The Society of Homeopaths agrees that it's unethical to claim to cure autism with CEASE

Pic credit: Water, aka Abstract Aqua Background from Pixabay

Several people have complained to the Society of Homeopaths (SoH) about their members (lay homeopaths with no medical training) making claims on their websites to cure or treat autism in children using a form of treatment (CEASE therapy aka Complete Elimination of Autistic Spectrum Expression). The treatment is likely to cause harm to these vulnerable customers.

After my own complaint to the SoH (Nov 2017) I kept an eye on the five websites I'd reported but when no changes were made to any of them that would have addressed my complaints I raised the matter with the Professional Standards Authority (PSA). The PSA accredits the SoH's members' register (people who are entitled to call themselves RSHom).

For the latest round of reaccreditation the PSA imposed a condition (as well as some suggested recommendations) on the SoH with the risk that their accreditation would be cancelled if the condition wasn't met. This was the condition -

"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linked above) - to improve governance on CEASE therapists and advertising (if this is not met then accreditation may be rescinded).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)." Source: Better monitoring of homeopaths advertising CEASE therapy for autism in the UK - hooray (my earlier post).

On Friday 25 May the PSA wrote to me to let me know that the SoH had met this condition, and that they had published a position statement on their website making it clear that homeopaths should not claim that they can cure autism and that writing out the full name of CEASE therapy (Complete Elimination of Autistic Spectrum Expression) is problematic as the name itself implies a cure

"A number of Society members have been trained in CEASE and make reference to it in their marketing. While this is acceptable, members should be aware the title, meaning ‘Complete Elimination of Autistic Spectrum Expression’ is misleading. RSHoms must not suggest that they are capable of a complete cure of autism as this would be unethical and in breach of the Code of Ethics.

The Society does not endorse any aspects of CEASE therapy contrary to NHS guidance and nor should RSHoms. In particular on vaccination, homeopathic prophylaxis, and the use of dietary supplements. It is beyond standard homeopathic practice to provide advice on the use of supplements and therefore any guidance given should be in line with the NHS Guidelines." SoH's position statement

As far as I can tell ALL aspects of CEASE therapy are contrary to NHS guidance and there is no mention of the fact that homeopaths have no business treating anyone with autism. Hopefully after the Bank Holiday the SoH will communicate this update to the relevant RSHoms.

I'm not sure how long it will take though for the misinformation to be removed from the homeopaths websites though.

I can't actually take any credit for this because the complaint I put in to the PSA was after they were well along in their decision-making on the conditions for the SoH's reaccreditation. Much of the credit goes to @UKHomeopathyReg (blog) who has also kept the media (both in UK and North America) informed of the problem of homeopaths attempting to treat autism. Stopping homeopaths from claiming to cure autism is one (good) thing but raising public awareness that they've never been able to do this goes along way too.

Further reading
More than 120 homeopaths trying to ‘cure’ autism in UK (27 April 2018) The Guardian
Exclusive: the ‘cure’ involves detoxing children of vaccines and antibiotics held responsible for the condition

Complaints levelled at B.C. naturopaths offering 'complete elimination' of autism (24 May 2018) CBC
3 practitioners offering unproven therapy are subjects of complaint to College of Naturopathic Physicians

Further background
The Society of Homeopaths has a register of homeopaths (who may use the title RSHom) and this register is accredited by the Professional Standards Authority. Accreditation does not, and is not meant to, imply that homeopathy is a valid system of medicine (it isn't), simply that the people who've signed up to be RSHoms have insurance and have agreed to follow a code of ethics.

Since the general public may not realise what accreditation means (perhaps believing it to be more of an endorsement than it actually is) there have been a lot of raised eyed mutterings over the strangeness of accreditation.

Some RSHoms (and some other non RSHom homeopaths) claim that they can cure autism by using CEASE therapy. The treatment is potentially very harmful to children with autism, requiring them to take dietary supplements (including high doses of Vitamin C) as well as following a restricted diet. The use of homeopathy alongside this is a bit of a red herring, it is just one component but not the main thing.

Children with autism are vulnerable, as are their parents and carers, to harms done by well-meaning people who offer bad advice. There are concerns that these homeopaths are acting well beyond their competency and putting kids' health at risk - this is really a safeguarding issue. I've no idea if the therapists have appropriate training in caring for children with autism or have passed the DBS check.

Better monitoring of homeopaths advertising CEASE therapy for autism in the UK - hooray

There's some more good news for homeopathy skeptics in the UK and for people with autism. @UKHomeopathyReg on Twitter alerted me to this new publication yesterday...

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.