What is a misleading homeopathy claim, and how to report it to the ASA

by @JoBrodie, brodiesnotes.blogspot.com

This post is written for people who might not have made a complaint to the Advertising Standards Authority before. 

If you're irritated by homeopaths making misleading claims on Twitter, Facebook or on their websites (or in-shop leaflets or any other marketing) you can complain about those claims to the Advertising Standards Authority (the ASA).

See part 4 below for info on just how busy the ASA is in general, and why, and note that your complaint about homeopathy will probably not be handled as a full complaint but be handled as a compliance issue. Also see part 6b for some reasons on why you may (or may not) want to blog about your complaint.

1. Make a complaint in the UK
This is the page on the ASA's website where you can make a complaint (you give your name and address but it isn't published): http://www.asa.org.uk/Consumers/How-to-complain.aspx 

If you are a private individual complaining as a member of the public your name and address is not given to the person or organisation you're complaining about and is not made public at any stage of the investigation - you are completely anonymous (unless you choose to make your complaint public in your blog etc). If you are complaining as a company (eg a company selling the second-best-selling face cream complaining about an advert by the best-selling face cream) then your company may be named in the adjudication.

2. Make a complaint in other countries too
The ASA deals with claims made on UK websites or leaflets but, thanks to its cross-border agreements, it will liaise with the relevant advertising standards authority in the following countries too -

Australia, Austria, Belgium, Brazil, Bulgaria, Canada, Chile, Czech Republic, Finland, France, Germany, Greece, Hungary, India, Ireland, Italy, Lithuania, Luxembourg, The Netherlands, New Zealand, Poland, Portugal, Romania, Slovakia, Slovenia, South Africa, Spain, Sweden, Switzerland, Turkey and of course the United Kingdom.

And that's it.

There's some background information below too.

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3. What happens next?
It used to be that any complaint to the ASA would result in them asking the homeopath for evidence and then considering each case. If the marketer agreed to amend their website then the case was closed and it appeared on the ASA's website as an 'informally resolved' case. If the marketer argued their case then the complaint went to the Board for an adjudication. Either the case was upheld against the marketer or it wasn't, and these were listed on the ASA's weekly adjudications. Persistent web marketing offenders find themselves on the non-compliant list of online advertisers.

4. Things changed in 2011
However after it became possible to complain about marketing material on websites too (from March 2011) the number of complaints about misleading homeopathy claims increased dramatically.

The ASA handled so many complaints about homeopathy in 2011 that it undertook a review of the evidence and, finding none of good quality, appears to have simplified the complaints procedure - it seems that the ASA no longer asks homeopaths for evidence for their claims but instead passes the complaint directly to the Compliance team (they're the ones that ask the marketer to remove the claims for which there's no evidence).

Because the Compliance team don't report on their work directly you may not hear about the outcome of your complaint in quite the same way but you can follow @NightingaleC on Twitter to see published lists of adjudications / rulings and informally resolved cases.

5. What can you complain about?
It is perfectly legal to sell homeopathy pills or consultations / treatment. Most homeopaths comply with advertising regulations and their websites talk about how they support people's health (which is true). The Society of Homeopaths has worked with the ASA to encourage their members to ensure that their marketing material is acceptable, see their guidance document for more info: http://www.homeopathy-soh.org/wp-content/uploads/2014/06/Mktg-Prom-guidance2014.pdf


However, if a homeopath is not medically trained and their website...

(a) claims that homeopathy is effective in treating various conditions for which there's no good evidence or
(b) refers to serious medical conditions

...then they may be in breach of the advertising recommendations. Following the 2011 review the Committee of Advertising Practice (CAP code) produced a set of guidelines for what is / isn't permitted in homeopathy marketing, it's worth a read. Note this sentence in particular:

"Those practitioners who are not medically qualified should not make claims about the efficacy of their treatments and should not refer to serious medical conditions..."

