Complementary and Natural Healthcare Council

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The Complementary and Natural Healthcare Council (CNHC) is a regulatory body in the United Kingdom which provides a voluntary register of complementary, rather than alternative medicine, therapists. The key purpose of CNHC is to act in the public interest and enable proper public accountability of the complementary therapists that it registers.

Contents

The CNHC was founded in 2008 with government funding and support and became fully operational in early 2009. [1] In 2013 it was approved as the holder of an 'Accredited Voluntary Register' by the Professional Standards Authority for Health and Social Care (PSA). In December 2014 it became an 'Accredited Register', for the PSA.

Origins

The Need for Regulation

In November 2000, the House of Lords Select committee on Science and Technology reported on complementary and alternative medicine and considered the public health policy needs and NHS provision of these treatments. In one of its many areas of consideration, the report considered the needs to provide public protection by regulating practitioners. It noted that those practices that could injure patients were either already statutorily regulated (chiropractic and osteopathy) or were soon to be (herbalism and acupuncture).

The remaining largely placebo based therapies and those without a sound evidence base for their efficacy and robust regulatory systems (e.g. reiki, massage therapy, aromatherapy, yoga and homeopathy), suffered from having a large number of fragmented registration bodies with considerable diversity of standards. The House of Lords found this unacceptable and that "in the best interests of their patients such therapies must each strive to unite under a single voluntary regulatory body". [2]

The House of Lords described the necessary features of an effective voluntary self-regulatory body. These included having a register of members, educational standards, a code of ethics and practice, a public complaints mechanism, and the capacity to represent the whole profession. [3]

The Federal Working Group

Following publication of the report, the Department of Health (DH) asked The Prince's Foundation for Integrated Health (FIH), a not for profit organisation founded by The Prince of Wales, to facilitate the development of a federal 'umbrella' regulator for these therapies. The Foundation, which is now defunct, promoted the inclusion of non-evidence based alternative therapies into public healthcare in the UK. [4] The process was funded by a DH grant of £900,000 over a three-year period from 2005 to 2008. [5]

On behalf of the FIH, Professor Dame Joan Higgins was asked to be Chair of a Federal Working Group which was to look into setting up what was to become the Complementary and Natural Healthcare Council. Therapies who participated in the Working Group were Alexander technique, aromatherapy, Bowen technique, cranial therapy, homeopathy, massage therapy, naturopathy, nutritional therapy, reflexology, reiki, shiatsu and yoga therapy. Other eligible therapists were aromatherapists, reflexologists and reiki practitioners, although these practices were not represented. [5] [6]

Structure

The Complementary and Natural Healthcare Council is a not-for-profit private limited company [7] made up of three elements:

The Council has five lay and four registrant members. Each Profession Specific Board has up to four registrants from the relevant profession. The Professional Committee is a pool of lay people from which investigating, conduct & competence and Health Panels are drawn.

CNHC Code of Practise supports Evidence-Based Approach

The CNHC’s Code of Conduct, Performance and Ethics states:

15. You must follow CNHC guidelines in relation to advertising your services

Any advertising you undertake in relation to your professional activities must be accurate. Advertisements must not be misleading, false, unfair or exaggerated. You must not claim that your personal skills, equipment or facilities are better than anyone else’s.

If you are involved in advertising or promoting any other product or service, you must make sure that you use your knowledge, healthcare skills, qualifications and experience in an accurate and professionally responsible way. You must not make or support unjustifiable statements relating to particular products or services. Any potential financial rewards to you should be made explicit and play no part at all in your advice or recommendations of products and services that you give to patients, clients and users. [8]

Progress since start-up

In December 2008, CNHC stated on their website that they hoped to have 10,000 practitioners registered with them by the end of 2009. This was later amended without comment to 4,000 by Spring 2010. However, by August 2009 a total of only about 500 registrations had been made in four disciplines: Massage Therapy, Nutritional Therapy, Aromatherapy and (from 24 August) Reflexology.

By February 2011 practitioners in eleven disciplines were eligible, but according to the organisation's website the total number of registrants was still less than 4,000.

Lack of enthusiasm for the CNHC among practitioners may be partly ascribed to the fact that at present anyone may legally practise in the UK without qualifications as a reflexologist, aromatherapist, homeopath, naturopath, nutritional therapist, acupuncturist, etc., and that voluntary registration by the CHNC will make no difference to this. [9]

Funding

In response to a Freedom of Information request, the Department of Health has confirmed that since the CNHC was set up the DH has provided funding as follows: £293,496 in 2007/8/9 (including start up costs), £409,300 in 2009/10 and £127,748 in 2010/11

Request was made for funding to be continued but this was dependent on satisfactory progress having been made, and as this was not the case official funding ceased in March 2011.

