I was shocked to open my mail the other day and find a flyer from Newton-Wellesley Hospital pushing bariatric surgery (stomach size reduction). This was not something suggested by my PCP (who is no longer affiliated with NWH) nor anything I’d ever sought information. In my view, it’s unethical inappropriate for our local hospital to be pushing elective surgery on people who have not had it recommended by their own healthcare providers.
How do other people feel about this?
[Updated title and added the section below]
The flyer I got was not personalized in anyway. Either it was sent indiscriminately to NWH patients (which would be extremely inappropriate – imagine someone underweight getting this) – or recipients were selected by accessing data of NWH patients who are not yet patients of the center, which is completely inappropriate and might be a HIPAA violation. I know that I don’t meet guidelines for having this type of surgery.The flyer does not mention any weight loss options other than surgery.
I do not think it has anything to do with ethics. I look at it as informing the community of a service they may not be aware of.
@Kathryn – to me, it read more like a drug commercial than an informational notice of a service. I don’t think invasive medical procedures that carry risks should be marketed.
Meredith: when medically appropriate, bariatric surgery reduces risks of death from heart disease, diabetes, and cancer. It can alleviate arthritis, gastroesophageal reflux, and a host of chronic conditions linked to obesity. Bariatric surgery is performed by board-certified surgeons who are well-versed on proper indications (reasons), risks, benefits, and techniques of bariatric surgery.
Based on your description, the hospital’s flyer is merely informing people with obesity that they may have a surgical option. If a patient responds to the flyer, all that will ensue is a discussion between the patient and surgeon.
There is nothing unethical about that. These surgeons are not “pushing elective surgery”; they are using their skills to treat well-informed patients suffering from the #1 cause of preventable morbidity and mortality in America. Those doctors and the hospital deserve more credit and respect than you give them.
I agree with Meredith. I think information on all the weight loss programs available to the public through the hospital would be more appropriate, even if they included information on the bariatric surgery options as part of a completely “global” approach to the real problems and risks of obesity. I understand the urge to market surgery. The surgeon has spent many, many years readying him/herself to perform this service. But surgery has real risks that should only be suggested and advised after exhausting all the more conservative treatment options.
I have updated the post.
@Michael – you wrote “These surgeons are not “pushing elective surgery”; they are using their skills to treat well-informed patients suffering from the #1 cause of preventable morbidity and mortality in America.”
I never said there was anything wrong with performing bariatric surgery on well-informed people.
The surgeons are not using their skills when they send this flyer. They are fishing for patients. This was not a personalized letter – it was a flyer advertising surgery and not listing other options. The people who receive this may be struggling with eating disorders or being underweight for medical reasons or not overweight enough for surgery to be appropriate.
@Meredith and Sallee:
I see that each of you has a very nice website advertising your services… or, to borrow your own uncharitable language: a website “pushing” your services and “fishing” for clients.
It is hypocritical of you to maintain that hospitals and physicians should not advertise their services to the public.
Why do you consider yourselves so qualified to decide what the public should or should not hear about bariatric surgery? It doesn’t look like either of you has every performed a surgery. How about this: let adults read the flyer and decide for themselves? They are not babies; they don’t need your supervision or censorship.
The government regulates hospital and physician advertising. If you really think Newton Wellesley Hospital has violated a regulation or rule of professional conduct, you can by all means file a complaint.
Try a Google Search for …
rhinoplasty boston hospital
.. or ..
“breast augmentation” boston hospital
The results listed are advertising, paid for just as surely as any USPS-delivered envelope.
At 17.7% of GDP, the US is a long long way from merely minimally needed healthcare procedures and nothing more.
I didn’t say they shouldn’t have websites or ads that show up in Google when people are searching for the service. I’m not objecting to them spending money. But websites and ads are different from mailing brochures for invasive medical procedures. I’m sorry you can’t see the difference.
“I don’t think invasive medical procedures that carry risks should be marketed.”
What kinds of invasive medical procedures are risk-free?
@MMQC: No invasive medical procedure is risk free. We shouldn’t have risk filled procedures marketed as a skip-the-much-less-risky-choices for weight loss first.
