Thursday, August 05, 2010

'At Cancer Treatment Centers, we won't even euthanize you for late payment!'

I realize that doctors, specialists in particular, can be detached, insensitive, and sometimes shockingly lacking in beside manner...but...I'm still skeptical of those ads from Cancer Treatment Centers of America (whom we've met before). The ads recount horror stories of patients' indifferent treatment at the hands of their previous doctors before they discovered the living, breathing angels at CTCA. The latest ad goes like this:

Male patient: "My doctor walked in and said, 'You mean you're still alive?! Why aren't you dead!? I want you dead! Die, die, die, damn you!... By the way, why haven't you paid my bill yet? My yacht needs some sprucing."
OK, I exaggerate. A little. The key verbiage in the actual ad is: "My doctor walked in and said, 'What are you laughing about? You have six months to live.' "

Really? Come on, now. Maybe I'm as jaded as the doctors described in the ads, but I'm not buyin' it. I don't think these are real quotes from real people. I think they're more likely the product of the fertile imagination of some copywriter who was charged with differentiating CTCA from the bunch. Of course, CTCA is also really, really big (at least for public-relations purposes) on the idea that you beat cancer with positivity and, above all, hopea fanciful notion that has been widely promulgated by the Pink Ribbon crowd...and roundly, deliciously debunked by Barbara Ehrenreich, herself a former cancer patient.

Anyway, I'm going to call CTCA's press office and see what I can find out. I'll also try to talk to their ad firm. Stay tuned.


SPEAKING OF The Power, it is, at this writing, No. 12 on Amazon, still in pre-order mode. I have no doubt that it will promptly shoot to No. 1 upon official publication on August 17 (if not before).

Amazing. Simply amazing.


RevRon's Rants said...

I get especially irritated with the "patients" who claim to have been written off "in Houston" (a clear reference to the M.D. Anderson Cancer Center, which is pretty universally recognized as one of - if not the - foremost cancer treatment facility in the world. If they're claiming that M.D. Anderson provides poor treatment, they should come out & say so. The legal battle would be entertaining, to say the least.

If I had a PR campaign that needed healing, I might give a thought to the creative souls behind the CTCA commercials, but if I were looking for treatment of cancer, the choice would be a no-brainer... even if Houston weren't so close to home.

Chad Hogg said...

This great article from the New Yorker earlier this week explains that in fact oncologists tend to be not enough like CTCA imagines them. Beyond that, it is a good discussion of the importance of palliative care and not necessarily focusing on squeezing every possible minute into everyone's lifetimes.

Steve Salerno said...

Chad, I had actually read that piece in connection with a project I'm working on. There is an almost horrifying beauty to the final scene, if such a description makes sense.

In the research phase of my own piece on longevity, for the current issue of Skeptic, I came across a startling figure. For the purposes of convenience and clarity, I'll quote from the piece itself, which provides the context for the number:

"Even at the very end of life, batteries of treatments--the infamous 'kept alive by artificial means' strategy--does not guarantee an extension of life anyway, at least according to a 2008 study by the Dartmouth Institute for Health Policy and Clinical Practice. 'Simply receiving more health care does not result in better life expectancy,' the panel noted. Too often such patients merely die a 'high-tech, ICU-associated death.' A costly one, too. The panel noted that at the esteemed Johns Hopkins Hospital, Medicare spending in the final two years of a patient's life amounted to $85,729."

Again, I find that remarkable, and chilling.

Anonymous said...

There is only one author in history who has changed the way people thought about themselves in the modern era, and she is Rhonda Byrne. The Power of her thoughts cut across cultures, religions, and she continues to change the quality of life of numerous people across the world.

Steve Salerno said...

Re Anon 7:47: Yanno...I'm posting that comment even though its promotional agenda is clear. (I get "comments" all the time from people who are actually not commenting at all, but merely trying to use the blog as part of their path to viral success.) In this case, at least it's relevant. And I thought it might spark some discussion of ol' Rhonda and her latest opus.

Anonymous said...

I wonder how Rhonda will deal with her approaching death?
Will she apply the LOA and hope to circumnavigate the appearance of the reaper by having positive thoughts?

Good luck with that one, Rhonda.

Having watched a close friend go through agonies of chemo treatment for terminal lung cancer-to no avail, I heartily endorse the palliative care approach for terminal cases. However, that is not a decision I would make for another without their prior understanding and agreement.

It seems to me that the subject under discussion is not the relative benefits of palliative care versus aggressive medical intervention (or the more fundamental euthanasia debate) but rather: who gets to make that decision when the patient is not willing to consider the inevitability of death for all of us.

Steve Salerno said...

I think the question is also how much false/misleading advertising we're willing to tolerate in our desperation to believe that certain precincts of the medical establishment have more answers (or better answers) than other precincts. CTCA is now running another ad that implies that a patient of theirs who "had six months to live," as diagnosed elsewhere, is still alive three years later thanks to the unique and wondrous medical agency of CTCA. I'd like to see that documented on more than a case-by-case basis (if it's even true in the advertised case to begin with, that is).