The CNHC do not publish details of the number of registrants it has attracted, but these are certainly only a fraction of the target of 10,000 set in 2007 and it is unlikely that income from fees is currently sufficient to cover running costs. [9]

Criticism

CNHC to tighten up on unjustified claims for which there is no evidence-base

Following complaints submitted by Simon Perry, a blogger and member of Leicester Sceptics in the Pub, regarding 14 reflexologists claiming to treat specific diseases without any credible evidence, Maggie Dunn, CEO of CNHC, has said that they will tighten up on therapists making unjustified claims for which they have no evidence. CNHC reviewed the claims made by the reflexologists against the Advertising Standards Authority (ASA) guidelines - and told the reflexologists to remove their claims. In a personal communication to Simon Perry from Maggie Dunn, the CNHC’s Chief Executive Officer, CNHC said that in the future: [10]

  • CNHC will tell practitioners to remove claims they cannot justify.
  • CNHC will conduct a review of evidence base for regulated therapies.
  • CNHC will contact all registrants to instruct them not to make claims without justification.
  • CNHC will contact complementary health course providers and authors to instruct them not to make claims without justification.
  • this is to cover all promotional materials and all interactions with the client.

However CNHC has made no public statement in this regard - possibly because many therapists will not want their public and private claims for efficacy to be regulated. The CNHC has attracted criticism, mainly for its role in appearing to legitimize what critics regard as quackery and for its efforts to promote alternate therapies which are often of dubious or unproven efficacy. It is satirized by skeptics as "OfQuack", mimicking other bodies such as OfCom. "How does a regulator decide what is good practice and what is charlatanry when none of it has peer-reviewed, scientific evidence that it works?... Professor Michael Baum protested that 'this is like licensing a witches' brew as a medicine so long as the batwings are sterile'... It matters that Newsnight found homeopaths advising patients visiting malaria areas not to take anti-malarial drugs. And that patients are told not to give their children the MMR jab." Polly Toynbee, The Guardian . [11] [12]

Private Eye magazine argued that the council had a conflict of interests between promoting and regulating alternative medicine: "Everyone would say that propagandists cannot be regulators because they cannot be trusted to act in the public interest." It quoted Edzard Ernst, professor of complementary medicine at the University of Exeter, as saying: "This is ridiculous. It really is a farce. All they will need to prove is that [practitioners] are following an established technique they believe to be appropriate. It's a ludicrous system."

Private Eye and The Economist reported that critics have nicknamed the council 'OfQuack'. Private Eye quoted a joke slogan, 'OfQuack - making quacks look professional since 2008'. [13] [14]

In January 2009, an online petition was started at the UK Government Petition website, asking for stricter requirements on efficacy and safety as a condition of certification. An official response to this was posted, but simply reiterated the terms of the current requirements. [15] However, in response to the point made by the petitioners and others, the CNHC has now amended its website, deleting its original statement that regulation by them gives a guarantee of the efficacy of the procedures carried out by their registrants. In addition to the medical criticism, CNHC have also been censured by the British Standards Institute for use of their trademarked term "kitemark", [16] and have also been criticised for poor openness [17] and an inconsistent approach to data protection. [18] It has, to date, failed to register more than a tiny proportion of the tens of thousands of CAM[ clarification needed ] practitioners in the UK; it is argued that it is failing in its stated aim to protect the public against incompetence or malpractice in the disciplines it claims to regulate, let alone in those - homeopathy for example - whose practitioners have no interest in the CNHC and claim to regulate themselves. While there has been considerable criticism of CNHC with regard to "quack" therapies their Code of Practise may support an evidence-based approach.

Related Research Articles

Alternative medicine is any practice that aims to achieve the healing effects of medicine, but which lacks biological plausibility and is untested, untestable or proven ineffective. Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine are among many rebrandings of the same phenomenon. Alternative therapies share in common that they reside outside medical science, and rely on pseudoscience. Traditional practices become "alternative" when used outside their original settings without proper scientific explanation and evidence. Frequently used derogatory terms for the alternative are new-age or pseudo, with little distinction from quackery.

Homeopathy Pseudoscientific system of alternative medicine based on the doctrine of "like cures like"

Homeopathy or homoeopathy is a pseudoscientific system of alternative medicine. It was conceived in 1796 by the German physician Samuel Hahnemann. Its practitioners, called homeopaths, believe that a substance that causes symptoms of a disease in healthy people can cure similar symptoms in sick people; this doctrine is called similia similibus curentur, or "like cures like". Homeopathic preparations are termed remedies and are made using homeopathic dilution. In this process, the selected substance is repeatedly diluted until the final product is chemically indistinguishable from the diluent. Often not even a single molecule of the original substance can be expected to remain in the product. Between each dilution homeopaths may hit and/or shake the product, claiming this makes the diluent remember the original substance after its removal. Practitioners claim that such preparations, upon oral intake, can treat or cure disease.

