A CNBC "guest expert" Wednesday, July 23, 2008 said something that has stuck in my mind that I need to sort out. He said that the entire pharmaceutical industry of the U.S. is now changing its marketing practices by encouraging American patients to request specific medicines. This CNBC guest went on to say that this marks a "sea change" by drug makers trying a new marketing strategy that makes patients aware of certain prescription drugs with relentless advertising.
As well as targeting the doctors as they have always done, now pharmaceutical companies are also aggressively targeting the end consumer, the patient, with prescription drugs and asking them in the ads to take the drug name to the doctor. I didn't think too much about it during my busy day, but it kept coming back to haunt me involuntarily because it explains what I have been suspecting for some time.
I think this new "sea change" started with new "enhancement" drug advertisements that are certainly graphic and not suitable for family television. It looks like the revenues of pharmaceutical companies are being increased with this new, off-color advertising of prescription drugs with kissing, scantily clad actors making naughty look respectable. But now the prescription drug ads have moved on to other medical problems. These ads discourage keeping secrets of your medical issues and encourage you to learn about rather alarming issues that they focus on and describe and amplify, from restless legs to (big secret of millions!) constantly leaky bowels, to discuss them with your doctor and request their pill remedy by name.
Drug companies have long widely advertised over-the-counter drugs, (Aspirin, Pepto-Bismol) but the difference now is that companies want patients to request certain prescription drugs from their doctors according to drug makers. Indeed, there is a new commercial that urges patients to say to their doctors, "Let's Have the ......(drug) Conversation".
Scoldings have so far been my reward for mentioning a possible prescription drug to a doctor. I suppose this "sea change" in advertising to the patient is a capitulation, or at least acknowledgment by pharmaceutical companies, that consumers are informed enough (presumably it is the internet that has changed patient awareness) to be able to ask their doctors for specific drugs.
Odd how the internet is blamed for changing the good and bad that has already long existed in society when it has only increased awareness and sometimes creates a sense of urgency or immediacy. I know that in my case, with most doctors I have seen, I tend to keep it fairly formal and avoid asking potentially embarrassing questions unless completely unavoidable, even childbirth specifics (for which there are classes). Doctors generally won't take the initiative to ask potentially embarrassing questions either, at least in America.
I think doctors should take the lead and not be shy. Maybe they could try harder to create environments conducive to answering intimate questions. Sometimes having a caring, detailed questionnaire filled out before an appointment helps to remind a patient of issues to discuss and encourages openness. Sympathetic, non-judgmental conversations would be more caring to most patients and provide better care. Being judged harshly (or scolded) for making personal behavior choices inevitably produces hostility. Probably this is why doctors shy away from the intimate, embarrassing questions they should ask. They wait instead for confessions of weakness that might not come.
I haven't requested any drug lately, as I generally avoid drugs, but that could change if everyone else is doing it, and if doctors know that the pharmaceutical companies are encouraging informed patients to request drugs. I thought we are all supposed to take our symptoms to the doctor and that the doctor is supposed to decide what the symptoms mean. Maybe lots of patients are suddenly showing up in doctors offices with the same (heavily advertised) unusual health problems, with drug suggestions.
Here are my random questions:
- Will unexpected knowledge of drugs on the part of a patient make a doctor impatient, or worse, ignore symptoms, if a patient self-diagnoses?
- Will it create a sometimes sinister atmosphere of threat of possible litigation if the patient, a possible drug buyer (like a store customer) is usually correct and wants the medicine now "or else"? I have already felt this by doctors whose first priority, it would appear, is to cover themselves from that threat of legal consequences.
- Will drug requests poison and erode a fragile doctor-patient relationship or will it not matter in the long run?
- As patients, will we soon seem lazy or ignorant if we don't offer drug suggestions for our own health issues that we are consulting and questioning the doctor about? How crazy that would be.
Maybe next, a way will be found (and probably already has been found) to profit from the internet by bypassing doctors completely. These profitable websites (definitely in business with drug makers) might encourage unsupervised self-diagnoses and self-medication with prescription drugs as we all do from time to time already with over-the-counter drugs. (I am sure the internet will again be heavily blamed as the enemy when things go wrong, as they inevitably will). Of course, this all sounds highly dangerous and undesirable. And I don't think doctors will ever be out of their jobs, as long as they keep considering caring for their patients their number one priority.