August 6, 2014 Leave a comment
Some of the most interesting literature on cancer comes from journals that are not directly involved in the field. I was reminded of this by an article that appeared in the June 17, 2014 Annals of Internal Medicine entitled “What Are Cancer Centers Advertising to the Public?”
The authors examined the types of clinical services that are promoted by commercial advertising. They reviewed advertisements that appeared in the top media markets during the year 2012, including both television and magazine ads. They excluded duplicates, public service announcements, fund raising and research subject recruitment. Of 1,427 total advertisements, 409 were considered to be unique ads that promoted clinical programs at 102 different cancer centers.
To analyze the content, the investigators developed a “code book” that included four domains; the types of clinical services, information provided, the use of emotional advertising appeals and the use of patient testimonials. Among the centers analyzed, 59% were for profit and the same percent were accredited by the Commission on Cancer. Sixteen percent were NCI designated centers. Advertising was also characterized by region of the United States. The results are interesting and instructive.
Of the 409 unique clinical advertisements, 88% promoted treatment. This was demonstrably higher than the percentage promoting cancer screening at 18% or supportive services at only 13%. While the benefits of therapies were described in 27% of the ads, the risks were only mentioned in 2%. Emotional appeals were frequent with 85% of the ads evoking hope for survival. Cancer was often described as a fight or battle, and the use of fear (of death, etc.) was found in fully 30% of the advertisements.
In their discussion, the authors pointed out several interesting findings. Among them, the “frequent use of emotional appeals and scarce mention of risk of services or quantification of benefit.” They also found “that NCI designated centers more frequently used emotional appeals related to survival or potential for cure.” These same centers “omitted information about risks, benefits and alternatives with similar frequency as non-NCI designated centers.” They concluded that “emotional appeals coupled with incomplete information are being widely used to promote services even among the nation’s most prestigious cancer centers.” Interestingly while only 5% of cancer centers in the United States are NCI designated, fully 16% of the clinical cancer advertising in 2012 was conducted by NCI-designated centers, a three-fold higher use.
What are we to gather from this analysis? First a journal like the Annals of Internal Medicine, removed from the direct delivery of cancer care, has the gravity to review processes that would rarely be reported in the oncology literature. Second, NCI designated (academic) cancer centers, who claim to eschew dissemination of unsubstantiated information, appear to be the very centers that engage in such promotion. As the authors note, “clinical advertisements that use emotional appeal uncoupled with information about indications, benefits, risks, or alternatives may lead patients to pursue care that is either unnecessary or unsupported by scientific evidence.”
We applaud the authors of this Annals of Internal Medicine article for their unbiased and informative analysis. We must all strive to provide patients practical and actionable information about cancer and its treatment. It appears from this study that the practice of self-promotion crosses all lines of cancer care delivery from the most august academic institutions to the for-profit cancer centers. As with all activities in life, cancer patients are to be reminded of the ancient Roman admonition “Caveat Emptor” (Buyer Beware!).