Ask your Doctor?

Carl Hendel, MD 3/05

I'm a doctor. Like everyone else I see the advertisements for the major prescription drugs on TV. I listen to the long list of toxic and often fatal complications that are listed by the announcer at high speed, reminiscent of disclaimers on car sales ads, with the little caveat, "ask your doctor."

There are several problems.

First, how much can one human being be reasonably expected to know, even if he/she is a doctor? The volume of micro-details contained in even one reference book is astounding! For example, the PDR (physician's desk reference) that is found in almost every doctor's office is now about 3,400 pages of fine print, requiring strong reading glasses to decipher. To fully comprehend the information, a doctorate in pharmacology, toxicology, mathematics, chemistry, statistics, and more would be needed.

Second, this very database, which your doctor is expected to have mastered, is corrupted. You are supposed to "ask your doctor" to advise you based on a corrupted database! It seems that medical science has been hijacked by the monetary interests of our culture. That includes so many aspects of our society, in advertising, sales, multi-level management, researchers, office staff, and more, in short our entire corporate structure. Financial bias affects decisions, which studies get funded, which raw data makes it into the literature, etc.

Recently we've witnessed the Vioxx fiasco. One of the main reasons that Vioxx was prescribed was because doctors believed that it was safer for your stomach than the much less expansive over-the-counter Advil, Motrin, etc. We didn't know about the cardiac risks. But, very troubling is the possibility that the raw data in the Vioxx studies may show that the supposed increased safety for the stomach may not be true for long-term use. Many people take these drugs for years. How does the financial structure of the industry influence which data is used?

Obviously, pharmaceutical advertising must be effective, since it continues on air and costs money (driving up the cost of drugs for us ). Now, Remecade, a powerful new drug that can offer life-changing relief for debilitating Rheumatoid Arthritis, is being advertised with the "ask your doctor" caveat. The drug can reactivate quiescent diseases such as tuberculosis. How many people will ask their doctor about Remecade for their aches and pains? The doctor, having only a few minutes of time in our currently horrific medical delivery system, to take a brief history, do a focused exam, and make lots of decisions, may or may not make time to study the PDR (which would take hours of expert examination to make educated guesses), cannot do such a decision justice. The prescription of Remecade is a complicated and difficult medical decision that is best made by a rheumatologist and a well-informed patient, not because the patient was sold on the idea by a TV ad.

Do we need to get our information about health from a clearly biased source, the pharmaceutical industry? We have the Internet. We have Google searches. We have reputable medical information available to anyone who chooses to look. You don't have to be a "rocket scientist" to get some useful information. If a person doesn't use the Internet, certainly, a loved one does, and can easily download and print information.

It is sad....... but true. Most of the time, when someone tells you what they can do for you, it is usually about really helping themselves. The pharmaceutical industry is no exception.

If we really want to change things, we need to start somewhere. I suggest that the ads become illegal, and that the savings cost in the advertising budget be directly applied to reduce the cost of the drugs themselves. The manufacture of drugs must be more than a profitable business, selling hopes for cures. There is a piece of soul missing from the formula.