Challenging misleading healthcare claims

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Campaign News: January 2012

Misleading reflexology claims still not removed

Happy New Year!

We begin with an update of the Tamsin Marshall reflexology website we reported on in a previous newsletter.

This was one of the three websites for our master complaint on reflexology to the ASA. Although the website changed before the ASA's adjudication was published — removing a reference to cancer — many of the misleading claims we complained about remained (see right).

We are pleased to see that this list of misleading claims has finally been removed.

reflexology_claims

However, it's disappointing to see many of these claims are still there (cached) in a slightly different form:

Do you suffer from insomnia or fatigue? Are you prone to recurrent infections, mild or chronic illnesses? Are you trying for a baby, or currently pregnant? Are you suffering from hormonal imbalances or thyroid problems? If so, Reflexology may be just what you and your body needs.

If you would like to discuss your treatment or make an appointment please email.

And here (cached):

Reflexology encourages and supports the body in its own healing process, as well as improving blood circulation, assisting in the removal of toxins, inducing relaxation and restoring balance to organs and glands.

It is widely acknowledged that Reflexology is effective not only in helping the body to heal, but also as a source of preventative health care and improved physical fitness. By supporting the mind and body, Reflexology encourages optimum health.

Since these are virtually identical to the claims the ASA ruled were misleading, it looks like this reflexologist still has a lot of changes to make to comply with the adjudication against her. We have informed the ASA.

Ensuring compliance

There can't be many people who believe there is no need for an advertising regulator. A quick glance through the ASA's adjudications gives an indication of what it might be like if there was a free-for-all. Should advertisers of double glazing, car insurance, washing powder, weight-loss diets or penis enlargements be free to claim whatever they like about their product or service? Are exaggerations, half-truths and downright lies acceptable?

No, there needs to be effective regulation that protects the public from the excesses of the marketing machine.

There are several possible models for regulation including one set up under legislation with legal powers to ensure and enforce compliance. However, the ASA is set up as a non-statutory regulator:

We are independent of both the Government and the advertising industry…

They are, of course, funded by a levy on advertisers. How else could they be funded? Who else would be willing to pay for the essential work they do?

Advertisers can choose to pay this levy, but they cannot choose to comply with the Advertising Codes or the ASA's rulings — compliance is mandatory.

However, finance is raised by arm's-length boards (one for broadcast and one for non-broadcast) so that those who investigate and adjudicate on advertising are completely unaware of who has provided the funding.

That separation gives them the necessary independence and authority.

Their job is to:

…make sure all advertisements are legal, decent, honest and truthful.

Very simple requirements; and ones that the public has a right to expect in all advertising, regardless of what it's for or where it appears.

But even though the ASA is a non-statutory body, it has considerable weight — a point that would appear to need highlighting to some CAM advertisers, some of whom have even proclaimed that there is no need to comply with the ASA's CAP Code and advise others to ignore any letter from the ASA. Some have even involved their lawyers.

The ASA outlines the strong basis for their authority:

Interaction with the law

Across the European Union (EU) there is a unified piece of consumer protection legislation to prevent the use of misleading or unfair trading practices. This law, called the Unfair Commercial Practices Directive, has been translated into UK law to make sure that we have the same rules as all the other countries in the EU.

The ASA works within this legal framework to make sure that UK advertising is not misleading or unfair. The ASA is able to refer advertisers who refuse to work with us and persistently make misleading claims to the Office of Fair Trading (OFT) for legal action. The OFT is able to act under the Consumer Protection from Unfair Trading Regulations 2008, which governs how businesses interact with consumers and the Business Protection from Misleading Marketing Regulations 2008, which govern how businesses advertise to each other.

The ASA is considered the ‘established means’ for gaining compliance with both these pieces of legislation. This means that the law itself is not usually enforced formally through the courts; instead the ASA is first allowed to tackle any problems under the Advertising Codes. This approach works well in the overwhelming majority of cases. The ASA is able to take action quickly and this avoids clogging up our court system.

Referral is rarely necessary, as most advertisers prefer to work with the self-regulatory system. Since 2000 around thirty advertisers have been referred to the OFT; in the same period the ASA has dealt with around 200,000 complaints.

In a nutshell: the vast majority of advertisers are responsible and work with the ASA, but the ASA have the option and authority to take strong action should that prove necessary.

Alternative regulation?

