ASA Adjudication on Kerala Ayurvedic Health Clinic

Ad

A regional press ad was headlined “Kerala Ayurvedic Health Clinic”. Text stated “FREE consultation Authentic and effective Kerala ayurvedic treatments Qualified and registered Ayurvedic physicians Affordable prices”. Bullet points stated “Massage therapies by experienced and highly skilled therapists Treatment is designed around your individual health needs Only natural herbal medicines are used No side effects at all Wide range of therapies”. Various conditions were listed, including high blood pressure, high cholesterol, paralytic conditions, back pain, whiplash, obesity, arthritis, diabetes and migraine. A flash stated “experts in natural medicine and massage therapies”.

Issue

The complainant challenged whether:

1. ayurvedic treatment was effective for the listed medical conditions;

2. the claim "qualified and registered Ayurvedic physicians" was misleading, because it implied that the clinic employed medically qualified doctors;

3. the claim "registered Ayurvedic physicians" was misleading, because he believed there was no UK body with which ayurvedic practitioners could register; and

4. the claim "Treatment is designed around your individual health needs" was misleading, because he believed the practitioners were not qualified to assess the health needs of their clients.

5. The ASA challenged whether the ad breached the Code, because it could discourage readers from seeking treatment of serious medical conditions, such as high blood pressure, obesity and whiplash, by medically qualified practitioners.

CAP Code (Edition 11)

Response

1.  Kerala Ayurvedic Health Clinic (Kerala) said they offered massage therapy for the listed conditions.  They sent articles from a magazine. One stated that the Sirodhara method, which involved trickling the medications over the forehead, was classically indicated in pain and diseases of the head and neck and successfully used in conditions such as stress and insomnia.  It stated that the process acted by transcutaneous penetration of medicine through the skin and absorption by capillary infiltration, as well as through exteroceptors, located near the surface of the forehead and the scalp.  It also said that nerve endings would be stimulated resulting in headaches subsiding, and pressure caused by the trickling of the medicated liquids created tranquillity of mind and induced natural sleep.   The article claimed that gentle massage improved circulation and relaxed muscles and nerve endings, increasing oxygen and glucose supply to the brain and cerebrospinal fluid circulation.  It added that the process stimulated the hypothalamus, which was responsible for regulation of mood, sleep rhythm and blood pressure.  Another article described a trial of 25 patients where Sirodhara had been found to be effective in relieving pain and other symptoms of chronic daily headache.   Kerala also sent a list of clinical trials which they said demonstrated some of the evidence supporting ayurvedic treatments for various conditions.

Kerala also referred us to the World Health Organisation (WHO) website.  They added that they had experienced 100% positive feedback from their clients.  They enclosed a client testimonial and said others would be willing to give their testimonies.  

2.  Kerala maintained that they used the qualifier "ayurvedic" to avoid misleading their clients, and never "physician" on its own, and it was therefore clear that they employed ayurvedic physicians rather than medical doctors.  They offered to amend the ad to state that the physician had a Batchelor of Ayurvedic Medicine and Surgery (BAMS) qualification.  They pointed out that their clients wanted to consult an ayurvedic physician and not a medical practitioner, otherwise they would have contacted their GP or a hospital, and that none of them had been confused by the ad.  They added that readers with queries could contact them using the details given in the ad.   

3.  Kerala said ayurvedic physicians were qualified professionals who could register with a recognised UK body, such as the British Register of Complementary Practitioners (BRCP) run by the Institute for Complementary Medicine (ICM), or the British Ayurvedic Medical Council (BAMC).  They explained that to be an Ayurvedic physician one had to hold a BAMS degree, a title that could be awarded only by an accredited university after passing a five and a half year course.  They said only certified ayurvedic physicians could be registered as such with the BRCP, and added that applicants who wished to register at practitioner level had to prove their ability and competence in making a complementary diagnosis and had to agree to the BRCP Code of Ethics and Practice.  

Kerala sent their physicians BAMC certificate, a university degree certificate, a  BRCP certificate and an outline of the BAMS course syllabus.  They maintained that any ayurvedic physicians they employed were registered and held the appropriate qualifications.