5a) for which conditions is homeopathy already known to lack evidence?
From a look at several adjudications in which complaints were upheld against homeopathy sites the following conditions were listed as being of concern. That is, the ASA asked a homeopath to remove reference to one or more of these conditions from their website after finding the evidence was insufficiently good.

acne, anxiety, arthritis, Candida, cataracts, cold flushes, dengue fever (prevention of), depression
diphtheria prevention, genital warts, hot flushes, exhaustion, heavy periods, influenza (prevention of)
irregular periods, irritability, Japanese encephalitis prevention ('homeoprophylaxis'), loss of libido, low mood, malaria prevention, menopausal symptoms, meningitis prevention, mood swings, mosquito bites, night sweats, other skin problems, PMS, PMT, polio prevention, psoriasis, serious medical conditions (this could include asthma, diabetes, high blood pressure etc), side-effects of the Pill, tetanus prevention, tick-borne encephalitis prevention, tiredness, typhoid prevention, vaginal dryness, yellow fever prevention.

It's not an exhaustive list.

5b) what are serious medical conditions?
Any condition where you'd reasonably expect someone to be under the care of a qualified medical doctor might include hypertension, asthma or diabetes and they're generally bit of a no-no on websites. Obviously there's no good evidence that homeopathy's of any use but the ASA is additionally concerned if, by mentioning serious conditions, consumers may be discouraged from seeking appropriately qualified advice.

5c. A note on cancer
In the UK it's actually illegal to make any claims to treat cancer - there is a separate act for this (the Cancer Act 1939) - very few homeopaths mention cancer on their website for obvious reasons.

6. What else can you do?
a) ask marketers to amend their website directly and / or
b) blog about misleading claims 

The ASA has to deal with a lot of enquiries, some of them much more problematic than minor misleading claims on homeopaths websites, so don't assume that your complaint will be a priority unless it's a seriously dodgy claim. So what else can you do?

a) Ask them yourself to amend their website
There's nothing to stop you from contacting a marketer directly and asking them for evidence for their claims or pointing out that you have concerns about what their website says. But go carefully. You are not there to tell people what they can and can't advertise (that's what the ASA is for) and it's a bad and unpleasant idea to go around threatening people and generally being a jerk. It's fine to contact people politely and express reservations about their adverts but let's not be mean-spirited about it. I've seen comments on some skeptic blogs that make me a little worried about people's motivation - it really comes down to the fact that people should be advertising their wares responsibly.

In general I'm not hugely in favour of contacting people directly though I do do it on occasion (politely) to see what happens (not much). You might think that discussing it informally (ie without involving regulatory bodies, saving everyone time) might be a positive thing but it can easily be misinterpreted and relations between skeptic bloggers / activists and homeopaths are at an all time low. So don't be surprised if your approach is not met with enthusiasm. Proceed with caution. I've written more on the 'ethics' of contacting misleading advertisers directly.

a) Blog about misleading claims and good evidence
Blogging is just a way of increasing the amount of information about a topic. You may not be able to remove bad information from the internet but you can slightly increase the amount of better information. When people search for a topic there' s a chance that they'll read your information instead of something worse. Blogging also raises awareness of a topic and connects you to a network of people who are trying to improve online information about health.

Do be careful about how you phrase things if you are naming a homeopath or company - it is fine to point out that their website contains information that has previously been shown to be in breach of the CAP code or that the information could be misleading. It is not fine to imply that anyone is being deliberately underhand and intending to deceive punters by telling them that homeopathy can cure things that it can't - avoid libelling people. From many years' immersion in homeopathy websites I'm genuinely convinced that, with the majority of homeopaths (and other alternative practitioners), there is no intention to deceive and that people truly believe the claims that they make - they are mistaken, not liars.

Be aware of nuance too. Although there's literally nothing in the homeopathy pills (because they dilute the starting material so much, to the point that the final remedy is 'empty') there is something in the 'theatre' of buying and taking pills, or the time spent with customers and kindness offered to them in a treatment setting. This has value to people and let's not assume that all homeopaths are idiotic moneygrabbers, they're not.