Last night we attended a meeting in the Houses of Parliament in Westminster, London, where we saw the UK Advertising Standards Authority’s (ASA) Director of Complaints and Investigations, Miles Lockwood, attempting to pour oil on some very troubled waters. The meeting was brokered by David Tredinnick MP, in his role of chair of the All Party Parliamentary Group for Integrated Healthcare meeting last night at the House of Commons.
The ASA-skeptics link
Relations between the ASA and the Complementary and Alternative Medicine (CAM) community have hit an all-time low this year since the extension of the ASA’s remit to regulate online marketing and media. The ASA has received 774 complaints against the CAM sector since 1st March 2011, the majority of which were initiated by skeptic group, The Nightingale Collaboration.
Is the ASA competent to adjudicate on CAM issues?
Despite Mr Lockwood’s assertions that the ASA is approachable and genuinely open to continuing dialogue with the CAM community, he was adamant that there will be no shift in position on the important issue of using subject-matter experts in investigations. Boiling things down to the essentials, the question of whether the ASA and its chosen experts are competent to investigate CAM evidence is at the heart of the debate.
Comments such as that from Vena Raffles, Head of Investigations, when she likened the assessment of CAM evidence to that of roofing and guttering at our meeting in August, does nothing to engender confidence that practitioners are going to get a valid or appropriate investigation. The fact that they are still refusing to engage in meaningful dialogue over this issue makes last night seem more of a slick PR stunt on the part of the ASA, than any real commitment to change.
Genuine change or a PR stunt?
Mr Lockwood was at pains to present the ASA as an unbiased, non-discriminatory organisation that acts independently of pressure groups in its investigations and is open to dialogue with the CAM community. He described the organisation as a “one stop shop for complaints across all media” and stressed that the codes of practice to which they work are not their [the ASA’s] codes, but codes that belong to industry — industry that includes the CAM sector. The inference here was that if we don’t like the codes of practice we should have said so during the public consultations back in 2008 when the new Codes of Advertising Practice (CAP) were written. This raises two interesting points that were highlighted at the meeting last night. In the first instance, the CAM community don’t regard the dissemination of information that relates to their practice as ‘marketing’ in the way interpreted by the ASA. Secondly, the CAM community could never have known in 2008 that the ASA’s remit would be extending in 2011 to all online/digital media or that the ASA would interpret so much of the communications about practice as ‘marketing’ or that they would clamp down using the bully tactics that they have employed in 2011.
Take home points
In summary, the main positive coming out of the meeting — clearly intended to ensure a favourable hearing given the audience of a significant number of homeopaths — was that the ASA has apparently severed its connection with the Nightingale Collaboration and prevented it from deluging the system with hundreds of complaints. This has put paid to the ‘one modality a month’ threat that was the central plank to Nightingale’s attack on CAM therapies and this change has reduced the flood of complaints to little more than a drip. There are only 38 of the 774 complaints still ongoing. New policies have been put in place to deal with persistent complainants and similar future situations and the ASA stressed it is open to working with trade bodies and professional associations to give advice and guidance to the sector. Apparently it is also willing to look at new evidence providing it contains at least one double-blind placebo controlled trial “or similar”. Worryingly the ‘or similar’ was added verbally to the sentence, but wasn’t on the slide presentation. With trials of this nature being inappropriate for much of CAM therapies, we are keen to see how willing the ASA is to explore the ‘or similar’ options now that Mr Lockwood is in the driving seat.
On a less savoury note, agreements have been made between the ASA and Google to secure the removal of paid advertisements for non-compliers. They can also interfere with searches and put up adverts of their own to indicate where an individual, organisation or advert has been found to be guilty of non-compliant advertising. This makes it all the more important to ensure that the investigators are competent to do so and that the acceptable evidence is widened to include that which is appropriate for CAM. We look forward to knocking again on the ASA’s door now that we have Mr Lockwood’s assurance that it is open.
Comments
your voice counts
17 December 2011 at 10:41 pm
The ASA is no more or less competent to judge the validity of CAM claims than any other. Check through the ASA's past rulings, you will find many that are in the field of health products.
CAM is in any case a (deliberate) misdirection. Complementary therapies may well have an evidential basis as adjuncts to treatment, whereas "alternative medicine" (or rather alternative-to-medicine) is a phrase which includes pretty much exclusively stuff that cannot be proven to work and which, for the most part, is allowed to be sold only because it existed at the time regulations were first created and there's no direct evidence of it actually killing people. Lumping them together gives a spurious air of legitimacy to a bunch of claimed therapies which are often abject nonsense.
The more cases of chiropractic strokes and malaria cases among victims of "homeoprophylaxis" fraud, the more likely it is that these grandfather clauses will be reviewed and eliminated.
For all of Big Homeo's railing against "Big Pharma", I do not know of a single homeopathic remedy that would get as far as even the first stage in a standard drug trial.
21 December 2011 at 7:47 pm
Dear Guy, many thanks for your comment. Regarding your opening point, that ASA is “no more or less competent to judge the validity of CAM claims than any other”, we are at a slight loss. Because the experience of the ASA and its experts lies exclusively in orthodox, Western scientific concepts of medicine, is it more competent to make judgements about CAM than, say, a class of kindergarten children? After all, neither the kids nor the ASA know a great deal about the theories and philosophies that underlie much of CAM! On balance, we’re not so sure. We’re certainly not sure that the Western scientific approach to evaluation is the most valid.
We contest the ASA’s competence to assess CAM claims based on one simple fact: that individuals within the ASA adjudication system appear to lack experience of evaluating the overall effects of CAM modalities. To keep this response short, our concerns are crystallised in an article written back in 2007 by our scientific director, Rob Verkerk PhD (we think the article is as relevant today as it was then). The article evaluates the randomised, controlled trial (RCT) approach, regarded as the gold standard by Prof Edzard Ernst — along with numerous others — for investigating the effects of the ‘specific therapeutic effect’ as opposed to what Ernst calls ‘total effect’: http://anhinternational.org/files/071115-Edzard-Ernst-exposee_final.pdf.
It is only the patient who experiences Ernst’s ‘total effect’, and the CAM practitioner becomes the most informed witness to it. At the same time, friends and family who observe a health turn-around in the patient often become advocates or supporters of the overall approach that, apparently, precipitated the improvement. This is a major reason why the take-up of so-called CAM modalities around the world continues to increase, not decline. This trend is occurring and accelerating despite repeated and high-profile rants from people of your ilk — who feel alternative medicine by definition has no support, due to its relegation outside of mainstream practice.
The present form of evidence-based medicine (EBM) is deeply deficient in its ability to evaluate clinical experience: http://www.orthomolecular.org/resources/omns/v07n15.shtml?mid=54. Observational and empirical evidence have generally been downgraded now that we are all made to worship at the altar of the RCT. Guy, we will have to agree to differ, but your bias against CAM therapies is, in our view, largely down to you looking at the wrong bits of evidence. Mainstream medicine fares badly when assessed in terms of clinical experience (see: http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp). And that’s exactly why ASA isn’t in a position to evaluate CAM: because they refuse to accept subject-matter experts into the fray.
We don’t think our push for the inclusion of subject-matter experts is at all far-fetched. If your heart were ever to take a turn for the worse, wouldn’t you be interested in the opinion of a cardiologist — or would that of a gastroenterologist or civil engineer do?
07 November 2014 at 10:01 am
The meeting between David Tredinnick MP from All Party Parliamentary Group for Integrated Healthcare ASA director are giving new hopes to the medical industry. Let us hope that their discussion will bring lights to many such covered topics in this industry.
Your voice counts
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