Princess Health and Detroit Hospitals' Advertising War. Princessiccia

Princess Health and Detroit Hospitals' Advertising War. Princessiccia

deception hospitals marketing

Gusty 12:51 Add Comment

Although pharmaceutical companies have been rightly criticized for pushing marketing rather than science, they are not the only health care organizations that may do so.
The Detroit News reports on an advertising war being waged by area hospitals. What's notable is how some hospitals, as the paper put it, "say hawking hospital services is no different than selling cola or a car." (The quote is of the article, but was not attributed to a particular person by the reporter.)
In particular, Beaumont Hospital has pursued an advertising campaign to get patients to pick a Beaumont doctor. Its web-site has a pop-up that flashes, "Are you at risk for a heart attack? Do you have a Beaumont doctor?"
Beaumont Director of Marketing and Public Affairs Michael Killian defended the campaign, first noting that patients still need to check out their doctors themselves, "Patients ought to ask every question they can, probe into everything that worries them." But he justified the "foreboding" advertising by saying that connecting with patients emotionally is necessary to get them to seek needed care, "People don't make decisions based on fact. They make decisions based on feeling. If you don't connect with somebody emotionally, you don't connect."
Emotional appeals are unlikely to create better informed patients. Cynically advocating decision making based on emotions may bring in more money, but is unlikely to inspire better decision making.
As I stated in my comment below, physicians need to become watchdogs with loud barks and sharp teeth who will protect patients against all kinds of exploitation by all kinds of powerful health care organizations.

Princess Health and Detroit Hospitals' Advertising War.Princessiccia

Princess Health and Detroit Hospitals' Advertising War.Princessiccia

deception hospitals marketing

Gusty 12:51 Add Comment

Although pharmaceutical companies have been rightly criticized for pushing marketing rather than science, they are not the only health care organizations that may do so.
The Detroit News reports on an advertising war being waged by area hospitals. What's notable is how some hospitals, as the paper put it, "say hawking hospital services is no different than selling cola or a car." (The quote is of the article, but was not attributed to a particular person by the reporter.)
In particular, Beaumont Hospital has pursued an advertising campaign to get patients to pick a Beaumont doctor. Its web-site has a pop-up that flashes, "Are you at risk for a heart attack? Do you have a Beaumont doctor?"
Beaumont Director of Marketing and Public Affairs Michael Killian defended the campaign, first noting that patients still need to check out their doctors themselves, "Patients ought to ask every question they can, probe into everything that worries them." But he justified the "foreboding" advertising by saying that connecting with patients emotionally is necessary to get them to seek needed care, "People don't make decisions based on fact. They make decisions based on feeling. If you don't connect with somebody emotionally, you don't connect."
Emotional appeals are unlikely to create better informed patients. Cynically advocating decision making based on emotions may bring in more money, but is unlikely to inspire better decision making.
As I stated in my comment below, physicians need to become watchdogs with loud barks and sharp teeth who will protect patients against all kinds of exploitation by all kinds of powerful health care organizations.

Princess Health and Questionable Deliberations on the Vagus Nerve Stimulator to Treat Severe Depression. Princessiccia

Princess Health and Questionable Deliberations on the Vagus Nerve Stimulator to Treat Severe Depression. Princessiccia

Cyberonics FDA

Gusty 15:01 Add Comment

The NY Times reports on the curious deliberations by a US Food and Drug Administration (FDA) expert advisory panel on the approval of an implanted vagus nerve stimulator as a treatment for severe depression. The committee was informed about the results of a randomized controlled trial which, as far as I can tell after several PubMed searches, has not yet been published.
The Times reports the trial showed that 17/111 patients who had the stimulator implanted and turned on had improvements in "standard measures of disease severity," while 11/110 who had it implanted, but not turned on also improved. This small increase in the likelihood of improvement was not statistically significant, i.e., could have been due to chance alone, rather than be an effect of the device. Furthermore, the absolute benefit increase implied by these data is at most 4.3%. That is, were 100 people to get the device, this data implies only 4 of them might improve because of it, while the rest would either not improve, or would have improved even without it.
Nonetheless, after hearing some emotional testimonials by patients who claimed that the device helped them, the advisory committee voted to make the device "approvable." The panel's chair, Dr. Kyra Becker, said "the feeling was that anything that gives these people hope is potentially worthwhile." However, one dissenter, Dr. Richard Malone, was bewildered by the panel's decision, "I walked out of there thinking I was nuts. It was stunning, but then I find much of life stunning."
The FDA does not have as rigorous standards to approve devices as those to approve drugs. However, when a device costs $15,000, is invasive, cannot be easily removed, and at best seems as if it may help only a small minority of patients, as is the case for the vagus nerve stimulator, the wisdom of these relatively lax standards comes into question.
Another question is why a scientific advisory committee, staffed ostensibly by medical experts, seemed more attentive to testimonials than to the results of a randomized controlled trial. Perhaps we will get some answers from an investigation by the Senate Finance Committee, which apparently is ongoing.

