Having recently read through the ASA’s 2011 annual report it soon becomes clear just how much work this organisation does in ensuring that the advertising seen by the public is Legal, Decent, Honest & Truthful.
However I am also reminded that in some sectors there is still much work to be done!
In particular online advertising by Complementary & Alternative health practitioners is still very problematic when it really shouldn’t be, the rules are quite clear. On 1st March 2011 the remit of the Advertising Standards Authority was extended to cover:
1. Advertisers’ own marketing messages on their own websites.
2. Marketing communications in other non-paid-for space under the advertiser’s control, such as social networking sites like Facebook and Twitter.
3. Marketing communications on all UK websites, regardless of sector, type of businesses or size of organisation.
This isn’t news, it happened over 17 months ago and there was plenty of prior notice that these changes were being implemented. The ASA’s recent 2011 annual report (published 30 May 2012) shows they have been very busy enforcing this new area of their remit, as this tweet from 30 May 2012 says:
2011: our online remit extension contributed to a 71% increase in cases overall. We dealt with 7,195 online remit complaints about 6,631 ads
— ASA (@ASA_UK) May 30, 2012
So perhaps it’s worth asking why we still have a large number of websites, twitter accounts and Facebook pages where CAM therapists feel it is acceptable to publish misleading claims.
I don’t believe the problem lies with the ASA, they are a relatively small organisation having to regulate a huge amount of advertising on a variety of media formats. I do believe the problems lie with the CAM therapist and also with a number or trade bodies and CAM regulatory organisations.
From my own experience the CAM therapists responsible for these lingering claims seem to fall into 3 broad categories. The Don’t Knows, the Don’t Understand and the Don’t Cares.
The Don’t Knows. It is difficult to see how any CAM practitioner who uses the internet could fail to be aware of the rules, however I’ll accept that there may still be some. Well if you are reading this I can only suggest you follow this link to the ASA’s website and do a little reading: http://www.asa.org.uk/ This should be enough for you to realise that there are some regulations you need to be aware of. At this point you may find that you move from being a ‘Don’t Know’ to a ‘Don’t Understand’ ….. If so, read on!
The Don’t Understands. There will be some who claim that they don’t fully understand what they are allowed or not allowed to say. To those people I can only suggest they take another look at the easy to understand, free advertising guidance issued on the ASA & CAP websites, it is quite clear on what is and is not permitted.
A quick visit to the CopyAdvice website http://www.copyadvice.org.uk/ should give you all you need to ensure your advertising and website complies with the regulations. At very least you will see that:
All ads in the UK, wherever they appear, must be legal, decent, honest and truthful in line with the UK Code of Advertising, Sales Promotion and Direct Marketing (The CAP Code). The Copy Advice service is here to help you avoid breaking the rules and potential action by the Advertising Standards Authority by giving you free advice on your non-broadcast marketing communications before they are launched.
The second part of that paragraph is important. You can contact the Copy Advice service and they will give you free advice on how NOT to break the rules. There are a number of industry specific guides, including rules for the ‘health & beauty’ sector and there are a number of clearly written guides for some specific therapies.
One common cry from the CAM practitioners who perhaps don’t understand the rules is that they don’t specifically claim to ‘cure’ a particular condition. What needs to be remembered is that the ASA look at any claim from the perspective of a member of the general public, not the therapist. Even listing medical conditions alongside your therapy could be seen as implying some form of benefit from treatment:
Guidance on Health Therapies & Evidence:
“4. I don’t claim to ‘cure’, why can’t I claim to ‘treat’ certain conditions?
Whether you use the words ‘treatment’, ‘treat’ or ‘cure’, all are likely to be seen by members of the public as claims to alleviate effectively a condition or symptom. We would advise that they are not used either directly or indirectly, through the use of visuals for example. Of course, if evidence has been shown to support the claims, then these words can legitimately be used.
Marketers should be mindful that merely listing medical conditions could imply their treatment or therapy is effective”
But there are claims you can make, even the ASA’s general guidance for therapies (Therapies: General) lists a number of conditions for which claims may be made: (I’ve highlighted the bit about evidence, just in case you were tempted to overlook it!)
“Examples of ailments that may be referred to in marketing communications (subject to the marketer being able to prove the efficacy of the product or therapy) include: arthritic pain, IBS, neck ache, feeling down and temporary erectile dysfunction.”
More importantly there are a number of specific conditions for which you cannot make claims. Remember you are responsible for the content of your advertising and if you want to avoid being the subject of an ASA complaint, you really should make yourself aware of the ones that apply to your particular form of therapy.
Finally we have the worst of the bunch …….
