Carnegie Mellon, Pitt ethicists question impact of hospital advertising

January 30, 2015

PITTSBURGH--If you have ever "googled" illness symptoms and possible treatments, you are not alone. A national Pew Research Center survey indicated that 72 percent of adults searched the Internet for health information in the past year. But, how reliable is that information and what are the ethical implications?

In a commentary piece published in JAMA Internal Medicine, Carnegie Mellon University's Alex John London and the University of Pittsburgh's Yael Schenker question the impact of health information that is available online, specifically hospital advertisements. London and Schenker argue that while the Internet offers patients valuable data and tools - including hospital quality ratings and professional treatment guidelines - that may help them when facing decisions about where to seek care or whether to undergo a medical procedure, reliable and unbiased information may be hard to identify among the growing number of medical care advertisements online.

"The marketing objective of selling services by making them seem attractive to consumers can create tensions or outright conflict with the ethical imperative of respect for persons, since the latter requires that patients make medical decisions in light of balanced information about the full range of risks and benefits associated with their care," said London, professor of philosophy in CMU's Dietrich College of Humanities and Social Sciences and director of the Center for Ethics and Policy.

Referencing a research article in the same journal issue that found hospital websites failed to disclose risk information for transaortic valve replacement (TAVR), a recently approved procedure to treat patients whose aortic valve does not open fully, London and Schenker pinpoint four risk concerns for patients seeking medical information online:

1. Identifying Advertising - Hospital websites often have the appearance of an education portal, leaving patients to assume that the information presented is informational, not persuasive.

2. Finding Unbiased Information - Unlike FDA-regulated direct-to-consumer advertising for prescription drugs, hospital advertising is overseen by the Federal Trade Commission and subject to the same "reasonable" standards applied to advertisements for common consumer goods such as cars and cereal. While hospital advertisements may describe specific medical interventions that entail significant risks, there is no legal requirement that these risks be disclosed.

3. Recognizing Incomplete or Imbalanced Information - Poor-quality medical information is hard to recognize unless the person reading it is a trained clinician.

4. Influence on Health Care Decisions - As patients seek out information online, the quality of their decision-making and care choices will be influenced by the accuracy or inaccuracy of the information they are likely to encounter.

To begin to fix the risk to patients seeking medical information online, London and Schenker recommend to clearly label hospital websites as advertisements; allocate resources to created balanced online informational tools; and focus future attention on not only the content of health care advertising but its impact.
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For more information, visit http://www.hss.cmu.edu/philosophy/faculty-london.php.

Carnegie Mellon University

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