The Perils of Selling Sickness to Consumers
By James Burdick
(A version of this post appeared April 8 in the Baltimore Sun)
There are a plenty of reasons why health care in the U.S. is so expensive and uneven in quality. But the direct marketing of expensive drugs, tests and even medical conditions to consumers is something we actually can—and should—do something about.
One ubiquitous advertiser in my neck of the woods promotes walk-in ultrasound testing of blood vessels and whatever other asymptomatic part you may choose to pay for. Worried older folks can feel lucky that Medicare will often reimburse for these tests. But in fact, the whole course of tests and treatments encouraged by these ads will not improve their life expectancy — and could even have some chance of decreasing it.
Shouldn’t we read these solicitations as symptoms of a very readily eliminated illness that plagues our health care system? An asymptomatic 65-year-old found to have an arterial abnormality in this profit-driven testing facility is almost certain to succumb, eventually, to something else. That is, of course, unless he is told of the findings, goes to his doctor scared, and the doctor injudiciously arranges an angiogram or other invasive procedure. And so this harmful and lucrative practice of persuasion keeps our country’s medical wheels turning.
It is worth wondering: If this test is medically indicated, why has the patient’s regular doctor not already ordered it? And if the testing is done and produces a normal result, how often should the patient get rechecked?
One person in the ad tells us that his ultrasound test detected a narrowing of the carotid artery (one of the two main arteries in the neck that go to the brain), and that he then had an operation to correct it. This is very bad news for both patients seeking quality care and a country looking to control health costs. That expensive operation carries a risk of stroke and is only done in selected cases, almost never on someone totally asymptomatic (apparently the case with this patient). Money was wasted and the patient needlessly endangered.
This is not an argument for denial. Another smiling patient in that offensive advertisement is said to have had an aortic aneurysm found and repaired, which certainly could have saved his life. Not said was how urgent the aortic abnormality was, or whether cofactors such as obesity, hypertension or cardiac disease, which commonly coexist with aneurysms, might have tipped off the family doctor that the test was needed. Yet, even if a panel of doctors were to recommend that every adult have their aorta imaged to rule out the rare spontaneous aneurysm, responsible doctors surely would surely be reluctant to follow this advice to seek that narrowed carotid artery in patients without symptoms.
Is this advertising really so bad? Everybody takes commercials with a grain of salt these days — right?
No. This is harmful profiteering. In their book “Selling Sickness,” Ray Moynihan and Alan Cassels state: “With promotional campaigns that exploit our deepest fears of death, decay and disease, the $500 billion pharmaceutical industry is changing what it means to be human … Because as Wall Street knows well, there’s a lot of money to be made telling healthy people they’re sick.” The creation of this market for well people has been an explicit, aggressive strategy by drug companies. This strategy is apparent in conditions ranging from high cholesterol or high blood pressure to attention deficit disorder, osteoporosis and “premenstrual dysphoric disorder.”
There may well be medical aspects to these conditions. The problem is that the routine of prescribing an expensive medicine with possible side effects, or doing a serious, risky operation, has become accepted by doctors and is expected by the public far in excess of a reasonable likelihood of benefit.
Moreover, advertising to consumers is expensive. The country can little afford the money spent by profitable hospitals, clinics and testing facilities to drive up their market share through advertisements. That money is needed by our health care system to extend coverage that will keep people healthy and protected from medical bankruptcy, and to help the nation’s finances.
Other developed countries prohibit such medical advertising. There are good, responsible medical newsletters in the U.S. that help people think about their options realistically (although we could do better). Media coverage of testing and treatment controversies highlights our lack of an authoritative national process for determining optimal care and publicizing that information.
Nevertheless, preying on people’s weaknesses and fears to try to influence how they choose their medical care is ridiculous, harmful and expensive. It is time to stop it.
Dr. James Burdick, a professor of surgery at Johns Hopkins University School of Medicine, had a career as a transplant surgeon and was director of the Division of Transplantation in the Department of Health and Human Services. He is writing a book detailing his doctors’ plan for health reform. His email is firstname.lastname@example.org.