The Don’t Cares. These are the ones who are aware of the rules and what they are permitted to advertise, but believe that the rules don’t, or more correctly shouldn’t, apply to them! They are Wrong!
It really doesn’t matter if you are a homeopath, osteopath, craniosacral therapist, chiropractor or any other type of therapist. The list at the top of this post shows (item 3) that the ASA’s remit applies to everybody regardless of whatever industry you are in …… but those in the ‘Don’t Care’ category already know this!
What all these therapists need to remember is that when it comes to evidence, you are not a ‘special case’, no amount of special pleading will lower the standards required nor will it remove your obligation to comply with the regulations. If your evidence isn’t up to the required standard, then you are unlikely to be allowed to make the claims and if you continue to do so then you leave yourself vulnerable to complaints.
Sadly there are a large number of therapists in this group who are in professions that have some form of statutory or voluntary regulation. Any type of regulation or membership of a trade body usually comes with an obligation to practice in accordance with some form of Code of Practice, Conduct or Ethics. The majority of these codes contain rules or guidance on advertising, even if this is missing (or has been deliberately removed, as was the case with the General Chiropractic Council), this does not mean that you are exempt from the ASA regulations.
Since the changes to the ASA’s remit, most of these organisations have issued their own advertising guidance or advice, so those still making claims are now in a situation where they are breaking the ASA/CAP codes as well as their own professional Codes.
In most cases it also means that the various regulators are failing to ensure their members comply with their own codes of practice or conduct, something that I’ve already looked at and will be coming back to in the near future. Organisations like the General Chiropractic Council and the General Osteopathic Council have certainly issued guidance, they have also made some limited attempts to view members websites and offer advice on CAP compliance as and where needed.
So you would assume that any remaining claims would be difficult to find, or the regulators would have taken some action to remove them. However many of their members continue to make unsubstantiated claims.
It would be better all round if these were voluntarily removed by the therapists concerned ….. but there are always other methods!
Richard Lanigan
June 8, 2012
Hi SB,
hope you are well. I would have to say i would come under the category “dont care” about the ASA. I have asked them who their “experts” and they refuse t tell me so I could care less what they have to say and they are funded by advertisers. In the UK if you make misleading claims and riping off people, Trading Standards are there to protect consumers. The ASA is a bit like the Press Complaints body, who sound important but what they say does not matter and they have no powers of enforcement. Another board of selfrighteous suits
skepticbarista
June 9, 2012
Hi Richard,
I’m fine thanks, hope you are doing good.
I’m not sure how much of a ‘Don’t Care’ you really are …. are you more of a ‘Don’t Like
Typically the don’t cares are ones who continue to make claims, despite knowing the rules and will avoid making changes until actually challenged by the ASA. A small number will argue against the ASA’s decisions, but the vast majority will eventually (and often reluctantly) make the required changes…..
There are however a large number of CAM therapists who could be described as ‘Don’t Likes’ – those who dislike the restrictions that the advertising regulations place upon them but avoid making direct claims (or have removed claims) that their particular therapy may cure/treat a specific condition.
There are quite a few CAM websites with some form of disclaimer along the lines of “the ASA prevent me from saying ….”. Often they will hint at benefits and link ‘off-site’ to sources of information in an attempt to avoid any possible consequences of ASA action.
As for any powers of ‘enforcement’ – As you rightly say it is Trading Standards who are best placed to take action against misleading claims and the ASA can refer those who refuse to comply to the Office of Fair Trading. As far as I am aware this is the ASA’s least preferred option, other routes usually suffice: http://www.asa.org.uk/Asa-Action/Sanctions.aspx
As for how effective the ASA are you only have to look at their adjudications page to see that they do get results!
Liam Mulvany
June 9, 2012
Hi Richard and Al, I beleive the ones that “don’t care” actually don’t care for the asa or their patients, its about making money. There are some but they are in the minority. If you care about your patients and have a level of evidence that supports your web claim, ie anecdotes or case studies then why should you be restricted from saying that? I also think that you and others like you (no disrespect) place too much weight on the internet or other advertising. I have been using a 0800 number for years for any advertising, yellow pages etc and I can tell you it represents a very small percentage of people that come along. I did though, about a year ago ask patients to start to leave reviews on google as a bit of a social experiment. type in leicester chiropractor in google to see the results. I have had few new patients from this over the year, though as I tend to see 1 or 2 new patients a day it is a small percentage of new patients. I do think it shows that anecdote, whether its trip advisor or google review carries some weight.
