The MP, the ASA and the Case of Alyssa Burns-Hill

Dr Alyssa Burns-Hill has advertised her medical services as “Harley Street Hormone Health”. With the Harley Street address and the title ‘Dr’ you might be forgiven for thinking that Alyssa Burns-Hill is a medically trained doctor. She is not. But she describes herself as a ‘practitioner of health in its broadest sense’, although not so broad as to be an actual qualified medical doctor.

Using the title ‘Dr’ is not protected in the UK. Its usage is usually associated with medical doctors or those who have obtained a PhD. The public is then not able to easily know what the ‘Dr’ means when you tag it to your name without further information. Perhaps we do not need to ask further questions of Dr Fox the DJ as we would not judge his ability to play songs on the radio according the the type and quality of his education. But if we are making informed health choices then we probably ought to understand what the title ‘Dr’ means when someone advertises themselves as a ‘practitioner of health’. Have they a sound medical training, a distinct specialism? Or do they lack appropriate qualifications in this area? No-one will mind too much if you use your title when checking into a hotel or using it to impress at the airport check-in in the vain hope of an upgrade. But using it in an advert carries responsibilities.

The Advertising Standards Authority (ASA) in the UK has seen this as an issue and has given very straightforward blanket advice to people advertising health services:

Advertisers wanting to refer to themselves as “Dr”, “a doctor” or similar, should take care not to imply that they hold a general medical qualification if they do not. The need for clarity is greatest when marketers are making health-related claims and the ASA has taken the tough line on marketers calling themselves ‘Dr’ in the context of health.. The safest and simplest way to avoid confusing consumers is that if they do not possess a general medical qualification, advertisers should not call themselves “Dr”.

Alyssa Burns-Hill has found herself the subject of an ASA complaint about such matters. A complaint was made about whether her claims on her website about saliva-based hormone testing could be substantiated and whether her use of ‘Dr’ was misleading. The ASA found that that Burns-Hill had failed to produce sufficient evidence to substantiate her claims and about saliva testing and that the papers she did submit had significant weaknesses. Such lack of evidence had ‘limited [saliva testing for hormonal imbalances] acceptance within the medical profession.’

On the use of the title, the ASA said, “we considered that most consumers would be likely to associate the reference to Harley Street with qualified medical doctors” and that by calling herself Dr Alyssa Burns-Hill PhD “consumers were likely to interpret the website as belonging to a medically-qualified doctor”. The ASA asked her to ‘ensure she stated that she was not a medically qualified doctor in a clear and prominent qualification’.

This much seems reasonable. Although obviously not to Dr Alyssa Burns-Hill PhD (not a medically qualified doctor). She has set up a campaign to try to expose the ASA as lacking transparency, legitimacy and the expertise to judge her. Her statement says,

I was pushed to the edge by the Advertising Standards Authority and I know that I am not alone with my frustrations at the seemingly arbitrary nature of its so-called adjudications.  Its procedures convey the action of one voice with an agenda that acts as prosecutor, judge and jury.  Evidence is selectively compiled and presented to its council by its staff alone without regard for integrity or even other Government department’s remits.  It can be held to account by no one as it is a Private Limited Company just like Boots or Tesco.  How can these activities be justified as an organisation that proposes to represent legality, decency, honesty and truthfulness and purports to be an Authority and official Regulator?

Dr Alyssa Burns-Hill PhD (not a medically qualified doctor) is not the only alternative health practitioner to want the ASA exposed. Homeopaths have seen the ASA as a bugbear and have been lobbying them to lower their standards of evidence for alternative medicine. Burns-Hill’s campaign website lists the support of other Alt Med organisations:

• The Alliance of Natural Health (a trade body lobbying organisation for vitamin pill sellers and other alternative therapists) who call the ASA the ‘Anti-Science Authority’  or the ‘Double Standards Authority‘.
• The notorious magazine ‘What Doctors Don’t Tell You’ (which specialises in printing misleading and dangerous health claims) which urges its readers and therapists to ignore ASA adjudications.
• Freedom4Health, which is another alternative medicine lobby group set up to campaign against the ASA.

Burns-Hill latest move was to convince her MP, John Glen to hold a debate in the House of Commons about her case. Last Monday, Glen spoke in the Commons about her case saying,

Following the ruling, Dr Burns-Hill was told in an email from the ASA to change her website, business cards and publications to say only her name followed by “PhD” and then the phrase “doctorate in healthcare”, followed by the rest of her post-nominals, including her MSc and professional memberships. Dr Burns-Hill refused to comply as she felt it conveyed that she was the holder of two doctorates, a PhD and a doctorate in health. After being rebuffed by Lord Smith of Finsbury and Guy Parker, managing director of the ASA, she went through the extended process of an independent review at her request, while the original judgment was still published on the ASA website. After the independent review, the ASA partially admitted its mistake but still insisted that she had to qualify that she was not a medical doctor next to any listing of her qualifications.

Glen raised the complaints of the alternative medicine practitioners that the ASA was not legitimate (being a private company), it was not transparent and that it has no expertise to judge alternative therapies.  People like Burns-Hill object to the ASA expert reports not being made by people who practice alternative medicine.

