How should homeopaths be regulated? I am not sure I have made up my mind yet about what I would like to see and I am not convinced there is a perfect solution. However, I hope some debate has been kicked off by all the goings on last year, here and on various other blogs and forums. One thing I am pretty sure of is that homeopaths have pretty much ruled themselves out of the discussion. Adults only from now on.
And the reason for this is that they have had their chance – and a good shot at trying to regulate themselves. Indeed, this was the stated aim of the Society of Homeopaths last year. Two of their annual goals were:
To facilitate the smooth handover of Society regulatory processes to a new regulatory and registration body
and,
To uphold and review The Society’s professional standards especially in relation to the development of a new regulatory and registration body (NRRB)
They failed miserably at both.
The farce of creating a single homeopaths’ single register is being documented at gimpy’s blog. Squabbling about money made sure the register did not get off the ground. I believe this reflected deeper rivalry between the various homeopaths’ groups based on philosophical differences and also just plain old human power struggles.
The Society also demonstrated that their code of ethics could not protect the public from the worst delusional beliefs of their members. Their utter two-faced failure to tackle the problems posed by members offering anti-malaria advice led to the Society being prepared to directly misrepresent their own actions to the papers. They were also last year promoting homeopathic intervention in HIV people in Africa. It is difficult to think of more exploitative, deluded and dangerous actions.
So, to start off – what are we trying to protect against? Ben Goldacre has been quite clear about the dangers of alternative medicine – bullshit. And that bullshit manifests itself in a couple of dangerous ways with homeopaths. Firstly, they may delay a customers access to effective treatment – in the case of serious illness this can be fatal. Secondly, they may present themselves as serious alternatives to real medicine. We have found this most shocking when homeopathic missionaries tell vulnerable African people with HIV that they can treat them. Homeopaths use the denigration of medicine as a standard marketing tool. Homeopaths stand out in the alternative medicine crowd in their anger and hostility towards real doctors and medical practices. It is how they define themselves and what makes them most dangerous to the public. They most definitely are not a ‘complementary medicine’.
It is not that I want people to stop visiting homeopaths and other therapists. People often do get benefit from the self-indulgent friendly chat that a GP is just not in a position to offer. Homeopaths ought to be in a prime position to offer this as I have said before. However, in visiting a practitioner, we need to consider how the public may be protected against two main problems we find in quackery: being exploited financially, and being given inappropriate and dangerous medical advice.
One potential solution is coming from Prince Charles and his Foundation for Integrated Health. FIH is looking into setting up a Natural Healthcare Council that will offer regulatory functions to the broad church of complementary and alternative therapies. The Times reports that this new voluntary register should be established this year and,
will be able to strike off errant or incompetent practitioners. It will also set minimum standards for practitioners to ensure that therapists are properly qualified.
Their hope is that,
all practitioners will be forced to join or lose business as the public will use the register as a guarantee of quality. The council will register only practitioners who are safe, have completed a recognised course, are insured and have signed up to codes of conduct.
Funnily enough, the homeopaths appear to be deeply hostile to this move. “The homeopathy profession has been unanimous in rejecting federalisation as an option for regulation” reports the Alliance of Registered Homeopaths. But, as I have said, I am not really interested in what they think – their only motives in discussing regulation appear to be self-interest and survival.
So, will the chief tree-talker’s ideas be a good move? Should Prince Charles’ organisation be allowed to succeed?
I have some serious reservations.
Firstly, by what standards will the Natural Healthcare Council set for competence and training? Professor David Colquhoun has documented the training dilemma of alternative medicine by noting that most alternative therapies are based on nonsense ideas that have no scientific and objective merit. “It cannot be expected that a universities will provide a course that preaches the mumbo jumbo of meridians, energy lines and so on… Can any serious university be expected to teach such nonsense as though the words [of alternative medicine] meant something? “. Since, homeopaths cannot even agree amongst themselves what homeopathy is and what are its essential elements (not surprising, as it is not based on reality) then the Council risks either alienating large swathes of practitioners or being completely arbitrary in its criteria. Either will not protect the public. Setting education standards for homeopaths is like trying to accommodate Hogwarts into the National Curriculum.
