More than two months after its launch, the Nightingale Collaboration is still attracting flak from CAM practitioners who apparently can’t abide the prospect of being held to the same standards as advertisers of other products and services. I don’t expect many of these critics to have the stomach to read much of what I say here. For them, I’m putting the case for the Nightingale Collaboration in a nutshell at the beginning:

P1. We believe we should be able to make an informed choice about healthcare treatments as we do about anything else
P2. Making misleading claims about healthcare therapies in order to encourage sick people to try them is unethical and potentially dangerous
P3: The vast majority of misleading claims are made about CAM treatments
P4. There are regulations in place intended to prevent questionable claims being made in the promotion of healthcare therapies
C1: Healthcare practitioners shouldn’t make misleading claims in their advertising
C2: We can and should challenge those misleading claims and try to get them withdrawn.

The most novel response so far has been homeopath Sue Trotter’s public explanation of her cunning plan to defend homeopathy from complaints to the Advertising Standards Authority by playing the race card.

If we can find some British Indians/ Pakistanis or Bangladeshi’s they can complain to the ASA explaining that homeopathy is a prefered system of medicine in their countries of origin, used to treat a wide range of illnesses. The current wave of complaints against homeopaths would therefore seem to be an attack on their culture and beliefs and therefore discriminatory. (I know homeopathy is not a belief system but many think it is, so why not use that to our advantage).

In the ensuing twitter storm, one tweeter put it more succinctly:

Homeopaths with integrity will no doubt be appalled and embarrassed by this suggestion and, although they haven’t found the time yet, I expect they’ll be publicly disassociating themselves from it and condemning it on Twitter and their various blogs very soon.

But in Sue Trotter’s defence, at least she is thinking out of her box, so to speak. Other responses have included the drearily familiar attempts to misrepresent facts, motives and arguments and cast aspersions. Let’s start with an extract from from Lionel Milgrom’s website:

These days, homeopathy is coming under mounting criticism for supposedly lacking any scientific evidence. Indeed, a group calling itself the Nightingale Collaboration has set its sights on anyone claiming homeopathy has any therapeutic benefits because of its putative ‘implausibility’.

I wish! Unfortunately, the Nightingale Collaboration has only set its sights on anyone making misleading claims about the products and services offered by healthcare practitioners. That the NC chose to focus on homeopathy first is not so much because it is scientifically implausible than because there simply isn’t any robust evidence that homeopathy is effective for anything and yet hundreds of UK homeopaths are claiming to be able to treat everything from asthma to multiple sclerosis.

Last year, for example, I found a pile of leaflets in the waiting area of my local optician advertising the services of a homeopath and stating that homeopathy could treat heart disease and cancer.

Who knows how many similarly outrageous leaflets by other unscrupulous quacks are still in circulation?

The Nightingale Collaboration’s official launch on 1st March coincided with the extenstion of the Advertising Standards Authority’s digital remit, which meant that we could finally start complaining about the pernicious self-promotion all over the web of people who push this nonsense.

The websites I personally complained about included one that suggested homeopathic remedies could be used to prevent pertussis and tetanus and another that advises us to

avoid antivirals, antibiotics, vaccinations, cell phones, wireless radiation, stress and other negative emotions, etc. as they lower the immune system…when you do catch the flu a 30 min. acute consultation (can be by phone) is required to establish the remedy that most closely corresponds to your flu symptoms. A chronic illness requires a 90 min. consultation.

Yet another claimed homeopathy could help people with HIV/AIDs and suggested that

By keeping patients healthy and balanced homeopathy might slow disease processes down.

Claims such as these are unsupportable and potentially harmful. It follows that making them is unethical and indefensible. It is not wrong to try to get such claims removed; it is wrong to make them in the first place. If you are one of the people who can’t see this then you are stupid and irresponsible and you should be ashamed of yourself.

We don’t make the rules

Fortunately, there are regulations in place to ensure that advertising is legal, decent, honest and truthful. Unfortunately, they don’t go far enough, in my opinion. If I made the rules, they would be more stringent. For example, I would forbid anyone who is selling a healthcare therapy or service from stating hogwash like,

homeopathy acts by virtue of a resonance between the energy pattern of the remedy and the person’s energy body

unless preceded by the words, ‘homeopaths believe’. Stop presenting this faith-based therapy with its fanciful explanations and weird rituals as if it were based on proven facts, because gullible people tend to believe whatever they like the sound of. Having them believe you might be good for business and wouldn’t matter too much if homeopathic treatments were only being taken to treat, say, nocturnal leg cramps, which is why one acquaintance of mine swears by it. It matters rather more when taken to treat malaria or colorectal cancer.

