July 2014 Auckland Skeptics in the Pub

Every month there’s a meetup at Juice Bar in Parnell, Auckland, of the Auckland Skeptics in the Pub group. This month, I was asked to be the speaker. The topic of my talk was the regulation surrounding medical advertisements in New Zealand, and what can be done by members of the public to counteract some of the misinformation out there.

I’ve shared the slides for my talk, and you can see them embedded below. Please have a look at the speaker’s notes too, as I have some relevant quotes and links in there:

Ethical Pharmacy Practice and Homeopathic NO-JET-LAG

Pharmacies are an integral part of the healthcare industry. They provide a valuable decoupling between the doctor you see for an examination and potentially a prescription, and the institution that stands to profit from the medicine you pay for. Without this separation, there’s the potential for a conflict of interest where the physician examining you would profit more from giving you a prescription than they would from telling you that you’re fine and sending you on your way.

I’m not trying to imply that bias has been entirely removed from the healthcare industry, but having independent pharmacies fill prescriptions from doctors does help. You unfortunately don’t generally see this sort of separation of interests in the alternative healthcare industry, where practitioners who claim to know the secret true cause of your “dis-ease” or “lack of wellness” (blocked chi, misaligned chakras, vertebral subluxation complexes etc.) also just so happen to also offer the solution; for a price, of course.

This association between pharmacies and doctors leads pharmacies to be respected and trusted institutions. After all, we expect the person behind the counter – the pharmacist – to not only be able to dispense the correct amount of the correct drug we’ve been prescribed, but also to have a sufficient understanding of how it works so they can advise us on such things as precautions we should take. “Do I need to take this with food?”, “Will this make me drowsy?”, and so on. However, pharmacies also need to be profitable to work as a business, which is why you’ll also be able to find all sorts of non-prescription products for sale such as cosmetics and non-prescription medication. Because of their involvement with the healthcare industry and respected status, it’s important that these other products sold in pharmacies also be reliable, and they should not be stocked without good reason. Essentially, pharmacies should be held to a relatively high ethical standard.

In New Zealand, there is a crown entity known as the Pharmacy Council that is established by the Health Practitioners Competence Assurance Act 2003. The Pharmacy Council is responsible for duties such as registering pharmacists and setting standards of conduct, although in cases where pharmacists require disciplining that is carried out by another crown entity also established by the Health Practitioners Competence Assurance Act: the Health Practitioners Disciplinary Tribunal. In order to ensure that pharmacists are held to an appropriate ethical standard, the Pharmacy Council has developed a Safe Effective Pharmacy Code of Ethics, published in 2011, which is publicly available on their website.

In my opinion, this Code of Ethics is an admirable document, and I’m encouraged by the idea that New Zealand pharmacists might be held to such an appropriate ethical standard. For example, it defines its principles to be the following:

AS A PHARMACIST YOU MUST:

  1. Make the health and well-being of the patient your first priority.
  2. Promote patient self-determination, respect patients’ rights, autonomy and freedom of choice.
  3. Use your professional judgment in the interests of the patients and the public and promote family, whānau and community health.
  4. Show respect for others and exercise your duties with professionalism.
  5. Actively seek and apply contemporary pharmacy knowledge and skills to ensure a high standard of professional competence.
  6. Act in a manner that promotes public trust and confidence in pharmacists and enhances the reputation of the profession.
  7. Practise in a manner that does not compromise your professional independence, judgement or integrity, or that of other pharmacists.

The Code of Ethics goes on to expand on each of its principles in seven sections. I encourage you to read through the document, as it’s interesting to come to a better understanding of the ethical standards to which New Zealand pharmacists should be held. For example, part 2.4 regards the patient’s right to informed consent:

YOU MUST… Explain the options available to patients and the public, to help them make informed decisions. Make sure the information you give them is impartial, relevant, up-to-date and independent of personal commercial considerations.

The section of this Code of Ethics which I found most interesting, as well as most encouraging, is section 6.9 (emphasis mine):

YOU MUST… Only purchase, supply or promote any medicine, complementary therapy, herbal remedy or other healthcare product where there is no reason to doubt its quality or safety and when there is credible evidence of efficacy.

Although it is written here in this code, most people who use a pharmacy in their day to day lives aren’t aware of it. Instead, it is more like an unspoken assumption: if it’s sold in a pharmacy, then surely it’s legitimate, reliable, and effective. And of course, this should be the case – if there is no credible evidence of efficacy then an ethical institution should neither promote nor supply it. The Pharmacy Council has also published Advertising Guidelines, and its General Principle 7 reiterates this point (emphasis mine):

Any medicine, complementary therapy, herbal remedy or other healthcare product associated with the maintenance of health must have credible evidence of efficacy and safety (Code of Ethics 2011: 6.9). Health claims for complementary therapies or herbal remedies must be able to be substantiated and must not breach the Medicines Act with regard to therapeutic purpose.

Unfortunately, it appears many New Zealand pharmacists do not abide by these rules. I was unfortunate enough recently to discover an instore display in an Auckland pharmacy for a product called “NO-JET-LAG”. While I was in the pharmacy, I took a photograph of this display with my phone:

NO-JET-LAG

As you can see, this display makes some strong and explicit claims regarding the effect of the product:

TRY NO-JET-LAG
It Really Works

Effective

Homeopathic Jet Lag Prevention

Hang on a minute… “Homeopathic”… That sounds familiar. I wonder what exactly is in these pills? Luckily, there’s a website listing their ingredients:

The five homeopathic remedies listed below are the active ingredients in No-Jet-Lag.

Arnica Montana 30C (Leopard’s Bane), Bellis Perennis 30C (Daisy), Chamomilla 30C (Wild Chamomile), Ipecacuanha 30C (Ipecac), Lycopodium 30C (Clubmoss)

If you’ve read my post on homeopathic dilutions, you may recall that “30C” means the ingredient has been diluted by 1/100 30 times. That is a mind bogglingly large dilution. If you were to end up with just one single molecule of the original ingredient at the end of that, you’d have to start with 1060 molecules of it.

That’s a hard number to visualise though, and it’s hard to think of things in numbers of molecules, so let’s compare it to something more familiar. The Earth is made up of roughly 1050 atoms, so the amount of ingredient we’d have to start with would be roughly 10,000,000,000 (yes, that’s ten billion) times bigger than the planet. Even the Sun only has around 1057 atoms in it: still 1,000 times fewer than the number we’d need. Needless to say, after the dilution is done there is absolutely no amount of any of these ingredients remaining in any “NO-JET-LAG” pills.

Knowing this, it seems rather implausible that they’d be effective for anything at all, let alone specifically preventing jet lag, but all the same it’s best to look at the evidence. The manufacturer’s website has a Scientific Test page. Now, given that I have spent some time writing up a complaint to the Advertising Standards Authority because I don’t think this evidence even comes close to being enough to substantiate the claims made about these products, I don’t particularly want to write out the same arguments all over again. So I am going to make this complaint public. While the first section specifically regards the instore display I saw in Parnell Pharmacy on the 2nd of July, the other sections are about the evidence regarding “NO-JET-LAG” and the ethical implications of my complaint, and these sections apply to all of the many New Zealand pharmacies that promote and supply this product.

This complaint should be read with the following in mind: Assuming I am correct regarding the evidence for this product, I think the appropriate response of pharmacies stocking it would be to immediately remove it from their stock, and to apologise to the customers they have failed to protect. The Code of Ethics for an industry is the absolute minimum acceptable level of ethical behaviour, and it appears for all the world that many New Zealand pharmacies haven’t even been doing that.

(Note that the original complaint was in plain text but I’ve edited it to add appropriate formatting here)


An instore advertisement for “NO-JET-LAG” in Parnell Pharmacy contains misleading therapeutic claims, in violation of the Therapeutic Products Advertising Code Principle 2. Because these claims are misleading, the advertisement also fails to observe the high standard of social responsibility required of it by the Therapeutic Products Advertising Code Principle 3.

