Miss Lara Watson and Miss Priyanka Chadha consider the arguments for and against the use of adverse events in a clinic’s marketing strategy.
The rise in demand for aesthetic procedures has seen a corresponding increase in the number of practitioners offering these services. However, as with any procedure, there is a risk that it can result in adverse outcomes.1-4 The use of promotional material illustrating adverse events in aesthetics remains a controversial issue without clear guidelines, yet these marketing tactics are frequently used. Practitioners may contrast their own successful outcomes with the adverse outcomes of other practitioners, or they might use these adverse outcomes as a platform to promote their services in corrective procedures. Whilst adverse events do occur and patient awareness of potential complications is an integral part of the ‘informed consenting’ process, there are a number of ongoing discussions centred around the appropriateness of advertising adverse events in marketing material. These issues include ethical, legal and business considerations.
Adverse events do occur and, as such, there is an undeniable audience that may be interested in services designed specifically around the correction of adverse events. Thus, the use of promotional material that highlights how a practitioner could potentially reverse or improve unsatisfactory results may represent a valid and necessary industry niche. As with any medical procedure, patient safety is paramount. Cultures in which people are open to speaking out about the risks of a procedure, and embrace the diagnosis and management of complications, may improve patient safety. It could therefore be argued that the publishing of adverse events by practitioners and clinics is in the interest of patient safety as it promotes better standards and facilitates informed decision making.
Considering how the aesthetic specialty has long been criticised for a lack of regulation and transparency, along with the exposure of ‘rogue practitioners’ in the media, there is another potential positive. The illustration of adverse events in advertising may remind patients that aesthetic procedures carry risks. It could therefore help practitioners achieve a better relationship with the public by appearing more integrous and trustworthy, especially in terms of the risks and complications associated with treatments.
The final argument in favour of allowing adverse event advertising, is that practitioners have a right to freedom of speech and advertising creativity. Provided they comply with the correct regulation and ethical standards (see section on relevant regulations) by, for instance, avoiding the slander of other practitioners and attaining appropriate patient consent,5 it would seem only reasonable to accept some degree of freedom in advertising adverse events.
One argument against advertising adverse events is that it could be considered as ‘fear-mongering’; thus, unnecessarily deterring patients and promoting a negative image of the specialty. In line with the 2015 Montgomery case,6 doctors are required to thoroughly explain the risks of any procedure and will ask a patient to sign a consent form to demonstrate their acknowledgement of these risks. However, nowhere states that practitioners should advertise these risks through the use of graphic images.
Another important argument against the use of adverse events for marketing and advertising is the potential risk of unethical or even illegal methods. Content must comply with the Committee of Advertising Practice (CAP) Code and the Broadcast Committee of Advertising Practice (BCAP) Code, which can request removal or amendment to an advertisement or inflict fines. Through these regulations, the Advertising Standards Agency (ASA) can enforce socially responsible marketing. It has the power to ban the use of promotional marketing tactics and misleading imagery that may inappropriately encourage those from a more vulnerable demographic, like teenagers, towards treatment. The ASA has recently reported the ruling against a number of adverts that were deemed irresponsible. For example, the use of a ‘Sex and the City’ style advertisement for a fat transfer procedure was considered to glamourise the operation. In another advert, phrases such as ‘the incisions are tiny’ and ‘you recover within hours’ were deemed to underplay the seriousness of breast augmentation.7 Moreover, images of ‘botched’ procedures used in marketing could arguably be seen as visually offensive, distasteful and insensitive, which would invite the public to raise complaints with advertising watchdogs such as the ASA. As described above, if public concern becomes a problem, the ASA would be motivated to enforce the relevant CAP and BCAP guidelines. Furthermore, if the marketing material includes negative remarks about other practitioners (even if they are not identifiable), this can contribute to a blame culture and negatively impact the morale of those within the specialty.8 A 2013 study, where 20 community-based oncologists and 19 family physicians had encounters with standardised patients, suggested that negative comments made about another practitioner to patients not only greatly diminishes patient satisfaction and quality of care, but also affects the wellbeing of healthcare staff in that environment.9
Additionally, there is significant risk in the unregulated advertisement of images of adverse events as this may disrupt the entire aesthetic specialty, through a loss of public confidence and a drop in demand for procedures. It may also encourage litigation, as studies have found that at least a third of malpractice plaintiffs felt that their doubts were endorsed by a medical professional.10,11 Advertising adverse events is labelling certain outcomes as adverse even though they may be subjective; if the public believe that this labelling is endorsed by trained, skilled practitioners, this may encourage unnecessary litigation. The advertising of adverse events may also falsely imply that corrective procedures carry less risk or risks dissimilar to the original procedures. This is obviously inaccurate; it may create distrust within the industry and could impose unnecessary litigious conflict for the practitioner in the event that an adverse event does occur.
It is the opinion of the authors that advertising adverse events may be appropriate in the right circumstances, such as when the practitioner has special training and skills in the correction of a brow droop from toxin administration or the elimination of granulomas and delayed onset nodules (DONs) from dermal filler treatment, for instance. These corrective procedures can involve a niche set of skills that only a minority of practitioners may have. This therefore indicates a special demand amongst patients which should be satisfied through their ability to seek treatment from an appropriate practitioner in order to minimise morbidity, as well as optimise patient outcome and experience. However, practitioners advertising adverse events should refer to guidance provided by governing bodies such as the GMC, NMC, GDC and CAP/ BCAP. It should be reported accurately and presented tactfully, sensitively and professionally without compromising patient confidentiality. Practitioners should also be aware of the potential repercussions of this type of advertising, including damage to their reputation, patient deterrence and industry disruption. If they are to use adverse events to persuade patients to come to their clinic, we believe they should safeguard their practice and their patients through careful wording and stringent adherence to the relevant guidelines. Comprehensive and thorough disclaimers can benefit both the patient and the practitioner; managing expectations by giving patients some idea of the risks involved in every procedure can help to protect the practitioner from lawsuits and fines by appearing responsible to both patients and the ASA. While it is difficult to say if a short disclaimer would be enough to invoke careful consideration on the patient’s part, this has potentially helped other cosmetic companies that had been singled out by the ASA to avoid fines, which would greatly outweigh the negative impact it has on advertising effectivity.5,12
This topic highlights a critical need for growth and development in certain areas of today’s specialty. Better communication between practitioners, transparency, accessibility of information and outcome-orientated audit and research would improve our understanding of this field, how to achieve better outcomes and how to avoid dangerous complications. This would ultimately lead to a safer practice environment, enabling patients to make more informed decisions about the treatments they receive and from whom, reducing the underlying need to advertise adverse events.
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