Over the weekend, the New York Times reported on how prestigious academic medical centers advertise cancer care. Here are some examples,
Prostate Cancer Surgery at Mount Sinai
A print advertisement for prostate cancer surgery at Mount Sinai Medical Center in Manhattan is typical of the way many elite research and teaching hospitals sell hope to the public.However, the article noted that the hospital could provide no studies that showed that its or Dr Samadi's results were superior to those of other hospitals or other surgeons.
'Our newest prostate specialist, Dr. David Samadi, has pioneered a minimally invasive approach that allows him to retain the highest cancer cure rates with the lowest risk of side effects,' says the ad.
Highest cure rates. Lowest risk. What evidence does the medical center have to back up such superlatives?
The ad�s claims are based on the successful results of Dr. Samadi�s operations and testimonials from his patients, said Jane Zimmerman, Mount Sinai�s chief marketing officer.
... the ad with the superlative prostate cancer claims ... was later revised to say that Dr. Samadi�s approach gives 'high rates of success coupled with lowered risks of side effects.' Ms. Zimmerman said Dr. Samadi was not available to be interviewed.Also,the people who concocted the advertisement said it was not really meant to tell prospective patients that the surgeon had better results than all others:
But marketing executives defend their approach, saying cancer treatment ads tend to play more heavily on emotion than on medical statistics because the ads are not intended to inform people who already have the disease. They are meant to make an impression on future patients, who may decide on treatments years after they have seen an ad, or to sway influential people who might advise a future patient.
'This isn�t retail advertising,' said Ellis Verdi, president of the DeVito/Verdi Agency in Manhattan.
The agency produced the Mount Sinai ad, which ran in The New York Times, and has created cancer ads for other hospital clients. 'This is reputation advertising,' Mr. Verdi said. 'There is a very big difference.'
But the advertisement said that the hospital's prostate cancer specialist had the highest survival and lowest adverse event rates. How would a patient with prostate cancer realize that the advertisement was only meant to enhance the hospital's reputation, but not meant to speak to him?
Radiation for Brain Tumors at Massachusetts General Hospital
'We gave Nick something he couldn�t find anywhere else in the Northeast. Life without cancer.'
That was the text of a print ad last year by the Massachusetts General Hospital Cancer Center in Boston, promoting its $50 million center for proton beam therapy, a kind of high-energy radiation to treat brain tumors and other cancers.
The hospital was the only medical center in the region with a proton therapy center, the ad said, enabling doctors there to successfully treat the brain tumor of a young man named Nick.
The ad�s concept was that Nick had a greater chance of survival because the precise proton beam could destroy malignant brain tissue while leaving surrounding healthy brain tissue intact, said Jodie Justofin, the marketing director at Mass General�s cancer center.
Dr. Thomas F. DeLaney, the medical director of the Francis H. Burr Proton Therapy Center at Mass General, said he had no involvement in the ad and did not have any information about Nick.
However, the article also noted that "no rigorous studies have shown that proton beam therapy has higher brain-cancer cure rates than other treatment methods, said Dr. [John D] Birkmeyer of Michigan [a professor at the University of Michigan and cancer outcomes researcher]. 'The ad might be accurate that they are the only hospital in the Northeast with this particular widget,' he said. 'But it could be misleading that the availability of this particular widget gave this patient better odds of survival.'"
Again, the advertisement said that the patient got "life without cancer," something he could not get anywhere else in the Northeast. How would a patient with a brain tumor realize that the advertisement was merely based on a "concept," rather than scientific evidence that his or her only hope for "life without cancer" could come from proton beam therapy at the Massachusetts General Hospital?
Surgery for Cervical Cancer at Memorial Sloan-Kettering Cancer Center
'Cancer, You said I�d never bear children,' reads the handwritten letter, held out by a pretty, healthy-looking woman, as a toddler peeks from behind the paper. 'My daughter says you�re wrong.'However, Ms Rogala told the NY Times, "hers had indeed been a special case. She had early-stage cervical cancer, she said, making her eligible for a novel operation that has now become a standard treatment at the center. After her operation, doctors told her she would need fertility treatments to conceive. But she said she turned out to be one of the few patients in the study who did not need radiation � which can cause fertility problems. She later became pregnant without medical intervention."
That recent print ad from Memorial Sloan-Kettering Cancer Center in Manhattan tells the story of Michelle Rogala, a patient with cervical cancer.
