CHAPTER 8: INFORMATION
8.49 One way for CAM practitioners to disseminate
information about their therapy is through advertisements. There
are, of course, restrictions on the claims that can be made in
advertisements. The Trade Descriptions Act 1968 and the Consumer
Protection Act 1987, enforced by local authority Trading Standards
officers, apply to professions, including complementary therapists,
which make claims for the goods and services they sell. There
is also legislation relating to specific illnesses and medical
conditions - for example cancer and venereal disease - which prohibits
non-medically qualified individuals from purporting to cure them
or even, in some cases, to treat them (P 104).
8.50 Some of our witnesses have expressed concern
that some CAM advertisements may be extending unacceptably the
boundaries of acceptable advertising, and that there may be a
need for tighter policing. For example, the Consumers' Association
wrote that: "The British Code of Advertising and Sales Promotion
states that advertising by complementary therapists should not
discourage people from having essential medical treatment; that
medicines or therapies for serious or prolonged ailments should
not be advertised; and that advertised products or therapies should
not claim to be guaranteed to work or be absolutely safe or free
from side-effects. It is important that this continues to be enforced
in the area of complementary medicine a small
but significant number of practitioners continue to make claims
for therapies which cannot be substantiated" (P 66). They
recommend that "Information and advertising material should
not make claims for complementary therapies that cannot be substantiated
by research. All bodies producing such information should be aware
of and comply with this requirement" (P 66). In our opinion,
while CAM therapists should not discourage patients from seeking
medical treatment, nor give guarantees of a cure, we can see no
obvious reason why they should be prevented from offering help
with chronic (prolonged) conditions, by methods which are substantially
free from side effects, since this is precisely where they appear
to be helping some patients at present.
8.51 The Consumers' Association went on to elaborate
that "In terms of advertising in health generally, not just
complementary therapies but health in a broader sense, we have
some concerns about the appropriateness of using advertising as
a means of conveying information" (Q 860). Such arguments
apply equally to advertisements of non-prescription medicines
and remedies and not just those relating to CAM.
8.52 Advertising can come in many forms and the Consumers'
Association told us that their concerns extended to the leaflets
that many CAM associations and practitioners put in consulting
rooms which, they told us, are covered by the rules of the ASA
(Q 861). They told us that: "The evidence base is really
important there. These leaflets should not be written by PR people,
they should be written by people who know what the evidence base
is for a claim. We have no problem with information from evidence-based
leaflets" (Q 862).
8.53 We received written evidence from the Advertising
Standards Authority (ASA) which "supervises the advertising
industry's system of self-regulation; promoting and enforcing
the highest standards in all non-broadcast advertisements"
(p 389). They highlighted the parts of the British Codes of Advertising
and Sales Promotion most relevant to the regulation of CAM advertising.
- Medical and scientific claims about health and
beauty products should be backed by trials conducted, where appropriate,
- Advertisers should not discourage people from
having essential treatment; medical advice is needed for serious
or prolonged problems and advertisers should not offer medicines
or therapies for them.
- References to the relief of symptoms or the superficial
signs of ageing are only acceptable if they are substantiated.
Unqualified claims such as "cure" or "rejuvenate"
are generally not acceptable.
- Advertisers should not use unfamiliar scientific
words for common conditions" (p 390).
8.54 The ASA gave us a breakdown of the number of
CAM adverts that they have been alerted to for breaking the British
Code of Advertising in the last three years. These are shown in
Complaints Against Advertisements
|Total number of complaints received by the ASA
|Number of complaints received about 'alternative therapies'
|Number of advertisements these complaints referred to
|Dealt-with informally (minor or technical Code breaches)
|Formally investigated (with published adjudication)
|Complaints recorded but not acted upon
* = 1 January - 30 September 2000.
8.55 They told us that "when unacceptable references
to serious medical conditions appear in advertisements for alternative
therapies, it is generally due to ignorance on the part of the
therapist about what is, and is not, acceptable within advertising.
If an advertisement is published in a newspaper or magazine it
is the responsibility of the publisher to check that it complies
with the Code's rules. In most cases, acceptable advertising copy
will be agreed before the advertisement is printed. Problematical
claims within this sector tend to appear in leaflets and brochures
that are written and produced by therapists themselves. These
are much more difficult for the ASA, or other authority, to regulate"
8.56 The ASA also told us: "Evidence provided
to the Committee by the Consumers' Association (CA) stated that:
"In terms of advertising in health generally
some concerns about the appropriateness of using advertising as
a means of conveying information". This indicates a profound
misunderstanding of the role and nature of advertising which largely
constitutes brand advocacy and, by its very nature, is partial.
