[bpsdb] The Complementary and Natural Healthcare Council, or "OfQuack", is a new government-funded "voluntary regulator" which is supposedly going to "regulate" the alternative medicine industry - although minutes released from their meetings suggested they have a keen interest in advertising on behalf of the industry too. Understandably, this body has been met with considerable criticism. Other bloggers have tackled this subject, (including the excellent Andy Lewis, and some wag who actually registered the OfQuack.org.uk domain name), so I thought I'd provide a definitive article about them, and also do a little digging around to see if I could dig up anything that others have missed.

Sections:
The History of OfQuack
The Register
Conflicting Interests
The Cracks Appear
Conclusions and Our Response

The History
Writing in the Guardian, Edzard Ernst noted that: "The history of the CNHC reads like that of a government body in a banana republic." He isn't far wrong. The story begins when the the Prince's Foundation for Integrated Health (PFIH) was given £900,000 from the Department of Health, along with £1million from the King's Fund, to be used to set up a regulatory framework for UK alternative practitioners.

Two million quid is a hell of a lot of money, but to give it to the PFIH is bizarre. As Ernst puts it: "Imagine a lobby group - and that is precisely what the PFIH is - for the pharmaceutical industry, sponsored with taxpayers' money, to regulate the pharmaceutical industry. Barmy? Corrupt? Incompetent? You decide."

Indeed, the FIH make no secret of their ambitions: "We want to make integrated health a reality by raising issues at the highest levels of policy and decision-making." They are lobbyists for the Alternative Medicine industry, so why on Earth give them two million pounds to establish a regulatory body for it? But this is all a bit ad hom - let's see how they operate.

The Register
The main purpose of the CNHC is to establish a national register of alternative health practitioners. The idea is that the register then becomes a handy tool for consumers - if your alt med quack is on the OfQuack register then he's okay, if not then he might be a bit fishy. Quacks who fail to meet certain standards get struck off the register, a bit like real doctors do. It all sounds fairly reasonable on the surface.

I'm going to start by stating the obvious. The most basic, fundamental task of an industry regulator should be to ensure that products meet a certain standard. If they cannot do that then they are utterly useless. If the Complementary and Natural Healthcare Council cannot demonstrate that the practitioners included on their register are selling treatments that work, then they should not include those practitioners on their register in the first place. Of course, were they to adopt this policy, then the register would contain precisely zero entries.

Of course the members of the CNHC are well aware of that - and just how they cope with the cognitive dissonance that must be raging in their heads defies belief. If you look through the website, it is an exercise in psychological denialism. Any mention of the efficacy of treatments has been carefully avoided. At no point in the application process are practitioners asked to provide evidence that their treatments actually work. Indeed, aside from the requirement to hold current professional indemnity insurance, I can see absolutely no obstacle to getting myself listed on the registry. If any of my readers do hold such insurance, and are willing to stump up £15 for the application process, I'd urge you to try it.

The nearest we come to anything like demanding evidence is the complaints process. The complaints which the CNHC are willing to listen to are as follows:

The types of complaints that we can consider are those where a practitioner’s “fitness to practise” is brought into question by:
• misconduct. Examples of this might include: failing to keep accurate records; working under the influence of alcohol; having sexual relationships with patients; not communicating well enough with patients
• a lack of competence (not having the required skills and knowledge)
• a caution or conviction for an offence in the UK (or somewhere else for an offence that would be a crime if it were committed in the UK). Examples of such offences might include theft; violence; child pornography
• physical or mental health problems
• a decision by another health care regulator

The closest we get here is "lack of competence", but note the weasel-worded clarifying clause appended "(not having the required skills or knowledge)". Since the "required" skills mentioned by the registration process do not seem to include "demonstrating that the treatment works", this is simply meaningless. I could be a perfectly well-qualified homeopath, fail to cure a single patient, and still demonstrate "competence" in the eyes of OfQuack.

Conflicting Interests
One of the most disturbing quotes from the Complementary and Natural Healthcare Council website comes courtesy of the minutes from their first quarterly meeting,held in November. Before you read this, firstly remember that these people are claiming to be industry regulators, and secondly imagine the uproar if this occurred in the minutes of a Pharmaceutical Regulatory meeting:

12 PR Strategy
MD reported that both CoChairs had met recently with Jon Hanlon (JH) and that two press releases had been agreed ready to distribute to the relevant organisations and publications. A list of contacts has been produced; all Board members were encouraged to submit details of other potential contacts, publications and organisations for inclusion in the PR database.

JG suggested the possible use of patients with ‘good news’ regarding complementary therapies on www.patientvoices.co.uk.

Incredible - a regulatory body seriously considering the idea of feeding positive reviews to a popular website. I can't put it any better than this anonymous commenter:

What worries me much more is that http://www.patientvoices.co.uk (on which patients can post comments about their experiences) has been a genuinely valuable site, to which I frequently refer medical students, in order to promote integrated, holistic, patient centred rational medicine. If it becomes swamped by posts of those with a financial interest at the behest of a Government funded organisation, then I would be deeply dismayed. And this is listed under "PR" - not even pretending to be about good health. I would complain. but the complaint would have to be to those who set it up. So I plan to just despair.

