The business of cancer: When does healing cross the line into exploitation?
Healthcare is big business. How much profit is too much?
This is a guest column by Taayoo Murray, an award-winning writer based in New York City. She regularly covers health topics, primarily inequity in healthcare and issues in aging. Her work has been published in Mayo Clinic Press, Yahoo, Essence, Cancer Today, New York Amsterdam News and many others. Taayoo is actively looking for assignments and contract work. When she’s not writing, she enjoys reading and bingeing on crime dramas. She can be reached at taayoo_murray@yahoo.com.
The things we write about are sometimes personal. It can be a journey you have taken yourself, or one taken by someone you know. A big distinction is that degree of separation, which should give you a clear-eyed perspective, free of bias and preconceived notions. And I say ‘should’ because our implicit biases color everything we do.
The genesis of this article was a brief conversation with Francine McKenna about one of her experiences during breast cancer treatment. Her experience at the University of Pennsylvania’s Abramson Cancer Center was phenomenal and successful but, when doctors offered cold capping to prevent hair loss during chemotherapy, their approach left a bad taste that still lingers two years later.
So I did a deep dive. Let me show you what I found.
Let’s talk cold capping
Cold capping is a scalp cooling therapy that works using a device that constricts blood vessels in the scalp. The constriction of the blood vessels decreases blood flow to the hair follicles, and decreased blood flow means less chemotherapy drugs reach the hair follicles. This is supposed to minimize hair damage and loss. The cooling also causes the hair follicles to go into a temporary state of “hibernation”, making them less susceptible to the effects of the chemotherapy drugs.
The cap is applied by technicians in the clinic or hospital, typically in the infusion center, about 30 minutes before chemotherapy starts. It stays on during chemotherapy and for about 90 minutes after chemotherapy ends. Francine told me she continued to teach at Wharton during her chemotherapy treatment, which was already five to six hours long, so the idea of spending so much more time at the hospital for each treatment was not appealing.
“It’s a very involved procedure because the hair needs to be wet when they put it under the cold cap,” explains Dr. Mario Lacouture, Medical Director, Symptom Management Program at Perlmutter Cancer Center, Long Island. “There’s better transmission of the cold when the hair is wet, and there’s very strict recommendations as to how often to wash the hair, so people cannot wash the hair very often.”
Cold capping is also only recommended for patients with solid tumors, like breast, uterine, lung, and prostate cancers. Blood cancer patients aren’t suitable, and the treatment isn’t approved for children. Another limitation is the treatment doesn’t work for patients using certain cancer drugs. The highest rate of success has been observed when cold capping is done for patients being treated with taxane-based chemo drugs like Paclitaxel (Taxol) and Docetaxel (Taxotere). Moderate success is expected when used in combination doses with drugs like Doxorubicin and Cyclophosphamide. The dosage and duration of chemotherapy also impacts success of cold capping treatment.
But what does “success” look like?
There are three companies with FDA approved cold capping products on the market - Dignitana which markets DigniCap, Paxman, and Cooler Heads which makes Amma. Cold capping provider Paxman, provides a tool for patients to use to estimate how successful the treatment might be in preserving their hair. Using the tool requires knowing which chemotherapy drugs you will be treated with. I found the definitions and literature around calculating success confusing. The more I read, the more hackneyed it seemed. Dr. Lacouture provided me with a clearer explanation.
“Success is defined if a person loses, in broad terms, less than 50% of the hair on their scalp,” explained Dr. Lacouture. He went on to share that while 50% may seem arbitrary, the thought is that if you lose less than 50% of the hair on your scalp, you will not need to use a wig, turban, scarf, or a hat, to conceal the hair loss. The hair loss may not be as noticeable to others because most people have a lot of hair on their scalp.
Clinical trials show that Paxman has a success rate at the high end of 63%. Dignicap in clinical trials had an average success rate of 66.3%. We should note that a combo cocktail of taxane and anthracycline chemotherapy drugs is the standard of treatment for triple negative breast cancer, which is the type for ten to fifteen percent of all newly diagnosed breast tumors.
What does a woman’s hair mean to her and to her self-image?
Shaving your head once the hair starts falling out during chemotherapy treatment is seen by many cancer patients as a resistance ritual. For some it is a way of taking control, boldly declaring that you are ready to take on this monster of a disease, and willing to embrace the new look to redefine what it means to be beautiful and strong.
