Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
I’m perfectly happy to think of alternative medicine as being a voluntary, self-imposed tax on the gullible (to paraphrase Goldacre again). But only as long as its practitioners do no harm and only as long as they obey the law of the land. Only too often, though, they do neither.
When I talk about law, I don’t mean lawsuits for defamation. Defamation suits are what homeopaths and chiropractors like to use to silence critics. heaven knows, I’ve becomes accustomed to being defamed by people who are, in my view. fraudsters, but lawsuits are not the way to deal with it.
I’m talking about the Trading Standards laws Everyone has to obey them, and in May 2008 the law changed in a way that puts the whole health fraud industry in jeopardy.
The gist of the matter is that it is now illegal to claim that a product will benefit your health if you can’t produce evidence to justify the claim.
I’m not a lawyer, but with the help of two lawyers and a trading standards officer I’ve attempted a summary. The machinery for enforcing the law does not yet work well, but when it does, there should be some very interesting cases.
The obvious targets are homeopaths who claim to cure malaria and AIDS, and traditional Chinese Medicine people who claim to cure cancer.
But there are some less obvious targets for prosecution too. Here is a selection of possibilities to savour..
- Universities such as Westminster, Central Lancashire and the rest, which promote the spreading of false health claims
- Hospitals, like the Royal London Homeopathic Hospital, that treat patients with mistletoe and marigold paste. Can they produce any real evidence that they work?
- Edexcel, which sets examinations in alternative medicine (and charges for them)
- Ofsted and the QCA which validate these exams
- Skills for Health and a whole maze of other unelected and unaccountable quangos which offer “national occupational standards” in everything from distant healing to hot stone therapy, thereby giving official sanction to all manner of treatments for which no plausible evidence can be offered.
- The Prince of Wales Foundation for Integrated Health, which notoriously offers health advice for which it cannot produce good evidence
- Perhaps even the Department of Health itself, which notoriously referred to “psychic surgery” as a profession, and which has consistently refused to refer dubious therapies to NICE for assessment.
The law, insofar as I’ve understood it, is probably such that only the first three or four of these have sufficient commercial elements for there to be any chance of a successful prosecution. That is something that will eventually have to be argued in court.
But lecanardnoir points out in his comment below that The Prince of Wales is intending to sell herbal concoctions, so perhaps he could end up in court too.
The laws
We are talking about The Consumer Protection from Unfair Trading Regulations 2008. The regulations came into force on 26 May 2008. The full regulations can be seen here, or download pdf file. They can be seen also on the UK Statute Law Database.
The Office of Fair Trading, and Department for Business, Enterprise & Regulatory Reform (BERR) published Guidance on the Consumer Protection from Unfair Trading Regulations 2008 (pdf file),
Statement of consumer protection enforcement principles (pdf file), and
The Consumer Protection from Unfair Trading Regulations: a basic guide for business (pdf file).
Has The UK Quietly Outlawed “Alternative” Medicine?
On 26 September 2008, Mondaq Business Briefing published this article by a Glasgow lawyer, Douglas McLachlan. (Oddly enough, this article was reproduced on the National Center for Homeopathy web site.)
“Proponents of the myriad of forms of alternative medicine argue that it is in some way “outside science” or that “science doesn’t understand why it works”. Critical thinking scientists disagree. The best available scientific data shows that alternative medicine simply doesn’t work, they say: studies repeatedly show that the effect of some of these alternative medical therapies is indistinguishable from the well documented, but very strange “placebo effect” ”
“Enter The Consumer Protection from Unfair Trading Regulations 2008(the “Regulations”). The Regulations came into force on 26 May 2008 to surprisingly little fanfare, despite the fact they represent the most extensive modernisation and simplification of the consumer protection framework for 20 years.”
The Regulations prohibit unfair commercial practices between traders and consumers through five prohibitions:-
- General Prohibition on Unfair Commercial
Practices (Regulation 3)- Prohibition on Misleading Actions (Regulations 5)
- Prohibition on Misleading Omissions (Regulation 6)
- Prohibition on Aggressive Commercial Practices (Regulation 7)
- Prohibition on 31 Specific Commercial Practices that are in all Circumstances Unfair (Schedule 1). One of the 31 commercial practices which are in all circumstances considered unfair is “falsely claiming that a product is able to cure illnesses, dysfunction or malformations”. The definition of “product” in the Regulations includes services, so it does appear that all forms medical products and treatments will be covered.
