Respectful Insolence

I’m not a big fan of Cancer Treatment Centers of America (CTCA). That I don’t much like CTCA should come as no surprise, given that this particular hospital chain distinguishes itself from other hospital chains by advertising its full body embrace of quackery, in particular “naturopathic oncology.” At the same time as it’s advertising its “integrative cancer care.” It all sounds great on the surface, but anyone who understands exactly what “integrative medicine” is and how it basically represents the evolution of quackery will also understand that when you “integrate” quackery and pseudomedicine with real medicine you don’t make the real medicine better. You make it worse.

The other aspect of CTCA that’s always irritated me is how it advertises how its outcomes are supposedly so much better than the average cancer hospital. For instance, they advertise their breast cancer survival at 3 years as being 14% better than what is recorded in the SEER Database, and on it goes: Lung cancer 11% better at 18 months, pancreatic cancer 8% higher at 18 months, and colon cancer 11% better at 18 months. I had wondered for some time whether these statistics were valid. To me, they didn’t really pass the “smell test,” and I rather suspected something was up. Specifically, I rather suspected a strong case of confirmation bias. Thanks to a news article by Sharon Begley that appeared yesterday on Reuters, I now realize that that almost certainly is the explanation for how CTCA produces such seemingly amazing statistics. In fact, if this report is to be believed, it borders on despicable how CTCA keeps its numbers seemingly so good.

It begins with the story of a cancer patient named Vicky Hilborn, who was diagnosed with a rare cancer, and her husband Keith Hilborn, who got her to CTCA because he had seen its better survival rates touted on its website:

Hilborn had seen CTCA’s website touting survival rates better than national averages. His call secured Vicky an appointment at the for-profit, privately held company’s Philadelphia affiliate, Eastern Regional Medical Center. There, the oncologist who examined Vicky told the couple he had treated other cases of histiocytic sarcoma, the cancer of immune-system cells that she had.

“He said, ‘We’ll have you back on your feet in no time,'” Keith recalled.

Vicky’s cancer treatment was forestalled by an infection and other complications that kept her at Eastern Regional for three weeks. In July 2009, when she got back home, things changed. Despite Keith’s calls, he said, CTCA did not schedule another appointment. As his wife got sicker, Keith, a former deputy sheriff in western Pennsylvania, was reduced to begging.

The oncology information specialist “said don’t bring her here,” he recalled. “I said you don’t understand; we’re going to lose her if you don’t treat her. She told me I’d just have to accept that.”

Vicky Hilborn never got another appointment with CTCA. She died on September 6, 2009, at age 48.

The first thing I noticed here was the enormous contrast between CTCA and where I work, actually between CTCA and everywhere I’ve ever worked. Of course, being in academia I’ve never worked in anyplace other than tertiary care hospitals, and my last two jobs have been at NCI-designated comprehensive cancer centers. NCI-designated centers cannot ever behave this way. We have to take all comers with cancer, and we cannot abandon the, which is what CTCA appears to have done in the case of Mrs. Hilborn. In the case of a patient whom we can no longer treat, we provide palliative care and hospice. Begley notes that hospitals turn away patients for all sorts of reasons, including lack of insurance or underinsurance, and this, unfortunately, is true. However, what amazed me about Begley’s story is how CTCA does this. Basically, this whole story is a compelling case that CTCA tends to turn away patients who might hurt its survival numbers. It also turns out that the numbers on CTCA’s website are cherry picked and deceptive, designed to exaggerate even the apparent advantage CTCA has.

For example, if you look at the graphs provided with Begley’s story, you’ll see that rarely do they use a full five year survival rate. True, the graphs are for advanced cancers, such as lung and pancreatic cancer, for which in some cases five year survival is uncommon. However, in the case of breast cancer, a more indolent tumor in many cases, five year survival with stage IV disease isn’t uncommon; overall the five year survival for stage IV breast cancer is in the 20% range. In any case, CTCA cherry picks shorter, earlier time points, and doesn’t extend the graphs comparing its results to the SEER Database out far enough. When that is done, the differences in survival between CTCA and SEER data largely disappear for all but prostate cancer, and for breast cancer survival at CTCA is actually slightly worse. Interestingly, in this infographic, it’s pointed out that these breast cancer survival numbers beyond what CTCA published were found in a document the CTCA submitted to the State of New Hampshire as part of its application to open a hospital in the state.