Advertising is purchased specifically to present advertisers'
views about their product, service or brand. On the basis of our
research and experience, it is clear that rational consumers in
today's 'consumer society' recognise this. Advertising must be
'legal, decent, honest and truthful', it must not mislead, but
it does not provide balanced, objective or full information"
8.57 False claims in CAM advertisements and leaflets
are a serious issue; but legislation exists to control such problems
We recommend that CAM regulatory bodies, whether statutory
or voluntary, should remind their members of these laws and take
disciplinary action against anyone who breaks them. Information
leaflets produced by such bodies should provide evidence-based
information about a therapy aimed at informing patients, and should
not be aimed at selling therapies to patients.
An Overarching Information
8.58 One way of making sure that the public and the
medical professions do have access to impartial, high-quality
information is to have a national information source covering
all of CAM. This is one role that NCCAM subsumes in the USA. Dr
Stephen Straus told us: "A disproportionately large investment,
approximately nine per cent of our funding at this point, is invested
in this area. We have a newsletter. Most importantly, we have
a web site which gets approximately 490,000 hits per month and
we fund a special modification of the National Library of Medicine
Medline database articulated in terms of complementary and alternative
medicine which has approximately 180,000 reference articles already
in it and we are meeting to enhance and expand that" (Q 1760).
The reason behind NCCAM's high level of investment in providing
information is that "The American public gets its information
very much like the public in the United Kingdom
Part of the
pressure to create our Center has been the need as well as the
desire of the American public for more competent guidance as to
what works and what is safe and what does not work and is not
safe. We are developing fact-sheets around various therapies,
we are doing evidence-based reviews, we are funding evidence-based
reviews" (Q 1760).
8.59 He went on to explain that the aim of their
service is to provide an objective information source. They do
not see a role for themselves in commenting upon bad quality material
or trying to challenge people who make false claims. Their attitude
towards countering the misleading material that is published on
various other web sites is that it is best to fund "research
whose results will set the record straight" (Q 1762).
8.60 The Natural Medicines Society (NMS), a voluntary
CAM consumer information body, told us that they thought there
was a great need for a national CAM information resource: "Even
more than in the United States we probably do need such a body.
The United States, to some extent, or parts of the United States,
are behind Europe on the whole in the availability of CAM therapies.
We have a proliferation of them and we have a very large percentage
of the population making some use
there is certainly so much
activity and so much misunderstanding that a central body might
very well be the focus that seems to be needed" (Q 1567).
8.61 The NMS felt that, in the United Kingdom, "It
would be desirable, for example, to see a national helpline where
patients and possibly their physicians could receive first-line
information. This is a function that the Natural Medicines Society
has been carrying out semi-formally for 10 or more years, but
lack of funding makes it impossible to develop our service to
the scale necessary to match public demand" (P 157).
8.62 We asked the NMS whether all CAM groups would
co-operate in setting up and running such an office. They told
us: "It may have to be done for them perhaps. They are not
the most co-operative of people. There are those who I think would
find it straightforward and would work with that because they
have already done it, who would see the sense of combining efforts.
If there are enough of those they can provide the information.
If others want to go outside of that then in reality the press
in the long run will be less likely to have recourse to them"
8.63 Both the Department of Health and the BMA have
called for practitioners of CAM to set the standard and provide
reliable information sources for the public. We agree that the
necessary expertise lies with the professional specialist. There
are, however, two significant problems with this prescription.
8.64 Firstly, much of the evidence we have received
has reinforced the view that CAM therapies are rarely co-ordinated
unless, like osteopathy and chiropractic, they have become statutorily
registered. Leaving the provision of information to fragmented
groups would possibly extend the current confusion that has already
been visited upon the public. It is difficult to see how unity
of view could be maintained in an information resource when it
is lacking on issues such as educational standards and philosophical
differences. When the frequent resort to self-promotion among
the fringe elements of CAM is added, then we are not confident
that unregulated professions are now able to meet this challenge
in the public interest, no matter how much they would like to.
Secondly, a consistent theme in this report is the lack of research
evidence and activity in CAM, and the poor academic infrastructure
available to subject the tenets of the various CAM therapies to
scrutiny. We consider it would be desirable to link the provision
of information to the public with at least the beginnings of a
process of enquiry about the basis of these therapies, with overt
efforts at quality assessments and audit, with acknowledgements
of the importance of public accountability, and above all with
clear-thinking guidelines for the practice of each therapy. Such
information would not be easy to compile and update without partnerships
with other resources and facilities, notably academic, regulatory
8.65 Several witnesses (e.g. NHS Alliance Q 148)
suggested that FIM was an ideal body to explore initiatives in
this area. FIM told us that they are very keen that there is a
major initiative in this area. "This certainly is an area
we believe that we can work in and assist the process" (Q
83). However, for such an initiative to be successful they believe
that there is a need for "a significant investment in that
by Government centrally" (Q 83). They went on to say: "I
do not think it is a satisfactory position that there is no central
initiative on this area. We would be very keen to work with other
partners the Government and CAM bodies to
actually begin to address this deficiency. There is an awful lot
of information out there but the quality of it is hugely variable"
8.66 RCCM also supported the case for a national
body; but they were more cautious, pointing out that "It
is a very major task. Just to give you a quick example, CISCOM
adds about 500 papers a month, and that is increasing month on
month. That is just published research. If you are going to talk
about different therapies and their regulatory bodies and everything
else, that is a very, very major task and one, I think, that the
Americans have found extremely difficult too"(Q 152).
