Author + information
- Valentin Fuster, MD, PhD∗ ()
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address correspondence to:
Dr. Valentin Fuster, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029.
For more than a century, the medical community has been battling the pressures around physician advertising. In 1899, Dr. Robert Babcock wrote: “All means are dishonorable and quackish which are intended to advertise the practitioner of medicine as such, directly to the people” (1). At the time, the American Medical Association’s code of ethics prohibited advertising by physicians (2). In 1975, however, the Federal Trade Commission accused the profession of “restraint of trade,” and legally persuaded doctors to permit advertising (3). This concept was upheld by the U.S. Supreme Court in Goldfarb v Virginia State Bar (2). Regardless of the rules in place, this practice is an ethical consideration for each of us, as we are obligated to protect the purity of our charge to provide medical care. As Dr. Robert Martensen so adeptly wrote in his JAMA perspective on physician advertising, “to practice medicine [is] to be engaged in a profession not a trade” (2). Yet, many of us seem to have forgotten this aspect of our calling, because the mass marketing or advertising of physicians has become shameful and unethical. As a medical community, we have criticized the unethical advertising practices of the pharmaceutical and medical device industries, in protection of our patients, but it may be the appropriate time to turn that scrutiny toward ourselves and colleagues.
While sitting on a plane recently, I picked up a magazine that claimed to list the top doctors, including cardiovascular specialists, from across the United States. It had lists of physicians from different regions, none of whom I recognized, which led me to wonder how these individuals were selected. In the most deceptive manner, it was intended to look as if the magazine itself had selected these doctors to honor. There are many other examples. A few years ago, ABC News conducted an investigation into the Consumers’ Research Council of America, which offers “top doctor” awards across nearly 24 specialties, including cardiology, surgery, and pediatrics (4). According to the news network, the Consumers’ Research Council of America stated that doctors are selected based on a point system that considers experience, training, membership in professional associations, and board certification, while claiming it does not accept fees, donations, or advertising. Yet, mailings obtained by ABC News show that the Consumers’ Research Council of America receives money for the award plaques that their subsidiary company sells to doctors, which cost anywhere from $99 to $530 (4). Of course, this is only 1 example, and I do not mean to imply that all of these lists have monetary backing, but these types of promotional activities seem generally inappropriate for our profession.
The reason these practices are so appalling is that the physician-patient dynamic must be built upon trust. This is why I am focusing on individual advertising, not institutional ranking lists. In fact, this is an important point of distinction. We all recognize that there are respectable rankings of medical institutions, such as those conducted and distributed by U.S. News & World Report, which uses complex analytics to recognize superior institutions. However, where the ethical line is crossed is when individual physicians misrepresent their accomplishments or pay for personal advertising. As physicians, we should be judged solely by our merit. In fact, I have personally observed that those physicians who are the most effective self-promoters—those who are frequently quoted in the national press as experts—are oftentimes those physicians who you would not want to take care of your family members.
Ethics Always Comes Down to Individual Integrity
In lieu of more stringent rules that would violate the Federal Trade Commission/Supreme Court decision, several medical societies have created recommendations to encourage ethical advertising behaviors among their specialists. As an example, through its code of ethics and advisory opinions on advertising, the American Academy of Ophthalmology issued 8 guidelines that “call upon the integrity of the ophthalmologist rather than providing specific language to use or avoid” (5):
1. Communications must be accurate.
2. Communications must not be deceptive.
3. Communications should avoid appeals to anxieties and vulnerabilities.
4. Communications should not create unjustified expectations.
5. Communications should provide a realistic assessment of risks, benefits, and alternatives.
6. Communications should never misrepresent credentials.
7. Communications should not make claims of superiority that cannot be objectively substantiated.
8. All paid communication must be acknowledged.
In my opinion, #6 and #7 are the most important, because they clearly outline how physicians should not overstep the trusting relationship with their patients. What I like about these recommendations is that they rely upon the individual’s integrity to make the appropriate decision, because we have no other recourse through which to police these inappropriate practices.
In summary, we are not above reproach as physicians, and we must apply the same level of scrutiny to ourselves and our professional colleagues as we do with industry. As always, our own personal integrity will guide our decision making, but we must remember that society at large does and should hold us to a higher ethical standard—and we should work never to break that trust.
- American College of Cardiology Foundation
- Babcock R.H.
- Tomycz N.D.
- ↵Adbdelmalek M, Cuomo C, Wagschal G, Rhee J, Doytchinova K. ABC News investigates top doctor awards: are they always well deserved? Available at: http://abcnews.go.com/Health/top-doctor-awards-deserved-abc-news-investigation/story?id=16771628. Accessed October 15, 2015.
- ↵Day SH. Ethical and risk management issues related to advertising and marketing. Digest. Summer 1996. Available at: http://www.omic.com/ethical-and-risk-management-issues-related-to-advertising-and-marketing/. Accessed October 19, 2015.