April 29, 2019

Understanding the Ethical Pitfalls Associated with Content Marketing

What every practitioner with a website needs to know
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Using content to connect with potential patients and grow a medical practice has become increasingly popular. Most practice owners are using some form of content to promote their business including a website, blogs, podcasts, social media posts, and/or email campaigns. In this podcast, the ethical ramifications of content marketing are explored with naturopathic physician and medical writer, Sarah Cook, ND.

Approximate listening time: 30 minutes

Continuing Education Credits Available

This podcast interview qualifies for 0.5 general continuing education (CE) units. The Oregon Board of Naturopathic Medicine has approved this educational content for 0.5 “ETHICS” CE units for naturopathic physicians. Naturopathic physicians licensed in any U.S. state except California may obtain general CE by listening to this podcast and completing a 10-question test on the material contained within the clinical topic. Click the button below to take the test for FREE thanks to an educational grant from IMPACT Health Media, Inc. Upon successful completion, you will receive an email confirming you passed. This CE approval may also qualify for the CE requirements of other practitioner types.

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About the Expert

Sarah Cook

Sarah Cook, ND, is a medical writer and a copywriter for the integrative medical community. She holds a naturopathic doctorate degree from Southwest College of Naturopathic Medicine, a certificate in biomedical writing, a professional diploma in digital marketing, and she is a StoryBrand certified guide. Sarah writes website copy, email campaigns, e-books, and other marketing materials—helping clinicians and small business owners create authentic marketing messages to reach more of the people who need them most. Connect with Sarah at www.ndpen.com


Karolyn Gazella: Hello, I'm Karolyn Gazella, the publisher of the Natural Medicine Journal. Using content as a way to connect with potential patients and grow your practice is an increasingly popular trend. Also called content marketing, most practice owners are using some form of content to promote their business. It may be a website, blog, podcast, social media posts, email campaigns. While it's true that content marketing can be extremely effective in growing your business, have you ever thought about what the ethical ramifications might be?

Today I'll be talking with Dr. Sarah Cook, who is a naturopathic doctor and seasoned medical writer. Dr. Cook has worked with us at the Natural Medicine Journal on many writing projects over the years. She also helps doctors with content creation and copywriting through her company, ND Pen. Dr. Cook is here to talk about the ethical pitfalls of content marketing. Thank you so much for joining me, Dr. Cook.

Sarah Cook: Thank you, Karolyn. I'm excited to be here.

Gazella: Well, before we dive into these ethical pitfalls, could you briefly tell us why you think this is such an important topic for clinicians to think about?

Cook: Absolutely. So, like you said, most clinicians are doing something with content. They're putting out content for their business, and most of them aren't really thinking about, "Well, how does this relate to ethics?" at all. And even if they thought about some of these things, they might not know where to go for information or really what precautions they should be taking. And I guess you asked why is it important, and I think it's really because it's just really too bad if they're well meaning clinicians, they're coming from a sincere place of wanting to put good information out to help people, and they make mistakes and just because they're not aware, and so then they end up with unexpected consequences. And so that's really what we want to avoid really just by creating awareness about it.

Gazella: Yeah, it's such a good point because I do agree; I think the clinicians are coming at it from the correct perspective. Now you mentioned unexpected consequences. What do you mean by unexpected consequences?

Cook: So, I mean, I can give a couple of examples of some things that I've seen happen. So for example, there was a doctor who I worked with to help him create his content for a while, and before I started working with him, he had been producing a blog, and one of his blogs, again, he just made a mistake. He found an image online that he thought went well with his blog and he posted that image along with that blog post, completely innocently, not trying to steal somebody else's content and not realizing that this image had a copyright and he was not supposed to use it. And ended up he got a letter in the mail for copyright infringement, and the thing is that the fines for copyright infringement, they're in the hundreds or even thousands of dollars, and so this is not a small thing.