I think I remember the singh case not being published on some sites because of the legal implications, funny how some skeptics thought it OK to save the published words and display them on web sites outside the UK, even though the law had restricted them from being on uk sites!! I’m not defending the BCA it’s just that sometimes things should be published on the web but they are restricted by some people because they believe statement or claims to be wrong. Wether they are or not can be a matter of opinion.
skepticbarista
June 10, 2012
Liam,
“If you care about your patients and have a level of evidence that supports your web claim, ie anecdotes or case studies then why should you be restricted from saying that?”
The problem is that you only have a level of evidence that supports your web claims, if it is YOU who sets the standard required …… and it isn’t!
There are regulations, rules and laws that that we all have to comply with and for each set of rules there are people responsible for setting and enforcing those rules. This may be the ASA, Trading Standards, regulators, professional/trade bodies or even the Courts.
The thing is that you don’t get to decide on which ones apply to your business or not.
If you have issues with the restrictions in place, then you are free to contact the relevant organisation and seek to get things changed.
But until any rules are changed they apply to everyone ……. you are not a special case, your profession is not a special case, CAM in general is not a special case!
I have seen figures published by various regulators that support your view that web advertising only accounts for a small percentage of new customers. So abiding by the rules shouldn’t be such a big issue!
Oh and as for a Google search on ‘Leicester chiropractor’ ….. Being fairly local to Leicester I’ve run that search a few times, the results I get now are far different from those I got a couple of years ago
Andy Lewis (@lecanardnoir)
June 9, 2012
Just to be clear Liam, In publishing Simon Singh’s article, I did not believe I was breaking the law. The real fear is that the law makes you a loser even if you win the case. Simon was not found guilty of libel, but was still out of pocket to a large sum. (The BCA was in a much worse position).
As for the ASA being “selfrighteous suits”, almost all industries (bar the odd Irish airline or online voucher site) respect the ASA and are happy to subscribe and be part of the voluntary regulation mechanism. What is it about alt med that makes them feel oh so very special here?
Liam Mulvany
June 11, 2012
Al, I know there are rules and levels of evidence, but who dictates the levels required? Richard asked “who was the expert” and they refused to provide the name of said expert. As for levels of evidence I’m not relating it to my business just sacketts ideas of evidence. Should every piece of advertising be restricted to Gold standard levels? If so those massive ad campaigns that state 80 out of 112 agree are farcical.
Andy,” In publishing Simon Singh’s article, I did not believe I was breaking the law.” that is what the hundreds of chiropractors said about their websites. Any real difference? Goose and gander?
To you both, alt or CAM is no different to any other form of busines that advertises, I agree there has to be protection for the public, I think what is causing such consternation here is that the levels of evidence required for cam seems far higher than almost any other form of advertising and the level has been set by experts that can be neither seen, identified or questioned.
skepticbarista
June 13, 2012
Liam,
Claiming something like 8 out of 10 cats prefer ‘Cat Chow’ is hardly the same as saying that a particular healthcare therapy is an effective treatment for a medical condition.
I fully appreciate that you and/or others don’t like or agree with the ASA/CAP regulations, however as we know they apply to all advertisers & that means all CAM therapists …..all chiropractors ……. and you!
As a registered chiropractor there are rules & regulations that come with the use of that title that you must comply with. So ……….
a. Do you AGREE all the rules the GCC require you to adhere to ?
b. Do you COMPLY with all those rules ?
I’m sure many chiros would answer a. = No & b. = Yes. I doubt many would argue that the GCC’s rules shouldn’t apply to them.
Skepticat
June 12, 2012
‘They withold the name of their expert’ has to be the lamest excuse ever for not abiding by an advertising code that was written to reflect EU Law and to protect consumers. Given altmed practitioner’s long-established convention of responding to critics by attacking the person on any grounds possible – no matter how absurd or trifling – in order to divert attention away from the lack of evidence supporting quack therapies, the ASA are justified in keeping the names of consultants confidential. They want to hang on to them.
The level of evidence required to support any given claim is decided by the ASA and if RCTs are the only way to properly assess whether any particular treatment is efficacious for any given condition, then that is what the ASA will demand and quite right too. Which healthcare treatment promotes itself with a “80 out of 112 agree” type campaign?
The difference between Andy’s belief that he was not breaking the law and that same belief by chiropractors is that Andy’s was an informed belief which, as it turns out, proved to be correct.
The level of evidence required for CAM certainly isn’t “far higher than almost any other form of advertising”; that it should seem that way to you is merely a reflection of your own personal investment in it. You are evidently unable to see it from another perspective.
Richard Lanigan
June 13, 2012
“The level of evidence required to support any given claim is decided by the ASA and if RCTs are the only way to properly assess whether any particular treatment is efficacious for any given condition, then that is what the ASA will demand and quite right too.”
