CEASE, which stands for Complete Elimination of Autistic Spectrum Expression, is a problematic multi-stranded 'therapy' which is marketed as a treatment for autism in the UK.
There appears to be no good evidence that it has any useful effect in people with autism (let alone the rather troubling framing of autism as something to be eliminated) and plenty of possibility that it could do harm. The therapeutic package includes megadoses of Vitamin C (which can lead to diarrhoea until the dose is adjusted) and is promoted to parents as a marvellous thing for their child with autism. The therapy is offered by 'CEASE trained' homeopaths (homeopathy is just one of the strands in the package) who mostly support the idea that autism is the fault of vaccination.
In other words parents have the experience of a treatment being promoted to them which doesn't work, which costs money and time, which blames them for their child having autism while suggesting it is curable, and which may give their child diarrhoea. As a bonus both the name and acronym market the treatment misleadingly. There are additional dietary restrictions, which may cause distress to a child with autism.
A number of skeptics and skeptic organisations have successfully raised concerns about the homeopaths who claim that they have something to offer families with a child with autism.
I'm hoping this image conveys 'hot air' as that's what I think of homeopathy
In terms of previous regulatory action we already had (2015) an Advertising Standards Authority (ASA) adjudication against one UK homeopath offering CEASE. Teddington Homeopathy did make some changes to their website after the ASA asked them to, but they also made it onto the ASA's list of non-compliant online advertisers after failing to make all of the required amendments.
Almond Homeopathy in Ireland were also told (in 2017) not to make claims that their treatment could reduce the symptoms of autism (though their treatments didn't relate to CEASE therapy).
While skeptics have had lots of small-level success in getting homeopathy websites amended, to a degree, many homeopaths persist in ignoring requests from the ASA. I'm not aware which homeopaths, if any, are scheduled to be reported to Trading Standards and the ASA may be prioritising other misleading advertisers first. However most homeopaths deal with patients who can at least give informed consent (perhaps less so with younger patients) but CEASE therapy deliberately targets a vulnerable -subpopulation, may cause harm and provides no benefit while costing money. It seems fairly clear that this is problematic so we needed a way of addressing this more directly. [See update to this at the end of this post]
It looks like we might have found another useful leverage point.
There are several professional homeopathic organisations in the UK (see Homeopathy Societies below) and one of them, the Societ of Homeopaths (SoH), managed to get its register of members accredited by the Professional Standards Authority (PSA). This accreditation doesn't confer any status on homeopathy or homeopaths beyond the presumption that members are conducting themselves professionally, have insurance and that sort of thing - it says nothing about the efficacy of homeopathy. To be fair, there's not much to be said.
Of course I'd assume that the SoH and its members are happy to have this accreditation and most members reference this on their pages.
A number of people skeptical of CEASE expressed concern to the PSA about a subset of SoH members who were making claims about CEASE and autism. These are outlines on pages 8 to 10 in the document below, along with the PSA's considerations. As a result of these complaints the PSA has now imposed a condition on the SoH's re-accreditation (for 2018) and other recommended requirements.
These require the Society of Homeopaths to produce a position statement on the treatment, on how it will be advertised by their members and also produce a document about the risks from CEASE - more details in the 'box' below. This is quite a big deal.
PSA Accreditation Panel's decision on the Society of Homeopaths
2017/2018 accreditation (18 page PDF)
The panel required several things to be addressed by the Society of Homeopaths within a particular timeframe. These fall under Conditions (which must be met to retain accreditation), Instructions (strong recommendations but probably no more than that) and Learning Points (a sort of 'things you might do better').
The PSA panel imposed one condition (p2 of the document linked above) - to improve governance on CEASE therapists and advertising (if this is not met then accreditation may be rescinded). The condition has three parts: (i) a position statement on CEASE therapy and on its advertising by homeopath members, (ii) develop some mechanism to ensure that homeopath members offering CEASE don't breach the Society's Code of Ethics, (iii) review the risks relating to CEASE therapy (and other treatments too).
The panel gave the SoH four instructions (p3), one of which is particular of interest to skeptics - "The Society is to develop and publish its persistent or vexatious complaints policy to make clear where it considers contact from people or organisations to be unreasonably persistent or vexatious and the approach it will take" - skeptic queries and complaints are often automatically treated as vexatious. That hasn't been my own experience (I've only contacted the SoH twice about a particular topic) but I've heard from others who felt they've been given the runaround.
The panel also gave the SoH two learning points (p3) and I think the second one will be of most interest here - "The Society should consider submitting its web page on ‘The evidence base for homeopathy’ to the Advertising Standards Authority’s Copy Advice team for independent review.". Heh.