So, one unexpected consequence certainly could be financial. And maybe even worse, I think the other thing to think about is your reputation. Really your reputation is on the line when you're putting content out for your business. And so I can share another example of where I recently saw this play out on social media, and essentially what happened was there was ... I try to stay out of the weeds on these things. I don't get involved, and so I don't have all the details on this, but essentially it was some sort of wellness practitioner, I think a nutritionist of some sort, was creating a lot of social posts and blogging about a concept that actually another better known physician who had written a book about this topic had really already coined these ideas and like I said, written a book about this specific concept, and this other practitioner essentially was promoting the same ideas using the same terminology and not giving credit to that original doctor who had come up with the ideas and had written the book about it.

And what happened, what I saw kind of play out on social media, was that people noticed and really her reputation was slammed for that. And I don't know, maybe ... We don't know. We can give her the benefit of the doubt. We don't know if she went intentionally stealing the ideas or if she just thought that she was putting helpful information out, but the mistake that she made was that she didn't give credit to the original person who came up with those ideas. So, I think that is really maybe even more important than the financial consequences is your reputation.

Gazella: Oh, I would agree. I think that's such a good point. I mean, your whole business model moving forward stands on your reputation, whether or not you get new patients, patient referrals, et cetera, so I would agree. I think that's critical, and I can see that the stakes are high. So what is your direct experience with the ethics of content marketing?

Cook: Yeah, so I mean, I can gratefully say that I haven't really personally suffered these consequences of making ethical mistakes. It doesn't mean I haven't made minor infringements. I'm sure I have, but I haven't been caught. But I've really just been forced to learn some of these concepts over the years of writing and creating content for the integrative medical community just really from being in the trenches and needing to.

So for example, you know very well, Karolyn, when we write anything for a dietary supplement company, we need to be extremely careful about the words that we use so that we don't make any claims that that supplement treats or prevents disease, right? And so that is one thing where writing for a dietary supplement company, they usually have their own lawyers, and they make sure that you're being compliant with your language, but even when I've worked with individual doctors where we might be writing a blog and they have a product that they really want people to know about, but it's a specific dietary supplement, and so now we're in the realm of where we have to be very careful about the words we use. And we can get more into this, but you can't talk about that supplement treating disease. You have to talk about it supporting the structure and the function of the body.

And so for one way, if there's clinicians listening to this and they're thinking, "Well, I'm blogging about this product," one thing I have done with doctors is like if you have any question, go to the company of that product and say, "Look, I'm writing this blog about this product. Is it okay how I'm wording this and what I'm saying?" I think it's always better to ask than to not exactly know if it's okay what you're doing.

So, working with supplement companies, working with doctors is certainly where I have just been in the trenches and having to figure this out as I go. I think the other area is when it comes to email marketing, so collecting people's email addresses, building an email list is huge now as part of content marketing, and the regulations just within the last year, there were sweeping changes in the regulations that actually change what you can ethically do with a person's email address. And so as those changes in regulations rolled out in this last year, any of my clients who I've been helping with their email list, we've had to figure out how to become compliant to these new regulations. So again, a lot of these things are not stuff you can necessarily just Google and find out. A lot of it, for me, has been learning as I go because I have to, and so that's really why I wanted to talk about this subject and make sure everyone else is informed.

Gazella: Yeah, it's such a good point, especially about emails, and it's interesting, I know we're going to talk about unsubstantiated claims, but I started out in the natural health industry in the early 1990s. It was like 1992. I became the marketing director of a very large supplement company, and within a couple of months after getting on the job, the company got into significant trouble with the FDA. Dozens of products had to be taken off the market. We had to change labels and literature, and I have to tell you, Dr. Cook, it was baptism by fire. I had to learn very quickly about structure/function claims, disease claims and how to write about products to keep the company safe. So, yeah, I think that that's such important topics. Now, I want to talk about-

Cook: Yeah, and I really believe, like you said, you then were like all of a sudden you have to learn structure/function. Well, it's like I also think we can learn from each other's mistakes, and so you and I have worked with structure/function a lot, so if we can share some pearls so that other people don't have to go through what we've been through.

Gazella: I know. It's so true, and I do like your advice about contacting the manufacturer because a clinician doesn't have the legal resources, but the larger manufacturers, they have a team of legal people that review content and make sure that the content is safe to publish, so I really like that piece of advice a lot.

Cook: And in my experience, they are happy to review an article if you're writing about their product because it helps them.

