ShenLong Chinese Medical Centre

On my way to Milton Keynes Sceptics in the Pub last week, I just had time to pop into a local Chinese Medicine shop.



Shenlong Chinese Medical Centre of Bedford offer a wide range of therapies, almost none of which are of any proven benefit.

The shops' flyer (available here and here) makes some outrageous claims about the efficacy (and, indeed, safety) of acupuncture, ear candles, cupping therapy and allergy tests.

Hoping to leave no stone unturned, Shenlong boast they can "help" with

"...eczema, psoriasis, dermatitis, vitiligo, other skin complaints, acne, herpes, mycosis, hair loss, arthritis, back pain, lumbargo, stiff neck, stroke[s], sciatica, rheumatism, neuralgia, frozen shoulder, hemiplegia, sprains, anxiety, depression, panic attack, stress, insomnia, fatigue, hay fever, sinus infection, earaches, ringing in ears, sore throat, dizziness, migraine, asthma, palpitations, indigestion, constipation, colitis, colds, flu, high blood pressure, ulcers, gastritis, diarrhoea, heartburn, IBS, myalgic encephalomyelitis, irregular periods, the menopause, pre-menstrual syndrome, impotence, infertility, hot flushes, bedwetting, Men's Problem [sic]..."

If you're asking my opinion, anyone who spends money in this den of quackery needs their head examined. ASA complaint follows!

"I write to complain about a leaflet I picked up outside the premises of the "Shenlong Chinese Medical Centre" in Bedford, on 11th November. (The leaflet was in a plastic holder on the outside window of the shop).

The leaflet promotes the Centre's medical services.

I suspect that the leaflet may be in breach of the British Code of Advertising, Sales Promotion and Direct Marketing (CAP Code). I can provide the original leaflet by post, if necessary.

1. The UK's leading authority on complementary medicine, Professor Edzard Ernst, has recently written about the difficulties of assessing Traditional Chinese Medicine (TCM) [1]:

"Conclusion: TCM is difficult to evaluate. Some elements may be effective for some conditions, while other elements (e.g. cupping) are unlikely to offer any benefit above placebo. Many aspects of TCM are potentially harmful."

(ii) About reflexology, Ernst writes "The notion that reflexology can be used to diagnose health problems has been disproved and there is no convincing evidence that it is effective for any condition." [2]

(iii) About ear candles, Ernst writes "Ear candles are based on the absurd idea that this method removes ear wax or toxins from the body; it is not supported by any evidence." [3]

(iv) The ASA Council have previously upheld a complaint about claims made for ear candling (complaint ref 120878), in which I was the complainant.

(v) The dangers of using unregulated TCM therapies were recently highlighted by the case of Ying "Susan" Wu of Essex, who had "pleaded guilty to selling a banned substance to a woman who went on to develop kidney failure and cancer." [4]

2. Under Sections 12.1 and 13.1 of the CAP Code, I challenge whether the advertisers can substantiate any of the following claims:

(i) Acupuncture "works by stimulating the body's healing responses or immune systems" along "channels in the body" which are "stimulated by the insertion of thin, fine needles", a fact which has been "systematically refined and verified by modern research methods"

(ii) Ear Candles "[help] to revitalize [sic] the acupuncture points, stimulate the blood circulation and to free clogged pores", and is a "method for resolving problems of ear hygiene safely and naturally"

(iii) Reflexology practitioners can "help clear disease" by "[applying] controlled pressure with thumbs or fingers to specific areas of the feet"

(iv) Cupping Therapy "promotes the free flow of Qi and blood in the channels [of the body]"

(v) The advertisers are able to "test your level of allergy to... 400 items" by examining "a piece of your hair"

(vi) The advertisers' "Beauty Therapy with TCM" is able to "treat effectively Dermatitis, Follieulitis, Chloasma, Rosacea, Acne, Warts, etc" and "regenerat [sic] the skin"

(vii) The advertisers' "new method for weight loss" can "speed up [the] metabolic process, consume fatty tissue and... help lose weight effectively."

