Marketing, Media, Wishful Thinking, and Conflicts of Interest: Inflating the Value of New Medical Technology


Richard A Deyo, MD, MPH

Spring 2009 - Volume 13 Number 2

In 1991, Nelene Fox, a 38-year-old mother of three, was diagnosed with breast cancer. She underwent bilateral mastectomies and chemotherapy but nonetheless developed bony metastases. Her physicians said her only chance for survival was high-dose chemotherapy and autologous bone marrow transplantation. Her Health Maintenance Organization (HMO) refused to cover the procedure (around $140,000) on the basis that it was experimental.1

Her husband launched a successful fundraising effort, and Mrs Fox received the procedure, but died eight months later. Her brother, an attorney, sued the HMO for the delay in her therapy, and won $89 million in damages. Similar lawsuits played out across the country with similar awards.

For the media, this was an irresistible David and Goliath story: relatively powerless individual patients were bringing insurance companies and HMOs to their knees. Reporting focused on access to the new technology, not questioning whether it was effective. With the media frenzy and lobbying, lawmakers began requiring insurance coverage for the new procedure. Insurers, facing lawsuits, bad publicity, and new legal requirements, began to routinely cover the new procedure.2



Click here to join the eTOC list or text ETOC to 22828. You will receive an email notice with the Table of Contents of The Permanente Journal.


2 million page views of TPJ articles in PubMed from a broad international readership.


Indexed in MEDLINE, PubMed Central, EMBASE, EBSCO Academic Search Complete, and CrossRef.




ISSN 1552-5775 Copyright © 2021

All Rights Reserved