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Byline: Yolanda (Linda) Chassiakos, M.D

Local View

The phrase primum non nocere -- "First, do no harm" -- has inspired practicing physicians for generations, underscoring the doctors' duty to ensure that their professional efforts, even if futile, do not magnify the risk or injury to a patient. But a bill working its way through the California Legislature -- SB 1096, by Sen. Ron Calderon, D-Montebello -- would undermine that guiding principle and could result in a negative impact on patient care and health.

Strict confidentiality laws in California currently prohibit health-care providers, unless specifically authorized by a patient, from sharing or selling patient health information or using it for marketing. SB 1096 attempts to sidestep that restriction by allowing companies to obtain patient prescription information and begin direct mailings to patients about their medications. These communications could be paid for by pharmaceutical, medical-equipment or service companies.

The supposed benefit of this legislation for patients would be their receipt of information and reminders about their medications or services to promote education and compliance. The reality of this Pandora's box, however, is that patients would have to "opt out" to avoid being inundated by marketing materials that "encourage" them to keep taking or using expensive brand-name products and services.

Advertisements, in many forms, have become an inescapable part of our lives. Billboards, TV and radio commercials, sponsorships, giveaways -- companies spend billions to separate us from our dollars. These efforts are extremely fine-tuned and focused by experts drawing from more than a half-century of marketing research. The intrusion of pharmaceutical advertising into the doctor-patient relationship will destroy a last bastion of privacy in our very unprivate world.

Supporters of SB 1096 might ask: But where is the harm? How can information provided to patients, albeit by an outside company, be a problem?

A look at the history, effects and cost of pharmaceutical advertising can provide a disturbing answer.

In 1997, the FDA finally allowed direct-to-consumer advertising, leading to an explosion of commercials hawking pharmaceutical products over the airwaves and to a significant allocation of drug company resources to the marketing of these goods.

A recent study in the New England Journal of Medicine found that "spending on promotion grew from $11.4 billion to $29.9 billion from 1996 to 2005, at an average annual rate of 10.6 percent." What's more, "real spending on direct-to-consumer advertising increased by 330 percent from 1996 to 2005." Promotional spending as a percentage of sales went up to 18 percent for some classes of drugs.

The impact has been significant. Research has shown that advertising inflates customer expectations of medication effectiveness. Consumers learn about new drugs before their doctors and, in some cases, before the drug's safety profile builds a good track record. In one study, when asked how they would respond if their physician refused a request for an advertised drug, 46 percent of patients said they would try to persuade their physician to prescribe the medication despite a refusal.

Additionally, concern has been expressed that growing marketing costs may increase the retail cost of pharmaceuticals. A report by consumer health organization, Families USA, documents that drug companies are spending "more than twice as much on marketing, advertising and administration than on research and development".

These costs are passed along to consumers in the form of higher prices for medications.

Health-conscious consumers can defend themselves from a 24-7 barrage of advertising by developing or honing their media literacy skills and approaching pharmaceutical ads with a large grain of low-sodium salt. Providers of health-care services -- and our state legislators -- should not ally themselves with Big Pharma efforts to access databases of vulnerable patients by allowing these companies to invade patients' privacy with manipulative "educational" materials.

Patient education is properly the role of caring doctors, nurses, health educators and pharmacists "doing no harm" -- not of profit-seeking enterprises seeking to disguise marketing as education and support. Supporters of SB 1096 would do well to remember a second timeless phrase as they reconsider pharmaceutical companies' motivation: "There's no such thing as a free lunch."
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Article Details
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Title Annotation:Editorial
Publication:Daily News (Los Angeles, CA)
Article Type:Editorial
Date:Jun 19, 2008

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