Medical Advertising

Not too many years ago, certainly before the growth of the for-profit Humana medical plans system in the late 1970s, it was considered unprofessional and really forbidden for doctors to advertise. Now, it isn’t even considered tacky.

But it is.

In almost any medium – the Internet, TV, radio, and print – sometimes outrageous claims are made for a drug, medical product, particular treatment, or particular doctor and/or hospital. These may take the form of “infomercials,” and are aimed at a vulnerable, medically unsophisticated audience. Often they target readers and listeners who suffer either from a chronic, relapsing, but self-limited illness, or a condition that will eventually resolve if left alone. Sometimes claims are made for the cure of illnesses or non-illnesses that really are best left untreated. After all, everyone sometimes has pain for one reason or another.

And sometimes, the proposed treatments are both unnecessary and potentially harmful.

An example of this latter are claims that spinal cord injuries resulting in paralysis can be cured by stem cell transplantation. While stem cells can be made to grow in the nervous system, to date no one has succeeded in making these cells connect to other neurons in the spinal cord, synapses required for function to be restored. The stem cells have grown, however, essentially producing a stem cell tumor and sometimes death of the recipient. Likewise chiropractic manipulation for the treatment of peripheral neuropathy, which may be a symptom of a broad range of unrelated diseases, is suspect and even hurtful. Neither is there good evidence that fusing the spine for back pain is useful.

Perhaps the most controversial advertising campaign in recent years involved Medtronic Corporation’s promotion of the bone morphogenic protein INFUSE®, claimed by the manufacturer to be superior to the grafting of autologous bone in encouraging bony fusion. The cost for one treatment with this product varies between six and ten thousand dollars. While there has been no independent evidence to prove the claimed benefit, a patient’s own bone, of course, can be harvested and implanted for nearly nothing. Moreover, last year the Senate Finance Committee found that Medtronic did not disclose a significant amount of royalties and consulting fees paid to physicians who wrote about and promoted their product. Between November 1996 and December 2010, these payments totaled $210 million, but the payoff information was never disclosed to surgeons encouraged by the manufacturer to use the stuff. In addition, the corporation apparently withheld some of the data.

A study to address the claimed advantages of INFUSE® was published in The Annals of Internal Medicine on June 18 of this year, and concluded that, “In spinal fusion, rhBMP-2 [Infuse] has no proven clinical advantage over bone graft and may be associated with important harms, making it difficult to identify clear indications for rhBMP-2. Earlier disclosure of all relevant data would have better informed clinicians and the public than the initial published trial reports did.”

Medtronic’s CEO, Omar Ishrak replied in a post titled “Understanding the Yale independent review of rhBMP-2, the active protein in INFUSE® Bone Graft.” He most disingenuously wrote that “the results add to a growing body of evidence regarding INFUSE® Bone Graft as a safe and effective treatment option in FDA-approved indications for use.” [italics added]

Never mind that it’s very expensive, isn’t necessary, and perhaps harmful.

The scientific standard to show whether a treatment is useful or not demands a randomized, prospective, double blind study to establish evidence. Such studies are difficult to do, costly, and require the independent oversight of clinicians and statisticians. It is much easier, and more profitable, to simply proclaim that a pill, a device, a special person or institution has something unique to offer.

Americans are easily convinced that somewhere there is an expert who will help them. Such authorities are often only those talking or writing most confidently about a topic. But these are illnesses that the experts and institutions themselves will certainly benefit by treating. Patients must be wary of such conflicts of interest, and conflicts they are, for a good deal of money is in play for individuals and corporations.

In his fine book Thinking Fast & Slow, Daniel Kahneman writes, “It is wise to take admissions of uncertainty seriously, but declarations of high confidence mainly tell you that an individual has constructed a coherent story in his mind, not necessarily that the story is true.”

For some time now, health care has been an industry, and like all industries it has sophisticated methods for distribution of products. Consumers should exercise the same caution in interpretation of advertising claims made by individual doctors, hospitals, drug companies and medical device manufacturers that they would in accepting any difficult to prove claims about any goods or services for sale. Not to do so may well profit the providers, but harm – or at the very least, fail to benefit – the patient. The safest way to ensure obtaining reliable health care information is through a long-term relationship with a trusted primary doctor who has internal access to salaried consultants.