Ad description
The website for Wiltshire Chiropractic, visited on 15 June 2011, stated "Imagine the scenario; you've fed and winded your baby, changed his nappy, made sure he's not too hot or too cold, soothed and comforted him, sung his favourite lullabies, and still he's unsettled. In fact, he's downright miserable. For many of you, this scene doesn't need imagining - you're living it on a daily basis. However, the reason for your baby's unhappiness could quite simply be down to his birth. Even better, there might be a simple yet effective solution. How does the birth process affect my baby's spine? ... slight damage to your baby's spine may cause several problems, leading to an irritable baby and desperate parents. These include: Crying, restless, easily startled - Unhappy lying on his back - Prefers to feed on one side ... How can chiropractic treatment help? ... if the bones in the spine are even slightly twisted, this can cause a knock-on effect to the rest of the body ... Research on chiropractic care and colic has shown significant benefits over other treatments such as dietary changes, medication, and infant positioning. A randomized clinical trial published in 1999 in the Journal of Manipulative and Physiological Therapeutics found that 'Spinal manipulation is effective in relieving infantile colic'. For this study the researchers randomly assigned infants diagnosed with colic into two groups. One group received chiropractic care for two weeks and the other group was given the anti-gas medication dimethicone for two weeks. The babies in the chiropractic group showed a 67% decrease in crying while the babies on medication showed a 38% decrease in crying. Another study with 316 children also showed significant improvement in colic in response to chiropractic care. This prospective study used diaries from mothers of colicky babies to track the amount of crying. The three month long study showed a 'satisfactory result of spinal manipulative therapy in 94% of the cases'. The improvements occurred after an average of only three adjustments within two weeks".
Issue
A complainant challenged whether:
1. the suggestion that an unsettled baby was likely to be due to a spine problem and that it could therefore be treated by chiropractic;
2. the claim that the symptoms of crying, restlessness, being easily startled, being unhappy lying on his back and preferring to feed on one side were caused by slight spinal damage and that chiropractic could help; and
3. the claim that chiropractic was an effective treatment for colic in babies were misleading and could be substantiated.
Response
Wiltshire Chiropractic said several of the claims were phrased conditionally, using the word "could" which, they believed, suggested the possibility that chiropractic could help rather than being a definite claim.
1. Wiltshire Chiropractic said they believed it was feasible that, during the birthing process, strong muscle contractions of the uterus, combined either with laying on one's back or the use of birthing aids, could cause additional stress on a baby's spine. The practitioner said she had direct experience of treating babies who were in distress with neck problems in the way described in the ad.
2. The practitioner said the symptoms listed were all symptoms she had seen in babies or small children. She believed it was reasonable to assume that a painful inability to turn to one side would present itself in a child as a preference to feed on one side.
3. The practitioner said she was an experienced, evidence-based chiropractor and had treated many babies with colic, the vast majority of whom she said had been helped by chiropractic care. She acknowledged, however, that the trials that had been conducted were unlikely to meet the CAP Code's requirements and gave her undertaking that she would withdraw the claim that chiropractic was an effective treatment for colic in babies until such a time as she held sufficient evidence. She said she had sought clarification from the British Chiropractic Association (BCA), who had also advised that action.
Assessment
1., 2. & 3. Upheld
The ASA noted that the ad used some conditional phrasing. We also noted, however, that the ad went on to make more definite claims in "Research on chiropractic care and colic has shown significant benefits over other treatments ... A randomized clinical trial published in 1999 ... found that 'Spinal manipulation is effective in relieving infantile colic' ... Another study with 316 children also showed significant improvement in colic in response to chiropractic care ... a 'satisfactory result ... in 94% of the cases'". Because of that, we considered the ad suggested that chiropractic was likely to be an effective treatment for the conditions listed.
Because the ASA had not previously seen evidence to substantiate claims that an unsettled baby and symptoms of crying, restlessness, being easily startled, being unhappy lying on its back, preferring to feed on one side and colic could be treated by chiropractic, the CAP Code required that the claims needed to be backed by evidence, if relevant consisting of trials conducted on people. While Wiltshire Chiropractic had explained why they had used the claims, they had not supplied evidence. We welcomed Wiltshire Chiropractic's undertaking that they would remove from their ad the claim that chiropractic was an effective treatment for colic in babies until such a time as she held sufficient evidence. Because Wiltshire Chiropractic had not supplied evidence to substantiate that claim or the others that had been challenged, we concluded that the ad was misleading.
On points 1., 2. and 3. 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.
and
12.6
12.6
Marketers should not falsely claim that a product is able to cure illness, dysfunction or malformations.
(Medicines, medical devices, health-related products and beauty products).
Action
The ad must not appear again in its current form. We welcomed Wiltshire Chiropractic's undertaking that they would remove from their ad the claim that chiropractic was an effective treatment for colic in babies until such a time as she held sufficient evidence.