Overall:

The experts were unanimous that CTCA’s patients are different from the patients the company compares them to, in a way that skews their survival data. It has relatively few elderly patients, even though cancer is a disease of the aged. It has almost none who are uninsured or covered by Medicaid – patients who tend to die sooner if they develop cancer and who are comparatively numerous in national statistics.

In all fairness, it must be pointed out that lots of hospitals play a bit fast and loose with the statistics to make themselves look as good as possible, and just because a hospital’s patient base is different from the national average is not evidence that the hospital is skimming the cream, so to speak. Just by the community such a hospital is located in, the types of demographics it attracts, and the diseases that it is known for, one hospital can have a very different patient base than another. However, what struck me about CTCA is that this sort of “differentiation” appears to be a deliberate policy:

Carolyn Holmes, a former CTCA oncology information specialist in Tulsa, Oklahoma, said she and others routinely tried to turn away people who “were the wrong demographic” because they were less likely to have an insurance policy that CTCA preferred. Holmes said she would try to “let those people down easy.”

Equally significant, CTCA includes in its outcomes data only those patients “who received treatment at CTCA for the duration of their illness” – patients who have the ability to travel to CTCA locations from the get-go, without seeking local treatment first. That means excluding, for example, those who have exhausted treatment options closer to home and arrive at a CTCA facility with advanced disease.

Accepting only selected patients and calculating survival outcomes from only some of them “is a huge bias and gives an enormous advantage to CTCA,” said biostatistician Donald Berry of MD Anderson Cancer Center in Houston.

Reading between the lines, I think it’s very obvious that CTCA appears to be doing exactly what the article describes. It appears to cherry pick the “best” patients at each stage of the process, selecting patients with the best insurance, who of course tend to be higher socioeconomic status and have access to better health care, nutrition, and the like, and then only reporting results from a subset of those patients who are similarly both still healthy enough to travel to one of CTCA’s locations right from the very beginning and who received all their treatment at CTCA. Later in the article, it’s described from former CTCA oncology information specialists, whose job it was to screen prospective patients. Basically, CTCA looks for patients with “Cadillac” insurance policies, takes very few Medicare patients, and tries very hard not to take Medicaid patients, resulting in a very skewed population.

Now, the part about Medicare is a bit tricky. In general, Medicare patients (for which the government keeps extensive data) do as well as any other patient population. However, the key point to remember here is that Medicare patients, except for those on disability, are almost by definition 65 or older. Discouraging Medicare patients is thus a built-in bias towards younger patients, and at one CTCA hospital for which data can be obtained, only 14% of patients were Medicare patients and only 4% were Medicaid patients, while in the SEER database 53% of patients were Medicare-eligible (i.e., 65 or over) and 14% were below the poverty level (i.e., likely to be either uninsured or on Medicaid). Moreover, the SEER Database has a number of factors that depress its apparent survival rates, including lumping together patients of all ages, patients with and without serious comorbidities, treated at cancer centers and community hospitals, and patients who weren’t even treated at all for cure or prolonged survival because their cancers were diagnosed too late, at a point beyond which medicine can do anything other than palliation. Moreover, if the former CTCA employees are to be believed, CTCA is quite blatant in its—shall we say?—discouraging of Medicaid and Medicare patients from coming to its hospitals:

The selection process begins when a prospective patient first contacts CTCA, by phone or web chat, and speaks to an oncology information specialist. “The first thing you do is be kind and greet them, but you’re qualifying them,” said Carolyn Holmes, the former oncology information specialist. “You ask, ‘How old are you?’ meaning, ‘Are you Medicare-age?'”

Holmes says she learned to recognize callers with “Cadillac insurance policies” and those from poor zip codes. She said she tried to redirect undesirable patients away from CTCA.

“You don’t want them,” Holmes said about Medicare patients. Medicaid? “Absolutely not.” Other former employees confirmed her account of screening patients based on their means of payment.

Again, in all fairness, many hospitals try to improve their payer mix, as Medicaid reimbursement is low and can even result in losing money. However, academic centers and NCI-designated cancer centers, at least, have a stated mission to care for all cancer patients. They can’t turn anyone away; so they usually try to improve their payer mix by attracting more patients with good insurance rather than using sophisticated strategies to turn away “undesirables.” What is striking about CTCA as reported in this article is how blatant it is about turning away those “undesirables,” even from the limited information in this article.

