The Nightingale Collaboration

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Written by Alan Henness. Published in The Skeptic, Volume 22, Issue 4 and Volume 23, Issue 1 (Double issue). Alan Henness outlines a recent initiative designed to help sceptics challenge unfounded medical claims.

I’m a serial complainer.

There, I’ve said it. But I don’t say that with any embarrassment; just an admission that I’ve been making complaints for years. Not as a fully paid-up member of the green ink brigade you understand, complaining for the sake of complaining, but as someone concerned at misinformation, particularly about healthcare.

I have been doing it for years and one of my early complaints was to the Advertising Standards Authority (ASA) about the high street Chinese herb shop, Dr & Herbs. In a leaflet, they were making claims about the efficacy of their products for all sorts of medical conditions and I wasn’t convinced these claims were backed by sound evidence.

They were making claims for acne, hair loss, stress, headache, asthma, sciatica, back pain, arthritis, digestive disorders, hay fever, eczema, and menopause. Now, it is perfectly plausible that plants could have pharmacological effects, but I wasn’t convinced they held the necessary evidence to back up these claims. When challenged, it is the responsibility of the advertiser to supply the ASA with evidence to substantiate any claims being made. They were unable to do so.

But they also seemed to be giving the distinct impression that they were qualified doctors. I argued that this could mislead a member of the public into thinking they would get proper medical advice. It turned out that their doctors had qualifications in Chinese medicine, but were not registered in the UK with the General Medical Council, so members of the public could be misled. The ASA agreed with me.

They lost on six out of the seven points so they got some free publicity on the ASA’s website.(1)

I’ve also complained about the advertising of magnet therapy products, faith healing, psychics, colonic irrigation and other products and services that have two things in common: they are not backed by robust evidence and claims about them frequently mislead the public. Then along came chiropractors.

Many readers will be aware of the libel action of the British Chiropractic Association against Dr Simon Singh for an article he wrote in the Guardian during ‘chiropractic awareness week’ in 2008. (2) In it, Simon said:

The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

The BCA didn’t much like the article and decided to sue Simon personally. The ensuing events certainly raised awareness of chiropractic!

I had some spare time and decided to have a look at some chiropractors’ websites. I was appalled by what I found: claims to treat everything from ADHD to whiplash; from colic to emphysema, Tourettes, dyslexia, PMS and all manner of infections. Having read a fair bit about chiropractic, it seemed to me that there was scant evidence that chiropractic was effective for any of these conditions. So, why were they making those claims? If they were the ‘primary health-care profession’ (3) and were regulated by a regulator set up by an Act of Parliament, surely they would be responsible in their advertising and only claim to treat conditions there was good evidence for?

It seemed not, so I gathered a list of claims from the websites of 500-odd chiropractors and submitted a complaint that will have landed on the desk of the statutory regulator, the General Chiropractic Council, when they started work on 8 June 2008. At 9.12 am, an email was sent out by one of the chiropractic trade organisations, telling its members to immediately take down their websites! (4)

The BCA eventually dropped their libel action against Singh in April 2010 after an adverse Appeal Court ruling, but my complaints are nowhere near finished yet.

Although there are still many cases to be decided by the GCC, the effect has been dramatic: many websites have been taken down; hundreds of claims removed or substantially modified and, as a result, there are far fewer claims out there to mislead the public. And the GCC commissioned a report on the evidence base for ‘manual therapies’, presumably because, up till then, they didn’t actually know much about the evidence (or lack of it) for what their charges did.

From all this, it was becoming obvious that anyone can make a real difference in stopping or reducing misleading advertising to the public by using existing rules and regulations. There is little doubt that misleading claims are  widespread: just try searching the Internet for any serious medical condition along with your favourite non-evidence based ‘therapy’.

Having these rules and regulations in place can certainly act as a deterrent — and I have no doubt they do. But many of those charged with enforcing them must rely on members of the public bringing possible breaches to their attention.

The ASA, for example. Although they do their own monitoring of adverts and will take action if they find something misleading, most of the complaints they deal with come from concerned members of the public. As the ASA’s slogan goes, adverts should be legal, decent, honest and truthful and the public deserve no less from any advertiser. With healthcare, it even more important: the public should not be misled by claims that say far more than there is good evidence for. Doing so may delay or dissuade some people with serious medical conditions from seeking proper and possibly urgently needed medical advice and treatment. And others may just be wasting their money.

