Background
Summary of Council decision:
Two issues were investigated, both of which were Upheld.
Ad description
Claims on a website for Steve Scrutton Homeopathy, www.stevehomeopath.co.uk:
(a) On a web page headed "Influenza", text stated "Many people ask homeopaths for advice about avoiding influenza. I usually recommend the remedy Oscillocochinum, and/or the remedy Influenzinum (often in combination with Bacillinum). Simply by taking a single remedy on a monthly basis, more regularly, perhaps fortnightly, for those people most at risk".
(b) On a web page headed "Arthritis", text stated "The Homeopathic Materia Medica. Homeopathy uses many remedies for people suffering with arthritis, and related illnesses. The main ones, with a brief description of the kind of symptoms they are used for, are as followed:
Rhus Tox
Perhaps the main remedy used for rheumatism, with pain and stiffness. Pain and stiffnes [sic] causing patient to shift and stretch. Restless in bed. Worse in morning, upon rising; at night; evening, with over-exertion; for cold, damp weather; sitting for a long time. Better for heat, continued gentle motion.
Causticum
There is joint pains and deformity; remedy in advance, deformative arthritis. Stiffness can be so severe the patients [sic] feels as if the join [sic] is paralyzed. Cracking joints.
Arnica
Great soreness all over. Even the bed feels too hard. Feels as if bruised or beaten. Must shift constantly to relieve pain.
Aurum Met
Serious or advanced rheumatism with marked stiffness. Rheumatism with siffness [sic] or spasks on chest wall. Severe spasm or tearing pains. Pains described as 'paralytic'. Wandering arthritis; moving from spot to spot.
Bryonia
Excrutiating [sic] pains, often stitching pains. Patient is averse to being examined or moved. Fears to move yet feels restless. Worst, slightest motion. Jarring. From cold, especially cold, dry weather. Better, heat, pressure, lying still, lying on painful side.
(These brief remedy descriptions have been taken from Roger Morrison, Desktop Companion to Physical Pathology. Hahnemann Clinic Publishing. 1998)".
Further claims compared randomised controlled trials (RCTs) on homeopathy with conventional medical treatment for arthritis and similar conditions.
Text at the bottom of the page stated "In my experience, I have certainly found homeopathy to be a safe and effective therapy for people suffering from arthritis, and related conditions. Of course, any views or advice given on this website are based on my training and experience of homeopathy. If you are looking for conventional medical views or advice for specific or serious illness please consult your GP."
Issue
The ASA challenged whether:
1. the web page headed "Arthritis", which made reference to randomised controlled trials on homeopathy, could discourage essential treatment for conditions for which medical supervision should be sought; and
2. the web page headed "Influenza" made claims that implied homeopathy was proven to be effective in the prevention of influenza.
Response
Steve Scrutton Homeopathy (Steve Scrutton) provided information about the background and history of homeopathy. He said professional homeopaths selected remedies for their patients on the basis of the principle 'like cures like', or the 'law of similars', which stated that any substance that can produce physical symptoms can be used to treat a disease manifesting similar symptoms. He said that homeopaths used the Homeopathic Materia Medica (HMM) to guide them when selecting a remedy for a patient's symptoms. He said he based his knowledge of homeopathic remedies on this large heritage of knowledge and his professional expertise.
Steve Scrutton believed the two web pages in question were editorial information relating to homeopathy in general. He did not believe the web pages were marketing, and considered them to be outside the remit of the ASA. He said the web pages represented the collective knowledge of over 200 years of homeopathy in practice, and said he had included references to his personal experience in order to share this information with interested parties. He said the information related to the known therapeutic action of homeopathic medicines when used correctly, according to homeopathic tradition, and that the information was fully referenced, wherever appropriate.
Steve Scrutton said that he did not manufacture or sell homeopathic products, and that any information on his website regarding specific homeopathic remedies and their potential therapeutic application was based upon homeopathic literature and his own clinical experience. He said that the homeopathic remedies mentioned on his website were all available in products from the main homeopathic pharmacies. He said he considered this to be basic information about homeopathic medicines, which the public had a right to access.
1. Steve Scrutton said he believed himself to be a qualified health professional, for the purposes of the CAP Code. He said homeopathy was a system of medicine, and that he was a trained, qualified homeopath. He said he was registered with and regulated by the Alliance of Registered Homeopaths, a lead body for the homeopathy profession in the UK. He said homeopathy was a lawful profession in the UK, and that he was insured as a homeopath, and that he therefore considered himself to be a qualified healthcare professional.
Steve Scrutton said the symptom descriptions given for each of the named remedies were taken from a reputable homeopathy source, and that most of these had been part of the HMM for over 200 years. He said that homeopathy did not recognise 'arthritis' as such, and so did not treat 'arthritis', as this was a condition defined by conventional medicine. He said that homeopathy dealt with 'pain' and the circumstances in which it occurs, but that most patients knew and described this pain as arthritis. He said many of his patients who saw him for 'arthritis' pain had been treated by their conventional doctor, only for their condition to worsen. He said he routinely referred any patient with undiagnosed pain, arthritis, or any other ailment, to their NHS doctor for a diagnosis. He said he agreed that arthritis was a serious condition, and said that NHS information stated that arthritis could not be cured, but that symptoms could be eased. He said his website did not make any claims, but simply stated that "homeopathy uses many remedies for people suffering from arthritis".
