A press ad for Manor Pharmacy’s PRO_Longevity service, seen in the Herts Advertiser on 20 September 2018. Bold red text stated “Our service PRO_Longevity will help you lose weight, and reduce your risk of Type 2 diabetes, cancer, heart disease, blood pressure and dementia-diseases we all fear!”. Further text in blue stated “Our service will help you lose weight, and reduce your risk of cancer, diabetes, hypertension, heart disease and dementia…diseases we all fear? Based on solid scientific and clinical evidence we provide a unique service with remarkable results: - No additional medication - Weight loss - Improved blood sugars - NO calorie counting - Specially tailored nutrition education - Drop in blood pressure - NOT a diet”. Large text to the left stated “Did you know that a long and healthy life is only 20% genetic and 80% lifestyle? Would you like to reverse lifestyle habits with small simple changes?”. The top of the ad featured an image of a monitor-like device captioned “The Kit” and another image of a woman with a patch on her arm, holding a mobile phone, captioned “The Sensor”.
The complainant challenged whether the efficacy claims which referred to diabetes, cancer, heart disease, blood pressure, hypertension and dementia for the PRO_Longevity service were misleading and could be substantiated.
GS Phillips t/a Manor Pharmacy said that the PRO_Longevity service was aimed at enabling individuals to live in good health for longer. Patients who signed up to the service were initially given a questionnaire about their personal health-related goals, which included a non-exhaustive list of specific objectives to choose from, such as reducing the risk of diabetes, lowering blood pressure, and reducing the risk of cancer or dementia.
Manor Pharmacy then gathered biometric data from the patient which included: weight; Body Mass Index; HbA1C (the measure for an individual’s average blood glucose level); a liver function test; lipid profile; cholesterol; blood pressure; details of ongoing prescribed medicines; nature of diet; sleep; stress levels; and exercise regime. The patient was then fitted with a CGM Freestyle device for two weeks, during which it was recommended that no lifestyle changes were made in order to establish a solid baseline of data. The CGM Freestyle device was accredited by the NHS and provided Continuous Glucose Monitoring (the universally accepted measure for the body’s sugar control mechanism) and HbA1c.
After two weeks the patients’ health risks and health-related goals were reviewed and incremental changes were introduced which were tailored to their specific objectives and health risks. A CGM Freestyle device was then fitted again. The service lasted in total for eight weeks with the option to extend. For each client using the PRO_Longevity service, data was collected by Manor Pharmacy in order to assess their health. Manor Pharmacy also worked with the client’s GP where there were medical issues of concern. They said that they did not accept clients who they felt would not benefit from the service; for example, someone who had anorexia. They said the PRO Longevity service did not involve cutting calories or food groups and was not primarily a weight loss programme. They said that there was a great deal of scientific evidence that consumption of excess sugar raised insulin levels and explained that sugars and carbohydrates were converted in the liver to triglyceride fat. A diet high in sugar, processed carbohydrates and processed food pre-disposed the body to metabolic syndrome, a combination of diseases which included those referred to in the ad. They said that the link between metabolic syndrome and certain types of dementia was well recognised by the medical and scientific community. The PRO_Longevity service was therefore a programme that reduced the risk of developing metabolic syndrome; any resulting weight loss was secondary. They considered the ad did not suggest that the CGM Freestyle device itself had any effect on the health outcomes referenced in the ad.Manor Pharmacy provided a series of infographics setting out, for example, the link between obesity and cancer, the role of insulin, the metabolic syndrome, the glycaemic index and a blood sugar level chart. They also provided eight testimonials from patients who had used the service and a copy of a study which looked at the glucose levels of non-diabetic individuals after they had consumed meals. They also referred to programmes they considered were equivalent, such as the NHS Low Carb Programme and the NHS Diabetes Prevention Programme.
