Advertising by Academic Medical Centers
According to a report by the Commonwealth Fund, academic medical centers have a public mission to “improve the health of their communities and the larger society in which they reside.” However, in order to serve this mission, they need to keep afloat financially—a task that has ostensibly become increasingly difficult since the 1990s, when policy changes began to place added financial pressures on hospitals. Some of these centers have turned to direct-to-consumer advertising as a way to generate more income. At the same time, this advertising has been met by a largely receptive public, who have lately become more interested in choosing their own health care services.
Regardless if advertising by academic medical centers is wrong or right or successful or not, it is helpful to get a handle on what type and how much of it is going on. As part of this effort, researchers from the Department of Veteran Affairs Medical Center in Vermont analyzed newspaper advertisements by 17 of the nation’s top academic medical centers in the year 2002. Their results, published in the March 28, 2005 issue of the Archives of Internal Medicine , revealed that out of the 127 ads, 53% promoted specific clinical departments within the medical center, and 17% promoted specific therapies or diagnostic tests, most of which were either cosmetic procedures or lacked data or consensus on their safety and effectiveness.
About the Study
The researchers limited their inquiry to a prominent subset of the approximately 120 academic medical centers in the US; they recruited only the 17 centers that made the highly-esteemed US News & World Report 2002 honor roll of “America’s Best Hospitals.” The study’s two main objectives were to examine the approval process for the ads and the content of the ads.
To achieve the first objective, researchers interviewed key marketing personnel at each participating medical center. To achieve the second, they collected all print advertisements placed by each center in the five most highly circulated newspapers in their vicinities in 2002. After excluding all ads that were recruiting participants for research studies, they analyzed each ad for overall purpose, specific subject, and marketing strategies.
Sixteen out of the 17 centers’ marketing departments reported using advertising to attract patients. The one that did not said “We’re just word of mouth.” A total of 127 non-research-related ads were identified among the surveyed newspapers—averaging 7.5 per hospital.
Before ads designed to recruit participants for research studies go out, they undergo a painstaking, mandatory approval process to ensure that they present fair, balanced, and straightforward information on what the study or intervention will entail. Not so for general health services ads: in fact, no formal approval processes seemed to be in place for these ads at any of the participating institutions. For that matter, marketing personnel at about half of them reported that individual departments could design and place their own ads without even informing the marketing department.
Subject & Purpose
Out of 127 ads, five were promoting community events or genuine public service events, so they were excluded from analysis. Of the remaining 122, 53% (65) promoted specific clinical departments, and 17% (21) promoted a single therapy or diagnostic test. The most commonly advertised clinical departments were those providing cardiovascular, cancer, screening and prevention, and orthopedic services.
Of the 21 ads promoting a specific intervention, most were either cosmetic procedures or those that lacked data or consensus on their safety and effectiveness. And while more than half of these ads specified benefits of the procedures, and a third compared them to inferior alternatives, only one acknowledged any risk.
The most commonly used marketing strategies were:
- Appealing to emotions (62%), e.g., hope, fear, happiness, anxiety, or sympathy
- Highlighting institutional prestige (61%), e.g., “top rated”
- Promoting an introductory lecture or special offer that would likely lead to further business (48%), e.g., free fertility symposium
- Highlighting advanced technology or resources (34%), e.g., “cutting edge”
- Mentioning convenience (21%), e.g., “multiple locations”
How Does This Affect You?
This study showed that the top academic medical centers circulate an average of seven or eight ads per year in their most widely circulated local newspapers, and employed typical marketing strategies such as emotional appeals, claims of superiority, and special offers.
Furthermore, this study found no formal approval process for health services advertising in these institutions. The researchers contend that prospective patients should receive the same fair and balanced advertising as research subjects do.
Consumers are generally wary of advertising, considering the obviously self-interested motives of most advertisers. But academic medical centers arguably inhabit a sort of sacred ground in the eyes of many Americans who may not view their ads with the same level of skepticism. Consumers who do not question the validity of some of these advertisements could be attracted to medical services that are unnecessary, or worse, harmful.
For what it's worth, consumers can take some comfort in the Federal Trade Commission’s responsibility to regulate advertising and ensure that it’s free of false, unsubstantiated, or otherwise deceptive claims. (The FDA also regulates advertising for prescription drugs.) Additionally, given the widespread concern over medical liability, it is not in the best interest of hospitals—particularly the top academic medical centers—to purposefully deceive the public.
The Commonwealth Fund
The Federal Trade Commission
Arora V. The Future of Academic Medical Centers (Book Review). New England Journal of Medicine . 2002; 346(14): 1100. Available at: http://www.amazon.com/exec/obidos/tg/detail/-/081570237X/002-3092517-2571218?v=glance . Accessed on March 29, 2005.
The Commonwealth Fund. Envisioning the Future of Academic Health Centers: Final Report of the Commonwealth Fund Task Force on Academic Health Centers . New York, NY: Commonwealth Fund; 2003.
The Federal Trade Commission. Advertising Regulation and the Free Market. Available at: http://www.ftc.gov/speeches/azcuenaga/lima.htm . Accessed on March 29, 2005
Larson RJ, Schwartz LM, Woloshin S, Welch HG. Advertising by Academic Medical Centers. Archives of Intrenal Medicine . 2005;165:645-651.
Last reviewed March 31, 2005 by ]]>Richard Glickman-Simon, MD]]>
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