What is the impact of medical advertising that is directly targeted at patients? What information do consumers of medical products and therapies need in order to make informed decisions about their health?
Consider the following:
Ms. J, a healthy 50-year old woman, drives by a billboard that advertises low-dose spiral computed tomography (CT) scanning to screen for lung cancer. Although she has no family history of cancer and has never smoked, several of Ms. J’s friends have been diagnosed with cancer recently. She worries that she herself may have an undetected malignancy.
Responding to this advertising, Ms. J decides to pay out-of-pocket for a CT scan at the imaging center advertised on the billboard. The radiologist at this imaging center profits from the number of scans interpreted. As a result of the CT scan, an abnormality is found, and Ms. J undergoes a biopsy of her lung. A complication occurs from this procedure, but Ms. J recovers, and the biopsy comes back negative. She is relieved to learn that she does not have lung cancer.
After reading this scenario and thinking about direct-to consumer medical advertising, which of the following statements best represents your views?
- STATEMENT A: Direct-to-consumer advertising improves patient education and patient-physician communication. Such advertising informs and empowers patients, so that their health care better reflects their needs and values. In particular, certain health services require complex medical equipment with high capital costs. Physicians who invest in such equipment do so because they believe in its promise, and they deserve payment to recoup their investment.
- STATEMENT B: Direct-to-consumer advertising often results in misunderstanding, increased costs, and disruption of the patient-physician relationship. Such advertising can skew information to portray products in a positive light and can prey upon patients’ fears. Physicians closely allied with a treatment cannot offer objective assessment to patients about the efficacy or risks of the treatment. Further, most patients are ignorant of the financial incentives to physicians for various procedures.
- STATEMENT C: I have not formed a viewpoint on direct-to-consumer medical advertising.
How do your answers compare?
CBDSM's Reshma Jagsi, MD, DPhil, has written a powerful challenge to the medical profession and medical industries in a recent issue of the Journal of Clinical Oncology. Dr. Jagsi argues that the increasing proliferation of direct-to-patient advertising has raised questions of how physicians can function as unbiased intermediaries between patients and industry.
In the article, she presents six case studies, one of which has been excerpted and adapted for this Decision of the Month. Dr. Jagsi uses these case studies to address serious issues related to both advertising and conflict of interest. Some examples:
- What implications does the frequently used advertising directive "Ask your doctor about X" have for the doctor-patient relationship?
- How ethical is it to disguise medical advertising—for instance, to hire celebrities to discuss treatments during interviews?
- Should a physician who prescribes a particular medical device be allowed to receive payment from the speakers' bureau of a company that produces that medical device?
- Should a physician who holds an ownership interest in an expensive treatment machine be required to explain alternate treatments to patients?
- When does a website about a medical treatment cross over from being informational to being promotional?
Dr. Jagsi argues that physicians have a strong ethical responsibility to their patients to call attention to potential conflicts of interest and to help interpret medical information in the best interests of their patients.
For more details about this study:
Jagsi R. Conflicts of interest and the physician-patient relationship in the era of direct-to-patient advertising. Journal of Clinical Oncology 2007;25:902-905.