The advertisement contained the following text (also see image attached):

TRY NO-JET-LAG
It Really Works

NO-JET-LAG
Homeopathic Jet Lag Prevention
Natural | Effective | No Side Effects or Drug Interactions

The Perfect Travel Companion

The product packaging, also visible from the front in the attached image, displayed this text:

The Perfect Travel Companion

NO-JET-LAG
Long Haul, for flights longer than 7 hours
Homeopathic Jet Lag Prevention

The strong and absolute therapeutic claims “Homeopathic Jet Lag Prevention”, “Effective”, and “It Really Works” require robust substantiation. Although it may not fall within the ASA’s jurisdiction, it is important to consider the advertisement within therapeutic context implied by its placement on the front desk of a pharmacy and by the prominently displayed name of the product “NO-JET-LAG”.


As far as I can tell, the only substantiation offered by the manufacturer is a small (n=19) pilot study that does not appear to have been published in a peer-reviewed scientific journal. This pilot study can be found on the manufacturer’s website: http://www.jetlag.co.nz/jet-lag6.html

Although it is not stated in the study, the POMS scale on which subjects rated their level of “fatigue-inertia” (the only measured end point reported to have statistically significant differences between control and experimental groups) is measured on a scale from 0-28. In this context, the mean difference between control and experimental groups of 3.84 is less impressive than in the context of a smaller scale that seems a sensible conclusion from reading the study, given that the y-axis of the bar chart only goes from 0-12. The non-significant measure of “vigor-activity” is similarly displayed on a chart with a y-axis from 0-22, whereas the actual scale is from 0-32.

Also, the POMS scale includes 6 measurements, yet there is no mention in the study of having corrected their statistical analysis for multiple measurements. Assuming that no adjustment for this was made, as none is mentioned in the study, this means that although one of the 6 measurements purportedly reached statistical significance it is fairly likely to have been a false positive. From random chance alone, the chance that 1 out of 6 measurements would reach this level of statistical significance is approximately 1/4 (26.5%). A relatively conservative method of correction, the Šidák correction, would alter the required p-value for statistical significance in this case to 0.0085. However, the measurement’s p-value of 0.026 doesn’t even come close to crossing below this threshold and would therefore not normally be considered statistically significant.

The study also brings the effectiveness of its participant blinding measures into question with the following statements:

When asked if they knew whether they had taken the remedy or the placebo, they said that at the time of arrival in Germany the whole party all felt very tired but most were already fairly sure which treatment they had taken.

On the outward journey, of the 19 taking part 13 (68%) correctly guessed whether they had taken the placebo or No-Jet-Lag. Of the others, three did not know and three incorrectly assigned themselves to the wrong group.

On the return journey, two were incorrect, three did not know and 14 (74%) correctly guessed.

Also, one of the study’s authors was the Director of Research at Miers Laboratories, the manufacturer of this product. It is not clear how much influence the manufacturer had over the study design or operation, or to what extent it may have been funded by them.

So, as far as I’ve been able to find, the only evidence that could be used to support the very strong claims made on this advertisement is a small unpublished non-independent pilot study with questionable blinding that does not appear to have reached the threshold for statistical significance. In short, the claims do not appear to have been adequately substantiated, and should therefore be considered to violate the Therapeutic Products Advertising Code Principle 2.


Although it falls outside of the ASA’s jurisdiction, I feel it would be appropriate to briefly discuss the Pharmacy Council’s Safe Effective Pharmacy Practice Code of Ethics 2011. Section 6.9 of this industry code of ethics states that:

YOU MUST… Only purchase, supply or promote any medicine, complementary therapy, herbal remedy or other healthcare product where there is no reason to doubt its quality or safety and when there is credible evidence of efficacy.

I sincerely hope that the manufacturer of this product has high quality rigorous scientific evidence that substantiates the claims made about this product hidden away somewhere and that, despite the fact that the only evidence they publicise on their website is the tiny low quality pilot study I discussed above, they have shared this evidence with every single one of the many New Zealand pharmacies who stock their product. If not, and things really are as they seem, then this would be an appallingly widespread violation of perhaps the most important part of the Pharmacy Council’s Code of Ethics.

What Does “37% More Powerful” Really Mean?

Yesterday, the Advertising Standards Authority released a decision regarding a TV advertisement for Panadol Extra. The advertisement claims that the product is “37% more powerful than standard paracetamol tablets”. Although this is not the claim that was challenged in the complaint, the advertiser, GlaxoSmithKline (GSK), provided a citation in attempt to substantiate their claim.

However, it seems to me that the citation they provided substantiates a different claim. The study they provided, Laska et al. 1984, substantiates the claim that their product is 37% more potent than standard paracetamol tablets, not 37% more effective. As far as I’ve found, in pharmacology, potency refers to the dosage required to achieve a particular effect. In claiming that their product is “37% more powerful” they didn’t mean that it is able to provide 37% more pain relief, but that you don’t have to take as much of it to get the amount of same pain relief.

In order to convince the Advertising Standards Complaints Board that saying “more powerful” when they meant “more potent” was not misleading, GSK pointed to a 2009 ASA decision in their response to the complaint:

Importantly, the claim ‘37% more powerful than regular paracetamol tablets‘ and the associated graph in question relate to the potency of Panadol Extra compared with regular paracetamol tablets and NOT its efficacy. That is, the reference to potency refers to the ratio of doses required to achieve the same analgesic effect rather than any improved efficacy result.

In October 2009, a complaint was considered by the ASA in relation to the claim that Panadol Extra is ‘37% more powerful than regular paracetamol tablets’. The ASA Panel was of the view that this was an accurate description of potency and that it did not communicate efficacy improvements. The Panel was also satisfied that the claim 37% more powerful had been substantiated by the Laska 1984 study (Attachment 2). Accordingly, the Panel determined that the advertised claim was not, directly or by implication, deceiving or misleading consumers (Attachment 3).

Given the historical consideration of this claim by the ASA it is GSK’s view that the claim accurately communicates the potency of Panadol Extra and not the efficacy of this product compared to regular paracetamol tablets.

The complaints board seems to have accepted this argument, as they state in their decision that:

Firstly, the Advertiser addressed the claim “37% more powerful than standard paracetamol tablets” and the Complaints Board noted the percentage was in relation to the potency not the efficacy. It also noted the Advertiser provided robust substantiation to support the factual claim.

Partly as a result of this, the complaints board ruled to Not Uphold the complaint.


However, things aren’t quite that simple. First, the Commercial Approvals Bureau also responded to the complaint, stating that:

The claim of 37% improved efficacy over standard paracetamol is verifiable fact, and the client has sufficient data to substantiate this claim.

(Emphasis mine)

Apparently the Commercial Approvals Bureau was misled by the advertisement, interpreting its claim that the product is more powerful as regarding efficacy, not potency. To tell the truth, when I read the claim I made the same assumption. I was very surprised when GSK defended the claim by essentially saying they meant something else so it was okay, and honestly felt as though I had been misled.

It seems the complaints board have likely been misled as well. When GSK referred to the 2009 decision (09/626), they missed a very important point. That advertisement appeared in a publication specifically for medical professionals, and the complaints board had considered the likely interpretation of “more powerful” in that context. From their decision, they stated:

The Panel was of the view that within this informed environment, there would be a greater awareness and familiarity with analgesics, the difference between analgesic effect and potency, and a level of comfort with references to scientific studies and the capacity and the ability to access these studies, if further clarification was required of the reference to them.

Having made these observations, the Panel was of the view that medical practitioners reading the advertisement would understand the word “STRONGER” in the advertisement to mean potency.

