Complementary and Natural Healthcare Council
Encyclopedia
The Complementary and Natural Healthcare Council (CNHC) is an industry body which provides a voluntary register of alternative medicine
therapists in the UK. The aim of the register is to "support the use of complementary and natural therapies as a uniquely positive, safe and effective experience." The CHNC was founded in 2008 and became fully operational in early 2009.
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.
Also, the fact that, four years after it was founded, it has failed to register more than a tiny proportion of the tens of thousands of CAM practitioners in the UK means that is not succeeding 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.
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".
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.
asked The Prince's Foundation for Integrated Health
(FIH), a not for profit organisation founded by HRH The Prince of Wales, to facilitate the development of a federal 'umbrella' regulator for these therapies. The Foundation promoted the inclusion of non-evidence based alternative therapies into public healthcare in the UK. but is now defunct. The process was funded by a Department of Health grant of £900,000 over a three-year period from 2005 to 2008.
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 therapies were aromatherapists
, reflexologists
and reiki
practitioners, although these practices were not represented.
Members of the Council and the functional boards will be laypeople, appointed independently; each Profession Specific Board (one for each profession) will have a lay Chair and four registrants from the appropriate profession. Each Profession Specific Board will select one of its practitioner members to sit on the Practice Advisory Panel which will provide a pool of expertise to support the Council.
The CNHC’s Code of Conduct, Performance and Ethics states:
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.
.
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'.
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. 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", and have also been criticised for poor openness and an inconsistent approach to data protection.
There is a twitter feed from OfQuack, an obvious parody as it has been described as "puerile and sarcastic", and occasionally refers to the CNHC separately from itself.
By February 2011 practioners 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.
Some of the 2009 reports from the CNHC to its parent organization, the Department of Health, have been made available under the Freedom of Information act. These largely confirm the view that income is much lower than originally planned and also show a major revision of planned income.
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....
therapists in the UK. The aim of the register is to "support the use of complementary and natural therapies as a uniquely positive, safe and effective experience." The CHNC was founded in 2008 and became fully operational in early 2009.
The CNHC has attracted criticism, mainly for its role in appearing to legitimize what critics regard as quackery
Quackery
Quackery is a derogatory term used to describe the promotion of unproven or fraudulent medical practices. Random House Dictionary describes a "quack" as a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, knowledge, or...
and for its efforts to promote alternate therapies which are often of dubious or unproven efficacy.
Also, the fact that, four years after it was founded, it has failed to register more than a tiny proportion of the tens of thousands of CAM practitioners in the UK means that is not succeeding 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.
The Need for Regulation
In November 2000, the House of LordsHouse of Lords
The House of Lords is the upper house of the Parliament of the United Kingdom. Like the House of Commons, it meets in the Palace of Westminster....
Select Committee on Science and Technology reported on complementary and alternative medicine and considered the public health policy needs and NHS
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
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
Chiropractic
Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. It is generally categorized as complementary and alternative medicine...
and osteopathy
Osteopathy
Osteopathy and osteopathic medicine are often used interchangeably for the philosophy and system of alternative medical practice first proposed by A. T. Still MD, DO in 1874....
) or were soon to be (herbalism
Herbalism
Herbalism is a traditional medicinal or folk medicine practice based on the use of plants and plant extracts. Herbalism is also known as botanical medicine, medical herbalism, herbal medicine, herbology, herblore, and phytotherapy...
and acupuncture
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
). The remaining largely placebo based therapies and those without a sound evidence base for their efficacy and robust regulatory systems (e.g. reiki
Reiki
is a spiritual practice developed in 1922 by Japanese Buddhist Mikao Usui. The teaching was continued and adapted by various teachers. It uses a technique commonly called palm healing as a form of complementary and alternative medicine and is sometimes classified as oriental medicine by some...
, massage therapy, aromatherapy
Aromatherapy
Aromatherapy is a form of alternative medicine that uses volatile plant materials, known as essential oils, and other aromatic compounds for the purpose of altering a person's mind, mood, cognitive function or health....
, yoga
Yoga
Yoga is a physical, mental, and spiritual discipline, originating in ancient India. The goal of yoga, or of the person practicing yoga, is the attainment of a state of perfect spiritual insight and tranquility while meditating on Supersoul...
and homeopathy
Homeopathy
Homeopathy is a form of alternative medicine in which practitioners claim to treat patients using highly diluted preparations that are believed to cause healthy people to exhibit symptoms that are similar to those exhibited by the patient...
), 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".
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.
The Federal Working Group
Following publication of the report, the Department of HealthDepartment of Health (United Kingdom)
The Department of Health is a department of the United Kingdom government with responsibility for government policy for health and social care matters and for the National Health Service in England along with a few elements of the same matters which are not otherwise devolved to the Scottish,...
asked The Prince's Foundation for Integrated Health
The Prince's Foundation for Integrated Health
The Foundation for Integrated Health was a controversial charity run by Charles, Prince of Wales and founded in 1993. The Foundation promoted alternative and complementary medicine and lobbied for its inclusion in the National Health Service...
