Who is in the driving seat?
by Karin Mont MARH, ARH Chair
According to a recent report in the Economist (13-19 September 2014) online advertising accounts for roughly one quarter of the total global advertising business. The online purchases we make are being invisibly tracked and monitored, and the results are used to build a peronal profile which covers every aspect of our lives, from where we live, to our preferred choice of bathroom tissue. Most of us are oblivious to the scale of this surveillance, but the fact is that online tracking is now commonplace and anonymity is no longer an option. We may like to think that the Internet has opened up international markets, thereby providing us with greater choice, but this comes at a price. For example, someone seeking personal accident insurance may be refused cover because invisible tracking has identified them as showing an interest in skydiving! Or someone seeking employment may be unfairly discriminated against as a result of information acquired through covertly tracking their social networking activities. We are probably realistic enough to expect advertising to be manipulative, but we may be over confident in our belief that we can make informed choices on most aspects of our life. How many of us are really aware of the influence which invisible surveillance exerts on our everyday life? We think we are in the driving seat, yet much of our perceived freedom is actually being controlled by a range of unseen, ‘external’ forces.
If we combine the surveillance gathering of the advertising industry together with that of the security forces tasked with protecting us, we can see that individual autonomy has already been compromised, and we have far less control over our lives than we realise. This may be an inevitable consequence of our increasing dependence upon sophisticated technology, and perhaps we will just have to learn to live with the results. However, surveillance is not the only tool used to manipulate and control our daily activities. Regulation, which is seen as an effective way to protect us from harm, operates in so many areas of life that we take it for granted. It is easy to forget the extent to which regulation influences everything we do.
During the build-up to the Scottish referendum, a number of ‘yes’ campaigners cited freedom as their reason for seeking independence from England. The exact nature of the freedom being sought was never properly explored, but presumably the term was being loosely used to indicate political and personal autonomy. At its most idealistic, freedom represents the fundamental right of an individual to determine the course of their life, and to think, act and speak without the imposition of external influences. However, in reality, our individual freedom will always be influenced by the environment in which we live. Laws, rules and regulations form the basis upon which our society functions, which is perfectly acceptable as long as the laws are fair, just and promote the common good. However, over the last couple of decades, we have witnessed a huge increase in the powers conferred to the regulation industry. We are told that regulation is there to offer us protection, but it frequently fails to deliver on this promise, as demonstrated by numerous high profile examples. For instance, we have witnessed the collapse of our global banking system, identified inexcusable systemic failures within our policing system, which have resulted in the exploitation of thousands of children going unreported for years, and patients dependent upon a range of NHS services have experienced consistent neglect and abuse. These are all areas where statutory regulation has been in place for many years and where it has indisputably failed to protect the public. Regulation can also be used as a tool to promote a particular agenda, or pro- tect vested interests. The activities of the Advertising Standards Authority (ASA), when investigating complaints made against homeopaths and other CAM practitioners, provide a classic example of regulation being misused, in order to promote a particular agenda.
The ARH has given serious consideration to applying for accreditation of our register (AVR) via the Professional Standards Authority (PSA). Last year we attended a special PSA workshop dedicated to exploring and understanding the implications of becoming an accredited register, and we studied the PSA standards in depth. Our conclusion was that we already have quality standards in place, which we consider to be proportionate to the potential risk posed to the public when consulting with a registered homeopath. We found it difficult to identify any actual (as opposed to hypothetical) benefits which AVR might confer. We have (for example) National Occupational Standards for Homeopathy (NOSs), which describe the practice of homeopathy according to clearly defined criteria. These standards, which meet the requirements generally considered necessary to uphold the principles of best practice, have been used to inform how we regulate our profession for over ten years. We believe that quality practice results from standards which are profession specific, and which change as a profession evolves. However, standards which pertain specifically to a particular profession, such as homeopathy, fall outside of the remit of the PSA, whose only concern is to uphold generic standards which can be applied across the spectrum, to all the health professions it regulates. Normally, this single focus might not matter, but the PSA is so keen to prove its credentials as a ‘robust’ regulator, that it appears to have taken on board every spurious ‘concern’ voiced by Sense About Science (SAS), and other anti-CAM vigilantes.
The PSA has granted accreditation to 13 voluntary registers since March 2013. Each register has to satisfy the PSA Accreditation Panel that they meet the 11 core standards set by the PSA, and have processes in place to ensure that all registrants are compliant with these standards. The Panel then produces a report which considers each individual application in detail, highlighting areas where they consider improvements should be made, or specific actions taken. All the Panel reports can be viewed on the PSA website, under the heading ‘Accredited Voluntary Register Panel Decisions’.
