Friday, March 16, 2012

How We Do Harm by Otis Webb Brawley, M.D.

The financial benefits of screening for a long chain of medical businesses have been measured almost to a penny. This is a game with a predetermined outcome: everyone but the patient wins.

I tell my friend and patient Ralph about a conversation I had with a marketing guy at a major American cancer center. He explained that they ran free screenings at a local mall every September as part of a Prostate Cancer Awareness Month. As I struggled to control my anger, this gentleman explained the business formula:

“First, free screening provides free good publicity for the health system. People really feel good about us, because this is a community service. It will cause women to come to our women’s center and men to come to our chest-pain center. It increases almost all our product lines. It’s cheap, effective advertising.

“For every thousand men over age fifty who volunteer for free screening, one hundred and forty-five will have an abnormal screen. Given the demography of the mall, ten of the one hundred and forty-five will have insurance that our health system doesn’t take. So, one hundred and thirty-five will come to us to see why they have an abnormal screen. We make up for the cost of offering the free screening by charging for evaluation of the abnormal screens. About forty to forty-five will have cancer. We hit bingo with them. We know the number who will get radical prostatectomy, the number who will get radiation therapy, the number who will get hormones.

“We know the number who will have incontinence so bad that they will want an artificial urethral sphincter implanted. We even know the number who will not be able to get erections and will want Viagra. We know for how many Viagra won’t work. We know how many penile prosthesis we will sell.”

Realizing that I had been granted an audience with Lucifer, I asked a fundamental question: “How many lives will you save if you screen a thousand men?”

The marketer took off his glasses and looked at me as if I were a fool. “Don’t you know, no one knows if this stuff saves lives? I can’t give you a number on that.”

Ralph is shocked. “You mean its big business?”

I tell Ralph about the business model employed by the National Prostate Cancer Coalition, now called Zero (an organization that has attacked me personally, because I publicly questioned whether screening and aggressive therapy saves lives). Zero sends its employees to a particular locale, partners with a local cancer-treatment center, enlists some local celebrities, and offers free screening. That center pays to advertise the screening push and helps Zero get donations.

But most of Zero’s budget comes via corporate donations from drug companies, and surgical and radiation-treatment-device manufacturers. The groups funders include Amgen, AstraZeneca, Aventis, Cytogen, Merck, Pharmacia, and Pfizer. My personal favorite Zero sponsor is Kimberly-Clark, the maker of Depend undergarments. Prostate-cancer screening and aggressive treatment may save lives, but it definitely sells adult diapers.

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