Friday, 29 March 2019

More on BBC and ASA reports re CEASE therapy

A previous post discussed recent BBC reporting and an Advertising Standard Authority (ASA) regarding CEASE therapy. It also looked at the potential impacts on the Society of Homeopaths (SoH).

This post has several different perspectives.

It is difficult to gauge how many people have seen the reports. They did not just appear on the BBC but in several newspapers and on many websites. What is curious though that that both the Guardian and Daily Mail did not reference their previous reporting.

A large number of local newspaper and radio websites carried the story but they were carrying the same AP story as most of the nationals. 

Some NHS websites carry BBC health news as a feed.

National Autism Society Statement
The NAS said on Twitter - 
Autism is lifelong. It’s not a disease or an illness. And many autistic people feel that their autism is a core part of their identity. It is deeply offensive for anyone to claim that unproven and even harmful therapies and products can ‘cure’ autism – and particularly appalling where people target vulnerable families. 
We are really pleased that the @ASA_UK is taking action against the bogus claims by people pedalling CEASE therapy. This sends a strong message to all homeopaths to make sure that their practice is evidence-based and follows national guidance and that failure to do this will lead to further sanctions and potentially prosecution by Trading Standards. 
There are around 700,000 autistic people in the UK. Life can be desperately difficult for autistic people and families, particularly just before and after receiving a diagnosis, when so much is unclear and support is often hard to come by.  
We must all do everything we can to protect autistic people and their families. This means challenging myths, reporting dodgy therapies to the authorities and making sure they use their powers to stop their production, promotion, sale and use.  
The Government and its agencies, like health and education, must also make sure autistic people and families have accurate information about the support that can actually help – and this support must be available when and where it’s needed.

The responses of homeopaths and their supporters to the reports are predictable. Generally, they seem to ignore the ASA's sending of Enforcement Notices and concentrate on "well, they didn't interview a homeopath! Bias!!!". Some also say that they did not interview any of the "hundreds" of parents whose children had been "cured" of autism. There are a couple of Youtube videos that purport to show "cured" children but their veracity can not be confirmed and at least one is highly suspect.

Something that comes across very strongly in some responses are anti-vaccination conspiracy theories. This post from Steve Scrutton that attempts to defend CEASE is a perfect example of how homeopaths are pathologically incapable of addressing the real issues - medically unqualified lay persons with no training in autism or safeguarding acting far beyond their competence who advocate neglect of autistic children. Emma Dalmayne is mis-characterised as an an "anti-homeopathy" campaigner. Dalmayne campaigns against bogus and dangerous treatments of autism full stop.  It displays not uncommon attitudes towards the ASA and the BBC. It makes the mistake of thinking all of this is about homeopathy. It isn't. It's about autistic children being put at risk.

Scrutton's attack on the National Autistic Society shows how deeply conspiracy thinking runs in some homeopaths. 
The programme also used the expert opinion of the National Autistic Society (NAS). This charity has an annual budget of almost £1 billion, and it’s an organisation funded to a significant degree by the pharmaceutical industry. Certainly, this exchange between Dr Vernon Coleman and NAS in 2007 confirms that this was the situation at that time, and I can find no evidence that this situation has changed since then. 
So perhaps unsurprisingly, NAS confirmed the view of conventional medicine that autism is a 'life-long condition’, and a "part of who people are", that it was "wrong and appalling that anyone to claim that bogus and potentially harmful therapies such as CEASE cure autism".
NAS's Annual Report tells a very different story and Vernon Coleman's "exchange" does not confirm Scrutton's assertions.

There has not been a tremendous amount of reaction from autism groups but what there is has been approving of the ASA's action. 

Implications for Individuals
What are the implications for those 150 homeopaths sent the ASA Enforcement Notice? What is going to happen to the five practitioners being investigated by Trading Standards?

Although Bucks and Surrey Trading Standards have not said that what they have done so far, what might well have gone on it is that after initial investigation they informally advised the accused of what legislation says and their obligations under it. Trading Standards have a range of options but a likely next step would be the issuing of a Compliance order. This will set a deadline for compliance. The accused will have to inform their insurer (and their membership organisation if they have one) at this point - it is a contractual obligation.  A business can appeal against such an order via the Courts. Non-compliance can result in prosecution.

Only the very foolhardy or ignorant would not seek legal advice at this point. Or perhaps a paranoid conspiracy theorist? An insurer or member organisation would very likely advise of the need to.

Trading Standards can go straight to the prosecution stage without issuing a Compliance notice. 

