Tuesday, July 01, 2014

Marketing versus evidence: Which helps patients decide?

Gary Schwitzer summarized a study a couple of weeks ago.  Perhaps it should be required reading by Dr. Stifelman and others at NYU Langone Medical Center.

Meantime, a paper published in the journal Surgical Innovation – “The impact of marketing language on patient preference for robot-assisted surgery” – describes a little experiment.  38 patients were asked to make two treatment decisions between robotic surgery and conventional laparoscopic surgery. One time, the robotic procedure was described as a “state-of-the-art, innovative new technology” – the marketing frame.  The other time it was termed a “promising new technology, which has not been used extensively and with research regarding its safety and effectiveness ongoing” – the evidence-based frame.  The methodology used is more thoroughly explained in the paper.

The results?  No surprise:
  • With the marketing frame, 20 of 38 chose the robotic approach.  Of those, 12 switched to conventional laparoscopy when the evidence-based frame was used.
  • 17 of 18 who chose conventional laparoscopy in the marketing frame made the same choice when the evidence-based frame was used.
  • Among the 13 patients who made discordant treatment decisions under opposing frames, the robotic approach was significantly more likely to be chosen under the marketing frame.
The researchers conclude:
“Our findings suggest that marketing strategies unrelated to the presentation of potential risks and benefits of a surgical technology may influence patient preference…This effect may be contributing to rising trends in the number of robot-assisted surgery procedures performed.”
They point out that “the evidence in favor of robot-assisted surgery is controversial” and “Robotic surgical systems typically cost between $1 million and $2.5 million, with $100, 000 to $200,000 in annual maintenance fees.”

Take home message:  “When patients are confronted with decisions regarding their care, they have a number of resources available to them.  Some of these resources misrepresent evidence relating to risk and benefits.”


Barry Carol said...

I think robotic vs laparoscopic surgery is another case where insurer use of reference pricing could help to steer patients toward the more cost-effective approach. If robotic surgery costs more, let patients pay the difference out-of-pocket especially if superior efficacy and safety with robotic surgery is unproven at best.

The Medical Contrarian said...

The confounding of education and marketing is rampant. Just go to any website of virtually any health system, including academic centers.


Anonymous said...

With most new health plans under the ACA capping the maximum you may pay out of pocket, it doesn't seem like pricing differentials will make much of an impact.

This isn't about pricing at the consumer/patient level (though there are many cost implications associated with this particular medical arms race that we all have to pay for sooner or laterm, somehow). It's about unethical and misleading advertising. And also about less-than-safe care when the full risks of a procedure aren't disclosed.

e-Patient Dave said...

Perfect. Shared it on Facebook.

Dike Drummond MD said...

Evidence and marketing can be naturally and automatically at odds with each other depending on the ethics of the person writing the copy.

Presenting research is an emotionally neutral act. It is simply reporting the evidence - pro or con - to the patient. The patient uses this in their own, internal and self motivated decision process.

Marketing language uses human psychology to prompt a specific and deliberate change in the reader's/listener's behavior. It pulls out all the stops to get the patient to say yes. It is specifically designed to produce this answer, whether or not there is evidence to support the patient taking the affirmative action. It is very easy for a marketer to fall from the ethical position of having the patient's best interests and the research evidence aligned with the "Yes" they are attempting to produce. This balancing act can be achieved and it is not easy.

In heathcare, the onus is on the marketer to back off the persuasion, favor the evidence and always keep the patient's best interests in mind and not be influenced by quotas and the P&L sheet for this quarter.

My two cents,

Dike Drummond MD
www.TheHappyMD (dot) com