Just look at that!
| One of the 31 commercial practices which are in all circumstances considered unfair is “falsely claiming that a product is able to cure illnesses, dysfunction or malformations” |
Section 5 is equally powerful, and also does not contain the contentious word “cure” (see note below)
Misleading actions
5.—(1) A commercial practice is a misleading action if it satisfies the conditions in either paragraph (2) or paragraph (3).
(2) A commercial practice satisfies the conditions of this paragraph—
(a) if it contains false information and is therefore untruthful in relation to any of the matters in paragraph (4) or if it or its overall presentation in any way deceives or is likely to deceive the average consumer in relation to any of the matters in that paragraph, even if the information is factually correct; and
(b) it causes or is likely to cause the average consumer to take a transactional decision he would not have taken otherwise.
These laws are very powerful in principle, But there are two complications in practice.
One complication concerns the extent to which the onus has been moved on to the seller to prove the claims are true, rather than the accuser having to prove they are false. That is a lot more favourable to the accuser than before, but it’s complicated.
The other complication concerns enforcement of the new laws, and at the moment that is bad.
Who has to prove what?
That is still not entirely clear. McLachlan says
“If we accept that mainstream evidence based medicine is in some way accepted by mainstream science, and alternative medicine bears the “alternative” qualifier simply because it is not supported by mainstream science, then where does that leave a trader who seeks to refute any allegation that his claim is false?
Of course it is always open to the trader to show that his the alternative therapy actually works, but the weight of scientific evidence is likely to be against him.”
On the other hand, I’m advised by a Trading Standards Officer that “He doesn’t have to refute anything! The prosecution have to prove the claims are false”. This has been confirmed by another Trading Standards Officer who said
“It is not clear (though it seems to be) what difference is implied between “cure” and “treat”, or what evidence is required to demonstrate that such a cure is false “beyond reasonable doubt” in court. The regulations do not provide that the maker of claims must show that the claims are true, or set a standard indicating how such a proof may be shown.”
The main defence against prosecution seems to be the “Due diligence defence”, in paragraph 17.
Due diligence defence
17. —(1) In any proceedings against a person for an offence under regulation 9, 10, 11 or 12 it is a defence for that person to prove—
(a) that the commission of the offence was due to—
(i) a mistake;
(ii) reliance on information supplied to him by another person;
(iii) the act or default of another person;
(iv) an accident; or
(v) another cause beyond his control; and
(b) that he took all reasonable precautions and exercised all due diligence to avoid the commission of such an offence by himself or any person under his control.
If “taking all reasonable precautions” includes being aware of the lack of any good evidence that what you are selling is effective, then this defence should not be much use for most quacks.
Douglas McLachlan has clarified, below, this difficult question
False claims for health benefits of foods
A separate bit of legislation, European regulation on nutrition and health claims made on food, ref 1924/2006, in Article 6, seems clearer in specifying that the seller has to prove any claims they make.
Article 6
Scientific substantiation for claims
1. Nutrition and health claims shall be based on and substantiated by generally accepted scientific evidence.
2. A food business operator making a nutrition or health claim shall justify the use of the claim.
3. The competent authorities of the Member States may request a food business operator or a person placing a product on the market to produce all relevant elements and data establishing compliance with this Regulation.
That clearly places the onus on the seller to provide evidence for claims that are made, rather than the complainant having to ‘prove’ that the claims are false.
On the problem of “health foods” the two bits of legislation seem to overlap. Both have been discussed in “Trading regulations and health foods“, an editorial in the BMJ by M. E. J. Lean (Professor of Human Nutrition in Glasgow).
“It is already illegal under food labelling regulations (1996) to claim that food products can treat or prevent disease. However, huge numbers of such claims are still made, particularly for obesity ”
“The new regulations provide good legislation to protect vulnerable consumers from misleading “health food” claims. They now need to be enforced proactively to help direct doctors and consumers towards safe, cost effective, and evidence based management of diseases.”
In fact the European Food Standards Agency (EFSA) seems to be doing a rather good job at imposing the rules. This, predictably, provoked howls of anguish from the food industry There is a synopsis here.
“Of eight assessed claims, EFSA’s Panel on Dietetic Products, Nutrition and Allergies (NDA) rejected seven for failing to demonstrate causality between consumption of specific nutrients or foods and intended health benefits. EFSA has subsequently issued opinions on about 30 claims with seven drawing positive opinions.”
“. . . EFSA in disgust threw out 120 dossiers supposedly in support of nutrients seeking addition to the FSD’s positive list.