8.67 However, other bodies we heard from were less
enthusiastic about funding an information body particularly dedicated
to CAM. The BMA told us: "We feel that it is really up to
the practitioners of CAM to devise their own bodies for this.
Having said that, they should also feel free to draw upon the
good and bad experiences that there have been within medicine
and the other paramedical fields who have been involved in regulation
and in provision of information for many years. There are models
within organisations such as the General Medical Council and indeed
the Medical Royal Colleges which may be of help, including some
elements of things best to avoid" (Q 355). "Clearly
again in this it is a matter of developing mutual trust between
what have in the past historically, sadly, been seen as two opponents,
and genuinely trying to help one another to form a body which
works and which you can each have confidence in" (Q 355).
8.68 The Department of Health were not supportive
of the idea of a Government-funded central CAM information resource,
although they did tell us that "Stressing the importance
of information and making sure that consumers are clear about
what is being provided to them and the choice of treatments available
is the principle which underscores a lot of the Government's initiatives
within the NHS. They want to see CAM follow that example"
(Q 58). They firmly held the belief that this was the role of
the practitioner and therapy organisations themselves and not
a role for Government.
8.69 Yvette Cooper MP, Parliamentary Under Secretary
of State for Public Health, explained to us that one of the Government's
concerns about providing information on CAM is that in some areas
"the information simply does not exist
there is a lack
of evidence base" (Q 1886). She explained that this was a
worry because if the Government provide information on CAMs the
public may believe they are advocating the use of those therapies,
and this is not what they want to be doing for therapies which
do not have an adequate evidence base to back up their claims.
She continued: "The NHS Kite Mark
is something the public
would take as authoritative, in a way they might not if they were
simply surfing the Internet or finding out information for themselves"
(Q 1888). Yvette Cooper also stated that the Government feel that
the lack of effective regulatory structures backing up some CAM
therapies means the Department would have worries about being
seen to promote those therapies: "I think it is an area where
the result of the lack of appropriate regulation also provides
in terms of what we are able to inform people
about" (Q 1888).
8.70 Despite these reservations, we support the idea
of a centralised information body because the level of public
interest in CAM is high, yet there is a large amount of confusing
information in the public domain, almost all produced either by
the press to provide a story, or by CAM practitioners themselves
who naturally want to advertise their particular therapy. Therefore
a neutral national information body could play a valuable role
in protecting the public by giving them the information they need
to make sensible, informed decisions. While we do not make formal
recommendations on this issue, we believe it is one which deserves
8.71 For many people who are well-informed, or have
already decided to accept a CAM treatment, the simple provision
of information, such as the contact details of local practitioners,
may be sufficient to satisfy their requirements. For the general
public or medical staff who are curious about CAM, perhaps with
interest stimulated by press coverage, recommendations from their
friends, or inquiries from their patients, there is a gap in the
information that is available from the NHS, their natural point
8.72 During our Inquiry we have become convinced
of the growing public interest in CAM, and we feel that the Department
of Health and the NHS should take a lead in guiding people (and
doctors) through the vast array of variable quality information
on CAM. The current position of the Department of Health appears
to be one of devolving the responsibility to the representative
bodies of CAM therapies, whose views may not be seen to be entirely
impartial, or the public media, whose coverage of CAM is often
criticised, or to individual GPs or PCGs, each of whom scarcely
has the time to find out about all of the various branches of
CAM available. There is a need, in the words of Dr Straus, for
more competent guidance as to what works and what is safe and
what does not work and what is not safe (see para 8.58). Only
then will the other types of information, such as points of contact,
places to look for the results of further research, and lists
of what various qualifications mean, be of value.
8.73 The natural place for people in the United Kingdom
to turn to for health advice is the NHS, and we feel it is not
adequately fulfilling its responsibilities in this area with regard
to CAM. However, we are encouraged by the developments of the
electronic National Health Library and NHS Direct, both of which
seem ideally placed to fill the gaps in the NHS's CAM information
provision as part of their wider remits. We urge that they do
so speedily, and seek the advice of FIM which is well-placed to