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At Issue: The use of direct-to-consumer and celebrity orthopedic advertising
Orthopedics Today asked orthopedic surgeons the following question: How has seeing celebrity endorsements for orthopedic products, such as at this year’s AAOS meeting and in recent advertising campaigns, affected your opinion or use of that product or its maker?
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C. Skip Whitman, MD
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Celebrity endorsement of a product is nothing new in America today. This has proven to be a very effective form of consumer advertising for many products. Competition for market share in the orthopedic device industry has always been very strong. My personal opinion is that in the past, a great deal of “advertising” resources were used by orthopedic device manufacturers to court orthopedic physicians. Recent changes in industry regulations now limit the orthopedic device manufacturing companies and their ability to provide incentives or “perks” for physicians using their products.
In an effort to maintain or increase market share, these companies have begun to use direct patient consumer advertising. I personally feel that a celebrity knee or hip is no more important than that of my neighbor, a farmer, a corporate executive, a homemaker, a grandparent, or factory worker. I will continue to use evidence-based medicine, cost, and service as my primary decision algorithm regarding orthopedic devices and products.
C. Skip Whitman, MD, can be reached at Tri-County Orthopedic & Sports Medicine, 400 Johnson Ridge Memorial Park, Elkin, NC 28621; 336-526-4500; e-mail: skipwhitman@tcosm.com.
William J. Robb III, MD
Marketing and sales programs for orthopedic medications, implants and devises have expanded significantly. Some of these include direct to consumer advertising and celebrity endorsement. Celebrities are frequently used in other types of consumer product advertising and increase advertising effectiveness through both enhanced product differentiation and campaign penetration. There is some added risk, however, as a celebrity’s reputation can change and may affect the public’s perception the endorsed product.
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Although primarily targeted for consumers or patients, celebrity endorsements can directly and indirectly affect surgeons as well. A surgeon directly may have increased interest or knowledge in a product from the celebrity endorsement itself. Indirectly, patients affect the surgeons as they may be more aware of specific advertised or endorsed orthopedic products, brands, technologies and even companies.
In my practice, patients are aware of advertised medical and surgical orthopedic products and treatments. They often identify the celebrity if there has been that type of endorsement for a product or treatment. To the extent that this expansion of orthopedic marketing increases public and patient knowledge about orthopedic diseases and treatments, there is shared value for patients, orthopedic surgeons and industry.
If direct-to-patient advertising or celebrity endorsement significantly alters patient expectation or knowledge inconsistent with the surgical experience, the physician-patient relationship can be eroded and the surgeon may appear less credible and a less reliable source for information.
Celebrity endorsements have a particular potential to increase unrealistic patient expectations. A recently published article demonstrated that many current orthopedic product claims are not supportable by peer-reviewed publication or scientific evidence. In my own practice, direct-to-consumer advertising and celebrity endorsements are a frequent source of conversation with patients. This has resulted in an increase of general consumer or patient information and medical and surgical treatment discussions often require more time. My recommendations for specific treatments are more detailed and consider alternatives that might not generally be included in my recommendations.
My patients are aware of some celebrity endorsed orthopedic products. My recommendations for specific orthopedic products or companies are neither influenced nor changed by these endorsements. Implant, drug and product recommendations must be based upon the individual surgeon’s experience and knowledge as well as knowledge about the product’s safety and efficacy. In this “patient-centered care” era, a surgeon’s medical and surgical recommendations should be communicated in an open ended style, allowing adequate time for patient questions and obtaining feedback to check patient understanding.
Patients will increasingly be both empowered and confused by medical information and misinformation in the 21st century. Marketing and advertising in orthopedics will most likely increase rather than decrease. A surgeon’s toolbox must include tools to enhance the quality of patient communication – not just hammers and drills. Our patients will know more about our technology including drug, treatment and implant options. We will need to learn how to increase the quality and, not necessarily, the quantity of our patient communication and to better identify and manage unrealistic expectations or misinformation often implied through endorsements. The “genie” is out of the bottle. It is unlikely that we will be able to get it back in.
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William J. Robb III, MD, can be reached at Northwestern University, Surgery, Feinberg School of Medicine, Department of Orthopedic Surgery, 645 N. Michigan Ave., Suite 910, Chicago, IL 60611; 847-998-5680; e-mail: w-robb3@northwestern.edu.
Carol C. Frey, MD
From a marketing standpoint, the use of a celebrity attracts attention to a print ad for a particular product. However, as a physician, it has no effect on my decision to use that product.
Carol C. Frey, MD, can be reached at 1200 Rosecrans Avenue, Suite 208, Manhattan Beach, CA 90266; 310-990-5253; e-mail: footfreymd@aol.com.
Augusto Sarmiento, MD
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The marketing of industrial products by alleged “celebrities” during the 2007 Annual Meeting of the AAOS did not come as a surprise to me. I saw it simply as an extension of a distasteful trend that began a few years ago, when some orthopedists chose to throw away traditional tenets of professional conduct and lowered themselves to playing the role of agents for industry. Some of them perhaps do not realize they are being used, and welcome industry’s invitation to speak in front small groups, thinking that the invitation is recognition of special expertise. Others do it because they think the public exposure helps the sales of products from which they receive royalties or kickbacks. The Department of Justice’s ongoing investigation of alleged serious transgressions in the relationship between industry and orthopedists has highlighted this issue.
The use of the media by some unscrupulous, megalomaniac orthopedists, be it through newspapers, magazines, radio, or television, hoping to market their practices and/or their own implants, and in doing so becoming “celebrities,” is an example of the growing collapse of professionalism in our ranks and the belief that medicine is no longer a profession but a business, where profit is the name of the game. In any event, I find these practices demeaning to the participants. I suggest to the academy to bring to an end its tacit endorsement and encouragement of these trends, which undermine the dignity of the participants as well as of the organization. It would serve also to make the fellowship more aware that under current conditions, the education of the orthopedist is primarily structured to satisfy the marketing needs of industry. It should not be that way.
Augusto Sarmiento, MD, past-president of the American Academy of Orthopaedic Surgeons, professor and chairman emeritus University of Miami, School of Medicine, can be reached at University of Miami, 13-27, P.O. Box 016960, Miami, FL 33101; 305-666-3310; e-mail: asarm@bellsouth.net.
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Douglas W. Jackson, MD
My answer is simple. It does not affect my decisions on product selection at all. Personally, I find it distasteful.
Douglas W. Jackson, MD, can be reached at Memorial Orthopedic Surgical Group, 2760 Atlantic Ave., Long Beach, CA 90806; 562-424-6666; e-mail: jacksondw@aol.com.