An Example of Some Advertising Tricks

By definition, when it comes to telling the truth, advertisers have a conflict of interest. They want you to buy whatever they’re advertising, so they’re going to try to show it in its best light. Often, this means using psychological tricks, and these tricks generally work best when consumers aren’t aware of them.

For example, most people are aware that the reason why products cost $39.90 instead of $40.00 is that they sound significantly less expensive, even though the difference is miniscule. Consumers tend to be aware that advertisers are prohibited from “false advertising” – they can’t tell us anything that isn’t true – and that advertising is regulated. This tends to give us a sense of security when it comes to taking advertisers at their word. Unfortunately, there are a lot of ways in which medical advertisers in particular can, and do, take advantage of this.

In today’s edition of my local newspaper, there was a full page ad placed by “The Natural Health Co”. This advertisement contains a lot of these tricks that can be used by medical advertisers to mislead consumers without technically breaking the rules, so I thought I’d use it as a case study to point out some of these tricks.

First thing’s first, here’s the advertisement:


The most common trick is one that I’ve written about before. The industry regulators of medical advertisements in New Zealand draw a distinction between “therapeutic claims” and “health claims”. Although they sound very similar to the consumer, the important difference is that the advertiser is only required to substantiate therapeutic claims. Any health claims they make can be entirely unsubstantiated and, to my knowledge, if they’re false there is no penalty. To quote the guidelines:

Health Claims are defined as claims which support the normal physiological function.

An example of a health claim made in this advertisement is “Supports cardiovascular health”, which is said for a couple of products in this advertisement. As far as I can tell, the reason why advertisers are allowed to make these claims without oversight is that they are not well-defined, and claims like that technically just mean it won’t interfere with normal physiological function, i.e. what would happen anyway in a healthy person.

So, when this advertisement says a product “Supports muscular and nervous system health”, you should interpret it as saying “This product will not interfere with your muscular or nervous system health if you’re already healthy”, and as far as I know they’re not even required to have evidence to support that.

That’s why advertisers can get away with saying that glucosamine and chondroitin supplements work “for maintenance of healthy joints”, despite the fact that statements that these substances have beneficial effects on joint health do not seem to be strongly supported by quality evidence.

Another trick used by these advertisers is making a point out of what is contained in the product. This allows the consumer to draw certain conclusions without the advertiser having to suggest them directly. It’s important to remember that advertisers will always put their best foot forward. If there’s evidence to show that a product has a beneficial effect, then they will say that instead of only saying “Potent antioxidant”.

Most people think they understand what that means (it’s good for you, right?) but, unfortunately, most people also lack the medical expertise required to make good health judgements, and are easily influenced by information like this.

I expect that’s the main reason why health-related testimonials in medical advertisements are prohibited by section 58(1)(c)(iii) of the Medicines Act 1981. Unfortunately, Medsafe seems extremely apathetic when it comes to enforcing this; I’ve contacted them about numerous violations but as far as I can tell they’ve never done anything about them. While it seems intuitive that more information is better, some types of information tend to lead to misinformed health decisions, and testimonials are foremost amongst these.

There are a lot of examples of marketing tricks used in this advertisement. I wouldn’t be surprised if there’s not even a single piece of useful information about the therapeutic properties of one of these products that is backed up by any evidence at all.

Feel free to point out more instances of marketing tricks in this ad, or mention others that you’ve seen in medical advertisements. Unfortunately, “health claims” are almost everywhere in medical ads in New Zealand. Keep an eye out for the word “supports”, as it’s usually a strong indicator that they’re making a health claim and therefore likely don’t have evidence to support it.

ASA Complaints: Niagara Healthcare

In September, I found an A4 insert in the New Zealand Herald advertising for Niagara Healthcare. A big red heading: “Arthritic Relief?” caught my attention, and when I looked a little closer I found it accompanied by some big red flags. This advertisement for a “FREE TREATMENT” that seemed like it could relieve practically any type of pain, as well as several other ailments, looked a little too good to be true, and experience has taught me that when something looks too good to be true, it probably is.

