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Original Contribution
Accuracy of Marketing Claims by Providers of Stereotactic
Radiation Therapy
By Amol K. Narang, MD, Edwin Lam, Martin A. Makary, MD, MPH, Theodore L. DeWeese, MD,
Timothy M. Pawlik, MD, MPH, Peter J. Pronovost, MD, PhD, and Joseph M. Herman, MD, MSc
Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Johns Hopkins
University, Baltimore, MD
Abstract
Purpose: Direct-to-consumer advertising by industry has
been criticized for encouraging overuse of unproven therapies,
but advertising by health care providers has not been as carefully
scrutinized. Stereotactic radiation therapy is an emerging tech-
nology that has sparked controversy regarding the marketing
campaigns of some manufacturers. Given that this technology is
also being heavily advertised on the Web sites of health care
providers, the accuracy of providers’ marketing claims should be
rigorously evaluated.
Methods: We reviewed the Web sites of all US hospitals and
private practices that provide stereotactic radiation using two
leading brands of stereotactic radiosurgery technology. Centers
were identified by using data from the manufacturers. Centers
without Web sites were excluded. The final study population
consisted of 212 centers with online advertisements for stereo-
tactic radiation. Web sites were evaluated for advertisements
that were inconsistent with advertising guidelines provided by the
American Medical Association.
Results: Most centers (76%) had individual pages dedicated
to the marketing of their brand of stereotactic technology that
frequently contained manufacturer-authored images (50%) or
text (55%). Advertising for the treatment of tumors that have not
been endorsed by professional societies was present on 66% of
Web sites. Centers commonly claimed improved survival (22%),
disease control (20%), quality of life (17%), and toxicity (43%) with
stereotactic radiation. Although 40% of Web sites championed
the center’s regional expertise in delivering stereotactic treat-
ments, only 15% of Web sites provided data to support their
claims.
Conclusion: Provider advertisements for stereotactic radia-
tion were prominent and aggressive. Further investigation of pro-
vider advertising, its effects on quality of care, and potential
oversight mechanisms is needed.
Introduction
Over the past decade, widespread adoption of the Internet has
drastically changed the manner in which health information is
obtained, with patients increasingly turning to Web sites as a
trusted source of medical information.
1-3
A 2010 survey exam-
ining Internet use revealed that 80% of Internet users, which
equates to 59% of American adults, gather their health infor-
mation online.
4
Although greater access to health information
may lead to a more engaged patient population, concerns
abound regarding the prevalence of misinformation on the In-
ternet, particularly in the form of advertising.
5-7
Furthermore,
although direct-to-consumer advertising (DTCA) by pharma-
ceutical and medical device companies has long been strictly
regulated by the US Food and Drug Administration (FDA),
similar practices by health care providers have only recently
been scrutinized.
8
In 2009, the New York Times drew attention
to hospital advertising with an article that exposed the often
emotional and anecdotal nature of these ads.
9
The article
pointed out that the nonprofit status of many hospitals excludes
them from the same FDA oversight as for-profit companies.
New technologies are particularly susceptible to controver-
sial marketing campaigns, as it takes time to fully evaluate safety
and efficacy while companies are eager to see returns on their
investment. In radiation oncology, novel stereotactic radiosur-
gery (SRS) platforms have sparked considerable enthusiasm for
their ability to deliver large doses of radiation to precisely
defined targets. Although SRS was first developed to treat
intracranial lesions, advancements in target localization
through continuous image guidance and increased robotic
mobility have spurred interest in the application of stereo-
tactic treatment to extracranial sites, a procedure known as
stereotactic body radiation therapy (SBRT). Indeed, the use
of SRS and SBRT has surged, with one manufacturer report-
ing worldwide growth rates for intracranial, lung, and pros-
tate tumors of 42%, 80%, and 113% respectively over the
past five years.
