Cancer Treatment Centers of America: Hope, But Don’t Hope

I often see these commercials for the Cancer Treatment Centers of America, and I find them misleading and unethical. I can’t seem to embed the video, but it can be found at this link. Most of their commercials are all about giving the patient “hope” where there was no hope before. But each commercial also carries a disclaimer: “No case is typical. You should not expect these results.” So the CTCA are suggesting that you should have hope and that they will offer you hope when other MDs fail to do so, but that you should also no have hope that it will work for you (although here “hope” is replaced with “expect”).

You need more than a second opinion. You need a second chance.

1. Legal Reasons for Disclaimers in Medical Advertisements

The reason for the disclaimer results from a lawsuit in the 1990s:

Cancer Treatment Centers of America was the subject of a Federal Trade Commission (FTC) complaint in 1993. The FTC alleged that CTCA made false claims regarding the success rates of certain cancer treatments in their promotional materials. This claim was settled in March 1996, requiring CTCA to discontinue use of any unsubstantiated claims in their advertising. CTCA is also required to have proven, scientific evidence for all statements regarding the safety, success rates, endorsements, and benefits of their cancer treatments. CTCA was also required to follow various steps in order to report compliance to the FTC per the settlement.

Cancer centers and hospitals in general (including Cancer Treatment Centers of America) have been the subjects of some controversy over their advertising. Many doctors and other observers have noted that many cancer organizations’ advertising are sparsely regulated and, therefore, often contain unsupported and misleading claims as to the efficacy of their cancer treatments.

In 2001, the FDA issued CTCA a Warning Letter concerning three clinical trials that were conducted in violation of FDA requirements. (From Wikipedia)

I understand that there are legal reasons for the disclaimer. Nevertheless, I find it creates an odd message overall. It also illustrates some of the problems with advertising in medicine.

2. Medicine and Advertising

When medicine is viewed as a product or commodity to be sold like any other, then it makes sense to use the techniques used in other forms of advertising.^[1] What one is really interested in when seeking medical services is the outcomes; that is, whether one will experience an improvement in one’s biological functioning, health, ability to cope with the condition and/or sense of well-being.

But discussing outcomes does not make good ad copy. Statistics are dry and boring, most medical treatments have a number of side effects (as drug commercials are now forced to disclose) and in most medical situations the outcomes are uncertain; medicine deals in probabilities more often than in certainties.

So rather than discussing these dry aspects, ads for drugs and medical centres instead rely on selling an experience or selling based on emotional pleas or manipulation.

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.” (From The New York Times)

And the CTCA are selling hope:

The Banner for CTCA Promotes Hope

3. The Problem With Selling Hope

There is some appeal to selling hope when faced with the risk of death, but this approach might also back-fire: people who are diagnosed with the disease expect to be given hope and treated as advertised. They might feel more let-down if this “hope” and “personal” treatment does not materialized. Indeed, some of the patient comments made at the American Cancer Society might imply that something of this sort is going on. Many of these quotes express dismay at the way their case was treated precisely because it differed from what they were led to expect from the commercials.

Take for example these two quotes:

My tumors were upgraded to brain cancer in 2005 and my husband and I contacted CTCA. I couldn’t even get past the “gatekeeper” who was only interested in what type of insurance I have.
…
There is nothing “kind” about these people when they are obviously in it for a profit. Profiting off of people at a time when they need assistance and guidance is just plain wrong. (April 7, 2011 – 8:56am)

And:

I called CTC (after watching their commercial) just to get information. I don’t have cancer (crossing self), but my brother does. Called the 1-888-381-5645 number and got the RUDEST lady! The first – and I mean the FIRST – thing she asked was “What insurance does he have”? I’m trying to give diagnostic information, and she’s all about insurance. She talked over me endlessly, saying there were (I’m quoting) “thousands and thousands of insurance companies, but we only accept a few, like Aetna and SOME Blue Cross policies, which allow treatments in different states.” I asked about Kaiser, and she laughed, saying, “Kaiser? No way!” This company is all about making MONEY!! And those commercials where “Peggy” says that her Doctor walked into her room after surgery and said “You have cancer”, and then turned around and walked away???? No way that happened!!! This company is just a money-maker!! The lady I spoke with was very rude, and tried to give ridiculous insurance “facts” This company is a scam! All they want is insurance and co-pay information. They could care less about anyone’s “condition”.  (August 22, 2010 – 9:32pm)