(viii) Acupuncture can help to "give up smoking"

(ix) TCM is "safe"

(x) A TCM doctor can find out about "the condition of your internal organs" by "examining your tongue and wrist pulses [sic]"

(xi) By using TCM, people can be "helped with" eczema, psoriasis, dermatitis, vitiligo, "other skin complaints", acne, herpes, mycosis, hair loss, arthritis, back pain, lumbargo, "stiff neck", stroke[s], sciatica, rheumatism, neuralgia, "frozen shoulder", hemiplegia, sprains, anxiety, depression, panic attack, stress, insomnia, fatigue, hay fever, sinus infection, earaches, "ringing in ears", sore throat, dizziness, migraine, asthma, palpitations, indigestion, constipation, colitis, colds, flu, high blood pressure, ulcers, gastritis, diarrhoea, heartburn, IBS, myalgic encephalomyelitis, irregular periods, the menopause, pre-menstrual syndrome, impotence, infertility, hot flushes, bedwetting, "Men's Problem [sic]".

3. I confirm I have no connections with the advertisers. I confirm I am not involved in legal proceedings with the advertisers.

Footnotes:

[1] Simon Singh, Edzard Ernst, "Trick or Treatment? Alternative Medicine on Trial", American edition 2008, p328
[2] Ibid., p323
[3] Ibid., p309
[4] http://news.bbc.co.uk/1/hi/health/8520171.stm
"

Dr Liu helps with "Habitual Abortion"

Companies who profit from alternative medicine fall into two distinct categories.

The first group are wealthy enough to bring in the professionals to write their adverts. As a result, on the rare occasions when the regulators get annoyed, it's invariably a deliberate ploy to create publicity.


As for the second group... well, meet Dr Liu!

Dr Liu Chinese Clinic (image from their website) is a London shop which sells "over 300" Chinese herbal medicines and a bewildering array of holistic therapies.

In the picture above you can just about see one of the leaflets which will arrive in the ASA's mailbag tomorrow morning.

Why? Because the leaflet claims that Traditional Chinese Medicine (TCM) can help with an astonishing seventy-four named conditions including

"Herpes...Vitiligo...Hay Fever...Halitosis...Arthritis...Repetitive Strain Injuries...Migraines...Facial Palsy...Chronic Fatigue Syndrome...Irritable Bowel Syndrome...Chronic Diarrhoea...Diabetes...Asthma...Flu...[Vaginal] Discharges...Infertitiliy...Impotence...Premature Ejaculation..."

...and the most worrying condition of all - of which, I admit, I was ignorant until today - something Dr Liu calls "Habitual Abortion"!

The problem with all these bizarre claims - the problem, in fact, with all Chinese herbal medicines - is that the clinical research is yet to be done.

The claims might turn out to be true, or they might prove to be undiluted bullshit. It will be decades before we know.

ASA complaint follows. Thanks go to a notable Nottingham-based sceptic who spotted the leaflet and generously passed it to me.

"I write to complain about a leaflet promoting the "Dr Liu Chinese Clinic" of Shepherd's Bush Road, London, picked up from a window display at the advertiser's premises.

I suspect that the advert may be in breach of 3 sections of the British Code of Advertising, Sales Promotion and Direct Marketing (CAP) code.

1. The leaflet describes the kind of service the clinc provides:

"Traditional Chinese Medicine (TCM)...is a comprehensive medical system...It uses a holistic approach to produce a highly sophisticated set of practices focusing both on curing illnesses..."

2. The leaflet continues:

"TCM has remarkable curative effects and few side effects, as the treatment is specifically tailored to address a patient's particular problem using natural herbs and acupuncture..."

3. The leaflet describes the method by which these "natural herbs" are prescribed to "patients":

"TCM makes use of a very wide range of herbs...Our TCM Doctors prescribe a unique formula of herbs for each patient's needs after inspecting and diagnosing. This will involve examining the patient's tongue, feeling their pulse, checking their (western) medical history. As well as the [sic] prescribed herbs should be boiled according to the doctor's instructions and drunk as a herbal tea."

