Tuesday, 26 November 2019

UK Homeopathy's response to media coverage etc

There have been a lot of media reports on UK homeopathy recently. Most of them focus on anti-vaccination but mention has been made of CEASE therapy and the Good Thinking Society's legal challenge to the Professional Standards Authority's decision to accredit the Society of Homeopaths.

This post will not concern itself with the media reports themselves but rather the responses by homeopaths, their supporters and organisations. In particular...

There are several things very wrong with this statement.

More than one thing going on
UK homeopathy hasn't had positive media coverage for several years. Whilst some more extreme homeopaths and supporters try to depict this as being part of a conspiracy involving an array of different parties, the reality is that there are several threads to it although it is fair to say that the Good Thinking Society (GTS) turns up in some of them.

The business of homeopathy on the NHS is important but not directly connected to current reporting.

CEASE therapy has a lot to do with it. The first proper reporting in the UK goes back to April 2018. There was also reporting associated with the Advertising Standards Authority (ASA) action against practitioners offering it. More reporting emerged as a result of the GTS legal challenge to the Professional Standards Authority's (PSA) decision to accredit the Society of Homeopaths (SoH) whilst members were still offering CEASE therapy being given permission to procede. Then a bomb dropped. As part of the accreditation process, the PSA invites key stakeholders to "share their experience" of registers. This year, Sir Simon Stevens CEO of NHS England and Professor Stephen Powis Medical Director of NHS England did just that. And copied in every major UK media outlet. This was widely reported and was on the front page of the Daily Mail. More detail can be heard here - letter is read out at about 20:00.

The Daily Mail also embarked on a campaign to combat "vaccine ignorance". This would per force involve reporting on anti-vaccination and there would be considerably cross over between that and homeopathy. That homeopaths were reported on is no surprise. Nor where the Mail the only outlet to report on it. The prevalence of anti-vaccination sentiment also forms part of the GTS's legal arguments.

Homeoprophylaxis is an ongoing issue for homeopathy. Over the years it has popped up from time to time in the media but The Times reporting back in May 2019 marks the start of more recent interest.

It doesn't give much away to state that there are other potential stories in the pipeline.

Some of the media did allow comments by readers. Whilst a few supporters of anti-vaccination and homeopathy did respond, most commenters were appalled. There were the usual demands from some that homeopathy should be banned. Which is not going to happen and is nigh on impossible. 

Defending the indefensible

There seems to be a line that undercover reporting is unfair and unethical. Some point to journaliatic codes of conduct and Independent Press Standards Organisation (IPSO) guidance, in particular -
10. *Clandestine devices and subterfuge 
i) The press must not seek to obtain or publish material acquired by using hidden cameras or clandestine listening devices; or by intercepting private or mobile telephone calls, messages or emails; or by the unauthorised removal of documents or photographs; or by accessing digitally-held information without consent.
And then fail to quote -
ii) Engaging in misrepresentation or subterfuge, including by agents or intermediaries, can generally be justified only in the public interest and then only when the material cannot be obtained by other means.
It would be difficult to argue that reporting of anti-vaccination, homeoprophylaxis and CEASE therapy is not in the public interest. One argument that has been seen is that the anti-vaccination etc views of those caught out were already in the public domain, so there was no reason to do undercover reporting. The claims uncovered go far beyond what is said on websites. It is extremely unlikely that those homeopaths would have made those claims in an interview, assuming that they'd even agree to an interview.

It has also been said that reporting distorts what was said. It is true that the media often do get things wrong, omit key information and so on. It is also true that the media will sometimes focus on the sensational and individual and lose sight of the bigger picture. For example, it has reported on individual homeopaths when the prevalence of anti-vaccination is of far more concern. Even so, the media did not materially misrepresent any of the homeopaths caught by undercover investigation. Some of the details are slightly wrong but that's about it. What the media missed is more interesting. For example, Freestone and Whitby featured in the video both offer CEASE therapy.

Some anti-vaccinationists make supportive nonsenses but they are couched in terms of the media reporting being an attempt to suppress or censor the anti-vaccination message of the homeopaths caught out. It's not really about homeopathy for them. Conspiracy theories seem to play a large part in their thinking. 

