Thursday, 17 October 2019

Data Project

As certain previous posts demonstrate, the content of various homeopaths websites and social media has been analysed for certain problem content. See this example about vaccination. This is a laborious and very time consuming process.

Being able to show how prevalent CEASE therapy was among homeopaths was very useful in getting media interest and getting regulators to act (even if homeopathy associations don't want to). The amount of effort involved is considerable. Part of the CEASE story is even with various actions, many media reports, homeopaths are still making claims and putting autistic children at risk of harm. It's an ongoing process and it will likely continue until open promotion of CEASE therapy and other associated harmful practices disappear from the UK.

Anything that would speed up the process would be a good thing. Most readers will not be interested in the technical details.

Whilst it may seem strange to reveal strategy and tactics, there are various good reasons for doing so. To be blunt, if homeopaths are aware that highly questionable claims will be detected more easily, that they can be monitored on an ongoing basis, they make be more reluctant to make them. Their associations may find it more difficult to dismiss concerns if presented with concrete evidence of the prevalence of problem claims. And of course, more evidence allows a more compelling case to be made to regulatory bodies.

Web scraping

What is web scraping?
Without going into too much technical detail, websites are made up of structured information. Sometimes that information can be cut and pasted into a spreadsheet and used directly, but more often not. Web scraping is a way of extracting relevant structured information from a website in a format that can be used in other computer programs. 

There are plenty of tools available that claim to be able to scrape websites without the need for coding. There can work very well for certain types of website with very well structured data but homeopathy related websites tend not to be. It is necessary to resort to coding. Because different websites structure data in different ways, different websites can require very different approaches.

Once written, a web scraping program can be set to run on a scheduled basis.

Association websites
Along with lots of extraneous information, homeopathy membership association websites will have membership lists. It would be strange not to. How they are presented varies and as does how easy they are to use. Some association websites do allow content beyond basic details. 

Capturing members over a period of time allows for tracking of numbers. As a side note, because of the way that some websites work(ed), using Wayback Machine it is sometimes possible to obtain historical data. This is proving very useful in charting the decline in membership numbers of the various homeopathy associations.

Directory listings
There are number of specialist directory websites in the UK that cover CAM practitioners. Examples include Natural Therapy Pages but non-specialist business directory websites such as also list homeopaths. However, with some of these websites, they are picking up their data from another external source. The homeopaths probably don't know that they are listed on them.

Some homeopaths don't have their own websites and will use directory listings as their primary online marketing. 

These websites can pick up homeopaths that are not members of an association.

"Training" websites  is the most obvious example of a website that lists practitioners that claim to have certain training but there are others. Some of the homeopathic colleges have lists of graduates. 

These websites can also pick up some homeopaths who are not members of any association.

The information of most interest are names and website addresses. Actual and email addresses, telephone numbers are of much less interest but can be useful in determining whether, say, two similar names are variations of the same name or actually two different people. 

Web spidering
A web spider (also known as a web crawler) is a programme that searches the internet for websites and their pages and stores the addresses in a database. Strictly speaking, a web spider doesn't have to capture the content of web pages but most web spiders do.

In practical terms of what is intended is to build a web spider than given a list of homeopath's websites will look for all the pages in that website that are linked to from the homeopage and capture their content. Whilst a web spider could follow links outside of those websites, it can result in huge numbers of web pages being capture.

Change detection
Obviously, if web pages are being captured on a regular basis, it is possible to track changes to them. Indeed, in order to reduce storage requirements it is better to store only webpages that change and track the date on which they have changed.

Most homeopaths' websites don't change very often, if at all. In many cases, it looks as if some homeopaths decide they need one, set one up and never do anything with it again. Indeed, some websites looked at have remained essentially unchanged for over a decade, based on the look of them and also some of the specific wording used. Copyright dates can also be a give away.

Saving pdfs of changed web pages is very likely to be useful if complaints are to be made.

Content analysis
Effectively, you have your own mini-Google to play with, restricted only those websites of interest. Whilst Google does have a Custom Search tool, it's limited to ten websites and the results would have to be scraped.

Being able to search selected webpages for certain keywords would drastically reduce the amount of work involved in analysis.

It would be possible to build lists of similar words/phrases. For example, yes, vaccine and vaccination are obviouly linked, but so is immunisation. It's known that anti-vaccination homeopaths sometimes use the phrase "natural immunity". "informed choice" or "informed decision" are phrases also used.

Examples of the kind of things that simple key word/phrase searches could determine are -
  • Whether common non-homeopathic therapies are offered such as cranio-sacral therapy, reiki and reflexology to name a few.
  • The institution a homeopath studied at. The qualification abbreviation used can narrow this done and sometimes the institution is explicitly named.
  • Protected title and bogus qualifications. Some titles are restricted to regulated professions yet some lay homeopaths will describe themselves as "homeopathic physicians". Some titles like doctor aren't protected but their use by the non-medically qualified can be misleading. There are also a few homeopaths with qualifications from diploma mills
  • Any other association the homeopath may belong to. Again, abbreviations can be indicative and sometimes they are explicitly named.
  • Conditions "treated". Of course homeopaths don't treat diseases they "treat the person" whatever that means. 
Links to external websites can be very revealing. Obviously, links to certain websites such as cease-therapy.comArnica Group and Informed Parent are of concern, but analysis is likely to find more problem websites. 