I can’t help but note a couple of things after reading this article. First, “integrative medicine” is clearly a marketing tool, and the embrace of integrative medicine can occur based on both ideology and profit. CTCA has quite intentionally occupied a niche caring for patients with advanced cancer using “integrative” methods in which quackery such as “naturopathic oncology” is “integrated” with conventional evidence-based treatment with surgery, radiation therapy, chemotherapy, and targeted therapy. Such patients with advanced cancer are a particular challenge, even to NCI-designated cancer centers, because we don’t have curative therapy for them. The best we can do is to prolong life, sometimes only by weeks or months, sometimes much longer, and to provide palliation. One way for a hospital to distinguish itself is to demonstrate significantly higher survival rates, which CTCA tries to do using statistically deceptive methods and comparisons of groups that are not comparable. Another is to claim to be better at palliation and to have the “human touch,” which CTCA also does, using woo such as acupuncture, naturopathy, and even homeopathy. AS I put it before, naturopathy is a Frankenstein monster, cobbled together using a lot of perfectly sound science-based treatments, including surgery, chemotherapy, and radiation with pure pseudoscience like naturopathy and traditional Chinese medicine bolted on like the head of the Frankenstein monster. CTCA has constructed and fully embraces that monster.

The next thing CTCA rather reminds me is that quackery is not, as is commonly claimed, primarily the purview of the left. I remind people of this time and time again when I point out the right wing contingent of the antivaccine movement, particularly the “health freedom movement.” The reason this observation is relevant is because the founder of CTCA is Richard J. Stevenson. I’ve mentioned him before but nothing about his politics. Basically, he founded CTCA in 1988 after his mother lost her battle with cancer, with a mission to “change the face of cancer,” because he and his family were “sorely disappointed by what they found. What were regarded as world-renowned cancer treatment facilities were singularly focused on the clinical and technical aspects of cancer treatment, ignoring the individual needs of the patient and the multi-faceted nature of the disease.” He also serves on the board of FreedomWorks, a nonprofit group that promotes low taxes and small government, including untying Medicare from Social Security in order to let people opt out of Medicare.

Finally, the way that CTCA advertises itself reminds me of how so-called “complementary and alternative medicine” (CAM) and “integrative medicine” practitioners and researchers do research and present evidence that CAM is efficacious. Instead of using good science, well-designed randomized clinical studies, and valid outcome measures compared to appropriate comparison groups, CTCA uses anecdotes, testimonials, and comparisons that consist of patients cherry picked to be treated at CTCA and then further cherry picked to have received all their care at CTCA and then comparing them to a database that they must know not to be a valid comparison. Yes, CTCA does indeed appear to select, use, and manipulate evidence the same way that CAM practitioners select, use, and manipulate evidence. I suppose this shouldn’t be surprising.

Whether CTCA is left or right, up or down, however, it really doesn’t matter. A very profitable business model can be made by combining pseudoscience with science, quackery with medicine, and wrapping it all together as being more “human” and “holistic.” Right now CTCA has that market cornered. Unfortunately, through the infiltration of quackademic medicine, medical academia seems poised to emulate something that medicine should not emulate, namely CTCA.

Comments

  1. #1 MikeMa
    In the snow
    March 7, 2013

    The CTCA ads on he teevee are so ubiquitous as to be almost unheard. Background noise. Still, the desperate may latch on to the success stories and link them with the caring staff, massages, other nice services offered. Not sure how much those things actually matter to the survivors.

  2. #2 The Midwesterner
    Where spring will soon appear
    March 7, 2013

    My teeth clench every time I see an ad for CTCA on television. I lost a brother to pancreatic cancer and am well aware of the odds of surviving such a diagnosis, so I’m particularly annoyed at the false impression CTCA tries to make that they are miracle workers. My brother was treated at our local university hospitals, was pleased with every aspect of his care, and had four and a half years after diagnosis of mostly good life. While we certainly wanted a different outcome, fortunately for my family, we were never deluded by slick marketing into assuming that was going to be the case.

  3. #3 Vaxine Skeptic
    March 7, 2013

    You must never pay attention to the disclaimer on the commercials. And what is the difference between how CTCA uses their charts (showing small data sets) and how vaccine proponents use their charts (showing small data sets and time frames that somehow show that vaccines are effective).

  4. #4 Eric Lund
    March 7, 2013

    a document the CTCA submitted to the State of New Hampshire as part of its application to open a hospital in the state

    This would presumably be our Certificate of Need process. Despite our well-known libertarian streak (we have no sales tax, and our income tax applies only to interest and dividends), our Republican politicians were once smart enough to realize that free market economic models don’t work in health care. Thus, before a hospital is built or adds significant capacity/capability, it must demonstrate that there is a need for the new capacity/capability.

