Background
Summary of Council decision:
Two issues were investigated, both were Upheld.
Ad description
The headline of a national press ad, for a health resort, stated "Type 2 Diabetes? Put it in reverse!" The body of the ad stated:
"Recent Stories in the press may give the impression that reversal of Type 2 Diabetes is a new phenomenon, but scientific research to support this has been available for over 30 years.
The aim of any reversal programme is to help people to control their condition and, where possible, reduce or eliminate the need for medication. The Obsidian Programme run at Obsidian Retreat, nr Alicante, Spain has been carefully designed to follow proven methods. It is medically supervised and incorporates four aspects: Diet... Exercise... Education... Mindset".
The ad included a photo and case study of Stephen Outram, a 60-year-old diagnosed with Type 2 diabetes. Text stated:
"His diabetes was so out of control that he had been told he would need to begin taking insulin ... After following the Obsidian Programme ... his diabetes was totally under control without medication...".
Text beneath the photo stated "Stephen Outram with all the medication he won't be taking after a successful stay at Obsidian Retreat".
Issue
The complainant challenged whether the ad:
1. exaggerated the outcomes that consumers were likely to achieve as a result of attending the retreat; and
2. was irresponsible and might discourage essential treatment for a condition for which medical supervision should be sought.
Response
1. Obsidian Retreat (Obsidian) highlighted that the aim of the retreat was to show their clients that there was a different approach that they could take when managing their diabetes. They stated that their aim was not to reduce their clients' medication but that that was often a consequence of the diet they promoted during the programme.
They said a reversal of Type 2 diabetes could be defined as a reduction in an individual's blood glucose levels, a reduction in their medication, and in some cases an elimination of the need for medication. They highlighted that if any of those outcomes were achieved that did not mean that the individual in question was cured of Type 2 diabetes. They acknowledged that there was currently no cure for Type 2 diabetes.
Obsidian said until recently the charity Diabetes UK had not used the word "reversal" in relation to Type 2 diabetes, even though it was in common usage in the United States. They explained that that had changed in June 2011 when a small scale study undertaken by Newcastle University, funded by Diabetes UK, showed that Type 2 diabetes was reversible through diet. They stated that as a result of the study Diabetes UK had accepted that a change in diet could lead to a reversal of the symptoms of Type 2 diabetes.
Obsidian explained that at the retreat, the reversal of the condition was achieved by a high carbohydrate, high fibre, low fat, vegan diet. That diet was governed by four principles: no animal products, low fat, low glycaemic index and home-made fruit and vegetable juices. They said the diet did not require calorie restriction. They hoped the retreat would encourage participants to change their diet habits, but that if a participant, having left the retreat, decided to continue with their old lifestyle and previous diet, then they would not achieve the same results as if they remained compliant with the programme's diet.
They stated that in addition to the Newcastle University study there was significant research that showed that the type of diet used at the retreat, a high nutrient vegan diet, could reverse Type 2 diabetes. Those studies were submitted as part of Obsidian's response.
Obsidian provided the names and contact details for 13 individuals who had previously booked a place on the retreat, and explained that all of them were willing to provide testimonials if required. 11 of these individuals, including one woman who had previously taken insulin to control her blood glucose levels, had stopped their medication, after taking part in the programme and the remaining two had reduced their medication.
2. Obsidian highlighted that the hotel where they were based was relatively small, and that they did not solely offer retreats for individuals with diabetes. They therefore considered that at any one time, approximately 25% of their guests would be on some form of medication, which equated to six to ten people.
They explained that they employed a fully qualified, state registered nurse, who had trained and worked in the UK and New Zealand, as a full-time member of staff. They highlighted that whilst working in New Zealand she had specialised as a diabetes nurse and had taken a specific course focusing on the management of patients with diabetes. They explained that she was onsite at the retreat six days a week.
They also explained that they worked closely with a local GP who attended the retreat once a week to assess the files of all the clients that were on any form of medication. During her weekly visits she also delivered a talk to all the guests, before taking part in an open session where any guest could have a private appointment with her free of charge.
Obsidian stated that if a guest was on medication they would have an initial appointment with the nurse on arrival at the retreat. She also had a daily check-up with each guest with Type 2 diabetes to check their blood glucose levels.
They explained that if, as a result of the programme, a guest decided they wanted to reduce or stop taking their diabetes medication, an appointment would be made for them to discuss any changes with the doctor. They also stated that when a guest left the retreat they were given a letter to pass on to their own GP detailing the programme, and were encouraged to make an appointment as soon as possible on their return to discuss their future medication requirements.
Assessment
1. Upheld
The ASA understood that Type 2 diabetes was a progressive condition which often required treatment to be adjusted over time. We noted guidance on the NHS Choices website stated that "For many people who are diagnosed with type 2 diabetes, the first approach to treatment is to make lifestyle changes. These include taking regular exercise, eating healthily and losing weight if you are overweight or obese". They explained that those changes could keep an individual's blood glucose levels at a safe and healthy level.
We understood, however, that Type 2 diabetes got worse over time and that there could come a point when lifestyle changes were not sufficient to control blood glucose levels, hence an individual might have to take oral medication to lower their blood glucose levels, or eventually insulin to ensure greater control.
We understood that Obsidian had intended the word "reverse" to mean that an individual who stayed at the retreat and adhered to its high carbohydrate, high fibre, low fat vegan diet, both during and post their stay, could gain greater control of their blood glucose levels and potentially adjust their medication as a result. We considered, however, that readers would not understand what the term "reversal" meant when used in relation to diabetes, and noted that nowhere in the ad was the term explained.
