Thursday, September 18, 2008

Ad out

We have all become accustomed to ads by pharmaceutical companies in which they try to convince us that we are at risk for one or another disease and therefore should ask our doctors about their medications. I think a lot of us find those ads distasteful, and many of us believe that they result in unnecessary expenditures on health care.

Well, today, for the first time, I heard a radio ad for a hospital that seemed to me to fit in the same category. It was an ad for a certain vascular center, and it suggested that leg cramps, among other things, could be a sign of peripheral arterial disease. The purpose, pretty clearly, was to get listeners to wonder if this and the other symptoms mentioned might be serious enough to warrant a diagnostic visit to this particular vascular center.

As you know, I am not a doctor, much less a vascular specialist of any sort, but I am guessing that the incidence of peripheral arterial disease among the general population with muscle cramps has to be very, very small. It would be one thing to explicitly target the ad to those at greater-than-average risk of vascular disease (e.g., those with diabetes, smokers, high blood pressure, heart disease, or high cholesterol), but this was a general audience ad. I certainly believe that some percentage of people with PAD who should be getting treatment are not getting treatment, but this ad felt to me (and my accompanying car passenger) to be designed to produce fear and/or anxiety beyond a legitimately targeted audience.

As I have mentioned below, many of us in the hospital world advertise our services. Those ads usually talk about our capabilities, our doctors, access or the like. This is the first time I can remember an ad that seems intent on actually stimulating the demand for specific disease-related medical services among the general population. I don't think this is good for us to do. Insurance companies, government, and employers are beseeching us to control health care costs, especially through a reduction in unnecessary utilization of services. They say that we are insensitive to those cost factors, and we give them support for this position if we advertise our services in the manner I heard today on the radio.

Hearing this ad has made me more sensitive to this issue, and I plan to ask our marketing folks to review all of our ads to make sure we have not gone down a similar path. I do not think we have, but I'll let you know in a later post if we find some.


Anonymous said...

Nice to hear a hospital CEO talk about what I call the medicalization of the human experience. Somehow we need to use medical terms and talk about near diseases to describe what happens to most of us from time to time.

This is my post about the same topic:

Medical Quack said...

That is a very good point as I hear those commercials on the radio out here too and it seems the ones that are a combination of advising of services offered along with an ongoing clinical trial seem to get closest to the line, in other words subliminal suggestion I guess might be the closest way of describing it.

Sometimes I think some of the advertising we are exposed to today has gone over the line, such as the recent ads for Viagra that were on Forbes that were in actuality a game you played on the ad, and since myself and other bloggers commented, the ad has been removed.

I was doing a post the other day about pay for performance and the $4.00 generic prescriptions and there was another somewhat strange program that was included in the post, which was a pilot program with Aetna doing a "lottery" with folks opting for an electronic device to store their pills, and if you took all your medications, you stood a chance to win a weekly lottery of $100.00 or so, and then if you did not, the electronic device would tell you what you could have won. It does make you wonder where advertising and compliance efforts are going these days. Here's the part that pertains to the Pill lottery below.

Now some companies like Aetna have a lottery pilot program going, that's right you heard that, take your pills and hit the lotto, well a small lotto that is. Almost reminds me of some of the reality shows today, "pill or no pill". I think if we are health conscious and can afford our medications, as patients we will take our pills without having it turned into a mockery of whether or not we take our pills. The electronic device will also tell you how much you could have won if you had taken your pills for the day. I would hate to see this graduate to Pay for Performance for the physician based on how may patients hit the lotto with the number of pills taken, but if you were a sick physician taking a prescribed medication you could double your odds. (grin).

"1-in-10 chance of winning $10 every day they take their medication and a 1-in-100 chance of winning $100. Each day a text message will tell a subject whether he or she has won the lottery, or, if the dose wasn't taken, whether he or she would have won."

