personalized medicine

One of the most popular stories on the BBC website this week is entitled,"The United States of Advertising." In it, the author takes on the direct-to-consumer (aka "DTC") advertising practiced by the drug industry in the US. One only has to step outside the country for a few hours to realize how unusual and bizarre this practice really is. Needless to say, the drug industry loves it and for a good reason: it really pushes sales of drugs into blockbuster territory. It has nothing to do with healthcare so much as with opening whole new markets for spending and consumption.

The success of DTC is the main reason the pharma industry has overwhelmingly moved their headquarters to the US. Unfortunately, it has also morphed drug development into a business that requires blockbuster sales numbers just to please Wall Street investors. It is called ROI or return on investment. ROI's make anything but a $1B a year drug a non-viable option for the industry. It is a prime example of how unlimited greed distorts our society. In the end we all pay.

The role of doctors in safeguarding patients is now seen as an obstacle to be conquered. The article points out for example that a simple message is sent: "If your doctor is not offering you this drug, maybe you should ask for it." What it does not say and what is perhaps more important, is that if your doctor does not offer you this drug, maybe you should find another doctor. Get a second opinion as they say in the business.

The author observes that the ads are "sending us in to see the doctor filled with nameless dreads about the symptoms of diseases we might have and a detailed knowledge of the drugs that might help us." This is putting it nicely because the DTC practice not only makes the doctors non-players, it also takes the disease out of the equation. It urges consumers to pop pills whether they are ill or not and whether their doctors think they should or not. I.e. as long as you dread symptoms of a disease you might have, you should take our pill. For good measure the ads are filled with common symptoms that are portrayed as the insidious portents of horrible illness. And those that may otherwise be thought of as harmless are shown as causing great social embarrassment.

Never mind that the symptoms are often caused by irrational behavior, nearly always overconsumption of one sort or another. In the author's case, a minor addiction to beef jerky. While the rational response would be to stop eating something that upsets one's stomach, the "appropriate" response is to keep eating it and go see a doctor instead. Once there, express fear that one maybe affected by "acid reflux disease" or some other horrendous malady, and ask for Nexium, affectionately known to the consumer as the "purple pill." The doctor better behave and do as you demand lest you seek a second opinion on the matter.

In other cases, a little insecurity will do the trick. Not up for intercourse tonight? Maybe you need Viagra, or -if you are frequently interrupted by social gatherings- Cialis perhaps? Aren't you happy that America's pharmaceutical companies are fighting the life-threatening illnesses so we may all live longer?