Wednesday, May 27, 2009

The BCA Writes

Thanks for your note. The BCA's Code of Conduct forms part of the BCA's Memorandum and Articles and is therefore only available for BCA members. What I can say, is that the Code relates specifically to members' responsibilities to the BCA - their requirements for professional conduct areset out in the GCC's Code of Practice and Standard of Proficiency. To my knowledge in the last five years, the BCA has not removed a member from the Association as a result of a breach of the Code of Conduct.

The Beacon Writes NICE

Dear sirs/mesdames,

Peter Littlejohns was recently paraphrased by the BBC in an article about the recent and controversial decision to support complementary and alternative medicines such as acupuncture and chiropractic, despite there being no evidence that they work better than treatments mentioned in previous advice. Littlejohns stated that:

the costs to the NHS would be minimal - in the order of £77,000 - because they are offset by the savings in terms of reducing future disability and healthcare needs and moving away from treatments with little supportive evidence.

This seems to suggest that these treatments have some kind of long-term benefit that rest, exercise and painkillers do not. I was wondering what supportive evidence NICE has that these expensive CAM measures are a long-term solution to back pain? Littlejohns quotes a specific figure, so I am assuming that the evidence exists and is robust; I'd be very keen to see it.

Kind regards,

Beacon Schuler.

Tuesday, May 26, 2009

Switzerland Embraces Pretend Medicine

There has been som quite jaw-dropping news from Switzerland where they have incorporated woo such as homeopathy (which doesn't work), acupuncture (which doesn't work), and herbalism (that mostly doesn't work) into their national health insurance scheme. Before, people's premiums were going towards funding evidence based medicine, but now rational human beings must stump up for a range of ineffective treatments. If someone ever says to you "alright, so these treatments are a load of hogwash, but what real harm are they doing?" you need only point to Switzerland to see the threat of real damage that these people pose. It's not even that the wrong pockets are being lined, but EBM is being massively undermined.

“It shows that we are beginning to come out of the two camps – one for orthodox medicine and the other for alternative medicine. In the future, hopefully, it will mean that medical students will study complementary therapies as part of their medical training and be able to integrate some of them into their practice,” says [Alexander] Harbaugh.

This is CAM fantasy, to force medical doctors to learn homeopathy, chiropractic and other nonsense despite it being at odds with our understanding of how our bodies work. David Colquhoun has attacked at length and with good cause at the fake respectability that CAM has been creating for itself, the creation of Bachelors of Science [sic] degrees in homeopathy, NICE's recent approval of chiropractic, Switzerland may prove to be a clear example of what may happen if such moves go unchecked.

The only fly in CAM's snake oil is hinted at in the following quote
The current criteria requires that the therapy benefits the patient, that it is cost-effective and appropriate for the patient’s condition.

This hopefully will mean that alternative medicine will have to prove that it is benefitial to the patient. I think most of us could live with evidence-based alternative medicine being included in state-run health schemes.

Friday, May 22, 2009

The General Chiropractic Council Writes

Dear Sir/Madam

The General Chiropractic Council investigates all the complaints its receives against its registrants, regardless of the source of the complaint.

The title 'doctor' is a courtesy title that chiropractors can choose to use. Our Code of Practice at C1.8 states that chiropractors

"must not use any title or qualification in such a way that the public may be misled as to its meaning or significance. In particular, chiropractors who use the title of ‘doctor’ and who are not registered medical practitioners must ensure that they make it clear that they are registered chiropractors and not registered medical practitioners."

The Code of Practice is binding and all registrants must comply with its provisions.

Please advise anyone who has a concern about a chiropractor to contact the GCC, the statutory regulatory body for chiropractors in the UK.

I hope this information assists you.

Yours sincerely

Specialist Officer (Regulation)
General Chiropractic Council
Anyone operating as a Chiropractic in the UK must be registered with the GCC; they are the statutory regulatory body for the industry. If a Chiropractic isn't registered they are already breaking the law. You can search for them in the GCC registry here.

I'm not quite sure how much effort a complaint about inappropriate advertising to the GCC may be. Instructions can be found here, though, and it would be useful to complain to both the GCC and the ASA simultaneously as the appropriateness of use of the term "Doctor" is ultimately subjective.

It amuses me that part of the GCC code states "Chiropractors must make sure their own beliefs and values do not prejudice their patients’ care." The rule is designed to prevent chiropractors discriminating against homosexual patients, say, or ethnic minorities. It's a pity "beliefs" doesn't include belief in efficacy.

The GCC appear to take regulation seriously, though they do put out a patient information leaflet which features implicit claims that chiropractic can help with asthma and colic. As the ASA pointed out earlier this week, there is enough evidence to suggest further research is needed, but not enough evidence to comfortably make these claims.

