Friday, August 07, 2015

The latest from BS Anderson Cancer Center.

I doubted that anything could make me post again at this time, with all that's going on in the background...little of it good, much of it quite trying. Then I turned on the TV this morning and saw the latest ad from the MD Anderson Cancer Center, now airing nationally on network.

Even in a realm where exaggerations are the norm, where indefensible statements are the marketer's stock in trade, the Anderson spot breaks new ground. 

Yeah, I know that these ads are all about feelings and positivity and keeping hope alive and other such gooey terms. But my first reaction to this ad involved a somewhat different term. That term is FRAUD. My second reaction was that I guess Beau Biden's brain lesion didn't get the memo; you see, poor Beau went to Anderson several years back and was treated and even deemed cancer-free, none of which stopped the disease from killing him this past May. A snarky comment on my part, I grant you, but justified given the tone and unconditional message of Anderson's advertising.
Patient (addressing Cancer): “You try to take everyone.”
Doctor: “But I wont let you."
Second doctor: “We will stop you..."
Doctor: “We will stop you..."
Patient: “My dad will survive you.”
Several doctors: “We're an army, thousands strong...and cancer, you're going to lose.”
Patient: “And we are going to win.”
I have a proposal for the august MDs of MD: Care to put that in writing? If I come to your facility and you fail to beat my cancer, such that I lose—which is to say, I dieyou will not only waive all fees, but you'll pay my survivors the cool sum of, oh, $10 million. How's that sound? After all, I don't see asterisks splashed all over your ad, or even a series of cleverly parsed disclaimers crawling across the bottom of my screen. You're telling me forthrightly that I'm going to beat this. I'm going to win. And you're multiplying the impact by incorporating heartrending human drama. 

We must concede here that MD Anderson's cancer protocols and cure rates are adjudged the best in the business. Though one is given pause by their free-and-easy use of the term survivor. This, from their site:
"MD Anderson defines a survivor as anyone whos [sic] been diagnosed with cancer. Survivorship starts at the time of disease diagnosis and continues throughout the rest of the patient's life. Family caregivers and friends are also considered survivors [though one would hope, God help us, that such second-hand survivors aren't counted in Anderson's official stats]. In fact, MD Anderson does not consider you dead until three years after you decompose..."
OK, I added that last line; forgive me. Anyway, below, for the record, are some overall survival metrics for various forms of cancer, using the traditional five-year benchmark. Bear in mind, if you die a few days into the sixth yearas did my Dad, back in 1978*you've still died of cancer, in the real world, despite having been counted as cured in the rarefied world of cancer stats:

Counting all cancers, 66.5% of us survive five years from diagnosis. That is admittedly a nice leap forward from a few decades ago, but could also be in part a statistical artifact of advances in diagnosis. People are not always living older. Whereas once we might've found Carol's breast cancer at 48 and she dies at 52, we now find it at 46 and she dies at 52. Though in the latter case Carol becomes a "5-year survivor," we have not increased her actual lifespan. We simply found out sooner what was going to kill Carol at age 52.

The "cure" rate for all cancers obviously includes specific cancers that have exceptional 5-year survival rates, if caught early enough. One such example is prostate cancer, clocking it at near 99%. Those afflicted with other cancers are not as lucky:
Leukemia (all types), 58.5%
Ovarian cancer, 45% 
Brain and nervous system, 33%
Stomach cancer, 29.3%
Esophageal cancer, 17.9%
Lung cancer, 17.4%
Pancreatic cancer, 7.2%
And to reiterate, if you're in the charmed 7.2% of victims of pancreatic cancer who make the 5-year cut, that does not mean you beat the disease and will live to be a cancer-free 107. It means that you satisfied the criteria for inclusion in an arbitrary health-care metric.

So, MD Anderson, if some woman walks in with a garden-variety case of pancreatic cancer, are you telling her that she's going to beat it? Just like that? She's going to win? As I said, put it in down in black and white. I dare you.

Wait...what's that you say? Oh, I'm supposed to know better. I'm supposed to know it's just a pep talk. In the bitterly competitive $100 billion market for cancer treatment, how can society (and regulators) permit a key player to give pep talks that fly in the face of statistical probability? Pep talks that make promises with no foundation in reality? In another context we'd surely expect the FTC, FCC or AMA to step in. Why not here? I do not believe that cancer ads should deal in metaphors or poesy.

(And that one line, "Cancer, we know you even better than you know yourself." What does that even mean, if anything? And is it in any way medically or scientifically defensible?)

Anderson isn't alone in this, of course. We've talked about Cancer Treatment Centers of America, and this cancer survivor reminds us that cancer advertising as a whole is deplorably sketchy on facts. But the current ad from Anderson, to my mind, is the worst offender. Remember that Anderson has been rated the top cancer center in America. Its true story is glossy and impressive. Anderson probably offers you better odds of survival than treatment anywhere else. Why isn't it enough to say that? Why must they jump the shark? 

