You’ve always enjoyed getting your haircut at Sal’s Barber Shop. Sal has been your barber for over 30 years, and he considers himself to be an expert on everything from global politics to marital problems. As you sit down for your haircut, Sal tells you about the latest edition of Your City magazine that is dedicated to highlighting the best ice cream shops in your town. Evidently, Sal is also an expert on ice cream. At the end of the magazine is a section that lists the regional dental professionals as an advertising initiative. There are full color photos of the dentists and their staffs. In addition to the usual claims of combining the most current technology with personalized, gentle care delivery, some of these advertisements raise your eyebrows. One endodontist claims to treat everyone painlessly. A pediatric dentist asserts that he donates $150,000 to charity care and financial contributions each year. An orthodontist espouses that she routinely and effectively uses a highly controversial technique of accelerating tooth movement. And her partner claims that early treatment eliminates the need for extraction of permanent teeth if future orthodontic therapy is needed. Finally, a periodontist boasts that he is “unconditionally the best in town.”

You can hardly believe your eyes. As professional as you try to be, the advertising arena now seems to be a free-for-all. Some advertisements are subjective, but many claims are clearly refuted by current research conducted by reputable investigative teams. Other are flagrant violations of our ethical code.

You wonder which of these claims are puffery and which are false advertising. Puffery is a subjective claim that highlights the attributes of a product to encourage business. It can be used to promote almost any service or product, including health services. False advertising, on the other hand, includes statements that are contradicted by facts. Yet even puffery can be deceptive to an uninformed, vulnerable patient and therefore can violate the ethical principle of veracity.

According to the Federal Trade Commission, the government’s consumer protection agency that is charged with promoting equitable business practices, sufficient substantiation of an advertising claim calls for several well-controlled, valid studies that are accepted by other experts in the field. If the studies involve conflicts of interest or significant design flaws, the claim might not be substantiated. Testimonials, including those listed on the Internet, are insufficient substantiation. The advertiser is responsible for the content of the claim, even if he or she does not produce the advertisement.

Many companies that manufacture exercise equipment assert that their product will provide multiple health benefits after only a brief period of use. In 1996, the manufacturer of the NordicTrack, a machine that was intended to replicate the motion of crosscountry skiing, claimed that users lost significant weight in short periods of time. The Federal Trade Commission challenged the company’s account of the number of buyers who actually lost weight, the magnitude of the weight loss, and how much use was needed to lose the weight within 3 months. An investigation showed that the claims were unsubstantiated because those who lost the weight had incorporated NordicTrack use into existing exercise regimens. The reports reflected only those who completed the study: half of the subjects. Finally, the weight loss was self-reported and did not account for changes in participants’ dietary habits.

Claims such as painless treatment, early treatment as a means to eliminate the need for future extractions, and reports that “innovative” techniques expedite tooth movement, especially when they are unsubstantiated, are specious at best. And reports of generous philanthropic contributions had better be substantiated by authentic documentation.

Sal might perceive himself as an expert in many topics, including the best ice cream spots in town, but you want him to know that everything he reads about your colleagues might not be the gospel truth. Sometimes there’s a thin line between puffery and lack of veracity.