Drug Ads Disservice to Patients and Doctors

 

They were once illegal and now they’re ubiquitous. I’m talking about pharmaceutical company advertisements on television.

If you watch television at all you know what I mean. It used to be that you went to your doctor to discuss medications that might benefit your health. Now you’re inundated with ads trying to lower your cholesterol, your blood sugar, and your “A1C” or raise your sexual performance. Worst yet, you’re told which cancer therapy drugs you should be taking if only you have the exact type of cancer they’re describing in terms you can’t understand!

As a doctor I can barely make sense of these ads so I wonder how the average consumer could possibly understand them. Then there’s the litany of side effects and complications they’re required to mention, so by the time they’re through you wonder why anyone would even consider taking them!

Who Benefits?

It’s hard to see how consumers benefit from this kind of advertising. They really can’t understand the medical language used to describe the condition nor the complex issues hastily covered in a few seconds. Yet many come to their doctors with unreasonable requests based on these misleading ads.

Dr. Melissa Young, writing for PhysicianPractice.com, says:

“I don’t like direct-to-consumer advertising of medications. It’s not the same as advertising for other things. There’s a difference between choosing which laundry detergent to buy and which drug is most appropriate.

On the one side, sometimes patients come in with vague requests. “You know that drug they keep advertising on TV? You know, the one that’s supposed to lower your a1c.” Um, you just described every diabetes medication.  Other times they are very specific, “Can I take drug W for my diabetes”. 

Sometimes the answer is yes, but most of the time the answer is no, because a) you don’t need it, b) you are already on something identical to it, c) you tried something like it before and had a reaction to it, d) you cannot be on it because you have kidney/liver/heart/etc. problems, or e) you said you can only take generic drugs due to cost (trust me, if it’s on TV, it’s expensive).  The bottom line is if I thought you should be on it, you’d be on it by now. 

Sometimes they are misled by the advertisement, or perhaps I should say, they misunderstand what is stated in the ad.  “I want to take the shot that’s just once a day.” You are already on a shot you take once a day, that’s your long-acting insulin.  “But I need to take the other shot before each meal.”  Yes, that’s your mealtime insulin, which you will still need to take even if you switch to the one in the ad.  “But the ad says you only need to take it once a day.” That is true, you only need to take it once a day; you still need your mealtime insulin.

Other times, since ads need to be “fair and balanced,” patients say, “I don’t want to take that drug, did you see the commercial? It says it can cause pain and bloating and infections and heart attacks and DEATH! Why would I take something that could cause death?”

Here are some other physician comments in response to her article:

“It was against the law when I started practicing; as was lawyer and doctor advertising! We should go back to the GOOD OLD DAYS!”

“I agree completely.”

Some disagree:

“It is a natural off-shoot of a for-profit medical system. Would we have many new medical treatments if the government ran it?”

Fortunately, in my practice of orthopedics I haven’t had many patients grill me on the drugs being advertised – because they aren’t in my specialty. But I’m sure internists, endocrinologists, cardiologists, and urologists must be inundated with the questions and requests. Perhaps oncologists must bear the largest burden of trying to explain why Drug X is not the cure for their cancer.

I’m all for informed patients who ask meaningful questions and I have a reputation for taking more time than most physicians to answer those questions. But I believe that these pharmaceutical ads, and internet medical web sites, actually undermine the trust between physicians and their patients.

Every patient needs to find a doctor they can trust for their medical decision-making – and then let that doctor guide those decisions. Drug ads aren’t helping that goal.

What’s Wrong With Taxpayers Financing HealthCare For Unauthorized Immigrants?

 

Last month I discussed how American taxpayers are paying $18.5 Billion to finance the healthcare of illegal (unauthorized) immigrants, according to the work of Duke University economist, Chris Conover. (How Taxpayers Finance Healthcare For Unauthorized Immigrants) Today, we’ll discuss Conover’s four reasons why this is a bad idea.

