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This time, we submitted a complaint to the Advertising Standards Authority (ASA) about an ad by Water for Health Ltd in the December 2014 and January 2015 issues and the advertiser's website. In their adjudication published today, the ASA identified two points and upheld them both.
Because of the number and extent of the claims being made, the points relate to those claims made on the advertiser's website, but the ruling applies to all media where the same claims are made — including WDDTY ads, of course.
The WDDTY ad and their website made several claims about the health properties of water: not just any water, but 'healthy alkaline ionised water'. The website claimed:
Alkaline nutrition has tremendous therapeutic power and is also vitally important to support your body if you are undergoing conventional medical treatment.
Their website also contained claims for a number of food supplements including chlorella, chia seedsia seeds, organic flax seeds oil, Brocco forte (a broccoli extract), organic prunes and 'maximised turmeric curcuminoids.
The claims we complained about included:
Green Food Supplements contain the nutrients to help to:
- Promote better body alkaline balance
- Energize the body from cellular level
- Remove toxins
- Improve immunity
Many of our natural health foods are also thought to play a significant part in:
- Improving the permeability of your cell membranes
- Promoting the health of your eyes, brain and skin
- Boosting your immune system
- Increasing resistance to a number of degenerative conditions
Chlorella has five main benefits:
- Promotes healthy cellular growth and repair to slow down aging
- Supports and strengthens the immune system
- Is highly alkaline to support a healthy pH in the tissues, and cells.
- Detoxifies and helps purify the body
- Provides complete nutrition to normalize body function
Chia Seeds are thought to help you:
- Support heart health
- Stabilize blood sugar
- Improve brain power
- Enable detoxification
- Encourage weight loss
[Organic Flax Seed Oil] will help to:
- Keep your skin, nails and hair healthy
- Maintain your cardiovascular health
- Ensure that your eyes and brain develop properly
- Boost your immune system
- Improve the flexibility, and permeability, of cell membranes, allowing for better cell hydration
Furthermore, taking an omega 3 Supplement like one of Omega Nutrition’s flax oils is recommended by several natural cancer treatment protocols, including the Budwig program and Gerson Therapy, and recent research also suggests that they may play a part in preventing neurological diseases such as Bipolar disorder.
Broccolo [sic] forte can help you to to [sic]:
- promote improved liver function
- combat allergens
- remove toxins
- neutralize toxic, cancer-promoting hormone metabolites
- only does it [sic] have a high broccoli sprout extract content, it is combined with 6 other immune boosting plant extracts to further boost its effectiveness.
The phytonutrients in organic prunes are also thought to help neutralize many of the harmful oxygen free radicals implicated in the development of:
- Cardiovascular disease
- Breast cancer
- Prostate cancer
- Alzheimer's disease
- Gastric Cancer
- Chronic fatigue syndrome
And some testimonials:
“I love the water. My skin is healing in front of my eyes.”
“All of the above have enabled me to reduce my prednisolone (steroids) with no difficulties and I can now see the end of their use within the next few months. My health has been turned around.
The ASA listed many of these and condensed them down to two points of complaint:
The Nightingale Collaboration challenged whether:
- the claims for the food and food supplements complied with the Code; and
- the claims related to alkaline water also complied with the Code.
Water for Health told the ASA that although they disagreed with the issues raised they had revised their advertising.
In their assessment, the ASA cited EC Regulation 1924/2006 on Nutrition and Health Claims made on Foods and pointed out that they were part of their CAP Code, saying:
…only health claims that appeared on the list of authorised health claims (the EU Register) could be made in ads promoting foods and that marketers must also ensure that they met the conditions of use associated with the claims in question. Health claims were defined as those that stated, suggested or implied a relationship between a food, or ingredient, and health.
The Regulation stated that references to general benefits of a nutrient or food for overall good health or health-related wellbeing were acceptable only if accompanied by a specific authorised health claim. Although some claims had been revised, we considered that they retained their original meaning. For example but not limited to, the revisions to the claims for Maximized Turmeric Curcuminoids, Clean Chlorella and Brocco Forte, which we considered were likely to be understood as general health claims, were not sufficient to alter their original impression.
We also considered that in the context of the ad, which included no reference to specific types of detoxification, "enable detoxification" for Chia Seeds, "Detoxifies and helps purify the body" for Clean Chlorella and "remove toxins" for Brocco Forte were likely to be understood to be general health claims. We noted that they were not accompanied by a related specific authorised health claim and were therefore not acceptable.
The ASA detailed the issues they had with the claims made and concluded:
Because the ad made general health claims which were not accompanied by a related specific authorised health claim, and included specific health claims, and a reduction of disease risk claim, for which evidence had not been provided that they were authorised on the EU Register, and because it included prohibited claims that the advertised foods could prevent, treat or cure human disease, we concluded that it breached the Code.
Pretty damning. The ad therefore breached CAP Code rules 15.1, 15.1.1, 15.2 and 15.6.2 (Food, food supplements and associated health or nutritional claims).
The second point of the complaint was about the claims for alkaline water. The ASA ruled:
Although Water for Health had told us that their ad had been revised, claims for "Alkaline Nutrition" continued to make the same claim that it "has tremendous therapeutic power and is also vitally important to support your body if you are undergoing conventional medical treatment". We considered in the context of the claims for the product's purported benefits for the body, the reference to alkaline nutrition's "tremendous therapeutic power" and that it was "vitally important to support your body" were likely to be understood as a general health claims, which we noted were not accompanied with a related specific authorised health claim as required by the Regulation. Because these general health claims were not accompanied by a related specific authorised claim, we concluded the ad breached the Code.
