Thursday, April 21, 2011

Of Course They're Consumers; What Isn't?

Paul Krugman thinks patients are not consumers:
Medical care is an area in which crucial decisions — life and death decisions — must be made; yet making those decisions intelligently requires a vast amount of specialized knowledge; and often those decisions must also be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping...

The idea that all this can be reduced to money — that doctors are just people selling services to consumers of health care — is, well, sickening. And the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.
Well, like the dismantling of the Fairness Doctrine, that laid the foundations for the takeover of the airwaves by radical conservatives and their sugar daddies, we can lay this one, too, at the feet of St. Ronnie, and you could have seen it coming over 25 years ago:
Direct-to-consumer advertising, or DTC, has been controversial from its inception. Pharmaceutical companies have championed advertising as an effective method for informing consumers of health care choices. Physician groups such as the American Medical Association have opposed the advertisements out of fear of disruption to the physician/patient relationship. From September 1983 to September 1985, at the request of the Food and Drug Administration (FDA), pharmaceutical companies agreed to a voluntary moratorium on advertising. During the moratorium, the FDA sponsored public meetings, invited comment, and conducted research. On September 9, 1985, the FDA withdrew the moratorium, announcing that existing advertising regulations which governed marketing directed toward physicians were also “sufficient to protect consumers.” With no regulations that “pertain[ed] specifically to consumer-directed promotion,” DTC became increasingly popular during the 1990s.

One restraint may have been the requirement that all advertisements include a complete description of risks and side effects. Pharmaceutical companies may have worried that such disclosure, which can take up to a half page of fine print, would detract from the appeal of otherwise “sleek ads on TV or in magazines.”

In August 1997, the FDA removed at least part of that deterrent. The Guidance for Industry Direct-to-Consumer Rx Drug Promotion19 affects only broadcast advertisements on television or radio. Print advertisements must contain a “brief summary” of the drug’s “side effects, contraindications, and effectiveness.” The Guidance authorizes broadcast advertisements to substitute for the “brief summary” an “adequate provision” “by which the majority of a potentially diverse audience can receive the advertised product’s approved labeling.” Thus, the pharmaceutical company may omit the summary of side effects by announcing that interested consumers can obtain package labeling by dialing a toll free telephone number, contacting an Internet site, or visiting a physician’s office. Advertisements for psycho pharmaceuticals began appearing shortly after the FDA published its draft guidance. Mental health professionals have decried the ads as inappropriate because they are directed toward “[p]eople who are seriously mentally ill [and who] often have impaired judgment.” The Pharmaceuticals Manufacturing Association has responded with an opposite take on the value of the marketing schemes: “This is the information age, and more information empowers patients to be able to have more meaningful conversations with their doctors about cures and treatments.” To assist in this goal of empowerment, pharmaceutical companies have recently turned to celebrity pitch makers as “the next step to reach out to consumers.”

DTC may have reached its zenith with the formation of a home shopping television network exclusively devoted to selling pharmaceuticals.
The seed of conversion of patient to consumer has been carefully and deliberately planted, and now the debasement of the healthcare debate shows just how well the tree has borne fruit.