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January 22, 2010

Righting all of hospitals' wrongs

Alas, "The Happy Hospitalist" moniker is taken in the hospitalist blogosphere, but no one has yet laid claim to this title: "The Hypocritical Hospitalist." Perhaps this is the niche I should fill.

No, I donít claim to be a hypocrite, although no doubt I have had my moments. I imagine myself taking this title as a sort of Superhero Hospitalist, calling out hypocrisy wherever it exists in medicine to right all the wrongs. Like Superman had kryptonite, I too will have an Achilles heel: narcotic-seeking patients, consultants who consult other consultants without first consulting me, and requests for medical management on the obstetrics floor.

But I digress. The pharmaceutical industry has been uprooted from hospitals, at least in terms of the industryís ability to "detail" physicians. This trend started in the great academic centers under the pretense that physicians should not be subject to undue bias. And I donít disagree. Impartiality would be important to me if I were a patient just prescribed a medication that cost a bundle. I'd want to believe that my physician thought it was the best medication based on objective evidence, not a slick ad campaign.

Shunned in our sphere, pharmaceutical companies have increased their direct to consumer advertising (DTCA). The ethics of DTCA have been debated at length, and the FDA closely regulates the practice.

But how about ad campaigns for not-for-profit hospitalsóare they regulated in a similar manner? Survey says Ö not in the least. In fact, these hospitals routinely run ads for cancer treatment that would run afoul of FDA guidelines if they were policed with the same rules to which the pharmaceutical industry must submit. What are these stifling rules? A requirement for evidence from rigorous trials that the treatment in question actually works.

Case in point, as reported extensively in an article by the New York Times about the questionable marketing campaigns of non-profit hospitals, was this advertisement by Mt. Sinai Hospital Center:

"Our newest prostate specialist, Dr. David Samadi, has pioneered a minimally invasive approach that allows him to retain the highest cancer cure rates with the lowest risk of side effects."

As reported by the Times, "Highest cure rates. Lowest risk. What evidence does the medical center have to back up such superlatives? The adís claims are based on the successful results of Dr. Samadiís operations and testimonials from his patients, said Jane Zimmerman, Mount Sinaiís chief marketing officer." Now admittedly, I am far removed from academia, but this level of evidence still strikes me as slightly inferior to the standard, randomized blind placebo controlled trials to which I have become accustomed.

Sloan Kettering ran an ad with a woman holding her child, conceived after treatment, with the comment that her "local doctor" told her that only a hysterectomy would cure her cancer. The same Times article notes, "If a customer had given a testimonial about, say, her amazing weight-loss at a for-profit clinic, the F.T.C. would have required the ad to clearly describe the results a more typical consumer might expect."

Mass Generalís foray into marketing: a picture of young people playing pool, and the line, "We gave Nick something he couldnít find anywhere else in the northeast, life without cancer." Okay, but the proton beam therapy that the patient received has not been proven to have superior cure rates, according to a leading cancer expert cited in the Times piece.

These advertisements are omnipresent, especially in print media and on hospitalsí home pages. For example, MD Anderson offers the following testimonial on its Web site: "My doctors back home gave me only a few weeks to live. That's when I made the decision that saved my life. I went to Ö That was seven years ago. And counting."

Clearly, marketing cancer treatment is not just an issue of hypocrisy for participating non-profits. Even if we were still gorging ourselves on endless industry-sponsored lunches and tricked ourselves out in pharmaceutical gizmos and pens, most of these advertisements would be very questionable if not outright perverse.

When advertising treatments for a cancer diagnosis, we should hold ourselves to a very high standard. One would believe that a more obvious statement could not be made. One would also believe that such an obvious statement is, well, too obvious to need stating.

Perhaps the hospital systems responsible for these ads would have done well to have attended the Schwartz rounds at Mass General on Pharmaceutical DTCA in 2006.

"When seeking a moral imperative to discuss the role Direct-to-Consumer advertising Ö perils are that it can be misleading, does not seem to be rigorously regulated, and can also undermine the providerĖpatient relationship. Worse, it may lead to inappropriate provider prescribing behavior and increased health care costs, especially in cases in which the best course of medical therapy is not clear."

Mass General sponsors the Schwartz Center Rounds, which is a monthly multidisciplinary forum in which caregivers reflect on important psychosocial issues faced by patients, their families and their caregivers, and gain insight and support from fellow staff members. Well, The Hypocritical Hospitalist can suggest a topic for the 2010 Schwartz rounds.

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3 Comment(s)

Larry wrote:
Bravo for telling it like it is. Too much fantasy, misdirection, and outright lies constitute the health care reform debate. My own blog seeks to give an unvarnished look at how things really work inside a major hospital, public and political perceptions aside. Keep up the good work.
Atlanta, Ga. | Tue, Feb 9 2010 08:28 AM

Erik DeLue wrote:
Thanks for your comments. I just checked out your interesting piece on childhood obesity. I shudder to think what the latter half of my career will look like as I try to treat this new wave of patients entering mid-life with end stage physiology.
Mt. Holly, N.J. | Wed, Feb 10 2010 06:40 AM

Sasha Willson wrote:
It was a great read. I never knew how hospitals run their business. It's a great blog. Thanks for taking time to write it.

Bangalore, Karnataka | Tue, Jun 18 2013 08:14 AM


About Erik DeLue, MD
Erik DeLue, MD, examines the challenges of running and reinventing a hospitalist program. He is medical director of the hospitalist program at Virtua Memorial, a hospital in Mt. Holly, N.J.

This is the third community hospital program that Dr. DeLue has worked for in his nine years as a hospitalist. Join in the dialogue on issues that range from compensation and 24/7 scheduling to how to work with competing hospitalist groups.

The opinions expressed by Dr. DeLue are his own and do not necessary reflect the opinions of his employer or Today's Hospitalist.
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