UK Health Centre: Misleading information about osteopathy – a second Advertising Standards Authority (ASA) complaint

Rulings - ASA I CAP_ UK Health Centre - https___www.asa.org.uk_codes-and-rI have previously highlighted the many misleading claims about complementary and alternative medicine on the UK Health Centre website. The website is owned by Core Health Ltd and they provide misleading information about osteopathy, chiropractic, acupuncture, homeopathy and herbal remedies. The information they provide is misleading the general public and has the potential to cause people to take unsuitable treatments. In the interest of public safety I therefore reported UK Health Centre to the Advertising Standards Authority (ASA) and focused on their claims relating to osteopathy in the first instance. That complaint was “informally resolved” but rather than addressing their misleading claims, Core Health Ltd actually added more conditions to the list of those that they claim osteopathy can treat. I therefore raised a second complaint to the ASA. This complaint was also “informally resolved” in January 2018. However, Core Health have still failed to address their misleading advertising.

The website has been changed in response to this second complaint with some claims being removed but also some new ones being added. The UK Health Centre website continues to make misleading claims about osteopathy as a treatment for a wide range of medical conditions including:

  • Whiplash
  • Asthma and chest problems
  • Long term illness
  • Stress
  • IBS
  • Infections and illness
  • Improving the immune system
  • Increasing the efficiency of nerve supply
  • Low energy
  • Dysmenorrhoea (period pains)
  • Recovery from childbirth
  • Common infant problems (including colic, sleep problems)
  • Monitoring baby’s growth and development
  • Improving cognitive function
  • Visual and hearing impairment

In this latest update they have removed the following:

  • Diabetes
  • Depression
  • Osteoporosis
  • Glue ear
  • Insomnia

However, this is not an improvement as they have added the following misleading claims in their place:

  • Improve blood flow
  • Reduce heart attack risk
  • Reduce risk of headaches
  • Increase bloody supply to the brain
  • Increase response time and feeling of “wellness”
  • Reduce side effects of drugs

Osteopathy hasn’t actually been shown to be effective for any of the above conditions.

As well as making misleading claims about specific health conditions the UK Health Centre website includes other inaccurate information. Of particular concern are things like this:

“Your GP may have suggested that you visit an osteopath. This is common for people who suffer from chronic symptoms including back pain, shoulder pain, migraines etc. Your GP may also refer you to an osteopath if you are pregnant or have just given birth (especially if your birth was particularly traumatic or your baby is experiencing problems sleeping or appears agitated).” I certainly hope that GPs are not suggesting that people visit an osteopath. There is little or no evidence that osteopathy provides benefit for any condition and GPs ought to be recommending evidence based treatments. There is absolutely no evidence that birth “trauma” causes any problems in babies. This is something that is claimed by some chiropractors and osteopaths but actually isn’t backed up by evidence and indicates the lack of even a basic understanding of paediatrics within these two professions. There is no reason to ever take a baby to an osteopath (or chiropractor). None.

Worryingly, osteopathy is not the only area where the UK Health Centre website makes misleading claims. For instance, they say that acupuncture can be beneficial for people with cancer including the nausea associated with chemotherapy and the anxiety and pain from the cancer itself. There is no evidence that acupuncture is effective for any of these things.

In spite of 2 complaints to the ASA, Core Health has failed to correct their misleading claims. As well as highlighting a problem with Core Health as an organisation, this also further highlights the ongoing problem with the osteopathy profession. It is now almost 3 years since the ASA issued clear guidance to osteopaths on the conditions they may advertise to treat. The General Osteopathic Council (GOsC) has also made it clear that osteopaths should be treating in an evidence based manner. It’s clear that some osteopaths are still willing to go against regulatory guidelines and continue to treat these conditions even though it isn’t in the patient’s interest to do so.

