Out with the old…
When I submitted my complaints about claims made on chiropractic websites in June 2008, a fundamental requirement regulating what chiropractors could claim — firmly embedded in their Code of Practice — was that they only advertise consistent with guidance issued by the Advertising Standards Authority (ASA).
Chiropractors must justify public trust and confidence by being honest and trustworthy.
C1 Chiropractors must act with integrity and never abuse their professional standing.
C1.6 may publicise their practices or permit another person to do so consistent with the law and the guidance issued by the Advertising Standards Authority. If chiropractors, or others on their behalf, do publicise, the information used must be factual and verifiable. The information must not be misleading or inaccurate in any way. It must not, in any way, abuse the trust of members of the public nor exploit their lack of experience or knowledge about either health or chiropractic matters. It must not put pressure on people to use chiropractic.29
29 For example, by arousing ill-founded fear for their future health.
This clearly mandates chiropractors to ensure any advertising complies with ASA guidance, remembering that ASA guidance includes the CAP Code, other guidance and their adjudications.
In prosecuting my complaints, the GCC inexplicably forgot all about the requirement to be consistent with ASA guidance and came up with some arbitrary standard of evidence for compliance. The Professional Conduct Committee begged to differ even with that and effectively allowed any old evidence to be used to substantiate chiropractors’ claims. To understand the whole story, see Humpty Dumpty regulation.
…and in with the new
In a process that took a while (as these things do), that CoP was re-written after a consultation and a new Code of Practice came into force on 30 June 2010.
The GCC sent out their consultation on this document in September 2008, some nine months before my complaints.
Although many of the words were the same, the new version was structured differently. In previous versions, it was clear everything in the document had to be complied with (even if that has not been entirely clear to some), but the 2010 version was split into columns, with the left column headed ‘Standards’ and the right, ‘Guidance’. The new version explains:
Achieving the requirements set out in the Code of Practice and the Standard of Proficiency will deliver a standard of chiropractic care that will promote patient health and wellbeing, and protect patients from harm. These requirements are laid out in the left-hand column in the following pages.
The right-hand column gives guidance and advice to help chiropractors meet these requirements and provides links to further information, including details on where the content of further legislation can be found. The guidance is not exhaustive.
Chiropractors must keep to all the standards within the Code of Practice and the Standard of Proficiency, including complying with all related legislation.
There is no further information given as to whether compliance with the ‘guidance and advice’ of the right-hand column is mandatory or whether a chiropractor can choose to completely ignore it.
The relevant clause in the June 2010 CoP is now clause C4, which says:
So, the requirement to follow the law and ASA guidance has been relegated to ‘Guidance’ instead of ‘Standards’ and it would appear that chiropractors can ignore that ‘Guidance’ and the pesky ASA guidance.
…and in with the new new
But it looks as if even this was too much for chiropractors.
Yet another new version of the CoP appeared on the GCC’s website on 22 December 2010.
It’s difficult to tell that it’s different because it’s got the same title, same file name (COPSOP_2010.pdf) same implementation date in bold letters on the front cover and exactly the same ISBN number. No hint that anything had changed. Just what you’d want to do if you didn’t really want anyone to notice what you were up to. But the metadata in the pdf shows it was modified on 20 December.
Surprise, surprise: clause C4 has changed:
The words that have magically disappeared from the ‘Guidance’ are:
You can advertise your practice, and allow someone else to do so, as long as you follow the law and guidance issued by the Advertising Standards Authority.
British Code of Advertising, Sales Promotion and Direct Marketing, Advertising Standards Authority, 4 March 2003 www.asa.org.uk/cap/codes/cap_code
So now chiropractors don’t even have the ASA’s guidance to help them when they try to decide what they can and can’t advertise.
I wonder what forced them to change their minds (again) and delete the guidance?
Saving the day
Just as well there is other GCC guidance to help them decide what they can and can’t claim in any advertising, including websites:
You are urged in the strongest terms to use the report and its evidence summary tables to review the content of your printed advertisements, practice leaflets and any website that publicises your practice, to ensure compliance with section C4 of the GCC’s Code of Practice and Standard of Proficiency: effective from 30 June 2010, the relevant law and guidance issued by the Committee of Advertising Practice (CAP) – the sister organisation of the Advertising Standards Authority.
You are urged in the strongest terms to use the report and the tables to review the content of your printed advertisements, practice leaflets and any website that publicises your practice, to ensure compliance with section C1.6 [sic] of the GCC’s Code of Practice, the relevant law and guidance issued by the Committee of Advertising Practice (CAP) – the sister organisation of the Advertising Standards Authority.
So although no longer mentioned in the CoP, ignoring ASA guidance doesn’t look like the sensible option.
A few months ago, the ASA changed their guidance on what advertising claims they would allow for chiropractic. This will be the subject of my next blog post, but the new ASA guidance can be found here (free registration required).
But just in case anyone thinks that the job is done and that no chiropractor would now openly advertise claims about conditions not supported by robust evidence should have a look at the results returned by even simple web searches for colic, ADHD, asthma, cerebral palsy, bedwetting and ear infections.
It looks like there is more that needs to be done if the public are to be protected from misleading claims.
Fortunately, it all changed on 1st March…