4. Under Sections 3.1 and 50.1 of the CAP Code, I challenge whether the advertisers can provide documentary evidence to substantiate any of the following claims:

(i) The TCM therapies identified in the leaflet (drinking herbal tea, acupuncture, etc.) are capable of "curing" any "illness" whatsoever

(ii) "TCM has remarkable curative effects"

(iii) "TCM has few side effects"

(iv) The clinic's employees are capable of "presrib[ing] herbs" based on a customer's "(western) medical history"

5. Under Section 7.1, I challenge whether, in the text I quote above, the use of the word "doctor" combined with the use of the words "diagnosing" and "prescribed" is misleading.

6. The leaflet describes some of the therapies offered by the advertiser (some of which are not TCM therapies).

7. Under Sections 3.1 and 50.1, I challenge whether the advertisers can substantiate any of the following claims:

(i) Acupuncture is "remarkable in its effect on alleviating painful conditions and in combating nerve and stress problems, amongst others..."

(ii) "Cupping Therapy...helps the body to work more efficiently"

(iii) Reflexology can "stimulate your inner healing ability - gradually improving your health..."

(iv) The advertiser's "Allergy testing services" are capable, "using only a sample of hair", of diagnosing allergies to "over 400 everyday items including every thing [sic] you are likely to eat, drink, breath [sic] or touch in [sic] during the normal every day [sic] run of affairs [sic]"

(v) The allergy test is capable of diagnosing allergies to "all food additives plus vitamins"

8. The leaflet lists helpfully all the conditions which the advertisers claim they can "help".

9. Under Sections 3.1 and 50.1, I challenge whether the advertisers can substantiate their claim that the herbal medicines and holistic therapies they offer can "help" with any of the following conditions:

(i) Acne
(ii) Eczema
(iii) Psoriasis
(iv) Tinea
(v) Herpes / shingles
(vi) Urticaria
(vii) Vitiligo
(viii) Athlete's foot
(ix) Other fungal infections
(x) Other skin problems
(xi) Hay fever
(xii) Sinusitis
(xiii) Tinnitus
(xiv) Otitis
(xv) Pharyngitis
(xvi) Sore throat
(xvii) Halitosis
(xviii) Mouth ulcers
(xix) Other ear, nose and throat (ENT) conditions
(xx) Arthritis
(xxi) Rheumatism
(xxii) Sciatica
(xxiii) Back pain and lumbargo, both acute and chronic
(xxiv) Periarthritis of the shoulder
(xxv) Headaches
(xxvi) Migraines
(xxvii) Trigeminal neuralgia
(xxviii) Facial palsy
(xxix) Cerebrovascular Accidental Sequela
(xxx) Hemiplegia
(xxxi) Cervical Spondylosis
(xxxii) Vaginal tendinis
(xxxiii) Thecitis
(xxxiv) "Carpel [sic] Tunnel Syndrome"
(xxxv) Chronic Fatigue Syndrome (ME)
(xxxvi) Sports injuries
(xxxvii) Palpitations
(xxxviii) Fatigue
(xxxix) Irritable Bowel Syndrome (IBS)
(xl) "Indiagestion [sic]"
(xli) Gastroenteritis
(xlii) Colitis
(xliii) Chronic Diarrhoea
(xliv) "Habitual Constipation"
(xlv) "Hemorrhoids [sic]"
(xlvi) High blood pressure
(xlvii) Diabetes
(xlviii) Asthma
(xlix) Bronchitis
(l) Water retention
(li) Cholecystitis
(lii) Arrhythmia
(liii) Hyperthyroidism
(liv) Dysthyroidism
(lv) Colds
(lvi) Flu
(lvii) Irregular periods
(lviii) Dysmenorrhea
(lix) Menopausal syndrome
(lx) (Vaginal) discharges
(lxi) Infertility in women
(lxii) "Habitual abortion"
(lxiii) Fibroids
(lxiv) Endometrisis
(lxv) Pre-menstrual tension
(lxvi) Problems in inducing labour
(lxvii) Vaginitis
(lxviii) Morning sickness
(lxix) Other "Women's problems"
(lxx) Prostatis
(lxxi) Male impotence
(lxxii) Male "seminal emmission [sic]"
(lxxiii) Premature ejaculation
(lxxiv) Other "Men's problems"

10. I confirm that I have no connections, and am not involved in legal proceedings, with the advertiser."

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.

(Image credit)

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
"

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."

