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Medicine for the Masses

Eric J. Plosky

Losing your hair? Chronic allergies? Can’t get it up? Maybe you should be paying more attention to your television -- pharmaceutical companies have lately been advertising all sorts of miracle drugs.

You know those commercials; they’re the ones that eloquently promise a better life, spell out a laundry list of harmless-to-fatal side effects, and then encourage you to consult your doctor. “Cure your allergies forever with Allergynot!... This product may cause dry mouth, nausea, diarrhea, and death. Consult your doctor.”

Sometimes, as federal law dictates, pharmaceutical companies must provide some scientific data (an equivalent to the dense page of text that often accompanies drug ads in magazines). The breathy, beckoning narrator suddenly becomes crisp and precise: “This product proved effective in 44 percent of patients, versus 41 percent for a sugar pill. Death occurred in 25 percent of patients, versus 12 percent for the sugar pill.”

I am quite sure prescription drugs were not always advertised on TV. Then again, the Marlboro Man used to gallop across the screen between acts of “The Donna Reed Show.” The more one looks back over half a century of television commercials, the less surprising is the shift in marketing. After all, Americans have always been ravenous consumerists. The recent publicity given to newly-developed “wonder drugs” has stimulated this consumerism and created a peculiar new monster -- the health-obsessed American, seeking solutions by the pill. Introducing Prozac and Viagra to television is therefore perfectly logical.

Isn’t it? Doesn’t it make sense that companies would want to shill their wonder drugs to the public? Well, of course -- except that there’s a pesky middleman standing squarely between Pfizer and Joe Limp: the friendly family physician. Only this Hippocratic person can authorize the disbursement of prescription drugs; therefore, the doctor must somehow be convinced to employ his illegible prescription-handwriting in order for pharmaceutical companies to make any money.

In the pre-direct-marketing era, doctors made up their own minds, keeping up with pharmaceutical trends and research and prescribing what they thought would do the trick. Patients may have heard of wonder drugs but weren’t themselves barraged by pharmaceutical salesmen. Nowadays, for the typical American, paid advertising seems to be sufficient information on which to base vital medical decisions, so hypochondriacal couch potatoes go off to see their doctors -- not to consult with them but to convince them to prescribe whatever drug was advertised during “Friends” that night. Often, doctors are convinced; it’s hard not to accede to a patient’s wishes.

Obviously, doctors, who know better, aren’t convinced all the time. And not every American goes straight from his TV couch to his doctor’s waiting room, drug slogans eagerly in mind. But the more prescription drug advertisements appear on television (and in magazines and on billboards), the more people begin to think they don’t need a doctor’s opinion. Increasingly, doctors are prescription dispensers, simple mechanisms beholden to Americans eager to get in on the latest wonder drugs.

Granted, in many cases a drug that claims to enhance potency, or allergy resistance, works as advertised. However, the problem isn’t that companies advertise individual pharmaceuticals falsely or fraudulently -- the problem instead lies with the basic premise behind drug ads. Important question: Should pharmaceutical companies be advertising a “quick-fix” mentality, encouraging Americans to seek consumerist solutions to their medical problems?

Ideally, medicine should be free from consumerist influences. As we know, though, the medical profession began “consumerizing” itself long ago, way back around the time doctors stopped making house calls. Modern health care is dominated by huge, impersonal health-maintenance organizations that, as profit-seeking businesses, are often more concerned with the bottom line than with the level or quality of personal treatment. HMOs have hastened the transformation of medicine into essentially a consumer product. Just as you buy a new car when the old one dies, you visit a doctor these days primarily for specific remediative care -- or in order to obtain a specific prescription. Long-term patient-physician relationships seldom develop, and as a result doctors frequently know their patients not as people with idiosyncratic health histories but only as a list of ailments, or simply as some sort of chart.

Consumer-oriented prescription-drug advertising fits in nicely with this consumerist model of medicine. The importance of the physician is further reduced; even less of a relationship is required between doctor and patient. Though this system may work well for large numbers of people (the HMOs and drugmakers, at least, can rake it in), continued consumerism in medicine bodes ominously for those too poor to pay, and for those too uneducated to sift the pharmaceutical wheat from the chaff.

What alternatives do we have to consumerist medicine? Surely the promotion of lifestyles that are healthful overall is at least as socially important as the marketing hype devoted to Zyban and Propecia. However, some critics charge that promoting healthy lifestyles is fundamentally at odds with the economic objectives of consumerist medicine; they look instead to socialist medical systems, such as the state-administered health care programs of Britain and Canada.

But socialist medicine has significant failings of its own -- I heard while in London last January, for instance, that there are only 1,000 intensive-care beds in all of England. This is presumably because socialist medical systems, though they may be better at encouraging generally healthy lifestyles, lack the economic incentives that motivate private health-care organizations to compete for business.

Is there no middle ground between socialism and consumerism? Can’t we somehow combine the economic efficiency of medical capitalism with the idealistic civic-mindedness of medical socialism? Perhaps not. Perhaps we’re simply on the consumerist road for good -- in which case, we’d better get used to Bob Dole smiling down on us from Viagra billboards.