Text mining
Text mining is a huge area encompassing all sorts of different concepts and techniques. Many will not be applicable to this project. Homeopaths' websites tend not to contain that much text and thus there is a practical limit to what can be inferred from them. Also, some of the techniques require a lot of computing power. But there are some simple things that can be done.

To give a practical example - homeopaths are neither qualified or competent to give advice on vaccination but some explicitly offer it. Both "vaccination" and "advice" are quite common words on homeopathy websites. There are a number of ways that the explicit offer of advice on vaccination could be phrased and it is unlikely that they could all be determined. However, the closer the two words are to each other in the text, the more likely that the offer is being made. A proximity search is required. Another example where a proximity search might return good results is when a homeopath claims to specialise in the treatment of particular conditions.

Social media
Capturing social media content can be trickier than simple web spidering. This is especially true for Facebook. One of the issues with social media content is that there can be no clear differentiation between posts that are purely personal and those that relate to homeopathy etc. Frequent users of Facebook can generate a lot of content that is irrelevant for the purposes of this project.

The business of the muddying of the personal and the professional is a problem. If a social media account is used to promote a homeopath's business in any way, it can be considered advertising. 

Social media content also doesn't change in the same way that website content does. Once a post is made, it is extremely unlikely to change (except, perhaps, to be deleted). Rather new posts are made. Because of the way that social media works, over time, older posts become less visible - although this does depend on how frequently someone posts. More sophisticated users of social media can employ automated tools to regularly make the same post so that key messages remain visible to visitors. 

However, historical posts are of interest because they can, for example, reveal anti-vaccination views even if visitors to a page are unlikely to see them.

Content analysis of links will likely reveal the most important social media platforms. But it is worth pointing out that not every homeopath will link to their social media from their website, assuming that they have a website. Indeed some don't and use social media as principal online marketing platform. Determing whether a homeopath has an actual social media presence on a particular platform can be complicated by some platforms automatically creating placeholder accounts from directory type information that the homeopath may not even know exists.

Social network analysis
Again, like text mining is a big subject. The two are often used together. 

SNA has been used in research looking at the spread of anti-vaccination messages via Facebook. There has also been research looking at content and reasons for anti-vaccination sentiment. Neither are the approach that is intended to be taken. It is links between homeopaths and also links to known anti-vaccination accounts that are of interest. Membership of certain groups too. For example, on LinkedIn there is a CEASE therapy group. There are several closed Facebook groups too but changes to Facebook mean that its no longer possible, quite rightly, to determine who is a member.

Limitations and priorities
The resouces that this project has are very limited. One person who is somewhat rusty at coding and slow to say the least. A motley assortment of elderly hardware and a domestic broadband connection. There is no budget to buy whizzy software tools or new hardware (although it may be possible to get hold of yet more elderly hardware). Nor is there any budget for cloud based computing. 

The scope of the project has to be very tightly controlled. Whilst it could be extended to cover practitioners over than homeopaths or countries beyond the UK, this would consume resources. There is also a temptation to use more advanced techniques, especially in content analysis. Key word/phrase searches might be good enough for most purposes.

Web scraping and spidering are both legal in the UK but there are some limitations on what can be done with the data obtained. The legalities also vary in terms of who is processing the data and who has access to it. It makes collaboration difficult. Scraping/spidering a site too often can lead to being blocked but this can be overcome.

The primary goal of the project is to track those who have ever offered CEASE therapy and the related Homeopathic Detox Therapy. Tracking anti-vaccination sentiment is an important secondary goal.

Reporting findings
The intention is to initially report any findings to any relevant membership organisation. There is no expectation that they will do anything but it does give them the chance to act. If they do act, any results of that action should become apparent. If they don't act...

In the case of homeopaths who belong to either the Society of Homeopaths (SoH) or another other Professional Standards Authority (PSA) accredited register, the PSA will also be made aware of any results.

Some homeopaths do belong to statutorily regulated professions. Their regulators will be made aware but they are unlikely to do very much. Doctors in particular also have professional associations, generally associated with particular specialties. This type of association can be involved in the setting of educational standards for the specialty. Other associations such as the British Medical Association are more like trade unions. 

The Advertising Standards Authority (ASA) are likely to be very interested in some of the results. It's reasonable to assume that the ASA would like membership organisations to be more proactive to getting their members to comply with advertising rules. Indeed, the SoH did make much of cooperating with the ASA although sampling exercises suggest that the SoH has either done very little or is ineffective in what it has done. 

In the current climate, media are very interested in the prevalence of anti-vaccination sentiment. Whilst the importance of homeopaths in spreading anti-vaccination misinformation is unknown, some homeopaths are involved with groups/individuals who appeal very influential in the UK anti-vaccination sphere. There are stories that need to be told. Media reporting can be very useful in getting regulators to act or getting Government to change policy.

Most of the above is thinking about prevalence of problems but it is possible that analysis will turn up individual websites that contain marketing claims that are beyond the pale or even evidence of illegal practices. 

