In an Aug. 9 op-ed in The New York Times titled “Cancer-Drug Ads vs. Cancer-Drug Reality,” the author contrasted the possible outcomes that pharmaceutical ads convey with the reality of the outcomes that most patients experience. The author has experienced loss in his own family due to cancer, and in the op-ed, he questioned whether ads for the immunotherapy that didn’t work for his loved one are unnecessarily instilling false hope in other patients. As a market researcher and reader of clinical data on drugs, I can see all sides of the story.
The Patient Side
A drug ad primarily promises hope—at least most pharmaceutical ads do. They go through the side effects in a fast, auctioneer-like style and focus on some of the benefits. It’s a positive story, unlike what many patients end up going through. You can take the perspective of, “Let’s try it, and if it doesn’t work, I was just unlucky.”
That is perhaps too rational. I would be heartbroken (like the author of the article) if I or a near and dear one ended up with false hope or suffered a lot for no apparent gain. At the same time, I would be glad to have a choice at all. Given that there hasn’t been much treatment choice for many tumors beyond chemotherapy, having any choice is better than nothing, but there has to be transparency as to what the choice entails. The “response rate” that makes it worth taking the gamble is subjective.
The Doctor Side
The patient comes in hoping to get this miracle drug, and hopefully that miraculous response occurs because if and when it doesn’t, the doctor feels the weight of the disappointment on her shoulders. And the odds are against her. Doctors don’t want to over-promise and under-deliver, yet they want to communicate a muted hopefulness. If a patient does achieve that miraculous response, it’s better that it’s a surprise rather than expected. And while drug ads, themselves, deliver hope and promise, patients and physicians are left with dashed hopes and the challenge of finding the next drug after the first fails to show results.
The Pharmaceutical Company’s Side
Pharmaceutical companies need to create awareness. It’s never quite clear how quickly physicians will know and learn to use a drug for the right patient, or if it’s even possible for them to identify “the right patient.” Creating awareness increases the chances that the right patient can be identified, even if it’s like finding a needle in a haystack. Today, and increasingly in the future, oncologists are going to have their hands and heads full of choices, and if we can just get the patient to ask their doctor about it, perhaps we have nudged our treatment ahead of the competition.
I find myself conflicted: I would hate to be on the wrong side of the statistic, almost as much as I would hate finding out too late that the drug could’ve helped me as a patient. The hope for a miracle is one to share, but miracles, by nature, are extraordinary events and skew perceptions—exactly like the lottery. But unlike the lottery, when your number doesn’t come up, life doesn’t just go on.
I don’t think that the challenge is solved yet, and we see different companies trying various approaches: There’s the expert-driven approach, in which the oncologist decides on the best course of action, or the patient-driven “ask your doctor about it” approach, and many hybrids in between. Is there a balanced story out there? Perhaps one that offers hope, but with restraint?