10
Yet, whereas SRS has been well studied for
intracranial lesions,
11-16
many clinicians still consider ex-
tracranial SBRT to be experimental in the absence of more
robust, long-term data.
17-22
As illustrated in Table 1, the
most recent Clinical Practice Guidelines of the National
Comprehensive Cancer Network (NCCN) designate inop-
erable lung and liver tumors as the only two approved first-
line indications for SBRT.
23
In addition, a recent position
statement on the use of SBRT for low-to-intermediate risk
prostate cancer by the American Society for Radiation Oncologists
concluded that “there is not sufficient or mature data at this time to
demonstrate equivalency to existing standard treatment modali-
ties.”
24
In light of the uncertain role of SBRT, advertisements by
manufacturers promoting the use of SBRT across multiple body
sites have been controversial.
25
Health Policy
JANUARY 2013 • jop.ascopubs.org 57Copyright © 2012 by American Society of Clinical Oncology
Notably absent from this discussion has been the role that
hospitals and/or individual providers might play in propagating
such inaccuracies through their own marketing campaigns. We
therefore sought to systematically examine the online advertis-
ing for stereotactic radiation by providers to assess its educa-
tional benefit and explore the prevalence of potentially
misleading information. Given the absence of formal regulation
for determining the bounds of acceptable marketing, we evalu-
ated the Web site advertising of SRS/SBRT by using the Amer-
ican Medical Association (AMA) Code of Ethics, which
includes an Opinion on Advertising and Publicity (Appendix,
online only).
26
These guidelines provide a framework for deter-
mining whether online provider advertising for stereotactic ra-
diation is being conducted in a manner consistent with our
profession’s ethical standards.
Methods
Study Population
We identified two leading manufacturers of stereotactic radio-
surgery technology that produce machines primarily designed
to administer SRS/SBRT treatments and that have been the
subject of criticism for aggressive advertising campaigns. Using
the manufacturer Web sites, we identified all academic hospi-
tals, community hospitals, and private practices in the United
States that provide either of these two brands of stereotactic
technology, counting organizations that had multiple locations
only once (N ⫽215). We excluded two centers that had re-
cently purchased stereotactic equipment and had yet to include
advertisements on their Web sites. We also excluded the Web
site of a large multicenter organization that lacked advertising
because only one of its locations had invested in a stereotactic
radiosurgery system. Our final study population consisted of
212 centers.
Data Collection and Study End Points
All pages of each center’s Web site were fully reviewed using a
predefined scoring sheet designed for prior studies of hospital
advertising.
27
Web sites were scored on the basis of prominence
of advertising, which was assessed by measuring the navigation
depth needed to reach stereotactic radiosurgery-related material
and by noting the presence of a unique webpage dedicated to
the center’s brand of stereotactic technology. Navigation depth
was defined as the number of mouse clicks required to arrive at
a Web page that mentioned the center’s brand of stereotactic
technology, beginning with the Web page of the hospital or
practice where the stereotactic system was located. In addition,
the presence of a link to the manufacturer’s Web site and the use
of manufacturer-provided stock material, as defined by images
or text from the manufacturer Web site, were tracked.
Web sites were also scored on the extent to which the adver-
tising material was consistent with the AMA guidelines on ad-
vertising and publicity, as outlined in Code of Ethics Opinion
5.02.
26
These guidelines state that “objective claims regarding
experience, competence, and the quality of physicians and the
services they provide may be made only if they are factually
supportable.” The guidelines also suggest that “it is unlikely
that a physician will have a truly exclusive or unique skill or
remedy. Claims that imply such a skill or remedy therefore
can be deceptive.” Thus, we focused on whether centers
made factually insupportable or unsubstantiated claims re-
garding (1) the center’s own expertise in using stereotactic
technology or (2) the quality of stereotactic radiation ser-
vices that the center provided.