In their response to this recent complaint, it seems GSK may have misled the complaints board when they told them that previous precedent has determined that “more powerful” means “more potent”, as they omitted the important and relevant fact that it was only decided to be the case for advertisements aimed specifically at healthcare professionals, not advertisements aimed at the general public such as this one.

It’s also relevant that, in some of the advertisements complaint 09/626 was about, GSK was making these claims:

Because Panadol Extra is 37% more powerful than regular paracetamol it provides extra pain relief and helps you break through the pain barrier

Panadol Extra…combines paracetamol with caffeine for 37% extra pain relief

That complaint was Upheld (in part) because the ASCB ruled that these claims had not been substantiated and were therefore misleading. Given that GSK has been willing to make this claim explicitly in the past, despite the fact that it seems to have been misleading, it would not surprise me at all if they intend for uninformed consumers to take away the same message from their more recent advertisement.

I also can’t help but wonder if the complaints board actually went through the details of complaint 09/626 when considering complaint 13/585, or if they just took GSK’s word for its contents. Their decision seems to imply the latter, unfortunately.

What do you think about the claim “37% more powerful”? Would you have assumed it meant “37% more pain relief”, or that it means you can take 37% less of the active ingredient in Panadol Extra than regular paracetamol to achieve the same result? Would you have been misled by this advertisement like the Commercial Approvals Bureau seems to have been?


Update 2014/03/27

I hadn’t realised that when I first wrote this article, but it turns out both Panadol and Panadol Extra each contain 500 mg of paracetamol per tablet. So although the main selling point of Panadol Extra seems to be that, because it also contains caffeine, you can take 37% less paracetamol to get the same analgesic effect, the pills themselves don’t actually contain any less paracetamol.

Doesn’t that make the claim that it’s more potent entirely irrelevant? They’re not claiming that it can product more pain relief at the same dose, they’re claiming that it can produce the same pain relief at a smaller dose. But then they’re not offering a smaller dose.

Maybe they expect you to cut off 37% from each Panadol Extra capsule before taking it. It seems more likely, in my opinion, that they’re just hoping people will misinterpret their claims in their favour, and expect Panadol Extra will provide 37% extra pain relief. You know, like they used to advertise before the ASA found those claims to be misleading.

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.

ASA Complaints: Punga Tails, Magic Bracelets, and Bad Appeals

2 days ago, the Advertising Standards Authority published 4 more decisions regarding complaints I’d made. Each of these decisions was focused on a different type of product, but they were all therapeutic products. The decisions released were:

  • 13/177 Amber Teething Beads – Punga TailsSettled
  • 13/180 Energy Bracelet – 6ShooterSettled
  • 13/190 Mohdoh – Punga TailsSettled
  • 13/011 Infrared Sauna – Innate HealthAppeal dismissed; complaint upheld

13/177 Amber Teething Beads – Punga Tails

Punga Tails is a New Zealand business that, as far as I can tell, is owned and operated by naturopath Lydia Dorotich. It sells products for infants and has a focus on therapeutic products, including Baltic amber teething necklaces.

Mrs Dorotich has made various public statements claiming that Baltic amber can relieve teething, and that she personally recommends them. For example, from one of her listings on Trade Me:

As a qualified Naturopath and Medical herbalist (see my profile), I highly recommend the use of Baltic Amber for teething babies. Many parents have found that by wearing a Baltic Amber teething necklace the symptoms of teething have reduced.

On a Grabone deal some months ago, a customer stated that she was “a little unsure what these are for”. Given that Grabone generally tries very hard to avoid therapeutic claims and had not mentioned any in this deal (although the listing was for “Authentic Baltic Amber Teething Beads”), that confusion can be understood. In response, Lydia posted this:

Amber teething necklaces are to be worn against the skin. When amber is worn against the skin the benefits from the amber are absorbed into the skin and help to soothe the pain and inflammation caused by teething. They reduce drooling, red cheeks, nappy rash, swollen gums, low-grade fevers and sleeping problems associated with teething.

I have already thoroughly dealt with claims such as these in my previous post on amber teething necklaces. If you’re interested in why claims such as these are completely implausible, have a read of that post. Of course, even if these claims were plausible, it would still not be reasonable to believe them given that they are entirely unsupported by evidence.

Although both of these advertisements were in blatant violation of the Advertising Standards Authority’s Therapeutic Products Advertising Code, in that they made unsubstantiated therapeutic claims, they are not the advertisements I have complained about. Instead, I complained about the advertisements on the Punga Tails website itself.

There are various advertisements on the Punga Tails website, and they all link back to the Baltic amber FAQs page. It is on this page that most of the therapeutic claims were made. Here are some of the claims from that page that I highlighted in my complaint:

  • “The therapeutic effects of Baltic amber come from the succinic acid contained in it.”
  • “Baltic amber warms against the skin, releasing it’s therapeutic properties safely and naturally.”
  • “The therapeutic properties of Baltic amber include analgesic, calmative, anti-inflammatory, antispasmodic, expectorant, and febrifuge (reduces fever).”
  • “[Baltic amber teething necklaces] can boost the immune system and ease many ailments such as eczema, fatigue, fibromyalgia, carpal tunnel syndrome, migraines, psoriasis, menstrual cramping, pain, all types of arthritis, reduces stress, anxiety and depression.”
  • “Baltic amber is a natural analgesic so is ideal for pain relief with no side effects!”
  • “[Hazelwood] will help with the teething just as well.”

A couple of other pages on the site also made therapeutic claims regarding these products, such as:

Baltic amber is a natural way to reduce pain & inflammation WITH NO SIDE EFFECTS!

In response to my complaint, Punga Tails changed a lot of the content on their advertisements for Baltic amber teething necklaces. All of the claims that were not on the FAQs page seem to have been removed, and the FAQs page itself had quite a content overhaul. In light of this, the chairman of the ASA decided that the complaint should be considered settled.

When a complaint is settled that means the chairman has decided that as a result of the advertiser’s self-regulatory action “it would serve no further purpose to place the matter before the Complaints Board.”

Disappointingly, the FAQs page is still misleading on the subject of amber teething necklaces. The therapeutic claims it still contains are no longer as explicit, but they are still clearly there. They have generally been changed to claims about what is commonly believed, and references to its “effectiveness” remain. For example:

Succinic acid is the component of amber that is believed to contribute to the beneficial effects on teething.

This could explain why some amber teething necklaces are less effective.

Looking on the bright side for once, in the remnants of the FAQs page there is still one small part that I am mostly happy to see. One small piece of grudging honesty:

Because Baltic amber teething necklaces have not been scientifically proven we cannot make any claims as to their effectiveness.

I’ve uploaded my complaint and the details of the complaints board’s decision for you to read if you’re interested: 13/177 complaint and decision details


13/180 Energy Bracelet – 6Shooter

A friend on Facebook alerted me to this one. 6Shooter is a deals website, and they’d posted a deal for an “Health Nano Quantum Energy Bracelet/ Wristband”. Given the name of this product, you might not be surprised to hear that it can basically turn you into a superhero. Here are some of the unsubstantiated therapeutic claims I listed in my complaint:

  • “It will transmit nutrients and oxygen to cell and expel toxin in our body,people wont have feel cold with hand and feet any more”
  • “It will provide energy to blood corpuscle and lower viscosity,then reduce the chance to get cardiovascular disease,heart disease and wind-stroke”
  • “Strengthen human body BIO energy field to prevent harmful electromagnetic wave.”
  • “Protect us from electromagnetic waves from computer, mobile phone, electrical appliance, telecommunications and so on,recover our body with balance and coordination.”
  • “Stabilize oxygen supply in blood, activate blood corpuscle”
  • “Provide relief from allergies and respiratory related illnesses.”
  • “Normalize hormonal imbalances.”

