Ad description
A local directory ad for the Advanced Wellness Chiropractic Clinic stated "Would you like ... A re-charged nervous system, Increased energy levels, Improved immune function, A healthy toned body? Chiropractic gives you great heath without costly drugs or surgery".
Issue
A GP challenged whether the claims were misleading and could be substantiated.
Response
Advanced Wellness Chiropractic Clinic (Advanced Wellness) said the ad had been withdrawn and replaced with one that stated "Chiropractic … focusing on wellness and illness prevention, without the use of drugs or surgery! Your nervous system controls everything including your immune system, your energy levels and your emotional state". They said their ad did not claim to treat any condition.
The advertiser said research had revealed that the nervous system controlled well-being and responded to continual changes in the environment and adapted accordingly, providing its best survival response. If the nervous system overloaded, it responded to its best ability, however, continued overloading caused an unbalanced neurological pattern to develop and recent research identified changes in brain waves before and after spinal adjustments, akin to rebooting a computer. They said the adjustments sent signals to the brain to reset muscle behaviour patterns. As the nervous system controlled all body functions, including the immune system, chiropractic care had a positive effect on this aspect of health. Subluxations – misalignments of the spine – that caused compression and irritation to the spinal joints and nerve pathways affected the body's organ systems that resulted in stress on the body which could result in a poorly coordinated immune response. They said resolving a subluxation had been shown to boost the coordinated responses of the nervous system and therefore the immune system and one study had shown that stressful conditions led to altered measures of immune function and increased susceptibility to a variety of diseases. They said an additional study showed that a thoracic adjustment, applied to a subluxated area, found that white blood cell count rose significantly.
Advanced Wellness said a detailed assessment was offered to all new patients, which assessed several aspects of their health and included various tests. After reviewing the findings, they said they could ascertain the cause of potential problems and why the patient had experienced low energy, fitness issues, carried excessive weight or decreased immune function. Patients were then reassessed one month after the initial examination that assessed objective and measureable changes in their health. They said areas in question were addressed through personalised lifestyle advice with health classes on nutrition, exercise and stress. There was no quick fix to these health problems and they had not suggested chiropractic care was the sole answer. They said chiropractic care, a healthy lifestyle that included exercise and nutritional modification, had led to claimed improvements in thousands of their patients. They routinely asked patients, via a questionnaire, about their own subjective and objective improvements. Patients regularly reported health changes such as increased energy levels, improved sense of wellbeing and improved sleep.
They said the statement "Chiropractic gives you great health without costly drugs or surgery" reinforced the World Federation of Chiropractors policy statement "Chiropractic is a healthcare discipline which emphases the inherent recuperative power of the body to heal itself without the use of drugs or surgery" and the focus of chiropractic was not on sickness but on prevention via wellness to achieve optimal health for an individual.
Assessment
Upheld
The ASA noted the advertiser had amended the ad. However, we did not consider the revision was significantly different from the initial ad in order to comply with the CAP Code.
Advanced Wellness submitted several abstracts to studies that examined the efficacy of chiropractic treatment on prevention of heart attacks, reduction in blood pressure, body surface electromagnetic field and neck pain. We did not assess these as we did not consider they related directly to the advertised claims and because it was not possible to assess the trials in full.
We acknowledged the additional, full trials submitted. However, one trial included a small sample size and another related to inflammatory disease. Due to these factors, we therefore considered they could not be applied to the general population or that they supported the claims made.
One trial considered the effects of chiropractic treatment on serum thiol levels which we understood was used, in some instances, to assess nutritional intervention, cancer assessments and anti-ageing status. We were concerned about the rigor of the trial as it omitted details that related to how participants were randomised and the inclusion/exclusion criteria. We also noted one sub-group underwent chiropractic treatment over 52 to 312 weeks and considered this wide time-frame may not reflect the length of time a consumer would undertake treatment. The trial also omitted details of the participants' results and did not take into consideration other influences on the immune system such as current health and illness, whether acute or chronic, diet and supplements, which we understood could affect the immune system. We were concerned that these additional variables could influence immunity other than the nervous system. Furthermore, the advertiser had not demonstrated that the absence of chiropractic treatment led to increased vulnerability to infection.
We noted the advertiser's argument that chiropractic treatment involved more than just physical manipulation of the spine. It also included lifestyle and nutritional advice, which we understood could influence factors such as energy and muscle tone. However, we considered that more objective claims relating to a re-charged nervous system and improved immune function were likely to be considered breakthrough claims which would need a high level of evidence to support them. We did not consider self-reporting of improved immune function was sufficient to support such claims.
We noted the advertiser's point that the claim "Chiropractic gives you great health without costly drugs or surgery" was taken from a secondary source. However, we did not consider this a sufficient basis in order to make the claim. We acknowledged that chiropractic treatment could contribute to general health, but noted the claim made broad references to surgery and drugs which could be interpreted as an alternative to these options when this would not always be the case. We also considered the claim "costly drugs or surgery" was misleading as treatment would be offered in most cases, by the National Health Service. We therefore concluded that the claims were 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 ad must not appear again in its current form. We told Advanced Wellness Chiropractic Clinic to ensure medical claims were based on robust evidence in future.