If you read the entire article I speak about the pay for performance issues that doctors have to deal with when patients don't use an insurance card and pay cash,and on reports due to the fact that this is not traced, it can give the impression that the patients are not taking their medications, thus the P4P compliance for that area looks bad for the physician, so some have to end up showing that they have in fact prescribed medicine,so as not to lose out.

Here's the link over at Reuters:

Anonymous said...

I am an employee at BIDMC and am so thrilled to read your take on this. I heard this ad as well and was very disheartened. Your concern over this is another reason I am proud to work for BID.

Anonymous said...

The pharmaceutical industry can say they are doing all of this research for the good of mankind and that is probably the intent of the physicians and doctors who do the research and testing. Unfortunately the companies are there to make money for their shareholders.

I would like to think that the Longwood area hospitals are above all this high pressure fear marketing. With the advent of large medical consortiums, a financial crisis with healthcare funding and just trying to keep institutions atleast somewhat in the black, These rules of good decorum are broken every day.

Anonymous said...

Paul, I completely agree with your post. I would add that these kinds of appeals are only intended for people with insurance coverage or independent wealth! To paraphrase a blogger on todays NYTIMES, "We can't afford socialized medicine, but we can afford to socialize bailouts for Wall Street?"

iKEANE said...

Advertising is a study in psychology.

As a parent, I have taught my children to be aware of how advertising works. I think it's as important to their mental health as exercise is to their physical health.

For example: While chauffering them to their various activities, I'd switch radio stations and point out the differences in advertising. On a classical station, the advertisement is for finacial investing, fine restaurants, the WSJ, etc. On the hip-hop station, the advertisements are for where to get money before you get your check, who to call when you need bail, and planned parenthood.

When viewing the proliferation of pharmaceutical advertisements on TV, I challenged them to pay attention to the side effects. Generally there are 10 potential side effects for every 1 attempt to alleviate a symptom.

If it weren't so serious, it would be hilarious.

As it is, it's just pathetic.

I am not in the medical profession (nor do I pretend to be a doctor on TV) haha -- but my medicine cabinet prettymuch consists of Advil and band-aids.

"For everything else, there's Midol."

Seriously, I have to say that my attempt to educate them about pharmaceutical drugs has been every bit as important as educating them against taking street drugs.

Just because they're "legal" doesn't mean they're safe.

Advertising agencies are not the enemy.

Greed is.

I applaud your attention to how you advertise.

Anonymous said...

I thought about your blog when I saw "good morning america" yesterday, which ran a story about a "silent killer"-- deep vein thrombosis. I am not a doctor, but one of the primary symptoms is leg pain and MOST people dismiss it, as you did -- "well that doesn't apply to me, I'm healthy." But the US Surgeon General has started a "call to action" to increase understanding of this issue -- including the leg pain symptom --among both patients and doctors. They want people to probe the pain further and understand whether they might be at risk. I think any "silent killer" is worth the advertising and if I'd lost someone to this killer, I would be eternally grateful for the ad you condemn.

Anonymous said...

I agree that this form of advertising is not appropriate. That said, I would very much like to help guide consumers of medical services to take a much stronger and proactive role in healthcare decisions that affect them. I wonder if advertising and other media messages could be crafted to work toward that goal...

Anonymous said...

Healthcare marketing ain't easy, folks. We have to consider the reasons hospitals - most of which are not-for-profit- feel advertising is even necessary. We view it as (1) our responsibility to the community to educate; (2) a way to reduce health care costs by promoting prevention or more economical ways to provide care (i.e. minimally invasive is many times more cost efficient; (3) a way to explain disease in terms your average consumer understands (meaning talking about the symptoms instead of a disease they can't even pronounce); (4) managing physician demands on what the hospital 'should' be doing to maintain excellent quality (5) a way that will show direct return on investment to drive business results and organizational success.

Leg pain? Maybe. Pee when you sneeze? Often. Head throbs when you try to market healthcare? Absolutely.