Dr & Herbs (part 3) - ASA complaint of epic proportions

Every time I walk through the town centre, I pass the Dr & Herbs shop, invariably bedecked with leaflets just daring me to complain about them.

(Image credit)

Today, with the accursed carnival noise ringing in my ears, the temptation for vengeance became too great.

Here, then, is a complaint of epic proportions covering five of the bullshit leaflets I picked up outside their store today. (A number of people helped to compile it, and I thank them.)

First up is this purported insomnia cure consisting of a course of Chinese Herbal medicine and Acupuncture. (Scans of the leaflet available here and here, and my previous complaints about Dr&Herbs appear here and here.)

"I write to complain about several flyers I picked up outside the Luton branch of "Dr & Herbs", a "Traditional Chinese Medicine" retail outlet, earlier today.

I suspect that the flyers may be in breach of a number of sections of the British Code of Advertising, Sales Promotion and Direct Marketing (CAP) code.

Because of the size limit on the ASA's online complaints form, I have submitted complaints about each of the flyers separately; apologies for the inconvenience. I can provide original copies of the flyers by post, if required.

FLYER 1: "Insomnia & Chinese Medicine" (green background)

1. The flyer claims that Chinese Herbal Medicine can "reduce insomnia" and that Acupuncture "may help restore normal sleep-waking patterns".

2. While researching this complaint, I was unable to find any clinical evidence attesting to the effectiveness of Chinese Herbal Medicine, as individually prescribed by "qualified Chinese expert[s]", in reducing insomnia.

3. With regards to acupuncture, the most recent Cochrane review [1] concluded:

"The small number of randomised controlled trials, together with the poor methodological quality and significant clinical heterogeneity, means that the current evidence is not sufficiently extensive or rigorous to support the use of any form of acupuncture for the treatment of insomnia..."

4. Under Sections 3.1 and 50.1 of the CAP Code, I challenge whether the advertiser holds documentary evidence to prove the following claims, and I challenge whether the claims are backed by evidence, where appropriate consisting of trials conducted on people:

(i) Chinese Herbal Medicine can "reduce insomnia"
(ii) Acupuncture "may help restore normal sleep-waking patterns"

Footnotes:

[1] Cheuk, DK; Yeung, WF; Chung, KF; Wong, V; Cheuk, Daniel KL (2007). "Acupuncture for insomnia". Cochrane Database of Systematic Reviews 2007 (3): CD005472. doi:10.1002/14651858.CD005472.pub2.
"

Next is a general appeal to health and well-being.

Acupuncture (it says here) can help you quit smoking, lose weight, reduce your anxiety - and probably give you super-powers as well. (Scans here and here.)

"I write to complain about several flyers I picked up outside the Luton branch of "Dr & Herbs", a "Traditional Chinese Medicine" retail outlet, earlier today.

I suspect that the flyers may be in breach of a number of sections of the British Code of Advertising, Sales Promotion and Direct Marketing (CAP) code.

This complaint concerns the second of the flyers.

FLYER 2: "Chinese Acupuncture & Health Being" (yellow background)

5. The flyer claims that "Acupuncture can help a wide range of diseases from Quit Smoking [sic], Losing Weight [sic] to Asthma, Anxiety. It has a brilliant reputation to help treat menstrual problems...joint pain...and so on."

6. Regarding smoking cessation, a 2006 Cochrane Review [2] concludes:

"There is no consistent evidence that acupuncture... [is] effective for smoking cessation, but methodological problems mean that no firm conclusions can be drawn."

7. Regarding asthma, a 2003 Cochrane Review [3] concludes:

"There is not enough evidence to make recommendations about the value of acupuncture in asthma treatment."

8. I have been unable to find any clinical evidence attesting to the effectiveness of acupuncture in joint pain, although evidence exists that acupuncture is not effective for shoulder pain [4] and tennis elbow [5].

9. Regarding weight loss, anxiety and menstrual problems, I have been unable to find any clinical evidence attesting to the effectiveness of acupuncture.

