With cancer care raining down more than $200 billion in billings on providers, giant hospitals and specialty treatment centers are resorting to unacceptable marketing and advertising hype, including pitches that “sell out” the credibility of science and a pillar of medical practice, commentators say.
Credit’s due to journalist Steve Salerno and the Wall Street Journal for a recent Op-Ed that’s worth a read as it makes the case outlined in the piece’s headline: “In war on cancer, truth becomes a casualty.”
Salerno blasts MD Anderson Cancer Center, Memorial Sloan-Kettering, and the Cancer Treatment Centers of America and others for waging costly, nationwide ad campaigns targeted at desperately sick patients. He faults these well-known institutions for relying on pure emotion and not fact to sell themselves. He says they resort to tugging at heart strings with “tear-jerker” patient testimonials, or by using pitch people with no other credibility than their celebrity.
“Cancer Inc.,” he says, sees no low bounds for making unsupported, evidence-free claims about its care directly to patients in ways that would be unacceptable for other kinds of drugs or services. He questions why major institutions make a “blitzkrieg” of claims about the effectiveness of their medical services, when patients likely have more convenient, closer hospitals nearby that can offer similar care.
Meantime, he recounts the American Cancer Society’s own information on “five-year survival statistics for various cancers: cervical, 69 percent; leukemia, 63 percent; ovarian, 46 percent; brain and nervous system, 35 percent; lung, 19 percent; liver, 18 percent; pancreatic, 9 percent.”
Salerno’s also joined, separately, by two science ethicists — Jonathan Kimmelman and Alex John London — who also have denounced cancer hospitals and specialty centers both for the volume and content of their advertising and marketing.
Kimmelman, an associate professor at McGill University and director of its Biomedical Ethics Unit, and London, professor of ethics and philosophy at Carnegie Mellon University and director of its Center for Ethics and Policy, have assailed cancer care hype in pieces in JAMA Oncology, a medical journal, and in an Op-Ed on Stat, a health information site.
As Salerno does, the ethicists start by asking why cancer centers spend an estimated $173 million annually on advertising, some of which they contend has now moved to debasing rigorous clinical trials, a critical way that disease treatment advances.
Kimmelman and London criticize major cancer centers for promoting themselves over others’ both with anecdotal claims from patients and because they’re offering select clinical trials. As they write of patient testimonials, versus the traditional demands of therapies tested in tough and scientific trials:
The fundamental reason for running clinical trials is to replace anecdote with scientific evidence. When prestigious organizations use anecdotes to encourage clinical trial participation, they lend their credibility to a practice they are trying to discourage and supplant with evidence-based medicine.
They attack institutions that hype themselves by arguing they give patients an advantage with their offer of clinical trials: “Some ads” they note, “imply that because every great treatment breakthrough was first offered to patients in clinical trials, patients who enter trials get access to great breakthroughs. Such claims commit what statisticians call the inverse fallacy. Think about the logic here. It’s like saying that most people who win the lottery buy their tickets at convenience stores, so buy your lottery tickets at a convenience store so you will win the lottery.”
They say that patients must put out considerable effort and inconvenience to get in to bona fide clinical trials, and, when they do, they may be given test drugs or undergo painful, invasive treatments or procedures that may add to the suffering they’re already experiencing due to cancer. And at what cost? As they write:
Suggesting that trials give patients ‘an edge’ obscures the fact that most new drugs turn out not to be superior to standard care and, in some cases, are unacceptably toxic. In addition, trials often entail more frequent visits and potentially burdensome research procedures like organ biopsies. It also hides the fact that patients in trials are often randomized to control arms that allow scientists to compare novel treatments to the standard of care.
In my practice, I see not only the significant harms that patients suffer while seeking medical services but also their major struggles to access and afford safe, effective, and excellent medical care. Medical science may be making strides in changing cancer from a killer into, perhaps, a chronic condition, or even an illness that can be reversed into major remission.
But shame on doctors and hospitals for hyping costly care that doesn’t improve patients’ lives and can further what many experts are describing as the financial “toxicity” of cancer treatment with modest outcomes but also sky-high, bankrupting costs for drugs, procedures, hospitalization, and travel and accommodation.
By the way, to see how extreme the decision-making can get in late-stage cancer care, take a look at the New York Times story on “desperation oncology,” in which some doctors offer untested treatments to those with little other hope. Vinay Prasad, an oncologist and professor at Oregon Health and Sciences University, has criticized costly cancer therapies with poor but hyped outcome, and he observed on Twitter about this story:
This is happening all across America. It’s important to remember living longer or living better is the goal of cancer drugs. Not shrinking tumors 30 percent. And it’s important to know we need [clinical] trials to lend clarity. Not anecdotes.
Medical scientists already fret about how few patients they can persuade to join rigorous clinical trials, which play a crucial role in providing reliable evidence about drugs and treatments. Enrolling subjects, of course, requires a high level of disclosure and ensuring patients’ informed consent. This is a fundamental, critical right for all of us: It’s every health care provider’s duty to ensure that you know fully your treatment options and that you decide what path to take, without strong-arming or scare tactics from the person in the white coat.
As patient-consumers, we need to stay informed and up to date so we don’t get gulled by doctors and hospitals, even when we feel terrible and may be fighting severe conditions. But Salerno, Kimmelman, and London also have prescriptions to deal with cancer hype — and they’re worth considering and putting in place, as appropriate.