Background
Summary of Council decision:
Three issues were investigated, all of which were Upheld.
Ad description
The website www.saltcave.co.uk, for a complementary health therapy, stated "Salt Therapy is a clinically tested DRUG-FREE treatment, which replicates the healing microclimate within a naturally occurring salt cave ... The dry, negatively charged, salt enriched air is easily inhaled with the natural breathing rhythm, as the salt particles are very small and hardly noticeable ... Once in place it dissolves and attracts the positively charged, small impurities, which are later coughed up by the patient or leave the body via metabolic processes". The website made a number of claims about the ability of salt therapy to treat various medical conditions including asthma, bronchitis, psoriasis, respiratory diseases and tonsillitis.
Issue
The complainant challenged whether:
1. the ad discouraged essential treatment for conditions for which medical supervision should be sought;
2. the efficacy claims in respect of the conditions mentioned in the ad, were misleading and could be substantiated; and
3. the claim that inhaled salt could dissolve and attract positively charged small impurities, which would then be coughed up or leave the body via metabolic processes, was misleading and could be substantiated.
Response
1. The Salt Cave (TSC) said that they did not feel they discouraged essential treatment because their clients filled in a registration form to advise them what condition they had, their prescribed medicines and where they went for check-ups. They told us they therefore knew that most of their clients took their medicine and went regularly for check-ups, but that clients came to them because they were not entirely happy with the results or side effects of those medicines. They said they never referred to salt therapy as an alternative therapy, but rather as a complementary therapy, and that implied that it was intended as an additional therapy, rather than that it should be used in place of conventional treatments. They provided details of a patient who had had treatment at their facility paid for by the NHS under a pilot scheme which allowed patients control over their own treatment choices, and who had wanted to continue after funding was stopped.
2. TSC said they did not believe their efficacy claims were misleading, because all their statements were supported by medical studies. They directed us to a page on their website, which purported to reproduce a clinical study on salt therapy as a respiratory remedy for various conditions, along with a another page that provided 12 links to abstracts of PubMed articles. In addition they provided us with clinical studies in respect of the effect of hypertonic saline aerosol inhalation on mucociliary clearance in asthmatic and healthy subjects, and two clinical trials looking at the effect of nasal irrigation with saline on those suffering from cystic fibrosis and on children with allergic seasonal rhinitis.
3. TSC directed us to a document that could be downloaded from their website, which they told us had been prepared by a respiratory specialist in Canada and which they said described the mechanism of action in more detail.
Assessment
1. Upheld
The ASA noted that TSC's website featured various claims that related to the ability of salt therapy to treat asthma, bronchitis, cystic fibrosis, psoriasis, respiratory diseases and tonsillitis. We considered that those were conditions for which qualified medical supervision should be sought, and we noted that the CAP Code stated that marketers must not discourage essential treatment for such conditions by offering treatment for them, unless that treatment was conducted under the supervision of a suitably qualified health professional. Because we had not seen any evidence to suggest that TSC administered salt therapy under the supervision of a suitably qualified health professional, we concluded that the claims breached the Code.
On this point, the ad breached CAP Code (Edition 12) rule
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).
2. Upheld
We noted that, of the three studies provided in full by TSC, one related to asthma and one related to cystic fibrosis, and that, for the reasons outlined in Point 1 above, those were not conditions for which TSC was permitted to make claims about in its marketing materials. We did not therefore assess that evidence, although we did note that the trial in respect of cystic fibrosis related to nasal irrigation using saline solution, which was not the same therapy offered by TSC. That was also the case in respect of the allergic seasonal rhinitis trial. We concluded that TSC had not substantiated their claims in respect of any of the medical conditions mentioned on their website.
On this point, the ad breached CAP Code (Edition 12) rules
3.1
3.1
Marketing communications must not materially mislead or be likely to do so.
(Misleading advertising),
3.7
3.7
Before distributing or submitting a marketing communication for publication, marketers must hold documentary evidence to prove claims that consumers are likely to regard as objective and that are capable of objective substantiation. The ASA may regard claims as misleading in the absence of adequate substantiation.
(Substantiation) and
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.
(Medicines, medical devices, health-related products and beauty products).
3. Upheld
Whilst we acknowledged that the document to which TSC had referred us provided a more detailed version of their claim about the mechanism of action of salt therapy, we noted that the studies referenced in the document had not been provided and that we had not been given full details of from where the document had been sourced. We therefore considered that the document did not provide sufficiently robust evidence to substantiate the claim.
On this point, the ad breached CAP Code (Edition 12) rules 3.1 3.1 Marketing communications must not materially mislead or be likely to do so. (Misleading advertising) and 3.7 3.7 Before distributing or submitting a marketing communication for publication, marketers must hold documentary evidence to prove claims that consumers are likely to regard as objective and that are capable of objective substantiation. The ASA may regard claims as misleading in the absence of adequate substantiation. (Substantiation).
Action
The ad must not appear again in its current form. We told TSC to ensure that they did not discourage essential treatment for medical conditions for which medical supervision should be sought, and to ensure that they held robust evidence to substantiate any other claims.
