The Cancer Centers’ War On Truth


Leonard Zwelling

Saturday’s Wall Street Journal contained a lacerating criticism of the manner in which the major cancer centers advertise for patients.

Unfortunately, it leads with the MD Anderson ads with the talking heads and the red line. Steve Salerno, the author and a journalism professor, objects to the claims made by the big centers saying that they oversell and under perform. He also objects to the fact that the advertisements of the major cancer centers are largely unregulated. The side effects of drugs must be listed in ads for them, but there is no listing the success or failure rates of any of the cancer centers in their ads. This is a good point.

As is pointed out in the article, these centers are in a competitive business. Cancer has become an industry unto itself with genetic testing, targeted therapies, and all kinds of screening to protect people from cancer and to reverse the effects of a cancer that has established itself in a consumer.

I am not exactly sure what Mr. Salerno expects of the centers. Each of them has a huge fixed cost in infrastructure and personnel that must be offset by revenue. The revenue streams are under pressure as payers (insurers) want better deals from providers (cancer centers) and salaries of physicians are not going down. Some of the leaders of these centers make salaries in the millions. This is big business and big business will beget big marketing.

If this is to end, and I am not saying that it should, but if—then the cancer-industrial complex will need to change. People with cancer who do not need the services of a major cancer center should stay in their communities if there is no benefit to be derived from going to a center. This may mean that more people need to be trained to be community-based oncologists. This is a good idea. It may also mean the major cancer centers can shrink a bit rather than grow insanely.

On the other hand, those patients needing the unique technical expertise of a cancer center or who have a disease that might be best studied at a center in a clinical trial ought to be hastened to the center and not excluded because of geography or cost.

This will necessitate a very different model of how we determine who gets what and how it will be paid for.

Mr. Salerno is attacking the cancer centers for making due with what the system has given them. This does not make the centers innocent of overselling, but it does indicate where the problem lies.

If the United States wants to have a true cancer care system, where everyone without cancer gets properly screened and everyone with cancer gets properly treated, this is possible. It is not possible under the competitive payment system we currently use where there are finite dollars for which every center is competing.

If the Congress really wants a War on Cancer, it can have one, but it will necessitate a true war strategy where the beneficiaries of the war are the people of the United States—those without cancer and those with it.

This would mean teaching kids how to avoid behaviors associated with the development of cancer. It would mean teaching everyone how to be screened and when. And then it would be getting the system organized so that patients with cancer are treated at the site that gives each one of them the best chance at survival. And, by the way, a single payer manner of defraying the cost that amortizes that cost across the population would make a lot of sense as well.

This can be done. Now all we need is someone to lead the charge.

Leonard Zwelling