Are Cancer Center Ads Problematic Ethically?
Direct-to-consumer advertising by cancer centers in the United States has raised ethical concerns among some physicians. These ads often imply that a given hospital offers superior treatment in an effort to win cancer patients' business, yet no data and scant facts are given to support such implied claims.
In May, a study in the Annals of Internal Medicine raised difficult questions about the medical content—or lack of it—in print and TV ads run by both profit and nonprofit cancer centers, including many of the most prestigious hospitals in the United States.
According to an analysis of over 400 ads from over 100 cancer hospitals, most (88%) promoted cancer treatments, but only 18% promoted cancer screening and even fewer (13%) promoted support services. Of those ads that promoted cancer treatments, 57% mentioned treatment for a specific type of cancer. Only 9% mentioned cancer stage. One quarter promoted the potential benefits of offered treatments or mentioned the potential risks. Only 2% quantified the benefits. Only 5% mentioned cost.
Most ads used emotional appeals to kindle hope of survival. Ambiguously worded copy often implied that a given center offered better odds of survival than competitors, but did not include actual survival data for the ad sponsor's own patients, the investigators found. Nearly one half of the ads used patient testimonials. In TV spots and print ads, former patients spoke of being "cured" of cancer and of a hospital or treatment as being "miraculous," "remarkable," or "extraordinary."
A Disconnect Between Emotional Appeals and Facts
Internist and bioethicist Yael Schenker, MD, at the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania, was the study's principal investigator. She told Medscape that although 59% of the ads were from for-profit cancer centers, 16% were from National Cancer Institute-designated centers and 59% were accredited by the Commission on Cancer.
"I don't think we were surprised by the use of emotional appeals," Dr Schenker reflected on the study results. "They're memorable, and certainly that was something we had noticed anecdotally about cancer center advertising. We were more surprised by the extent to which those appeals were uncoupled from actual information about quality and costs in the ads, even in some of our most prestigious nonprofit cancer centers."
For some physicians, such tactics are problematic. Internist John Santa, MD, MPH, director of the Consumer Reports Health Ratings Center, is one of them.
"Proponents claim that such advertising, whether for drugs or treatment centers, increases awareness of a disease, prompts people to see their doctor, and helps foster doctor/patient partnerships. And they might be right if marketers focused on those objectives—but they don't. Their goal is to sell their product regardless of risk or cost," Dr Santa wrote on the Consumer Reports website.
He added, "Modern cancer treatment has plenty to offer without resorting to exaggeration and emotional manipulation."
"Advertising is really just about rearranging market share," notes oncologist Ezekiel J. Emanuel, MD, PhD, director of the Clinical Bioethics Department at the National Institutes of Health and chair of the Department of Medical Ethics & Health Policy at the University of Pennsylvania in Philadelphia. "I understand it's a business practice. But it's not a professional practice. It's not really about ensuring the health of the community. And I think that's what is essentially frustrating to people."
Dr Emanuel finds that emotional manipulation in ads is unsurprising. "What would you expect them to put up except an anecdote that's favorable to them? Ads are meant to sway people; they aren't meant to give people data," he says.
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Cite this: Is Cancer Hospital Advertising Misleading Patients? - Medscape - Dec 04, 2014.