So the CNHC, who are setting themselves up as industry regulators, intend to use some pretty devious methods to promote the practitioners they are supposed to be clamping down own? Worse still, this blatant conflict of interest is enshrined in their mission statement:

"CNHC's mission is to support the use of complementary and natural healthcare as a uniquely positive, safe and effective experience"

Uniquely positive? Uniquely effective? How on Earth can they make such claims when they can provide nothing in the way of evidence to back it up? And why on Earth is a government sponsored regulator behaving like a bunch of lobbyists in making these claims in the first place? How can the body responsible for regulating therapists also be allowed to promote them? Again, if a pharamaceutical regulatory body behaved in this way, alternative medicine advocates would (rightly) be up in arms about it! It is utterly scandalous.

The Cracks Appear
Things haven't been plain sailing for the CNHC so far. Firstly, the idea of government regulation has gone down like a lead balloon with some elements of the alternative medicine. So far the only disciplines eligible to register are Massage Therapy and Nutritional Therapy. Other professional groups have stalled for a variety of reasons, ranging from the assertion that they are perfectly capable of maintaining their own registers, to suggestions that the CNHC is part of some Big Pharma conspiracy to clamp down on the Alt Med community.

Andy Lewis provides a summary of some of the responses on his blog. One aromatherapist, apparently oblivious to how the body was formed, rambles:

"What is the real motivation behind this? Its all about money & control. The pharmaceutical trade has for a long time looked with envy at the £130 million per year turnover generated by Complementary Alternative Medicine (CAM), which is expected to rise to £200 million within four years (Hawkes 2007) and its storm troopers have..."

...blah blah blah and so on and you get the idea. The head of the Reiki Regulatory Working Group haughtily suggests: "We believe the Regulator should have an overriding duty to regulate the practitioners, but not the practices or therapies themselves, e.g. such as the teaching of Reiki in its many diverse forms." Because god forbid that an industry regulator should actually regulate the product that the industry produces. Similar rejections have come from the Society of Homeopaths over the last year, but I won't dwell on those as I'm saving up for a concerted attack on SoH in the near future.

Further problems have come from their attempt to introduce a Kitemark. You can read more about this on Quackometer, but just to briefly summarize, the CNHC stated that members would receive a CNHC kitemark for public display, which they could then use in publicity materials. This was brought to the attention of the British Standards Institute, who are in fact the only people allowed to issue kitemarks. The idea has been quietly dropped from the CNHC website, but it is frankly rather embarassing that a government-funded body that has taken so long to set up has gotten such basic things wrong.

Will this all matter in the long run? It's difficult to say. On the one hand, clearly they are not welcome by the alternative medicine establishment. On the other, the establishment does not necessarily represent the views of alternative medicine practitioners, who may join for the perceived commercial benefit. The aim of the CNHC is to add 10,000 members to its register by the end of 2009 - time will tell if they reach that goal.

Conclusions
The Complementary and Natural Healthcare Council have achieved one notable first, becoming possibly the only body in the world that is derided by both skeptics and alternative medicine practitioners. Putting them into the middle of this debate armed with little more than a plucky attitude is like trying to achieve peace in the middle East by sending Quincy to the Gaza border armed with a large baguette. They are toothless, lacking any real power, and with little support from the community.

And even if they were likely to be effective in their mission, that mission is so lacking in effectiveness as to be meaningless. The only complaints they will deal with involve a member's "fitness to practice", but since they have no punitive powers any such matters are likely to be better dealt with by the police, trading standards, or other relevant officials. Indeed, as the Economist pointed out recently, there is a bizarre conflict between the establishment of this agency, and the creation of new consumer-protection laws in 2008 that specifically forbid false claims that a product can cure a disease. Since the government has so far been unwilling to draw a line in the sand over what works and what doesn't, we are in an insane situation where money is being pumped into a body designed to regulate industries that could well be effectively illegal.

But what's worse than all of this is the way in which this has been set up. To award money to lobbyists so that they can establish a regulatory body for their own industry is a decision that I find utterly bewildering. I cannot understand how such a decision came about, and I plan to dig deeper, perhaps using the FOIA if it applies here, to try and find out. If anyone else finds anything interesting, I'd love to know.

There are two other obvious courses of action that the more mischievous among you may choose to take. Firstly, the complaints procedure needs to be tested - specifically their clause regarding competence. If I visit a homeopath, and they tell me that a glass of highly-priced tap water will cure Malaria, can I have them struck off for misconduct or incompetence?

And secondly, given that the only barrier to entry on the register I can see is a lack of indemnity insurance, perhaps if one of my readers happens to have such a policy, they might give the application process a go and let us know whether they succeed. There could be no greater demonstration of the ineffectiveness of this Council than the ability of a skeptic with no industry experience to get themselves registered.

And with that challenge, I finish this mammoth post. I hope I've given a comprehensive overview of these people, and I'll be bringing you more on the CNHC as and when I find it.

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Thanks to Dr*T of the Badscience.net Forums for the excellent OfQuack Logo :)