Background
Summary of Council decision
Two issues were investigated, of which one was Upheld and one Not upheld.
Ad description
a. A poster for Lloyds Pharmacy seen in the men's toilets at a motorway service station was titled "£10 off Men's treatments". The ad featured three men standing naked and covering their genitals with cowboy hats. Two of the men were shown to be holding the hats in place with their hands, the third man had his hands behind his back. Text stated "Guess who's used our Online Doctor? Get treatment for Erectile Dysfunction and Premature Ejaculation. Discreet online service at affordable prices".
b. The landing page detailed in the ad listed a number of conditions including Erectile Dysfunction and Premature Ejaculation. The Premature Ejaculation page included the text “Free online assessment. Looking for advice on how to treat premature ejaculation? Use this confidential service and one of our doctors will recommend the best options for managing this condition. If appropriate, after your free consultation one of our doctors will make the oral medicine Prilogy and/or a local anaesthetic cream EMLA available for you to purchase”. The page provided basic information about the two treatments which consumers could then select.
The Erectile Dysfunction page was headed "Not sure what to choose. Get a free doctors assessment" and "Want to know more about the treatment options? Not sure why you have erectile dysfunction? Just fill out a questionnaire and one of our doctors will give you a recommendation normally within one working hour. Get a free assessment". Under the title "Know exactly what you want. Pick a treatment below” text stated “All orders include a medical assessment from an NHS accredited doctor. Your medicine will be delivered in discreet packaging”, and provided basic information about five POMs that consumers could select, before being required to go through the GP consultation.
Issue
1. Pharmacy2U, who specifically complained about the word "treatment", challenged whether the ad promoted prescription-only medicines (POMs) to the public.
2. The ASA challenged whether the website www.lloydspharmacy.com/hat, detailed in the ad, advertised POMs to the general public.
Response
1. & 2. Lloyds Pharmacy Ltd said the referenced conditions (Erectile Dysfunction (ED) and Premature Ejaculation (PE)) were important health issues which they believed men should be more aware of because they could relate to other underlying health issues. They explained they only provided their services to patients who had completed a questionnaire, which was assessed by a UK qualified GP. When the GP assessed the responses to the questionnaire, they not only assessed the patient's suitability for the prescription medicine they had requested, but also considered other aspects of the patient's health and made recommendations accordingly.
They explained that each patient's suitability for the POM was considered on its own merits along with any medical history that was held in relation to that patient. Unlike many online practitioners of POMs selling ED and PE, they offered a variety of treatments for patients that did not always result in the prescription of a medicine. After completing a medical questionnaire, patients could be recommend for further investigation (including a cardiovascular risk profile), referred to a private psychological service or prescribed a medicine. They explained that the psychological therapies that were available to purchase online were referenced alongside the POMs treatments with further details available upon click-through. They said that the links connected to a live online psychological therapy service called ThinkWell (who they partnered with) that provided an online consultation. They said they also provided referrals to a London-based private consultant urologist who was able to make available treatments such as vacuum devices, penile implants and hormonal therapies. They said they charged patients a fee for providing the referral (payable online) to this urologist, with the patient also paying the consultant directly.
They said that patients who were unsuitable for the online service were advised to see their GP for a face-to-face consultation. Given the variety of treatment options available to patients who would enquire about their services, they believed the word "treatment" did not promote a POM,, but rather a range of different options.
With regard to the presentation of POMs on their website, they believed the ad complied with both MHRA guidance and the CAP Code. They understood that although specifically named POMs could not be referenced on a website home page (in order to prevent casual browsers being provided with information about POMs) the deeper content of websites were permitted to give this information, providing that it was presented in the context of a fair overview of the treatment options. They believed the presentation of the information about the POMs in the deeper sections of the Lloyds Pharmacy website met that requirement and that casual browsers were unlikely to navigate to that content. They additionally said that it was clear that those POMs were only available following consultation with a doctor.
Assessment
1. Not upheld
The ASA considered that consumers would understand from the ad that treatments for ED and PE could be obtained online as a result of using the Lloyds Pharmacy Online Doctor, but that they would not assume from the presentation of the potentially available "treatments" that specific POMs would be prescribed as a result of consulting the online doctor. We therefore considered consumers would understand the poster ad to be an ad for the online doctor service itself and not a direct or indirect ad for a POM.
On this point we considered ad (a) under CAP Code (Edition 12) rule 12.12 12.12 Prescription-only medicines or prescription-only medical treatments may not be advertised to the public. (Prescription only medicines), but did not find it in breach.
2. Upheld
We considered that references to POMs on condition specific pages were acceptable providing they contained only factual non-promotional information and were presented as potential outcomes of a GP consultation.
The web page for Premature Ejaculation stated "Free online assessment. Looking for advice on how to treat premature ejaculation? Use this confidential service and one of our doctors will recommend the best options for managing this condition. If appropriate, after your free consultation one of our doctors will make the oral medicine Prilogy and/or a local anaesthetic cream EMLA available for you to purchase". The page provided basic information about the two treatments, which consumers could click on to find out more. We considered that because consumers were not invited to select a particular medicine of their choice and were clearly informed that the online doctor would be assessing suitability for the two listed treatments following consultation, the information about the POM treatment was presented as factual and non-promotional and therefore did not advertise a POM to the public.
However, the web page for Erectile Dysfunction stated "Not sure what to choose. Get a free doctor's assessment" before listing five available POM treatments under the title "Know exactly what you want. Pick a treatment below". After selecting a POM, consumers were required to go through the GP consultation prior to purchase in order to assess suitability. We considered that the web page therefore presented the POMs as a choice for the consumer to select prior to GP consultation, as opposed to the potential outcome of that consultation and subsequently advertised POMs to the public.
On this point ad (b) breached CAP Code (edition 12) rule 12.12 12.12 Prescription-only medicines or prescription-only medical treatments may not be advertised to the public. (Prescription only medicines).
Action
Ad (b) should not appear again in its current form. We told Lloyds Pharmacy Ltd to take care when referencing POMs on the website.