Secondly, by what standards will practitioners be judged in handling complaints and when upholding professional standards? Should we uphold a homeopath to standards of homeopathy, aromatherapy, reiki or – heaven forbid – evidence and science? This is important. In deciding whether a homeopath has crossed a line of ethics in offering malaria prophylactics, who will judge them? If homeopaths are involved, the the public will not be protected as they have dangerous and delusional ideas about their magic sugar pills. However, if they are to be judged by the standards of best evidence, then no homeopath will join the organisation as they know that they cannot practice within their strongly held beliefs. In either case, the Council will fail to protect the public. You might think that homeopaths would be willing to disengage from their wilder healing fantasies in order to gain the credibility of the name of Prince Charles, but all my experience says that homeopaths are fiercely proud, angry and determined not to be constrained by any external forces (probably orchestrated by ‘allopaths’).
And if the Council do uphold the strongest standards and do this in a transparent and accountable way, will the UK suddenly be free from rogue practitioners? Well, no. My recent example of the the ASA upholding a complaint against Osteomylogist, Robert Delgado, showed that even statutorily registering complementary therapists has big loopholes. This non-statutory and voluntary registered body, the Natural Healthcare Council, will have even less power over practitioners.
But what it will achieve is that Prince Charles’ name will give credibility to all sorts of unproven therapies and wacky non-medically qualified people to go out there and pretend to be healers. And at the same time, offer no guarantee of protection to the public.
I don’t think this is the answer and I think it will even lead to a greater threat to the public.
As you and others have mentioned earlier regulating homeopathy effectively is difficult, if not impossible. The main questioned that I think needs to be answered is: ‘Does the benefit some people get from their belief in homeopathy (reassurance from consultations, any placebo responces, etc.) outweigh the potential harm that can occur from the spurious claims of homeopaths?’
If the answer is yes then the options available would be to continue with the status quo or put in place some weak regulation to try and prevent homeopaths from making their more dangerous claims.
If the answer is no then the only option would be to put in place legislation whereby anybody giving medical advice with no evidence base is deemed criminally negligent. This type of legislation would affect a much larger range of ‘treatments’ than merely homeopathy.
NJ – I think the problem is that it is very difficult to quantify what the total harm that is caused by quackery such as homeopathy, principally because there is nothing in place to measure such negative effects. Conventional medicine has lot of bodies, procedures and regulation to report adverse effects independently, transparently censor malpractice and conduct research into safety and efficacy. None of this exists within homeopathy or other alternative medicine (with a few exceptions).
Homeopaths have demanded I quantify what harm they are doing. But it is not up to me. If they take on the considerable responsibility of caring for sick people they should take on the professional mantle of systematically monitoring their outcomes, researching their safety, transparently upholding a code of ethics and publicly making this data available. They most distinctly do none of these things. Prince Charles’ Council will not do this either in my opinion. It will not induce the ethic of professional care that is required.
If you set up an ‘alternative’ building practice that did not believe in (say) scaffolding regulations, and said your labourers could come to no harm due to your alternative management skills, you would be quite right in insisting that they follow all the safety codes that other builders follow. Building companies have a duty of care. Claiming we have never done any harm is not good enough.
“Setting education standards for homeopaths is like trying to accommodate Hogwarts into the National Curriculum.”
Mr Duck, I have to take issue with this flagrant misrepresentation. When a Hogwarts student claims to be able to make someone fly, they fly. When they claim to be able to turn a turtle into a tea-kettle, they damn well turn a turtle into a tea-kettle.
What can the homeopaths do? They bleat ad nauseam about marginal, non-repeatable results using inappropriate end-points in various trials of their sugar pills. They punt pointless customer satisfaction surveys such as the Spence (2005) study as if these are valid alternative means of demonstrating efficacy.
Can they produce the equivalent of a load of turtles reliably transformed into tea-kettles? No they cannot.
Can they produce even a single case record of a serious disease clearly ‘cured’ by homeopathy by normal medical criteria? The evidence so far clearly shows that they cannot.
I do not propose that they should be encouraged to fiddle about with real diseases and seriously ill people, but there are millions of patients who have fallen into the hands of many thousands of sugar retailing practitioners over 200 years in circumstances where modern conventional medicine has either not existed or been unavailable. With all that track record can they produce a few or even one dramatic case that would give us sceptics serious pause for thought? Not so far.