    I haven’t been following this story, so I don’t know if CTCA was allowed to build this facility. We already have a facility comparable to Orac’s place of employment (Dartmouth-Hitchcock Medical Center in Lebanon), and most people who aren’t close to that are close to Boston.

  5. #5 Qwerty
    March 7, 2013

    I live in Philly and it seems that CTCA has pushed really hard with advertising in this area (particularly w/ TV ads). I had always wondered why in a city with such great hospitals, someone would choose CTCA for treatment. “Smell test” indeed.

  6. #6 Mu
    March 7, 2013

    Hmm, this article is a bit of a non-sequitur for me, the second half on IM has no direct connection with the first on CTCAs patient screening for unethical reasons. The shady business practices of steering undesirable patients away from the clinic have nothing to do with their treatment approach. It would be just as shady and you’d see the same statistical “advantage” if they were doing strict SBM. In this case, it happens to make IM look better than justifiable, but that’s a secondary consequence of CTCA using it as marketing tool to set themselves apart from SBM centers.

  7. #7 Denice Walter
    March 7, 2013

    OT: but are Internecine Wars amongst antivaccinationists played out publicly on the internet Ever Truly OT @ RI?
    Didn’t think so.

    The war for the hearts, minds and money of supporters continues at AoA with Jake and Tim inserting themselves into the mix ( as I report elsewhere)

    At any rate… I have work.

  8. #8 Bob Hirst
    Long Island, NY
    March 7, 2013

    CTCA is owned by a very conservative activist in right wing politics: http://en.wikipedia.org/wiki/Richard_J._Stephenson who is at one point railing against government supported healthcare and at the same time preying on those who have private healthcare. I think he’s a shaman.

  9. #9 MikeMa
    March 7, 2013

    @Vaxine,
    What small vaccine proponent data sets are you referring to ?
    Global eradication of smallpox?
    Nearly global eradication of polio?
    Andrew Wakefield lies and the incidence of measles goes up throughout Britain?

  10. #10 Edith Prickly
    March 7, 2013

    Is Vaxine Skeptic for real or just another Thingy sock puppet?

  11. #11 Anj
    March 7, 2013

    I was waiting for you to comment on CTCA because I’ve listened to the commercials and they reek of snake oil.

    In addition when wealthy foreigners come to the states for treatment, they are usually at places like the Cleveland Clinic, John Hopkins or the Mayo Clinic.

    Thanks for the post!

  12. #12 lilady
    March 7, 2013

    I believe most States have a CON (Certificate of Need) process, for every type of health care facility (hospitals, nursing homes, rehab centers). If you follow your local news, you will see that as neighborhoods “change”, or as health care changes, hospitals will downsize some of their units or eliminate them altogether. It’s all figured out based on a “bed utilization” process.

    Eric Lund mentions the efforts of CTCA to open a facility in New Hampshire and I located two interesting sites.

    The first link is to an (undated) editorial about early efforts by Rep. Garcia on behalf of CTCA to open a hospital in New Hampshire:

    http://www.nhha.org/blog/61-other-qblogq-posts/243-qdestinationq-cancer-hospital-bill-misses-the-mark

    “…But the most egregious aspect this effort to bring a new cancer hospital to New Hampshire is the assertion that it will not treat Medicaid patients. In testimony before the House HHS Committee, the president of one of the CTCA facilities in Philadelphia, John McNeil, said that they do not intend to treat Medicaid patients because Medicaid does not cover the cost of caring for those patients. He’s absolutely right. But, don’t Medicaid patients suffering from cancer deserve the same level of health care that all others do?

    Mr. McNeil went on to say that their hospital couldn’t be all things to all people. But that’s exactly what he wants the rest of New Hampshire’s hospitals to be. New Hampshire’s hospitals treat all patients without regard to their ability to pay. Refusing to treat Medicaid patients is simply the wrong policy for New Hampshire and it must be unequivocally rejected….”

    So…in order to get around the CON process, Rep Garcia (again), introduced a new bill which was successful and New Hampshire now plans to get rid of the CON process:

    http://www.nashuatelegraph.com/news/961131-196/senate-approves-repealing-hospital-certification-process.html

    “House Republicans initially proposed the bill this fall seeking to encourage competition and growth in the health care sector.

    “We have a regulatory process in place which stifles competition and prevents new entries,” Rep. Marilinda Garcia, R-Salem, said earlier this year. Garcia sponsored a similar bill, HB 1642, seeking to exempt for-profit specialty hospitals from the certification process.