Naturopathy Form of alternative medicine

Naturopathy or naturopathic medicine is a form of alternative medicine that employs an array of pseudoscientific practices branded as "natural", "non-invasive", or promoting "self-healing". The ideology and methods of naturopathy are based on vitalism and folk medicine, rather than evidence-based medicine (EBM). Naturopathic practice relies on unscientific notions, often leading naturopaths to diagnoses and treatments that have no factual merit.

Osteopathy Alternative medicine that emphasizes physical manipulation of muscle and bones

Osteopathy is a type of alternative medicine that emphasizes physical manipulation of the body's muscle tissue and bones. Practitioners of osteopathy are referred to as osteopaths. Its name derives from Ancient Greek "bone" (ὀστέον) and "pain, suffering" (πάθος).

Reiki is a Japanese form of alternative medicine called energy healing. Reiki practitioners use a technique called palm healing or hands-on healing through which a "universal energy" is said to be transferred through the palms of the practitioner to the patient in order to encourage emotional or physical healing.

Reflexology Alternative medical practice involving pressure to parts of the body

Reflexology, also known as zone therapy, is an alternative medical practice involving the application of pressure to specific points on the feet and hands. This is done using thumb, finger, and hand massage techniques without the use of oil or lotion. It is based on a pseudoscientific system of zones and reflex areas that purportedly reflect an image of the body on the feet and hands, with the premise that such work on the feet and hands causes a physical change to the supposedly related areas of the body.

Craniosacral therapy Pseudoscientific alternative medicine technique

Craniosacral therapy (CST) is a form of alternative therapy that uses gentle touch to palpate the synarthrodial joints of the cranium. CST is a pseudoscience, and its practice has been characterized as quackery. It is based on fundamental misconceptions about the physiology of the human skull and is promoted as a cure-all for a variety of health conditions.

History of alternative medicine

The history of alternative medicine refers to the history of a group of diverse medical practices that were collectively promoted as "alternative medicine" beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled "irregular practices" by the western medical establishment. It includes the histories of complementary medicine and of integrative medicine. "Alternative medicine" is a loosely defined and very diverse set of products, practices, and theories that are perceived by its users to have the healing effects of medicine, but do not originate from evidence gathered using the scientific method, are not part of biomedicine, or are contradicted by scientific evidence or established science. "Biomedicine" is that part of medical science that applies principles of anatomy, physics, chemistry, biology, physiology, and other natural sciences to clinical practice, using scientific methods to establish the effectiveness of that practice.

The Health and Care Professions Council is a statutory regulator of over 280,000 professionals from 15 health and care professions in the United Kingdom. The Council reports its main purpose is to protect the public. It does this by setting and maintaining standards of proficiency and conduct for the professions it regulates. Its key functions include approving education and training programmes which health and care professionals must complete before they can register with the HCPC; and maintaining and publishing a Register of health and care providers who meet pre-determined professional requirements and standards of practice.

Thalia Pellegrini is a British television presenter and registered Nutritional Therapist.

Energy medicine is a branch of alternative medicine based on a pseudo-scientific belief that healers can channel healing energy into a patient and effect positive results. Practitioners use a number of names including various synonyms for medicine and sometimes use the word vibrational instead of or in concert with energy. In no case is any empirically measurable energy involved: the term refers instead to so-called subtle energy.

The Research Council for Complementary Medicine (RCCM) is a charitable organisation founded in 1983 to develop and promote good quality research into alternative and complementary medicine (CAM) and enhance evidence-based medicine in this area.

Regulation and prevalence of homeopathy Alternative medicine

Homeopathy is fairly common in some countries while being uncommon in others. In some countries, there are no specific legal regulations concerning the use of homeopathy, while in others, licenses or degrees in conventional medicine from accredited universities are required.

The Ministry of Ayurveda, Yoga, Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy is purposed with developing education, research and propagation of indigenous alternative medicine systems in India. As per a recent notification published in the Gazette of India on 13 April 2021, the Ministry of AYUSH, will now be known as the Ministry of Ayush. The Ministry of Ayush includes the seven traditional systems of healthcare.