Gazella: Yeah, absolutely. And yeah, it's different when you're talking about a product specifically versus if you're talking generically about a nutrient or herb.

Cook: Yes. Yes, absolutely.

Gazella: You have to be a lot more careful. Yeah, lot, lot more careful when you're talking about a product specifically.

So, let's get to the ethical pitfalls of content marketing. What are some of the common pitfalls that you've seen?

Cook: So, I was thinking I would just highlight three so we keep this manageable here, so certainly copyright infringement would be one thing to talk about. Secondly, unsupported claims, which I can get into a bit more what I mean by that, but not being able to support what you say with evidence. And then the third thing, misuse of personal information, and that really comes into play when we're collecting people's email addresses and what we're allowed to do with that personal information. So I think those three things are probably a good place to start.

Gazella: Yeah. I would agree, those are perfect. So let's talk a little bit about that first pitfall. What advice do you have for clinicians to help them avoid copyright infringement?

Cook: Yeah, so honestly, this one probably is the easiest pitfall to avoid if you just have a little bit of awareness. But copyright applies to any content that somebody else has created, so it applies to words, images, videos, and it even applies to ideas, and so the example I gave of where the practitioner had been using these ideas from a book and not giving credit to the author of that book, she wasn't directly copying any paragraphs from that book, but she was copying the ideas, and it's something that's called derivative work. We use that word derivative where it's basically like she's deriving that content, and that is a form of copyright infringement that people might not realize. You don't have to directly copy the words to be infringing on their copyright.

So, derivative work is just something to keep in mind where ... I mean, the point is give credit to the person who came up with that idea in the first place. That's all you need to do. And that really goes across the board for any kind of a word. Any words, written content that you are using from somebody else, it's really just a matter of giving them credit, so either linking over to their website or linking over to wherever it was first published in a different article. Giving credit.

Images. Images are something to think about. Again, I gave that example of where the doctor didn't realize he shouldn't be using that image. You can't just go to Google images and use any image that comes up. Most of those would have a copyright on them, and here's the thing about images: it doesn't have to have that little copyright symbol on there. It doesn't have to have a watermark to be copyrighted. If somebody took the time to design that image on their own and put it on their website, by default, they own the copyright to that image, and you should not be using it without their permission.

So that's something to keep in mind about images, but probably the safest way to go about using images, I would say there's 2 categories of images that you can use without getting permission because you can always ask for permission, but of course that's a hassle, and probably for the most part you don't want to bother with trying to get permission to use somebody else's images. So, really the 2 types of images you can use would be either what's called royalty-free or images in the public domain. Now, I don't know if you want me to go into what's the difference between those, or what do you think, Karolyn?

Gazella: Sure. Let's just, yeah, let's touch on that.

Cook: Yeah, so royalty-free images, the free part doesn't necessarily mean they're free. You can buy these, so websites like iStock, you pay for it, but it's royalty-free meaning that you're getting a license to use it freely. And so some royalty-free images are paid for, like the iStock photos. Some royalty-free images are available for free at sites like Pixabay.com for example. But the point of being a royalty-free image is that they're granting you a license to use that image freely, and usually, I always would double check what the license agreement says, but for most of these, the license agreement says you can use this freely. You do not have to tell where you got it. The word is attribution. When you give credit, you do not have to give attribution. So you don't have to even document where it came from. Most of those licenses say that for royalty-free images.

And then the second category is images in the public domain. And so those are different in that they actually either never had a copyright on them or the copyright has expired, and so they're just in the public domain, again, for anybody to use freely, you do not have to give attribution. So some of the places that you would find those would be on like Wikipedia or it's called Wikimedia Commons, I believe. And that's a nice place if you're looking for more science kind of ... A lot of times you might want to draw a flowchart of the hormones from the hypothalamus down to the ovaries or something, right? That's not something you're probably going to find on iStock Photo, but you might find it in the public domain on like Wikimedia Commons for example.

Gazella: Yeah, that sounds pretty straightforward, and I'm glad that you went into that detail. Now, what about that second pitfall? This is the one that I'm really interested in hearing you talk about. What do you mean by making unsubstantiated claims? Can you give us some examples?