Any prosecution is likely under the Consumer Protection from Unfair Trading Regulations 2008. The claim to treat or cure autism with homeopathy is misleading but claims that vaccines cause autism might also be considered. There is no specific provision that relates to the use of creating undue fear in consumers it might well be considered an aggressive marketing practice. Whilst prosecution under the Human Medicines Regulations 2012 is possible, because a service is being advertised rather than named medicines, this route may not be taken. There is a seeming reluctance to act on supply of unauthorised homeopathic remedies (see this for discussion of the legislation and also this).

If they do end up in Court, it is unlikely that their insurance will cover their legal costs. Having looked at some policies, breaches of the Human Medicines Regulations 2012 and Consumer Protection from Unfair Trading Regulations 2008 are not included. Accused would have to find funding themselves.

Offences under both sets of Regulations can be tried in a Magistrates Court. If the accused pleads guilty, the prosecution will set out the facts of the case and the accused will present any mitigation. Sentence may or may not be made at this point. It must be pointed out that it would be impossible to claim ignorance of the Regulations as mitigation at this point as Trading Standards will have made them aware prior to this.

It seems unlikely that a homeopath who got to that stage would plead guilty (would have ample opportunity to comply prior to this). If a not guilty charge is entered, the court will adjourn and a date will be set for a trial. Bail may be set to prevent further offences being committed. To be explicit, the Court could forbid a homeopath from practicing. If they did, they could find themselves back in front of the Court. It would not necessarily have a direct effect on determination of guilt and sentencing but...

Any credible defence would have to deliver concrete evidence of CEASE "curing" autism and also evidence of the "hundreds" of cases claimed. Anecdotes and testimonials are unlikely to be accepted, nor are unethical and illegal medical trials. The situation with "vaccines cause autism" is worse because scientific evidence is so strong against such a link. The claim to cure vaccine injury is almost impossible to prove as it would require a diagnosis.

In some trials involving quacks, multiple witnesses have been called to testify to their "cure" and/or the good character of the accused. It would be unfortunate if the parents of autistic children were asked to appear. 

Courts often have little patience for the submission of lengthy reports, spurious "evidence" and the calling of "expert witnesses" who are nothing of the sort. Character witnesses likewise. All of these things extend the duration of a trial and increase legal costs.

A conviction is likely to result in a fine. A prison sentence is unlikely. The Court might well make a Criminal Behaviour Order (CBO). An referral to the Disclosure and Barring Service to place on the Barred List could be made. It is also likely that they will have to pay Trading Standards' legal costs as well as their own (which is why a lengthy trial is such a bad idea).  

A CBO might well force a homeopath to find employment but a criminal record/entry on Barred List will preclude some roles, especially those involving children. An offender practices homeopathy part-time and has other employment could well lose their job. 

Broader Implications
A conviction would set a legal precedent with huge implications for UK homeopathy. Not only in terms of any future prosecution. Whereas homeopaths often try to dismiss ASA rulings on the basis of "bias", a clear ruling on the illegality of certain claims and actions would be difficult to ignore.

Of course, some would paint it as the judiciary being part of a conspiracy against homeopathy and the establishment being under the thrall of Big Pharma. Of course, conviction would be impossible if legislation didn't exist. But it does. Historical deliberate misinterpretations of that legislation will be put to bed.

There would be extensive media coverage, have no doubt of that.

If homeopaths and their associations had acted responsibly and accepted the de facto limitations of homeopathy, none of the above would happen. If regulators like the Medicines and Healthcare Product Regulatory Agency and General Pharmaceutical Council had made efforts to curtail the supply of unlicensed medicines to lay homeopaths by pharmacies, CEASE therapy could have been made very difficult to practice. The media will ask why these things have not happened.

Homeopathy is not popular in the UK, whatever homeopathy associations might like you to think but it could become even less popular. 

Readers can draw their own conclusions about how bad things could get. 

Saturday, 23 March 2019

BBC and ASA on CEASE therapy and the Society of Homeopaths

It's been known for a week or so that the BBC Breakfast report of 22/04/2019 on CEASE therapy was coming. It wasn't known until more recently that there would also be a report on BBC Radio 4 You and Yours. The Advertising Standards Authortity (ASA) blog post came out of the blue though (it was available to journalists though).

Some astute readers may have noticed a link between what is written on this blog and various media reports. This blog has a limited audience and working with journalists and mainstream media outlets is a way to reach a much wider audience. To be frank, it often has the effect of getting regulators to act. Some regulators seem to believe that they can ignore concerns about CEASE therapy from members of the public.

These reports have nothing directly to do with this blog.

ASA action
The blogpost by ASA CEO Guy Parker is quite hard hitting and tells us -
As part of that, our team has referred several cases to Trading Standards for further investigation. Any breaches of criminal legislation could lead to prosecution. Others could well follow.
Elsewhere is said that there are five cases. One of them is almost certainly Alan Freestone but the identity of the others is unknown. The ASA recently changed to using Bucks and Surrey Trading Standards as their legal backstop.