Of course, this blog will publish various analysis as results become available but it must be stressed that placing details of problem homeopaths and their websites into the public domain is not a first resort.

One possibility is submitting a paper to a relevant academic journal.

Potential Impacts
Homeopaths, their supports and associations are not very tech savvy. Nor do they seem to be very good at identifying emerging potential risks (or alternatively, they are very good at ignoring them). A more automated approach to monitoring homeopaths' marketing claims is very definitely a threat.

Some homeopaths should have noticed that Facebook is flagging their accounts as promoting anti-vaccination misinformation. 

UK homeopathy is in decline. Yet more negative media reporting could have the effect of further marginalising homeopathy and reducing what little public demand there is. True, it is unlikely to have any effect on the small core of "true believers" but it does make attempts to promote homeopathy to the general public much more difficult.

Although some aspects of this project are technically fiddly, none of it is rocket science. The associations could implement similar website monitoring themselves, if they wanted to.

Tuesday, 8 October 2019

Good Thinking Society Judicial Review

The Good Thinking Society (GTS) have been granted permission by the High Court for judicial review of the Professional Standards Authority (PSA) decision to accredit the Society of Homeopaths (SoH).

This post will repeat content very familiar to some readers. It is intended to be more stand alone than some other posts.

It isn't intended to provide a full explanation of the judicial review process. It is recommended that readers consult this from the Public Law Project. In short, judicial review is a process by which the decisions of public bodies can be challenged in Court when other means of redress have failed.

What is CEASE therapy?
CEASE stands for "Complete Elimination of Autistic Spectrum Expression". It is based on the belief that vaccines and other medicines are the primary causes of autism. It posits that homeopathic remedies made from these toxins can remove the "toxic imprints" that cause autism. It suggests that autism can be cured or at the very least improved.

Homeopathic remedies are in themselves harmless, unless contaminated. CEASE clearly advocates medical neglect of autistic children. To quote from the book Autism Beyond Despair written by the inventor of CEASE, Tinus Smits -
... All kinds of detoxification reactions may occur. The most common are eliminative reactions with an increase of reactivity (fever). Fever should not be treated with medication, as it is a healthy reaction of the organism and not a disease! It helps greatly to overcome an acute disturbance, shortens the healing process, stimulates reactivity and avoids complications. Eliminations like diarrhea, flu, expectoration, and bad-smelling and cloudy urine should also be left alone, because they are a part of the healing process.
A case of diarrhea as a cleansing reaction
I remember an autistic child who got diarrhea during the detoxification of his vaccines. The diarrhea relieved his system so much, that his autism almost disappeared instantly. After ten days the mother started to worry and went to the family doctor because I was absent at that moment. He prescribed Immodium (Loperamide) to stop the diarrhea by paralyzing the peristaltic motions of the bowels. Almost immediately the child had a setback and became autistic as before. The diarrhea was a perfect detoxification for his bowels and brain. Neither the doctor not the mother understood this, and the medication interfered with the progress of the cure.
CEASE advocates ignoring symptoms of potentially serious diseases. CEASE also states that autistic children should not be vaccinated. It also involves very high doses of vitamin C to the point where it causes diarrhoea (and then reducing the dose).

The vast majority of CEASE practitioner sare medically unqualified lay persons. The vast majority have no training in autism awareness. There are questions about whether they have had suitable training in safeguarding vulnerable children: they appeal unable to recognise that CEASE is neglect (if they did they would not practice it).

Some background
The PSA is an official body with two separate but related functions. It acts as an oversight body for the regulators of the staturorily regulated medical professions. It sets standards for regulation and monitors performance against them.

It also has a voluntary accrediation scheme for registers that admit practitioners who are not regulated medical practitioners. Registers can apply to join this scheme if they can demonstrate that they meet the Standards set by the PSA. They are assessed every year against the standards.

The Society of Homeopaths was formed in 1978. It is the largest homeopathy association in the UK (but not the richest). It currently has around 1,000 members. The majority are medically unqualified lay persons. There are some nurse/midwife members. Some are still reigistered, other are not. They are a very few doctors too. Its membership is predominantly female. Whilst it is the biggest association it is likely that more homeopaths do not belong to the SoH than do.

The SoH was originally accredited by the PSA in 2014. There were numerous objections to this but the PSA took the line that legislation prevented them from considering the efficacy of any therapies that might be offered by members of a register applying for accreditation. They considered it ultra vires. It is understood that someone did at some point indicate an intention to seek judicial review of a decision to accredit (it is not clear if it was the initial decision or a subsequent one) but no application was made.

The existence of CEASE therapy has been known for years but outside of homeopathic circles not much detail was. Seemingly no-one had picked up that it advocates the medical neglect of autistic children. The SoH were informed of concerns about members offering CEASE therapy towards the end of 2017.

Concerns were raised with the PSA that given their history, the SoH were unlikely to do anything concrete to address issues other CEASE therapy and might even ignore them. Also around this time the Advertising Standards Authority (ASA) were alerted to widespread online advertising of CEASE therapy - although this did not single out SoH members.

