Thursday, June 13, 2013

Televised Snake Oil

I was looking up the meaning of a word on my desktop the other day when a small box containing an advertisement drifted, uninvited, onto the screen.

The advertisement was for an inhaled steroid used to treat asthma and chronic obstructive pulmonary disease.  The drug is often effective, but it is in no way a first line treatment as there are multiple strategies, with significantly lower cost and fewer side effects,  which may work as well or better.

It is only in recent years that drug firms have taken their products directly to the public on television and the internet.  Previously, the main sales strategy was to have drug representatives meet directly with physicians to trumpet their products.

Doctors were flattered, cajoled and bought to gain their endorsements.  For example, lavish lunches were provided for the doctors and their staffs in exchange for ten minutes of the doctor's time.  Clinicians and staff came to regard these lunches as an enshrined benefit.  

While  wolfing down sandwiches (stuffed with arugula), golf balls,  pens, refrigerator magnets, pads and all manner of tchotchkes were put out for the taking. While any self-respecting  robber would never steal a tchotchke, doctors couldn't get enough of them.

Physicians, who additionally agreed to give talks favoring use of a company's new drug, were oftentimes regaled with all expense trips for two to exotic places.  Generous stipends such as a financial aid package for millionaires were not uncommon.

Altogether, the relationship between many drug companies and a sizable  minority of doctors was whoreish.  The pharmaceutical industry has lots of money to buy favors and many doctors are on the take.  Even physicians who never put themselves up for sale were too willing to accept drug companies as the first and last word on treatment issues.   In doing so, doctors left the fox (the pharmaceutical industry) guarding the hen house.

Happily, many medical organizations have now set limits on gifts which doctors can take from a drug company.  The free lunch is disappearing and many clinics do not allow drug reps on their premises.  Moreover,  free drug samples, a major hook for commanding physician time, is now regarded as off limits.

Despite these reforms, the relatively new phenomenon of marketing medications directly to the public via TV or the internet is even more sinister and egregious than the previous system of marketing centered around drug reps and a culture of payoffs to doctors. 

Television has proven to be a remarkably effective tool in influencing and seducing buyers.  This is not much of a concern for, say, tooth paste commercials,  but it becomes a big concern when viewers are left to interpret medication commercials which at bottom are high on promises and low on scientific rigor. 

The physician is conspicuously left out of the equation until calls start pouring in from patients who want to go on an advertised medication.  Many of these patients (consumers) were doing just fine until they came face to face with the idea that they could have, say, low testosterone.  No wonder they felt tired and could no longer press 300 pounds.  Both men and women were alert to the suggestion that correcting low T with an under arm application of a testosterone gel might well promote a feeling of sexual vibrancy. 

While some  people might benefit from T.V. promoted drugs, the vast majority either do not need them or are already doing well on standard treatments.  Moreover, since someone has to pay for air time,  publicly advertised drugs are usually much more costly.

The point remains that the devil you know is better than the one you don't know.

It's the doctors job to evaluate new treatments, including benefits and side effects.  Their  opinions should result from scholarly sources such as the best medical and pharmacological journals. 

Responsible journalism, promoting rational discourse, also has an important role to play in engaging and informing the public on medical issues.

Direct advertising is biased and misleading, it raises prescription costs, and is without a net benefit to society.

Canada, the UK and Australia ban direct advertising and we should do the same.  In doing so we would go far to insure  that when treatments are ordered, it is the doctor, not the drug company, that is guarding the hen house.