Thursday, 12 August 2010

Dr & Herbs (part 4) - IBS and depression


These two complaints are the eighth and ninth occasions on which I've complained to the ASA about Dr & Herbs, a Chinese medicine store in my town.


I'm still waiting for something to be done.


I've already complained about their leaflet promoting acupuncture and herbs for depression - you can read the update below, if you like - but first, here is my complaint about their flyer which promotes a bullshit treatment for Irritable Bowel Syndrome.

"I write to complain about a flyer I picked up outside the Luton branch of "Dr & Herbs" earlier this week.

The flyer promotes a various TCM treatments for Irritable Bowel Syndrome (IBS).

I suspect that the flyer may be in breach of three sections of the British Code of Advertising, Sales Promotion and Direct Marketing (CAP) code. I can send an original copy of the flyer by post, if required.

1. On numerous occasions in the past I have complained about flyers from this advertiser. I have not complained about the IBS flyer before.

2. Under Sections 3.1 and 50.1 of the CAP Code, I challenge whether the advertiser can substantiate the following claims:

(i) "IBS can be [the] result of either the imbalance between [the] stomach meridian, spleen meridian and liver meridian or the weakness of internal Meridians such as [the] spleen and stomach meridian[s]"

(ii) "The imbalance[d] liver and spleen meridians could be the main reason of [sic] IBS"

(iii) The claim that "Acupuncture" and "herbal medicine" are "natural treatments"

(iv) The claim that the listed therapies can treat IBS ("Dr & Herbs can help patients free [sic] from IBS with a wide range of natural treatments, such as Acupuncture, herbal medicine, Massage and so on")

(v) The claim that the advertisers' employees are capable of creating an effective "treatment" for IBS by "checking [a] patient's pulse, tongue and asking some questions", so that "a group of herbs is combined together to specifically address a person's unique constitution"

3. Under Sections 3.1 and 50.1, I challenge whether the advertiser can substantiate any of the claimed "BENEFITS you can get from the [sic] Chinese Medicine and acupuncture at Dr & Herbs", namely:

(i) "It helps relax your abdominal muscles, which may lead to more normal bowel activity. Acupuncture can relax muscle spasms and improve bowel function, calm the person and promote emotional well-being"

(ii) "Reduce stress and anxiety"

(iii) "Down-regulate [sic] the neural activities of the intestine"

(iv) "Reduce muscle spasms of the intestine and relax the smooth muscle"

(v) "Reduce physiological stress in the body"

(vi) "Reduce abdominal cramping, rumbling and promote 'normal' digestive functions"

4. (i) The flyer refers to "an Australian study" which it claims "lends strong scientific support to treating IBS with Chinese Herbs".

(ii) The study is almost certainly "Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial", Bensoussan et al (1998) [1]. The study's abstract states:

"CONCLUSION: Chinese herbal formulations appear to offer improvement in symptoms for some patients with IBS."

5. (i) The 2007 study, "A systematic review of randomised clinical trials of individualised herbal medicine in any indication" [2], states:

"Results: Three randomised clinical trials of individualised herbal medicine were identified."

(ii) One of the three identified studies is the 1998 Bensoussan study.

(iii) Discussing the Bensoussan study, the 2007 systematic review states:

"The abstract reports statistically significant findings favouring herbal treatment over placebo, but this refers to data derived from standardised and individualised herbal treatment combined together....only four of the five showed significant intergroup differences favouring individualised herbal treatment over placebo. The gastroenterologist’s assessments for the main outcome measure...were not significantly better than placebo in the individualised group. Overall, changes from baseline and responder rates were larger in the standardised than in the individualised group in all measures. Patient-assessed BSS at a follow up 14 weeks after the end of the trial favoured individualised over standardised treatment, but this difference was not statistically significant."

(iv) The review continues:

"Overall, the results of the three studies included in this review do not provide support for the use of individualised herbal medicine in any indication... While Bensoussan observed that individualised treatment was better than placebo in four of five outcome measures in the treatment of IBS, it was inferior to standardised treatment in all five outcomes and standardised treatment therefore appears to be preferable for reasons of cost and safety... These data indicate that almost all individualised herbal medicine is practised without the support of any rigorous evidence about effectiveness whatsoever.

6. Taking into account the two studies, under Section 7.1, I challenge whether the flyer's claim that "An Australian study lends strong scientific support to treating IBS with Chinese herbs" is misleading, and I challenge whether it exaggerates the the clinical evidence supporting "treating IBS with Chinese herbs."

Footnotes:

[1] http://www.ncbi.nlm.nih.gov/pubmed/9820260
[2] http://pmj.bmj.com/content/83/984/633.full
"

Here's my second complaint about their bullshit depression cure. Can you sense my indignation?

"I write to complain about a flyer I picked up outside the Luton branch of "Dr & Herbs", a "Traditional Chinese Medicine" (TCM) retail outlet, earlier this week.

The flyer promotes various TCM treatments for depression.

I suspect that the flyer may be in breach of four sections of the British Code of Advertising, Sales Promotion and Direct Marketing (CAP) code. I can send an original copy of the flyer by post, if required.

1. This is the ninth occasion in which I have complained about flyers from this advertiser.

2. In April this year, I wrote to you to complain about an identical flyer I had picked up.

3. Later that month, you wrote to advise me:

"Given that we have an established position on ads that refer to serious medical conditions such as depression in this way I've passed the case to our Compliance team, which will follow it up."

4. I protest that, despite any action the Compliance Team has taken, the flyer continues to be distributed at advertier's stores.

5. Therefore, once again, under Section 7.1 I challenge whether the flyer misleadingly compares "modern [Western] medicine" and "Chinese medicine [TCM]" by failing to note that only the former is an evidence-based practice.

6. Under Section 7.1, I challenge whether the following statements are misleading, and under Section 6.1 I challenge whether the statements "exploit the credulity, lack of knowledge or inexperience of consumers":

(i) "Protracted or excessive emotional depression could consume the heart Qi and undermine the blood so that the heart fails to be nourished and is thus unable to house the mind, so the mind becomes out of order."

(ii) "Excessive thinking and worrying could over-exert the heart and spleen, leading to the insufficiency of both Qi and blood, so the heart is malnourished and the mind is disturbed, resulting in the waning of heart Qi and declining of courageousness."

(iii) "Consitutional Yin deficiency or prolonged liver-Qi stagnation turns to fire, which takes from the Yin-fluid in the body, so the insufficient Yin leads to the flaring up of fire and the floating of the imbalanced Yang."

7. Under Sections 3.1 and 50.1, I challenge whether the advertiser holds documentary evidence to prove the following claim, and I challenge whether the claim is backed by evidence, where appropriate consisting of trials conducted on people:

(i) The advertiser's employees are capable of selecting "a group of raw herbs...to form a prescription, which is tailor-made for the patient [who has depression]"

8. In my previous complaint about this flyer, I submitted evidence from a Cochrane Review study [1] which stated:

"We found insufficient evidence to recommend the use of acupuncture for people with depression. The results are limited by the high risk of bias in the majority of trials meeting inclusion criteria."

9. Under Section 3.1, I challenge whether the advertiser holds documentary evidence to prove the following claim; under section 50.1, I challenge whether the claim is backed by evidence, where appropriate consisting of trials conducted on people; under Section 7.1, I challenge whether the claim is misleading:

(i) "Acupuncture: Chinese acupuncture treatment can ease depression. Some studies found it superior to anti-depressant drugs and with less side-effects"

10. 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.

Footnotes:

[1] http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004046/frame.html
"

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