To analyze whether centers made claims of unique institu-
tional expertise, we tracked those centers that labeled them-
selves as either the regional leader in stereotactic technology or
the region’s first center to implement its use. We also recorded
whether centers supported these claims by detailing the number
of years that they had been offering SRS/SBRT. To analyze
whether centers made unsubstantiated claims regarding the
quality of their stereotactic radiation services, we examined
whether Web sites made statements of improved efficacy, mor-
bidity, and quality of life without providing clinical data or
referencing peer-reviewed publications to support these asser-
tions. Claims of efficacy included implications that SRS/SBRT
represents the standard of care for treatment of certain tumors
Table 1. National Comprehensive Cancer Network indications
for SRS/SBRT
Cancer Type Indication
Brain Brain metastases
Limited metastatic disease (1-3 metastases) in
patients with either limited systemic disease
or for whom reasonable systemic treatment
option exists. For resectable lesions,
options include surgery or SRS. SRS may
be used for a limited number of small (⬍2
cm), deep, nonsymptomatic lesions.
Surgery may be more appropriate for larger,
symptomatic lesions. For unresectable
disease, WBRT and/or SRS can be used.
Recurrent limited metastatic disease is
additional indication.
Primary malignant tumors
Small WHO grade 1 meningiomas and
recurrent adult ependymoma,
medulloblastoma, supratentorial PNET
Lung Inoperable stage I non–small-cell lung
carcinoma
Hepatobiliary For patients with unresectable/inoperable
disease consisting of 1-3 tumors with
cumulative diameter ⬍6 cm or larger
lesions if volume of uninvolved liver is ⬎800
cm
3
Spine Recurrent spinal metastases that have
undergone prior surgery and/or
conventional radiotherapy
Pancreas May be considered for LAPC as part of a
clinical trial
Colon/rectal May be considered for limited liver/lung
metastases in context of clinical trial
Head and neck No mention of SRS/SBRT
Prostate No mention of SRS/SBRT
Cervical/ovarian/uterine No mention of SRS/SBRT
Kidney No mention of SRS/SBRT
Sarcoma No mention of SRS/SBRT
Abbreviations: LAPC, locally advanced pancreatic cancer; PNET, primitive neu-
roectodermal tumor; SBRT, stereotactic body radiation therapy; SRS, stereotac-
tic radiosurgery; WBRT, whole brain radiation therapy.
Narang et alNarang et al
58 JOURNAL OF ONCOLOGY PRACTICE •VOL.9,ISSUE 1Copyright © 2012 by American Society of Clinical Oncology
(ie, “gold standard,” “most effective,” and so on) or provides a
benefit in either survival (ie, “saves lives,” “cures,” and so on) or
disease control (ie, “more complete eradication of cancer,” “bet-
ter disease control,” and so on). Assertions of decreased mor-
bidity included implications that stereotactic treatment reduces
toxicity (ie, “less complications,” “less risk of infection,” and so
on) or recovery time (ie, “immediate return,” “get back to your
life faster,” and so on). Statements that stereotactic radiation
improves quality of life were also noted. In addition, Web sites
that directly compared outcomes or toxicity with stereotactic
treatment versus with alternative surgical or radiation treatment
options were documented.
Furthermore, we compared the specific tumors that Web
sites advertised as amenable to stereotactic treatment with those
tumors listed by the NCCN as indications for SRS/SBRT. We
chose the NCCN guidelines, which are outlined in Table 1, as
our reference standard because they were the most robust state-
ment from a professional society regarding use of stereotactic
radiation. Thus, we documented whether advertisements for
non-NCCN– endorsed disease sites were characterized as inves-
tigational or as part of a clinical trial. All data were summarized
with simple proportions.
In order to explore the potential impact of practice type on
outcomes, we divided our cohort into academic centers, defined
as the primary center affiliated with a medical school, and non-
academic centers. Outcomes were compared between both
groups by using the two-sample z-test.
