Monday, 24 October 2011

Censorship by any other name! Egged on by the enemies of homeopathy the ASA sails into uncharted waters without a navigator and gets out of its depth!

The Advertising Standards Authority has recently made an Adjudication against parts of a fully referenced New Statesman press release last year by the homeopathic charity, H:MC21 [Homeopathy for the 21st Century] urging integration of homeopathic practitioners into front-line healthcare whilst monitoring both clinical and cost benefits. There are serious concerns both over the manner in which the ASA arrived at its assessment, using discredited sources often quoted by denigrators of homeopathy, and the twisted logic and lack of fairness in the conclusions it arrived at. It took it a staggering 10 months to get there with some clear shifts of goalposts in its challenges of H:MC21 on the way. Its staff seemed hellbent on finding spurious ways of attacking purely factual statements. The outcome flew in the face of commonsense; it is without doubt an unashamed attempt at censorship of facts being published to support the case for an expanded use of homeopathy within the NHS alongside conventional medicine. This is unacceptable in a democratic society which cherishes the principle of freedom of expression1.

Separately the ASA has been attempting with threatening letters to bully a number of individual homeopaths into self-censorship of some of the content of their websites. And at 
you will also be able to read the ASA’s attack against a qualified herbalist who is stating certain long recorded truths about the benefits of natural herbs such as echinacea, astragalus, goldenseal etc. I have used all these personally on myself. They are part of the wide and very effective range of natural remedies that can often support your immune system sufficiently to enable it to throw off rapidly flu, colds, sore throats, gastro-intestinal problems etc without you having to bother your doctor for chemical drugs and risking the possibility of side effects. They are the remedies every human being has a right to elect to have access to information on, to discuss freely with others on websites or elsewhere, and to be able to purchase at a reasonable price, thereby ensuring that he/she can self-medicate should he/she so wish without accepting blindly the dictates of others.

A bit more about the ASA and its method of operating.

The ASA is a non-statutory body set up and paid for by the advertising industry to regulate advertising. It has no statutory powers to enforce its adjudications. It has only recently extended its activities to websites. We know from what ASA staff have said to H:MC21 and some homeopathic associations that they have inadequate in-house expertise to be able to understand, and accept, that there are significant differences between the homeopathic and conventional medicine paradigms, and the different test methods each of these two medical systems considers most appropriate for testing the effectiveness of its remedies and prescribing procedures. They did not find a suitable external “expert” to advise them in the H:MC21 case. So they defaulted to applying, wrongly, to the H:MC21 case the current mindset of conventional medicine’s controlling clique.

This means that despite the fact that homeopathic medicine is far older than conventional medicine and has been safely practised with much success since the 1800s, and as part of the NHS since 1941, the ASA are unable, or unwilling, to accept that the historical record of homeopathic medicine - two centuries worth of observations, clinical reports and case studies in Europe, the USA and the rest of the world by some of the finest medical minds (fully qualified MDs and other professionals) of their era, including the present - is itself more than sufficient proof for both general and specific statements about its usefulness in treating a very full range of ailments, and certainly to confirm the truth of the statement “Homeopathy has a history of success in chronic illness”. In order for this not to be true i.e. that homeopathy is no more effective than slipping a patient a placebo we would have to assume the greatest case of medical self-delusion across continents and time in the history of science.

References in the text of the ASA adjudication make it clear that their reasoning has been well and truly misinformed by these two things:
1. The very hostile approach taken by the Chairman, Phil Willis, and Dr Evan Harris, both of whom were already wellknown for their extreme anti-homeopathy views, in the House of Commons Science and Technology Committee review which fed through into every paragraph of the Committee Report (Evidence Check 2)3 dated Monday 22nd Feb 2010.
2. The (conventional medicine) notion that the gold standard4 of scientific evidence for their, and hence, in their view, every, medical paradigm is a double blind RCT (randomised controlled trial). As far as we can tell, since they wouldn’t tell H:MC21 (in itself a breach of due process), the ASA justify the upholding of some of the challenges to H:MC21’s statements by reliance on just one flawed meta-analysis in 2005 by Shang et al.

