The Marketing of Medicine

Who would you rather have operate on you, a newly minted Doctor recently out of her residency or a surgeon with 16 years of experience?

The statistics would indicate the later is more error prone than the former. That means if you think experience in the operating room matters you may be wrong. This post uncovers the hidden side of the medical industry that you never knew about. Freakonomics did a three part series called Bad Medicine, below are the three podcast and one marketers banter. 

What else could we simply be wrong about in the medical establishment? 

Prescription opioid use has gone up about 300-400 percent since the year 2000.

83% of all Oxycodon sales come from the United States.

Medical error is the third-leading cause of death in the United States.

Prescription opioid use has gone up about 300-400 percent since the year 2000

Do you think that the United States has 83% of the World’s pain?

America is a world leader in the consumption of painkillers? We’ve created a pill dependant society always searching for the next quick fix. It’s always so easy to ask the doc for one more prescription, just something different, maybe a new pain killer will work. Maybe not.

Bad Medicine Part 1 – The Story of 98.6

A famous number. On average our body temperature are 98.6 degrees centigrade. A doctor by the name Carl Wunderlich came up with the number. A budding Doctor Mackowiak sought out to see if this data was actually true. What did he find?

8% of people tested were on “average”. That means 92% of people temperatures were wrong!? That couldn’t be. It turns out 98.6 is actually not the average temperature of your body. And this starts the journey down what else was the medical community wrong about? 

We’re wrong more often than we think. 

It was once common, if someone was sick, to take a few pints of blood out of them thinking that would help. Lobotomies, The Tuskegee experiments, Thalidomide, DES, the list goes on and on. There’s a lot we can learn from the past; never assume something stays the same forever, specially a medical treatment.

We used to treat mental illness with a lobotomy, we were so very wrong

We used to treat mental illness with a lobotomy, we were so very wrong. 

Now we live in the era of “evidence based” medical treatments. Opposed to “Eminence based” treatments where you just trusted the Shaman or whoever was administering the “treatment”. Just as it sounds, evidence based treatments have a cause and effect relationship. There has to be proof for it to be a treatment.

As funny as it sounds, up until the 1980’s no one did randomized trials for drug testing. That means up until then, if you were a malicious drug manufacturer you could have created any “trial” that proved your drug to work and go to market. Evidently the very first studies with randomized trials were with tuberculosis.

One of the guests on the podcast was Vinayak Prasad an oncologist and an assistant professor of medicine at Oregon Health and Science University who studies Medical Reversals. Those being the rare moments where treatments that have been used for years are proven to have no effect or even sometimes making a patient worse off. Prasad even wrote a book on the topic Ending Medical Reversal: Improving Outcomes, Saving Lives. It’s astounding how much of our medical advances have literally been in the past few decades.

And it’s only gets more interesting!

Part 2 – {Drug} Trials and Tribulations 

What you ever heard of the drug Thalidomide? A tragic story about a drug developed in Germany in the late 1950’s for women during pregnancy, only finding out later that it causes major defects to a baby growing inside the whom. It’s incredible how the drug spread worldwide, except for the US. The head doctor for the United States Drug Administration turned down Thalidomide citing not enough trials done to be approved. He was later hailed by President Kennedy as a hero who saved thousands of lives.

There’s a great documentary on the Thalidomide case called Attacking the Devil: Harold Evans and the Last Nazi War Crime

The craziest part of the story was the media ban on anyone talking about Thalidomide publicly, so no one knew. We can’t imagine in a day with instant communication that a drug so horrible, that ruined so many lives, couldn’t be talked about in the media.

Drugs trials and how drugs get approved are a bit of a wormhole to go down.

When a drug company funds a test on one of their own drugs statistically they get approved 30% more often.

Drug companies evaluate their own products. DRUG COMPANIES TEST THEIR OWN PRODUCTS? What other industry is like that? Could you imagine if car manufacturers were allowed to test their own engines? Building owners doing their own inspections? Restaurants inspecting their own kitchens? How does the pharmaceutical industry get away with this?

Another shady tactic discussed was when drug trails fail, more often then not the results are withheld from the public.

About half of the clinical trials that are done never see the light of day. They don’t get published. The results of trials are routinely and legally withheld, from doctors, researchers, and patients. The people who need this information the most. That is a systematic, structural failure. -Iain Chalmers, a co-founder of the Cochrane Collaboration

They talk a lot about Cancer treatment drugs that cost into the hundreds of thousands of dollars to administer and only prolong life expectancy by a few extra months. The costs far out weigh the effects of the drug.

 

Part 3 – Death by Diagnosis

How is it that medical error is the third-leading cause of death in the United States?

The podcast attempts to answer this question as well as uncover a startling statistic in mortality rates in the U.S. They’re on the rise.

Mortality rates in the United States have risen for the first time in 10 years.

That’s a stat that has been decreasing year on year for the past 100 years. Largely attributed to the over prescription of medication and patients “demanding” drugs that may be doing more harm than good. Something needs to change in how we’re administering drugs, or maybe we’re wrong.

Marty Makary, a surgical director and health-policy scholar at Johns Hopkins pin-pointed the problem. Patient wants vs patient needs. Doctors that get patients complaining or even demanding certain drugs, at one point they relent or see their patients going to a different clinic.

MAKARY: They cope with their job by giving an angry patient what they want, not what they need.

Then on top of patients “demanding” the latest and greatest drug they see in commercials on TV, the medical community doesn’t do much follow up. When asked on the podcast, “what’s the number one problem with healthcare?”

the number one problem in healthcare right now

MAKARY: I think the number-one problem is we don’t measure performance. We don’t measure the outcomes of patients in health care for 99 percent of the health care that’s delivered.

It couldn’t be summed up any better than what Keith Wailoo, a Princeton historian who focuses on health policy said.

We are a consumer society that believes in the power of the magic pill.

We are a consumer society that believes in the power of the magic pill

Everyone wants a quick fix.

The problem is many things in life take time, our health included, for many illnesses there is no magic pill. The pharmaceutical industry has an obvious interest in trying to make you believe there’s a cure for everything when it’s simply not true. Treat the symptoms, there’s no money in curing the actual problem. Chris Rock taught that years ago!

The business of medicine is one we’ll hear about again and again. There are a lot of marketing lessons to be learned, most by what not to do. It may be easy to raise prices, create monopolies, demand high profits, but in the long run you can’t screw people over, eventually people will find out.

Just like any topic in life the more education you get on it the better informed you will be. The podcasts will make you look at the medical establishment in a different light. The medical industry has always intrigued me as it’s an industry that doesn’t have a positive case study to resemble. Who gets health care the best? I haven’t the foggiest clue.

Thanks for reading. (: