Recently, there have been several TV advertisements on cancer treatments that may extend life. They report survival data that can mislead cancer victims to the extent of possible longevity. Additionally, they present a false picture of how life can be spent.
I have strong reservations regarding medication advertising to the public. Its purpose is to increase profits, not medical education. I know that businesses gamble significant amounts of money on drug development, and a successful product must support losses. Still, desperate, dying individuals will grasp at anything that promises a longer life. I consider this false advertising inappropriate as it generates false hope and thus unethical.
In the small print at the bottom of the screen, the commercials tout the extra months of survival from their product instead of an older medication, and report these months as medians. But, without additional information, these are uninterpretable. Medians are a measure of central tendency but are not necessarily an average. They represent the midpoint of the range. Thus, given 100 patients whose extra life-span ranges from 2 to 27 months, the median would be 13.5 months. However, this representation neither represents the range or distribution of the data.
For example, if one has a bell-shaped curve, then the median represents central tendency. However, most data do not conform to a bell curve but have a skewed distribution, and the median does not represent central tendency. Using the 100 patients, 13.5 remains the median, but most of the remaining data are skewed with few deaths, for example, less than the median, and the greater portion of mortalities clustered above the median: a right-sided skew. If the non-median expiries are reversed, the median remains the same, but we have a left-handed skew as most cases are below the median. Thus, most longevity would be greater for the right skew, perhaps significantly so, than the median, which then presents a falsely pessimistic picture of survivability. For the left-skew, we have the opposite, and the data represent lower survivability than the median, which then provides a falsely optimistic view of longevity.
Thus, hyping a median only is deceitful. In one promotion, approximately two months greater longevity existed for the new medication as opposed to the older one. Yet, without knowing the distribution of the two medians — is one a left-skew, while the other is a right-skew — it is possible that the older drug’s lower median provides greater potential longevity than the new one! It then becomes the physician’s responsibility to have the distribution data available and to demonstrate to a patient that sadly, s/he is more likely to live less than the advertised median or present the good news that s/he could live longer than the median.
Presenting the data as ranges is more understandable for conveying longevity. For example, I would indicate that for all patients with your cancer and this treatment, longevity ranged from 2 months to 27 months. However, most patients are clustered between 4 and 17 months; a left skew. Consequently, you should plan on the latter range, and if you survive longer, consider it a bonus.
My other concern has to do with the people and activities presented. I assume that the individuals are celebrating being in the life extension period provided by the new medication, implying that terminal cancer patients remain healthy and lively until death, and then just die! Such is not the reality of the terminal patients I have dealt with. My wife, a former women’s health and hospice nurse practitioner, claimed that she too did not recognize these hale and hardy individuals as late-stage cancer patients. She pointed out that breast cancer patients with advanced disease often have a mastectomy, but that the women in the advertisements are all double-breasted! Too, the age of the purported cancer victims is divergent from actuality. While breast cancer can occur from an early age, it is more likely to be diagnosed after age 60, and yet only a rare actor is this age or older.
The cancer patients that we, and I suspect you, have seen with late-stage disease are gaunt, almost skeletal. They are weak and certainly not capable of dancing, crewing a sailboat, or swimming a significant distance. Too, unlike in the commercials, these patients do not have full, “lustrous heads of hair.” Are the actors wearing wigs?
The cardinal sign we have seen is engulfing fatigue. Many of these individuals are bedridden, while others, with assistance, can hobble to and from a chair. Certainly, they could not perform the actors’ activities, and the doctor would be responsible for deflating these fabricated images.
I would like the appropriate medical societies to issue statements on this dishonesty, requesting the removal of the present advertisements and replacement by more accurate ones. An FTC investigation would also be appropriate. The pharmaceutical companies should also be required to broadly post disclaimers for their duplicitous advertising on multiple platforms.
M. Bennet Broner is a medical ethicist.
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