The ad therefore breached CAP Code rule 15.2 (Food, food supplements and associated health or nutritional claims).
Overall, the ASA ruled:
The ad must not appear again in its current form. We told Water for Health to ensure they did not make general health claims which were not accompanied by a relevant authorised health claim, or to include specific health claims or reduction of disease risk claims which were not authorised on the EU Register, or make claims to prevent, treat or cure human disease for foods.
So another misleading WDDTY advertiser.
Although the adjudication doesn't mention the ad in WDDTY explicitly, as always, the adjudication covers all adverts regardless of the medium: after all, if a claim is misleading in one medium, it will be just as misleading in others.
With this one, we now have 11 adjudications and 12 informally resolved cases against WDDTY advertisers and at least one of these advertisers — and WDDTY regular — Wholistic Research, has now ceased trading:
The ASA provide several pages of guidance on the rules for health and nutrition claims for foods including:
These rules stem from the European Commission Regulation No 1924/2006 — the various authorised and non-authorised claims can be checked in the EU Register on nutrition and health claims.
(The ASA also helpfully provide a (non-exhaustive) list of some 444 Acts and regulations affecting advertising.)
The Government also produce Guidance on nutrition and health claims on foods, which states:
The ASA is the UK body responsible for advertisements in broadcast (TV and radio) and non-broadcast media. There are two advertising content codes: the Committee on Advertising Practice writes and maintains the non-broadcast advertising code (the CAP code) and the broadcast committee of advertising practice writes and maintains the TV and radio advertising standards code (the BCAP code). The ASA is the independent body responsible for administering those codes and is able to require advertisers and broadcasts to remove non-compliant claims. The advertising codes reflect the requirements of the Regulation.
With all this advice and guidance, there should be no need for any advertiser to make non-authorised nutrition and health claims for foods. Additionally, the ASA offer free advice to advertisers via their Copy Advice Team as well as other help to prospective advertisers.
If Water for Health weren't aware of authorised and non-authorised claims under the Regulations, they are now. We welcome their decision to amend their advertising even if that initially did not go far enough to satisfy the ASA. They have made other changes, but we don't think it yet complies and we hope that they will look again at the claims they made for the products mentioned in the ASA's adjudication and ensure that they are now compliant.
They might also like to check the claims they make about the other products they advertise — whether on their website or in the pages of What Doctors Don't Tell You.
There can be no excuse for not complying with the rules, regulations and laws in place to protect the public.
27 May 2015
A year ago, we reported on the decline in the number of English NHS prescriptions for homeopathy that were fulfilled in community pharmacies. This showed a steady decline over the previous 17 years, down to just 7.5% of the number in 1996, with each year fewer than the previous.
These data come from the Prescription Cost Analysis data for England provided by the Health and Social Care Information Centre (HSCIC), the official source of data on the NHS.
My blog post, An idiot’s guide to understanding NHS homeopathy prescription data, gave the details of where these data came from and how to extract them so anyone could check for themselves.
The information is published annually and the data for 2014 have just been published.
So, has the decline of the previous 17 years been halted?
I've updated my charts to include the new data from 2014.
The complete data for these charts are (all these figures can be verified from the original HSCIC data):
So, what does this show?
In 2014, the number of prescriptions for homeopathy fell for the eighteenth consecutive year, this time by over 21% — the fourth largest percentage fall since 1995 — continuing the downward spiral.
The number of prescriptions are now just 6% of what they were at their peak in 1996 — a fall of over 94%.
The total cost of these prescriptions also fell by 20% to a new low.
The cost per prescription has risen again, this time by 2%, compared to an increase of 13% in 2012/2013.
It's clear that doctors are writing fewer homeopathy prescriptions, but because these figures are for England only, the decisions by NHS Tayside and NHS Lothian in the past few years (and the recent decision by NHS Lanarkshire) to cease funding homeopathy referrals cannot explain this continued decline.
At the start of World Homeopathy Awareness Week, perhaps doctors are now more aware than ever that prescribing 'medicines' for which there is no good evidence can no longer be justified either on medical1 or ethical2 grounds.
1 “NHMRC Statement on Homeopathy and NHMRC Information Paper - Evidence on the Effectiveness of Homeopathy for Treating Health Conditions | National Health and Medical Research Council.” Accessed March 11, 2015. http://www.nhmrc.gov.au/guidelines-publications/cam02.
2 Shaw, David M. “Homeopathy Is Where the Harm Is: Five Unethical Effects of Funding Unscientific ‘remedies.’” Journal of Medical Ethics 36, no. 3 (March 1, 2010): 130–31. doi:10.1136/jme.2009.034959.
10 April 2015
Our supporters (and others) will remember our long-running campaign to test the resolve of the Complementary and Natural Healthcare Council to protect the public by properly regulating their members.
With your help, we gathered many examples of claims that you did not think were backed by good evidence or otherwise were not complying with the CNHC's Code of Practice or the Advertising Standards Authority's CAP Code. We highlighted some of these: Endemic problems with CNHC registrants.
That was nearly two years ago.
Last December, we reported on the re-accreditation of the CNHC by the Professional Standards Authority, giving them what we strongly believe to be unearned and undeserved legitimacy. We also documented the long story of events about how the CNHC had dealt with these 10 complaints — it was long because we felt it necessary to record just how the CNHC had dealt with them.
