Junk science? Number 15: Time to change the 1939 Cancer Advertising Act

Junk Science Number 15 (revised) : The 1939 Cancer Advertising Act is being regularly abused

Decent, honest, truthful

I spent 22 years of my life in Advertising; 14 years at the very top, both running other people’s Advertising agencies and Communication groups and then my own. With every TV commercial created, approval was sought from the Advertising Standards Authority at script stage and again in advance of first airing. Any claim had to be justified in advance. Press control was a little less formal but this has been tightened up over the years. Messages such as ‘Guinness is good for you’, ‘a Mars a day helps you work rest and play’ and ‘Maltesers, with the less fattening centre’ all bit the dust as the justification of claims became more stringent. Every advertiser had to prove their claim was correct.

Of course this is a totally proper goal for any advertiser, be they purveyors of cars, washing machines, drugs or vitamins. In a professional advertising agency, this is firmly established in stone.

Unfortunately, advertising is no longer confined to TV and press and with the newer media many advertisers do not use professional advertising agencies. Radio, skywriting, posters and now ‘new media’ like the internet all seek to persuade you to do something. And that is what advertising is: The provision of information in a way relevant to you and your needs/lifestyle so that you change your attitudes, and take action. That action might be anything from visiting a Renault dealership, to buying a pint of Heineken, to taking sensible steps to ensure you do not develop AIDS. The biggest advertiser in Britain is not a car company or a beer, it is the Government.

Creating advertising is rather like managing a football team or running a Government: Every Tom, Dick and Harry thinks they could do it just as well. So for 22 years I struggled (along with my agency teams) with advertisers who wanted to say on TV that they made ‘authentic German beer’ when it was brewed in Mortlake; or that ‘nothing worked faster than their analgesic’, when all the new brands, in fact, did!

‘Decent, honest, truthful’ were the three watch words.

A World Wide Issue

When Catherine, my 22 year old daughter developed her brain tumour, she was told she had, at most, 6 months to live. The drugs did not cure; the orthodox offerings could not save her life. So we set out to find alternatives.

Both Catherine and I had science degrees (Chemistry and Biochemistry respectively) and to our surprise we found so much research and information in other countries about brain tumours and what compounds and treatments may help. Now, some of you may know that there exists a blood/brain barrier designed to keep nasties out of the brain. Not surprisingly, a big problem for drugs is getting across this barrier. Not surprisingly too, is the fact that a number of natural compounds do get across this barrier as one of their properties can be to nourish the brain.

The issue was simple: Why wasn’t anyone in the UK telling us about natural compounds that had shown promise in research?

Of course, the World Wide Web is also a mine field of dodgy explosives – it was staggering. Shark cartilage, B-17, coral calcium and more. Did you know they each cure cancer? I can assure you they don’t.

All over the web there are advertisements for everything from allicin to zeolite. Every week to this day someone sends me an e mail which starts, ‘Have you heard of…’, or, ‘Why don’t you cover this amazing new cancer cure …….’

There is little or no regulation on health claims on the web, and the majority of this starts in the USA, whether it be chiropractors (I was treated once in Barbados and, as with Sharon Stone, he nearly killed me), or coral calcium. In my opinion there is no reason why the purveyors of health services, be they practitioners or supplements should not conform to best advertising practices. But they don’t. For this reason I applaud some of the things the Nightingale Collaboration are trying to do. (I covered them 6 months ago in an e-news.) But I think they have their work cut out. How do you stop a UK chiropractor when it is essentially an American health concept and various exaggerated claims can be found on an adjacent site? How do you stop the over-claims of the UK sellers of shark cartilage when the compound and argument originated in the USA? How do you police the World Wide Web, but just in the UK?

Game Playing

But then, ‘mischievous imps’ play games. It must, for example, be galling for MacMillan Cancer Support who a few years back ‘took over’ Cancer Backup, to find the old web site www.cancerbackup.com (not org) covers a multitude of links, some of which offer cosmetic surgery, and others ‘Innovative cancer treatments that may extend your life’ (Champions Oncology Inc – offering those well known cancer treatments called ‘tumor grafts’).

But there is a further complication in the UK: The 1939 Advertising Act. This was originally designed to stop the purveyors of potions, over-claiming their wares in a sensitive area called cancer.

