Is it time the ASA told us how it makes its decisions?

August 19, 2011

buy Lyrica india After @landtimforgot‘s successful campaign to get the MHRA to publicly list its registered homeopathic ‘medicines’ and a quick chat with @jimbobthomas at @GuildfordSitP, I decided to write about some correspondence I recently had from the ASA.

ve sleep parameters were measured using polysomnography with four nights of recordings (two weeks apart). I complained about my local acupuncturist, who was making some claims about treating, amongst other things, asthma and gallstones (he has now changed his website). Having suffered from both conditions in the past, I know that both can be life-threatening. Thankfully, I seem to have stopped suffering from asthma and, due to a Cambridge surgeon, no longer have a gall bladder to fill up with nasty stones. Asthma can kill: no doubt about that. Gallstones can also kill you, if left untreated, due to infection, although this is rare. They also hurt like… well, women who’ve been through childbirth and had biliary colic told me they’d rather pop out some more kids than go through it again.

You can view the images that I sent to the ASA about my local acupuncturist here.

(thanks to @Simon_Perry for creating Fishbarrel, which you should install immediately, should you wish to make complaints to the ASA)

So… on to the ASA. They wrote to me to tell me:

“CAP and the ASA have previously seen evidence that acupuncture can help treat dental pain, nausea and vomiting, provide short-term relief of tension-type headache, migraine headaches relief, temporary or short term relief of low back pain and provide temporary adjunctive treatment for osteoarthritis knee pain. The ASA therefore accepts that acupuncturists can make the above claims about their therapy. However, the complaints we have received highlight that some acupuncturists are making claims to treat other medical and health conditions for which we have not seen evidence.

We intend to take one complaint about advertising claims for acupuncture forward as a formal investigation, which will be chosen on the basis that the claims made in the advertising are representative of the types of advertising claims made across all the complaints we have received. We will ask the advertiser in that case to provide substantiation for their claims, and we will publish our findings on our website as a formal adjudication. We will then be able to follow up any further complaints we receive about efficacy claims for acupuncture (for which we have not seen evidence), as a compliance issue.”

I was surprised to note that CAP and the ASA have seen evidence to substantiate the claims acupuncturists make about the above list, so I had a look around, wondering what I could possibly be missing. Had new evidence come to light? Were there new studies? I thought that it was likely I would have heard about this new physiological basis for acupuncture, on Twitter, especially from Simon Singh and Edzard Ernst, writers of ‘Trick or Treatment‘.
I found nothing that seemed to properly substantiate these claims in terms of studies. So I wrote to the individual at the ASA again:

“I note that in your letter that you write that CAP and the ASA have seen evidence that acupuncture can treat dental pain, nausea and vomiting, tension-type headache, migraine, low back pain and oesteoarthritis knee pain and that therefore acupuncturists can make claims that they treat this on their marketing material and websites.

I would be very interested in the specific evidence that you have received to this effect and would politely request you to point me in the direction of this evidence as I’m sure that it could put my mind at rest as to the efficacy of acupuncture in these circumstances.”

I thought that, given these are medical claims, there would be some kind of resource the ASA provide that say what they base their decisions on; maybe even some links to peer-reviewed articles? Who, on behalf of the ASA, evaluates the evidence? After all, it’s not always easy for the layman to see through some methodology: even having studied research methods at uni, I often find my evaluation skills lacking and somewhat lazily rely on people like Ben Goldacre to re-explain where there are holes in scientific data collection methods, or a skew in population sampling, or other confounding variables. Having looked at a job profile for a position with the ASA in recent months, I note that a science-based education is not mandatory (not that I believe it should be). It’s just an observation. Who is responsible for deciding what alternative therapists can claim to treat? The ASA’s biography list of Council Members, who decide on each advert, doesn’t specifically include anyone with a medical or scientific background. However, the senior management team does have one person who has a degree in chemistry. Although, when I asked on Twitter, someone who saw my question said that there was a possibility they did call on scientific experts. Just to be clear: I am not decrying the work of the ASA here, just asking some questions.
Anyway, I received a response that seemed to me, at least… a bit… well, I don’t know… you read it:
“The ASA has almost 50 years experience of investigating advertising claims, and CAP and the ASA are experienced in assessing the evidence sent to us in support of advertisers’ claims, including evidence for claims to help or treat medical conditions. We assess both the content and the methodology of the research in our assessment of whether the evidence backs up the advertising claims. Our current position about advertising claims for acupuncture reflects our assessment of the evidence we have seen for the use of acupuncture in the treatment of certain conditions and it does not form part of our current investigation. Please note that we are not in a position to forward that evidence on to you.”