Whether or not any of these cases will result in prosecution is not clear. 

It has been known for some time that the ASA conducted a compliance exercise but the ASA did not want this to be made public. The enforcement notice was sent to 150 homeopaths that the ASA knew of from a few websites that listed UK homeopaths with a "qualification" in CEASE back in May 2018. Why it has taken the ASA so long to make this public is unknown.

It is the advice given in the notice that is of note -
Although advertisers may provide information about the history of a therapy, care should be taken not to make unsupported claims for the treatment when describing its background. It is very likely that referring to the therapy by its full name will also be problematic given the implied efficacy claim within it (see below).
As noted in point 1 above, the ASA would be likely to regard a reference to the therapy’s full name, ‘Complete Elimination of Autism Spectrum Expression’, as an implied efficacy claim. Further, any text which links CEASE therapy to autism and / or other spectrum-related conditions could amount to an implied efficacy claim. As shown in the ASA’s ruling, this can include visible text within URLs (as actual website page names, and as URLs within that website linking to external websites). 
If a testimonial includes direct or indirect efficacy claims, then this will be subject to the same rules as any other claim. In other words, where efficacy has not been established, a testimonial should not be used to imply that it has. Patient testimonials alone are unlikely to substantiate objective claims about the efficacy of a product or therapy. Moreover, the use of a disclaimer is unlikely to be sufficient to counteract any misleading impression.
CAP and the ASA understand that the body’s liver and kidneys automatically detoxify and excrete many toxic materials, including metabolic wastes, and has not seen evidence to support the theory that toxins can be removed from the body by other means, so care should be taken to avoid claiming or implying otherwise.
The last point suggests that it may be worth looking again at the websites of CEASE practitioners for claims relating to "detox".

There is something missing from the notice though and that is the claim that vaccines cause autism. In the current climate, using anti-vaccination propaganda in marketing is an absolute no-no. 

Implication for the Society of Homeopaths
So, it is now known that the enforcement notice was sent to SoH members. It is also the case that if the SoH were not made aware of this by the ASA, they certainly were by others. The SoH's response to the BBC reporting is somewhat odd -
The Society of Homeopaths said the therapy may now be renamed.
Yes, renaming something is going to magically transform it from an bogus cure for autism that advocates medical neglect of children into something else? Hardly. As previously discussed the name "Complete Elimination of Autistic Spectrum Expression" is both misleading and deeply offensive to many autistic people.
The Society of Homeopaths said that some of the terminology surrounding Cease has been misleading and it would take steps to avoid unsubstantiated claims being made.
Again the focus on claims, not the practice. The SoH should have taken the guidance on board during their reviews of member websites. The ASA are very clear in the kind of claims that are unacceptable.

The SoH seem to have forgotten what the Professional Standards Authority (PSA) made of the practice. They saw risk written all over it.
The Society stated that undertaking CEASE training does not imply that a practitioner will claim to completely ‘eliminate autistic spectrum expression’, apply the entirety of CEASE methods within their practice, or undertake any action that would breach the Society’s Codes. However, there did not appear to be any supporting evidence for this, such as mitigating statements, on registrants’ websites or on the Society’s website or other public materials. The team suggests that the main sources of information for CEASE therapy would inform the public that its purpose is to treat autism (and other disorders and diseases) and to steer clients away from conventional medicine. 
The team suggested that from the information available, the Society would need to provide significant assurance to the Panel that it continues to meet the Standards for Accredited Registers. The Society committed to developing public guidance outlining the scope of CEASE therapy that is acceptable to incorporate into registrants’ practice. The Society would then develop a mechanism to assure that registrants who do apply aspects of CEASE in their practice do not contravene relevant standards. The team suggested that the Society had an opportunity to enhance public protection by publishing an industry-leading resource highlighting risks associated with CEASE therapy and appropriate standards and advertising guidance for practitioners.
And there's the rub. Although the SoH were subsequently re-accredited by the PSA, this was conditional on the implementation of a plan to deal with the PSA's concerns over CEASE. There is little evidence that much in the way of action has been taken. Does the SoH currently meet the Standards for Accredited Registers?

As things currently stand, this seems unlikely. Many members are still listed on the website. It is possible that some have requested removal and it hasn't happened but that might be a violation of General Data Protection Regulation. Some still link to the site and a few still make outrageous claims. All potentially face expulsion for the SoH. 