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Magic isn’t real and neither is homeopathic medicine

magicOn 1st June the Society of Homeopaths encouraged its members to “host local screenings of Magic Pills, Ananda Moore’s thought-provoking film about her quest to establish the truth about homeopathy”. This is apparently to support 4Homeopathy’s aim to have the film screened by 20 people in 20 towns and cities around the UK. The “truth” about homeopathy is completely clear and doesn’t require any film screenings to help establish it … but more on that later.

The film

More info on the film can be found on the Magic Pills movie website. Some of the claims on that website are both ridiculous and seriously concerning. Here are just a few examples:

  • “Homeopathic medicine is one of the most widely used forms of alternative medicine on the planet”. Widespread use does not provide any indication of effectiveness. In the case of homeopathy, this widespread use is an indication that homeopathic organisations have been successful in misleading members of the public into thinking that homeopathy is actually beneficial.
  • “The controversy surrounding homeopathic medicine is founded in the belief that something so highly diluted cannot work without violating the laws of chemistry”. That’s true. Homeopathy can never work.
  • “Many medical journals refuse to publish positive studies due to systemic bias”. This is a ridiculous argument. Many journals do indeed publish disappointingly poor quality research and studies. I have written about one particularly awful example of research that should never have been approved for publication and there are many such examples on Edzard Ernst’s blog. There are also plenty of apparently positive studies in homeopathy that have been approved for publication.
  • “Journey with Ananda to Tanzania, where for the past 25 years a husband-and-wife duo of homeopathic doctors are using their skills to help thousands of HIV/AIDS patients in the most remote regions of the country”. This is truly awful. There is no evidence that homeopathy provides any benefit for HIV/AIDS and this is misleading members of the public into taking inappropriate treatments that can never help them.
  • “To Kolkata, India, where the Banerji Clinic is having unparalleled success treating otherwise incurable brain tumors and other forms of cancer”. There is no evidence that homeopathy provides any benefits for cancer. None. Unfortunately, people with incurable cancer are ideal targets for quacks who promote unproven and (often) nonsensical treatments. When someone is told that no conventional treatment is available they are often willing to try anything in the hope that it will work. This is entirely understandable but unfortunately exposes people in this situation to being misled into taking “treatments” that are never going to help and may cost them large sums of money. Talking about money, I would be willing to wager a very large sum that truly incurable brain tumors are not being treated with “unparalleled success” with homeopathy.

Why can’t homeopathy be effective?

A full discussion of the principles of homeopathy deserves a blog post in its own right so here I’m going to focus on just one part. Dilution. Homeopaths take their proposed “treatment” and dilute it, often with water, so much that there is literally nothing of the original substance left. They claim that water has “memory” and therefore the treatment will be effective. It requires only a very basic understanding of science to realise that this is nonsense. Homeopathy therefore involves “treating” people with water (or sugar pills or whatever else has been used to perform the dilution). Is it appropriate to treat people with HIV or cancer with water? Of course not! That is effectively what homeopaths are doing which is deceitful, unethical and immoral.

The truth about homeopathy

The choice of title for this film “Magic Pills” is an interesting choice. Magic isn’t real and neither is homeopathic medicine. Magic is used for entertainment and even though we know it’s not real it can still be enjoyable to watch a skilled magician carrying out their tricks. It’s also harmless. Homeopathy on the other hand is offered as a medical treatment and has the potential to do real harm to members of the public. There have been cases of homeopathic medicines containing dangerous substances that have caused harm to people such as homeopathic teething medicines. However, the bigger risk that homeopathy presents is people believing that it has medicinal value and using it instead of real medical treatment. It is ethically and morally wrong of homeopaths to deceive unsuspecting members of the public in this way. The Society of Homeopaths is promoting this film in order to try and highlight the “truth” about homeopathy. This film does anything but. The actual truth about homeopathy is that it’s a bogus “treatment” with no evidence of effectiveness for any condition.