I also brought up the fact that the advertisement misused a lot of scientific terms. This was relevant to my complaint as the Therapeutic Products Advertising Code requires that:

Scientific terminology must be appropriate, clearly communicated and able to be readily understood by the audience to whom it is directed.

I explained that the product name misused the terms “nano”, “quantum”, and “energy”. It seems quite clear that whoever is trying to sell these bracelets has simply put some sciencey-sounding words in the name to help convince their target audience: innocent people who simply don’t know any better.

The advertisement also refered to a “human body BIO energy field”, yet there is no such thing as far as we’ve ever been able to detect. Finally, I referred the following as “an example of gratuitous use of pseudoscience”:

Negative ion is the basic element to maintain good health.It can neutralize oxidized substance,such as cells.So the cells are revived and improved the immunity of human body.

I also mentioned that the claim that the product would offer protection from “electromagnetic waves from computer, mobile phone, electrical appliance, telecommunications and so on” constituted playing on consumers’ fair without justifiable reason, since there is no evidence to suggest that such electromagnetic radiation is harmful to humans.

This complaint was settled, after the advertiser responded by permanently removing the product from their stock. They also stated that they never intended to mislead consumers.

I think this case is a good example of why it is important to support science information and to point out pseudoscience for what it is. There are many products such as these which rely on people’s ignorance in order to convince them by sounding like science without having any of the actual substance. If more people can be educated in how to tell the difference between science and pseudoscience, scammers like the people who make and sell these bracelets will have less of a chance for success.

I’ve uploaded my complaint and the details of the complaints board’s decision for you to read if you’re interested: 13/180 complaint and decision details


13/190 Mohdoh – Punga Tails

After submitting my complaint about their amber teething necklaces, I found this product as well on the Punga Tails website. It’s basically smelly playdough, which is claimed to provide certain specific health benefits via aromatherapy and colour therapy. I submitted a complaint about this not so much because I was worried about health fraud, since this product appears to be harmless in that aspect, but because I also feel committed to fighting pseudoscience.

Similar to their amber teething necklaces advertisements, the majority of claims here were on an FAQs page. The misleading information here mostly related to aromatherapy and colour therapy, instead of being specific to the products being advertised, although there were a few specific claims as well. Here are a couple of the most egregious pseudoscience that were on that page:

  • “Colour therapy is a holistic and non-intrusive form of healing, which introduces the optimum balance of colour energies into the human organism in order to promote harmony between the body, mind and spirit.”
  • “If our energy centres (Chakras) become blocked or depleted, then our body cannot function properly and this, in turn, can lead to a variety of problems.”

The products also used to have specific indications. Bizarrely, even though they appeared to be marketed toward infants (including being in the “Babies Natural Care” section), one of the products was given the following indication:

Helps you quit smoking

This complaint was settled, after the advertiser removed most of the pseudoscience and therapeutic claims from the page. I was happy to see the introduction of the following disclaimers:

While Aromatherapy is not scientifically proven…

Colour therapy is not a scientifically proven therapy.

I’ve uploaded my complaint and the details of the complaints board’s decision for you to read if you’re interested: 13/190 complaint and decision details


13/011 Infrared Sauna – Innate Health

13/011 Innate Health Advertisement

Recently, I wrote about 3 complaints against Innate Health. One of these complaints, number 13/011, was about an advertisement in Coffee News for an infrared sauna that made various unsubstantiated therapeutic claims, and bizarrely stated that the product could:

Activate every cell in your body to increase your sense of well-being

The complaint was originally upheld on the 18th of March. On the 9th of May, I received a notice from the ASA saying that an appeal that had been submitted on this complaint had been accepted. This doesn’t mean the complaint had been successfully upheld, it just means that the appeal will be heard by the complaints board and they would then decide whether or not their decision should be changed. I was contacted because, as the complainant, I was to be given an opportunity to respond to this appeal.

The appeal claimed to present new evidence, and was basically just one really long citation of a bad review. I got the impression that Barbara Good Hammond, owner of Innate Health, came across this article some time after the complaint was upheld and thought she saw an opportunity to have the decision changed.

The article in question is a review published in Alternative Medicine Review in 2011, entitled Sauna as a Valuable Clinical Tool for Cardiovascular, Autoimmune, Toxicant-induced and other Chronic Health Problems. It was written by a naturopath called Walter Crinnion.

The article was a (non-systematic) review of the evidence regarding saunas as a therapeutic intervention. It seemed to rely very heavily on pilot studies and unpublished research, and seemed to be a rather unreliable source.

In the original complaint, the complaints board decided that “Activate every cell in your body” could be considered puffery. This means that it is obviously meant to be a ridiculous exaggeration and would not be taken seriously by anyone, so does not require substantiation. As part of the appeal, the advertiser disagreed with this analysis, claiming that the statement is not puffery and could be substantiated. They then proceeded to attempt to substantiate the claim:

With the whole body being effected [sic] during therapy, circulation is enhanced to every cell. The modality of Far Infrared sauna therapy has been substantiated world wide [sic] for improving cardia-vascular [sic] function, and with the heart being directly responsible for pumping and circulating blood to every cell in the body (as reported in Anatomy & Physiology books and being general knowledge) this would have a direct impact to increase the bodies [sic] sense of well-being, as proven and shown in published clinical studies worldwide.

She then went on to quote a paragraph from Crinnion’s review that seemed to be pretty much irrelevant to the claim, then declared that the statement “is legitimate and should not be considered puffery”.

This appears to be the one thing on which both Ms Hammond and I can agree: that statement should not be considered puffery. Bizarrely, even though the advertiser specifically said the statement is not puffery the complaints board reiterated their previous decision on this statement, saying that it should be considered puffery and therefore doesn’t need to be substantiated.

The rest of the text of the appeal is fairly benign and unconvincing, but there are 38 references listed at the end of it. At first, I thought that seemed pretty intimidating. However, after a minute or so I noticed that they were copied and pasted directly from the review, including spelling mistakes and formatting errors. Worse than that, many of them were duplicates, and there were actually only 25 unique references.

I got the distinct impression that Barbara Good Hammond didn’t even attempt to find these references to look at them herself. I’m not sure how else I can explain the fact that she cited the same piece of unpublished research 3 separate times. Nonetheless, with the help of a contact at the University of Auckland, I was able to get my hands on the full text of 12 of the references, and the abstracts of a further 6 references.

I went through each reference one by one, and found them all to be either irrelevant or inadequate substantiation for the claims made in Innate Health’s advertisement. In their decision, the complaint board seemed to agree with me, stating that:

Turning to the Advertiser’s evidence, the Complaints Board considered the Advertiser had not adequately substantiated the claims. It noted that one research authority was a naturopath, not a doctor or scientist, and the saunas about which the research was done were not infra red saunas but Finnish saunas. While the Complaints Board noted the research said there may be some merit in using Finnish saunas, this did not reach the threshold to validate the very strong claims in the advertisement, particular [sic] as that research discussed a different type of sauna.

If you’re interested, you can read the entire appeal application and my response: Complaint 13/011: appeal 13/013, response to appeal, and decision details

ASA Complaints: Innate Health

On the 3rd of January 2013, I picked up a copy of the Whangarei edition of Coffee News. This is a weekly publication that has different editions for various areas of New Zealand, and seems to contain a relatively high proportion of questionable advertising. I make a habit of looking at it whenever I get the chance, in case I find something I should complain about. In this case, I found what I was looking for.

13/011 Innate Health Advertisement

I wasn’t familiar yet with the product being advertised, but the claims sounded too good to be true so I thought it certainly warranted further investigation.

Once I got back to my computer, I looked up the Innate Health website. There I found other advertisements like the one I’d seen in Coffee News. There was one advertisement for an “Ionic Detox Foot Spa” (scroll down on that page), and another for a “Quantum Magnetic Analyser Report“.