That said, the fact that the regulations as they stand are being breached on a massive scale by homeopaths and other healthcare practitioners makes the task of challenging them somewhat easier. We simply have to complain about them to the ASA and to other regulatory bodies as appropriate. The decision on whether their rules are being broken lies not with the NC but with the regulatory bodies themselves, obviously.

That the NC was set up to help and encourage people to use this very legitimate means of challenging false claims provoked much self-righteous indignation from those who want to spout whatever baloney they like all in the cause of lining their own pockets. “Sceptics acting like policemen”, is how one critic put it in an email to me. Well, why the hell shouldn’t we act like policemen? You’re the ones who are trying to con us into buying your worthless cult therapies, not the other way around, so spare us the sanctimonious whining.

Red Herrings

Here’s Lionel again:

This willful attitude of closed-mindedness (that incidentally, would see the public robbed of its right to receive homeopathic treatment free on the NHS), ignores the fact that by end of 2009, 142 trials of homeopathy had been published in peer-reviewed journals. In terms of statistically significant results, 74 of these trials were able to draw firm conclusions: 63 were positive (patients given a homeopathic medicine improved significantly more than the comparison group given either an inactive placebo or established conventional treatment), and 11 were negative (i.e., no significant difference was seen between the action of the homeopathic medicine and the comparison group)  [ref 1].

The evidence Lionel references has been examined and re-examined and exposed for being deeply flawed time and time again on many websites and blogs, including this one. It is precisely because the evidence presented for homeopathy is so weak that homeopathy is so confidently ridiculed and its availability on our NHS so passionately opposed.

I have asked it before and I’ll ask it again: Why on earth do homeopathists think we wouldn’t be absolutely delighted if homeopathy – or any other quack therapy for that matter – was as good as they say it is? It would revolutionise healthcare systems and save our National Health Service a fortune. Pharmaceuticals that have taken years and cost millions to research and develop could be replaced by homeopathic remedies produced at a fraction of the cost. I’m aware that my least favourite homeopathic ingredient – excrementum caninum – can be produced very cheaply and goes a long, long way when used in homeopathic remedies. In fact, it is diluted so much there’s nothing left of it. Thank goodness.

The answer they commonly give is that we’re all “denialists”, wilfully closed-minded to the manifest benefits of CAM because we are being paid by Big Pharma. Well, people who would stoop to claiming that sugar pills have the power to treat serious diseases in order to make a few quid would say that, wouldn’t they? In fairness, I’m not saying that everyone who exploits the vulnerability of sick and desperate people by pushing worthless therapies at them is only motivated by money. I think they get off on the feeling of power that being a…ahem…”healer” brings too.

But I’ve never really understood why they think Big Pharma would pay us to oppose something with so many benefits for humankind, rather than just cash in on it. This is how one anonymous correspondent explained it to me:

The current smear campaign against CAM is due more to it having a positive rather than negative effect, and its growing popularity is beginning to worry drug companies. Pharmaceuticals are big business, and if the public loses faith in prescription drugs then it will severely affect their profits.

The main reason I haven’t posted here much over the past several months is that I wasn’t feeling well. I spent many weeks over the winter waiting for medical appointments and then spent many hours sitting in hospital waiting rooms that were packed with other people and their loathsome diseases. I can’t say I’ve seen any evidence that the British public are abandoning the NHS with its medically qualified personnel and modern pharmaceuticals, so I’m not convinced that Big Pharma feels threatened by homeopathy at all, let alone enough to start paying anyone to attack it.

Do they seriously think people working for pharmaceutical companies couldn’t find another way to get rich? If homeopathy worked, they could surely cash in on it. Even though it doesn’t work, the Boiron family seem to be doing well out of it.

If only homeopathy worked, I’m sure many of us would be queuing up to train as homeopaths. Given the prices some of my local homeopaths are charging – up to £90 for an initial consultation and up to £50 for every follow-up appointment – it would seem that, if only they can get enough people to believe in it, a decent living could be made from homeopathy. That’s even more than Big Pharma are paying me to write this blog.

Lies, damned lies…

If it worked of course, there would be an abundance of good quality clinical trials demonstrating it conclusively. But there isn’t – there is only an abundance of crappy little trials which, on the whole, prove homeopathy works no better than placebo. That would explain why the lies told by homeopaths on their websites are such huge lies, such brazen lies, such desperate lies. Like this one from Lionel Milgrom:

In addition, the Nightingale Collaboration ignores on-going research published by the British Medical Journal which demonstrates that out of 2500 conventional medical procedures tested recently, only 11% proved beneficial, while more than half (51%) turned out to be of unknown effectiveness [ref 2].

