Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, MD
26 March 2008

YOUR TELEVISION’S PRIME DIRECTIVE

            Separating truth from fiction.  Trying to figure out what is real and what is not.  Trying to understand what is believable and what is simply not believable.  Our modern society puts this task before all of us almost constantly.  What is the best car to buy?  Which beer should the person drink?  What insurance and with which company should a person buy?

            If one watches television virtually every program is sponsored by some company trying to sell their product to you.  Not everyone realizes that the program that you are watching is there to attract you to the commercials.  It used to be commercials took up three to five minutes of a half hour television slot.  Now almost 12 minutes of the half hour t.v. slot is devoted to advertisements.  Your television’s prime directive is to influence you to buy the product that is being advertised.  The ball game or the movie that you watch between commercials is incidental and the program’s only purpose to get you to watch the advertisement.

            In the last 10 years, direct to consumer advertising for medicines has become big business.  Previously, pharmaceutical companies sent their representatives around to visit with doctors directly.  The thought was that the doctor had to write to the prescriptions and therefore educating and influencing the doctor was the primary way to sell a pharmaceutical company’s medicine.  There has been and continues to be turmoil over the ethics and morality of a pharmaceutical company’s influence on a physician.  The physician’s prime directive is to serve the patient.  A pharmaceutical company’s prime directive to sell their product.  Often times, these two motives are both met when a safe and effective medication prescribed by a health care provider alleviates a patient’s medical problem at a reasonable price.

            Whereas doctors are constantly warned and aware that a pharmaceutical representative is trying to sell a product, the general public is not quite so aware when it comes to direct to the consumer t.v. advertising for medications. 

            And so we come to the reason for this column.  A lady moved to Pierre about 10 years ago and I had cared for her medically since then.  She had been diagnosed with fibromyalgia prior to coming to Pierre and had several medications that she felt alleviated her symptoms.  She made it clear that she didn’t want to change her medicines and simply needed her prescriptions filled.  She also wanted to know my views about her diagnosis of fibromyalgia and the implications of this diagnosis.  I reviewed her medical history from the previous physician who had done a very thorough workup.  I pointed out to her the fibromyalgia was a diagnosis of “exclusion”.  Basically, that meant that multiple other diagnoses have been tested for and not found to be present.  She didn’t have lupus or rheumatoid arthritis or a chronic infection or cancer or a host of other diagnoses that had been looked for.  Thus, when other multiple diagnoses are “excluded”, a person is left with the diagnosis of fibromyalgia and treatments are symptomatic to alleviate the pain.  She made it clear that she believed that some day doctors would get smart enough to find the cause of fibromyalgia but we both agreed that that simply hadn’t happened yet. 

            Recently she came for a visit almost indignant that I had not prescribed Lyrica for her fibromyalgia.  She had been watching television and  seen the advertisement pointing out that Lyrica was the first FDA approved medication to treat fibromyalgia and why hadn’t I started that for her?

            I pointed out to her that she was already taking a drug called gabapentin (Neurontin).  I pointed out to her that Neurontin and Lyrica were very similar medications.  They both decreased the sensitivity of her nerves that detected pain.  In other words, the pain messages that she was getting from her “pressure points” were being decreased so that she didn’t hurt so much.  The pharmaceutical company making Lyrica had targeted fibromyalgia patients and shown that individuals with the diagnosis of fibromyalgia felt better when they started Lyrica.  What that pharmaceutical company didn’t show was that the patients taking Lyrica felt better than those taking Neurontin.  I pointed out to her that since she seemed to be stable and doing relatively well, changing her Neurontin to Lyrica was not really a useful step especially in light of the huge price difference.  Lyrica costs about $200/month compared to Neurontin costing about $43/month.

            Lastly, I pointed out a South Dakota rule that seems to work very well for me.  “If it ain’t broke, don’t fix it.”  I pointed out that she seemed to be doing relatively well with the Neurontin that she was taking and that changing to a new medication had the potential for side effects that she really didn’t need. 

            And then I got up on my soap box and pointed out to her that my job was to take care of her.  Television’s job was to sell her a product that may or may not work, may cost a lot more, and may have side effects when she changed medications.  I told her that I would prescribe the Lyrica for her with those reservations if she really wanted to spend more money for her medications.  The Lyrica might work better than the Neurontin was already doing.  I asked if it was a chance that she wanted to take.

            After further discussion, it was elected to put the Lyrica on the back shelf for the time being.  If her symptoms were to get worse, or the Neurontin were felt to not be working as well as she wanted, the Lyrica could be something that she could try to see if it worked better for her.  I asked her to please keep in mind that television’s prime directive is the advertisement, not the program.  For their own protection, the buyer needs to beware!

This and other columns available at www.macpierre.com.