The Past Went Thataway
A smartly dressed, attractive young woman enters a doctor’s office wheeling a luggage carrier. Strapped to the carrier is a large cardboard carton with one word prominently displayed on the side: “Viagra.”
No, that’s not the set-up for a joke. A friend of mine observed this scene while sitting in his urologist’s waiting room. And because he’s an e-Alert reader he knew immediately that the woman was a drug company representative and that her carton was filled with free sample packs of the hottest selling drug for erectile dysfunction.
And how was she received by the office staff? “She interacted with them like she was a fellow employee,” my friend said, “asking the receptionist how her kids were, and chatting with a nurse about a recent vacation.”
What’s wrong with this picture? Not a thing in the world. The woman was laying on the goodness; just doing what all salespeople have done for thousands of years. But while there’s nothing wrong with this picture, it sends an important message that needs to get through to virtually every patient who visits a doctor: Things have changed.
Perks that “educate”
The old patient-doctor trust – which in simpler times was largely automatic – is now outmoded. The relationship has a new model. And if you’re not alert to the change, what you don’t know may hurt you. Of course, this won’t be a surprise to most HSI members, but it seems that little by little the mainstream is catching on.
In a recent NBC News report, medical correspondent Robert Bazell asked: Is it unethical for physicians to accept perks from drug companies? That question wasn’t answered directly, but the answer was implied when a doctor told Bazell that the best drug company perk he’d ever received was an all-expense paid trip for he and his wife to Monaco in the early 80s.
But all that has changed, says that doctor who enjoyed the Monaco vacation. Now, he says, if you look hard enough you might be able to score a trip to Hawaii. (Help me out here – how is that a change?) But failing that, a doctor can enjoy a nice meal almost any evening with a drug company representative if he doesn’t mind listening to a sales pitch.
Of course the drug companies don’t refer to this as a pitch. It’s “education.”
Education, pitchcall it what you like, it’s still sales. And this sales drive is one part of a two pronged attack. Your doctor gets wined and dined (and sometimes vacationed), while you’re subjected to a daily barrage of television and print ads known as direct-to-consumer advertising (DTC). So every time you walk into the examination room, at the moment when it’s supposed to be just you and your doctor, the two of you are not really alone because you’ve both been elaborately conditioned to purchase the products.
I’m not a patient, but I play one on TV
Richard Kravitz, a professor of medicine at the University of California, recently led a team of researchers in an unusual study to evaluate the effects of DTC advertising on doctors.
The researchers recruited several actors (referred to as “standardized patients” or “SPs”), to pay visits to more than 150 internists and family physicians. In nearly 300 visits, the SPs described symptoms of major depression. When they mentioned an antidepressant drug by name (Paxil) more than half received a prescription. When they asked for a drug without stating a specific product, more than 75 percent received a prescription. When an SP didn’t request or mention medication, prescriptions were written in more than 30 percent of the cases.
In half of the visits, SPs described symptoms such as stress or fatigue that don’t necessarily indicate depression. In these visits, when the SP mentioned Paxil more than half received a prescription for the drug.
These results are revealing, but not really surprising. What is a little surprising is this wrinkle in the design of the study: All of the SPs visited the doctors unannounced, without having made an appointment. So in each case, the doctors were seeing a patient they’d never seen before, who walked in off the street, simply asked for a prescription and, in the majority of cases, received it.
Turn off the autopilot
Soshould we regulate? Some of the commentary I read on this study called for new government regulations to oversee the relationship between drug companies and doctors. But this is just typical quick-fix thinking. Put the feds on the case and everything will fall in line? Hardly. The major drug companies run rings around the FDA as it is. Expanding the Code of Federal Regulations will accomplish one thing: it will expand the Code of Federal Regulations.
Meanwhile, here in the real world, it’s self-regulation time. Now that more and more patients are beginning to understand the many ways drug companies influence a doctor’s choices, it’s time to rethink the patient-doctor relationship, understanding that the trust you place in your doctor can’t be automatic. That’s not to say doctors don’t deserve our trust. But as the Kravitz study illustrates, trust is earned, not given.
In the end, each of us has to take responsibility for our personal healthcare. So with every decision a doctor makes, a responsible patient must ask himself: Is this choice motivated by my needs or by a drug company sales drive?
To Your Good Health,
Jenny Thompson
Health Sciences Institute
Sources:
“Drug Companies Pile on Perks for Doctors” Robert Bazell, NBC News, 4/20/05, msnbc.msn.com
“Influence of Patients’ Requests for Direct-to-Consumer Advertised Antidepressants” Journal of the American Medical Association, Vol. 293, No. 16, 4/27/05, jama.ama-assn.org
“Doctors Influenced by Mention of Drug Ads” Shankar Vedantam, Marc Kaufman, Washington Post, 4/27/05, washingtonpost.com
