Summary of Council decision:
Two issues were investigated, both were Upheld.
The website www.alyssaburns-hill.com, for a complementary health practitioner, was headed “Dr Alyssa Burns-Hill Harley Street Hormone Health”. Text underneath this stated “Dr Alyssa Burns-Hill, PhD, MSc, FRSPH, MIHPE Hormone & Holistic Health Specialist Health Educator”. Text at the bottom of the home page stated “Dr Alyssa Burns-Hill has provided this website for information purposes only. It is not intended as a substitute for advice from your registered physician or healthcare professional”.
Under the “Hormone Testing” tab, text stated “Sometimes it’s important or just plain necessary to test your hormones to: see what is really going on through a comprehensive hormone review, rather than an isolated spot check; identify previously unidentified hormone deficiencies, excesses, or imbalances so that appropriate courses of action can be identified (holistic or medical according to your needs). This supports you in a very clear way in your aims of understanding your health and yourself … So, to reiterate, these are not vague testing procedures that are similar to those offered at most chemists today - these are advanced medical tests that use cutting-edge technology developed specifically for hormone processing and analysis, which are able to identify hidden hormone imbalances that will make sense to you through my in-depth, easy-to-read reporting that is included along with your personalized natural health protocol”.
The complainant challenged whether:
1. the claim "these are advanced medical tests that use cutting-edge technology developed specifically for hormone processing and analysis, which are able to identify hidden hormone imbalances" was misleading and could be substantiated, because she did not believe that saliva testing was a reliable method; and
2. the ad misleadingly implied that the advertiser was a medical doctor.
1. Dr Alyssa Burns-Hill (DBH) said that the hormone levels found in saliva represented the quantity of hormone actually available to target tissue, and there was a relationship between those levels and the specific symptoms of hormone excess or deficiency. She said that rationale had been clearly established in the published works she had provided as substantiation for the claim. She provided the ASA with a study that had been published in a peer-reviewed medical journal, which had looked at saliva as a medium for investigating sex hormone levels in premenopausal women, along with two articles on salivary hormone testing and an article on human saliva as a diagnostic specimen. She accepted the NHS did not offer salivary testing for issues relating to hormone imbalances, but she did not feel that reflected on whether it was a viable and accurate technology and pointed out that they did use saliva tests for some other purposes, such as HIV testing.
2. DBH said she had no wish to be confused with a medical doctor and, as such, she was always identified as Dr Alyssa Burns-Hill, PhD. She told us that full details of her qualifications and professional memberships were provided on the "About" page of her website, and that that page also contained the text "For absolute clarity - I am not a medical doctor". She pointed out that the bottom of her homepage included a section entitled "Why do I say clients and not patients?" which further stated "I use the term client because I work in partnership with my clients to educate and inform them of aspects of health and wellbeing that are relevant to them ... Patients are, by definition, passive, as they only receive medical care or treatment" which she felt further clarified the differences between her practice and that of a medical doctor. She explained that the research for her PhD focused on 'Holistic healing from breast cancer through the lens of hormones: Synopsis and synthesis' and, as that was relevant to her business, she believed it was appropriate to use the title "Dr" in her marketing material.
THIS ADJUDICATION REPLACES THAT PUBLISHED ON 5 SEPTEMBER 2012. THE WORDING ON POINT 2 HAS BEEN CHANGED BUT THE DECISION TO UPHOLD REMAINS.
The ASA acknowledged DBH had provided a study from a peer-reviewed medical journal which stated, in conclusion, that the results supported the use of salivary measurements for exploring changes in cumulative exposure to endogenous estradiol and progesterone in premenopausal women. However, we noted the study's authors had accepted that their data had several limitations, including a small starting sample size of 19 women, after which further women were excluded from the analysis because they had anovulatory cycles or had excessive missing samples; and the fact that the study only sampled saliva from two consecutive menstrual cycles. We further understood the study only looked at two hormones in women aged between twenty and forty years old. We therefore considered it was not sufficient to substantiate the general claim that saliva could identify "hidden hormone imbalances".
We noted that the articles provided by DBH referred to a number of advantages to testing hormone levels using saliva samples but that, equally, the authors discussed a number of disadvantages to that method, which had limited its acceptance within the medical profession.
We accepted that the NHS used saliva tests for the diagnosis of some conditions but we did not consider that provided any evidence in support of the use of saliva testing for other unrelated purposes.
We concluded the claim had not been adequately substantiated and was misleading.
On this point, the ad breached CAP Code (Edition 12) rules
Marketing communications must not materially mislead or be likely to do so.
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.
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).
We acknowledged that DBH held a PhD in an area relevant to her business but that the suffix PhD had not been in her headline title. We noted that the website’s headline said ‘Dr Alyssa Burns-Hill Harley Street Hormone Health’ and, while we acknowledged that Harley Street contained a variety of health professionals, we considered that most consumers would be likely to associate the reference to Harley Street with qualified medical doctors. We also noted that the suffix PhD was not used consistently throughout the website and, in any event, we did not consider that that alone would be sufficient to make it clear to consumers that DBH was not a medically qualified doctor, particularly when taken in the context of her website as a whole, which was heavily concerned with health related matters and in which she referred to herself as a hormone and holistic health specialist. We accepted that DBH explicitly stated that she was not a medical doctor within the body text of her ‘About’ page but we considered that that information could easily be missed by consumers, who may not read the website in its entirety. Although we acknowledged DBH made a number of references to her holistic approach, we considered most consumers were likely to interpret the website as belonging to a medically-qualified doctor with an interest in alternative health, rather than that of an alternative health practitioner. We concluded that in the context of the website viewed by the complainant DBH’s use of the title ‘Dr’ was misleading.
On this point, the ad breached CAP Code (Edition 12) rule 3.1 3.1 Marketing communications must not materially mislead or be likely to do so. (Misleading advertising).
The ad must not appear again in the form which gave rise to the complaint. We told DBH to ensure that she held adequate substantiation for her claims in future, and to ensure she stated that she was not a medically qualified doctor in a clear and prominent qualification positioned close to the first reference to the title Dr Alyssa Burns-Hill PhD.