Wednesday, March 16, 2011

Being Patient

When I was taking care of my parents, I spent quite a bit of time as a reluctant viewer of daytime TV.  The stuff that's on after Katie Couric in the morning but before the soap operas in the afternoon.

One thing I quickly noticed is that, after a certain age, human beings (both male and female) are expected to become (in my opinion, inordinately) observant of the ins and outs of their various orifices.  And there are a wide range of products designed to assist them in these observations and ultimately reward their due diligence.

Personally, I made a mental note that if I find myself succumbing to this temptation I will either get a job bagging groceries or find a new hobby-- or both.

Reading Daniel Gardner's book, The Science of Fear gave me an entirely new perspective on this tendency, however (and I'm grateful for that).  Gardner notes that, in many ways, our keen observance of the rituals of health and the symptoms of potential illness is a by-product of aggressive, direct-to-consumer marketing on the part of the pharmaceutical industry.

Think about it.  Prior to 1997, if I had experienced sleeplessness, weight gain, mood swings and general dysphoria, I might have simply decided, "Well, it's January and it's dark and snowing all the time." 

But now, direct-to-consumer advertising informs me that I may in fact have any number of medical issues. 

But never fear, there's a pill for each and every one of them.  I should just ask my doctor.

My mom used to comment that the trade-off in side effects often seemed to outweigh the alleged problem itself.  After all, which would you rather experience: male pattern baldness or impotence?  A panic attack or erectile failure? (At least the latter would no longer be accompanied by the former, thanks to modern medicine.)

Gardner points out that the trend in the pharmaceutical industry goes beyond typical marketing and advertising: "It is about nothing less than shifting the line between healthy and diseased, both in consumers' perceptions and in medical practice itself" (132). 

Pharmaceutical marketing is all about getting us to ask about pills, and we probably won't do that unless we think we have a problem.

We're more likely to ask if we think it's a pretty common problem.  So the pharmaceutical industry tends to push numbers that make it sound more likely than not that we have what our neighbor has. 

For their part, advocates for direct-to-consumer advertising of pharmaceuticals argue that it serves the public interest: it informs potential patients about their options, so that they can approach the medical establishment as informed consumers.

The problem is, which comes first, the patient or the consumer?  In order to be a consumer of pharmaceuticals, we must first be a patient.

So, the industry focuses its marketing efforts on making patients of us all, by offering vague descriptions and ambiguous definitions of a wide range of health conditions.

In countries where direct-to-consumer advertising is prohibited, doctors and medical professionals are the ones who make determinations about who is and is not a patient and what medications she or he might need.  Obviously, this can generate a degree of helplessness on the part of the consumer, who is limited by what his or her doctor determines and advocates.

At the same time, however, the numbers are disheartening.  Money spent on marketing is money not spent on research.  And a lot of money is spent on marketing.

Ultimately, Gardner argues that the pharmaceutical industry markets fear, not health.  Obviously, there are always some advantages to the medications being offered and many people who can benefit from them.  But as in any industry that seeks to earn a profit, it's not just about maintaining a client base, it's about expanding it.

At one point, after listening to the incessant ads promoting a safer, healthier world, my mom said, "I just wonder what people did years ago."  When I commented, "Well, illness was pretty rampant and a lot of people just died," my mom remarked:

"I don't mean in the 1800's.  I mean in, like, 1972."

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Ralph Waldo Emerson once wrote, "Life is short, but there is always time for courtesy."