The return of the snake oil salesmen.

It’s the time of the year when an annual editorial is due. Thinking about possible topics, I noticed the extraordinary amount of media advertising going on directed to the public concerning new medical tools. Today radio and television ads directly discuss prescription medications and their potential benefits (never the down side) and finish with the comment, “Ask your doctor.” Obviously, vendors and drug companies have decided to target their products directly to patients and hope that a patient interaction will intimidate the unwitting physician to write the prescription. At a recent conference on intensity-modulated radiotherapy (IMRT), I was amazed to see a representative of one of the vendors take approximately 30 minutes in a formal presentation to discuss explicitly with radiation oncologists and hospital administrators how they should advertise and market IMRT to get the public’s interest and entice the patient to facilities with this new technology. Not a single word was expressed concerning the lack of long-term data or the potential down sides associated with this new treatment approach, which actually conflicts with several principles of radiation biology that I would have thought were well known and accepted before this present era. Those principles have been reviewed (1), and need not be discussed here. In this editorial, I would like to focus on the efforts of vendors for both drugs and devices that appeal directly to patients and their families, most of whom are in no position to be able to evaluate the message received. Formal use of the media as a means of selling such medical drugs and devices directly to the consumer seems to be a phenomenon of the last 15–20 years. There was a time when technologic and pharmacologic information was considered too complex for patients, and there was an attitude of patronization exclusively with respect to physicians on these issues. Not any more. Some of the present attitude is probably because of the political climate of the 1980s and 1990s, but much of it is also because of the concurrent rise of the Internet as a major means from which both patients and physicians get their information. The point to be emphasized is that this media hype is all one-sided. There is no balance in the presentation, either to patients or to physicians. Everything is portrayed as bigger and better, and no mention of possible and even predictable risks as opposed to benefits. The Internet websites usually have their own agenda, and there is no restraint on the Internet, because of First Amendment rights, even though the lack of restraints on the Web may actually jeopardize the unsophisticated and the unwary. I don’t know how to distinguish personal opinion from intentional deception, but Justice Oliver Wendell Holmes did point out that freedom of speech did not permit one to scream, “Fire!” in a crowded theater; there are limits, but they are simply undefined (as yet). Another factor relates to present-day Darwinian competition, not only among physicians, but also among hospitals. Many of today’s hospital administrators presume that they know the issues better than physicians, but the issue of most concern seems to be the issue of revenues. Some simply smell the aroma of profits with a very low threshold. Is there any other way to interpret hospital advertisements such as one that was clipped from The New York Times and recently sent to me? One of the New York hospitals advertised publicly a “quantum leap” in the improvement of the treatment of lung cancer because of the development of respiratory gating! There are obviously no data on lung cancer to demonstrate a quantum leap of any kind associated with gating, irrespective of any theoretical rationale for potential benefit. It remains a research area and one in which the major justification centers upon the desire to use IMRT for the treatment of mobile intrathoracic neoplasms, largely presupposing improvement from dose escalation. The mo-