ASA Adjudication on Spire Healthcare Ltd
7 December 2011
Health and beauty
Number of complaints:
A poster ad for breast enhancement surgery in the style of a magazine cover, featured a woman in a strapless top under the headline "COSMETIC". Text beneath stated "BOOB JOBS", and underneath that, smaller text stated "more affordable than you may think". Text beneath the heading stated "SAME DAY SURGERY", and "CONSULTANT PLASTIC SURGEONS". On the right-hand side of the image, text in a circle stated, "get more, pay less".
Ten complainants objected that the ad was:
1. Irresponsible because they believed it trivialised cosmetic surgery.
2. Offensive because they believed it portrayed women as sex objects and demeaned women by implying having large breasts was necessary in order to be attractive.
3. Unsuitable to appear in an untargeted medium such as posters where children, and particularly young girls, might see it.
CAP Code (Edition 12)
Spire Healthcare Ltd (Spire) said the poster was generated as part of a test campaign for a new service by one of its two hospitals in the Edinburgh area and was not submitted to, or approved by, their central copy clearance team, using its centralised copy approval process. They stated that the poster did not conform to its brand guidelines, and was no longer in use.
Spire said the campaign comprised six poster ads displayed at bus stops in Edinburgh City centre during a two-week period during August and September 2011, to advertise a new concept of day-case breast augmentation surgery. They said the campaign was aimed at the female 18-25 age group, and that local customer feedback and market research using its own staff had established there was demand amongst that age group for day-case breast augmentation surgery not requiring an overnight hospital stay. They said the image was intended to be eye-catching, informative, and to "emulate a magazine cover feel". Spire believed such a service would meet the needs of women who were very cost-driven, but not concerned about treatment by a particular consultant, or at a specific location.
1. Spire said the poster was not intended to trivialise breast augmentation surgery. They said the reference to "Same day surgery" was not misleading, and was intended to state that the surgery and discharge of the patient would occur on the same day. They said that text was also intended to differentiate the advertised service from Spire's in-patient breast augmentation service, which involved an overnight stay at a hospital. They stated that, following discussion with CAP copy advice, the poster was amended to clarify "prior to surgery patients must attend hospital for two separate appointments with a consultant plastic surgeon and a nurse". They said the reference in the ad to consultant plastic surgeons was to reassure patients about the standard of care they would receive regardless of the route to surgery, and that whilst space was limited in the ad, a link to the hospital website where further advice was offered, was clearly visible in the ad. That website advice stated, "Our expert consultant plastic surgeons will carry out your surgery and provide pre and post surgical consultation as part of this special cosmetic surgery service. Deciding whether same day cosmetic breast enlargement is right for you can be made with the advice and expert opinion provided by our experienced consultant surgeons. Aftercare is provided in the reassuringly experienced hands of our cosmetic surgery nurses, who will support your recovery and healing process".
2. Spire said neither they nor their hospitals promoted the objectification of women or implied that having large breasts was necessary in order to be attractive. They said they had taken CAP copy advice on the text and image used in the poster, and the possibility of causing offence. They argued that text, "more affordable than you think" and "get more, pay less", referred to this procedure being cheaper than in-patient breast augmentation surgery offered at a second group hospital in the Edinburgh area. Spire also stated the image used was of a young woman who had undergone breast augmentation surgery and was to provide a realistic portrayal to customers of the likely outcome to ensure that the marketing campaign was not misleading.
3. Spire said the ad was not designed or intended to attract young adults or children, but was targeted at a specific 18–25 years demographic. They explained that the campaign was timed to coincide with the Edinburgh Fringe Festival, at a time the intended target audience would be using the local transport links more frequently to travel around the city centre. They stated the use of the images in the poster was to appeal to an audience familiar with images seen in glossy lifestyle magazines.
We noted that the ad poster gave factual information about cosmetic surgery, where it referred to price, location of surgery, and the involvement of consultant plastic surgeons, but also contained the phrases, "get more, pay less", and "Boob Jobs More affordable than you may think". Although Spire stated that both phrases were used in reference to, and in comparison with, the cost of overnight breast enhancement surgery at another local hospital within its group, we considered that was not made clear in the ad. We noted that the ad included the phrase, "prior to surgery patients must attend hospital for two separate appointments with a consultant plastic surgeon and a nurse" in small print at the foot of the ad. However, we considered this text was not prominent enough to significantly modify the overall impression created by the more prominent "Same day surgery" text.
We considered that the ad appeared to describe serious surgery as a straightforward financial transaction, and also stated that the results of that surgery were "more affordable than you may think". Therefore, the emphasis of the ad on speed of treatment and cost, conflicted with the advice contained in the ad about the need for consultations prior to surgery. We concluded the overall presentation of the ad was likely to be seen as trivialising breast enhancement surgery.
On this point the ad breached CAP Code (Edition 12) rule 1.3 (Social responsibility).
2. Not upheld
We noted the ad showed an image of a woman who had undergone breast enhancement surgery, which we considered was relevant to the advertised service. Although we acknowledged that some people might object to the idea of cosmetic breast augmentation, we considered that the image and text in the ad were unlikely to be seen in themselves to portray women as sex objects, to demean women, or to imply that having large breasts was necessary in order to be attractive.
On this point we investigated the ad under CAP Code (Edition 12) Rule 4.1 (Harm and Offence) but did not find it in breach.
We noted target demographic for the ad was women 18–25 years of age, and that the ads were displayed during the period of the Edinburgh Fringe Festival, because it was believed people in that demographic would be using public transport.
We considered, however, that posters on bus shelters were an untargeted, uncontrolled medium, visible to all passing the ads. We were concerned that the image, which showed a woman with large breasts and a top which accentuated that, together with the words "BOOB JOBS more affordable than you may think" and the style of the ad, which resembled a glossy lifestyle magazine, conveyed the message that breast surgery was a straightforward, risk-free lifestyle decision. We concluded that, in an untargeted medium likely to be seen by children, Spire had not promoted their cosmetic surgery service in a sufficiently responsible manner.
On this point the ad breached CAP Code (Edition 12) Rule 1.3 (Social responsibility).
The ad must not appear again in its current form.