Reaccreditation of the Society of Homeopaths

The Professional Standards Authority (PSA) recently re-accredited the Society of Homeopaths. The PSA stated that SoH met all their standards. It made some recommendations but did not impose any conditions.

There are some serious questions about whether the SoH should have been re-accredited. Much of this is to do with CEASE therapy but there are other issues. Homeoprophylaxis and anti-vaccination statements are among them. 

The decision to re-accredit isn't just a case of whether the SoH could demonstrate that they met Standards. The PSA as a public body has broader duties - some explicitly stated in legislation, other implicit. There are also questions about whether the SoH always acts in good faith.

This is very carefully worded. 

Previous accreditation
As discussed here and here, the SoH's last accreditation was subject to Conditions all related to CEASE therapy. Strictly speaking, it met those conditions. The PSA did not set any time scale for the SoH to ensure member compliance, rather time scales for the implementation of measures to ensure compliance. Nor did the PSA specify what compliance would look like e.g. whether links to the cease-therapy.com website are permitted.

Accreditation Process
The current accreditation process can be found here. There seems to have been a change to the process. Previously, the accreditation decision was made by a panel. Now it seems a single moderator can make the decision to re-accredit (although a panel can be called - only a panel can issue Conditions).

Accreditation Standards
These can be found here. There are eleven standards -

1. Hold a voluntary register of health and care practitioners
2. Be committed to protecting the public
3. Understand, monitor and control risks
4. Be financially sound
5. Inspire public confidence
6. Develop your knowledge
7. Provide strong and effective governance
8. Set good standards for practitioners on your register
9. Ensure appropriate education and training for practitioners
10. Run your register well
11. Manage complaints fairly and effectively.

2 is the most important but 3 is part of how a register would protect the public. Although the PSA do provide guidance on what compliance with these standards might be (and looking at accreditation of various other registers is also helpful), the standards are open to subjective interpretation.

Rather than consider compliance by standard, it is better to look at some of the issues raised with in the recent re-accreditation.

CEASE therapy
The report discusses in some depth what the SoH did to meet the Conditions of the previous accreditation. It seems that the SoH 

The re-accreditation report states -

5.14 The Authority had regard to the ASA’s recent statements about CEASE therapy, including its Enforcement Notice to CEASE practitioners, and the Society’s work to ensure that registrants did not use the full title or work outside its standards. The Authority noted an ongoing risk that CEASE practitioners may seek to treat or cure autism or promote harmful practices regardless of their advertising. The Authority issued the following Recommendation: Although presently a distinction is being made between use of the CEASE acronym and its full title, this distinction may not be meaningful. The Authority is concerned that the suggestion that autism can or should be eliminated may be wrong and is potentially discriminatory. The Authority notes that the CEASE acronym is readily linked to the words of the acronym. The Authority recommend that the Society consider banning the use of the acronym. If the Society does not do this, the Authority would need to be satisfied that the use of the word by registrants is not misleading or discriminatory and the Society should provide its report on this to the Authority. (Recommendation 2)

Potentially discriminatory? This will be discussed later.

The SoH were made aware of the ASA enforcement exercise in 2018, well before the statement was made. It is known that enforcement notices were sent out in May 2018. It is not currently known at what point in time the PSA became aware of this. Correspondence obtained between the SoH and PSA does not seem to mention it. This is odd. It is possible that it was discussed by telephone or in face to face meetings. 

Members of the SoH are still offering CEASE therapy. The spelling out of "Complete Elimination of Autistic Spectrum Expression" is still going on. Claims that vaccines cause autism are still being made. Some link to the CEASE therapy website where dubious claims are made. Likewise, some are still listed on the website which often links back to their own as well as providing contact details. Disclaimers about third party website content are irrelevant - the linking to the website is a deliberate act made in knowledge of its contents. Whilst the initial listing on the CEASE therapy website may not be a deliberate act, remaining on it is in the light of various reporting and actions.

CEASE as described by Smits and others advocates neglect of autistic children. It carries the risk of serious harms. It promotes unnecessary suffering. It is not at all clear how the SoH have mitigated this. From what has been seen of correspondence between the SoH and PSA, there are lots of assurances and nothing in the way of evidence. Some advertising has been amended but advertising can be very different from reality.

