The problem with cancer is not advertisements

#ICYMI the Wall Street Journal recently posted an opinion piece about the horribleness of cancer center advertising:

Yes, there is a relationship between cancer center volume and outcome in leukemia. The discussion we had on this topic was started by a recent paper from England on this association. I agree the piece was overly cynical and missed the mark several ways.

Outcomes are better for many diagnoses in large treatment centers, but those benefits are not shared equally among our population, with low income patients having less access to care. Health care disparity is a much more pressing issue than advertising, I think.

Does Steve Salerno have a point? Kinda. The article’s subheading, “The multi-billion dollar treatment industry appeals to emotion in misleading ads,” is true but isn’t that the nature of the advertising business? Does the automobile industry appeal to emotion to sell cars? Sure. Did you notice there’s never any traffic in those ads? Neither do they mention climate change or traffic fatalities.

Cancer patients are different in class from car buyers because patients are at a vulnerable time in their lives, but Salerno fails to make this argument.

“Predatory advertising?” These cancer centers lure people into their clutches, and….what? Give them state-of-the-art diagnosis and treatments?

By focusing on “truth in advertising,” Salerno also sails right past the unsettling fact that treating cancer is a multi-billion dollar industry. Should cancer treatment be this profitable? That’s a separate, complex discussion, with good arguments on different sides.

The relentlessness of the Oprah-initiated positivity industry and it’s effect on cancer patients has was better addressed by Barbara Ehrenreich.

The closing sentences of the piece completely torpedoed it for me. The internal inconsistency of the the following sentence is ridiculous: “But the war on cancer is not the place for pep talks or poetic license.” What the heck is “the war on cancer” but poetic license?? I agree with many who feel that the “war on cancer” metaphor is itself misleading and unhelpful. Do I give pep talks? All the time.

In my experience, pessimism is simply unhelpful. A great clinician once told me, “it’s not your job to take away anyone’s hope.” I’m also brutally honest with my patients, but one can do both. One can be honest with facts, and still approach a tough situation with optimism.

“Hope” is the thing with feathers –
That perches in the soul –
And sings the tune without the words –
And never stops – at all –
And sweetest – in the Gale – is heard –
And sore must be the storm –
That could abash the little Bird
That kept so many warm –
I’ve heard it in the chillest land –
And on the strangest Sea –
Yet – never – in Extremity,
It asked a crumb – of me.
– Emily Dickenson

Full disclosure: I work as interim Director of the Hematologic Malignancy Section at a large academic hospital a

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