Ideal Spine Centre 30 Whitstable Road Blean Canterbury Kent CT2 9EB Number of complaints: 2

Date: 20 February 2008 Media: Leaflet Sector: Health and beauty

Ad
a). A leaflet, for the Ideal Spine Centre (ISC), was headlined "Healthcare Practitioner's Confession to the City of Canterbury".  The author was entitled "Dr Christian Farthing BappSc (ClinSc); BCSc. WELLNESS DOCTOR & SPINAL WELLNESS PRACTITIONER".  The text described him as a "Doctor of Chiropractic".  Text at the bottom of the page stated "Background Information: Dr Christian H.E. Farthing is not a medical doctor or chiropractor in the United Kingdom.  However, Dr Farthing is a Doctor of Chiropractic in Australia where he gained his double degree (Bachelor of Applied Science (Clinical Science); Bachelor of Chiropractic Science) and his title of Doctor." The leaflet went on to state "Having practised as a Spinal Specialist in the United Kingdom, it has been alarmingly obvious that more people (including children) are taking an increasing number of drugs and other forms of medication than ever before.  The problem is, people believe that drugs are correcting the problem ... The problem is, you may not even feel these misalignments [of the spine], but ultimately feel the effects of them.  Some of the effects include headaches, migraines, pins and needles, numbness, sciatica, carpal tunnel, neuralgia, back and neck pain to even things like frozen shoulder, difficulty sleeping and poor concentration."

b). A second leaflet, also for the Ideal Spine Centre, was headlined "CANTERBURY HEALTH ANNOUNCEMENT FREE SPINE AND HEALTH CHECK".  The text stated "Ever heard these comments before? - You have just got to live with it OR It's just old age - It's just wear and tear - You need to take 'pain killer' medication OR - YOU are still suffering - YOU don't know what is causing your problem - Your problem affects your work or family life - Other methods have failed & provide only temporary relief  If any of these sound familiar, you need to have your spine assessed, as this is often the root cause of many common ailments."  Testimonials from patients included "I was getting to the point that I felt disabled.  I had been down the endless road of doctors, specialists and consultants.  However, the Ideal Spine Centre has provided correction to my spine and I have never looked back."      

Issue
1. The General Chiropractic Council (GCC) noted Christian Farthing was currently suspended from the GCC's Register of Chiropractors and that he did not appear on the GMC's List of Registered Medical Practitioners.  They objected that ad (a) misleadingly implied that Christian Farthing was a registered medical practitioner or chiropractor.

2. The ASA challenged whether ad (a) implied that the ISC could treat serious medical conditions such as migraine.

3. A member of the public challenged whether ad (b) encouraged treatment of serious or prolonged medical conditions by unqualified practitioners.

4. The same member of the public objected that it was misleading for ad (b) to offer a "Spine & Health check" as he believed this was not carried out by medically qualified staff.  

The CAP Code:

3.1;7.1;50.1;50.3

Response
1. The ISC confirmed that Christian Farthing of the Ideal Spine Centre had been suspended from the GCC register.  They maintained, however, that he had requested to be removed months before the event because he did not agree with its administration.  They said, although he was no longer registered with the GCC, Christian Farthing was still able to provide spinal health care using chiropractic methodology because he had a chiropractic qualification and was registered in Australia.  They asserted that the GCC regulated chiropractors and the title chiropractor, but did not regulate the use of the term 'chiropractic'.    They argued that he was a Spinal Specialist and was also registered as an Osteomyologist in the UK.  They claimed that although he was not registered with the GCC, he was a very responsible health-care practitioner who was also governed by IRMER 2000 Regulations in relation to the use of ionising radiation (diagnostic X-ray imaging). They said he had qualified as a chiropractor in Australia and had had the training to practice chiropractic. They argued that the disclaimer in the ad made clear that he was not a medical doctor or chiropractor in the UK.  They said they would remove any references in the ad that posed a problem to the ASA.  