Also -

3.12 A concern was raised about claims by practitioners of a treatment related to CEASE therapy called ‘Homeopathy Detox Therapy’ (HDT). HDT aims for practitioners to ‘recognise and treat toxicity-related symptoms’. HDT’s creator stated that ‘the acute and chronic consequences of vaccinations can also be treated well. In fact, every complaint can be improved by HDT.’ The team had asked the Society if it considered HDT to be a separate modality to CEASE and if it had risks that needed to be considered separately. The Society advised it did not consider ‘HDT’ to be a separate adjunctive modality, with its own risks. The Authority noted that the Society should ensure practitioners of HDT are aware they must act in line with the Society’s position statement on CEASE as well as the Code of Ethics.

HDT is just a re-branding of CEASE with a minor variation in the remedies used. The SoH seem to recognise that re-branding does not change the risks.

Homeoprophylaxis
Homeoprophylaxis has always been an issue for the SoH. Like CEASE therapy, it does represent the potential to cause huge negative publicity. It has also been a concern of the PSA. In the light of the Sunday Times reporting, this from the accreditation report is particularly telling -

3.4 The Society has reviewed its risk register and updated existing risks according to recent evidence and mitigating actions introduced, for example from recent complaints cases and the work of its new Safeguarding Officer. The Society noted a low incidence of risk in most areas, for example when lone-working and ‘ability to identify and interpret clinical signs of impairment’. The Society recognised a need to revisit its controls against the risk of practitioners using ‘homeopathic remedies as prophylactics’, where a homeopathic remedy may be recommended instead of a conventional vaccination. The Society also recognised where it would need to provide new Continuing Professional Development (CPD) resources such as writing and storing of patient case notes.

The risks of homeoprophylaxis are obvious - someone may believe that they are protected against an infectious disease and go onto contract it. That belief that they are protected may cause them to engage in behaviours that make infection more likely. There are documented cases of this occurring with malaria. 

Anti-vaccination
Those who offer homeoprophylaxis are almost certainly anti-vaccination. But those who are anti-vaccination may not offer homeoproprophylaxis (openly).

The individual risks of not vaccinating vs vaccination are well understood. Likewise the impact on public health of lowered vaccination rates are well understood. Openly expressed anti-vaccination sentiment is relatively common among SoH members.

From the report -

12.8 A concern was raised about registrants, alleging they had written books that made statements that did not reflect NHS recommendations, for example by arguing against vaccinating children. The team noted that the book named in the blog was listed on the Society’s updated Resources page and asked the Society if the book was in line with its standards. The Society responded that it had since removed the book and other resources posted as it was not sufficiently familiar with them to promote them to its registrants. The Society emphasised that it 'supports informed decision-making, parents should be advised to include their GP in any decision relating to vaccination’. 

12.9 The team asked if concerns regarding statements made in a book could be investigated in the same manner as any other. The Society advised it would have to meet its normal complaint criteria about services provided by registrants. The team noted previous Panel decisions regarding concerns raised indirectly, that it ‘would expect a register to consider a complaint under their procedures and to consider whether there is any action they should reasonably take to enable them to assess whether they do have concerns and to assure themselves that it is reasonable not to take action notwithstanding that an allegation is broadly or vaguely stated rather than specific.’ The team suggested that in this case for example, it could have checked whether there was a concern that could be handled under Section 2.2b or 2.9 of the complaints procedure.

The persons in question are Yvonne Stone and Liz Bevan-Jones. What resources the SoH currently provide/link to re vaccination is unknown as they are now hidden from public view. Not that they are relevant - whether the SoH wants to accept it or not, it is beyond the competence of any homeopath to discuss vaccination with clients (but potential clients?).

It is obvious that some kinds of behaviour not directly related to advertising or practice of homeopathy might bring the SoH and UK homeopathy into disrepute but where to draw the line?

ADHD Trial
This was blogged about here. The University of Sheffield are yet to report on their investigation at the time of writing. What the accreditation report has to say is interesting -

12.10 A concern was also raised about a registrant’s involvement in a university research project, and their ‘treatment of vulnerable children’ and ‘supply of unlicensed medicines in breach of the Human Medicines Regulations 2012’. The Society had responded that the complaint did not fall within its complaints process and that enough evidence was not provided to progress the complaint. The Authority suggested that the Society might have made an enquiry of the University to consider whether any action was necessary, in line with the above.

Again, there are questions raised about whether the SoH should be concerned about activities of their members that fall outside of the advertising/practice of homeopathy.

Mental Health

The SoH made mental health their "theme" for 2017/18. Not just for their annual conference but there were other events too and heavy promotion on their website. But...

3.7 A concern was raised with the Authority about the Society’s recent mental health campaign, where the Society sought to raise ‘awareness of the potential of homeopathy in promoting mental and emotional wellbeing, as well as addressing mental health issues, among other organisations, including funding and regulatory bodies.’ The complainant stated that offering talking therapies was outside of the scope of practice of homeopathy. 

