Neal's Yard withdraw Homeopathic Malaria pills - back-pedal back-peddle

Following the recent blog on this site and others about Neal's Yard Medicines Director, Susan Curtis trying to explain on BBC's Inside Out program how it was ethical to sell homeopathic malaria sugar pills, Neal's Yard have announced they are pulling the range with immediate effect:

The BBC’s Inside Out programme - Homoeopathy and Malaria (YouTube video here)
We love the BBC, but we all know from time to time they can be guilty of naughty editing, especially when it comes to showing people apparently storming ‘out’. Our Medicines Director Susan Curtis was interviewed for the Inside Out programme last week, and unfortunately a lot of what she was trying to say was not shown. The most important point, and something we are very passionate about, it that as our health is so important, we advise that people seek professional advice on all matters of health.

We know there have been no clinical trials for the use of homoeopathy in the prevention of malaria but homoeopathy does have a good track record in preventing and treating other epidemic diseases.

No they don't - that is, in fact, a lie. Perhaps they would have pointed the interested customer to where details of this track record is?

Susan said that there is no absolute guarantee that you will not get malaria with any treatment and that the most important factor is to take measures to prevent being bitten by mosquitoes.

This is a fallacious argument - Product A is effective 99% of the time, Product B is effective 0% of the time. Conclusion: No absolute guarantee that you will not get malaria with any treatment. Neal's Yard do seem so treat their customers as simpletons, don't they?

We do not advertise or sell the remedy as a prevention for Malaria. It is supplied on request by practitioners working in Neals Yard Remedies stores, and in fact, the practitioners have been trained to always explain that the remedy should not be considered as a guarantee of prevention of malaria. The name of the remedy is based on its latin name and not on its claim to cure or prevent an ailment.

Weasel weasel weasel weasel weasel. Slippery words used to try and weasel out of the situation. I can't believe that it was written with any conviction - as I've written before, Quacks seem to be quite happy to change the normal meanings of words and conventions for their own ends. Hence we get Homeopaths saying "No, no, no, it specifically DOESN'T do what it says on the tin, it's just a name!", which in a way, is closer to the truth than they ever admit otherwise.

However, as this is obviously a contentious issue which is causing customer concern...

For 'contentious' read 'illegal' and 'immoral'.

... we have decided to withdraw the product, Malaria Officinalis 30c from sale with immediate effect.

Hoorah. All on their own. And nothing at all to do with Medicines and Healthcare Products Regulatory Agency (MHRA) investigation, of which I look forward to hearing the outcome. EDITED TO ADD (06/05/08): Outcome of MHRA report here.

EDIT: The Quackometer has also done an excellent fisking of the press release here.

Get an Ideal Spine - Have a quack crack your back.

According to Web 2.0's favourite information pile-up, Wikipedia, the word 'Quack' comes from:

... the archaic word "quacksalver," of Dutch origin (spelt kwakzalver in contemporary Dutch), meaning "boaster who applies a salve."[2] The meaning of the German word "quacksalber" is "questionable salesperson (literal translation: quack salver)."

The dictionary defines it as:

quack (kwk)
n.
1. An untrained person who pretends to be a physician and dispenses medical advice and treatment.

And so, a band of duck-noisers have claimed the area in fighting pseudoscience; hence we get QuackWatch and the excellent Quackometer, and the newly created Complementary and Natural Healthcare Council being dubbed Ofquack in The Times. (Incidentally, I think the first recorded use of the term was here by The Quackometer in January 2008. Just so as you know.)

Anyway, once again the Advertising Standards Authority, the fantastically vigilant, thorough (but ultimately rubber-toothed) guardian of the advertising world has struck quack-gold. (For other Thinking Is Dangerous entries on the ASA, see here)

Let me introduce CHEF, or , to give him his full name, Christian Hamilton Edward Farthing, the main man behind the "Ideal Spine Centre" in Canterbury, UK. He also likes to be called 'Dr', although on his website he has two interesting statements:

... [Dr Christian Farthing] attended the University at the Royal Melbourne Institute of (RMIT) Technology in Melbourne, Victoria. In 1997 he gained a double degree in Bachelor of Applied Science (Clinical Science) and Bachelor of Chiropractic Science and swore an oath to become a Doctor of Chiropractic

Dr. Farthing is not a Chiropractor, Osteopath or Medical Doctor.

