On the way to work recently, I heard a radio advertisement that sparked my interest. A cancer center (not my own) was advertising 3D mammography to patients as an alternative to standard mammography. As a GI oncologist, I have to admit knowing very little about 3D mammography. But as a health services researcher interested in cost of care and comparative effectiveness, I wondered whether that claim was accurate. A cursory literature review suggested that this technology is more accurate than digital mammography, but it also requires the same dose of ionizing radiation (if not more if you count the conventional mammogram that has to be done at the same time), the reading time can be twice that of standard mammography, and I don’t believe the test is covered by Medicare. Not surprisingly, none of these potential negatives were covered in the ad.
Of course, this wasn’t the first time I had encountered direct-to-consumer advertising (DTCA) of a medical intervention. Once, traveling in Ohio, I saw not one but two billboards between the airport and my destination advertising gamma knife therapy. And those billboards can really drum up business. I’m certain you’ve had patients ask, “Doc, why can’t I get that gamma knife treatment?” Or the ubiquitous, “Can’t I get that shot to boost my blood cell counts?” Cancer treatments aren’t anywhere near the most common subjects of direct-to-consumer advertising. If I showed you an unlabeled image of a couple relaxing in claw-footed bathtubs, holding hands, and gazing into the sunset, I have no doubt you could name the associated drug.
So, what was it about the 3D mammography radio ad that got me thinking? Maybe it was hearing about yet another breast cancer screening modality marketed to patients when we aren’t really sure how to best use the ones we already have. Or, maybe it was because it brought to mind others who also heard the ad—maybe the woman in the car next to me just had regular old mammograms the day before; after hearing the ad, did she now doubt the accuracy of her negative result?
For decades, there have been restrictions on doctors’ involvement in product advertising (“I’m not a doctor, but I play one on TV…”). If we as physicians are uncomfortable hawking medical interventions, why is that ad any better without an MD in the picture? To better understand the effect of direct-to-consumer advertising, I contacted Dr. Gregory Abel at Dana-Farber who has done some interesting work in this field (see here and here). He pointed out that DTCA might be useful in raising awareness: “… [I]n our survey of actively-treated cancer patients, a majority of the 86.2% of patients who were aware of cancer-related DTCA reported it made them ‘aware of treatments they did not know about’ (62.2%).” On the other hand, DTCA might undermine patient faith in their physicians: “For example, in our survey 11.2% reported that cancer-related DTCA made them ‘less confident’ in their providers’ judgment, which could be devastating for patients facing a lethal disease.”
These days, billboards and radio ads are just the gateway to direct-to-consumer advertising. More and more, our patients are pushing past conventional advertising into the far reaches of the Internet to learn about their disease and the best treatment options available. I have to wonder whether we have played any role in this process—if we communicated options better, would patients have to rely on a radio ad? Leave a comment—let me know what you think.
Jose G. Barreau, MD
Dec, 08 2013 11:55 AM
Nice article. I think most physicians believe our profession is above DTCA and that our patinets come to us from word of mouth advertising or referrals from physicians who trust us. This is changing quite rapidly as health care organizations consolidate and employ more physicians. As we know most DTCA in other industries is not concerned about a balanced view of their product backed by scientific evidence. They want to sell the product to the consumer, period. We are heading into a different time in healthcare as big corporations employ more physicians and it will be the physicians responsibilty to ensure that what the oganization promotes is in the best interest of the community.
Yousuf Zafar, MD, MHS
Dec, 08 2013 10:13 PM
Hi, Jose. Thanks for your comment. I totally agree. It's an interesting business we are in, where at times we almost act as intermediaries between industry and patients. Hope you are doing well!
Jeffrey Bryan VanDeusen, MD, PhD
Jan, 04 2014 7:34 AM
Great article Yousuf. I think this crosses a lot of our minds. I no longer work at a large academic institution so trust in my plans and my care can be a fragile thing when we first meet. I think a lot of practitioners at smaller hospitals face this.
I keep an open and honest dialogue with patients. I let them know I don't know everything but that I'm willing to consider anything they bring to me. I give them websites for information where they can go to learn more if they wish. I tell them this right at their first visit. Rather than erode confidence in me I find it builds trust in me to be open and honest with them and it reassures them that their voice counts in our plans. Open dialogue will take care of that 11.2% erosion.
Yousuf Zafar, MD, MHS
Jan, 10 2014 8:59 AM
Hi Jeff, Great to hear from you. You make a great point about being upfront about what we do and do not know. I've so often found that my relationships with patients grow stronger when I do so.