Cook: Yeah, so we can start with what we talked about when we're talking about specific dietary supplements. That's really just a matter of needing to use words that talk about how that supplement supports what we call structure/function of the body. So for example, if you're talking about a certain curcumin supplement, you can't say, "Oh, this treats pain and inflammation in arthritis." You have to just modify your wording and say something like, "Supports a healthy inflammatory response." And again, that is when you're talking about specific supplements, and I'm glad you brought up that if it is just you're generally talking about curcumin, you can be more free in your language.

However, it kind of brings me to the next point about supporting your claims, and that is even if you're just generally talking about curcumin, you shouldn't be making claims that you can't back up with evidence, and so either being able to link over to some study that supports what you're saying, if you're going to say curcumin really is great for knee pain or something, then you would want to be able to link to a study that showed that or be able to at least say, "Look, this is in my experience or what I have seen with my patients," and that's perfectly fine to use as evidence as long as you're clear that that's what you're basing this on, that's what you're basing your statement on.

So it's really all just about being transparent about if you're making a claim, being able to back it up with either research or your personal experience and just being open and honest about that.

Gazella: Yeah. That makes a lot of sense, and I think it's a great reminder.

Now let's move on to that third pitfall. What does misuse of personal information have to do with content marketing?

Cook: Okay, so this really gets into collection of email addresses, and so the thing is, this is a huge trend in content marketing is give away something free. So people call it all different things; they call it a freebie or a lead magnet or a lead generator, but they're giving away maybe like a free PDF download, and it used to be that you could give away this free, really valuable piece of content, and it was just assumed that when somebody put in their email address to download that guide, they're automatically put into your email list of subscribers, and they're going to start getting your regular emails like your e-newsletter or your promotions or anything.

And that actually used to be fine, and there's an email regulation called the CAN-SPAM Act, which has some items in place to make sure you don't spam people with mass emails, but it used to be very easy to be compliant with CAN-SPAM if you were using any regular kind of MailChimp or Constant Contact or any of those things, you were pretty much automatically compliant. It was just required things like having a little unsubscribe button at the bottom of every email.

But here's the thing is that just in the last year, so May of 2018, regulation went into effect in Europe called GDPR, and it totally changed this situation. So, quick disclaimer, I'm not a lawyer, so please, Karolyn, do not take anything I say as legal advice, Okay?

Gazella: That's a great disclaimer. I like it.

Cook: This is not legal advice.

Gazella: I'm going to make that same disclaimer. I'm not an attorney.

Cook: I am not an attorney, but in a broad sense, I think it's useful to understand what GDPR is about because it completely relates to ethically what we do with people's email addresses. So, I want to just broadly tell you what this is. Pretty much what GDPR says is that people should have a say in what you do with their personal information. So, it's really 2 things that we need email subscribers to give us, number 1 explicit consent to email them stuff, so they need to specifically say, "Yes, I want to be on your email list," and the second thing, granular consent. So it means you can't lump everything into a bucket anymore and say, "When you download this guide, you're also going on my general email list." They need to specifically check a box that says, "Yes, I want the guide, and yes, I want to be on your email list," so they need to specifically say they want to be there to be compliant with GDPR.

So, it doesn't mean ... We can still use freebies or lead magnets or whatever you want to call them. It's just a slight variation on how you create that form on your website to collect that email so that you'll be compliant.

Gazella: Yeah, that makes a lot of sense, and clinical practices are used to dealing with personal health information, so as long as they take that same care when dealing with the personal emails I think that ... And it can be confusing. A lot of this-

Cook: But wait. Can I say one more thing about ... I'm sorry. Excuse me.

Gazella: Uh-huh (affirmative).

Cook: One more thing I just want to mention because a lot of people might say, "Well, I'm a US-based business and GDPR is a European law, so it doesn't apply to me," but here is the thing is that GDPR, if somebody in Europe accesses your website, even if you're a US-based business, you need to be compliant with GDPR. And so if somebody sitting in a coffee shop in Madrid, Spain looks at your website and opts in for your guide for smoothies, then you're supposed to be GDPR compliant for that person. And so that ... Oh my gosh, email marketers are doing all different kinds of things, and some are getting really technical and monitoring like, "Oh, if somebody is in Europe and they're on my website, I'll show them the GDPR-compliant form, and if they're in New York and they look at it, I'll show them the noncompliant form."

