British Advertising Standards Authority
Adjudication on Lifescan Ltd
5 November 2008
12 Montacute Road
Sector: Health and beauty
Number of complaints: 1
Complaint Ref: 50805
A circular for Lifescan stated “We’ve been checked! Put your mind at ease with a health check from Lifescan, the UK’s leading provider of private CT assessments”. Text inside the leaflet stated “Lifescan has given thousands of people peace of mind about their health and future wellbeing Your health is your greatest asset, when it comes to living life long and to the full. The chances are, though, that it may take a back seat because of the many other things going on in your life … Lifescan can help give you reassurance at a very affordable price. We offer a range of CT assessments, and a warm welcome from our highly trained staff … We use advanced ‘open’ CT scanning technology to take high resolution images of the inside of your body, creating a unique picture of your state of health. The images are so detailed, our Consultant Radiologists can tell how well your body is functioning. They can also check for early signs of a range of illnesses, including heart disease, lung cancer, colon cancer, aneurysms or osteoporosis, even before there are any symptoms … When you’ve had your scan one of our Consultant Radiologists will review the images and prepare a confidential report … Wouldn’t it be reassuring to be given a clean bill of health … Would you benefit from a Lifescan health check? Certain things can put your health at risk - smoking, for example, or if your family has a history of heart disease, stroke or cancer. So, too, can diabetes, high blood pressure or high cholesterol, and a stressful or sedentary lifestyle”. On the back cover of the leaflet was a brief list of lifestyle questions. Text at the top of the list stated “If you answer YES to any of the questions you could benefit from the services offered by Lifescan”.
The complainant, a doctor, challenged whether the ad was misleading and irresponsible because:
- it might discourage recipients from seeking advice from their GP, who might be more appropriate, especially for some conditions;
- it implied that a CT scan could identify any type of health problem; and
- it didn't make clear that CT scans exposed patients to radiation and could be harmful if used frequently. The complainant was particularly concerned because the NHS National Screening Committee did not recommend CT scans.
1. Lifescan said there was no reference to GPs in their circular and that they did not believe it discouraged recipients from seeking advice from their GP. They said their follow-up brochure encouraged individuals to seek advice from their GP if they had any specific symptoms.
2. Lifescan said their circular specified the health problems for which they checked. These were heart disease, lung cancer, colon cancer, aneurysms and osteoporosis. They said some of their scans identified other illnesses such as kidney cancer, kidney stones and some gallstones. They did not imply, however, that their scans could identify any type of health problem. They said their staff and their follow-up brochure covered this in more detail.
3. Lifescan said they did not believe their circular was misleading or irresponsible for not mentioning radiation. They said they stated clearly that they used CT scanners. They also said they were regulated under IR(ME) Regulations. They said excess cancer risk had not been demonstrated by epidemiological studies at doses below 100mSv; that Lifescan did not offer whole body scans; that their scans were of specific areas of the body and did not exceed 10 mSv, and were only recommended and available on a once-in-five-years basis. They said they believed, therefore, that any risk was negligible. They cited airlines, who were not required to state that there was exposure to radiation every time someone flew. They said the NHS National Screening Committee's primary remit was "to advise Ministers, the devolved national assemblies and the Scottish Parliament on the case for implementing new population screening programmes not presently purchased by the NHS within each of the countries in the UK" and that it was not responsible for policy relating to private health assessments such as those offered by Lifescan. They said other private health providers offered similar assessments.
The ASA noted that the wording of Lifescan's circular did not actively discourage recipients to forego consulting their GP and take a Lifescan CT assessment instead, and that Lifescan said the follow-up brochure encouraged individuals to seek advice from their GP if they had any specific symptoms. We also noted, however, that underneath the heading "What's the procedure for booking a scan?" the circular stated "If you are over 40 you can book a CT assessment direct at a Lifescan centre near you ..." We noted that the questionnaire began with the heading "If you answer YES to any of the questions you could benefit from the services offered by Lifescan" and that while the circular referred to checking for early signs of conditions before symptoms developed, the lifestyle questionnaire asked, among other questions, "Do you have a family history of: Heart disease? Diabetes? Lung cancer? Colon cancer or polyps?" and "Recently experienced unexplained weight loss?" and "Had a change in your bowel habit, such as diarrhoea or constipation?" We considered recipients with a family history of heart disease, diabetes and certain types of cancer might already be having regular medical assessments which Lifescan should not replace, and that those who had not already contacted their GP about those aspects of their family history should do so before booking a CT scan. We also considered unexplained weight loss or a change in bowel habit were symptoms for which it was important to consult a GP without delay.
