Marketing versus science: a fight between necessary evil and stern good over the adoption of new technology in medicine.

Early one Monday morning, while making rounds in the ward, I stopped by the presurgical center and visited Bill, who was being readied to have surgery for prostate cancer. He asked half jokingly—and half anxiously—if I’d had a good night’s sleep. ‘‘Let me see those steady hands,’’ said Jane, his lovely wife, who was seated at his bedside. ‘‘You must play the piano, ‘‘she added. I reassured both of them and headed to the operating room. Normal nervousness is something I have grown used to over my years as a surgeon. In fact, comments like Bill’s and Jane’s come from an instinctive anxiety about profound events over which patients have little control. Patients seek and need comforting signs that their surgeon, through his or her hands, is meticulous, precise, and accurate. Surgery or ‘‘hand work’’ is an act that most people see as serious and potentially dangerous, requiring skillful planning and precise execution. The perceived need for such precision and skill is even more pronounced among men facing surgery for prostate cancer. In these cases, the most personal aspects of the quality of a man’s life after surgery depend on the preservation of fine, fragile nerve structures running alongside the prostate. Keeping those nerves intact allows modern surgery to remove the threat of cancer and still preserve sexual function. The optimal outcome of radical prostatectomy as a surgical treatment for prostate cancer is the complete removal of cancer with the best preservation of sexual and urinary functions. But these aims compete with each other. Maximizing cancer cure may risk harm to urinary and sexual function. Preserving function at all costs could reduce the chance of curing the cancer. Such intricacy, requiring the surgeon to walk the fine line between removing the threat of the cancer and providing the least possible disruption to sexual function and urinary control, has become the point over which urologists and their patients agonize in their decision to proceed with treatment. The surgical industry has been quick to recognize this need and to capitalize on it. Over the last decade, the industry has conducted an aggressive marketing campaign to sell surgical products under the tagline of enhancing the surgeon’s accuracy and precision and therefore improving the patient’s outcome. This marketing strategy is clever: It approaches both health care providers and recipients as consumers, and in both, it creates and thrives on fear. Patients hear and read that the new product may improve their surgeon’s accuracy, and therefore, they demand the product, out of fear of a less desirable outcome without it. The surgeons fear that without the new surgical tool, they will be seen as antiquated and will lose patients. A marketing strategy that exploits fear, ambition, anxiety, and other subconscious energies hidden under the surface of the human psyche is not new and has been used in advertising and public relations for many years. Edward Bernays championed it by using his uncle Sigmund Freud’s psychoanalytic theories to revolutionize marketing and