Both of these advertisements were concerning. Fraudulent “detox foot spas” and similar pads, which change colour and appear to gunk up after placing your feet in them and are claimed that they’re removing “toxins” are nothing new. There are a few varieties, but they have essentially been shown to be fake:

As for their “Quantum Magnetic Analyser Report”, the way they described it didn’t even sound superficially plausible, and the spattering of pseudoscientific language didn’t particularly help their case. The product seems to be a hand grip connected to a computer, and allegedly when you hold onto the grip the computer will tell you what’s wrong with you.

So far, I have laid 3 complaints against Innate Health with the ASA.


Ionic Detox Foot Spa – Complaint 13/010

Innate Health made a lot of claims about what their foot spa could help with:

  • Joint Pain, Arthritis
  • Chronic Fatigue
  • Foggy Brain, Poor Concentration
  • Sleeplessness
  • Poor Circulation
  • Heavy Metal Toxicity
  • Allergies
  • Eczema, Psoriasis
  • Parasites
  • Candida
  • Obesity
  • Hormonal Imbalance
  • Low Sex Drive
  • Weak Immune System
  • Cellular Acidosis (Ph [sic] is too high)

There was absolutely no attempt made to substantiate any of these claims, making them in violation of the Therapeutic Products Advertising Code Principle 2.

The advertisement also used scientific terminology in an inappropriate way, attempting to take advantage of consumers’ lack of knowledge by talking about such sciencey sounding things as

balancing the body’s natural energy system

utilizing principles of reflexology and the science of ionization and osmosis, create a positive cellular environment

Because these statements used scientific terminology in an inappropriate way, I considered them to be in violation of the Therapeutic Products Advertising Code Part B2 R4.3. I also considered them to be in violation of Part B2 Requirement 4(a) and 4(b), because they abused consumers’ lack on knowledge in order to deceive them.

I also argued that the advertisement violated Principle 3 of the Therapeutic Products Advertising Code, which requires that advertisements such as this exhibit a high standard of social responsibility.

In response to the complaint, the Innate Health representative seemed to think that it was sufficient to explain to the ASCB that anyone wanting to buy their products could just search on Google for the product name and research it themselves. Instead of attempting to substantiate their claims they just told the ASCB how many results Google said it found when they searched for their product name. I have no idea why they thought this was a good idea, especially given that the ASA’s website has information available on how to respond to a complaint regarding misleading claims, but I guess that’s just what they decided to do.

In complaints like this the onus is always on the advertiser to substantiate their claims. As they had failed to do so convincingly, the ASCB upheld the complaint and ruled that the advertisement be removed.

However, this complaint was a bit more interesting than that. Innate Health had actually already removed the advertisement from their website before the ASCB met to make a decision about the complaint. Normally, at least in my experience, this would result in a complaint being considered settled. However, the ASCB did something for which I commend them in this case:

The Complaints Board noted the advertisement for this product had been removed from the Advertiser’s website, but considered it was in the public interest the issues raised by the Complainant be addressed.

I hope that this precedent may be useful in future complaints that involve advertisements with a short lifespan, such as GrabOne deals, which may be removed before the ASCB is able to meet and potentially uphold a complaint against them. If you would like to refer to this precedent in a complaint of your own, remember this is complaint 13/010.

I’ve uploaded the details of this decision, which includes my original complaint, for you to read: 13/010 Decision Details


METAbolic Infrared Sauna Chamber – Complaint 13/011

The advertisement in Coffee News was similar to Innate Health’s other advertisement, in that it made various unsubstantiated health claims and misused scientific terminology. The line in particular which grabbed my attention was:

Activate every cell in your body to increase your sense of well-being

Aside from that, various therapeutic claims were also made in the advertisement, without any attempt to substantiate them. Apparently the product will:

  • Promote weight loss and burn calories
  • Enhance metabolism, immune system and blood circulation
  • Assists with removal of toxins, heavy metals, lactic/fatty acids
  • Promote relaxation, reducing stiffness, pain and fatigue

Honestly, I don’t doubt that sitting in any sort of sauna, including an infrared one like this, could be relaxing. The other claims though, particularly the claim about helping remove heavy metals and other “toxins”, were quite concerning.

As always, before I made this complaint I searched to see what evidence I could find. I didn’t find much at the time, but I did manage to find a 2008 article from the LA times that quotes relevant experts saying that, as I’d expected, sweating is not a valid method of treating heavy metal toxicity. Here’s a link to the article: You sweat, but toxins likely stay

My complaint argued that the claim about “activating” your cells was an inappropriate use of scientific terminology, that the therapeutic claims made were unsubstantiated, and that it was highly irresponsible to imply that a serious condition like heavy metal poisoning could be treated in this way.

Like in the previous complaint, the Innate Health representative’s tactic involved searching for their product on Google and reporting the number of results, so the ASCB upheld the complaint.

Unfortunately, though, instead of agreeing with me that “Activate every cell in your body” was a misuse of scientific terminology, the ASCB decided it should be treated as “puffery”. As far as I understand, that basically means a claim that is exaggerated to the point of appearing so ridiculous that no one could possibly take it seriously, and therefore doesn’t require substantiation. I disagree with their decision here, but I got the result I was after overall.

I’ve uploaded the details of the ASCB’s decision, including my complaint, for you to read: 13/011 Decision Details


Quantum Magnetic Analyser Report – Complaint 13/012

I found this one very amusing. Here’s how the product was originally described in the advertisement:

Quantum Magnetic Analyzer collect the weak magnetic field sensors of frequency and energy from the human body through the hand grip sensor. The instrument magnifies your body functions and the computer processes the information collected and compares with the diseases on record which are installed inside the instrument and compares against the standard spectrum. According to the results, the therapist is able to make an analytic judgement for the person and put forward standard advice for any preventive treatment that may be required.

The complaint about this ad focused on similar points to the previous ones: its therapeutic claims are unsubstantiated, it’s socially irresponsible, and it’s taking advantage of consumers’ lack of knowledge.

You can probably guess how the Innate Health representative responded to this complaint. That’s right, they searched for their product on Google and told the ASCB how many results they got. In light of this, the complaint was upheld.

Despite this, and despite the fact that having a complaint upheld against you by the ASA means you are asked to remove the advertisement, Innate Health has not removed the advertisement. I have submitted a new complaint to the ASA regarding this.

I always make records of the original state of advertisements against which I complain so I can tell what, if anything, is changed. For online advertisements, I use this Chrome extension: Screen Capture (by Google). In this case, the important changes were that the latter half of the advertisement was changed, removing some unsubstantiated claims and adding a new one, and a disclaimer was added. I don’t really know how Innate Health could have decided this was an acceptable route for them to take, because the ASCB clearly stated this in their decision:

The Complaints Board said that even if there had been a disclaimer, that alone would not remove the responsibility to provide substantiation.

As always, I’ve uploaded the decision details and my complaint for you to read: 13/012 Decision Details

ASA Complaint: Balanced Energy and Airborne Viruses

On this blog so far I’ve written about 2 complaints I’ve made to the ASA. Last year I wrote about the first official complaint I ever made, about a chiropractor and acupuncturist being referred to as a doctor in a TV ad, falsely implying he was a medical doctor. This complaint was settled when the advertisement was amended to specify that he is a chiropractor, not a medical doctor.

After that, I wrote about the second complaint I ever made against U-GO for their online advertisement of amber teething necklaces, and the associated appeal I made after it was considered settled when all the advertiser had done was mark the product as “sold out”. My appeal was rejected, but only because the advertiser voluntarily removed the ad and opted to stop selling the product, so the appeal was no longer necessary.