@MMQC – I did not mean to imply that any invasive med procedures are risk-free.
I object to a hospital (this was not from a private practice) sending out material saying “there are all these reasons you should look into having this surgery that we provide”. I’m writing this as someone who works in health research, with a background in public policy.
“it read more like a drug commercial than an informational notice of a service. I don’t think invasive medical procedures that carry risks should be marketed.”
Life-changing procedures shouldn’t be marketed? And it’s not like you respond to the flyer, show up, and receive bariatric surgery. It’s marketing to you so you can become informed. How else are you supposed to know about novel procedures, medical advances, etc, but for marketing in some form or another?
“But websites and ads are different from mailing brochures for invasive medical procedures. I’m sorry you can’t see the difference.”
This is the 21st century. Targeted electronic advertisements are probably, on average, more effective than mailers.
“The people who receive this may be struggling with eating disorders or being underweight for medical reasons or not overweight enough for surgery to be appropriate.”
Again, they don’t show up and boom, get a surgery. As much as I love to rag on doctors for their god complex, I highly doubt NWH is performing bariatric surgery on anorexic women.
We can stop confusing having the right to do something with it being the right thing to do. I did a double take when I received the flyer and had the same reaction. Notifying the public of all their services is informational. Promoting their bariatric surgical services in a glossy brochure is another. Maybe if hospitals want to increase their demand, they should think more about their prices.
It seems to me, despite the impersonal nature of the flier, someone took it personally.
@Michael
It is not hypocritical to treat hospitals and doctors differently than we do other businesses for one simple reason: the hospital is a public charity, not a business.
So long as NWH remains a 501c(3) and as such doesn’t pay property tax to the City (on its exempt operations), I think it’s fair game for the citizens who are subsidizing the hospital to be critical of its operations.
Perhaps I’m letting on as to my age, but this kind of unsolicited advertising is a daily part of my life – constant mailers, and even first class mail, offering a wide variety of expensive services and appliances because most certainly I can’t hear, climb stairs, or do any number of daily activities. The more troubling ones are the healthcare scam calls urging me to get disability insurance from people impersonating Social Security representatives. I get these calls several times a day, and that’s not an exaggeration. Then there are the people who assume I want to sell my house – these are quite frequent – the latest one even claimed to have a cash buyer.
It’s all noise. The mailers get tossed in the recycle bin. If the phone call isn’t picked up as spam, I click off before the person has spoken three words.
I will say I drew the line at the offer for a discounted cemetery plot – “to help your loved ones at that most difficult time”. No joke. Though I will admit, we ended up having a good laugh about it.
There are serious things to be concerned about, especially as you age. Mailers and unsolicited advertising simply don’t make the list at this point in my life. They’re all trying to make money. Such is life.
My initial response to this post was something like: yeah, the entire premise of advertising medical treatments or drugs is all unethical, as is the fact that the medical system is entirely private. Said brochure is same to me as a TV add for a drug. Wrong, but not in itself but because it’s part of a system that’s all wrong.
It also did not escape me that the recipient of the brochure probably took this specific brochure personally because she perceived it as an implication that she should do something about her weight…
But then – NWH is a non profit. As such, I think it is entirely reasonable to expect it to be better at contributing to the health of the community than at marketing profitable procedures. So yes, I agree we should hold NWH to a higher standard, to the degree we have any say in the matter at all.
For the record, I did not take this flyer personally. To take it personally would mean assuming that they’d looked at my confidential patient data before deciding to send it to me. If they accessed NWH patient data for marketing purposes, that’s definitely unethical in my opinion.
I can think of so many other things ppl should really be offended about. This ranks extremely low
Perhaps this is a good sign that newton residents have run out of important things to complain about
@11:05a — And yet, depending on details of the flyer/advertisement, NWH might be well within their rights, under the HIPPA Privacy Rule, to do precisely what you might otherwise have assumed and then asserted as “unethical”.
Hard to decide, in the abstract, but HIPPA’s “Marketing” has carve-outs that allow a hospital to do as you would seem to abhor.
Here is definitive word on that.
