Taking the strain
But there is an occasional interesting item or two.
The ASA Committee of Advertising Practice (CAP) – the debate goes on
The latest issue we’ve flagged up to the team at CAP relates to claims to treat minor sports injuries.
Its AdviceOnline in respect of osteopathy and physiotherapy states that CAP has accepted that they may claim to help minor sports injuries, but there is no mention of this for chiropractic. In respect of physiotherapy, CAP goes on to state that
“At the present time, CAP is unlikely to ask to see evidence for the treatment of minor conditions.”
We’ve asked CAP to confirm that it would take the same approach to any claims made by chiropractors about minor sports injuries. As ever, we’ll keep the profession in touch with progress.
We have the situation where the GCC — the statutory regulator for chiropractors, who frequently claim to be a primary health-care profession — is asking the ASA — the voluntary advertising regulator, funded through a levy on advertising spend — to add minor sports injuries back onto their list so their registered chiropractors can make claims about it!
Let’s see if we can help answer the GCC’s query.
- Back Pain
- Neck/Shoulder Pain
- Road Traffic Injuries
- Sports Injuries
Among others, sports injuries are mentioned as one of the ‘conditions’ this chiropractor treated. But some of the others are also interesting.
After having considered the Bronfort report last year, the ASA revised their guidance on chiropractic, effective from 1 September 2010. The full guidance is on the ASA’s Copy Advice website as Therapies: Chiropractic (free registration required).
To date, CAP accepts that chiropractors may claim to treat these conditions: (NB: this advice was updated following a review of evidence conducted in September 2010):
- Joint pains including hip and knee pain from osteoarthritis as an adjunct to core OA treatments and exercise
Chiropractors may also refer to general aches and pains including those of joints, muscle spasms and cramp
- General, acute and chronic backache, back pain (not arising from injury or accident), including Lumbago
- Uncomplicated mechanical neck pain (as opposed to neck pain following injury e.g. whiplash)
- Headache arising from the neck (i.e. cervicogenic)
- Frozen shoulder, shoulder or elbow pain, or tennis elbow arising from associated musculoskeletal conditions of the back and neck, but not isolated occurrences
- Prevention of migraine
- Tension and inability to relax (through lifestyle advice rather than chiropractic care)
In line with the review of evidence conducted in September 2010, chiropractors are advised to avoid referencing the following conditions unless they hold suitable evidence.
- Rheumatoid pain, rheumatism and neuralgia
- Peripheral joint/ muscle/ nerve complaints e.g. repetitive strain injury
Some of these are interesting, particularly the restrictions (my bold) and I may return to them in a future blog post.
No mention of sports injuries, minor or otherwise.
How does the Islington Chiropractic Clinic claims fit in with this list?
Not much, it would appear.
I submitted a complaint to the ASA.
The ASA were originally going to conduct a formal investigation that would have resulted in an adjudication being published on their website, but the ASA then told me that the advertisers:
…have given us an assurance that they will remove the claims from their advertising and ensure in future that their ads comply with the relevant guidance set out in the CAP Code Advice document ‘Therapies: Chiropractic’.
…and they closed the case. All that appeared on the ASA’s website was a mention for the advertiser under Informally Resolved Cases on 16 February this year.
It’s good to get the assurance that they would abide by the ASA guidance in future.
In the 10 February 2011 issue of the same local free paper, they had a new ad:
- Lower back pain
- Neck pain
- Headache/Prevention of Migraine
- Neck related Headaches & Dizziness
- Shoulder, Elbow & Wrist Pain
- Hip, Knee & Ankle Pain
- Minor Sports Injuries
This might be closer to the ASA’s guidance, but it’s not quite there yet.
I complained again, noting the conditions not listed in the ASA’s guidance.
The ASA told me:
…with a view to acting quickly, we have instructed Islington Chiropractic Clinic to change the ad. We have asked them to remove from their ads, any claims relating to migraines, dizziness, wrist pain, ankle pain & minor sports injuries.
The advertiser’s name appeared a second time on the ASA’s website on 23 March as another Informally Resolved Case.
And the answer is…
The Investigating Committee noted the reference to: disc problems; shoulder, arm, wrist and hand problems; sports injuries; and leg, knee, ankle and foot problems. It concluded that such terms are broad in nature and the [web] pages provided do not enable the Committee to understand what is covered by the use of these terms. The Committee accepted that due to the generic nature of the terms, it is unlikely that randomised controlled trials will have been conducted that address them.
Note the mention of ‘sports injuries’.
Even though the IC couldn’t understand what it meant, they still thought it unlikely there was any robust evidence for treatment by chiropractors.
However, including ‘sports injuries’ in an advert is a clear claim to be able to treat, well, ‘sports injuries’ and if it’s too broad a term for even their statutory regulator to understand what is meant, then perhaps chiropractors shouldn’t be claiming they can treat sports injuries with chiropractic (cached)?
But the ASA seem clear about it: ‘minor sports injuries’ was removed last year from the the list of conditions they allow chiropractors to make; ‘sports injuries’ doesn’t appear at all and they have now asked at least one advertiser to remove ‘minor sports injuries’ from their advert.
When they asked the ASA, I hope the GCC was able to tell them exactly what they meant by ‘minor sports injuries — they certainly didn’t know last year when they were dealing with my complaints.
But perhaps we already know the ASA’s answer.