    Medical professionals and hospital officials, however, opposed both proposals, saying repealing or amending the certification process would invite medical centers who serve only patients with full insurance coverage. This would leave traditional hospitals serving those patients on Medicare and Medicaid who are unable to pay for their own care, Steve Ahnen, president of the New Hampshire Hospital Association, said earlier this year.

    This would force hospitals to absorb those costs not covered by the federal programs, possibly at the cost of other hospital programs, he said.

    “Every hospital in the state of New Hampshire takes care of patients without regard to pay or without regard to the insurance they have,” Ahnen said. “But (these for-profit institutions) say they can’t be all things to all people. … That’s a very dangerous precedent to set.”

  13. #13 Narad
    March 7, 2013

    You must never pay attention to the disclaimer on the commercials.

    I’ve got five quatloos on Th1Th2 in the library with a candlestick.

  14. #14 lilady
    March 7, 2013

    I’m just ignoring delusional insane Thingy and her sock puppets.

  15. #15 herr doktor bimler
    March 7, 2013

    Mr. McNeil went on to say that their hospital couldn’t be all things to all people.
    … not without reducing the profit margin.

  16. #16 palindrom
    March 7, 2013

    I haven’t followed the bid for a CCTA hospital in NH, but there’s some hope that lilady’s links are out of date. NH elected what I would characterize as s horde of far-right loonies to the legislature in 2010, but the results were so alarming to most people that the Republicans were trounced in 2012 — Democrats got the governership, the two house seats, and the legislature. So wiser heads may have prevailed on this matter.

  17. #17 ursa major
    United States
    March 7, 2013

    The CCA commercials do have a very interesting disclaimer. Not the ubiquitous “Results not typical” but the much stronger “Do not expect these results”
    First time I saw that I took it as a “yes, we are lying through our teeth”.

  18. #18 Narad
    March 7, 2013

    First time I saw that I took it as a “yes, we are lying through our teeth”.

    They also advertise on radio around here. While there is, very rarely, recruitment for legitimate clinical trials on the air, I’ve long assumed that anything health-related advertised on the RF residue of “Col.” McCormick is de facto a bad idea, at least in the cases in which it’s not outright fraud.

  19. #19 jergen
    March 7, 2013

    I cant figure out why they would choose New Hampshire when it is so easy for New Hampshire residents to get to Boston. You cant swing a dead cat in Boston without hitting a few hundred Harvard trained oncologists.

  20. #20 Denice Walter
    March 7, 2013

    @ Narad:

    It seems that the Third Court of Appeals in Texas has received a response from BMJ et al:
    http:// bit.ly 1olXjeR

  21. #21 palindrom
    March 7, 2013

    jergen @19 — As Eric Lunc pointed out, Dartmouth-Hitchcock Medical Center has a large cancer center, too, for folks farther to the north. Harvard, Schmarvard.

  22. #22 palindrom
    March 7, 2013

    Sorry, for ‘Eric Lunc’ read ‘Eric Lund’.

  23. #24 lilady
    March 8, 2013

    More about Richard J. Stephenson, founder of CTCA and his affiliation with “Freedom Works” and the “Tea Party”.

    http://articles.washingtonpost.com/2012-12-25/politics/36015740_1_freedomworks-tea-party-matt-kibbe

  24. #25 Narad
    March 8, 2013

    Better link to the Texas lawsuit response of BMJ, Deer and Godlee.

    As much as I respect Brian Deer, I kind of wish his attorneys hadn’t let him write part of this. The writing style in the prefatory matter seems distinctive. And, while I’m not going to be able to get through it until the day after tomorrow at best, the presentation is striking me as somewhat odd. There are obviously interesting details in here (Wakefield contends that the special appearance was waived by virtue of the anti-SLAPP? This is what you’ve got?)*

    I will note that my suspicion that Wakefield’s attorneys failed to file a demand from the tiral court findings of fact and conclusions of law is borne out by ¶ 1 of the “Standard of Review” section (p. 16); this should thus turn on law, with the fact-finding of the trial court taken for granted.

    Then again, I’m operating on three hours’ sleep, so take everything with an extra grain of salt.

    * This is looking more and more to be the whole deal, viz., BMJ et al. consented to jurisdiction by showing up.in the first place. It seems that Wakefield is somehow contending that this will prevent the anti-SLAPP from being reached.

  25. #26 Narad
    March 8, 2013

    ^ Please excuse the plenitude of typos.