Aside from these complaints, I have been making many more, all motivated by the same desire to expose and prevent health fraud. In this series of posts I’m going to write about the complaints I’ve been making and their outcomes. Once I’ve written up posts about each of my complaints that have already been completed, I’ll continue to publish similar posts as more complaints are completed.


Balanced Energy Website Advertisement – Complaint 12/649

For some time now, I have had a Google Alert set up to let me know when certain keywords appear in new articles on the NZ Herald website, so I can quickly catch any articles about quackery such as iridology.

I set up this alert after I read an article about qigong and Henri-Noel Venturini. Venturini not only thinks that “chi”, described in the article as “intrinsic life energy, or life essence”, exists, but he also seems to think that it is relevant to one’s health. The article ends with a little advertisement about his qigong classes and a link to his company’s website, and I found myself completely unable to resist checking out the website of a company called “Balanced Energy“.

I wasn’t disappointed either – the website is absolutely full of pseudoscience and superstition. The page dedicated to Mr. Venturini talks about his use of…

  • Vibrational medicine
  • Colour therapy
  • Crystal therapy
  • Energy healing
  • Sacred geometry
  • Numerology
  • Astrology
  • Five Element Theory
  • Aura Balancing

It seems nothing is too crazy for Henri-Noel Venturini.

Most of the Balanced Energy website’s content is typically vague and mystical, but there was one product description in particular that stuck out to me. Almost all of their products are split into 6 different types, and the description for the “Element of Air or Metal” type of products included this in the description:

great… as a preventative for airborne viruses

I couldn’t find any substantiation for this claim on the product detail pages, although their ingredients page did say this much:

Anything we sell that we do not make our selves has been thoroughly researched to ensure it meets our strict standards for purity and effectiveness.

We do not test our products on animals, only willing humans!

Given that this business thinks chakras, chi, and meridians are both real and relevant to health, I don’t expect they have particularly strict standards for measuring effectiveness. That page has been updated since I first saw it, and now explains that they test their products on themselves first, then “on a group of willing, human volunteers”, but still mentions no details of the testing process (I doubt, for example, that it is controlled in any way) and no longer makes any mention of standards for effectiveness.

Needless to say, I made a complaint to the ASA. I explained that the description constituted a therapeutic claim, but lacked the substantiation required by the ASA’s Therapeutic Products Advertising Code Principle 2. I also said that, given this lack of substantiation, the advertisement also didn’t adhere to the high standard of social responsibility rquired by the Therapeutic Products Advertising Code Principle 3, as consumers’ false sense of security may lead to an increased incidence of infectious disease.

My complaint was received by the ASA on the 22nd of November 2012, and I received the details of their decision on the 27th of February 2013. The advertiser changed the contents of the advertisement and told the ASCB that they’d registered with ANZA’s TAPS to ensure that future advertisements didn’t breach the ASA’s codes.

To be honest, I’m not happy with the outcome of this complaint. The updated advertisement simply claims that the ingredients of the product have antiseptic and antiviral properties, implying that the product itself shares the same properties in a useful way. Of course, this hasn’t been substantiated, and is probably not true either.

I’m disappointed that the ASCB considered a complaint about an unsubstantiated therapeutic claim to be settled when the advertisement was changed to instead make a different unsubstantiated therapeutic claim, even if the advertiser did promise to get TAPS approval (as far as I can tell they haven’t done this yet), but I haven’t laid another complaint about this website. At least not yet.

I’ve uploaded the details of the ASCB’s decision for you to read. My original complaint is included at the bottom of this post.


Various products on the Balanced Energy website are described as being “great… as a preventative for airborne viruses”.

I have looked throughout the website for any attempt to provide supporting scientific evidence for this medical claim, and the closest I could find was this (retrieved 16/11/2012 from http://www.balancedenergy.co.nz/products/ingredients/):
“Anything we sell that we do not make our selves has been thoroughly researched to ensure it meets our strict standards for purity and effectiveness.

We do not test our products on animals, only willing humans!”

I could not find any information on how (or if) the claims about which I am complaining were tested, or on the details of their “standards for… effectiveness”.

In light of this, I think this medical claim is in breach of the Therapeutics Advertising Code Principles 2 and 3:
Principle 2 – As far as I am aware, there is no scientific evidence supporting the claim. No substantiation of the claim appeared to be available via the website.
Principle 3 – People purchasing and using these products may believe that they are being protected against airborne viruses, which has not be shown to be true. This may lead to increased incidence of infectious disease, and therefore does not observe a high standard of social responsibility.

I anticipate that Balanced Energy may claim that the products in question should not be considered therapeutic products. However, the Therapeutic Products Advertising Code specifies that products “represented in any way to be, or that is… likely to be taken to be for therapeutic use” are therapeutic products, and furthermore specifies that “therapeutic use” includes “use in or in connection with… preventing… a disease… in humans”.

ASA Appeal: U-GO’s Amber Teething Necklaces

A week ago I published my write-up of a complaint I made to the Advertising Standards Authority about an advertisement for amber teething necklaces on the U-GO website.

In my write-up, I explained how I had appealed the ASA’s decision to settle the complaint without the advertisement being removed or changed, and that my appeal had been declined but I was not sure why. As it turned out, I received the details as to why my appeal had been declined in the mail on the same day as I published my write-up. I edited my previous post to explain this, but the vast majority of people who have read it did so before I made that edit.

Usually I receive correspondence from the ASA regarding my complaints both via email and on paper, but for some reason this was only sent to me via the post. Whenever they send out details of their decisions, they ask that they not be made public until the ASA has released them to the media, which is why I’ve waited until now to publish this write-up.

It turns out that my victory was bigger than I’d realised. When U-GO removed their advertisement on the 19th of February (the date my appeal was declined), I thought that it was still going to be later republished after they had attained the approval of TAPS, the Association of New Zealand Advertisers’ Therapeutic Advertising Pre-vetting System, as this had been implied in their original response to my complaint:

Also, because our business has taken us in to other areas of advertising we have employed the services of TAPS adjudicators and understand more the seriousness of making therapeutic claims in our advertising.

When we make these necklaces available again we will ensure the standards are met.

However, the response to my appeal revealed that U-GO has decided to stop selling these necklaces. Here is the entirety of the correspondance from U-GO that the ASA forwarded to me in relation to my appeal:

… [T]he Baltic Amber Teething Necklaces have been withdrawn from sale. We will not be offering these for sale again.


Because these necklaces were a very minor part of U-GO’s business, they were easily able to withdraw them from sale in response to the complaint. While I am very happy with this result, the fact that they were willing to informally resolve the complaint instead of requiring the Advertising Standards Complaints Board (ASCB) to make an adjudication and choose whether or not to uphold the complaint means that no useful precedent has been set.

Since receiving this news, I have made 2 more complaints about advertisements for practically identical products. One of these advertisers’ businesses relies entirely on the sale of amber necklaces for therapeutic purposes, so I anticipate that the ASCB will have to uphold that particular complaint instead of it being informally settled. Once a precedent has been set, it should make it much easier and quicker to have future complaints about advertisements of these products upheld.

The advertisements that I have complained about are on the Belly Beyond website and the Baby Amber Teething New Zealand website. You can expect to see write-ups for each of these complaints here eventually.


I feel as though I should acknowledge that it’s possible that U-GO only didn’t remove the advertisement immediately because they thought it should be left in place for the duration of my ASA complaint in order to help the ASA’s process. I can’t say for sure, but this seems implied by a couple of things they said in their original response to my complaint:

I would like to say that had I seen this advertisement on our website I would have changed it immediately.

We have left the advertisement as it is on the website for the duration of this complaint but have made it unavailable for sale.

If they had no problem with removing the advertisement then they should have removed it as soon as they received the complaint, but I can believe that they may have misunderstood this.


The full details of my appeal and the decision to have it declined are available on the ASA’s website and on Honest Universe.