The Charity Commission consultation on complementary and alternative medicines reveals some “interesting” responses

charitycommissionBetween 13th March and 19th May 2017 The Charity Commission held a consultation about whether an organisation which uses or promotes CAM (Complementary and Alternative Medicine) therapies should be allowed to be a charity. This was prompted by the work of the Good Thinking Society. Although the consultation closed over 12 months ago, The Charity Commission have yet to publish the outcome and have stated that they will do so “in the first half of 2018”. A summary of the feedback received is available on this page and makes for “interesting” reading.

The first thing that’s apparent is that The Charity Commission is surprised by the number and type of responses they received. They say We received over 670 written responses, far in excess of the number usually received for a Commission consultation.” I’m struggling to understand why this was such a surprise. CAM covers a whole range of therapies such as homeopathy, chiropractic, osteopathy, acupuncture, reiki, reflexology, naturopathy and many others. There are a large number of organisations and individuals who have an interest in this area for a variety of reasons. Therefore it’s to be expected that there would be a large response. The Charity Commission also seem surprised by the number of individuals who responded. They say “The majority of responses received were from individuals apparently writing in a personal capacity”. Many individuals have relevant expertise in this area that enables them to usefully contribute to this sort of consultation even if they don’t work for an organisation that itself has an interest. Again, I’m not sure why The Charity Commission finds this surprising.

The Responses

The Charity Commission say “A broad range of opinions were expressed in response to the consultation, some of which clearly are strongly held.” Indeed they are. Some of those responses are reasonable and make logical sense and some, quite simply, don’t.  Reading through the responses gives an interesting insight to some of the highly illogical thinking of CAM providers.

Responses to the first question “Question 1: What level and nature of evidence should the Commission require to establish the beneficial impact of CAM therapies?” include those that think patient testimony is more valuable than scientific evidence. This is, of course, nonsense. It is well known that most CAM practitioners promote their services largely or exclusively based on testimonials. The trouble is that testimonials actually tell you very little about the effectiveness of a treatment and they should therefore not be used as a basis for making treatment decisions. It’s clear that CAM practitioners either lack an understanding of the science behind measuring treatment effectiveness or conveniently choose to ignore it because it conflicts with the weird and wonderful therapy that they happen to provide. The most sensible responses to this question are the ones that align with this “Some responders expressed the view that the evidence to be considered in respect of CAM therapies should be the same in nature as that to be considered in respect of any other therapies. When assessing effectiveness of a therapy this should be done without bias. Therefore the level of evidence required should be the same regardless of the type of therapy. The suggestion by some respondents that “the breadth and/or history of use of a therapy should be used as a measure of evidence is laughable. Should we go back to using leeches as a treatment because it has a long history? Of course not. Science and medicine gradually improves by accepting new treatments that are shown to be effective and dropping those that are shown to be ineffective or where the risk / benefit ratio is not acceptable. Unfortunately, what we are seeing here is the opinion of CAM practitioners and organisations who have failed to reject the things that don’t work and keep misleading people into taking them as “treatments” for a whole range of conditions.

The second question in the consultation was “Question 2: Can the benefit of the use or promotion of CAM therapies be established by general acceptance or recognition, without the need for further evidence of beneficial impact? If so, what level of recognition, and by whom, should the Commission consider as evidence?” This is a really strange question to ask because the only rational answer is clearly “no”. The suggestion that a benefit of any therapy can be established merely because it is accepted or recognised is nonsense. It requires only a basic understanding of science to realise that this is not how treatment effectiveness should be assessed.

The responses to “Question 3: How should the Commission consider conflicting or inconsistent evidence of beneficial impact regarding CAM therapies?” show an astounding lack of science comprehension from some respondents. For instance, some responders urged the Commission to give applicants “the benefit of the doubt”, or to register CAM organisations unless and until their contentions are disproven.” Again, this is simply not how science works. The person or organisation making the claims needs to provide the evidence that they are valid rather than expecting that there should be proof that they are invalid first. This is really the only way that science can sensibly work and an example will help to make this completely clear. I could choose to make the claim that somebody on the planet is able to fly to the moon by flapping their arms. If we have to disprove my claim before it is seen as invalid then we would have to get every single person on the planet to try before we could do so. This is something that is clearly both impractical and very silly. Instead, we should assume that it’s not possible until someone proves otherwise. We can also use science to calculate the amount of force required to leave the earth’s atmosphere and conclude that even to try going to the moon by flapping your arms is an entirely pointless activity. No further research required. If only the same approach was used with CAM therapies, a lot of public money would be saved that is currently squandered on research into things that are completely implausible.

