Head To Head Head to Head

Should all advertising of cosmetic surgery be banned? No

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7508 (Published 07 November 2012) Cite this as: BMJ 2012;345:e7508
  1. Sally Taber, director
  1. 1Independent Healthcare Advisory Services, London WC1A 1DU
  1. SallyTaber{at}independenthealthcare.org.uk

After the recent breast implant debacle, the Department of Health is reviewing cosmetic procedures in the UK, including advertising to the public. Fazel Fatah says advertising preys on patients’ vulnerability and should be banned (doi:10.1136/bmj.e7489), but Sally Taber thinks regulation can give sufficient protection

Cosmetic surgery in the United Kingdom is a growing market, and behaves like the market for any other consumer good. A growth in demand (fuelled by coverage of celebrities in the media) leads to a competitive increase in supply, leading in turn to lower prices. What was once the preserve of the rich few is now affordable to many.

Every consumer magazine from Woman’s Own to Hello! gives advice on how to improve one’s appearance and stay young. Direct advertising of cosmetic surgery is a tiny, albeit important, aspect of this culture, and it is misguided to think that banning it will reduce demand.

The functions of advertising in this, as in any free market, are to inform and persuade. Restriction of information can lead to monopolies that deform the market, acting against the public interest. It would be regressive to back an advertising ban in this multimillion pound industry.

The Independent Healthcare Advisory Services (IHAS) is a trade body of which all major independent acute healthcare providers in the United Kingdom are members. The IHAS believes that advertising of members’ services is a legitimate and reasonable business practice, and that a general restriction would not be in the public interest. However, advertising in healthcare, as in any other sector, must not lead to public harm. Some invasive procedures included in our members’ repertoires contain such inherent risk to a patient that restraint must be applied in advertising them. This is why IHAS members have established and follow a code of practice for the advertising of their services that is designed to avoid harm to the public.

Cosmetic surgery and injectible procedures are not clinically indicated and have risks attached. The UK government holds that it has no place in regulating activities such as these, which are undertaken entirely at the volition of the consumer. It expects the industry to regulate itself, acting within the general framework of existing laws—for example, the Medicines Act (to control use of prescription-only drugs) and the Health and Safety at Work Act (to ensure the environment is clinically acceptable).

Advertising copy should not aim to persuade a patient to opt for multiple procedures if they would not otherwise do so. In particular, advertisements should not offer discounts or any financial inducement for multiple procedures. The IHAS, representing the responsible element of independent healthcare, thinks that such practices overstep the mark of fully informed consent. IHAS guidelines therefore ban them outright.1 2

The underlying principle of advertising in this sector is that providers should act responsibly towards patients by giving them balanced and factual information, giving them adequate time to reflect, and making sure that they understand that not all advertised treatments may be suitable for them. The IHAS has three relevant codes to which all members accede: the Policy Statement on the Advertising and Promotion of Non-Surgical Cosmetic Treatments by Independent Sector Providers, 1 the Policy Statement on the Advertising and Promotion of Cosmetic Surgery by Independent Sector Providers, 2 and Good Medical Practice in Cosmetic Surgery 2011.3

The IHAS works in conjunction with the Advertising Standards Authority committee on advertising practice and the authority’s code. This, like the IHAS advertising code, is voluntary, but is backed by sanctions if transgressed. Although the credibility of voluntary codes may be criticised because of problems with policing and enforcement, some cases illustrate the effectiveness of the IHAS codes. For example, Botox providers used an online company called Groupon to advertise at a reduced price to a small number of consumers within a limited timeframe.4 This breached the Medicines Act of 1973, which forbids direct advertising of a prescription-only drug to consumers. The IHAS also found concerns with a cosmetic surgery provider using Groupon to advertise breast augmentation, with an advert that provided too little information about the procedure, no opportunity for prior consultation, and no time to reflect.5 It raised these concerns with the ASA, which told Groupon to remove these advertisements. An investigation by the Office of Fair Trading found “widespread” examples of breaches of consumer protection rules by Groupon.4 Another company, Wowcher, advertised cosmetic treatments in the Metro newspaper with discounts for a fast sign-up. The IHAS advised Wowcher of its transgression, which has not been repeated.6 Of course, not all advertisements that offend ethics can be handled by IHAS.

Our members, intense rivals in the marketplace, sometimes unintentionally overstep the mark with their advertisements. Upon detection, all transgressors have agreed to remove the offending article and to be more careful to comply in future. Should a member not comply, it would probably be evicted from membership—as was the member that used Groupon to advertise breast augmentation—and the transgression repudiated publicly on behalf of complying members.

The substantial demand for, and profits from, cosmetic injectible treatments has led to many new providers entering the market. Many of these providers are inappropriately trained and use products of uncertain provenance in unhygienic surroundings. The public dangers of this uncontrolled incursion into what should be medical territory are substantial. At government request, the IHAS established an industry reference group that has assembled industry standards of best practice. It then set up a quality assurance mark and a publicly accessible register of professionals and clinics that meet the standards (www.treatmentsyoucantrust.org.uk). Providers that do not comply will be starved out of the market. This is the only means in the UK for a consumer to assure themselves that their cosmetic injectible treatment will be safe.

The register will work only if patients know about it. Unfortunately, many doctors who use injectible cosmetic substances refrain from joining the register, lessening its impact, confusing the public, and leaving the door open for rogues. The British Association of Aesthetic Plastic Surgeons would do better to put its weight behind this quality assurance initiative, and the IHAS codes for good practice in promoting cosmetic surgery, than to seek a ban on advertising, which will merely leave a confused public prey to dangerous exploitation.


Cite this as: BMJ 2012;345:e7508


  • Competing interests: The author has completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares: SMT had support from IHAS for the submitted work; SMT is director of IHAS.

  • Provenance and peer review: Commissioned; not externally peer reviewed.