ASA Complaint: U-GO’s Amber Teething Necklaces

In my previous post on amber teething necklaces, I described the problems with the therapeutic claims commonly associated with them. One of the websites I quoted is a New Zealand website, “U-GO” Products, that sells amber teething necklaces (among other things) online.

Late in 2012, I made a complaint about the content of their site. Took a screenshot of the site as it was at that point, with the offending phrases highlighted. Here’s what the advertisement said:

Wearing Baltic amber close to the skin is a traditional European remedy for baby teething.

Considered a natural analgesic, Amber is reported to help calm a baby without resorting to drugs. Used for centuries in Europe, amber’s natural anti-inflammatory and pain relieving properties are perfect to soothe teething babies.

Amber is a fossilized resin containing high levels of succinic acid, attributed for its pain relief and anti-anxiety properties.

When worn the bead warm against the skin, releasing its therapeutic properties safely and naturally.

After reading this, I wrote up a complaint to the ASA, which is included at the end of this post. The complaint followed this format:

  • Explained how this product is a therapeutic product as defined in the ASA’s Therapeutic Products Advertising Code.
  • Identified the therapeutic claims made in the advertisement.
  • Stated that these claims lack substantiation, which is required by the code.
  • Explained why these claims are unlikely to be true.
  • This product has associated risks (I was able to cite the Ministry of Consumer Affairs here) but lacks warning labels and therefore also does not demonstrate the high degree of social responsibility required of such advertisements.

It took quite some time for me to hear back from the ASA. My complaint was accepted on the 11th of December 2012 to be put before the Advertising Standards Complaints Board (ASCB), but I did not received the full details of the decision until the 12th of February.

The advertiser’s initial response to my complaint was not to change the content of the advertisement. Instead, they changed the page to show the product as being “SOLD OUT” and said my concerns are dealt with on the supplier’s website. Their entire response has been included at the bottom of this post.

Amazingly, the ASCB considered this action to be sufficient to consider the complaint to be settled and not bother to uphold it or ask them to remove the advertisement or the unsubstantiated claims contained within it. I was quick to see that this precedent provided a massive loophole through which advertisers could make whatever therapeutic claims they want (so long as they don’t draw too much attention to themselves) while effectively escaping all regulation. I did all I could do in response to this decision: I appealed.

In my appeal I addressed both my concern with the poor precedent set by the decision and the claims made by the advertiser that the supplier’s website addressed my concerns. The website did partially address my safety concerns, but not enough to justify a lack of safety warnings. However, their attempt to address my claims as to efficacy and plausibility were laughable, and I reveled in the opportunity to use that wonderful word “quackery” in my appeal. You can see my appeal in its entirety at the bottom of this post.

After making my appeal on the 13th of February 2013, I checked the advertisement daily. On the 18th, it still appeared unchanged, but on the 19th the page was removed entirely. Soon after this, on the 21st, I heard back from the ASA that my appeal had been declined. Although the complaint’s decision is now listed on their website, I have received no more information regarding my appeal, and it is not mentioned alongside the complaint on their website.

I have set up a Google Alert so that if U-GO ever lists amber teething necklaces on their website again, I’ll know about it as soon as Google does. I also hope to use this complaint as precedent to have other similar advertisements removed. I’d hope to be able to have such complaints upheld without having to wait over 2 months for a decision on each complaint, but as this complaint was settled and not upheld I don’t know whether or not the ASCB will treat it as setting a strong precedent.

I encourage anyone else reading this to do the same if you ever see an advertisement for amber teething necklaces in New Zealand (or elsewhere, it’s just that this precedent is specific to New Zealand). For reference, the complaint’s identifier is 12/611.


The full details of the decision can be seen on the ASA’s website here. I have also hosted the Complaint Decision Details, including complaint and advertiser’s response, here on Honest Universe.

Here is the content of my appeal:


I would like to appeal the decision of complaint 12/611 on the basis that it is in the interests of natural justice that the matter be reheard.

While I appreciate that the advertiser apologised for the advertisement, the primary concern is that the therapeutic claims made in the advertisement are unsubstantiated and this still has not changed. If the advertiser is willing to admit that “had I seen this advertisement on our website I would have changed it immediately” then I expect they would not be opposed to changing it immediately now that it has been drawn to their attention.

I also appreciate the advertiser’s obvious wish to comply with the ASA’s standards, presumably as they have no wish to mislead consumers. However, leaving the advertisement unchanged until the product is made available again does nothing to address the concerns with unsubstantiated therapeutic claims. If they wish to make the product unavailable for any duration then that’s their prerogative, but regardless they should also remove the unsubstantiated therapeutic claims made about it.

The advertisement about which the complaint was made has not been altered or removed. This means that the unsubstantiated therapeutic claims made in the advertisement remain published and continue to potentially mislead consumers.

That the product being advertised is currently listed as “SOLD OUT” should have no effect on the decision made about this complaint. The issue at the heart of the complaint is the content of the advertisement, not the availability of the product. As that has not changed, the complaint should not be considered to be settled, in the same manner as a complaint made about the content of an advertisement for a product temporarily listed as “SOLD OUT” should not be dismissed as having no grounds to proceed.

If the content of the advertisement is to be changed in the future to comply with the ASA’s codes in that it will only make therapeutic claims if they have been substantiated then that is good, but in the meantime the unsubstantiated claims made in the current advertisement should not remain published. In lieu of being changed, the advertisement should be taken down so as not to mislead the public further.

By utilising the tactic used by U-GO in response to this complaint, it would be possible for any business to advertise a product with misleading information, potentially even intending to defraud consumers, but escape regulation by listing the product as “SOLD OUT” for as long as such content remains published. This does not prevent consumers from being misled by such an advertisement, and they may be influenced to return to purchase the same product when it becomes available again in the future, or to purchase an identical or similar product elsewhere. This behaviour does not exhibit the high standard of social responsibility required by the ASA’s Therapeutic Products Advertising Code principle 3.

As written in the ASA’s constitution, the primary object of the ASA is:
“To seek to maintain at all times proper and generally acceptible standards in advertising and any other activity regulated by the Code of Practice” (emphasis mine).
Providing advertisers with a loophole such as this that they might be permitted be publish misleading and unacceptable advertisements free of industry regulation goes counter to this goal.

==========

With regard to the advertiser’s claim that “The complaints raised by M. Hanna regarding strangulation and succinic acid are explained on the suppliers [sic] website”, upon reading the pages provided by the advertiser I am unconvinced. While my safety concerns are dealt with to a small degree (despite existing safeguards a warning would still be pertinent) the issues of substantiation and the plausibility of the succinic acid hypothesis are not.

I realise that, not being a New Zealand website, the content of the Amberizon website does not fall under the ASA’s jurisdiction, but for completeness’ sake I will discuss this here.

———-

On the “Healing properties of amber” page (http://www.amberizon.com/page/healing_properties_of_amber_healing_gemstone.html), the following is stated:

“Amber is a powerful chakra cleanser and healer. At a physical level, is [sic] imbues the body with vitality and has the power to draw disease out of the body. By absorbing pain and negative energy, amber allows the body to rebalance and heal itself. Amber alleviates stress.

Amber provides decisiveness. It strengthens your memory and intellect and helps with emotional calming and centering. It is an excellent grounding crystal, and transmutes negative energy to positive. Amber radiates a warm and bright energy.”

The vast majority of this content is meaningless pseudoscience. For example, there is no high-quality scientific evidence that “chackras” exist at all, let alone that they are relevant to health and can be affected by objects such as this.

“is [sic] imbues the body with vitality and has the power to draw disease out of the body” is similarly nebulous pseudoscientific nonsense, lacking both credibility and substantiation.

