ASA Adjudication on Atlas Wellness Centre

Ad

A regional press insert was headlined "A Doctor's Confession to the Town of Bedford …" The text stated "… I go to the medical doctors. They do dozens of tests, but they can't find out what's causing my awful headaches … later on, I start having terrible back pain. I try pain medications, but nothing helps. That's when I decide to give a new doctor a try. This doctor does an examination, takes some x-rays, and then ’adjusts‘ my spine … I get relief from the back pain and guess what else! Pretty soon my awful headaches are completely gone! Oh, did I mention that this doctor is a spinal specialist? It works so well for me, and I'm so impressed with the other ’miracles’ I see in his office, that I eventually go to college so I can learn this myself … now people come to see me with their headache problems. Also they come to see me with their migraines, chronic pain, neck pain shoulder/arm pain, whiplash from car accidents, carpal tunnel syndrome, backaches, ear infections, asthma, allergies, numbness in limbs, athletic injuries, just to name a few." Testimonials from patients included "After years of constant back and leg pain, I was at the point where I couldn't sit, stand or lie down without pain. Thanks to Dr. Peter, my back and leg pain have [sic] improved dramatically and my IBS even seems to be much better!" The text continued "… the studies speak for themselves, like the U.S. study that showed that over 90% of patients who saw a spinal specialist were satisfied with their results … published, peer-reviewed research indicates that the immune system may be enhanced by spinal adjustments … Although all people respond differently to care, maybe you won't be running off to the doctor as much once you start spinal care." The ad was signed from Peter Olsson.

Issue

1. The General Chiropractic Council (GCC) and a member of the public objected that Peter Olsson was not entitled to describe himself as "doctor".  The GCC said Peter Olsson had taken voluntary removal from their Register of Chiropractors and he did not appear on the GMC's List of Registered Medical Practitioners.

The same member of the public challenged whether:

2. the description "spinal specialist" misleadingly implied that the advertiser was a medically-qualified specialist;

3. the claim "I'm so impressed with the other miracles I see" gave a misleading  impression of the efficacy of the treatments offered;

4. the claim "over 90% of patients who saw a spinal specialist were satisfied with their results" was misleading and could be substantiated;

5. the claim "published, peer-reviewed research indicates that the immune system may be enhanced by spinal adjustments" was misleading and could be substantiated.

6. The ASA challenged whether the ad implied that chiropractic treatment could treat serious or prolonged medical conditions such as migraines, whiplash and chronic pain.

CAP Code (Edition 11)

Response

1. Peter Olsson, on behalf of The Atlas Wellness Centre, said he was not aware that the law required someone to be registered with the GCC or GMC in order to describe themselves as "doctor".  He argued that a recognised regulatory governing body, the GCC, stated on their website that anyone could use the title "Dr" in the UK as long as they did not lead anyone to think that they were registered with the GMC as a medical practitioner or falsely claim to have a doctorate awarded by a university, such as a PhD.  He said he did not understand why the GCC had objected in the light of those guidelines.  He also said he appreciated the need for vigilance given the current contention about the overuse of the term "Doctor" within the media, for example House Doctor and Debt Doctor.  He asserted that he held the relevant qualifications and sent copies of his degree certificates.  He stated that until the matter was settled he would amend the ads to ensure that they distinguished between medical doctors and their own non-medical specialist provision.  He added that they did not wish to be associated with allopathy (treatment of disease using conventional medical therapies) or UK Chiropractic in any way.     

2. Peter Olsson said Atlas had been unable to find literature to explain the limitations of the use of the description "specialist".  He pointed out that they had conferred with an educational specialist, a physical training specialist and a specialist in dyslexia and basic skills, and had found that none of them had been questioned regarding their medical qualifications or experience or challenged about their use of the term in advertising.

He explained that "specialist" was a very accurate description of the service he provided. He said he spent the vast majority of patient contact time solely analysing and adjusting their spines.  He claimed that he specialised in the identification of the vertebral subluxation complex and care of the human spine, and was fully qualified to do so.  He said he studied for five years in full-time higher education and as part of his professional development he continued to attend post-graduate training with global specialists, to keep abreast of the latest advancements in spinal care protocol, spinal neurology and the physiological impact of an unhealthy spine and nerve function.   

3. Peter Olsson acknowledged that the use of the word "miracle" had religious connotations and might concern people of a certain faith.  He said he would use "amazing results" instead.  He sent signed patient testimonials which he claimed confirmed that he did achieve amazing results.

4. Peter Olsson said the data was taken from a review conducted by the FCER (Foundation for Chiropractic Education and Research) in the United States.  He sent a copy of the review.  He said it showed that patient satisfaction with professionals specialising in spinal care and chiropractic ranged from 8/10 to 100%, and that when he wrote the ad he felt that 90% would be the most accurate representation of the papers reviewed in the study.  He added that Atlas had a very high patient satisfaction rate, which was consistent with the study.  He said he had thorough training in Chiropractic and previous experience as a chiropractor.  He explained that although the research, which referred to chiropractic findings, informed his current practise, it was not the basis for it.  He said he specifically referred to US research because the work he did in the UK would be recognised as chiropractic in the US.  He added that due to differing regulations, the care that he provided was not included under chiropractic in the UK.

5. In support of the claim, Peter Olsson provided copies of peer reviewed research articles and summaries of further studies taken from a publication.