We understood that the headline of the ad stated "Type 2 Diabetes? Put it in reverse!", and that a large portion of the ad was dedicated to the story of a particular guest who had attended the retreat, Stephen Outram. The text highlighted that prior to attending the retreat he had taken six different types of medication and that "his diabetes was so out of control that he had been told he would need to begin taking insulin". As a result of the retreat, the ad stated "… his diabetes was totally under control without medication", that he was "clear of all medication" and felt "reborn". We also understood that the ad did not advise a minimum length of time that a guest had to stay at the retreat for a "reversal" of their condition to be achieved and that it failed to mention that a guest would have to comply with the programme once they left the retreat to ensure any improvement in their blood glucose levels was maintained. We therefore considered that without any understanding of what the term "reverse" meant in relation to Type 2 diabetes, in the context of the ad, a consumer could interpret the claim "Type 2 Diabetes Put it in reverse!" to mean that the retreat offered an isolated treatment which could cure the condition.
We noted that lifestyle changes, such as an improved diet and increased exercise could improve an individual's control of Type 2 diabetes, and we considered that the retreat could motivate an individual to make such changes and improve their glycaemic control. We considered, however, that by using the words "reverse" and "reversal", the ad exaggerated the benefits that a guest could expect to achieve when attending the retreat, and could be interpreted to imply that an individual could be cured as a result of the taking part in the programme. We therefore concluded that the ad was misleading.
On that point, the ad breached CAP Code (Edition 12) rules
1.3
1.3
Marketing communications must be prepared with a sense of responsibility to consumers and to society.
(Responsible advertising),
3.1
3.1
Marketing communications must not materially mislead or be likely to do so.
(Misleading advertising),
12.1
12.1
Objective claims must be backed by evidence, if relevant consisting of trials conducted on people. Substantiation will be assessed on the basis of the available scientific knowledge.
Medicinal or medical claims and indications may be made for a medicinal product that is licensed by the MHRA, VMD or under the auspices of the EMA, or for a CE-marked medical device. A medicinal claim is a claim that a product or its constituent(s) can be used with a view to making a medical diagnosis or can treat or prevent disease, including an injury, ailment or adverse condition, whether of body or mind, in human beings.
Secondary medicinal claims made for cosmetic products as defined in the appropriate European legislation must be backed by evidence. These are limited to any preventative action of the product and may not include claims to treat disease.
and
12.6
12.6
Marketers should not falsely claim that a product is able to cure illness, dysfunction or malformations.
(Medicines, medical devices, health-related products and beauty products).
2. Upheld
The ASA noted that the retreat employed a nurse full time and that she had specialised as a diabetes nurse when working in New Zealand. We understood that any guests with Type 2 diabetes had an initial meeting with the nurse on arrival at the retreat and had a daily check-up with her to monitor their blood glucose levels. We also noted that the doctor assessed the records of all the clients at the retreat who were taking any form of medication and was available for consultation once a week if individuals had any particular queries or concerns. We understood that if an individual wished to adjust or withdraw from their medication whilst at the retreat, they would discuss that with the doctor prior to making any change. We therefore considered the advice and that any adjustments clients made to their treatment whilst at the retreat were conducted under the supervision of suitably qualified health professionals.
We were concerned, however, that the ad implied that the retreat offered a cure for Type 2 diabetes, a serious medical condition, and could therefore discourage consumers from seeking essential medical treatment. We considered that an individual who saw the ad and booked a place on the retreat believing that the condition could be "reversed" as a result, could decide to delay other treatment or avoid seeking further medical advice in the interim. Similarly, we considered that if an individual read the ad and about the possibility of reversing the condition through lifestyle changes alone, even if they did not intend to attend the retreat, they could consequently choose to avoid essential treatment. We therefore concluded that the ad was irresponsible and could discourage essential treatment for a condition for which medical supervision should be sought.
On that point the ad breached CAP Code (Edition 12) rules
1.3
1.3
Marketing communications must be prepared with a sense of responsibility to consumers and to society.
(Responsible advertising), and
12.2
12.2
Marketers must not discourage essential treatment for conditions for which medical supervision should be sought. For example, they must not offer specific advice on, diagnosis of or treatment for such conditions unless that advice, diagnosis or treatment is conducted under the supervision of a suitably qualified health professional. Accurate and responsible general information about such conditions may, however, be offered (see rule
12.1
12.1
Objective claims must be backed by evidence, if relevant consisting of trials conducted on people. Substantiation will be assessed on the basis of the available scientific knowledge.
Medicinal or medical claims and indications may be made for a medicinal product that is licensed by the MHRA, VMD or under the auspices of the EMA, or for a CE-marked medical device. A medicinal claim is a claim that a product or its constituent(s) can be used with a view to making a medical diagnosis or can treat or prevent disease, including an injury, ailment or adverse condition, whether of body or mind, in human beings.
Secondary medicinal claims made for cosmetic products as defined in the appropriate European legislation must be backed by evidence. These are limited to any preventative action of the product and may not include claims to treat disease.
).
Health professionals will be deemed suitably qualified only if they can provide suitable credentials, for example, evidence of: relevant professional expertise or qualifications; systems for regular review of members' skills and competencies and suitable professional indemnity insurance covering all services provided; accreditation by a professional or regulatory body that has systems for dealing with complaints and taking disciplinary action and has registration based on minimum standards for training and qualifications.
(Medicines, medical devices, health-related products and beauty products).
Action
The ad must not appear again in its current form. We told Obsidian that in future they should ensure that they did not exaggerate the outcomes that were likely to be achieved as a result of the retreat. We also told them to avoid making claims that could discourage essential treatment for conditions for which medical supervision should be sought.
