The first sentence of a letter from a public relations firm representing a Beverly Hills ophthalmologist was dramatic and eye-catching enough.
"There is a 20-minute procedure that 'cures' myopia (nearsightedness)," it said, and it went on to promise miracle surgery that can permit someone who is nearsighted to "throw those glasses away."
Striking though it was, the letter received by The Times a few weeks ago was merely representative of a flood of pitches sent to the nation's news media in the last 12 months or so on behalf of doctors all over the country.
The subject of this promotional onslaught is a type of eye surgery called radial keratotomy in which the cornea--the eye's outer lens--is flattened by a series of microscopic incisions to bring an acutely nearsighted eye back to close to normal vision. In some cases, people with vision as out of kilter as 20/600 have realized correction to near the norm of 20/20.
Radial keratotomy's promise, however, remains unestablished in a scientifically consistent way, most experts agree. Even Dr. Paul First, who retained the public relations agency to bolster his radial keratotomy practice, now says he has some doubts about marketing claims being made for the surgery. First said the PR campaign yielded only about 25 patients and he has since severed relations with that firm.
"Some of the ads (and public relations pitches) I think (amount to) overmarketing," First said, conceding that the assertion made on his behalf that the operation can "cure" nearsightedness--technically called myopia--"is not a truthful statement.
"Some of the ads I've seen that say, 'throw away your glasses,' they're selling a dream and I guess that is what ads sell. On some people, the dream can come true, but it seems like that's not medicine--guaranteeing things."
The campaign on First's behalf was orchestrated by account executive Jane Summer of the firm of Boonshaft-Lewis Public Relations. She asserted that while she had not, in fact, shown the letter to First, she based its contents on conversations with First and other doctors who perform radial keratotomy. "I consider myself a person of integrity and I'm not in the business of hype," she said. Radial keratotomy is the object of a still-incomplete national study that recently reported results of the first year of its intended five-year inquiry. Preliminary though those results are, the controversy over the effectiveness of the procedure and how widely it should be performed has already prompted two federal court lawsuits by doctors who want to offer the surgery more widely and to have insurance companies reimburse them for it but who have alleged restraint of trade by other physicians who have labeled radial keratotomy "experimental."
A wide array of experts believe that radial keratotomy--for most nearsighted people--doesn't result in vision that is any better than what they already experience with glasses or contact lenses. In some cases, the vision may be worse--or at least not as reliably corrected. This is all at a cost of as much as $3,000 per eye.
All of this, however, has not been enough to prevent radial keratotomy from becoming an example of how the changing nature of medical practice and the increasing effects of economic pressure on doctors are combining to turn medicine into a profession in which marketing plays an ever-increasing role. Radial keratotomy, which many eye specialists still consider to be unproven and some still fear may lead to unanticipated long-term complications, has become one of the most promoted developments in medicine's recent history.
Dr. Byron Demorest of Sacramento, president of the American Academy of Ophthalmology, described radial keratotomy as "an alternative treatment for nearsightedness that can be offered or may be offered to any individual who is unable to tolerate glasses or contact lenses or who needs vision better than a certain level to qualify for a job."
Asked if the claims in the enthusiastic first paragraph of the letter sent out on First's behalf were true, Demorest chuckled for a moment, then said, "Of course not."
Demorest added in a telephone interview: "The problem is there is no predictability about the outcome and there still are some side effects. With this procedure, there's a question of the long-term side effects after five or 10 years. We honestly don't know. Some of the results (so far are) really encouraging, but it is still an evolving technique."