Monday, May 11, 2009

Conflicting Reports And Commercials

Today came an announcement of two dramatically different medical conditions and the results of studies which may change a patient's view of each. The article in Time Magazine, by John Cloud, points out the issues surrounding the clinical studies of Depression Medication. And, HealthDay News reported today that conflicts of interest between medical research and pharmaceutical company research is affecting the outcomes of cancer treatment studies- to the detriment of the patient.

What both articles point out is that our doctors, who read information via the same news services, are also getting confused by conflicting reports on clinical studies. Efficacy rates, which should be a priority in medication research, vary for reasons ranging from the patients available for studies, to the demographic in which the research is conducted, to the medications being tested against placebos rather than similarly formulated options. There isn't any one set of standards that are in place that protect the patient and give the researchers accurate information. Each study is done based on criteria set by those in charge of that study.

Company A- which manufactures "Kiwi Juice" can test its product for results against "scurvy". It can sit ten people in a room, have them drink a glass of juice once a day for a week, and put the same ten people in another room and give them access to nothing but bread and crackers for a month, compare the two results, and say, "Kiwi Juice did better at preventing Scurvy than other foods." They'd be telling the truth, but they aren't comparing against citric fruits, or other juices, or under the exact circumstances, and the results could be approved the the FDA.

Pharmaceutical Company B- which is seeking to cure teens of acne, can hire doctors who have promised to only use products from Pharmaceutical Company B. Then, they can ask these doctors how the product has helped their patients. The results will be "Seven out of Seven Doctors agree- Pharma-B is the best medicine for teen acne!" They'd be right. And, results could be verified and approved by the FDA.

When our doctors read the same studies, they assume, as we do, that there have been some sort of standards in place that clearly outline the correct patient for the correct medicine, treatment, or product. In fact, they'd be wrong. Most people who take part in clinical trials are volunteers, not selected for gender, genetics, or age. It is probably not surprising to you that many of the birth control options available to women were tested on male prisoners, some even well into their later years, and not on women of many nationalities, of childbearing ages. And, it's far less surprising that we don't get the full results of a medication or food product until well after it has been in the market and in our homes.

Our doctors are as easily confused as we are. Most are given long sales pitches about specific drugs or treatments that are so convincing that many become advocates for them. In recent news, the failure of a catheter for heart patients has become a big headline, but the information was available as long ago as 2005. There are also failures of heart treatments on women that seem to work well for men. The procedures have been in practice at numerous hospitals and cardiac specialist clinics- and yet, the studies that show proof of these theoretical failures have only come to light after many women died. The first studies published on this were as long ago as 2006, but no definitive tests were completed. Deaths of patients were the only true statistics that could be verified- well after these theories were tested.

A lot of the confusion in our doctors office is directly related to the same television commercials we see when we watch our favorite programs. More confusion comes from the placebo affect patients feel when given those same publicized drugs and treatments. Psychologists have long confirmed that hearing something enough will make it seem factual, even when there is a lack of supporting information. As patients, we're likelier to believe a celebrity endorsement of a treatment before we read the facts and statistics. When we hear our friends say "This worked wonders for me" enough times, we start to believe it will work wonders for us too.

You may note that the birth control option, Yaz, has changed their advertising to make it sound more truthful. It begins "We have been told by the FDA that we should clarify points regarding the prescription medication, .." Then a very pretty woman, with a very sincere face, explains the side effects and issues with the medication, including the words "fatalities". In fact, previous advertising listed the exact side effects, but in written form, so it wasn't as clearly stated to the television consumer. Our favorite magazines, Sunday paper inserts, and even posters on public transportation, advertise medication and treatments, showing required Side Effects, prescribing information, and the phrase, "Be sure to talk to your doctor about...".

As consumers who want to sound informed, we may just do as the ad requested, and say to our doctors, "you know, I'm reading about that pill X, and it says that it would be good for people like me who have Y." Your doctor probably has seen the same advertising, and even heard other patients request the same medication for the same reasons. Your doctor is under the belief that this medication is something that may help you because you have told her so. The doctor may have other patients who claim to feel different on that treatment. The placebo affect may prove true, or the medication formula may be the one you need, but do the research beyond the advertising first. Keep in mind that every thing we see on television is designed to make us watch, and repeat what you have learned. That's the power of group thought, of advertising, of things that SOUND true.

Tonight, I saw an advertisement for the product touted as a cosmetic industry "must"- Botox. This form of botulism has proved useful to patients who suffer from MS, and those who have nerve damage, joint issues, and even muscle atrophy. But, the ad featured a beautiful actress, Virginia Madsen, who also offered her story for People Magazine. Jamie Lee Curtis has become spokeswoman for Activia, a yogurt product which has probiotics as part of its formula. Probiotics are relatively new to the public consumer, but are used in Veterinary Medications, and by gastrointerologists, and have been for years. Botox isn't what improved Virginia Madsen's looks enough to aid her career. In fact, a contract with Botox helped her career, by giving her a new job in the public eye, and offering her an income for letting people know about her use of the toxin.

Both women, beautiful, older, and trustworthy in the public eye, are causing doctors to hear patients requests for "probiotics" and "injectible cosmetics". Neither woman is a medical professional, nor did either take part in long term studies for either treatment. Public trust has helped increase the number of patients coming to doctors. Advertising has convinced doctors to "try" these treatments.

We all are aware of the lawyer advertisements that warn us against the dangers of specific medications, such as Phen-Fen. The lawyer ads are not as prevalent, and instead, for each ad that claims a diet drug causes heart damage, there are dozens if not hundreds more, praising the results of the same drugs. This weekend, Hydroxycut was pulled from shelves by the FDA. As a product that has paid for more advertising that motor companies do for entire lines of cars, this may be the lawyers' next "phen-fen". Because it is an over-the-shelf product, consumers think of it as "safe". We don't often tell our physicians if we are taking a treatment like this, because we mistakenly assume we're safe by taking it. It is important to give your doctor a list of all medications, supplements, including vitamins, and over-the-counter products we consume to keep her informed, and to help protect our overall health. It is part of being a smart self-health advocate.

Today's questions- Have recent news stories changed your opinion of treatments you have had? Have commercials influenced your discussions with your doctors? Do you find that news stories and advertisements are in conflict? Have you read the unbiased studies regarding your treatments prior to accepting them from your physicians?

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