The Alliance for Natural Healthcare (a pressure group of herbal and supplement manufacturers, retailers and supporters) recently pronounced:

…the CAM community don’t regard the dissemination of information that relates to their practice as ‘marketing’ in the way interpreted by the ASA.

hurdle

That so many CAM practitioners have responded positively to complaints would suggest there are many in the CAM 'community' who would disagree with this generalisation and who realise that to be socially and ethically responsible, they have to abide by the ASA's rules.

However, other CAM practitioners demand that they be considered a special case; that they shouldn't be regulated to the same set of rules as everyone else.

To accept a lower hurdle for CAM would put the public in even more danger of being misled. Indeed, because of the possible effects on our health and wellbeing, a case could be made for a higher level for healthcare claims.

Responsible advertising

The ASA only demands that claims about CAM meet the same evidential requirements as all other advertisers. No special pleading is allowed because they think they work in some alternative paradigm.

It's clear that there are many CAM practitioners who agree that advertising should be legal, decent, honest and truthful and that advertising rules must be applied equally and fairly to all adverts — whatever they are for.

That is all the Nightingale Collaboration is seeking.

Sanctions

In addition to their existing sanctions, on-line advertisers who have failed to abide by the ASA's adjudications can be listed on their Non-compliant online advertisers page. However, they also have other sanctions available to them including:

  • Removal of paid-for search advertising — ads that link to the page hosting the non-compliant marketing communication may be removed with the agreement of the search engines.
  • ASA paid-for search advertisements — the ASA could place advertisements online highlighting an advertiser's continued non-compliance.

Since the ASA's agreements with search engines include Google, advertisers should not underestimate the effect these might have on visitors to their website.

Named and shamed

Five out of the 14 advertisers currently highlighted on their Non-compliant online advertisers page fall into the alternative therapy category and include one advertising detox foot pads, two advertising reiki and one advertising liquid chlorophyll. The latest additions include Ionic Balance and an 'osteomyologist'.

Ionic Balance were advertising a plastic bracelet, promising all sorts of medical benefits, saying it produced 'negative ions, far infrared rays [heat] and alpha waves'. It would require a source of power to produce any of those and there is no evidence that, even if it did emit these, it had the benefits claimed for it.

The osteomyologist, Back Trouble UK, claimed they could treat:

whiplash and arthritis and be effective for migraine, headaches, period pains, behavioural problems in children, diabetes, stress, asthma, glue ear, colic in babies, sleep disturbance, strokes and other neurological problems

These bear more than a passing resemblance to the types of medical conditions that some chiropractors and osteopaths have claimed. Many chiropractors have removed lots of claims — although there are still far too many questionable claims — so perhaps it's time for the osteomyologists to fall in line and abide by the rules?

Legal aid

As part of our plans for the coming year, we could do with some legal help. We need a lawyer who either already knows all about the Consumer Protection from Unfair Trading Regulations 2008 or who is willing to become familiar with them.

If you can help or know someone who might be able to assist us, please contact us.

06 January 2012

Season's Greetings

xmas_card_small

We know from what our supporters tell us that there are more than a few pharmacists up and down the country who still either aren't sure what homeopathy is and even recommend it to some of their customers in the mistaken belief that it is a proven, efficacious alternative medicine.

We thought we'd seize the opportunity of this time of year to try to raise awareness among high street pharmacists and their staff about homeopathy.

We have sent greetings cards to the pharmacists and staff of nearly 2,000 Boots pharmacy stores up and down the country.

The front of the card is shown above and we included some information explaining the absurdity and lack of evidence for homeopathy. The complete card can be downloaded here (pdf).

We hope that pharmacists will use the card to help make sure staff are properly informed about homeopathic products when responding to queries about them from customers.

If you like this idea, please feel free to print the card out and drop it into your local pharmacy or health store.

Homeopathic advertising

While you're there, you might like to check if they have any advertising next to homeopathic products. You may remember that the medicines regulator (the MHRA) told Boots to stop making medical claims for pills with no active ingredient and we asked our supporters to check their local Boots to make sure this prohibited point-of-sale advertising had been removed.

After a supporter found that it had not been removed from their local Boots near Birmingham, he complained to the MHRA who took it up with Boots. The MHRA assured him that Boots had now put a process in place to ensure all the prohibited advertising was not only removed, but also destroyed — and their head office are actively checking that this has all been done.

Boots are to be congratulated on taking such firm and responsible action.

It's unfortunate that this prohibited advertising had been around so long unchallenged in the first place, but at least now, no member of the public can be misled by it.

But what about other shops and pharmacies?

Boots isn't the only shop to use this kind of advertising. Boots homeopathic products are made by Nelsons and they also supply many other high street pharmacies and health food shops — one of the best known is Holland and Barrett. Our local H&B sells Nelsons homeopathic products and had similar point-of-sale advertising to Boots, so we complained to the MHRA.

