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.

Reach
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.

Reactions
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. 



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