At the end of that chapter, the 100 initial complaints had been 'informally resolved' by the CNHC and our sample of ten of these that we did not believe had been properly resolved were on hold while we provided a list of the 'specific words' we had concerns about (even though we had already done that). We subsequently provided the CNHC with a list of specific words so that they could have no more excuses for not doing their job and dealing with our complaints.
Out of those ten, five were dropped because they were no longer CNHC members, leaving just five. We don't know why these five are no longer registered, but a 50% drop out is interesting. A manifestation of the OfQuack Paradox, perhaps?
If you remember, I provided the CNHC with screenshots of the pages I was concerned about with specific text highlighted in yellow, such as the one on the right. Click here to see that extract in the context of the complete page. Some pages had more text highlighted than others.
That was on 9 July last year, but the CNHC didn't even bother to look at them until January this year! How do I know? I provided the screenshots in a zip file placed in my Dropbox account. For some reason, Google's Chrome browser considered the file to be malicious but it downloaded correctly from Firefox and Internet Explorer. When the CNHC came to look at the file in January, they got an error message. Not knowing what caused this, they said:
In respect of the remaining five complaints, when I try to download via Dropbox the compressed file that contains screenshots of the web pages and copies of documents listed with highlighted text, using the link you sent me, I receive a ‘malicious download warning’. I would be grateful if you could check your zip file and send me a fresh link.
I carefully and deliberately asked:
Regarding the zip file, I don't understand what the issue is: can you tell me if you have had any trouble downloading the file previously?
I got the same warning message when I tried to download it originally but didn’t raise it with you at that time because you were stating then that your complaint was about every word on every page.
So, even though I had provided the CNHC with screenshots of the pages I was concerned about with the words I was concerned about highlighted for them to see last June, they hadn't bothered looking at them.
The CNHC never confirmed whether they did, finally, look at the screenshots I had provided.
However, on 5 February this year, I was told that the first complainant — a hypnotherapist — had provided:
…evidence that the wording on her website about which you complained is in line with very detailed advice that she received from the Committee of Advertising Copy Advice Team in December 2013. I can confirm that this complaint has been resolved informally.
A few days later, a second one was also 'informally resolved', the registrant having provided:
…published RCT evidence to support claims in respect of all but two of the 10 conditions/symptoms that appear on the acupuncture page on the Longfield Polytechnic website. The two are overactive bladder syndrome and temporomandibular (TMD/TM) pain.
References to them have been removed from the website page. I can confirm, therefore, that the complaint has been resolved informally.
A third was 'informally resolved' on 12 February; a fourth on 6 March and the final one on 20 March.
So, the CNHC were happy that they had informally resolved them and that these were now fully compliant. But did we agree?
We'll be saying more about the rest of them later, but, no, we don't think some of these websites are now fully compliant with the CNHC's own 'therapy descriptors', their Code of Conduct, Performance and Ethics or the ASA's CAP Code.
Let's look at the fourth one that the CNHC told us was now 'informally resolved'. This registrant's website, http://www.helenbarnard.co.uk/, made claims for Bowen therapy. If you've not heard of this particular 'therapy' before, take a few minutes to watch this video from the Bowen Therapy Professional Association, the trade body to which Helen Barnard belongs.
The screenshots of the three pages I sent to the CNHC on 09 July 2014 were (click to enlarge):
The specific words we highlighted to the CNHC on 04 December 2014 were:
Muscle and joint aches and soft tissue injuries including sports injuries, Any age group from babies to elderly, fit and healthy, to frail or chronically ill, Stress related problems from IBS to insomnia, Injury prevention for sports men and women
the relief of pain, improved range of movement and a general feeling of well-being and relaxation. , it is suitable for all ages and fitness levels, from young babies to the frail and elderly. It can be used on acute injuries and sport injuries to chronic conditions.
Back pain, Eczema, Frozen Shoulder, Lower back pain, Migraine headaches, Neck pain, Hamstring Injury
The last ones were claims made in testimonials.
As well as their more general guidance and advice, the ASA have issued advice specifically for Bowen therapists:
This technique uses pressure to mobilise soft tissue. CAP accepts that marketers can make claims about relieving stress or anxiety and helping relaxation. In August 2012, the ASA upheld a complaint about general claims that the Bowen technique could increase flexibility and improve movement (The Bowen Consultancy, 22 August 2012). Although it rejected some claims, the ASA accepted that the Bowen technique could improve flexibility, in the short term, of hamstring muscles in healthy, fit adults aged 18-50 years with no musculo-skeletal symptoms. Claims to improve flexibility would need to be qualified in those terms. Neither CAP nor the ASA has seen evidence that the technique can treat other conditions and advertisers should not refer to conditions for which medical supervision should be sought (Howard Bult, 8 February 2012).
It should be clear to many that the claims made by Helen Barnard are problematic at best.
On 06 March 2015, the CNHC told us:
Having received advice from the Committee of Advertising Practice Copy Advice Team, Ms Barnard has removed from her website the following wording
"The subtle and gentle nature of Bowen treatment means it is suitable for all ages and fitness levels, from young babies to the frail and elderly. It can be used on acute injuries and sport injuries to chronic conditions. However, practitioners do not diagnose, nor do they prescribe or alter medication. They may recommend assessment by a Doctor. Bowen is not intended as a substitute for medical treatment."
"Gentle fingertip pressure in precise locations can help any age group from babies to elderly, fit and healthy, to frail or chronically ill."
and replaced it with
“The subtle and gentle nature of Bowen treatment means I have clients of all ages from young children to the elderly”.