6. Peter Olsson argued that the ad did not claim that chiropractic treatment could treat the medical conditions referred to, but merely mentioned that people came to him with those conditions.  He also pointed out that he did not mention chiropractic in the ad because he was not a chiropractor.  He said he did not seek to cure, heal or care for any specific diagnosed condition other than reducing/correcting the vertebral subluxation complex and facilitating the body's ability to heal itself, that being the "confession" of the ad.  He also said patients who suffered with the medical conditions mentioned were cared for world-wide by osteopaths, chiropractors and spinal specialists.  He said he would focus on the specific conditions of migraine, whiplash and chronic pain referred to in the complaint, and said he had gathered an evidence-based collection of reports and peer reviewed articles to give more perspective on those issues.  He supplied copies of peer reviewed articles and summaries of further studies taken from a publication.  

Assessment

1. Upheld

The ASA noted Peter Olsson held UK degrees in Neuromusculoskeletal Sciences and in Chiropractic.  We also noted his argument that the title "Dr" was not protected in law.  We understood the GCC allowed registered chiropractors to use the title providing they made clear that they were registered chiropractors and were not registered medical practitioners.  We noted Peter Olsson was no longer registered with the GCC.  We considered that the use of the headline "A doctor's confession ..." and the references to "doctor" and "Dr. Peter" throughout the ad gave the impression that Peter Olsson was a registered medical doctor.  Because he was not, we concluded that the ad was likely to mislead.

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

2. Upheld

We noted Peter Olsson's argument that practitioners in many fields described themselves as specialists.  We considered, however, that the description "spinal specialist" in an ad that referred to "doctor" and to the treatment of medical conditions could give the impression that Peter Olsson was a registered medical doctor who was a specialist in the spinal field.  We concluded that the references to "spinal specialist" in the context of the ad were likely to mislead.

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

3. Upheld

We noted the term "miracle" was used to describe the results of treatment for medical conditions.  We considered that the claim was strongly worded and could lead readers to believe that spinal adjustments were likely to result in dramatic improvements to patients' health.  Because we had not seen evidence to show that that they did, we concluded the reference to "miracles" was misleading.

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

4. Not upheld  

We noted the study referred to several patient surveys carried out in the US in the 1990s.  For example, a survey of 3000 randomly selected patients showed that 94% were satisfied or very satisfied with the chiropractic care they received.  A study conducted by Gallup showed that nine out of ten chiropractic users felt their treatment was effective and eight out of ten were satisfied with their treatment.  A survey of chiropractic patients in medically underserved areas reported a 100% satisfaction rate with the care they received.  We also noted the ad summarised the surveys and referred to "over 90% of patients" being satisfied with their results.  We considered that ad made it clear that the data referred to came from a US source. We also considered that readers would understand that the claim was not necessarily representative of all patients.  We concluded that the claim 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.  

5. Upheld

We took expert advice.  We noted his comments that, of the studies supplied,  some were not relevant because the trial was carried out on specific patient groups (for example, HIV-positive people or those suffering from Crohn's disease), meaning that results would not be applicable for the immune system in general. Another of the studies was not useful because the results suggested a down-regulation of the immune system, contrary to the enhancement claimed in the ad, and the clinical relevance was uncertain with the study requiring independent replication before its results could be accepted.   We also noted his comment that the further studies summarised in the submission had not been supplied in full and were published mostly in journals that were not available through the usual sources.  We understood from the expert that the question of whether spinal manipulation affected the immune system had not been extensively studied, that existing studies were not of high quality and independent replications were not available, and that there were also studies that showed no effect on immune parameters.  We noted his conclusion that the evidence provided did not support the claim that spinal manipulation affected the immune system, and that, even if effects were proven, the matter would be open to further debate and research to determine whether that translated into beneficial clinical effects on the health of patients or healthy people.  We concluded that the claim was likely to mislead.

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

6. Upheld

We took expert advice.  We noted our expert considered that one of the articles supplied, a randomised controlled trial with migraine patients that suggested a positive symptomatic effect, was sufficiently rigorous to support the claim that spinal manipulation was effective to relieve symptoms of migraine. We also noted he was aware of other studies that showed that spinal manipulation was effective at treating the symptoms of migraine.  We also noted his comment that an article supplied to substantiate the efficacy of treatment for whiplash was a case report and was not therefore sufficient to prove the effectiveness of an intervention.  We noted, furthermore, the other evidence summarised was not supplied in full and the expert was unable to verify its authenticity.

We acknowledged that Peter Olsson had provided evidence to show that chiropractic spinal manipulation therapy could be effective for migraine, but we noted that we had not seen sufficient evidence to show that spinal manipulation could treat the other medical conditions mentioned in the ad. We understood that ads could refer to serious ailments like migraine, whiplash and chronic pain only if advice, diagnosis or treatment was conducted under the supervision of a suitably qualified health professional.  Although we noted Peter Olsson used to be registered with the GCC and had trained in chiropractic, we considered that because he was not a medical doctor and because he was not subject to regulation by a statutory or recognised medical or health professional body, the ad should not have referred to serious or prolonged medical conditions.   

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

Action

The ad should not reappear in its current form.  We advised Atlas to seek copy advice from CAP.

Adjudication of the ASA Council (Non-broadcast)