The random thoughts of a sceptical activist

Another ASA win against quackery

I’ve had another victory against woo.

The Advertising Standards Authority have today published their adjudication on complaints I submitted against an ayurvedic clinic, Kerala Ayurvedic Health Clinic. This is a clinic that advertised in a local paper and made claims about the effectiveness of their ayurvedic treatments. In total, I made four specific complaints and the ASA added a fifth; three were upheld. The full adjudication can be read here.

Many of these clinics selling woo make claims that they can treat all manner of medical conditions and invariably, they cannot substantiate those claims when they are challenged. Such adverts also try to give the impression that they are proper doctors and medical practitioners, again, usually without being able to substantiate those claims.

I’ve already blogged about the ASA’s Code of Advertising Practice (CAP) and how they apply to quackery, particularly paragraph 50.1:

Substantiation will be assessed by the ASA on the basis of the available scientific knowledge.

When an advertiser is called to substantiate claims they have made, there is a standard of evidence that is required by the ASA and this standard is almost always far too high for woo advertisers to reach. They frequently cite magazine articles, customer testimonials and customer satisfaction surveys as their best ‘evidence’. This doesn’t even come close.

It goes almost without saying that my complaint that:

I doubt they could substantiate the claim that their Ayurvedic treatments are effective for any of the claimed conditions.

was going to be upheld.

The Kerala clinic advert had a list of medical conditions, each preceded by a tick mark:

✓frozen shoulder
✓digestive disorders
✓high blood pressure
✓pulled muscles
✓high cholesterol
✓trapped nerve
✓paralytic conditions
✓certain skin conditions
✓stress and strain
✓back pain
✓whiplash
✓obesity
✓joint pain
✓arthritis
✓diabetes
✓sleeplessness
✓stiffness
✓migraine

This clearly implies that the clinic could treat these medical conditions.

In this case, the advertiser tried the magazine article route of substantiation, but also supplied a list of clinical trials. The latter is at least a step in the right direction. But the ASA were having none of it. In their own words:

The Advertising Standards Authority regulates the content of advertisements, sales promotions and direct marketing in the UK.

We make sure standards are kept high by applying the advertising standards codes.

We can stop misleading, harmful or offensive advertising.

They are there to protect the public from bogus claims and they dismissed the list of trials, magazine articles and the one trial submitted as substantiation, saying that they had not seen ‘controlled clinical trials that would allow for a possible placebo effect’. The clinic automatically loses on that point. It’s good to see that the ASA requires such a reasonable level of substantiation.

The advertiser also pointed the ASA to the World Health Organization (WHO), claiming that ayurveda was ‘recognised by the WHO’. However, the ASA noted that WHO say:

Scientific evidence from tests done to evaluate the safety and effectiveness of traditional medicine products and practices is limited. While evidence shows that acupuncture, some herbal medicines and some manual therapies (e.g. massage) are effective for specific conditions, further study of products and practices is needed.

The ASA therefore rejected the clinic’s ‘evidence’ for the efficacy of their treatments, saying:

Because we had not seen evidence to show that they [could treat those conditions], we concluded that the ad was likely to mislead.

It is enough to list medical conditions, leading the average reader to take the (intended) implication that the advertisers treatment could help/heal/cure these conditions. It matters not one jot that the advert didn’t explicitly say something like “we can cure the following conditions…”. It is also clear that by ‘treat’ they mean that there would be some significant effect on a condition, not just some woolly ‘feeling a bit better’ kind of ‘treat’.

This reinforces what I said last week about claims not needing to be explicit: the mere mention of medical conditions is enough to mislead the public.

It’s simple: you make a claim that someone challenges, you are expected to supply good quality evidence to substantiate your claim. If you don’t, then you are misleading the public and automatically lose. Not a difficult concept to understand or to understand why it has to be that way.

Being a registered physician

Another point I complained about was the clinic’s use of the phrase ‘Qualified and registered Ayurvedic physicians’:

I am not aware that there are any registration bodies, statutory or otherwise, in the UK, so this claim may lead some to understand that the Kerala Ayurvedic Health Clinic practitioners are registered with a regulatory body that guarantees the quality and effectiveness of the treatments, perhaps with a code of practice.

This claim also says their practitioners are ‘physicians’, which will be understood by many to mean that they are medically qualified and GMC registered doctors. Since I doubt their practitioners are medically qualified or GMC registered doctors, this claim is misleading and I doubt they could substantiate it.

The ASA noted that the advertisers did not use the word ‘physician’ in isolation but only in conjunction with the modifier ‘ayurvedic’, but nevertheless agreed with me that readers would be likely to infer that the clinic employed properly qualified medical practitioners, therefore that claim was misleading. Another win.

