University Of New South Wales: Orthopaedic surgeons not complying with advertising guidelines

The internet can be a double-edged sword for patients seeking health information, particularly in terms of direct-to-consumer advertising. In a paper recently published in The Medical Journal of Australia, researchers at UNSW Sydney revealed a considerable proportion of orthopaedic surgeons who are members of the Australian Orthopaedic Association (AOA) did not comply with AOA and Australian Health Practitioner Regulation Agency (AHPRA) advertising guidelines.

Orthopaedic surgeons specialise in diagnosing and treating musculoskeletal injuries and diseases. This includes problems relating to bones, joints, ligaments, muscles, and tendons. The surgeries they perform range from elective procedures such as joint replacement surgery to emergency surgery on patients with musculoskeletal injuries.

A breach of online advertising standards
The study included 81 randomly selected Australian Orthopaedic Association surgeons, and a list of 59 surgeons who appeared in the top Google search result list. From these two sample groups, the researchers found 64 per cent of randomly selected orthopaedic surgeons, and 81 per cent of surgeons who appeared in the top Google search results did not comply with medical board and association online advertising guidelines.  

In the AOA random sample, most of the non-compliance was due to misleading or deceptive advertising, arousing unreasonable expectations of benefit, using testimonials, and making claims of superior performance. Reasons for non-compliance among the AOA Google sample were similar, with a high proportion also non-compliant due to referencing specific brand names on their websites and failing to declare if a commercial relationship exists with these brands.

The lead author of the paper, A/Prof Sam Adie says the exploratory analysis found non-compliance to the AHPRA guidelines was higher in the AOA Google sample compared to the AOA random sample. The researchers found the level of compliance to be influenced by the state they operated in, but not by geographic location – for example rural versus metropolitan – or sub-specialty.

“Patients are increasingly relying on online health information to inform their medical care, so it’s important to recognise that misleading online information can have serious implications for informed patient decision making,” explains A/Prof Adie.

A/Prof Sam Adie, who is a conjoint senior lecturer at St George and Sutherland Clinical School at UNSW Medicine & Health says the high degree of advertising non-compliance found in the study demonstrates a need for greater care to be taken by surgeons regarding the information they publish online.  

“Stricter enforcement of advertising guidelines by AHPRA and AOA may also be needed to protect patients from misleading advertising.”


Not just happening in Australia
The researchers note previous studies conducted overseas demonstrated poor quality advertising material on orthopaedic surgeon websites, with websites containing exaggerated and subjective information with no scientific references.

“Our study is consistent with overseas studies, suggesting that poor quality online material may be typical in orthopaedic surgery. Our study is the first to examine the nature of online information published by Australian orthopaedic surgeons,” says A/Prof Adie.

“It was surprising to find the high prevalence of advertising that blatantly violates advertising guidelines. The guidelines are clear, and there are many online resources available for advertisers to determine if their advertising is compliant – particularly with the AHPRA guidelines. This suggests to us that surgeons or those responsible for their online material don’t fully understand or are not aware of the guidelines or are intentionally violating guidelines to gain commercial advantage.”

The impact on patient care
A/Prof Adie says the potential impact on patient care is of concern. “A recent systematic review found that the internet and physicians are the most frequently utilised sources of health information by patients. This is important, since misleading or deceptive advertising may interfere with informed patient decision making, as well as increase patient demand for specific treatments. It may also lead to inappropriate use of health care resources and adoption of novel technologies with uncertain efficacy.”

The methods used in the study were designed to gain a representative sample of advertising material patients may encounter when accessing information about orthopaedic surgeons. The AOA random sample was taken from 500 AOA members who elected to make their details publicly available. The sample size calculation estimated that a sample of 81 surgeons would be required to gain a 95% confidence level of +10 percentage points.

“Previous research has found that patients are most likely to visit webpages linked in top search results. So, we obtained our AOA Google sample by searching for “orthopaedic surgeon” and the name of the major city in each of the eight Australian states and territories. We then took the top eight search results. Therefore, our results can be seen as a good reflection of advertising material published by AOA members overall and is reflective of advertising material that is likely to be encountered by patients,” explains A/Prof Adie.

The study provides evidence for the level of non-compliant advertising among Australian orthopaedic surgeons. “However, what remains unanswered are the actual implications of these online advertisements in an Australian context, including the effect on patient perceptions of required treatments, brands of implants, and treatment expectations. Additionally, we only looked at compliance among orthopaedic surgeons, and there are very few Australian studies examining online advertising among other medical and surgical specialities.”

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