Healthcare in the US
March 23, 2009 11:35 pm GeneralFor a European travelling in the US, one of the things that jumps out at you when you turn on the TV is the number of ads for prescription drugs you get in the US.
These 30 or 60 second ads are all very similar: 5 to 10 seconds presenting the medication, followed by 20 to 25 seconds of disclaimers and disclosure of secondary effects, with a warning to consult with your physician and ask him about the drug in question.
It’s symptomatic of the approach to healthcare in the US, which says that the patient is responsible for his care – your doctor’s role is to advise you what medications are available, and let you decide what you use to medicate yourself. Thus, drug companies market their drugs directly to the public, rather than to doctors.
Like Bary Schwartz in “The Paradox of Choice” I don’t think this is a healthy state of affairs. Excessive choice creates stress, and asking someone to make a decision they are not sufficiently informed to make is asking for trouble. You might as well ask me to fix the financial crisis – it doesn’t matter how good my advisors are, I’m not equipped to make decisions in the area.
Where I live, patience go to their doctors for expert advice. The doctor decides what medication, if any, is appropriate for your condition, and gives you a prescription. Of course, it is your choice if you fill that prescription afterwards, and if you’re like me, you ask the doctor lots of questions during your visit, but the chain of responsibility is substantially different. There is no point marketing prescription medication to the general public, because the doctor is the one who decides what prescription medication you use.
March 23rd, 2009 at 11:55 pm
Agree
(Belgian, European)
March 24th, 2009 at 12:13 am
Also agreed! But isn’t there a comparison to be made here between the paradox of too much choice in drugs and too much choice in a desktop environment?
The whole reason (ok, maybe not the *whole* reason) Gnome is awesome – and the big reason a lot of people choose it over other DEs – is it’s the result of learned people trying to make the best choices *for* you, so you can get back to work, instead of working on your DE.
Maybe I phrased that poorly; I hope it gets across the comparison. When I saw the words “Paradox of Choice” my mind just leaped straight to it.
March 24th, 2009 at 12:30 am
You have to also realize that many of these drugs are for chronic conditions which patients are unaware that they can even talk to a doctor about treating. Similarly, patients may have tried treatments for their existing conditions without success, and may be unaware that something new is available.
March 24th, 2009 at 12:33 am
Ummmm… you’ve got a _very_ mixed-up opinion of American healthcare.
Doctors are the ones who prescribe medications, even here in the USA. I have _never_ had a doctor let me choose which medication to take.
The only time I have ever been given a choice is between the Name Brand and Generic versions of the _same_ drug.
Where I live (North Carolina, USA), patients go to their doctors for expert advice. The doctor decides what medication, if any, is appropriate for your condition, and gives me a prescription.
March 24th, 2009 at 12:39 am
I have to ask – with all due respect – if you’ve actually talked to an American about how the prescription drug system works in the U.S. before making assumptions based on TV ads.
For prescription drugs, if I’m having some problem or disease where a prescription drug becomes necessary, I *have* to go to a doctor, and that doctor can, as you said, offer advice, but they also have to write a prescription – I can’t go to a pharmacy and ask for some random drug without a doctor’s prescription – they won’t sell it to me. And the doctor can, and often does, reject patient’s requests for a prescription if he/she feels it isn’t right for a patient or, well, anything really. Granted, I can just go to another doctor, but chances are they won’t let me have a prescription if they don’t think it’s right. Our system is the same as you describe yours.
I agree with what you say regarding the public-aimed TV ads. The best explanation I’ve heard for these is two-fold: pharmaceutical companies want their drugs to be known by the public – so they can go to the doctor and ask for a prescription if they think they need it, but as I said it’s completely up to the doctor to give it. The second reason is that they are advertising to the doctors: they want them to know about new medicine and to learn more information about it, so that they might begin to prescribe it.
There are some major issues with the Unites States’ healthcare system, mainly in the affordability department, but this isn’t one of them.
March 24th, 2009 at 1:25 am
Hi Daniel (and Kevin),
Yes, I understand, of course, that doctors fill in prescriptions. My impression of healthcare in the US (based on both the paradox of choice and my experience with TV) is that patients are expected to do most of the heavy lifting. It would never occur to me to go to my doctor and ask “Do you think I should be on?” I might go to him and say “I regularly have lower back pain – do you think I should be getting treatment?” I also understand that in some regions, this may not be the normal way things happen, but I have to think that if pharma giants are advertising brandname drugs for migraine, back pain, PMT and other chronic conditions on TV, they think it’ll increase their sales.
Dave.
March 24th, 2009 at 1:31 am
But that’s the problem! Pfizer is deathly afraid that you might go to your doctor and say something vague like “I’m having problems in the bedroom”, because if you did that, your doctor might give you Levitra or Cialis! Pfizer wants you to ask for Viagra by name. Likewise with every other drug.
This has nothing to do with the organization of health care in the US. It’s strictly about capitalism gone mad.