*Dr & Herbs (part 2) - depression is all about stagnated Qi, you know

Dr & Herbs - a Traditional Chinese Medicine (TCM) shop, trading on a high street near you - is one of my favourite advertisers.

UPDATE, 28 Apr: ASA say "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."


In one of their flyers (available here and here) they make some odd claims about a possible treatment for depression.

I'd like to know if they can sustain their claims. ASA complaint follows.

"I write to complain about flyers available outside the Luton branch of "Dr & Herbs", a "Traditional Chinese Medicine" retail outlet.

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

I have submitted scans of the flyer. I can provide an original copy of the flyer by post, if required.

1. The CAP Code, Section 7.1, states "No marketing communication should mislead, or be likely to mislead, by inaccuracy, ambiguity, exaggeration, omission or otherwise."

2. The flyer states:

"The depression in modern medicine falls into the categories of "Yu-syndrome" (depressed syndrome) and "Zang Zao" (restlessness of Zang-organs" in Chinese medicine, which are understood to be caused by abnormal emotions leading to the stagnated flow of Qi."

3. (i) Under Section 7.1, I challenge whether the flyer misleads, or is likely to mislead, in comparing "modern [Western] medicine" and "Chinese medicine [TCM]" by failing to note that only the former is an evidence-based practice.

(ii) Under Section 7.1, I further challenge whether the following statements mislead, or are likely to mislead:

(iii) "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."

(iv) "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."

(v) "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."

4. The CAP Code, Section 3.1, states "Before distributing or submitting a marketing communication for publication, marketers must hold documentary evidence to prove all claims, whether direct or implied, that are capable of objective substantiation."

5. The CAP Code, Section 50.1, states "Medical and scientific claims made about beauty and health-related products should be backed by evidence, where appropriate consisting of trials conducted on people..."

6. (i) 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:

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

7. (i) Regarding the treatment of depression with acupuncture, the Cochrane Review states: [1]

"Main results

This review is an update and now contains data from 30 studies... Thirty trials with 2,812 participants are included in the meta-analysis.

There was a high risk of bias in the majority of trials. There was insufficient evidence of a consistent beneficial effect from acupuncture compared with a wait list control or sham acupuncture control...

Authors' conclusions

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."

(ii) 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 misleads, or is likely to mislead:

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

8. 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.

9. I confirm that I am happy to be identified as the complainant.

Footnotes:

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

Dr & Herbs - at last, a cure for hayfever!

UPDATE, 27th Feb: According to a sign posted on the front door of the Luton branch, Dr & Herbs has gone into compulsory liquidation. Good riddance.

UPDATE, 6th Apr: Dr & Herbs were back in business a few days later. Boo! Hiss!

"Dr & Herbs" is a chain of shops in the UK offering Chinese Traditional Medicine, acupuncture and other "alternative" treatments.

(Image credit)

As a life-long sufferer of hay fever myself, I was particularly excited to discover that they claim to offer a cure. Unfortunately, the claim doesn't seem to stand up, as my complaint to the Advertising Standards Authority argues.

"I write to complain about the advertising leaflets produced by "Dr & Herbs", a Chinese medicine retail outlet, on 30th January 2010.

The leaflet is entitled "Hay Fever - Looked everywhere for a cure? Pre-season prevention plan from just 33p per day". I believe the leaflet is in breach of several sections of the British Code of Advertising, Sales Promotion and Direct Marketing (CAP) Code.

For your convenience, I have made a scan of the leaflet available on a popular image sharing website [here and here]. I can provide a copy of the scan by email, or send an original copy of the leaflet by post, if required.

1. "Dr & Herbs" is a chain of shops selling Traditional Chinese Medicine, courses of acupuncture and other treatments.

2. I obtained this leaflet from a stand at the entrance of the Luton branch of Dr & Herbs. Their full address is: Dr & Herbs, Unit 182, The Arndale Centre, Luton.

3. The leaflet makes four separate claims of a cure for hay fever based on a "Chinese Medicine Approach". In addition, the leaflets presents two testimonials attesting to the efficacy of the treatment.

