White Coat Underground

In a recent post, Dr. Free Ride made some excellent points about conflict of interest and medical professionalism (emphasis mine):

What I find more interesting, and problematic, here is [the authors'] unexamined premise that it is a bad thing that medical experts have a certain kind of monopoly. Indeed, their monopoly is recognized by the state: you can’t practice medicine without being properly trained and licensed.

Because of their specialized training, physicians and medical scientists have an expertise that arguably puts them in a better position than the state to promulgate disease definitions and treatment recommendations, and to evaluate research reports. Neither lay people nor elected officials can be assumed to have the expertise to make these decisions. Asking the state to make the rules about which submissions to a medical journal ought to be accepted seems like a really bad idea — so why would asking the state to interfere with the judgment of medical experts in such “gate keeping” seem like a good idea?

I bring this up not because she hits it just right, but because the whole idea of medical “expertism” bugs people. As an internist, I have knowledge that others do not. People seek me out for that knowledge. Application of my tools without the proper knowledge is a very dangerous thing.

That’s why direct-to-consumer drug advertising is a bad idea. It puts a profit-making, product-promoting entity between the patient and the doctor. It essentially enlists the patient in its advertising campaign. These ads corrupt the doctor-patient relationship, and attempt to “de-professionalize” medicine.

Many of these ads are simply deceptive. For example, a popular allergy pill is advertised as being the only one approved for “indoor and outdoor allergies.” Medically, this makes no sense, as they are the same thing. It’s a simple technicality. But really, deceptive or not, these ads are a bad idea.

So, when I saw the headline about objections to certain drug ads, I figured there was some sort of health concern, such as a failure to disclose risks.

Nope. Rather than complain about unethical or deceptive ads, the complaint was about the unseemly nature of one particular common medical problem, erectile dysfunction.

Give me a damned break. This is just another fake morals issue at a time when the entire economy is in the shitter. According to one Representative Jim Moran (D-VA) who apparently isn’t concerned about Pakistan’s nukes or Comerica’s solvency:

A number of people have come up, including colleagues, and said I’m fed up. I don’t want my three or four-year old grandkid asking me what erectile dysfunction is all about. And I don’t blame them.

Hint to all of you offended by ED ads: your kids are going to be asking difficult questions FOREVER. You’d better learn to answer them. Also, these ads aren’t placed during Sesame Street. How do you handle questions from the kids about the plot of Desperate Housewives?

Look, I’m all for getting rid of direct-to-consumer drug advertising (and honestly, I’d like to get rid of direct-to-doctor ads too). But to single out ED ads because they give you the willies is just plain stupid.

Comments

  1. #1 Stephanie Z
    May 7, 2009

    Not to in any way undermine your message, which is dead on, but that’s the best use of the phrase, “give you the willies,” ever.

  2. #2 PalMD
    May 7, 2009

    heh.

  3. #3 John H.
    May 7, 2009

    Indeed. Frankly, incontinence ads really piss me off, too.

  4. #4 PalMD
    May 7, 2009

    so you’re saying we shouldn’t be so hard on ED ads?

  5. #5 Danimal
    May 7, 2009

    Seeing Bob Dole do a ED ad, that gives me the willies. Ew.

  6. #6 Mike Haubrich, FCD
    May 7, 2009

    I’m not as bugged by the ED ads as I am the bogus ED ads; the ones that don’t claim to cure ED but claim that they make men larger in that “certain feature of the male anatomy (wink, wihk, nudge, nudge.)” These things appear on late night infomercials so why not just use the word penis?

  7. #7 leigh
    May 7, 2009

    but the ads for genital herpes treatments, those are totally cool. they can be used as instruction in why sex is horrible and bad and can hurt you.

  8. #8 RMM Barrie
    May 7, 2009

    “Pfizer is committed to responsible advertising,” the company said. “In line with our policies and the policies of the industry, Viagra advertising is aired in shows most likely to reach men suffering from erectile dysfunction.”

    Demonstrates why direct to consumer advertising is morally bankrupt in every conceivable way, and should be banned (as in Canada, which is a ruse because US station advertising gets here).

    Jim Moran wants a 6AM to 10PM ban so those he talked to do not have to explain erectile dysfunction. Guess hemorrhoids, incontinence and condoms is easier to explain. Mind boggling dumb. Enough of this science-y show and off to bed so I do not get typecast by Pfizer, as it is almost 10.

  9. #9 Kim
    May 7, 2009

    @leigh: It’s about suppression! (Sorry, couldn’t resist a little primetime TV herpes ad tag line humor.)

    I would love to see direct to consumer drug advertising go away, I just don’t see what positive value it brings to the situation.

  10. #10 Dianne
    May 8, 2009

    (and honestly, I’d like to get rid of direct-to-doctor ads too).

    In principle I agree but the problem is that drug companies are always going to have an agenda (selling their drug) and are therefore always going to want (need?) to advertise. If they aren’t allowed to do it openly, they will resort to more tricks like fake journal, supposedly independent “institutes” which are really run by drug companies, and other dishonest methods of advertising.

    So in the end I’d rather have a drug rep wander by occasionally and say, “Hi, I’m from Amgen and I’m here to tell you why neupogen is the Best Drug in Existence” than have to sort through whether the Institute for the Study of Neutropenia is legit or a cover organization for Amgen. Not, of course, that drug companies might not simply do both.

  11. #11 Stephen
    May 8, 2009

    Today’s Physician should consider Thinking IN and Outside of the NE Journal of Medicine Box.

    Are not > NE Journal / Medical Journal Studies > Lagging Indicators anyway > confirming what many physicians already know ?

