Background
Advertising and the National law in Australia
Understanding misleading or deceptive or likely to be misleading or deceptive
the astute and the gullible, the intelligent and the not so intelligent, the well-educated as well as the poorly educated, men and women of various ages pursuing a variety of vocations. … all persons exposed to the conduct should be considered although conduct which is only likely to mislead or deceive an extraordinarily stupid person would not fall within the ambit of the provisions [6].
AHPRA’s compliance and enforcement strategy: education & engagement
Conduct notifications & advertising breaches: the Australian scene
Advertising Complaints | 2013/14 | 2014/15 | 2015/16 | 2016/17 | 2017/18 |
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Total | 547 | 300 | 1013 | 1895 | 1043 |
Chiropractic | 186 | 120 | 601a | 162 | 15 |
Physiotherapy | 28 | 25 | 44 | 903b | 8 |
There is no evidence chiropractic care benefits babies or can treat them for medical conditions and there is not enough evidence to suggest it [chiropractic] can achieve general wellness or treat various organic diseases and infections.
it [CBA] was concerned about a number of practitioners who were falsely advertising that chiropractic care for spinal problems could also treat a range of other ailments [21].
Objectives
Methods
Data collection
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Where breaches in multiple categories were found only one example per practitioner per category was recorded.
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Where multiple breaches were found in a single category, only one example was recorded.
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The auditors were careful to attribute breaches to individual practitioners where it was clear the utterance applied to an individual, and to attribute the breach to all practitioners where the utterance reasonably applied to all practitioners in the practice.◦ Example: Use of association membership as postnominals or a specialisation claim was attributed only to the individual practitioner.◦ Example: A claim made on a home page or FAQ section was attributed to all practitioners in the practice.
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If a claim could be allocated into more than one category, it was registered in the category deemed to have the greatest potential for harm. For example, the claim:If you’re a frequent flyer, make the best of it and remember to come in for your chiropractic adjustments often.is a misleading unsubstantiated claim breach and a breach of the “encourages inappropriate, indiscriminate, unnecessary or excessive” use category. The greatest potential for harm would be by encouraging inappropriate or excessive use of a health service therefore this example was only counted as a breach of that category. (Please refer to Breach Categories below for details of how breaches were classified).
Locating and auditing practitioner websites & linked facebook pages
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Home page
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About/Meet the Team
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What is chiropractic/physiotherapy?
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Frequently Asked Questions
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Conditions treated
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Blog posts
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How it works/Research1
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Testimonials
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Facebook◦ Videos◦ Reviews◦ Info & Ads◦ Photos
Association membership
Breach categories
Category | Minor: Unlikely to harm | Major: Likely to harm |
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c1 Association membership presented as postnominals. | Persons displaying association membership in this way are presumably abiding by their association’s code of ethics when dealing with clients so the potential for harm is lessened. | |
c2 Use of the title Dr. without professional clarification. | Relatively unlikely that a member of the public would be misled into thinking a chiropractor using the title Dr. is also a medical practitioner. | |
c3 Use of Doctor of Chiropractic or DC without holding the qualification but having graduated with a chiropractic qualification from an accredited chiropractic program. | Unlikely to mislead the target audience because members of the public would be unlikely to know the distinction although if they misrepresent their academic qualifications they may do so in other areas. | |
c4 Specialisation claim. | Practitioners using this designation presumably have a special interest in a particular area however this does not necessarily mean qualifications that would deem them ‘specialists’ and hence the public may be misled. | |
c5 Claims to affect positioning of an unborn child.a | Any advertisement claiming or implying that a technique can affect an obstetric breech presentation is misleading and potentially harmful. | |
c6 Misuse of the literature. | High likelihood of misleading the target audience because almost inevitably the advertiser omits critical information from the literature cited or fails to provide a balanced report of the literature. | |
c7 Failure to mention possible adverse outcomes. | Failure to mention possible adverse outcomes has a relatively high chance of misleading the target audience into believing that a form of treatment is free from possible adverse outcomes. | |
c8 Making unsubstantiated claims. | An advertiser must have reasonable grounds for making a claim of effectiveness.b | |
c9 Misrepresenting awards. Eg. Presenting a business award as though it is a clinical award. | A practice which has won a business award may be more likely to comply with required practice standards and is therefore less likely to mislead patients in clinical practice areas. |
Recording and data analysis
If you’re a frequent flyer, make the best of it and remember to come in for your chiropractic adjustments often.
