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?

The “Convince Your Colleagues They Are In Error” Challenge

There is no easy way to say “you’re wrong” or “you’re mistaken”. In my experience, it isn’t the best approach to convincing you work colleague that taking homoeopathic potions is as likely to clear up your minor ailment as is smothering it with Vegemite (actually, Vegemite has more chance of clearing it up because it has active ingredients in it).

Besides, telling people they are wrong just serves to piss them off and serves to harden their attitudes towards whatever you think they are wrong about. Furthermore, it probably will reinforce their opinion that skeptics are naysayers and fun police whose sirens go off at the mere mention of an outlandish, half-baked, nothing but wishful thinking idea.

So what to do? Your work colleague (insert acquaintance if applicable) wants to have some options other than the medical remedies prescribed by their doctor. That itch really isn’t going away and besides, work colleague #2 has just recommended a really good naturopath.

It is the case that you as the skeptic probably know more about “alternative” medicine than they do and you also know there is no alternative to effective, conventional medicine (anything that is alternative and can be demonstrated to be safe and efficacious will be accepted as proper medicine). So you are the expert in this case and imparting your knowledge would likely help the other person make better informed decisions, so… Should you pipe up or just bite your lip?

The answer I have found is: It depends.

First of all, it should be noted that there are degrees of harm that saying nothing could cause. If your colleague is just choosing to taking homoepathic pills for sleep deprivation, then probably there is no reason to go into a lengthy exposé about how homoepoathy is pre-scientific speculation, has been repeatedly proven to be no better than a placebo and its proposed mechanism violates well established laws of physics.

If, however, your colleague is replacing proper medical treatment for a more severe ailment – say, a eczema or the extreme – cancer – then it is probably a good time to provide some cautionary warning about the bogus treatment.

There are good and bad ways of approaching talking with colleagues as you can come across as a know-it-all nuisance. The idea is to promote the evidence – not try and win the argument so you can feel good about being right. Admittedly, this is tough to do sometimes and it is the difference between a mature skeptic who cares about the other person’s wellbeing, rather than the git who just wants to stroke his own ego. Let’s face it, nobody likes those guys and all too often skeptics do themselves, their arguments and reason in general, a disservice by alienating others.

This is the second post on communication approaches to teaching and promoting science and skepticism. It is a tough call, because we are by nature attached to our beliefs, emotional in nature as they are, and nobody enjoys being told they are in error. To be effective as a skeptic, you must be able to avoid personalising the issue and making them feel as if they are wrong – in all likelihood, they weren’t aware of the vast body of evidence for or against a certain claim. If they continue to go against the information you dispense (which should be what the evidence says) then that is their choice. The more dire the situation the more adamant you can be but beginning in this vain is not a way to win friends.

No One Died!

Surprise, surprise… the public overdose on homeoopathy pills and potions led to no casualties. Good on the 10.23 “Homeopathy there’s nothing in it” organisation for rallying skeptical support on this. Will the UK pharmacy Boots make the ethically correct decision and pull these placebo pills off the shelf? Will the British government pull NHS funding on discredited alternative medicine modalities?

I suspect not… the politics involved is too sensitive for many (NHS funding cuts are as popular as root canal work) and Boots make a lot of money supplying pills and supplements to people who believe these things to be efficacious.

I suspect the public demonstration that homeoptahic ‘remedies’ won’t change the mind of the true believer. On the contrary – believers know that you can’t overdose on homeopathic formulations because it’s supposed to be a gentler approach to medicine (if you put nothing but water in your medicine then yes, there will be no side efects, but then all you’re curing is thirst).

Support for homeopathy requires many nonsensical notions to be accepted first and a laundry list of logical fallacies. Probably the most obvious fallacy employed to believe homeopathy works is special pleading: clinical trials are not sufficient to test homeopathy; a spiritual imprint of the substance is left in the water after dilution (which we can’t find but know is there); the less active ingredient the more active the medicine??? The post hoc rationalisations for these are absurd yet funny and sad at the same time.

The biggest question of all is: Will Prince Charles accept the scientific evidence on homeopathy or will he continue sound like a pompous arse everytime he addresses this topic?

P.S. Withdrawing support and funding from modalities that have repeatedly been shown not to work (and violate well established laws of physics) is not restricting health freedom. No one stopping people from getting these things. It is, however, ethically deplorable to disguise these potions as achieving anything beyond the placebo response and as viable alternatives to proper medicine. Pharmacists – who used to be trustworthy and scientific in nature have let their profession down by including hocus pocus remedies in amongst proven pharmaceuticals that actually work.

