Celebrity im­pact

Ben­e­fits, risks seen in hype over Jolie’s dis­clo­sure

Modern Healthcare - - THE WEEK IN HEALTHCARE - Jaimy Lee

Celebri­ties drive aver­age Amer­i­cans to want what they have. That pow­er­ful im­pulse can even in­flu­ence grave health­care de­ci­sions and could prove com­pli­cated for women who fear they’re at high risk for breast can­cer af­ter An­gelina Jolie’s dis­clo­sure that she un­der­went a preven­tive dou­ble mas­tec­tomy—a treat­ment op­tion in re­sponse to a rare ge­netic mu­ta­tion.

As is of­ten the case when pub­lic fig­ures choose or en­dorse a med­i­cal pro­ce­dure, health­care providers say they ex­pect to see in­creased in­ter­est from pa­tients who may seek test­ing for the BRCA1 and BRCA2 genes or con­sider a preven­tive mas­tec­tomy. And some providers will cap­i­tal­ize on Jolie’s celebrity to mar­ket test­ing for the BRCA gene mu­ta­tions and re­lated preven­tive treat­ments.

The Basser Re­search Cen­ter for BRCA, part of the Univer­sity of Penn­syl­va­nia, placed an ad in the New York Times within days of Jolie’s dis­clo­sure, not­ing its ap­pear­ance in the pa­per and ad­ver­tis­ing that the cen­ter is “fo­cused on de­vel­op­ing new preven­tion and treat­ment op­tions, and on sup­port­ing BRCA af­fected fam­i­lies.”

“When fa­mous peo­ple like An­gelina Jolie have preven­tive surgery for breast can­cer, it will gen­er­ate in­ter­est be­cause celebri­ties seem to be above it all, but in fact, they are hu­man just like the rest of us,” Dr. Kathie-Ann Joseph, as­sis­tant pro­fes­sor in NYU Lan­gone Med­i­cal Cen­ter’s depart­ment of surgery, said in an e-mail. “That has a pow­er­ful im­pact.”

How­ever, th­ese types of dis­clo­sures raise im­por­tant ques­tions about the im­pact of celebrity on how pa­tients make de­ci­sions about their treat­ments for po­ten­tially fa­tal dis­eases or con­di­tions.

Chris Christie, gover­nor of New Jersey who may be con­sid­er­ing a run for pres­i­dent in 2016, re­cently made his own health dis­clo­sure, con­firm­ing this month that he had re­ceived gas­tric band­ing to re­duce his weight.

“There’s no ques­tion that stars in­flu­ence clin­i­cal prac­tice,” said Jef­frey Lerner, pres­i­dent and CEO of the ECRI In­sti­tute. “That’s why drug com­pa­nies will use a celebrity in a di­rect-to-con­sumer ad.”

There are nu­mer­ous ex­am­ples of celebri­ties, politi­cians and other pub­lic fig­ures who have pub­licly ad­dressed, dis­closed or ad­vo­cated for types of treat­ments. Some have been lauded for rais­ing aware­ness of a cer­tain dis­ease or con­di­tion, while oth­ers have been crit­i­cized for en­cour­ag­ing pa­tients to un­dergo un­nec­es­sary or in­ap­pro­pri­ate treat­ments.

Notably, Oprah Win­frey came un­der fire al­most a decade ago for rec­om­mend­ing whole-body scans even as the Food and Drug Ad­min­is­tra­tion urged cau­tion be­cause there was no sci­en­tific ev­i­dence prov­ing the ben­e­fits of the screen­ing.

But in the cases of Jolie and Christie, the dis­clo­sures fo­cused less on pro­mo­tion and more on the role of proac­tively ad­dress­ing per­sonal health is­sues.

“I choose not to keep my story pri­vate be­cause there are many women who do not know that they might be liv­ing un­der the shadow of can­cer,” Jolie wrote May 14. “It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong op­tions.”

Christie, like­wise, de­scribed his pro­ce­dure as a per­sonal choice. “It’s not a ca­reer is­sue for me,” he said dur­ing a news con­fer­ence. “It is a long-term health is­sue for me.”

Physi­cians say there are ben­e­fits and risks to the me­dia hype sur­round­ing celebri­ties and their health­care choices, which can sharpen a pa­tient’s un­der­stand­ing of a par­tic­u­lar pro­ce­dure as well as boost in­ter­est among pa­tients who may not meet the clin­i­cal cri­te­ria.

“I think it’s very re­spon­si­ble and a good thing what peo­ple like Gov. Christie and An­gelina Jolie did,” said Dr. Ru­min Sorkhi, a bari­atric sur­geon who is af­fil­i­ated with the Palo­mar Health sys­tem in San Diego County. “Peo­ple look up to them and peo­ple learn from them.”

The num­bers of pro­phy­lac­tic mas­tec­tomies and bari­atric surg­eries per­formed in the U.S. are ris­ing.

A study re­leased last year by the Penn­syl­va­nia Health Care Cost Con­tain­ment Coun­cil found that the num­ber of women who chose preven­tive mas­tec­tomies be­fore a breast can­cer di­ag­no­sis rose to 455 women in 2011, com­pared with 94 in 2002.

NYU Lan­gone’s Joseph also at­trib­uted some of the growth in preven­tive mas­tec­tomies to women who have a fam­ily his­tory of breast can­cer, but are not car­ri­ers of the gene mu­ta­tion.

Even for the pa­tients who do carry the BRCA1 and BRCA2 genes, there are al­ter­na­tives to surgery. Op­tions in­clude close mon­i­tor­ing or use of ta­mox­ifen and ralox­ifene, which are hor­mone ther­a­pies that can re­duce breast can­cer risk.

While most in­sur­ers that cover mas­tec­tomies have been re­quired by law since the late 1990s to cover breast re­con­struc­tion, a com­bi­na­tion of in­creased aware­ness and bet-

ter re­con­struc­tion op­tions has led more women to choose mas­tec­tomies to re­duce their breast can­cer risk, said Dr. John Kim, a plas­tic and re­con­struc­tive sur­geon at North­west­ern Me­mo­rial Hos­pi­tal in Chicago.

“It makes it eas­ier for pa­tients to choose the more ag­gres­sive treat­ment,” he said.

Sorkhi said in­ter­est in bari­atric surgery usu­ally spikes fol­low­ing pub­lic an­nounce­ments such as Christie’s and, in many cases, Palo­mar Health will re­port higher num­bers of con­sul­ta­tions or at­ten­dees at its free monthly bari­atric sem­i­nars.

How­ever, there are con­cerns that broad pub­lic en­dorse­ments of th­ese surg­eries can sim­plify what are still com­plex med­i­cal pro­ce­dures. Ads and celebrity dis­clo­sures of­ten do lit­tle to ad­dress the full ben­e­fits and risks.

“Peo­ple as­sume … she’s fa­mous, rich and pow­er­ful. She must have checked this out. This must be good,” ECRI’s Lerner said.

AP PHOTO

“When fa­mous peo­ple like An­gelina Jolie have preven­tive surgery for breast can­cer, it will gen­er­ate in­ter­est be­cause celebri­ties seem to be above it all, but in fact, they are hu­man just like the rest of us,” said Dr. Kathie-Ann Joseph of NYU Lan­gone Med­i­cal Cen­ter.

New Jersey Gov. Chris Christie de­scribed his gas­tric band­ing pro­ce­dure as a per­sonal choice. “It is a long-term health is­sue for me,” he said.

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