The next question was “Question 4: How, if at all, should the Commission’s approach be different in respect of CAM organisations which only use or promote therapies which are complementary, rather than alternative, to conventional treatments?” Some respondents “questioned whether there is a real distinction between the two categories referred to in this question, or whether it is possible to draw the distinction clearly.” If you study the way that CAM practitioners use their treatments it does indeed become difficult to separate these two things. Regardless of whether the particular type of CAM that a practitioner happens to use is homeopathy, acupuncture, chiropractic, osteopathy or anything else there is a need to believe in the treatment approach. In most cases this is in direct conflict with mainstream medical treatment and science. For instance, homeopaths believe that “like cures like” and that diluting a substance makes it stronger. Osteopaths and chiropractors believe that structure dictates function. Belief in any of these treatment approaches requires the practitioner to reject conventional approaches because it’s simply not possible to fully understand and accept science and medicine and to hold these beliefs. It’s therefore almost impossible for a CAM practitioner to apply their treatments in a complementary manner to conventional treatments. They will inevitably want to steer their patients away from conventional treatments that do not align with their belief system.

For “Question 5: Is it appropriate to require a lesser degree of evidence of beneficial impact for CAM therapies which are claimed to relieve symptoms rather than to cure or diagnose conditions” we have some further nonsense responses such as “Some responders thought that the Commission should assume that a benefit is provided by a particular therapy, unless it can be shown that it is harmful.” This is pretty ridiculous and again is clearly not how science and evidence actually works. Is it really okay to just use dubious unproven treatments on unsuspecting members of the public and continue to do so until harm is shown? Are we supposed to wait until people die or are suffer serious health consequences before putting a stop to a particular therapy? If conventional treatments were developed in the same way then lots of people would die. There is a reason why treatments are carefully developed and researched over a number of years before they start being used in routine care. Many initially promising treatments either turn out not to work that well or have harmful side effects. The same approach should be applied to CAM therapies. Why do CAM providers not want this? It’s very simple, most or all of them would not show sufficient benefit and have too many risks to recommend using them. CAM providers don’t want this research to be done because it would probably signal the end of their business.

Question 6 was “Do you have any other comments about the Commission’s approach to registering CAM organisations as charities?” Like the earlier questions, there are some responses that really make no logical sense. For instance, “CAM therapies are not susceptible to assessment in the same way as conventional treatments.” This is something that a large number of CAM providers claim. They say they don’t have evidence for their treatments because they can’t be assessed in the normal way or because they treat the individual not the condition. This is a complete cop out. With some thought it should be possible to test pretty much any treatment in a scientific and objective manner to see if it is effective. Again, CAM providers are making excuses because they know that when their treatments have actually been assessed they have been shown to be ineffective. This is the case with many CAM approaches that have been around for a long time such as homeopathy, acupuncture, osteopathy and chiropractic. They have actually had significant research carried out on them and the results are spectacularly uninspiring as they show that they have little or no benefit.

One of the answers to this question raises a classic argument from many CAM providers: “A decision which might result in the removal of CAM organisations from the charity register would compromise patient choice.” There are two key points here. Firstly, this consultation is about whether CAM organisations can be eligible as charities. Even if the decision is that they can’t that doesn’t stop CAM providers from existing, just that they can’t be registered as a charity and receive the associated benefits. Secondly, and more importantly, providing patients with a “choice” that includes treatments that don’t work is misleading and unethical. Imagine if you went to a doctor and they said “Would you like to try treatment A that has been shown to be effective or treatment B that hasn’t?” This kind of “choice” is a false balance argument that is absolutely not in the interest of patients.