This cuts to the heart of their claims. Homeopathy is allegedly a “complete system of medicine” but as soon as they begin to be questioned closely it becomes clear that their big claims are not consistent with even a very generous interpretation of their own feeble evidence base.
The annoying thing is that even by bothering to offer to consider further trial data we lend them far too much credence. Homeopathy simple presents no problem to answer. It doesn’t work (beyond placebo…). There is nothing worth investigating.
The is where they end up in the logical conundrum that you present very well. If they are held to objectively valid standards then they will all fail to comply. If they are not held to objectively valid standards then the Natural Healthcare Council would merely be a PR exercise and in pretending to regulate the alt. meddlers then it will serve society no better than creating a self-regulating mechanism for the members of the burgling community, OfNick perhaps.
Hey, ho.
Thank you for banging a large number of nails firmly on their heads.
p.s. I’ve always liked the analogy of whether I’d like to fly in a plane built by a committed believer in Alternative Aerodynamics who insists that their planes need no testing before being allowed to fly.
Can I be first to dare we call Prince Charles’ Foundation for Integrated Healthand the Natural Healthcare Council Council Ofquack?
(Apologies to American friends who won’t get this.)
“Can I be first to dare we call Prince Charles’ Foundation for Integrated Healthand the Natural Healthcare Council Council Ofquack?”
For the benefit of our American friends, may I suggest Ofbull?
It should be very simple; to practise legally as a homeopath all anyone should have to do is pass a trivial little practical examination in which they show they can identify a remedy from the symptoms it induces in them, like your challenge of a few weeks ago.
Then they can have a nice certificate to hang on their wall and all their patients will know they are competent in the healing arts.
“Then they can have a nice certificate to hang on their wall”
and $1,000,000
Come to think of it- they wouldn’t need to work.
The aim of the new body is to set minimum standards. I think we can rest assured that minimum standards is what we will get from it.
Its like the joke school report…
“He sets himself the lowest possible standards and constantly fails to achieve them.”
The SOH have issued a statement
The Natural Healthcare Council
Further to coverage in the media today, The Society of Homeopaths has issued the following statement:
As the UK’s largest membership association and regulator of homeopaths, The Society of Homeopaths supports the establishment of an independent single register and regulatory body for homeopaths. Indeed, a recent survey of its membership indicated that at least 65% would support statutory regulation for homeopaths.
Registered members of The Society of Homeopaths (identifiable by the designation ‘RSHom’) have a recognised professional qualification, comprehensive insurance and have agreed to abide by a strict Code of Ethics & Practice.
The Society of Homeopaths has yet to assess the suitability and standards of the Natural Healthcare Council for the purpose of providing regulation of homeopaths.
I will refrain from commenting on their strict code.
I think His Royal Highness is going to be dissapointed as his new regulatory body is going to fall at the first hurdle. None of his woo friends want to come out to play with this group.
The Reiki people also have taken their ball home and refuse to play with the royal rules…
from
http://www.reikiregulation.org.uk/
Following a meeting in November 07, The RRWG has now formally withdrawn from the Federal Working Group set up by the Princes Trust for Integrated Health. The Group is considering its options and the way forward in January 2008.
Registered members of The Society of Homeopaths (identifiable by the designation ‘RSHom’) have a recognised professional qualification
Recognised?
I recognise it in the sense that I share the same alphabet with them, if not the same planet, so I recognise the letters R, S, H, o and m.
As to the meaning of the letters, there I think we may have a problem. Is RSHom a synonym of ‘idiot’? On the other hand, it is presumably homonymous with ‘arsehom’. Does that help us get closer to its meaning?
Is ‘m’ a contraction of ‘le’?
I’d not come across that before.
No mention of FSHom on the SoH press release. Fellows are free to breach whatever guidelines they like, only RSHom’s are bound by the code of ethics. I have an email to prove this btw from when I complained about Jeremy Sherr.
Thanks for giving your ideas. I’d also like to say that video games have been at any time evolving. Modern tools and innovative developments have helped create sensible and active games. Most of these entertainment video games were not as sensible when the concept was being tried. Just like other forms of technology, video games as well have had to develop through many generations. This is testimony towards fast growth and development of video games.