Study Questions Practice of Hospital Advertising

MONDAY, March 28 (HealthDay News) -- Academic medical centers are relying more and more on advertising to attract patients, yet there appears to be little oversight of these practices, experts say.

The result is that many of these ads seem to place the interests of the medical center above the interests of the patients, a new study contends.

An internal review process would go a long way toward ensuring that the interests of patients are protected, said the authors of the study appearing in the March 28 issue of the Archives of Internal Medicine.

"We''re not looking for huge regulation of medical centers and we don''t necessarily think they shouldn''t advertise at all," said Dr. Robin Larson, lead author of the study and a clinical researcher with the VA Outcomes Group at the Veterans Affairs Medical Center in White River Junction, Vt. "This is the reality of how it is, but there are things they can do to make it better."

The study was also presented at the 2003 annual meeting of the Society of Internal Medicine.

Others, however, feel that oversight should be more stringent.

"Advertising is a form of propaganda. It attempts to bypass the viewer''s or listener''s rationality and get people to respond to things emotionally, to instill needs where needs might not exist, to make people feel comfortable when they have no idea what it''s really about," said Paul Levinson, chairman of the department of communications and media studies at Fordham University in New York City.

"It''s fine when it comes to cereal or even automobiles. It''s fine when it comes to clothing and perfume. It''s not fine when it comes to hospitals," he said.

Direct-to-consumer advertising of prescription drugs had come under intense scrutiny in the wake of the recent Vioxx debacle. Experts across many fields felt that the huge advertising effort behind Vioxx and other cox-2 inhibitors contributed to an over-prescribing of the drugs, and the subsequent heart-related problems experienced by some users.

Ads by medical centers are a more recent phenomenon, another product of an increasingly competitive health-care market, but they have not been analyzed so closely.

Medical centers already advertise widely to attract participants for clinical trials, but these ads are subject to approval by an institutional review board.

To try to characterize ads aimed at attracting patients, the authors of the new study looked at all 2002 non-research print ads in the five most widely circulating local newspapers for the 17 academic medical centers included in U.S. News & World Report''s annual list of "America''s Best Hospitals." The authors also interviewed members of the hospital''s marketing departments about their advertising practices.

Of the 17 institutions, which included Johns Hopkins in Baltimore and the Mayo Clinic in Minnesota, 16 reported advertising to attract patients.

The authors identified a total of 127 print ads not related to recruiting participants for clinical trials. Three of these promoted community events sponsored by the institution, two announced "genuine" public services while the remaining 122 were geared to attracting patients.

Of those 122 ads, 29.5 percent (36 ads) promoted the entire medical center, 53.3 percent (65 ads) promoted specific departments and 17.2 percent (21 ads) promoted single tests or interventions.

Then, of those 21 ads for a single intervention, 28.6 percent were for cosmetic procedures. More than half of the ads outlined benefits of the procedure but only one mentioned potential dangers, the study found.

Whole body imaging was one technique that was advertised, and one which does not have science to back its widespread use. "The advertising gives it credibility it doesn''t deserve," Larson said.

The most popular marketing strategies included appealing to emotions (61.5 percent), highlighting the prestige of the institution (60.7 percent), singling out a symptom or disease (53.3 percent), and promoting introductory lectures or special offers (47.5 percent). These offers included complementary health screenings and first-aid kits.

And while all 17 centers said they had an institutional review board to approve advertising for research subjects, none had a similar process in place for ads to attract patients.

But there is hope for change, the authors added.

"My sense is the medical centers want to do the right thing," Larson said. She added that when she presented her findings to Dartmouth University (where she also holds an appointment) responses from both the marketing department and the medical director were overwhelmingly positive.

Larson said an internal review process -- even one overseeing a consortium of academic medical centers -- might be a way to instill standards in advertising.

Levinson, however, was tougher and more specific.

"I would urge that these ads be banned," he said. "What ads are designed to do through images and music is to get people to feel good about these products. That''s not appropriate when dealing with medical situations. I''m against FCC [Federal Communications Commission] control of the media, but this is one of the few instances where I think the government has to step in and stop these ads."

More information

The U.S. Food and Drug Administration has an article on direct-to-consumer advertising.

SOUCES: Robin J. Larson, M.D., clinical researcher, VA Outcomes Group, Veterans Affairs Medical Center, White River Junction, Vt.; Paul Levinson, Ph.D., chairman, department of communications and media studies, Fordham University, New York City; March 28, 2005, Archives of Internal Medicine