Hospitals have relied on publicity campaigns for decades, rolling out a mix of ads in newspapers, on radio and on television to help drum up business and differentiate themselves from their competitors.
Lately, however, marketing departments at top-flight academic medical centers have become increasingly creative in their pitches to patients, drawing on the kinds of subtle, sophisticated techniques that some critics say are more often associated with pharmaceutical firms and car salesmen than healthcare providers.
In the first study of its kind, a report in the March 28 issue of the Archives of Internal Medicine condemned this trend among the nation's most prominent hospitals to borrow slick, Madison Avenue-style marketing methods to publicize such high-margin services as fertility treatments, Botox and Lasik surgery.
The study, which analyzed newspaper ads for 17 of the nation's best-known academic medical centers, concluded that the marketing efforts appeared to "place the interests of the medical center before the interests of the patients" by highlighting "unproved" or "cosmetic" procedures instead of services that promote the general well-being of the community. What's more, the academic medical centers-which included the Mayo Clinic, Rochester, Minn.; Johns Hopkins Hospital, Baltimore; and the University of California at Los Angeles Medical Center-traded on their reputations to appeal to the emotions and trust of prospective patients, researchers said.
"When you see these kinds of ads from, say, a car company, that's one thing," said Robin Larson, an internist who is the lead author of the study and an instructor at Dartmouth Medical School, Hanover, N.H. "You know there's a financial gain when the car company's doing advertising. When we think of healthcare, we like to think that the `patient-first' ethic is what's important."
She suggested that academic medical centers are "creating the same sense of need" in the minds of the public as pharmaceutical companies, which have come under harsh attack in recent years for their reliance on expensive direct-to-consumer advertising.
Some academic medical center officials bristled at the suggestion that they have used manipulative advertising campaigns to attract new patients for profitable services.
Jim Blazar, chief marketing officer for the Cleveland Clinic, one of the facilities studied by the researchers, said the institution has no intention of changing the way it has advertised its services over the past quarter-century. "The purpose of our advertising is to provide information, to motivate people to learn more," he said. "I believe that when people are more knowledgeable, they make better decisions."
Elaine Freeman, vice president of corporate communications for Johns Hopkins, which came under fire for advertising a series of free seminars on uterine fibroids, said the hospital is "very cautious about not making inappropriate claims" regarding treatment. Freeman said she disagreed with many of the conclusions of the report but added, "I think it never hurts to raise sensitivity to the issues."
A spokesman for Duke University Medical Center in Durham, N.C., another institution cited in the study, said no one was available to comment. Elaine Rubin, a spokeswoman for the Association of Academic Health Centers, a trade group that represents about 100 institutions, declined to comment.
While acknowledging academic medical centers must generate revenue to stay in business and serve the public, Larson said the kind of advertising she discovered isn't the appropriate way to do it. "They need to find other creative ways of staying in business," she said.
These facilities, she said, should "limit anything that is causing fear or exaggerating benefits and work on providing messages that help the public make good decisions."
The study, which examined marketing efforts throughout 2002, found that most of the academic medical centers relied on a list of headlines that "exemplifies several commonly used marketing strategies," underscoring attention-grabbing words and headlines such as "at the forefront," "breakthrough," "tomorrow's medicine today" and "world class."
Bold headlines "commonly mentioned symptoms or diseases or used strategies that might appeal to patients' emotions or fears," the study found. The University of Chicago Hospitals, for example, advertised an offer for a $25 heart screening under the headline, "Early detection is key to surviving heart disease."
Consumers, the report added, are conditioned to regard ads from drug companies and other mass-merchandising markets with a degree of suspicion about motivation. "It is reasonable to assume that consumers do not bring the same skepticism to health-services ads from academic medical centers that they do to other forms of advertising," according to the report, a joint effort by Dartmouth and the Veterans Affairs Medical Center in White River Junction, Vt., where Larson is a researcher. These institutions, Larson said, risk "eroding" public trust by using these kinds of advertising techniques.
In one attempt at high-tech marketing, the American Hospital Association joined U.S. News & World Report in late 2003 to create an online directory that offers information to consumers about specialized services, treatments and URLs for about 6,000 hospitals (Nov. 17, 2003. 14). It was the AHA's first consumer-oriented alliance.
The vast majority of U.S. healthcare facilities use some form of marketing or advertising to attract patients, experts said. It's the only way to differentiate their services or educate the public, said Susan Alcorn, a longtime hospital marketing official and a spokeswoman for Geisinger Health System, Danville, Pa.
"I don't think (the level of advertising) is surprising in the least," said Alcorn, who is also the president-elect of the Society for Healthcare Strategy and Market Development, an affiliate of the AHA that represents about 3,500 marketing and public relations officials across the country. "Especially for academic medical centers, who have highly specialized services, if people don't know about them they can't utilize them."