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Advertising: Why, what, and how?
guest editorial Advertising: Why, what, and how?
"Physicians, hospitals, dentists-these are all businesses. They have to approach their audiences the same way that Coca-Cola does." This statement by Ms. S. Jacobs, President of Healthware Images, recently appeared in the New York Times. We might expect the same from some of our colleagues. One recently wrote that advertising can "attract students to pursue careers in medicine, following your example" (Ophthalmology Management, October 1988, p 77). Advertising in ophthalmology: Why it came about, what are its effects, how do we deal with it? First, let's discuss why it came about. At the turn of the century, rampant advertising by medical and quasi-medical practitioners flourished. This prompted a symposium on ethics at the 1899 meeting of the American Academy of Medicine. R.H. Babcock there stated: "All means are dishonorable and quackish which are intended to advertise the practitioner of medicine ... directly to the people. The employment of such methods reduces the healing art to a business in which success, other things being equal, is proportionate to the cleverness of the advertising."l Put in place was a code of ethics banning advertising. The code went unchallenged until 1975, when the Federal Trade Commission successfully sued the American Medical Association, charging unlawful restriction of advertising by its members. A Supreme Court decision in 1982 forced the AMA to remove restrictions on member advertising unless false or misleading. Cost containment fanned this reborn flame of commercialism. This begot our villain, the commercial doctor, the COMDOC. Advertising: Why, what, and how? What is it, and what are its effects? Dr. Sherman Folland, 2 in a 1985 study of Penn sylvania physicians, found that most disapproved of advertising because it was an "unsuitable means of communicating" medical information, because it fostered a
negative image, and because it was of doubtful economic benefit. Nearly half, however, stated that under pressure, they would consider further use of marketing techniques. What is marketing? Is marketing the same as advertising? Webster's dictionary tells us that advertising calls something to the attention of the public; marketing involves movement of goods from producer to consumer. What goods do we peddle? A bill of goods? I believe that marketing is a euphemism for advertising. The marketer, the advertiser, the commercial doctor, the COMDOC. It's all the same. Physician advertisements may be informational, educational, or laudatory. Informational advertising includes telephone directory listings, business cards, business signs, and handbooks listing hours of service, physician credentials, fee schedules, and credit arrangements. Educational advertising includes seminars, health-related pamphlets and sponsorship of screenings. Laudatory advertising extols quality of service, competence, exclusive treatments, unique facilities. Yes, it has even denigrated colleagues. It has high potential for abuse. Rodning and Dasco3 proposed these definitions for informational, educational, and laudatory advertising. By them, we all advertise to some degree. It is only laudatory advertising, however, that most of us abhor. It takes the form of billboards, radio, television, newspaper ads, even door-to-door and telephone solicitation. The message often preys on public fears and ignorance. It commonly seeks to fulfill a need that it has created. It is this laudatory advertising that we associate with the COMDOC. Now that we have defined advertising, let's consider its effects. Canby and Gellhorn 4 state, "Advertisements by their very nature simplify, and all simplification contains an element of potential deception." This is bad enough, but we all know examples of COM DOCs who
Presented at the Welsh Cataract Congress, Houston, Texas, November 1988.
J CATARACT REFRACT
SURG- VOL 15, MAY 1989
251
go far beyond. A COMDOC clinic gave my patient a free examination. The COM DOC found a cataract, and urged the patient to stay and have surgery that day so she could receive a full treatment in one visit. She thought she could still see well, and refused surgery. I saw her for a second opinion, and found 20/20 Snellen acuity with clear lenses. Could it be that the pressure to pay for all of that expensive advertising clouds judgment? COM DOCs regale patients with promises of "free surgery," with offers of safe treatment, and with subtle suggestions of laser cataract removal. No wonder this leads to erosion of public confidence. No wonder it engenders divisiveness, distrust, and demoralization within our ranks. Remember the doctors who went fishing in Alaska? A bear awakened them. They grabbed their boots and ran. The bear followed, and was gaining. One doctor sat down and hurriedly pulled on his boots. His companion shouted, "Are you crazy? That's not going to help you outrun the bear!" The other replied, "It's not the bear I have to outrun." Advertising: Why, what, and how? How do we deal with it? We have seen that the law protects advertisers. Furthermore, government policy supports advertising on the theory that competition will lower fees. Moreover, the recent Supreme Court decision in Patrick vs. Burget makes it even more difficult for us to discipline our peers (Ocular Surgery News, August 1, 1988, page 4).