Wednesday, May 20, 2009

How to Complain to the ASA

In forumland and the blogosphere I see a lot of people complaining about this or that advert for CAM, but suspect that these complaints don't get much further. Complaining to the ASA is quick, easy and worthwhile; they have the power to have ads removed and can insist on advertisers having to seek out approval from the Committee of Advertising Practices before placing further ads. Here's a quick guide on complaining where it counts.

1. Are the ASA the right people to complain to?

The ASA have a specific remit to handle complaints about the following media:
  • Magazine and newspaper advertisements
  • Radio and TV commercials (not programmes or programme sponsorship)
  • Television Shopping Channels
  • Posters on legitimate poster sites (not flyposters)
  • Leaflets and brochures
  • Cinema commercials
  • Direct mail (advertising sent through the post and addressed to you personally)
  • Door drops and circulars (advertising posted through the letter box without your name on)
  • Advertisements on the Internet, include banner ads and pop-up ads (not claims on companies’ own websites)
  • Commercial e-mail and SMS text message ads
  • Ads on CD ROMs, DVD and video, and faxes
But they don't cover:
2. What are the grounds of the complaint

There are three main columns of advertising regulation: misleadingness, harm and offense. Is the ad likely to materially mislead consumers? Is it likely to cause harm to consumers? Is it likely to cause widespread offense? As far as complaining about CAM advertising goes, you will primarily find grounds to complain due to misleadingness, where ads make unproven medical claims for a particular product, or harm, where ads, in promoting unproven products for serious conditions serve to dissuade consumers from seeking proper medical attention.

3. What is the procedure?

It couldn't be easier. The ASA website has an online form where you will be asked for information regarding the ad you wish to complain about - where and when you saw it, on what medium, and the specifics of your complaint. You don't need to go into too much detail here; it is enough to say that an advertiser is claiming homeopathy can treat asthma and that there is no evidence without having to point the ASA to a Cochrane review. The ASA take an evidence-based view of the world anyway - factual claims must be proved by the advertiser.

You will also be asked to provide, where possible, a copy of the advert itself. This isn't so important for radio or television, but is pretty vital for billboards, press and pamphlets. I find it easiest to just take a decent quality photo of the errant ad, which you can then upload to the ASA via the form.

It's also important to point out that although you give personal data to the ASA, they cannot pass this data on to the person being complained about without your consent. It's usually irrelevant, and tends only to come up where someone has failed to get something that was offered in an advert, or have entered into an agreement with an advertiser that didn't match the claims in the ad.

4. What Happens Next?

The ASA do not investigate every complaint that comes in. For each complaint lodged, they will identify whether a breach of the advertising standards codes may have taken place, and investigate only where they feel it appropriate. What they also will do is highlight aspects of the ad that they feel are in breach, whether or not that breach was part of the initial complaint. It is not unheard of for the ASA to not uphold a complaint from a member of the public, but go on to uphold elements of a complaint they themselves have introduced.

The ASA will keep you informed of the progress of the complaint. There are, in essence, three outcomes. The complaint will be either upheld or not upheld. Either way, the details of the complaint, the advertiser's response, and the ASA Council's decision, will be published on the ASA website. If the complaint is upheld, then there will be instructions to the advertiser on what they must do; invariably to withdraw the ad. Multiple offenders and non-respondents (not uncommon for CAM) will find themselves with additional instructions and the ASA may notify trade bodies of the issue with them. The third possibility is that the advertiser admits up front that their ad is misleading, withdraws it, and agrees to abide by the code in future. On this occasion the details of the investigation are not published in full on the website. This is what happened with a complaint I made against the Church of Scientology Stress hand-outs, who agreed that their medical claims were unfounded and that Dianetics was more of a belief system than a science as stated. So I just posted the letter from the ASA.

5. Post Adjudication

Once an adjudication is online, make use of it. They occasionally get picked up by the mainstream press (though often in a churnalism style) but ought to be bandied about a bit online. Complaints tend to be upheld because it is down to the advertiser to prove the claims they make and can't. That's something skeptics ought to be shouting out about!

Tuesday, May 19, 2009

Simon Singh's Bogus Journey

I was lucky enough to get along to the Simon Singh love in at Penderel's Oak last night. Simon, for the uninitiated, is a science journalist and co-author of Trick or Treatment, an excellent look at the evidence, or lack there-of, behind the claims of alternative medicince. Around the time this book was published, he wrote an article addressing some worrying claims being made about chiropractic and its use in the treatment of colic, along with feeding and sleeping problems. In it he suggested that the British Chiropractic Association promotes these "bogus treatments". The BCA felt such claims were damaging, and so decided, rather than to rebutt Singh's claims in the press, to simply silence Singh and other critics by bringing a libel suit against him.