  26. #27 Kathryn
    Silicon Valley
    March 8, 2013

    I’m always irritated when my NPR affiliate (KQED) announces that CTCA sponsors various programs. I think I’m going to forward this to them. Probably won’t help–they do need money from somewhere to pay for stuff–but it’s worth a try.

  27. #29 prn
    March 9, 2013

    Orac’s criticism is awfully ambiguous or nonspecific about which treatments. Perhaps kewpie dolls with a needle stuck through the “cancer” or Hahnemann’s homeopathy?

    I’ve seen patients refer to nutritional supplements with their chemo from CTCA, and they seem to suffer a lot less than normal. The only person I’ve known that went to CTCA got more than a year extra for each month predicted after the local talent gave up. Starting from ca ~500 CEA, ~4000 CA15-3 and widespread mets from recurrence.

  28. #30 Chris
    Neither here nor there...
    March 9, 2013

    prn:

    d they seem to suffer a lot less than normal.

    That is because CTCA refuses patients that are sicker. The thing is that they pick and choose the patients they treat.

    This is exactly why certain private schools can claim to have higher test scores, they specifically exclude children like my oldest who has developmental disabilities. Come on! Which school do you think will have the higher test scores:
    a) The one that requires and entrance exam for preschool and kindergarten?
    or
    b) The one that legally required to admit any child no matter their intelligences, disabilities or ability to pay?

    That is what this article is about. CTCA saw that Vicky Hilborn was not going to survive, and refused to deal with her case any longer. That is what Orac means with “cherry picking.”

  29. #31 prn
    Chris@30:
    March 10, 2013

    CTCA refuses patients that are sicker
    CTCA does take end stage/3rd line patients from outside that are at death’s doorstep, like in my example. I know one other that was accepted by CTCA and was actually getting ready to go but didn’t make it out of a “Hotel California,” her employer, before succumbing.

    CTCA apparently is only reporting patients that are 100% treated at CTCA. A somewhat different cherry binning.

  30. #32 Chris
    March 10, 2013

    prn, then explain what happened to Vicky Hilborn.

  31. #33 prn
    March 10, 2013

    Speculatively, it sounded like perhaps she was not well funded enough to be considered full pay if there is some weighting that might trade off CTCA’s probability for change of outcome, and income.

    Doesn’t really matter, I am not the one making blanket statements that CTCA excludes the sickest people. My statement is simply my experience – two desperately sick people, literally sick unto death, that I personally knew and the only ones that I know of that tried or applied to CTCA. Two out of two accepted suggests a contradiction to others’ glittering generalization to say the least.

  32. #34 Jerry
    Its cold here
    March 11, 2013

    I’m fine with CTCA wanting to be ‘out front’ in collecting and presenting outcome data. I’m not fine with the fact that they aggregiously mis-quote their collection and their results. First off, despite primarily not being statistically significant, they present the data as though they are superior. Secondly, I can’t get past the fact that they compare to SEER. There are other databases to choose from that would be more ‘apples to apples’. To only include patients that received their full treatment at CTCA to a database that looks at everyone diagnosed with cancer is disgusting. It’s complete data manipulation. And, it’s been brought up to them internally before. I worked at this shell company when they touted this great enhancement, and despite my vocal misgivings as to their practice of publishing this noise, I was essentially forced to direct people to these results. Putting pretty pictures in front of desperate people is enough to sway opinion. Unfortunately, Americans by and large are not statistically versed, so viewing these graphs is a way to mislead and allow individuals to misinterpret what they are buying into.

    The lady from CTCA that they interviewed was spot on as to their focus and treatment. Employees there are under pressure to push out Medicare patients 8-12 months while getting in commercial PPO plans within a week. Medicaid and uninsured patients will be brushed off, ideally within 4 minutes. There are car salesman, enterprise rent a car clerks, insurance salesmen etc all masquerading as “oncology information specialists”. In actuality, they are people who go through one month of ‘sales training’, driven by non-clinical training managers who have never worked in an actual healthcare setting. It’s sad, and I really hope these negative stories put pressure on state commissions to look into the seedy practices these indivdiuals push.

  33. #35 Kathryn
    Silicon Valley
    March 14, 2013

    The VP of Marketing & Brand at KQED wrote back to me saying that CTCA is a national PBS sponsor, which is why the local affiliate is playing their somehow-not-an-advertisement. Would it be worth going after PBS at the national level to complain that they are lending their respectability to a shady operator?

  34. #36 ExCTCA
    March 24, 2013

    Ha! You should see how they treat their employees and they type of people they hire (managers directing calls to favorites and then getting fired etc) I got sick (needed major surgery) and fired!

