QUACKBUSTERS UNDER SIEGE

Has alternative medicine been accepted too easily? HealthWatch thinks so, and has supplied scientific ammunition for media attacks on, for example, clinical ecology. But non-orthodox practitioners are fighting back

Shortly after I had completed my first interviews for this article, the telephones began to ring. There were calls to my home, calls to the offices of the Independent on Sunday; calls from interviewees, calls from their solicitors; even calls - and a 12-page letter to the editor - from someone tangentially connected with the story to whom I hadn't even spoken. They all said much the same: my article was a pack of lies and, if published, would almost certainly lead to legal action.

This was odd. I hadn't written the article; I wasn't even sure what it would say. But the barrage confirmed what I was already beginning to suspect: that I had stumbled on to a ferocious ideological battlefield, where one false move could result in litigation.

Initially, I'd expected something quite different. It was hard to imagine the subject - a controversy surrounding a small medical charity called HealthWatch - exciting any passion at all. HealthWatch's press spokesman, Dr Vincent Marks, describes it as "rather a dull organisation", adding: "We haven't had an enormous amount of success." Its motto, "Enhancing informed choice through reliable information", sounds as banal as the mission statement in its publicity leaflet: to promote "good practices in the assessment of and testing of treatment and the conduct of clinical trials". But raging passions are often provoked by unexpected subjects.

HealthWatch was set up in 1989, by a group of scientists, doctors and medical writers who were concerned at the unchallenged rise of non-orthodox medical thinking. Initially it was called Campaign Against Health Fraud, but it changed its name on becoming a registered charity in 1991. It was modelled on a similar organisation in the United States, where the National Council Against Health Fraud was formed in 1984 and set up "Special Task Forces" with targets like Aids Quackery and Herbal Remedies. The NCAHF are widely known as "quackbusters".

HealthWatch defines itself as "pro-science" and argues, among other things, that all natural therapies should be subjected to rigorous double blind tests in the same way as pharmaceutical drugs. More generally, it aims to dispel the miasma of woolly thinking and half-truth which, it claims, hangs over the world of alternative health. Dr Marks recalls a surge of public enthusiasm - particularly media enthusiasm - for complementary medicines and therapies at the end of the 1980s. "This was becoming a fashion," he explains. "There were full-page stories [in the national press] pointing out how sugar was causing our people to be delinquent ... quoting people who had no credibility in the world of science ... what I'll call pseudo or instant experts

The charity's most obvious activity to date has been the publication of a newsletter, which it sends to its 200 members (who pay an annual subscription of pounds 12) several times a year. This consists mainly of articles with headlines like "Chestnut Seeds in HIV Marketing Fear" or "Warnings Needed on Herbal Remedies" - all linked by the theme that the claims of alternative medicine are not subjected to sufficiently rigorous testing.

But it is the involvement of HealthWatch members in the mainstream media that has caused the greatest controversy. There are, as Caroline Richmond points out, few controls on alternative and complementary practitioners. "What can a doctor be struck off for?" she asks. "Conduct unbecoming, sexual hanky-panky, and not much else." Discrediting people through the media can therefore be an important sanction. "If someone is doing something bad and it can be shown, then turning them over in a classic journalistic way is very useful," says Richmond.

The past seven years have seen a series of alternative medicine causes celebres, involving attacks in the media on various non-orthodox therapies or therapists. In 1990, a World in Action programme attacked the hitherto unquestioned reputation of the "clinical ecology" practised at Dr Jean Monro's Breakspear Hospital; also in 1990, two BBC programmes castigated the Bristol Cancer Help Centre on the basis of the famously critical - and flawed - report involving HealthWatch member Professor Tim McElwain (who subsequently committed suicide); in 1992, a BBC Watchdog programme attacked the claims of a vitamin supplement for schoolchildren called Tandem IQ; and so on. Each used scientific information supplied by HealthWatch members or associates. Each was followed by a furious controversy that continued for years afterwards.

IT IS this last feature that gives the story of HealthWatch and its sympathisers and enemies a wider relevance. One might assume that alleged "quacks", once busted, would stay busted. But some of those who have been the subject of media criticism involving HealthWatch experts have stubbornly refused to accept the verdicts against them - and have fought back.

Dr Jean Monro, probably Britain's best-known practitioner of environmental medicine, was unaware of CAHF (as HealthWatch then was) until 15 October 1990, when ITV broadcast "The Allergy Business", a World In Action programme about her and her private allergy hospital in Hertfordshire. Caroline Richmond featured on the programme criticising Dr Monro, on behalf of CAHF. Allergist and fellow campaign member Dr David Pearson also appeared as an expert. The programme portrayed Dr Monro as unscrupulous and suggested that her treatments endangered patients. Her hospital closed in the ensuing bad publicity, although it has since re-opened. Dr Monro brought a libel action against Granada which was finally settled with a statement read in the High Court in March 1995, Granada withdrew the suggestion that Monro had taken "wrongful advantage of her patients' vulnerability", but stuck to its claims that "the principal treatments offered by Dr Monro are not supported by most orthodox medical opinion".

