Hospital ads for the latest novelty treatment tell patients nothing about what matters

All of us have seen them — those ubiquitous TV hospital ads that are designed to impart a warm and fuzzy feeling about the medical facilities they are promoting. In New York City, where I live, the ads have reached a new level of silliness.

This winter a subway ad for Mount Sinai Hospital advised riders, “When researching hospitals, consider how much research they do.” It went on to say, the research “we do today drives medicine we will do tomorrow,” and noted that the hospital was proud that it “ranked in the top four medical schools in the country in research dollars per investigator.”

If I were looking for a hospital for a surgical procedure or if I were taken to a facility in critical condition as I was in 2017, the last thing I’d care about was that the hospital was ranked highly for “research dollars per investigator,” whatever that means for patients. I can think of several other measures, such as a hospital’s rates for blood stream or surgical site infections or its readmission rates, that are far more useful for indicating the quality of care.

But you’re not likely to see those measures touted in any ads for your local hospital. Instead you’re likely to see ads promoting unique treatments such as the CyberKnife for prostate cancer from NYU Winthrop Hospital. The ads usually convey something special about the hospital and sometimes the miraculous cures they enable, like a recent Cleveland Clinic commercial featuring a woman whose heart was failing. “No one else could figure out what was wrong with me,” she said. The Clinic saved her life, she added. An ad for Vanderbilt University Hospital promises patients they can “get everything that medical science has to offer,” and for kidney and heart transplant patients, “we can now test your DNA to give you a more precise dose of a common anti-rejection drug.” For some patients, the commercial says, “It’s the difference between life and death.”

What’s wrong with these dramatic testimonials?

I checked in with Arthur Caplan, a professor of bioethics at New York University Langone Medical Center, who has made a practice of questioning those medical miracle ads. Caplan says they may not be giving a realistic picture to people who have serious life-threatening cancers and other diseases, and the narrative suggests that survival, if not certain, is at least likely. That is, if you go to the hospital sponsoring the ad.

The ads are misleading, Caplan explained. He said many ads push individualized or personalized medicine. “They give the impression there’s a pharmacy up in the attic brewing a medicine just for you,” Caplan said. They aren’t, he added. “It’s cruel to suggest you’re getting something special or unattainable when that’s not the case. You’re deceiving them.”

Caplan’s comments on the ethics of hospital advertising and the current genre of hospital miracles that permeate the advertising space invite a much larger discussion: Namely, what are the right metrics to judge a hospital’s performance, how useful are such metrics in emergency situations, and how could you possibly refer to them once you are in the hospital as a patient?

The steps a hospital takes to ensure that medication errors don’t occur or that its staffing ratios are sufficient to protect patients are not the stuff of local advertising. Billboards and TV ads are for CyberKnives and cancer miracles. No hospital I know is promoting the how many nurses it has on the night shift.

Meanwhile, the hospital business is changing. What were once individual facilities historically run by charitable and religious institutions are now more likely to be part of mega-conglomerates where patients are now treated as customers and doctors are known as providers. “Hospitals are being treated like a business,” Caplan told me “You’d be a sap if you don’t advertise.”   

As hospitals buy up other hospitals and establish satellites in cities near and far to trade on the hospital name and attract new patients, it’s fair to ask whether the satellites deliver the same kind of care as the mother ship. Presumably the hospitals with marquee names hope the impression of excellence — fostered by the ads, of course — rubs off on their affiliates.

But does real or perceived excellence in a particular medical specialty such as prostate cancer treatment shown by the mother ship mean the satellites will provide the same kind of care?

Most potential patients don’t know, and they’re likely to equate the two based on little evidence. A recent study published in JAMA Network Open reported that the likelihood of surviving complex cancer surgery appears to be greater for those who had the procedure at the top-ranked hospital than at their affiliates.

Researchers said their study had limitations and that they might not be able to generalize their observations to all scenarios in which hospitals extend their brand. They concluded that whatever the public’s perception is, “there is currently no evidence to support or refute assumptions of care equivalency within cancer networks.”

What do patients want from a hospital stay aside from getting well and getting out? Assuming they get the right treatment, patients want to be safe and avoid any surprise bills at the end that can send them to the poor house. They want to feel like they’re in trusted, skilled hands. Those dimensions, however, are usually unknown to patients before they are hospitalized. The steps a hospital takes to ensure that medication errors don’t occur or that its staffing ratios are sufficient to protect patients are not the stuff of local advertising. Billboards and TV ads are for CyberKnives and cancer miracles. No hospital I know is promoting the how many nurses it has on the night shift.

Even Zuckerberg San Francisco General Hospital, which recently ended its controversial practice of balance billing — when a hospital sends patients bills for a balance that an insurer won’t pay — has seemed less than eager to publicize its far-reaching changes to help its patients, according to Vox’s health policy writer Sarah Kliff. Kliff deserves a lot of credit for pushing the balance billing story into national prominence by collecting more than 2,000 emergency room bills from October 2017 through April 2019. Although balance billing is outlawed by Medicare, it has become commonplace among privately insured patients in the last few years.

“I hear from patients with bills they are not aware of the policy changes,” Kliff told me. “I have no evidence they are advertising it widely. They made a decision not to send out notices to patients.”

I asked the hospital if they ever advertised their new billing policy. “We don’t buy ads or have an advertising budget,” said Rachael Kagan, director of communications at the San Francisco Dept. of Public Health. “There’s been extensive local and national media coverage, as well as press releases and public meetings of the health commission. There’s information posted on our website.”

While this is all to the good, these steps aren’t likely to capture the public’s imagination or burnish the brand the way that miracle cures or the CyberKnife have. But how great it would be if some hospital that was really improving safety, for instance, or designing more humane billing practices would take the giant step of shouting it from the roof top.

Veteran health care journalist Trudy Lieberman is a contributing editor at the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care blog.