Background
Summary of Council decision:
Two issues were investigated, both of which were Upheld.
Ad description
A website for Liverpool Homeopathy, www.liverpoolhomeopathy.org, seen on 15 September 2020, stated "Homeopathy is used throughout the world to keep healthy … People in the UK have been using it to successfully help with migraine, anxiety, chronic pain, woman’s [sic] health issues, depression, eczema, chronic fatigue, asthma, IBS, rheumatoid arthritis, and many other conditions".
Issue
The Good Thinking Society challenged whether:
1. the ad discouraged essential treatment for conditions for which medical supervision should be sought, namely migraines, chronic pain, women’s health issues, depression, asthma, rheumatoid arthritis; and
2. the claim "People in the UK have been using [homeopathy] to successfully help with anxiety, chronic pain … eczema, chronic fatigue syndrome … IBS" was misleading and could be substantiated.
Response
1. Homeopathy UK said that the Liverpool Homeopathy website did not seek to dismiss or present homeopathy as an alternative to conventional medicine or dissuade patients from seeking essential treatment for medical professionals. They said Liverpool Homeopathy was headed by a registered General Practitioner (GP), and that healthcare professionals prescribing homeopathic treatment did so within General Medical Council (GMC) guidelines. They said that all Liverpool Homeopathy members were members of UK registered bodies and acted within the limits of their level of training and qualification – referring patients back to their GP if they felt conventional treatment was more appropriate.
2. Homeopathy UK said there was a substantial body of evidence that showed the effectiveness of homeopathy in treating the conditions listed in the ad, and provided three studies in substantiation.
Assessment
1. Upheld
The CAP Code required that 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 or treatment for such conditions unless that advice, diagnosis or treatment was conducted under the supervision of a suitably qualified medical professional. Among other conditions, the ad referred to “migraines”, “chronic pain”, “woman’s [sic] health issues”, “depression”, “asthma”, and “rheumatoid arthritis”, which we considered were conditions for which medical supervision should be sought, and therefore advice, diagnosis or treatment must be conducted under the supervision of a suitably qualified medical professional. We noted that the practice was run by a GMC-registered GP, who we considered was a suitably qualified health professional. However, the individual homeopaths were not registered and did not hold the same qualifications. Therefore, Homeopathy UK had not shown that all treatment and diagnoses conducted at the practice would be conducted under the supervision of a suitably qualified medical professional. Because Homeopathy UK had not supplied evidence that treatment would always be carried out by a suitably qualified health professional, and because reference to the conditions listed in the ad could discourage consumers from seeking essential treatment under the supervision of a suitably qualified health professional, we concluded that the ad had breached the Code.
On that point the ad breached CAP Code (Edition 12) rule
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).
2. Upheld
We considered that consumers would understand the claim “People in the UK have been using [homeopathy] to successfully help with anxiety, chronic pain … eczema, chronic fatigue syndrome … IBS" to mean that homeopathy could be used to successfully treat those conditions. We considered that Homeopathy UK should hold scientific evidence in support of the claim that homeopathy could treat anxiety, chronic pain, eczema, chronic fatigue syndrome, and Irritable Bowel Syndrome (IBS). Homeopathy UK provided three studies to substantiate the claim. Because neither CAP nor the ASA had previously seen evidence that homeopathy could be effective in treating the medical conditions listed, we considered that a high level body of relevant evidence was needed to prove the claims. However, when we reviewed the evidence provided by Homeopathy UK, we considered that the studies provided did not meet the standard of evidence we required for the types of claims being made, both in terms of adequacy and relevance. The first study, from 2008, aimed to develop and assess quality assurance across the UK’s homeopathic hospitals. Participants were asked to rate changes in their medical condition and change in overall well-being using the outcome related to impact on daily living (ORIDL) scale - a ten-point scale ranging from “Disastrous deterioration” to “Cured/Back to normal”. The study included participants with eczema, chronic fatigue syndrome, and depression. We noted the study’s discussion, which stated that no control group had been used and that factors such as “improvement of symptoms that may have happened spontaneously over time” and “where conventional treatments might have had an important impact during the package of care” had not been taken into account.
The study did not feature patients with anxiety, IBS, or chronic pain, so we considered it was therefore not relevant to the claims in the ad. The second study, from 2005, was conducted using hospital outpatients who had a wide range of chronic conditions and were assessed as to whether health changes were observed following routine homeopathic care. The participants, on average, attended three or four homeopathy treatment sessions and self-reported their perceived overall improvement or deterioration over their first session, on a ten-point scale ranging from “Much worse” to “Much better”. The study concluded that the participants reported improved health and well-being. We considered that while the study suggested positive results, there were a number of key flaws. The study was not randomised and did not use a control group.
We noted that the study incorporated some objective parameters, such as changes to medication, but that the study was otherwise purely subjective and based on patients self-reporting. We considered that undermined the objectivity and reliability of the results. We also considered that improvements in well-being were not synonymous with treatment of the featured conditions. The study did not feature patients with anxiety or chronic pain.
The third study, from 2003, was a survey of outpatients’ views on the impact of Complementary and Alternative Medicine (CAM) on their clinical problems. It was was found that 81% reported that their health condition had improved at least slightly. Participants in the study had referred themselves for CAM treatment, which we considered raised issues of self-selection bias. Additionally, the study stated that its limitations included information and self-selection bias and that its findings could only be hypothesis-generating. The study concluded that data on the use of CAM as a replacement for conventional medicine was “patchy and inconsistent”. Also, the study was not randomised and did not use a control group. We considered that Homeopathy UK had not supplied sufficient evidence to substantiate the claims made about the efficacy of homeopathy in treating anxiety, chronic pain, eczema, chronic fatigue syndrome, and IBS. We therefore concluded that the ad was misleading.
On that point the ad breached CAP Code (Edition) 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 the form complained about. We told Homeopathy UK to ensure their future marketing communications did not to refer to conditions for which advice should be sought from suitably qualified health professionals. We also told them to ensure they did not make claims for homeopathy unless they were supported with robust evidence.
