Why hospitals now face advertising curbs: The case that changed the rules

For years, Indian doctors have faced restrictions on self-promotion while corporate hospitals could market their facilities, procedures and outcomes with far fewer constraints. The National Medical Commission (NMC) has now moved to close that gap, bringing hospitals and medical institutions under a common ethical advertising framework with doctors.The NMC’s new Guidelines on Ethical Advertising and Public Communication by Hospitals/Medical Institutions and Registered Medical Practitioners, issued on October 6, apply immediately.They cover conventional advertising as well as websites, social media, sponsored and targeted content, influencer-led campaigns, search-engine promotions, audiovisual communication and AI-generated or AI-assisted promotional material.The central principle is this: healthcare communication must be factual, transparent, verifiable and ethical, rather than a tool to solicit patients or commercially promote medical care. The guidelines bar hospitals and doctors from misleading or exaggerated claims, fake or paid patient reviews, testimonials and endorsements, celebrity or influencer-led promotion, fear-based marketing and claims such as “best”, “No.1”, “100% success”, “miracle treatment” or “guaranteed cure” unless objectively verifiable.They also restrict promotion of unnecessary investigations or procedures, discounts and inducements designed to draw patients, and promotional use of patient stories, photographs and treatment outcomes. The laying down of the new boundary could mark a significant shift for hospitals, whose advertising has historically occupied a grey zone.WHY THE RULES NOWThe immediate backdrop is a public interest litigation in the Supreme Court filed by Mumbai-based infertility specialist Dr Aniruddha Malpani in 2023.The petition raised concerns over what it described as unfettered advertising by corporate hospitals and venture capital-funded healthcare start-ups.The SC subsequently directed the NMC to examine the issue, leading to a seven-member committee on advertising by corporate hospitals. The panel concluded that ethical advertising standards applicable to doctors should also extend to hospitals and medical institutions.The committee had backed the principle that corporate hospitals should not have a separate, more permissive advertising regime.The need for such a framework arose from a basic regulatory mismatch. While the ethics rules were clear about doctors: they could not solicit patients, boast about cases, operations or cures, or use their professional standing for self-promotion, hospitals were not explicitly covered in the same way.The older Code of Medical Ethics, for instance, said a physician could not advertise in a manner that highlighted professional skills, qualifications, achievements or specialities for self-aggrandisement. It allowed only limited institutional announcements, such as starting a practice, changing an address or publicly declaring charges.The gap became more consequential as healthcare became increasingly corporate and digitally marketed. Dr Malpani, whose PIL triggered the regulatory process, welcomed the NMC’s decision but said it did not go far enough.“Our wish has come through – but only partly,” he told India Today, pointing to the fact that hospitals have now been brought under advertising norms, but enforcement for violations will depend on agencies responsible for the Clinical Establishments (Registration and Regulation) Act, 2010 at the state level.“That’s a big problem because the CE Act itself is barely implemented in the country,” he said.Dr Malpani argued that the commercialisation of healthcare has changed the nature of patient acquisition. Large hospitals can spend heavily on advertising and digital marketing, with the eventual cost potentially being reflected in what patients pay for healthcare.“With freely flowing foreign funding, hospitals today are hypercommercialised while single-doctor clinics are dying, and they can afford big advertising expenditure which is then extracted from patients,” he said.His broader argument was that healthcare advertising is not equivalent to advertising a consumer product. A patient often cannot independently assess whether a test, procedure or treatment being promoted is necessary.WHAT HOSPITALS MUST CHANGEUnder the new framework, hospitals cannot use advertising simply to create demand for medical services. The guidelines specifically prohibit communications designed to encourage unnecessary consultations, diagnostics or procedures, as well as fear-based marketing and promotional claims that create unrealistic expectations about treatment.Hospitals also cannot use patient testimonials, reviews or endorsements to promote their services, nor can they manipulate ratings, reviews, followers, search rankings or other digital engagement to create a misleading impression of their reputation.Before-and-after photographs, surgical results and promotional case histories are also restricted when used for marketing. They may be used in scientific or educational contexts subject to the safeguards laid down by the guidelines, including appropriate patient consent and anonymisation where required.The rules also bring AI into the regulatory net. Hospitals and doctors cannot use AI to manufacture or manipulate patient testimonials, voices, images or clinical outcomes, or create a synthetic endorsement purporting to come from a real patient or doctor.AI-assisted promotional material that is permitted under the guidelines has to meet disclosure and ethical requirements.To be sure, the new rules however, do not amount to a blanket ban on communication for hospitals and they can still provide factual information about their infrastructure, facilities, specialities and services.Public-health education, awareness campaigns and academic communication are also allowed, provided these are not converted into disguised patient solicitation or promotional marketing.Dr Anshuman Kaushal, a robotic gastrointestinal and bariatric surgeon who is active on social media, meanwhile, said hospitals coming under the advertising norms should also mean greater involvement of doctors in reviewing medical content before it is released as educational or awareness material.“Because it’s ultimately doctors who are responsible for what goes under their name,” he said.But Dr Malpani insisted that the bigger test is enforcement.He said he now intends to implead the states in the ongoing case because the new framework places responsibility for hospital-level violations with state authorities.- Ends