Academic medical centres need to monitor advertising

Although many prominent academic medical centres develop and distribute advertisements to attract patients, none have a formal review process to assess the balance and straightforwardness of these advertisements, according to a study by researchers at the Veterans Affairs Medical Centre and Dartmouth Medical School (DMS), who have concluded that some advertisements promote services of unclear health value to the public and many appear to put the financial interests of the medical centres before the interests of the patients.

Similar advertising practices by pharmaceutical companies have been criticized for creating demand for services and failing to present balanced information, but academic medical centres have not been criticised, says Dr. Robin Larson, instructor in medicine at DAMS and lead author of the study.

In the study, published in the March 28 issue of the Archives of Internal Medicine, researchers examined the marketing practices of the 17 academic medical centres named in the 2002 US News & World Report's 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 centre's marketing department and obtained all non-research-related print advertisements distributed by the centres during 2002.

16 of the 17 academic medical centres advertised to attract patients, but none had a formal process for reviewing the ads to assure balance and straightforwardness. Of the 122 ads that were aimed at attracting patients, the most common marketing strategy involved an emotional appeal to evoke feelings of fear, hope, or anxiety about a health risk. The researchers also found that several of the advertisements promoted tests or services whose health benefits are unclear, such as full body CT scans, and all but one of the ads for specific services neglected to note the potential harms or side effects of the treatments they were promoting. Several of the ads were for cosmetic procedures.

They were surprised by the apparent mismatch between academic medical centres status as prominent and trusted sources of information and their use of emotional appeals and promotion of unproven services to generate revenue, said co-author Dr. Steven Woloshin, associate professor of medicine and of community and family medicine and a member of Centre for the Evaluative Clinical Sciences at DMS. Of concern was that while the financial interest of pharmaceutical companies invoked a healthy degree of scepticism among viewers of their advertisements, academic medical centres were possibly viewed as more trustworthy sources of information.

While the authors stress that they are not against advertising by academic medical centres and acknowledge public advertising may help to address financial challenges in what is becoming an increasingly competitive marketplace in healthcare, they recommend that the centres re-examine the process by which their advertisements are developed and view the findings as an opportunity for improvement and a stimulus for developing guidelines for their advertising procedures. Advertisements should promote evidence-based services or at least those likely to improve overall public health and should be presented in ways that assists the public in making good health decisions by providing balanced and objective information.