Academic medical center advertising may risk eroding public trust, study says

Most well-known academic medical centers develop and distribute advertisements to attract patients. Yet, all of them lack a formal review process to assess the balance and straightforwardness of these ads, according to a study by researchers at the Veterans Affairs Medical Center and Dartmouth Medical School (DMS).

The study was funded in part by grants from the National Cancer Institute, the Robert Wood Johnson Foundation, and a Research Enhancement Award from the Department of Veterans Affairs and conducted at the VA Hospital in Vermont.

Several of the ads promote services of uncertain health value to the public and, in some cases, appear to place the financial interests of the medical centers ahead of the interests of patients, the authors concluded.

“We found it interesting that similar advertising practices by pharmaceutical companies have been criticized for creating demand for services and failing to present balanced information, but no one seemed to be turning the same critical eye on ads from academic medical centers,” said Dr. Robin Larson, DMS instructor in medicine and the study’s lead author.

Published in a recent issue of the Archives of Internal Medicine, the study examined marketing practices of the 17 academic medical centers named to the US News & World Report’s 2002 honor roll of “America’s Best Hospitals.” The researchers, all DMS faculty and members of the VA Outcomes Group in White River Junction, VT, interviewed each center’s marketing department and obtained all non-research-related print advertisements distributed by the honor roll centers during 2002.

They learned that while 16 of the centers advertise to attract patients, none have a formal process for reviewing the ads to assure balance and straightforwardness. Of the 122 ads aimed at attracting patients, the most common marketing strategy involved an emotional appeal to induce feelings of fear, hope, or anxiety about a health risk. The researchers also found that several of the advertisements promoted tests or services with unclear health benefits (for example, full body CT scans) and all but one of the ads for specific services failed to note potential harm or side effects of the treatments they were promoting. Several of the ads were for cosmetic procedures.

“We were surprised by the apparent mismatch between academic medical centers’ status as prominent and trusted sources of information and their use of emotional appeals and promotion of unproven services to generate revenue,” stated co-author Dr. Steven Woloshin, associate professor of medicine and of community and family medicine and a member of Center for the Evaluative Clinical Sciences at DMS.

The researchers noted that while the generally apparent financial interest of pharmaceutical companies may invoke a healthy degree of skepticism among viewers of their advertisements, academic medical centers may be viewed as more trustworthy sources of information. “We are concerned that when potential patients read these ads, they may not realize that the underlying motivation may be to attract patients, not necessarily to promote the health of the public,” Larson said.

While not against academic medical center advertising and acknowledging public advertising may help to address financial challenges in what is becoming an increasingly competitive marketplace in health care, the authors recommended that the centers reexamine the process by which their advertisements are developed.

“We hope that academic medical centers will view our findings as an opportunity for improvement and a stimulus for developing guidelines for their advertising procedures,” said Larson “If they are going to advertise, we would like to see them promote evidence-based services or at least those likely to improve overall public health. Ideally, ads would be presented in ways that assisted the public in making good health decisions by providing balanced and objective information.”

SOURCES: “Advertising by Academic Medical Centers,” Robin J. Larson; Lisa M. Schwartz; Steven Woloshin; H. Gilbert Welch Arch Intern Med. 2005;165:645-651.  

Dartmouth Medical School News Alert, Mar. 28, 2005.