The amount of advertising by cancer centers has exploded over the past decade - and so have come-ons that emotionally manipulate or even mislead patients.
That is the bottom line of a study and accompanying editorial published Monday in JAMA Internal Medicine.
"Cancer center advertisements generally make appeals based on emotion - not fact," wrote Steven Woloshin, a physician and a medical communication researcher with the Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire. "The appeals raise the stakes, in essence saying you can be saved provided you make the right choice or doomed if you do not."
Between 2005 and 2014, ad spending by 890 U.S. cancer centers more than tripled, rising from $54 million to $173 million, according to the study by researchers at Indiana University School of Medicine and the University of Pittsburgh.
However, just 20 centers accounted for 86 percent of that 2014 outlay - and the Philadelphia area had three of the top four:
Cancer Treatment Centers of America (CTCA), the for-profit, five-center company with a hospital on East Wyoming Avenue, spent $101.7 million across all its hospitals.
Houston-based MD Anderson Cancer Center, which has a partnership with Cooper University Health Care in Camden, spent $13.9 million across its system.
Fox Chase Cancer Center, in Northeast Philadelphia, spent $3.5 million.
Two of Philadelphia's leading facilities - the University of Pennsylvania's Abramson Cancer Center and Jefferson University's Kimmel Cancer Center - did not make the top 20, but that may be due to how the figures were gathered.
The researchers relied on data collected by the London-based ad-tracking firm Kantar Media, which does not count ads that do not explicitly name the cancer facility, or that are placed by affiliated advocacy organizations. (Penn Medicine said its total mass media spending in 2014 was $7.4 million; Jefferson said it could not provide a figure because its marketing manager was on vacation.)
Compared with pharmaceutical companies, which poured $5.2 billion into ads last year, cancer center spending is paltry.
And the centers make no apologies.
"We're in a competitive marketplace, so our spend has to reflect that," said Fox Chase spokesman Jeremy Moore. "We're committed to patient care. We have a good story to tell."
"Given our national and global reach, we feel our advertising investment is appropriate and responsible," MD Anderson senior vice president Tadd Pullin emailed.
At CTCA, which runs infomercials on TV, its website, and YouTube, chief growth officer Peter Yesawich said, "They're intended to be instructional and . . . we get wonderful feedback from patients."
But the researchers say advertising likely adds to the cost of care without improving its quality. Possible evidence of this: of the 20 top-spending centers, five were for-profit, and only nine (including MD Anderson and Fox Chase) have "National Cancer Institute designation," a measure of distinction.
"Cancer care is a highly profitable clinical service," said lead author Laura B. Vater, a fourth-year medical student at Indiana. "These ads use emotional language, omitting information about risks, and promoting unrealistic expectations."
The editorial notes that "medicine has long been ambivalent about advertising services." The American Medical Association's original ethics code actually banned ads as "derogatory to the profession" until litigation forced it to back down in 1980.
Now, there are quandaries about where persuasion - and exaggeration - fit into a puzzle as complex, costly, and sometimes dire, as cancer treatment.
In ads, Winthrop NYCyberKnife Center in New York City, for example, declares prostate cancer radiosurgery is "as effective as surgery, with no cutting or pain, no incontinence, less risk of impotence." But the CyberKnife company's website lists urinary and sexual dysfunction as potential side effects, the editorial says.
Ads that feature patients with near-miraculous results got CTCA into trouble with the Federal Trade Commission. CTCA now includes a disclaimer saying, "No case is typical. You should not expect to experience these results."
But atypical patients are a staple of all cancer marketing. Fox Chase, for example, on Sunday ran an Inquirer ad featuring a 68-year-old patient with a "rare gastrointestinal tumor." The tag line: "Before my clinical trial, I was given 18 months. That was 15 years ago."
"They're emotional tag lines," Moore said. "But cancer is an extremely emotional experience."
Woloshin countered, "These ads cross the line when they make people think, 'Going there will change the prognosis.' "
But maybe it will, said Julius Rauch, 78, of Cape May. He has done radio and TV commercial describing his Lazarus-like remission from metastatic melanoma six years ago in an immunotherapy clinical trial at Penn.
"How could anybody think negatively about describing the benefits of whatever is available?" Rauch said. "I think it has more positives than negatives. You try to make the hope side as strong as you can."
So what can be done to keep places that offer hope from selling hype?
The researchers suggest more studies, more regulation, more enforcement of existing rules limiting advertising claims, and self-restraint.
"Instead of focusing on the miracle," Woloshin said, "they could focus on what it is they do well. They could say, 'We have years of experience,' or, 'We pioneered this drug.' "
"Advertising is not going away," he said. "It's getting bigger. Can't it get better?"