4. (i) The first page of the leaflet states "Hay Fever. Looked everywhere for a cure? Pre-season prevention plan from just 33p per day"

(ii) Although the "prevention plan" is not explicitly claimed to be a cure, these three sentences together make a strong implied claim that the "prevention plan" is as effective as a cure might be.

5. (i) The third page of the leaflet states "Unlike antihistamines which are conventially used to lessen hay fever symptoms, chinese [sic] herbal medicine offers a preventative cure designed to stop hay fever before the peak season starts."

(ii) With the use of the word "cure", the leaflet makes an explicit claim of a cure for hay fever.

6. (i) The third page of the leaflet states "Dr & Herbs offer a two-month pre-season prevention plan of once-daily Chinese herbal medicine tablets which will benefit over 90% of sufferers."

(ii) With the use of the words "90%", the leaflet makes an explicit claim of a cure for hay fever.

7. (i) The third page of the leaflet states "We are so confident that our pre-season prevention plans will cure your hay fever, we offer a 100% refund if it isn't completely effective."

(ii) With the use of the word "cure", the leaflet makes an explicit claim of a cure for hay fever.

8. The leaflet includes two testimonials attesting to the efficacy of the treatment offered by Dr & Herbs.

9. (i) "L Penney - Watford" is reported to state "My hay fever symptoms have been nominal despite the high pollen counts we've experienced."

(ii) "M Crane - Bayswater" is reported to state "I had very bad hay fever and all other conventional tablets had failed... for me, this form of alternative therapy has really worked."

COMPLAINT

10. The CAP code, section 3.1, states “Before distributing or submitting a marketing communication for publication, marketers must hold documentary evidence to prove all claims, whether direct or implied, that are capable of objective substantiation.”

11. I have not been able to find any clinical studies attesting to the efficacy of Chinese Traditional Medicine in treating hay fever.

12. I challenge whether:

(i) Dr & Herbs hold documentary evidence to prove any of their three direct claims of a cure for hay fever;

(ii) Dr & Herbs hold documentary evidence to prove their implied claim of a cure for hay fever;

(iii) Dr & Herbs hold documentary evidence to prove that any of their "five treatment plans" might be more suitable for a given individual than any of the other "five treatment plans";

(iv) Dr & Herbs hold documentary evidence that anyone is capable of recognising the correct treatment plan (out of the five) for any given individual;

(v) Dr & Herbs hold documentary evidence that any of their staff is capable of recognising the correct treatment plan (out of the five) for any given individual.

13. Section 50.1 o the CAP code states "Medical and scientific claims made about beauty and health-related products should be backed by evidence, where appropriate consisting of trials conducted on people."

14. I challenge whether Dr & Herbs' claims of a cure for hay fever are backed by evidence.

15. Section 6.1 of the CAP code states “Marketers should not exploit the credulity, lack of knowledge or inexperience of consumers.”

16. Few consumers are aware of the clinical evidence, published in peer-reviewed medical journals, for Traditional Chinese Medicine.

17. If satisfactory clinical evidence supporting this treatment does not in fact exist, I challenge whether Dr & Herbs has exploited the credulity and lack of knowledge of consumers by representing their treatment as a "cure".

18. Section 2.1 of the CAP code states “2.1 All marketing communications should be legal, decent, honest and truthful.”

19. If satisfactory clinical evidence supporting this treatment does not in fact exist, I challenge whether the leaflet, in making its claims of a cure, is either honest or truthful.

20. Section 14.1 of the CAP code states "Marketers should hold signed and dated proof, including a contact address, for any testimonial they use.

21. I challenge whether Dr & Herbs hold signed and dated proof of the testimonials of "L Penney" and "M Crane".

22. Section 14.3 of the CAP code states "Testimonials alone do not constitute substantiation and the opinions expressed in them must be supported, where necessary, with independent evidence of their accuracy."

23. I challenge whether Dr & Herbs have, in their leaflet, used testimonials as the only source of substantiation for their claim of a cure for hay fever, without supporting the claim with independent evidence of its efficacy.

24. I confirm that I have no connections with the Traditional Chinese Medicine in general, or specifically with Dr & Herbs. I confirm that I am not, and have never been, involved in legal proceedings with Dr & Herbs.

25. I confirm that I am happy to be identified as the complainant."