Monday, August 24, 2015

The latest from BS Anderson...bad news comes in threes.

The American Cancer Society is tracking a worrisome rise in second cancers. To be clear, these are not mere recurrences of the original disease, but rather a different type of cancer in a different area. Here's a summary of the trend-line, from the linked story: 

"About 19 percent of cancers in the United States now are second-or-more cases, a recent study found. In the 1970s, it was only 9 percent. Over that period, the number of first cancers rose 70 percent while the number of second cancers rose 300 percent."
This raises a number of questions that might at first seem snarky but are thoroughly valid, even by the admission of some courageous souls within Cancer Inc. 

1, Do we know as much about cancer as we think we do? (One is reminded of that ridiculous line from the MD Anderson ad: "Cancer, we know you even better than you know yourself.") Are these "new" and "different" cancers really entirely new forms of disease...or could they be unexpected mutations of the same cancer cells that were present originally? 

2, Are some people cancer-prone? We already know that when it comes to certain types of cancer, e.g. breast cancer, the answer is Yes. But is there more to this predisposition than we realize? Can such people ever really be "cured" of cancer, or will the first cancer give way inevitably to a second?

3, To what extent are the second cancers caused by the treatment for the first cancers? This is not in any way as curmudgeonly as it sounds, but rather is acknowledged fact within the cancer community. Browse around Google and check for yourself. 

Bottom line, we have even more reason to take ads like Anderson's with about a half-pound of salt. Yeah, you maymaybeat this cancer...but even if you do, that may not be the last you see of your positive-thinking pals at BS Anderson.

Saturday, August 15, 2015

BS Anderson...the sequel. As if to prove my point.

This shouldn't be hilarious, inasmuch as we're talking about life and death, but I confess to laughing so hard I almost fell off my chair when this ad for cancer research came on-screen mere minutes after the latest ad from MD Anderson, which we examined last time. Have a look:

So let's get this straight. On the one hand, if you already have cancer and Cancer Inc. wants your cash, you're gonna beat this. No worries! It's in the bag. You win! Cancer loses! On the other hand, if Cancer Inc. wants your cash for research, OMG, we're still at square one and without your continued support 94% of you will die! ... Oh, the humanity...!!

As noted in my original post on Anderson, the cure rates for pancreatic cancer rank among the worst in the realm, so I'm not that upset with Cranston and the respected organization for which he's stumping. The dire stats show that there's clearly a lot of work to be done in the battle against pancreatic cancer...and by the way, that same grim truth applies in the case other cancers as well. (Although interestingly, the 6% stat quoted in Cranston's ad is even more dire than the figure I got from the National Cancer Institute. Funny how that works, eh?) But if there's a lot of work to be done, how can a hospital like MD Anderson simply say, as a blanket statement, that their patients will beat the disease?

I certainly don't expect leading cancer hospitals to put out a message implying that most patients are apt to die. It's just, we could do with a bit more realism and a bit less (a lot less) hype. More disclosure, less delusion. This is why I don't think I'm nitpicking or being Mr. Insensitive when I attack these ads, or even when I attacked a prior iteration of such ads from Lynn Redgrave (and I got a lot of grief for that). If even 50% of patients succumb to a given disease within five years, it is just plain wrong, in my book, for a hospital to put out the message, COME TO US AND YOU WILL BEAT THIS. It is fraudulently wrong. It is b.s. and the hospital knows it. So why do we smile and get all gooey over such ads? As consumers, why aren't we outraged?

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.

Tuesday, June 09, 2015

Back by popular (albeit puzzling) demand...?

Since I took down SHAMblog about a week ago, perhaps a dozen people have contacted me by various means to inquire about the factors motivating my decision. Several, including one or two media types, asked if I could at least keep the archived content up. One emailed plaintively, "I began my day by going to your blog with my morning coffee and I miss it!" A third reader wrote to say, "You really had a huge impact on my life and the way I think and feel." 

I suppose SHAMblog does represent an enviable body of worka legitimate oeuvreand its place in the history of self-help criticism seems assured. Plus, as noted, I loath the idea that the folks on the other side might giggle with schadenfreude at the fact that my "negativity" and "naysaying" had come home to roost. So, as requested, I'm bringing the archives back up. 

I do want to thank all of you who wrote to express your dismay at the blog's demise. At this time I do not expect to post going forward.

Saturday, May 16, 2015

Dispaches from the SHAMscape... May 16, 2015

Here's another reason why some educators/administrators don't like standardized tests (see yesterday's item): Testing puts a numerical face on the dimensions of America's efforts in the area of social engineering. Given affirmative action's loss of luster in the wake of several damning court decisions and voter referendums, administrators in Higher Edwho were always its most ardent practitionershave tried to fly under the radar in their continuing endeavors to micromanage equality and "social justice" (or their conception of same). If the data quoted in this story are valid, it appears that a given black applicant to Harvard can get in with an SAT score that's fully 450 points lower than a given Asian applicant, and 310 points lower than your everyday white applicant. As the entire exam comprises 2400 points, a 450-point margin is a difference of nearly 20%. That is huge in a society in which major qualitative decisions are made daily on the basis of fractional increments of a single percentage point. As I wrote in an essay back during my senior year at Brooklyn College (1972), which was just then embracing affirmative action, "Even if it's true that the underperformance of minority students is an ongoing vestige of slavery and oppression, it strikes me as fundamentally unfair that a random white [or Asian] student of today, who has never owned a slave and has no personal history of oppressing anyone, should have to suffer for it in recompense. Two wrongs don't make a right." (Apologies for having ended on a cliched note. Hey, I was young.)