  • Federal tax financing is unconstitutional
  • Federal tax financing is unnecessary
  • Federal tax financing is immoral
  • Federal tax financing is inefficient

 

Federal Tax Financing is Unconstitutional

This is a simple argument. There just is nowhere in the Constitution that authorizes or requires Congress to appropriate funds for this purpose. Since all federal funding requires Congressional appropriation, any such funding is unconstitutional.

In fact, Medicaid and ObamaCare expressly forbid funding of healthcare for illegal immigrants – though it happens anyway. The prime example of this is in the State of California where the Health For Kids Act allows state Medicaid funds to be used for healthcare for unauthorized immigrant children.

Federal Tax Financing is Unnecessary

Since Federal taxpayers finance $11.2 Billion of the $18.5 Billion needed to cover healthcare for unauthorized immigrants, state and local governments would need to pick up this additional expense if federal dollars were excluded. Conover says this would only require a 0.2% increase in state and local taxes – a nominal additional amount.

Having state and local governments pick up the tab would be a good thing since it would incentivize them to be more efficient in the spending of these dollars. It would encourage innovative thinking to lower expenses and improve efficiency and quality of care.

Voters in each state could determine their willingness to provide such care and this would likely lead to redistribution of residents according to the election results. This is currently happening as a result of the new changes in the Trump Tax code. Voters have already shown wide variations in their willingness to pay for expanded Medicaid under ObamaCare.

Federal Tax Financing is Immoral

One way of financing healthcare for unauthorized immigrants might be charitable donations. But if such funding proved inadequate, would we consider it moral to seize the same money involuntarily from American taxpayers? We don’t consider it moral to force taxpayers to pay for abortions, so why should they pay for healthcare for illegal immigrants?

There is a prevailing attitude among some Americans that we are obligated to provide the same standard of living to the rest of the world that we enjoy here in America. Such people are welcoming the caravan of illegal immigrants storming our southern borders in California as I write these words.

But America cannot take on the troubles of the whole world lest we have the same troubles here in our own country. Conover says, “A claim that Americans have some sort of obligation to level up the entire world to the same standard of care as we are willing to provide to our poorest citizens, i.e., those on Medicaid, is fiscally untenable. Medicaid spending per enrollee was $5,736 four years ago. That’s only about 71% of overall U.S. health spending per capita. But more than 70 percent of the world’s population live in nations with health spending per capita below 10 percent of U.S. levels. Ten percent of U.S. levels in 2014 would be $800. Even if we assumed the U.S. spent twice what it needed to on Medicaid, closing the gap between America’s poor and the rest of the world in terms of healthcare would imply spending about $2,000 per person for 4.9 billion people. That would be 9.8 Trillion dollars – more than half the nation’s GDP in 2014.”

In other words, we literally can’t afford it! Taking on a debt you can’t afford to pay is immoral itself.

Federal Tax Financing is Inefficient

Some might argue that collecting taxes to pay for the $11.2 Billion in federal financing of unauthorized immigrant healthcare is more efficient than increasing charitable giving. But Conover points out the fallacy of this argument. He says that there is a 44 cents/dollar expense collecting federal taxes. If the federal government was considered a charity, in the parlance of CharityWatch, the federal government would be given an efficiency rating of D.

In other words, the federal government is very inefficient about the way they collect and spend your taxes. Surprise! There are many charitable organizations that could do the same job much more efficiently – and therefore more cheaply.

If we want to provide charitable donations to support a cause we believe in we can always do so without government intrusion. Support for the victims of hurricanes is a prime example. But federal taxpayers’ dollars shouldn’t be used to support programs or people who are breaking the laws of the same government.

Cancer Therapy Ads Hide the Truth

 

If it sounds too good to be true, it probably is. That’s an old maxim that applies to a lot in life – and especially to cancer treatment advertising.

