I Am Not a Doctor

As far as I know, I am not licensed to practice medicine. At least, I have no memory of attending, let alone completing, such training – Pre-Med; Med School; Internship; Residency. I do remember taking an animal science class at Eastern Kentucky University, and I did very well in that, so maybe...I am a vet?

Maybe I have simply forgotten. I am often accused of forgetting things...where my son put the cord to the satellite TV box; where my husband put his keys...things like that. Yes, I am almost convinced that I "slept" through the last many years and medical school because...major drug companies treat me as though I am a doctor! Drug companies are heavily involved in research so surely they checked my credentials and found them valid. These companies seem convinced that I am up-to-date on the latest diseases and afflictions; know how to interpret lab results; am knowledgeable about medications including their possible side effects and possible interactions with other prescription drugs being taken. I realized all of this when drug suppliers began sending me the information I will need to make decisions regarding my prescriptions, rather than wait for my doctor to do it! We all know that such information is sent to...doctors!! If the drug companies believe in me so strongly that they share such information with me, why should I not believe myself to be one?

However...I realized the error in my thinking when I recently picked up a copy of the Readers Digest. Everyone should be familiar the small family magazine that so many people, of all ages – even those with limited reading skills – turn to for a bit of fun; light reading; interesting stories that they might have missed elsewhere. I have long enjoyed that publication. Even as kids, we fought over who would get to read it first (and end up reading the jokes aloud, thus spoiling it for everyone in the family).

I had not read a RD for some time though, so was shocked to find the magazine full of the same kinds of medical information that normally is only sent to doctors (and now to me). It was all there for anyone to see (although I had to take my glasses off in order to read the small print). I realized then that the drug companies are trying to inservice everyone in the art of doctoring!!

Millions of people see numerous drug ads on TV: idiots playing chess in the wee hours; butterflies entering windows that any sane person would have closed to prevent the entry of mosquitoes and cat burglars; people 'celebrating' in a field. One-page; two-page; multi-page ads, all offering medical information to anyone who ever dreamed of making decisions like a doctor, or of becoming an official doctor-nagger. Everyone is being informed; educated; advised – in regards to which medications a patient should decide they want.

Actually, I think drug companies are only pretending to educate everyone. They are aware of IQs and know that only a small percentage of the population are accepted into Med School. They understand that if they want to sell more of their product, they must advertise to create a new market. I believe that their real goal is to create a new kind of patient – an armchair physician who is also skilled at nagging.

These brave new consumers will arrive at the doctor's office prepared to demand a prescription for "L" brand name drug rather than for "Z." These unlicensed medical decision-makers will provide the (real) doctor with information to support their demands – information and claims now widely distributed by drug companies. In many cases, these armchair physicians will only remember the name of the drug – which, of course, will be the drug with the most entertaining commercial or the largest, most complex (i.e. incomprehensible for many people) ads in all kinds of magazines (not just RD!).

These product-loyal drug-namers will have an arsenal to support their demands – small-print ads from the mail or publications; notes scribbled on the edge of a TV Guide; retelling of commercials; anger; tears; threats. The conflict will begin. Just as children do, these "informed consumers" will try anything to push a doctor into letting the patient decide the medication to be prescribed. When Armchair Doctors do not get what they think they want, it will be "no holds barred," and that is probably what the ads hope to accomplish.

I feel sorry for the Real Doctors. In the past they listened to, "My sister-in-law said I should ask for..." or "My 4^th cousin, twice removed, on my father's side of the family, swears by drug "T." Now physicians are faced with drug company claims regurgitated by patients. Ads will be spoken word-for-rehearsed-word, just like poems and pieces small children memorize to make the teacher happy. Too often the words remain meaningless to the speaker. (In school, my father had to memorize a lengthy passage from Chaucer, in Old English, and could flawlessly recite the mostly-meaningless chatter until he died at age 76. His teacher would be so proud.)

