Tag: ASA

Ethical Pharmacy Practice 3: Running Out of Excuses

Ethical pharmacy practice is something I have written about before. If you’ve read those posts, please bear with me as I cover some familiar background.

In New Zealand, we are lucky enough to have an industry code of ethics for pharmacists, published by the Pharmacy Council of New Zealand, which holds pharmacists to high ethical standards. This code of ethics is the Safe Effective Pharmacy Practice Code of Ethics. One of the most important parts of this code of ethics is section 6.9, which states:

[PHARMACISTS] 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.

Pharmacy Council’s Safe Effective Pharmacy Practice Code of Ethics Section 6.9

The Pharmacy Council of New Zealand isn’t a voluntary member organisation like the Pharmacy Guild or the Pharmaceutical Society. Instead the council is established as part of the Health Practitioners Competence Assurance Act 2003. Their roles are set out in this act and include:

  • Registering pharmacists
  • Reviewing and maintaining the competence of pharmacists
  • Setting standards of clinical competence, cultural competence, and ethical conduct for pharmacists

Which means that the Safe Effective Pharmacy Practice Code of Ethics is not a voluntary code of ethics. It is published by the body whose legal duty it is to set the standards of ethical conduct for pharmacists. Yet all over New Zealand, many pharmacists ignore it.

Walk into any New Zealand pharmacy. Chances are that you will find a section where they advertise and sell a range of homeopathic products. To anyone familiar with the evidence for homeopathy, it will come as no surprise when I tell you that there is no credible evidence of efficacy for any homeopathic product. Therefore, it seems to me, New Zealand pharmacists have an ethical obligation not to promote or sell them.

Yesterday, the Australian National Health and Medical Research Council (NHMRC) issued their final statement on homeopathy, following an incredibly extensive and rigorous review of the literature. They looked at over 1,800 scientific papers, and found that 225 met their criteria for methodological rigour, sample size, and placebo control. Their main finding was:

there are no health conditions for which there is reliable evidence that homeopathy is effective.

NHMRC Statement: Statement on Homeopathy

As I said, this conclusion does not come as a surprise. This research is the latest in a long line of reviews of the evidence for homeopathy that drew essentially the same finding:

  • A 2002 systematic review of systematic reviews of homeopathy published in the British Journal of Clinical Pharmacology concluded that:

    the hypothesis that any given homeopathic remedy leads to clinical effects that are relevantly different from placebo or superior to other control interventions for any medical condition, is not supported by evidence from systematic reviews. Until more compelling results are available, homeopathy cannot be viewed as an evidence-based form of therapy.

    A systematic review of systematic reviews of homeopathy

  • A 2010 systematic review of systematic reviews of homeopathy published in the Medical Journal of Australia concluded:

    The findings of currently available Cochrane reviews of studies of homeopathy do not show that homeopathic medicines have effects beyond placebo.

    Homeopathy: what does the “best” evidence tell us?

  • A 2010 report from the UK House of Commons concluded:

    homeopathy is a placebo treatment.

    Evidence Check 2: Homeopathy

  • In 2013, the NHMRC published a report based on their research that found:

    There is a paucity of good-quality studies of sufficient size that examine the effectiveness of homeopathy as a treatment for any clinical condition in humans. The available evidence is not compelling and fails to demonstrate that homeopathy is an effective treatment for any of the reported clinical conditions in humans.

    Effectiveness of Homeopathy for Clinical Conditions: Evaluation of the Evidence

I could go on, but I hope by now you get the idea.

New Zealand pharmacists need to respond to the NHMRC’s research. And if they mean to practice responsibly and ethically, that response should be to immediately stop all promotion and sale of homeopathic products. The ethical standard to which they should be held is clear, and it is not consistent with promoting or supplying homeopathic products.

Last year, I complained to the Advertising Standards Authority under the auspices of the Society for Science Based Healthcare about a homeopathic product for preventing jet lag (No-Jet-Lag) that was advertised in Parnell Pharmacy. The pharmacy responded by removing the advertisement, and agreeing to stop selling the product if it was found that the claims were not supported by credible evidence, and my complaint was upheld. Unsurprisingly, my complaint was upheld when the ASA decided claims such as “it really works” were not supported by credible evidence. However, despite Parnell Pharmacy’s example, many New Zealand pharmacies still sell this exact product.