The MHRA upheld our complaint and the prohibited advertising materials are being withdrawn from Holland and Barrett stores.

Since the MHRA had contacted Nelsons over this, we now hope that Nelsons will respond positively and responsibly and withdraw all such advertising from all shops that have been supplied with it.

If you find a shop that is still using it, feel free to use our updated information sheet to inform the pharmacist or shop owner of the MHRA's rules.

The use of advertising for homeopathic products registered under the MHRA's Simplified Scheme that links medical conditions to those products is prohibited and such advertising should now be a thing of the past.

Season's greetings to those who are our supporters…and to those who aren't!

20 December 2011

The final reflexology ASA master complaint

feet2The Advertising Standards Authority (ASA) has published its adjudication on the third and final of our reflexology master complaints.

The website of Tamsin Marshall Reflexology was chosen as one of three reflexology websites for our master complaint because of the broad range of questionable claims being made. Two of the pages carried long lists of conditions under the claim that reflexology "can be used in the treatment and relief from" them.

Given that reflexology apparently involves nothing more than pressing different areas of the feet and hands, we challenged whether this therapy could actually help the conditions named and whether the claims on the website could have the consequence of discouraging people from seeking essential medical treatment.

The ASA additionally challenged whether the efficacy claims in the customer testimonials could be substantiated.

The evidence submitted by the website owner in support of the claims on her website did not meet the standard required by the ASA and the complaint was upheld on all four points, identifying a total of 24 breaches of the CAP Code.

Making changes

We note that some amendments to the main text of the Tamsin Marshall Reflexology website have been made recently and that cancer has been removed from the list of conditions on the About Reflexology (cached) page. However, the website still carries the claim that reflexology can be used in the treatment of many serious conditions including asthma, "eye and ear disorders", endometriosis and polycystic ovary syndrome. It also still carries the customer testimonials that the ASA had objected to.

As it is now eight months since the ASA's remit was extended to include websites, some six months since this practitioner was notified of the complaints and a fortnight since she was notified of the adjudication, it is surprising that she has made little progress in making her website comply with the standards of truthfulness required by the ASA, so that we as consumers are better able to make an informed choice.

We are encouraged, however, to note that the first of the reflexology websites we challenged, Jackie Ginger Reflexology, which was adjudicated on two months ago, has now been amended accordingly, which shows it can be done. The other website we complained about, The Reflex Clinic, is still down at the time of writing.

The ASA continue to work with those responsible for the long list of other reflexology websites we supplied and with the relevant reflexologist trade bodies. This process will take time, but we are confident that the ASA will succeed in ensuring that these websites become legal, decent, honest and truthful — as they should be.

Credit

handsWe seem to be getting the credit for quite a lot of the complaints being made to the ASA about misleading websites, even if the complaints weren't submitted by us!

For example, we came across a blog called Reiki Medicine [sic] with the story of complaints made to the ASA about the website of a reiki practitioner in Newcastle. We are told that the complaints are believed by the practioner in question to have "originated with the Nightingale Collaboration" and that she "expressed concern about skeptic groups in effect dictating the work of the ASA because of personal beliefs rather than in the best interest of the general public".

We don't know whether the complaints about this particular website were inspired by the Nightingale Collaboration or if the complainant was assisted by the information on our website. What is clear is that there were a number of very questionable claims on this particular website, beginning with, "Reiki is believed to have many beneficial effects by: Treating the symptoms and causes of illness…" and that one or more members of the public objected enough to take the time to complain about them.

The result is that these claims have now been removed from that website, whose owner advises other practitioners receiving complaints:

…to not take it personally, and to view it as a challenge rather than as an attack… This is an opportunity to be clear about our own information and intention, and to demonstrate a professional and reasoned attitude to both complainants and the ASA… It is possible to play the game and remove taboo words, not list conditions, and be more creative with language.

Good advice, on the whole, though we are a bit dismayed to see promoting a healthcare therapy in a way that is honest and decent and unlikely to mislead people who may be ill and vulnerable being described as "a game".

No indications allowed: how you can help!

Boots Pharmacies had their knuckles rapped recently for listing medical conditions in their in-store, point-of-sale (POS) advertising of homeopathic products by the medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA).

POSDisplayThe products — made for Boots by A Nelson & Co Ltd — are not licensed with therapeutic indications, ie they are not allowed to say what medical conditions the manufacturers think they can be used to treat.