Ah hmmmm.....Let me see, now; he swore an oath to become a Doctor, but not a Doctor in any traditional sense of the word. He's definately not a Chiropractor, as the General Chiropractic Council chucked him out a few years back following a "dispute with the regulatory body".

Indeed a previous ruling by the ASA in February 2008 (see further down for more) considered that

the references in the main text to "Dr Farthing", "The Family Doctor" and "Spinal Specialist" gave the impression that Christian Farthing was a registered medical doctor who was a specialist in the spinal field. We considered that the disclaimer, which appeared in small print, could be overlooked.

On this point, the ad breached CAP Code clauses 3.1 (Substantiation) and 7.1 (Truthfulness)

As has been found before, ASA rulings don't cover the interweb and so CHEF can call himself a Doctor (providing Trading Standards aren't told about it). I'll call him CHEF.

CHEF first came to the eyes of the ASA from adverts for his book, "The World's Best Kept Health Secrets - REVEALED" (which raises the questions, who is keeping them and how did CHEF find out? What is it about Quacks and conspiracy theories?). The webpage contains an anonymous quote (possibly even CHEF's own):

This book takes you directly to the center of the Human Universe. Without a full understanding of Subluxation, you can never remain forever young

Eh? Of course, he is being somewhat disingenuous. The meanings of subluxation (medical) and vertebral subluxation (metaphysical chiropractic) are not the same. Complimetary and Alternative Medicine practitioners have a nasty habit of taking sciency sounding words and changing the meaning for their own ends (have a listen here to Ben Goldacre speaking to Sue McGinty from BANT - she tries to redefine 'phenotype' for her own dubious purposes). In addition, I'm still pretty young but even I have figured out that no-one remains forever young, regardless of their subluxation understanding levels.

One of the gems on the advert for the book said:

If you're sick, the wellness messages are being trapped or interrupted, probably somewhere along the spine...

Are they really? And pray, what proof have you for this? *Silence*. So the ASA ruled that the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.1 (Health and beauty products and therapies). The full blurb is here.

His next flirtation with the ASA happened in February this year. He popped a few leaflets hither and thither authored by:

Dr Christian Farthing BappSc (ClinSc); BCSc. WELLNESS DOCTOR & SPINAL WELLNESS PRACTITIONER”.

Remember, that's 'Doctor' as in 'not a Chiropractor, Osteopath or Medical Doctor' but as in 'Wellness Doctor'. See how he gives the words new meanings. He (or Ideal Spine Clinic) also offered the excuse that:

...they had not realised the leaflet to be within ASA's remit

Oh I see, so as long as it isn't policed, you can write what you like. This is an insight into the mentality that perhaps their belief in their 'wellness' regimes is not as strong as their paying punters'.

Given his penchant for double meanings, this testamonial caught my eye:

I had been down the endless road of doctors, specialists and consultants. However, the Ideal Spine Centre has provided correction to my spine and I have never looked back.

.
Heh, not such a good testimonial after all...

Anyway, as mentioned above, the ASA said using the title Doctor was likely to mislead. Funny that, what with him not being a medical Doctor and all. The ASA also got CHEF and ISC to admit:

that chiropractors could not treat serious or prolonged conditions but that they did not claim to cure them, and that they merely corrected spinal dysfunction, better known as vertebral subluxation, and the body functioned better

.
And so to the present, and three regional adverts from the Ideal Spine Centre - which made a number of bizarre claims. The full gory affair is documented here on the ASA website. Needless to say (as twice before) it wasn't in the mood for such paltry things as 'proof' or 'references':

Some of the adverts Claims:
1. Hospital admissions from errors relating to medication had hit an all time high
2. Vertebral Subluxation affects 75% of the population, and can be caused by ... chemical imbalances and mental stress within the body
3. Vertebral Subluxation (misalignment of the spine) can manifest itself in all sorts of ways - headaches, migraines, neck pain, numbness, asthma, high blood pressure, pins and needles, poor concentration, sciatica, neuralgia, scoliosis, behavioural problems, bedwetting, and ear infections in children, lowered immunity, indigestion and back pain just to name a few
4. the facts tell us that our planet is now sicker than ever before in recorded history

The comparison to conventional medicine

1. An average 300 people die each day due to errors made by medicine. That number has increased in the past five years to make medicine the leading cause of death in the UK after heart disease and cancer

2. the new model for health that is sweeping the nation and the world is WELLNESS CARE and it works. [Conventional Medicine is] useless and [is] the world's greatest failure

3. The power that made you, is the same power that keeps you and is the power that heals you. It is the same healing power the planet's best surgeons rely on for you to recover from life-saving surgery. That power is better known as 'innate intelligence' and it runs through your nervous system

Wow. Those are pretty big claims. The ISC website doesn't stop at providing case studies of chiropractic help for behavioural problems, high blood pressure and ear infections. No, you'll find cancer, autism and diabetes to name a few, oh, and AIDS.