… MGH is a multi-billion dollar enterprise intellectual property lawyers, venture deal makers, and corporate development departments fully staffed and actively pursuing profit .. that bears little relationship to a community supported charitable institution of our grandparents’ days …
[full disclosure: I am not a physician nor do I play one on TV]
@Flier – my understanding from that link is that if the hospital were just sending the mailing to all patients, that would not be a violation of HIPAA – and I wasn’t suggesting that it is. However, if they are using specific health information (such as weight, BMI) then it seems they would require authorization.
@1:06p: I believe there are additional interpretations of that language that might result in permissible uses that your “however” does not anticipate.
A major advantage of the public option for government-run health insurance is NO marketing!
I truly wish my biggest complaint was junk mail. Just throw it out and get on with your day.
It’s that simple.
The problem isn’t junk mail. I throw most out without a second glance. But when I get mail from a hospital where some of my specialists are affiliated, I open it because it might be something important. And as someone working in the health field, I’m very disturbed to see a hospital marketing surgery.
Hospitals are absolutely not public charities. They are money spending and money making machines. Being a “non-profit” does not mean that you don’t need to make more money than you spend. Part of evaluation for bariatric surgery includes psychological, nutritional and other workups and consultations. Bariatric surgery without significant changes is lifestyle will result in rapid regain of weight and surgical failure so the hospital has a large stake in a person gaining a healthier lifestyle, including weight loss.
Hospitals biggest moneymakers are Neuro, Orthopedic, Cardiac and Bariatric surgeries.
Hopefully, someone benefited from that brochure.
Hospitals have been marketing surgeries for years. I’ve been in healthcare for over 16 years and marketing isn’t anything new. I constantly see commercials on the television and hear them on the radio and see them online.
Why shouldn’t they market anything that might make improve/save your life?
If you are a candidate for bariatric surgery I think it’s likely you aren’t the epitome of good health. *I am not a doctor
I don’t give advice on this type of surgery. I know people who have had it and benefited from it. I haven’t given advice on the surgery – I haven’t written anything that says it shouldn’t be used. I didn’t say anything shaming people exploring healthy lifestyles. Don’t put words in my mouth.
Of course there are individuals who wouldn’t benefit from this, either because it’s inappropriate for them (such as someone who doesn’t meet the criteria) or because they’re high risk for surgical complications or because they can’t make the commitment to do the required post-surgery work. Similarly, there are individuals who wouldn’t benefit from hip replacements or open heart surgery. No treatment benefits everyone. No treatment works 100% of the time.
What I have written about is hospitals marketing medical procedures consumer goods. I know other people have reacted the same way to this flyer, because I’ve heard from them. It didn’t come across as the hospital sharing health information – to me, it read like the hospital was trying to drum up business.
And to answer your final question about whether I’m a clinician, I am not. I’m a biostatistician who has spent almost 3 decades doing medical research, including the last 15 years working in clinical trials for an international pediatric HIV research network.
Hi Meredith – I agree with you and don’t like the TV drug commercials either. Advertising medical products drives up the cost of medical care and also gives overly emotional and incomplete information about problems that are best discussed in a doctor’s office between doctor and patient.
In addition, the Hospital is a non-profit and receives tax-free status on most income and property because of this. It also receives substantial public funding from Medicare and Medicaid. Using this public funding for advertising, lawyers, lobbying, and public relations, to convince or control the public seems wrong. You are not being disrespectful, petty, or “triggered” in questioning the flyer you received.
@Mark G MD – you ask “How do you suggest they market without jeopardizing sensitive patient information?”
As I’ve said already, I don’t think they should market surgery. If they want to share information about this procedure and why it can be helpful, they can submit articles to the local news websites (The Patch, WickedLocal, etc.) They can give informational brochures to NWH-affiliated physician groups for PCPs to share with their patients. They can start the information by making it clear that it’s only directed at people who are very overweight (BMI>40 or BMI>35 with one or more obesity-related co-morbidities).
As to your last comment, there are many people and institutions I value but I’m always also aware of their flaws. When I express disappointment with their actions, it doesn’t mean I’m painting them as villains. No one and no institution is perfect.
Mark G MD.