Last year, the Society of Homeopaths (SoH) announced their intention to apply for AVR. Their application was successful, and the SoH was granted AVR in September 2014. Now they are obliged to comply with, and implement, the PSA requirements, as outlined in a 20-page report. Signing up to the establishment model of regulation comes at a price. Registered members of the SoH are not allowed to use their AVR status to promote homeopathy as a system of medicine which actually works!
I have studied the reports relating to the British Acupuncture Council (BAcC), the Complementary and Natural Health Council (CNHC) and, most recently, the SoH, and they make unsettling reading. The PSA’s sole function is to scrutinise and analyse the performance of each register, to ensure that the register can demonstrate its commitment to protecting the public from harm. In terms of ‘public protection’ the PSA’s primary objective could be regarded as misleading, because it only accredits the register, not individual practitioners. However, the AVR logo is displayed by registrants, and they have only been accredited by their register. I appreciate that this is a practical approach, but it seems to take us back to square one, where the register is self-regulating, as it was in the first place! It is perfectly reasonable to expect to receive safe and effective treatment delivered by a competent practitioner, but those standards already apply to the homeopathy profession. Regulation cannot guarantee our protection; it is impossible to regulate against human error, or to anticipate the perverted actions of those who set out to deliberately harm the sick and vulnerable, so it is difficult to see the quantifiable advantages of AVR.
When a register first applies for accreditation, the PSA circulates a ‘call for information’, asking for comments and feedback about the applicant. The PSA received 18 responses to their call for information about the SoH’s application, only two of which were positive. This means the majority of responses were probably made by SAS ‘vigilantes’, and their distorted perspective of the nature of homeopathy is reflected throughout the PSA Panel’s 20-page report.
For example, several ‘learning points’ were identified, which will be re-evaluated when the SoH’s accreditation is reviewed next September. They have been asked to provide their members with guidance about sourcing medicines from correctly authorised suppliers only. Surely the majority of practitioners are caring and responsible enough to do that anyway? Furthermore, what evidence is there to suggest that any patient has suffered harm as a result of being prescribed a homeopathic medicine from an unlicensed source? Is it actually possible to monitor and control how members access their medicines, and what happens if a member does source an unauthorised product? Other recommendations include the establishment of a risk register, to record and manage any risks associated with the practice of homeopathy, and finding ways in which to support people who want to make a complaint against a registrant, but are unable to do so in writing. Risk management and complaints procedures are explored at length in all the Panel reports I have read, and some of the recommendations made seem so disproportionate I wonder what a human rights lawyer would make of them. But there is more to cause concern.
Most alarmingly, one ‘call for information’ argued that homeopathy has no evidence base, so therefore does not constitute a health care occupation. The Panel responded to this point by noting that their role is to confirm if their accreditation standards have been met, not to determine the efficacy of a particular therapy. The PSA go on to specifically instruct the SoH to ensure that they only communicate their accredited status in relation to their voluntary register. They must not present accreditation as ‘support for the efficacy of homeopathy’. This would seem to imply that a homeopath registered with the SoH can only use the much-vaunted AVR logo if they refrain from claiming that homeopathy works, or that patients get better following homeopathic treatment! Surely, if this is the case, AVR represents a total betrayal of our profession? Are practitioners expected to deny homeopathy, simply to gain the right to use a logo?
SoH members will be expected to comply with ASA rulings on marketing and promotional materials, and the SoH will check members’ websites at random, to offer advice / support if they consider a website to be in breach of the CAP Code. It is not clear what sanctions would be taken against a member who refused to make changes to a non-compliant website. What is clear is that the SoH will not be in a position to support a member who chooses to challenge an ASA ruling. So even if a website is legal, decent, truthful and honest, and contains correct information about homeopathy, including references to quality research, if the ASA considers the CAP Code has been breached, the website must be changed or the member may face a disciplinary hearing.
The SAS vigilantes have already announced their intention to inundate the SoH with fabricated complaints and, now that they have AVR, the SoH will be obliged to investigate each complaint according to the protocols described in their AVR application. If this does happen, the SoH will have to focus time and resources on implementing a set of standards which have been heavily influenced by the personal views of the homeopathy detractors. I believe that the SoH are no longer in the driving seat, nor indeed are the PSA. The hands on the wheel have ‘SAS & Co’ written all over them, so SoH members better prepare themselves for a bumpy ride.
I would like to believe that, as homeopaths, we are the custodians of a complex, finely balanced discipline. We have a duty of care to ensure we preserve the integrity of homeopathy, complete with all its nuances, for the ongoing benefit of our patients. AVR appears to be an antithesis to this view, and the ARH will not be applying for PSA accreditation in its current form. We consider it to be more important than ever to remain independent, and continue our quest to see homeopathy recognised and valued according to its own unique merits.