The NHMRC’s report represents the same finding, but on a larger scale. New Zealand pharmacists who promote and sell homeopathic products should follow the responsible example of Parnell Pharmacy, and remove homeopathic products from their shelves.

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.

How to Read Medical Advertisements

Lately, I have been familiarising myself with how medical advertisements are regulated here in New Zealand. In doing this, I have come to realise that regulatory bodies do not always interpret advertisements in the same way as I would expect the public to interpret them.

This sort of discrepancy can be, and frequently is, exploited by advertisers of medicine, both legitimate and less so. While it may be in the advertisers’ interest to have these differences in interpretation as it allows them to mislead the public about the effectiveness of their product, for the exact same reason it is not in the best interest of consumers.

In this article I describe how advertisers and regulators appear to interpret medical advertisements, and the implications of their interpretations. I hope that understanding this might enable others to understand what these ads are really saying. It is my sincere hope that, after reading this, you will never look at another medical advertisement in the same way again.

The first step I took in this project was familiarising myself with the codes of the Advertising Standards Authority (ASA), particularly those relating to therapeutic products and services. Their codes for weight management and ethics were also relevant. Based on these, I’ve submitted 11 complaints to the ASA since my first complaint last year, and I have more drafts that haven’t been submitted yet for various reasons.

As well as looking through the ASA’s codes, I’ve searched through previous decisions made by the Advertising Standards Complaints Board (ASCB) so I might better understand the codes’ application. The ASA website lets you search decisions from 2006 onwards, but older decisions can still be found by searching on Google within 203.152.114.11*.

If the ASCB decides to uphold a complaint, they request that the advertiser voluntarily withdraw the advertisement. As far as I am aware, it is at least very uncommon for an advertiser to refuse this request (the ASA website states that “This request is invariably followed.”) but the ASA does not have any actual legal authority with which they can enforce their decisions and they are unable to investigate breaches of the law as they only have jurisdiction over their codes.

When it comes to statutory regulation, Medsafe (part of the Ministry of Health) administers the Medicines Act 1981 and Medicines Regulations 1984, and the Commerce Commission enforces the Fair Trading Act 1986. For the most part, however, the advertising industry regulates itself via the ASA.

In reading past ASCB decisions about therapeutic advertising, I noticed that the ASCB frequently recommends the use of “TAPS”, the Therapeutic Products Pre-vetting System. Information on TAPS is available on the Association of New Zealand Advertisers (ANZA) website: TAPS.

Unfortunately, and somewhat counterintuitively, TAPS seems in practice to serve the opposite purpose of the ASA. The ASA and their codes mainly focus on protecting the consumer, particularly from misleading claims. In contrast, TAPS seems to focus on allowing advertisers to make whatever claims they want without running afoul of the ASA or the law. To see an example of this, see TAPS guideline 13, Examples of Health Claims in contrast to Therapeutic Claims Digestive System.

In this guideline, TAPS details the difference between a “therapeutic claim” and a “health claim”. “Health claims” are defined within this guideline as…

claims which support the normal physiological function.

“Therapeutic claim” essentially has 2 sets of definitions. One can be found within the ASA’s Therapeutic Products Advertising Code and the other in the Medicines Act 1981. The ASA defines “Therapeutic Use”, where a therapeutic claim is a claim for therapeutic use. Medicines Act defines “Therapeutic Purpose”, where a therapeutic claim is a claim for a therapeutic purpose. Both of these sets of definitions are fairly broad.

The ASA’s Therapeutic Products Advertising Code defines therapeutic use as…

Therapeutic use

  1. means use in or in connection with:
    1. preventing, diagnosing, curing or alleviating a disease, ailment, defect or injury in humans;
    2. influencing, inhibiting or modifying a physiological process in humans;
    3. testing the susceptibility of humans to a disease or ailment
    4. influencing, controlling or preventing conception in humans;
    5. testing for pregnancy in humans; or
    6. the replacement or modification of parts of the anatomy in humans; and
  2. includes any other use which the law provides shall be treated as a therapeutic use for the purposes of the code; but
  3. does not include any use which the laws provides shall not be treated as a therapeutic use for the purposes of this code.

