Like many academic physicians, I fly a great deal on the way to lectures, meetings, and study sections. My flights are frequent, but I am not nearly in the league of the George Clooney character in the movie, “Up in the Air.” I have Platinum status on American Airlines; TSA agents at the Raleigh-Durham airport know me by name; and some weeks I get more work done in the Admiral’s Club than in my own office. Alas, flying is no fun. To paraphrase and modernize a venerable quotation, flying is nasty, brutish, and at least two hours delayed.
In-Air Distractions
When stuffed in my coach seat (next to a charming, albeit shrieking baby or a persistent little girl who will relieve her boredom by engaging me), I often get weary of reviewing manuscripts or catching up on back issues of A&R. For a moment’s pause and refreshment, I like to peruse the SkyMall catalog in search of a really nifty purchase like Video Recording Sunglasses or a Head Massager that uses heat from vibrating magnets to relieve tension. I have a lot of tension, but I’m not ready to fork over $199.95 for this device, especially since the four AA batteries to power that baby are not included.
When the baby shrieks or the girl’s questions rise to the level where the Head Massager seems like a good idea, I look at the airline magazines. They usually have nice stories about where Sandra Bullock likes to eat tacos in Austin or why I should hold my next convention in Greenville, S.C., or Topeka, Kan., or some other place dubbed the “Gateway to the Whatever,” also known as the place the American Airlines commuter line happens to stop.
What I find especially interesting about the ads in the airline magazines is the manner in which they portray illness … the impact of illness is often minimized and, indeed, may be an object of mirth, merriment, or whimsy.
Like all magazines, the airline magazines are not just about the content (i.e., the human interest features or travel pieces); they also are about the ads. What impresses me the most about these magazines is that, in virtually every publication of a U.S. airline carrier, ads for physicians, hospitals, and medical procedures are among the most common, competing tooth and nail for space with Vegas resorts, steakhouses, and matchmaker services.
While the Food and Drug Administration might regulate direct-to-consumer (DTC) ads, it seems that there is wide latitude for claims for hospitals or physician services, whether to open up a carpal tunnel, obliterate unsightly varicose veins, or laser multiple bulging discs in a single sitting.
Please, don’t get me wrong in my reaction to these ads. I find them interesting and potentially useful. As in the case of DTC materials, advertisements of medical services have value in alerting the public to treatment options, as well as physicians and centers with experience and expertise in particular areas.
Business Side of Medicine
Medicine is a very competitive business, and I would like to emphasize the word business. Business is about customers, and customers have to know who is providing services and need direction on how to get there. Every medical center that receives a top ranking from U.S. News and World Reports (interestingly, an also-ran magazine that dropped out of the competition with Time and Newsweek to get into the ratings game) makes that achievement known even if the criteria for selection are uncertain and some of the rankings, based on reputation, are downright suspect. Until there are more objective measures of performance, reputation will be a major determinant of rankings—and reputation is often fluff.
What I find especially interesting about the ads in the airline magazines is the manner in which they portray illness. (This situation also pertains to ads in regular newspapers and magazines, although I tend to ignore them when I am not a captive in a cramped seat and that baby next to me is scrunching his face in a way I can only assume means he is filling his diapers). In these ads, the impact of illness is often minimized and, indeed, may be an object of mirth, merriment, or whimsy. On a recent trip, I saw an ad touting the expertise of a top medical center, although I am not sure what was being recommended. The text, which accompanied a picture of a navel of a surgerized abdomen, was simple: “Removing a kidney through a tiny incision. Going out through an inny.”
I am mystified about the intended meaning of this ad. Surgery to remove a kidney is major, performed only for serious indications like a nephrectomy for a hypernephroma or donor organ harvest. I have to ask myself whether, in the face of a renal carcinoma, which can cause real misery when it spreads, whether the size and location of the scar really matter. And what do outies do? Is there surgery for them at the center as well, or do they need to go someplace else?
Who Is The Target Audience?
I am a big believer in the freedom of commercial speech and the great value of consumer education on medical subjects, whether the information is provided by a physician’s organization, voluntary health organization, hospital, or pharmaceutical manufacture. Nevertheless, medicine is a deadly serious business. Surgery can fail, and it is just as likely that the new MRI scanner will show a tumor that has grown wildly as one that can be eliminated. I don’t watch much television, except for sports, and during the Olympics last year I saw many ads for a brand of MRI scanner. The more I saw that ad, the more convinced I became that this particular scanner actually cured cancer or detected only benign lesions. Unlike the machine in my hospital, the advertised scanner seemed to produce only good news.
While I am glad that a top company has perfected MRI machines (truly, they are marvels and can show the smallest lesions), I am not sure about the message for the viewing public. Clearly, unlike laundry detergent, beer, or an automobile, an MRI is not a purchase choice for an average consumer. Should the person, when visiting the doctor, request that the MRI be done with a brand-name machine? Should he say, “Frankly, doctor, I would like my back imaged with the GE (or Siemens or whomever). I saw it on The Jay Leno Show last night; it gets really good images.” Maybe the ads are to build good will in a company like Boeing, whose ads I see a lot although I am not ready to buy one of their planes or missiles.
The marketplace that is today’s media is a strange place. It can present public service announcements of the most esteemed kind or descend to hucksterism of the most venal. Unfortunately, it is sometimes difficult for the average person to know which is which. Therefore, to the extent that physicians determine or influence the content of these ads, I hope that they will choose wisely. Our treatments are more valuable than vibrating magnets. We must act that way.
Dr. Pisetsky is physician editor of The Rheumatologist and professor of medicine and immunology at Duke University Medical Center in Durham, N.C.