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David Kerr: Social medicine

17 Feb, 11 | by BMJ

David Kerr“The UK coalition government’s proposals for health reform have generated much heat without a great deal of light. One predictable response has been the “concern” that the private sector is about to take over the running of the health service. Worse still is the prospect of turning the NHS into a clone of the US model of healthcare.

There are indeed many curious aspects to the American view of health. One oddity is direct-to-consumer advertising of pharmaceutical products. Surprisingly these ubiquitous commercials (a.k.a. “messages”) have almost a standard format irrespective of the medicine being advertised. Against a background of introductory canned music, the characters in the commercial are incredibly good-looking and appear to be in excellent health despite the purported illness. At some point a voice-over will announce that “product X may not be suitable for everyone” and then lists a multitude of ghastly complications associated with the product, including death! The story always ends with satisfied customers, huge smiles, and impossibly white teeth, with the advice to “talk to your doctor if you think drug x is for you.” Apart from being irritatingly cheesy, there are two important problems with these commercials. Firstly, the use of medical jargon and the rapidity with which the information is presented makes accurate understanding impossible for a non-expert. Secondly, the risk of potential and serious adverse events is presented as a simple list without any attempt to quantify the frequency of the risk. Although the commercial exhorts patients to “tell your doctor if you notice symptom a, b, or c” it does not give any indication of the immediacy of when to report these symptoms.

Given the relative awfulness of some of these commercials it is no surprise that there are a growing number of parodies being uploaded to sites such as YouTube, with the overwhelming majority being extremely derogatory (and occasionally funny). This is not a small problem given the potential for millions of people to view the parodies over a short period of time if they go viral. The consequences of being able to view the commercial and a parody are unknown but intuitively are likely to be negative for the pharmaceutical and medical device industries.

Another notable feature of “the American Way” of life is the onward march of the behemoth of other forms of social networking beyond YouTube. As an example, Facebook now has more than 600 million active users, with 50% of them logging on every day, and using this particular social medium is now more common than undertaking a Google search. Apparently each Facebook user has an average of 130 “friends.” From a medical perspective, several disease-specific information exchanges already exist on Facebook and other online social networking sites. With the growth in social media comes the major concern of patient confidentiality. Online social networking for patients with chronic illnesses such as diabetes is already happening and includes unsolicited sharing of diabetes management strategies. Clinically inaccurate recommendations are rare, although promotion of products not approved by regulatory bodies such as the US Food and Drug Administration is not uncommon. Although the pharmaceutical and medical device industries have barely dipped a toe in the social media waters, this is likely to change once guidance is produced as to who is responsible for the regulation of the content of the information available through this genre. In the area of social media and product promotion, there are also other legitimate concerns about third parties gaining access to personal data without consent and being able to place wall posts or discussion questions related to their products on social sites as an indirect form of advertising. Although there is the potential to use privacy settings to protect certain levels of personal information on a social network site, this still means that at least some of their data is “owned” by a third party for use by advertisers, employers, and other organisations such as insurance companies.

Television commercials for medical products have important limitations, yet they are presumably very successful, given the $4bn spent on direct-to-consumer advertising in the US. However, as the ratio of television to internet viewers is moving more and more towards the latter, the likelihood is that manufacturers will very soon put more of their money into developing a strategy for product promotion through social media. The challenge for healthcare professionals is to make sure that this is appropriately controlled and regulated and that patients are not put at risk by the black art of marketing.

David Kerr is the managing editor of the Journal of Diabetes Science and Technology.

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