It would be difficult for the PSA to re-accredit the SoH for another reason. The Equality Act 2010 and Public Sector Equality Duty (PSED) were mentioned in a previous post. Autism is a protected characteristic - and it could be very strongly argued that accrediting a register whose members practice something that advocates neglect of autistic children would be PSED failure.

If they did re-accredit the SoH without the issue of CEASE therapy being resolved, that could be challenged by Judicial Review. The PSA are aware that an application for Judicial Review is very possible.

This is crunch time for the SoH. They must decide between dealing with members offering CEASE (which would have severe financial implications) or giving up accreditation (which would be humiliating and might cost CEO Mark Taylor his job). 

If they don't deal with CEASE, the PSA will have to remove accreditation.

This is a lose-lose situation for them. Media reporting is likely to be extremely hostile in any case.

Tuesday, 5 March 2019

Faculty of Homeopathy developments

The Faculty of Homeopathy (FoH) has recently changed its entrance criteria. Or at least it says it has.
The Faculty is now pleased to be able to accept membership applications from medical, nursing, pharmacy, veterinary and other medical professionals eligible for statutory registration in their own jurisdictions, who have completed a course of homeopathic study. This makes the Faculty a supportive home for BHMS / DHMS colleagues plus those practicing in fields such as naturopathy, functional medicine, environmental medicine, integrated medicine and the range of complementary therapies.
The FoH believes -
The Faculty of Homeopathy is the preeminent global association for healthcare professionals who are trained to use homeopathy alongside conventional medicine. To date the majority of the Faculty’s members have been doctors practicing in the United Kingdom or European Union plus international members from India, Japan and Australasia. Today the Faculty moves to embrace further its international mission as it moves into its 175th Anniversary celebrations in 2019. 
It is a bit wider ranging than the headline and FoH website suggest -
Therefore Faculty membership will in future be also open to: 
• those who have relinquished their licence to practise medicine but continue to work as homeopaths, upholding the standards of the Faculty of Homeopathy and eligible for statutory registration 
• members of similar organisations of similar standing who do not have Faculty awarded recognition of training in homeopathy but who are qualified for statutory registration 
• healthcare professionals who have undertaken a recognised degree in homeopathy 
• healthcare professionals trained overseas who are not eligible to be International Members, and UK citizens undertaking suitable healthcare training overseas.
The first category is confusing and is discussed below. 

Because the FoH is a statutory corporation and because of the way that the Faculty of Homeopathy Act 1950 was written, there is no duty to report its accounts and membership numbers to anyone except its members. It is not accountable to any public or private organisation.
As we know homeopathy has been under pressure from detractors for some years, and consequently membership of the Faculty has fallen. With this in mind, it has been particularly difficult to correspond with a number of members who are reluctantly being forced to leave the Faculty because of our historical interpretation of the membership eligibility criteria in the Faculty of Homeopathy Act.
Information is difficult to find. Membership has dropped because members retire and recruitment has fallen dramatically. In 2008, they claimed to have more than 1,400 members. Now they say they have "over 500". It is moot whether "detractors" have had any direct effect on this. Lay homeopathy associations have also seen falls in membership but nowhere near as steep.

The FoH has also experienced a sharp decline in income particularly from training courses (yet associated cost have increased). Membership income has declined less steeply. It is very likely the FoH has a deficit. 

The UK professions that can join the FoH are -
  • Doctors
  • Dentists
  • Veterinary surgeons
  • Pharmacists
  • Nurses
  • Midwives
  • Veterinary Nurses
  • Osteopaths
  • Chiropractors
  • Opticians
There are also the professions looked after by the Health and Care Professions Council (HCPC).
  • Arts therapists
  • Biomedical scientists
  • Chiropodists/podiatrists
  • Clinical scientists
  • Hearing aid dispensers
  • Occupational therapists
  • Operating department practitioners
  • Orthoptists
  • Paramedics
  • Physiotherapists
  • Practitioner psychologists
  • Prosthetists/orthotists
  • Radiographers
  • Social Workers in England
  • Speech and language therapists
It seems extremely unlikely that social workers would want to practice homeopathy or that the FoH would regard them as "healthcare professionals".