My first response to this advertisement was to look for any research I could find corroborating its claims. This took me to the Niagara Healthcare website for New Zealand. They appear to be based in Australia, and have a separate but nearly identical website for their New Zealand branch. Their website’s key benefits page, which states that “Much research has been conducted on the physical benefits of Niagara’s Cycloid Vibration Therapy since 1954”, contained a convenient list of therapeutic claims for me to look at:

  • Increase local area blood flow
  • Assist in the reduction of musculoskeletal pain
  • Increase joint mobilisation
  • Reduce excess oedema (swelling) whether the cause is vascular or lymphatic
  • Assist in the treatment of wounds where an improvement in circulation is a factor
  • Assist in the treatment of pressure ulcers where and [sic] improvement in local circulation is a factor

The only study I was able to find (searching Google Scholar and PubMed) with the keywords “Cycloid Vibration Therapy” was a small uncontrolled preliminary study of 21 patients. That is nowhere near enough to substantiate a therapeutic claim. Luckily for me, there were also 4 other studies cited on the webpage.

I was able to find the full text of what I believed may be the first study mentioned. This study appeared to use a Niagara Healthcare product, Lymphease, but it was only a pilot study with a small sample size and no control group, not a clinical trial as claimed on the website, and therefore not rigorous enough to substantiate any therapeutic claims.

Interestingly, although this was not stated on Niagara Healthcare’s website, this study was funded by “Cyprossage Pty Ltd”, which holds the patent for the product used in the study. Both Cyprossage Pty Ltd and Niagara Healthcare are divisions of CT Healthcare Pty Ltd, and they share the same director, Anthony Thompson. Even if everything else in these advertisements checked out, this would violate the ASA’s Therapeutic Products Advertising Code Part B2 R4.3:

Publication of research results in an advertisement must identify the researcher and the financial sponsor of the research.

I was only able to find citations of the second and fourth studies, and only the abstract of the third study. As far as I was able to tell, the second and fourth studies were not clinical trials, and the third study did not adequately account for the placebo effect via its “no treatment” control group. These papers were also published in 1984, 1981, and 1961 respectively. Worryingly, the Australian version of this webpage describes those same studies as “recent”, despite the majority of them having been published years before I was born. If this was Niagara Healthcare putting their best foot forward, it wasn’t very impressive.

I was also able to find that the Advertising Standards Authority in the UK upheld a complaint against Niagara Healthcare in 2005, on the basis that the therapeutic claims they were making were not adequately substantiated. It looked like the evidence behind the advertisement didn’t live up to the claims, which was particularly worrying considering that the print advertisement claimed that the products had been “Medically proven for 60 years”, and had been approved by TAPS. The Therapeutic Advertising Pre-vetting System, TAPS, is a service provided by the Association of New Zealand Advertisers (ANZA) that is intended to help advertisers avoid publishing ads that violate the relevant codes and legislation.

The back of the print advertisement also contained a testimonial. I still don’t understand how a medical advertisement containing a testimonial could have been approved by TAPS, considering that the Medicines Act 1981 Section 58 subclause (1)(c)(iii) effectively prohibits all testimonials in medical advertisements:

no person shall publish, or cause or permit to be published, any medical advertisement that… directly or by implication claims, indicates, or suggests that… a medical device of the kind… advertised… has beneficially affected the health of a particular person or class of persons, whether named or unnamed, and whether real or fictitious, referred to in the advertisement

After finding how problematic these advertisements seemed to be, I laid a complaint with the Advertising Standards Authority. My complaint ended up being treated as two separate complaints: one for the print advertisement and a separate one for the website advertisement. On Friday, the ASA released their decision regarding both of these complaints. They were both upheld, meaning that the ASA has told Niagara Healthcare the advertisements must be removed. As I do with all my complaints, I have set up a monitoring service so I will be notified of any changes to the web advertisement. So far, the only change is that a note that the research they cite was funded by them has been added to their Key Benefits page.

I found the advertiser’s response to my complaints quite interesting and, I think, revealing. To start with, they claim that the printed material was published incorrectly, and contained obsolete material. This seems odd to me, considering that the ad had been approved by TAPS, which requires a fee, and stating that it contained obsolete material implies that the material was once correct, but this certainly does not seem to be the case.

In attempting to substantiate their therapeutic claims, it seems the advertiser provided a clinical evaluation performed by CT Healthcare, which it called “an Australian based manufacturer”. CT Healthcare is the parent company of both Niagara Healthcare and Cyprossage (the company that funded the small trial mentioned on the Niagara website). Here’s what the ASA had to say about that:

The Complaints Board also noted the substantiation provided by the Advertiser which was a “Report Review” on “Vibration Therapy.” It said while the Advertiser provided references on the subject and the claims were of a low level, the Complaints Board were of the view that it did not provide adequate substantiation particularly because the review was not conducted independently.