Osteomyology is a form of alternative medicine found almost exclusively in the United Kingdom and is loosely based on aggregated ideas from other manipulation therapies, principally chiropractic and osteopathy. Osteomyologists are often therapists who have usually been trained in osteopathy or chiropractic but take on the title osteomyologist after they have refused to be regulated by the General Osteopathic Council (GOsC) or the General Chiropractic Council (GCC) for political or philosophical reasons, or cannot join as they have not submitted the required papers to the governing bodies or achieved training standards necessary to satisfy the terms of the acts of parliament.

The Foundation for Integrated Health (FIH) was a controversial charity run by Charles, Prince of Wales, founded in 1993. The Foundation promoted complementary and alternative medicine, preferring to use the term "integrated health", and lobbied for its inclusion in the National Health Service. The charity closed in 2010 after allegations of fraud and money laundering led to the arrest of a former official.

Aromatherapy pseudo-scientific alternative medicine practice

Aromatherapy is a pseudoscience based on the usage of aromatic materials, including essential oils, and other aroma compounds, with claims for improving psychological or physical well-being. It is offered as a complementary therapy or as a form of alternative medicine, the first meaning alongside standard treatments, the second instead of conventional, evidence-based treatments.

Because of the uncertain nature of various alternative therapies and the wide variety of claims different practitioners make, alternative medicine has been a source of vigorous debate, even over the definition of "alternative medicine". Dietary supplements, their ingredients, safety, and claims, are a continual source of controversy. In some cases, political issues, mainstream medicine and alternative medicine all collide, such as in cases where synthetic drugs are legal but the herbal sources of the same active chemical are banned.

Kimball Atwood American medical doctor, researcher and alternative medicine critic

Kimball C. Atwood IV is an American medical doctor and researcher from Newton, Massachusetts. He is retired as an assistant clinical professor at Tufts University School of Medicine and anesthesiologist at Newton-Wellesley Hospital.

CEASE therapy is a pseudoscientific practice used by naturopaths who claim that it can treat or even cure people with autism, claims which have been adjudicated by the UK's Advertising Standards Authority as "bogus". It involves a mixture of supplements, high-dose vitamin C, 'orthomolecular support', dietary restrictions, and homeopathy. The therapy was developed by Dutch doctor Tinus Smits, who claimed to have used it to treat over 300 children with autism. It became more notable in 2017/2018 because of regulatory action taken by professional bodies in The Netherlands, UK, and Canada following a series of complaints about unfounded claims.

References

  1. ↑ The Complementary and Natural Healthcare Council
  2. ↑ Features of an Effective Voluntary Self-Regulatory Body, Science and Technology Sixth Report 21 November 2000 Archived 2008-05-13 at the Wayback Machine
  3. ↑ Features of an Effective Voluntary Self-Regulatory Body, Features of an Effective Voluntary Self-Regulatory Body 21 November 2000 Archived 2008-10-12 at the Wayback Machine
  4. ↑ http://www.fih.org.uk/ Prince's Foundation for Integrated Health
  5. 1 2 Press Release from Prince's Foundation for Integrated Health Archived 2008-09-28 at the Wayback Machine
  6. ↑ Final Report of the Federal Working Group [ permanent dead link ]
  7. ↑ http://wck2.companieshouse.gov.uk/e26c10b4db895db39b7fd1426c7dfa74/compdetails CNHC Details at Companies House
  8. ↑ CNHC Code of Conduct, Performance and Ethics Archived 2011-04-09 at the Wayback Machine , http://www.cnhc.org.uk
  9. 1 2 "Archived copy" (PDF). Archived from the original (PDF) on 2015-09-23. Retrieved 2015-03-11.CS1 maint: archived copy as title (link)
  10. ↑ CNHC Wishes to Thank Simon Perry, http://adventuresinnonsense.blogspot.com, Friday, 27 November 2009
  11. ↑ Quackery and superstition - available soon on the NHS Polly Toynbee The Guardian January 8, 2008
  12. ↑ New laws to govern alternative medicine Nigel Hawkes The Times January 5, 2008
  13. ↑ Private Eye no. 1229 p.28, February 2009.
  14. ↑ Trust me, I've got a licence: Regulating the Quacks The Economist April 17, 2008
  15. ↑ CNHC Safety - epetition response Archived 2012-01-23 at the Wayback Machine Number 10 website June 19, 2009
  16. ↑ Ofquack's 'Kitemark' is Deflated Archived 2011-12-23 at the Wayback Machine Andy Lewis The Quackometer February 4, 2009
  17. ↑ Ofquack: "Minutes? We never posted any minutes!" Martin Robbins The Lay Scientists April 17, 2009
  18. ↑ Department of Health response to CNHC letter "Dr* T" Thinking is Dangerous blog March 12, 2009
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