If Lionel would actually read the paper he references and links to, he would see that it doesn’t refer to “2500 conventional medical procedures” but to “3000 treatments” and that,

included within the category of unknown effectiveness are many treatments that come under the description of complementary medicine, for example, acupuncture for low back pain and echinacea for the common cold….

So it’s not about conventional treatments, it’s about all kinds of treatments, including the one Lionel is peddling. To be fair, maybe Lionel did what all quacks seem to do and just took someone’s word for it, instead of reading the damn paper. That reminds me of a jolly jape you might like to try:

1. Google the phrase: ‘Homeopathy was recognised by an Act of Parliament in 1948 as a safe alternative form of medicinal treatment’.
2. Select a bunch of websites that include this claim – there were dozens when I tried this some months ago;
3. Send a polite email asking them which Act of Parliament this claim refers to;
4. Sit back and enjoy any responses. You probably won’t get many.

To cut a long story short, one advertiser I contacted spilt the beans with this:

Thank you for your email concerning the Homoeopathy Act of Parliament. This information came from a homoeopathy booklet that was the main source for the page. This information seems to be widely spread and taken for granted.

Evidently.

One advertiser told me that homeopathy itself was “ratified” by parliament under The Faculty of Homeopathy Act 1950 (untrue), while someone at the Society of Homeopaths, to whom I was referred by another clueless advertiser, said:

I believe the information maybe referring  to the 1948 NHS Act from which time homeopathy has been available on the NHS which does not endorse homeopathy.

That sounds about right.

My favourite response was from the owner of this site.

I have received your enquiry through my website re the 1948 Act relating to homeopathy. I would be delighted to answer your query and discuss this further. Send me your name and number and I will give you a call to chat through.

I think she’ll do well in her chosen career. I see that claim is still on her site, together with claims that homeopathy helps autism, Crohn’s disease, fertility problems and much more besides. (Edit: 29/11/11. I’ve just seen the site is currently offline. I have the claims page frozen for posterity, however.)  Most of the others I contacted – among them the Homeopathic Medical Association – have removed it, to their credit. Another who hasn’t is Nelson’s, which is where I spotted it in the first place. I didn’t even get the courtesy of a response from them but then you know what these callous drug companies are like.

Anyway, that digression was simply another illustration of how homeopaths seem to believe whatever they want to believe, regardless of the evidence and therein lies the explanation of why they became homeopaths in the first place. By the way, I hope everyone’s read Le Canard Noir’s illuminating blog entitled, Escaping the cult of homeopathy, which quotes extensively from an ex-homeopath/cult survivor.

…tu quoque…

But to get back on topic, what does the effectiveness or otherwise of conventional medicine have to do with the Nightingale Collaboration, whose purpose is to challenge misleading claims in the promotion of healthcare treatments to the public? As the NC website states in the FAQs:

If there are misleading claims in advertising for conventional medicine, then we believe these should be challenged too and the resources we make available on this site should help people to do that.

The most common response from defenders of altmed to skeptics is to talk about the failings of conventional medicine. There is a widespread failure on the part of altmed defenders to comprehend that the failings of conventional medicine have no bearing whatsoever on the truth of whether alternative medicines work or not. A lot of them seem to take the view that anyone who attacks quackery is by definition an apologist for every sin ever committed in the history of mainstream medicine and, according to some of them – such the embittered group of chiros who hang around chiropracticlive and stalk skeptics’ blogs – we’re “bigots” for attacking CAM and ignoring conventional medicine. (By ‘bigots’ they of course mean ‘hypocrites’ – they’re not the sharpest knives in the drawer.) It’s the tu quoque fallacy.

What I say to such people is that the only thing we can do about conventional medicine is challenge any misleading claims made in its advertising to the public. Same as for CAM, in fact. The NC website is full of information about how to make complaints, so if you come across a UK website or other advertisement promoting a healthcare product or service that you believe is making a false claim, then use the information helpfully provided to do something about it. Together we can work to ensure that healthcare advertising is truthful and accurate! And if you come across conventional medicine websites that make false claims about being able to treat heart disease and cancer or prevent whooping cough or measles, then please send an email alerting the Nightingale Collaboration. (Assuming you believe it’s OK to police such websites and try to get such claims removed. I do.)

…and diversions

While busy policing CAM websites, I have seen several that do not make false claims, demonstrating that it is possible to promote CAM without lying. It is indisputable, however, that the vast majority of misleading healthcare claims appearing in advertising aimed at the UK general public are in promotions for CAM therapies and products. You can try to divert attention away from that fact but you can’t hide it and it becomes wearisome to see opponents of the NC resort to diversionary strategies such as going on about stuff we can’t do anything about. Like Lionel Milgrom does with:

Then a House of Commons Select Committee reported that in 2006 alone, a staggering 2.68 million people i.e., 4.5% of the UK population) were harmed by the effects, side-effects, and errors of conventional medical practice [ref 3]. In the USA, the situation is even worse: its healthcare system is the third leading cause of mortality in the US after heart disease and cancer….more deaths than through firearms [ref 4].