    Are they not just Pharma Studies to back up some Pharma Drug that ONLY Masks Symptoms and does nothing to Address Source of Problem ?

    To me > the cutting Edge Medical Opinion can be found in Socialistic Country Medical Circles i.e. Sweden, Canada, where the Profit activator is diminished & True Medicine is the goal …

    Or > ” Books” published by Forward Thinking Dr.’s who want to get their info out there without the delays / hassles / barriers that ” the Old School System” put in front of them

    > Sure there may be some ” TOO ” forward thinking Dr.’s out there > but here is where your Dr. is the Information Traffic Cop to make the decision.

    To me physicians suffer from ” Not Invented / Studied Here ” Syndrome and only considier Evidence Based Info from the US > stating non complicance with their study methods / excuses just so they can ignore ..

    I also know that most Dr.’s are ” Employee’s” working for Bean Counters and Lawyers and have their Medical Hands Tied by ” Corporate ” protocols ..

    But come on… Break Lose.

    In connecting the DOTs of Illness … You do not have to WAIT for Evidence Based to give you EVERY Single ” DOT ” > Rather an Educated Extrapolation of A > C > F to H is not out of the Question > this is where your training comes into play …

    When you Think you know it ALL you Stop Learning .

    Right now > Your Talents are being held back by your constrained ” methods ” > perhaps it is time to expand and Treat.

    You Guys & Gals have worked VERY Hard, made a lot of Personal , financial Sacrifice to be where you are today …

    You have a gift > Use ALL your Skills / Resources / Logic to do what you went into Medicine for > to HELP Your Patient’s Illness and Return them to a Quality of Life they so desperately desire.

    Keep up the Great work > But Please > Think In & Out of the Western Based Box and see what happens.

  12. #12 DPSisler
    May 8, 2009

    @Stephen: WTF????? “Think int & Out of the Western Based Box and See what happens”

    Simple, people die and/or suffer needlessly. How about you just think logically, examine all the information and use what works based upon science?

  13. #13 Michael Simpson
    May 8, 2009

    As the only individual AFAIK that actually is employed by and makes significant money in Big Pharma, I’m not sure what to think. I agree that direct to consumer advertising by the Pharmaceutical industry is horrible. Thankfully, it’s protected by the First Amendment to the US Constitution. I think all of you know it well. Free speech. Shall we review? I’m sorry but I’d rather see ED ads (well, I don’t watch ads ever since I got TiVo 7 years ago), than have censoring of any sort. So, despite the fact that we all find it horrible, it is protected speech as long as it is violates FDA labeling regulations for medical products. So whatever our opinion, it’s here to stay, because the Supreme Court probably won’t allow its banning. If you see something you think is illegal or off-label, then contact the FDA. Or ignore the ad.

    I do have a problem with these ads subverting physician responsibility. I can only imagine what patients say to physicians when they show up, but if they ask for Viagra, I’m not sure that’s a bad thing. And I believe any responsible physician will make sure that the patient can tolerate the drug. I certainly wouldn’t want to prescribe the drug to a man who’s one prime rib short of a massive MI (for West Wing fans, I stole that).

    Let’s talk about the ED medications. Yes, it’s a comedy routine’s cottage industry to make fun of the drugs and ads. But let’s be serious here. The three main drugs had worldwide sales of about $3 billion in 2007. The EBITDA (a more useful tool of determining profits) probably exceeded $2.3 billion for the three companies that hold patent rights for the drugs. Since much of that $2.3 billion is reinvested in future R&D projects, that’s a lot of cash to find a blockbuster new drug. The company that manufactures and markets Sildenafil is Pfizer, who has a significant oncology drug development business. Maybe the male libido will help uncover a drug that can treat breast cancer more effectively.

    As for ads to doctors, I’m going to have to strong disagree with the good doc who writes this blog. I have about 1000 research studies that show that everyone from primary care physicians to interventional cardiologists learn about new technologies, drugs, and procedures from the marketing and sales efforts of Big Pharma (in which I include the medical device and equipment industry, which is my bailiwick). I watched how the interventional cardiology device industry basically trained and educated almost every cardiologist in the USA and Europe in the late 80′s and early 90′s. Yeah, I know, maybe stents don’t work so well.

    So I hope that I’ve been able to make a contrary opinion to what everyone has said here. Please don’t hate on me, I’m not sitting in my office and rolling in money because of viagra sales.

  14. #14 Dianne
    May 8, 2009

    Thankfully, it’s protected by the First Amendment to the US Constitution. I think all of you know it well. Free speech.

    Is it? If cigarette advertising can be banned (as it is, at least from TV), why can’t viagra advertising? Any lawyers out there who can explain the subtleties of the law on this point?

  15. #15 G Felis
    May 8, 2009

    I think the hype over ED ads is ridiculous, of course, but I do have to take exception to one tiny point: If I wanted to watch baseball (or any other sporting event) with a child, I’d either have to distract the child during commercials or answer awkward questions about ED. Of course, I’d also be exposing them to a metric shit-ton of horribly sexist advertising and alcohol promotion, so the ED ads would be the least of my problem with the assumption that “targeted advertising” doesn’t reach a lot of kids.

  16. #16 Juniper Shoemaker
    May 10, 2009

    Hint to all of you offended by ED ads: your kids are going to be asking difficult questions FOREVER.

    AHAHAHAAHAHAHAHAHAHAHAHAHAHAHAHA!!!!!!!

    (As someone reared in a social environment where questions– particularly “uncomfortable” ones– were oft frowned upon, I take particular delight in this.)

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