Java Zen:Thinking Out Loud Friday, 2017.12.15
Some changes are so slow, you don't notice them. Others are so fast, they don't notice you.

2002.01.25

Marketing 101 for Medical Students and Researchers

Word Chefs have a long tradition of serving palatable word salads to the masses for as long as there have been words. Governments do it (maimed and murdered civilians are described as “collateral damage”). Corporations do it (people aren’t fired, they’re “downsized”). Caveat Emptor. Riiiiiight. More like Cave Canem. Particularly when this type of spin is applied to all things medical. Centuries of voodoo, witchcraft, hocus-pocus and colossal arrogance have endeavored to pound the idea of “Trust your doctor – ALWAYS, OR ELSE!” into the collective psyche. So such spin carries quite a bit of danger for us average Jane’s and Joe’s.

Case in point. There’s a tornado of recent controversy over the efficacy of mammograms in breast cancer diagnosis. Seven large studies of mammography have been called into question as being “seriously flawed” and according to a New York Times article by Gina Kolata, “An independent panel of experts [the PDQ screening and prevention editorial board] said there is insufficient evidence that mammograms can prevent breast cancer deaths.” Previously, this same group had said “the evidence showed mammograms, starting at age 40, prevented breast cancer deaths.” Emphasis added.1

It’s this last phrase, “prevent breast cancer deaths”, with which I take issue. Whether the article is in favor or critical of a particular medical product or procedure, it is the meaning carried by each word and the resulting meaning carried by the sequence of these words that has an impact on the reader or listener. In this article on mammograms, the implication is that mammography could somehow directly prevent breast cancer deaths. It cannot. At best, it can detect breast cancer earlier and therefore, by logical extension, increase the chance of surviving breast cancer given the currently available treatments. The assumption is that detecting cancer sooner is better than detecting it later. While it can be argued this particular phrase was crafted by a medically uninformed writer, it is reflective of a plethora of statements I’ve heard uttered by physicians and other medical health care providers.

In the case of my wife, who suffered a 12 month delay in the diagnosis of her breast cancer while in the care of her OB/GYN, Dr. Pamela Kimbrough, the medical community had no problem tossing these assumptions of early detection aside for the sake of argument in the ensuing medical malpractice law suit. Dr. Pamela Kimbrough wanted to have her cake and eat it too. To her peers, it was good practice to wave the “Early Is Better” flag, but stifle it’s importance when it was her own professional butt on the line after dropping the ball with one of her patients. We won the case and in the process learned, at great cost, most doctors take the Hippocratic Oath while many other’s take the hypocrite oath.

Other examples from the world of breast cancer treatment include: “Bone Marrow Transplant” and “Stem Cell Rescue”. We all know transplants are a good thing, right? Chances are we know someone who has had a heart or kidney or cornea or liver transplant and they have gone on to live rewarding, productive lives.

Who could refute the value of a “rescue”. Those are good things, too, aren’t they? We’ve all seen news stories of small children rescued from deep wells and shared the sense of relief when they are returned to the loving arms of their families. We’ve all experienced the grief when rescues haven’t succeeded.

In the context of breast cancer treatments baring these labels, however, “transplant” and “rescue” mask the real medical intervention in play. The transplant or the rescue is only need because the colossal, physically violent and hideous treatment which proceeds the transplant/rescue. It would be much more accurate, but a lot less marketable, to call the medical intervention what it really is: extremely high dose chemotherapy followed by an all out effort to salvage what ever survives the treatment – hopefully none of the rapidly dividing cancer cells. Death from such treatments is not uncommon. Even if the patient survives the treatment, it is likely they will suffer a long term decrease in the quality of their life – something else that is virtually always left out of the sales pitch. Excuse me, “treatment options”.

If the treatment weren’t so corrosive, there were be no need for a “rescue”, no need for a “transplant”. Unfortunately, far too many patients discover the harsh reality of the end result only after arriving at the end result.
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1 This is, of course, now in conflict with recommendations available from the Nation Cancer Institute.