In each the writer seems particularly upset by the way in which their experience trying to access the CTCA did not match what they were led to expect from the commercials. A third quote comes from a patient who was able to access treatment but then found that the “hope” and “personal” treatment they received only superficially reflected these values:

…they lay it on thick, really make you feel like you’re the mosy important person in the world. First they asign you your personnel nurse navigator who is suppose to meet you everytime and take you to your appointments – well we never saw her again after the first visit – you’re on your own going floor to floor to each appointment with all these different titled people. We finally meet with a Dr. who tells us he’s 99% sure the treatment will work and your so excited.
…
We went back to Mayo, our Dr. there was so nice – he said with cancer you never throw out 99% 50-50% yeah. Well they did scans and the cancer was all over – liver, lymph nodes, lungs, thyroid, everywhere. Never heard from the treatment center again til I called and told them my husband had passed and I thought it was terrible they abandoned us the way they did. (March 23, 2010 – 9:45am)

Although selling hope might be effective in getting individuals to contact your center for care, it might also set them up for disappointment when the reality of the care they receive does not reflect what they were led to expect from the ads. By setting the patient up to expect “hope” and “personal care” these ads might actually end up undermining that hope or sense of personal connection once the patient attempts to contact them or manages to receive care through their services.

4. Pitting Doctors Against Doctors

A final problem I have with these commercials is the way that they portray non-CTCA physicians as callous and uncaring. It is true that many physicians are busy and they do not always take as much time with the patient as the patient would like, but most physicians are concerned with their patients and do want to give them the best experience possible when they are going through a difficult treatment for a life-threatening diagnosis. The last problem with the way that the CTCA commercials sell hope is that it can undermine the trust one has in one’s physician if the patient is not receiving care through the CTCA.

A post at This Commercial Sucks specifically targets the way the commercials pit patients against their doctors as a strategy for promoting the CTCA.

Apparently this country is just dominated by evil doctors who can’t wait to tell their patients that hey, they are gonna die, so please leave our offices now and try not to spread the stench of your impending death to our other patients (you know, the ones we care about.)

Commercials for Cancer Treatment Centers of America aren’t about promoting alternative cancer treatments- they are about bashing standard health care practices. (From Cancer Treatment Centers of America–It’s You vs. Your Doctor)

One physician commenting at the American Cancer Society also makes this point:

I have a few comments about the TV commercials CTCA uses to promote itself. While they promote their physicians as being competent and compassionate, they shine a rather negative light on the rest of their medical colleagues as heartless people who do not know what they are doing. Even CTCA’s staff physicians would agree that there are thousands of dedicated, competent, and compassionate non-CTCA oncologists out there. Most oncologists I know strive to, and do succeed in, providing the best care available for their patients, both physically and emotionally. Unfortunately, often, the best care available do not always lead to a cure. However, most oncologists I work with do research the available data from clinical trials from around the world, as well as taking into account each individual patient’s medical history and condition, before carefully formulating the treatment plans. Yes, there are a few bad apples in every barrel, but those are exceptions rather than the rules.

If an institution is truely as great as CTCA claims to be, there is no reason for it to put down the rest of medical profession to raise itself up. To me, this raises a huge red flag. I cannot ever recall hearing an advertisement from MD Anderson, Mayo, Mass General, or Memorial Sloan Kettering Cancer Centers where former patients give testimonies stating how awfully they were treated by other doctors before going there, and now they are cured of all sorts of terminal diseases. Can anyone? (May 30, 2011 – 10:33pm)

One of the reasons that I find these commercials to be unethical and not merely misleading is the possible effect that they might have on important values in medical ethics: hope, trust, and solidarity. The commercials purport to be selling future patients on the idea that the CTCA will give them hope where none existed, but the disconnect between what is sold and what is possible given the current state of medical knowledge can actually undermine that hope. Second, the way that they portray non-CTCA doctors can undermine patient trust in their physician. Finally, the commercials undermine the sense of solidarity that patients might have with one another and with their physicians by creating an “elite” of cancer patients treated with elite care at the CTCA and then substandard patients treated with substandard care elsewhere. Not only is this misleading it is also divisive.

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[1] A really interesting argument against thinking of medicine as a commodity for sale can be found in the book Everything For Sale by Robert Kuttner. He argues that medical markets are unlike the ideal markets considered by economists in a number of important ways. See Especially his discussion in Chapter 1 pages 16-19 (available in the Google Books preview) and Chapter 4 . I highly recommend the book to anyone who is interested in the topic of markets in medical care.