Two momentous events took place on Thursday, June 28th, the day I am writing this post. First, the Supreme Court of the United States Upheld the legality of the Affordable Care Act, setting the stage for continued massive healthcare industry change including nearly universal health insurance coverage. I could have written in depth about this topic, I suppose, but so much has already been written that I can hardly think what new angle one might take to make that reportage interesting. I did see a quote from Rush Limbaugh saying he would leave the country if the ACA was upheld, so I was hoping to cover his departure, but so far I have not seen him at the Border. One can dream.
The second news story of the day that caught my eye was the obituary of Barry Becher, the guy who made famous the late night infomercial phrase, “But wait, there’s more!” Becher was an advertising pioneer who brought a combination of sophisticated marketing techniques and Barnum-style grandiosity to the advertising of otherwise mundane and often barely useful household products. Perhaps most famous for selling ginsu knives, Becher introduced the ideas of urgency (“Order now, supplies are limited!”) and visual proof of concept to the TV viewing crowd, paving the way for Sham-Wow, Thigh Master, and a wealth of evidence that there is, in fact, a sucker born every minute.
So how do these seemingly unrelated news stories connect, you might ask? Will consumers be receiving a ginsu knife set when they sign up for insurance through the newly minted exchanges in 2014? Probably not (health insurers don’t give things away for free!) but we are definitely heading now into a world where consumer engagement and accountability for one’s own health will become more important than ever. And in such a world, those of us who fall victim to the advertising of crap health products that offer a panacea in the face of no scientific proof of concept will be the suckers who make the concept of consumer engagement look ill-advised.
This thought came to me as I enjoyed my brief Hawaiian vacation this week, during which, as a consumer, I actively engaged in Mai Tai-fueled Scrabble and beach-related sloth. In one of the very limited moments where I attempted to open my eyes to the outside world, I opened the local city newspaper, the Honolulu Star Advertiser. Prominently featured among the stories of the swimmer who got bit by a shark and the impending RIMPAC, where 22 countries’ maritime military forces are undertaking cooperative maneuvers, were a series of giant advertisements for what I will generously call quasi-medical products dressed up as silver bullet cures for serious conditions.
Considering this is a pretty small newspaper as capital cities go, the amount of real estate taken by these ads was notable and the implications frightening, at least to me. If we are going to cut consumers loose to make better healthcare purchases with monies they more actively control, it is essential that the healthcare information they receive helps rather than hinders the pursuit of healthcare value. That is a fantastic ideal, but our consumer products marketplace is a long way away from it, based on the types of medical-ish ads that we allow to fill the consumer consciousness.
The first ad I encountered on page A8 had a big bold title in a font size of at least 40 which said, “Memory pill does for the brain what prescription glasses do for the eyes, claims US Surgeon General candidate.” In slightly smaller print but featuring the first of numerous exclamation points was this addition, “Remarkable changes observed, helps restore up to 15 years of lost memory power in as little as 30 days!” At the very end of the article, in a font size nearly too small for the human eye to perceive,was this gem, “This product is not intended to diagnose, treat, cure, or prevent any disease. These statements have not been evaluated by the FDA.”
The product itself, a prescription-free pill called Procera AVH, is then described as one that, in a randomized double-blind placebo-controlled study, demonstrated that it could “increase memory, mood and mental clarity, but it does much more than that.” Apparently this study, which was not described in any further detail although they did show a picture of the building where it supposedly took place (?), let scientists observe the formula “biochemically coaxing aging brains to function more your fully, helping restore the speed, memory abilities, and mental powers enjoyed as far back as 15 birthdays ago.” They note that the study results were published in the scientific journal known as JANA. No, that is not a typo for those of you expecting JAMA, but the definition of JANA is conveniently not provided.
But wait, there’s more! A plethora of proof of concept testimonials fills the second half of the ad, suggesting that this miracle pill improves not only memory, but depression, low self-confidence, and even students’ school performance. And with supplies limited, if you buy now you get a free book on brain power and some other product that “helps flush away environmental toxins from the brain to help enhance memory and focus even further.” Call toll-free! Seriously.