She has also removed any reference to specific health conditions for which suitably qualified medical advice should be sought.
I confirm that this complaint has been resolved informally.
Here are the before and after screenshots of the changed text (click to enlarge):
This was the only page to change but it's good to see that the advertiser removed some of these words. But why has it taken the CNHC two attempts to get this website changed? They have twice told us all the websites we complained about had been rectified and that they were now compliant.
But, even after all that, are they?
Before we look at that, the CNHC's phrase 'health conditions for which suitably qualified medical advice should be sought' is significant.
The ASA's CAP Code states that they will not allow many advertisers to make claims for some more serious conditions. In their Health, beauty and slimming marketing communications that refer to medical conditions Help Note, CAP provides two lists: the first identifies medical conditions for which medical advice from a suitably qualified person should be sought and the second identifies conditions which could legitimately be referred to in marketing communications without breaching Rule 12.2 (subject to them complying with all other appropriate Code Rules, of course). This Rule states:
Marketers must not discourage essential treatment for conditions for which medical supervision should be sought. For example, they must not offer specific advice on, diagnosis of or treatment for such conditions unless that advice, diagnosis or treatment is conducted under the supervision of a suitably qualified health professional. Accurate and responsible general information about such conditions may, however, be offered (see rule 12.11).
Health professionals will be deemed suitably qualified only if they can provide suitable credentials, for example, evidence of: relevant professional expertise or qualifications; systems for regular review of members' skills and competencies and suitable professional indemnity insurance covering all services provided; accreditation by a professional or regulatory body that has systems for dealing with complaints and taking disciplinary action and has registration based on minimum standards for training and qualifications.
There are, of course, no medical conditions listed by the ASA that they would allow an advertiser of Bowen therapy to claim to treat.
But that's not the whole story. As well as 'health conditions for which suitably qualified medical advice should be sought', the advertiser listed other medical conditions that were not on the ASA's list — as shown on the screenshots above. Why weren't they removed? Why were the CNHC content with the advertiser removing just the more serious medical conditions? The CNHC seem to think they had done their job and declared the case closed.
We were not so easily convinced and we don't think that the CNHC should have been content either; not if they were competently doing their job of protecting the public, that is.
But we're not the ones to judge these things: that's what the regulators are there to do. In fact all we are able to do is question claims made, submit complaints to the relevant organisation and let them decide according to their own rules and procedures.
We've been extremely patient with the CNHC and already given them two attempts and nearly two years to ensure the websites of the registrants we'd complained about were properly dealt with. We could see no point in trying a third time, so we've submitted complaints to the ASA who we know will deal with the issues professionally, competently and thoroughly, in the interests of protecting the public from misleading claims.
So far, we've submitted three complaints to the ASA about the websites that the CNHC have told us they are happy with and a fourth will be submitted soon.
The outcome of the first of these complaints — Helen Barnard's website — is published today as an informally resolved case. We'll tell you about the others once they've been resolved by the ASA — and what we propose to do subsequently.
Our ASA complaint was essentially about the same words and some claims made in a video on her website.
The ASA asked her to remove some claims from her website as they had previously been investigated and found to breach the CAP Code. They were going to ask her to provide evidence for the other claims, but she told the ASA she had taken her website down and that if it was live again, it would include her qualifications only.
As far as the ASA is concerned, the case is closed: the misleading claims are no longer being made.
As far as we're concerned, this is not the end.
What we have shown is that, despite the CNHC's assurances that her website was fully compliant, the ASA decided otherwise.
Who should we place our trust in? Who should the public place their trust in? One who sets high standards and adjudicates fairly to protect the public? Or one who claims to but seems to pay lip service to protecting the public from its members?
So, is the CNHC fit for purpose? That depends on whether their purpose is to protect the public or protect their members.
We'll leave you to decide.
08 April 2015
And cancer. And depression. And Dengue Fever, Japanese Encephalitis, Yellow Fever, hayfever, allergies, fungal infections, Crohn's disease, ADHD, IBS…
The list of conditions this device from Bicom can treat is long. With that and their cheap, 48-hour home blood test kit that only requires a drop of your blood, it's a wonder every hospital doesn't have one, particularly since Bicom claim many of these diseases have been treated successfully for over 30 years in humans. It must be a well-kept secret.
A well-kept secret that Bicom tells everyone about on their website. On multiple websites in fact. On the World-Wide Web. And trains people to use it in the twelve UK training courses they have scheduled for this year. Maybe we all need to tell our GP about it.
But maybe doctors already know, but don't tell you for some reason?
Alternatively, there may be very good reasons why doctors don't tell you about this miraculous machine and the blood tests.
We came across an advert for the Bicom device and the home blood test kits in the September 2014 issue of What Doctors Don’t Tell You (WDDTY).
We wondered whether the advertiser would be able to substantiate the claims made in the ad and on his websites: www.reson8.uk.com and www.blood-test.co.uk related to the ad and another one owned by the same company, www.ebolatreatments.com so we submitted a complaint to the Advertising Standards Authority.
Their adjudication is published today, upheld on all six points.
The ad in WDDTY said:
WHAT DOCTORS CAN'T TELL YOU We can, with Bioresonance, treat the cause and not the symptoms by working at cellular level! Allergy Food Intolerance Bacterial and fungal infections Virus and toxins The above items and many more have been treated successfully for over 30 years in humans and over 10 years with animals. Many experience complete recovery without the side effects of drugs…48HR TEST RESULT Can Save Your Life! Try our Home BLOOD TEST Kits Blood test from own home Easy to use kit 48 hour returned results Only need a drop of blood (unlike other tests) Allergies, Parasites, Toxins, Virus's [sic] and many other tests available.
