By Stacey Kusterbeck
Living in Houston, Andrew Baldassarre, PhD, continually saw television advertisements for MD Anderson Cancer Center, where he worked as a clinical ethics intern. Baldassarre began wondering about the ethical implications. “Direct-to-consumer advertising raises ethical concerns in general. The U.S. is alone amongst its peers, economically speaking, in advertising pharmaceuticals directly to consumers. It’s hard to be surrounded by ads for the institution you are affiliated with [and] not to ask, is this not falling into the same category? If this is different, then why is this different? If this is acceptable, why is it acceptable?” asks Baldassarre, currently an adjunct instructor at Houston Community College and Lone Star College, who teaches courses on clinical ethics and philosophy.
Baldassarre began to investigate what guidelines existed for ethical standards for cancer care ads and if top providers generally are adhering to all of them. “There really wasn’t a definitive answer as to compliance. That is a little troubling, considering that in some states it’s actually the law to comply with certain guidelines. And it doesn’t seem like anyone is actually checking,” says Baldassarre.
From an ethical standpoint, some key concerns are that the ads may be making false promises or may be giving patients a false sense of hope. “Obviously, we want to avoid feelings of despair among our patients who might be feeling despair. But we don’t want them to avoid that through misinformation. We don’t want to promise things that we really can’t deliver on,” says Baldassarre.
Advertisements tap into people’s emotions, and hope is a powerful message to convey. This is ethically problematic because advertisements are directed toward the general public. “Inevitably, promises made can’t be delivered on for some of those people. How tolerant should we be of advertising that leans on hope? That is an open question right now,” says Baldassarre.
Baldassarre and a colleague analyzed 31 television ads from 2019-2024, produced by 12 top-ranked cancer centers, to determine compliance with ethical guidelines from the American Society of Clinical Oncology and the American Medical Association.1 Most of the direct-to-consumer cancer care television advertisements were non-compliant with clearly established ethical guidelines.
The researchers categorized the ads as compliant, borderline (defined as having ambiguous claims, with at least one problematic interpretation), or transgressive (defined as explicitly violating guidelines). Of the 31 ads, 16 either were borderline or transgressive. Just four of the 12 cancer centers produced ads that were entirely compliant with ethics guidelines.
“In an ideal world, we would have found maybe one or two questionable ads here and there. But we found, more often than not, that top care providers had TV ads that bring a toe up to the line, and sometimes step over the line, as to what is acceptable as a claim,” says Baldassarre.
More than one-third of the ads contained unrealistic expectations. One ad claimed the center was able to help “patients who are out of options.” “It’s not a fair thing to say. It’s just disingenuous to patients who are out of options — what could you possibly have?” asks Baldassare. “If you were told by a healthcare provider that you are out of options and you are unwilling to accept the conclusion, then anyone promising to help you, whether or not they actually can, is going to seem almost miraculous.”
Many ads implied that the cancer center had exclusive treatment availability. “Given the way that physicians are expected to participate in ongoing skills-based training and education at top institutions, it’s very, very unlikely that an institution will have a radically new therapy exclusively. And if they do have it exclusively, they won’t have it exclusively for very long,” says Baldassarre.
When immunotherapy for cancer was first being developed, only the institutions that participated in its discovery had access to it. That soon changed, and many other institutions offered the treatment. The same is true going back decades ago, when radiation therapy was only available at a few centers. “The machines were big, expensive, and difficult to install, so only a few institutions had them. But that quickly became the standard, and every oncology center has one now. It’s rarely the case that some kind of technology has been proven effective and only one or two institutions have access to it. That kind of claim is a tough pill to swallow,” says Baldassarre.
Other ads were misleading about eligibility criteria for clinical trials. A center might run a clinical trial in partnership with a pharmaceutical company to determine if a drug, in combination with standard care, will increase the likelihood of survival by a certain percentage. The problem is that only some of the people viewing the ad meet the eligibility criteria for the clinical trial. It is possible that researchers are recruiting only patients from a certain age group, for example.