(FIH), a not for profit organisation founded by HRH The Prince of Wales, to facilitate the development of a federal 'umbrella' regulator for these therapies. The Foundation promoted the inclusion of non-evidence based alternative therapies into public healthcare in the UK. but is now defunct. The process was funded by a Department of Health grant of £900,000 over a three-year period from 2005 to 2008.
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
Alexander Technique
The Alexander Technique teaches the ability to improve physical postural habits, particularly those that have become ingrained and conditioned responses...
, aromatherapy
Aromatherapy
Aromatherapy is a form of alternative medicine that uses volatile plant materials, known as essential oils, and other aromatic compounds for the purpose of altering a person's mind, mood, cognitive function or health....
, Bowen technique
Bowen technique
The Bowen technique or Bowen therapy is a term used to describe a variety of therapies based on the work of the Australian layman Tom Bowen, and was later taught to others by his students Oswald and Elaine Rentsch. The practitioner lightly rolls across different muscle groups, with two minute...
, cranial therapy
Craniosacral therapy
Craniosacral therapy is an alternative medicine therapy used by osteopaths, massage therapists, naturopaths, and chiropractors. A craniosacral therapy session involves the therapist placing their hands on the patient, which allows them to "tune into the craniosacral rhythm"...
, homeopathy
Homeopathy
Homeopathy is a form of alternative medicine in which practitioners claim to treat patients using highly diluted preparations that are believed to cause healthy people to exhibit symptoms that are similar to those exhibited by the patient...
, massage therapy, naturopathy, nutritional therapy, reflexology
Reflexology
Reflexology, or zone therapy, is an alternative medicine involving the physical act of applying pressure to the feet, hands, or ears with specific thumb, finger, and hand techniques without the use of oil or lotion...
, reiki
Reiki
is a spiritual practice developed in 1922 by Japanese Buddhist Mikao Usui. The teaching was continued and adapted by various teachers. It uses a technique commonly called palm healing as a form of complementary and alternative medicine and is sometimes classified as oriental medicine by some...
, shiatsu
Shiatsu
Shiatsu is Japanese for "finger pressure;" it is a type of alternative medicine consisting of finger and palm pressure, stretches, and other massage techniques. There is no scientific evidence proving that shiatsu can treat any disease, but shiatsu practitioners promote it as a way to help people...
and yoga therapy. Other eligible therapies were aromatherapists
Aromatherapy
Aromatherapy is a form of alternative medicine that uses volatile plant materials, known as essential oils, and other aromatic compounds for the purpose of altering a person's mind, mood, cognitive function or health....
, reflexologists
Reflexology
Reflexology, or zone therapy, is an alternative medicine involving the physical act of applying pressure to the feet, hands, or ears with specific thumb, finger, and hand techniques without the use of oil or lotion...
and reiki
Reiki
is a spiritual practice developed in 1922 by Japanese Buddhist Mikao Usui. The teaching was continued and adapted by various teachers. It uses a technique commonly called palm healing as a form of complementary and alternative medicine and is sometimes classified as oriental medicine by some...
practitioners, although these practices were not represented.
Structure
The Complementary and Natural Healthcare Council is a private limited company made up of four elements:- Federal Regulatory Council
- Profession Specific Boards
- Functional Boards
- Practice Advisory Panel
Members of the Council and the functional boards will be laypeople, appointed independently; each Profession Specific Board (one for each profession) will have a lay Chair and four registrants from the appropriate profession. Each Profession Specific Board will select one of its practitioner members to sit on the Practice Advisory Panel which will provide a pool of expertise to support the Council.
CNHC Code of Practise supports evidence-based approach
While there has been considerable criticism of CNHC with regard to "quack" therapies their Code of Practise may support an evidence-based approach.The CNHC’s Code of Conduct, Performance and Ethics states:
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: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.
Criticism
"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 GuardianThe Guardian
The Guardian, formerly known as The Manchester Guardian , is a British national daily newspaper in the Berliner format...
.
Private Eye
Private Eye
Private Eye is a fortnightly British satirical and current affairs magazine, edited by Ian Hislop.Since its first publication in 1961, Private Eye has been a prominent critic and lampooner of public figures and entities that it deemed guilty of any of the sins of incompetence, inefficiency,...
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
The Economist
The Economist is an English-language weekly news and international affairs publication owned by The Economist Newspaper Ltd. and edited in offices in the City of Westminster, London, England. Continuous publication began under founder James Wilson in September 1843...
reported that critics have nicknamed the council 'OfQuack'. Private Eye quoted a joke slogan, 'OfQuack - making quacks look professional since 2008'.
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. 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", and have also been criticised for poor openness and an inconsistent approach to data protection.
There is a twitter feed from OfQuack, an obvious parody as it has been described as "puerile and sarcastic", and occasionally refers to the CNHC separately from itself.
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 practioners 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.
Funding
Because so few registrations have been made, it is very unlikely that the CNHC will be self-supporting (from fees) in the near future. The major source of finance has been the Department of Health, and application has been made to them for further funds, However, this is dependent on adequate progress being made, which has not so far been the case.Some of the 2009 reports from the CNHC to its parent organization, the Department of Health, have been made available under the Freedom of Information act. These largely confirm the view that income is much lower than originally planned and also show a major revision of planned income.