Results
Of the 212 centers that constituted our study, 43 (20%) were
academic institutions, and 169 (80%) were community-based
hospitals or private practices. Seventy-five percent of facilities
were operated out of a nonprofit hospital or center. Table 2
summarizes data regarding characteristics of Web site advertis-
ing for SRS/SBRT. One in five centers (19%) highlighted their
brand of stereotactic technology on their Web site’s homepage,
and 39% of centers mentioned their stereotactic technology
within two clicks of the homepage. Most centers (76%) had a
unique Web page dedicated to their stereotactic equipment,
and roughly half of Web sites contained manufacturer-pro-
vided stock images (50%) or stock text (55%). Of the Web sites
that used manufacturer-provided material, only 30% listed the
source. Furthermore, 26% of all Web sites supplied a direct link
to the manufacturer’s homepage.
A majority (66%) of Web sites advertised SBRT as a treat-
ment modality for non-NCCN–designated indications with-
out stating that the use of stereotactic radiation in these
instances is unproven or being conducted on a clinical trial.
These included endorsements of SBRT for spinal (58%), pros-
tate (50%), pancreatic (39%), head and neck (19%), and renal
(15%) cancers, as illustrated in Table 3. Literature supporting
SBRT for these tumor sites was rarely provided, with clinical
data referenced in only 9% of Web sites. In addition to listing
indications for SRS/SBRT, Web sites frequently included a
separate section purporting improved clinical outcomes with
stereotactic treatment. However these sections rarely stipulated
the specific tumors to which these claims applied. Table 3 illus-
trates the prevalence of these claims of clinical benefit, which
included language suggesting that stereotactic radiation im-
proves survival (22%), disease control (20%), and quality of life
(17%). Nineteen percent implied that stereotactic radiation is
the standard of care for certain tumor sites. Claims of shorter
recovery time (77%) and decreased toxicity (43%) were also
common, although specific adverse effects were mentioned in
only 8% of Web sites. AlWhile comparisons to alternative
forms of radiation therapy were rare, a number of Web sites
noted better outcomes with SRS/SBRT versus surgery, partic-
ularly with respect to toxicity (22%). Furthermore, although
40% of centers labeled themselves as the region’s “leader” in
stereotactic services, and 35% claimed to be the first in the
region to acquire stereotactic technology, only 15% of Web
sites provided the actual length of time the center had been
treating patients. This information is summarized in Table 3.
When the data were stratified by academic status, there were
no significant differences in the proportion of center Web sites
in each group that had a dedicated stereotactic radiation page
(P⫽.078), stock images (P⫽.2062), stock text (P⫽.3472),
or a direct link to the manufacturer (P⫽.206). In addition,
average navigation depth was not significantly different (P⫽
.134) between academic and nonacademic centers. There were
also no significant differences in the proportion of centers
claiming to be the regional leader in delivering radiation or the
first to acquire stereotactic technology (P⫽.295). Also, aca-
demic centers did not differ from nonacademic centers in the
proportion of Web sites that maintained advertisements for
non-NCCN–designated indications (data not shown) or that
provided supporting literature or references for their claims
(P⫽.652).
Discussion
Our analysis of health care providers’ advertisements for stereo-
tactic services raises serious questions regarding the transpar-
ency and accuracy of provider DTCA for stereotactic radiation.
Indeed, many of the centers in our study used marketing that
Table 2. Characteristics of Center Web Site Information
Web Sites
(N ⴝ212)
Characteristic No. %
Navigation depth
Hospital or practice homepage 40 19
One click 38 18
Two clicks 45 21
Unique page
Yes 161 76
Use of stock material
Images 106 50
Text 117 55
Direct link to manufacturer Web site
Yes 55 26
Provider Marketing of Stereotactic RadiationProvider Marketing of Stereotactic Radiation
JANUARY 2013 • jop.ascopubs.org 59Copyright © 2012 by American Society of Clinical Oncology
prominently displayed stock industry images and text without
proper attribution. More concerning was the prevalence of un-
substantiated statements and misleading language, which fre-
quently promoted the benefits of SRS/SBRT without providing
evidence to support these claims while also failing to describe
potential risks. In addition, centers commonly labeled them-
selves as the region’s leader in stereotactic services or the first to
offer stereotactic technology, which, even if true, runs counter
to AMA guidelines by implying an ability to offer unique or
exclusive services. Interestingly, these findings seem to apply to
both academic and nonacademic institutions equally. Given the
absence of clinical data, emphasis on institutional expertise, and
claims of improved outcomes compared with alternative treat-
ment options, we found that the advertising campaigns for
stereotactic technology appear to be largely shaped by the com-
petitive market for radiosurgical services rather than a specific
interest in patient education.