Anonymous said...

Steve, that's the best point you've made in all of these discussions. The issue here isn't hope but false hope and the way Cancer Inc. fans its flames. It's disgraceful the way major hospital systems imply, or sometimes state outright that they have new treatment protocols that their competitors lack, when everyone in the industry itself knows the best practices soon become standard throughout the industry. Certainly this is true at major hospitals and treatment centers. Competition demands it.

Forget about hope and positivity and all that sentimental stuff, I'd like to see CTCA document that they have actual treatment protocols that others don't!

Steve Salerno said...

"Cancer Inc."

I like that. Hmmm.

Steve Salerno said...

Here's an interesting article that's relevant to the topic in an umbrella sort of way:

I do think we need to "consider the source" here, but the piece is interesting nonetheless.

Cosmic Connie said...

Re Anon Aug. 6, 7:47's sneaky plug for Rhonda Byrne's new book... one sneaky plug deserves another. I was so inspired by the upcoming opus that I wrote a hymn about it:

(For those who are interested, there's now also a link in that post to the book trailer.)

Verification word: humsf

Elizabeth said...

My dad was diagnosed with lung cancer this spring, and as the person who's been taking him to the docs' appointments, tests, etc., all within the conventional medical model, I can tell you that the docs and medical personnel we've met along the way, so far at least, have been sensitive, caring and helpful, more so than we are used to.

We've not experienced any of the horror scenarios "advertised" in CTCA commercials; in fact, I've observed the tendency of the docs to "err" on the side of optimism and hope,* similar to that described by Gawande in TNY.

*I'm thankful for it, too.

Steve Salerno said...

Eliz: Thanks for that addition. I wish your dad well in his battle.

Seems to me that even if, once in a while, we do encounter a doctor who's seriously lacking in empathy and/or people skills and says stupid things as a result, that isn't the norm. For CTCA to home in on those kinds of stupid statements, implying that all other doctors are callous bastards while only their doctors are caring humanists, is dirty pool--and, at least in my view, likely fraudulent advertising.

Dimension Skipper said...

Honestly I've pretty much reached the point where if something's advertised I assume there's a not insignificant fraud to fact ratio. Maybe not in what's actually said—though often enough, yeah—but more commonly in what is NOT said or what is implied/portrayed. (Not to mention what is actually and technically negated by the impenetrable paragraph or more of fine print flashed on the screen for all of a nanosecond.)

Even labels on packaged food items at the supermarket tout various health benefits, but if you read the ingredients you'll often find near-obscene amounts of various questionable components.

Now, I sort of recuse myself from this post a little bit because A) I've actually BEEN to a CTCA (Tulsa), but B) I don't actually have real first-hand knowledge/experience of their Drs or much of their personnel because I was only accompanying my cousin-in-law Dan at the time.

The few personnel I met—mostly nurses or receptionists, orderlies, whatever—seemed nice enough. But then so have most of the personnel I've encountered on too-numerous occasions in my life via my parents.

Dan was quite enthusiastic about the place at the time. The CTCA would arrange and pay for his flights to Tulsa and back home to Alabama. When we drove, they reimbursed generously for gas. I have no idea how they were able to do that, if there were certain qualification criteria that had to be met.

Of course, by the time he was going there it was his—inevitable, it seems—recurrence of pancreatic cancer and that's, statistically speaking, near enough to impossible to beat such that you may as well just say that. The odds were very long indeed and in fact he finally came up short on those odds in early June.

Also, by that time he refused further traditional IV chemo. He'd had a long round of that the first time in addition to radiation (which he was maxed out on and so could not receive any more) so he knew what he was refusing. He took some pills which were technically an oral/chemical form of chemo, but he didn't consider them as such. Test results indicated they may have helped to slow the cancer some, but who knows... Dan's attitude by this point was to try to make the most of what time he had left rather than spend it being horribly sick simply from the effects of some treatment that was almost certain to not work anyway.

So that's the extent of what I can say from my limited personal experience. If anyone's interested in some visuals, check here. The pics are more generally to set the scene. I deliberately tried to avoid photographing medical personnel or patients. I just stuck to the common areas.

Last I just want to say that I do feel it's very important to keep in mind that there's a BIG difference between the people who design and implement these ad campaigns and the actual day-to-day operating facilities themselves. Don't confuse the message (or the way it's delivered) with the practice.

As I indicated at the top, I often have negative reactions to something simply BECAUSE it is being advertised and therefore things are being deliberately focused and exaggerated. "Best hoagies on the planet?" I highly doubt that. And who judged? ...Let ME go try every hoagie joint on Earth and get back to you. Still though, the hoagie in question might indeed be very good. I just don't take the ad's say-so. That's all I'm sayin'.

Dimension Skipper said...

(Commenting difficulties persist. Blogger said my comment was too long, so I lopped off the following paragraph in hopes that would be good enough. I think the first part probably went through, but I can't be sure. At any rate here's the trailing paragraph I lopped. Just consider it a minor P.S....)