For homeopaths and supporters of homeopathy, it's a lot more about portraying the reporting as attacks on homeopathy and less about censorship of anti-vaccination. An "attack" on one is an attack on all and must be defended again (however ineffectual that defence may be).

Homeopaths who publicly support the homeopaths caught out don't seem to realise that it marks them out as potentially anti-vaccination even if they are not. 

Not a problem
Some have tried to downplay the reporting in terms of saying that the homeopaths caught out by the media represent "a few bad apples". If this analysis is anything to go by, this is certainly not the case.

There is also a thread of the associations working well to deal with problem members. This is manifestly untrue. Linked to this is the idea that the PSA accreditation of the SoH should not be removed for that reason and also because somehow removing accreditation would decrease public protection. This is a bogus argument. This post explains some of the issues in great detail but in short, the PSA is not a regulator, it is an external assessor of quality assurance.

Not Homeopathy
Andrew Ward is a former Director of the SoH. On Facebook he says -
Homeopathy is under relentless attack in the media. This has been going on for several years now, however in the last few days it has been escalated on the back of the anti-vaccination league and CEASE therapy trouble. 
I would like to state my position on this. I am a Classical Homeopath. As such I do not give homeopathy-prophylaxis and I do not use CEASE therapy. Both of these things I believe have nothing to do with homeopathy. Real homeopathy. Prophylaxis with homeopathy is impossible. There is no question about that. It’s a fantasy and a dangerous one. We cannot give a homeopathic remedy to prevent an epidemic disease. It’s not possible. Those that believe it are deluded I am afraid. 
Secondly CEASE has nothing to do with true homeopathy. It’s something that those who practice it have added to their practice. I have no problem if they want to use it but please don’t mix it with or call it homeopathy. It isn’t. 
By not being aware of the consequences of this criticism has been attracted to homeopathy. When homeopathy is innocent of this. It is disrespectful to homeopathy and Hahnemann to distort and misuse our wonderful science in such a way. It’s selfish and may well see the end of free practice in this country if it continues. Be warned.
Ward has a problem with homeprophylaxis but not CEASE? But neither are "real homeopathy"? The mention of the "anti-vaccination league" is curious.

It is important to understand that Ward is a disciple of George Vithoulkas. Vithoulkas may be lauded by some homeopaths but is very dismissive of certain other homeopaths including Rajan Sankaran. George does homeopathy right and all those other homeopaths are doing it wrong. This is a recurrent pattern in homeopathy starting with Hahnemann himself. In that context, his comments make some sense but it is contrary to the idea that homeopathy is all one big happy family. Compare (as discussed here) this from ex SoH CEO Mark Taylor -
Two weeks into this job I found out there was not one sort of homeopathy but many. Most patients still have no idea and most don’t care. We can either accept that there is so much more that unites us than divides us or we can confuse our patients and delight our enemies by seeing how many homeopathic angels we can get to dance on the head of a pin.
Ward's position isn't one of group cohesion but exclusion. This is not a luxury that the SoH can afford given decline in membership numbers.

Vithoulkas is not a proponent of homeoprophylaxis but is anti-vaccination. Ward has given talks to local Arnica Groups along side Andrea Dell who is anti-vaccination and has advertised CEASE therapy in the past.

Ward's warning is wrong headed in that the criticism that not "real homeopathy" has attracted is going to result in homeopathy being banned. It won't. What it might result is the loss of the SoH's accreditation. It might result in further marginalisation of homeopathy and even further contraction. 

4Homeopathy were discussed here. The statement above purports to be agreed with all of the participants but it bears a strong resemblance to a statement previously made by the British Homeopathic Association (BHA). It's difficult to believe that it represents any sort of consensus position. For one thing the Alliance of Registered Homeopaths (ARH) don't care.

Thing is, there are definitely links between individual homeopaths and anti-vaccination groups, including board members/trustees. Some of the associations have promoted events that are anti-vaccination. The associations might assert that there are no formal links between themselves and anti-vaccination organisations but some of their members are very definitely members of such organisations. Many other members even if not members of these organisations are supportive of them. Probably even more are sympathetic towards anti-vaccination. Do the homeopathy associations exist as some sort of abstract entities several steps removed from their members? Do they presume that they represent "homeopathy" whereas members don't?