So you can get into the weeds really fast here, but in my opinion, GDPR brings up an ethical issue that is people should have a say in what you do with their information, and if they want to be on your email list, you should get their permission for that.

Gazella: Yeah, I think that's a good general piece of advice, but I can also see where some of these issues might get a little complicated quickly. Where do you suggest people go for more information if they have additional questions?

Cook: So, that's a great question because I think I mentioned earlier a lot of these things, Google doesn't necessarily get you where he need to go. So, I actually put together a list of resources, at least from what I have, that I can share with your listeners, and so I just put together a resource guide. It has some things of where you can find royalty-free images or images in the public domain, linking over Copyright Alliance is actually an organization that just has really simple to understand information to understand copyright law. I have a link in that guide for where you can find FDA guidance on the structure/function language, and then of course some links to where you can learn more about GDPR.

So, I tried to put together just some things that I have found to be reliable and really useful in that guide, and so I think we're going to share that maybe in the show notes, but you can find it. It'll be on my website, which is NDPen.com/ethics.

Gazella: Yeah, and we'll also-

Cook: Oh, and by the way ... I keep cutting you off, Karolyn. I'm so sorry.

Gazella: Oh no, that's okay. Go ahead.

Cook: I am setting that up to be a GDPR compliant opt-in so that you can see an example of what that looks like, so you can just download the guide and that's it, or you can choose to be on my email list, but I will not just add you to my email list when you download the guide.

Gazella: Yeah, and we're also going to be linking to that guide. On this page of the podcast, there's going to be a link so our listeners can just click over. I mean, from a clinician standpoint, this might be something that you're going to want to share with your office manager or the people who are actually executing your marketing communication plan, your content marketing plan. So, yeah, thank you for doing that free guide for our listeners, Dr. Cook.

Now, I have a question here. With all of these ethical pitfalls, do you think that content marketing to grow a medical practice is worth the risk?

Cook: Yes, absolutely. Oh my gosh. I mean, here's the thing. The chances, if you are going about this from your heart, with good intentions, honestly the chances of getting in trouble for minor infractions of any of these things is so slim. It's so slim that you would ever get in trouble for anything, and yet the benefits of getting your content out there are massive. So, I mean really, if you're putting content out there, it's a way to really show your expertise, it's a way to get ... I mean, all of these integrative health practitioners, everyone has a unique message. Everyone's message is different. They have their own authentic voice and way of sharing it, and you get that out with your content. And really, yeah, creating content takes time, and you might hire some people to help you with all the parts and pieces, but it is a really effective way to promote your business without getting into a massive advertising budget.

So, I mean bottom line is like getting your content out gets you connected with people who need you the most; that's what it's about. It's about getting your message out there and helping people, and I really believe that that content marketing is a solid way to do that and really to just grow a thriving business.

Gazella: Yeah, I would agree with you. I have been a content publisher of integrative health information since the early 1990s, and I really feel that content is king. So, I have a love of quality content just as you do, Dr. Cook. I think that you brought up some really good points. It allows the practitioner to showcase his or her expertise. It can help you distinguish yourself from the competition. So for example, if you have areas of expertise or specialty areas that the doctor down the street doesn't have, you can showcase that, and you can actually target the patients that you want coming into your clinic. You can use content marketing as a referral tool.

There's so many great things about content marketing, and the fact that you highlighted, Dr. Cook, the fact that content marketing helps practitioners help people; it helps a ton of people, so it's not just the patients that they're seeing, it helps a broader audience, and I think that is very much in line from a vision standpoint for most of the practitioners, and that's probably true in the case of the practitioners that you're working with, that they have this mission; they're on a mission.

Cook: Yep. Absolutely.

Gazella: Yeah, I think that this is great. Well, this has been a lot of great information, and we are going to be submitting this podcast for continuing educational credits in the area of ethics, so thank you for helping us out it with that, Dr. Cook.

Cook: Awesome.

Gazella: And I hope you have a great day.

Cook: Thanks so much, Karolyn. You too.

Gazella: Bye-bye.

Cook: Bye.

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