ASA Ruling on County Durham & Darlington NHS Foundation Trust
County Durham & Darlington NHS Foundation Trust t/a
Trust HQ, Executive Corridor
Darlington Memorial Hospital
23 April 2014
Number of complaints:
A TV ad promoted Balance, an alcohol awareness charity. It featured a man in a kitchen preparing a meal. As he began, he took a beer out of the fridge, poured it into a glass and took a sip. At the bottom of the glass was a small tumour which began to grow as the man took more sips of beer from his glass. As the man took the final sips of beer from the glass, the tumour was seen sliding down the glass towards his mouth. A voice-over stated, "The World Health Organisation classifies alcohol as a group one carcinogen. Like tobacco and asbestos, it can cause cancer. The more you drink and the more often you drink, the more you increase your risk of developing cancer. Find out how you can reduce your risk. Go to reducemyrisk.tv."
The British Beer & Pub Association (BBPA), the Campaign For Real Ale (CFRA), the Society of Independent Brewers (SIB), J W Lees and Co Brewery and three other complainants challenged whether the ad was misleading and irresponsible, because they believed it amounted to scaremongering and gave the impression that drinking a small amount or drinking moderately would increase someone's risk of developing cancer.
County Durham & Darlington NHS Foundation Trust t/a Balance highlighted that the ad had been shown in the North East of England, which experienced some of the worst alcohol related health problems, including the highest rate of alcohol related hospital admissions, in England. They also explained that according to their most recent survey of over 2,700 people, 38% of adults were found to be drinking above the Government's recommended limits, but that 91% of that group still classified themselves as 'light' or 'moderate' drinkers. Therefore, as a public health body, they believed it was responsible to raise awareness of the links between alcohol and a range of health harms and to encourage individuals to reduce their risk and drink within the Government's recommended guidelines.
Balance said there were a range of peer-reviewed academic papers, available in the public domain, which proved that consuming alcohol increased the risk of developing cancer. In particular they highlighted a World Health Organisation (WHO) paper, published in 2012, entitled "Alcohol in the European Union: Consumption, harm and policy approaches", which stated "In 2007, the International Agency for Research on Cancer concluded that there was a causal link between alcohol of the oral cavity, pharynx, oesophagus, liver, colon, rectum and female breast. All these cancers showed evidence of a dose response relationship; that is, the risk of cancer increases steadily with greater volumes of drinking". In addition, they highlighted a growing body of evidence which suggested that the consumption of any amount of alcohol could increase the risk of cancer. They provided a report entitled "Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective", authored by the World Cancer Research Fund/American Institute for Cancer Research which stated "The evidence on cancer justifies a recommendation not to drink alcoholic drinks ... The evidence does not show a clear level of consumption of alcoholic drinks below which there is no increase in risk of the cancers it causes. This means that, based solely on the evidence of cancer, even small amounts of alcoholic drinks should be avoided". Similarly, they highlighted that Cancer Research UK's website stated "The more alcohol someone drinks, the more their cancer risk increases. But even quite small amounts of alcohol, around 1 drink a day, can increase cancer risk. Expert reports have concluded that there is no lower limit of alcohol drinking where cancer risk isn't increased". They also provided further papers exploring the impact of 'light' or 'moderate' drinking on the risk of developing cancer.
In spite of compelling evidence linking 'moderate' and 'light' drinking with an increased risk of cancer, Balance said they did not want the ad to be too alarmist. Therefore, the ad aimed to depict routine drinking, whereby a man consumed a bottle of beer as part of a typical every day task; cooking dinner for his children. They said the ad conveyed the impression that the man featured consumed alcohol on a regular and routine basis, and that at no point did the ad state or imply that the man featured was only consuming one glass of beer on that particular occasion. They believed the ad was similar to the approach utilised by the NHS when promoting an awareness of the harms associated with smoking, in that one cigarette would be used to represent habitual usage. Similar to that approach, Balance intended the consumption of one drink to be interpreted as a proxy for routine drinking. They also highlighted that the ad's voice-over clearly stated "… the more you drink and the more often you drink …", further enforcing the impression that routine or regular drinking would enhance the risk of developing cancer.
Balance also highlighted that the ad directed viewers to the website www.reducemyrisk.tv where they could access advice and information, including the Government's recommended drinking guidelines.
Clearcast stated that the agency had provided evidence to show that alcohol consumption did increase the risk of certain cancers and that the WHO classified it as a group one carcinogen in line with tobacco and asbestos. They had also taken advice from their medical consultant who confirmed that there was a strong scientific consensus that there was an association between drinking alcohol and certain types of cancers. However, the consultant said the risk should not be exaggerated and therefore the ad should make clear that the risk of cancer depended on the amount of alcohol consumed along with the frequency of consumption. Clearcast did not believe that the ad suggested that drinking a small amount or drinking moderately would increase someone's risk of developing cancer.
The ASA noted that the BBPA, CFRA and SIB objected to the ad as they believed it did not accurately present the risks associated with moderate alcohol consumption. In particular, they stated that there was evidence to suggest that moderate levels of alcohol intake were associated with lower mortality risk and might confer an overall net health benefit when compared with either abstention or a high-level of intake. They said there was mounting scientific evidence that moderate alcohol consumption, as part of a healthy and balanced lifestyle, could have a beneficial effect on a number of heath conditions including coronary heart disease.
We reviewed the papers provided by Balance and understood that there was general consensus in the scientific and medical communities that the consumption of alcohol could increase an individual's risk of developing particular cancers such as cancer of the breast, larynx, liver or oesophagus. We also noted that there was evidence to suggest that even moderate consumption could increase an individual's risk of developing cancer, although those risks were relatively small and could be affected by other influences such as pre-disposing genetic factors. Having reviewed the relevant guidance, we understood that the NHS recommended that men should not regularly drink more than three to four units of alcohol a day, women should not regularly drink more than two to three units of alcohol a day, and that alcohol should be avoided for 48 hours after a heavy drinking session. We understood that 'regularly' meant drinking those amounts every day or most days of the week.
We noted that the ad showed a series of shots of a man consuming one beer, whilst a tumour developed in the glass. We also noted that the voice-over clearly stated that alcohol could cause cancer and that "… the more you drink and the more often you drink, the more you increase your risk of developing cancer". We considered that the overarching message of the ad was that the consumption of alcohol could cause cancer, the more alcohol an individual consumed the greater that risk, and that viewers should reflect on, and potentially reduce, their alcohol intake. We did not consider that the ad over-emphasised the risk of developing alcohol related cancers, or suggested that viewers should significantly reduce their intake or abstain from the consumption of alcohol completely. In addition, we noted that the ad encouraged viewers to visit the website www.reducemyrisk.tv and find out more about the Government's recommended guidelines and for guidance regarding their own drinking habits. Therefore, we concluded that the ad was not misleading or irresponsible.
We investigated the ad under BCAP Code rules 1.2 (Responsible advertising) and 3.1 (Misleading advertising), but did not find it in breach.
No further action necessary.