The court case seemed, until recently, simple enough. The BCA simply cannot provide robust evidence for the claims made of chiropractic, and the court should note that Singh's article was correct inasmuch as he lays out exactly that claim in print. However, things took a rather unexpected turn when the Judge in the case, Sir David Eady, decided that what Singh had meant by "bogus" was that the BCA was knowingly and dishonestly promoting treatments that do not work. This placed Singh in a difficult position - if he were to continue with the trial it would be by defending a meaning he had not intended, and was much harder to prove, because it may well be that only the high-ups at the BCA really know their own mind when it comes to whether or not they believe in the powers of subluxation.

What the skeptic movement want to see happen is for Singh to appeal against Eady's ruling, to have the meaning returned to Singh's original sentiment, but, and quite rightly, this will only happen if Singh and his advisors feel that particular game is worth the candle. Last night's gathering was an opportunity for Singh to keep us posted as much as he is legally able, and for people following the trial to show their support.

Dave Gorman, TV humourist and professional geek, was the first to speak and rasied an interesting point, that in the eyes of the public Chiropractic isn't considered alternative medicine at all. It has taken people like Singh to bring to a wider audience the fact that Chiropractic has very little going for it in terms of evidence - some weak evidence that it may help with back pain; something slightly more intuitive than claims that it can cure deafness or heart disease.

And parallel to this, thanks to David Cohen's speech, it is becoming very clear to a widening audience that there is something dreadfully wrong with the English Libel laws. England's laws favour the plaintiff so much that we have become a destination for Libel tourism - where someone from Iceland sues someone from the Ukraine in an English court for something that was never even published in the English language.

It was clear from the mood in the room that there is a growing need for action, both against the pseudo-respectable claims made about Chiropractic and that drastic reforms are required for libel law in this country. What seems immediately clear is that the skeptic blogosphere is going to be scrutinising Chiropractic and Chiropractics very closely for the foreseeable future. I for my part will be writing to the BCA to ask if they have disciplined any bad advertisers and to request what evidence they had for the withdrawn pamphlet that Singh's article originated from. All in the interests of open discourse, of course.

Probably the best place to follow the Singh trial is the excellent legal blog Jack of Kent. And below is a post that, it seems, never made it to the Beacon proper, covering the origins of Chiropractic and some unusual parallels with a certain well known cult. During the seventies Chiropractics were considered ideal targets for recruitment for the Church.

Chiropractic was invented by D D Palmer, who believed that manipulation of the spine could cure all manner of ills, such as measles and deafness. Palmer believed that "innate intelligence" channeled through the spine and became blocked by misaligned vertebrae, and that reseating these vertebrae would bring the innate intelligence back into balance. Typical of much complimentary and alternative medicine, having had early initial successes in curing deafness in one individual and heart problems in another, Palmer went on to claim that Chiropractic could cure pretty much anything, despite seemingly never doing any proper research on it.

His "science" was so groundbreaking to him that he considered his discovery religious, likening himself to "Christ, Mohamed, Jo. Smith, Mrs Eddy, Martin Luther and other[s] who have founded religions." Palmer was repeatedly arrested for practicing medicine without a license, but this martyrdom only led to a strengthening of the cause of Chiropractic.

D D Palmer was killed after being run over by his son, B J Palmer, also a Chiropractor, and it is claimed that this may have been deliberate, as the two did not see eye to eye on a lot of things.

BJ went on to "invent," in 1924, a device called a neurocalometer that was said to be able to detect the blocks or "subluxations" in the innate intelligence. These devices were just thermocouples, a standard piece of lab equipment designed to detect temperature. That didn't stop BJ selling the devices for the price of a house.

As time went on, and as many earnest chiropractors became disillusioned with Palmer's initial claims for his treatment, the world of chiropractic became divided into the "straights" who stuck to Palmer's guns, and the "mixers" who recognised that chiropractic treatment could work towards easing back pain, but very little else. The straights accuse the mixers of never having been chiropractics to begin with. The mixers accuse the straights of being self-delusional.

So, a pseudo-scientific treatment offering medical claims with quasi-religious aspirations, an expensive device that is really just a simple bit of kit heavily overpriced, intergenerational rivalry leading to automobile-related death and a following fragmented into a body of fundementalists and a defamed bunch of open-minded and relatively more skeptical practitioners.

This, as a member of the Co€ pointed out to me in recent conversation, is true of many such organisations. What makes it moderately tastier, though, is that the e-meter's inventor, Volney Mathison, was a practicing chiropractor, and many chiropractors used e-meters in their treatments. This is conjecture, of course, but I can't help wonder as to whether or not Hubbard was familiar with Palmer's story as he set about creating Dianetics and Scientology.