title: Advertising, patient decision making, and self-referral for computed tomographic and magnetic resonance imaging.
abstract: BACKGROUND
  Self-referred imaging is one of the latest health care services to be marketed directly to consumers. Most aspects of these services are unregulated, and little is known about the messages in advertising used to attract potential consumers. We conducted a detailed analysis of print advertisements and informational brochures for self-referred imaging with respect to themes, content, accuracy, and emotional valence.
  
  
  METHODS
  Forty print advertisements from US newspapers around the country and 20 informational brochures were analyzed by 2 independent raters according to 7 major themes: health care technology; emotion, empowerment, and assurance; incentives; limited supporting evidence; popular appeal; statistics; and images. The Fisher exact test was used to identify significant differences in information content.
  
  
  RESULTS
  Both the advertisements and the brochures emphasized health care and technology information and provided assurances of good health and incentives to self-refer. These materials also encouraged consumers to seek further information from company resources; virtually none referred to noncomplying sources of information or to the risks of having a scan. Images of people commonly portrayed European Americans. We found statistical differences between newspaper advertisements and mailed brochures for references to "prevalence of disease" (P<.001), "death" (P<.003), and "radiation" (P<.001). Statements lacking clear scientific evidence were identified in 38% of the advertisements (n = 15) and 25% of the brochures (n = 5).
  
  
  CONCLUSIONS
  Direct-to-consumer marketing of self-referred imaging services, in both print advertisements and informational brochures, fails to provide prospective consumers with comprehensive balanced information vital to informed autonomous decision making. Professional guidelines and oversight for advertising and promotion of these services are needed.
authors.affiliation: Stanford Center for Biomedical Ethics, Program in Human Biology, and Department of Radiology, Stanford University, Stanford, Calif, USA. illes@stanford.edu
authors.forename: Judy
authors.initials: J
authors.lastname: Illes
authors.forename: Dylan
authors.initials: D
authors.lastname: Kann
authors.forename: Kim
authors.initials: K
authors.lastname: Karetsky
authors.forename: Phillip
authors.initials: P
authors.lastname: Letourneau
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Raffin
authors.forename: Pamela
authors.initials: P
authors.lastname: Schraedley-Desmond
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Koenig
authors.forename: Scott W
authors.initials: SW
authors.lastname: Atlas
mesh_terms: D000329:Advertising / Q000639:trends*; D003657:Decision Making; D008279:Magnetic Resonance Imaging; D010361:Patients / Q000523:psychology*; D018584:Physician Self-Referral / Q000639:trends*; D014057:Tomography, X-Ray Computed; D014481:United States