3.8 The team noted relevant risks and mitigating actions within the Society’s risk matrix, which describes, for example working with registrants who have a formal diagnosis for a mental health condition, or those who appear to exhibit signs of this without disclosing a formal diagnosis. The Society highlighted that registrants must act within their scope of competence and should refer to relevant guidance such as its safeguarding policy and by engaging in supervision. 

3.9 The team asked the Society for further information about mental health materials provided to registrants to assist their practice. The team also asked if the Society, as it was seeking to assist registrants to address mental health issues, had considered specific risks related to working with mental health issues, and mitigating actions related to this. The Society responded that its campaign aimed to ‘promote the role that registered homeopaths can play in supporting mental health and wellbeing’. The Society had recognised that registrants were seeing an increasing number of patients who identified as having mental health issues and sought support for this. The Society advised it had worked with a mental health charity and developed a reciprocal agreement for registrants to attend local support group meetings from an Accredited Register working with talking therapies. The Society advised that it continued to develop its work in this area. 

3.10 The Authority noted that there was no evidence that practitioners were encouraged to work outside their scope of competence, for example by offering talking therapies. The Authority noted that practitioners treating patients and service users with mental health problems should have the tools to make appropriate referrals and issued a Recommendation for the Society to ensure it has regard for this in the information and tools it publishes. (Recommendation 1)

In 3.8, it is assumed that "for example working with registrants who have a formal diagnosis for a mental health condition" actually means "for example working with clients who have a formal diagnosis for a mental health condition".

This is a complex area. The major concern is that of competence and recognising its limits. It is not intended to discuss it here.

Asyra, other machines and other therapies
The SoH has long recognised that the use of radionic remedy makers is a risk if for no other reason that public ridicule. The accreditation report states -

12.12 The team had received concerns about Society registrants offering therapies adjunctive to homeopathy such as the ‘Asyra bio-energetic screening system’ and ‘Vega Machine’. Such devices are used to identify ‘information from the body about aspects of health that are balanced or imbalanced’ or ‘test for food sensitivity and allergens’. Results from those tests may then inform registrants’ homeopathic practice. The concerns highlighted that incorrect claims had been, or could be made about their efficacy, as reflected in decisions by the Advertising Standards Authority. 

12.13 The team highlighted a recent decision by the Authority which stated that where the register is aware its registrants are providing adjunctive therapies … the register should consider what risks they may pose to the public, what controls may be needed to protect the public, and whether the practices are compatible with registration.’ 

12.14 The team asked if the Society had considered risks that may occur regarding such devices and set standards or provided guidance accordingly. The team had also asked if the Society would investigate and act on concerns raised around such practices. The Society responded that it did not review or regulate additional therapies offered by members and would refer to registration bodies covering a broader range of therapies. 

12.15 The Authority noted that as devices such as the above informed registrants’ homeopathic practices the Society could investigate related allegations, such as claims about efficacy. The Authority issued a Recommendation for the Society to consider what risks any adjunctive therapies it becomes aware of may pose to the public, what controls may be needed to protect the public, and whether the practices are compatible with registration. (Recommendation 11)

Examination of websites of SoH members who use the Asyra machine etc reveals that its use can be integral to the member's practice, rather than being adjunctive. In some cases, there is a clear separation between therapies. In which case, yes, being registered with separate registers would make sense.

The implication is that the SoH is not the right register for those that "mash up" homeopathy with other things. 


Public Sector Equality Duty
As previously discussed, CEASE therapy is problematic for the PSA in very many ways but to quote a statement that made by the PSA on Twitter -

In applying our equality duties, we made the decision that therapies underpinned by a philosophy that a protected characteristic under the Equalities Act (e.g. autism, sexual orientation) is a negative characteristic to be eliminated, must not be provided by ARs.

A slight detour to provide some context. The PSA have been very clear on gay conversion therapy. This statement -

Christine Braithwaite, Director of Standards and Policy at the Professional Standards Authority, said: 

‘The Professional Standards Authority welcomes this Memorandum.  The Memorandum clarifies the positions of the counselling and psychotherapy organisations and reinforces our decision, under our equalities duties, not to accredit any register which allows this therapy to be practised’.

is very clear but looking at the Equality Act 2010, it is not clear exactly what provisions are involved.

