Previously, I wrote about the patient’s responsibility to gain knowledge about their condition and treatments, and how this is not always easy to do. This is increasingly important, however, as clinicians have decreased time with patients for reasons often beyond their control.
This need for knowledge applies not only to medical visits, but also to advertisements for nostrums (e.g., Neuriva) and for legitimate drugs. Both create enticing visions on TV and the internet that (over) emphasize potential while minimizing negative aspects.
The First Amendment protects these ads, and there are limited regulations on them. The FDA and advocacy organizations have expressed concern about the lack of significant content for years. Although the FDA has considered directives requiring more information and less glitz in the TV ads, they have delayed proposing them, and the effort was canceled by the present administration. These regulations would not have affected internet ads, which are even less substantial, but harder to control as they are often delivered by influencers rather than by companies.
I wrote about the picture given by a drug being marketed for certain cancers that showed how wonderful life could be with its use, about two years ago; that people would be as fit as they had been before the disease up until their demise. I raised questions about these claims. A recent review noted that this wonder drug offered little benefit, confirming my concerns.
The man, the heart, and the couch
I am presently irritated by ads for a drug to lower cholesterol. One version is especially irksome. In it, a thin gentleman, over 50, sits at one end of a couch. At the other end is his heart. A woman is sitting in a chair facing them both.
The man and his heart disagree over his treatment after a heart attack. The man contends that the lifestyle changes he has made are sufficient along with the statins he is using to prevent another attack, but his heart is advocating asking his clinician for the advertised medication to further decrease his cholesterol and the possibility of another heart attack.
The woman is mediating the disagreement. Her status is ambiguous, except that she is not a medical professional. With no knowledge of the man’s present status or the extent of his lifestyle modifications, she agrees with his heart that he needs to inquire about the drug. In doing so, she commits a crime and breaches professional ethical standards, assuming she was a mental health professional.
The crime is blatant. As a non-medical professional advising the use of a medication, she is “practicing medicine without a license.” Depending on the state where this occurs, and whether he takes the drug and any damage results, this could be a misdemeanor or a felony. Of course, people recommend treatments all the time, but professionals have a higher standard than the average citizen as to what is permissible speech. The ad’s purpose, however, is to sell medication, not to adhere to legal niceties.
Bad caregiving for profit
I was reminded of a recent commercial for a medication for agitation in dementia in which the caregiver approaches her mother from behind without announcing her presence. Understandably surprised, the mother becomes agitated, showing the need for the medication. The daughter violated two cardinal rules of dementia caregiving, but the ad’s purpose is corporate profit, not the display of proper caregiving.
Assuming the woman in the cholesterol commercial is a therapist of some type; by recommending a medication she is acting outside the scope of her training. Having been on ethics boards deciding on actions like this, the penalty could range from a reprimand and requiring added ethics education, to loss of her license to practice if the man suffered significant harm.
The clinical blind spots of advertising
Putting these issues aside, the advertisement presents other problems. As noted, she does not know the man’s present status; perhaps his serum cholesterol level is satisfactory, and no added medication is needed. I would think that if it was not, his clinician would increase his statins if possible or if another drug was necessary, it would have been prescribed.
What other conditions does the man have? Perhaps the advertised drug is contraindicated, and its use could be harmful or deadly? It could result in a severe allergic reaction and death without prompt treatment. It can also cause high blood sugar which can also be deadly if he has diabetes, which is common in older individuals. Too, it can increase blood pressure, which is not advisable with a cardiac condition, and it can increase the likelihood of urinary and lung infections, which tend to be more severe in the elderly, more difficult to treat, and can be life-threatening.
His lifestyle could be explored as there may be more adjustments he could make to lower his cholesterol. This would be safer than adding medication. Alternatively, there are other, less potentially dangerous cholesterol-lowering drugs that could be considered.
So, when you view a medication commercial, do not assume that the glitz means the drug is worthwhile. At most, ask your clinician if they think you even need another medicine, do not ask for a specific one because of a commercial’s attractiveness. Most times, newer drugs are not better than ones already available, only more expensive!
M. Bennet Broner is a medical ethicist.
