Background
Summary of Council decision:
Three issues were investigated, all of which were Upheld.
Ad description
A regional press ad for Salin Plus, a natural salt therapy, seen in the Down Recorder on 26 October 2016 and several other dates up to 17 February 2017, stated in the headline that “COPD, Asthma and Sinusitis sufferers can get relief with Natural Salt Therapy - No Masks or Tubes”. The ad stated that “according to pharmacists, this natural salt therapy service can improve the health of sufferers of debilitating issues including Asthma, Sinusitis, Rhinitis … Cystic Fibrosis, Allergies, Chronic Obstructive Pulmonary Disease (COPD), Snoring and Sleep Apnoea”. Below this the article included a testimonial from a father that had a subheading which stated “Relieves chronic asthma” and stated in the testimonial, “Our son has not been to a doctor since we purchased the Salin Plus unit for any breathing related issues” alongside a photo of the father and his son with the picture caption “… great for Chronic Asthma”.
Issue
1. The complainant, who understood that the product contained a similar level of sodium to table salt which they believed contributed to high blood pressure, challenged whether the claim “unlike table and cooking salt it does not contribute to high blood pressure” was misleading and could be substantiated.
2. The ASA challenged whether the efficacy claims for the medical conditions listed in the ad were misleading and could be substantiated.
3. The ASA challenged whether the ad discouraged essential treatment for Asthma, Bronchitis, Cystic Fibrosis and COPD, conditions which medical supervision should be sought for.
Response
1. Virginia Medical Supplies Ltd responded that table salt was linked to high blood pressure due to an anti-caking agent, which could increase the risk of heart attacks and strokes, is contained within it. They stated that Salin Plus Salt Therapy did not contain the anti-caking agent. They stated that as the Salin Plus Salt Therapy was inhaled through the respiratory system it would not be ingested, therefore it would not enter the stomach, heart or kidneys.
2. Virginia Medical Supplies Ltd stated that they did not directly claim that their product could cure any of the conditions listed in the ad. They believed that “get relief” was an acceptable way to describe what the product did. They stated that did not make factual statements about the product but simply included testimonials from others about the effects of the product. They stated that the testimonials were completely anecdotal and were opinions of pharmacists and customers who had seen benefits from using Salin Plus. Virginia Medical Supplies Ltd provided evidence that the device was CE marked as a class 1 device.
3. Virginia Medical Supplies Ltd stated that they did not discourage essential treatment and did not state anywhere in the ad that consumers should not seek medical supervision for the listed conditions. They stated that the “No masks or tubes” statement referred to the fact that the product did not come with any masks or tubes and they did not claim that the product was superior to other products or prescribed treatments.
Assessment
1. Upheld
The ASA considered that consumers would interpret the claims that “unlike table and cooking salt it does not contribute to high blood pressure” to mean that table salt and cooking salt contributed to high blood pressure and that the salt used in Saline Plus Salt Therapy contained properties different to these products. Virginia Medical Supplies Ltd had not provided evidence to support the claims that table salt was linked to high blood pressure due to an anti-caking agent that the salt in the Saline Plus Salt Therapy did not contain. We further noted Virginia Medical Supplies Ltd had not provided evidence to support the claim that inhaling the salt, rather than ingesting it, would not contribute to high blood pressure. We therefore considered that the claim had not been substantiated. Because of this, we concluded that the claim in the ad was misleading.
On this point 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).
2. Upheld
We considered that consumers would understand the claims in the article to be medical claims. Although we acknowledged that the ad did not make a claim that it would directly cure any of the conditions, it did make a number of claims including “can improve the health of sufferers of”, “Relieves”, “Can get relief” and “Great for”. We considered that consumers would understand these claims to mean the product would be able to relieve the symptoms of the conditions listed. The ad also included a number of testimonials. The CAP Code required that claims that were likely to be regarded as factual and appear in a testimonial must not mislead the consumer. We considered that consumers would interpret claims such as “We have found Salin Plus very beneficial for …” as factual because they appeared to have been made either by pharmacists, who we considered consumers would regard as having some expertise on the product, or the experiences of patients who had used the product. We therefore considered that consumers were likely to interpret the claims that the product would assist with the symptoms of the listed conditions within the testimonials was an accurate reflection of the likely results of using the product.
We therefore required Virginia Medical Supplies Ltd to provide evidence to support the claims made in the ad. Virginia Medical Supplies Ltd provided certification that the device was CE marked as a class 1 medical device. Because Class I medical devices are generally sold on a self-declaration basis, we therefore required Virginia Medical Supplies Ltd to be able to support any of the medical claims with evidence. We did not receive any evidence to support the claims that the device could relieve any of the conditions or symptoms of the conditions referred to. We therefore concluded that the ad was misleading.
On this point 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),
3.47
3.47
Claims that are likely to be interpreted as factual and appear in a testimonial must not mislead or be likely to mislead the consumer.
(Endorsements and testimonials) 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).
3. 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 of or treatment for such conditions unless that advice, diagnosis or treatment was conducted under the supervision of a suitably qualified health professional.
We considered that the statement “COPD, Asthma … sufferers can get relief using Natural Salt Therapy. No Masks or Tubes” implied to consumers that the product offered treatment for COPD and Asthma. We further considered that by contrasting the treatment with commonly prescribed treatments that included “Masks or Tubes” would be taken by consumers to mean the product had aspects that were superior to other prescribed treatments.
We noted that the ad contained a number of testimonials from pharmacists. For the reasons above we considered that consumers would regard these as factual and we therefore considered that they offered specific advice on the treatment of these conditions. Additionally we considered that the statements, “I can’t recall their last doctor’s appointment” and “After the first week of using it [Salin Plus] I no longer had to use my proscribed Symbicort turbo haler … and Nasonex to prevent sinus infections (a side effect of using the Symbicort” would be taken by consumers to mean that Salin Plus functioned better than medicine that had been prescribed by a medical professional and we therefore considered that these quotes discouraged essential treatment for the conditions.
We acknowledged that the ad stated “Pharmacists advise that you should never go off your medication without speaking to your doctor; salt therapy should be used in conjunction with existing medical treatment and not as a standalone therapy”. However, we considered that this did not override the other content in the ad which we considered offered advice and treatment for the symptoms of Asthma, Bronchitis, Cystic Fibrosis and COPD.
We therefore concluded that the ad discouraged essential treatment for conditions for which medical supervision should be sought and therefore breached the Code.
On this 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).
Action
The ad must not appear again in its current form. We told Virginia Medical Supplies Ltd not to claim that their therapy did not contribute to high blood pressure unless they held adequate evidence to support the claim. We told Virginia Medical Supplies Ltd not to state or imply that the device could treat or assist with medical conditions unless they held robust evidence that was the case. We also told Virginia Medical Supplies Ltd not to state or imply that the device could treat conditions that required medical supervision unless that treatment would take place under the supervision of a suitably qualified health professional.