From 2012 -
Along with revalidation and appraisal, a major concern that we are hearing is what happens when members retire from their statutorily registered profession. The Faculty constitution is very clear. Faculty membership is for members of statutorily registered professions. If a member is no longer fulfilling the requirements of registration with his or her statutory body, then they are no longer active members of the Faculty and considered retired and no longer practising. Being a designated body requires that we uphold these standards.
From 2017
Another key theme going forward is broadening the Faculty’s appeal by reviewing our membership eligibility criteria. We must become more user-friendly for Faculty members who are relinquishing their licence to practice one of the conventional medical disciplines, but still practising as homeopaths. Broadening our community’s appeal is of course an important element in ensuring the Faculty’s long-term future. The Faculty receives requests for membership from credible, like-minded supporters including psychologists, psychiatrists, dieticians, overseas clinicians and homeopaths, academics, researchers, etc., and we must consider supporting their joining aspirations.
The Faculty of Homeopathy Act 1950 says -
4. (1) The objects of the Faculty shall be to continue the work hitherto carried on by the existing Faculty for the advancement of the principles and the extension of the practice of homœopathy and to do all such other things as are incidental or the Faculty may deem conducive to the attainment of those objects. 
(2) Without prejudice to the generality of subsection (1) of this section the objects of the Faculty are - 
(a) to advance and extend the principles and practice of homœopathy; 
(b) to establish the status of fellowship of the Faculty and to admit to such status members of the Faculty who are judged by the Faculty to be qualified for such status; 
(c) to admit to the membership of the Faculty such persons as shall be eligible in accordance with the regulations thereof and shall conform thereto; 
(d) to grant to medical practitioners registered in the countries in which they practise diplomas certificates or other equivalent recognition of special knowledge in homœopathy either alone or in co-operation with teaching or examining bodies authorised to grant recognition as aforesaid:

There are various levels of membership -
  • Affiliate
  • Associate
  • Licenced Associate (which requires LFHom qualification)
  • Full Member (which requires MFHom qualification)
  • Fellow
  • Student
  • Retired
Only Licensed and Full members are allowed to use qualifications after their name and to be listed in FoH online directory (and the FindAHomeopath website - although they can be listed there if they belong to either Society of Homeopaths or the Alliance of Registered Homeopaths).

There are introduction to homeopathy type courses run but the qualifications the FoH validate are -
  • LFHom Vet (Licentiate of the Faculty of Homeopathy)/Primary Health Care Examination (PHCE)
  • MFHom
  • Specialist Registration
Note that "specialist registration" doesn't mean a specialism as far as the General Medical Council (GMC) or NHS are concerned. There used to be a Diploma of the Faculty of Homeopathy but that was abandoned at some point and those with the qualification were "grandfathered" to MFHom status. 

The FoH doesn't offer courses itself, it accredits others to offer them. There are a number of organisations that offer them but most interesting are -
The LFHom qualification is not particularly demanding. One example of the course suggests 150 private study and 30 hours tuition, although this may be spread out over several years (the taught elements of the course happen infrequently over weekends).

Much is made of how demanding the MFHom course is but even the Fast Track course pales into insignificance to the training to become a veterinary or medical specialist. It is unsurprising that homeopathy is not recognised as a speciality. It seems very unlikely the Fast Track course will ever be run again given that NHS homeopathy has ended there.

The Specialist qualification does not involve training per se but the writing of a dissertation.

Prescribing Rights
This is a huge problem for the FoH. As have often been stated on this blog, the majority of homeopathic remedies have the status of unlicensed medicines. This provides a good overview of prescribing rights by profession. 

Regulation and Ethics
The FoH don't have a Code of Ethics per se - because members are statutorily regulated, the FoH defer to the statutory regulator. They do have conditions of membership (which at the time of writing have been removed - archived). A future post will discuss non-compliant members.

One thing that it makes clear is -
Faculty members are also bound to act within the defined level of competence of their Faculty accredited training and qualification in homeopathy. Members may practise homeopathy beyond the limits of their Faculty accredited qualification only under supervision and as part of a Faculty of Homeopathy accredited training programme.
European Committee for Homeopathy
The ECH was mentioned in a previous post along with its strong links to the BHA. The ECH claims to represent "approximately 6,500 homeopathic doctors across Europe". The FoH is a member of the ECH, however, it is unclear whether the FoH fulfils the criteria for membership.

Admission of new members is governed by the following conditions:
  • full members: individuals or organisations which, at the same time, fulfil the following criteria:
    • 1º they are, or they represent, doctors of medicine who are entitled to work in their country of residence.
    • 2º they are recognised as, or are comprised of, medical doctors who have acquired an adequate knowledge of homoeopathic medicine – the level of knowledge required being defined by the education subcommittee of the E.C.H.
  • individuals or organisations, which the Council considers necessary to accomplish its aims.
  • associate members:
    • individuals or organisations which do not meet the criteria for full membership but nevertheless espouse the aims of the association.

The ECH does offer individual associated membership.

What is interesting that the ECH do not recognise any of the FoH accredited training centres.

Liga Medicorum Homoeopathica Internationalis
The LMHI is an international association of trade associations that represent doctor homeopaths plus dentists, veterinary surgeons and pharmacists. The FoH is a member. The LHMI also allows individuals in countries that do not have an association to join directly. It seems to allow DHMS/BHMS graduates as well as medical doctors et al to join but as individuals as no trade association in the sub-continent is a member. The LMHI also offer associate membership to other statutorily regulated professions.