For the www.reson8.uk.com website, the ASA quoted some of the claims and said:
"Disorders Hayfever & Allergies Cancer Depression Smoking Weight Gain Electronic Smog Asthma Digestive Skin problems Gastro-intestinal diseases Auto Immune diseases Infectious diseases Neurological disorders Dental Pain Sports Injury Migraine". A video on the website gave details about how the treatment worked and featured individuals, some of which were introduced as medical professionals, talking about how the treatment had helped a number of conditions including gut problems, irritable bowel syndrome, Crohn's disease, allergies, neurodermatitis or ADHD and dental purposes. On a page, entitled "Bio-resonance treatment options for Ebola", text stated, "BICOM bioresonance therapy has been able to help many patients with just three or four sessions. Could this proven method of testing and treatment help people with Ebola and disable the virus early? Lets [sic] hope so…
Claims on www.blood-test.co.uk stated:
Home Blood Testing… Allergy testing in the UK has never been easier…During the testing, the frequencies of most known substances are measured against your blood sample. Upon detection, frequency patterns that match emit a "resonance" which is then recorded. The substances which contribute to your stress, or are likely to cause stress, or that may have caused stress in the past are rendered identifiable…For a fast, affordable, reliable and convenient home blood test service you need look no further than Blood Test UK…Order a free allergy test kit now
But perhaps most worryingly, on www.ebolatreatments.com:
Ebola Treatments and Testing: Give hope to those who need it most without medication! Bioresonance has not been tested or verified with the Ebola Virus, however it has been very successful with other hemorrhagic virus's [sic]. It is hoped that medical institutions in affected areas can apply our treatment protocols listed on this site and register their successful outcomes. We only use Class 2A medical devices such as the Bicom Optima which also is CE approved.
Further text on a page entitled Vaccine stated:
Ebola Vaccine No proven vaccine currently exists but…A bioresonance company in Australia has had some success preparing travellers against other pathogens like Bird Flu, Dengue, Japanese Encephalitis, Yellow Fever etc, in fact many pathogens can be used in a single tablet. The pathogenic frequencies are inverted and stored in pill form and taken during the trip.
Just to repeat those last few words:
The pathogenic frequencies are inverted and stored in pill form and taken during the trip.
You can see why we were concerned about these adverts — and we weren't the only ones. Someone else also complained, but of course, due to ASA confidentiality, we have no idea who that was.
The issues identified by the ASA were mostly concerned about whether the advertiser could substantiate the claims and whether the ads 'discouraged essential treatment for conditions for which medical supervision should be sought.' Like Ebola.
When asked by the ASA to substantiate the claims made, the advertiser, Bicom UK LLP, said:
…the claims were carefully worded, not making reference to the effectiveness of the treatment, and a disclaimer on their websites encouraged people to visit their doctor if they had a serious condition. They said that the listed disorders were being treated on a daily basis by 15,000 practitioners. They provided a 2009 press release following a German court case, which cited a decision not to impose an injunction on Bicom's claim to treat allergies, and an academic paper, which explored the electromagnetic effects on humans.
Needless to say, this 'evidence' did not satisfy the ASA's high standards. To understand how the ASA came to their decision to uphold all six points, please read their assessment of this 'evidence'.
The ASA decided the ads breached the CAP Code on a total of 18 counts and the advertiser was told:
The ads must not appear in their current form. We told Bicom to ensure that they held adequate substantiation for the efficacy claims made in their advertising and did not offer treatment or discourage essential treatment for conditions for which medical supervision should be sought.
Since the ad included claims about cancer, the ASA have referred the matter to Trading Standards (TS) for further investigation. It should be noted that TS have had a lot of success in prosecuting those making cancer claims. See Jo Brodie's blog post: Cancer Act 1939 convictions in the UK for full details.
We noticed that Bicom had stated that:
We only use Class 2A medical devices such as the Bicom Optima which also is CE approved.
This is a technical point about compliance with the EU Medical Devices Directive (MDD) 93/42/EEC and CE marking of a device. This CE marking is what is seen on many household items these days from electrical goods to toys and is a declaration by manufacturer or EU importer that the product meets the essential requirements of all applicable EU Directives, such as safety. For medical devices this is the MDD and there are several Classes, depending on the product and its function. Bicom are claiming their device is Class IIa, but we doubted this was correct and that they could substantiate this. The ASA took this up and told us:
We requested that they provided evidence to substantiate the claims “Class 2a” and “CE approved” appearing on www.ebolattreatments.com. Further to this, the advertiser provided some documentation to substantiate the claims. As we were not initially certain were the certifications were legitimate, we contacted the Medical Healthcare Regulatory Agency (MHRA) who confirmed that they were and, therefore, that the evidence did substantiate the claims.
However, the MHRA have decided to investigate the advertiser on the basis that they may not be using the device in the certified way. Unfortunately, due to statutory confidentiality restrictions, the MHRA will not be able to provide any further information about their investigation or update us on its progress.
Although the MHRA are investigating, this highlights two problems: how such a device ever came to be classified under IIa and the secrecy under which the MHRA operate.