At the end of the document is a list of organisations that responded to the consultation.  It’s quite the collection of CAM organisations promoting a whole range of weird, wonderful and unproven therapies from homeopathy to reiki to osteopathy to meridian energy to acupuncture. There are also a small number of organisations that provide a more rational view such as the Good Thinking Society and The Nightingale Collaboration.

Conclusion

Charities are required to provide a “public benefit”. The benefit part states “a purpose must be beneficial – this must be in a way that is identifiable and capable of being proved by evidence where necessary and which is not based on personal views” (https://www.gov.uk/guidance/public-benefit-rules-for-charities). Many CAM charities fail this test as they actually promote treatments that have either been shown not to work or that have not been shown to work. I have written about a couple of examples previously: The Sunflower Trust and CORE of Clapton. An excellent article from Michael Marshall of the Good Thinking Society highlights several others. However, this really only scratches the surface and there are a whole range of charities offering unproven “treatments” from the whole spectrum of CAM. When The Charity Commission finally get around to reaching a conclusion from this consultation it is hoped that they will act in the interest of the health and safety of the general public and remove all CAM charities from the charity register.

Foundation for Paediatric Osteopathy Conference 2017: Osteopaths embracing quackery

quackeryThis weekend (8th and 9th April 2017) it’s the Foundation for Paediatric Osteopathy Conference. The osteopathy profession in the UK currently has major issues with many osteopaths making misleading claims about what they can treat in order to lure patients into their practices. I have previously highlighted that this problem also exists with some of the training being offered to osteopaths. The Foundation for Paediatric Osteopathy Conference seems to be taking this misleading training information to a whole new level. Talks at the conference include:

  • “Osteopathic Support of the Immune System in Infancy and Childhood”
  • “Special Aspects of Treating Unborn Babies”
  • “Vaccination – the Science”
  • “The Immunity Spiral – How being ill can make kids better”

You will notice that there is a focus in the above talks on medical care and treatments. In the UK, osteopaths are not licensed to practice medicine so they have no business doing anything to do with the immune system, vaccination decisions or, heaven forbid, treating unborn babies! All of these are things that should be handled by medical professionals and osteopaths shouldn’t be learning about them. With regards to the immune system, there is no evidence that any osteopathic treatment can help the immune system. “Osteopathic Support of the Immune System” is therefore a fallacy.

The talk about “Vaccination – the Science” is particularly interesting. It’s being given by Dr Jayne Donegan who, from her website, appears to be anti-vaccination. She is also a homeopath and recommends it for a range of different conditions including bruising and shock, burns and scalds and fever management. Homeopathy isn’t effective for any of these conditions, or anything else for that matter. She supports disgraced doctor Andrew Wakefield who wrongly claimed that the MMR vaccine can cause autism. Oh dear. It is well known that some alternative medicine practitioners recommend against vaccination. Might this talk result in more osteopaths becoming anti-vaccination? That can’t be a good thing for the health of their patients or the public as a whole. After the talk, the Foundation for Paediatric Osteopathy posted this on twitter “Dr Jayne Donegan inspired us about how to treat acutely ill children, and boost immunity naturally”. It’s quite incredible that osteopaths are being offered training in treating acutely ill children. Acutely ill children need proper MEDICAL help from a DOCTOR not quackery from an osteopath. They certainly don’t need their immune system “boosting naturally”.

