Study faults ads for CT and MR screening

Dec 12, 2004

Direct-to-consumer advertisements for CT and MR screening services often include scientifically unsupported statements, according to a new study by Stanford University ethicists and physicians, who advocate the development of guidelines covering such ads.

The study, led by Judy Illes, Ph.D., of the Stanford Center for Biomedical Ethics, is published in the latest issue of the Archives of Internal Medicine (December 13/27, 2004, Vol. 164:22, pp. 2415-2419).

"Unlike prescription drugs, screening and diagnostic imaging procedures that may be purchased without physician referral have fallen through regulatory cracks," the authors noted.

The researchers systematically looked for advertisements in several newspapers, and ultimately evaluated 40 print ads from eight newspapers around the U.S. The majority of evaluated ads (73%) appeared in The New York Times, The Washington Post, and the San Francisco Chronicle.

In an aside, the researchers noted that the largest number of evaluated advertisements came from AmeriScan, a company that shut down after being sued for false advertising of its breast MR screening services.

As part of their study, the researchers also requested informational brochures from the entities advertising CT and MR services. Two independent raters then analyzed the content of both the ads and the brochures.

Thirty-eight percent of the newspaper ads from four companies had limited supporting evidence for the use of their screening services, as did 25% of the informational brochures.

The main difference between newspaper ads and the brochures was in the use of statistics, which were found in 80% of the brochures, but only 23% of the ads.

The independent raters also found scientifically unsupported claims in a third of the advertisements and a fifth of the brochures. "Such specific claims furthermore stretch the definition of proper advertising under FTC (Federal Trade Commission) and FDA guidelines," the authors wrote.

"Troubling" phrasing was also found in many of the ads. Specifically, one-quarter of the ads claimed that their technology was FDA-approved, "even though the FDA has explicitly stated otherwise," the researchers stated.

"References to the potential risk of irradiation associated with CT scans were also notably missing from the advertisements," the authors continued. "In contrast, we observed that advertisements from these same companies for MRI make explicit reference to the nonradiation modality."

"Several advertisements also conveyed negative evaluations of accepted screening practices, including colonoscopy, mammography, and treadmill and cholesterol tests, compared with the benefit of as yet unevaluated scan-based screening procedures," the authors wrote. "These strategies may have an adverse impact on patient views about well-substantiated primary care disease screening practices."

Overall, the researchers found that ads and brochures tended to play on patients' fears while offering sweeping reassurances.

"These results suggest that DTC (direct-to-consumer) marketing of self-referred imaging services through either form of print media does not provide prospective consumers with the information that allows them to be truly autonomous, informed decision makers," the authors wrote. "If the information presented to consumers overestimates the value of technologies and does not reasonably disclose risks, then choice is constrained, not enhanced."

"A model of advertising and promotion that favors true autonomy in decision making is needed for self-referred imaging today and for new applications of self-referral to medical interventions in the future," the authors concluded. "To achieve this goal, guidelines need to be formulated from dialogue among stakeholders in the medical community, professional associations, industry, and patient advocacy."

By Tracie L. Thompson
AuntMinnie.com staff writer
December 13, 2004

Utility of CT screening for lung cancer remains unproven, June 1, 2004

Is your preventive imaging program responsible? November 24, 2003

AmeriScan closes its doors, November 3, 2003

Guidelines sought for self-referred imaging amid ethical concerns, August 14, 2003