By Sung-Yeon Park and Max J Coppes.

In 1975, the U.S. Federal Trade Commission filed an administrative complaint that the American Medical Association (AMA)’s ban on medical service advertising directly targeting consumers (medical advertising hereafter) was anti-competitive because it “prevented doctors from providing the public with truthful information about the price, quality, or other aspects of their service.” Although the AMA filed lawsuits against the FTC, the U.S. Supreme Court sided with the FTC, eliminating the professional restriction on medical advertising. Since then, spending on medical advertising has exploded to $2.9 billion in 2016. Surprisingly there has been little research on medical advertising, its content, practice, and effects on consumer knowledge and empowerment, although the critics of medical advertising and the advocates of market-based healthcare economy have continued debating its ethics.

In light of the increasing visibility of medical advertising and continuing philosophical debates, we set out to offer an objective account of the content of medical advertisements. From analyzing 313 television and 200 online medical service advertisements collected in Nevada, USA, we found that, while most advertisements reliably shared information on the services provided, less than half featured hours of operation and information on which health insurances were accepted. Alarmingly, less than a quarter of the ads supplied demonstrable information on the quality of care provided and the actual price of services. The lack of evidence to substantiate any quality claims indicated that current medical advertisements do not even meet the principle of “truth in advertising” the FTC and FDA apply to food and dietary supplement advertisements.

We also noted differences between online and television advertisements. In general, television advertisements seemed to be solely focused on service provided and how to make an appointment. Hours of operation, cost of services, information on quality provided, and which insurances would be accepted were woefully absent in the vast majority of television advertisements. A second difference noted relates to the number of distinct advertisers. Just 10 providers placed 54% of the 546  television advertisements that we initially collected, while online ads were placed by many more providers. This television advertising market dominance by a small number of providers was quite remarkable and invites for further research. We wonder whether television advertising aids a small number of deep-pocketed practices to gain high visibility or create demands for specialty services rather than being used by multiple practices to compete over patients in need of essential care.

In 2015, the AMA voted to ban direct-to-consumer prescription drug advertising on television and presented the decision based on the concerns about the negative impact of commercially-driven promotions, the role of marketing costs in high drug prices, and the inflated demand for brand-name drugs, even when they may not be appropriate. Interestingly, these are parallel to the concerns medical ethicists and practitioners raised against medical advertising. The accusations about the negative impact of direct-to-consumer prescription drug advertising is supported by voluminous research whereas the impact of medical adverting is barely understood yet. As we discuss in our paper, there are many research questions that need to be answered, including the impact of advertising on patients’ decision to use medical services and choice of providers, patient outcomes, and the cost of care for patients and the healthcare system. The impact of medical advertising on price and competition are also of interest because these are direct benefits commonly touted by the advocates of medical advertising.

Access to medical service in the event of sickness is one of the fundamental human rights articulated in the International Covenant on Economic, Social and Cultural Rights and yet many countries, including the wealthiest country on earth, fail to assure the inalienable right for its citizens. In theory, medical advertising could be a solution to the problem by making the distribution of healthcare resources more efficient. But, our findings cast doubts that medical advertising serves as part of solution, at least in its current form.

Paper: US direct-to-consumer medical service advertisements fail to provide adequate information on quality and cost of care.

Authors: Sung-Yeon Park¹, Gi Woong Yun², Sarah Friedman¹, Kylie Hill^1,3, So Young Ryu¹, Thomas Schwenk⁴, Max J Coppes^5,6

Affiliations:

¹ School of Community Health Sciences, University of Nevada Reno, Reno, NV, USA

² Reynolds School of Journalism, University of Nevada Reno, Reno, NV, USA

³ Center for Biobehavioral Health, Nationwide Children’s Hospital, Columbus, OH, USA

⁴ Dean, University of Nevada Reno School of Medicine, Reno, NV, USA

⁵ Pediatrics, University of Nevada Reno School of Medicine, Reno, NV, USA

⁵ Physician-in-Chief, Renown Children’s Hospital, Reno, NV, USA

Competing interests: This work was supported by the U.S. National Science Foundation (Grant #1759113). However, the content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agency.

Social media accounts of post authors: @mtypark