So what happened when the ASA asked for proof of the claims? ISC said they:

were unable to send evidence to substantiate the claims at this point in time

Same games played three times. Say what you want, then shrug your shoulders when the ASA comes knocking. It is a real disgrace that CHEF and ISC can get away with the nonsense they are advertising. As I've written before, I would like to see the ASA get some real teeth - repeat offenders should be subject to public flogging, or at least a fine. Otherwise, what is to stop it happening again? And again?

Ironically, "Dr" Christian Farthing has a registered trademark "GET IT STRAIGHT UK" - let's hope he does from now on, eh?

BPSDB

Transcript of Susan Curtis (Medicines Director of Neal's Yard) explaining how Homeopathy can cure and prevent malaria

Following the sting by Sense About Science on homeopaths in London demonstrating that they were willing to break public health protocols by providing unproven homeopathic pills to protect against malaria, South West UK regional program Inside Out decided to investigate claims by Neal's Yard that homeopathic remedies it sells (now past tense!) in its stores can help prevent and treat serious fatal diseases such as malaria.

The full program is on BBCi player for 4 more days, but it may be possible to get a link from elsewhere in due course.

EDIT: Some kind person has put it onto YouTube

In any case, for non-UKers, here is the transcript of the interesting parts of the report. Susan Curtis scores a few cracking own goals, including getting all grumphy and storming out of the interview. I look forward to hearing from Susan - especially as to what "evidence by extension" is. It's not a term I've across before.

-------------------------------------------------------------------------------------
[Janine Jansen – voiceover and interviewer]
Ever since ancient times, plants have been used for their medicinal qualities and today alternative medicine is big business. Every year we spend millions of pounds on it. Now one strand is homeopathy, but Inside Out can reveal that a leading national chain is selling homeopathic products and claiming they can help prevent a major tropical killer, malaria. It is a claim hotly disputed by medical experts.

[Dr Behrens (Tropical Diseases Travel Unit)]

“It is potentially highly dangerous, it puts lives at risks and I think the science behind it doesn’t exist and people should be aware of this.”

[Prof. Edzard Ernst, Professor of Complementary Medicine, Peninsula Medical School]

“It is the worst end of the spectrum of alternative medicine. That’s why I’m angry about it.”

Neal’s Yard Remedies is an upmarket chain of stores that claims to sell the UK’s largest range of organic herbs and skincare. It can count celebrities like Kylie and Danii Minogue as fans of their products and in 2007 they won a Sunday Times Best Ethical Brand Award. They sell all sorts of lotions and potions to make you smell nice.

But they also provide advice about homeopathic alternatives to immunisation and they sell a book that contains pratical information on preventing and treating major infectious diseases such as malaria. So I went to the Neal’s Yard store in Exeter to investigate.

I told them I was back-packing around Congo and Namibia, two places where malaria is endemic and I asked for some travel advice. [Additional information on malaria]

It is not just people from developing countries who die from the disease, with overseas travel now so cheap, people from the UK are also at risk.

[Case study on UK death due to malaria]

[Dr Behrens]

“You cannot assume because you have been there repeatedly that you have built natural immunity and therefore you need to be continuously on malaria tablets”

Meanwhile back at Neal’s Yard, I’ve got my advice about travelling to sub-Saharan Africa. The manager of their Exeter store recommended two homeopathic medicines, or remedies as they refer to them, to help me deal with malaria. He sold me malaria Officianalis 30 and China 30c. He also photocopied a page out of this book, it’s written by Susan Curtis, she’s the Medicines Director for Neal’s Yard. In it, she describes these remedies as prophylaxis, which in everyday english means prevention of disease and though she says that no remedies, orthodox or alternative can guarantee prevention of malaria, she does however say the risk and severity of an attack can be lessened with appropriate remedies.