The Foundation for Paediatric Osteopathy has recently been the subject of a complaint to the Advertising Standards Authority due to making unsubstantiated claims about the effectiveness of osteopathic treatment for babies, children and pregnant mothers. This complaint was informally resolved after they updated their website. However, they still do not comply with the guidance and continue to make misleading claims. This includes suggesting that osteopathy can help babies “recover from delivery” and treat indigestion and heart-burn in pregnant mothers. There is simply no evidence to support osteopathic treatment in these situations. They also suggest that babies would benefit from an “osteopathic check-up”. Babies receive perfectly adequate checks in the hospital after they are born and are subsequently monitored by health visitors. Osteopathy has no place in this and osteopaths are not the right people to be carrying out checks on newborn babies. By suggesting otherwise, osteopaths are blatantly misleading parents. Through their conference, the Foundation for Paediatric Osteopathy are now providing training to other osteopaths in the very things that they shouldn’t be treating and therefore spreading this misleading information more widely. Other authors have written about how osteopathy is closely linked with pseudoscience. Conferences like this suggest that osteopathy is fully embracing quackery.

Osteopaths seem to be continuously trying to widen their scope of practice, presumably to increase their income. However, by trying to move into areas that they have no skills and for which their treatments are not effective they are putting their own income ahead of the needs of patients. This is a dangerous game and in the long-term can only be harmful to the reputation of the profession.

UK Health Centre: Misleading information about osteopathy, chiropractic, homeopathy and acupuncture all on one site

The UK Health Centre website says that it provides “Access to Health and Medical Information on the Internet”. However, this is not a site that just provides information. It has an appointment booking service and the focus seems to be primarily on providing information that encourages people to make bookings for private treatment. Unfortunately, the information is therefore somewhat biased and in some cases very misleading. Some of the information on the site is actually of a good quality and provides evidence based advice. One example of this would be the information on vaccines. The area where the advice is much more misleading is alternative medicine. This includes osteopathy, chiropractic, acupuncture, homeopathy and herbal remedies. Mixing this misleading information about alternative treatments with more accurate information about conventional medical treatments is likely to cause confusion for the general public and could result in them opting to take treatments that are completely unsuitable.

Osteopathy

The UK Health Centre website promotes osteopathy as a treatment for a wide range of medical conditions including:

  • Whiplash
  • Asthma and chest problems
  • Diabetes
  • Long term illness
  • Stress
  • Depression
  • Tiredness
  • Osteoporosis
  • IBS
  • Glue ear
  • Infections
  • Insomnia
  • Growing pains
  • Dysmenorrhoea (period pains)
  • Issues specifically related to pregnancy (such as morning sickness, wounds from childbirth)
  • Common infant problems (including colic, colds and teething pain)
  • Conditions arising from oxygen deprivation during birth
  • Monitoring baby’s growth and development
  • General poor health

Osteopathy has not been shown to be effective for any of these conditions and therefore advertising such treatments breaches advertising regulations. It is in conflict with the guidance provided by the General Osteopathic Council (regulatory body for osteopathy in the UK), the Advertising Standards Authority and the Committee of Advertising Practice (http://www.osteopathy.org.uk/news-and-resources/document-library/practice-guidance/gosc-asa-cap-letter-to-osteopaths/ and https://www.asa.org.uk/asset/44783612-C34B-4084-9B8A7036F01C43D7/ ). This misleading information could result in someone booking an appointment with an osteopath when their treatments are completely unsuitable. Some of the conditions on the list, such as asthma, are serious medical conditions that should only be handled by a suitably qualified MEDICAL professional and definitely not an osteopath.

Chiropractic

Although less outrageous than the treatment claims made for osteopathy, the information provided about chiropractic is also misleading. The site suggests that chiropractic treatment can improve the immune system, provide a solution to fertility problems and also to treat asthma. None of these claims can be substantiated and this information is therefore misleading. Elsewhere it says “The National Institute for Health and Clinical Excellence (NICE) support the use of chiropractic for treatment of acute lower back pain as they have analysed the results of studies that prove its effectiveness in this area.” Actually, the recent NICE guidelines have downgraded the role of chiropractic in treatment of low back pain due to a lack of evidence for its effectiveness.

Besides treatment for specific medical conditions, the site has other misleading information about chiropractic such as “It is considered most beneficial to undergo chiropractic treatments on a regular basis in order to prevent future damage to the skeleton.” Wow! There is no evidence to suggest that chiropractic is suitable as a preventative treatment. Furthermore, suggesting that not having such treatment might result in “future damage to the skeleton” is blatant and unsubstantiated scaremongering to try and get people to take treatments.

