We’ve been tracking claims for Cyberknife’s “knifeless surgery” for a long time. See our blog search results. We’ve seen billboards promoting it in the metropolitan healthcare market we live in.
And major East Coast medical centers promote it at subway stations.
But it’s only recently that we’ve started noticing a lot of TV commercials promoting the technology, which was recently described this way:
Rohit Inamdar, senior medical physicist and senior associate in the Applied Solutions Group at the ECRI Institute in Plymouth Meeting, Pennsylvania, a nonprofit organization that evaluates medical products and processes, agrees that clinical evidence on the use of the CyberKnife for prostate cancer is “a little early…and a little weak. It is still in development and does not hold up..”
You don’t get that sense in TV spots broadcast in Minneapolis:
Or in New Jersey:
Or in Television, print or outdoor advertisements of another New Jersey medical center:
This is probably only a glimpse of what is happening in the United States, but I only had to ask the opinion of Harold DeMonaco, MS, one of our expert reviewers and guest bloggers. He watched some of the ads and here is his analysis:
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In Minnesota: Turn devastation into hope
In New Jersey: The ray of hope you’ve been looking for
Elsewhere in New Jersey: Cancer doesn’t fight fair, neither should you
The above three quotes are final statements made in videos promoting the Cyberknife Radiation Therapy System and its availability in select hospitals. These ads are clearly aimed at cancer patients, however vulnerable they may be. At best, these advertisements are incomplete and misleading. But then again, these are advertisements. We do not expect full disclosure in any other advertising. Should we expect more from healthcare providers? Should we impose a higher standard on hospitals and health networks in their advertising? And what is the legitimate role of local journalists in the face of this type of publicity?
Unfortunately, excessive claims in medical advertising have been around since the Dark Ages. Given the significant economic stakes of a competitive healthcare market, we may be witnessing the beginnings of the 21st Centennial version of “snake oil” promotions. The Cyberknife system isn’t the issue here. Like most new technologies, the Cyberknife system can play an important role in improving the treatment of many cancer patients. It is the advertising that is in question. Does a hospital really need to use phrases like “turning devastation into hope” to promote the use of a new treatment option?
I want to be clear from the start, I’m a technogeek. I love new technologies and advocate their use when and where they can best benefit the patient. I am, however, simply appalled at the efforts of some hospitals and health systems to promote their new technology. While some hospitals are doing a very good job promoting the Cyberknife, others apparently see the need to distort the reality of the device when it comes to published evidence of its superiority. I am also appalled that journalists seem perfectly willing to ignore the growing excesses of hospital promotions.
Wikipedia defines “advertising as a form of communication for marketing and used to encourage or persuade an audience (viewers, readers, or listeners; sometimes a specific group) to continue or take a new action. Most often the desired result is to stimulate consumer behavior in relation to a commercial offer, although political and ideological advertising is also common.In Latin, ad vertere means “to turn the mind towards”.
Advertising is clearly not intended to educate. “Education in its general sense is a form of learning in which the knowledge, skills and habits of a group of people are transferred from one generation to another through teaching, training, research or simply by the autodidact….”, according to Wikipedia. .
Can we doubt then that these promos aim to “turn the minds of cancer patients towards” these local institutions? That, in itself, may not be problematic. The clinicians at these facilities are likely practicing good clinical care. It is also likely that cancer patients who are not eligible for treatment with this form of radiotherapy would be appropriately managed by other means. But, that being the case, why then do marketers have to twist their message?
I appreciate the fact that hospitals are actually businesses. Although most hospitals are structured as “not-for-profit”, all must generate a profit to survive. The key to the survival of hospitals, like any business, is the margin between costs and revenues. In a low margin business, volume is key. Like any business in a competitive market, identifying an advantage over your competitors and exploiting it is key to maintaining or increasing market share. And that’s where advertising comes in. This is especially true when a local hospital is investing millions of dollars in new technology like the Cyberknife. These large sunk costs must be transformed at least quickly into a financial “break-even point”. Thus, the volume of patients is critical. The same goes for any new and expensive technology, from the proton beam center to the surgical robot, and is not unique to the Cyberknife. What seems to be unique is the length that some would go to for increased volume. Unless they lived in a cave somewhere, is there anyone who hasn’t seen a billboard, local news report, or press release about a DaVinci Robot system or a Cyberknife ? I guess there are a few reasons for this level of marketing a product. The first is the significant investment made by local hospitals in these technologies and the subsequent need to increase volume to pay for them. The second is the marketing support provided by the companies themselves. A visit to the websites will give you an idea of the finish and completeness of the marketing support.
The Cyberknife System is an impressive device that was first approved by the FDA over a decade ago. Whether this is really an advantage over intensity modulated radiation therapy (IMRT) is still in question. It may be more convenient, requiring fewer treatment sessions than IMRT, but the long-term results seen in prostate cancer, for example, compared to IMRT are still in question. The published studies are few and I am not aware of any comparative test in the literature. The majority of studies published to date have involved low- and intermediate-risk prostate cancer patients and have not been randomized, comparing them to IMRT. At this point, it appears that Cybeknife provides similar results to short-term IMRT and is definitely more convenient. We just don’t know if the accuracy of the device is actually a long-term benefit. We also don’t know if the side effect profile is better. This is not a new phenomenon nor unique to the Cyberknife. In fact, IMRT became the dominant method of delivering radiation therapy to patients long before trials demonstrated its superiority.
Comparative trials are not required for FDA approval. No manufacturer needs to demonstrate that their new device is in fact superior to existing technology. The market will define the eventual role of most new technologies. But, more recently, even when it is intuitively obvious that there is a technical advantage, it may not be clinically better. For example, a recent itempublished in the Journal of the American Medical Association concluded that IMRT was superior to conventional radiotherapy in patients with prostate cancer. This is a validation of the underlying assumption and market confidence in the technology. Interestingly, proton therapy, the presumed gold standard for radiation accuracy, appeared to offer no benefit and had a higher likelihood of producing gastrointestinal damage than IMRT. The authors used administrative data to draw conclusions and the results, while interesting, are not from a randomized controlled trial. But they point out that the newer ones may in fact be no better. A class clinical test may provide somewhat more definitive answers.
Some local hospitals seem willing to push the boundaries of their advertising while the local media seems to be silent on the issue. Or worse, as evidenced by a recent story that Gary pointed to from a Dallas Radio. I was able to find an excellent storyon a Cyberknife system newly installed at Georgetown University Hospital several years ago by Rob Stein. Why aren’t there more?
Every hospital and healthcare network in the United States has a public relations/news and media department. Most do an excellent job of emphasizing the benefits of care in their particular settings. Some may be stretching the truth. And a minority seem willing to stretch the truth out until it comes out.
As always, these comments only reflect my point of view on the subject. I’m curious to see what journalists have to say.
