Selling quicker recoveries

Advertising surgical procedures means walking fine lines.

There’s nothing too novel about Virtua Health System’s knee-replacement commercials.

Good-looking baby boomers bathed in soft lighting do a little kick-boxing, while a deep-voiced narrator explains how surgeons can give you the same vitality.

“At Virtua, we don’t cut the quad tendon during knee replacement, so you don’t have to cut anything you love to do,” goes the tagline.

The ad is part of a broader campaign to promote its innovative quadricep-sparing knee replacement surgery, a minimally-invasive procedure it says provides a faster recovery time than other techniques. ‘It’s what we don’t cut that counts’ graces ads on the New Jersey-based group’s website.

One of Virtua’s biggest competitors, though, says the claims aren’t backed up by science.

The Rothman Institute filed a complaint with the National Advertising Division (NAD), an arm of the Better Business Bureau, arguing there’s no evidence supporting Virtua’s assertion of quicker healing.

Rothman supplied the NAD with five randomized studies to back up its belief that quad-sparing procedures don’t offer patients any additional benefit. In August, the watchdog group sided with Rothman. Virtua agreed to modify its ads, but stands by its claims.

“We are disappointed by NAD’s decision and still feel that the quad-sparing knee replacement technique practiced by the highly-skilled doctors at our Virtua Joint Replacement Institute allows patients to reach a positive outcome sooner than traditional techniques,” the group writes in a statement. “No matter what our competitors say or do inside or outside of an operating room, you simply cannot, despite 99 percent patient satisfaction based on their overall rating and willingness to recommend us.”

Neither group would agree to interviews for this story, but Rothman spokesman Rick Cushman wrote in an email, “Rothman Institute believes that the overwhelming majority of healthcare systems and physicians in the region share our commitment to responsible orthopaedic marketing that is in the best interests of our patients.”

Medicine’s brave new world 

Dr. Jack McPhilemy looked into the research on quad-sparing procedures a few years ago, but decided it wasn’t the right avenue for his patients.

He’s chair of orthopedics at the Philadelphia College of Osteopathic Medicine, and has more than 30 years in practice. He’s not affiliated with either Rothman or Virtua.

Over the long term, McPhilemy concluded, both traditional knee replacement patients and those electing for the quad-sparing procedure “do pretty well.”

The technique is what is sounds like: doctors cut into the knee, but from the side, to avoid the big quadriceps muscle running down the front of the thigh. McPhilemy says that gives the surgeon a smaller window to work in.

“And it is a little more difficult to get exacting cuts so that the knee is in as good alignment as you can get it,” he says.

If the artificial joint isn’t aligned correctly—and this is where millimeters matter—that can lead to problems down the road.

He says his patients are seeing Virtua’s ads and coming into his office at least once a week requesting the quad-sparing procedure.

“Which is a testament to the power of advertising,” he says.

Selling an emotion 

Ads for pharmaceuticals and medical devices, as opposed to an actual medical procedure, fall under the regulation of the Food and Drug Administration. It closely monitors claims, and requires disclosure of associated risks.

Florence Buchanan, a New York-based freelance commercial art director, says that forces campaigns to take an emotional approach to the product, and the illness it aims at relieving.

“You have to sort of talk in a voice that makes it empathetic to what the person is going through, and present the solution as something that will really help,” says Buchanan. “It is how you talk to them.”

If you’re selling an erectile dysfunction drug, which Buchanan has done, she says you can’t come out and say that it will rekindle romance or desire in a marriage, because there’s nothing on the drug label about romance or desire.

Instead, the emotional benefits of an erection have to be suggested lightly, through the characters, lighting and action. And so, soaring music, horseback riding and couples in bathtubs often grace the screen. The concept is aspiration…pharmaceutical ads are very good at making promises that aren’t out-and-out promises.

But hospitals and health providers that are only advertising a procedure, such as a joint replacement surgery, don’t fall under the FDA’s regulations.

Groups like Virtua and Rothman still must be truthful and accurate in their claims, but they have more flexibility in their messaging, and they don’t have to list the possible side effects like the drug ads do.

Incisions and infection risk, after all, don’t make great copy. 

A booming business 

In the past two decades the rate at which Medicare recipients get a knee replacement has nearly doubled. The Journal of the American Medical Association (JAMA) says an estimated 600,000 procedures are now performed annually in the United States.

For the high-volume clinics, all that business leads to more efficiency.

Robert Field at Drexel University says doctors have streamlined the process so much that they can wring good profit out of the $15,000 price tag.

He says that’s why facilities target it in their campaigns, along with usually only a few other medical conditions.

“You don’t usually see ads for old, frail people with cancer or with Alzheimer’s or with Parkinson’s. Those are not the high efficiency, highly profitable diseases, so the hospitals are not going after that,” says Field.

The competition for those dollars isn’t all bad for consumers, he says, especially when it leads to innovation and lower prices. But an ad that stretches the truth is good for no one. And Virtua, by the way, is far from unique here.

There was a small study done earlier this year looking at the accuracy of some medical advertisements, and not even ones aimed at consumers. These were printed in academic journals read pretty much only by doctors.

Of 50 ads selected at random, the study found that more than half of the claims being made by sponsors lacked well-supported evidence.

The report offered the following recommendation: “Orthopedic surgeons must remain skeptical about the claims made.”

Patients, it goes without saying, would do well to follow that same advice.