The ill will engendered by the case was not so easily dispelled. Lorraine Hoskin, a woman whose daughter had been treated by Dr Monro, was so incensed by the programme that she protested outside Granada's London studios. At the same time, a sympathetic investigative writer called Martin J Walker was asked to find out more about the CAHF - and set to the task with enthusiasm.

Walker found that the CAHF acknowledged donations from four sources from July 1990 to the end of May 1991: one was Private Patients Plan, a medical insurance company which had withrawn recognition of Dr Monro for the purposes of insurance cover in April 1989. Other donors were the Wellcome Foundation (charitable arm of the pharmaceuticals giant), Pfizer Ltd and Astra Pharmaceuticals Ltd. Between them the four donors gave a total of pounds 3,750. By most standards this sum - which was publicly disclosed - is hardly princely, but the campaign's critics seized on the issue.

Walker spent the next three years researching HealthWatch and its members and looking for connections - however tenuous - with the drugs and processed foods industries. He also interviewed a number of people in the fields of health food and alternative medicine who alleged that they had been targeted by members of the charity. The result was a 729-page book, published privately in Finland in 1993, called Dirty Medicine: Science, Big Business and the Assault on Natural Health Care. One person mentioned in the book threatened to sue distributors. Walker sold 6,000 copies by mail.

Much of Walker's material is libellous and cannot be repeated here; some - such as the donation details mentioned above - is trivial. But the basic conspiracy theory it tries to establish is plain enough: that HealthWatch doesn't simply defend scientific orthodoxy, it defends a scientific orthodoxy that reflects the interests of the pharmaceutical industry.

Ian Stoakes, a businessman whose company nearly closed in 1994 after his NuTron diet was criticised in the media by, among others, HealthWatch member Dr David Pearson, describes HealthWatch as a "wraith-like" organisation, adding, mysteriously: "The general public think that everybody who talks about a conspiracy is probably mad. And that of course is the greatest cover they can possibly get."

HealthWatch finds talk like this infuriating, and Thurstan Brewin, who recently completed a three-year term as the charity's chairman, dismisses it with contempt: "It's a fairy-tale that people love, with goodies and baddies - it's only fit for the nursery. HealthWatch is a poor charity, and for several years we've not had a penny from a drug company. The amounts we have received were peanuts. You might be amused to know that Glaxo recently enquired about corporate membership. We sent them all the details and they decided they didn't want to join."

Yet not all the arguments against HealthWatch can be dismissed so easily. Orthodox science, which is what HealthWatch promotes, has a long history of applying its rigorous standards of proof with what some consider to be misplaced confidence. Think of the years of complacent statements that there was "no evidence" of global warming, or of a threat to humans from BSE. Truth takes many forms, and there are many in the world of complementary medicine who passionately deny that orthodox medicine has a monopoly on it. Health, they point out, is a very personal thing: what patients want are therapies that work for them, not therapies whose efficacy can necessarily be demonstrated. In other words, there are different kinds of medical validity, different kinds of truth. HealthWatch's enemies have taken this argument a step further, arguing that orthodox science's version of truth, far from being an absolute, is merely the pharmaceutical industry's version.

Thurstan Brewin scorns such reasoning. "We reject that idea completely. I don't know any good doctor who doesn't reject that. People who propagate all this magic will slow up progress. They're creating a public mood which will slow up the real solving of problems.

"Investigative programme-makers don't need any prompting from anybody else," he adds. "Everybody thinks we've put them on to them. It simply isn't the case." But genies are not so easily put back in bottles: in the eyes of its enemies in the alternative health fraternity, HealthWatch is out to discredit non-pharmaceutical medicine, and any attack by the media on specific practitioners can be explained away in those terms. The scientists who tend to assist in such programmes (that is, scientists who believe that it is worth speaking out publicly against the perceived excesses of non-orthodox medicine) have every reason to sympathise with HealthWatch (an organisation which shares those beliefs) and often turn out to be associated with it. So, reason the conspiracy theorists, their attacks must be part of a pro-pharmaceutical industry conspiracy.

