As summer begins to give way to autumn (although, with these heatwaves, that might be hard to believe), we all need something to look forward to. So, I hope that many are in possession of tickets for the upcoming British Association of Cosmetic Nurses (BACN) annual conference, which is being held at the East Side Rooms in Birmingham on 15–16 September 2022. There is an excellent lineup of speakers who should not be missed. Some who I am personally looking forward to are Sarah Gilmore and Kimberly Cains, who will be discussing body dysmorphia, and Elizabeth Hawkes, who will speak about surgical blepharoplasty. The BACN works tirelessly to bring about an annual conference of diverse and interesting speakers with a professional and welcoming atmosphere. I personally feel very privileged to have this conference to look forward to.
Advertising within the scope of aesthetics
On a more serious note, I would like to take this opportunity to reflect upon the issue of advertising within the scope of aesthetic practice. Although the law clearly states that it is illegal to directly advertise prescription-only medicines (POMs) to the public, it seems that a lot of confusion remains around what practitioners are allowed to advertise in regard to promoting aesthetic businesses. I understand that some aesthetic practitioners feel aggrieved that they are unable to promote their businesses in the way that they may wish to on social media or otherwise. However, regardless of personal feelings and concerns, the fact remains that it is not lawful to advertise POMs or allude to them within an advertisement directly to the public. To help to explain what we can and cannot do, I have interviewed an incredible person called Dawn Knight. I refer to Dawn as the Erin Brockovich of the medical aesthetics world.
» It is hoped that changes to the Online Safety Bill will have a positive impact on the adoption of ethical advertising among practitioners who administer aesthetic procedures «
Background
Dawn was a patient who was seeking to address her appearance and functional issues. Following a blepharoplasty, she was left unable to close her eyes, thus risking her sight. The treating surgeon removed too much skin from her upper eyelids and then accepted no responsibility for what had occurred. On the back of this, Dawn became a patient safety advocate and now acts as a patient voice, who, at her own cost, financially, emotionally and physically, has campaigned tirelessly to bring about positive futureproof change within the UK cosmetic surgery and non-surgical cosmetic aesthetic sectors. She is a lay trustee for the board of the Joint Council for Cosmetic Practitioners (JCCP) and has been actively involved in the recent tabling of the licensing amendment to the Health and Social Care Bill (UK Parliament, 2022a). She has also played a critical role in briefing cross-party parliamentarians and peers within the House of Lords to enable them to have more insight and understanding of the true and present risk to the public from the lack of standardisation within the surgical and non-surgical aesthetic sectors. Dawn's journey has also seen her campaigning to highlight and bring about awareness that the rules around advertising POMs are largely being ignored or misunderstood within the medical aesthetic sector.
Overview of current issues
At the time of writing, the Aesthetic sector is on the verge of long-awaited change; this was recently detailed by fellow board member Sharron Brown in her article for the Journal of Aesthetic Nursing (JAN) (Brown, 2022). Sharron discussed the changes that are occurring within the sector. She highlighted that the Health and Social Care Bill (UK Parliament, 2022a) was a much-needed vehicle aimed at bringing about positive change to the NHS and private healthcare sectors, including the surgical and non-surgical aesthetic sectors. This change in the law will require the health secretary to implement a licensing scheme following on from a period of public consultation about what procedures will be included within the scope of the license. Simultaneously, while the Health and Social Care Bill (UK Parliament, 2022a) was at the forefront of everyone's minds, Dawn was actively working for amendments to be put within the up-and-coming Online Safety Bill (UK Parliament, 2022b). Luke Evans MP tabled the Online Safety Bill in an attempt to tackle issues linked to online safety and the lack of accountability in regard to this.
Patient safety and advertising
Dawn feels strongly that there is a current tsunami of illegal, predatory and coercive advertising on social media, and that this must be addressed (Knight, 2022). It is hoped that changes to the Online Safety Bill will have a positive impact on the adoption of ethical advertising among practitioners who administer aesthetic procedures. Dawn has worked alongside her MP, Kevan Jones, who has tabled the new clause 8 within the Online Safety Bill (UK Parliament, 2022b). This will require all cosmetic surgery and non-surgical cosmetic aesthetic adverts to carry a risk disclaimer or warning logo. Unfortunately, due to current Government instability, the Government has had to pause the Online Safety Bill; however, in a twist of fate, the very recently published report from the Health and Social Care Committee inquiry (2022) has included in recommendation 26 that a risk logo or a disclaimer should be included on all adverts for non-surgical aesthetic procedures that will fall within the scope of the new licensing regime. Personally, I feel that, although the Keogh report (2013) did more damage than good, it did raise a valid point when it discussed that there is a distinct lack of any risk disclaimer within the surgical and non-surgical sectors when compared to other advertisements, for example, for smoking (‘smoking kills’).
Since the announcement of the proposed licensing scheme, it is felt by some that there has been an increase in illegal advertising linked to aesthetic procedures on social media. I argue that this trend has been steadily increasing regardless. I also feel that this is not solely linked to lay practitioners, with many adverts targeting and attempting to influence often vulnerable people with incentives, such as ‘Brotox’, buy one get one free treatments and champagne Botox parties, etc.
Does using the above terms render an advert illegal? The Advertising Standards Agency (ASA) and the Committee of Advertising Practice (CAP) (rule 12, 12) advise that ‘prescription-only medicines cannot be advertised directly to the public. This includes abbreviations or other references, including product images, photographic images of ‘before and after’ treatments, videos, hashtags or anything that implies, encourages, entices or incentivises someone to partake in having a POM administered.
Part two of the Medicines Act 1994 (advertising—general section seven), the prohibition of advertisements for medicinal products that are prescription only, states that no person shall issue an advertisement that is likely to lead to the use of a relevant medicinal product that is a product for supply by prescription only, and which is subject to any of the restrictions imposed by section 58(2) of the Act. These laws are enforceable by the Medicines and Healthcare products Regulatory Agency (MHRA). If the MHRA considers that a serious offence has been committed by failure to comply with the above, then this could carry a penalty of an unlimited fine or 6 months imprisonment (MHRA, 2020). This should leave practitioners in no doubt that it is not legal or morally correct to advertise POMs directly to the public. The confines of the word limit of this article enable only a brief reminder and overview that aesthetic practitioners do have a moral, ethical and legal duty to ensure that their advertising is decent, honest and truthful.