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Direct-to-Consumer Marketing Does Not Provide Balanced Information

Chicago Advertisements for body-imaging to screen for cancer, cardiac disease and other illnesses, do not provide adequate information to consumers, according to an article in the December issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, self-referral to health care products and services has risen steadily since 1988, when direct-to-consumer (DTC) marketing of pharmaceuticals was authorized by the U.S. Federal Trade Commission (FTC). Self-referral for whole-body computed tomography (CT) scans and magnetic resonance imaging (MRI) for early detection of cancer, cardiovascular disease, and other diseases has also increased, the article states. These imaging procedures are marketed directly to consumers.

Judy Illes, Ph.D., of the Stanford Center for Biomedical Ethics, Palo Alto, Calif., and colleagues conducted a detailed analysis of print advertisements and informational brochures for self-referred imaging.

The researchers evaluated 40 print advertisements from U.S. newspapers and 20 informational brochures. The material was analyzed and grouped according to theme: health care technology, emotion, empowerment and assurance, incentives, limited supporting evidence, popular appeal, statistics and images.

The researchers found that both the advertisements and the brochures emphasized health care and technology information and provided assurances of good health and incentives to self-refer. The researchers also found that the advertisements did not refer to noncompany sources of information or to potential risks of having a scan. Statements lacking clear scientific evidence were identified in 38 percent of the advertisements (n=15) and 25 percent of the brochures (n=5).

Direct-to-consumer marketing of self-referred imaging services, in both print advertisements and informational brochures, fails to provide prospective consumers with comprehensive balanced information vital to informed autonomous decision making, the authors write. Professional guidelines and oversight for advertising and promotion of these services are needed.

Arch Intern Med. 2004;164:2415-2419. Available post-embargo at archinternmed.com

Editors Note: This study was supported by The Greenwall Foundation, New York, N.Y.

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In an accompanying editorial, Patrick G. OMalley, M.D., M.P.H., and Allen J. Taylor, M.D., of Walter Reed Army Medical Center, Washington, D.C., write, We propose a call to action by the medical community to halt DTC marketing and self-referral for screening imaging and advocate for regulatory control comparable to what is in place for pharmaceutical advertising.

The only basis upon which DTC marketing and self-referral would be justified is if they actually expanded the use of effective but underused medical interventions, they write.

Before implementing a health communication strategy, it seems rational to prove that what it promotes is effective, safe, worth-while, and meets the standard of medical professional ethics.

The editorialists continue: What are the risks of screening tests? This is an area that also needs better study, but some justifiable concerns are disease labeling, false-positive test results, incidental scan findings, psychological effects (including worry and anxiety), radiation exposure, wasteful costs, and lower likelihood of insurability.

Arch Intern Med. 2004;164:2406-2408. Available post-embargo at archinternmed.com

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