Joining the FoH means that such persons would automatically be members of LMHI via its corporate membership. 

This standards for Batchelor of Homeopathy Medicine and Surgery. DHMS is a Diploma. DHMS/BHMS are found on the Indian Sub-continent. Pakistan, India, Bangladesh and Sri-Lanka. The DHMS is 4 years long including 6 month internship, BHMS 5.5 years including 1 year internship. These are undergraduate courses. The entry standards are lower than for medical degree. The teaching standards are lower too.

DHMS/BHMS are not recognised outside of the Indian sub-continent. It is impossible to get a work visa for most countries with one. Whilst in the sub-continent, the use of "Doctor" is permitted and graduates are legally recognised as medical practitioners, elsewhere they are not permitted the title and are regarded as no more medically qualified than an ordinary lay person.

Depending on jurisdiction, DHMS/BHMS might face criminal charges if applying for a work visa and stating they have a medical degree. If they get into another country, they could face prosecution for practicing - in most civil law jurisdictions like France, only registered medical professionals can practice medicine. This is also true in some common law jurisdictions. There are US cases where BHMS graduates have been prosecuted for practicing medicine without a license. In the UK, assuming they have residence status, as long as they do not use the title doctor, do not engage in certain activities, they can practice but they can not join the FoH even if still registered in their home country.

The MFHom is recognised in Indian law. It permits medical doctors to practice homeopathy and call themselves homeopaths. This has caused some upset in the past.

In some jurisdictions, other medical professions are statutorily regulated that aren't in the UK. South Africa regulates homeopathy.  In some US states and Canadian provinces naturopathy is recognised (and homeopathy is in Ontario). Physician assistants are regulated in some jurisdictions.

The FoH's attempts to broaden its membership are problematic.

There no absolute definition of "healthcare professional" in UK legislation but it is generally understood to mean those in professions that are statutorily regulated. The likes of the Society of Homeopaths may like to describe members as "healthcare professionals" but from a legal standpoint, they are medically unqualified members of the public with no special knowledge.

So healthcare professionals who have undertaken a recognised degree in homeopathy does not mean that lay homeopaths with BSc Homeopathy can join the FoH. If the FoH accepted such persons they could be in breach of the Faculty of Homeopathy Act. Even if they weren't arguably admitting them would cause the FoH to loose some of its distinctiveness.

The FoH has an existing membership category for retired practitioners but the conditions for that is that members do not practice. But it seems that the FoH wants to allow membership of those who have given up being a doctor, nurse etc but who carry on practicing homeopathy. To be clear, when someone gives up their profession, they give up the prescribing rights associated with the profession.

Saturday, 2 March 2019

Canadian Government funding of Homeopathy in Honduras #3

The previous two posts (here and here) were not easy to write. Hence these posts are shorter than they might be. The more that this matter is looked into, the more alarm bells ring. It is difficult to believe the hubris of the homeopaths involved. It is difficult to believe that there has been no real oversight, no check on their activities.

Homéopathes de Terre Sans Frontières
HTSF doesn't directly say what it does on the pages devoted to it. That's elsewhere -
Homeopathic remedies help reduce the symptoms of Chagas disease and reverse the illness, improving the quality of life of those affected.
That is an astonishing claim. In the chronic stage, Chagas is incurable. Early diagnosis and antibiotic treatment is essential.
The purpose of the project in Honduras is to train local resources in homeopathy, homeoprophylaxis and prevention, to bolster their community health interventions, in particular those related to Chagas disease. Homéopathes de Terre Sans Frontières will focus on four municipalities located in the centre of the country and will work with Universidad Nacional Autónoma de Honduras (UNAH) professors and students, as well as community health promoters.The project also entails the creation of a laboratory to manufacture homeopathic remedies, as well as the set-up and supply of homeopathic dispensaries. 
It is expected that the project will have an impact on close to 36,000 people over the next five years.
36,000 people? Even if only a fraction of those were given homeoprophylaxis and believe they are protected against infectious diseases, it is possible to imagine bad outcomes.

It is strange that the UNAH website makes no mention of working with HTSF. Martine Jourde gets a mention in this document on a symposium on natural medicine products but it makes no mention of any links to UNAH. It also tells us that the "initiative" has been going on since 2006.

Terre Sans Frontières
HTSF doesn't really exist as a separate entity. It is part of Terre Sans Frontières (TSF). TSF has its origins in evangelical missions by the Brothers of Christian Instruction. Its current mission statement doesn't mention any religious activities.