I certainly understand and share the skepticism/cynicism toward advertising in general and even the CTCA spots in question, but that skepticism/cynicism (and any other -ism) is mainly for the advertising itself. There are very few things in life I can say I truly "hate," but I think marketing may be one of them, at least in its evolved bastardized "hard sell" form of promise rainbows and moonbeams, spin it this way and that, anything just to get the proverbial almighty dollar.

Dimension Skipper said...

Lastly, here are two first-hand experiences of "bad" doctors...

#1. Many years ago, I developed an ear infection. Didn't really have a doctor at the time, so just went to a well known nearby one. Ended up seeing one of the lesser associates, of course, and he prescribed amoxycillin (sp?). Turned out I took about 5 days worth of the 7-day supply because as I took it I found my strength just sapping away and soon just the idea of getting out of bed was too much.

So naturally the infection soon recurred. I went back to the same Dr and told him I didn't think I could take amoxycillin because of the effect it seemed to have on me. His response? "That's what we treat it with." And like a sap I took the new script and tried again, thinking in my mind, "Well, maybe it wasn't the medicine, maybe I had some sort of general bug in addition to the ear thing." So I tried it and got the same result.

Ended up going to another Dr next time it recurred (i.e. soon after), explained about the amoxycillin and he said, "There's other medicines we can use. Here, try this one." That one worked like a charm in that I could take it for the full course of treatment with no ill effects, just the effect of actually feeling better as time went on.

#2. I consider this one direct experience even though I wasn't the patient, my Mother was... She had developed shingles of the eye, but at first we (me, Dad, and various Drs) didn't immediately recognize what it was. When one eye specialist did figure it out, he recommended she also consult a pain specialist.

At the time, there weren't very many pain specialists around. The nearest one was a decent hike away, but not at all unreachable.
So I called to get her an appt, explaining to the person on the phone what the problem was and that it was important that she see the doc ASAP, if not immediately. Was told in a flat uncaring, unyielding tone that the soonest appt available was a week away. No amount of urging swayed this person. All I could do was get her to promise that if there was a cancellation they would call us to fill the slot. (Honestly, though, my impression was that she didn't give a rat's ass to even bother if that occurred, but I could be wrong. Hard to tell over the phone.)

So a week went by, all the time my Mother suffering more and more, and then we get to the office and finally get into see the Dr. What's one of the first things he says? "If you'd come in to see me right away when this started, we could have avoided all of this."

!!!!!!!!!!! (I cannot put enough exclamation points on that!)

I actually wanted to haul off and hit the guy. I tried not to scream at him, but told him that that in fact was what we TRIED to do and his office wouldn't allow it, that maybe he should better educate his personnel so that when someone says they have shignles of the eye starting, they find a way to get that person in to be seen.

All in all, the fact that police were not called in indicates I was too easy on the guy.

Mom saw him a while (not much choice at that point) and was prescribed capsules which in the end seemed to do very little for her and she suffered the neuralgia effects (mainly unbearable persistent itching) for years after.

Most all Drs and medical personnel I've ever encountered have been very nice and caring people, but those are two examples of "the bad ones." So forgive me if I have trust issues when it comes to things medical, especially once you start wrapping it all up in the same wadded money ball with advertising (by Drs, facilities, drug companies) and insurance.

Elizabeth said...

DimSkip, I'm really sorry to hear about Dan. Cancer sucks (pardon my inelegant expression).

All in all, the fact that police were not called in indicates I was too easy on the guy.

What admirable restraint. ;)

How lucky you are to have only two unpleasant docs' encounters. I could, sadly, come up with a much longer list -- for myself and my loved ones -- so it's all the more surprising that my dad's cancer docs and nurses are so caring, prompt and kind. It really helps. Really.

I think we seriously underestimate the importance of the right attitude in approach to any and all patients. Not that they are a cure-all, of course, or a substitute for expertise and knowledge, but kindness, attentiveness and caring are very much underrated in our mechanized, depersonalized, for-profit model of medical care (as well as in our relationships in general).

I see this so clearly with my parents now, even more so than I've ever seen it (or cared to see it) in my own life.

My mom had an emergency abdominal surgery two weeks ago and I'm absolutely convinced that her painful and arduous recovery would have been much easier and faster, if she were treated with just a bit more kindness by her surgeon.

And I'm not talking hand-holding (though there is nothing wrong with that), but simply sitting at her bedside for just a few minutes, explaining the surgery to her, answering her questions and concerns, sympathizing with her pain and worry, and dispelling her fears.

As it is, she is now firmly convinced that she didn't need the surgery (she very much did -- it saved her life), the doctors were hasty and sloppy (they weren't), and because of that her recovery is very slow and problematic. It doesn't matter what I say to her, or my dad, or anyone else at this point -- what matters, or what would have mattered, is the doc's behavior.

To think that only ten minutes of her surgeon's time would have made all the difference for her... How simple, and yet how difficult, no?

Last but certainly not least, thank you, Steve, for the good wishes for my dad.