In conclusion, let me add that this post is not about taking away anyone's hope or kicking people when they're down. This post is very much in keeping with the reasons I wrote SHAM. It's about protecting consumers who are desperate for answers; protecting people who are in a weakened, vulnerable state of mind. It's about protecting consumers from being preyed upon by the unscrupulous purveyors of false hope. It's about giving consumers a fair shake. We all deserve that much. And people facing an odious disease like cancer deserve it more than most. 

* And Happy Birthday, Dad. I miss you every day.


Jenny said...

My dad died the same year, 1978. Glad to see another post here, Steve. I hope you find more and more reasons to let us in on what you are thinking. Hey, you might even be a reader's last hope! (Couldn't resist that one.) Seriously, though, seeing a new post from you does make me happy. :)

Steve Salerno said...

Thanks for the kind words, Jenny. I almost considered putting the donation (or a subscription) tab back up--in exchange for which I'd promise to post as often as I could--but I got such a cold shoulder last time that I figured there was no point. I am convinced that some folks, including one or two regulars, actually stopped reading the blog simply because I brought up "the money thing." So be it. I reserve the right to write if and when I'm so moved... ;)

But thanks again. I know I can always count on you. You're a sweetheart, Jenny. A truly nice human being, from what I can tell out here in the wilderness.

Steve Salerno said...

Jenny, I have some trepidations about posting your most recent comment, and I think you can deduce my reasoning. I very much appreciate the sentiment, however, so let's see what the next few weeks bring. Heck, I should've had you as my publicist when SHAM first came out; the book would've sold a zillion copies.

Thanks again for your loyalty.

roger o'keefe said...

Good to see you back at it again, Steve, even if it doesn't last. Good to see you catering to your "base" too, to use a political term.

renee james said...

When my mom was dying of liver cancer, I had a delusional moment where I was almost taken in by a “sales pitch” (for lack of a better term) from a very, very reputable health care organization about how they offer hope and a “cure” for patients exactly like my mother. That moment lasted for about nine minutes before I realized it was pointless and highly unlikely that they could help her.

A very dear friend of mine – a surgeon - helped me through this difficult time and I’ll never forget how much he supported me with kind words (while softly delivering the unwelcome but undeniable harsh truths), with endless compassion and love for me and for my family. He contends that this kind of “cancer hope marketing,” whether it come from a reputable teaching hospital or someplace like CCA, borders on medically unethical and in the end, offers so very little for so very few.

All this to say: there are some good guys out there, Steve. Who see through the hype; whose goals are to acknowledge reality with and for their patients, and offer them the best end of life care they can. I realize you know that but thought it was worth sharing.

Steve Salerno said...

Thank you for sharing that, Renee. I did not mean to imply that all oncologists nowadays are frauds and snake-oil salesmen. In fact you make my point, when you write that your surgeon "supported me with kind words (while softly delivering the unwelcome but undeniable harsh truths)..." That's all I ask is that the parenthetical part not be swept under the carpet for marketing reasons. As I say in the post itself, I'd have no problem with Anderson if they declared, "Look, Mr. Pancreatic Cancer Patient, your odds aren't good, but our track record shows that you're better off with us than you'd be somewhere else." I'd have no problem with hospitals that promise to "support you with hope and TLC" throughout the treatment process...but when hope BECOMES the treatment process (and the entire public persona of the institution), that's when I go a bit ballistic. And, again, like your surgeon/friend, I don't know how places like Anderson and especially CTCA are allowed to get away with this. It "borders" on medically unethical? I think he's being extremely generous in an effort to still honor The Code that connects all top practitioners.

Cosmic Connie said...

First of all, I too am glad to see you blogging again, Steve, and I think you should solicit donations if you want. There's nothing wrong with that. My absence from SHAMblog has been due to being involved in my own stuff; in fact I've even been mostly absent from my own blog lately. I suspect that the "cold shoulder" you have been experiencing is really par for the course with blog donations. I've had my own donation button up for nearly five and a half years and the donations have always been sparse. (Not that this prevented one of my stupid targets from claiming, in a failed lawsuit, that I am making lots of money from my blog.)

Second... I hear you about the cancer treatment hype. The cancer industry does patients and their loved ones a disservice by continuing with this deceptive marketing. And yes, the industry's commonly accepted definition of "survivor" is totally arbitrary and really almost meaningless. Unfortunately, these flaws and others give the cancer quacks (like that monster who sued me) a toehold, and they are able to exploit the shortcomings and misdeeds of the cancer establishment to attract customers, and even totally turn some patients away from legitimate treatments that might actually help them. The quacks love to holler about medicine being profit-driven, which is certainly an unfortunate truth, but quackery too is profit-driven.

Steve Salerno said...

Thank you for reappearing, Connie. As you know from your own experiences, it can get damned lonely out here on the fringe.