• Who is Doing the Prescribing These Days — Doctors or Patients?

    by Debra DeAngelo

    After mulling over the “logic” behind our medical marijuana laws recently, it was serendipitous that one night last week, I didn’t set my DVR correctly and was subjected to television commercials during the evening news.

    Normally, I leave the DVR on NBC and hit “rewind’ to the beginning of the news, and fast-forward through the commercials. There’s nothing I want to watch badly enough on TV to sit through commercial breaks, and thanks to my beloved DVR, I don’t have to.

    On this particular day, I was exhausted, plopped onto the recliner to watch the news, discovered the TV on the wrong channel, and frankly, it was just too much effort to hit “pause” and go do something else while some commercial cushion built up. I decided to just endure the commercials.

    Rather than getting annoyed, I viewed it as an opportunity to glimpse into middle America’s television experience… see what sort of manure is being pumped into our collective American subconscious these days.

    I expected a montage of fast food and fast cars, dish soap and laundry soap, diapers for young and old, but what I discovered was far more insidious. So insidious that I was reenergized, and leapt from my comfy recliner and started taking notes.

    Here’s what was being peddled to America during one 30-minute show:

    ~ Pradaxa, for irregular heartbeat (atrial fibrillation).
    ~ Restasis, for chronically dry eyes.
    ~ Enbrel, for rheumatoid arthritis and psoriasis.
    ~ Cialis, for erectile dysfunction.
    ~ Plavix, to prevent blood clots that cause heart attack or stroke.

    So what, you say. Why shouldn’t drug companies advertise their products. I’ll tell you why. Because Average Joe or Jane American doesn’t know diddly-squat about biochemistry. Ninety-eight percent of the population doesn’t have the educational depth or breadth to understand what these drugs do to the human body, and the two percent that does has “M.D.” after their names. And that two percent doesn’t get its medical information from commercials.

    The average person can’t purchase these medications without a prescription. Period. These products are being pitched to consumers who can’t actually consume them. At top dollar during the evening news on a major network, no less.

    Why.

    Why target an audience that can’t actually purchase your product. There’s only one logical answer: because it’s working.

    Every commercial recommends talking to your doctor about taking these drugs. Excuse me? Talk to my doctor about taking this or that medication? I don’t want to talk to my doctor about medications, I want my doctor to talk to ME about medications! I expect her to be fluent on medications and what they might do for me, and to me, not vice-versa.

    What sort of bizarro alternative universe have we stumbled into, where patients are educating their doctors about medications? I’m horrified to consider that doctors are actually being persuaded by their patients to prescribe some really heavy-duty drugs. But clearly they are. Or the drug ads wouldn’t exist. Companies don’t throw millions of dollars into advertising unless it’s paying off.

    Beyond the lunacy of promoting the idea that patients must educate their doctors about medication, the ads invariably end with a high-speed summary of all the medical contraindications for taking the drug (as if your doctor has no clue about your medical history or the drugs you’re already taking) as well as the potential side effects, ranging in severity from blurred vision to cardiac arrest. Some of the side effects are worse than the condition for which the drugs are prescribed.

    Consider Enbrel: “Serious infections have happened in patients taking Enbrel. These infections include tuberculosis and infections cause by viruses, fungi or bacteria that have spread throughout the body. Some patients have died from these infections. Patients treated with Enbrel also may be at risk for other serious side effects including nervous system problems, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes; rare reports of serious blood problems (some fatal); heart failure, including new heart failure or worsening of heart failure you already have; new or worsening psoriasis; allergic reactions; immune reactions, including a lupus-like syndrome, lymphoma and other cancers.”

    Not only can Enbrel cause these diseases, it can actually worsen the condition for which it’s been prescribed! I’d rather have full-body arthritis than roll the dice with this poison.

    But, the ad features a friendly-looking golfer (People! He’s an actor!) who can now hit the links, thanks to this drug. And that’s what we remember, and that’s why we ask for the drug, and… that’s why doctors prescribe it? Really? Because patients want it? Where are doctors getting their medical degrees these days? Bizarro U?

    To bring this full circle, in the mainstream medical industry, trying medical marijuana for my developing arthritis is out of the question. But taking Enbrel (particularly if I advise my doctor that this is what I need, based on my extensive medical background) is perfectly legitimate; it’s far easier to get a drug that could cause a cornucopia of horrific diseases than an alternative “drug” that doesn’t.

    Why.

    Ka-ching, that’s why. Big Pharma doesn’t make any money off back yard pot, and selling drugs is big business, whether on a dark alley or at the pharmacy. But drug makers need dealers. In the case of Big Pharma, the pusher clearly has M.D. after his/her name. Which ultimately makes no sense, because doctors don’t profit from drug sales. So why are they complicit?

    Why?



    • I worked for doctors in private practice and hospitals for 15 years and let me tell you, most doctors get their information from drug reps. The drug reps bombard the doctor’s offices making them run later and later as they leave samples and literature for the doctor’s viewing. Doctor’s are so busy seeing patients that they tend to stick to drugs they know and in some cases there are actually better drugs out there. The reps leave free samples and in some cases the doctors give them to their most needy patients so they can use them for free. Now I would like to think my doctors are up on the latest and greatest and that they stay current with all the journals but I don’t think this is the case. A patient must be his own advocate and I saw many a patient come in with an idea or drug that they heard of that was off the doctor’s radar and it worked for the patient to have the knowledge. MD’s are not miracle workers nor godlike and it is essential today to understand your own medications and how they interact. I am an alternative medicine type and have suggested laser light therapy, hyberbariac treatment and acupuncture to my doctors who weren’t up on all these modalities. I had a very serious wound from a surgery and I insisted on checking these above things out and my doctor now has her patients call me if they want some of these things. She was very appreciative of my effort to help myself. I learned through the years that you must do your own legwork to really see what works best for you and not depend exclusively on your doctor’s knowledge of medication or alternative sources.



