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Thursday, March 10, 2011

Marketing vs. Education

Do health care services really need to be marketed to the public? Patients might benefit from educational outreach efforts if they are not availing themselves of services which may enhance the length or quality of their lives. That is a given. However, when the message is self serving, what sort of disclaimers need to be made. Furthermore, whose domain should the educational efforts reside in and which parties should be the drivers and who should vet the materials? What is the difference between educational and marketing materials?

Are materials from "non-profit" entities more likely to be educational than materials from for profit entities such as pharmaceutical companies or for-profit hospitals?

Let's look at a few actual scenarios. I browsed the web, looking at the nature of patient educational materials.What do the "educational" materials say to patients about screening mammography? In my non-scientific but random discovery of Web based resources, I came upon the the the University of Colorado Imaging Services and their patient educational materials. (http://www.uch.edu/conditions/imaging-services/mammograms/patient-education/index.aspx). There under the labeling of patient educational materials are the the following recommendations:
Talk to your caregiver about mammograms and when you should have them. The American Cancer Society suggests the following:
  • All women 40 years and older should have a mammogram each year.
  • Younger women who are at high risk for getting breast cancer should talk to a caregiver about mammograms.
The next two sites at UPMC and UCSF relayed the identical message.   (http://www.upmc.com/HealthAtoZ/patienteducation/C/Pages/mammogram.aspx  and http://www.ucsfhealth.org/education/breast_health/american_cancer_society_guidelines/index.html)
Note there was no mention of the possible downside to undergoing the test, something that you might expect to find in educational materials. The exception to this is the University of Wisconsin which actually presents both sides of the story (http://apps.uwhealth.org/health/hie/1/003380.htm) along with a Q&A( http://www.uwhealth.org/news/uw-health-screening-mammography-guidelines-faq-for-patients/25624) dated in 2009, albeit it is buried in the News section and unlinked to the patient education page. They briefly mention risks but discuss only the risks of radiation.

Contrast this to the NCI which includes additional information regarding things such as potential harms from mammography, presenting concepts such as false positives and false negative test. This site provides educational materials. The other sites present essentially marketing materials dressed up as educational materials. Kudos also to Wake Medicine which provided a nuanced and understandable patient educational materials. http://www.wakemed.org/videos/information/Mammography-Cary.pdf

The difference between the the UCol/UPMC/UCSF sites and the NCI site is that the former represent marketing tools, not educational tools. The former sites provide no reason for patient not to decide to commit to annual mammograms after age 40. Given how controversial the recent mammography data and discussions have been among experts, any balanced educational presentation should provide some recognition that it is reasonable for selected patients to elect less aggressive screening. An argument could be made that this sort of nuance is presented to patients face to face by their care providers. However, I doubt this happens on a consistent basis. It is just easier to keep feeding the machine.

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