Meanwhile, the example of Dr Monro's counterattack has set a precedent that HealthWatch and its supporters find most alarming. Alleged "quacks" of all descriptions are not only refusing to walk when the HealthWatch umpire gives them out; they are also counterattacking, accusing their critics of bad faith and worse. This has made criticising alternative medicine an increasingly awkward business. For much of this summer, for example, the BBC, the British Medical Journal, the New Statesman, the Daily Telegraph, a BBC Watchdog journalist and a number of doctors were tied up in three related court cases, accused of libel and malicious falsehood by three men who ran a clinic in London, offering a "cure" for cancer and Aids, which was investigated by Watchdog and the New Statesman in 1989. All three actions failed (although at least one plaintiff aims to appeal); but many of the defendants may none the less be inclined to think twice before getting involved in an attack on non-orthodox medicine again.

There are HealthWatch sympathisers who have suggested that those opposed to the charity's aims now constitute an organised campaign devoted to hounding anyone who dares to criticise them. Precisely how organised they really are is open to debate; the HealthWatch conspiracy theory has gained such currency that the charity now has a wide variety of enemies, not all of whom have the same objectives or beliefs. What is clear is that some HealthWatch supporters have become exceptionally sensitive to criticism, citing even the most mildly critical questioning as evidence of the journalist in question being part of an alternative conspiracy; and that anyone who publishes anything about the controversy is now almost certain to be deluged subsequently with letters of complaint, usually from both sides.

It is futile to point out the circularity of much of the reasoning (on both sides). The conflict surrounding HealthWatch is, among other things, a conflict of fundamental belief systems, and has taken on the bitter intensity of most rows about religion. It has also developed the kind of profound mistrust more usually associated with quarrelling neighbours than with health practitioners. Nothing entrenches a feud like litigation, and no one who has been involved in any capacity in cases like Dr Jean Monro v Granada Television Ltd, or Larkhall Natural Health and Dr RJ Woodward v Professor John Garrow and HealthWatch, or James Caveney Sharp v the BBC and others, is likely to feel much inclination to see the other side's point of view. In short, communication has broken down, leaving only fear and loathing.

A LARGE part of the HealthWatch publicity leaflet is dedicated to denying some of the allegations most persistently made about the charity. "Is HealthWatch a front for the drug companies?" it asks. ("Definitely not.") "Does HealthWatch attack alternative medicine?" ("Yes and no.") "Does HealthWatch run witch-hunts?" ("This is emphatically not our intention.") But some of those who have been criticised by HealthWatch members are not convinced.

Robert Woodward runs Larkhall Natural Health Ltd, a small company in west London which makes vitamin pills and dietary supplements. A pharmacist by training, Woodward describes himelf as one of the vitamin industry's foremost spokesmen. "I am very much in favour of non-drug therapies, including dietary supplements, where you haven't got to use foreign chemicals," he says. "I'm not condemning drugs, I'm just saying they're grossly overused."

For the past eight years, Woodward and HealthWatch have been engaged in constant, low-grade warfare on the subject of vitamin supplements. On the table in front of him is a huge dossier on the charity. "I have tried to join, but they won't have me, so I've arranged a plant," he tells me in all seriousness. "A sleeping member. They let me know what's happening."

Hostilities started after one of Woodward's products, a vitamin supplement for schoolchildren called Tandem IQ, was featured favourably in a BBC QED programme in 1988. This was precisely the sort of non-orthodox "science" that HealthWatch exists to challenge. John Garrow, then Professor of Nutrition at St Bartholomew's Medical College and chairman of HealthWatch, wrote to the BBC criticising the programme. In 1990 the BBC broadcast a Food and Drink Programme on "the vitamin conspiracy" which criticised Larkhall and Tandem IQ; in 1992, another BBC programme, Watchdog, dismissed suggested links between vitamin supplements and IQ. The Watchdog programme featured John Garrow as a scientific expert. "The health food industry launched a counter-attack by way of the Broadcasting Complaints Commission," reported Garrow in a subsequent HealthWatch newsletter. The complaint of unfairness was not upheld.

Then, in 1993, the charity published an article by Garrow in its newsletter which celebrated the successful prosecution of Woodward by Shropshire Trading Standards for false trade description on the packaging of Tandem IQ (on the grounds that it didn't make it sufficiently clear that only a minority of children were likely to benefit from the supplements). Garrow's article wrongly suggested that the courts had found Larkhall guilty of "fraudulent misrepresentation" of its vitamin pills, and of having "conspired with the BBC [QED programme] and senior academics to misrepresent the evidence" to promote its sales.

Woodward sued for libel. In 1994, the HealthWatch newsletter published a two-page statement of retraction and apology to Woodward and his company. HealthWatch paid out pounds 2,350 in costs and damages. The settlement also stipulated an "early meeting" between Woodward and Garrow; Woodward insisted that this should take place at Larkhall's factory, over a wholefood lunch.

