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Advertising Standards Authority

Any topic related to science can be discussed here.
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Maria Mac
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Posts: 8573
Joined: July 3rd, 2007, 10:34 pm

Re: Advertising Standards Authority

#101 Postby Maria Mac » July 26th, 2009, 11:27 am

Latest post of the previous page:

Hello Lily

Lemonade Lily wrote:Are you going to attack me when I set up in practice? From where I sit today, I'd say that you are.

I think the answer to that will depend on whether you make false or misleading claims in your promotional material. In your previous paragraph you say that you will not claim to treat conditions that you cannot treat yet the advertisement Alan has complained of does exactly that.

You say the osteopaths you know work from a medical scientific/basis. How so?

According to Ernst & Singh, the evidence for osteopathy is that it is no better or worse than conventional medicine for treating muscular skeletal conditionals (in other words, it is largely ineffective for back pain) and that several clinical trials demonstrate a failure to be effective for non muscular skeletal conditions such as migraine.

The British Institute of Osteopathy's website promotes "traditional osteopathic practice as first disseminated by Andrew Taylor Still in June 1874 and his followers" and offers this defintion:

Osteopathy is a system, or science, of healing that uses the natural resources of the body in the corrective field:

* for the adjustment of structural conditions
* to stimulate the preparation and distribution of the fluids and free forces of the body; and
* to promote cooperation and harmony inside the body as a mechanism.

(snip)

'The body is its own commissariat, taking in material substance in the form of the proximate principles, such as water and oxygen. Nothing is assimilated to the body that is not first vitalised and every process that takes place in the body is a vital process; every lesion that we find in the body is a vital lesion in relation the vitality of life, of the patient. This implies that every part of the body is supplied with blood and nerve force, a dual activity that is used continually as corrective means in osteopathic practice.


Lemonade Lily wrote:Why don't you focus on the nutters first? They are lined up waiting for skeptics to have a shot at them. Why take a shot at this osteopath?

As you say, there is a lot of woo and quackery out there. I am curious as to why you would exclude osteopaths from this definition. The fact that osteopaths - like chiroquacks - have achieved a degree of incorporation into mainstream medicine, especially in the US, seems to me a reason why it is more important to go after those of them who make unsupportable claims than it is to worry about the more demonstrably ridiculous therapies like ear candling, which aren't so widely supported. However, in defence of Alan, he complains to the ASA about every false claim he comes across, whoever makes it and has been doing so for many years.

Calling it a witch-hunt seems strangely appropriate given the appeals to the supernatural that these therapies - including osteopathy - appear to depend on. I'm all for hunting witches myself and don't understand why it's perceived as wrong to do so.

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Alan H
Posts: 21833
Joined: July 3rd, 2007, 10:26 pm

Re: Advertising Standards Authority

#102 Postby Alan H » July 26th, 2009, 1:35 pm

Lemonade Lily wrote:Your post about this osteopath made me feel me very uncomfortable indeed. Infact I am upset and annoyed about it.
I'm sorry to hear that.

What next dermatology?
I don't think dermatologists advertise their services, but I would complain if I thought a commercial organisation made claims I didn't think were valid: any such claim can have an undue influence on people buying their products and may be prevented or delayed from seeking good medical advice.

Do you think this is maybe turning into a bit of a witch hunt? I do.
I'm not sure one person (or even a few) making complaints against others who appear to be making claims about a product they are selling to the general public can be construed as a witch hunt, particularly when it is done through legitimate organisations, set up to protect the public.

Aren't you possibly using the ASA the same way as the BCA are using our flawed libel laws?
No. I am using the ASA in the way they were set up to be used: to act as a disincentive to companies making claims they cannot substantiate and misleading the public.

There is a lot of woo and quackery out there. Yes - way too much.
Can't argue with that!

I am fighting hard against it from within. Not an easy thing for me personally - but so be it. I want to see it debated and challenged.
I want it debated and challenged too and I'm glad you're fighting as well. But the debate about an awful lot of woo has already taken place and treatments like osteopathy have been shown lacking except for a very small range of conditions (and even then, the evidence isn't particularly strong).

