A study of newspaper ads for 17 top university medical centers found they "employ some of the same advertising [3] techniques doctors often criticize drug companies for -- concealing risks and playing on fear, vanity and other emotions to attract patients." Of the 122 ads examined, 62% used emotional appeals and one-third "used slogans focusing on technology, fostering a misperception that high-tech medicine is always better." Twenty-one ads promoted specific services, including one proclaiming, "We do Botox!" Spokespeople for some of the medical centers involved stressed advertising's educational value and said review processes ensured their ads were responsible. Hospitals began advertising 20 years ago, as managed care increased competition among hospitals.