The Past Went Thataway

[Guest guest]

" HSI - Jenny Thompson " <HSIResearch

HSI e-Alert - The Past Went Thataway

Tue, 10 May 2005 06:59:00 -0400

HSI e-Alert - The Past Went Thataway

 

Health Sciences Institute e-Alert

****************************************************

May 10, 2005

 

Dear Reader,

 

A smartly dressed, attractive young woman enters a doctor's office

wheeling a luggage carrier. Strapped to the carrier is a large

cardboard carton with one word prominently displayed on the side:

" Viagra. "

 

No, that's not the set-up for a joke. A friend of mine observed this

scene while sitting in his urologist's waiting room. And because he's

an e-Alert reader he knew immediately that the woman was a drug

company representative and that her carton was filled with free sample

packs of the hottest selling drug for erectile dysfunction.

 

And how was she received by the office staff? " She interacted with

them like she was a fellow employee, " my friend said, " asking the

receptionist how her kids were, and chatting with a nurse about a

recent vacation. "

 

What's wrong with this picture? Not a thing in the world. The woman

was laying on the goodness; just doing what all salespeople have done

for thousands of years. But while there's nothing wrong with this

picture, it sends an important message that needs to get through to

virtually every patient who visits a doctor: Things have changed.

 

-----------

Perks that " educate "

-----------

 

The old patient-doctor trust - which in simpler times was largely

automatic - is now outmoded. The relationship has a new model. And if

you're not alert to the change, what you don't know may hurt you. Of

course, this won't be a surprise to most HSI members, but it seems

that little by little the mainstream is catching on.

 

In a recent NBC News report, medical correspondent Robert Bazell

asked: Is it unethical for physicians to accept perks from drug

companies? That question wasn't answered directly, but the answer was

implied when a doctor told Bazell that the best drug company perk he'd

ever received was an all-expense paid trip for he and his wife to

Monaco in the early 80s.

 

But all that has changed, says that doctor who enjoyed the Monaco

vacation. Now, he says, if you look hard enough you might be able to

score a trip to Hawaii. (Help me out here - how is that a change?) But

failing that, a doctor can enjoy a nice meal almost any evening with a

drug company representative if he doesn't mind listening to a sales pitch.

 

Of course the drug companies don't refer to this as a pitch. It's

" education. "

 

Education, pitch...call it what you like, it's still sales. And this

sales drive is one part of a two pronged attack. Your doctor gets

wined and dined (and sometimes vacationed), while you're subjected to

a daily barrage of television and print ads known as

direct-to-consumer advertising (DTC). So every time you walk into the

examination room, at the moment when it's supposed to be just you and

your doctor, the two of you are not really alone because you've both

been elaborately conditioned to purchase the products.

 

-----------

I'm not a patient, but I play one on TV

-----------

 

Richard Kravitz, a professor of medicine at the University of

California, recently led a team of researchers in an unusual study to

evaluate the effects of DTC advertising on doctors.

 

The researchers recruited several actors (referred to as " standardized

patients " or " SPs " ), to pay visits to more than 150 internists and

family physicians. In nearly 300 visits, the SPs described symptoms of

major depression. When they mentioned an antidepressant drug by name

(Paxil) more than half received a prescription. When they asked for a

drug without stating a specific product, more than 75 percent received

a prescription. When an SP didn't request or mention medication,

prescriptions were written in more than 30 percent of the cases.

 

In half of the visits, SPs described symptoms such as stress or

fatigue that don't necessarily indicate depression. In these visits,

when the SP mentioned Paxil more than half received a prescription for

the drug.

 

These results are revealing, but not really surprising. What is a

little surprising is this wrinkle in the design of the study: All of

the SPs visited the doctors unannounced, without having made an

appointment. So in each case, the doctors were seeing a patient they'd

never seen before, who walked in off the street, simply asked for a

prescription and, in the majority of cases, received it.

 

-----------

Turn off the autopilot

-----------

 

So...should we regulate? Some of the commentary I read on this study

called for new government regulations to oversee the relationship

between drug companies and doctors. But this is just typical quick-fix

thinking. Put the feds on the case and everything will fall in line?

Hardly. The major drug companies run rings around the FDA as it is.

Expanding the Code of Federal Regulations will accomplish one thing:

it will expand the Code of Federal Regulations.

 

Meanwhile, here in the real world, it's self-regulation time. Now that

more and more patients are beginning to understand the many ways drug

companies influence a doctor's choices, it's time to rethink the

patient-doctor relationship, understanding that the trust you place in

your doctor can't be automatic. That's not to say doctors don't

deserve our trust. But as the Kravitz study illustrates, trust is

earned, not given.

 

In the end, each of us has to take responsibility for our personal

healthcare. So with every decision a doctor makes, a responsible

patient must ask himself: Is this choice motivated by my needs or by a

drug company sales drive?

 

****************************************************

 

....and another thing

 

File this one under " Study no one was crying out for. "

 

The headline of a NutraIngredients.com report that covered the study

was very intriguing: " Dairy Calcium Has 'No Effect' On Weight. "

 

Inasmuch as calcium intake has been recognized in helping weight loss

diets, a finding like this would be very important.

 

Here's how it went: Researchers at Purdue University recruited 155

women who were randomly assigned to three groups to follow three

different diets for one year. One group continued their normal diets

in which less than 800 mg of dietary calcium were consumed per day;

the second group - a " medium dairy " group - consumed dairy products

for a daily intake of about 1,000 mg of calcium; and the third group -

" high dairy " - received a daily intake of about 1,350 mg of calcium.

 

The results: There were no significant changes in body weight or fat

mass in any of the three groups over the course of the year.

 

The study was led by Dorothy Teegarden, M.D., who told

NutraIngredients.com that the results were " not surprising. "

 

Not surprising? In study after study we've seen how calcium intake may

improve the effectiveness of weight-loss diets for overweight and

obese people. So how could these Purdue results be not surprising?

Simple: All of the subjects were young, active and had normal body weight.

 

Hmm. Okay. So dairy intake causes neither weight gain nor loss for

that very specific group of people: young, active females who have

normal body weight. In which case the NutraIngredients.com headline

" Dairy Calcium Has 'No Effect' On Weight " would be, for most of us,

off the mark.

 

It's almost as if NutraIngredients.com knows my pet peeve about

misleading headlines and decided to punch my buttons.

 

Meanwhile, for information about the usefulness of non-dairy calcium

for those who are trying to lose weight, you can check the e-Alert " A

Date With Density " (1/21/04), which can be found in the e-Alert

archives on our web site at hsibaltimore.com.

 

To Your Good Health,

 

Jenny Thompson

Health Sciences Institute

 

****************************************************

 

Sources:

 

" Drug Companies Pile on Perks for Doctors " Robert Bazell, NBC News,

4/20/05, msnbc.msn.com

" Influence of Patients' Requests for Direct-to-Consumer Advertised

Antidepressants " Journal of the American Medical Association, Vol.

293, No. 16, 4/27/05, jama.ama-assn.org

" Doctors Influenced by Mention of Drug Ads " Shankar Vedantam, Marc

Kaufman, Washington Post, 4/27/05, washingtonpost.com

" Dairy Products Do Not Lead To Alterations in Body Weight or Fat Mass

in Young Women in a 1-Y Intervention " The American Journal of Clinical

Nutrition, Vol. 81, No. 4, April 2005, ajcn.org

" Dairy Calcium Has 'No Effect' on Weight " NutraIngredients.com,

4/18/05, nutraingredients.com

 

************************