    • Oh, very true. I pay attention to whatever the docs give me. But I definitely prefer alternative choices, particularly natural ones. Both my parents were doctors, and I used to work in their office, and I remember the drug reps coming through and all the samples and gizmos they left behind. And I know for sure that back in the day, doctors didn’t watch TV to get drug information. Something has changed, and it seems to be concurrent with the switch from truly private practice to the HMO system. Medicine is Big Business.


      • Debbie

      • July 10, 2011 at 1:28 pm
      • Reply

      I get my medical care through an HMO – Kaiser – and they always prescribe generics. I imagine I could have the ‘name brands’ if I insisted (and was willing to pay a higher premium), so you may be correct that Pharma is trying to convince the consumer that they *need* Brand X and need to ask for it.

      As an aside, my primary care provider is a Nurse Practitioner and she is always interested in and responsive to my obsessive Google research on any issues I am having. I have on several occasions brought to her attention studies with which she was not familiar and together we have modified a treatment plan based on what I’ve found. I know that most people don’t do that – I do it because my mother, who was a walking practicum for any doctor who wanted to study just about any condition, was totally passive and compliant and probably suffered as much from doctoring as from disease.



    • Debbie, it’s not just your mother… lots of people suffer from doctoring! I had doctors all ready to perform carpal tunnel surgery on me for my tingling hands/arms, and a sharp neurologist correctly diagnosed the problem as herniated disks in my neck. I’m very wary of trusting something without another opinion, my regular physician excluded. She’s awesome. Even if she doesn’t support my interest in trying medical marijuana.


      • Carolyn Wyler

      • July 10, 2011 at 4:50 pm
      • Reply

      I too have a problem with pharmaceutical companies. They are out to make money, bottom line as you mentioned. They used to be able to come into our offices where I work, but UCD stopped them from doing that. Not all, but there were a couple doctors that would “prostitute themselves” to these companies. The reps would bring in food, gifts, tickets to shows, games to bribe the doctors into using their products. A lot of the medications were decent meds and ones that the doctors were already using. The free samples of medication that the reps often provided to us were very beneficial to those patients that didn’t have a lot of money and couldn’t afford to pay for medication. So when UCD stopped the reps from coming around, we lost those free samples. I imagine that other places have done the same thing as UCD so since the reps can’t get to the doctors as readily, then they have to go another route, appeal to their patients.

      I am all for patients being aware of what is happening to them medically and know and understand their disease and treatment. But when you have patients running to doctors, after they have looked up all the information on Web M.D. and seen the ads, demanding him/her to give them certain drugs, there can be problems. Though most doctors won’t give in to these patients, you are right, some of them do, usually after after much persistence from the patient. (Again I am not implying that patients should not go to their doctors well informed and ask them for certain meds/tests/treatment and at certain times even be very insistent that these tests be performed at times). The doctor is often limited by the insurance companies (don’t get me started on them) or the business that he/she works for that are telling him/her to prescribe only particular meds or certain tests, trying to get them to spend as little money as possible by ordering very little tests to cut down costs, cause as you said, it’s all about the Ka-ching!


      • Judy

      • July 10, 2011 at 6:28 pm
      • Reply

      What I don’t understand is why anyone would want to take a drug that has all the side affects, including loss of life, that are referred to in the commercials. But I suppose the Pharm companies have done studies showing that if menacing side effects are described in a soothing voice accompanied with images of healthy people, some receptor in the brain is shut down.



    • Carolyn – that is shocking!
      And Judy – there is something mesmerizing about those commercials. Something subliminal going on.
      Check out this link – Big Pharma is spending more money on advertising than research!
      http://www.sciencedaily.com/releases/2008/01/080105140107.htm


      • Linda Hirst

      • July 11, 2011 at 1:08 pm
      • Reply

      Yeah, ka-ching, as in kickbacks to the doctors. From Austin Cline on About.com: Drug makers have readily admitted that they routinely pay insurance companies to increase the use of their products and to be added to the recommended list of drugs. They admit that they give rewards to both pharmacists and doctors for switching patients from one brand of medication to a rival. Finally, they admit that they provide all sorts of gifts and gratuities to doctors, ranging from financial aid to educational programs to bags and writing pads, in the hopes that they will encourage doctors to remember and perhaps prescribe their brand of drugs.


      • Sivan

      • July 11, 2011 at 3:14 pm
      • Reply

      Don’t forget they make a drug for Restless Leg Syndrome, Deb!



    • Debra,
      Pradaxa makes you feel like you are floating. Restasis makes you feel like you can’t move. Enbrel makes you forget everything-that’s the one I like. Cialis, got to get some of that. Plavix makes you need Cialis. If you take them all at once, you will wreck your car. That way the insurance industry will get a larger share in the Ka-ching.



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