The Medicines Act defines a therapeutic purpose as…

Meaning of therapeutic purpose
In this Act, unless the context otherwise requires, the term therapeutic purpose means—

  1. treating or preventing disease; or
  2. diagnosing disease or ascertaining the existence, degree, or extent of a physiological condition; or
  3. effecting contraception; or
  4. inducing anaesthesia; or
  5. altering the shape, structure, size, or weight of the human body; or
  6. otherwise preventing or interfering with the normal operation of a physiological function, whether permanently or temporarily, and whether by way of terminating or reducing or postponing, or increasing or accelerating, the operation of that function, or in any other way; or
  7. cleaning, soaking, or lubricating contact lenses.

TAPS guideline 1 – Therapeutic Claim/Purpose – has this to say about whether or not products are to be considered medicines:

Whilst natural, herbal, marine and dietary supplement products are not classified as medicines they would come under the Medicines Act for two reasons that might not be obvious. This means that certain herbal or dietary supplement products would be deemed to be a medicine for two reasons. This is because of a) a therapeutic claim as per the Medicines Act or b) the ingredients in the product which could be classified as a medicine under the Classification of Medicines

I’m not a lawyer, and in reading through the Medicines Act I haven’t been able to determine which section in particular causes this outcome. If anyone is able to shed any more light on this I’d be very grateful.

What I get from this, though, is that any advertisement that includes a therapeutic claim as defined in section 4 of the Medicines Act (quoted above) should be treated as a medical advertisement.

The guideline goes on to describe how advertisers can effectively circumvent this (emphasis mine):

a company may still advertise a product without getting consent [from the Minister of Health] and without a “therapeutic claim”. Essentially there is leeway for certain health or nutritional claims or statements relating to the normal physiological or biochemical function. This is covered generally by such statements as “assists or supports the normal physiological function”. Even terms like “enhancement” “fortify” and “improvement” would need to be used with care and would generally be a problem, as they imply an improvement or acceleration to the normal function. Often it is a simply a question of wording. For example, a statement such as “provides nutritional support for a healthy immune system” escapes therapeutic specificity whereas, “prevents, treats or cures flus or viruses” attracts liability and would be prohibited under the Medicines Act.

Here are some examples of “health claims” from TAPS guideline 13, which it claims “would not breach the Medicines Act”:

Aids healthy digestion

Helps restore normal bowel flora

Aids normal bowel function

According to TAPS, at least, none of the above claims would qualify for a therapeutic claim. This means that they would be considered to not require substantiation. For this reason, it is of the utmost importance for consumers to be able to distinguish between a therapeutic claim and a health claim. Therapeutic claims in advertising are required both by law and by industry regulations to be substantiated, whereas it seems health claims may be freely made without any supporting evidence whatsoever.

TAPS approval for an advertisement is something that the ASCB considers when an advertisement has been complained about, but it is not enough to prevent a complaint from being upheld. Here are some examples of previous ASCB decisions in which a complaint was upheld due to a breach of the Therapeutic Products Advertising Code despite the advertisement having attained TAPS approval:

Given the recommendations in the TAPS guidelines, it should be reasonable to assume that any advertisement with TAPS approval which makes health claims instead of therapeutic claims does so because it would be unable to substantiate those claims if a complaint were submitted to the ASA. It’s also likely that any claims containing a modifier such as “may” or “could” will be similarly unsubstantiated.

Advertisements with TAPS approval may cite a TAPS approval number, but as far as I’ve been able to find this gives no more information than that the advertisement has been approved, as there is no publicly accessible database of TAPS approvals and their details that I have been able to find.

Many complaints have not been upheld by the ASCB because the advertiser successfully managing to convince them that no therapeutic claims were made, even though the advertisement contains content likely to be interpreted by the public as a therapeutic claim. For example, take this complaint: 07/113 – BioMag Television Advertisement, which was not upheld by the ASCB.

For those of you unfamiliar with this product, it’s a magnetic underlay for your bed that is apparently intended to relieve pain. Here are some statements from a Woolrest Biomag NZ representative in response to complaint 07/113:

I have never said “underlays increase circulation“, on television. In fact I haven’t mentioned the word circulation this year, and in previous years under TAPs [sic] guidance I have only ever spoken of “supporting circulation“.

The word arthritis has never been used in our TV ads, in fact we do not refer to any specific pain conditions and never have.

[The complainant] also alleges we say the BioMag relieves pain. This is wrong. We are always careful to say it “could” relieve pain, as indeed tens of thousands of our clients can attest.