10. Under Sections 3.1 and 50.1 of the CAP Code, I challenge whether the advertiser holds documentary evidence to prove the following claims, and I challenge whether the claims are backed by evidence, where appropriate consisting of trials conducted on people:

(i) Acupuncture "can help a wide variety of diseases"
(ii) Acupuncture "can help...Quit Smoking, Losing Weight...Asthma, Anxiety"
(iii) Acupuncture "has a brilliant reputation to help treat menstrual problems...joint pain...and so on"

Footnotes:
[2] White AR, Rampes H, Campbell J. Acupuncture and related interventions for smoking cessation. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD000009. DOI: 10.1002/14651858.CD000009.pub2

[3] McCarney RW, Brinkhaus B, Lasserson TJ, Linde K. Acupuncture for chronic asthma. Cochrane Database of Systematic Reviews 1999, Issue 1. Art. No.: CD000008. DOI: 10.1002/14651858.CD000008.pub2

[4] Green S, Buchbinder R, Hetrick SE. Acupuncture for shoulder pain. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD005319. DOI: 10.1002/14651858.CD005319.

[5] Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft WJJ. Acupuncture for lateral elbow pain. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD003527. DOI: 10.1002/14651858.CD003527
"

The third leaflet promises to treat hayfever, a promise which is, at last, supported by scientific evidence!

Unfortunately, the "evidence" consists of one thirty-five year old study, and another nameless one.

You'll have to do better than that, doctor! (Scans here and here.)

"I write to complain about several flyers I picked up outside the Luton branch of "Dr & Herbs", a "Traditional Chinese Medicine" retail outlet, earlier today.

I suspect that the flyers may be in breach of a number of sections of the British Code of Advertising, Sales Promotion and Direct Marketing (CAP) code.

This complaint concerns the third of the flyers.

FLYER 3: "Hay Fever & Chinese Medicine" (blue background)

11. The flyer claims that acupuncture can be used to treat hay fever, and quotes two studies: one unnamed, and one from 1975.

12. A 2008 Systematic Review [6] concluded:

"It is not possible to recommend acupuncture as a proven treatment for [Allergic Rhinitis] on the basis of published evidence. However this evidence is derived from inadequate clinical trials."

13. Under Sections 3.1 and 50.1 of the CAP Code, I challenge whether the advertiser holds documentary evidence to prove that acupuncture is effective in treating hayfever, and I challenge whether the claim is backed by evidence, where appropriate consisting of trials conducted on people.

14. Under Section 7.1, I challenge whether using an unnamed study in support of the claim, which cannot be checked, is misleading.

15. Under Section 7.1, I challenge whether using a 35-year-old study in support of the claim, without reference to the vast body of subsequent clinical research, is misleading.

Footnotes:

[6] Roberts J et al. A systematic review of the clinical effectiveness of acupuncture for allergic rhinitis. BMC Complement Altern Med. 2008; 8: 13.
DOI: 10.1186/1472-6882-8-13.
"

Still with me?

Chinese Herbal Tea, so the "doctor" reckons, is safe. The advertisers make the astonishing claim that their staff know which herbs will interfere with which "Western Medicines".

If true, this claim would be something of a miracle - the effects of many "traditional" herbs have never been subjected to actual research, whether used alone or in conjunction with "Western" medicines. No-one knows how ineffective, or dangerous, they might be.

Perhaps acupuncture equips one with the ability to read 25th Century medical journals. (Scans here and here.)

"I write to complain about several flyers I picked up outside the Luton branch of "Dr & Herbs", a "Traditional Chinese Medicine" retail outlet, earlier today.

I suspect that the flyers may be in breach of a number of sections of the British Code of Advertising, Sales Promotion and Direct Marketing (CAP) code.

This complaint concerns the fourth of the flyers.

FLYER 4: "Chinese Herbal Tea" (green background)

16. The flyer claims that Chinese Herbal Medicine (CHM) can be safely taken in conjunction with (Western) medicines, and that in any case, the advertisers are able to advise on the safety of particular combinations of Chinese Herbs and (Western) medicines.

17. Very little, if any, evidence exists for the efficacy and safety of CHM. A 2007 comparitive study [7] concluded:

"136 CHM trials (119 published in Chinese, 17 published in English) and 136 matched conventional medicine trials (125 published in English) were analysed... Only few CHM trials of adequate methodology exist and the effectiveness of CHM therefore remains poorly documented."