But not in a climate of fear and retribution. I do not feel that your complaint to the ASA about this osteopath is going to help me in my battles. It will just create even more entrenched views and draw lines between people where none exists.
If they make valid claims then there is nothing to fear. But if they are making claims they cannot substantiate, then what should happen to them? Should they be left to confound, confuse and mislead the public? Whilst it's good that you are battling from within, I'm not sure that you are going to make a huge difference all by yourself. A small and important one, no doubt. But we all have to do what we can. And I do ASA complaints. As Maria said, I've been doing them for years and have been quite successful in getting complaints upheld. However, not everything is upheld. The ASA are the arbiters, not me - they decide if anyone has broken the rules they have to abide by.

I'm not sure what you mean by 'drawing lines between people where none exist'. There is only one line here - and I didn't create it. Is an advertiser making claims they cannot substantiate? I am firmly on one side of that line, but it is the woo-sellers who cross the line in attempts to sell their wares.

Why don't you focus on the nutters first? They are lined up waiting for skeptics to have a shot at them. Why take a shot at this osteopath? The osteopaths I know wholeheatedly support the battle against delusional thinking and quackery. They work from a medical / scientific basis.
Osteopathy appears to be based on vitalism. Vitalism is woo. I wouldn't go as far as to call them nutters and I'm sure many of them are sincere in what they do. However, it appears to be based on pseudo science and appears to be making claims they may not be able to substantiate.

I intend to practice as a medical herbalist. I will not invoke any supernatural powers or superstitions to explain how herbs work. I will not claim herbs can treat everything or are a panacea. I won't claim to cure cancer or autoimmune disease. I don't hold with ridiculous concepts like vitalism and energetics which have no basis in science. I only use medical textbooks to study and refuse to countenance anything that isn't back up by good evidence. I take a balanced skeptical view of herbal medicine. I see herbal medicines as an adjunct to biomedicine not a replacement. I hope to make a living from herbal medicine. No way near what GP makes but enough to get by.
I don't know enough about medical herbalism and what it does/claim to comment.

Are you going to attack me when I set up in practice?
Are you going to make claims that contravene the Code of Advertising Practice or the Code of Practice for a professional body you've signed up to or the CoP of a statutory regulator?

From where I sit today, I'd say that you are.
Ditto.

I fear that if skeptics start attacking respected professions, like osteopathy,
As Maria said, there is some evidence for osteopathy for a few conditions, but no better than conventional care. In that way, perhaps they could be seen as 'respected'. But they do appear to sign up to vitalism and that immediately loses them Brownie points. However, I am also not blinded by their statutory regulation: that does not make them immune from critical analysis of the claims they make, nor should it.

for what I can see is a pretty innocuous advert,
It's only innocuous if the claims made are not misleading. If the ASA decides that the claims are not misleading, my complaint will not be upheld.

then it wlll be very difficult for any reasonable person to do or say anything.
Nonsense. People making valid medical claims would be regarded reasonable. But surely not those who make claims that cannot be substantiated? None of this stops reasonable people making reasonable claims.

Please reconsider your complaint.
You've not persuaded me.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

Lemonade Lily
Posts: 45
Joined: February 21st, 2009, 5:32 pm

Re: Advertising Standards Authority

#103 Postby Lemonade Lily » July 27th, 2009, 1:05 pm

Hi Maria & Alan

Pardon - was out much of yesterday

Thanks for your polite responses. Not what I am used to when I offer an opinion or challenge anything in CAM.

My ‘surprise’ when reading Alan’s ASA complaint was wondering why turn attention on osteopathy when there are so many whacky things out there. Why go for the most medical and most respected of CAM professions?

I think there are a number of issues here:
1. Whether individuals are making specific medical claims which cannot be backed up by evidence (accepting there are different levels of evidence). Yes - agree that should not happen in any medical practice - be it NHS or private. The medical profession does not (as far as I am aware) have gold standard evidence for all medical practices (I’m not attempting to set up a strawman here) and dermatology was just an example (dermatologists of course do not have to advertise as they are part of the NHS). In the case of this particular osteopath when I read the advert yesterday, I felt it was not making any claims that I thought were misleading or unsubstantiated by reasonable clinical evidence (saying that, I am not an expert and cannot claim to examined the ‘evidence’ in detail to back up this statement). I look forward to hearing the ASA ruling.