This isn't because — as many homeopathists would have us believe — there is some big conspiracy against homeopathy, but because, for the homeopathic products registered with the MHRA, not one jot of scientific evidence of their efficacy is required as part of that registration. Advertising the products with therapeutic indications would therefore be misleading.

This advertising, found in many Boots stores, took the form of a booklet of next to a rack of homeopathic products. The booklet listed indications, symptoms and corresponding homeopathic products. Boots have now agreed to remove all such advertising from their stores.

But Boots aren't the only shops that sell homeopathic products and many others have similar POS advertising that lists medical conditions for those products: we've seen it in branches of high street 'health' food shops, particularly for Nelsons own-branded products.

How can you help?

We are sure that Boots will take their responsibilities seriously and remove all such advertising. But what if you find a store that hasn't? What do you do if you find a health food shop with a similar booklet?

You could politely ask to speak to the manager or the Superintendent Pharmacist and make them aware of the MHRA's decision against Boots and ask them if they will review their advertising.

But if you're not confident about doing that, we have produced an information sheet that you can download and print out (in black and white or colour) to help you.

We've made the sheet informative and non-confrontational: it simply gives details of the MHRA's decision and asks that the shop reviews its in-store advertising to make sure it complies with the MHRA requirements.

If you are successful in persuading a shop to remove these unlicensed indications, please let us know; if you find that the advertising hasn't been removed, please also let us know.

 

POS_advertising_of_homeopathic_products

Working within the "cranial paradigm"

The Advertising Standards Authority (ASA) published another of our 'master' complaints today. This time it was about claims being made on a website advertising craniosacral therapy, Being in Stillness (BIS). The full adjudication can be found here, but it's worth considering some of its points.

As part of their general response, BIS stated that they:

…worked within the cranial paradigm, rather than a conventional scientific paradigm.

The didn't, however, explain in any understandable terms what this different paradigm was other than to claim:

[craniosacral therapists] worked with the subtle energies of the individual, which represented and seemed to correspond to physical tissues and emotions. Practitioners, experienced in their hands certain sensations, or ‘energy fields’, around the client, which was in turn experienced by the client as subtle movements in the body, or various emotions and insights. BIS said that was a highly subjective experience and each practitioner may experience the work differently.

None of this is evidence-based, of course. The BIS website explains further:

'Being in Stillness' means resting in a place of deep peace and wholeness that encourages profound relaxation of the body, mind, emotions and energy, and enhances our natural healing, self-repair and self-correction abilities, reminding us who we are underneath the conditioning of our day to day lives and unresolved experiences. It is inherently non-judgmental, honouring our body's present perception of how things feel.

Recognise this for what it is: non-specific yet possibly sciency-sounding to some and typical of far too many webpages promoting alternative therapies.

However, it's a huge leap from talk of relaxation to claims that this can treat any illness or condition, never mind serious ones like the ones mentioned by BIS: autism, learning difficulties, epilepsy, recurrent infections, migraines, headaches and asthma that need proper medical attention, as well as all the usual suspects of colic, feeding problems, poor sleep and 'failure to thrive'.

But another recurrent theme on many sites advertising alternative therapies is 'birth trauma'. This is certainly a favourite of many chiropractors and suchlike, but preys on women at a time when they are understandably concerned about the well-being of their baby. BIS stepped up the pressure:

During birth the baby's head is subjected to strong compressive forces. Particularly with a long or difficult labour, forceps or ventouse [suction] intervention, there may be residual effects which need some help to clear. Craniosacral therapy recognises the subtle effects of birth trauma on the still-forming bones of the skull which if left untreated may lead to more persistent problems.

Fully upheld

The ASA identified 10 points in our complaint and upheld them all, including one that the ad could discourage people from seeking essential treatment for conditions for which medical supervision should be sought.

However, it is disappointing to note that, although the page on craniosacral therapy (cached) on the BIS website has changed in light of the ASA's adjudication and some text has been altered, the website now contains three disclaimers in what would appear to be an attempt to comply with the adjudication, but without removing many of the claims or the long list of medical conditions. The ASA have been notified of this.

Regulatory paradigm

In the regulatory paradigm, claims made have to be evidence-based and the ASA require that evidence be robust and scientific. The ASA demand this because their remit is to protect the public from being misled: if an advertiser makes a claim, the advertiser should be prepared to substantiate that claim with robust evidence. If they cannot substantiate it, then they should remove the claim.

Now that this adjudication adds to the CAP Code and previous adjudications on craniosacral therapy, there can even less excuse for craniosacral therapists to make misleading claims.