18. The MHRA have recently advised [8]:

"There may be an erroneous perception in some quarters that the practice of herbal medicines poses few safety issues. In fact, given that in some cases practicioners, who may be inexpert, are supplying potentially powerful unlicensed herbal medicinal products, the range of opportunities for things to go wrong is significantly greater than is the case with many other complementary and alternative medicine therapies."

19. Under Sections 3.1 and 50.1 of the CAP Code, I challenge whether the advertiser holds documentary evidence to prove the following claims, and I challenge whether the claims are backed by evidence, where appropriate consisting of trials conducted on people:

(i) All Chinese Herbs supplied by the advertisers are "safe" and have "no side effects"
(ii) "Usually Chinese herbs won't interfere with western medicine"

20. Under Section 7.1, I challenge whether the advertisers misleadingly imply that their staff can advise customers on the safety of Chinese Herbal Medicines used in combination with any Western medicine.

21. Under Section 2.1, I challenge whether it is "legal" for the advertisers to advise customers on the safety of (Western) medicines.

22. An ASA judgement in 2003 (ref 35844), also concerning Dr & Herbs, upheld the complaint that the term "Dr" in the advertiser's trading name misleadingly implied that the advertiser's practitioners were properly qualified, registered medical doctors.

23. With consideration to the 2003 judgement, and noting that this flyer claims its staff can advise on the safety of "Western" medicines, under Section 7.1 I challenge whether the term "Dr" in the advertiser's trading name misleadingly implies that the advertiser's practicioners are properly qualified, registered medical doctors.

Footnotes:
[7] Aijing Shang, Karin Huwiler, Linda Nartey, Peter Jüni, Matthias Egger. Placebo-Controlled Trials of Chinese Herbal Medicine and Conventional Medicine-Comparative Study. International Journal of Epidemiology. 2007;36(5):1086-1092.

[8] "Public Health Risk With Herbal Medicines: An Overview", MHRA Policy Division, July 2008
"

Finally, the leaflet which really took my breath away.

The march of women's lib will have to be halted in its tracks, I'm afraid: before they reach the menopause, a woman simply can't hope to compete with her male counterparts in the workplace.

Their vaginal discharges cause them to have too much yin, you see. Back to the kitchen you go, Miss! (Scans here and here.)

"I write to complain about several flyers I picked up outside the Luton branch of "Dr & Herbs", a "Traditional Chinese Medicine" retail outlet, earlier today.

I suspect that the flyers may be in breach of a number of sections of the British Code of Advertising, Sales Promotion and Direct Marketing (CAP) code.

This complaint concerns the fifth and final flyer.

FLYER 5: "Menopause & Motherly Medicine" (purple background)

24. The flyer claims that Chinese Herbal Medicine and acupuncture can successfully treat the syptoms of the menopause.

25. Under Sections 3.1 and 50.1 of the CAP Code, I challenge whether the advertiser holds documentary evidence to prove the following claims, and I challenge whether the claims are backed by evidence, where appropriate consisting of trials conducted on people:

(i) The quoted symptoms of the menopause ("hot flushes, night sweats, insomnia, mood swings, vaginal dryness, fatigue and tiredness, poor memory and concentration, poor libido") have all "been successfully treated by acupuncture and herbal medicine"
(ii) "Menopause can be made much smoother through Chinese herbal therapy"
(iii) Chinese Medicine "works very well" and "has helped women for thousands of years to enjoy their second spring without any of the growing pains"
(iv) "Acupuncture has been used to treat menopausal symptoms for thousands of years with excellent results in easing these symptoms without any side effects"
(v) "Acupuncture treatment regulates unstable hormone levels during menopause"
(vi) Chinese Herbal Medicine are a "safer alternative" to Hormone Replacement Therapy

26. The flyer states "Many women, after menopause, because of the slowing of the flow of 'yin', discover their yang principle and go on to achieve, for the first time in their lives, success in business and other areas which have been traditionally dominated by men and their prominent 'yang' principle'.

27. I complain that the claim women are unlikely to be successful in business and other areas traditionally dominated by men, until they reach the menopause, is grossly offensive to women under Section 5.1 of the Code. I further complain that the flyer is not "decent" under Section 2.1 of the Code.

28. I confirm that I have no connections with the advertiser or with the alternative medicine industry in general. I confirm that I am not involved in legal proceedings with the advertiser."