Background
This Ruling forms part of a wider piece of work on long COVID treatments, identified for investigation following intelligence gathered by the ASA. See also related rulings published on 30 August 2023.
Summary of Council decision;
Two issues were investigated, both of which were Upheld.
Ad description
An Instagram post on the Peachy Acupuncture page @peachy_acupuncture_n8, posted 16 June 2023, featured an image with text that stated, “In the clinic this month […] Long Covid […]”. The post included the caption “[…] Covid has cast a long shadow, and while it may be out of the Press, it's still hanging around in peoples [sic] bodies. Long Covid at its worst is life changing and debilitating. Gentle acupuncture and b12 [sic] shots can chip away at the fatigue, brain fog and gut issues to support healing […] WhatsApp Rita on 07961346822 to book”. The post included a series of hashtags including “#longcovid”.
Issue
The ASA challenged whether the:
1. efficacy claims that acupuncture could contribute to the treatment of long COVID was misleading and could be substantiated; and
2. ad breached the Code because it advertised prescription-only medicines to the public.
Response
1. Peachy Acupuncture said that they were careful about the wording they used in the ad and did not say they could cure long COVID, only the symptoms that some people with long COVID presented with. There was significant evidence that acupuncture could help reduce those symptoms.
They provided links to and excerpts from a number of studies and articles that they believed demonstrated acupuncture could be used to treat long COVID as part of a multidisciplinary approach.
2. They said that they were qualified to deliver vitamin B12 injections and provided a copy of their training certificate. This was for the symptoms of fatigue, brain fog and gut issues, which vitamin B12 was known to help. Prescription vitamin B12 was used for pernicious anaemia, but they were able to deliver it for general well-being. They provided links to an article and parliamentary debate on vitamin B12 injections.
Many patients with long COVID had insufficient levels of vitamin B12 and so they were simply supplementing them as qualified technicians.
Assessment
1. Upheld
The ad stated “Long Covid at its worst is life changing and debilitating. Gentle acupuncture and b12 [sic] shots can chip away at the fatigue, brain fog and gut issues to support healing”. We considered consumers would understand the ad to mean that acupuncture could contribute to the treatment of long COVID, and in particular the symptoms including fatigue, brain fog and gastrointestinal issues. We therefore expected to see robust scientific evidence to substantiate the claims.
We assessed the evidence provided which included links to a published case study, five articles and a meta-analysis and systematic review. They also provided excerpts from one of the articles, as well as from another meta-analysis and review article. However, none of these were provided in full. In any case, we did not consider that the evidence met the standard we required for the type of claim being made.
The two meta-analyses and one of the articles related to the use of acupuncture as a treatment for conditions other than long COVID, namely chronic fatigue and irritable bowel syndrome. Also, the review article, which summarised the results of systematic reviews for acupuncture in a large number of conditions, did not reference long COVID. We therefore considered these were not relevant to substantiate efficacy claims about acupuncture as a treatment for long COVID or certain symptoms of it.
The remaining four articles discussed research on acupuncture in subjects with long COVID. However, because these were articles and not the studies themselves, we did not consider they were sufficient to substantiate efficacy claims that acupuncture was effective in the treatment of long COVID or certain symptoms of it.
The published case study described the experience of one patient who had long COVID who, after receiving seven acupuncture sessions and six physical therapy sessions over a period of nine weeks, reported having improvements in their symptoms. This included having more energy, reduced coughing and not having brain fog. However, we considered that because the treatment was a combination of acupuncture and physical therapy, it was not possible to establish what contribution the acupuncture had on the improvement in long COVID symptoms. In any case, because it was a case study that only included one participant, it did not meet the standard of evidence we expected to see. For those reasons, we did not consider that it was sufficient to substantiate the claims.
Therefore, because we had not seen sufficient evidence to substantiate the claims that acupuncture could contribute to the treatment of long COVID or certain symptoms of it, we concluded that the ad was misleading.
On this point, the ad breached CAP Code (Edition 12) rules 3.1 (Misleading advertising), 3.7 (Substantiation) and 12.1 (Medicines, medical devices, health-related products and beauty products).
2. Upheld
The CAP Code stated that prescription-only medicines or prescription-only medical treatments may not be advertised to the public.
The ASA understood that vitamin B12 injections were a prescription-only medicine. The post was visible to anyone visiting Peachy Acupuncture’s Instagram page and included text that stated, “Gentle acupuncture and b12 [sic] shots can chip away at the fatigue, brain fog and gut issues to support healing […] WhatsApp Rita on 07961346822 to book”. We therefore considered the ad promoted a prescription-only medicine to the general public and concluded that it breached the Code.
On this point, the ad breached CAP Code (Edition 12) rule 12.12 (Medicines, medical devices, health-related products and beauty products).
Action
The ad must not appear again in the form complained of. We told Peachy Acupuncture not to state or imply that acupuncture could contribute to the treatment of long COVID or certain symptoms of it unless they held robust evidence to substantiate the claims. We also told them not to promote prescription-only medicines to the general public in future.
