CAM practioners in the UK taken to task for extravagant claims

The Advertising Standards Authority is coming down hard on quack remedies and modalities and it’s about time too.

And CAM (complementary and alternative medicine) practitoners are scrambling. Unregulated, “alternative”, unscientific medical interventions are squarely in the crosshairs of the British Advertising Standards Authority (ASA). Purveyors of dubious remedies and magical “cures” are now being taken to task for claims on their websites.

The immediate reaction of the CAM practitioners is of course predictable: “They’re limiting health freedom”, “the medical establishment are greedy”, “but the ASA are supposed protect the public”.

Which leads me to some specific reactions from an NLP trainer, practitioner and therapist Nick Kemp. Uneasy with the implications of the newfound teeth of the ASA, Nick wrote a blog post outlining what he sees as an organised attack on alternative health modalities.

The NLP (Neurolinguistic programming) community is unregulated externally and has a number of features of a pseudoscience. Nick is all to aware of this, pointing out that many NLP individuals and institutions write cheques they can’t cash in terms of claims.

Mentalists and skeptics Derren Brown and Banachek point out that there is some good stuff in NLP, but as a field unhinged from the need to prove its claims NLP amasses a fair degree of quack alternative ideas also.

Evidence please?

People who make claims that are supported by evidence have nothing to be afraid of.

However, CAM modalities are alternative because they do not pass scientific muster. If a modality works it becomes accepted as medicine and does not remain “alternative”.

There is no ‘alternative versus conventional medicine’ dichotomy. The CAM industry has created this “us versus the elite establishment” semantic distinction, but it doesn’t represent the reality that there is either science-based medicine or unscientific belief-based medicine. The only real question that needs asking is “Is there objective evidence that it works?”

Avoiding the real question (does it work?)

So most of the complaints by CAM practitioners are elaborate red herrings and non sequiturs designed to evade the question “does it work?” Not just anecdotally, but is there science showing it works?

Nick Kemp’s main beef is that the ASA is being far too strict and doesn’t understand NLP or alternative therapies. Essentially, practitioners of all stripes, homoeopaths, naturopaths, chiropractors, NLP practitioners… Are crying foul and pulling the martyr card.

The need for public watchdogs

Mr Kemp also conveys some disdain for the Nightingale Collaboration – a campaign that challenges questionable claims made by healthcare practitioners in order to hold them accountable.

He says:

“Groups like The Nightingale Collaboration actively encourage “skeptics” to make complaints about websites to support their own agenda.”

He is dismayed by the fact the Nightingale Collaboration has previously attacked chiropractors, homoeopathy and cranial sacral therapy.

I pointed out to Mr Kemp that there is good reason why these health modalities deserve criticism – they don’t work! In the case of chiropractors, the essence of chiropractic (still claimed by many chiropractors) is sympathetic magic. When this was pointed out by journalist Simon Singh The British Chiropractic Association responded by suing him. This kicking of the hornets’ nest is why skeptics and other concerned citizens upped the anti in opposing false and potentially harmful medical claims.

Aside from a handful of good journalists like Singh and Ben Goldacre, the media has proven itself incapable of  properly informing the public about the reality of CAM quackery.

The public needs groups like the Nightingale Collaboration to publically hold purveyors of quackery accountable for the very real danger they pose in promoting belief-based medicine over solid science.

(See this Guardian article for some background information on the Nightingale Collaboration and why Simon Singh and others formed the organisation).

“Leave your logic and science at the door thanks”

When I put forth the true state of the evidence for homeopathy (it doesn’t work beyond placebo) this is the response Mr Kemp gave:

“As someone who has used homeopathy for 30 years I have enough evidence that it’s not placebo.

“As for the ASA vetting, well they are check ad copy and have no therapeutic insights. I could write a lengthy post about the absurdity of many ASA deductions, but don’t really have time at present!”

It is a shame Mr Kemp doesn’t have more time because I would really like to know how the ASA is making absurd deductions AND I would like to know what he uses homoeopathy for.

The deductions the ASA make are simple – if there is objective evidence something works and you are a properly qualified practitioner then great. If the objective evidence is not in or worse if it repeatedly shows the treatment is hooey, then you can’t make claims to effectiveness.

Mr Kemp’s statement about absurd deductions is rather ironic. Any way you look at homoeopathy, the deduction that it works beyond placebo is absurd.

Homoeopathy is absurd because:

  • Double blind placebo controlled trials repeatedly show homoeopathy does not work.
  • The proposed mechanism for homoeopathy violates the laws of physics, therefore proponents have a huge burden of proof on their hands that they cannot meet.