Steve Scrutton said that on his website he provided evidence of ten randomised controlled trials (RCTs) conducted into the efficacy of homeopathic treatment of people suffering with arthritis. He said he also provided information about the conventional medical treatment of arthritis, taken directly from an official NHS patient website, giving the possible adverse effects of that treatment. He said he was providing people with important information about the homeopathic treatment of pain, known as arthritis, and giving them evidence which he believed would be useful when they came to make personal choices about their future treatment. He did not believe individuals would have been misled by the information, or to have failed to seek medical advice where appropriate.
2. Steve Scrutton said the remedy Oscillococcinum to which the web page referred was a homeopathic medicine. He said that in France it was frequently recommended by pharmacists as safe and effective in the treatment and prevention of influenza. He provided an article published in a British pharmacology journal, in relation to a French study into the effectiveness of Oscillococcinum in the treatment of influenza-like symptoms during the influenza epidemic of 1987. He also said that this study has been replicated in Germany in 1990.
Assessment
The ASA considered whether the homeopathic remedies referred to in the web pages were homeopathic medicinal products for the purposes of the CAP Code. However, because the web pages referred only to the generic names for various homeopathic remedies, and did not offer the remedies for sale or refer to specific strengths or manufacturers, we concluded the remedies referred to were ingredients rather than products.
1. Upheld
We noted Steve Scrutton did not believe the web page headed "Arthritis" to be marketing material, and that he considered the page was merely editorial information. However, the web page included the statements "Homeopathy uses many remedies for people suffering from arthritis, and related illnesses" and "In my experience, I have certainly found homeopathy to be a safe and effective therapy". We considered that, in the context of a website for homeopathic services, these statements meant the web page was marketing his services as a homeopath in the treatment of arthritis. The web page contained contact information, and a link along the side to "Appointments & Fees". We therefore considered the web page was marketing material, and was within the remit of the CAP Code.
We noted Steve Scrutton said he was merely providing information to people about arthritis to inform their future treatment choices. However, the CAP Code stated marketers must not discourage essential medical treatment for conditions for which medical supervision should be sought, and this included offering specific advice on the treatment for such conditions unless that advice or treatment was conducted under the supervision of a suitably qualified health professional. We considered that arthritis was a condition for which medical supervision should be sought. We noted the Code made an exception for accurate and responsible general information, and that the web page contained the statement "If you are looking for conventional medical views or advice for specific or serious illness please consult your GP". However, we considered that the content of the web page would be viewed by consumers as both advice on the treatment of arthritis, and marketing for Steve Scrutton's services in the treatment of arthritis, rather than just general information. We also considered that, although it was sourced from an NHS website, the selection of the content meant the section in relation to conventional medicine focused strongly on the negative aspects, and side effects, of medicines used to treat arthritis.
We noted Steve Scrutton was a member of a UK based registering organisation for professional homeopaths, and said he would refer undiagnosed patients to a GP for a diagnosis. However, we also noted that 'homeopath' was not a protected title in the UK and that homeopathy was not subject to statutory regulation. In the absence of supervision by a suitably qualified health professional, we did not consider that Steve Scrutton had demonstrated he was suitably qualified to offer, in a marketing communication, specific advice on, or treatment for, conditions for which medical supervision should be sought, including arthritis.
We concluded that, because the web page offered advice and marketed treatment for arthritis, the ad 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
The ASA noted Steve Scrutton did not believe the web page headed "Influenza" to be marketing material, and that he considered the page was merely editorial information. However, the web page included the statements "Many people ask homeopaths for advice about avoiding influenza. I usually recommend ..." and "I have done this with my family and friends, and with many patients, for nearly 10 years now". We considered that, in the context of a website for homeopathic services, these statements meant the web page was marketing his services as a homeopath in the prevention of influenza. The web page contained contact information and a link along the side to "Appointments & Fees". We therefore considered the web page was marketing material, and was within the remit of the CAP Code.
We noted Steve Scrutton had provided an article regarding one study, and provided information about a second study, in which the efficacy of Oscillococcinum in treating influenza-like symptoms had been examined. However, the claims on the web page referred to the prevention of influenza, rather than treatment, so we did not consider the evidence provided to be relevant to the claim. No evidence was provided in relation to the prevention of flu or in relation to Influenzinum or Bacillinum. We considered the claims made implied that the named remedies were proven to be effective in the prevention of influenza. As we had not seen any evidence that this was the case, we concluded that the claims were misleading.
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).
Action
The web pages must not appear again in their current form. We told Steve Scrutton to ensure he held robust evidence when making claims in future, and to ensure that he did not offer, in a marketing communication, specific advice on, or treatment for, conditions for which medical supervision should be sought. We advised him to contact CAP Copy Advice for advice on amending his marketing material.