The law is still on the statute books but is blatantly out of date. Herceptin, Temozolomide and Tamoxifen were unheard of in 1939, and many vitamins had not even been named. In some cases research on compounds such as vitamin K, resveratrol and curcumin is even now still in its infancy and benefits in the fight against cancer are only just becoming clear.

The law covers the paid-for advertising of cancer treatments and treaters. This is also a confused area. At the CANCERactive 2004 Cancer Prevention Conference, Professor Tony Howell of Christies, Manchester confused many people in the room by saying that once you have had breast cancer, medicine now had the weapons to prevent it returning and promptly listed a variety of drugs! One man’s treatment is another man’s prevention, it seems.

Double Standards

In 1939 there was only just Television and certainly no Television Advertising. Today, in the USA you can advertise drugs on TV. In the UK you can advertise some drugs (like cough mixtures) and some vitamins (as long as you don’t make any efficacy claims apart from the usual blah about pregnant women and children). You can advertise that something treats a hay fever (even though the key ingredient might affect your DNA) but you cannot advertise that something might treat cancer even though MD Anderson in Texas might be using it right now to do just that. It’s a mess.

The law says basically (yes, I know 4 of my immediate family were/are lawyers but I write to be understood) that you cannot advertise to Joe Public that anything in whole or in part can be used as a cancer treatment. And also (to stop the potion sellers), no one can claim that they treat cancer.

Clearly, this UK law is being broken all over the place; and it is encouraging mischief and double standards.

A) Doctors: In 1939 there were just ‘Doctors’ – no distinction between GP’s and oncologists. But now it seems OK for an oncologist to tell you he treats cancer by definition of his title and also to send you across the car park to the hospital nutritionist and Tai Chi teacher. But a GP who has specialised in helping cancer patients for 25 years and has the same counselors, dieticians, yoga teachers and whatever on staff cannot even have a leaflet telling you of his experience or his personal, independent clinic. We can’t have a two-tier law. Either they both break the law, or neither does.

B) Complementary Centres: And what about complementary cancer centres – some independent, others run by existing cancer hospitals – Maggie’s, The Butterfly, The Rainbow, The Haven, Penny Brohn? They can talk about cancer support. But don’t yoga classes reduce cortisol levels and isn’t there a recent US study that shows people who go for ‘Stress management’ survive twice as long? One lady’s support is another lady’s treatment. Some support centres even talk about advice and treatment. Are they breaking the law?

C) Charities? Cancer Research UK, MacMillan/Cancer Backup, Breast Cancer Care, CANCERactive and so on all have web sections entitled ‘Treatment’. Ah, but we are not advertising, we are merely informing. No one is paying for any communicated message – or are they? We wrote to Cancer Research asking if they received royalties for all the hard work they put in to the development of new drugs. Sure enough, they hand over the idea and drugs companies take the drug through Clinical Trials and on to market. When that happens, came the reply, is we receive a royalty which goes into a special fund to be used for more CRUK work. I’m not against CRUK, they do a fine job. But if they communicate the benefits of a drug on their web site and in Press Releases and then receive money, isn’t there a danger that this could be construed as funded communication, however it is wrapped up?

D) Treatments: Next, this 1939 law makes no differentiation between a drug, a synthetic supplement or a natural compound nor of research standards, which anyway have changed considerably.

To some people there is only one proof of efficacy, and that is a double blind, placebo controlled, Clinical Trial. But this ‘stringency’ is used selectively. If every treatment had to go through it, 90 per cent of all drugs currently on the market would have to be withdrawn.

A lack of such a Clinical Trial will see some people criticising any claims for curcumin or any diet therapy as potential cancer treatments.

Yet Hospitals in America are using curcumin in the treatment of colorectal cancer. There are currently no Clinical Trials for Virotherapy or Dendritic Cell Therapy either, but MD Anderson and Dukes openly tell of their use and anecdotal ‘research’ successes.

So are we to conclude that anecdotal evidence is fine as an evidence for an ‘alternative’ treatment if you are a Hospital, but not if you are anybody else? So if UCL talk of Photodynamic Therapy as a potential treatment, that’s OK, but if a Doctor specialising in cancer at his UK Private Clinic does the same, he is a quack and breaking the 1939 Act?

Helping the cancer patient?

