US and NZ sittin’ in a tree, K-I-S-S-I-N-G.

New Zealand is the only other country in the world that allows direct-to-consumer marketing. Those Lipitor ads, the Mucinex boogers — they don’t exist outside of those two countries. The pharmaceutical companies claim that their advertisements provide important educational value to patients. “They can learn about diseases they might have!” the companies say. I say humbug.

Patients learn nothing from these ads, besides seeing ridiculously attractive, healthy-looking, active people pretend to have any number of diseases. I’ve said it before–if the companies were truly interested in educating patients, they would teach them about any number of topics that many patients do not understand. Instead, they hawk products half the time and quickly ramble a list of side effects with the other half left.

Remember–the Pharma corporations are responsible to their shareholders, not the public. Their goal is to make more money, by selling more pills. They do not “educate patients” because it’s good for patients. They “educate patients” because it’s better for their bottom line. Do we not trust physicians to make accurate diagnoses that we need patients to ask for Lipitor?

Ban direct-to-consumer advertising.

If not that, make the field “direct-to-consumer educatisng.” 95% of your advertising time teaches the public how scientific studies work, or what a cardiac stress test does, or why antibiotic resistance is a problem and why doctors don’t like to give out antibiotics liberally, or why CT scans aren’t always a good idea, or why vaccines are safe. There’s an almost limitless number of topics physicians are repeating over and over to patients. In the last 5 seconds, you get to flash your drug logo. “Brought to you by Pfizer.” Put out or get out.

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You know Airborne, that product “invented by a school teacher” that’s supposed to make you feel all better from a cold? It claimed it had a study done to show its clinical efficacy; turns out they finally admitted the “research company” was just two dudes , none doctors, created just to do the study. The company agreed to a class-action lawsuit settlement. Submit your claim if you have one.

(If it’s too good to be true, it probably is!)

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Hey Jon Marshall, DO, thanks for recommending Hydroxycut ! I know you’re just a “Resident Physician” as the commercial says (funny, it didn’t mention you’re a radiologist in training ) but you radiologists interact with patients and advise them on weight loss pretty consistently, right? Look, you’re pretty hot and all, and I’m sure that helps sell the pills, but seriously, dude. You chose medicine for “the science behind it. I also like dealing with people and helping them,” and you’re hawking a product with pretty iffy science behind it (Hydroxycut was sued for making false statements about it being “clinically proven” and paid to settle). And you have to admit, it’s kind of funny that you “like dealing with people,” so you went into radiology.

(Side note: what’s with Midwestern University DO School ? They seem to be churning out the resident DO physician product marketers–it’s where both Dr. Marshall and Dr. Swanson went.)

To be fair, at least the Hydroxycut site gives references for their scientific research (in one study of 30 whole patients, another with 60) plus two studies that seem to be about caffeine and green tea.

But also to be fair, the advertised weight loss of 29 pounds in 8 weeks actually isn’t healthy , Dr. Marshall. And I think people are really looking for long-term weight loss, not just 8 weeks’ worth.

Hydroxycut isn’t limited to DOs, however. They’ve got Nick Evans , a MD and attending orthopedist/sports medicine man hawking the product, too. (At least his specialty is related to exercise and weight loss.) Dr. Evans, dude, you look huge! (My favorite is the Bodybuilding Anatomy book with his head photoshopped on a drawing of a bodybuilder torso.)

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Great piece by a psychiatrist who used to give lunchtime talks to other docs to promote Effexor . $750 a pop for an hour’s talk. And you wonder why it’s easy for doctors to get mixed up in it all. (Answer: we’re human.)

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I just suffered through a stupid Zetia ad featuring this lady:

who goes on to say something to the effect of, “My doctor tested my cholesterol, and it was a little higher than we wanted, so he prescribed Zetia!” And now my life is perfect! (Okay, the last line is my cynicism talking.)