252
The deck seems stacked against us. It's like having a buddy dead, or a love lost. You want to go back to the way it was before, but you can't. We could lobby Congress to once again let us control advertising within our profession. I don't see much hope for that. We must apply the highest ethical standards in our care of every patient. We must hold the high ground. We must trust that in time the American public will recognize the laudatory advertiser, the COMDOC. Will we allow ourselves to become that which we despise? Who will save us from ourselves? In summary, I have told why it has been possible for unsavory advertising to emerge. I have told you what some negative effects of that advertising are. I have told you how we must stand against it. Remember Disraeli's words: "Man is not the creature of circumstances; circumstances are the creatures of men." Jared Emery, M.D. REFERENCES l. Babcock RH: The ethics of medical advertising: Its methods ethical and unethical; the forces that bring it about, and its inevitable tendency if not checked. Bull Am Acad Med 4:207-213, 1899 2. Folland ST: Advertising by physicians: Behavior and attitudes. Med Care 25:4, 1987 3. Rodning CB, Dacso CC: A physician/advertiser ethos. Am J Med 82:1209, 1987 4. Canby AG, Gellhorn HJ: Physician advertising: The First Amendment and the Sherman Act. Duke University Law Journal 543:558-564, 1978
J CATARACT REFRACT SURG- VOL
15, MAY 1989
"Physicians, hospitals, dentists-these are all businesses. They have to approach their audiences the same way that Coca-Cola does." This statement by Ms. S. Jacobs, President of Healthware Images, recently appeared in the New York Times. We might expect the same from some of our colleagues. One recently wrote that advertising can "attract students to pursue careers in medicine, following your example" (Ophthalmology Management, October 1988, p 77). Advertising in ophthalmology: Why it came about, what are its effects, how do we deal with it? First, let's discuss why it came about. At the turn of the century, rampant advertising by medical and quasi-medical practitioners flourished. This prompted a symposium on ethics at the 1899 meeting of the American Academy of Medicine. R.H. Babcock there stated: "All means are dishonorable and quackish which are intended to advertise the practitioner of medicine ... directly to the people. The employment of such methods reduces the healing art to a business in which success, other things being equal, is proportionate to the cleverness of the advertising."l Put in place was a code of ethics banning advertising. The code went unchallenged until 1975, when the Federal Trade Commission successfully sued the American Medical Association, charging unlawful restriction of advertising by its members. A Supreme Court decision in 1982 forced the AMA to remove restrictions on member advertising unless false or misleading. Cost containment fanned this reborn flame of commercialism. This begot our villain, the commercial doctor, the COMDOC. Advertising: Why, what, and how? What is it, and what are its effects? Dr. Sherman Folland, 2 in a 1985 study of Penn sylvania physicians, found that most disapproved of advertising because it was an "unsuitable means of communicating" medical information, because it fostered a
negative image, and because it was of doubtful economic benefit. Nearly half, however, stated that under pressure, they would consider further use of marketing techniques. What is marketing? Is marketing the same as advertising? Webster's dictionary tells us that advertising calls something to the attention of the public; marketing involves movement of goods from producer to consumer. What goods do we peddle? A bill of goods? I believe that marketing is a euphemism for advertising. The marketer, the advertiser, the commercial doctor, the COMDOC. It's all the same. Physician advertisements may be informational, educational, or laudatory. Informational advertising includes telephone directory listings, business cards, business signs, and handbooks listing hours of service, physician credentials, fee schedules, and credit arrangements. Educational advertising includes seminars, health-related pamphlets and sponsorship of screenings. Laudatory advertising extols quality of service, competence, exclusive treatments, unique facilities. Yes, it has even denigrated colleagues. It has high potential for abuse. Rodning and Dasco3 proposed these definitions for informational, educational, and laudatory advertising. By them, we all advertise to some degree. It is only laudatory advertising, however, that most of us abhor. It takes the form of billboards, radio, television, newspaper ads, even door-to-door and telephone solicitation. The message often preys on public fears and ignorance. It commonly seeks to fulfill a need that it has created. It is this laudatory advertising that we associate with the COMDOC. Now that we have defined advertising, let's consider its effects. Canby and Gellhorn 4 state, "Advertisements by their very nature simplify, and all simplification contains an element of potential deception." This is bad enough, but we all know examples of COM DOCs who
Presented at the Welsh Cataract Congress, Houston, Texas, November 1988.
J CATARACT REFRACT
SURG- VOL 15, MAY 1989
251
go far beyond. A COMDOC clinic gave my patient a free examination. The COM DOC found a cataract, and urged the patient to stay and have surgery that day so she could receive a full treatment in one visit. She thought she could still see well, and refused surgery. I saw her for a second opinion, and found 20/20 Snellen acuity with clear lenses. Could it be that the pressure to pay for all of that expensive advertising clouds judgment? COM DOCs regale patients with promises of "free surgery," with offers of safe treatment, and with subtle suggestions of laser cataract removal. No wonder this leads to erosion of public confidence. No wonder it engenders divisiveness, distrust, and demoralization within our ranks. Remember the doctors who went fishing in Alaska? A bear awakened them. They grabbed their boots and ran. The bear followed, and was gaining. One doctor sat down and hurriedly pulled on his boots. His companion shouted, "Are you crazy? That's not going to help you outrun the bear!" The other replied, "It's not the bear I have to outrun." Advertising: Why, what, and how? How do we deal with it? We have seen that the law protects advertisers. Furthermore, government policy supports advertising on the theory that competition will lower fees. Moreover, the recent Supreme Court decision in Patrick vs. Burget makes it even more difficult for us to discipline our peers (Ocular Surgery News, August 1, 1988, page 4).
252
The deck seems stacked against us. It's like having a buddy dead, or a love lost. You want to go back to the way it was before, but you can't. We could lobby Congress to once again let us control advertising within our profession. I don't see much hope for that. We must apply the highest ethical standards in our care of every patient. We must hold the high ground. We must trust that in time the American public will recognize the laudatory advertiser, the COMDOC. Will we allow ourselves to become that which we despise? Who will save us from ourselves? In summary, I have told why it has been possible for unsavory advertising to emerge. I have told you what some negative effects of that advertising are. I have told you how we must stand against it. Remember Disraeli's words: "Man is not the creature of circumstances; circumstances are the creatures of men." Jared Emery, M.D. REFERENCES l. Babcock RH: The ethics of medical advertising: Its methods ethical and unethical; the forces that bring it about, and its inevitable tendency if not checked. Bull Am Acad Med 4:207-213, 1899 2. Folland ST: Advertising by physicians: Behavior and attitudes. Med Care 25:4, 1987 3. Rodning CB, Dacso CC: A physician/advertiser ethos. Am J Med 82:1209, 1987 4. Canby AG, Gellhorn HJ: Physician advertising: The First Amendment and the Sherman Act. Duke University Law Journal 543:558-564, 1978
J CATARACT REFRACT SURG- VOL
15, MAY 1989