CyberKnife ads in NY subway raise 'direct-to-consumer' marketing questions at AUA

May 09, 2019
by Thomas Dworetzky, Contributing Reporter
Subway ads in New York City promoting CyberKnife for prostate cancer are leaving straphangers with "inaccurate impressions" of how it ranks against other therapies in “effectiveness and safety," according to a survey presented at the American Urological Association (AUA) annual meeting in Chicago.

The ad campaign — which is for Winthrop Hospital in Mineola, New York, not CyberKnife maker Accuray — states:

"CyberKnife is the biggest advance in prostate cancer treatment in a decade. CyberKnife is as effective as surgery for prostate cancer. But there's no cutting, no pain, no incontinence and less risk of impotence. Treatment takes just one week — five brief appointments."

The survey results about the ad campaign were discussed at a press briefing by lead author Dr. Joseph Caputo, a urologist at Columbia University Irving Medical Center and New York–Presbyterian Hospital.

"This advertising tends to emphasize benefits over risks and offer unsubstantiated claims," he said at the briefing, according to Medscape.

Caputo and senior author Dr. Elias Hyams surveyed a total of 400 men, which they split into four groups.

One was shown the CyberKnife subway ad. A second group was shown the ad along with “disclaimers” that were in italics after the original subway ad. A third group was shown “scientifically-based information about other prostate cancer treatments,” according to the Medscape report.

A fourth group acted as controls and were shown an ad that had nothing to do with either CyberKnife or prostate cancer.

The subjects were then asked to discuss risks and benefits of the CyberKnife and whether they would pursue it for treatment compared to other therapeutic modalities.

Participants who saw just the CyberKnife ad material had a 40 to 45 percent higher likelihood of preferring it over other treatments — and they were the only group to think CyberKnife better when it came to erectile and urinary function preservation.

For the second group, shown the ad with disclaimers, the percentage favoring the treatment dropped to 20 percent.

The third group, which only examined the more scientifically balanced information, had the most accurate idea of the risks and benefits.

The study was begun after Caputo and Hyams starting seeing the ads all over the subway. The ads, observed briefing moderator Dr. Stacy Loeb, an NYU Langone radiologist, are “front and center” at his own home train stop. The goal was to shed light on the larger issue of the direct-to-consumer (DTC) type of marketing it represents, which, they said, “we believe should be discussed at the AUA meeting."

Such DTC marketing is far from new, although the researchers did state that they believe this is the first-ever DTC marketing study specifically concerning urology.

In 2016, for example, then New York Times correspondent and now editor-in-chief of Kaiser Health News, Dr. Elisabeth Rosenthal, reflected on the DTC challenge, stating at the time that, “a little more than a decade ago, most health care advertising was confined to mass-market drugs, and hospitals and doctors generally considered the practice tacky or ethically dubious. More often than not, the ads appeared in unassuming places like cheaper women’s magazines or the New York subway — for decades New Yorkers sat beneath ubiquitous rainbow posters for Dr. Jonathan Zizmor that promised to conquer blemishes: 212-594-SKIN!”

Prescription drug makers were then spending about $4.8 billion a year, and hospital advertising was also booming — up 40 percent in 2014 from 2011, to $2.3 billion, according to Rosenthal's report.

The marketing is aimed at increasing share in a growing and increasingly crowded radiation oncology market.

A 2017 report highlighted a number of factors behind the growth of the global cancer market for oncology, then set to reach $10.1 billion by 2025.

A rising cancer rate is “the prime factor responsible for substantial growth of [the] radiation oncology market over the forecast period,” according to the market analysis by Grand View Research.

“The American Cancer Society projects a total of 1,660,290 new cancer cases and 580,350 cancer deaths in the United States in 2013,” wrote radiation oncologist Dr. John Powell in a 2017 issue of the Stargazette newspaper, noting that, “it is encouraging that overall cancer death rates in the U.S. have declined 20 percent from the peak in 1991, yet cancer remains one of our greatest public health challenges, as well as a life-changing diagnosis for patients.”

He noted that between half and two-thirds of these patients will get radiation treatment either for curative or palliative reasons during the course of their illness.

Partly fueling this growth in radiotherapy are technological advancements, which have led to this modality's increased share as “a primary treatment line of cancer,” the market analysts reported. Such advances include breakthroughs in compact advanced options such as CyberKnife, Gamma Knife, and tomotherapy.

“These advanced methods pose lesser postoperative complications and faster recovery time,” noted the review, which has added to growth of radiotherapeutic approaches.