Would Publishing Survival Data Be Better?
Critics charge that cancer center advertising would be more ethical if such hospitals published survival data to back up their emotional appeals. Most don't. A 2012 Attadale Partners survey of 94 cancer centers found that only 12% reported survival data for a single type of cancer, 18% reported data for more than one type of cancer, and 69% didn't report any survival data.
But even if cancer centers could somehow squeeze survival data—with all their qualifications and caveats—into a print ad or TV spot, there isn't a standard benchmark to compare apples with apples. The Attadale survey found that 62% of cancer centers used the National Cancer Database as a benchmark; 14% used the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program data set; 14% used other data sets; and 10% didn't compare their data against any benchmark.
Given this, how would publishing survival data help a patient seeking to improve her odds? Dana-Farber/Brigham and Women's Cancer Center in Boston, Massachusetts, for one, has concluded that it wouldn't—and furthermore, that publishing survival data, however good, could be used against them by competitors, who may cherry-pick patients to include to improve their numbers.
"On a risk-adjusted basis, we have some of the best, or the best, survival data in the country," surgical oncologist Michael Zinner, MD, Dana-Farber's clinical director, reflected in a 2014 Harvard Business School case study on cancer center advertising. "So I asked my colleagues, 'Why don't we tell people this?' They said it will be misinterpreted. Even the best survival data, comprehensively and transparently presented, can be made to look inferior in comparison to data based on selecting only the patients more likely to survive longer."
Should These Ads Be Better Regulated?
Should cancer centers be held to a higher standard than other types of advertisers because the products and services advertised are inherently different from those of other industries?
"Most of us know that even the best of ads contain a kernel of truth surrounded by deceit and exaggeration," Dr Santa of Consumer Reports writes. "It's one thing when you're talking about which car to buy or laundry detergent to use. It's another when it comes to the best way to treat a health condition or where you'll get that medical treatment."
In March, the American Journal of Bioethics published an article, "The Ethics of Advertising for Health Care Services," arguing much the same thing. "Common advertising techniques that may not be problematic to consumer goods or services pose unique ethical risks when used by health care institutions to advertise clinical services," the authors wrote.
Dr Schenker, the article's lead author, notes that even the tag lines used in the ads may be misleading. For example, an ad for Memorial Sloan Kettering Cancer Center in New York reads, "Where you're treated can make all the difference."
"The statement may be factually true (where you are treated is likely to make a difference in something) but differs from what is understood: Where you are treated will make a difference in whether or not you survive, and if you are treated here you have a better chance of survival" than elsewhere, the authors assert.
Similarly, the use of first-person accounts, including those by celebrities, creates empathy, the authors observe, but "what most advertisements do not emphasize is the degree to which featured personal stories exemplify the experiences of most patients or the probability of achieving similar results," Dr Schenker says.
"In spirit, we could hold cancer centers to the same standard as other types of advertisers," says pediatric oncologist and bioethicist Steven Joffe, MD, MPH, vice chair of Medical Ethics and a professor at the University of Pennsylvania. "To my knowledge, there's no regulatory structure in place that ensures they are held to those standards. But we could make it mandatory for advertisers to provide links to the evidence that supports the claims that are made."
"My concern is that the evidence be there somewhere," Dr Joffe adds. "Yes, it will be very difficult for patients to parse detailed factual data if they're presented in the ads," he concedes. "And that may be too high a standard to hold cancer centers to. But I just think their ads need not be misleading."
"Personally, I would like to see us view advertising as part of the ethical responsibility of healthcare institutions," Dr Schenker says. "That responsibility is based on different premises from the responsibilities of other kinds of companies that may be advertising their services. But in terms of data to inform the debate, it's lacking."
The Federal Trade Commission (FTC) does have rules for what healthcare advertisers can and can't say in ads, but the budget sequestration in 2013 left the agency understaffed, reducing its oversight capabilities.
In any case, "the issue of when to regulate and what warrants action becomes complex," Dr Schenker says. "To the extent that you don't provide actual information, perhaps you're not misleading patients. We can argue about whether or not that's true, but I wonder whether we're not seeing the effects of that in these ads to some extent."
"We need to remember that advertising is advertising," Dr Schenker says. "If and when we see easily accessible public reporting of quality data, I don't think advertising will be the place where we're likely to see it."
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Cite this: Is Cancer Hospital Advertising Misleading Patients? - Medscape - Dec 04, 2014.