1. Evidence Check 2

As Lord Baldwin of Bewdley, chairman of the House of Lords’ Science and Technology Committee which had carried out a review of Complementary and Alternative Medicine in 2000, commented in a typical British understatement, “The (S&T) Committee however has been less than rigorous in its approach to this evidence. Its choice of witnesses favoured a medical media opponent of homeopathy over a research centre of excellence. It was unwise to rely heavily on the interpretations of one professor of CAM [Ernst], some of whose statements are unsound or in conflict with other statements of his, and who is not without his critics in the worlds of research and academia whose views were given less prominence. The 2005 review by Shang et al has been inaccurately represented as ruling out specific effects of homeopathy, in a summary statement by the Committee that goes beyond present evidence......These limitations make the Committee’s report an unreliable source of evidence about homeopathy”. That is a polite euphemism for saying the conclusions of the report were BS, as 70 MPs also subsequently signalled by supporting the Early Day Motion on 23rd Feb 2010 against the report (extracted at the end of this posting), and as no one reading the report with an open mind could be in any doubt about.

How large and impartial was this socalled Science and Technology Committee?
For the sake of completeness, I would remind the ASA staff and Council in case they overlooked just what a “kangaroo court” lay behind this report and the reason for the follow-up EDM, that the Chairman and Dr Evan Harris were known in advance for their extreme anti-homeopathy views and that out of the THREE MPs who voted for the eventual report (Ian Cawsey, Evan Harris and Doug Naysmith5, now all ex-MPs), two hadn’t even attended the hearings and one of the two was not even a member of the Committee when the hearings were held6! Talk about a stacked deck! See
to understand how blatantly biased the proceedings were and consequently rather irrelevant to a proper consideration of those of H:MC21 statements that have been challenged by homeopathy’s “professional” detractors.

The Government itself followed up in July 2010 when the Secretary of State for Health presented to Parliament the “Government Response to the Science and Technology Committee report 'Evidence Check 2: Homeopathy’ “. Overall, he too was far too polite in responding to the recommendations of the anti-homeopathy Gang of Three MPs, but in doing so he properly stressed the legal requirement under EU directive that patients must have access to the medicinal products of their choice. In his words

“37. Homeopathy has a long tradition in Europe and is a recognised and
widely used system of medicine across the EU. The Government takes
the view that consumers who choose to use homeopathic medicines
should be fully informed about their purpose and assured that standards
of quality and safety are maintained. If homeopathic medicines were not
subject to any kind of regulatory control consumers would not have
access to such information or assurances. Conversely, if regulation was
applied to homeopathic medicines as understood in the context of
conventional pharmaceutical medicines, these products would have to be
withdrawn from the market as medicines. This would constrain
consumer choice and, more importantly, risk the introduction of
unregulated, poor quality and potentially unsafe products on the market
to satisfy consumer demand.
38. The concern to achieve consumer choice while protecting public health is
also reflected at a European level. Thus Recital 9 to Directive
92/73/EEC7 made clear the overall policy position concerning
homeopathic products in the EU: “Whereas, despite considerable
differences in the status of alternative medicines in the Member States,
patients should be allowed access to the medicinal products of their
choice, provided all precautions are taken to ensure the quality and
safety of the said products.”

2. The differences in the two medical paradigms and the relevance of RCT evidence

It has been said that there are two laws of healing –- the law of opposites (allopathy/conventional medicine) and the law of similars (homeopathy).

Conventional medicine is based on the treatment of a diagnosed disease and suppression of its symptoms with material doses of chemicals. Pharma drugs work through the Law of Opposites, eg. antibiotics, anti-inflammatories, anti-convulsants, anti-hypertensives, anti-depressants, anti-psychotics, etc. This can be effective, especially the use of antibiotics for bacterial acutes, but it risks giving the semblance of healing and sometimes plays havoc with the internal ecology of the body, trusting one supposes that the body’s innate immune system is strong enough to come to the rescue. Whatever ... it is a system of medicine for all its faults. Many have benefited from it, though many also have not, and a million Britons are hospitalised by prescription medicines every year, costing the NHS £2 billion8.

