Doctors step out; drug salesmen step in
“alexplore”
Doctors step out; drug salesmen step in
By Ivan Oransky
Imagine it's late at night. You've been feeling blue for a while.
You turn on the TV, and someone depressed appears on the screen.
Soothing music is accompanied by the name of a popular
antidepressant. ''Speak to your doctor,'' intones a voice-over,
as the formerly depressed patient appears again, this time
smiling and playing with his daughter.
The ad seems to be made for you. So you make an appointment to
see your doctor, who, seeing that you're depressed, prescribes
the drug you saw on TV -- after you suggest it during your
5-minute visit.
Sounds great. A patient was educated and empowered to get the
drug he needed. The only problem: You actually suffer from
bipolar disorder -- formerly known as manic depression -- and the
antidepressants you thought would help you will only throw you
into a mania, placing you at real risk of committing reckless
behavior.
Your doctor didn't ask the right questions. He didn't ask about a
past history of mania or members of your family who had the
disease. Depression -- which you're undoubtedly suffering from --
is actually just half of your illness.
The scenario sounds scary. And it is. But who's to blame? The ad
that sent you to the doctor or the doctor for not making the
right diagnosis?
Direct-to-consumer drug advertising, on which drug companies
spent $1.8 billion in 1999, is growing, with substantial results.
A 1997 survey found that more than a third of patients had asked
their doctors about drugs they saw in ads, and nearly a quarter
of patients had asked for a prescription for the drugs the ads
promoted.
Proponents of the ads say that they help educate patients about
diseases they may not know they have, or about better ways to
treat their known illnesses. Citing actions by the Food and Drug
Administration (FDA) to curb certain ads, critics say many ads
understate risks and side effects or oversell what drugs are
meant for.
More troubling, however, is the segment of doctors who won't
''just say no'' when patients ask them for drugs. In the 1997
survey, three-quarters of patients who asked for a specific drug
left their doctors' offices with a prescription for that drug.
Some doctors think that if they make a clinical decision that a
patient doesn't need a drug they ask for, they'll lose
credibility in the eyes of patients.
''We have a lot of data that suggest that physicians having those
office experiences do roll over and prescribe the drug that's
requested,'' says Steven Findlay, director of research at the
National Institute for Health Care Management.
Direct-to-consumer advertising has become part of our pill
culture. That makes it difficult for doctors to control their
relationship with patients, particularly demanding ones.
Some groups are understandably concerned about these trends. At
its June annual meeting, the American Medical Association (AMA)
considered but failed to approve a resolution that would urge the
government to ban direct-to-consumer drug ads from television,
newspapers and magazines.
Banning the ads, which already are regulated by the FDA, isn't a
great solution, even forgetting that it cuts close to a violation
of the First Amendment. The proposal made at the AMA meeting
would have only sidestepped the real issue, which is that too
many doctors can't or won't spend the time necessary to make a
correct diagnosis.
Pressured by a ticking managed-care clock, doctors take the quick
way out. If it looks like a duck and walks like a duck, it must
be a duck. Who wants to argue with patients? If you're sneezing
and it's May, you must need the antihistamine you saw on TV. If
you have a fever and a cough, you must need antibiotics, even if
that sort of practice gives rise to superbacteria that can't be
killed by any antibiotics in our arsenal, as we're learning.
Many times, that logic will hold and is perfectly safe. But if
you look like a patient with depression, and you're actually a
patient with bipolar disorder, you'd best hope that your doctor
doesn't prescribe an antidepressant without asking the right
questions first.
Doctors need to stand firm and do what's right in the long term
clinically for their patients, not what's right in the immediate
term to avoid angering the demanding ones. The buck stops here,
where the pen hits the prescription pad.
Ivan Oransky, M.D., is editor of Praxis Post, an online medical
magazine.
--
"Thou shalt not covet thy neighbor's ASS" Exodus 20:17/Deutoronomy 5:21
"Thou shalt not lie with mankind as with womankind; it is an ABOMINATION"
Leviticus 18:22 "And if a man lie with mankind, as with womankind, both of
them have committed ABOMINATION: they shall be put to DEATH" Leviticus 20:13
"And the men likewise gave up natural relations with women and were consumed
with passion for one another, men committing shameless acts with men and
receiving in their own persons the due penalty for their error." Romans 1:27
"Do you not know that the unrighteous will not inherit the kingdom of God?
Do not be deceived; neither the immoral, nor idolaters, not adulteres, nor
HOMOSEXUALS, nor thieves, nor the greedy, nor drunkards, nor revilers, nor
robbers will inherit the kingdom of God." 1 Corinthians 6:9,10