Author’s reply to the ministerBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c640 (Published 02 February 2010) Cite this as: BMJ 2010;340:c640
- David Colquhoun, research professor1
I think the minister1 is wrong in two ways, one relatively trivial but one very important.
Firstly, he is wrong to refer to homoeopathy as controversial. It is not. It is quite the daftest of the common forms of magic medicine and essentially no informed person believes a word of it. Of course, as minister, he is free to ignore scientific advice. But he should admit that that is what he is doing, and not hide behind the (imagined) controversy.
Secondly, and far more importantly, he is wrong to say I was mistaken to claim that “you cannot start to think about a sensible form of regulation unless you first decide whether or not the thing you are trying to regulate is nonsense.” If it were irrelevant that the subject you are trying to regulate was nonsense then why not have statutory regulation of voodoo and astrology? The Pittilo proposals would involve giving honours degrees in nonsense2 if one took the minister’s view that it doesn’t matter whether the subjects are nonsense or not. Surely he isn’t advocating that?
The minister is also wrong to suppose that regulation, in the form proposed by Pittilo, would do anything to help patient safety. Indeed, a good case can be made that it would endanger patients3: the main danger is patients being given “remedies” that don’t work. The proposed regulatory body, the Health Professions Council (HPC), has already declared that it is not interested in whether the treatments work or not. That in itself endangers patients. In the case of traditional Chinese medicine, there is also a danger to patients from contaminated medicines. The HPC is not competent to deal with that either. It is the job of the Medicines and Healthcare products Regulatory Agency (MHRA) or the Trading Standards Institute, or both. There are much better methods of ensuring patient safety than those proposed by Pittilo.
To see the harm that can result from premature statutory regulation, it is necessary only to look at the General Chiropractic Council (GCC). Attention was focused on chiropractic when the British Chiropractic Association decided to sue Simon Singh for defamation. That led to close inspection of the strength of the evidence for its claims to benefit conditions such as infant colic and asthma. The evidence turned out to be pathetic.4 At the same time something like 600 complaints were made to the GCC (including two by me against practices run by the chair of the GCC himself, complaints which are being defended).
The processing of these complaints continues, but what is absolutely clear is that the statutory regulatory body, the GCC, fell foul of the Advertising Standards Authority and the Trading Standards Institute for making false claims itself. There is no doubt that the HPC would be similarly engulfed in complaints if the Pittilo proposals went ahead.
It is one thing to say that the government chooses to pay for things like homoeopathy, despite it being known that they are only placebos, because some patients like them. It is quite another thing to endanger patient safety by advocating government endorsement, in the form of statutory regulation, of treatments that don’t work.
I would be very happy to meet the minister to discuss the problems involved in ensuring patient safety. He has seen herbalists and others with vested interests. He has been lobbied by the Prince of Wales.5 Perhaps it is time he listened to the views of scientists too.
Cite this as: BMJ 2010;340:c640
Detailed critiques of the points made by Fisher and colleagues and Pittilo are available on bmj.com at www.bmj.com/cgi/eletters/339/dec15_1/b5432#228877
Competing interests: None declared.