Lori Wallace sits on a couch with her 11-year-old son and his new pet snake. It burrows under his armpit, as if afraid. Wallace is sure it鈥檚 not.
鈥淚f he was terrified, he would be balled up,鈥� Wallace said. 鈥淪ee, that is why they are called ball pythons. When they are scared, they turn into a little ball.鈥�
Wallace is dying of breast cancer, but a stranger wouldn鈥檛 know. She has a pixie haircut and a warm tan. She is vibrant and chatty and looks you right in the eyes when she talks. Wallace doesn鈥檛 shy away from what is happening to her. She shows her cracked feet. They bleed from the chemotherapy pills she takes.
As Wallace鈥檚 cancer has progressed over the past seven years, she has become more critical of what she sees as excessive positivity in health care marketing. It鈥檚 everywhere: TV ads, radio commercials, billboards. The advertisements feature happy, healed patients and tell stories of miraculous recoveries. The messages are optimistic, about people beating steep odds. The ads spread false hope, Wallace said, and for a patient like her, they are a slap in the face.
A couple of decades ago, hospitals and clinics did not advertise much to customers. Now, they are spending more and more each year on marketing, according to university professors who study advertising.
Wallace, who lives in San Jose, Calif., said she used to be a hopeful person, someone who believed you could fight through any misfortune. Then she was diagnosed with breast cancer at 39. Her son was 4 at the time. She couldn鈥檛 believe it.
She is now in her fifth round of chemotherapy and it makes her brain foggy, she said. Her stage 4 cancer has spread throughout her body. It鈥檚 going to kill her, she said.
鈥淭he median survival of a woman with metastatic breast cancer is 33 months,鈥� Wallace said. 鈥淢y 33 months would have been Dec. 6 last year. So I am on bonus time right now.鈥�
Wallace pulled up an ad on her computer from聽, in San Francisco. An announcer intones, 鈥淎mid a thousand maybes and a million nos, we believe in the profound and unstoppable power of yes.鈥�
There is a similar kind of optimism at the heart of a lot of the ad campaigns by health care providers 鈥� with slogans like 鈥淭hrive鈥� and 鈥淪mile Out.鈥� Wallace said the subtext of the ads is that people like her 鈥� who get sick and will die 鈥� maybe just aren鈥檛 being positive enough.
鈥淚 didn鈥檛 say 鈥榶es鈥� to cancer,鈥� Wallace said. 鈥淚 have tried everything I can. I have done clinical trials. I have said 鈥榶es鈥� to every possible treatment. And the cancer doesn鈥檛 care.鈥�
聽is executive director of Breast Cancer Action. She said health care providers are following in the footsteps of other companies.
鈥淚t鈥檚 the basics of marketing,鈥� Jaggar said. 鈥淚n order to sell products or services, you have to sell hope.鈥�
She said health care advertisers are adopting the kind of optimistic messaging that really began in force with the pink ribbons and rosy depictions of breast cancer.
鈥淭hirty years ago, breast cancer was the poster child of positive thinking,鈥� Jaggar said. 鈥溾�楲ook good, feel better, don鈥檛 let breast cancer get you down. Fight strong and be cheerful while you do it.鈥欌��
Back then, health care providers marketed to physicians more than consumers. The ads were drier, more factual, said聽, an economist and professor of health care management at the University of Pennsylvania.
鈥淲hen the ads are more consumer-facing as opposed to professional-facing, the content tends to be more passionate,鈥� David said.
The hospital ads Wallace objects to tug at emotions, just like other advertising that is trying to win over consumers. With increasing health care costs and choices, patients are shopping around for care.聽These days hospitals have to sell themselves, said聽聽a professor of marketing at Northwestern University.
鈥淩ight now in health care, if you don鈥檛 have some leverage, if you don鈥檛 have a brand people care about, if you don鈥檛 have a reason for people to pick you over competitors 鈥� well, then you are in a really tough spot,鈥� he said.
Hospitals are spending more than ever on advertising, he said, and, as with other products, that advertising is filled with lots of promises. He noted that you don鈥檛 see the same promises in the pharmaceutical industry. Their ads are regulated by the Food and Drug Administration, which is why they have to list side effects and show scientific backing for their claims.
鈥淗ospitals aren鈥檛 held to any of those [FDA] standards at all,鈥� Calkins said. 鈥淪o a hospital can go out and say, 鈥楾his is where miracles happen. And here鈥檚 Joe. Joe was about to die. And now Joe is going to live forever.鈥欌��
Lori Wallace is not going to live forever. Before cancer, she said, she would have been attracted to the messages of hope. But now, she craves realism 鈥� acceptance of both the world鈥檚 beauty and its harshness. She wrote an essay about that for the women in her breast cancer support group.
The essay is titled 鈥淔*** Silver Linings and Pink Ribbons.鈥� Wallace reads the whole piece aloud, from start to finish, sitting at her kitchen table. Her son is nearby with his pet snake.
Toward the middle of the essay, Wallace writes, 鈥淢y ovaries are gone, and without them my skin is aging at hyperspeed. I have hot flashes and cold flashes. My bones ache. My libido is shot and my vagina is a desert.鈥� The essay is open, funny and unflinching, just like Wallace.
She reads the final paragraph: 鈥淚 will try to be thankful for every laugh, hug and kiss, and other things, too. That is, if my chemo-brain allows me to remember.鈥�
鈥淭hat鈥檚 what I wrote,鈥� Wallace said. 鈥淭hat鈥檚 what I wrote. Brutal honesty.鈥�
This story is part of a partnership that includes , and Kaiser Health News.