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Consumer ads skewing doctor-patient relationships

From the November 1998 ACP-ASIM Observer, copyright 1998 by the American College of Physicians-American Society of Internal Medicine.

By Lucy A. Buencamino, ACP-ASIM Member

Not so long ago, the general public had to worry about being exposed to treatments for minor ailments like halitosis, body odor and dandruff. Now, during an hour of television, commercials hawk treatments for everything from ulcers to impotence, fueling every real or imagined symptom. Although the public needs to be informed about these advances, paid advertising is not the appropriate forum.

Physician visits are supposed to follow a logical sequence of events that includes information gathering, examination and treatment planning. In this new age of customer demands, however, patient visits often start with conclusions and work backward to patients' desired treatments.

How many times has a patient encounter started out with, "Doc, I heard about Medication X, and that's what I want for my sinus headache"? Immediately, we start asking about the sinus headache and wondering what medication we should try first. We focus on the treatment before we have heard the whole story.

Or does this sound familiar? "Doc, I want you to order that new heart test for me just to see if I have any blockages." Hold on! Can we start with the patient's history and determine if there are any risk factors? Is this the appropriate screening test, and is any test even necessary? Has medical practice become a cafeteria, where physicians do nothing more than serve the products pushed by drug companies?

While this reversal of events will not typically endanger a patient's health, it can lead to hasty assumptions and a tendency by physicians to limit their investigations of symptoms. It is a lot easier to simply give in and be "a nice guy," especially when many of us are being measured by how satisfied our patients are and would prefer to avoid confrontations.

We live in a society driven by consumerism and capitalism. Pharmaceutical companies have a responsibility to their shareholders to make a profit, and they only have a few years in which to accomplish this on a new medication before patents run out and "me-too" drugs are produced. The problem is that these companies are spending astronomical amounts of money promoting the drugs and treatments not only to practitioners but to consumers, who aren't concerned about the efficacy and efficiency of other tried-and-true alternatives. It won't be long before these promotions are geared toward children as well.

As a society, we all end up paying for these promotional efforts. Is it right to charge $12 or more for a single tablet? While we are busy blaming managed care for escalating costs and criticizing HMOs for every problem that occurs in medicine, others in medicine are getting away with highway robbery.

Who is countering the pharmaceutical industry's aggressiveness in marketing drugs? Certainly not physicians, who are losing their voice when it comes to controlling the use of medications and their costs.

As a consumer, I am cost-conscious. I take generics, opt for economical alternatives and use nonmedical therapy when possible. I don't feel compelled to try out every new medication on the market; in fact, I am leery of these new drugs for the first one to two years. I've seen anti-arrhythmics, antiemetics and weight loss medications withdrawn too many times because of unforeseen side effects.

I embrace the advances made in medical treatments and hope we will one day find cures for all illnesses and medical conditions. However, I support a more conservative approach in situations that are not life-threatening, and I would like to see pharmaceutical companies evaluate their methods and pricing in order to make the best therapies available to the greatest number of individuals. I hope we do not jeopardize the patient-physician interaction by making demands for a product more important than a thorough review, examination and presentation of alternatives, from which the best treatment can be selected.

Dr. Buencamino is a general internist and assistant medical director at MacGregor Medical Association in Spring, Texas.

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