    I am a bit confused about this specific patients story. Most patients would have a clinical nurse manager when they enter the hospital (for an evaluation etc). They would not be calling (formally me) in OIS (oncology Info)- I would have no access to their insurance limits or the authority to set up that appointment.. those are handled by that hospital when the patient arrives.

    While working there I got a lot of patients in and I also had patients with great outcomes – this is a while ago, and things changed, they have upped the quota etc.
    We never even had statistics at that point.

  35. #37 ExCTCA
    March 24, 2013

    ** to clarify if you come in and have an evaluation you can call me etc but I don’t have anything else to do with your scheduling, clinical judgement or insurance- that gets passed on to the hospital they were evaluated at.

    OIS only deals with the initial appointment.

    BTW I felt like I did a great job there and loved helping patients, but I was appalled because they would limit the number of Medicare patients and you would get a “convo” with the manager if you scheduled more. They would lie about the actual time for Medicare patients also, even though there was no wait they would make us say 6 months etc.

    I was happy to be fired.

  36. #38 CJ
    Atlanta
    April 5, 2013

    I personally have seen great outcomes from CTCA and have been involved in seeing the care my friend has been and is continuing to receive. She is 2 months in treatment at CTCA…with still no call back from her Harvard trained oncologist that treated her during her first battle. Amazing comments here promoting a holistic approach as quackery. I think all of you critics dabble in quackery since you have nothing better to do with your time than try to dig up and highlight some big “news flash” that is no different than what could be said about any hospital in America. If you haven’t had the need to compare a conventional hospital cancer center approach vs. CTCA then count that as a blessing and use your time and energy to find something really news worthy to complain about.

  37. #39 Lawrence
    April 5, 2013

    @CJ – you can take your “tone-trolling” somewhere else. No one here is saying that treatment there is bad, just that they cherry-pick patients to make the most money and highlight the best possible results.

  38. #40 JGC
    April 5, 2013

    Amazing comments here promoting a holistic approach as quackery.

    No one has suggested that a holistic approach to treatment is of itself quackery, however. ‘Holistic medicine’ simply means addressing all the patient needs, and embracing science based medicine is no barrier to doing so.

    What has been noted, and quite accurately, is instead that the CTCA embraces quackery (accupuncture, naturopathy, etc.) marketing it as providing holistic treatment.

  39. #41 JGC
    April 5, 2013

    BTW it’s hardly surprising you’ve seen “great outcomes from CTCA”: that’s a major point of ORAC’s article: that because their selection/qualifying process is designed to weed out patients who aren’t likely to produce good outcomes their results are skewed toward good outcomes.

  40. #42 MIRose
    April 5, 2013

    I’ve compared the two and used my local cancer center, thank you very much.

  41. #43 Inlegaleagle
    April 6, 2013

    They’re private – they GET to pick/choose/select who they accept. Nothing sinister about that. If teaching research hospitals can do the same and accept other payees – who and why is anyone complaining. Sounds like sour grapes to me……

  42. #44 AdamG
    April 6, 2013

    They’re private – they GET to pick/choose/select who they accept.

    Well yes, sure. But you must admit that advertising based on results comparisons to centers that DON’T pick and choose in the same way is rather disingenuous, right?

  43. #45 Narad
    April 6, 2013

    Sounds like sour grapes to me……

    The applicability of this fable here is completely eluding me.

  44. #46 Steve
    April 15, 2013

    Yet they claim a 501c status

  45. #47 TC
    Arizona
    April 16, 2013

    Don’t be so proud of yourselves…ignorance is not bliss…first of all, no place is perfect, but I personally will say that CTCA is the best cancer care. Unfortunately, not all hospitals take all insurances, don’t point the finger at CTCA for this–CTCA saved my life and many others…yes they take late stage cancer patients who have been misdiagnosed or used as guinea pigs for other cancer centers–my local hospital would have played their own game of “let’s guess” and open the chemo book and ask the patient what kind of chemo they want…that actually happened to a friend of mine–the oncologist “back home” basically told her she had not hope and was going to die…she did later that summer…she liked her local Doctor and refused to go to CTCA–I knew they could have helped her…CTCA hires Oncologists who KNOW what they are doing and they look at the individual person…at CTCA it is not a cookie cutter cancer center like many others…they employees care about their patients and treating the whole person: mind, body, spirit is the right thing to do–people are people–CTCA treats the people with cancer not just the cancer…that is a huge difference in cancer care…I am living proof that CTCA works–surviving 5 years longer and living my life, raised my sons who are in college now–it was scary but CTCA actually offers people HOPE–it is REAL… The people posting these ignorant comments need to get the facts, not their idea of what the facts are… Life happens and not everyone will survive cancer or other disasters…at the end of the day CTCA is making a difference in many lives and families–instead of complaining about something you don’t understand go volunteer at a cancer center and at least try to encourage people to find a positive outlet during their journey…