If EFSA was bewildered by the lack of data in the dossiers, it needn’t hav been as industry freely admitted it had in many cases submitted such hollow documents to temporarily keep nutrients on-market.”
Or, on another industry site, “EFSA’s harsh health claim regime”
“By setting an unworkably high standard for claims substantiation, EFSA is threatening R&D not to mention health claims that have long been officially approved in many jurisdictions.”
Here, of course,”unworkably high standard” just means real genuine evidence. How dare they ask for that!
Enforcement of the law
Article 19 of the Unfair Trading regulations says
19. —(1) It shall be the duty of every enforcement authority to enforce these Regulations.
(2) Where the enforcement authority is a local weights and measures authority the duty referred to in paragraph (1) shall apply to the enforcement of these Regulations within the authority’s area.
Nevertheless, enforcement is undoubtedly a weak point at the moment. The UK is obliged to enforce these laws, but at the moment it is not doing so effectively.
A letter in the BMJ from Rose & Garrow describes two complaints under the legislation in which it appears that a Trading Standards office failed to enforce the law. They comment
” . . . member states are obliged not only to enact it as national legislation but to enforce it. The evidence that the government has provided adequate resources for enforcement, in the form of staff and their proper training, is not convincing. The media, and especially the internet, are replete with false claims about health care, and sick people need protection. All EU citizens have the right to complain to the EU Commission if their government fails to provide that protection.”
This is not a good start. A lawyer has pointed out to me
“that it can sometimes be very difficult to get Trading Standards or the OFT to take an interest in something that they don’t fully understand. I think that if it doesn’t immediately leap out at them as being false (e.g “these pills cure all forms of cancer”) then it’s going to be extremely difficult. To be fair, neither Trading Standards nor the OFT were ever intended to be medical regulators and they have limited resources available to them. The new Regulations are a useful new weapon in the fight against quackery, but they are no substitute for proper regulation.”
Trading Standards originated in Weights and Measures. It was their job to check that your pint of beer was really a pint. Now they are being expected to judge medical controversies. Either they will need more people and more training, or responsibility for enforcement of the law should be transferred to some more appropriate agency (though one hesitates to suggest the MHRA after their recent pathetic performance in this area).
Who can be prosecuted?
Any “trader”, a person or a company. There is no need to have actually bought anything, and no need to have suffered actual harm. In fact there is no need for there to be a complainant at all. Trading standards officers can act on their own. But there must be a commercial element. It’s unlikely that simply preaching nonsense would be sufficient to get you prosecuted, so the Prince of Wales is, sadly, probably safe.
Universities who teach that “Amethysts emit high Yin energy” make an interesting case. They charge fees and in return they are “falsely claiming that a product is able to cure illnesses”.
In my view they are behaving illegally, but we shan’t know until a university is taken to court. Watch this space.
The fact remains that the UK is obliged to enforce the law and presumably it will do so eventually. When it does, alternative medicine will have to change very radically. If it were prevented from making false claims, there would be very little of it left apart from tea and sympathy
Follow-up
New Zealand must have similar laws.
Just as I was about to post this I found that in New Zealand a
“couple who sold homeopathic remedies claiming to cure bird flu, herpes and Sars (severe acute respiratory syndrome) have been convicted of breaching the Fair Trading Act.”
They were ordered to pay fines and court costs totalling $23,400.
A clarification form Douglas McLachlan
On the difficult question of who must prove what, Douglas McLachlan, who wrote Has The UK Quietly Outlawed “Alternative” Medicine?, has kindly sent the following clarification.
“I would agree that it is still for the prosecution to prove that the trader committed the offence beyond a reasonable doubt, and that burden of proof is always on the prosecution at the outset, but I think if a trader makes a claim regarding his product and best scientific evidence available indicates that that claim is false, then it will be on the trader to substantiate the claim in order to defend himself. How will the trader do so? Perhaps the trader might call witness after witness in court to provide anecdotal evidence of their experiences, or “experts” that support their claim – in which case it will be for the prosecution to explain the scientific method to the Judge and to convince the Judge that its Study evidence is to be preferred.
Unfortunately, once human personalities get involved things could get clouded – I could imagine a small time seller of snake oil having serious difficulty, but a well funded homeopathy company engaging smart lawyers to quote flawed studies and lead anecdotal evidence to muddy the waters just enough for a Judge to give the trader the benefit of the doubt. That seems to be what happens in the wider public debate, so it’s easy to envisage it happening a courtroom.”
