Background
Summary of Council decision:
Three issues were investigated all of which were Upheld.
Ad description
A TV ad and website, for TAMPAP, a home HPV (human papilloma virus) testing kit:
a. The TV ad featured various women who stated, "I did it ... Why wouldn't you? ... It's so simple ... It's accurate ... I think it's amazing ... It could save your life." The ad showed animated silhouettes of eight women and the voice-over stated, "Each day in the UK, around eight women are diagnosed with cervical cancer. Three of those will die." A female presenter stated, "We now know that virtually 100% of cervical cancers are caused by the human papilloma virus, usually just known as HPV." The voice-over stated, "Introducing the TAMPAP test, a HPV test. It's accurate, private, convenient and can be taken at home by simply using a tampon. By detecting the presence of HPV we can determine whether a woman may be at risk of developing cervical cancer. Being aware allows you to seek further advice if required." The ad ended with a shot of the product packet and the voice-over stated, "That's tampap.com. It could save your life." On-screen text stated "91% of new HPV infections clear within two years (Centre of Disease Control)" and "TAMPAP can be taken in addition to your regular smear & not as a replacement".
b. The website, tampap.com, included claims, such as “DON’T RISK THE SILENT KILLER CERVICAL CANCER ... PEACE OF MIND. TAKE THE TEST TODAY! EARLY DETECTION HPV TEST ... PAINLESS, PRIVATE, ACCURATE, NO DOCTOR”. The website featured videos and claims by Dr Christian Jessen and Dr Dawn Harper. The “TESTIMONIALS” section of the website included claims, such as “Cancer is a killer, and taking the TAMPAP TEST is a life choice, and it’s a choice all women should take ... My sister actually had cervical cancer when she was only 30; she was one of the lucky ones because she did survive it. But it is a silent killer. So, unless you have regular screening you will not know whether you’ve got it until it’s too late ... Cervical cancer can affect anyone. I encourage all women to undertake screening!”
Issue
The complainant a medical doctor, challenged whether:
1. the ads were irresponsible and likely to cause undue fear about the risk of getting cervical cancer from HPV;
2. the ads were irresponsible because they may cause a reduction in women attending their routine smears due to inappropriate reassurance from a negative result; and
3. the use of GMC registered doctors to endorse the product in ad (b) would give individuals a misleading impression that the product was medically advised and did not provide a balanced view of the limitations of the test.
Response
1. Home Test Direct (HTD) said the HPV virus was almost always the cause of cervical cancer and was responsible for 99.7% of incidences. They said they had taken great care in planning the launch of the product so as not to cause unsubstantiated alarm or fear and denied that any aspect of their ads were irresponsible or could cause undue fear about the risk of the disease. They explained that their website contained statements directly from the TV ad script which had been substantiated carefully with Clearcast. They provided us with correspondence between themselves and Clearcast throughout the process of having a different ad approved. They said their website was rich in information about HPV, the TAMPAP test, risks of getting cervical cancer, FAQs and a range of matters that may be relevant to HPV and cervical cancer. They also submitted a report from a focus group meeting involving medical practitioners and medical advisors who had discussed the product.
Clearcast said they disagreed with the complaint and that the importance of HPV testing had been recognised in the UK. They said they felt the information provided within the TV ad was sufficient to explain the differences between being diagnosed with HPV and actually developing cancer from HPV. They noted that the on-screen text in ad (a), which stated "91% of new HPV infections clear within two years", would have addressed any concerns that the script may have caused unnecessary anxiety. They said the voice-over stated, "Being aware allows you to seek further advice if required" and that clarified that the presence of HPV would encourage women to seek further advice and not miss their next smear test appointments. They said HTD had provided them with step by step information on how further advice would be given so women were aware of the clinical consequences and they believed that, despite the references to cancer at the beginning of the ad, there was no ambiguity as to what was exactly advertised.