They added that the leaflet was available for patients to read at the practice, and that they could take photocopies if they wished, but that it had not been distributed outside the practice.  They said the words "I am sorry for adding to your mail this week" referred to the fact that the leaflet was additional reading material to what people might receive in the post.  They added that following previous discussions with the ASA they had complied with its guidance whenever they placed newspaper ads, but that they had not realised the leaflet to be within ASA's remit.  They said they would no longer use the leaflet or make it available for patients to take home.

They pointed out that the Chiropractors Act 1994 stated that a person "who (whether expressly or by implication) describes himself as a chiropractor, chiropractic practitioner, chiropractitioner, chiropractic physician, or any other kind of chiropractor, is guilty of an offence unless he is a registered chiropractor."  They asserted that their advertising had already been investigated by the Crown Prosecution Service (CPS), which had ruled that it did not breach Section 32(1) of the Chiropractors Act and was not misleading.


2. The ISC pointed out that a 'Patient Information Leaflet' on the GCC website referred to patients seeing an improvement in some types of headaches, including migraine.  They said they had believed the governing body's education literature would contain proven claims and that they were not irresponsible to rely on the accuracy of that literature.  The ISC sent a leaflet by the British Chiropractic Association (BCA) and pointed out that it stated that chiropractors treated many of the causes of headaches and it also referred to migraines.  They said they expected information from the BCA to be valid, reliable and evidence-based and if they were found to be in breach, then the GCC and BCA were also in breach of the CAP Code.  They said they would remove references to migraine from the ad and send the ASA evidence if they decided to use it again. They said they agreed that chiropractors could not treat serious or prolonged conditions but that they did not claim to cure them, and that they merely corrected spinal dysfunction, better known as vertebral subluxation, and the body functioned better.  They said GCC-registered UK chiropractors worked at the ISC.  They stated that Dr. Farthing was the owner of the practice, but the ISC employed registered chiropractors to assist in the evaluations and treatment of all patients.  They maintained that all patients were seen by a suitably qualified health professional.

3. The ISC said GCC registered UK chiropractors worked at the ISC and helped with the screening process.  Two UK chiropractors, who were currently registered with the GCC, sent letters to confirm that they assisted with the free spine and health checks at the ISC.  The ISC said the registered chiropractors were also present at screenings, carried out consultations and provided spinal health care using chiropractic methodology. They maintained, therefore, that all patients were seen by a suitably qualified health professional.  The ISC pointed out that no treatment was given at a screening, they did not encourage treatment for any conditions and that, if  a medical condition was revealed in the screening process that the ISC could not assist with, the patient was referred to a medical doctor immediately.  They argued that the testimonials and claims about medical conditions in the ad related mainly to lower back pain.  They claimed that references to "getting to the point where I felt disabled" and to "the endless road of doctors" did not mean the conditions were serious or prolonged, but merely that other treatments had not worked.  They argued that the testimonials were genuine and showed how people's lives had changed.  

The ISC repeated their argument that that chronic conditions were referred to in the BCA and GCC literature.


4. The ISC reiterated that registered chiropractors carried out the spine and health check and that the ad referred to preliminary screening and not to treatment.  They explained that the check consisted of completion of a detailed screening questionnaire by the patient, followed by a relevant spine, posture and health check.  They said the World Health Organization referred to chiropractors as "drugless healthcare practitioners" and that it was perfectly valid for the practice, which employed registered chiropractors, to advertise that it carried out health checks.  They reiterated that they referred patients with conditions they could not treat to a medical doctor and were very aware that they screened people to see if they could help their back pain.

Assessment
1. Upheld
The ASA noted the ISC did not consider the leaflet to be within the remit of the ASA because it was available only in the surgery.   We noted text in the leaflet referred to it as a "letter" and stated "I am sorry for adding to your mail this week" which suggested that it had been available for distribution at some point.  We also noted it was available to be photocopied and taken away by patients.  We considered that it was an ad for the purposes of the Code.

We noted ISCs comments about the CPS but understood that the CPS had considered only directory ads that had not referred to Christian Farthing as a doctor or referred to chiropractic treatment.  The CPS had concluded that there was not a realistic prospect of conviction under The Act .