Interestingly, they do highlight risks of chiropractic: http://www.healthcentre.org.uk/chiropractors/chiropractors-safety.html . What’s rather puzzling is that the site doesn’t consider similar risks of osteopathy even though many of the same risks apply to both.

Acupuncture

The UK Health Centre website recommends acupuncture or acupressure for a range of different conditions including:

  • Tooth pain
  • Other pain
  • Muscle tightness
  • Nausea
  • Erectile dysfunction
  • Bronchitis
  • Anxiety
  • Stress
  • Drug use / alcoholism
  • Overeating
  • Fertility
  • Conditions during pregnancy including tiredness, anxiety, tenderness in the breasts, varicose veins, induction of labour, to correct foetal position

Acupuncture hasn’t been shown to be effective for any of these conditions and claiming otherwise is misleading. This also conflicts with the Advertising Standards Authority guidelines for acupuncture.

It then goes on to say that effectiveness of acupuncture for some conditions is in a “grey area”. Conditions that it puts into this category include depression, neck pain, stroke, sciatica, tinnitus, asthma, addictions (substance abuse). However, there is no such thing as a “grey area” in treatment effectiveness. Either a treatment has been proven to work or it hasn’t – in this case it hasn’t and suggesting otherwise is misleading.

Like osteopathy, some of the items on the list are serious medical conditions that should only be handled by a suitably qualified MEDICAL professional and definitely not treated with acupuncture.

Homeopathy

The site suggests that homeopathy is an effective treatment for hay fever (http://www.healthcentre.org.uk/allergies/hay-fever-homeopathy.html ) and snoring (http://www.healthcentre.org.uk/sleep-disorders/snoring-natural-alternative-homeopathic.html ). It then goes on to say that homeopathy is the most suitable treatment during pregnancy (http://www.healthcentre.org.uk/sleep-disorders/snoring-natural-alternative-homeopathic.html ). None of these claims are backed by any sort of evidence and are misleading the general public into potentially taking a treatment that is completely ineffective.

Herbal Remedies

The UK Health Centre website suggests that herbal remedies are effective for allergies, menopause, erectile dysfunction, skin tags and sleep problems. There is no evidence to back up these claims and they are therefore misleading the general public.

Actions Taken and Next Steps

I contacted UK Health Centre in November 2016 to ask them to amend the misleading content on their site. In the first instance I opted to focus on the content about osteopathy to see if they would be willing to correct their site. If they responded positively I then planned to tackle the other issues. Here is the e-mail I sent:

“I’m following up on the information provided about osteopathy on your website. A number of the claims made about osteopathy on your site do not have evidence to support them and are therefore misleading prospective patients and the general public. Furthermore, making these kinds of claims breaches advertising regulations and is in conflict with the guidance provided by the General Osteopathic Council (regulatory body for osteopathy in the UK), the Advertising Standards Authority and the Committee of Advertising Practice. See this link for the guidance they provided to osteopaths: http://www.osteopathy.org.uk/news-and-resources/document-library/practice-guidance/gosc-asa-cap-letter-to-osteopaths/ Many of the pages on your site breach these guidelines and provide misleading advice. This includes references to treatment for whiplash, asthma and chest problems, stress, depression, tiredness, osteoporosis, IBS, glue ear, infections, growing pains, common infant problems and “general poor health”. Furthermore, your site suggests that preventative osteopathic treatment is appropriate and that “osteopathy can provide health benefits to most people”. However, there is no evidence to support either of these claims and therefore your site is misleading prospective patients and the general public.

Could you please remove all of your misleading articles about osteopathy from your website or amend them to make it clear what osteopathy can / cannot actually treat? I look forward to hearing from you.”

