Deliberately Misleading – naturally

I’ve been meaning to post this for far too long, and I have stung myself into it by revisiting a previous post about Dr Jessica Braid (neé Middleton). She operates as The Natural Doctor, from her family’s chiropractic business near Stockport. I can hear the alarm bells already. I suggest you read the first instalment before reading on here.

What also stung me were some rather odd exchanges with the Advertising Standards Authority, which I covered in my last post. The Committee on Advertising Practice (CAP) seems to have some sort of `hands off’ policy, which allows Dr Braid to carry on making therapeutic claims for homeopathy. As the CAP refuses to have any dialogue with the public it’s impossible to find out why this is being allowed to happen.

Anyway, I thought you would be interested in the General Medical Council’s view of a registered doctor who offers health care, makes claims which are not allowed by the advertising regulator, and willfully offers to tell people things on the phone that she is not allowed to say in writing. I had previously complained to the GMC, who of course threw the whole thing out, so I asked for the decision to be reviewed. Here is the result of that.

Complaint about Dr Braid (nee Middleton)

You asked us to review our decision to close your complaint against Dr Braid with no further action.

I am writing to inform you that, having carefully considered your request, the Assistant Registrar is of the view that the decision to close your complaint should not be reviewed. This letter sets out the reason for her decision.

Any review of a decision must be carried out under Rule 12 of our Fitness to Practise Rules. This allows the Assistant Registrar, through authority delegated from the Registrar, to review all or part of certain specified decisions on her own initiative or on the application of any party.

There are two alternative grounds for such a review. Firstly, under Rule 12(2) (a) of the Rules, the Registrar has the power to undertake a review if he has reason to believe that the original decision ‘may be materially flawed (for any reason) wholly or partly. Secondly, under Rule 12(2)(b) of the Rules, the Registrar has the power to undertake a review if he has reason to believe that there is new information which may have led, wholly or partly, to a different decision.

That said, even if the Registrar has reason to believe that a decision taken at the investigation stage of the GMC’s Fitness to Practise procedures may be materially flawed or that there is new information which may have led to a different decision, a review can only be undertaken if the Registrar is also of the view that one or more of the grounds specified in Rule 12(3) of the Rules are also satisfied, namely that such a review is necessary for the protection of the public; necessary for the prevention of injustice to the practitioner; or otherwise necessary in the public  interest. (Their italics throughout)

Is the decision materially flawed?

We noted that you were concerned that you had made several specific allegations which you believe were not fully considered by the Case Examiners when they made their decision to close your complaint.

When considering your complaint the Case Examiners assessed the allegations you made under the umbrella of two central issues: that Dr Braid was practicing (sic) without a licence, and that Dr Braid was providing false or misleading information through her website.

Despite the fact the Case Examiners did not specifically refer to each allegation in the decision, we are of the view that they had thoroughly considered all of the issues you had raised and appropriately categorised the allegations into the two principle issues. The Assistant Registrar concluded that as all of the information was carefully considered by the Case Examiners, this does not amount to a material flaw in the decision.

On review of the information that was provided, we are of the view that the Case Examiners were entitled to conclude that there was no evidence Dr Braid was engaging in medical practice. Whilst we accept that Dr Braid does describe herself as ‘Doctor’ and she refers to her previous NHS experience, this is not in itself a breach of Good Medical Practice as she is entitled to describe herself in those terms.

The Assistant Registrar determined that when assessing  the website as a whole, the Case Examiners were correct to conclude that there was no evidence Dr Braid was attempting to mislead patients about the types of therapies that she was providing. The disclaimer displayed on her website is sufficient to establish that she is not attempting to hold herself out as a practicing (sic) Doctor.

Their logic here is baffling. What has the validity of therapeutic claims to do with whether she is claiming to be a medical doctor? The GMC seems to be saying that if you are a doctor, but say you are not practising as such, you can say misleading things with impunity. Also, any lawyer will tell you that disclaimers have very little force, as what matters to a court is what the reader understands.

We noted that you have concerns about the types of therapies that Dr Braid is providing. The Case Examiners concluded that Dr Braid choosing to advocate alternative therapy does not raise fitness to practice issues. The Assistant Registrar is of the view that they were correct to make this conclusion, as it is not our role to censure registered doctors who choose to offer complementary therapies outside of their medical practice. We accept that this position would be different if the evidence was such that Dr Braid was holding herself out as a practicing (sic) clinician rather than a practitioner of complementary therapies or if she was actively encouraging patients to avoid medical treatments. However in this case there is no evidence to support such a view.

Ah, this is the great let-out clause. Loads of GMC registered doctors push all sorts of quackery, and this seems to be the way the GMC avoids regulating them. Mostly, a quack only gets disciplined by the GMC if they kill someone, or get close to that.

You also had concerns that we had failed to consider the merits of the therapies Dr Braid is offering. In light of the conclusion that Dr Braid was not holding herself out as a medical practitioner, the Assistant Registrar determined that it was not necessary for the Case Examiners to enter into an analysis of the benefits of complementary therapies. We note that you have concerns about the evidential basis for complementary therapies however the failure of the Case Examiners to address this issue does not constitute a material flaw in the decision.

In light of the above reasoning, the Assistant Registrar determined that there is no evidence regarding Dr Braid which would suggest impaired fitness to practice. As a result she concluded that our decision to close your complaint was not materially flawed.

This is bizarre. They are saying that Dr Braid is not practising as a doctor, so in what manner is her fitness to practise not impaired? There is nothing to impair!

New Information

We noted your concerns that Dr Braid may be in breach of ASA and Committee of Advertising restrictions (sic). In light of the above reasoning, that Dr Braid is not holding herself out as a practicing (sic) Doctor, the Assistant Registrar does not consider that breaching ASA restrictions would automatically engage our fitness to practice procedures and that at this stage any possible breach would be for the ASA to investigate in the first instance.

The Assistant Registrar therefore determined that this does not amount to new information which may have led to a different decision.

Conclusion

In light of the above the Assistant Registrar concluded that there are no grounds for a review under Rule 12 and the original decision must stand.

I appreciate that you are likely to be very disappointed by the Assistant Registrar’s conclusions but I would like to assure you that she has considered your request for a review including all of the information and the comments that you have made very carefully.

Yours sincerely

John Barnard

Rule 12 Investigation Manager

Fitness to Practise Directorate

Well they were able to spell `practise’ correctly at the end, but only because it was in the template. Of course they mean the Committee of Advertising Practice, not the Committee of Advertising. The lack of care in writing the letter does make me wonder about the care taken with the complaint. I’m not just disappointed, I am appalled.

I will simply leave you good readers to decide for yourselves whether Dr Braid’s use of the title `doctor’, both before her name and as her business name, is totally irrelevant to what she does, as the GMC seems to think. Do you think there is “no evidence Dr Braid was attempting to mislead patients about the types of therapies that she was providing”, particularly in view of her offer to say things on the phone that she is not allowed to say in writing. Finally, is the GMC the slightest use as a regulator of charlatans such as this?

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