The Ethics Of Marketing Cancer Treatments

(Inside Science) — A group of doctors clad in white lab coats smiles beneath the heading: "Standing behind your cancer care with nationally recognized excellence."

The advertisement was part of the 2009 Dartmouth-Hitchcock health care marketing campaign promoting the Norris Cotton Cancer Center, which has locations in Vermont and New Hampshire. The ad focuses on the facility's reputation and backs up its claims by including its awards of recognition.

Some cancer centers and hospitals focus on an individual patient's success story for a more emotional approach. Cancer-related marketing strategies vary wildly and spark discussion about what tactics are ethical. 

"Cancer is a bad word," said Randall Holcombe, Director of Clinical Cancer Affairs for Mount Sinai Health System. "It's the disease that people fear most."

It's also a big business — the National Institutes of Health estimated that the United States spent $86.6 billion on cancer-related health care in 2009, prompting pharmaceutical companies, hospitals, and cancer centers to market to cancer patients. A big slice of their efforts targets the consumer directly in magazine ads, TV spots and other popular media outlets. The advantage of direct-to-consumer marketing is that cancer patients can learn about new treatments and clinical trials, said Holcombe.

Now, a new report published in the Journal of Cancer Policy recommends guidelines to ensure ethical marketing to cancer patients.

The Food and Drug Administration keeps pharmaceutical companies accountable by requiring that every claim on the advertisement be backed up by scientific evidence. But nothing regulates nonprofit entities, such as hospitals and cancer centers, which could mislead patients about their cancer care, according to the report.

"The report highlights those things that we need to be cautious about when we're marketing cancer services because patients are fearful," said Holcombe, the author of the report.

First, marketing should follow the strict guidelines recommended by the American Marketing Association, which says that ethical marketing campaigns center around honesty, fairness, respect, and transparency, said Holcombe.

Additionally, when promoting new research, the advertisement should explicitly state that not all patients may be eligible for the clinical trial. Such advertisements rarely include this information, according to the report.

In fact, most cancer centers avoid using data and statistics on their advertising, according to the report. Instead, many use personal testimonies.

"They make a very good basis for a marketing campaign," said Holcombe. "People are very interested in personal stories."

The problem with these advertisements is that they could be misinterpreted to be the average outcome for the treatment, when in fact the story is the exception. These advertisements could be omitting information that says the results are not typical, said Holcombe.

"It's an important conversation to have and be thinking about," said Yael Schenker, assistant professor of medicine at the University of Pittsburgh. She was not involved in the study.

"Cancer is a big business and advertising is common, but regulation and oversight of cancer-related marketing is minimal – some people don't realize that," said Schenker.

In 2014, Schenker and colleagues published a study analyzing the types of information in cancer center advertisements. They found that the majority promoted cancer therapy with emotions evoking hope and fear and rarely included data-driven information such as risks and costs.

"It's more interesting to hear about someone who survived cancer and beat the odds than looking at a table of risks," but using personal testimonials could promote false hope, which might not be the average outcome, Schenker said. "It's not the same as sitting down with your doctor and discussing the pros and cons of treatments."

"It's not inherently wrong to market to vulnerable populations," said Trevor Hedberg, a PhD candidate at the University of Tennessee at Knoxville who co-authored an article in 2013 about the ethics of marketing to vulnerable populations and was not involved in the report. Though vulnerable populations may be at risk of being harmed by immoral marketing campaigns, "you just have to hold yourself to a higher standard than you would to other clients," said Hedberg.

The main challenge is implementing oversight to keep cancer centers and hospitals accountable, said Holcombe.

"It's a self-regulated industry. I think that most people do that pretty well, but probably not everybody," said Holcombe. "I don't want to propose regulation to medical centers necessarily, but it might be nice to have some sort of oversight agency."

The report suggests that The Joint Commission, the organization that gives hospitals accreditation, could provide the oversight. If The Joint Commission added ethical marketing strategies to their requirements, then hospitals would likely comply rather than risk their accreditation, according to the report.

While pharmaceutical research has received scrutiny regularly, advertisements for cancer treatment have rarely been studied, said Schenker. "In some ways, it's a discussion that's just getting started." 

Lisa Marie Potter is a science writer based in San Francisco, California. She tweets at @Lisa_M_Potter.