CHRE annual report: Regulation meets Quackery.

Posted on July 1, 2011

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The Council for Healthcare Regulatory Excellence have recently published their 2010/2011 annual report  http://www.chre.org.uk/media/18/405/

Volume II covers the performance reviews of the 9 healthcare regulators who come under their remit.

Volume II can be found here   http://www.chre.org.uk/satellite/402  Or the PDF is here:  http://www.official-documents.gov.uk/document/hc1012/hc10/1084/1084_ii.pdf

This document contains lots of  detail on issues surrounding health care regulation, many are worthy of a  much  closer look.  This post is simply a very quick look to highlight a few select areas where the business of regulation meets quackery.

There are some interesting mentions for homeopathy & pharmacies, herbalists, GCC complaints, along with a quick mention of the BCA’s failed libel action against Simon Singh.  Also issues surrounding the advertising of CAM, including the GOsC’s concerns over the potential for ‘mass complaints’.

Section 1 – Chief Executive’s foreword:

 There has also been considerable public attention given to those therapies where the evidence for efficacy is contested. Pharmacy regulators have had to consider the place of homeopathic remedies in pharmacy practice in the face of criticism from the Science and Technology Committee. 

The inclusion of herbal products in the regulatory framework means that herbalists will be regulated in future by the Health Professions Council. 

Chiropractic has come under scrutiny as a result of the attempt by the British Chiropractic Association to sue a science journalist for libel and the General Chiropractic Council has had to deal with several hundred complaints relating to the claims made about the efficacy of chiropractic for certain conditions.

Section 9. The General Chiropractic Council (GCC)

Some comments on the GCC’s complaint workload and the vote of no confidence by its members.  There is lots to read in this section.

GCC under external pressure …

9.2  “The GCC’s investigating committee considered 29 non-website cases and 689 website cases and its final fitness to practise committees determined 16 non-website cases and 375 website cases”.

GCC under internal pressure …

9.4 “The GCC has also had to respond to an expression of no confidence from some members of its profession. The four chiropractic professional associations jointly wrote to the GCC in October 2010 to outline concerns about a wide range of issues” 
No mention here of the GCC removing the ASA/CAP guidance from its Code of Practice!   Maybe the CAP guidance is too difficult for the average chiropractor to understand (see 9.13 below)
9.12 “As a consequence of the number of complaints received about the content of some chiropractors’ websites, the GCC identified a need for specific guidance to help registrants address requirement C4 of its code of practice and standard of proficiency”
The wording of the new (and old) COP was pretty clear on the requirements ….. did some chiropractorsreally not understand it!
9.13 “The GCC has carried out an evaluation of the impact of its advertising guidance. It has reviewed the websites of all chiropractors, to ascertain whether any claims about the effectiveness of chiropractic care which are not based on the ‘best research of the highest standard’ are still being made.
 
If the GCC has really “reviewed the websites of all chiropractors” then all the misleading claims should have been removed by now..
“This work identified a number of websites that do not comply with the advertising guidance, and therefore may be misleading the public about what they can expect from chiropractic care. The GCC is engaging with the chiropractors involved to resolve this informally.”
 
It might be interesting to have a look and see what claims are still out there and then sending these to the GCC to ask for  their opinion!
 Section 13. The General Osteopathic Council (GOsC):

The GOsC clearly aware that there is an issue with claims made on the basis of anecdotal evidence and the potential impact this has …… good, I’m glad they’re taking is seriously!
13.14 The Advertising Standards Authority’s (ASA) British Code of Advertising (the ASA code) requires that all health promotion claims are based on sound clinical evidence. The GOsC has expressed a concern that some of the osteopathic practice information that is currently available online may be based on anecdotal, rather than empirical, evidence, and therefore falls short of the required standard.
 
I have expressed similar concerns direct to the GOsC and the ASA – it seems we have much in common!
“To manage this matter, we note that the GOsC has sought legal advice about the way in which it could best deal with a bulk complaint similar to that received by the GCC, should one arise, without jeopardising its operational performance. It is also conducting a review of online advertising published on osteopathic websites in order to assess compliance with the ASA’s code. With collaborative input from the British Osteopathic Association, NCOR and ASA, the GOsC has developed a strategy to assist registrants to comply with ASA’s code by using direct correspondence and profession-specific media”
I would really like to see some of this GOsC correspondence and profession-specific media advice.  Does anybody have a copy ?
Section 14: The General Pharmaceutical Council (GPhC)

Some interesting comments on the sale of homeopathic remedies in pharmacies – Also see sect 17

14.12 Under the Pharmacy Order 2010, the GPhC has a new role in relation to setting standards for pharmacy premises. The GPhC has established a ‘premises project’ and will be developing its standards.

14.13 “The premises standards will include those relating to the sale of homeopathic products in pharmacies”

 “We note that the sale of homeopathic products in pharmacies is an issue that has recently attracted media attention because of the lack of a consensus about the efficacy of those products and the potential implications for patients who take them in preference to conventional medicines. It is therefore a significant issue for the pharmacy regulator to consider”.

Well it would be kind of hard to have missed the media attention!   Any ‘lack of consensus‘ only comes in to play when you talk to a homeopath about the fact that there is no reliable evidence to support their quackery claims.

Section 15. The Health Professions Council (HPC)

On herbalists …

15.17 As yet there is little detail about how practitioners of herbal medicine and traditional Chinese medicine will be regulated, but the government has said that the focus will be ‘solely on minimising risk to the public’. The HPC register will be a register of people who are able to dispense unlicensed herbal medicines.”

 Section 17. The Pharmaceutical Society of Northern Ireland (PSNI)

On homeopathy …

17.9  Registrants raised concerns with the PSNI following the House of Commons Science and Technology Committee’s review of the evidence base for homeopathy (which found that homeopathy is not an efficacious form of treatment). Supply of homeopathic products in pharmacies is legally permitted, and pharmacists have the right to sell them as part of their business

Legally permitted is one thing …. but that doesn’t address the ethical issue of selling ineffective sugar pills alongside genuine medicines!

“However, as there may be a risk to public protection if patients use such products in preference to conventional medicines to treat serious health conditions without being aware that there is no consensus regarding the evidence base for the treatments, the PSNI developed, consulted upon and published guidance on the supply of homeopathic products in pharmacies. The guidance made it clear that when registrants provide a homeopathic product the patient should be advised that there is no consensus on the efficacy of homeopathy.”

It is good to see an acknowledgement that using homeopathy in preference to conventional medicines represents a potential  risk to patient safety ….. that’s because it doesn’t work!

The full report is worth a read.

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