Results
Breaches by the numbers
Section 5 of the 2014 AG (§5) Category | Chiropractors with Breaches: Number & (%) | Example |
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(a) Create unwarranted and unrealistic expectations about service effectiveness | 75 (21%) | Research has shown chiropractic to be an effective form of health care for back pain, neck pain, headaches, reflux, bedwetting, ear aches, otitis media, leg pains, headaches, migraine, visual disturbances, dizziness, breathing difficulties, asthma, constipation and dysmenorrheal [sic]. |
(b) Encourage (directly or indirectly) inappropriate, indiscriminate, unnecessary or excessive use of health services; | 42 (12%) | Wellness Care. Once your condition has stabilised you then have a choice of continuing Chiropractic care with a focus on preventing the initial condition returning and new conditions appearing. By having regular check-ups and adjustments we can help you maintain and achieve your ideal level of health. Most patients find that periodic chiropractic check-ups help keep them in tip-top shape. Those who are active, have stressful jobs, or want to be their very best, find that a schedule of preventative visits are helpful in the maintenance of good health. |
(c) Mislead, either directly, or by implication, use of emphasis, comparison, contrast or omission | 205 (57%) | |
(d) Use testimonials or purported testimonials | 80 (22%) | Thanks ‘Chiropractor’, I was dead in bed for 3 days and thanks to you I was back on my feet within few days! Strongly recommend. Example of a visual testimonial: |
(e) compare professions without evidence | no breaches found | |
(f). Claim or imply that a practitioner provides superior services to those provided by other registered health practitioners | 5 (1.4%) | Traditional chiropractic vs NeuroStructural Correction. Traditional chiro aka band-aid care … |
(g) exaggerate recovery time; | no breaches found | |
(h) Lead Audience to Self-Diagnosis | 3 (0.8%) | links to videos encouraging viewers to perform each of Contracted leg length test; cervical range of motion test; carpal tunnel test; and a spinal health test. |
(i) Abuse the trust of or exploit a lack of knowledge by the target audience (unconscionable conduct) | no breaches found | |
(l) Contain language that could cause undue fear or distress | 58 (16%) | A LITTLE SECRET: Don’t let symptoms, or the absence of them, be your guide as to how you are doing. Many cancer patients never have a symptom until the first tumor is detected. By then, for many, it is already too late. |
(m) Contain any information or material likely to make a person believe his or her health or wellbeing may suffer from not taking or undertaking the health service | 16 (5%) | As a short-term solution to overwhelming physical, chemical or emotional stress, spinal joint dysfunction is a brilliant coping strategy. Yet, when this stress response doesn’t resolve in a timely manner, or the stress is chronic, it may lead to other consequences. Do you have undetected spinal joint dysfunctions? Find out! |
(n) misrepresent price information | no breaches found | |
(o) Unfounded Claims: a practitioner has an exclusive or unique skill or remedy, or that a product is ‘exclusive’ or contains a ‘secret ingredient’ | 9 (3%) | Integrative Diagnosis is the only complete system for the diagnosis and conservative treatment of muscle, nerve and joint problems … [unlike other chiropractors] we can accurately and quickly diagnose what is causing your lower back pain. |
(o)4. Claim or imply that results are always effective | 1 (0.3%) | “every adjustment has a positive effect on the brain” |
(j, k & p) Combined: Failure to disclose risks, warn of material risks, omit warning statements | 32 (9%) | How safe is chiropractic: If the vertebrae are misaligned, the nerves will lack the ability to carry messages that in turn can affect how well our body functions. This can cause problems in the digestive system, anxiety, uneasiness, depression, headaches or ear infections to name a few. A clear example is of an ear infection which can be caused by a bone that is out of alignment. Commonly, migraines, neck pain, back pain or foot pain can be treated or prevented by chiropractic care. Studies have also proved that it can improve blood pressure in patients who have hypertension. |
(q) provide a patient or client with an unsolicited appointment time not requested by the patient or client | no breaches | |
(r) promote tobacco products, smoking, alcohol, or any other addictive substances or products known to affect health adversely | no breaches | |
(s) be vulgar, sensational, contrary to accepted standards of propriety or likely to bring a health profession into disrepute, for example, because the advertising is sexist. | no breaches |
Section 5 of the 2014 AG (§5) Category | Physiotherapists with Breaches: Number & (%) | Example |
