Ethics and advertising of ART services

Ever heard of bait and switch?

Back in the last century, this was a marketing technique used by unscrupulous portable fruit stalls in London streets. The stalls displayed enticing fresh fruit, which passing punters were lured to buy with the seller’s loud sales patter. “Get yer luvley strawberries ‘ere, four pence a pahnd! Wot yer waitin’ fer, luv? Come an’ get yer luvley strawberries!”

Who, on a hot summer’s day, could resist? But when you got home you found that only the top layer in the bag were fresh strawberries. The rest of the contents were old, mouldy strawberries that belonged in the bin.

That’s bait and switch, which the dictionary defines as, “A deception based on a false claim or enticement that proves to be disappointing.”

This nefarious practice is not confined to last century’s Cockney fruit vendors and street hawkers, however. The term is now applied to dodgy sales claims for everything from Internet sales to the manifestos of political parties and IVF clinics.

IVF clinics should not display their success rates in advertisements.

The main issue is the way some clinic websites display success rates, which is the first thing that potential patients are interested in! The Society for Assisted Reproductive Technology (SART) updated its core online advertising policy in 2018¹. It now recommends that IVF clinics do not display their success rates in advertisements.

The US public has the right to know pregnancy and multiple pregnancy rates from ART procedures such as IVF. The reporting of this data for clinics is mandated by the 1992 Fertility Clinic Success Rate and Certification Act². The statistics for each clinic are displayed on public websites and are updated annually³. Because the format for submitting data is strict, there is little opportunity for anyone to massage the numbers.

But this is not the case with advertising, which does indeed offer opportunities to massage numbers. And this is why SART made the recommendation not to display success rates in advertisements.

What is the problem?

The problem is that recent research has highlighted that many clinics are not adhering to the guidelines.

Investigators⁴ at Brown University in Rhode Island in the US evaluated the websites of 361 IVF clinics to see if they were adhering to the SART policy. This is geared toward consistent apple to apple reporting of pregnancy rates.

They found that:

About one third of websites report success rates, contrary to SART policy
Of those that reported rates, only about half had up-to-date data; some cited statistics from 2012 and even 2004
Roughly 46% of the clinic websites displayed a link to the society for data, in compliance with the SART guidelines

This is where the bait in the bait and switch trick comes in. The SSRT guidelines have explicit rules. They state that supplemental data be provided in their entirety, and that no partial presentation of data is allowed. Yet, according to the recent research, only 11% of the websites adhered to the requirement that supplemental data be complete. And that it includes live birth rates per cycle, per egg retrieval, and per embryo transfer for each age group.

Dr Eve Feinberg, Vice President of the Society for Reproductive Endocrinology and Infertility, had some choice words to offer, “The dirty little secret of some IVF clinics is that they transfer way too many embryos. One clinic in Illinois has a twin rate of 50%, which is malpractice as far as I’m concerned. But they don’t advertise that. They aggressively market their own success rates, which is against the (SART) rules, and their success rates are skewed because they are not practicing good medicine. Many women looking for information on IVF clinic websites may be swayed by some of the unethical advertising and message blogs. Highlighting that this is predatory is important.”

What is good practice?

Outside of the US, where inclusion in SART is not possible, it is still possible to learn from and implement aspects of good advertising practice from the SART model. These are the main areas to pay attention:

Adhere to relevant national codes on advertising for all commercial goods and services. It goes without saying that ART services are about as high end as you can get. So, it is important to adhere to all the general rules that are in place for advertising any form of goods.
The advertisement must not lead the public to believe that the chances of success are greater than they really are.
Claims made in advertising must be supported by verifiable data. Data verification can be achieved by independent publication of the or by certification by an external body.
Avoid claims of superiority, this is obviously because practice patterns and patient demographics differ among clinics. So, a statement like, “Our clinic has consistently achieved superior success to other clinics in the country.” This is meaningless without qualification
Do not denigrate other competitor ART programs. Apart from being unethical it is also demonstrating a poor marketing strategy.
Data and statistics: because countries other than the US do not pool data in a central location where the public can see it, any data or statistics quoted should be transparent and inclusive. It may be helpful to refer to the SART guidelines for ethical data presentation, if it’s good enough for SART, you can be confident that it’s good enough for your potential patients!
Disclaimer: if you ARE presenting data and statistics it may be helpful to include a disclaimer, which puts your data into perspective. This warns the patient to be discerning when comparing your data with another clinic that may not be quite as ethical in claims as you are.

Here’s an example from SART, “A comparison of clinic success rates may not be meaningful because patient medical characteristics, treatment approaches, and entry criteria for ART may vary from clinic to clinic.”

It should be made clear to patients when advertised procedures or treatments are still considered investigational/experimental.

It is human nature to exaggerate your greatness and this in most cases is what the transgressors in the US Brown University study are doing. But it is another thing to bait and switch. Adherence to an ethical standard of advertising is another hallmark of quality that every IVF clinic should aspire to and implement in practice wherever they are located in the world.

Neil Madden, Editor

The Fertility Hub

References