I wanted an expert opinion on the products I’d been sold, so I showed them to Edzard Ernst, Professor of Complementary Medicine at the Peninsula Medical School in Exeter. For the last 15 years he’s been studying the evidence for and against alternative medicine.

[Prof. Edzard Ernst]

“To be absolutely precise, there is nothing in them. You know, it is so dilute that you will not find a single molecule of whatever it says on the label, so nothing biologically active. It doesn’t prevent anything, it doesn’t prevent malaria, it doesn’t treat malaria, it doesn’t do anything.”

[Brief recap of homeopathy]

Some homeopaths like Susan Curtis, the Medicines Director for Neal’s Yard, believe that when the active component is diluted and repeatedly banged, then its full potency is released.

[Susan Curtis] It’s an energy medicine so it works by stimulating your natural immunity to illnesses.
[Janine Jansen] And how can a homeopathic remedy help prevent malaria?
[Susan Curtis] Well it works in the same way as I just described really, but there haven’t been any actual clinical trials with malaria.

Conventional anti-malarial tablets must past stringent tests before any claims can be made about their efficacy.

[Dr Behrens]

“We actually give people a tablet and then you get them bitten by a malarial mosquito, and you know that they’ve been injected and if none of them get malaria then the tablet has worked and that is what is required to be convinced that preventative tablets work.”

I couldn’t help thinking that it might be more helpful for customers if Neal’s Yard spelt out that these products had not been tested scientifically.

[Janine Jansen] You don’t say it on your page that there’s been no clinical trials into these preventative products.
[Susan Curtis] Well, I do say that there is no guarantee that the remedy will prevent malaria, however there is some evidence by extension that homeopathy can be very effective in certain epidemic diseases and there have been trials that show that so it is…
[Janine Jansen] Not for malaria.
[Susan Curtis] That is exactly right which is why I keep saying that there is no clinical trials that we know of that show that the homeopathic remedies work for malaria.

---
[Edzard Ernst]

“When it comes to serious diseases like malaria it is awful. I wouldn’t hesitate to call this criminal. I don’t whether this is legally criminal, but in my view this is so … amoral and unethical that I wouldn’t hesitate to call it criminal.”

---

[Janine Jansen] Do you think this page is misleading?
[Susan Curtis] I think that I will continue to emphasize that there is no 100% guaranteed prevention for malaria.

In her book, she uses a trip to India as evidence that Homeopathic remedies can prevent malaria. I wanted to know what happened to her.

[Janine Jansen] Did you get stung, bitten by a mosquito with malaria?
[Susan Curtis] Well I didn’t get malaria.
[Janine Jansen] But Were you bitten by a mosquito with malaria?
[Susan Curtis] Well you wouldn’t know would you?
[Janine Jansen] But how do you know it worked how do you know that you were safe?
[Susan Curtis] There have been no clinical trials to prove or disprove that homeopathic medicines work against malaria.

15 minutes in and Susan Curtis stopped the interview.

[Susan Curtis] I’ve actually had enough

Even though we had not put all our points to her including Professor Ernst’ allegations:

[Janine Jansen] He says what you are doing is criminal and unethical and very dangerous to customers.

[SC exits stage left.]

We contacted the Medicines and Healthcare Products Regulatory Agency. They told us that “prepackaged homeopathic medicines must be either Registered or authorised by the MHRA and that neither Malaria Officianalis 30 nor China 30c were registered or authorised by them and that non-orthodox practioners who sell a prepackaged homeopathic medicine not registered or authorised by them are acting illegally.”

[Dr Behrens]
If you take malaria tablets you have 98% chance of being protected whereas the evidence doesn’t support an protection from taking a homeopathic remedy. I know which strategy I would prefer.

We are now passing on our findings to the MHRA and Trading Standards.
-------------------------------------------------------------------------------------
End of transcript.
-------------------------------------------------------------------------------------

Further analysis can be found on The Quackometer. In a funny sort of round about way, The Society of Homeopaths tried to sue The Quackometer for saying pretty much what Susan Curtis is saying. But then other homeopaths will tell you they don't treat the disease, just the person. It's pretty clear they don't really know what they believe.

And it is purely belief.