Good grief – the Nightingale Collaboration to the rescue! Let’s forget about challenging false claims in advertising and sort out the USA healthcare system shall we? What a dickhead. (If anyone thinks that’s harsh, I invite them to read what Lionel said about Lord Taverne here.)

But Lionel’s not the only one. Quite a few critics think we shouldn’t be spending our time on the heinous crime of trying to ensure that healthcare advertising is truthful and would be better employed instead doing just about anything else including,

complaining about so called pharmaceutical drugs and their effects on humankind

(doing something) about the many dangers in food production, such as the use of aspartame, and the continued widespread use of flouride,

going after the drug companies and getting them to put “Taking this drug may endanger your life/health” in large RED Letters on the label and in adverts,

protecting us from misapplied drug therapy, covered up drug trials, commercial frauds by the pharma industry. Government funded misguided political errors. Scientists with the compassion and emotional level of a newt,

All the above suggestions were culled from emails and – yes, I know – it’s amazing just how much power and influence our critics seem to think we have, isn’t it? By the way, Ben Goldacre blogs about the evils of Big Pharma fairly regularly (recent examples: 1, 2, 3) but I don’t see many quacks applauding him for doing so.

Best of all was the tweet by the holistic vet:

The Nightingale Collaboration have their sites on #homeopathic folk. Pity they’re not concerned with arms manufacturers.

Yeah, we should really take on the arms manufacturers instead of challenging all those lies about being able to treat heart disease and prevent measles. We’d achieve world peace and they’d be able to continue ripping people off and endangering their lives. Win-win, I’d say.

Back to Lionel:

Also, the often-repeated claim by sceptics [ref 6] that homeopathy is dangerous because patients seek its help rather than conventional healthcare is simply not backed up by the evidence.

Well, it is actually. Have a look at this report, for example, from the National Cancer Institute in Karachi:

Breast cancer patients in Pakistan frequently (53%) delay seeking medical advice. Antecedent practice of CAM is widespread and a common underlying reason. The delay results in significant worsening of the disease process.

The report tells us that 70% of the CAM used is homeopathy.

The callous and dismissive attitude quacks display about victims of their propaganda reminds me of the anti-vaxers who protest that “only” 16 children died of measles in England and Wales in the year prior to the launch of the MMR jab. In fact it was the death of just one child, Cameron Ayres, that alerted me to the fact that putting faith in batshit insane therapies like homeopathy isn’t as harmless as I’d previously assumed. A hat-tip to the homeopath who is said to have begged Cameron’s parents to get him to proper doctors but, the thing is, if you encourage people to have faith in implausible and unsupported therapies in the first place, you’re not entirely blameless if people take you seriously and tragedies ensue. As the spokesman from the Society of Homeopaths told the BBC when the story of Cameron was reported,

Increasingly, with the rise in popularity of complementary medicine these situations are going to arise.

Quite.

Later I read the story of Janeza Podgorsek who died because he believed a homeopath’s claim that homeopathy would work to prevent him getting malaria and, when it didn’t, he believed the homeopath’s claim to be able to treat the malaria he’d caught. Most recently we’ve read about Penelope Dingle who refused to have the surgery that could have saved her life because she believed a homeopath could cure her colorectal cancer. And there are loads more at http://whatstheharm.net/.

Edit: A heartbreaking documentary on Penelope Dingle’s fate, has been uploaded to youtube and here’s an early news report on the alleged manslaughter of 4 year-old Luca Monsellato by his homeopathist parents.

Motives

So what on earth motivates us to try to get the kind of claims that have lead to needless deaths removed?

Yes, for people who are evidently so thick, so lacking in human compassion and empathy, so self-interested and so blinkered, that is a serious question and one to which, for precisely the same reasons, they are unable to grasp the answer even when it’s thrust right under their stupid noses.

Or could it be that they know their battle for the right to happily promote bogus therapies is all but lost and that the only battle they have left is a personal one against the people who burst their bubble? And that’s one they obviously can’t win because they have neither the ammunition nor the brains to use it.

I’ll leave the last word to one of them, who sent me this constructive suggestion.

Maybe you should detach yourselves from the Dark Cabal and global elite which plan to wipe out 90% of this human population, you really don’t wish to have this on your conscious or to deal with in kama,…and rather get to work on finding out why so many natural healing products CAN actually heal the patient, how quantum energy can be infused with this, and how our ancients were so much more advanced with this knowledge, making us look like living in the dark ages in comparison, with so many selling out the human race.

Yeah, whatever.

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