Surgeons’ breach of advertising regulations prompts a call for stricter enforcement

Marketing & Strategy: A considerable proportion of Australian 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, according to a new study. These results have prompted a call for stricter enforcement of professional advertising regulations, including disciplinary action.

Researchers led by Associate Professor Sam Adie, from the St George and Sutherland Clinical School at UNSW, examined the online advertising of two samples of orthopaedic surgeons – 81 randomly selected from a list of members of the Australian Orthopaedic Association (AOA) with publicly available contact details; and, a sample obtained by searching with Google for “orthopaedic surgeon” and the name of the major city in each of the eight Australian states and territories in turn.

“Of the 81 surgeons in the AOA random sample, 52 (64%) were non-compliant with at least one aspect of the Australian Health Practitioner Regulation Agency (AHPRA) guidelines, and 53 (65%) were non-compliant with at least one aspect of the AOA guidelines. Of the 59 surgeons in the AOA Google sample, 48 were non-compliant with the AHPRA guidelines (81%) and 46 with the AOA guidelines (78%),” Adie and colleagues reported.

“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,” said A/Prof Adie. 

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In summary, online advertising complied with medical board and association guidelines for only 20 of 81 of the AOA surgeons, and 7 of 59 surgeons at the top of Google search result lists.

“Direct-to-consumer advertising is common in orthopaedic medicine, particularly by surgeons who use new medical technologies,” Adie and colleagues wrote.

“Advocates argue that the advertisements are empowering educational tools that support informed decision making by patients. However, critics voice concerns about inaccuracies, misleading claims, and biased information, as the primary aim of advertising is to increase the demand for particular services.

“Non-compliance [in our study] was often characterised by unverified claims of reputation and skill, or misleading representations of the benefits of treatment,” they wrote.

“We did not investigate the reasons for these breaches, but our findings suggest that surgeons, or those responsible for their online material, either do not fully understand the guidelines or intentionally violate them seeking commercial advantage.

“We found that guideline violations were frequent in advertisements for robotic surgery. Installing robotic surgery systems can cost as much as $1,000,000 and these costs are likely to be passed onto patients.

“The AOA guidelines specifically advise surgeons not to claim that the clinical outcomes of robotic surgery are superior to those of standard surgery, but this advice was breached by 14% of surgeons in the AOA random sample and 29% of the AOA Google sample,” Adie and colleagues explained.

“As patients increasingly rely on online health information, it is important that surgeons recognise that misleading information on their websites can have serious implications for informed patient decisions. Increasing patient demand for specific treatments can lead to inappropriate use of health care resources and adoption of novel technologies of still uncertain efficacy.

“Our findings suggest surgeons must take greater care with the information they publish online, and that AHPRA and AOA must undertake further steps to enforce compliance with their advertising guidelines,” they concluded.