That's the conclusion of researchers at the Stanford University School of Medicine who recently analyzed 40 ads from companies that provide medical images directly to consumers, not requiring any consultation with a physician. Their report, published in the Dec. 13 issue of Archives Of Internal Medicine, recommends that guidelines be developed that require these ads to present a more balanced and detailed picture.
"People are capable of being very savvy consumers of medical technology, but the information has to be available to them to allow them to be savvy," said the study's lead author, Judy Illes, PhD, senior researcher in the school's Center for Biomedical Ethics and in the Department of Radiology. "While we can appreciate that in a short telegraphic ad not all the information can be presented, it should at least refer to other sources as well as to more thorough information on the company's own Web site or in their printed brochures."
Virtually none of the ads in the study did this.
"In pharmaceutical ads, people are encouraged to ask for their doctors' advice," Illes added. "Why is that not the case here?"
There is no question that these screens are beneficial for many people who are presenting symptoms of cardiovascular disease or cancer, helping to detect and pinpoint their illnesses. Doctors almost always refer such people for imaging.
But it is much less clear how useful such screens are for people who are asymptomatic-the apparent target for much of the imaging industry's advertising, Illes said. Not only may such people be needlessly exposing themselves to more radiation and payments that can exceed $1,000, but there's also scarce evidence as to whether the images will actually improve their chances of a longer life.
lles' team analyzed ads from nine companies that ran from November 2001 to February 2003, as well as brochures obtained from 20 companies. Two team members then rated them in seven categories: 1) references to the technology's ability to detect diseases; 2) emotion, empowerment and assurance; 3) financial incentives; 4) unsupported statements; 5) appeals based on the popularity of the procedures; 6) statistical information and 7) images.
Messages about the happiness and other positive feelings the scans would provide were found in 100 percent of the ads. Fear-evoking messages and other negative pitches were found in 45 percent. The approaches run the gamut from one ad that has people thanking the company, "You've given us peace of mind," to another that says, "I had a ticking time bomb in my body."
While the study found that the ads and brochures referred consumers for additional information to other sources at the company, the researchers noted, "Virtually none referred to secondary sources of information such as a primary-care physician, or mentioned risks of having a scan." The raters also found statements that were scientifically unsupported in one-third of the advertisements and one-fifth of the brochures.
"Direct-to-consumer marketing about new imaging procedures has the potential to enhance consumer choice," the authors write. "However, if the information presented to consumers overestimates the value of technologies and does not reasonably disclose risks, then choice is constrained, not enhanced."
The research follows up on earlier work by Illes and colleagues, published in the July 2003 issue of Radiology. That article called attention to the lack of medical profession guidelines for appropriate scanning, while documenting the rapid growth of the direct-to-consumer scanning business. It identified 88 such imaging centers nationwide, and in an interview last year at the time of publication, Illes noted that since the research had been completed, some centers had closed their doors but 48 more centers had opened.
In addition to Illes, the authors of the latest paper are Dylan Kann, in Stanford's Program in Human Biology; Kim Karetsky and Phillip Letourneau at the Center for Biomedical Ethics; Thomas Raffin, MD, professor of medicine, emeritus, and co-director of the Center for Biomedical Ethics; Barbara Koenig, MD, associate professor of neurology and neurological sciences and a faculty member at the Center for Biomedical Ethics; and Scott Atlas, MD, professor of radiology and senior fellow, by courtesy, at the Hoover Institution.
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Journal
Archives of Internal Medicine