E) The curbing of knowledge and information: Joe Public can, of course, go to the Internet. He/she can find out that there is research from Memorial Sloane-Kettering showing curcumin reduces cellular inflammation; or from H. Lee Moffitt that sodium bicarbonate reduces metastases. They can find out about mistletoe therapy, photodynamic therapy and hyperthermia and where to go in America or Germany to receive treatment.

But, under the 1939 Cancer Advertising Act, it is illegal for a Doctor in the UK to say he has specialised in treating cancer for 20 years and that he too offers hyperthermia (which actually has good Clinical Trials to support it), mistletoe treatment or PDT (a therapy that Cancer Tsar Mike Richards is now putting some force behind). Worse, ‘mischievous elves’, sometimes claiming to work with The Nightingale Collaboration, are running round ‘tipping off’ Trading Standards to chase these UK Doctors and practitioners and telling them not to tell anybody that they treat cancer or have anything that might improve the immune system, or slow down metastases.

How does this help a 70 year old Londoner with breast cancer, who has been told by her UK oncologist that he has nothing more that can help her?

F) Increasing patient costs: Of course, she and her buddies can still read the American Hospital, German and Swiss Clinic websites and may try to raise the money to head off abroad for Photo Dynamic Therapy, when she could have got it cheaper and just as good just down the road – if only she had known!

G) Funding overseas Centres: The net result of that can mean that American Hospitals, German and Swiss Clinics simply generate more funds and grow their presence. Ring up a US Cancer Hospital and ask about PDT or Virotherapy; they will tell you all and invite you over – it is big money for them. Make no mistake. These ‘authoritative’ web sites are advertisements for ‘Alternative’ Cancer Treatments’ and big money is made by Americans, Germans and the rest.

Isn’t there a danger of merely increasing the costs of our lady being treated and, indirectly, helping the business at these overseas cancer centres grow at the expense of the cancer industry in the UK?

Back to double standards – are these self-styled ‘Health Vigilantes’ next going to stop the American Hospitals web sites running in the UK? There is a new law planned in America which allows the US Government to turn off web sites which conflict with ‘Official’ Goverenment views on Healthcare (think fluoridation, vaccination, GM Foods). So in the interest of fairness, are these self-styled ‘health vigilantes’ going to lobby David Cameron to turn off all US web sites that ‘advertise’ that they treat cancer with alternative treatments that have no Clinical Trials behind them? Then where do you draw the line. Is someone going to tell UCL or Christies that they can’t offer virotherapy as a last resort?

H) Personal Choice: The UK is out of step; The NHS openly states that it wants patients to have more choice but here is a law actually restricting choice by actively limiting advertising treatments and independent cancer centres in the UK. In America Doctors can set up ‘Integrative cancer centres’; there’s one in every town. 37 per cent of mainstream hospitals already have the phrase ‘Treating Mind, body and soul’ in their mission statements and the likes of MD Anderson conclude from their research that vitamin C improves the performance of bladder cancer drugs and astragalus improves the performance of radiotherapy. Sloan-Kettering has Clinical Trials on several natural compounds, Harvard on acupuncture and Presbyterian New York on Meditation cutting blood loss if used prior to surgery. The National Cancer Institute has 36 pages covering Energy Therapies on its web site; the American Cancer Society has just issued a report reviewing more than 100 research studies since 2006 and concluded that there is ‘overwhelming’ evidence that three complementary therapies in particular can result in ‘longer survival’ and the cancer not returning.

But what do cancer patients find in the UK? Answer – an ever more myopic ‘orthodoxy’ where surgery, radiotherapy and drugs are increasingly the norm, little learning from overseas research is encouraged and indeed most is actually ignored.

Back in the 1990s the American Government brought in the National Institute of Complementary Health to provide funds to properly study complementary and new therapies. At the same time they banned subjective claims about ‘Integrative’ or ‘Complementary’ medicine. Skeptics cannot simply say ‘It’s all a load of rubbish’ or ‘There’s no evidence’. They’ve been driven underground and also hit by law suits when they libel or get their facts wrong.

Health freedom is now understood to be allowing the patient access to sensible potential treatments in a localised environment, whilst (of course) taking action against the real quacks.

More and more US Doctors are encouraged to ‘Think Integrative’ – there are now medical degrees in Integrative Medicine.In the UK, you simply cannot have an Integrative Cancer Centre. Doesn’t this just make Joe’s fight against cancer harder? Doesn’t it just restrict personal choice.