2. Whether 'professional organisations' are making claims that cannot be backed up by evidence (same provisos as above). I think professional representative bodies ought to be more carefully audited/examined as they are setting standards / regulating their professions and should be, IMHO, constantly reviewing and assessing evidence for efficacy of treatment (as no individual practitioner could hope to do this).

3 Whether professional organisations (or individuals) are talking woo on their website. I don't think there’s no law against talking woo. Sadly. Re. Maria’s quote from the BIO website - I’ll check it out. Yup it looks wooy at first glance. Saying that, whatever the organisations might put on their webpages, that does not mean the individual osteos believe this or work like this. Personally (ooops anecdote!) I do not know any osteopaths who subscribe to vitalism or woo. I cannot say what the osteo who is being complained about believes - as I cannot tell from his advert. When I look at many herbal websites they make me cringe with embarassment. I can only keep fighting and talking sense /science, and hope that higher powers than me come and crush the woo underfoot. I am doing my best from within but agree that one person hardly makes a dent in the giant woo industry.

4 The semantics of what is meant by treat, cure, etc.. I have had this argument with herbalists claiming to treat cancer. The advert in question, to my mind is balanced in its use of words - compared to many that I have seen of late. It says 'can help treat'. Hmmm. The advert also limits the list of possible conditions to musculoskeletal conditions only. It makes no claims for being able to treat asthma or other non musculoskeletal pathologies. Yup - will be interesting to see what ASA says.

I whole heartedly agree that we should challenge erroneous claims. I do so myself - although do so anonymously and not so openly or vigorously as Alan. I agree with everything you say about valid claims and seeking medical advice. Many CAM adverts prey on people’s fears. Woo is used in lieu of evidence. The claims for cures for cancer are particularly wicked. But having said that I feel in this case that this advert would not have tweaked my woo or unsubstantiated claim radar.

Best

Lily

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Alan H
Posts: 21833
Joined: July 3rd, 2007, 10:26 pm

Re: Advertising Standards Authority

#104 Postby Alan H » July 27th, 2009, 3:19 pm

Lemonade Lily wrote:Thanks for your polite responses. Not what I am used to when I offer an opinion or challenge anything in CAM.
:smile:

My ‘surprise’ when reading Alan’s ASA complaint was wondering why turn attention on osteopathy when there are so many whacky things out there. Why go for the most medical and most respected of CAM professions?
I'm not convinced it's not just pyhsiotherapy blended with vitalistic woo and I am not fooled by their statutory regulation. The advert appeared in one of the free local papers, prominently on the back page. It was shouting out to me! And I'm not to sure about 'respected' and 'CAM' in the same sentence! ;-)

1. Whether individuals are making specific medical claims which cannot be backed up by evidence (accepting there are different levels of evidence). Yes - agree that should not happen in any medical practice - be it NHS or private. The medical profession does not (as far as I am aware) have gold standard evidence for all medical practices (I’m not attempting to set up a strawman here) and dermatology was just an example (dermatologists of course do not have to advertise as they are part of the NHS). In the case of this particular osteopath when I read the advert yesterday, I felt it was not making any claims that I thought were misleading or unsubstantiated by reasonable clinical evidence (saying that, I am not an expert and cannot claim to examined the ‘evidence’ in detail to back up this statement). I look forward to hearing the ASA ruling.
Yes, it will be interesting what the ASA says, but Singh and Ernst say:

The evidence that the osteopathic approach is effective for treating back pain is reasonably sound. If, however, you receive no significant benefit then be prepared to switch to physiotherepeutic exercise, which is backed up by similar evidence and which can be done in groups and therefore is more cost effective. There is no evidence to support osteopathy for the treatment on non-musculoskeletal conditions.


I think a few sample pages from various websites show why alarm bells ring:

British School of Osteopathy: What is Osteopathy? Says nothing about WHAT osteopathy is. They 'work through the neuro-musculo-skeletal system'. They 'pay special attention to how the internal organs affect, and are affected by, that system'. 'Relevant psychological and social factors also form part of the diagnosis.' 'the body has its own self-healing mechanisms'.