Dealing with the first point, under the MDD, a manufacturer has to provide a dossier to a Notified Body to check everything is in order and it looks like the MHRA have checked this and decided the paper work was all present and correct. We believe there is a serious problem with how this works and the ease with which devices can appear to be compliant with the MDD with no evidence that they actually work. Possibly the worst example of this we have found was ear candles marked as Class I medical devices. This was a few years ago and the MHRA dealt with it, but this brings us on to the second issue: that of MHRA secrecy.
We don't know the details in this case, but the MHRA sometimes cite Article 20 of the MDD on confidentiality:
Without prejudice to the existing national provisions and practices on medical confidentiality, Member States shall ensure that all the Parties involved in the application of this Directive are bound to observe confidentiality with regard to all information obtained in carrying out their tasks.
There are certainly arguments to be made about treating possibly commercially sensitive information that the MHRA obtains from a manufacturer in the course of an investigation, but we believe that this cannot be interpreted as covering all information relating to a complaint or investigation, including whether a complaint had any merit, whether the MHRA investigated, what they found and concluded and what action they took or sanctions they imposed in order to fulfil their duty to enforce the MDD and protect the public.
This is certainly something we will return to at a later date.
We didn't say much about it at the time, but we had also submitted a complaint about another advert in the September 2014 issue of What Doctors Don't Tell You. This one was informally resolved by the ASA and only the advertiser's name and brief details were published on the ASA's website on 5 November 2014.
The products being advertised were various models of sauna, with these claims:
Japanese studies have shown that Far Infrared Saunas are beneficial for arthritis, fibromyalgia, chronic fatigue, diabetes, insomnia, stress, psoriasis, chronic pain and can aid detoxification, weight loss, and fitness.
As with the Bicom WDDTY ad above, we also looked at this advertiser's website www.firzone.co.uk. We included some examples of the claims made on the website in our complaint, including:
Its application is suitable for slimming, detoxification, complementary cancer therapy (hyperthermia), cardio vascular fitness, treatment of aches & pains, healing, or as a pre massage treatment to relax muscles and increase blood flow.
Health Benefits of Infrared Sauna
- Treat muscular aches and & sprains
- Improve circulation
- Promote weight loss
- Have healthy looking radiant skin
- Relax mind and body
- Enhance detoxification processes
- Improve cardiovascular conditioning and fitness levels
- Treatment of aches and pains
- General fitness
We don't know if the advertiser provided the evidence they mentioned in the ad or any other evidence they might have had, or whether they just agreed to remove the claims the ASA were unhappy about. All we know is that they removed these claims from their website: it's always interesting to see how an advertiser tries to substantiate claims, but removing the claims is still a good result.
Because of the cancer claims, we brought this to the attention of Trading Standards (via the Citizens Advice Bureau's webform) who investigated. Once the advertiser had removed the claims, TS closed the case.
We found other adverts in What Doctors Don't Tell You — and on those advertisers' websites — we were concerned about and submitted comprehensive complaints about those as well. They are still being investigated by the ASA, but we'll bring you the details when the outcomes are published.
It is however, very disappointing, despite the large number of previous adjudications and informally resolved cases about adverts published in WDDTY, that its publishers continue to carry ads making misleading claims and that some of their advertisers have been found to be publishing ads that are not only misleading, but are also irresponsible.
28 January 2015
The report recommends that:
NHS Lanarkshire should cease new referrals of Lanarkshire residents to the CIC as of 31 March 2015 on the basis of the lack of clinical effectiveness evidence for homoeopathy, and other health interventions noted in this paper, delivered by the CIC.
It is expected that the Board will accept its recommendations this afternoon at their extraordinary meeting.
[Updated at 14:55] NHS Lanarkshire have just announced their Board's decision to accept the report's recommendation to stop all referrals to the Glasgow Homeopathic Hospital after next March.
Their Director of Public Health and Health Policy, Dr Harpreet Kohli, and his team (which included the homeopath and Lead Clinician at the GHH, Dr Bob Leckridge) conducted a thorough review:
In reaching a consensus on recommendations for the future of the homoeopathy service, the Group considered all the evidence gathered during the course of the review and also took account of A Healthier Future and NHS Scotland’s Strategy Ambitions.
Following full consideration and deliberation, the Group concluded that, whilst the subjective evidence from patients expressing benefit from and support for the service was strong, there was clear and unambiguous evidence that homoeopathy and associated services were lacking in terms of therapeutic benefit. In addition there was a strength of clinical opinion across the UK that homeopathic treatments should not be provided by the NHS. On that basis, the Group’s view was not to recommend referral to the CIC, which offers homoeopathy and associated services.
They conducted a literature review for the treatments provided by the GHH, concluding:
The literature reviewed in relation to homoeopathic care for various conditions including fibromyalgia (coping with pain and depression), prevention and treatment of influenza and influenza-like illness, therapy for preventing or treating the adverse effects of cancer treatment, attention deficit/hyperactivity disorder (ADHD) and insomnia, found insufficient or no evidence to support homoeopathy.
Mindfulness-based cognitive therapy
Reviews of MBCT for the treatment of various conditions including fibromyalgia, chronic diseases, stress reduction for breast cancer, chronic fatigue syndrome and anxiety and depression concluded that there is some evidence that MBCT improves psychological health in breast cancer patients and improves mental health and symptom management in patients with chronic disease.
No systematic reviews or meta-analyses were identified for HeartMath.
Mistletoe for cancer symptoms
Reviews of mistletoe extracts for cancer patients had differing results – a Cochrane Review concluded that there was insufficient evidence while two other studies concluded that mistletoe extract may be associated with better survival and that there was some evidence to support the effects on quality of life. Limitations of the studies were highlighted however and a caveat added to treat the findings with caution.