The PSA did renew SoH accreditation in 2018 but the announcement was made many months after the notional end of the previous accreditation period. That accreditation was conditional on the SoH developing an action plan to deal with members offering CEASE therapy. From correspondance obtained by Freedom of Information Act (FOIA) requests it would appear that there was a reluctance on the part of the SoH to act and even less to act quickly. The action plan aimed for member compliance by December 2018. The 2018 conditional accreditation was widely reported by the media. It caused major upset in the UK homeopathic community. The initial reporting coincided with the SoH's annual conference.

It is also known from FOIA requests that during the accreditation process the ASA send out an enforcement notice to all CEASE practitioners pointing out the types of marketing claims that were prohibited and that non-compliance could result in referral to Trading Standards who have the powers to prosecute.

During 2018, it became clear the SoH's action plan was not acheiving widespread compliance. Whilst some members did amend their marketing claims, some did not. Some members did remove all mention of CEASE from their websites but many simply modified the language, in particular to remove claims that vaccines cause autism and so on. Removing certain marketing claims is one thing but many link to the website where the prohibited claims are still made. Of course, removing marketing claims does not mean that practitioners were not making the claims face-to-face, on social media, via Skype, in email newsletters and so on.

The question started to be raised in 2018, given the unwillingness/inability of the SoH to achieve compliance, whether they should be accredited by the PSA in 2019. It also became clear that if the PSA did, the decision could be challenged via judicial review.

Again, announcement of accreditation did not happen on time but before any announcement was made the ASA went public regarding the enforcement action and it revealed referrals had been made to Trading Standards. Again, this caused much upset in the UK homeopathic community and curiously, happened just as the SoH annual conference started.

At one point on Twitter and also in board papers, the PSA did imply that they were aware that CEASE could be considered discriminatory.

The PSA 2019 accreditation of the SoH appeared very quietly some time in April 2019. The PSA accredited the SoH with no conditions.

On 29/06/2019, the GTS announced that they had applied for judicial review.

Accreditation Process
It is necessary to understand a little about how the PSA accreditation process works. Registers are expect to signal their intent to renew months in advance of the expiry of accreditation term. The public and other stakeholders are invited to comment on the register. It's not an invitation to talk about the efficacy of a therapy or the service recieved from a member of a register. The PSA may also monitor communications issued by the register during the year, media reporting and so on. It is expected of certain stakeholders that if they have major concerns about a register that they raise them immediately rather than wait for the invitation period. 

The register is expected to submit by the end of the tenth month of the accreditation period (November 2019 in the case of the SoH) -
- A completed and signed renewal application form 
- Any supporting documentation 
- An updated Risk Matrix 
- Responses to feedback shared by stakeholders through our Share Your Experience process 
- Registrant numbers to allow us to calculate the annual renewal fee.
Why is the 2019 accreditation is problematic?
To begin with the 2018 accreditation was condititional and there is a lack of clarity about what was expected from the SoH beyond an "action plan" and what the consequences would be if the SoH did not fulfill the terms of it. To repeat the Conditions -
1. The Society must:  
a. Develop and submit to the Panel for review its position statement on the use of CEASE therapy by registrants, including advertising this. This must be submitted to the Panel for review and published within three months  
b. Develop mechanisms to ensure that registrants who use and advertise CEASE therapy follow the Society’s position and do not breach its Code of Ethics and Practice. An action plan outlining how this will be achieved must be submitted to the Panel within one month  
c. Review risks related to CEASE and other therapies additional to registrants’ regular scope of practice, as part of its ongoing risk assessments. This must be incorporated into the Society’s risk matrix within three months.
There is demonstrable evidence that with (b), whilst the SoH may have developed "mechanisms", they were not effective. 

The accreditation report mentions CEASE extensively. It is clear that the PSA understands that CEASE is problematic in a number of ways, it was certainly aware that some SoH were still making problematic claims (and likely practicing it) but yet it saw fit to renewal accreditation unconditionally. Yes, it made a number of recommendations re CEASE but they are not binding. Recommentations are - "Actions that would improve practice and benefit the operation of the register, but do not need to be completed for compliance with the Standards to be maintained. Implementation of recommendations will be reviewed at annual renewal." 

Also, to quote from the PSA -
The Accreditation team will present the report to the Moderator to make a decision. Outcomes may be:  
- Accredited  
- Accredited with Recommendations  
- Referral to targeted review  
- Direct referral to an Accreditation Panel 
Outcomes of an Accreditation Panel may be: 
 - Accredited with Recommendations 
 - Accredited subject to certain Conditions that you must satisfy to retain accreditation 
- Suspension dependent on appropriate action 
- Removal of accreditation.
The accredition decision was made by a single Moderator. A Moderator can not impose Conditions. Only an Accreditation Panel can do that and the Moderator chose not to refer.

