Select Committee on Science and Technology Sixth Report


Advertising CAM

8.49 One way for CAM practitioners to disseminate information about their therapy is through advertisements. There are, of course, restrictions on the claims that can be made in advertisements. The Trade Descriptions Act 1968 and the Consumer Protection Act 1987, enforced by local authority Trading Standards officers, apply to professions, including complementary therapists, which make claims for the goods and services they sell. There is also legislation relating to specific illnesses and medical conditions - for example cancer and venereal disease - which prohibits non-medically qualified individuals from purporting to cure them or even, in some cases, to treat them (P 104).

8.50 Some of our witnesses have expressed concern that some CAM advertisements may be extending unacceptably the boundaries of acceptable advertising, and that there may be a need for tighter policing. For example, the Consumers' Association wrote that: "The British Code of Advertising and Sales Promotion states that advertising by complementary therapists should not discourage people from having essential medical treatment; that medicines or therapies for serious or prolonged ailments should not be advertised; and that advertised products or therapies should not claim to be guaranteed to work or be absolutely safe or free from side-effects. It is important that this continues to be enforced in the area of complementary medicine — a small but significant number of practitioners continue to make claims for therapies which cannot be substantiated" (P 66). They recommend that "Information and advertising material should not make claims for complementary therapies that cannot be substantiated by research. All bodies producing such information should be aware of and comply with this requirement" (P 66). In our opinion, while CAM therapists should not discourage patients from seeking medical treatment, nor give guarantees of a cure, we can see no obvious reason why they should be prevented from offering help with chronic (prolonged) conditions, by methods which are substantially free from side effects, since this is precisely where they appear to be helping some patients at present.

8.51 The Consumers' Association went on to elaborate that "In terms of advertising in health generally, not just complementary therapies but health in a broader sense, we have some concerns about the appropriateness of using advertising as a means of conveying information" (Q 860). Such arguments apply equally to advertisements of non-prescription medicines and remedies and not just those relating to CAM.

8.52 Advertising can come in many forms and the Consumers' Association told us that their concerns extended to the leaflets that many CAM associations and practitioners put in consulting rooms which, they told us, are covered by the rules of the ASA (Q 861). They told us that: "The evidence base is really important there. These leaflets should not be written by PR people, they should be written by people who know what the evidence base is for a claim. We have no problem with information from evidence-based leaflets" (Q 862).

8.53 We received written evidence from the Advertising Standards Authority (ASA) which "supervises the advertising industry's system of self-regulation; promoting and enforcing the highest standards in all non-broadcast advertisements" (p 389). They highlighted the parts of the British Codes of Advertising and Sales Promotion most relevant to the regulation of CAM advertising. These are:

  • Medical and scientific claims about health and beauty products should be backed by trials conducted, where appropriate, on people.

  • Advertisers should not discourage people from having essential treatment; medical advice is needed for serious or prolonged problems and advertisers should not offer medicines or therapies for them.

  • References to the relief of symptoms or the superficial signs of ageing are only acceptable if they are substantiated. Unqualified claims such as "cure" or "rejuvenate" are generally not acceptable.

  • Advertisers should not use unfamiliar scientific words for common conditions" (p 390).

8.54 The ASA gave us a breakdown of the number of CAM adverts that they have been alerted to for breaking the British Code of Advertising in the last three years. These are shown in Table 4.

Table 4: Complaints Against Advertisements
Total number of complaints received by the ASA
Number of complaints received about 'alternative therapies'
Number of advertisements these complaints referred to
Dealt-with informally (minor or technical Code breaches)
Formally investigated (with published adjudication)
Complaints recorded but not acted upon

* = 1 January - 30 September 2000.

8.55 They told us that "when unacceptable references to serious medical conditions appear in advertisements for alternative therapies, it is generally due to ignorance on the part of the therapist about what is, and is not, acceptable within advertising. If an advertisement is published in a newspaper or magazine it is the responsibility of the publisher to check that it complies with the Code's rules. In most cases, acceptable advertising copy will be agreed before the advertisement is printed. Problematical claims within this sector tend to appear in leaflets and brochures that are written and produced by therapists themselves. These are much more difficult for the ASA, or other authority, to regulate" (p 390).

8.56 The ASA also told us: "Evidence provided to the Committee by the Consumers' Association (CA) stated that: "In terms of advertising in health generally…we have some concerns about the appropriateness of using advertising as a means of conveying information". This indicates a profound misunderstanding of the role and nature of advertising which largely constitutes brand advocacy and, by its very nature, is partial. Advertising is purchased specifically to present advertisers' views about their product, service or brand. On the basis of our research and experience, it is clear that rational consumers in today's 'consumer society' recognise this. Advertising must be 'legal, decent, honest and truthful', it must not mislead, but it does not provide balanced, objective or full information" (p 389).

