Friday, March 23, 2007

The Internet's in the Mix as well.....

Well no stone has been left unturned, as I said. Today I got an email from "InfoSessions at Medscape.com" with the title in the Subject line: "GERD Patient Education Program." Well, sounds all nice and good. We PCP's sometimes don't have enough time to go over every single detail of what GERD is all about. Sure, it would be nice to refer our patients to an impartial online source of information about GERD, its consequences, and how to modify the diet to prevent symptoms. The subtitle is:

Could you use extra help educating your patients about erosive GERD?

Wow! Could I? Yeah! It goes on to say, " Making sure that patients understand their medical condition and comply with therapy can be challenging. Now, an exciting new free patient education program from the makers of PROTONIX® (pantoprazole sodium) is here to help you educate your patients about their condition and PROTONIX 40 mg."

Well, there's the catch. It's sponsored by the makers of Protonix (i.e. Wyeth Pharmaceuticals).

7 Comments:

Blogger Andy said...

Hey Sha-man,
Is there a problem in primary care currently with patients coming in and insisting that they be prescribed certain meds they saw advertised on tv?
Also, I enjoyed your post about drug companies and their ties to physicians. I read this in the quotable Osler, and think you might enjoy:
Treatment is controlled by pharmaceutical manufacturers. "Far to large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science. The remedy is obvious - give our students a first -hand acquaintance with disease and give them a thorough practical knowledge of the great drugs and we will send out independent, clear-headed, cautious practitioners who will do their own thinking and be no longer at the mercy of a meretricious literature which has sapped out independence." The Treatment of Disease. Can Lancet 1909;42:899-912

11:01 AM EDT  
Blogger Medicine Man said...

Thank you for your input, andy. For an answer to your question about Direct-to-Consumer pharmaceutical advertising, I recommend reading the book, "Overdosed America" by Dr. John Abramson. He writes an erudite account of the transformation in medicine that has occurred in the last 30 years, which has seen such changes as the pharmaceutical industry sponsoring more of university-based clinical trials by relationships with principal investigators, the infiltration of the FDA by drug money, and Congress passing the law that allowed for the first time direct marketing to the consumer by the drug companies (a law which was lobbied for by the drug companies, of course). With this came the erosion of the old doctor-patient relationship with a building distrust of the physician as an authority on disease. The internet has increased this discord with so much information floating out there to both confirm and refute what your doctor may tell you. We are in a very difficult stage for American medicine, because there is a struggle between providing good quality care that improves health outcomes and the interests of the rest of the medical/pharmaceutical corporate complex. Of note, the U.S. and New Zealand are the only two countries that allow direct-to-consumer marketing by pharmaceuticals.

3:38 PM EDT  
Blogger Andy said...

Thanks for responding, Sha-man. I was tickled at the quote, because it was written close to 100 years ago, and still seems relevant today.
As a pharmacist, and as someone who will be starting medical school this fall and hopes to one day practice primary care, I am curious about how direct to consumer advertising has affected the patient physician relationship. In a time where visits must be hurried and the physician does not have the time necessary to spend with each patient, I guess if there were a lot of demands by patients to try "something I saw on tv" then there could be some pressure to prescribe a drug you don't think is necessary.
Does this happen often?

5:47 PM EDT  
Blogger Medicine Man said...

I reference you back to the book, "Overdosed America," written by a Harvard Medical School professor. It will illuminate how this process has altered medicine, not always in the best interests of the patient. For example, Ambien CR (a combo fast/late release Ambien) showed up on the market just as Ambien, Sanofi-Aventis' original product, was going to lose its patent, making generic (i.e. cheaper) versions possible. The new formulation, of course, is under patent and cannot be replicated. Was it made in the best interests of patients? Well, it's not necessarily the right choice for every insomnia patient. In fact, during their original marketing blitz for Ambien CR, I got a lot of requests to try the new version. Most of those that were granted the option to try it, ended up not liking it. In this case, little harm is done (we think, as we don't yet know the long-term effects of using this type of medication for sleep). In the case of Vioxx, a lot more harm was done.

8:53 PM EDT  
Blogger Medicine Man said...

Furthermore, direct-to-consumer advertising has encouraged a more "stop and shop" type relationship between doctor and patient, taking away from the true collaborative nature of a fruitful interaction between a patient and their primary care doctor. In countries where primary care doctors are the norm for healthcare, people's health is better and utilization of the healthcare system is more cost-effective.

btw, thank you for the quote from one of the most respected physicians in history - Sir William Osler. Here's another:

"It is much more important to know what sort of patient has a disease than what sort of disease a patient has."

The drug industry would have us treat the disease and forget the patient. Whereas, the answer often lies with the patient, and ignoring the whole picture will have one spinning their wheels in vane.

Not to be construed that I am anti-drugs (because they have done great things for humanity). I'm just anti- expensive healthcare when there are cheaper, proven alternatives, and anti- clinical studies that lack impartiality, and anti- not publishing studies that show negative results for a particular drug.

Keep your wits about you, and good luck with medical school.

9:07 PM EDT  
Blogger Andy said...

You're preaching to choir sha-man. If you ever to take one month and study drug literature, you will find that 90-95% of primary literature is seriously flawed.
Here's another good one from Osler:
"Far to large a section of the treatment of disease is today controlled by the big manufacturing pharmacists, who have enslaved us in pseudo-science. The remedy is obvious - give our students a first hand acquaintance with disease and give them a thorough practical knowledge of the great drugs and we will send out independent, clear-headed, cautious practitioners who will do their own thinking and be no longer at the mercy of a meretricious literature which has sapped our independence." The Treatment of Disease. Can Lancet 1909;42:899-912

I will always be able to keep my wits about me, provided there are sites such as this one to go to!

2:15 AM EDT  
Blogger Andy said...

BTW, meretricious: to attract in a vulgar manner. Plausible but false or insincere. Relating to prostitution. (American Heritage Dictionary)

2:18 AM EDT  

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