We selected stereotactic radiosurgery as the focus of the cur-
rent study because of its expanding role in radiation oncology
and the preliminary nature of the data supporting its use, par-
ticularly for extracranial applications. With advanced opera-
tional capabilities, newer stereotactic radiation platforms have
garnered considerable enthusiasm among radiation oncologists,
and studies across multiple body sites have suggested favorable
survival, toxicity, and quality of life, particularly for brain, lung,
and liver lesions.
11-18
However, most published work to date
has consisted of nonrandomized analyses of small cohorts of
patients without significant follow-up, and some reports have
described unacceptably high toxicity levels, underscoring the
need for caution when advocating the benefits of stereotactic
radiation.
19-22
Without more robust, long-term data, contro-
versy has centered on the promotional language that some man-
ufactures of stereotactic radiation platforms have used in their
DTCA.
25
Rather than focusing on manufacturer DTCA, which has
long been controversial, we instead sought to explore DTCA by
the hospitals and centers that provide stereotactic radiation ser-
vices. Aggressive marketing by health care providers has become
an increasingly recognized phenomenon that threatens the fi-
duciary duty of providers to offer nonbiased assessments of
medical interventions.
28-30
Indeed, a 2005 study of the adver-
tising of 17 leading medical centers revealed that marketing
strategies were frequently based on exploiting emotional ap-
peals and institutional reputation, with rare quantification of
potential benefits or mention of potential harms.
31
The study
also exposed the lack of internal or external measures to regulate
the content of hospital advertisements, a topic more recently
discussed in the popular press.
8,9,32
Although patients generally
exhibit a healthy skepticism of private industry, misleading
DTCA by providers may be particularly worrisome given that
patients often perceive these advertisements to be representative
of the physician perspective.
33,34
Our study suggests that providers need to better ensure that
their advertisements contain accurate and valid information
regarding the risks and benefits of therapies. Furthermore, pro-
viders should seek to distance themselves from medical device
companies by removing links to manufacturer Web sites and
eliminating manufacturer-provided material, or at the very least
acknowledging the source of such material. Providers should
also institute formalized internal processes for evaluating and
approving advertisements. Whereas the institutional review
boards of medical centers are required to approve marketing
materials aimed at recruiting research participants, it is striking
that similar oversight does not exist for advertisements targeted
towards the general population. Recent discussion of these is-
sues at both the Association of American Medical College’s
2010 Group on Institutional Advancement annual meeting
and the NCCN⬘s 2010 annual meeting is encouraging.
8
A number of important limitations of our study must be
acknowledged. First, our analysis was primarily rooted in ethics
using the AMA guidelines to define end points, but future
studies should expand on the possible implications of provider
advertising by examining the effect of this advertising on more
Table 3. Prevalence of Center Web Sites Endorsing Non–NCCN-
Designated Indications for Stereotactic Treatment, Claiming Clini-
cal Benefits With Stereotactic Radiation, and Describing Their
Expertise in Delivering Stereotactic Radiation
Web Sites
(N ⴝ212)
No. %
Non–NCCN-designated indications for stereotactic
radiation endorsed by center websites
Spine 123 58
Prostate 106 50
Pancreas 83 39
Head and neck 40 19
Kidney 32 15
Efficacy
Survival benefit 47 22
Improved disease control 42 20
Standard of care 40 19
Morbidity
Decreased recovery time 163 77
Decreased toxicity 91 43
Description of specific side effects 17 8
Improved quality of life 36 17
Comparison to surgery
Efficacy 11 5
Toxicity 47 22
Comparison to alternative radiation therapy modalities
Efficacy 2 1
Toxicity 4 2
Provision of data
Unreferenced study data 6 3
Referenced study data 19 9
Region’s leader in stereotactic radiation 85 40
First in region to acquire stereotactic technology 74 35
No. of years treating patients with stereotactic radiation 32 15
Abbreviation: NCCN, National Comprehensive Cancer Network.