Studies, however, tell a more nuanced story: that women often find hair loss during chemotherapy to be a traumatic experience. Many women say they feel a loss of identity, femininity, and positive self-image. Nearly 58% of women who experience chemotherapy rank hair loss as the worst or most traumatic side effect of the treatment. Some even consider foregoing life-saving treatment because of their fear of side effects including hair loss.
That’s because, for many women, their hair is strongly tied to their perceptions of feminine identity, self-image, and sexual attractiveness. For women who may want to keep their cancer journey private, hair loss also risks publicizing their illness. This can trigger feelings of shame and anxiety based on what they may see as a negative perception of their appearance or abilities. They may be sensitive to being seen as sick, weak, and in need of help.
Francine told me she felt a predatory vibe when cold capping was proposed. She said it seemed like the push for the treatment could exploit some women’s fears that losing your hair would impact your femininity and attractiveness.
The profit in healing
Healthcare, in general, is big business. There are huge profits to be made from illness and the enduring question is, “How much profit is too much?” Or, in this case, at what point do healing drugs and devices become exploitative?
The business of cold capping is booming and the industry has seen a major consolidation in recent months, essentially creating a monopoly. Paxman recently acquired its major competitor Dignitana, resulting in its complete dominance of the cold capping market in North America. Paxman is a publicly traded company listed on the Nasdaq First North Growth Market in Sweden. Its market value exceeds a billion dollars and it has seen its revenue and gross profit soar in the past three years.The company is also very profitable. Its working capital is growing, its debt to asset ratio healthy, and it has positive equity and positive earnings per share.
Paxman’s business model is B-to-B, selling to hospitals that lease the cold capping machines. The FDA does not allow Paxman to market directly to the consumer, so all treatment is done inpatient through cancer centers in hospitals where Paxman provides training. DigniCap is currently available in hundreds of hospitals across the United States, and Paxman was already in notable private cancer centers like Memorial Sloan Kettering and NYU Langone’s Perlmutter Cancer Center.
According to the National Cancer Institute, the price range for one cycle of cold capping is $1500 to $5000. With the average breast cancer chemotherapy treatment requiring four to eight cycles of chemotherapy, a patient will potentially incur a cost of $6000 on the low end, to $20,000 at the high end for four cycles of chemotherapy. This cost is mostly out-of-pocket, not covered by health insurance. The upside is if you can afford the cash your entire deductible will be spent in one swoop. New York State recently passed a law effective January 1, 2026, that requires all large private health insurance providers to cover cold capping for eligible cancer patients. With an estimated 16,700 women diagnosed with breast cancer every year in New York, the potential earnings for Paxman just in New York can skyrocket.
As a Black woman, I also wondered if women like me are benefitting from this treatment. Cold capping has been available for over a decade, but when I reached out to two Black cancer survivors — one breast cancer and the other uterine cancer who would have been eligible for this treatment — neither were ever offered cold capping. The breast cancer survivor is a nurse practitioner in New York and the uterine cancer survivor a resident in Georgia, where she was treated.
My belief is that providers may have assumed they couldn’t afford it, or probably would not be interested. That assumption is supported by studies showing that Black women are often not offered medical treatment options, beyond the routine, such as clinical trials. Ironically, with mandated health insurance coverage in New York, many more states may follow its lead. In an effort to increase profits, many Black women may now have the choice to take advantage of this treatment.
My verdict
Has cold capping crossed the line from healing to exploitation? It seems the line moves sometimes, or at the very least requires some creative juggling. Our empathic streak doesn’t look kindly on anyone making a profit on disease and suffering. Then, if we add the layer that cold capping is a product that, by its own admission, has at least a 33% failure rate, this product can feel at best unethical to some, and at worst an outright scam to others.
However, I don’t agree that the business model is unethical or a scam. The success rates are clearly communicated, and I have not seen or spoken to a doctor who hasn’t been crystal clear that the process is onerous and that success isn’t guaranteed. In a capitalist society, knowing clearly what you’re getting before spending your money is the best case scenario. Companies profiting off of someone’s illness is just another Tuesday and not illegal. Buying some shares may be one indirect way to hit back at cancer if your moral compass can take it.
© Francine McKenna, The Digging Company LLC, 2025
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Good question. The issues in my mind are: 1) the US subsidizes other first world countries since they have price controls, 2) the lawyers have too much free reign, and 3) the laws for pricing new products are too lax. The former and latter are pretty self-explanatory. The middle is when doctors are sued even though they followed standard protocol. That should not happen. Yes, I have had much experience with the health care system.