149 Public sector equality duty 

(1) A public authority must, in the exercise of its functions, have due regard to the need to— 

(a) eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under this Act; 

(b) advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it; 

(c) foster good relations between persons who share a relevant protected characteristic and persons who do not share it. 

(2) A person who is not a public authority but who exercises public functions must, in the exercise of those functions, have due regard to the matters mentioned in subsection (1). 

(3) Having due regard to the need to advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it involves having due regard, in particular, to the need to— 

(a) remove or minimise disadvantages suffered by persons who share a relevant protected characteristic that are connected to that characteristic; 

(b) take steps to meet the needs of persons who share a relevant protected characteristic that are different from the needs of persons who do not share it; 

(c) encourage persons who share a relevant protected characteristic to participate in public life or in any other activity in which participation by such persons is disproportionately low. 

(4)The steps involved in meeting the needs of disabled persons that are different from the needs of persons who are not disabled include, in particular, steps to take account of disabled persons' disabilities. 

(5)Having due regard to the need to foster good relations between persons who share a relevant protected characteristic and persons who do not share it involves having due regard, in particular, to the need to— 

(a) tackle prejudice, and  

(b) promote understanding. 

(6)Compliance with the duties in this section may involve treating some persons more favourably than others; but that is not to be taken as permitting conduct that would otherwise be prohibited by or under this Act. 

(7)The relevant protected characteristics are—age;disability;gender reassignment;pregnancy and maternity;race;religion or belief;sex;sexual orientation. 

(8)A reference to conduct that is prohibited by or under this Act includes a reference to— 

(a) a breach of an equality clause or rule; 

(b) a breach of a non-discrimination rule. 

(9)Schedule 18 (exceptions) has effect.

Those who advocate gay conversion are a small but vocal minority. They can pull on a base of support that is generally associated with conservative Christian groups (although homophobic sentiment is not universal among conservative Christian nor is it confined to these groups). Social attitudes towards homosexuality have changed in the UK, although some groups/communities have changed less than others. 

The legal protections against discrimination on the basis of sexual orientation have been strengthened.

Gay conversion therapy is not itself illegal. There is legislation in the pipeline, the Counsellors and Psychotherapists (Regulation) and Conversion Therapy Bill but what it proposes is the statutory regulation of psychotherapists and counsellors and making the offer and/or practice of conversion therapy a criminal offence. The former is difficult even though many in the profession would welcome both statutory recognition and regulation. The bill covers also covers gender identity. Given the lack of parliamentary time given to the bill and the complexities of what it entails, it is unlikely to made law in the short term. Even if statutory and voluntary regulators outlaw their members from offering it, there may be voluntary regulators that don't and it isn't necessary to belong to an organisation. It is the same problem that exists with quackery in general and the only real solution is to legislate.

(It might be possible to amend the bill to include certain other characteristics protected under the Equality Act 2010.)

The advertising of gay conversion therapy services would potentially breach advertising regulations but would likely be dependent on wording. But there do not seem to have been any rulings by the ASA on the matter of gay conversion therapy (although see below). Advertising might well in breach of consumer protection legislation, especially if words like "treat" or "cure". 

The situation with the promotion of gay conversion therapy in an abstract sense, where consumers are not directed to those offering the service is less clear. This blog has discussed the differences between commercial speech and free speech. The case of Core Issues Trust v Transport for London relates to a legal challenge TfL's decision not to allow advertising by a conservative Christian group promoting gay conversion therapy on buses. The judgement points out inconsistencies in TfL's approach (allowing the Atheist Bus Campaign and Stonewall adverts for example, which were controversial in a different way). But to quote Justice Lang - 

1. In my judgment, TfL would be acting in breach of its duty under section 149 if it allowed the Trust's advertisement to appear on its buses, as it encourages discrimination, and does not foster good relations or tackle prejudice or promote understanding, between those with same-sex sexual orientation and those who do not.

What is interesting that that advice was sought from the ASA as to whether the advertising would breach the CAP codes. Their response was that it did not. Also interesting are the quoted public responses to the possibility of the advertising appearing. Newspaper reporting did reveal the text of the ads and many were deeply offended by it.

The work of Patrick Strudwick is important in bringing attention to gay conversion therapy. This Guardian story from 2011 makes for powerful reading. 

But why isn't "Complete Elimination of Autistic Spectrum Expression" equally as problematic as gay conversion therapy? Are autistic people somehow less important than the gay community? That any offence or harm that is caused to them matters less?

Sadly, the answer is largely yes. It's partly about visibility, it's partly about ignorance (both about autism and the treatments inflicted on autistic people). Things are slowly changing but there is a long way to go.