Most hip, knee surgeons say DTC ads weaken doctor/patient relationships

Survey questions the value of ads in educating patients, promoting new surgical techniques.

SAN DIEGO — While direct-to-consumer advertisements may help patients make medical decisions, a recent investigation shows that the ads may adversely affect orthopedic surgeons' practices and patient relationships.

In a poll of 737 hip and knee surgeons, Kevin J. Bozic, MD, MBA found that over 75% of surgeons reported that direct-to-consumer (DTC) advertising negatively impacted their practice and the relationship with patients.

The survey also revealed that 53% of respondents at least occasionally felt pressured to use a specific technique or implant based on a patient's request, sometime sin a way they perceived could be harmful to patients, and 77% felt that the ads mislead patients, according to the study abstract.

"Advertising related to orthopedic devices and procedures is here to stay," Bozic, who presented the results at the American Academy of Orthopaedic Surgeons annual meeting, told Orthopedics Today.

"If used appropriately, in terms of accurate [and] objective information, it can be a useful tool to surgeons and hospitals and the medical device industry. But, the vast majority of surgeons we surveyed believe that the information being transmitted is inaccurate, biased and misleading."

Impact of advertising

To determine the impact of DTC advertising on orthopedists, the researchers distributed a 36-question survey to 737 members of the American Association of Hip and Knee Surgeons.

Of the 361 respondents, 99% had experience with patients who were exposed to DTC ads and more than 90% said they felt that DTC advertising exposure has increased within the last 3 years. Although the survey results showed that 76% of respondents reported that the ads had an overall negative impact on their practices and patient relationships.

"The older surgeons in the cohort, specifically surgeons who were in practice longer than 25 years, were less opposed to direct-to-consumer advertising and were more likely to believe that advertising had a positive impact on their practice and interaction with patients," Bozic said.

Biased ads

Most surgeons noted that they believed that the ads presented a skewed view of procedures and devices by exaggerating the benefits and down playing risks.

"The vast majority of the physicians felt that the information contained in the advertisements was in most cases inaccurate or misleading, which is consistent with the literature on DTC advertising related to prescription drugs," Bozic said.

While proponents of the ads argue that they can be helpful to patients in their healthcare decision making, many respondents felt that they failed to educate patients.

"They felt that they were not more educated about the risks and benefits, not more educated about the alternatives, not more educated about the costs and that they were less open to alternatives after reading or viewing direct-to-consumer advertisements related to orthopedic devices or procedures," Bozic said.

The surgeons also believed that most of the information given to patients was industry driven. "They felt, in some cases, pressure to use devices or surgical techniques that they may or may not be familiar with," Bozic said. "They felt that patients were asking for things that were inappropriate and, in some cases, that they felt could be harmful to patients."

They also reported spending more time with patients who brought in advertising information, although the majority of surgeons felt that advertising increased the length of office visits by only 5 minutes or less. Bozic warned that the misleading information in the ads could translate into new risks for surgeons and patients.

"Our efforts should be focused on improving the quality and accuracy of the information related to orthopedic devices and procedures," he said.

For more information:
Bozic K J, Smith A, Hariri S, et al. Impact of direct to consumer advertising on physician attitudes and behavior in orthopaedic surgery. #477. Presented at the American Academy of Orthopaedic Surgeons 74th Annual Meeting. Feb. 14-18. 2007. San Diego.
Kevin J. Bozic, MD, MBA, is an orthopedist at University of California, San Francisco, 500 Parnassus, MU-320 W, San Francisco, CA 94143; 415-476-3320; bozick@orthosurg.ucfs.edu. He indicated that he received funding for this study by a grant from the Orthopedic Research and Education Foundation and that he has no conflicts of interest related to the subject of the study.