NWH has NEVER paid a PILOT to Newton as of FY20. The only PILOT payments that Newton received are 100K from B.C. and 20K from Stone Institute for the last three fiscal years.
NWH is also not a teaching hospital and, although it is part of a network with teaching hospitals, so is almost every other hospital in the Metropolitan Boston area. That doesn’t mean hospitals should do whatever they want to or spend public money however they want to.
MG – NWH is NOT a teaching hospital despite what it says in its own promotional material, which you are using as your source.
Almost all Boston metropolitan hospitals have some residencies, but the Medicare Payment Advisory Commission (MEDPEC) defines a “teaching hospital” as having at least 25 full-time equivalent medical school residents per 100 inpatient beds. The Center for Healthcare Information (CHIA) is the Massachusetts state agency responsible for healthcare statistics. They use the MEDPEC definition and for FY19 (last year reported), CHIA categorizes NWH as a “community hospital” and they also state that NWH has a public-payer mix of 45%. NWH is part of parent company that owns teaching hospitals, but most hospitals in the Boston metropolitan area are owned by this type of parent company. CHIA info on NWH can be viewed at https://www.chiamass.gov/assets/docs/r/hospital-profiles/2019/newt-wel.pdf.
We are in FY 21, which doesn’t end for a few months. I only have Newton PILOT payment figures for the last three complete fiscal years, meaning FY20 is the latest. For those last three complete fiscal years, NWH paid no PILOT payments. I believe they have never paid, but my actual data only goes back three years. To say that data is invalid because it is not continuously updated in real time, means that almost all public data is invalid, because there is always a reporting lag in public data. I am relieved to hear from you that NWH is paying their water/sewer/stormwater fees. I assume they are also paying their electricity bills, but this is not the same as paying taxes or PILOT payments.
I stand by my initial statement on this topic which was that using public funding for advertising, lawyers, lobbying, and public relations, to convince or control the public seems wrong.
Sorry – It is MEDPAC, Not MEDPEC.
I also have a website, NewtonRezoing.org, which supplies document reference links, data analysis, and fact-checking about Newton’s current comprehensive rezoning effort. According to the draft version of the rezoning ordinance, it is proposed that NWH and all of Newton’s nonprofit educational institutions be given standalone zoning that allows them to put 100’ buildings within 15’ of their borders, regardless of their residential neighbors. This is documented at https://newtonrezoning.org/currentlanduse/ , which also discusses Newton’s general lack of PILOT payments, as of FY20.
The website makes the point that the Newton government is being too generous in letting its nonprofit institutions, including NWH, escape the restrictions on both taxation and zoning. Perhaps NWH has paid a PILOT payment in FY21 as part of its campaign for the standalone zoning and 100’ buildings in the proposed Newton rezoning. I won’t be updating the tax and PILOT data, however, until after the close of FY21.
Just a point about elective surgery. An elective surgery does not always mean it is optional. It only means that the surgery can be scheduled in advance, it is not an emergency situation. For example, I recently had hip replacement surgery. I was rear ended by a tractor trailer truck and the hip became arthritic and unmovable from the trauma. I could not walk, even sitting and sleeping were painful – but this was considered elective surgery because I scheduled it in advance and it wasn’t a condition where I was rushed to the ER and needed surgery. I got that mailing as well. I’m a slender person and just tossed it.
What logical extreme do you want to take this hypothetical prohibition on marketing health-related care to individuals? Surgery? Ok. Medication? Alright. Supplements? Fitness programs? Fitness equipment? Diets?
On the other hand, Mark G, you are awful protective of how this procedure is represented by someone on a little internet blog.
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Two years ago the airwaves were bombarded with ads for their “minimally invasive” procedures for eliminating (brain and cardiac) aneurisms. I hated listening to that over and over. Post Covid – given that hospitals make their money mostly from elective surgery and so they lost from almost a year of no elective surgery – they’re mass mailing for bariatric surgery. That’s all it’s about. Given how much people have struggled with their weight during Covid, many of whom started out at an unhealthy weight, it’s not so surprising or shocking. At least to me.
A pandemic comes through and now you can’t go to restaurants and there is more time than ever to workout — and people get more fat. I love it.