| Writers of medical advice--including columnists, | | | | publications and web-pages is backed by their |
| insurance companies, governmental agencies, medical | | | | reputations, which they zealously protect. So you can |
| organizations, drug companies and even | | | | be sure that the medical content is subjected to |
| practitioners--are all biased. They always have | | | | rigorous quality-control. And fortunately, although their |
| agendas. They all choose to write about certain topics | | | | messages are motivated by commercial needs, the |
| and not others. They make choices about what to | | | | linkages are obvious and easy for the consumer to |
| include in their articles, what to leave out and how to | | | | take into account. |
| state their cases. They're all self-serving. They all have | | | | How about individual health practitioners? Giving advice |
| something to "sell," even when there is not an | | | | is what they do for a living, so what's the issue? Well, |
| immediate cash-return. | | | | in the U.S., at least, there is a genuine "medical |
| Does that mean you should throw up your hands, say | | | | marketplace" where competition reigns supreme. So |
| the hell with it, and never read or listen to another | | | | when you need help with your health, each practitioner |
| medical message? I don't think so, but in order to | | | | (including me!) would like to make the short-list of |
| derive value from these messages, you sure as heck | | | | advisers whose opinions you trust and value. |
| better understand the agendas of the people who | | | | Let's move on to the drug companies. In my opinion |
| created them. Or as the psychologists say, if you want | | | | there is no medical information that is both as |
| to understand a behavior, you need to figure out what | | | | pervasive and biased as that created by drug |
| motivated it. Let's examine some advice-givers and | | | | companies. And in many cases the connection |
| their biases. | | | | between the message and the drug company's name |
| What motivates health columnists? Well, how about | | | | has been obscured or hidden, so the consumer doesn't |
| their continued employment, the needs of their | | | | even know to be wary. |
| publisher-employers, and the needs of the companies | | | | I have written elsewhere about the comical turn of |
| the publishers wish to attract as advertisers? It's not | | | | events in the "advice" that drug companies have |
| hard to imagine there are some subtle and | | | | provided to people with headaches. For many years |
| not-so-subtle influences and incentives at play in | | | | the makers of sinus medications invested heavily in |
| framing the subject-matter and slant of the articles. | | | | convincing people with headaches that most of them |
| Certainly, it's hard to attract the business of potential | | | | were due to sinus disease. But now that effective and |
| advertisers when you have written devastating | | | | lucrative drugs for migraine exist, companies are |
| critiques of their products. | | | | sinking even larger sums of money into the message |
| Yet don't infer that you should ignore what the health | | | | that those headaches weren't due to sinus conditions |
| columnists have to say. They provide a wonderful | | | | after all. Instead, they've been due to migraine. This |
| service in discussing health issues, the business of | | | | vignette illustrates the hazard in allowing marketing |
| medicine and its practice. I personally enjoy reading the | | | | departments of drug companies to diagnose one's |
| health columns of that great medical publication, The | | | | headaches. |
| Wall Street Journal. In fact, I still distribute to my | | | | Another hazard is in allowing drug companies to write |
| patients an excellent article about medication-overuse | | | | the information-sheets that doctors hand patients at |
| headaches that Tara Parker-Pope, one of their | | | | the ends of office visits. Every doctor gets buried in |
| columnists, wrote years ago. | | | | pamphlets that sales reps from drug companies leave |
| One of the odder chapters in the business of medicine | | | | at their offices. For years I actually looked at these |
| is that certain insurance companies have positioned | | | | things, trying to select the 30% that might be worth |
| themselves as providers of health advice, particularly | | | | retaining and passing along to my patients. After a |
| those companies paid by employers to manage their | | | | while, 30% seemed too optimistic, so I searched for |
| medication-benefit plans. I won't waste the reader's | | | | the 20% that was worth keeping, and then the |
| time in building a case that insurance companies have | | | | 10%...well, you get the idea. The pamphlets kept getting |
| agendas and conflicts-of-interest in providing such | | | | more biased and less useful. At one time the sales |
| advice. This should be self-evident. | | | | reps passed out some real gems that were genuinely |
| Governmental agencies like the National Institutes of | | | | helpful to patients and their families. But those days are |
| Health provide medical information which is generally | | | | gone. |
| reliable and useful, but influenced by the agency's | | | | So when it comes to medical advice, consider the |
| understandable needs for self-promotion and | | | | source. |
| self-preservation. The same holds true for medical | | | | (C) 2005 by Gary Cordingley |
| organizations like the American Academy of | | | | Want to find out about breast lift without implants and |
| Neurology (to which I belong) and big group-practices | | | | transumbilical breast augmentation? Get tips from the |
| like the Mayo Clinic and Cleveland Clinic. The advice | | | | Breast Discomfort website. |
| tendered by these medical organizations in their | | | | |