Narang et alNarang et al
60 JOURNAL OF ONCOLOGY PRACTICE •VOL.9,ISSUE 1Copyright © 2012 by American Society of Clinical Oncology
patient-centric end points such as patient education, quality of
care, cost of care, and use of services. Considerable literature
exists on the effect of DTCA by industry on patient education,
patient-physician communication, patient adherence to treat-
ments, and overuse of treatments, and future analysis on pro-
vider advertising should parallel this work.
35
Second, we
examined the advertisements of providers for two brands of
stereotactic technology, and so our results may not be represen-
tative of provider marketing in general. We also included both
hospitals and private practices when assessing the prominence
of advertising, despite the disparity in range of services pro-
vided. In addition, by examining only Web sites, we excluded
other forms of advertising such as print, radio, and television.
Furthermore, our methodology for interpreting and classifying
Web site language was subjective and was constrained by the
fact that Web sites often did not specify tumor sites or differ-
entiate between SRS and SRBT when expounding on the clin-
ical benefits of stereotactic radiation, prohibiting stratification
of our results. Moreover, we used the clinical guidelines of a
single professional society in defining our reference for appro-
priate use of SRS/SBRT. We recognize that the NCCN guide-
lines do not represent a legal standard of care and that use of
SRS/SBRT for non-NCCN–endorsed indications may be le-
gally and/or ethically justifiable given the specific clinical con-
text. Finally, because the NCCN does endorse SBRT for
patients with recurrent spinal metastases who have undergone
prior surgery and/or conventional radiotherapy, but Web sites
rarely clarified the specific patient or tumor characteristics that
would qualified a patient with spinal disease for SBRT, the
percentage of Web sites deemed as advertising a non-NCCN–
designated indication may represent an overestimate.
Nevertheless, by selecting an emerging, expensive technol-
ogy with limited definitive data and using the profession’s eth-
ical code to define end points, we believe our study methods are
sufficient for highlighting an important issue that merits the
attention of providers. Given the extensive literature on the
relative merits of industry DTCA, we believe that similar
attention should also be given to the marketing practices of
providers.
In summary, we found that more than 20% of provider Web
sites advertising stereotactic radiation made unsupported claims
of clinical benefit, 40% championed their own expertise in
delivering stereotactic radiation treatments, and more than
60% endorsed the use of stereotactic radiation for indications
not supported by professional societies. Although the FDA pro-
vides protections against exaggerated advertising by manufac-
turers, consumers have no such protections against aggressive
marketing campaigns by providers. Greater oversight is needed
to ensure that the claims made by providers regarding the ben-
efits of therapies are accurate.
Authors’ Disclosures of Potential Conflicts of Interest
The author(s) indicated no potential conflicts of interest.
Author Contributions
Conception and design: All authors
Administrative support: Joseph M. Herman
Provision of study materials or patients: Edwin Lam, Joseph
M. Herman
Collection and assembly of data: Amol K. Narang, Edwin Lam,
Joseph M. Herman
Data analysis and interpretation: All authors
Manuscript writing: All authors
Final approval of manuscript: All authors
Corresponding author: Joseph M. Herman, MD, MSc, Department of
Radiation Oncology, 410 North Broadway, Suite 1440, Baltimore, MD
21231-2410; e-mail: jherma15@jhmi.edu.