But seriously, I believe this new advertising gimmick is going to backfire. This time, I think the drug companies have really stepped into a big cowpie...a fresh one that is only going to spread wider; become stickier; a brown river of no return. Why? Picture this likely-to-occur thousands-of-times scenario:

An Armchair Doctor arrives at the clinic convinced, thanks to a 3-page ad with mail-in envelope, that they will become healthy, strong, sleep like a baby, and play chess like a champ – if only – Real Doctor prescribes "X" drug. Real-doctor disagrees, believing that "Y" drug is much more appropriate for this unique individual with his/her very unique blood tests and history, both of which support the physician's decision.

Request thwarted!! Armchair Doctor moves to the next level of a developing tantrum, waving an ad torn from a magazine, while insisting that he/she be given a prescription for his/her preferred medication (a choice that was encouraged by widely distributed information, accurate or not, and sometimes cute, repeatedly run, television commercials). Real doctor holds firm, explaining possible side-effects and/or conflicts with other prescriptions currently being taken by the patient. Receiving another, and very unwelcome "No," while neither listening to, nor comprehending the doctor's logical explanation, patient resorts to whining, nagging, begging, tears, anger! What is a Real Doctor to do?

A) Give in and prescribe the less appropriate medication, making the patient (and the drug company) happy but possibly putting the patient at-risk.

OR

B) Stick to his educated decision. Prescribe the correct medication, thereby making the patient so angry that he/she either 1) does not fill the prescription, or 2) fills it but refuses to take the pills as prescribed, possibly putting him/herself at-risk.

This is a lose-lose situation and drug companies should consider such problems and the possible repercussions for unhealthy people as such scenes play out. (Lawsuits? Big, 7+-figure lawsuits?) If I were a doctor, I would document everything – "Two ads, usual nagging, whining, and begging. Finally, evil threats of harming myself and my family."

One drug company's ad does includes the statement, "It is important for patients to take their medicine every day as directed by their doctor or health care provider." At first I thought, "Finally! At least one drug supplier is attentive to the basic issue – the health of the patient." I was hopeful that at least one drug supplier was mending its ways...until I read the second sentence, "If patients stop taking 'WOW-Rx' suddenly, they could have chest pain and/or a heart attack." Nothing like FEAR as a sales strategy!

Would it not be more ethical for said company to state, "Whether or not you should take 'WOW-Rx' is a decision that your physician should make. Take any prescribed medication, whether ours, or another's, as it is prescribed. Do not stop taking any medication without your doctor's advice."

As the original second sentence reads, the company may as well have added, "Choose WOW-Rx! You will only be safe if you take that specific, brand name drug. You might even die if you do not take "WOW-Rx," so do not stop taking it until you have taken hundreds and thousands of doses; until you have lost your effectiveness at nagging or threatening your doctor into renewing your prescription."

No, I am not a doctor, and neither are most people, and I believe it is unconscionable for drug manufactures to advertise; to push their products to non-medically-trained persons. This policy – this gimmick – sets patients up to undermine treatment plans that their doctors have chosen after careful study and thorough knowledge of the patient. People should not be encouraged to believe that they know better than doctors regarding how to treat their symptoms. Such unfounded confidence in one's medical knowledge has come about because untrained persons are being bombarded with slick ads by drug pushers companies.

This setting up; this encouragement; of conflict between doctors and patients is unethical and potentially very harmful. I thought so the first time I saw one of the brand-pushing ads, and now I only feel more strongly so. None of the cleverly-worded disclaimers makes me feel any more comfortable about an advertising practice that encourages non-medical persons to believe that they know and understand more than they really do; that gives people the idea of doing battle with medical doctors in order to get what they want and think they need.

I was happy to write a statement that drug companies can include in their final for-the-public ads: "Medical decisions, including assessments, interpretations, treatment plans, and medications, should be made by physicians. We will immediately stop all ads that provide medical information to the general public and will limit our future ads to publications and journals specifically designed and written for trained medical personnel."