GTS grounds for application
This blog isn't privy to what was submitted but some of evidence the GTS and their legal team likely used is in the public domain. The arguments made are not very different from those suggested on this blog. The exact detail is unknown but the main thrust is very clear. To quote from the GTS -
Good Thinking argued that the effect of PSA accreditation is to sanction treatments performed by members of the accredited organisation, such as the Society of Homeopaths, and that the PSA must carefully consider whether such treatments are harmful as part of its deliberations.  Additionally, Good Thinking argued that in reaccrediting the Society of Homeopaths the PSA failed in its legal duty to consider the potential effects of its decision on disabled people, such as the autistic children at whom CEASE therapy is aimed.  It was also argued that the decision to reaccredit given what the PSA knew about CEASE therapy was irrational.  The Judge granted permission on all grounds.
Bindmans, GTS's solictors repeat the same statement here.

From the permission itself -
  1. The Claimant has raised an arguable case to the effect that in taking an accreditation decision, the Defendant must make an assessment of the likely impact of doing so in particular on users of health care and other members of the public. There is an issue between the parties as regards the nature of, and the limits of, the Defendant's role and remit in making accreditation decisions. The Defendant says that the impact of accreditation is to impose standards of organisation and governance on bodies, but the Claimant says that it goes beyond that because the effect of accreditation is indirectly to sanction treatments performed by members of the accredited organisation. This then gives rise to issues regarding the inquiries required of the Defendant and whether the inquiries made were sufficient.
  2. It is acknowledged that the Claimant says that this is not a public law issue, but one of whether the Claimant would have formed a different view from that of the Defendant. That might be the conclusion at the end of the case, but it is at least arguable that the difference was about the Defendant failing to pay adequate regard to relevant considerations required of a person accrediting. The effect contended for was that the Defendant did not ask itself the right question or make sufficient inquiries or conscientiously consider the facts. There are also arguments about whether the Defendant breached the public sector equality duty and/or acted irrationally.
It is important to remember that the granting of permission is not a judgement. The legal meaning of "arguable" is different from the everyday one. It is suggestive of argument having merits which need to be explored rather than the reverse.

Strange as it may seem, the enabling legislation (the Health and Social Care Act 2012) of PSA with regards to accredited registers does not explicitly state that it has a statutory duty towards public health and safety beyond what is in . Nor is the PSA directly responsible to any legal entity that has such a statutory duty. There is more of a statutory duty on the PSA with regards to staturorily regulated professions but bodies such as the General Medical Council have considerable (quasi) legal powers themselves. Many in the regulated professions are also employed by NHS bodies that have statutory duties to public health and safety.

Regardless of the lack of a clear statutory duty, the PSA states as one of its objectives -
1. Increasing the influence of the Authority’s work to improve regulation and registration and promote the health, safety and wellbeing of patients, service-users and other members of the public.
"Influence" is a very vague term but one tool that the PSA has is place conditions on an accreditation to improve areas in which a register falls short on protecting the public. It has the powers to refuse, suspend or remove accreditation.

The PSA describes the overall benefits of accreditation as -
Whether you are a member of public looking for a health practitioner, an employer recruiting staff or a commissioner buying services, Accredited Registers can help you choose with confidence. 
When you choose to see a health and care practitioner you want to know that you are in safe hands. Using someone on an Accredited Register gives you peace of mind, knowing that:
  • Practitioners on an Accredited Register are part of a government-backed scheme to protect the public
  • The organisation holding an Accredited Register has been rigorously assessed by us and awarded our quality mark
  • We make sure you are given clear and accurate information to help you choose a practitioner to meet your needs
  • We make sure Accredited Registers handle complaints fairly and robustly
  • If a practitioner is struck off an Accredited Register they are not allowed to join another one in the same occupation (or another in a different occupation if removed for misconduct), so you and others can avoid poor practice
  • Accredited Registers are recognised and supported by key stakeholders in the UK.
Practitioners who are committed to high standards choose to join an Accredited Register. Responsible employers and commissioners choose practitioners on Accredited Registers. 
We recommend the public only see practitioners on an Accredited Register (or a Statutory Register). Look out for our quality mark which is displayed by practitioners on Accredited Registers.
"You know you are in safe hands" and "Practitioners on an Accredited Register are part of a government-backed scheme to protect the public" are very suggestive statements.

CEASE does advocate medical neglect of autistic children. It can hardly be said to be safe.

The question of whether accreditation of a register indirectly sanctions treatments offered by members is not straightforward. Certainly some SoH members believe that it does - claims that they are accredited by PSA (rather than belonging to an accredited register) have been seen. Likewise similar claims have been made by homeopathic colleges. It is understood that the PSA aren't happy about these claims and will seek to have them removed if made aware. Unlike some other registers, the SoH's focus is on a single therapy - homeopathy. It does not support or endorse the use of other therapies by members. Public awareness of the accredited registers scheme is low and understanding of its niceties likely very much lower. Would a member of the public upon encountering a website of an SoH member believe that the PSA sanctions homeopathy?

The SoH position on CEASE (and vaccination and homeoprophylaxis) is muddled. It says -
The Society does not endorse any aspects of CEASE therapy contrary to NHS guidance and nor should RSHoms, in particular on vaccination, homeopathic prophylaxis, and the use of dietary supplements. It is beyond standard homeopathic practice to provide advice on the use of supplements and therefore any guidance given should be in line with the NHS Guidelines
So it endorses those elements of CEASE that don't contradict NHS guidance? NHS guidance on homeopathy is vague but says -
Some people who use homeopathy may see an improvement in their health condition as the result of a phenomenon known as the placebo effect. 