Homeopathy is different. It is not suppressive of symptoms. It focuses on triggering the best possible healing reaction from the immune system with the minimum remedy dose (highly diluted and vigorously shaken to ‘energise’ it) after an individualised casetaking of all the symptoms and case history of the patient has identified a remedy known to produce similar symptoms in a healthy person (the law of similars). Importantly, one or more remedies may be prescribed in succession, sometimes in different potencies as symptoms change, and over what may be an extended period.

The mechanics of an RCT based as they are upon the reductionist principle of dividing the whole into ‘parts’ small enough to be measured or monitored in isolation, hence restricting the test to a single remedy, and not taking account of the patient’s overall experience of the treatment being trialled, do not lend themselves well to testing the homeopathic process. For this reason, as well as the very high cost of RCTs, the substantial body of evidence for homeopathy very properly comes from clinical research, from outcome studies9, from cost-effectiveness studies and from empirical evidence (i.e. from practice ‘on the job’). It is therefore truly “evidence based”10. This has been possible because homeopathic remedies won’t kill or damage the patient.

Notwithstanding the above, there are a considerable number of RCTs of individual homeopathic remedies for specific conditions which have been conducted vs placebo11. Of those which came up with conclusive results, more are indeed positive (44%) than negative (7%), as H:MC21 stated; a factual statement which the ASA considered couldn’t be stated, unless accompanied by the information that 49% were (for unexplained reasons) inconclusive.

In the end however the ASA’s hands were over their ears because they wanted only to hear evidence that said that homeopathy was no better than placebo, the corollary to which is that all the people it had helped cure through history had been duped idiots.

The Adjudication says that the ASA had been given “a substantial review of over 100 placebo controlled trials (which) showed no convincing evidence that homeopathy was superior to placebo”. The ASA told H:MC21 about this very late in the investigation and refused to say exactly what review that was (another lack of due process). The only review it could have been was the 2005 Shang et al review which was a meta-analysis which selectively eliminated all but 8 RCTs out of the 110 they started with in order - surprise surprise - to come to a conclusion which would say homeopathy was no better than placebo. Shang et al’s methods and conclusions have - no surprise - since been found to be flawed as HMC21 pointed out [A.L.B.Rutten and C.F.Stolper, ‘THE 2005 meta-analaysis of homeopathy: the importance of post-publication data’, Homeopathy, 97 (2008), 169-177, - “Re-analysis of Shang's post-publication data did not support the conclusion that homeopathy is a placebo effect. The conclusion that homeopathy is, and that conventional is not, a placebo effect was not based on comparative analysis and not justified because of heterogeneity and lack of sensitivity analysis. If we confine ourselves to the predefined hypotheses and the part of the analysis that is indeed comparative, the conclusion should be that quality of homeopathic trials is better than of conventional trials, for all trials (p=0.03) as well as for smaller trials (p=0.003).” and L├╝dtke R, Rutten AL , J Clin Epidemiol. 2008 Dec;61(12):1197-204. Epub 2008 Oct 1. “Homeopathy had a significant effect beyond placebo ..... Shang's negative results were mainly influenced by one single trial on preventing muscle soreness in 400 long-distance runners“].

In conclusion, if one was overly suspicious one might suspect that the ASA needed 10 months to find some stretched “interpretations” of the true facts in plain English which H:MC21 had used in its press release (see previous post), which could, just possibly, provide them with an excuse to Uphold some of the challenges which the rather nasty Nightingale Collaboration and fellow travellers had made. Something which would allow them to say, with fingers crossed behind their backs and ignoring the length of their own noses, “we note that you H:MC21 believe that you have provided evidence for certain factual statements known already by millions around the world that e.g. “Homeopathy has a history of success in chronic illness” and that “In Cuba, an integrated approach to healthcare has led to homeopathy being used to enable 2.3 million ... to be cheaply and effectively protected against endemic Leptospirosis”, but we, the ASA, concluded (after referring to the skewed information the kind people at the Nightingale Collaboration gave us) that you hadn’t supplied sufficient evidence.”

“Phew! (sighs of relief). That got us out of a possibly embarrassing position with the companies which help pay ASA salaries and spend such a lot of money on advertising in the UK, and have such close links with important people in government and the medical profession”.