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(a) Create unwarranted and unrealistic expectations about service effectiveness | 2 (0.53%) | Your physiotherapist will use a combination of joint mobilization, stretching, manual therapy, electrotherapy, ultrasound and structured exercise programs to get you back to 100% health. |
(b) Encourage (directly or indirectly) inappropriate, indiscriminate, unnecessary or excessive use of health services; | 8 (2%) | Book your Free Initial Assessment today [without terms or conditions] |
(c) Mislead, either directly, or by implication, use of emphasis, comparison, contrast or omission | 78 (20%) | |
(d) Use testimonials or purported testimonials | 179 (47%) | I started going to ‘Suburb’ Physio last year after getting some terrible neck pain from a combination of bad sitting posture at work, and a heavy training schedule. Bob and Jane have done an amazing job at relieving my neck pain! Bob gave me a comprehensive assessment and really took the time to understand what was causing my pain. He gave me exercises to help strengthen the affected muscles and to prevent further injury. |
(e) compare professions without evidence | no breaches found | |
(f). Claim or imply that a practitioner provides superior services to those provided by other registered health practitioners | 51 (11%) | ‘Y’ Physiotherapy is Australia’s leading physiotherapy clinic for swimmers. |
(g) exaggerate recovery time; | no breaches found | |
(h) Lead Audience to Self-Diagnosis | no breaches found | |
(i) Abuse the trust of or exploit a lack of knowledge by the target audience (unconscionable conduct) | no breaches found | |
(l) Contain language that could cause undue fear or distress | no breaches found | |
(m) Contain any information or material likely to make a person believe his or her health or wellbeing may suffer from not taking or undertaking the health service | no breaches found | |
(n) misrepresent price information | no breaches found | |
(o) Unfounded Claims: a practitioner has an exclusive or unique skill or remedy, or that a product is ‘exclusive’ or contains a ‘secret ingredient’ | no breaches found | |
(o)4. Claim or imply that results are always effective | 8 (2%) | we will find out what the problem is and treat to fix it. We can help you, no matter what your goal is |
(j, k & p) Combined: Failure to disclose risks, warn of material risks, omit warning statements | no breaches found | |
(q) provide a patient or client with an unsolicited appointment time not requested by the patient or client | no breaches | |
(r) promote tobacco products, smoking, alcohol, or any other addictive substances or products known to affect health adversely | no breaches | |
(s) be vulgar, sensational, contrary to accepted standards of propriety or likely to bring a health profession into disrepute, for example, because the advertising is sexist. | no breaches |
Misleading Claim Category | Chiropractors | Physiotherapists |
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Misrepresenting awards | ‘X’ Chiropractic: The Award Winning Spine Experts.b | No examples found. |
Misrepresenting Qualification | John Chiropractor DC.c | No examples found. |
Association membership presented as postnominals | Mary Chiropractor BSc, DC, MCAA.d | Bob Physiotherapist B AppSc (Physio) MAPA.e |
Specialization claim | • a specialist chiropractor for more than a decade. | • specialising in the diagnosis and treatment of musculoskeletal dysfunction and sports injuries |
Use of the title Dr. without professional clarification | 67 of breaches found. No example required. See explanation below.f | No examples found. |
Misleading Claim Category | Chiropractors |
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Failure to mention adverse outcomes | 1. There is ample evidence that chiropractic care is safe for children and NOT A SHRED of evidence that it is harmful or dangerous. |
Misuse of the literature | 1. In relation to the treatment of neck and back pain, studies have shown that a course of chiropractic care was 250 times safer than a course of anti-inflammatory drugs.c 2. Studies show that mothers under chiropractic care, delivering the first baby, have 25% reduced labour time in comparison to women without care and even 31% shorter labour time in case of pregnancy after the first child.d 3. An Australian study indicates that women consulting with chiropractors during pregnancy are less likely to require a caesarean section after onset of labour or to have a premature birth.e 4. chiropractic care may help with: asthma & allergies, reflux & colic, blood pressure & more. f |
Webster technique or claims to affect positioning of an unborn foetus. | 1. However, a realignment method, known as the Webster Technique, has a 92% success rate in optimal foetal positioning. |
Making unsubstantiated claims. | 1. If I had cancer or any illness, I’d rather remove my subluxations, so my nervous system is functioning at 100%. It would be many times worse if I had cancer and a nervous system that isn’t working well. |