The advertiser also tried to substantiate their therapeutic claims by providing the ASA with certificates from the Australian Register of Therapeutic Goods (ARTG).

[The Advertising Standards Complaints Board] was of the view that the certificates provided were not categorical evaluations of the product, but rather they confirmed registration of the products.

As well as finding that the therapeutic claims made in their advertisements were not substantiated, the complaints board said that…

The Complaints Board agreed with the Complainant that the lack of the research listed under the heading “Medical Research”, its quality and the fact that some of it had been paid for by the Advertiser was not robust enough to support the statement “much research had been conducted on physical benefits of Niagara’s Cycloid Vibration Therapy since 1954” as the overall consumer takeout of that statement would be this meant 60 years of independent peer-reviewed medical studies which was not the case.

The most interesting part of this whole thing is, I think, the way in which the advertiser tried to defend their statement that their products have been “Medically proven for 60 years”. Here is how the advertiser tried to justify this statement:

However, to provide clarification regarding the statement on the advertisement Niagara devices have been proven for 60 years, this originates from the basis that CT Healthcare has been involved in medical research relating to the product since 1952.

The complaints board responded to this by stating that the words used in the advertisement simply did not mean what the advertisers claim they meant, and therefore exploited consumers’ lack of knowledge. I think the board’s response was entirely appropriate, and consider such behaviour from a medical advertiser, whom consumers should be able to take at their word, to be utterly reprehensible.

In the end, the complaints board said that both advertisements were in breach of Principles 2 and 3, and Part B2 Requirements 4(a) and 4(b) of the Therapeutic Products Advertising Code. They also said that the website advertisement was in violation of Part B2 Requirement 4(c). Here’s a quick rundown of what those codes are (some paraphrased by me):

Principle 2
Must not be misleading and claims must be substantiated
Principle 3
Must observe a high standard of social responsibility
Part B2
Refers to advertisements for medical devices targeting consumers
Requirement 4(a)
Must not be misleading
Requirement 4(b)
Must not abuse trust or exploit lack of knowledge
Requirement 4(c)
Must not exploit the superstitious or, without justifiable reason, play on fear or cause distress.

You can read the full decision of the complaints board, including my original complaint and the advertiser’s response, on the ASA’s website:

I’ve also uploaded a scanned copy of the print advertisement that you can look at: Niagara Healthcare Herald Insert

Even though the ASA’s Advertising Code of Ethics Basic Principle 1 and its Therapeutic Products Code Principle 1 both require that “All advertisements must comply with the laws of New Zealand”, the complaints board had this to say about the testimonial in the print advertisement:

The Complaints Board noted that compliance with the laws of New Zealand under Basic Principle 1 under the Code of Ethics and Principle 1 of the Therapeutic Products Advertising Code were also raised in the complaint. While acknowledging they are part of Advertising Code, the Complaints Board agreed that whether or not the advertisements complied with the laws of New Zealand was a matter for the Courts.

I’m of two minds about this. For one, I agree that it’s appropriate for the ASA not to overstep their authority, and that the courts are the appropriate place for it to be determined whether or not the law has been breached. However, this precedent effectively makes the first principles of the majority of their codes useless, by placing them outside of their own jurisdiction.

If the complaints board is not willing to consider whether or not an advertisement is in breach of New Zealand law, then the advertising codes should be modified to emulate the relevant laws. These include sections 57 and 58 of the Medicines Act 1981, particularly section 58 subclause (1)(c)(iii), which effectively prohibits the use of testimonials in medical advertisements.

This is a step that has been taken by at least one other New Zealand body that is involved in regulating advertising. The New Zealand Chiropractors Board’s Advertising Guideline section 3(f) prohibits the use of testimonials, in accordance with the Medicines Act.

In my opinion, perhaps the most important aspect of this complaint, taking into account that it was upheld, was that the print advertisement had been approved by TAPS. Even though the complaints board found that the advertisement was full of misleading claims that weren’t backed up by the required evidence, the advertiser was able to convince TAPS to approve this ad for publishing.

Another complaint (not one of mine) about an advertisement approved by TAPS was also recently upheld on the basis that it contained unsubstantiated therapeutic claims: Complaint 13/372 against BioMag.