelevant for the same reason as Klougart N, Nilsson N and Jacobsen J, but with only two subjects.	This is irrelevant. It is irrelevant for the same reason as the first study.
6. Browning M. Miller, J. Clinical Chiropractic (2008) 11, 122—129	This study compared two different forms of chiropractic in the treatment of colic. Maybe they both work, maybe neither work. This study did not attempt to answer that question.	This is irrelevant. It is irrelevant because it did not test if the treatment worked. It merely compared two different types of chiropractic treatment. This outcome would be expected if neither method worked.
7. Leach RA (2002) J Manip Physiol Ther, 25, 58 -62.	Simply another two case studies as Hipperson AJ (2004) above.	This is irrelevant. It is irrelevant for the same reason as the first study.
8. Miller J (2007) Clinical Chiropractic 10, 139—146 Cry babies: A framework for chiropractic care.	This is not a study at all, we are not sure why it has been quoted by the BCA.	This is irrelevant, as it is not a study of any kind.
9. Nilsson N. 1985 Eur J Chiropr 33, 264 – 255 Infantile colic and chiropractic.	This is merely a survey of parents who have had their child gone through chiropractic treatment for colic. No parents who did not take their children to chiropractors were questioned, making this study even more poorly designed than Klougart N, Nilsson N and Jacobsen J.	This is irrelevant. It is irrelevant for the same reason as the first study.
10. Olafsdottir E, Forshei S, Fluge G, Markestad T (2001) Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation.	AIMS: To investigate the efficacy of chiropractic spinal manipulation in the management of infantile colic. METHODS: One hundred infants with typical colicky pain were recruited to a randomised, blinded, placebo controlled clinical trial. RESULTS: Nine infants were excluded because inclusion criteria were not met, and five dropped out, leaving 86 who completed the study. There was no significant effect of chiropractic spinal manipulation. Thirty two of 46 infants in the treatment group (69.9%), and 24 of 40 in the control group (60.0%), showed some degree of improvement. CONCLUSION: Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic. This study emphasises the need for placebo controlled and blinded studies when investigating alternative methods to treat unpredictable conditions such as infantile colic. This is the only properly conducted trial comparing chiropractic against placebo for the treatment of colic. The conclusion is that it simply does not work.	This is highly relevant, and clearly shows that chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic.

Part 2, Section 5 of the regulations list misleading actions as below. You can see from the text below that a trader is in breach if they present information in a way that is misleading even if it is factually accurate. For instance, a trader presenting a testimonial from a client promoting efficacy or even just stating "some parents have found chiropractic useful in treating colic" or a trader citing a poorly conducted trial as evidence without informing the potential customer of a well conducted trial showing the opposite outcome is therefore performing a misleading action under the regulations.

Misleading actions
5.—(1) A commercial practice is a misleading action if it satisfies the conditions in either paragraph (2) or paragraph (3).
(2) A commercial practice satisfies the conditions of this paragraph—
(a)if it contains false information and is therefore untruthful in relation to any of the matters in paragraph (4) or if it or its overall presentation in any way deceives or is likely to deceive the average consumer in relation to any of the matters in that paragraph, even if the information is factually correct; and
(b)it causes or is likely to cause the average consumer to take a transactional decision he would not have taken otherwise.

According to The Consumer Protection from Unfair Trading Regulations 2008, the onus of evidence relating to any factual claim is on the company making the claim. So it is not a requirement that a prosecutor proves that the claims are factually incorrect, rather it is a requirement that the company must be able to show that their claims are backed by adequate evidence. Section 27 of the regulations state:

(1) This section applies where an application for an enforcement order or for an interim enforcement order is made in respect of a Community infringement involving a contravention of Directive 2005/29/EC of the European Parliament and of the Council of 11 May 2005 concerning unfair business-to-consumer commercial practices in the internal market.
(2) For the purposes of considering the application the court may require the person named in the application to provide evidence as to the accuracy of any factual claim made as part of a commercial practice of that person if, taking into account the legitimate interests of that person and any other party to the proceedings, it appears appropriate in the circumstances.
(3) If, having been required under subsection (2) to provide evidence as to the accuracy of a factual claim, a person—
(a) fails to provide such evidence, or
(b) provides evidence as to the accuracy of the factual claim that the court considers inadequate,
the court may consider that the factual claim is inaccurate

As an enforcement authority, you also have the right to demand any documentation, such as their evidence for the claim, from the company. Section 21 (b) states "if he has reasonable cause to suspect that a breach of these Regulations has been committed, he may, for the purpose of ascertaining whether it has been committed, require any trader to produce any documents relating to his business and may take copies of, or of any entry in, any such document;"

So, to summarise the points above:

• The consumer protection regulations cover the overall impression given by the trader and the trader may be in breech even if the actual claims are factually accurate.
• The consumer protection regulations require the trader to provide evidence for any claims they make, rather than the prosecutor needing to prove those claims to be false.
• The evidence we have found from chiropractic organisations so far appears not to be relevant to the question of efficacy in all but one study. In the one study where it is relevant it appears to be inconclusive, with a complete lack of blinding.
• The only properly conducted trial of the use of chiropractic in treating colic shows this treatment to be no more effective than placebo.
• While prosecution can proceed solely on the grounds that the company provides no evidence, or inadequate evidence; your position is much stronger: the best evidence available clearly shows this treatment to be ineffective.

We have only checked the claims on this company's web site. They may also be making similar claims in leaflets within their practice, or their advice to their customers. We hope you will be able to visit the practice to ensure compliance with the law.

While we have focused on colic for the purposes of this letter, we have also found some practices also claiming to treat children for sleeping and feeding problems, ear infections, asthma and prolonged crying. The evidence for chiropractic's efficacy for these treatments is similar to that for colic above. We sincerely hope you will take similar action against any such claims.

Yours faithfully,

[list of names, titles etc]

You can sign the letter by filling out this form.