Screening centers skew ads to favor benefits

Whole-body screening centers fail to provide balanced advertisements, often touting unsupported benefits while downplaying known risks. Although not calling for federal legislation, researchers say the industry needs better oversight to protect consumers.

Stanford University researchers analyzed scores of newspaper ads and brochures from screening centers across the country. Overall, they found an emphasis on information about healthcare technology, assurances of good health, and financial incentives to self-refer (Arch Intern Med 2004;164:2415-2419).

Many ads and brochures contained messages with a false sense of reassurance. Some ads stoked fear of the consequences of not obtaining a scan, but references to the potential risk of radiation associated with CT were notably missing. In contrast, ads from these same companies - but for MRI - made explicit reference to that modality's lack of radiation.

Both ads and brochures encouraged consumers to seek further information from company resources by calling a toll-free number or consulting the company's Web site. Virtually none referred to secondary sources of information, such as a primary-care physician, or mentioned risks.

"Consumers are not made aware of the possibility of false-positive findings and the procedures needed to follow up ambiguous test results, or of the absence of clinical trial findings that validate the benefit of screening asymptomatic individuals," said lead author Judy Illes, Ph.D., and colleagues at Stanford's Center for Biomedical Ethics.

Such slanted focus fails to allow consumers to make truly autonomous, informed decision, the authors concluded.

They analyzed 40 newspaper ads and 20 informational brochures for self-referred imaging centers. Nine different companies were represented by the ads, and 94% of them were collected from national newspapers including the San Francisco Chronicle, the New York Times, and the Washington Post.

Two researchers rated the material according to seven categories:

• references to the technology's ability to detect diseases

• emotion, empowerment, and assurance

• financial incentives

• unsupported statements

• appeals based on the popularity of the procedures

• statistical information

• images

The theme of healthcare technology was present in 93% of the ads. Emotion, empowerment, and assurance appeared in 98%, incentives in 88%, and images in 100%.

In the brochures, the healthcare technology theme was present in 100%. Emotion, empowerment, and assurance appeared in 85%, incentives in 80%, and images in 100%.

Statistics were present in 23% of the ads, compared with 80% of brochures, representing the largest thematic difference between the two media.

One-third of the newspaper ads contained unsupported statements, while one-fifth of the brochures had such statements. Such specific claims stretch the definition of proper advertising under Federal Trade Commission and FDA guidelines, according to the study.

"Unlike the unregulated direct-to-consumer marketing of CT and MRI services, guidelines for prescription pharmaceuticals require that companies present balanced information, including possible adverse effects, contraindications, and effectiveness," the authors said.

Positive messages such as "give the gift of health" appeared in 100% of the ads. Fear-evoking messages such as "you deserve better protection than a mammogram" appeared in 45% of the ads.

In one ad, a man who presumably had not undergone an exam and did not survive an undetected heart problem is shown as a ghost. His outline walks arm-in-arm with others who appear to be family members. A Web-based video contained a walk-through of a graveyard with a narrator commenting on diseases and the necessity of early screening, according to the study.

Researchers also found troublesome phrasing. Twenty-five percent of the ads stated that the technology was FDA-approved, but the FDA has never approved or cleared or certified any CT system specifically for use in screening. No manufacturer has ever demonstrated to the FDA that its CT scanner is effective for screening for any disease or condition.

Several ads conveyed negative evaluations of accepted screening practices, including colonoscopy, mammography, and treadmill and cholesterol tests. The researchers suggested that this strategy may have an adverse impact on patient views about well-substantiated primary-care disease screening practices.

The investigators acknowledged some value in direct-to-consumer marketing for new imaging procedures but recognized the dangers of overestimating the technologies and underestimating the risks. They suggested that guidelines be formulated from dialogue among stakeholders in the medical community, professional associations, industry, and patient advocacy.

"A multidisciplinary proactive approach will receive far greater acceptance in the professional community than legislation created reactively to monitor unregulated medical practices," they said.

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