“Maybe someone started out at the institution because they saw the advertisement and thought they could get into the trial. But they can’t get a spot — and now you’ve really done wrong by this patient,” says Baldassarre.
Some ads on buses or subways ask a question such as, “Are you a smoker younger than 50 years of age trying to quit? Come see if you are eligible for our clinical trial.” Ads on TV are more likely to say something that implies that the institution is uniquely offering a therapy option as part of a clinical trial. “That might be true, but the patient watching might not qualify,” says Baldassarre.
Many people do not have any understanding of how clinical trials are run and do not know the implications of a particular clinical trial for their type of cancer and situation. “If you are putting out information for a mass audience that says, ‘Come here, we are doing research on your kind of cancer,’ it is not fair to assume that an average viewer of that advertisement knows to differentiate themselves from other potential cases,” says Baldassarre.
People will travel very far to get top-tier care, incurring significant financial costs. Some will find that they do not meet eligibility criteria for an advertised clinical trial or that an advertised treatment does not have statistical significance in helping patients like them. “Now this patient is worse off. And they are probably worse off because the advertising wasn’t clear enough,” says Baldassarre.
Although direct-to-consumer pharmaceutical ads are ethically controversial, they do identify common side effects at the end of the ad. In contrast, ads for cancer centers do not list the potential “side effects” of choosing cancer center A over cancer center B. “Advertising only does one half of the job. It only informs you of the pros. It leaves out important context — all the reasons you might not want to pursue care at that center,” says Baldassarre.
Some people do not realize that an institution near them actually is part of the same clinical trial as the one being advertised by a faraway center. Those patients would be better off pursuing treatment close to home. It is unclear how often patients travel for cancer care that does not end up improving their outcomes. “This study shows that providers are advertising in a way that doesn’t fit with ethical guidelines. We would love to serve as a jumping off point for us or others to do more intensive research on the quantifiable impact that this advertising has,” says Baldassare.
As things stand currently, cancer centers really do not have much choice about whether to advertise directly to consumers. Their competitors will do so, and the cancer center that does not advertise will be edged out of the market. “If none were allowed to advertise, then at least they would be on a level playing field,” says Baldassarre. Ideally, patients would talk directly to their physicians about their treatment options without being influenced at all by advertisements. The physician has an ethical obligation to provide appropriate context about the pros and cons of a treatment option. “Short of that, there needs to be a great deal more pressure on the advertisers to provide appropriate context. It would be better for everyone if these ads offered only demonstrably true claims,” says Baldassarre. For instance, an advertisement could state that the center was ranked No. 1 by U.S News & World Report. Patients who are interested in learning more about the ranking can look it up and can find out how the ranking metrics were developed.
With so many ads non-compliant with ethical guidelines, it raises the question about whether there should be harsher penalties for non-compliance. The study authors would like to see more regulatory guidelines and enforcement in the cancer care advertising space.
“We looked at what the penalties were for violating these guidelines. In Texas, it was a fine of about $1,000 per transgression. Given that the ad buy for a top care provider will vastly dwarf that, it doesn’t seem like a disincentive. It seems like the cost of doing business,” says Baldassarre.
Stacey Kusterbeck is an award-winning contributing author for Relias. She has more than 20 years of medical journalism experience and greatly enjoys keeping on top of constant changes in the healthcare field.
Reference
1. Baldassarre AJ, Palmer A. Marketing cancer care: A content analysis of ethical compliance in television advertising by top-ranked U.S. cancer centers. J Cancer Policy. 2025;44:100591.
Most direct-to-consumer cancer center ads fail ethical standards, often misleading patients with unrealistic claims, false hope, and unclear clinical trial eligibility. This raises concerns about misinformation, inequity, and insufficient regulatory enforcement in healthcare marketing.
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