  46. #48 Dan Williams
    Huntsville, AL
    April 19, 2013

    In Respond TO: “…But the most egregious aspect this effort to bring a new cancer hospital to New Hampshire is the assertion that it will not treat Medicaid patients. In testimony before the House HHS Committee, the president of one of the CTCA facilities in Philadelphia, John McNeil, said that they do not intend to treat Medicaid patients because Medicaid does not cover the cost of caring for those patients. He’s absolutely right. But, don’t Medicaid patients suffering from cancer deserve the same level of health care that all others do?”

    The logical conclusion of this thinking is that everyone should have a Mercedes Benz in their two car garage, a four bedroon, five bath house, and make a six fugure income because everyone deserves these things.

    No doubt it would be nice for everyone to have this level of income and nice things but the truth is that this is not the case. The niavity of this way of thinking leads to another form of unfairness; wealth redistribution! This philosophy sounds good but it would lead to forcing people who make more to give their wealth or worse that the government would take away their income, savings, etc because someone else needs and deserves what you have so I’ll take what you have so someone else I believe has a greater need can have what I think they need despite the hard work and sweat equity you put into your savings, and personal blongings.

    This is socialism and we as a nation are better than that.

  47. #49 AdamG
    April 19, 2013

    The logical conclusion of this thinking is that everyone should have a Mercedes Benz in their two car garage, a four bedroon, five bath house, and make a six fugure income because everyone deserves these things.

    You don’t see any difference between basic access to quality health care and owning luxury items?

    This philosophy sounds good but it would lead to forcing people who make more to give their wealth or worse that the government would take away their income, savings, etc because someone else needs and deserves what you have

    Do you believe that you should be obligated to pay taxes at all? Do you believe that the government has no obligation to provide a safety net for those individuals who cannot afford access to basic health care?

  48. #50 Krebiozen
    April 19, 2013

    Dan Williams,
    At risk of derailing this thread into a political debate (who was it who said that these are most appropriately condcuted on all fours?)…

    The niavity of this way of thinking leads to another form of unfairness; wealth redistribution!

    Wealth redistribution is only unfair if you accept that the economic system and the rules of commerce we operate under are fair. If you believe that our economic system is intrinsically unfair, as godless socialists like myself do, then redistributing the wealth that has been accumulated by some at the expense of others is entirely fair.

  49. #51 Mephistopheles O'Brien
    April 19, 2013

    AdamG – it depends on what you combine into the set of things labeled “basic access to quality health care”.

  50. #52 Mephistopheles O'Brien
    April 19, 2013

    TC – I’m glad you had a good experience at Cancer Treatment Centers of America, and I’m especially glad that you received good treatment and an excellent outcome.

    Do you have a view on the topics raised by Orac above – the use of misleading statistics in its advertising and the use of techniques such as acupuncture and homeopathy which are either shown to have no significant benefit or not proved to have a benefit?

    Thanks.

  51. #53 AdamG
    April 19, 2013

    it depends on what you combine into the set of things labeled “basic access to quality health care”

    I totally agree with you, MoB…but I suspect Dan Williams thinks we shouldn’t pay for any part of anyone’s healthcare at all.

  52. #54 Mary Lane Dawson
    Texas
    May 19, 2013

    I called CTCA for an appointment. I was diagnosed with Inflammatory Breast CA Stage 3c. I am 76 years old and also have heart problems. My insurance was Medicare and Tri-Care For Life. I was turned down. Diagnosed in 2008, and guess what I am cancer-free and very much alive. No thanks to
    CTCA I went to MD Anderson. God was my GREAT physician
    though.

  53. #55 Kim weibley
    Philadelphia
    May 20, 2013

    Amazing! I just contacted cancer treatment center in phila. And was told they do not accept Medicare! Period ! Guess they only treat those with fantastic insurance? How very sad!

  54. #56 pdxmike
    May 29, 2013

    CTCA commercials make my skin crawl… and I am very disappointed in NPR for taking their money. But then something is wrong with NPR too. They are not keeping up with the times in my opinion. They are some creative new shows, but they are so locked into their format, and there seems to be more and more show promotion, and less and less reporting.

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