We understood that the 12th Report of the Committee on Medical Aspects of Radiation in the Environment (the COMARE report) recommended against CT scanning as a screening method for asymptomatic individuals unless it was done as part of a national screening programme. The report also stated that CT scanning should not be undertaken for identifying osteoporosis in asymptomatic individuals because there were more appropriate methods which had lower radiological risks; that there was no evidence to justify CT scanning of the lung in asymptomatic individuals; that other screening methods should be undertaken before undergoing a CT scan and that CT scanning for colon cancer on asymptomatic individuals should only be offered to those aged 50 years or above. We noted that the conditions listed in the circular were given as examples of the range of illnesses for which a CT scan could be used in order to detect the early signs. Because Lifescan did not scan the whole body but specific areas of it only, we considered the references to "a unique picture of your state of health", "a range of illnesses" and a "clean bill of health" were misleading for suggesting Lifescan provided an overall assessment of the whole body when they provided CT scans for particular conditions on asymptomatic individuals. We considered that went against the recommendations of the COMARE report, which was considered the most authoritative and comprehensive advice on the subject. We concluded the ad could discourage recipients from seeking advice from their GP in situations where it would generally be considered more appropriate to do so.
On this point the ad breached CAP Code clauses 2.2 (Responsible advertising), 7.1 (Truthfulness) and 50.3 (Health & beauty products and therapies).
We noted that the circular stated "We use advanced 'open' CT scanning technology to take high resolution images of the inside of your body, creating a unique picture of your state of health. The images are so detailed, our consultant Radiologists can tell how well your body is functioning. They can also check for early signs of a range of illnesses, including heart disease, lung cancer, colon cancer, aneurysms or osteoporosis ..." We considered that wording was likely to suggest to recipients that a Lifescan CT scan was able to identify any kind of health problem, not just those listed in the circular.
On this point the ad breached CAP Code clause 7.1 (Truthfulness).
We noted that the circular clearly referred to CT assessments and CT scans, as well as Lifescan's assertion that their scans were recommended and available only on a once-in-five-years basis and that they therefore believed any risk from exposure to radiation was negligible. We also noted that the Department of Health had instructed COMARE to consider exposure to radiation from medical practices; to address CT scanning of asymptomatic individuals particularly; that the report constituted advice to the Department of Health, was endorsed by the Health Protection Agency and that it was considered the most comprehensive and authoritative document to date. We noted that the IR(ME) Regulations applied to both NHS and commercial scanning but that complying with them would not guarantee that an ad would not discourage recipients from speaking to their GP in the first instance or that it would include information about the risk from exposure to radiation. We noted COMARE expected dose reduction and other advances in technology might influence advice on the appropriateness of CT scanning for asymptomatic individuals, subject to new research evidence demonstrating improved benefits, but that at present CT scanning should not be used on asymptomatic individuals where there was evidence that it was not the most suitable method to screen for a particular condition because other, more appropriate methods with lower radiological risk consequences were available. Because established advice was that the level of radiation exposure from a CT scan was significant, we considered that in omitting that information the circular was likely to mislead.
On this point the ad breached CAP Code clauses 2.2 (Responsible advertising), 3.1 (Substantiation) and 7.1 (Truthfulness).
The ad must not appear again in its current form. We told Lifescan to amend their circular to make clear that they scanned specific areas of the body only and not to suggest that they offered whole body scans; not to suggest that people with family history of the conditions, the lifestyle factors or the symptoms listed should arrange a CT scan before consulting their GP; not to suggest that a CT scan could identify any kind of health problem; and to include information about the risk from exposure to radiation.
Adjudication of the ASA Council (Non-broadcast)
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