The “average consumer”.
(3) A commercial practice is unfair if—
(a) it contravenes the requirements of professional diligence; and
(b) it materially distorts or is likely to materially distort the economic behaviour of the average consumer with regard to the product.
It seems,therefore, that what matters is whether the “average consumer” would infer from what is said that a claim was being made to cure a disease. The legal view cited by Mojo (comment #2, below) is that expressions such as “can be used to treat” or “can help with” would be considered by the average consumer as implying successful treatment or cure.
The drugstore detox delusion. A nice analysis “detox” at .Science-based Pharmacy
30 Responses to Most alternative medicine is illegal
Leave a Reply
This site uses Akismet to reduce spam. Learn how your comment data is processed.
Fantastic work.
I would like to add that Prince Charles may not be so safe for so long. Our King to be is becoming just one more quack huckster as he launches his own herbal/homeopathic remedies through his brand – Dutchy Originals.
Wow. That would be a court spectacular to see him prosecuted as a test case in this area.
http://www.quackometer.net/blog/2008/12/charm-of-powerful-trouble.html
A lawyer I’ve spoken to (and indeed have heard give a talk about these very regulations) takes the view that because the regulations are implementing an EU directive they should be interpreted broadly, so that expressions such as “can be used to treat” or “can help with” should be considered as implying successful treatment or cure.
[…] Like the quacks and fraudsters who have infiltrated legitimate medicine and palm off useless, often … […]
Gimpy has exposed the links between those espousing ‘health freedom’ and the notorious Dr Rath, in the context of the Irish EU referendum, where alternative health campaigners were vociferous – and, I’m told, influential – in their support for a ‘no’ vote. It was dismaying to witness the EU/EFSA’s efforts to establish good standards of evidence in the CAM marketplace being misrepresented – inevitably – as an unholy conspiracy between big pharma and conventional medicine to annihilate ‘natural health’. Even more dismaying, people whom one might have hoped would be more objective and critical seem to have bought these arguments. Current polls suggest the treaty will be accepted in the second referendum but I suspect that’s more to do with current economic realities rather than an outbreak of critical thinking about the claims of the natural health lobby.
A brilliant exposition David. The picture is even worse though, after a long conversation I had with Trading Standards the other day. What irks me is that the breach of legislation by these people is simply not taken seriously. This chap said to me that basically if people want to waste their money on fake medicines that’s their problem and they only have themselves to blame. Yes, he really said that. Then it seems that the attitude of the courts is bizarre. If there is a very clear breach of one law, but another law overlaps and it isn’t so clear, the defendant gets the benefit of the doubt. It’s because barristers get rich by arguing fine points in court, and TS can’t take the risk that judges (who are also lawyers) won’t follow a silken tongue. The whole scene is immoral, but as a lawyer once told me (not one that I liked), the law has nothing to do with morals.
One aspect of all this that needs to be considered is what happens if a person hawking nonsense medicine is taken to court and wins the case. They may then try to use the verdict as confirmation of the validity of their claims!
FrankO -yes you are quite right there. The first serious cases need to be as watertight as possible But it worked in New Zealand so it can work here.
Perhaps, despite the comment of lecanardnoir. above, it might be better not to go for the Prince of Wales in the first instance.
“On the other hand, I’m advised by a Trading Standards Officer that “He doesn’t have to refute anything! The prosecution have to prove the claims are false”. This has been confirmed by another Trading Standards Officer who said…”
Wouldn’t be surprised if there’s a loophole somewhere between “cure” and “treat” but the TSOs seem to be overly pessimistic there. The second even appears to be worried that evidence that the “cure” is false would be needed to demonstrate that the claim to “cure” is false. Surely not?
[…] unknown wrote an interesting post today onHere’s a quick excerptI’m perfectly happy to think of alternative medicine as being a voluntary, self-imposed tax on the gullible (to paraphrase Goldacre again). But only as long as they do no harm and only as long as the obey the law of the land. … […]
Douglas McLachlan has written a clarification of the difficult question of ‘who must prove what?’
I added it to the follow-up section.
It seems to me that even if, and this is a big if, making health claims is illegal it doesn’t stop quacks from selling products based not on their claims, but the public’s perception of perceived benefits of the product.
I suspect this is how it works anyway, it’s not the homeopaths convincing people that their little pills of nothing have an effect, it’s a public that gets its information from the main stream media and doesn’t realise that these are little pills of nothing. Likewise most other alt-therapies.