In the paper’s next section a full page ad leads with a font size worthy of announcing the capture of Bin Laden and exclaims, “Is Star Trek Medicine Here Now?” The ad is for some sort of seminar that is intended to teach the therapeutic effects of something never fully described called Medinetics. The ad starts thusly:
“What if you could just sit in an energy field and experience your aches and pains diminish or disappear. What if this could help your fatigue, jet lag, and depression and be replaced by a feeling of vitality. What if you could recharge your energy like you recharged your phone, just by plugging in to an energy system?”
It goes on to very obliquely describe some sort of energy field chamber thingy that “generates multiple bio-active life-enhancing energy fields, which can allow cell regeneration, improve immune function, provide relief from pain, detoxify the body, and enhance the body’s Qi to increase energy levels”.
But wait, there’s more! The thingy is an anti-depressant, has an anti-inflammatory effect, improves circulation, and enables neurotransmitter repair. Once again it is mentioned in passing that the FDA has not blessed these claims, but never you mind–lots of unnamed doctors use it and even Dallas TV show actress Linda Gray says it is the cat’s meow, making her feel like her “cells are pumped up.” I can hear them responding to the Theme from Rocky now. Even better is the obligatory proof of concept testimonial from some retired doctor saying, “Thanks to the system, I’m in my 70s and I don’t have any gray hair! And this is probably the best prostate treatment in the world.” Makes me wonder exactly what part of you goes into the chamber. I am guessing that the next version of the product will also effectively remove stretch marks and bring harmony to the Middle East.
How can we expect consumers to be effectively and properly engaged in making healthful choices when they are subjected to a barrage of quackery like this, dressed up in pseudo-science and packaged with a slick sophistication that the drug companies wish the FDA allowed them to use. We are subjecting even the most basic, non-invasive and barely even medical mobile health products to intense FDA scrutiny and yet other actually ingested or potentially invasive products are allowed to market themselves to consumers? What gives?
But wait, there’s more! Consumers who trust meaningless medicine to cure their ills will probably eventually need the even-more-expensive-and-intensive-than-they-would-have-been medical services to correct the damage caused by these products or treat the now more advanced disease. I am not trying to suggest that all alternative medicine is suspicious, but there is a definite line between what might be mainstream-ish alternative medicine with some real scientific evidence and something PT Barnum would be proud to call his own. We need to help consumers through this advertising jungle if we are going to set them loose with medical accounts and hope they make good choices.
No doubt there are plenty of consumers willing to take a more active role in accounting for their own health if we give them the right tools and make it easy for them to try. But this means we need to foster the kind of preventative medicine that prevents them from getting robbed by a guy with a rented white coat, a large advertising budget and a lifetime supply of exclamation points. It would be nice to see the FDA or some other consumer protection agency take a more meaningful role here.
Caveat emptor–buyer beware–is often used as an excuse for suggesting it is a consumer’s fault when he or she gets taken by scoundrels promising quick fixes to big problems through silly products. But we in healthcare know how complicated medical and healthcare issues are to understand and address, even for people with advanced degrees who work inside the system. In this case it is we, the taxpayers who better beware, as we have, with the Supreme Court ACA decision, become the buyers of our fellow citizens’ healthcare at a level far greater than ever before. We must find a way of balancing free speech with responsible speech when it comes to the promotion of medical products and services. And if we do so by midnight tonight, maybe we can get ourselves a set of those handy dandy ginsu knives! We’re going to need them to slash healthcare costs.
A most useful comment. I see this unfolding in very unpleasant ways. And as suggested, the move to more prescriptive, regulatory mechanisms, which seems to be the American Way, might not be the best answer. Although it might be the easiest, in the minds of public “defenders”.
Maybe we will have to rely on social media approaches like this, but we may then just be bringing coal to Birmingham, or preaching to the converted.
One never knows, but the lowly re-tweet may gain the ascendancy in this incipient war of hucksters against unsuspecting consumers. Maybe we have to convert unsuspecting to “suspecting”!
Happy Canada Day US of A!
The answer is in the question. Good treatments which cannot be protected by patents or process cannot finance FDA approval, and so should be marketed in the health food first adopter distribution system, instead of hiring pretty girls and biased studies to push damaging drugs and devices to doctors…? Backup up by openess of documentation of the limits of ‘no harm’ dosing, and benefits that may exceed the quality of disclosure of big medicine big marketing? then patients become sales reps to doctors, if they carry the solid references to thier doctors? Can you get insurance companies to reimburse treatment protocols involving specific materiels bought at health food stores and over the counter medicines?