Selective outrage about direct-to-consumer advertising

In the January 2007 issue of The Hospitalist Dr. David Oxman (p.17) writes: “By now Americans are accustomed to seeing advertisements for medical goods and services. The steady supply of direct-to-consumer TV advertisements by the pharmaceutical industry is probably the most high-profile example. But while much has been written about the negative effects of these advertisements, the impact of healthcare service advertising—by hospitals as well as by individual physicians—receives comparatively little attention and almost no debate.”

Although the ethics of hospital and physician practice advertising are, to say the least, problematic, the practice is widespread---every bit as widespread as pharmaceutical company advertising. And let’s face it: many of the outreach and “educational” programs put on by hospitals are little more than promotional events.

This survey from Archives of Internal Medicine a couple of years ago (cited in Oxman’s article) looked at the 17 “America’s Best Hospitals” and concluded “Advertising to attract patients is common among top academic medical centers but is not subjected to the oversight standard for clinical research. Many of the ads seemed to place the interests of the medical center before the interests of the patients.” All but one of the institutions advertised. Commonly the ads appealed to patients’ emotions or emphasized institutional prestige. Over half mentioned a symptom or a disease and many offered introductory free or discounted services.

In other words, the investigators found evidence of conflicts of interest, disease promotion (or what some might call “medicalization”), non-evidence based claims and free “samples.” Does this sound familiar at all? Isn’t it interesting how doctors rail about pharmaceutical ads while remaining silent about the equally pervasive and questionable promotions coming from their own practices and institutions? Our profession’s ethical stance on this issue is disingenuous. We have no credibility in criticizing DTC advertising until we put our own house in order.