Princess Health and Questionable Deliberations on the Vagus Nerve Stimulator to Treat Severe Depression.Princessiccia

Princess Health and Questionable Deliberations on the Vagus Nerve Stimulator to Treat Severe Depression.Princessiccia

Cyberonics FDA

Gusty 15:01 Add Comment

The NY Times reports on the curious deliberations by a US Food and Drug Administration (FDA) expert advisory panel on the approval of an implanted vagus nerve stimulator as a treatment for severe depression. The committee was informed about the results of a randomized controlled trial which, as far as I can tell after several PubMed searches, has not yet been published.
The Times reports the trial showed that 17/111 patients who had the stimulator implanted and turned on had improvements in "standard measures of disease severity," while 11/110 who had it implanted, but not turned on also improved. This small increase in the likelihood of improvement was not statistically significant, i.e., could have been due to chance alone, rather than be an effect of the device. Furthermore, the absolute benefit increase implied by these data is at most 4.3%. That is, were 100 people to get the device, this data implies only 4 of them might improve because of it, while the rest would either not improve, or would have improved even without it.
Nonetheless, after hearing some emotional testimonials by patients who claimed that the device helped them, the advisory committee voted to make the device "approvable." The panel's chair, Dr. Kyra Becker, said "the feeling was that anything that gives these people hope is potentially worthwhile." However, one dissenter, Dr. Richard Malone, was bewildered by the panel's decision, "I walked out of there thinking I was nuts. It was stunning, but then I find much of life stunning."
The FDA does not have as rigorous standards to approve devices as those to approve drugs. However, when a device costs $15,000, is invasive, cannot be easily removed, and at best seems as if it may help only a small minority of patients, as is the case for the vagus nerve stimulator, the wisdom of these relatively lax standards comes into question.
Another question is why a scientific advisory committee, staffed ostensibly by medical experts, seemed more attentive to testimonials than to the results of a randomized controlled trial. Perhaps we will get some answers from an investigation by the Senate Finance Committee, which apparently is ongoing.

Princess Health and Jacobi Hospital's Executive Director Fired. Princessiccia

Princess Health and Jacobi Hospital's Executive Director Fired. Princessiccia

Jacobi Hospital Mismanagement

Gusty 14:55 Add Comment

Another quick follow-up on the story about Jacobi Hospital's failure to notify patients about abnormal pap smear results.
The NY Times reports that in an unusually fast response, the hospital's executive director and deputy director of nursing services have been fired. The hospital's chief operating officer (COO) and medical director have received disciplinary warnings.
Coincidentally, the NY Daily News noted that the hospital's executive director was previously employed at Staten Island University Hospital, which has just settled its second big case of Medicaid fraud.

Princess Health and Jacobi Hospital's Executive Director Fired.Princessiccia

Princess Health and Jacobi Hospital's Executive Director Fired.Princessiccia

Jacobi Hospital Mismanagement

Gusty 14:55 Add Comment

Another quick follow-up on the story about Jacobi Hospital's failure to notify patients about abnormal pap smear results.
The NY Times reports that in an unusually fast response, the hospital's executive director and deputy director of nursing services have been fired. The hospital's chief operating officer (COO) and medical director have received disciplinary warnings.
Coincidentally, the NY Daily News noted that the hospital's executive director was previously employed at Staten Island University Hospital, which has just settled its second big case of Medicaid fraud.

Princess Health and Is the adversary model the answer?. Princessiccia

Princess Health and Is the adversary model the answer?. Princessiccia

Gusty 13:13 Add Comment

In his post of Wed 18 May, Roy Poses commented on the PLoS article by former BMJ editor Richard Smith opining that medical journals have been co-opted into Big Pharma's marketing system. Coincidentally, the BMJ reports that the CEO of Merck has resigned, in a move widely seen as a response to the increasingly damaging disclosures about Merck's marketing of Vioxx (though Merck of course denies any connection).

Merck's campaign for marketing Vioxx was clearly a campaign of deliberate deception, with intensive training of detail reps in specific techniques for misleading physicians about the benefits and concealing the risks of the drug. Should we be surprised? No, not really. Consider what is at stake for any drug company marketing a new agent. Hundreds of millions of dollars have gone into its development. Even though the company itself probably hasn't paid for much if any of the actual basic science or discovery, the development of someone else's discovery to marketability costs a bloody fortune. There's no predicting whether it'll be a big seller, a market mediocrity, or a fiasco that proves dangerous but only after all the costs are incurred.

When big money is at stake, people will lie. It's human nature. Are they "bad people"? No, they're people. As the Milgrom experiment and others showed, and WWII gruesomely illustrated, the majority of people can convince themselves that literally anything - no matter how abhorent - is OK. We vastly underestimate in our usual thinking how readily people will believe what's in their interest to believe. Not just a few "bad apples", but the majority of normal people. Further, those few who are squeamish about fibbin' a bit in marketing the product are selected out at low rungs on the corporate ladder in Big Pharma. The upshot is that we just plain have to assume that Big Pharma will lie. Not because they're evil, but because they're humans in a system where extremely strong incentives exist to do so.

So what do we do? Well, we could propose that drug development be placed in the hands of neutral foundations or some similar arrangment that divorces self-interest from the product. Personally, I doubt that will work well though. The nice thing about self-interest is that it really motivates people. Only self-interest will reliably make the majority of people really work hard. Folks just naturally coast a bit if they don't have skin in the game. (You don't need to point to the economic failure of communism to illustrate that point; just check out any organization that has no competitors. Go down to the Secretary of State's office to get your driver's license paperwork, for example.)

So it's time we formally and clearly recognized that doctors and their patients vs. Big Pharma is an adversary relationship. Like prosecutors and defense attorneys, we need each other and society needs us both, but like any good defense attorney we're nuts to trust anything the prosecutor says. (The metaphor is apt, sadly, as the shocking number of falsely convicted men freed from death row or life imprisonment over the last decade demonstrates.) If we want to do the best for our patients, we need to behave adversarially toward Big Pharma. Don't socialize; assume an ulterior motive; if given a paper "proving benefit" look for how it might have been fudged or find out how many negative papers are being kept out of view; never believe industry-funded clinical trials; assume risks are being downplayed and benefits overplayed.

An adversary relationship will put a real crimp in the incomes of quite a few physicians who are used to taking drug money. It'll also raise some serious financing issues for CME, but it's time those came out on the table anyway. Patients deserve much more aggressive protection of their interests than our profession's cozy relationship with Big Pharma has provided. Time to un-cozy.