But there are other regulators as well, both statutory and voluntary. These include numerous trade bodies that represent various healthcare marketers and many of them have their own code of conduct. However, we know from experience that this does not always happen5 — ‘regulation’ by a trade organisation is unlikely to be in the best interests of the public. After all, would we let newspapers regulate themselves? MPs regulating their own expenses? Bankers, anyone?

The crux of the matter is that regulation needs to consider the public first and foremost. And if they are not enforcing the rules their charges are supposed to be following, the regulation is worthless — they are not protecting the public.

Simon Singh had similar concerns and was adamant that the groundswell of sceptical activism that the BCA’s action had engendered should be encouraged and given focus. We could also see that some larger, coordinated campaigns would be necessary to highlight particular problem areas and to ensure regulators had robust rules, rigorously enforced for the protection of the public.

The key is thus finding potentially misleading claims and bringing them to the attention of the appropriate regulatory organisation. This is what I’d been doing and is the blueprint we wanted to use. Thus, the Nightingale Collaboration was set up to enable my wife, Maria MacLachlan, and I to share our knowledge and experience in challenging misleading claims in healthcare advertising and to encourage anyone who is concerned at protecting the public from misinformation in healthcare promotion to join us in challenging it.

There is certainly no shortage of concerned individuals, aching to try to curb the worst health claim excesses. However, many were unsure on how they could help, what they could complain about and how they could go about it.

We launched our website on 1st March 2011 — the same day the ASA’s remit was extended to cover marketing communications on marketers’ own websites. Up until then, they had covered ads in newspapers, magazines, leaflets, etc., and had only covered third-party banner-type ads on websites and ads alongside results returned by search engines. The extension to cover ‘marketing communications’ on sellers’ own websites provides an excellent opportunity to challenge what we think might be misleading claims.

Our focus of the month for March was claims made on homeopathy websites. Like shooting fish in a barrel, some might say. In many ways, it doesn’t concern me too much that someone spends a fiver on a bottle of sugar pills in the expectation it’ll cure their cold. They have certainly wasted some money, but it’s important to remember that there are homeopaths out there ‘prescribing’ their sugar pills as malaria preventatives and manufacturers selling homeopathic ‘vaccines’ for MMR, polio, typhoid and meningitis. Like
many pseudoscientific ‘therapies’ the risk does not lie in believing they can be relied on for minor, self-limiting conditions: but the real danger isn’t far beneath that warm, fuzzy exterior.

We will have a different focus each month that we hope will encourage people to look critically at claims being made and submit complaints they think might be misleading. Also, with the help of trusted and enthusiastic volunteers, we will be working in the background on larger, more focussed campaigns that require research and planning — but I’m not about to give anything away just yet!

It’s important to emphasise that we are not making any decisions about whether we think any claim is misleading. In all my complaints, neither the ASA nor the GCC have once asked my opinion of the evidence; the ASA, at least, is perfectly capable of making up their own minds (if required, after consulting experts)!

Nor are we making or imposing any rules. The rules and regulations are already out there — we just want to ensure they are used effectively for the protection of all of us.

If you’d like to find out more or would like to help, please visit our website at www.nightingale-collaboration.org or contact us at info@nightingale-collaboration.org.

Footnotes:
1 http://asa.org.uk/Asa-Action/Adjudications/2003/4/Tian-Tian-(U,-d-,K,-d-,)-Ltd/CS_35844.aspx
2 http://www.guardian.co.uk/commentisfree/2008/apr/19/controversiesinscience-health
3 http://www.chiropractic-uk.co.uk/about-chiropractic-3-mi.aspx
4 http://www.quackometer.net/blog/2009/06/chiropractors-told-to-take-down-their.html
5 http://www.quackometer.net/blog/2008/10/society-of-homeopaths-failure-of-self.html


Alan Henness spent over 30 years in industry, including 10 years as R&D Manager in a large multinational (non-pharmaceutical!) company, and continues to work part time in the same industry. He is a former Convenor of the Humanist Society of Scotland and has also been an active volunteer for a humanitarian charity for the last 17 years.

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