If you choose health treatments that provide only a placebo effect, you may miss out on other treatments that have been proven to be more effective.
The more bizarre elements of CEASE simply aren't covered by NHS guidance. Does the SoH, for example, endorse the prohibition on microwaving of food? There are problems with rejecting parts of a therapy but accepting others - Smits would have said this is not CEASE therapy. To quote a Dutch homeopath -
Tinus has high expectations of himself, but also of his colleagues. He has a strong Hahnemanian attitude, saying: make it like I do, but do it exactly like me, otherwise you will not the same results. Perhaps this is exactly the quality you to achieve what he has done, the ability to open up new horizons.
Does the PSA by accrediting the SoH endorse the elements of CEASE that the SoH does not prohibit? It would likely say not.

Is Judicial Review Avoidable?
Possibly and there are good reasons to do so.

Judicial review is expensive. There are ways to limit the cost but the loosing party can end up facing having to pay the other side's legal costs in addition to their own. For example, the British Homeopathic Association ending up having to pay £120,000 pounds in their failed judicial review of NHS England's decision to issue guidance to the effective that GPs should not prescribe homeopathy on the NHS. 

Whilst the PSA is a considerably larger and better funded organisation than the GTS, the accredited registers scheme is intended to be self funding. It isn't yet and the PSA are given a subsidy by the Department of Health and Social Care (DHSC) to keep the scheme running. It is likely that the costs to the PSA in dealing with the SoH are already higher most other registers. Depending how the PSA budget for legal costs, the judicial review could have the effect on making self funding an even more distant prospect, which is unlikely to please the DHSC. Other registers would also be effectively subsidising the SoH. They might not be happy about this.

The GTS are using crowdfunding to cover (some of) their initial legal costs. It is possible that they might not secure enough to proceed any further. Sometimes public authorities will gamble on this and the complainant's fear that they will lose and have to cover the public authority's legal costs. 

A ruling in favour of the GTS is unlikely to have much impact on the overall credibility of the PSA and accredited registers scheme (although it may raise questions about certain registers). It could be severely deterimental to the SoH. Reputational damage is one thing but it could give more power to those disatisfied with the SoH deferring to external regulators etc, assuming they do not leave. Whether an adverse ruling would have an effect on UK homeopathy as a whole is debateable. 

Whether the GTS would abandon judicial review if the SoH, say, declared that it would prohibit members from offering CEASE etc, would discipline any member found doing so and made a firm commitment to carry through is unknown. Ditto if the SoH said that it had decided that PSA accreditation was no longer tenable. The SoH are very unlikely to do either. Both would be damaging.

There also good reasons why judicial review should go ahead. One less obvious reason is that there is little or nothing in the way of relevant case law. Various public authorities do have accreditation schemes. The extent to which public sector equality duty (PSED) should be considered in accrediting organisations/individuals is unclear. This article talks about PSED in a procurement context. Of course, with accreditation, registers are effectively buying a service from the PSA rather than the other way around but even so...

A word about evidence
The PSA have in the past refused FOIA requests relating to the SoH. One of these refusals was appealed and ended up with Information Commissioner's Office (ICO). The ICO upheld the refusal. 

There are limits to what FOIA requests can obtain. The ICO's ruling is quite helpful in understanding why the PSA refused the request and - 
21. The PSA further stated the qualified person has closely evaluated all of the information and has reached the reasonable conclusion that this ‘would’ inhibit the free and frank provision of advice and the exchange of views for the purposes of deliberation and that it ‘would’ prejudice the effective conduct of public affairs. After reaching this decision the qualified person, as well as the relevant team members closely considered the arguments for and against releasing the information and reached the conclusion that the public interest in transparency is, in this case, outweighed by the public interest in the Accreditation programme being successfully maintained for the purposes of public protection. 
And later -
25. The PSA explained that as this is an ongoing process, without the trust of the organisations involved it would be unable to fulfil its statutory functions in relation to accreditation. The Accreditation team have received feedback from a number of registers that are involved in the accreditation process or considering applying, that they would be unwilling to provide information that they consider to be sensitive as part of the application process if they believed that it would be released into the public domain. The BACP (another accredited register) has advised the PSA that they would consider it to be a ‘breach of confidentiality’, highlighting the wider impact on the programme. 
26. It further confirmed that this conclusion had been reached after considering responses received from other accredited registers, which they stated they would not have applied for the scheme and disclosed the information had they believed it would be disclosed under the FOI, and indications from other organisation that they would not provide full and frank information in future should it be released.
What will be presented to the Court will not be subject to these limitations. 