It's quite possible that TSF does not fully understand what HTSF is doing in Honduras. It's possible TFS don't know that the HTSF homeopaths are medically unqualified lay persons, that they are conducting unethical research and so on but that would be poor governance to say the least.

It could be that TSF are fine with HTSF members and their activities. That would be deeply worrying. 

Global Affairs Canada
It's unknown whether GAC were aware of who the HTSF are and what they get up to. It is not clear if the money that HTSF are spending was specifically allocated by GAC to the mission or if monies were granted to TSF who then decided to allocate it to HTSF.

GAC are handling criticism badly. 
Instead spokesperson Maegan Graveline reaffirmed Global Affairs's support for the homeopaths in an email, "The World Health Organization and Pan American Health Organization in its 2014–2023 strategy encourage the integration of traditional medicine and complementary medicine, including homeopathy, into national health systems". 
In fact, WHO in 2009 after criticism stated that there were a number of conditions that homeopathy should not be used for

Picking up the pieces
If there are bad outcomes, if people believe that they are protected against infectious diseases, especially Chagas, who is going to support these people when they become ill? The homeopaths? The Canadian government? 

Canadian Government funding of Homeopathy in Honduras #2

A previous post discussed the use of homeoprophylaxis by Canadian homeopaths in Honduras in a project partly funded by the Canadian government. There has also been another news story. There is yet another story which mentions the illegality of homeoprophylaxis in Canada.

Montreal Institute of Classic Homeopathy
MICH would appear to be a driving force behind Canadian homeopathy "volunteers" in Honduras and a source of the volunteers. 

There is something called Homéopathes de Terre Sans Frontières (HTSF - which will be discussed in the next post) but as the website states - 
MICH Faculty, Alumni and Students have all played a part in these missions often funding their passage and accommodations by themselves.
Homeopaths associated with MICH claim to have been travelling to Honduras for many years, long before the founding of HTSF.

The founder of MICH is Judyann McNamara. McNamara has some strange ideas about quantum biology and vitalism as evidenced by her own website. This interview makes for even stranger reading. It would not appear that she has been to Honduras herself. Even more bizarre -`
The proposal this article is making is that mitochondria are “informed” by an underlying field, the vital field. As the primary structures related to adaptation and evolution, they also bridge the environment (larger reality) with the perceived inner reality of the individual. They determine if, when and how the organism will adapt to the environment. 

Martine Jourde is apparently the originator of the "missions" to Honduras.
Her background in physiology and epidemiology, as well as her more than 30 years of experience in using homeopathy both in private practice as well as in community settings in Canada, France and Cuba among others, make her an expert in the use of homeopathy to strengthen communities. Because of its ecological and economic aspects, homeopathy can contribute to sustainable development and to access to health care and prevention in both the developing and Western worlds. Martine’s strong motivation comes from all these years of seeing the positive impact of homeopathy wherever it is used and knowing that homeopathy can help to restore harmony between all living organisms on the planet.
What this "background" is is never mentioned. To practice homeopathy in France, Jourde would need to be a doctor. Likewise Cuba.
During countless homeopathic missions in Africa, Central and South America, Martine developed homeopathic complexes and protocols that are effective in circumstances where disease goes hand in hand with wide-scale poverty and lack of medical services. The HTSF model of intervention is not solely based on giving access to homeopathic services, but also includes training of local professionals and community leaders to increase their capacity to provide these services themselves and increase their autonomy. Research is another aspect of the work of HTSF and Martine Jourde leads a scientific homeopathic research project on Chagas disease in Honduras, and participates in many homeopathic clinical and prophylactic pilot projects in Cuba.
Apparently Jourde presented a report at a conference NOSODES 2008 in Cuba. No published research can be found. Jourde is mentioned along with Isaac Golden in the infamous Cuban leptospirosis paper but was not directly involved in it.

Jourde also gave a talk at the 2018 Canadian Homeopathic Conference - the blurb there says she is director of the Agency in Research & Development and Education in Homeopathy of Quebec (ARDEHQ) which seems to have no online presence. 

Jourde also seems be behind a Canadian company Labo Solidago that sells homeopathic veterinary medicines.

The person who currently seems to be at the heart of this is Carla Marcelis who seems to originated from the Netherlands. Marcelis may be the co-author of what appears to an AIDS denialist tract. The paper was put together with assistance from Alive & Well AIDS Alternatives (HEAL as was) which is a notorious AIDS denialist organisation. 

Charles Geshekter and Carla Marcelis

Here is a photo of Marcelis with AIDS denialist Charles GeshekterMarcelis may have changed her position on HIV/AIDS but Honduras has the highest prevalence of AIDS in Central America.