DOI: 10.1200/JOP.2012.000693; published online ahead of print
at jop.ascopubs.org on November 20, 2012.
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Attend the 2013 Gastrointestinal Cancers Symposium
The 2013 Gastrointestinal Cancers Symposium (January 24-26, 2013, in San Francisco, California)
is celebrating its 10th year. This high-profile, specialized oncology event is designed for the
exchange of the latest research and science in cancers of the esophagus and stomach;
pancreas, small bowel, and hepatobiliary tract; and colon and rectum. Cosponsors:
AGA Institute, ASCO, ASTRO, SSO. Bookmark gicasym.org and
visit regularly for meeting updates.
Narang et alNarang et al
62 JOURNAL OF ONCOLOGY PRACTICE •VOL.9,ISSUE 1Copyright © 2012 by American Society of Clinical Oncology
Appendix
American Medical Association Code of Ethics
Opinion 5.02 on Advertising and Publicity
There are no restrictions on advertising by physicians except
those that can be specifically justified to protect the public from
deceptive practices. A physician may publicize him or herself as
a physician through any commercial publicity or other form of
public communication (including any newspaper, magazine,
telephone directory, radio, television, direct mail, or other adver-
tising) provided that the communication shall not be misleading
because of the omission of necessary material information, shall not
contain any false or misleading statement, or shall not otherwise
operate to deceive.
Because the public can sometimes be deceived by the use of
medical terms or illustrations that are difficult to understand,
physicians should design the form of communication to com-
municate the information contained therein to the public in a
readily comprehensible manner. Aggressive, high-pressure ad-
vertising and publicity should be avoided if they create unjus-
tified medical expectations or are accompanied by deceptive
claims. The key issue, however, is whether advertising or pub-
licity, regardless of format or content, is true and not materially
misleading. The communication may include (1) the educa-
tional background of the physician, (2) the basis on which fees
are determined (including charges for specific services), (3)
available credit or other methods of payment, and (4) any other
nondeceptive information.
Nothing in this opinion is intended to discourage or to limit
advertising and representations which are not false or deceptive
within the meaning of Section 5 of the Federal Trade Commis-
sion Act. At the same time, however, physicians are advised that
certain types of communications have a significant potential for
deception and should therefore receive special attention. For
example, testimonials of patients as to the physician’s skill or the
quality of the physician’s professional services tend to be decep-
tive when they do not reflect the results that patients with
conditions comparable to the testimoniant’s condition gener-
ally receive.
Objective claims regarding experience, competence, and the
quality of physicians and the services they provide may be made
only if they are factually supportable. Similarly, generalized
statements of satisfaction with a physician’s services may be
made if they are representative of the experiences of that physi-
cian’s patients.
Because physicians have an ethical obligation to share med-
ical advances, it is unlikely that a physician will have a truly
exclusive or unique skill or remedy. Claims that imply such a
skill or remedy therefore can be deceptive. Statements that a
physician has an exclusive or unique skill or remedy in a
particular geographic area, if true, however, are permissible.
Similarly, a statement that a physician has cured or success-
fully treated a large number of cases involving a particular
serious ailment is deceptive if it implies a certainty of result
and creates unjustified and misleading expectations in pro-
spective patients.
Consistent with federal regulatory standards which apply to
commercial advertising, a physician who is considering the
placement of an advertisement or publicity release, whether in
print, radio, or television, should determine in advance that the
communication or message is explicitly and implicitly truthful
and not misleading. These standards require the advertiser to
have a reasonable basis for claims before they are used in adver-
tising. The reasonable basis must be established by those facts
known to the advertiser, and those which a reasonable, prudent
advertiser should have discovered. Inclusion of the physician’s
name in advertising may help to assure that these guidelines are
being met.
JANUARY 2013 • jop.ascopubs.orgCopyright © 2012 by American Society of Clinical Oncology