Music and movement therapy
Some reviews of music and movement therapy, while concluding that listening to music may help to reduce anxiety, reduce pain and respiratory rate and have a beneficial effect on the quality of life for people in end-of-life care, did not have strong evidence. The therapy appeared to have benefit for patients with Parkinson’s disease but concluded that future studies should include greater numbers of patients.
For homeopathy, their Homeopathy Review Group built on the work carried out by the House of Commons Science and Technology Select Committee in their Evidence Check on homeopathy, looking at appropriate evidence published since then, up to October 2014. They found that the report's conclusions were unaffected by any new evidence.
As well as surveying existing patients and GPs, and visiting the GHH and its outreach clinics in Coatbridge and Carluke, a public consultation was also carried out by NHS Lanarkshire — the results of that have also just been published. Nearly 6,000 responses were received with the majority in favour of continuing to refer to the GHH. Our response to the consultation can be read here.
However, the report notes that there had been a concerted campaign to 'Save the Glasgow Homeopathic Hospital', including an online petition, instigated by homeopath Louise Mclean of the Homeopathy Heals website. It also noted that an analysis showed most signers were from outwith Lanarkshire. We have been made aware that Mclean has called for supporters intending to demonstrate outside the building where this afternoon's meeting is being held and to write to MSPs and the Scottish Health Minister to complain.
Of the responses expressing support, the main themes were:
Of the responses expressing no support, the main themes were:
Despite the praise for the services (mostly from those not actually using them), we commend NHS Lanarkshire for going with the best evidence rather than popularity in deciding what treatments to provide.
Patients will not be left high and dry by this decision. New referrals will cease on 30 March 2015, but those currently attending the GHH or the two outreach clinics will continue to receive the treatments.
New patients from April will be able to receive a wide range of conventional, evidence-based, treatments such as those provided by psychosocial services, the addictions service and a number of condition-specific services already provided by NHS Lanarkshire.
Overall, this is a damning indictment of the services provided by the GHH. It can only be an embarrassment to NHS Greater Glasgow and Clyde to have a 'hospital' that is providing treatments for which their Lanarkshire colleagues have concluded there is no good evidence.
After the closure of its pharmacy in 2011, the withdrawal of referrals from NHS Highland in 2010 and from NHS Lothian in 2013 and the decline in outpatient attendances over the last ten years, this must surely be the final nail in the coffin of the Glasgow Homeopathic Hospital.
09 December 2014
There seems to be widespread use of the term ‘primary healthcare/contact practitioner/profession/provider’ by chiropractors. Some of the many variations include:
Chiropractic is a primary health-care profession that specialises in the diagnosis, treatment and overall management of conditions that are due to problems with the joints, ligaments, tendons and nerves, especially related to the spine. (Source)
The perception of Chiropractic is often limited to the treatment of back, or neck pain, but as Primary Healthcare Providers Chiropractors are consulted about a whole range of conditions. (Source)
Chiropractic is a primary health care profession which emphasises the inherent recuperative power of the human body to heal itself without the use of drugs or surgery. (Source)
As primary healthcare practitioners we are perfectly situated to help you within our areas of expertise and point you towards other specialists as appropriate. (Source)
Chiropractic is the third largest primary health care profession in the world after medicine and dentistry. (Source)
Chiropractors are primary contact, primary healthcare practitioners – as such, no form of referral is required as a prerequisite to visit a chiropractor. (Source)
A Chiropractor is trained to diagnose and treat your condition and will refer you to another healthcare professional if necessary. (Source)
Chiropractors are neuro-musculoskeletal specialists, trained as primary healthcare practitioners – meaning that no matter what the ailment, each patient will receive the appropriate care or referral as necessary. (Source)
There are some common themes in these, but we were concerned that members of the public might see chiropractors as a first port of call for a variety of medical conditions, rather than their GP.
Why would we think this might be a problem? We already know the evidence for chiropractic spinal manipulations is scant, even for their 'trade mark' condition of non-specific lower back pain (LBP). And it's not without specific and non-specific harms either, of course.
But maybe it wouldn't be a great problem if their advertising was restricted to a few musculoskeletal conditions such as LBP and were fully informed?
There are problems, however.
For example, one website claims:
Chiropractic care can also help children with:
- prolonged crying
- sleeping and feeding problems
- breathing difficulties
- frequent infections especially in the ears
These are some of the more common musculo-skeletal conditions which nearly everyone suffers from at some time in their life. Many conditions start as minor ailments which can progress to more severe and longer lasting episodes of pain if left untreated or ignored. Our goal is to get you out of pain as soon as possible, whilst improving joint movement. Failure to restore normal function usually means that any pain relief is temporary.
After the British Chiropractic Association (BCA) dropped their libel case against Simon Singh for an article he wrote in 2008 for the Guardian in which he highlighted chiropractors making claims for many of these same childhood conditions, it's surprising to see them still being made.
Many websites were changed as a result of this and my 524 complaints submitted to the statutory regulator, the General Chiropractic Council; this resulted in the ASA revising their guidance on claims made by chiropractors — and that guidance certainly doesn't include asthma, colic, bed-wetting etc!
So why are such claims still being made? And, more importantly, what is a member of the public supposed to think when they see claims like these?
