Truth in orthopedic advertising, marketing: voluntary professional standards

Issue: August 2003

ByDouglas W. Jackson, MD

Douglas W. Jackson, MD [photo] --- Douglas W. Jackson, Chief Medical Editor

Flying back from New York City recently, I came across an advertisement that six different patients had brought to my office the previous month. My patients had thought the advertised treatment sounded wonderful and wanted to know if I thought it was something they should explore.

As I reread the advertisement, it made me think about the changes we have seen over the years in the type of marketing, advertising and public relations done by some physicians and institutions. We have seen more and more individuals, groups and institutions turn to professional marketing and advertising departments and outside agencies. While most of this behavior is legal in our country and is the protected right of the individuals doing it, thankfully just a small percentage of orthopedic surgeons find it necessary.

The particular advertisement I was reading raised specific issues. Three of several statements that concerned me are listed:

“The physician will introduce natural growth stimulants into damaged, inflamed, arthritic cells.”
“This process will induce natural regeneration and Nuevo-generation of ligaments, Tendon fibers, Cartilages and Joints, reversing Arthritis, Sports injuries and therefore improving Mobility and Pain.”
“The Center for Regeneration Medicine offers a level of expertise unrivaled elsewhere in the globe.”

The wording was somewhat confusing to me (ie, expertise unrivaled in the globe). I assume patients would interpret this as in the world but it read in the globe. In addition, the promise of regeneration even in the broadest definition implies restoration of a normal body or bodily part. To most orthopedists, regeneration means that the native cells (ie, chondrocytes, fibroblasts, etc.) of a specific tissue are replenished and alive. Included in regeneration of a specific tissue is that these cells are capable of producing and maintaining the site-specific matrix of that unique tissue.

If someone could stimulate regeneration of degenerative (arthritic) cartilage, it would be such a breakthrough, in my opinion, that it would engender consideration for a Nobel Prize in medicine. The ability to regenerate degenerative musculoskeletal tissues other than bone would be groundbreaking.

Overzealous marketing and advertising

Over the years I have had the opportunity to review many letters sent to national organizations complaining of perceived offensive marketing and advertising by orthopedic surgeons or their agents. Those that seemed to be most offensive usually included one or more of the following: They were perceived to be self aggrandizing, they generated unrealistic expectations and hopes in patients, they promoted special skills or treatments unique to the individual physician or institution, they reported research and pioneering breakthroughs that implied some authorship and most often it had been developed elsewhere, and the intent of the promotion was to act as a net to attract patients for joint replacement, spine surgery or other surgery.

I have had the opportunity to discuss these grievances with physicians on both sides of the specific issue. It often boils down to the fact that there is often a difference in what is legal and what engenders a professional and responsible approach as judged by peers. Often they are the same, but occasionally they are different enough to be offensive and detrimental to patient education and care.

Another point to consider is that once someone is a member in a national medical organization, we have little or no control over their advertising and marketing behavior. If they lose their medical license for some reason or the behavior is flagrantly fraudulent or it results in a conviction, very little action will be taken by a national organization. Fortunately the great majority of doctors do not find it necessary to push the envelope of good taste and professional behavior and ethics.

Backed by research, review

Physicians who are pioneering new treatments have an obligation to present and/or publish their peer-reviewed scientific advances to knowledgeable audiences. We all applaud and recognize legitimate scientific work and progress. Our medical system is designed to disseminate new and groundbreaking developments in patient treatment and care. Credit is given those who develop these new concepts and treatments. Self-aggrandizing promotions of unique treatments outside the peer-reviewed system often do not hold up in the bright light of scientific review.

As professionals I feel we not only have an obligation to educate the public but also to help them interpret nonscientific premises and promotions. The type of promotion that stimulated me to write this column is not isolated to one particular center, but it serves as an example of what I feel are most of our concerns.

We all know many patients who are desperately looking for treatments for their degenerative musculoskeletal conditions. They come to our clinics everyday with articles cut out from publications or information downloaded from the Internet. They like to have them explained, interpreted and to see if the treatment applies to them.

The advertisement used as an example touches the new field of tissue engineering. This exciting area has the potential to help many and holds much promise. Many advances will be coming and should be based on methodical and reproducible testing. If promises and promotions are given to patients or the public that engender unrealistic expectations and promote treatments without a scientific basis, it will slow clinical applications in this field in the future and result in additional regulations.

I invite your letters to the editor about this issue. Send to kholliman@slackinc.com.