Unfortunately, Nick Kemp displays the precise thinking the ASA is meant to safeguard the public against.

Firstly, his appeal to 30 years of personal experience of homoeopathy typifies the kind of anecdotes that the CAM industry relies on as the definitive evidence. As clinical data is unfavourable to their cause they have to use anecdotes. They either don’t like science or believe anecdotal reports trump science. This is the very problem the ASA must throw cold water on.

Testimonials are great marketing devices (people love stories) but testimonials are poor evidence of clinical effectiveness. The reliance on testimonials is a huge red flag when flicking through practitioner websites.

Cures

Regulators like the ASA (UK) and FDA (US) have become increasingly sensitive to the word “cure” due to the large number of unsubstantiated claims to cures for all kinds of ailments, especially those relating to cancers.

Most of the claims with “cure” in them come from scientifically discredited modalities. The public absolutely needs to be on guard from these kinds of extravagant (read: absurd) claims by internet charlatans.

There are countless stories about people abandoning their cancer treatment, medical treatment and prescribed medicine on the advice of a quack practitioner. Until now, purveyors of cancer cures have been largely unaccountable for the claims on their websites.

Conclusion

Unregulated, unscientific modalities and practices need to be brought to the surface so that the public can make informed choices based on the best evidence available. This protects the public from being misled, ripped off and prevents the promotion of harmful (untrue) medical advice.

For too long claimants have not been required to meet reasonable standards of objective evidence. Often claims are reduced to what people want to hear, what people want to believe rather than what is responsible and effective. It is misleading and dangerous to make false claims and then hide behind “well, I am giving people the freedom to decide what’s best for them”.

If CAM practitioners really do subscribe to the dictum “first do know harm” why are they so unwilling to submit their work to the evidence?

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5 responses to “CAM practioners in the UK taken to task for extravagant claims

  1. I am flattered that you would be so interested to quote my blog.

    Let me clarify a few points

    I am not ‘an NLP Trainer” and have not trained others in NLP for a few years now, although I remain an advisory member to ANLP that promotes NLP standards and has worked closely with ASA and CAP to ensure members adhere to guidelines
    I think people can Google “Nightingale Collaboration” and its directors and make their own minds up on their motives…
    The idea that people should ignore medical advice is quite ridiculous and I don’t know of any professional therapists who would advocate this
    I will let the homeopaths made their own case, I am not a homeopath, but simply report my experience of its effiectiveness over many years. I am happy for others to question whether I am imagining the benefits! LOL
    You comment – “I pointed out to Mr Kemp that there is good reason why these health modalities deserve criticism – they don’t work”
    I am unsure of your experience with approaches such as chiropractic, but have found my experience does not match your assertion. Once again I probably imagined the benefits when I went to see a practitioner for whiplash after a car accident! LOL

    Lets also remind ourselves tha since often changes its mind and “objective evidence” is all too often rather more subjective than one might imagine…

    Warm Regards

    Nick Kemp

    • viewfromreality

      Hey Nick, apologies if I got your title wrong. You seem to have the pop culture opinion of Chiropractors, which is fine as most chiropractors actually do restrict their work to back and neck problems. However, the core of chiropractic theory is not restricted to back problems.

      If you do some research you will note that Simon Singh (one of the founders of the Nightingale Collaboration) was sued by the British Chiropractic Association for pointing out that many chiropractors were advertising claims on their websites that were “bogus” (including infant colic and ear infections).

      Nick, if you wish to be informed of Simon’s true motivations for his work with Nightingale, please read this: http://www.senseaboutscience.org/pages/simon-singhs-case.html

      The link above outlines pretty clearly why his motivations are from sinister as you imply (while also giving you some insight into why people’s opinions about health claims need to be reined in).

      I don’t dispute you have personal reasons to use homoeopathy, I do however take exception for your claim that you know it works better than a placebo because you have 30 years experience using it. The only way we can separate placebos from real effects is through well controlled double blind clinical studies. Many alternative practitioners believe as you do – that their personal opinions about what works is enough. Well, that is setting a really low bar for evidence (in a field as important as medicine and health!!!)

      You seem to misunderstand science also. The fact that our knowledge improves over time and we have to update our ideas is not a case against scientific testing. We don’t claim perfect knowledge in science because the learning process is cumulative. In the intermediate stages we have competing ideas but ultimately the data determines which idea trumps the others.