British School of Osteopathy: How do we treat? 'Osteopaths treat the whole person'. 'The main tool for diagnosis and treatment is touch (palpation).'

The London School of Osteopathy - About Osteopathy, What is it? 'It is based on the recognition of the components involved in the reciprocity of structure and function.'

The London School of Osteopathy - About Osteopathy, What is the evidence base Their main evidence base seems to be the BEAM trials: IIRC, this talked about manipulation and not osteopathy specifically.

The London School of Osteopathy - About Osteopathy, What does it treat? 'At first, osteopathy may not look an obvious choice for irritable bowel syndrome but the bowel is made up of muscle and controlled by nerves, and muscles become tense and tight when a patient is stressed or anxious.'

Not a good start.

2. Whether 'professional organisations' are making claims that cannot be backed up by evidence (same provisos as above). I think professional representative bodies ought to be more carefully audited/examined as they are setting standards / regulating their professions and should be, IMHO, constantly reviewing and assessing evidence for efficacy of treatment (as no individual practitioner could hope to do this).
I think this is the nub of the current problem: the GCC does give guidance about x-rays, even though this is in response to an EU Directive, so why don't they give guidance on what claims can legitimately be made?

3 Whether professional organisations (or individuals) are talking woo on their website. I don't think there’s no law against talking woo. Sadly.
There is when it is misleading. Trading Standards law applies, but this is mostly run on a complaints basis.

I do not know any osteopaths who subscribe to vitalism or woo.
However, many do. Definitely unscientific, but will have to do for now: Google osteopathy vitalism site:.uk and I get 435 hits.

4 The semantics of what is meant by treat, cure, etc.. I have had this argument with herbalists claiming to treat cancer. The advert in question, to my mind is balanced in its use of words - compared to many that I have seen of late. It says 'can help treat'. Hmmm. The advert also limits the list of possible conditions to musculoskeletal conditions only. It makes no claims for being able to treat asthma or other non musculoskeletal pathologies. Yup - will be interesting to see what ASA says.
The ASA don't look at it that way. They look at it from the point of view of the public and take any mention of conditions as claims that the particular treatment will have some beneficial effect on them. Unfortunately, many people are not as discerning as us and will take any mention of treat/diagnose/help/cure frequently as much more than intended. Indeed, my previous blog post about the ASA highlighted a case of a TV ad that only showed someone limping into a clinic and then playing football afterwards. No explicit claims at all, but the underlying implication was that the clinic cured his limp. The clinic lost because the remit of teh ASA is to protect the vulnerable (and frequently gullible) public.

The ASA may or not uphold my complaints, but it will be interesting to see what happens. To have the complaint rejected, the clinic will have to hold and provide good scientific evidence for those claims: if they do, the complaint will not be upheld.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

Lemonade Lily
Posts: 45
Joined: February 21st, 2009, 5:32 pm

Re: Advertising Standards Authority

#105 Postby Lemonade Lily » July 27th, 2009, 4:30 pm

Hello Alan

I did write 'CAM' and 'respected' in same sentence didn't I? Pardon! :redface: And I wrote 'CAM profession'. :redface: Good grief!

I've got some work to do (which I keep putting off) and then I am going to look at those links you put up. Thanks for making that effort to put them up (for me).

I have Ernst & Singh - excellent book - am trying to get it on reading list at my University - haha! Lent it to someone at present so cannot refer to it. Grrrr.

I agree about PAs (Professional Associations) but am not quite clear under what basis I could challenge what they put up on their sites as they are not directly advertising services to the public. I will be very interested to see what debate there is once the consultation on the regulation of herbal med (and others) is announced - I assume very soon. Of course regulation is not about evidence of effectiveness or claims for what can be treated or not. Hmmm.

I am frustrated by definitional issues re. cure/treat or other weasel words used in ads - although as I said I was mainly concerned with a site offering seminars which claimed to 'deal with' cancer. That wording 'shouted' at me! Never heard back from Trading Standards though and site still up and running.

I may have a go (later this year) at writing a HM website page and put it up here for you to evaluate. I woud be genuinely interested in your (& others) opinion.

Right - must go and do that 'work'.
Will keep eye on blog

Lily


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