Direct-to-Consumer: Fertility Clinic Advertising on the Web

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The Women's Health Activist
March/April 2013

By Rachel Walden

The National Women’s Health Network has long argued for stricter regulation and elimination of direct-to-consumer (DTC) drug advertising due to its tendency to overstate drugs’ benefits and understate risks in order to increase pharmaceutical companies’ profits. A Kaiser Family Foundation analysis found that every $1 the pharmaceutical industry spends on DTC advertising yields $4.20 in drug sales, and that DTC ads are responsible for 12 percent ($2.6 billion) of the total growth in drug spending in 2000.i

The U.S. and New Zealand are the only nations that even permit DTC ads.ii There is some minimal governmental regulation of traditional DTC ads (i.e., print, TV) with respect to the claims companies can make and information they must provide — although the level of oversight is insufficient to fully protect consumers from misleading and manipulative claims about drugs. For web-based DTC advertisement, however, there is even less oversight and more mixing of advertising and information content, increasing the risk that consumers will be confused and misled. This is the case with fertility clinic websites, which represent a multi-billion dollar industry. Evidence suggests that fertility clinics’ approaches to web-based advertising present significant problems for consumers seeking objective information about success rates and clinic practices.
 
Since 1992, as a result of pressure by consumers (including NHWN members!), U.S. clinics have been required to report their success rates to the Centers for Disease Control and Prevention (CDC), which publishes these data (see http://www.cdc.gov/art/ARTReports.htm).iii More than 146,000 cycles of assisted reproductive technologies (ART) are reported to the CDC each year (primarily in vitro fertilization attempts), meaning that there are many consumers who are having these procedures.iv But, consumers looking for fertility-related information and/or providers are more likely to visit fertility clinic websites than the CDC’s page.

Sadly, these clinic sites too often try to influence consumers with misleading information about their ability to create successful pregnancies. ART is expensive (averaging $12,400 per cycle, with many patients requiring two or more cycles) and often is not covered by insurance, so it is natural for patients to seek a provider that can maximize their chance of success.Yet, a recent analysis of web content from 372 U.S. fertility clinics (out of a total of 381 clinics) suggests that the success rates being promoted are not based on reputable practices and/or standards.vi

The analysis examined websites of the clinic members of the Society for Assisted Reproductive Technology (SART), which represents most U.S. fertility clinics. SART’s guidelines require clinics to compare their success rates only to the national average, but 46 percent of the clinics violated this policy.vi Of those, 47 percent described their success rates as “superior” or “among the best”, without indicating what they were comparing themselves to (which is prohibited under SART guidelines). Over one-third (39 percent) of clinics that provided a success rate failed to describe how the rate was calculated (as SART requires), making it impossible for potential clients to gain a meaningful understanding of the rates.

Clinics also fail to meet the American Medical Association’s (AMA) guidance on website content; one study found the majority of fertility clinic websites failed to meet basic AMA guidelines such as describing how they protect patient’s privacy.vii The AMA does not investigate websites’ compliance or issue non-compliance penalties, however, and the only consequence for noncompliance with SART’s guidelines is for clinics to lose their membership (not a very significant penalty).

Consumers face other challenges when trying to evaluate clinic performance in other areas as well. ART clinic sites frequently use non-medical and non-verifiable content and advertising tactics to entice potential patients. Many use words like “dream” (30 percent of websites) on their homepages. Many mention their excellent technology (84 percent), personal approach (75 percent), and high-quality doctors (70 percent) — factors that, while important, do not provide objective information by which to compare clinics. An example of non-specific information is provided by a clinic that calls its prices “competitive” and says it “lacks hidden fees,” but does not provide an actual fee list.vi

Concerns about ART advertising date back to the field’s beginning in the late 1990s.viii Then, as now, concerns include the commercialization of medicine, inability to assess service quality, and a lack of accountability. Studies have found that clinics fail to provide objective measures of success; to note when their procedures are experimental (and may have lower success rates); and to generally comply with SART guidelines.ix  The only thing that’s new is that consumers now have ready access to misleading and poor information on-line, making it easier for consumer to access and, therefore, to be misled. 
 
What can be done to help patients navigate the maze of on-line fertility clinic information? First, consumers should view these sites with a critical eye, recognizing that words like “miracle” and photos of smiling babies are intended to evoke specific feelings and encourage spending lots of money at a specific clinic. The sites should be considered to be advertisements rather than sources of accurate, verifiable medical information. Consumers should consult the CDC data (recognizing that comparisons may be difficult and clinics may select patients in ways that influence their rates).

Second, we need better oversight of clinic website content, including independent assessment and disclosure of how well clinic websites meet industry guidelines.SART and the American Society for Reproductive Medicine should establish new guidelines that reflect how clinics actually advertise (e.g., on-line), commit resources to member education, and impose significant consequences for non-compliance. Any new guidelines should include the use of social media (like Facebook), used by about one-third of clinics already to reach potential customers.  More broadly, Federal restrictions and regulations on DTC marketing should include web-based and social media as well as TV ads and other forms of advertising.  

Rachel R. Walden, MLIS is a medical librarian and blogger for Women’s Health News and Our Bodies Our Blog.


[i] Rosenthal MB, Berndt ER, Donohue JM et. al., Demand Effects of Recent Changes in Prescription Drug Promotion, Menlo Park CA: Kaiser Family Foundation, 2003. Available online at: http://www.kff.org/rxdrugs/6084-index.cfm.

[ii] National Women’s Health Network, “Direct-to-Consumer Advertising: ‘Education’ for the People, or Increased Profits for Drug Companies?” Women’s Health Activist 2001, 26(2). Available online at: http://nwhn.org/direct-consumer-advertising-%E2%80%9Ceducation%E2%80%9D-people-or-increased-profits-drug-companies
 
[iii] Centers for Disease Control and Prevention (CDC), Assisted Reproductive Technology (ART): Policy Documents, Atlanta: CDC, July 24, 2012. Available online at: http://www.cdc.gov/art/Policy.htm. 
 
[iv] Centers for Disease Control and Prevention (CDC), American Society for Reproductive Medicine, Society for Assisted Reproductive Technology, 2010 Assisted Reproductive Technology Fertility Clinic Success Rates Report, Atlanta: CDC, 2012. Available online at:  http://www.cdc.gov/art/ART2010/PDFs/ART_2010_Clinic_Report-Full.pdf
 
[v] American Society for Reproductive Medicine (ASRM), “Is in vitro fertilization expensive?”, Online Resources, Birmingham: ASRM, Available online at: http://www.asrm.org/detail.aspx?id=3023
 
[vi] Hawkins J, “Selling Art: An Empirical Assessment of Advertising on Fertility Clinics’ Websites,” Forthcoming in the Indiana Law Journal 2013, 88(4). See:  http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2167409.
 
[vii] Huang JY, Discepola F, Al-Fozan H, et. al., “Quality of fertility clinic websites,” Fertil Steril. 2005; 83(3):538-44. PubMed PMID: 15749475.
 
[viii] Women's Health Issues (Special issue), 1997; 7(3): 127-196.
 
[ix] Abusief ME, Hornstein MD, Jain T, “Assessment of United States fertility clinic websites according to the American Society for Reproductive Medicine (ASRM) / Society for Assisted Reproductive Technology (SART) guidelines,” Fertil Steril. 2007; 87(1):88-92. Epub 2006 Nov 1. PubMed PMID: 17081534.
 
[x] Cowan BD, “Veracity in in vitro fertilization Web pages,” Fertil Steril. 2005; 83(3):548-9. Review. PubMed PMID: 15749477.