Incidentally last year's accreditation resulted in no conditions, instructions or learning points.
I think all of us who complained about the SoH member CEASE therapists did so directly to the SoH first (I certainly did). Their response to me was prompt and courteous indicating that they'd take a look at the websites and if there was a problem they'd take action. Sadly the websites didn't change which suggested to me either that (i) the SoH didn't think there was a problem or (ii) they did think there was a problem, and communicated this to their members who then ignored them. As far as I could see the SoH were not effectively monitoring those members making these misleading claims about autism, so I escalated my concerns to the PSA (though, as it happens, after they'd made their decisions based on complaints from other skeptics - so I can't actually take any credit for this helpful outcome!).
This was the thinking behind my complaint (I can't speak for the other people and organisations who made the complaints that actually resulted in this change though). Several homeopaths offer CEASE therapy. Some are members of the SoH, some aren't (and not all SoH members offer CEASE!). But those that are members on SoH's accredited register should abide by the society's terms and conditions (the SoH also provides a support document to help members abide by the ASA's guidelines on advertising!) so it is fairly straightforward to find people who are members, offering CEASE and making misleading claims. I found five, complained and followed up my complaint when nothing happened.
Professional Societies
Society of Homeopaths - the subject of this post
Faculty of Homeopaths - for homeopaths who also have a medical degree
Alliance of Registered Homeopaths
There are probably others.
The Society of Homeopaths will be hosting its Annual General Meeting at UCL's School of Pharmacy in April. To kick things off they'll screen a pro-homeopathy film called Magic Pills.
Update 28 July 2018
Since this post was published in February 2018 skeptics have learned that the ASA / CAP have in fact (as of May / June 2018) been writing to CEASE homeopaths in the UK to remind them of what they may and may not say in their marketing material / websites. This was discovered thanks to two of the homeopaths writing on their websites about their exchanges with the ASA, as well as amending the claims on their websites as requested. According to their information the ASA / CAP sent UK homeopaths an Enforcement Notice relating to CEASE advertising. The enforcement notice isn't currently published on CAP's website. It would also be interesting to know how many homeopaths received a copy, and the compliance rate.
In fact, the reaccreditation is dependent on the SoH meeting those conditions in the specified time frames to the satisfaction of the Accreditation Panel. If the SoH do not, the PSA has the power to suspend or remove accreditation. PSA have suspended accreditation of another register before.
ReplyDeleteIt is difficult to know how the SoH can meet the conditions. Putting aside the issue of advertising, how the SoH can in the space of three months undo the brainwashing of years is beyond me. It may be easier for the SoH not to have members who are CEASE therapists.
Thanks for your comment UKHR. I'd missed that - had assumed that they HAD been accredited but that it may be at risk of being rescinded if they didn't sort out the CEASE thing. It sounds like you've read it as they will get accreditation only if they complete the required tasks.
ReplyDeleteI'm curious to know how things will proceed. It's crossed my mind that the SoH may decide to give up accreditation (and even the cachet of having it) to retain members that otherwise are perhaps going to cause problems, or maybe they can be persuaded. Perhaps the SoH will just jettison the CEASE therapists (there are quite a few RSHom CEASE folk I think). Of course losing accreditation is a fillip to skeptics so probably not ideal for them!
When I'm next in touch with the PSA I'll suggest that RSHom CEASE therapists who have a therapist's page on that CEASE-therapy website should not mention anything on that page that they'd not get away with on their own UK-based site - the situation we have at the moment is a bit ridiculous.
I'm sure I read that SoH might be planning on expanding their membership internationally - that will cause even more headaches as, of course, members in different countries will be subject to different advertising restrictions.
How will it end?! :)
Jo
May be talking at cross-purposes. To be clear, the conditions are imposed on the current accreditation. You are right to say that the accreditation can rescinded. The dates are confusing as the accreditation process was very late. I got confused.
ReplyDeleteSome in the SoH pushed very hard for PSA accreditation. It was partly sold on the idea that SoH members would possibly be able to get referrals from the NHS (manifestly untrue). To lose it would be a massive loss of face for them. The Alliance of Registered Homeopaths rejected the PSA accreditation route but the ARH was formed by dissidents from the SoH many years.
If the SoH do decide to give up PSA accreditation, it is not clear how this would reflect on the PSA. It would raise questions as to why they accredited them in the first place and the whole business of accrediting quack registers. The repercussions of the conditional reaccreditation of the SoH will be felt by some other registers too. In particularly the Complementary and Natural Healthcare Council. Some members of its member organisations also other dodgy treatments for autism.