Judicial Review
A judicial review is different from most other Court proceedings (especially as depicted in film and TV). The Public Law Project explanation is very clear so quoted here -
Usually within 35 days of the decision to grant permission the defendant must file and serve its detailed grounds of resistance, setting out in more detail the basis on which it is defending the claim. That must include any written evidence it wants to rely on. The case is then set down for hearing before a judge in the Administrative Court. The time estimate for the hearing will normally be agreed by the lawyers for all the parties. 
The full hearing is very formal. It involves lawyers from both sides making arguments about the lawfulness of the decision, act or failure to act which you have challenged. It is very unlikely you will have to give oral evidence, and you may not even need to attend the hearing, unless you would like to do so for your own interest. 
At the end of the hearing the judge can give judgment there and then, but that is unusual. The judge usually “reserves” the judgment, which means that the judgment will be given later, usually a few weeks after the hearing has taken place.
There's no back and forth between the lawyers. Witnesses are rarely called and cross examination is very rare. Arguments are largely set out in writing and both sides them before the hearing. There is a possibility for interested parties (in this case the SoH) to speak. 

Looking again at the permission -
Consideration should be given as to whether the scope of relief is too broad referring to a declaration of about accreditation generally. Further, there is a question as to whether the declaration as regards the Decision is about the interested Party generally or as regards the Interested Party relating to CEASE therapy. These are matters as to which greater definition is required as to the scope of the challenge. This appears to be the intention of the Grounds of Claim, whereas as currently drafted, the relief may be broader than is required.
Relief here mean the legal remedy sought. The GTS are asking that the decision to accredit the SoH is overturned on the basis of irrationality. For practical purposes, the scope of relief has little differences to the likely arguments. The jist of the skeleton arguments are clear but what might the more developed arguments be? It is possible to speculate...

Developing the arguments - PSA
So what grounds might the PSA's lawyers set out in its defence? They will point out that legislation does not allow them to take into account the efficacy of the therapies offered by a register. They are likely to stress the PSA's role in accrediting voluntary registers is limited to setting Standards relating to how registers carry out their functions and how they are run. It is not a regulator of regulators, it is an assurer of bodies that practitioners voluntarily join. Those bodies are under no compulsion to apply for accreditation.

The onus is on registers to do what is required to meet the Standards. The PSA specifies what the Standards are and whilst it produces guidance on how to meet them it is not its role to dictate exactly how a register should go about this. 

An example might help. The PSA does not have powers to investigate complaints about members of a specific register. It would direct the complainant to the register. If the complainant was unhappy with how the register dealt with their complaint? The PSA has no powers to deal with that either. However, it would consider whether the register was meeting the Standards in the manner it deals with complaints in a more general context.

Looking at the Condition that was placed on the SoH, the PSA specified that the SoH needed to come up with an action plan but it did not specify what that action plan should be. Nor did it specify what the outcomes of that action plan should be. 

There is an assumption that if a register meets the Standards then its members will, for practical purposes, be generally safe in their practices. Things can go wrong for all manner of reasons that can not be blamed on a register. 

One argument that might be made is that for many practical purposes a Recommendation will achieve the same effect as a Condition. This assumes that a register takes accreditation seriously and has a desire to improve. 

The PSA would have made their decision to accredit the SoH on the basis of evidence made available to them at the time by a register. There is an expectation that registers will be open and frank in their submissions, that they will not hold back information that might be prejudicial. The PSA may request specific additional information from a register but it has no statutory powers to demand such information. It is dependent on registers being cooperative.  It could, in theory, refuse or place restrictions on accreditation if requested information was not supplied but this seems unlikely.

Here is a bland statement from the accreditation report -
14.1 The Authority had regard to its duty under the Equality Act 2010 when considering the application for renewal of accreditation.
What deliberations the PSA made in deciding that it meets the

Developing the arguments - GTS
What more detailed arguments might the GTS' lawyers make? It must again be stressed this blog is no more privy to the discussions between the GTS and their lawyers than any other member of the public. This does mean that it is possible to speculate without prejudicing any legal action. The only possible advantage that this blog has over another member of the public is familiarity with information that it already in the public domain.

There are multiple arguments that could be advanced. The problem for a lay person (and even a lawyer who is not a specialist in public law) is determining their relative relevance and strengths. There is a distinct difference between, say, writing polemic blog posts about why the PSA were wrong to accredit the SoH or some SoH members are bad people and getting a Court to rule on the irrationality of the PSA's decision.

The GTS say their goals are to -
  • If successful, the challenge could see the accreditation decision ‘quashed’ (annulled) by the court and the PSA ordered to take into account the harms associated with CEASE therapy in considering any reaccreditation application from the Society of Homeopaths
  • Good Thinking hopes that this will result in the Society of Homeopaths being required by the PSA to take action to protect autistic children from harmful therapies, or lose their accredited status
It isn't neccessary to deploy lots of arguments to achieve these.

Whilst the exact legal duty of the PSA towards public safety is unclear, there is no doubt that it has a moral duty. It is also clear from various statements that it was Government's intention that it should have such a duty. Likewise statements from the PSA itself seem to indicate that it feels that it does. Whereas the framing of the legislation may be such that consideration of the efficacy of a particularly therapy would be ultra vires, there is nothing in legislation that prevents the PSA considering the safety of a therapy. 