But, hang on a moment fellows. Isn’t what you have said the same as saying "we don’t believe that your metal boat can float because we have seen no convincing evidence" when it has merrily been floating in sight of everyone for over 200 years and the majority of those choosing to be carried by it are very happy with the boat's progress!" And didn’t the homeopathic associations, including one, the BHA,that represents 400+ qualified doctor homeopaths, send you loads of evidence in 2008?

So now we are awaiting The Independent Reviewer’s decision whether to hear H:MC21’s appeal, and, if he does, what he will make of this Big Muddle. Could he indeed decide that what we have here is in fact a clash between two ideologies, and point out to the ASA that the CAP Code specifically states “IV These criteria apply to the Code: ... j. the ASA does not arbitrate between conflicting ideologies.” ?

Whatever the Independent Reviewer says, what we have seen here is an attempt at CENSORSHIP, which incidentally if allowed to pass through would be a considerable assistance to one medical paradigm - conventional medicine - which already has a near monopoly within the UK, enjoys well over 99% of the funds available from H.M Government for healthcare, and wants the remaining percent, and no competition, please - regardless of some of their taxpayer patients' wishes. Time for the OFT to step forward. And, on judicial review if it comes to that one trusts the ASA will get another heavy ruler on the knuckles. 11

Early Day Motion
EDM 908

Tredinnick, David

That this House expresses concern at the conclusions of the Science and Technology Committee's Report, Evidence Check on Homeopathy; notes that the Committee took only oral evidence from a limited number of witnesses, including known critics of homeopathy Tracy Brown, the Managing Director of Sense About Science, and journalist Dr Ben Goldacre, who have no expertise in the subject; believes that evidence should have been heard from primary care trusts that commission homeopathy, doctors who use it in a primary care setting, and other relevant organisations, such as the Society of Homeopaths, to provide balance; observes that the Committee did not consider evidence from abroad from countries such as France and Germany, where provision of homeopathy is far more widespread than in the UK, or from India, where it is part of the health service; regrets that the Committee ignored the 74 randomised controlled trials comparing homeopathy with placebo, of which 63 showed homeopathic treatments were effective, and that the Committee recommends no further research; further notes that 206 hon.Members signed Early Day Motion No. 1240 in support of NHS homeopathic hospitals in Session 2006-07; and calls on the Government to maintain its policy of allowing decision-making on individual clinical interventions, including homeopathy, to remain in the hands of local NHS service providers and practitioners who are best placed to know their community's needs.

1 For another recent case involving Freedom of Expression which the ASA lost at judicial review see . Art 10 European Convention on Human Rights: Judge Treacy - “Article 10 protects not only the content and substance of information but also the means of dissemination since any restriction on the means necessarily interferes with the right to receive and impart information.”
2 The Adjudication mentions this report as having been “noted” by the ASA, in a paragraph headed Assessment, which precedes their findings on each challenged statement, which makes it clear that the “noted” is code for “we believed the S&TC report and not HMC21‘s evidence”
3 Sir Michael Rawlins (Chair of NICE and no supporter of homeopathy/CAM) pointed out - Harveian Oration 2009,
"RCTs, long regarded as the 'gold standard' of evidence, have been put on an undeserved pedestal. Their appearance at the top of hierarchies of evidence is inappropriate; and hierarchies are illusory tools for assessing evidence. They should be replaced by a diversity of approaches that involve analysing the totality of the evidence base."
4 in an earlier life an immunologist at Beecham Laboratories. Later a researcher at Edinburgh and Bristol Universities.
7 Sarah Boseley, The Guardian
8 such as the Bristol Homeopathic Hospital study of 6,500 patients mentioned in H:MC21’s press release where the researchers recorded that 50.7% of patients reported that improvement in their symptoms was “much better” and, in all, 70.7% reported a degree of improvement.
9 See Dr Lionel Milgrom
10 Up to the end of 2010, 156 randomised controlled trials (RCTs) in homeopathy have been reported in 135 full papers in peer-reviewed journals. This represents research in 75 different medical conditions. Of these 156 RCTs, 41% were positive, 7% negative and 52% non-conclusive.
11 I am indebted to James Panozzi, Dana Ullman, and Lionel Milgrom, and NaturalNews for excerpts from material they have posted on the internet

1 comment:

  1. Great blog Tim; keep up the good work, no matter how hard they try to shut us up!