The Nonsense That Lurks – Homoeopathy

Did you know that even the most preposterous, implausible medical modality or supplement can have an effect? I’m sure most people have heard of the placebo effect but how many realise that many (if not all) “alternative” medicine claims are pure placebos and therefore medically inert?

Homeopathy is one such health modality associated with all kinds of claims to mechanisms and efficacy, yet has never been established as such by well-conducted, clinical trials. In fact, the effects of homeopathy are scientifically proven to be purely placebo, yet it still survives and even support for it thrives.

The basis of belief in homeopathy appears to be the same old ideological arguments: distrust of a corporate pharmaceutical industry (Big Pharma) and the fallacy that because something is natural it must be good. Like all alternative health belief systems, homeopathy thrives on an ignorance of science in even its most basic forms.

As noted in my previous post When Belief Unjustifiably Trumps Science, many publically accepted beliefs are adopted when there appears to be a correlation between a modality/supplement and the relief/cure of some ailment. This unscientific way of determining the efficacy of some claimed cure/reliever is unfortunately all many people need to endorse it.

Many people form the erroneous belief that homeopathy is valid merely because of the placebo effect and because of the vagueness of the ailment (dizziness, headaches).

The problem with a purely placebo-based health modality such as homeopathy is that, because it is belief-based, it requires deception in order to work. This point was made forcefully by Simon Singh and Professor Edzard Ernst in their book, Trick Or Treatment – Alternative Medicine on Trial. If a treatment is proven, scientifically to be bunk and purely placebo, then the patient must be deceived about the efficacy of the procedure in order for it to work.

A Short Primer on Homeopathy and Why It’s Nonsense

In order for homeopathy to operate as a base or operating system for medicine “for the 21st century,” the entire system of measurement and of course all physical laws would have to be changed. In analogous political terms, it would be similar to – but more massive a change than – changing a nation from a democracy to a completely different system such as a theocracy with completely different laws and behavior expectations.

– “Homeocracy II,” by Wallace Sampson, Science-Based Medicine Blog.

The above quote may sound odd to many, but do read on and you will see exactly why Wallace Sampson is right on the mark.

Homeopathy is a pre-scientific idea proposed by Samuel Hahnemann in 1809 and is predicated on a couple of nonsensical (farcical) ideas. I suspect that many people do not know exactly what homeopathy is. If they did know then they would realise why those of us opposed to it are screaming “SCAM”.

Here is a good description of homeopathy from a producer of these quack remedies here in New Zealand:

Homeopathic medicines are manufactured using a method that dilutes the original substance to a point where there are no molecules of original substance left. Remedies this dilute contain no drugs and create no side effects. Each of the remedies is selected to match a series of symptoms that have been recorded in over 200 years of use.

– from the Naturo Pharm website http://www.naturopharm.co.nz.

Do you see it? The glaring anomalies that renders homeopathy useless? Dilute the original substance to a point where there are no molecules of original substance left. Why start with original substance at all if you are merely going to produce a sugar pill or bottle of water? And this dilution is supposed to be effective? This is where, if homeopathy were true, there would be a rewriting of all physics and chemistry as we know it.

And there is the ideological line too “dilutes contain no drugs and therefore no side-effects”. True, but then water or sugar pills never do have side effects do they? Of course, without any active ingredient there won’t be a side effect because there is no primary beneficial effect either!

Homeopathy is concerned purely with symptoms and is completely ignorant of the cause. This fact alone would render one highly suspicious of homeopathy, simply because treatment of the cause of ailment/pathogen is how you heal the body and rid the body of the illness. Treating symptoms of illness (unwellness in new age speak) will not allow the illness to subside.

Think about it, if treating symptoms were an even plausible way of treating an ailment, then shouldn’t a baseball bat over the head cure your headache? No of course not, but homeopathy logic means a cure would entail tiny whacks over the head, without actually touching the head. Whammo, no side effects!

Of course, as long as people get proper medical treatment there will be no harm from nonsense like homeopathy. The converse – using homoeopathy to the exclusion of scientific medicine – is a great way to create a bodycount. This was brought horrifically to public attention recently when an Australian man, and homeopath disciple, decided not to treat his 9-month-old daughter’s severe eczema with prescription medication. He opted to use homoeopathic remedy (which we know now to be nothing but water). Through no fault of her own, the young girl was suffered bad malnourishment and ultimately died in hospital, all because of an erroneous, false set of beliefs. Unjustified certainty can be dangerous.

The mechanisms of belief that keep useless modalities such as homeopathy alive represent a departure from the quest for knowledge and genuine understanding of the human condition.

COOL LINK:
The Skeptic Blog – “Homeopathy Awareness Week” – Steven Novella, June 2009.