This was about claiming to be a physician, but exactly the same applies to someone claiming to be a doctor (see the adjudications I discussed in this post: What the ASA have to say about chiroquacktic).

They did not uphold my third complaint about their use of ‘registered’. The sole practitioner at Kerala claimed to be registered with the British Register of Complementary Practitioners (BRCP), but I cannot find him on their public register. However, it appears that the ASA have had sight of a BRCP certificate and were satisfied. I have contested this: he is not currently on the register and, as far as I’m aware, was not at the time the advert was published. The ASA told me that “he is in the process of renewing his insurance and will reappear as a registered practitioner once that has been obtained”. However, the position still is that the advertiser is not on the public BRCP register. I cannot understand the ASA’s position on this: if he was not on the BRCP’s register at the time of publication, then he was making a false claim. It could be that the certificate supplied to the ASA showed that he was, indeed, registered at that time, but the ASA have not been clear on this and I have not seen the certificate myself.

However, like OfQuack and other voluntary registers, the BRCP is voluntary and there is therefore no statutory requirement to be registered. (This’ll be the subject of a future blog post.) Statutory registrars like the GCC, although they give an undeserved legitimacy to woo and its members, at least it has a decent Code of Practice and one that appears to be properly and legally enforced.

But, although I know nothing about the BRCP and how they deal with complaints, we know that other voluntary registers haven’t exactly been diligent in dealing with serious complaints against their members.

If I get a response from the ASA to my last email to them about whether the Kerala practitioner was, in fact, registered with the BRCP, I’ll update this post. I’ll also be checking the BRCP register regularly.

Because of the reference to physicians, a copy of the adjudication has been sent to the Royal College of Physicians for their information.

Individualised treatments

The ASA did not uphold my fourth complaint about their claim that their treatments are ‘designed around your individual health needs’. I argued that since they were not properly qualified medical practitioners, they were not qualified to make any judgement about a customer’s health needs and therefore couldn’t design treatments around their needs. The ASA disagreed with my interpretation.

Serious medical conditions

The final complaint upheld was one they raised, but one I also raised — I have no idea why they made it their own. I said:

The advert gives a list of 18 medical conditions, some of which are serious medical conditions and I doubt they could substantiate the efficacy of their treatments for any of these conditions.

I believe that the claims made and the overall tone of the advert will lead many to understand that their treatments are medically effective and proven and may dissuade or delay a reader from seeking proper medical advice and treatment.

The ASA said:

The ASA challenged whether the ad breached the Code, because it could discourage readers from seeking treatment of serious medical conditions, such as high blood pressure, obesity and whiplash, by medically qualified practitioners.

Slightly different, but close!

The ASA ruled that, since the clinic did not employ health professionals that were suitably qualified to treat these conditions, customers could be discouraged from seeking proper medical advice. Upheld.

Summary

The advertiser did what I’ve seen many others do: make medical claims they just could not substantiate. Whether or not the advertiser believed he could treat the conditions he listed, I have no idea. Nor can I; it is impossible for me to know whether he was being deliberately dishonest in happily promoting what, in effect, the ASA have ruled to be bogus treatments.

However, a few minutes’ research would have made him realise that he was just not allowed to make such claims unless he held proper, quality evidence to back up those claims. He may also have found out that ayurvedic is considered ‘alternative’ in the UK for good reasons — there is no good evidence to support its use.

Perhaps he could have had an excuse: he is one man in a clinic. However, there is no excuse for large organisations who should be well aware of all the rules they or their members have to abide by and should be aware of all the contrary evidence…and be able to discriminate good evidence from poor evidence. Unless they are incompetent, that is.

4 Responses to Another ASA win against quackery

  • And a soft tap on the wrist to Kerala Ayurvedic Health Clinic from the ASA paper tiger – "The ad must not appear again in its current form". This only has teeth if there is some other code enforcing it, such as the GCC apparently requiring chiropractors to conform to ASA requirements. Does the BRCP have this sort of rule?

    It does seem extraordinary that someone who is not insured, and therefore not eligible for registration with the BRCP, can get away with claiming to be registered and the ASA don't object.

  • Very nice work. Keep it up.

  • Well done sir, one dragon slain, 999 more to go!

    (Well, maybe not slain, but it was coughing up blood last night.
    Better send it to a veterinary draco-homœpathist!**)

    ________
    Don't laugh:-
    There could well be such an outrageous woo-wrangler out there.

  • Obesity….a 'medical condition'?!…or an over-eating problem?
    Just a thought BUT,…
    wouldn't using the same criteria of required 'proof' put claims made for many mainstream treatments,medications, vaccination efficacy, antivirals,or even safety and efficacy of various body lotions, potions and sunscreens, at serious risk? especially since most research is conducted by vested interests and is often flawed in content, method or conclusion, or 'cherry picked'.

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