Money and Medical Care

Glycemic control is deteriorating.
Beta-cell function is decreasing.
It's time to rethink what a single agent can do for your patients with type 2 diabetes
It's time for Byetta.
      --Junk mail 




Now there's an advertisement  my eyes skipped over. It's just one of those many fliers I get daily, one of those ads which infiltrate the medical journals,  like the New England Journal of Medicine. They are ubiquitous now. I hardly even notice any more.


Except when I stop to think about it. It's like greasy fingerprints smudged on the walls of your old house; you just don't see the blight after a while.  But it's just one of those things which signifies a much larger neglect. We just don't care any more whether or not medical information presented to doctors is true or not. All that matters is whether or not the company makes money.

Like the fiber industry and the calcium industry, all the snake oils the FDA used to guard against, things which don't work, or things which may actually do more harm than good, like any of dozens of new medications brought on line monthly. The important thing is getting the image out there, the words out there, a kind of background buzz so the names are familiar. And after a while, doctors, especially newly minted doctors lose the capacity to critically appraise drugs, or new therapies; they just numbly write the prescriptions.

I saw a TV ad the other day saying if you were a good mother you'd be sure to feed your kids Fruit Loops cereal because they are a wonderful source of fiber. Fruit Loops ! How much is wrong with this picture? I cannot even begin to count the ways--simply too depressing. Fruit loops. Michelle Obama where are you now? Obesity in America. Fiber. Ye gads. Have you no shame? 



The profit motive, we are constantly told, is a force of good, the best way to encourage the creative energies of American industry and what makes our medical care system the best in the world, the envy of other nations.


Not that any of that is actually true: We no longer have the best system in the world, if we ever did, and we are certainly not the envy of the world. We simply have more glitter and more energy, but we are using that energy to chase after dollars.

So we have local magazines putting out those Best Doctors in Washington, DC or Best Doctors in New York, and you can hardly tell the magazines "ratings" from the advertisements for plastic surgeons, urologists and heart surgeons.

We hear radio ads for doctors. On TV and we see doctors who have their own TV shows advertising themselves while trying to become the new wizard of Oz, the new Oprah. 

Self promotion is no longer suspect, it's admired. It's marketing. It's good.


When I was an intern in the emergency room, years ago, in New York City,  a fifteen year old East Harlem mother brought her three year old daughter with her into the exam room. The mother had a cough and a fever and she brought her daughter in with her because there was nobody to take care of her at home. They spent their days togehter, watching TV.


When I stepped into the exam room, the daughter said, "I seen you on TV."


Apparently, they watched a lot of soap operas with doctors.


I smiled at the mother and expected her to correct her daughter but to my amazement, she said, "Yes, we saw you."


The awful truth dawned on me. These two, the mother and child, did not understand the soap opera was just commercial fiction. To them, it was on TV; it was as real as anything else in their lives.


Now, of course, doctors and magazine buyers are supposed to be more sophisticated than that, but over time, you stop seeing distinctions.


It's like that scene from the last page of Animal Farm, where the animals are looking through the windows into the farmhouse and the pigs are having dinner with the human beings and the animals on the outside look from pig to human and from human to pig, all around the table, and they cannot distinguish pig from human being.