Why is a patient’s testimonial treated as my claim?
Because you chose to publish it. The Endorsement Guides say an ad using consumer endorsements about a product’s performance will be read as saying the product is effective for that purpose, so the advertiser needs the same substantiation it would need to say it directly.1 The same section adds that consumer endorsements are not themselves competent and reliable scientific evidence.1
The FTC’s Health Products Compliance Guidance puts it more bluntly: advertisers should not make claims through testimonials that would be deceptive or could not be substantiated if the advertiser made them directly, and they need evidence that the product will work for buyers as it did for the endorser.5 The guides speak of “products,” but the FTC Act they interpret covers the advertising of services too.
So a chiropractor who could not write “we fix sciatica” cannot publish a patient saying “Dr. Lee fixed my sciatica” and treat it as someone else’s opinion. For the wording side of this, see health claims on practice websites.
What changed in 2023?
The FTC finalized revised Endorsement Guides in June 2023, the first revision since 2009.3 The changes most relevant to practices:
- A new principle against procuring, suppressing, boosting, organizing or editing reviews in ways that distort what customers think.3
- Explicit treatment of incentivized reviews and reviews written by employees.3
- A definition of “clear and conspicuous,” and a warning that a platform’s built-in disclosure tool might not be enough.3
The Guides are guidance, not a statute. They describe what the FTC considers deceptive under the FTC Act, which is the law it enforces.3 Separately, the FTC’s Consumer Review Rule covers fake and bought reviews; the FTC Consumer Review Rule article covers asking for reviews under that rule.
Can I still show dramatic results?
Yes, with the typical result next to them. Under section 255.2, a testimonial about a key attribute will likely be read as what patients generally achieve. If you cannot show that it is representative, you must clearly and conspicuously disclose the generally expected performance, and that disclosure must change the overall impression of the page.1
The FTC’s question-and-answer guide is direct about the old workaround: noting that results are not typical is not sufficient on its own.2 You have to say what is typical, which means you need to know it.
For a practice, this is a data question before it is a design question. If you track outcomes for a program, you can publish a before-and-after with an accurate line underneath about what most patients experienced over the same period. If you do not track outcomes, you are not in a position to publish the outlier.
Which testimonials need a disclosure?
Any where the reader would not expect the connection. Section 255.5 says material connections can include business, family or personal relationships, payment, free or discounted services, and the chance of winning a prize, and they must be disclosed clearly and conspicuously when the audience would not expect them.1
| Situation | Disclosure needed? | What to do |
|---|---|---|
| Patient paid full price, no incentive | No | Publish as written, with consent |
| Patient got a discount for the review | Yes | State the discount beside the review |
| Front desk staff member reviews you | Yes | Say they work at the practice |
| Spouse or relative of the owner | Yes | Say who they are |
| Outlier result, e.g. 40 lbs in 3 months | Yes | Add what patients generally achieve |
The Q&A guide adds that employees should disclose their connection even if their workplace is listed on their profile, because readers of a single post will not see it.2 It also says the closer the disclosure is to the endorsement, the better, and that a disclosure buried on another page is easy to miss.2
Can I edit or shorten a testimonial?
Shorten, yes. Change the meaning, no. The Guides say an endorsement may not be presented out of context or reworded so as to distort the endorser’s opinion or experience, and that quotation marks represent the endorser’s exact words.1 The endorser must also have been a real user of the service when they gave it.1
The safest workflow: keep the original review or form submission, publish a faithful excerpt, and record the date and the patient’s consent.
What about star ratings and “as seen in” logos?
Star ratings are endorsements shown in aggregate. The Q&A guide warns that organizing reviews so the five-star ones dominate can create a misleading impression.2 If you show an average, show the real average, from a named source, with the review count.
“As seen in” logos tell a patient a publication vouched for you. Use a logo only when that outlet actually featured you, and link to the piece. A paid placement or a press release republished on a news site is not the same thing, and presenting it as editorial coverage misleads.
Where does HIPAA come in?
If your practice is a HIPAA covered entity, a patient’s name, photo or story in your marketing is protected health information. The Privacy Rule says a covered entity must obtain an authorization for any use or disclosure of protected health information for marketing, with narrow exceptions such as face-to-face communication.4 A signed, specific authorization before publishing is the minimum; a verbal “sure, go ahead” is not.
Health coaches and other non-covered businesses are outside HIPAA, but the FTC rules above still apply. This article is not legal advice; have counsel review your authorization form.
The free check looks at the testimonials, ratings and badges on your site and flags anything missing a disclosure.