That there have been no reports of harm caused by CEASE therapy is irrelevant. The absolute risk of harm may be low but its impacts could be disasterous. That in Court cases where harm has resulted for medical neglect involving CAM treatment by medically unqualified lay persons, the blame is generally placed on parents is also irrelevant. The Standards state that a register that meets them -
3a) Has a thorough understanding of the risks presented by their occupation(s) to service users and the public – and where appropriate, takes effective action to mitigate them.  
3b) Is vigilant in identifying, monitoring, reviewing and acting upon risks associated with the practice of its registrants and actively uses this information in carrying out its voluntary register functions. Evidence provided should demonstrate how the organisation seeks, gathers and handles information, and provide examples of having acted to prevent or mitigate risk. The Professional Standards Authority will decide whether this Standard is met with reference to guidance provided in the Accreditation Guide (2016).
Note the emphasis on risk and "effective action". It stands to reason that the PSA does in its evaluation of whether a register meets this standard make its own evaluation of risk to some extent. 

It can be strongly argued that the very phrase "Complete Elimination of Autistic Spectrum Expression" is discriminatory. Whatever the reasoning behind the choice of words, it could be read as suggesting that autism is something undesireable that should be got rid of. Autistic people vary considerably in their needs and their abilities. The politics surrounding autism are very complicated but for some autistic people, autism is very much part of their identity. The phrase can be read as invalidating that identity. The reactions of autistic adults to the phrase without prior knowledge of the therapy are illuminating. All were negative but some found it very menacing. Comparisons to eugenics and even the Nazi Aktion T4 euthanasia programme were made. 

CEASE does single out autistic children as a group. That practitioners claim that it can be used for other conditions is a red herring. The advocacy of neglect could be read not just as discriminatory but also as victimisation, albeit more passive that some forms.

The PSA understand that CEASE is discriminatory. By accrediting the SoH they are in breach of PSED.

It boils down to this. Given what the PSA knew about -
  • the risks associated with CEASE therapy
  • the questionable efforts of the SoH to mitigate the risks
  • the discriminatory nature of CEASE therapy
  • the prevalence of CEASE therapy among SoH members
was it rational for the PSA Moderator to (unconditionally) accredit the SoH? Would a reasonable person reach a different conclusion from the Moderator?

Re-run of Accreditation Process
If the GTS are successful in overturning the PSA's decision, the PSA will have to re-run the accreditation but in such a way as to correct the deficiencies identified. This does not necessarily mean that the re-run accreditation will have a different result but it will have to be done differently. It would seem sensible that it would be carried out by an Accreditation Panel. 

Even if the GTS are unsuccessful, unless the SoH choose not to apply for accreditation for 2020, the PSA are likely to be very mindful of CEASE therapy and other factors. The accreditation decision is likely to come under far more scrutiny that any previous one and it is possible that there 

Compared to 2019 accreditation, the PSA are in posession of considerably more evidence. They are also aware that there is key evidence that may be available for the asking. For example, whilst CEASE is obviously a bad thing, the exact details of CEASE training are unknown. It is known that at least one training session also included homeoprophylaxis. Some homeopaths on their websites have mentioned it includes information on the Jarisch–Herxheimer reaction. Given that is the result of endotoxins being released by pathogens when treated with antibiotics, whatever is being seen isn't that and must be caused by something else. There are questions about what other potentially dangerous wrong things it contains.

This blogpost from Les Rose contains something chilling. It is about an open day held by the Salisbury Homeopathy College (SHC). 
We then had a wrap-up session with Annie, whose task presumably was to get us to commit to a four-year part-time course. There was the usual discount for signing up on the day. This was supposed to be an opportunity to ask questions, but Annie was so fired up that it was hard to get a word in edgeways. I was going to mention CEASE therapy anyway, but she got in first and divulged that they teach it on the course. Some of the tutors are qualified CEASE therapists, including Joanna. This is interesting in view of the storm that The Society of Homeopaths is sailing into right now. Briefly, the PSA has placed the SoH on notice to discipline members who practise it, on pain of losing its accreditation. The team in Salisbury must be aware of this, but they didn’t mention it.
And -
I tried to press Annie on vaccination, but she was careful not to come out as 100% against it. She does advise patients on homeopathic alternatives for travel, but generally leaves it to them to have the jabs if they want, and “sort it out when they get back”, ie a homeopathic `detox’. She is clearly convinced that vaccines can be harmful, but won’t deny that they have some benefits.
SHC are accredited by the SoH. If the SHC is still teaching CEASE, this raises all sorts of questions about their accreditation by the SoH. It means that any graduate of SHC will be need to be monitored by the SoH. It also means the SHC hold CEASE training materials.

The prevalence of anti-vaccination sentiment is a real problem for the SoH. Roughly 30% of members with websites are openly anti-vaccination in one way or another. Troublingly, this also includes some of its directors which may explain why it has done very little. Some members are very extreme. Some colleges also host talks by anti-vaccination speakers which are considered "professional development".

But is isn't just about the headline grabbing issues. There are board questions as to whether the SoH meets some of the Standards. Reading the SoH website it is difficult not to come away with the impression that it is more interested in itself and its members than it is in protecting the public. It seems to have become less open, more defensive, secretive even. It is known from FOIA requests that the SoH has a history of seeking delay, putting obstacles in the way of reaching agreement, implementing action plans etc. Some of this may have been down to ex-CEO Mark Taylor but the board must also shoulder some responsiblity.