BIS should have been well aware of these requirements: the therapist at BIS is Amanda Biggs and she is a member of the Craniosacral Therapy Association of the UK. The reason the CSTA know all about the ASA's rules is because of the adjudication against them just over a year ago after a complaint by Al Grant. The ASA have also told us that they had informed the CSTA of our current complaint.

As part of our complaint, we supplied the ASA with a list of several hundred other cranisacral therapy websites and the ASA will now be contacting them to ensure they are well aware of the rules they have to abide by. They will now also be contacting the CSTA again and another trade body, the Upledger Institute, to inform them of their decision and to work with them to help seek compliance by their members.

We sincerely hope that both trade bodies will realise their professional responsibilities and cooperate fully with the ASA to bring their members into line with the CAP Code.

Boots told to stop making medical claims for pills with no active ingredient

Boots Pharmacies have been told to stop listing medical conditions in their in-store advertising of homeopathic products by the medicines regulator, following a complaint by Simon Perry.

The point-of-sale advertising in Boots stores recommended homeopathic products as suitable treatments for a wide range of medical conditions including allergies, infections, insect bites, headaches and earaches. But homeopathic products contain only sugar — they have no active ingredients.

The products Boots were advertising (manufactured by A Nelson & Co Ltd of Wimbledon) are prohibited from indicating any medical conditions by the Medicines and Healthcare products Regulatory Agency (MHRA), which is the statutory body charged with regulating medicines and homeopathic products.

The Boots products are registered under the MHRA's Simplified Scheme for homeopathic products. This does not require the manufacturer to provide any evidence that they actually work — unlike the conventional medicines licensed by the MHRA.

Alan Henness, Director of the Nightingale Collaboration, which campaigns against misleading healthcare advertising to the general public, said:

This is a victory for informed consumer healthcare choice. These products are frequently displayed near the pharmacy areas and could mislead members of the public into thinking they were effective medicinal products. However, as well as being biologically improbable, there is no good scientific or medical evidence that any homeopathic product has any effect over placebo.

Boots came under pressure in 2009 after telling a House of Commons Select Committee they sold homeopathic products despite having no evidence or belief that they were effective for any condition. This admission prompted consumer demonstrations against the high street store, with the 10:23 Campaign protesting sales of the products by publicly overdosing on Boots-brand homeopathy.

Mike Marshall, co-founder of the 10:23 Campaign said:

When we set up the 10:23 Campaign, we appealed to, and petitioned, Boots to remove homeopathic products from their stores — as a responsible and respected healthcare provider we strongly believe they should value their customers enough not to sell them ineffective so-called 'medicines'. With many people considering Boots synonymous with good-quality health advice, their sale and advertisement of useless treatments to trusting customers ought to be utterly unacceptable.

As such, we wholeheartedly welcome this ruling from the MHRA — hopefully it should result in fewer people being fooled into believing that homeopathy is effective, and ensure there's less time and money wasted on products which have been comprehensively demonstrated to be ineffective.

Alan Henness went on to say:

Manufacturers of homeopathic products are being put under increasing pressure by regulators to abide by the same rules that other advertisers have to abide by. While anyone is free to make their own healthcare decisions, they must be given full and impartial information about those choices. Misleading information can be dangerous and must be challenged.

Notes

  1. The MHRA stated:
  2. The Advertising Standards Unit has recently taken action in response to a complaint from a member of the public about specific advertisements in Boots stores.  The complainant was concerned that the advertisements included indications for use but the products were not licensed with indications.  The MHRA upheld the complaint.  Boots withdrew the advertisements from their stores.
  3. The Nightingale Collaboration was set up to challenge misleading claims in healthcare advertising and to encourage anyone who is concerned at protecting the public from misinformation in healthcare promotion to join them in challenging it.
  4. The Medicines and Healthcare products Regulatory Agency (MHRA) is the government agency that is responsible for ensuring that medicines and medical devices work, and are acceptably safe. The MHRA is an executive agency of the Department of Health.
  5. Boots have over 2,000 pharmacies in the UK.
  6. The MHRA state:
  7. The Simplified Scheme

    In 1992 Directive 92/73/EC introduced a Simplified Scheme for homeopathic products. It is regarded as simplified because although the safety and quality of products has to be demonstrated, products are not permitted to make medical claims. The Scheme is restricted to products for oral and external use and does not allow indications (the descriptions of diseases or conditions for which the medicine is intended to be used). In order to qualify for registration the products must:

    • be for oral or external use - this includes all methods of administration with the exception of injections

    • be sufficiently dilute to guarantee their safety

    • make no therapeutic claims.

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