Marcelis claims to have studied medicine but decided not to practice it. There is no way of proving this either way but it is interesting to note that no mention is made of any qualification obtained.

A video of Marcelis talking about the "mission" can be found here. There is also a very long podcast here. The podcast is specially disturbing. It reveals that combination remedies "complex" are being used. Classical homeopathy it is not. There's a focus on epidemics that is worrying. The volunteers use homeopathy for prevention - including nosodes. Which is problematic.

Marcelis' efforts at fundraising in 2018 did not seem to go too well.

Status of Homeopathic/Naturopathic Practitioners in Quebec
Quebec is a civil law jurisdiction, unlike the other other Provinces and Territories of Canada. The practice of homeopathy, naturopathy and other forms of CAM seems to be tolerated although strictly speaking, the practice of any form of medical treatment by medically unqualified lay persons is illegal.

On the Terre Sans Frontières (TSF) website, there is this in French. It seems likely that there was an English language version of this somewhere - a dead link was found on another homeopath's website to an English language pdf. The pdf has not be archived unfortunately.
Chagas disease is caused by a microspic blood parasite called Trypanosome Cruzi, it is one of the principal cause of death, andtouches almost a quarter of the population of Central and Latin America. There is no vaccine for this plague. Early detection is difficult, analysis uncertain, and prophylaxis inexsistent. It is one of the worst attributes of poverty. In 2007, the Chagas project was born, partly funded by the ACDI and a donation from the Third World Alliance Trade Unions (CSN), and an extraordinary inter-professional collaboration between HTSF (led by Josée Grenier, microbiology technician and homeopath, and Martine Jourde, director of HTSF – Homeopathie de Terre Sans Frontieres) and Dr Momar N’dao, director of the National Center in parasitology of Mc Gill University (NCRP) at the Montreal General Hospital. The first goal was to set up a clinical laboratory allowing the detection and the transfer of analysis of Chagas disease in the targeted population from Valle de Angeles.Two homeopathic nosodes were then made by the NRCP, including one which was a world premiere. In the first phase of the pilot project, a population of over 500 people, mostly children under fifteen years and women of childbearing age were tested, received prophylaxis and training as to how to identify and avoid transmitting agents of the trypanosome, and a general homeopathic consultation.
The ACDI is l'Agence Canadienne de Développement International -  French for Canadian International Development Agency (CIDA). It's now part of Global Affairs Canada.
Because of this success, we are putting in place the second phase of this project which is the extension of this approach to other communites at risk, where the prevalence of disease is worse than the one in Valle, especially in remote areas. Through this project, we can save and improve the health of many communities at risk, especially the young and women, in other areas of Honduras and in all the Americas. For this, we need to continue our collaboration and we invite our inter-professional to get involved.
It is unknown whether CIDA knew what the money was partly being used to fund a trial into homeoprophylaxis for Chagas. The potential involvement of McGill University is more problematic. If the research was conducted in collaboration with McGill then it would require ethics approval. It is very unlikely that approval would be given by a Canadian university.

As for McGill manufacturing nosodes? That would be highly unusual.

This from TSF is not very helpful but..
Scientific collaboration agreements can be signed between the UNAH-NRCP (National Reference Centre for Parasitology of McGill University, under the direction of Dr. N’Dao) and HTSF. Honduras can become independent in the early detection, prevention and care of Chagas patients thanks to homeopathy.
UNAH is the Universidad Nacional Autónoma de Honduras. If such collaboration agreements exist, they can be obtained. It is curious that neither McGill or UNAH make mention of a collaboration. Certainly for UNAH, this would be very newsworthy. Worse -
In order to render the project of integration of first line community based homeopathy and homeoprophylaxis autonomous and sustainable within 5 years, HTSF will guide UNAH in the installation of a laboratory that will manufacture homeopathic complexes for first line use, as well as the organization of a central pharmacy as storage location, and for distribution of first line homeopathic remedies necessary to supply the communities taking part in the homeopathic integration project.
In November 2015, Norbita Medina and Carla Marcelis were sent to install a homeopathic dispensary and begin the practical training in first line homeopathy of professionals and volunteers in two selected Honduran communities (Opatoro and Teupasanti). In April 2016, Josée Grenier, a homeopath and microbiologist-technician, who collaborated in the Chagas project since its beginning in 2006, will go to Honduras to reactivate the technical transfer to Honduran microbiologists.
Grenier would appear to be a laboratory technician as well as a homeopath. It would be odd for McGill to send a technician.

It will be interesting to read what McGill and UNAH have to say about this. Experience has demonstrated that the statements of homeopaths often can not be taken at face value. Exaggeration of the nature of links, engagement, etc is common.