8.57 False claims in CAM advertisements and leaflets are a serious issue; but legislation exists to control such problems We recommend that CAM regulatory bodies, whether statutory or voluntary, should remind their members of these laws and take disciplinary action against anyone who breaks them. Information leaflets produced by such bodies should provide evidence-based information about a therapy aimed at informing patients, and should not be aimed at selling therapies to patients.

An Overarching Information Body?

8.58 One way of making sure that the public and the medical professions do have access to impartial, high-quality information is to have a national information source covering all of CAM. This is one role that NCCAM subsumes in the USA. Dr Stephen Straus told us: "A disproportionately large investment, approximately nine per cent of our funding at this point, is invested in this area. We have a newsletter. Most importantly, we have a web site which gets approximately 490,000 hits per month and we fund a special modification of the National Library of Medicine Medline database articulated in terms of complementary and alternative medicine which has approximately 180,000 reference articles already in it and we are meeting to enhance and expand that" (Q 1760). The reason behind NCCAM's high level of investment in providing information is that "The American public gets its information very much like the public in the United Kingdom…Part of the pressure to create our Center has been the need as well as the desire of the American public for more competent guidance as to what works and what is safe and what does not work and is not safe. We are developing fact-sheets around various therapies, we are doing evidence-based reviews, we are funding evidence-based reviews" (Q 1760).

8.59 He went on to explain that the aim of their service is to provide an objective information source. They do not see a role for themselves in commenting upon bad quality material or trying to challenge people who make false claims. Their attitude towards countering the misleading material that is published on various other web sites is that it is best to fund "research whose results will set the record straight" (Q 1762).

8.60 The Natural Medicines Society (NMS), a voluntary CAM consumer information body, told us that they thought there was a great need for a national CAM information resource: "Even more than in the United States we probably do need such a body. The United States, to some extent, or parts of the United States, are behind Europe on the whole in the availability of CAM therapies. We have a proliferation of them and we have a very large percentage of the population making some use…there is certainly so much activity and so much misunderstanding that a central body might very well be the focus that seems to be needed" (Q 1567).

8.61 The NMS felt that, in the United Kingdom, "It would be desirable, for example, to see a national helpline where patients and possibly their physicians could receive first-line information. This is a function that the Natural Medicines Society has been carrying out semi-formally for 10 or more years, but lack of funding makes it impossible to develop our service to the scale necessary to match public demand" (P 157).

8.62 We asked the NMS whether all CAM groups would co-operate in setting up and running such an office. They told us: "It may have to be done for them perhaps. They are not the most co-operative of people. There are those who I think would find it straightforward and would work with that because they have already done it, who would see the sense of combining efforts. If there are enough of those they can provide the information. If others want to go outside of that then in reality the press in the long run will be less likely to have recourse to them" (Q 1573).

8.63 Both the Department of Health and the BMA have called for practitioners of CAM to set the standard and provide reliable information sources for the public. We agree that the necessary expertise lies with the professional specialist. There are, however, two significant problems with this prescription.

8.64 Firstly, much of the evidence we have received has reinforced the view that CAM therapies are rarely co-ordinated unless, like osteopathy and chiropractic, they have become statutorily registered. Leaving the provision of information to fragmented groups would possibly extend the current confusion that has already been visited upon the public. It is difficult to see how unity of view could be maintained in an information resource when it is lacking on issues such as educational standards and philosophical differences. When the frequent resort to self-promotion among the fringe elements of CAM is added, then we are not confident that unregulated professions are now able to meet this challenge in the public interest, no matter how much they would like to. Secondly, a consistent theme in this report is the lack of research evidence and activity in CAM, and the poor academic infrastructure available to subject the tenets of the various CAM therapies to scrutiny. We consider it would be desirable to link the provision of information to the public with at least the beginnings of a process of enquiry about the basis of these therapies, with overt efforts at quality assessments and audit, with acknowledgements of the importance of public accountability, and above all with clear-thinking guidelines for the practice of each therapy. Such information would not be easy to compile and update without partnerships with other resources and facilities, notably academic, regulatory and professional.