Ms. Rogala�s hospital in New Jersey could offer her only a hysterectomy, an operation that would have left her unable to have children. Instead, she went to Memorial Sloan-Kettering, where she entered a clinical trial that was studying less invasive surgery. Ms. Rogala now has a little girl named Maddie.
Ellen Miller-Sonet, vice president for marketing at Memorial Sloan-Kettering, said consumers seeing the ads realizes that these were individual stories. 'They know that no two people are the same,' she said.
Again, why "consumers," much less patients with cervical cancer, would realize that the advertisement was just an "individual story," not a promise that the hospital's treatment of cervical cancer would not prevent future pregnancies, was entirely obscure.
Summary
The three advertisements described in the NY Times article had some features in common. All seemed to promise exceptional results. None were based on clear scientific evidence. All seemed to have been products of marketers and advertising agencies working without input from the physicians who actually provide the treatments they were advertising. All the marketers defended their work by saying that the advertisements did not actually mean what they appeared to mean.
My most obvious comment is that hospitals, even the most prestigious teaching hospitals, now seem to be willing to market their services like the used car salespeople seen on late night television. Such advertisements, of course, are unseemly and undignified coming from such august institutions. Worse, they seem to promise more than what these or any hospitals can be proved to deliver, and the only defense of the marketers who produced the advertisements were that they did not mean what they seemed to mean.
This shows the sad, and ultimately deceptive and unethical effects of turning the leadership of our best medical institutions over to businesspeople with little knowledge or understanding of the values of health care.
It also shows what has happened to health care in an age of hype, scam, sham, spin and flim-flam. It all seems part of what Frank Rich just wrote about in the NY Times:
If there�s been a consistent narrative to this year and every other in this decade, it�s that most of us, Bernanke included, have been so easily bamboozled. The men who played us for suckers, whether at Citigroup or Fannie Mae, at the White House or Ted Haggard�s megachurch, are the real movers and shakers of this century�s history so far. That�s why the obvious person of the year is Tiger Woods. His sham beatific image, questioned by almost no one until it collapsed, is nothing if not the farcical reductio ad absurdum of the decade�s flimflams, from the cancerous (the subprime mortgage) to the inane (balloon boy).I would note that the health care precursor to all this was how the former CEO of the Allegheny Health Education and Research Foundation (AHERF), the biggest health care system in Pennsylvania in the 1990s, was hailed as a visionary in the medical press and scholarly literature, which later ignored AHERF's bankruptcy and its former CEOs criminal conviction (see post here.) So my one disagreement with Mr Rich is that the problems are much older than the 21st century.
What makes the golfing superstar�s tale compelling, after all, is not that he�s another celebrity in trouble or another fallen athletic 'role model' in a decade lousy with them. His scandal has nothing to tell us about race, and nothing new to say about hypocrisy. The conflict between Tiger�s picture-perfect family life and his marathon womanizing is the oldest of morality tales.
What�s striking instead is the exceptional, Enron-sized gap between this golfer�s public image as a paragon of businesslike discipline and focus and the maniacally reckless life we now know he led. What�s equally striking, if not shocking, is that the American establishment and news media � all of it, not just golf writers or celebrity tabloids � fell for the Woods myth as hard as any fan and actively helped sustain and enhance it.
People wanted to believe what they wanted to believe. Tiger�s off-the-links elusiveness was no more questioned than Enron�s impenetrable balance sheets, with their 'special-purpose entities' named after 'Star Wars' characters. Fortune magazine named Enron as America�s 'most innovative company' six years in a row. In the January issue of Golf Digest, still on the stands, some of the best and most hardheaded writers in America offer 'tips Obama can take from Tiger,' who is typically characterized as so without human frailties that he 'never does anything that would make him look ridiculous.'
Rich concluded,
after a decade of being spun silly, Americans can�t be blamed for being cynical about any leader trying to sell anything. As we say goodbye to the year of Tiger Woods, it is the country, sad to say, that is left mired in a sand trap with no obvious way out.
The way out of our sand trap in health care, of course, is to refuse to be spun any more. We need to stop believing the hype propogated by all the clever marketers, and all the self-interested CEOs who hire them.
Meanwhile, I would suggest to any cancer patient who failed to get the wonderful results promised by some slick hospital advertisement, there may be some lawyers who with whom you ought to speak.
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