What is going on here appears to be a plea for a double standard to be made for alternative medicine. Apparently, claims in advertising should be subjected to tests of truthfulness set only by those who advocate such therapies. As such, it is part of the whole programme of alternative medicine that seeks to set up a double standard in healthcare. There is medicine that is subjected to reason and objective scientific evidence and then there is alternative medicine that only wants to be judged on its own standards. And those standards are very low. The ASA applies a consistent evidential standard across all sectors of advertising. But for alternative medicine, they want to be a special case. The ASA simply asks advertisers to hold the evidence for their claims. If it is insufficient to convince the ASA then the adverts should not be made. Burns-Hill quite obviously failed to supply sufficiently robust evidence as explained by the ASA in their judgement.

Ed Vaizey, the responding minister, made a suitably robust defense of the ASA whilst making a few recommendations such as that expert reports should be published. The ASA is an efficient and sensible approach to regulating advertising. It pretty much ensures advertisers never have to defend their adverts in court and provides a low cost mechanism for managing issues. For this reason it is near universally accepted by the industry as the arbiter of fair advertising. It is of course incompatible with the philosophies of the cult-like world of alternative medicine who will never accept external authorities and their views on their beliefs and practices and their refusal to accept any evidential constraints on what they claim. Increasing transparency in the ASA will just allow alternative health advertisers to make ad hominem attacks against those who judge their claims.

It does appear though that Burns-Hill biggest gripe is over the use of her title. She says,

Did you know that the ASA says that you cannot use the title Dr in your professional context? the ASA sought no guidance from academia on the use of the title of Dr, which is bestowed on people who have reached advanced learning.  Instead they made an arbitrary decision …

The ASA did not make an arbitrary decision. They made it quite clear how they made their decision by considering how people might perceive the implications of its usage in the adverts.

There are several ways the use of Dr might mislead,

• If you have a PhD and use the title in a medical context, consumers might be misled into thinking you are a medically qualified practitioner.
• If you are selling a service and use a PhD title, but that title is in an unrelated subject, consumers might be misled as to your expertise and experience.
• If you have a PhD from an unaccredited institution or degree mill then people might be misled as to the quality of your qualification. This has been best exemplified in the UK with the case of Gillian McKeith, or to give her full medical title… (As a side note, Dr Burns-Hill states she is a Hormone Health Specialist for the Complementary Medical Association. The President of the CMA claimed to have a Professorship from a burnt-down Nepalese University.)

It is not true what Burns-Hill claims that the ASA are stopping people from using the title Dr in their professional context. If that qualification is relevant, transparent and not likely to mislead in an advert then that is fine. The ASA have advised Burns-Hill how to achieve this. The ASA has no remit over how you use your title in your professional life apart from how you advertise your services.

What is missing from Burns-Hill’s argument is any meaningful details about her own PhD. We do not know the details of her qualifications. I have repeatedly asked her on her Facebook page and she has refused to say where she obtained her PhD. Her website merely gives the title of the thesis ‘Holistic healing from breast cancer through the lens of hormones: Synopsis and synthesis’. (The word ‘holistic’ should ring very loud alarm bells.) We do not know when or where this research took place or who awarded the qualification. I cannot find any reference to this thesis in an academic context online. This is quite remarkable. I cannot think of any meaningful reason why an academic would not make clear this information. Her LinkedIn page lists Bath Spa as her education but this could be for an undergraduate degree or for her MSc in ‘Health Promotion’ (although I cannot find any such programme listed.) I have asked Burns-Hill to explain why she is withholding this information and she replies,

when you have an understanding of the issue here I will be pleased to communicate further. Until you can do your research and gain that understanding I see no point in continuing. You really are trolling and to what end or agenda I do not know but can only guess.

Insisting that you can style yourself ‘Dr’ in order to promote your business whilst refusing to be transparent about the nature of that qualification strikes me as problematic. Burns-Hill and her helpful MP John Glen accuse the ASA of lacking transparency in their work. Perhaps we could take these concerns seriously if Burns-Hill herself was transparent in her own work so that we and her prospective clients can make informed decisions about whether or not her services were backed by good evidence, had good outcomes with low risks. This is central to medical ethics – informed decision making. And so, I would challenge Burns-Hill to be transparent now and give full disclosure about the nature of her qualifications.

This goes to the heart of what the ASA seeks to achieve. It wants consumers to not be misled. Claims should not be made that cannot be substantiated or are untrue. It does a pretty good job in holding advertisers to those standards. The world of alternative medicine has a problem with this. Only its own ‘truths’ count. Calling yourself Dr implies things about yourself: your expertise, your experience, the quality of your education. It should not be an advertising tool but a marker of trust. If that trust cannot be backed up then it using the term Dr has no place in healthcare. Dr Burns-Hill, can we trust you?

 

Updates

Dr Burns-Hill replies (via Facebook)

You deserve no reply to this. The title of your blog is well known to those in the know. You are nothing more than an internet troll, intent on disparaging more natural approaches to being healthy. As I am someone who has overcome cancer more naturally and regularly work with people who want a more natural approach to being healthy I have nothing to say to you. Someone who spends so much time putting an article of this size together has their own agenda and it’s certainly not based on truth and integrity.

I am not convinced this is an adequate reply from a health professional to the concerns raised.

Saturday 28th May 2016

It looks as if the well-trodden path of deleting material is now being followed. I am somewhat long in the tooth when it comes to investigating alternative medicine and so naturally anticipated this action being taken. So, for completeness I post screen-grabs of the facebook discussion where I and others asked for details of her PhD.