Caveat patiens: American Cancer Marketing (part 1)

This is the first of a two-part post about dubious marketing techniques newly-diagnosed cancer patients are likely to encounter. 

Like anyone who has heard the words “you” and “cancer” in the same sentence, when my urologist said, “Craig, you have a nasty cancer,” I felt as if I were looking death square in the eye.  Never before had I felt so vulnerable–both physically and emotionally.

Targeted HypodermicNor did I realize that I had just become a prime target in the fast-growing cancer treatment market.  Serious money is at stake:  $32 billion was spent in in the US in 2012 on cancer drugs and chemotherapy alone.(1)  Radiotherapy and surgery added billions more.

 The cancer treatment industry works hard to project an image of wise and experienced doctors using the very best methods and technology, motivated by unbiased judgement of what is absolutely the best course of treatment for a patient’s particular situation.  Happily, that is generally true.

But treating cancer in America is also a competitive battleground where medical practices, hospitals, cancer centers, equipment makers, and pharmaceutical companies all skirmish to maximize their piece of this growing multi-billion dollar market.  Frightened and emotionally susceptible patients (and their families) sit squarely in their marketing sights.

I’m a marketer by training and experience, and I know that there is no more fertile ground for planting seeds of desire than a state of emotional vulnerability.  It’s one thing for a marketer to create yearning for a new car, a designer handbag, a luxurious vacation, or (in my case) a new piece of photography gear.  It’s how our capitalist system operates.  But for treating cancer?  Given the very real dread that inevitably accompanies a cancer diagnosis, it’s just too easy for marketers exploit the fear that choosing a particular treatment method or hospital could be the crucial deciding factor in whether a patient lives or dies. 

Regardless of its source, the marketing message is basically the same: “Use our equipment/doctors/ hospitals/ cancer center and you’ll receive the best possible care and a happy outcome.”  Unfortunately, many of the means used to communicate that message border on the egregious, if not the strictly unethical.

Four marketing strategies stand out when it comes to cancer treatment:

  1. Seductive technology
  2. Education with a hidden agenda
  3. Outcome data manipulation
  4. Unacknowledged self-referral

Seductive Technology.  We are awash in consumer products such as smart phones and expensive automobiles that are touted as inherently superior because they incorporate advanced technology—a marketing technique that works especially well on us men, who value our gadgets.

In the case of my particular disease—prostate cancer—Intuitive Surgical, Inc. based in California’s Silicon Valley, has successfully positioned its DaVinci robotic surgery equipment (at a couple million dollars per copy) as the preferred method for prostatectomies—the most common way this cancer is treated.  Despite its impressive technology, there are as yet no peer-reviewed published data establishing clear superiority for robotic over more traditional surgery.

At a December 2013 presentation at the Society of Urologic Oncology, Vincent Laudone, MD, observed that Intuitive Surgical has achieved a remarkable 51% return on investment throughout its corporate history.(2)  Its primary marketing strategy has been to place its robotic equipment first in “flagship hospitals,” and then igniting a “robotic arms race,” inducing other area hospitals to buy this expensive gear.  The robot then creates a state-of-the-art technology “halo effect” for the hospital, clearly implying it’s the ideal venue for prospective cancer patients who should demand the very latest technology and thereby obtain the very best outcome.

In his talk, Laudone stated that his research of institutional web sites and marketing materials “revealed alarming rates of descriptions regarding safety, [the inferiority of] alternative treatments for prostate cancer, [minimal] risks of robotic surgery, or [lower] costs.”  In short, classic marketing hyperbole.

Moral for patients: Avoid the seduction of alluring technology.  Instead, the primary treatment decision criterion needs to be the skill and experience of the surgeon—independent of whether he or she is using hand tools (traditional surgery) or power tools (robots).

Education with a Hidden Agenda.  After being diagnosed, I embarked on an feverish Internet quest to educate myself thoroughly about how prostate cancer is treated, seeking impartial information in order to make a fully informed decision.  Aware that people like me turn first to the Internet, marketers have been quick to launch websites chock-a-block with substantial information that at first blush looks unbiased.  However, there is often an editorial subtext suggesting one treatment method’s superiority because that site is actually sponsored by a company or institution with a vested interest in directing readers to that particular method.

Although they accomplish the same goal, Proton Therapy (PT) is far more expensive than conventional Electron Beam RadioTherapy (EBRT) in terms of capital outlay and operating cost.  As yet, there are no peer-reviewed data published that demonstrate an unambiguous superiority for PT over EBRT.   Nevertheless, many men have become convinced psychologically by “studying all the facts” that PT is their only alternative.  Hang the cost (which insurance and Medicare pay anyway.)

The authors of a recently published study “applied a systematic search process to identify 270 weblinks associated with PT [to treat] prostate cancer,” and discovered that PT center websites were encountered far more frequently than “academic and nonacademic medical centers without ownership stake in proton centers.”(3)   The paper’s conclusion notes drily, “Patients should be aware that online information regarding PT for prostate cancer may represent marketing by proton centers rather than comprehensive and unbiased patient education.”

Covert corporate sponsorship in the guise of education also complicates life for physicians since, as the authors also observe, “An awareness of these results will also better prepare clinicians to address the potential biases of patients with prostate cancer who search the Internet for health information.”

While sponsored websites have their place, a newly-diagnosed patient should consult educational websites that have no treatment ax to grind.

The best, in my opinion, is cancer.gov,  the website of the National Cancer Institute, a unit of the National Institutes of Health, (and an excellent example of taxpayer dollars well spent.)  The American Cancer Society site, cancer.org is also helpful.  The National Comprehensive Cancer Network, “an alliance of leading cancer centers devoted to patient care, research, and education” at http://www.nccn.org/patients/default.aspx has a trove of useful information.

In part two of this post we will explore “Outcome Data Manipulation” and “Unacknowledged Self-Referral,” as well as discuss what patients and families can do to resist the cancer marketing tide.

FOOTNOTES:
(1) http://www.prnewswire.com/news-releases/the-cancer-drugs–treatments-market—data-analysis–forecasts-to-2023-232842321.html accessed 1/31/14

(2) http://www.urotoday.com/Endourology/suo-2013-session-highlights-marketing-robotic-surgery.html accessed 1/31/2014

(3) Sadowski DJ, et al, Proton therapy for prostate cancer online: Patient education or marketing? Can J Urol. 2013 Dec; 20(6):7015-20.  Abstract at  http://www.urotoday.com/Prostate-Cancer/proton-therapy-for-prostate-cancer-online-patient-education-or-marketing-abstract.html accessed 1/31/2014

Comments

  1. says

    Thanks for this series, Craig. It’s a discovery many of us make on our own–alas, often after the fact.

    In my world view, the two most important activities that should not be handed over to free-market capitalism are the military and the health of a nation’s citizens.

  2. says

    A very powerful, spot-on post, my friend. One need only look at the American Cancer Society’s Cancer Survivors Network chat boards on prostate cancer to see the towering influence of fear, mis- and dis-information and it-costs-more-so-it-must-be-better kind of thinking. Too often the marketing is aimed at side effects, rather than effectiveness of treatment in dealing with our cancers — even when there’s no data! Fear: the best marketing platform ever. Can’t wait to read the second installment.

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