EDITED TO ADD (29/04/08) - Neal's Yard have removed the homeopathic malaria range from their shelves - see here

EDITED TO ADD (6/05/08) - Neal's Yard have been smacked for being naughty by the MHRA. See here.

ScienceMangle™ - The UK is unregulated. (A Case Study with Artrosilium)

I've introduced the ScienceMangle™ before, when discussing the Daily Mail's herculean effort to categorise everything in the known world in to either cancer-causing or cancer-curing pigeonholes.

However, I thought it was time to dust it down and see if it still works.

WHiiiirrrrrr wwwwhiiirrrrr

Good.

I've been in discussion with the MHRA - the Medicines and Healthcare Products Regulatory Agency regarding yet another natural wonderdrug for arthritis.

Let me introduce you to Artrosilium. It is one in a very long line of dodgy products aimed at the 5 million or so Britons who have arthitis or similar diseases. Your humble blogger is sadly included in that statistic.

There is no cure for arthritis and so depending on the severity (very mild in my case) sufferers adhere to an often complicated regime of pain management, that can be seemingly affected by small changes in diet, the weather, possibly even aliens.

(This last one, incidentally, is proof of someone's rule - I'll call it Dr* T's Second Rule until someone corrects me - whereby regardless of what you imagine, someone on the net has already written about it. Perhaps I have a limited imagination).

Anyway, Artrosilium is being sold via a .co.uk website, which to me indicates a UK company, and I was a) not convinced that the product had any efficacy, and b) concerned that the website made unsubstantiated claims with no real proof or indeed the direction to find the proof.

So, I started by sending a letter to the MHRA outlining my concerns. Initially, they told me it was a Guernsey based company and not under MHRA control, although they would inform the authorities.

Since I started my conversation with MHRA regarding Artsosilium, the website undertook an overhaul. Previously it had claims of being "The Proven Natural Remedy for Arthritis", which has now become "Guaranteed Arthritis Relief". A subtle change from remedying the arthritis itself, to remedying the pain from arthritis. Baby steps no less. However even the 'alleviation of pain' is not proven or backed up anywhere on the site.

The claims that

"Although Artrosilium was initially developed to treat arthritis, more and more customers are reporting that it relieves other ailments such as skin irritation, burns, sunburn, insect bites, herpes and even prostate problems – so this really could be a “miracle cure”.

have also been removed.

Nonetheless, I persevered with MHRA to find out what they would do about a company advertising pain relief for Arthritis on a co.uk website using a gel that contains silica (without going into the details of how this will be transported to the desired area).

This was their reply:

The UK address I identified at the beginning of my investigation turned out to be that of a web-designer working on behalf of a Swiss Company. It therefore seems that the companies associated with artrosilium are not based in the UK which makes enforcement of UK medicines legislation almost impossible. However, I have written to the regulatory authorities in both Guernsey and Switzerland to ask them to investigate whether the product and its advertising comply with any relevant legislation. Realistically, in the absence of a UK presence for the company placing Artrosilium on the market I do not think there is any further action I can take.

I am sorry to send you what will seem a very disappointing reply.

Now, the updated website has indeed changed its address from Guernsey to Switzerland but is still linking to books about nonsense like:

How to get rid of Arthritis and Rheumatism by Robert Dehin

which is also a .co.uk website.

We have a framework in this country for regulating medicines and healthcare products. I want to know that if I buy something medicinal in UK, it has been through the relevant tests for efficacy, safety etc. and I can rely on bodies like MHRA to ensure that rogue traders are dealt with efficiently.

However, it appears that this is not the case. In my mind, anyone selling a product on a .co.uk website should come fully under the authority of the UK and its agents.

The MHRA has admitted that does not happen. I think that is dangerous - next stop, parliament.

EDIT (30/5/08): I'm getting there, things are starting to move. In the mean time, it turns out that the Advertising Standards Authority (ASA) has already pulled ARTROSILIUM up for talking rubbish, making nonsense claims and not backing anything up. This product really is dubious - yet this company is making money from vulnerable people.

EDIT (15/9/08): IntraMed have once again been censured by the ASA for their product Ginkgo Biloba. Same old same old.

The Mighty Randi

The Mighty Randi is appearing in London on Sat 19th April with a few local skeptics, including Bad Science ninja Ben Goldacre.

Irritatingly, despite this posing as an excellent birthday present, I can't make it.

grrrrrrrrrrrr.......