2. HTD said there may be any number of factors that could influence a future reduction in routine smear participation and the suggestion that that may be due to the TAMPAP test or its advertising was far-fetched. They provided a research article (not on the Tampap product) that stated "a kit for self-collection and return to a testing laboratory, followed by practitioner notification and follow-up if required should result in wider participation", which they believed contradicted the complaint. HTD said they hoped the product would have appealed to women who would never undertake a routine smear test. They said in the event of a negative result, they explained in some detail to customers what that meant and what it did not mean and likewise for a positive result, in which case their main advice was to contact a GP. They said they noted in various places throughout their advertising that the TAMPAP test did not replace a smear test.
Clearcast said they disagreed with the complaint on that point. They stated the idea of the product was to encourage women to take up their routine smear tests. They said the ad made clear what the test was for and made a distinction between HPV testing and smear testing. They highlighted the disclaimer in the ad, which stated "TAMPAP can be taken in addition to your regular smear & not as a replacement". They provided a template letter that women received in the case of a negative result, which carried a reminder that women still needed to attend their regular smear test.
3. HTD said all views of doctors on their website were absolutely their own opinions and were uninfluenced in any way by the company. They stated it was clear those doctors endorsed HPV testing and some doctors on their site stated further that the product was an accurate test for the detection of the HPV virus. They said the FAQ section of their website clearly explained a range of common questions that, in their opinion, provided a balanced view about HPV, cervical cancer and the TAMPAP test.
Assessment
1. Upheld
The ASA noted that one woman featured in ad (a) said, "It could save your life", immediately before the voice-over stated, "Each day in the UK, around eight women are diagnosed with cervical cancer. Three of those will die." We noted that that claim was directly followed by facts relating to the causes of cervical cancer. Whilst we acknowledged that brief on-screen text stated "91% of new HPV infections clear within two years (Centre of Disease Control)", we considered the overall impression of the ad was that women were likely to go on to develop cervical cancer if they contracted HPV. We noted the Centre for Disease Control statistic used in ad (a) was not quoted anywhere on the website and there was no mention of the fact that, in most cases, the human body would clear itself from the virus on the page titled "What is HPV and how is it related to Cervical Cancer?". The website video that featured the two GMC registered doctors in ad (b) also did not state that fact. We noted the focus group meeting report showed the group thought HTD should "consider phrasing to manage scaremongering for 'the virus that can cause cervical cancer'". We also noted the "TESTIMONIALS" page in ad (b) featured statements that made the product appear more like a test for cancer, than a HPV test, such as "Cancer is a killer, and taking the TAMPAP TEST is a life choice, and it's a choice all women should take". Whilst we acknowledged how important it generally was to emphasise the seriousness of cervical cancer, we concluded that these ads were irresponsible and likely to cause undue fear and distress about the risk of getting cervical cancer from HPV
On this point, ad (a) breached BCAP Code rules 1.2 1.2 Advertisements must be prepared with a sense of responsibility to the audience and to society. (Social responsibility), 4.10 4.10 Advertisements must not distress the audience without justifiable reason. Advertisements must not exploit the audience's fears or superstitions (Harm and offence) and ad (b) breached CAP Code (Edition 12) rules 1.3 1.3 Marketing communications must be prepared with a sense of responsibility to consumers and to society. (Social responsibility) and 4.2 (Harm and offence)
2. Upheld
We acknowledged the medical journal entry referred to by HTD and noted the phrase "should result in wider participation" referred to the method of using the HTD test, in comparison to the sampling procedure of smear tests and did not imply that a HPV test, such as TAMPAP, would result in wider participation of women attending smear tests. Whilst we noted that on-screen text in ad (a) did state the product was not a replacement for regular smear tests, we considered the ad implied it was an alternative that was more private and convenient than a smear test and it could therefore discourage women from attending routine smears. We noted the "TAMPAP TEST FAQ'S" section of the website stated "Receiving a negative result means you are not currently at risk of developing Cervical Cancer" and did not advise women that they still needed to attend their regular smear test. The answer to the question "I won't have a smear test. Can the TAMPAP Test help me?" was “yes” and did not explain that the product was not a replacement for a smear test. Part of the answer stated "These types of 'high risk' strains of HPV do not show any symptoms and that's why it is so important to get tested regularly" and we noted that sentence was not in the context of discussing smear tests and was instead promoting regular use of the product. We noted the website video featured quotes relating to the ease of taking the test at home and the perceived advantage that "you don't actually have to go and see a doctor, which for a lot of women, they might actually quite like", and we considered that implied the product was a replacement for a smear test. We were concerned that the "LATEST NEWS AND RESEARCH" page of the website listed three articles specifically about the product, followed by an editorial article titled "Home Smear Test Kit Could Help Shy And Embarrassed Women", which implied the product was a "Smear Test Kit". We noted the website quoted one article on the product, which stated "Urgh smear tests. We shudder at the thought. But what if you could detect whether you were at risk of developing cervical cancer from the comfort of your own home?". We considered that the overall tone of both ads implied that the product would reduce the need for women to attend routine smear tests and we understood that the product did not replace a smear test and that, regardless of the result, women should still regularly have a smear test. We therefore concluded that the ads were irresponsible and breached the Code.