But for some chiropractors (certainly not all), claims like these are perfectly acceptable and, indeed, an integral and utterly necessary and inescapable part of chiropractic 'philosophy' as invented by DD Palmer. Some are taught that 'dysfunction' of vertebrae in the spine can cause 'nerve interference' that in turn can cause all sorts of medical problems and that what's needed is a chiropractic adjustment to correct the displacement and so allow proper nerve flow, permitting the body's vital force to heal itself. There is, of course, no good evidence that this dysfunction — or vertebral subluxation complex (VSC) in their parlance — even exists or that it results in any pressure on the nerves never mind that any adjustment of the spine can somehow alleviate anything.
So, even claims such as those above are seen as musculoskeletal issues that chiropractic can treat — as that chiropractor states.
We also are aware of concerns about the attitude of some chiropractors to the medical profession in general and things like vaccinations in particular. Prof Ernst warns of such non-evidence based attitudes in the US, but it doesn't take much effort to find similar attitudes in the UK.
We saw the use of the terms incorporating 'primary' as potentially misleading to the general public, particularly those not familiar with chiropractic or health and medicine in general, so we submitted a complaint to the ASA.
We argued that the various phrases used by chiropractors that referred to 'primary healthcare'. We included a definition by the World Health Organisation. In its Declaration of Alma-Ata, the World Health Organisation defined primary care as:
…essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community…It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.
The Health and Social Care Information Centre (HSCIC) introduce Primary Care:
As many people's first point of contact with the NHS, around 90 per cent of patient interaction is with primary care services. In addition to GP practices, primary care covers dental practices, community pharmacies and high street optometrists.
The Department of Health defines the essential attributes of Primary Care as:
- co-ordinates the care of the many people with multiple, complex health needs
- delivers care closer to people, increasing convenience, especially in areas remote from hospitals.
- is a first point of contact for patients to facilitate the early detection of illness, and thereby improves outcomes.
- provides a long-term perspective to support disease prevention and healthy lifestyles.
- provides more cost-effective treatment for minor illnesses and injuries than hospitals
The primary care systems for the 21st century are built on the foundations of:
- multi-disciplinary teams of healthcare professionals trained for family medicine
- suitable facilities and infrastructure, integrating digital healthcare, to provide a range of access options and support dispersed populations
- clinical pathways for consistent and effective care, with referral processes for specialist consultations
- information systems including electronic patient records to optimise clinical activity
We did not see chiropractic as fitting any of these criteria and therefore believed any association with 'primary healthcare' to be misleading.
But it's not what we think that's important. We don't make the rules or enforce them. In this case, because this was all about adverts on the websites of chiropractors, we submitted a complaint to the Advertising Standards Authority (ASA), providing them with quotes from 12 websites and inviting them to choose whichever they felt best covered the issues.
They considered our complaint and, as we had suggested, chose just to investigate the wording on one website, Kingsbridge Chiropractic Clinic. They considered two points and decided that there had been no breach of the advertising code. However, we don't think the two points fully covered the issues we complained about.
The ASA's adjudication is published today.
The ASA decided:
The ASA understood that the term "primary healthcare practitioners" was not protected and did not have a fixed definition; although we acknowledged that the term "primary healthcare" was generally used in the health sector to refer to the first point of contact for the public to access healthcare in the community, such as GPs, dentists and optometrists. We considered that the average consumer was likely to have an awareness that chiropractic focussed on musculoskeletal conditions and considered that, in the context of the ad, consumers were likely to understand the term "primary healthcare practitioners" to refer to their ability to access chiropractic treatment directly, without referral. We did not consider the term implied that chiropractors held general medical qualifications, that they were able to treat a wide variety of conditions (beyond musculoskeletal conditions) or that they could act as a primary contact for those with general health concerns. We also did not consider the term was likely to discourage essential treatment for conditions for which medical supervision should be sought. We therefore concluded the claim did not breach the Code.
Their assessment rested on the assumption that "average consumer was likely to have an awareness that chiropractic focussed on musculoskeletal conditions". The ASA are generally good at understanding how a member of the general public would regard adverts and what they would take wording to mean. However, we think that the public are not as aware as the ASA assume.
We cited research conducted by the General Chiropractic Council in 2012: Research into Patients Views and Expectations of Chiropractic Care 2012 that concluded:
The majority of patients in the national survey rated their knowledge of chiropractic prior to treatment towards the lower end of the scale i.e. ‘I knew very little’.
We also cited an older study: Consulting the Profession: A Survey of UK Chiropractors, 2004. The GCC has asked chiropractors what they treated: as well as musculoskeletal conditions, other conditions included (number and percentage of chiropractors who believe this can be treated or managed by chiropractors):
26.58% believed they could treat the following range of conditions (some are musculoskeletal, but the majority are not):
We believe this amply demonstrates that chiropractors represent themselves are treating a lot more than just "musculoskeletal conditions".
However, the ASA was not convinced by our arguments and did not uphold the complaint.
Although we didn't win the adjudication, we now have the ASA's view on what an average member of the public would be likely to understand by the phrase "primary healthcare practitioner":
…consumers were likely to understand the term "primary healthcare practitioners" to refer to their ability to access chiropractic treatment directly, without referral.
This now gives us something concrete to work on and, no doubt, we will refer to this in future complaints.
As a result of this adjudication, we have updated our Results page. The following chart shows our ASA record so far:
"Daniel David Palmer" by Unknown - http://www.palmer.edu/PFCH/hometowngallery/3-family-dd.jpg. Licensed under Public domain via Wikimedia Commons.
12 November 2014