Now, I guess I don’t know all her risk factors, but for an otherwise healthy woman, with a cholesterol level “a little higher” than “we wanted,” I’m pretty sure her doctor should have tried 12 weeks of diet and exercise changes first. Or maybe the guidelines have changed, and the Zetia advertisers are more up to date and know more than me. It’s happened before, I’m sure.

This is exactly the reason every other country has banned direct to consumer snake-oiling advertising (besides New Zealand)–it doesn’t present information fairly or in accordance with national guidelines, doesn’t show patients that your doctor actually has to do some quick thinking and calculating to determine if drugs are the right answer for you, and that drugs aren’t always the right answer for you to begin with. (Drugs have SIDE EFFECTS and can do BAD THINGS to people.)

Let’s either jump on the Evidence-Based Medicine bus–and make our advertisers and patients do so, too–or else it’s going to just be another thing we have to explain to our patients and educate them about. Or, I guess, the other option is to just prescribe drugs, admit patients, and do procedures when we feel like it or think it might be a good idea.

On that note, I think I’ll go ahead and get my appendix out, while I’ve got a few free weeks before I’m back in clinics.

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… are mostly due to inability to show benefit greater than placebo or current therapies . Yikes.

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(The Part Two in the Series)

People seem to be taking sides in our little medblogger health care debates; I hear a lot of people that would be unhappy with a single-payer solution, but not a whole lot of other ideas to fix our health care system (ie: more negative ads than positive ones). The fundamental thing I don’t understand from libertarians is this: what’s a better option? Libertarians would have you believe that if we all just were responsible for our own health care costs, we would decrease our spending and la la la everything would be okay. But that’s not going to happen.

We have a law on the books saying that any ER has to screen patients who walk through the door. Now, you can take this law and do one of two things with it:

1) Keep it, and deal with the consequences that it creates.
2) Repeal it. (But let’s be honest, people, no one but wealthy crazies actually believes that this is reasonable policy.) So we repeal it, and ERs are allowed to turn away emergency patients (or patients who think they might be emergencies). We’re going to let people die on the streets? This would never, ever happen, and if it did–talk about health care revolution.

So here we are. We as a society have agreed that we will take care of the acutely ill, no matter the cost.

From where I’m standing, then, if we’re going to take care of the acutely ill, we might as well keep societal costs lower by preventing people from becoming acutely ill (or from developing the consequences of chronic illness). Am I crazy? Am I missing something here? You can’t tell me that our system makes sense in this way. We will allow an uninsured diabetic to go years without any preventive care, because lack of ability to pay, but once his foot becomes necrotic and he needs an amputation, and gets an ICU stay for becoming septic–oh well, let’s definitely pay for that!?

So here are the facts: single-payer would not cost us any more in ABSOLUTE dollars than we are paying today (as evaluated in the California Health Care Options Project , The Vermont Single-Payer Study , The Maryland Single-Payer Study , Massachusetts Health Care Studies , and Maine’s Single-Payer Microsimulation . Just to be clear, these analyses were done by The Lewin Group and Mathematica Consulting , two economic analyst groups. Not single-payer supporters.

(A note: single-payer critics will say that single-payer causes tax increases; while this is technically true, as money would be directed to the government, it would not be new money, it would essentially be the same money that employers are already paying for health insurance to HMOs right now.)

Single-payer would cover everyone.

Single-payer would slow costs.

Single-payer would allow people true choice–to see any doctor they wanted, provided that the doctor was available to see them.

Single-payer would allow for lower prescription drug costs.

Single-payer would not “cherry pick” healthy people; single-payer would eliminate the American concept of “pre-existing conditions.”

Look, if you have a problem with the “political feasibility” of single-payer, that’s fine, we can debate that. If you’re weary of allowing a government entity to set all health care reimbursement, that’s fine, we can debate that. But to stick your thumbs in your ears and ignore that we’re already ready to pay for emergency care, because of the consequences of the alternative is just stupid, plain and simple.

So, what’s your better solution?

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Dr. Sid takes on direct to consumer advertising , which apparently is now advertising implantable defibrillators. I don’t blame him. All of it should be banned–only the US and New Zealand allow it–to our detriment.

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