Ad description
Claims on a website for Bowen Technique stated "The Bowen Consultancy Balance the body with Bowen". Claims under the heading "Sports Performance & Injuries" stated "Many injuries in sports are as a result of sudden additional stresses being placed on an unbalanced body. This is commonly seen in calf and hamstring injuries. Overcompensation, bad postural alignment and the body's tendency to lock in old injuries, as can often be seen with Frozen Shoulder, will result in an unbalanced body. By asking the body to recognise and make the changes necessary to bring it back to homoeostasis (physiological equilibrium), regular Bowen treatments will help reduce the incidence of injury and often bring rapid relief so an athlete can get back to the game quickly".
Claims under the heading "May benefit and help ..." stated "Increase flexibility & movement; Speed up post-match recovery; Re-balance the structure of the body; Increase energy levels; Along with Cider Vinegar can help fight inflammation in acute injuries; As an on-field treatment; Reduce pre-competition anxiety; Reduce swelling; Improve breathing".
Issue
The complainant challenged whether the efficacy claims for Bowen Technique were misleading and could be substantiated.
Response
The Bowen Consultancy (TBC) said they had rewritten various parts of the site in 2011 when they became aware that claims on websites were subject to the CAP Code. They had taken care not to mention any specific diseases or medical conditions and they had been unaware that their website in its present form might present problems under the Code and they would undertake to make corrections. The pages on which the challenged claims appeared clearly stated that they would identify anyone for whom the Bowen Technique would be ill advised or detrimental to their short- or long-term well-being and refer clients to a doctor or healthcare professional where necessary.
Notwithstanding that, they provided research documents as evidence for the efficacy of Bowen. They provided a research abstract entitled "Effects of The Bowen Technique on Flexibility Levels: Implications for Fascial Plasticity" and a study entitled "The Psychophysiological Effects of the Bowen Technique" which they said showed that Bowen could enhance moods and reduce feelings of tension, anxiety, fatigue, anger, depression, confusion as well as decreasing heart tension. They also provided an article about Bowen and sports injury management.
Assessment
Upheld
The ASA understood that Bowen was a light touch therapy and we considered that the claim to reduce anxiety was an acceptable claim for such a therapy. We considered that the remaining efficacy claims under the heading "May benefit and help" required substantiation such as robust, appropriately controlled and blinded clinical trials conducted on people in order to support them.
We noted the Sports Scientist article but we did not consider that a general article was suitable substantiation for the claims made. TBC had submitted a research abstract regarding the effect of Bowen on the flexibility of the hamstring muscles and a copy of the full study had already been submitted to CAP for assessment and CAP had taken expert advice. The trial was an assessor-blind, prospective, randomised controlled trial which had been performed on 120 asymptomatic volunteers. Participants were randomly allocated into a control group or Bowen group and three flexibility measurements occurred over one week, using an active knee extension test. The intervention group received a single Bowen treatment and the study concluded that within-subject and between-subject differences for the Bowen group had been observed with continuing increases in flexibility levels being observed over one week. The expert said the study was well designed and conducted with appropriate sample sizes and robust and independent randomisation. They considered that the trial results provided a clear finding that patients in the Bowen group experienced an improvement in hamstring flexibility immediately after a 20-minute treatment session, which was maintained but not further improved, one week later, compared with the control group who had no intervention. They said the difference between the two groups was statistically significant and that, although the study could benefit from replication, it provided good proof-of-principle evidence to support the claim that the Bowen Technique could improve flexibility, in the short term, of hamstring muscles in healthy, fit adults aged 18-50 years with no musculoskeletal symptoms. We noted, however, that the ad did not feature that suitably qualified claim.
TBC had also submitted a paper entitled "The Psychophysiological Effects of the Bowen Technique", that related to a trial which sought to examine the effects of the Bowen Technique on participants' mood state, heart rate and muscle tension. We noted that ten undergraduate students had undergone tests to assess those factors prior to, immediately after and one week after the administration of the Bowen Technique. We noted that the study concluded that the Bowen Technique had prompted a reduction in anxiety, fatigue and muscle tension. However, the study had not been published or peer-reviewed and the trial did not include any controls or blinding. We also considered that a sample size of only ten individuals was not large enough to demonstrate the effects claimed and we therefore concluded that the study was not sufficiently robust to substantiate claims about Bowen Technique's efficacy.
We considered the claim "Increase flexibility & movement" was a general one and likely to be interpreted as relating to other muscles and joints in the body, and not just to hamstring muscles, and to people experiencing problems with their joints and muscles and not just to healthy, fit people with no musculoskeletal symptoms. Although we considered that the hamstring trial was robust and would be suitable substantiation for appropriately worded claims in future, because we had not seen evidence to support the more general claim in the ad, "Increase flexibility & movement", we concluded that this claim had not been substantiated and was therefore misleading.
We noted that we had not seen evidence to support the remaining efficacy claims "Speed up post-match recovery; Re-balance the structure of the body; ... can help fight inflammation in acute injuries; As an on-field treatment ... Reduce swelling; Improve breathing" and concluded that these claims had not been substantiated and were therefore misleading. We considered the claim “Increase energy levels”, which was made alongside these claims, would be interpreted as a claim about improving levels of physical fatigue, was also not substantiated and was also therefore misleading.
The ad breached CAP Code (Edition 12) rules
3.1
3.1
Marketing communications must not materially mislead or be likely to do so.
(Misleading advertising),
3.7
3.7
Before distributing or submitting a marketing communication for publication, marketers must hold documentary evidence to prove claims that consumers are likely to regard as objective and that are capable of objective substantiation. The ASA may regard claims as misleading in the absence of adequate substantiation.
(Substantiation) and
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.
(Medicines, medical devices, health-related products and beauty products).
Action
The unsubstantiated claims must not appear again in their current form. We told TBC to ensure that claims regarding the efficacy of the Bowen Technique in improving or increasing flexibility were suitably qualified to make clear it related to short-term hamstring flexibility in healthy adults.