Garrow laughs when I mention this and begins to talk about a number of other health food advocates who have come under HealthWatch's scrutiny and consequently "hate our guts". Is it not understandable, I wonder, that they should resent HealthWatch's attentions, especially if they are sincere in their beliefs? Garrow answers with a "qualified" yes. "They may be emotionally sincere, but they're certainly not scientifically sincere, because they're not prepared to consider the possibility that they are wrong and let some outside person put them to the test."

The whole area is, Garrow agrees, highly emotive - something which, he believes, goes with the "alternative" territory. "Lots of people think yoga is terribly beneficial. It probably is. But you'll find people that are so evangelical about it that they accuse people who do not share their fervour of bad faith.

"I can understand people who are accused of selling their goods under false pretences being very upset. After all, it's their livelihood at stake. But the Advertising Standards Authority has no clout and the Medicines Control Agency often can't be bothered, so the charlatans have a clear field unless someone takes the trouble to demonstrate that their claims are untrue."

LAST YEAR, the row reached Parliament. In the House of Lords, the Countess of Mar (who has campaigned on various environmental issues) asked Baroness Blatch, Minister of State at the Home Office, if she was "aware of the activities of an organisation - formerly the Campaign Against Health Fraud and now called HealthWatch - which has been systematically destroying the reputations of people working in complementary medicine...?" Baroness Blatch replied that "the allegation that [HealthWatch] was acting as a political pressure group was not supported by evidence", but the Countess of Mar does not seem to have been persuaded.

"You get the same group of doctors turning up over and over again," she says now. "They have the appearance of attacking anything which might have long-term effects on existing drug therapies or even future drug therapies."

The countess has also raised the issue of HealthWatch's charitable status. Charities Commission guidelines say that, "when contemplating high profile campaigning", charities must "bear in mind" that "charitable status is seen as confirming that an organisation exists for the benefit of the whole of society, not just narrow sectional interests." How you interpret this depends on your starting point. To HealthWatch's supporters, exposing the failings of pseudo-science is self-evidently in the interests of the whole of society; to its enemies, it isn't.

"I wouldn't have thought it was charitable," says the countess, "to attack providers of health care which, from the patients' point of view, is effective." "We don't attack anybody," counters Brewin. "It's rational criticism, and there's no conflict with our charitable status there." Mar was recently treated for organophosphate poisoning by Dr Jean Monro - another case of the same people turning up over and over again?

MORE or less everyone concedes that, in some instances, HealthWatch members have been involved in the exposure of what might be called bona fide quacks and frauds. The difficulty comes in the more ambiguous areas - a difficulty exacerbated by the fact that both sides, in their different ways, crave certainty.

Most HealthWatch members, if asked, would probably agree with the proposition that they represent dispassionate science in opposition to the intuition and passion of the complementary therapists. Yet they too are passionate.

I meet Dr Vincent Marks in his office at the University of Surrey. Marks was, until his recent retirement, Professor of Surrey's Department of Biochemistry which between 1985 and 1990 received over pounds 500,000 in grants from the Wellcome Foundation. Such grants are common in the academic world, but HealthWatch's critics have, predictably, made much of this - to Dr Marks's intense irritation.

Marks makes a point of distinguishing between the original Campaign Against Health Fraud, and HealthWatch as it exists today. He describes Caroline Richmond as "rather more militant than some of us" and points out that she has not been a committee member for several years. "We are not now a campaign against anybody," he says. "We may have started that way. We decided that was not the way forward. That was how we came into being, and how we came into being and what we are now are two different things."

He is patient and reasonable, but when I repeat some of the more extreme charges made by the anti-HealthWatch conspiracy theorists our discussion becomes more tense.

Why has there been so much controversy about the organisation? "Because we are concerned with evidence-based medicine and there's a lot of money being made by some organisations who are very frightened of us," says Marks.

They sound a bit sinister to me. "Well they are ... making money. They think that we are threatening them. If they are honest they have everything to gain from us... Look at the people who are campaigning against us ... and you may see the people who ought ... who have something to be frightened of."

Dr Marks is starting to sound heated, like someone whose patience has been exhausted by unrelenting controversy. "Yes, that's right: we have been attacked. We have never attacked anybody. Never, ever. You will never find us having attacked anybody and that's why we don't. We do not go around witch-hunting or anything like that. Now that doesn't mean that we haven't been witch-hunted."

Shortly afterwards, he brings our interview to an abrupt end.

PERHAPS the most curious thing about this battlefield is the fact that the two sides should, on the face of it, have much in common. Both are concerned - or should be - with the promotion of health and well-being, and the alleviation of human suffering. Yet they are now so far apart that it is almost impossible to imagine them ever being reconciled.

And that, of course, is the great thing about feuds: they are self-fuelling. Whatever the original causes, new resentments thrown up in the course of the struggle soon supersede them, making reconciliation all but impossible - and, often, causing hostilities to continue for decades. I see no reason to believe that this feud will be an exception. !