OP-ED

If Marketing Is so Dangerous, Should Medical Schools Be Doing so Much of It?

flying cadeuciiBeginning about 5 years ago, many US medical schools introduced severe restrictions on marketing activities by pharmaceutical companies and medical device manufacturers.

These measures often prohibited representatives of such firms from entering patient care areas and even medical school facilities, with the exception of tightly controlled training activities, and then by appointment only.  In some cases, medical schools have issued outright bans against industry support of educational activities.

What is the rationale behind such actions?  It boils down to a concern that industry funding may inappropriately influence both medical education and patient care.  For example, a physician visited by an industry representative might be more likely to prescribe one of the firm’s drugs.  In announcing a ban on such activities, one school likened the industry to Don Juan, worrying that physicians might prescribe drugs because they were “seduced by industry,” and not because “it’s best for the patient.”

There is evidence that even physicians who believe their decision making is not biased by marketing are in fact affected by it.  Moreover, a good deal of such marketing is not exactly purely scientific.  A perusal of medical journals reveals a plethora of full-page ads featuring slogans such as:

“Simplicity is clear information at your fingertips,” and highlighting images such as a physician walking down a hallway with a tiger, describing the featured drug as a “powerful partner.”

Such marketing is not inexpensive.  Placing a full-page ad in a medical journal typically costs around $4,000.  On the other hand, as an air traveler I have come across a number of slick full-page airline magazines ads touting medical schools and their affiliated hospitals.

These cost on average $24,000.

Such expenditures naturally raise questions. Why would academic health systems spend such large amounts of money on marketing, and what form does their marketing take?  Let’s look at some examples.

Several years ago, a prominent Big Ten medical school officially banned all industry support for continuing medical education, citing concerns of inappropriate influence on faculty.  Yet the same medical center has a full-page ad in an airline magazine featuring a confident looking patient and the slogan, “Hail to the Victors Valiant.”

In the accompanying text, it states that the patient, who is identified by name, “cannot imagine being taken better care of anywhere else.”

An Ivy League school prohibited its faculty from “presenting at programs designed solely or in part for marketing purposes,” describing them as “a fundamental violation of our academic and care missions, responsibilities, and integrity.”  Yet the same school was featured in a “Best of Health” series in an airline magazine, which includes a full-page ad declaring that “If your heart is in need of serious care, [we] are your best chance of survival.”

A third school, whose hospital often finishes at the top of national rankings, adopted similar marketing restrictions for the express purpose of “protecting patients.”  Yet it, too, has purchased full-page ads in airline magazines, claiming that it “coordinates the highest-quality healthcare for patients from all 50 states and more than 100 countries,” and capping it off with a description of itself as “Where the world comes for the best medicine.”

Even a casual reader cannot fail to notice the remarkable similarity between the marketing approaches of industry and academia.  Both often feature heartwarming photos of smiling patients or confident physicians interacting with grateful families.  Both tend to present their products and programs in the best possible light.

And both often make claims that are not entirely supported by the facts, at least not in the broad and typically superlative terms they employ.

For example, the patient featured in the Big Ten School’s ad might not be able to imagine better care, but widely touted quality indices and rankings suggest that better care is available elsewhere.  The Ivy League School claims that it offers the best chance at survival, but again, national performance metrics suggest otherwise.

And even the nation’s purportedly best medical center overstates its case, since many of its own faculty would prefer care at a local competing institution if they were seriously injured.

 There is something disingenuous and perhaps even hypocritical about academic medical centers that treat industry marketing as disreputable and even dangerous, yet employ many of the same techniques – and in some cases the very same marketing consultants – to hawk their services.

If highly educated physicians capable of critically appraising the medical literature cannot be trusted to see through sophisticated marketing strategies, how likely is it that ordinary patients will be able to do so?

The real point here is not that marketing is evil and no one should do it.  It is rather that those engaged in marketing healthcare – whether drugs, devices, or professional services – should hold themselves to the same high standards they demand of others.  The fact that iPhones were marketed extensively does not necessarily taint their utility or suggest that purchasers have been unfairly duped.

In healthcare as elsewhere, good marketing may in fact alert patients and physicians to great products.

This being said, however, if industry must be restricted from marketing its products to medical school faculty members and physicians in training, is it unreasonable to think that medical schools and their affiliated hospitals should exhibit a bit more circumspection – and yes, even humility – in their own marketing efforts?

It is an affront to academic integrity for medical schools to hold others to exacting marketing standards yet grant themselves broad license in self-promotion.

Richard Gunderman, MD, PhD, is Professor of Radiology, Pediatrics, Medical Education, Philosophy, Liberal Arts, and Philanthropy at Indiana University; he was a past president of the faculty at Indiana University School of Medicine and currently serves as Vice Chair of Radiology. Gunderman is also the 2013 Spinoza professor at the University of Amsterdam, the author of over 380 scholarly articles and has published eight books, including Achieving Excellence in Medical EducationWe Make a Life by What We Give,  Leadership in Healthcare and most recently, X-Ray Vision.

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Mighty Casey
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I’ve long wondered the same thing: why the ivory towers of academic medicine seemed to be playing the “do as I say, not as I do” game in many areas, including marketing *and* outcomes reporting. To take Dr. Jha’s bipedal pig metaphor and shift it, on the patient side of the house we’re often expected to buy a pig in a poke. Most hospitals trumpet some sort of “Best [whatever],” with the major academic medical centers – including the one in my own city – thumbing the perception scale further by pumping up the volume on their cutting-edgy-ness. Meanwhile, low… Read more »

lawyerdoctor
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I agree with (Dr.) Jha – this a wonderful and succinct expose’ of the contradictions of academic medicine. I have long been bothered by this same conundrum, even though I am doubly-guilty of having been both on an academic faculty at one time, and also having received a free turkey sandwich from a large pharma company!! Dr. Gunderman omitted one small item, however – which is that the totally evil, manipulative, and uncaring pharmaceutical and device giants DO NOT receive one penny of my tax dollars. Safe and secure in their hollowed out volcano lairs, they make their billions the… Read more »

Saurabh Jha
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Saurabh Jha

Brilliant piece elegantly dissecting the impossibilities of maintaining a consistent standard.

Society seems to have identified its enemies. For now big pharma bad & big oversight good. One day we’ll see that all pigs walk on two legs.