Some cancer centers that advertise don't like to advertise the fact.
That seemed to be the reaction of certain academic cancer centers when OT began calling around the country about institutional advertising programs and whether what was being put forth to the public in ads or commercials was vetted internally regarding accuracy and certain claims.
Currently, there is no external review of hospital advertising—no Food and Drug Administration or Federal Trade Commission-like governmental agency overseeing the truth or accuracy of advertising messages, and that means that advertising claims by nonprofit hospitals can fly under the radar of oversight.
And marketing of cancer treatments has been very competitive, especially in larger cities with numerous choices—and large outlays of capital for expensive devices.
For example, in Philadelphia where I've resided most of my professional life, there are times of the year when the public will be bombarded by large numbers of competing commercials summoning potential patients to the area's many cancer facilities touting their considerable expertise on the airwaves and in print in what could best be described as cancer center marketing wars.
There was one academic center in the City of Brotherly Love that used to make the claim in the 1990s that “We're tougher on cancer,” while another hospital proclaimed (for various diseases) that it was a “genius in health care” because it was named after a certain physicist who had exemplified brilliance.
And while this article was being researched one cancer center asserted in a local TV commercial that it had “the most experienced surgeons.”
The New York Times published an article in December under its “Forty Years’ War” series, “Cancer Center Ads Use Emotion More Than Fact,” by Natasha Singer. That story dealt with the lack of regulation of hospital advertising and the fact that some ads’ anecdotal claims, such as “highest cure rates, or lowest risk” would not be considered statistically valid by medical science, “but ads for nonprofit medical centers are not held to scientific standards of evidence.”
I called the five NCI-designated comprehensive cancer centers followed in OT's series last year about how the cancer community was affected by the recession.
The institutions—City of Hope, Ohio State University/James, Johns Hopkins, M. D. Anderson, and Roswell Park—were chosen again because they reflect diverse structures and regional differences.
However, a number of centers seemed reluctant to cooperate and initially only offered “interviews”’ via e-mail, until multiple requests—some to cancer center directors—finally yielded human spokespeople willing to discuss their respective cancer center's advertising programs by phone.
Some of these centers also wanted to know which other institutions had agreed to be interviewed before they consented.
I also contacted several organizations representing the interests of academic medical and cancer centers—the Association of American Cancer Institutes (AACI), the National Comprehensive Cancer Network (NCCN), the National Cancer Institute Public Affairs and Marketing Network (PAN), and the Association of American Medical Colleges (AAMC).
I also spoke with Lisa M. Schwartz, MD, MS, Professor of Medicine (General Internal Medicine) and of Community and Family Medicine at Dartmouth Medical School, and a member of Dartmouth Institute for Health Policy & Clinical Practice, who coauthored (with Robin J. Larson, MD, MPH, Steven Woloshin, MD, MS, and H. Gilbert Welch, MD, MPH) the article “Advertising by Academic Medical Centers” in Archives of Internal Medicine (2005;165:645-651).
‘Can Generate False Hope & Unrealistic Expectations’
“People are often surprised that this is unregulated advertising, and it can generate false hope and unrealistic expectations about treatment. They may assume it falls under the FTC but it doesn't,” Dr. Schwartz said, adding that the only oversight may come from each state's respective attorney general's office, but that she wasn't aware of any specific actions that have taken place.
Her 2005 study concluded that top academic medical centers commonly use direct-to-consumer advertising to attract patients, but it is not subjected to the same oversight that is standard for clinical research; although the FDA does have guidelines for advertising to attract research participants in clinical trials.
“Many of the ads seemed to place the interests of the medical center before the interests of the patients,” she and her coauthors wrote.
She noted that when a colleague addressed some AAMC members following publication, the reception was less than welcoming.
Elisa K. Siegel, AAMC's chief communications officer, told OT that the New York Times article had sparked some internal and informal conversation about the issue and that the association's Group on Institutional Advancement (GIA) was developing a panel discussion for its fall 2010 annual meeting to discuss some of the issues raised.
She also noted that the American Hospital Association (AHA) had published a management advisory in 1990 about “Advertising by Health Care Facilities.”
Health care advertising content, that document stated, “must be measured primarily by its truthfulness, fairness, accuracy, completeness, and sensitivity to the health care needs of the public.
“False or misleading statements, or statements that might lead the uninformed to draw false conclusions about the health care facility, its competitors, or other health care providers are unacceptable and unethical. As with all health care services, advertising must be crafted and executed in the spirit of putting the needs of the patient first.”
Ms. Siegel said that AAMC's role is “exchanging information and better understanding of issues and promoting best practices.
“I would say it is a general rule that most of our member institutions have some sort of centralized review process for advertising that involves their senior administrative and clinical staff,” she said.
As for the reaction to the 2005 Archives article, she said that certain institutions didn't necessarily agree with some of the study's methodology.
‘Not an Issue Until NY Times Article Appeared’
NCCN EVP and COO Patricia J. Goldsmith said that regulation of cancer center advertising had not been an issue among the Network's 21 member institutions until the Times story appeared.
She said that some NCCN members had been interviewed for the article, and that the group's communications committee comprised of representatives from the 21 cancer centers would be discussing the issue on March 10 during NCCN's annual meeting.
“We'll be bringing in a former Federal Trade Commission lawyer who will talk about these issues from a regulatory perspective, which should lead to some active and robust discussion.
“But NCCN does not mandate what member institutions do in terms of marketing,” she added. “We are not a mandating organization and some of our members have very different situations and it wouldn't make sense to have universal standards.”
When OT contacted AACI regarding an overall statement about its 95 members’ advertising practices and policies, and to ask permission about submitting a short e-mail survey to the institutions’ respective marketing heads, the communications director said that advertising had not been much of an issue at AACI, but later noted that querying its members about advertising issues was a sensitive topic.
He then cited time and logistical constraints as major obstacles to fulfilling the survey in time for this article.
Several days later I spoke with AACI Executive Director Barbara Duffy Stewart, MPH, who said that advertising has not been on the group's agenda to date, since AACI's focus has been working with established and “emerging” cancer centers such as Stanford, Emory, and South Carolina (which have recently been granted NCI-designation status) on clinical and funding issues.
She said AACI has been involved in helping the centers work together and developing various initiatives including patient access to clinical trials and Project Cancer Education to aid elected officials in understanding more about cancer research and state-of-the-art cancer care (OT, 12/10/09).
Kevin Koga, steering committee chair for the Public Affairs and Marketing Network, who is vice president for communications at City of Hope, said that hospital advertising had not been formally addressed by the Network.