In today’s Sunday Times there is an article about the University of Westminster closing down its renowned school of ceramics (Harrow Ceramics): http://www.timesonline.co.uk/tol/life_and_style/court_and_social/article5575028.ece.
I’ve commented (awaiting moderation) that they should be closing down their quack pseudo science courses.
Your comment is up on the Times website, Alan
[…] kan se den samme tendensen i Storbritannia, der regelverket om Consumer Protection from Unfair Trading Regulations 2008 har et stort potensiale som pådriver for forbrukernes rettigheter og selgernes plikter. Problemet […]
[…] to me to raise some interesting legal points. Perhaps they have read Prof David Colquhoun’s post. There is certainly a restriction in the UK on making false claims but I am not sure there is any […]
[…] may also be useful to point out that some of the claims made are almost certainly illegal. Even people who care little about evidence of efficacy are impressed by the idea that they […]
[…] No doubt she would claim that the word “remedy” was a special weasel word of homeopaths that did not imply any therapeutic efficacy. But its use in this context seems to me to be cruel deception, even murderous. It also appears to breach the Cancer Act 1939, as well as the Unfair Trading laws. […]
All sCAM is part of the “woo economy” — if you tell enough lies about it (whatever magical, unproven and unprovable claim that is made), some gullible punters will buy it.
The woo economy is a subset of the mainstream economy — a very large subset, and if it were to be summarily decommissioned, I fear the repercussions would rival the ruinous financial woes observable today. Hence we must dismantle it one unbelievably and heinously stupid brick at a time. Bravo Prof. Colquhoun, I understand you to be one of the good guys; ie, someone who cares enough about other human beings to tell the truth — the truth that is supported by evidence.
I added a section about the use of the term “average consumer“, under follow-up. Also an amplification about section 5 of the rules.
[…] blame. Of course this is not just an Australian issue – I have recently returned from the UK where irrational dogmatic arguments on one side are busy fighting with irrational dogmatic arguments on the other side and the […]
Perhaps not so challenging a year ahead. Pharmaceutical Journal, 9th May 2009:
“First homeopathic medcicine approved for labelling with indications.”
Chairman of Nelsons, Robert Wilson, said “The fact that therapeutic indications may now be included on the packaging of licensed homoeopathic medicines not only opens the practice of homoeopathy up to new users but also gives it added credibility as a safe and natural complement to conventional medicine.”
An MHRA spokeswoman said:
“The purpose of the National Rules Scheme is to address the anomalies in regulating homoeopathic medicinal products and enable consumers to make an informed choice.
“It is not to encourage new users to make their first-time purchase, nor to give homoeopathy ‘added credibility as a safe and natural complement to conventional medicine’.”
Hmm. What do you think the general public will think ? Do you think they understand the subtleties of MHRA regulations ?
Also, same issue of the PJ – Front Inside cover – full 1-page ad for “Jointace” Vitabiotics.
🙁
[…] see no legal loophole that allows the manufacturers of Arnica 30C to evade the provisions of the Consumer Protection from Unfair Trading Regulations 2008. One of the 31 commercial practices which are in all circumstances considered unfair is […]
[…] has a statutory duty to enforce the Unfair Trading Consumer Protection Regulations of May 2008. These laws state, for example, that “One of the 31 commercial practices which are in all circumstances considered unfair is […]
[…] Colquhoun discusses the Unfair Trading Regulations here. His post on whether most alternative medicine is illegal includes links to the relevant pieces of […]
[…] Colquhoun discusses the Unfair Trading Regulations here. His post on whether most alternative medicine is illegal includes links to the relevant pieces of […]
[…] case seemed so horrifying that I referred it immediately to Trading Standards on 1 October 2009. Despite the fact that the TS officer concerned had an interest in the […]
[…] Standards Authority and/or Trading standards. They are almost certainly illegal under the Consumer Protection Regulations (May 2008). The UCLH Trust should be ashamed of […]
[…] company should be prosecuted by Trading Standards for making illegal false health claims. But Trading Standards don’t do their job. Instead another honest clinician faces […]
[…] Regulations (2008) This European legislation is pretty good. it caused a lawyer to write " Has The UK Quietly Outlawed “Alternative” Medicine?". Unfortunately Trading Standards people have consistently refused to enforce these laws. The whole […]
[…] with this is, if course, is that although there is plenty of law, it’s rarely enforced : see Most alternative medicine is illegal Trading Standards very rarely enforce the Consumer Protection Regulations (2008) but Walker is too […]