      To class science as “more subjective than I imagine” you really have to ignore the fact that the world we live in today has advanced because of objective scientific inquiry. It is not subjective opinion that an airplane flies due to well known laws of physics, objects fall to the earth, aspirin relieves pain, or that invisible light waves are picked up by my television. By the same token, we know that many alternative therapies are bogus and that they survive purely because of placebos and confirmation bias in believers. This causes harm.

      I hope this clarifies the position of us skeptics.

  2. I didn’t realise you spoke for “the skeptics!” LOL

    I’m all for discrimination and professional standards, I just prefer to believe in my own personal experience over a period of time rather than what others insist is or isn’t true! Lets agree that when you say

    “It doesn’t work” you mean “It doesn’t work for you” or you imagine “It wouldn’t work for you”

    When I say “I’m satisfied that its not a placebo” that is my experience, others may have a different experience and I encourage people to be open minded enough to explore for themselves new possibilities.

    I am also aware that “data” can be interpreted in all manner of ways, both in science, accountancy, politics and many other fields and such interpretations of course change all the time…

    Have a great day

    Regards

    Nick Kemp

    • viewfromreality

      Well, I’m part of a movement of skeptics so yes I speak as one of the representatives. Hopefully I can be a gateway drug for others!

      It seems that we have a difference of opinion that isn’t going to be resolved over blog postings to and fro so this will be my last post.

      My final comments – I don’t say it doesn’t work for me – I’m saying there are objective ways of approaching the question that can remove the subjective element from our investigations.

      Data can be interpreted other ways but what your presupposition here is that therefore we can’t determine with a high degree of probability that some proposition is true or not. The statement “Homoeopathy does not produce any beneficial clinical effects outside of a placebo” is something that has been determined beyond doubt. Not by me but by a collection of indivduals over a number of years employing a method of testing, criticsm and refinement.

      In your case, the sample size is 1, your experience. To determine whether it is just in your experience or a measurable clinical effect we increase the sample size and give some of them the treatment and others the placebo. That way we can filter out all the subjective foibles that lead to incorrect conclusions. **Derren Brown’s “The System” special is worth a look because it puts the focus squarely on subjective interpretations and why this leads to error.

      All I’m saying is that your experience alone is not enough to determine whether a phenomenon is real or not. In medicine, personal experience as evidence would be incredibly reckless so science-based medicine improves our knowledge over time by controlling for the noise in our subjective perceptions. In other words, your experience is great but a controlled test repeated successfully many times is a far more reliable indicator of what is real than our flawed inferences.

      Over time we converge on the reality of what is going on via the data. Eventually the alternative interpretations of the data can be eliminated until we develop a high certainty of reality. It isn’t perfect and is open to revision when better refined data comes in but we know a lot about oursleves and the universe because of this refinement process.

      What surprises me Nick is that you deal with the cognitive processes in your work but seem to be unaware of the ways in which we can deceive ourselves. This is not a put down of humans – just a recognition of the fact our cognition has adapted to an environment that didn’t necessarily require absolutely accurate maps of reality. We are pattern seeking creatures and seek patterns often where none exist (Professor Bruce Hood’s book “supersense” is a great expose on this tendency).

      We are so good at seeking patterns we make them all the time – true or not. This is how a lot of superstitious thinking works.

      Here are few ways we can get things wrong:
      – Confusing correlation with causation
      – Post hoc ergo propter hoc (happened after A therefore because of A)
      – Confirmation bias
      – Cognitive dissonance
      – Observational bias (counting the hits/successes and ignoring the misses)
      – Taking an alternative medication and crediting that with our recovery when the natural recovery is taking place
      – Here are more: http://en.wikipedia.org/wiki/Cognitive_bias#Types_of_cognitive_biases

      I really do suggest you read the psychological work that has been done on perception and cognition. Michael Shermer’s recent book “The believing brain” is a good summary of what I’m discussing here. “Sleights of Mind” is also a great recent book – written by two neuroscientists that have studied magicians closely.

      One that would really help as a therapist would be “Mistakes Were Made (But Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts” by Carol Tavris.

      Take care Nick. I hope at the very least I have given you some insight into how we can determine which ideas to explore and which ones to drop.

      I will be in Birmingham in October so if you’re in the neighbourhood I would happily catch up with you over a beverage and have a polite discussion about therapy, communication and change if you like?

  3. “I’m saying there are objective ways of approaching the question that can remove the subjective element from our investigations. ”

    I would suggest that the “subjective element” is never fully removed as all interpretations are subjective! Good discussion though

    Warm Regards

    Nick Kemp

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