This sort of behaviour is representative of advertisers of products like this when responding to ASA complaints. Typically, their defense relies on convincing the ASCB that their advertisement contains no therapeutic claims, as opposed to providing substantiation for the claims they’ve made. For another example, see complaint 12/393, which I’ve already mentioned in the list above as having been upheld despite TAPS approval. The advertiser’s response to this complaint rested on the argument that no therapeutic claims were contained within the advertisement. In this case, the ASCB disagreed and, as the claims had not been substantiated, the complaint was upheld.

There are 2 main ways in which advertisers avoid the use of therapeutic claims.

First, by making “health claims”, which sound like therapeutic claims but tend to be technically meaningless (what the TAPS guidelines have called “escaping therapeutic specificity”). For example, a claim that a product “supports normal immune function” sounds as though it means it supports or improves immune function, but the advertiser could defend the claim by saying that by specifying that it supports normal immune function it does not imply that any physiological process is affected and therefore does not constitute a therapeutic claim.

Second, by using language in such a way as to not make an “absolute” claim. Often this involves qualifiers such as “may” and “could”, but it can also include words that normally would seem to imply therapeutic claims to the public, such as “supports”. For example, the complaints board decided not to uphold complaint 12/402 based partly on this:

Turning to the other claim that “the base of apple cider vinegar … assists your body in breaking up the mucous associated with winter ills and chills” the Complaints Board said the word “assists” was not an absolute claim.

Because of this, when reading, watching, or listening to a medical advertisement it is important to do a few things to make sure you are not misinterpreting it:

  • Identify “health claims”, as opposed to “therapeutic claims”, and realise that they most likely have not been substantiated.
  • Interpret every positive claim in the most conservative way possible. For example, if a product “may reduce pain”, it probably means “may not reduce pain, and hasn’t been proven to reduce pain”.
  • Interpret everything literally. Exaggeration and “puffery” are typically not allowed in medical advertisements, so you shouldn’t need to worry about misinterpreting something in this way. For example, if a product “helps resist winter ills and chills”, this does not mean “helps resist colds and the flu”. This also means that “supporting normal function” does not mean “supporting function”, as “normal function” refers to function when not interfered with.

Expect advertisers to always put their best foot forwards. If they are allowed to say their product “relieves cold and flu symptoms” then that is what they will say. If they say something like “helps you overcome winter ills and chills naturally” instead, it’s likely because they are not allowed to make the former, more definite claim.

Here are 2 examples of advertisements that are misleading yet manage to escape regulation.

1. Eken power bands: Golf Centre | Your Chemist

ASA complaint 12/393, already mentioned twice above, was upheld because an advertisement for this product implied unsubstantiated therapeutic claims:

Designed to assist with Strength, Balance, Flexibility, Endurance

Now that they cannot make such claims, the advertisements listed above instead simply list the same attributes without any description. It is still implied that the product is intended to improve the attributes, but not in such a way as a complaint would be likely to be upheld.

2. Detox foot patches: GrabOne

ASA complaint 12/502 was settled after someone complained that “the advertisement contained false and misleading claims that were not supported with evidence”. In response to this, the advertisers changed the advertisements so that the same false, misleading, and unsupported claims are still implied but are not made in such a way as to make a complaint likely to be upheld.

Note that this advertisement has a TAPS approval number. Instead of acting in the public’s interest by not allowing the advertiser to make false claims, they have helped them to make the same claims in such a way as the public will interpret them as claims and the regulators will not, effectively allowing them to escape regulation.

Finally, remember that not every advertisement is in line with the ASA’s codes and the relevant legislation. If you think an advertisement makes a therapeutic claim that is not valid and/or has not been substantiated, I encourage you to research it further and, if it appears your concerns are warranted, submit a complaint to the ASCB. Unsubstantiated therapeutic claims are in breach of the ASA’s Therapeutic Products Advertising Code principle 2.

*I have set up a search engine for this within my installation of Google Chrome, so I can search previous ASA decisions by entering “ASA ” into Chrome’s Omnibar on my computer. To do this yourself, click “Manage Search Engines…” inside Chrome’s Settings, scroll down and enter the following details to create a new search engine:

  1. ASA Complaints
  2. asa
  3. https://www.google.com/search?q=site%3A203.152.114.11+%s

Now, for example, if you want to search for “homeopathy” within previous ASA decisions you would just need to type “asa homeopathy” into Chrome’s omnibar and it will find all decisions containing the term “homeopathy”, including those from before 2006 like this decision from 2003.

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