Cancer patients are among our most vulnerable consumers. The diagnosis of cancer sends shock waves through our systems and we desperately want to hear there is a solution to our disease. Cancer treatment centers take advantage of that desperation.

Steve Salerno, writing in The Wall Street Journal, gives us the unfortunate truth behind many of those cancer center advertisements that sound – well, just too good to be true. By 2020 the treatment of cancer is expected to generate $207 Billion in medical bills. That’s a lot of incentive for those in the cancer treatment industry.

The Annuals of Internal Medicine published a study of cancer treatment advertising in 2014 and found that they relied on emotional appeals evoking hope or fear, while pointedly omitting useful information. “Eighty-eight percent touted treatments and only 18 percent mentioned screening, even though early diagnosis is more critical to survival than the interventions romanticized on TV. Risks appear in barely 2% of ads.”

Typical ads include testimonials, sometimes featuring celebrities. “Natural” remedies are often mentioned to tap into the growing cachet of alternative medicine. Such ads prompted urology oncologist, Dr. Benjamin Davies, to write in Forbes, “Eating a balanced (organic?) diet after your prostate cancer surgery has no effect on your cancer outcome. None. Suggesting it is part of ‘the plan’ insinuates it will. It will not.”

Dr. Steven Woloshin, a medical communication researcher, wrote an editorial in the Journal of the American Medical Association (JAMA) describing his view of these cancer center advertisements: “The appeals raise the stakes, in essence saying you can be saved provided you make the right choice or doomed if you do not.”

Cancer treatment centers are big business. In the decade from 2005 to 2015, ad spending by U.S. cancer centers climbed from $54 million to $173 million. Cancer Treatment Centers of America spent $100 million by itself. In 2016 alone, M.D. Anderson Cancer Center of Houston had seven rotating TV spots that were viewed about a billion times.

Cancer Treatment Centers of America has been widely criticized for deceptive advertising. Their ads proudly tout “genomic testing,” which guides patient-specific chemotherapy. However, the ads fail to mention that there is a dismal success rate of such tests in trials. Only 6.4% of patients were successfully matched with a drug, according to a 2016 study published in Nature.

Part of the problem is that these so-called “direct to consumer” treatment ads do not fall under the jurisdiction of the Food and Drug Administration (FDA). We’re all familiar with pharmaceutical company advertising that is required to reveal all the potential side effects of the drugs they’re pushing. Unrealistic success rate predictions as seen in cancer center ads would never be tolerated by the FDA.

Tim Calkins, professor of marketing at Northwestern University said in an interview with NPR radio last year, “Hospitals aren’t held to FDA standards at all, so a hospital can go out and say, ‘This is where miracles happen. And here’s Joe. Joe was about to die. And now Joe is going to live forever.”

Perhaps this explains a phenomenon discussed in Atul Gawande’s book, Being Mortal. Gawande reports that oncologists typically approach many of their cancer patients with the hope they can survive two or more years while patients report they are expecting to survive ten or twenty years. This gap in expectations may reflect the unrealistic advertising many of the same cancer treatment centers are promoting.

None of this is intended to destroy the hopes of cancer patients. Hope is vital for the successful treatment of any medical condition, especially cancer. Cancer survival statistics are improving. But hope must be balanced with realistic expectations lest patients feel abandoned in their desperate search for the truth about their future.

Here are some realistic cancer five-year survival rates taken from The American Cancer Society:

  • Cervix – 69%
  • Leukemia – 63%
  • Ovary – 46%
  • Brain/nervous system – 35%
  • Lung – 19%
  • Liver – 18%
  • Pancreas – 9%
  • Breast – nearly 100% (without metastasis) to 22% (with metastasis)

 

These survival rates reflect averages with each diagnosis but may vary widely according to the stage of disease at diagnosis. (Note the wide variation with breast cancer.)

If your doctor has just given you a diagnosis of cancer, stop and take time to think before you act. Discuss it with your doctor, consider a second opinion, and then pray. Don’t look to the TV for your answers.