In which I play devil's advocate

I don't really know a lot about Andrew Weil, MD. While I tend to be somewhat skeptical of celebrity doctor types (because some of them traffic in all manner of hooey), Dr. Weil doesn't seem all that bad. His website offers vaguely medical self-help and "healthy living" advice, and much of the advice he offers seems relatively sensible, if perhaps couched in feel-good terms I find a bit cloying. But he doesn't recommend crack-pot detox plans or eschew vaccines, so all things considered I don't have much of a beef with him.

That being said, I can't endorse the sloppy thinking on display in his recent blog post over at HuffPo. He takes issue with direct-to-consumer ads for medication. I don't actually like DTC medications ads myself, and consider them detrimental to our overall health, as well. But his argument is shoddy.
Sally Field is a talented actor. But what qualifies her to promote Boniva, an osteoporosis drug that is of limited benefit, has worrisome side effects, and for which there are natural alternatives that merit careful consideration?
Well, Ms. Field appears in the ads as a patient who takes Boniva herself. Thus, while she is obviously being paid to do so, her own experience qualifies her to talk about the product at hand as much as any other celebrity endorsement. (All those athletes who hawk Wheaties aren't nutritionists, after all.)
In "What's Wrong with American Medicine?" I point out that many high-technology treatments have a shadow side. In most areas of life, technological development has made services better and cheaper, but (with a few notable exceptions) it has made health care worse and more expensive. The result: an unhealthy populace and an economy that's lurching toward disaster.
I'm not going to quibble with the idea that our health care is too expensive and yields outcomes that are frequently poorer than those in other developed countries. This has been well-documented. But decrying the technological advances in health care as generally making it worse is patently ridiculous. Heart attach victims have much higher survival rates now because of technological advances in opening occluded arteries. We can diagnose appendicitis with much greater ease because of advances in imagining technology. There are myriad examples, and Dr. Weil's medical Ludditism is foolish.
A major component of today's high-tech medical treatment is the reckless overuse of pharmaceutical drugs. An estimated 50 percent of Americans take at least one prescribed medication every day; in 2007, drug sales accounted for an astonishing $315 billion in revenue. When I was growing up, far fewer Americans took prescription drugs.
Um... so? What does that have to do with anything? Many of the medications that are currently available weren't around back then. Perhaps more people would have availed themselves of Claritin (or Lipitor [or Viagra]) had they been available. Perhaps they suffered with ailments (even minor ones) that they would just as soon have done without if they could have. The comparison is meaningless.

On those pesky DTC ads, he writes:
Americans now accept these ads as a matter of course, but in my experience, visitors from other countries find them both amusing and appalling. As well they should: the United States and New Zealand are the only two developed countries that allow DTC advertising.
Again... so? Why does it follow that anyone should be amused or appalled by something just because it only occurs in the United States and New Zealand?
If this anomalous American phenomenon didn't work, it would indeed be merely amusing. Unfortunately, when you "ask your doctor," about a given drug, he or she is likely to hand over a prescription. In 2000, every $1 pharmaceutical companies spent on DTC advertising yielded an additional $4.20 in sales. This bewildering return on investment makes it easy to see why a quarter of drug company revenue is spent on advertising.
I don't dispute those findings, and agree that they are troublesome. However, the libertarian in me (who doesn't get to talk much) puts the responsibility squarely on the patients and their doctors. As much as the pharmaceutical industry functions as an all-purpose boogeyman, I don't see why we should fault them for trying to market their product. It is the responsibility of consumers to make their own decisions with regard to their health, just like they have to decide if they think Pantene will make their hair as shiny as the model's, or that their kids will be suffused with joy just like those kids in the Disneyland commercial.

Further (and I will concede that this can be a big fat pain in the patootie), it's a doctor's job to say if a new medication is worthwhile, or the best option for the patient. Sad to say, but the ease with which patients can stroll home with a new, expensive prescription speaks to lazy medical providers. It's an annoying and frequently stressful part of our jobs to dissuade people when they "ask" us about new medications as per the ads' instructions, but part of our jobs it is, nonetheless.
The free market works well in many ways, but it has failed us here. Whether it is done independently or as part of an omnibus health care reform initiative, we need to make the same decision that the rest of the developed world has made: that is, ban direct-to-consumer advertising of prescription pharmaceutical products.
Well, caveat emptor say I. There are lots of things advertised that aren't good for us. But that's what happens when you value the autonomy and presumed good sense of your populace.

1 comment:

  1. You are such a sensible physician, I almost regret not living nearby so that you could be my children's pediatrician. Fortunately, I do have a talented and caring doc for them, who, like I imagine you would do, takes time to be sure I understand what and why of exams and treatment as well as listening to and addressing my concerns. I value that interaction highly, and I would deeply regret having the economics of healthcare reform reduce this level of communication to improve throughput (if I can use queueing theory terminology).