I received no response so sent a follow up in December 2016. Again there was no response. The information they provide is misleading the general public and has the potential to cause people to take unsuitable treatments. As such, the information on this site represents a risk to the public. I have therefore reported UK Health Centre to the Advertising Standards Authority (ASA). It will be interesting to see the outcome of this.

NetDoctor: The medical advice website that recommends alternative medical treatments that have been shown not to work

The NetDoctor website provides online information and medical advice to patients. This includes medically focused articles and the opportunity to have specific questions answered by the NetDoctor team. NetDoctor subscribes to appropriate ethical guidelines including “Any claims relating to the benefits/performance of a specific treatment, commercial product or service will be supported by appropriate, balanced evidence.” However, some of the advice provided on the NetDoctor website is not evidence based and includes recommendations of “alternative” treatments that have been shown to be ineffective. Specific issues with the content of their site include:

  • Recommending treatments which do not have an evidence base or have been shown not to work. This includes osteopathy, chiropractic, acupuncture and homeopathy.
  • Sometimes providing an online diagnosis based on very little information.

I contacted NetDoctor about the misleading advice on their site. Whilst there are many articles that are misleading and lack an evidence base behind the recommendations being made, I opted to highlight just three of the worst offenders when contacting NetDoctor.

Here is the message I sent to NetDoctor on 20/09/16:

I think it’s great that patients have a resource like your website where they can go for independent medical information and advice. It is also good that you subscribe to appropriate ethical guidelines including “Any claims relating to the benefits/performance of a specific treatment, commercial product or service will be supported by appropriate, balanced evidence.” However, some of the articles on your website give advice that is not evidence based, does not follow the ethical guidelines and is therefore misleading to patients.

I’d like to highlight three specific articles that are amongst the most misleading. The first article
(http://www.netdoctor.co.uk/ask-the-expert/pregnancy-and-family/a10060/i-am-pregnant-what-can-i-do-to-stop-myself-feeling-sick-all-day/)
provides advice to someone who is feeling sick during pregnancy. Within this article, homeopathy and acupuncture are recommended. However, neither of these recommendations are evidence based. Homeopathy, for instance, has been repeatedly shown to be no more effective than placebo for any condition and is “scientifically implausible” (see http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/4502.htm) I therefore believe it is completely inappropriate for your website to recommend homeopathy as a treatment for sickness during pregnancy.

The second article
(http://www.netdoctor.co.uk/ask-the-expert/aches-and-pains/a2561/do-i-have-sciatica/
) includes an online diagnosis of sciatica and then goes on to recommend an osteopath because “they can treat this kind of problem quite successfully”. Firstly, from the very brief description of symptoms from the patient it would seem to be inappropriate to make a diagnosis (“you almost certainly have sciatica”). Furthermore, the NICE guidelines for sciatica recommend specifically against the use of spinal manipulation (such as that provided by an osteopath) and the recommended treatment is therefore not evidence based. It would surely be far more appropriate to refer the patient to their GP so that they can be given an actual diagnosis and an appropriate treatment.

The third article
(http://www.netdoctor.co.uk/ask-the-expert/brain-and-nervous-system/a304/homoeopathic-remedies-for-cerebral-palsy/)
advises a parent of a child with cerebral palsy to use homeopathy. As mentioned earlier, this has been repeatedly shown to be no more effective than placebo for any condition and is “scientifically implausible”. This advice is therefore not evidence based. There is the risk that parents of a child with cerebral palsy reading this may decide to pursue homeopathy treatment when other conventional treatments would be much more appropriate.

None of these articles comply with your own ethical guidelines, do not provide a balance, evidenced based view and are therefore misleading to patients. Could you please remove these and any similar articles from your website? I look forward to hearing from you.

Having heard nothing I sent a follow up on 19th October. To date, I’ve still had no response. It’s rather concerning that a site like NetDoctor is promoting treatments that are either unproven or have actually been shown not to work. It’s particularly disappointing that they are failing to comply with their own ethical guidelines and have not taken any action to address these problems when they were highlighted. This really brings into question the rest of the advice provided on the site.