8.65 Several witnesses (e.g. NHS Alliance Q 148) suggested that FIM was an ideal body to explore initiatives in this area. FIM told us that they are very keen that there is a major initiative in this area. "This certainly is an area we believe that we can work in and assist the process" (Q 83). However, for such an initiative to be successful they believe that there is a need for "a significant investment in that by Government centrally" (Q 83). They went on to say: "I do not think it is a satisfactory position that there is no central initiative on this area. We would be very keen to work with other partners — the Government and CAM bodies — to actually begin to address this deficiency. There is an awful lot of information out there but the quality of it is hugely variable" (Q 83).

8.66 RCCM also supported the case for a national body; but they were more cautious, pointing out that "It is a very major task. Just to give you a quick example, CISCOM adds about 500 papers a month, and that is increasing month on month. That is just published research. If you are going to talk about different therapies and their regulatory bodies and everything else, that is a very, very major task and one, I think, that the Americans have found extremely difficult too"(Q 152).

8.67 However, other bodies we heard from were less enthusiastic about funding an information body particularly dedicated to CAM. The BMA told us: "We feel that it is really up to the practitioners of CAM to devise their own bodies for this. Having said that, they should also feel free to draw upon the good and bad experiences that there have been within medicine and the other paramedical fields who have been involved in regulation and in provision of information for many years. There are models within organisations such as the General Medical Council and indeed the Medical Royal Colleges which may be of help, including some elements of things best to avoid" (Q 355). "Clearly again in this it is a matter of developing mutual trust between what have in the past historically, sadly, been seen as two opponents, and genuinely trying to help one another to form a body which works and which you can each have confidence in" (Q 355).

8.68 The Department of Health were not supportive of the idea of a Government-funded central CAM information resource, although they did tell us that "Stressing the importance of information and making sure that consumers are clear about what is being provided to them and the choice of treatments available is the principle which underscores a lot of the Government's initiatives within the NHS. They want to see CAM follow that example" (Q 58). They firmly held the belief that this was the role of the practitioner and therapy organisations themselves and not a role for Government.

8.69 Yvette Cooper MP, Parliamentary Under Secretary of State for Public Health, explained to us that one of the Government's concerns about providing information on CAM is that in some areas "the information simply does not exist…there is a lack of evidence base" (Q 1886). She explained that this was a worry because if the Government provide information on CAMs the public may believe they are advocating the use of those therapies, and this is not what they want to be doing for therapies which do not have an adequate evidence base to back up their claims. She continued: "The NHS Kite Mark…is something the public would take as authoritative, in a way they might not if they were simply surfing the Internet or finding out information for themselves" (Q 1888). Yvette Cooper also stated that the Government feel that the lack of effective regulatory structures backing up some CAM therapies means the Department would have worries about being seen to promote those therapies: "I think it is an area where the result of the lack of appropriate regulation also provides a constraint…in terms of what we are able to inform people about" (Q 1888).

8.70 Despite these reservations, we support the idea of a centralised information body because the level of public interest in CAM is high, yet there is a large amount of confusing information in the public domain, almost all produced either by the press to provide a story, or by CAM practitioners themselves who naturally want to advertise their particular therapy. Therefore a neutral national information body could play a valuable role in protecting the public by giving them the information they need to make sensible, informed decisions. While we do not make formal recommendations on this issue, we believe it is one which deserves serious consideration.

8.71 For many people who are well-informed, or have already decided to accept a CAM treatment, the simple provision of information, such as the contact details of local practitioners, may be sufficient to satisfy their requirements. For the general public or medical staff who are curious about CAM, perhaps with interest stimulated by press coverage, recommendations from their friends, or inquiries from their patients, there is a gap in the information that is available from the NHS, their natural point of reference.

8.72 During our Inquiry we have become convinced of the growing public interest in CAM, and we feel that the Department of Health and the NHS should take a lead in guiding people (and doctors) through the vast array of variable quality information on CAM. The current position of the Department of Health appears to be one of devolving the responsibility to the representative bodies of CAM therapies, whose views may not be seen to be entirely impartial, or the public media, whose coverage of CAM is often criticised, or to individual GPs or PCGs, each of whom scarcely has the time to find out about all of the various branches of CAM available. There is a need, in the words of Dr Straus, for more competent guidance as to what works and what is safe and what does not work and what is not safe (see para 8.58). Only then will the other types of information, such as points of contact, places to look for the results of further research, and lists of what various qualifications mean, be of value.

8.73 The natural place for people in the United Kingdom to turn to for health advice is the NHS, and we feel it is not adequately fulfilling its responsibilities in this area with regard to CAM. However, we are encouraged by the developments of the electronic National Health Library and NHS Direct, both of which seem ideally placed to fill the gaps in the NHS's CAM information provision as part of their wider remits. We urge that they do so speedily, and seek the advice of FIM which is well-placed to assist.