Ad description
A website for The Fibro Guy, www.thefibroguy.com, that made various claims to treat chronic pain and other medical conditions, was seen on 3 January 2023.
The claims were spread across several pages of the website and included the statements “Living with chronic pain or hypermobility can feel like a never-ending battle … That’s why we’ve redefined the traditional approach of supporting those with chronic pain and hypermobility … Working this way has helped hundreds of our clients around the world, [sic] improve their health, feel more empowered, and get back to doing the things they love the most” and “… with our expertise in working with those who have chronic pain and hypermobility, we’ve helped many of our client [sic] to achieve remarkable results, including: … reducing pain and improving mobility, even for those who had been told there was no hope”.
The website featured several video testimonials. Text alongside one of them stated “After receiving a diagnosis of Fibromyalgia from a leading UK-based rheumatologist, Debs, a 51-year-old woman, had experienced almost a decade of chronic pain and debilitating fatigue. Her mobility had gradually decreased to the point where she relied on a crutch to get around, and her social life had become non-existent … She eventually found us and reached out for our help to support her on her journey … we watched her begin to be able to play with her grandchildren again and even open her own business, which she still runs today”.
Text alongside another video testimonial from a client named as Angela stated “When I first met with [The Fibro Guy], I struggled with mobility issues due to my Ehlers-Danlos syndrome and other health complications. I was permanently on crutches for even short distances and relied on a wheelchair for anything further. It was a difficult and painful way to live. After joining the course and starting with the foundation exercises, [The Fibro Guy] worked with me every step of the way. And the results were nothing short of amazing! I am now able to walk on my own without crutches, and I no longer experience the extreme levels of pain that I once did. I feel like a completely new person, and I am absolutely delighted with the progress that I’ve made”.
Issue
The complainant challenged whether the efficacy claims that the treatments or techniques used could achieve recovery from chronic pain, fibromyalgia, hypermobility and Ehlers-Danlos syndrome were misleading and could be substantiated.
Response
The Fibro Guy said they were a multi-disciplinary team that worked with each client individually to provide them with the combination of therapies that would be the most effective for them. The therapies or approaches they offered included movement therapy, chiropractic treatment, yoga, manual therapy, counselling, access to their registered social worker and education to clients about their condition and how to manage it.
The Fibro Guy said treatments were conducted in line with National Institute for Health and Care Excellence (NICE) guidelines and were evidence-based. They cited a recent systematic review of 35 randomised, controlled trials which showed that multi-disciplinary approaches gave superior results compared with treatments that used one mode of therapy only. They said the treatments they provided were the same as the ones used in the studies.
The Fibro Guy said they used a Biopsychosocial approach to support and work with their clients. They supplied ten documents which they believed supported the efficacy of such an approach. These included guidance and best-practice advice published by medical organisations and similar bodies based in the UK and USA which were based on those organisations’ experiences and assessments of dealing with patients and managing their pain. They typically described how effective pain management needed to involve working with patients using a multi-faceted approach which could include physical, educational and psychological techniques as well as medication. The Fibro Guy said that was the approach they used as well and that they therefore believed the evidence supported the claims they made for their treatments and techniques.
The Fibro Guy said their treatments had a “no time limit” policy, which meant treatment continued for as long as it was necessary; this was something they had not seen offered by other providers. They said they deliberately referred to “supporting those with chronic pain and hypermobility” rather than “treating”. They believed there was a distinction and that clients understood the difference and would not be misled by the claims in the context in which they appeared on their website.
Assessment
Upheld
The ASA considered readers would understand the various claims on the website to mean that The Fibro Guy provided effective treatment programmes for chronic pain, fibromyalgia, hypermobility and Ehlers-Danlos syndrome.