We noted, although he was not medically qualified and had been suspended from the GCC, Christian Farthing was registered as a chiropractor in Australia.  We acknowledged he was also registered as an osteomyologist in the UK.  We noted, however, osteomyology was not subject to statutory regulation and did not require an entry qualification beyond a degree in a physical medical discipline such as chiropractic or osteopathy.  We also noted the ISC's argument that the disclaimer in the ad made it clear that he was not a medical doctor or UK-qualified chiropractor.  We considered, however, that the references in the main text to "Dr Farthing", "The Family Doctor" and "Spinal Specialist" gave the impression that Christian Farthing was a registered medical doctor who was a specialist in the spinal field.  We considered that the disclaimer, which appeared in small print, could be overlooked.  We also considered that the statement "I graduated ... as a Doctor of Chiropractic in Australia" was likely to lead readers to believe that he was a UK chiropractor who had qualified in Australia.  We noted the Chiropractors Act 1994 stated that a person "who (whether expressly or by implication) describes himself as a chiropractor, chiropractic practitioner, chiropractitioner, chiropractic physician, or any other kind of chiropractor, is guilty of an offence unless he is a registered chiropractor."  Because he was suspended from the GCC's Register of Chiropractors and therefore was not entitled to call himself a chiropractor in the UK, we concluded that the claims were misleading.      

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

2. Upheld
We understood that ads could refer to serious ailments like migraine only if advice, diagnosis or treatment was conducted under the supervision of a suitably qualified health professional.  We noted we had seen evidence that two qualified chiropractors worked at the ISC but that one of the practitioners was Christian Farthing who had been suspended from the GCC's Register of Practitioners.  We noted the ISC had based its claims about migraine on information published by the GCC and BCA.  We also noted the ISC had not sent documentary evidence to show that chiropractors were able to treat migraine or other conditions such as sciatica and neuralgia that were referred to in the ad.  We had, however, recently seen evidence from another chiropractor that satisfied us that chiropractors could treat migraine.    However, because we had not seen evidence that patients would be treated by a suitably qualified health professional or evidence that chiropractors were able to treat sciatica or neuralgia, we concluded that the ad breached the Code.   We welcomed the ISC's assurance that they would remove references to migraine and other serious conditions from the ad.

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)

3. Upheld
We noted the ISC employed registered UK chiropractors who attended the spine and health checks.  We also noted their assertion that patients would be referred to a medical doctor if the practitioners considered they were unable to treat their condition.  We acknowledged that accepted scientific evidence suggested chiropractic treatment could be effective for lower back pain, and that the ad was for a preliminary assessment rather than for treatment.  We also noted, however, the main text stated "You are still suffering", "Other methods have failed" and the testimonials referred to "the endless road of doctors", "getting to the point where I felt disabled" and "debilitating pain down my leg".  We considered that the references to prolonged pain were likely to lead readers to believe that chronic pain and other serious conditions could be treated at the ISC.  Because we had not seen evidence that all patients would be seen by a suitably qualified health professional, or that chiropractic treatment was effective for the treatment of the chronic conditions described in the ad we concluded that the ad breached the Code.

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)

4. Not upheld
We noted the ad was headlined "CANTERBURY HEALTH ANNOUNCEMENT" and advertised a spine and health check.  We also noted the ISC's argument that the ad referred to preliminary screening and not to treatment, and that a referral system existed for those ailments that were not considered treatable at the clinic.  We understood the health checks were carried out by qualified chiropractors registered with the GCC and that they consisted of a screening questionnaire and a spine and posture check.  We considered that chiropractors who were registered with the GCC were suitably qualified to carry out spine and health checks.  We concluded that the ad was not misleading.

On this point, we investigated the ad under CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness), 50.1 and 50.3 (Health & Beauty products and therapies) but did not find it in breach.

Action
We told the ISC to remove references to Doctor.  We noted ISCs assurance that they would not refer in future ads to serious or prolonged medical conditions.  We advised them to seek advice from the CAP Copy Advice team when preparing future advertising.


Adjudication of the ASA Council (Non-broadcast)