Skepticat your above statement highlights a lack of understanding of what David Sackett described as Evidence Based Medicine and it might be worth your while reading up on EBM, because if RCTs are the “only way” for assessing treatments, it could be an innovative way of reducing NHS waiting lists for treatment. Are you one of the “experts” the ASA use to tell me what I can “claim”, because i am not impressed and will not be acting on your advice and there is nothing you or the ASA can do about it.
For a number of years now skeptics have told me I was deluded for thinking I could palpate spinal subluxations. Then about six weeks ago I stopped working because I could no longer feel these spinal subluxations, however a neuroligist has pointed out than I am not deluded, I have a peripheral nuropathy as a result of six months of chemotherapy and I can no longer feel motion in spinal joints. If ever there was an unscientific intervention its chemotherapy, which “may” improve my five year survival by only 15%, the truth is I have a peripheral nuropathy and no one knows if I have received any benefit from the chemo treatment, odds were 50/50 without chemo.
Any person who presented at my clinic would get better odds than a best estimate of 15% improvement, Hopefully one day I will get the feeling back in my hands and i can return to providing spinal care for satisfied clients. No one forces people to come into my clinic, they come in the hope that they will benefit from spinal care and I provide this service, Ernst et al try to convince them otherwise, but it would appear, I am able to make a more convincing argument for the importance of maintaining spinal joint motion. I have told Simon Singh, Ernst, Andy Lewis and other skeptics, that I am more than happy to be challenged on a public platform or a skeptic in the pub get together on my knowledge of anatomy, physiology and its relationship to chiropractic, none of them would appear interested, so we will just have to agree to disagree on the benefits of maintaining spinal joint function.
skepticbarista
June 13, 2012
Funny how one thing can lead to another ……..
Having a quick look at Liam’s website led me to the website of the Eastgate Complementary Health Centre in Leicester. Here I found a familiar name, one of Liam’s collegues at the clinic … Craniosacral therapist, Pat Hughes.
It was a craniosacral leaflet distributed by Pat Hughes that resulted in this ASA adjudication
Along with a few other CST complaints & blog posts http://skepticbarista.wordpress.com/category/craniosacral/
She also has an informally resolved complaint against one of her own leaflets from 30 March 2011 http://www.asa.org.uk/ASA-action/Adjudications.aspx?SearchTerms=hughes#2
Strange then that Pat Hughes website is still listing a number of ‘Conditions Treated’ for which there is no good evidence: Pat Hughes – Dynamic Treatments Some of these are also listed on the Eastgate website.
Liam may want to give them a nudge to tell them that these claims are now in the hands of the ASA!
skepticbarista
June 20, 2012
Here’s a tip. Practitioners at the Eastgate Complementary Health Centre might want to have a look their advertising claims. http://www.eastgatehealth.co.uk/therapies.htm The ASA compliance team will be visiting shortly to check out Pat Hughes craniosacral claims (Incl Cerebral Palsy) who know what else they will find!
Reiki, Homeopathy, Bowen, Herbal Medicine, Kinesiology, even a stray whiplash claim for chiropractic.
Skepticat
June 13, 2012
Richard, I’m afraid it is your own understanding of Sackett’s heirarchy of evidence that is at fault. You have somehow missed the crucial point that Sackett’s work is on the teaching and practice of EBM and the pyramid of evidence is intended to assist healthcare practitioners when making decisions about clinical interventions.
As Sackett himself said,
”Evidence-based medicine is not restricted to randomised trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions….If no randomised trial has been carried out for our patient’s predicament, we follow the trail to the next best external evidence and work from there.”
The ASA are not in the business of trying to help patients in their predicaments but of trying to protect consumers. The CAP is solely concerned with whether the claims made in advertising to the public are legal, decent, honest and truthful and it is up to the ASA to decide whether evidence submitted by advertisers is enough to support the claims made. For claims that a particular healthcare therapy can help or treat a particular condition, only the most robust evidence will do and this usually means reports of high quality clinical trials. If they settle for anything less than robust, independent evidence then they are not fulfilling their function of ensuring that adverts are truthful.
I’m not sure what relevance you think your anecdote about your peripheral nuropathy or your views about the need to “maintain spinal joint movement” has to this discussion.
Richard Lanigan
June 13, 2012
Hi Skepticat, you have read Sackett and do realise RCTs are not the only way to evaluate a treatment, so we are in agreement.
My anecdote merely illustrates the point that clinical science is very different from physical science. Much evidence is merely an aid to support a clinicians experience because it becomes dated very quickly. Every patient is different and responds differently to various treatments.No one promised to cure my cancer and I would never promise to cure anybody of anything, however peoples physiology works better if their joints function properly. Maintaining joint motion is the key and plenty of evidence to support that hypothesis.