ASA Adjudication on BritChiro Clinics Ltd

Ad

A regional press ad, for a chiropractic clinic, stated "When Getting Better Matters BritChiro Clinics ... ". Text beneath the headline listed different ailments: " ... whiplash ... arthritis ... migraine ... chronic pain". The names of the clinic's practitioners were listed at the bottom of the page with the prefix "Dr". The qualifications MSc and DC appeared after their names. Smaller text at the foot of the page stated "Registered with the General Chiropractic Council and Members of the British Chiropractic Association".

Issue

1. The Carlton Clinic challenged whether the ad misleadingly implied that the practitioners listed held general medical qualifications.

2. The ASA challenged whether the ad offered treatment for serious medical conditions without the supervision of a doctor or suitably qualified health professional, and

3. whether the treatment was proven to be effective for the serious medical conditions listed, as implied by the ad.

CAP Code

Response

1. BritChiro explained that their practitioners were registered with the General Chiropractic Council (GCC).  They said the GCC permitted registered chiropractors to use the titles "Dr" and "Doctors of Chiropractic".   BritChiro told the ASA that the ad normally included the words "Doctors of Chiropractic" under the headline "When Getting Better Matters", but that text had been omitted from the ad in error.   They pointed out, however, that the ad included the references "DC", "Registered with the General Chiropractic Council" and "Members of the British Chiropractic Association" and did not suggest that the people referred to held general medical qualifications.  BritChiro therefore disagreed that readers of the ad would infer that the practitioners listed were medical doctors.  They said future ads would include the term "Doctors of Chiropractic".   

2. & 3. BritChiro said they were registered practitioners as required by the Chiropractors Act 1994.  They explained that registration could not happen until the chiropractor was qualified to practice following graduation from an institution operating a degree course that met the General Chiropractic Council's Criteria for the Recognition of Degrees in Chiropractic.  BritChiro therefore believed they were suitably qualified health professionals for the purposes of CAP Code clause 50.3 (Health and beauty products and therapies - general).  They sent the ASA a large number of journals and studies that they believed showed the efficacy of chiropractic in treating the listed serious medical conditions: whiplash, arthritis, migraine and chronic pain.   The evidence mainly consisted of articles published in journals such as the British Medical Journal (BMJ), the Journal of Manipulative and Physiological Therapeutics (JMPT) and the Journal of Chiropractic Medicine.  Some studies took the form of randomised controlled trials consisting of a large number of subjects; others took the form of case studies that focused on the effects of treatment on one patient.  

BritChiro nevertheless agreed to remove the reference to chronic pain from future ads.

Assessment

THIS ADJUDICATION REPLACES THAT PUBLISHED ON 28 MAY 2008.  THE VERDICT ON POINT 2 HAS CHANGED, MAKING THE COMPLAINT NOT UPHELD, AND A NEW POINT 3 HAS BEEN ADDED WITH AN UPHELD VERDICT.

1. Upheld

The ASA noted BritChiro's comments.  We noted the term "DC", which we understood was a courtesy title meaning "doctor of chiropractic", was included in the ad, as well as small text at the foot of the ad that stated "Registered with the General Chiropractic Council" and "Members of the British Chiropractic Association".  We considered that suggested that the listed practitioners held chiropractic qualifications.  We nevertheless considered that, because the term "Dr" was also included in the ad, readers were likely to infer that the practitioners mentioned in the ad held general medical qualifications, as well as chiropractic qualifications.  Because they did not hold general medical qualifications, we concluded that the use of the word "Dr" could mislead.  We also considered that the suggested claim "Doctors of Chiropractic", for use in future ads, did not go far enough to remove the implication that the practitioners held general medical qualifications as well as chiropractic qualifications.

The ad breached CAP Code clause 7.1 (Truthfulness).

2. Not upheld

We noted that all BritChiros practitioners were suitably qualified and subject to regulation by a statutory body, the General Chiropractic Council. We therefore concluded that the treatments on offer were conducted under the supervision of a suitably qualified health professional.

On this point, we investigated the ad under CAP Code clause 50.3 (Health and beauty products and therapies - general) but did not find it in breach.

3. Upheld

We noted the ad made references to conditions that were considered serious by the CAP Help Note on Health, Beauty and Slimming Marketing that Refers to Ailments: whiplash, arthritis, migraine and chronic pain.  

We considered that the evidence submitted about migraine supported the efficacy of chiropractic in treating that condition.  We therefore considered that BritChiro could continue to refer to the treatment of 'migraine' in future ads.

We instructed an independent expert to assess the evidence BritChiro submitted in support of the treatment of whiplash and arthritis.  Our expert concluded however that the studies were not sufficient to support efficacy claims for either condition.

BritChiro instructed their independent expert who, evaluated the evidence they had submitted in support of whiplash and arthritis, produced two reports and who also evaluated our expert's two reports.  BritChiro's independent expert concluded that the evidence for whiplash showed that chiropractic was effective in treating that condition, but was not effective in the treatment of arthritis.  He concluded that "... chiropractic is effective (as opposed to doing nothing) in the treatment of whiplash ... The evidence for the treatment of osteoarthritis is less good ... Chiropractic could rationally be seen as an adjunctive and not primary treatment for osteoarthritis".  With regards to clinical trials he stated "Bearing in mind that it would probably not be possible to produce an ideal chiropractic placebo ... it would be very difficult to assess the specific efficacy of chiropractic."  He also stated "While ... there are some placebos which have been "suggested" for trials of chiropractic, they are not properly validated or convincing or currently completely methodologically sound." and that it was "misleading to suggest that placebo controlled trials in this area are simple, possible or reasonable at the moment ... There is so much debate about what constitutes a placebo in the context of a physical intervention ... that it is almost impossible for us to define a placebo in this context."  

BritChiro agreed to remove references to arthritis from their ad.  They nevertheless asserted that, because chiropractors who were registered with the GCC were suitably qualified health professionals for the purposes of CAP Code clause 50.3 and because the evidence supported the efficacy of chiropractic as a treatment for whiplash, they should be allowed to continue to refer to that serious condition.

Our expert pointed out that BritChiro's evidence for whiplash and arthritis failed to include controlled clinical trials and therefore had no control for a placebo effect.  With regard to whiplash, he concluded "Collectively, this evidence fails to demonstrate the effectiveness of chiropractic for whiplash injuries."  We noted BritChiro's expert considered that it would be difficult to produce an ideal chiropractic placebo but also noted his concern that, without it, it was difficult to assess the specific efficacy of chiropractic.  Our expert said "The following forms of sham have been used in clinical trials of chiropractic manipulation: non-therapeutic manipulation at the site of subluxation, therapeutic manipulation at the site of no subluxation, non-therapeutic manipulation at the site of no subluxation.  These sham interventions might not be ideal placebos in every respect but they do exist and have been employed in clinical trials to minimize bias."  He added that, "Even if we accept that [clinical studies] cannot be rigorously placebo-controlled, there is no reason whatsoever why a controlled trial of chiropractic versus either no treatment or a standard treatment would not be feasible."  We therefore concluded that the evidence submitted by BritChiro fell short of the standard required by the CAP Code.

We welcomed BritChiro's decision to remove the references to arthritis and chronic pain from their ads but concluded that the reference to whiplash should also be removed.

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

Action

We told BritChiro to remove the word "Dr" and reference to whiplash and to seek advice from the CAP Copy Advice team for their future advertising.

Adjudication of the ASA Council (Non-broadcast)