You have probably seen the TV commercials or other ads for Cancer Treatment Centers of America. They make it sound like “the place to go” if you have cancer. They claim to be “different,” to combine the best cancer technologies with natural therapies in a humane, patient-centered approach that helps you fight the disease and maintain your quality of life. They offer a kinder, gentler, more effective oncology. Those ads are misleading.
Dr. Gorski has written about the practices of Cancer Treatment Centers of America here and here. He has shown how they “integrate” real medicine with nonsense like homeopathy and how they misrepresent components of science-based medicine like exercise and diet, re-branding them as “alternative.”
A recent study by Vater et al. published in the Annals of Internal Medicine asked “What are cancer centers advertising to the public?” They found that the ads appealed to emotion, failed to provide important information, falsely portrayed testimonials as typical, and should be viewed as critically as any other advertising.
History and ethics
There is an excellent article by N.D. Tomycz in the Journal of Medical Ethics titled “A profession selling out: lamenting the paradigm shift in physician advertising.” It covers the history of the relationship between doctors and advertising and the ethical issues involved.
From the first American Medical Association (AMA) Code of Ethics in 1847 to 1975 any advertising by doctors was strictly forbidden. Advertising was a commercial business practice; medicine was a profession, not a business. Only quacks and snake oil salesmen advertised. Advertising was considered incompatible with ethical patient care, and publishing testimonials or promises of cures was grounds for ostracism. Other professions followed suit; the American Bar Association prohibited advertising in the early 20th century. A U.S. Supreme Court decision in Goldfarb v. Virginia State Bar determined that lawyers were “engaged in trade or commerce” and therefore were not exempt from antitrust laws. In 1975 the Federal Trade Commission (FTC) accused the AMA of exercising “restraint of trade” in violation of antitrust laws and persuaded the medical profession to allow advertising. This led to what we have today: prescription drugs widely advertised in the media, doctors advertising their practices, and advertisements for cancer treatment centers. This commercialization may well have diminished public trust in the medical profession. In other countries, the ban on advertising persists.
Tomycz offers these ethical arguments:
Patients are not consumers in search of a commodity. There is a unique vulnerability that comes for want of relief from disability and disease, and patients are unlikely therefore to be capable of defending themselves with the incredulousness they may normally bring to other forms of advertising.
Physician advertising manipulates choice by presenting limited and biased information that aims to entice rather than inform. Advertisements often fail to cite complications and rarely present treatment alternatives not offered by the physician. The fleeting medium of advertisement—billboards, short radio segments, fliers, rapid television infomercials—is not appropriate for initiating the informed and often complex decision making process that should underlie all health interventions.
Now that medical quackery has returned with unprecedented sophistication, annually draining billions from the population with unproven treatments and supplements, physicians may be more tempted than ever to advertise and secure some piece of the healthcare pie. Yet no matter what the law permits, advertisement in medicine should remain a taboo that unifies doctors in the defence of professionalism and the unique covenant they share with patients.
Cancer center advertising study
Vater et al. did a systematic content analysis of cancer center ads in top consumer magazines and on television networks in the US in 2012. After excluding duplicates, employment opportunities, fundraising ads, etc. they found 409 unique advertisements promoting clinical services at 102 cancer centers. They most commonly promoted cancer treatments (88%) rather than cancer screening (18%) or supportive services (13%). They frequently made vague claims like “Our team has saved lives through groundbreaking technology, personalized treatments, and research.” The type of cancer treatment was not specified, and very few mentioned palliative care or symptom management services. Less than 2% mentioned the possibility of risks from treatment. Only 5% mentioned costs or insurance coverage.
85% included emotional appeals relating to survival or potential cure. 61% used language that evoked hope (“your last hope,” etc.). 31% mentioned that treatments would be tailored to the individual. Nearly half of the ads included endorsements from patients, testimonials that emphasized survival or cure. Only 15% included a disclaimer that these results were not typical, and no ads described the outcome that a typical patient could expect. The FTC has recently mandated that testimonials include disclaimers and a description of results that a typical patient may expect to see. Most of these advertisers were not in compliance.
The ads failed to provide crucial information that patients need to make an informed decision about where to seek cancer treatment. They seldom mentioned risks and failed to quantify benefits.
The authors mentioned the limitations of their study. They did not include other media such as the Internet, newspapers or radio. Their sample may have been incomplete. Most importantly, they did not examine the effect of advertising content on patients.
An accompanying editorial praised the rigor of the study but expressed some caveats about its potential implications. It said it would be unreasonable for such ads to present quantified survival data because that data is easily manipulated and difficult for consumers to evaluate. It pointed out that advertising has potential benefits such as destigmatizing cancer. It mentioned a survey that asked whether these ads should be banned; only 11% of respondents supported a complete ban, 33% favored limited restrictions, and 56% believed no changes should be made. It concluded:
If marketing increases or decreases that burden for patients with cancer, it behooves us to know how. Vater and colleagues should be commended for taking an essential first step toward that goal.
The advertising by cancer centers is frequently misleading, but we don’t yet have any data on how those ads actually impact patients. It would be a mistake for consumers to base their decisions about where to go for treatment only on the incomplete information in the ads.