Some people choose to be vegetarians; some people choose not to have treatments that burn, cut or damage their immune systems when trying to fight off cancer. This outdated law – and its one-sided enfocement – actually stops them exerting their right to choose non-invasive therapies in the UK. Many patients would dearly love to talk to an independent doctor who could devote time to discussing possible causes and non-invasive treatments, or complementary therapies that could increase survival times, but this law stops Doctors and Clinics telling people they exist.

 I) Curbing Medical width: The law also makes it far less likely that ‘Integrative’ or ‘Holistic’ medicine will ever grow in the UK – who would want to spend seven years learning medicine and complementary therapies if they could not tell patients exactly what they could do for them?

Of course ‘orthodoxy’ loves this thought. It helps the drugs companies and the oncologist control the whole process.

J) Curbing possible increases in survival times: Survival times in America are considerably better than in the UK. Do you think that all their open-mindedness has nothing to do with that? Do you think that a UK oncologist who pooh-poohs his patient’s attempts at changing her diet is helping? Or articles in the BMJ by leading oncology Professors that ‘changing your diet doesn’t make a jot of difference to your survival outcome’ actually help? Especially when they are not true and the American Cancer Society is talking about an ‘explosion of research’ over the last 5 years showing that complementary therapies like diet ‘increase survival times and can stop cancer returning’.

K) The most flagrant breach of the law? But there is one area in which the 1939 Cancer Advertising Act is flagrantly broken. The 1939 Act stated that the only ‘advertising’ allowed was from pharmaceutical companies directly to doctors. In my former life as an advertising man, I worked on two pharmaceutical companies’ businesses. You may ask yourself why, when the 1939 Act was in place at the time, did they need an advertising agency? No, you don’t really need me to answer. Nowadays they have all manner of professional Communications companies working for them – from lobbyists to PR agencies.

I am now a part-time journalist, just like the guys at the Daily Mail and the other newspapers. We regularly receive PR releases from Pharmaceutical Companies about new drugs. It is clearly paid for communication to people who are not doctors.

Worse, when the scientists have finished their research report it is handed over to the Pharmaceutical Company who funded the research. The marketing, communication, PR people then massage the results to produce a Press Release and Doctor Sales Aids that will communicate the benefits in the best possible light, whilst limiting communication of less flattering matters like side-effects. Those will be contained in the full research report out more than 6 weeks later.

But how many journalists wait the six weeks? No, they work straight from the PR release and get the ‘Great new life saving Drug’ story out urgently, today. Only a few months ago I received a press release direct from a drugs company talking of a ‘Wonder Drug’ in the headline; and I am not a Doctor. Nor are at least 95 per cent of ‘health’ journalists.Then there is the pressure sale: When Herceptin was first launched in the UK, NICE decided it was not worth the cost for certain patients; the same logic applied a couple of years later to four new kidney drugs. Within days a member of the public with breast cancer, or someone with kidney cancer was telling their story in the press and saying how bad/sad it was that NICE was denying them these ‘life saving drugs’. Do you really believe a journalist went scouting round the country and found the lady in Wigan?

Do you think that when a cancer charity issues a press release they are not influenced one jot by their involvement with the drug companies? Only a few years ago, investigative journalists from the Times found ‘slush fund payments’ (their words) to certain charities by drugs companies and posed the question, ‘How unbiased is their advice?’The drug companies and their communication agencies can be in flagrant breach of the 1939 Act. Are the ‘health vigilantes’ worried about this in their aim to protect the patient?  Are they going to move to stop this breach of the law too?

Overhaul this outdated law

The 1939 Cancer Advertising Act should be completely overhauled. At the moment it is standing in the way of developing the most effective cancer care services for patients in the UK. It is standing in the way of increased knowledge and choice for patients. And it is in danger of inhibiting cancer treatment in the UK whilst being abused in a way that restricts patient choice and self-empowerment. It may well help fund overseas clinics and it is being one-sidedly enforced to protect  drug company profits.It also stops any challenge to current medical thinking, which is hardly in the interests of developing improvements in medicine or patient survival.

Meanwhle leave the policing part to the ASA. Admittedly they might need some more funding and more people. But ‘Decent, Honest, Truthful as a rule is just as applicable to an internet ad from a herbal supplier as it is to Guiness or Ford.

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