4.  Kerala gave an example of a treatment being tailored around an individuals health need: if a client came in because they had neck stiffness, the ayurvedic physician would arrange a consultation to determine what type of herbal oil and massage to use, based on that particular health need.  They said the ayurvedic holistic health system by definition approached conditions by tailoring treatments to the individuals health need, taking into account details such as body and personality type.  Kerala disagreed that only medically qualified practitioners were qualified to assess an individuals health need.  They said, for example, people could assess their own health needs if they had a headache or muscle pain, and could buy and consume paracetamol.  Similarly, an overweight person could attend a meeting in order to reduce weight, and it would be the individual and the people at the meeting who would help to assess their health need.  They explained that in their clinic the client would come in with a preconception of what their health need was, and had therefore self-assessed and felt that the clinic might meet that need.  They said during the consultation they would find out what the health needs were and whether they could actually address them.  A suitable massage therapy would be chosen and lifestyle advice could be offered.

5. Kerala said none of their advertising or literature discouraged medical treatment for any condition, whether serious or not.  They argued that ayurvedic therapy was recognised by the WHO and classified under Complementary and Alternative Medicine (CAM).  That meant that their treatments complemented or supplemented any existing medical treatments.  They maintained that they would recommend seeking treatment from medical practitioners if the client had not already done so.  They pointed out that, although the ayurveda health care system covered a large area regarding lifestyle, such as yoga and meditation, their main aim was to provide the massage therapy aspect of ayurveda, and that was made clear in the ad.  They said they were not a substitute for any national health service, and commented that spas also provided massages that could help the listed conditions, but were not usually accused of discouraging treatment.  They added that they offered free consultations where clients would have their queries answered before embarking upon treatment.

Assessment

1.  Upheld

The ASA noted the material provided by Kerala but considered that we had not seen sufficient evidence, for example in the form of controlled clinical trials that would allow for a possible placebo effect, that the ayurvedic treatments offered by the clinic could treat the listed conditions.  We also noted, although ayurvedic treatment was recognised by the WHO, its website stated "Scientific evidence from tests done to evaluate the safety and effectiveness of traditional medicine products and practices is limited. While evidence shows that acupuncture, some herbal medicines and some manual therapies (e.g. massage) are effective for specific conditions, further study of products and practices is needed."  We considered that readers would understand from the list of conditions with a tick alongside each that the treatments offered by the clinic could treat those conditions.  Because we had not seen evidence to show that they did, we concluded that the ad was likely to mislead.

On this point, the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.1 (Health and beauty products and therapies).

2. Upheld

We noted the ad referred to "qualified and registered Ayurvedic physicians" and "therapists" and did not use the term "physician" in isolation.  We considered, however, that readers were likely to infer from "physicians" that the clinic employed staff who were qualified in conventional medicine.  Because it did not, we concluded that the reference to physicians was misleading.

On this point, the ad breached CAP Code clauses 3.1 (Substantiation) and 7.1 (Truthfulness).

3.  Not upheld

We understood that ayurveda was not subject to statutory regulation in the UK.  We noted, however, practitioners could register with the BRCP which required them to have completed the BAMS degree in order to practice Ayurvedic medicine.  We understood that registration with the ICM was voluntary and the ICM was not a statutory regulator, although they did have a system of self regulation. We noted the BRCP regulation requirement to adhere to a code of practice and to be able to make a complementary diagnosis.  Because we understood Keralas sole practitioner was registered with the BRCP, we concluded that the claim that they were registered was unlikely to mislead.

On this point, we investigated the ad under CAP Code clauses 3.1 (Substantiation) and 7.1 (Truthfulness) but did not find it in breach.

4.  Not upheld

We noted Keralas argument that ayurvedic treatments were by definition tailored to the individuals needs and that the initial consultation would establish whether the treatment they offered would be suitable.  We considered that readers would view "health needs" in the context of the ad which made clear that the treatments were massage-based.  We concluded that the claim was unlikely to mislead.  

On this point, we investigated the ad under CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness), 50.3 and 50.6 (Health and beauty products and therapies) but did not find it in breach.

5. Upheld

We noted the ad referred to serious conditions such as high blood pressure, whiplash and obesity.  CAP Code clause 50.3 states that ads should not offer advice on, diagnosis of or treatment for serious ailments unless conducted under the supervision of a doctor or a suitably qualified health professional.  We considered that the clinic did not employ health professionals that were suitably qualified to treat conditions such as high blood pressure, whiplash and obesity.  We were concerned that by suggesting they could treat those conditions the ad could discourage readers from seeking essential medical treatment for serious ailments.

On this point, the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness), 50.1, 50.3 and 50.6 (Health and beauty products and therapies).

Action

The ad must not appear again in its current form.

Adjudication of the ASA Council (Non-broadcast)