There is more to come on the prevalance of anti-vaccination among homeopaths and their involvement with anti-vaccination groups and high profile individuals.

Society of Homeopaths
It would be remiss not to start with this story from the Daily Mail. It must have been embarrassing for the SoH to have their Chair and a couple of other Directors outed as anti-vaccination. The Daily Mail did not print the offending Facebook posts from Linda Wicks but here they are -

Oh dear.

To be fair to the SoH, there has been a marked change in what it says publicly compared to when Mary Taylor was CEO. The day that the Simon Stevens story broke was Emily Buttrum's first day as the new CEO. Of course, the change may also have something to do with the GTS judicial review. It would be foolish of the SoH to say anything that might adversely affect that.

Rather than unleash some reflexive, highly defensive and paranoid statement, the SoH seem to have spend some time considering what to say. This blogpost from Selina Hatherley uses a lot of words to say not very much. Then a new position statement was issued - 
The Society expects professionalism in every aspect of Homeopathy practice. RSHoms will encourage patients to maintain a relationship with their GP and other healthcare professionals involved in their care. 
The Society does not endorse the use of protocols dedicated to specific named conditions. RSHoms must not suggest that they are capable of a complete cure, or promote such protocols for named conditions including, for example, CEASE therapy. 
The Society does not endorse the use of homeopathic medicines as an alternative to vaccination for the prevention of serious infectious diseases. RSHoms must not offer homeoprophylaxis, provide advice onor actively participate in a patient’s decisions regarding vaccination. 
The Society encourages clarity for the public regarding the credibility of its registered homeopaths. RSHoms claiming expertise in a specialist area must evidence relevant qualifications or experience. 
Advice for the Public 
Homeopaths are not able to offer advice on vaccination and the Society recommends that members of the public seek the advice of their GP and/or relevant Department of Health guidelines concerning vaccination and protection against disease whilst travelling.
Compared to previous versions it is much less ambiguous. It stops short of an outright prohibition on the practice of CEASE by members but it is a de facto prohibition on even mentioning vaccination. Directing addressing the public is unusual for the SoH.

Given the prevalence of open anti-vaccination expression among SoH members (around a third), the implications are not good for the SoH. If it is serious about this position and members do not voluntarily comply, it faces an even bigger problem in ensuring compliance than it did with CEASE. Compliance is something that the PSA will look at given that the SoH has effectively made a public commitment to deal with the issue.

There was also this statement -
Emily Buttrum, Chief Executive of the Society of Homeopaths, has written to members setting out the Society’s plans to update its guidance for members on a range of issues. 
Emily, who took over the role in October, has been working with the Society Board to explore how its strategy can be refined to give greater focus to key areas, including professional standards. 
The move comes in the wake of a series of negative press stories about the profession including Society members. 
In a communication sent to members, Emily said: “The Society Board has discussed recent events and taken some time to align our leadership on the direction the Society must travel. The discussions were deep and far ranging but unanimous agreement was formed on the importance of professional standards. 
“With this as my mandate, I will bring together a revised Society strategy which will ensure that professional standards are at the heart of all we do. Included in this strategic work will be opportunities for members to have their say.” 
Emily added that she was positive the new direction would bring the homeopathic community together and that this is reflected in a joint statement issued on behalf of UK homeopathic organisations including registers; the Society of Homeopaths, Faculty of Homeopathy and the Alliance of Registered Homeopaths.

The statement implies that professional standards were not at the heart of all that the SoH did. Current and previous Board members must bear responsibility for that along with Taylor. Some would say that in light of that and the media reporting, some directors need to go if the SoH wants to demonstrate that it is serious about this.

What was said in Buttrum's communication to members is unknown and the communication was via email it may not have been read. It's known that the SoH email newsletter is often not read by members. It would have to do a mail shot or even pick up the telephone to ensure that it reached all members. But given what is said, there are "plans" but nothing concrete yet.

In terms of members "having a say", very likely the question that the SoH dare not ask is the choice between PSA accreditation and the freedom to say whatever they want (short of prosecution). 

If the SoH were really serious about change they should seek external help and not look inward. They need external help rather than looking inwards. They can't really afford external consultancy and would likely baulk at most recommendations for change.