We acknowledged that the testimonials were preceded by text which stated, “Please note: The testimonials on this website represent the opinions, experiences and views of our clients, and individual results may vary. Whilst we have considerable experience working with people with chronic pain and hypermobility syndromes, we can never guarantee or intend to, that everyone will achieve the same or similar results. Client stories are provided for informational purposes only and should not be relied upon as medical advice or a guarantee. The testimonials have been provided, voluntarily, without compensation or incentive, provided by our clients who wished to share their experiences. All views and opinions are their own”. We considered, nevertheless, that the interpretation of the testimonials, particularly for people with the conditions who had been unable to see improvement from other sources so far, was that they could have similar results if they visited The Fibro Guy. The testimonials therefore contained objective claims about the efficacy of the service and needed to be supported by adequate substantiation.
Because we had not previously seen evidence to substantiate claims that a programme of treatment or techniques could treat chronic pain, fibromyalgia, hypermobility and Ehlers-Danlos syndrome, we expected The Fibro Guy to provide a suitable body of evidence to support them. We would normally expect the evidence to include at least one adequately controlled experimental human study which, in this case, needed to demonstrate a causal effect between the treatments and techniques provided by The Fibro Guy and recovery from chronic pain, fibromyalgia, hypermobility or Ehlers-Danlos syndrome.
We assessed the documents The Fibro Guy had provided. None of the documents provided referred to hypermobility or Ehlers-Danlos syndrome and we therefore considered that The Fibro Guy had not provided evidence in relation to those conditions. The documents provided only related to the treatment of chronic pain and fibromyalgia.
Eight were guidance documents for the management of pain published by hospital departments, medical schools or other specialist medical organisations based in the UK or USA. All eight recommended a multi-disciplinary approach to pain management using various combinations of physical therapy and psychological techniques. The Fibro Guy said they used the same approach. One document referred specifically to pain management for chronic pain including fibromyalgia. It concluded by saying that changes to ways of working needed to be made for outcomes to be better for people with chronic widespread pain or fibromyalgia. We considered that the document looked to the future rather than at solutions that were possible at the time of the ad. Another document was concerned with the management of chronic spinal pain, while another was concerned with pain management for patients in hospital following surgery. We considered that neither of those situations related to the claims made in the ad.
Of the remaining two documents, one was a service specification for specialist pain management centres contracted by the NHS in England. It said pain management could include pain-specific psychological interventions, inpatient care, complex medicine optimisation, follow up and rehabilitation. The Fibro Guy believed that was sufficient evidence for the success of their treatments because they used broadly the same approach. The second document had evaluated psychosocial contributions to chronic pain outcomes. It referred to behavioural, emotional and cognitive techniques for coping with pain and the role of the individual’s belief in their own ability to control their symptoms and achieve their desired outcome in spite of them.
We acknowledged that, on a very general level, the information The Fibro Guy had provided showed that there could be value in using a multi-disciplinary approach to managing chronic pain conditions, including fibromyalgia, which included elements such as exercise, education and psychological techniques.
However, in addition to those elements, some of the guidance documents also mentioned medication as playing a part in a multi-disciplinary approach to managing chronic pain. We considered medication was likely to have a place in the management of chronic pain for a significant proportion of patients. The Fibro Guy had not mentioned the role of medication in their response but we considered many patients would obtain it separately. We considered that was a further factor which needed to be addressed in The Fibro Guy’s evidence for the efficacy of their treatment, because they needed to be able to show that any improvement in symptoms was down to their own treatments and not medication.
For those reasons, we considered The Fibro Guy had not provided a suitable body of evidence, including a randomised, controlled study on humans which demonstrated a causal link between the exact protocol of treatments and techniques they provided and improvements in the symptoms of chronic pain, fibromyalgia, hypermobility and Ehlers-Danlos syndrome. We therefore concluded that the claims had not been substantiated and were likely to mislead.
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).
Action
The ad must not appear again in its current form. We told The Fibro Guy not to claim that the treatments or techniques they used could treat chronic pain, fibromyalgia, hypermobility and Ehlers-Danlos syndrome unless they held adequate evidence.