On this point, the ad (a) breached BCAP Code rules
1.2
1.2
Advertisements must be prepared with a sense of responsibility to the audience and to society.
(Social responsibility) and
11.3
11.3
Advertisements must not discourage essential treatment for conditions for which medical supervision should be sought. For example, they must not offer specific advice on, diagnosis of or treatment for such conditions unless that advice, diagnosis or treatment is conducted under the supervision of a suitably qualified health professional (see rule 11.9). That does not prevent advertising for spectacles, contact lenses or hearing aids.
(Medicines, medical devices, treatments and health) and ad (b) breached CAP Code (Edition 12) rules
1.3
1.3
Marketing communications must be prepared with a sense of responsibility to consumers and to society.
(Social responsibility) and
12.2
12.2
Marketers must not discourage essential treatment for conditions for which medical supervision should be sought. For example, they must not offer specific advice on, diagnosis of or treatment for such conditions unless that advice, diagnosis or treatment is conducted under the supervision of a suitably qualified health professional. Accurate and responsible general information about such conditions may, however, be offered (see rule
12.1
12.1
Objective claims must be backed by evidence, if relevant consisting of trials conducted on people. Substantiation will be assessed on the basis of the available scientific knowledge.
Medicinal or medical claims and indications may be made for a medicinal product that is licensed by the MHRA, VMD or under the auspices of the EMA, or for a CE-marked medical device. A medicinal claim is a claim that a product or its constituent(s) can be used with a view to making a medical diagnosis or can treat or prevent disease, including an injury, ailment or adverse condition, whether of body or mind, in human beings.
Secondary medicinal claims made for cosmetic products as defined in the appropriate European legislation must be backed by evidence. These are limited to any preventative action of the product and may not include claims to treat disease.
).
Health professionals will be deemed suitably qualified only if they can provide suitable credentials, for example, evidence of: relevant professional expertise or qualifications; systems for regular review of members' skills and competencies and suitable professional indemnity insurance covering all services provided; accreditation by a professional or regulatory body that has systems for dealing with complaints and taking disciplinary action and has registration based on minimum standards for training and qualifications.
(Medicines, medical devices, health-related products and beauty products).
3. Upheld
We noted HTD said the views of the doctors on their website were their own opinions. However, whilst we understood that celebrities endorsing a product were likely to only mention the positive aspects of the product, we considered that a doctor's opinion should provide a balanced view. The first question the presenter asked began with the phrase "So as a trusted professional" and we considered viewers were likely to regard the opinions given as advice that should be followed, which would reduce their motivation to find out more about the test before purchasing it. We noted both doctors did not mention, for example, that the body would clear itself from the virus in most cases, and we considered that omitting such facts would not allow consumers to make an informed decision. We noted that many quotes in the website video were originally featured in a different ad that was viewed by Clearcast and concerns were raised over many of the quotes, including those which undermined the NHS screening programmes. We therefore concluded that ad (b) was misleading.
On this point, ad (b) breached CAP Code (Edition 12) rules 3.1 3.1 Advertisements must not materially mislead or be likely to do so. (Misleading advertising).
Action
The ads must not appear again in their current form. We told HTD to ensure their ads did not cause undue fear about the risk of getting cervical cancer from HPV and to ensure they made clear the test is not a replacement for routine smear tests and do not imply the product is medically advised.
BCAP Code
1.2 11.13 11.3 11.4 11.9 3.1 3.9 4.10