“By absorbing pain and negative energy” again is utter nonsense. Pain is not some substance that can be absorbed, and the phrase “negative energy” is inappropriate and, in this context, undefined.

I hope that it is absolutely clear to everyone that the second paragraph quoted above contains absolutely no sense or science. In fact this looks like a brilliant example of quackery, in which pseudoscientific nonsense is used to peddle a probably useless product. Although I am happy to note that U-GO has not quoted any of this nonsense in their own advertisement, that it considers this group “experts for this product” is concerning, to say the least.

That page also has this to say about amber teething necklaces:
“Wearing baltic amber close to the skin is a traditional European remedy for baby teething. A natural analgesic, amber will help calm a baby without resorting to drugs. Used for centuries in Europe, amber’s natural anti-inflamitory [sic] and pain relieving properties are perfect to soothe teething babies. Amber is fossilized resin, which warms against the skin, releasing it’s [sic]theraputic [sic] properties safely and naturally.”

This paragraph is practically identical to the one currently used by U-GO in their advertisement, which I have already discussed in my original complaint.

———-

The “Baby Teething Necklaces” page (http://www.amberizon.com/shop/amber_teething_necklaces_baby_teething_necklace_teething_beads_babies.html) says this:

“As a safety feature there is a knot before and after each bead, so that even in the extremely unlikely event of the string being torn, no beads are lost and there is no risk of choking. Amber teething necklaces are secured with a traditional screw clasp, not a hook and ring!”

I am glad to hear that the products have these safeguards in place, but I also feel it is important to note that they do not entirely negate the significant risks of choking and strangulation. It would be pertinent to include a similar warning to the one issued by the Ministry of Consumer Affairs about amber teething necklaces (http://www.consumeraffairs.govt.nz/for-consumers/goods/product-safety/keeping-kids-safe/amber-teething-necklace), namely that infants should be supervised at all times while wearing these necklaces.

It also seems relevant to point out that a consumer has previously complained about these necklaces (purchased from Amberizon) citing safety concerns despite the website’s reassurances after testing the necklaces themselves: http://www.scambook.com/report/view/36179/Amberizon-Complaint-36179-for-$113.15

It seems relevant that the Therapeutic Products Advertising Code part B2 requirement 2(a) specifies that:
“If the medical device has… specific warnings that may affect the safe use of the device… an appropriate warning must be given.”

———-

I have not been able to find any information on those 2 pages of the Amberizon website that respond to my complaints regarding the succinic acid hypothesis. Since originally making this complaint and researching the issue further, I have uncovered several more serious issues with this hypothesis that I have not seen dealt with and would be happy to detail if necessary.


After submitting my appeal, I was asked to clarify the “supplementary material” included in my appeal application. They seemed satisfied when I told them I was responding to the claims made by the advertiser in their response to my complaint, and that the information I discussed was found by following the links provided by the advertiser in their response.

I also sent them information regarding the recent decision by the UK’s ASA on another advertisement for amber teething necklaces, which was passed on to me by Autismum:

I thought it might be worth mentioning that new evidence relating to complaint 12/611 has been brought to my attention in the form of advice published by the UK’s Committee of Advertising Practice in response to a complaint upheld against an advertisement similar to the one in this complaint. I realise that regulation in the UK is not identical to here in New Zealand, but the information still seems relevant.

This advice can be found published online at this location: http://www.cap.org.uk/Advice-Training-on-the-rules/Advice-Online-Database/Amber-Jewellery.aspx


UPDATE:

After arriving home after this post was published and checking the mail, I now have the details of why my appeal was declined. I’m not sure why this information was not emailed to me, but at least I have it now.

The ASA ask that the details of their decision not be released publicly until after they’ve released them publicly themselves, so I’ll publish a follow-up post with this information once that has happened, on the 4th of March.

Misusing the Term “Doctor” in New Zealand Advertising

Earlier this year, I saw an infomercial on TV for “Dr Ho’s decompression belt”. This was only a few days after I’d encountered this post on Science-Based Medicine, which mentioned “decompression therapy” in a post entitled “Chiropractic Gimmickry”, so my alarm bells were ringing and I wrote down as much detail about the ad I could in one of my pocket notebooks.

Later, when I was able to look the product up online, it seemed that the only official claims made of it were related to pain relief. As far as I could tell, that seemed consistent with the evidence, so I decided not to pursue that avenue. However, I did find that so-called “Dr Ho” is not a medical doctor, but instead a “Doctor of Chiropractic and Acupuncture”.

For quite some time now, I’ve had a link in my bookmarks to an article published in 2008 in the New Zealand Medical Journal entitled Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy, and this situation reminded me very strongly of that article. To sum it up, “Doctor” is not a protected term in New Zealand, but there are laws that prevent it from being used in such a way as to imply that a person is a medical doctor when, in fact, they are not. That study outlines the law and shows roughly how common such misrepresentation appears to be (spoiler: very common). The law in question is in the Health Practitioners Competence Assurance Act 2003.

In response to this, I wrote in to the ASA (Advertising Standards Authority), asking if anyone there could clarify for me when it is and isn’t appropriate to use the term “Doctor” in advertising. I’ve inserted this original message at the bottom of this post.

After about a month and a half, during which I’d received a couple of notifications to let me know that they were looking into it, I received an email to let me know that the matter has been settled. About a week after that, I was sent this ruling.

It seems that the people responsible for the advertisement have altered it to clarify that Dr Ho is a chiropractor, and not an MD as was previously implied. I’m sure the distinction will be lost on most viewers, but I’m happy to consider this a victory. Even though ads tend to have short lifetimes, the fact that a precedent has been set makes me optimistic.

I would encourage other people living in New Zealand (and elsewhere, of course, but the law may differ in other countries) to make similar complaints when they observe this behaviour. If you do so, it would probably be useful to refer to this complaint and, if appropriate, the relevant provisions listed in the ruling:

Principles 2 and 3, and Part B2 Requirement 3 of the Therapeutic Products Advertising Code.

Here’s the original email I sent:


To whom it may concern,

I saw an infomercial on TV last Sunday evening (19/08/2012, around 7:30-7:45 on Prime) for “Dr. Ho’s decompression belt”. This advertisement raised my suspicions as, a couple of days earlier, I’d read an article on the highly reputable website Science-Based Medicine that described “decompression therapy” as something which is commonly recommended by chiropractors for dubious reasons.

As far as I’ve been able to tell, the only claims made for this product (that it can relieve back pain) don’t seem illegitimate, and although I’ve found numerous references to the product having been “clinically tested” and “scientifically proven” without any corroborating references I’m not sure if official promotions have made such claims. However, in my search I discovered that “Dr. Ho”, as he described himself in the infomercial where he authoritatively promoted the product, is not a medical doctor. Instead, he is a “Doctor of Chiropractic and Acupuncture”.

The Health Practitioners Competence Assurance Act 2003 states that “a person may only use names, words, titles, initials, abbreviations, or descriptions stating or implying that the person is a health practitioner of a particular kind if the person is registered, and is qualified to be registered, as a health practitioner of that kind”. I was under the impression, from the use of the term “Doctor” in this advertisement, that “Dr. Ho” was a licensed medical doctor and therefore actually had the authority with which he promoted his product.

My conclusion that this use of the term “Doctor” can be seen as misleading, and therefore violate the Health Practitioners Competence Assurance Act 2003, when used in such a context by non-medical doctors is corroborated by this article from the New Zealand Medical Journal.

I’d very much appreciate it if someone with authority on the matter could clarify for me just what is and isn’t acceptable when it comes to referring to oneself as “Doctor” in a medical context within advertising. Can such behaviour be considered a breach of advertising standards, or is it considered acceptable? If it is considered acceptable, is there a list of qualifications which allow one to call themselves “Doctor”, or would no qualifications be necessary?

Thank you in advance,

Mark Hanna