The ASA considered that consumers would interpret the claims that the PRO_Longevity service would help reduce an individual’s risk of “Type 2 diabetes, cancer, heart disease, blood pressure and dementia” and “hypertension” to mean that the PRO_Longevity service was effective in reducing the risk of a person developing those conditions. Manor Pharmacy had said that the service was intended to reduce the risk of developing metabolic syndrome and that any resulting weight loss was secondary. However, the ad did not reference metabolic syndrome at all, but did reference weight loss: the claims to reduce the risk of developing specific conditions appeared in sentences which began by stating that the service would “help you lose weight”. The claim “Weight loss” also appeared in bullet points. We therefore considered that consumers would understand from the ad that a key part of the service ‒ and particularly of its effectiveness in reducing the risk of a person developing the conditions named in the ad ‒ was that it was effective in helping to achieve weight loss.
The ad prominently featured images of the CGM Freestyle device in its bag and on a woman’s arm, labelled “The Kit” and “The Sensor”. The ad did not provide any further information about the device and only minimal information about what the service entailed (i.e., that it did not involve medication or calorie counting and that it was not a diet, but that it did include education on nutrition). We considered consumers were therefore likely to understand that the pictured device was central to achieving the weight loss, and as a result the reduced risk of developing the diseases, referenced in the ad.
We understood that generally accepted medical opinion was that people who were obese or overweight had a greater risk of developing a number of conditions, including Type 2 diabetes, heart disease and some types of cancer. We therefore acknowledged that through a tailored nutrition and exercise plan participants would be likely to lose weight which would be beneficial to overall health and, as a result of weight loss, participants who were overweight or obese would therefore have a reduced risk of developing such conditions. Claims about the potential health benefits of weight loss achieved through a tailored diet and exercise programme administered by a qualified pharmacist were therefore likely to be acceptable in advertising in certain circumstances.
However, Manor Pharmacy had said that the service was intended to reduce the risk of developing metabolic syndrome and that any resulting weight loss was secondary. We considered that the claims needed to be supported by evidence, including trials of the PRO_Longevity service conducted on people which demonstrated its efficacy.
We understood that the PRO_Longevity service consisted of a consultation with a pharmacist, a tailored nutrition plan and the CGM Freestyle device which monitored blood glucose levels and submitted results to a mobile app, allowing the user to identify spikes in insulin levels throughout the day. Manor Pharmacy had provided information relating to, for example, the link between obesity and cancer and the role of insulin in the body, but they did not provide any evidence which specifically related to the effects of the PRO_Longevity service in reducing the risks of developing the conditions referenced in the ad.
We also reviewed the customer testimonials which referred to participants reducing their sugar intake and resulting weight loss. This alone, however, was not sufficient substantiation for the claims in the ad. Additionally, we considered that claims such as “NOT a diet” were contradictory and implied that consumers would not need to change their diet to achieve weight loss However, the service required a consumers following a tailored nutrition plan which involved reducing the consumption of foods which caused spikes in blood sugar levels. Consumers would interpret this as being similar to following a diet. We therefore considered that the claim that the PRO_Longevity service was not a diet was misleading. Furthermore, while the ad stated “Did you know that long and healthy life is only 20% genetic and 80% lifestyle?”, we also considered that the ad overly emphasised the reduction of the risk of developing diabetes, heart disease, blood pressure, hypertension and dementia and suggested that the PRO_Longevity service would always be effective in reducing the risk of developing those conditions, which would not always be the case, for example, where individuals may be genetically pre-disposed to cancer or dementia.
Because we had not seen evidence which substantiated the claims relating to the reduction of the risk of developing the diseases stated in the ad for the PRO_Longevity service, we concluded that the claims were misleading.The ad breached CAP Code (Edition 12) rules 3.1 (Misleading advertising), 3.7 (Substantiation), 12.1 and 12.6 (Medicines, medical devices, health-related products and beauty products).
The ad must not appear again in its current form. We told GS Phillips t/a Manor Pharmacy not to state or imply that the PRO_Longevity service could help to reduce the risk of developing conditions such as diabetes, cancer, heart disease, blood pressure, hypertension and dementia, unless they held adequate evidence. We also told them not to imply that participants would not need to change their diet in order to achieve weight loss.