Also, what Russ said. There was a huge ad push a few years ago for some toenail-fungus-curing pill. There, the problem was that not enough people were even asking their doctors what could be done about their toenail fungus “problem”, so the pharmaceutical company had to make ads projecting the idea that having slightly-yellowish toenails was an incredibly embarrassing problem that obviously every “sufferer” was looking for an escape from, so that then people who had the “problem” would think “oh my god, all this time I never realized what a loser I was. I wasn’t keeping my toenails hidden from the world like the people in the commercial! I need to get this fixed right now!”.
So you’re right to be cynical about America here, you’re just being cynical in the wrong way. :-/
March 24th, 2009 at 1:42 am
Does anyone else find it a bit Orwellian that this post discusses the positive benefits or legislating away choice from people’s lives?
Heck, I could do anything with my life, any career, and I know that creates stress in people. Some more than others, for some it even creates a severe depression. I don’t think the answer is to have the state decide for people what their vocation will be.
I realize that personal liberty and choice creates stress and responsibility, but I don’t think I’d trade it.
March 24th, 2009 at 1:44 am
Clarifying a little based on your comment #6: it’s not that “the system” expects patients to do the heavy lifting, it’s just that the pharmaceutical companies hope they will. (And this is a recent development; drug ads on TV only started like 10 years ago or something.) I think doctors hate it when patients come in with preconceived notions about what medicines they ought to be on.
March 24th, 2009 at 1:47 am
The more I read this post, the more it drives me crazy because I know its the way the US is currently heading. The patient’s care is not the responsibility of the patient? WHAT!?! Then who’s is it, the state? Your doctor? Who chose your doctor? Who decides if a second opinion is necessary? If the you choose your doctor, and you choose to get a second a opinion, then you are ultimately responsible for your care. If the state or your doctor does, then they are responsible for your care.
I don’t want someone else to be responsible for something as private and personal as my health. Is anyone else with me on this?
March 24th, 2009 at 1:53 am
“legislating away”? When did I say anything about legislation?
Having choice *also* means having the choice to leave the choice to someone else. Whether it be ordering breakfast, a Subway sandwich or a Starbucks coffee, I’ve had to answer lots of questions I haven’t cared about today. This seems to be the American idea of choice. My idea of choice as a consumer is being able to change what I’m buying if I want to, and have a reasonable default if I don’t care.
Actually, this is a bit like GNOME’s principle of selecting reasonable defaults, while leaving the user in control, rather than forcing the user to answer questions he doesn’t care about (or that he doesn’t have the information he needs to answer).
Dave.
March 24th, 2009 at 2:02 am
Zu Risiken und Nebenwirkungen, fragen Sie Ihren Arzt oder Apotheker.
March 24th, 2009 at 2:16 am
This is a straw man. It raises a non existent point about the US health care system, and beats it down. Yes. What Dave describes would suck, but that’s not how it is.
The doctors offer expert advice and will not fulfill a prescription unless they think it is sound judgment. It is illegal for them to do so.
The ads on TV are just that: ads. They raise brand awareness. Like any other thing you drink, Coke, whatever. They create an image which they want to stick in people’s minds so that the company is held in high regard.
March 24th, 2009 at 3:23 am
I’m sure that you’ve realized by now that there is no small irony in your comments on “excessive choice” while subscribed to planet GNOME….
March 24th, 2009 at 4:50 am
Hrm. Next time you visit the USA just don’t watch TV. It is a waste of time and the amount of commercials makes it annoying.
Most of the programming is just not worth it. There are only a few shows that I’ll watch anymore.
I guess you never really had much healthcare in the USA because this is how it generally works:
You go into the doctors office, complain about a symptom that is bothering you.
You talk to the doctor for a bit, get a few tests if it makes sense.
The doctor perscribes you some medicine, if appropriate.
You go and then take the perscription to a pharmacy, or have the doctor assistant send the perscription to your prefered drug store (usually the one closest to your home).
You then collect the medicine and then consume it appropriately.
————
I guess all of that is completely alien compared to what you experience in Europe.
I guess in Europe they must chase you down the street, rope you, then forcibly inject you with drugs.
Something like that. Must be indicative to socialized medicine or something. I heard a guy from Europe talking about it in the news a few times and I read a few socialist newletters that come from Europe, so I guess that makes me a expert or something on your culture.
March 24th, 2009 at 6:22 am
I agree completely.
To the Americans that disagree, you really ought to think of _why_ the pharmacuetical companies advertise to the general public. If they don’t think that it’s money well spent they wouldn’t do it! Clearly patients do influence doctors when prescribing drugs.
Another point, this to the people who see the existance of ads for drugs as a sign of freedom. How can it be freedom to allow companies to direct ads to ignorant people? (It’s a little bit like arguing the relative freedomness of GPL and BSD licenses. I think Aq said it best when he said that “the freedom to take free code and make it proprietary is not a freedom worth protecting” (most likely somewhat paraphrased).
It is also worth pointing out that there is legislation against American-type drug-ads in some European countries.
In my view, one of the tasks of a government is to prevent profiteering that is harmful to individuals and society. This is one of those situations where the government stepping in leads to a better society as a whole.
March 24th, 2009 at 3:49 pm
Those TV ads are not only geared to the patients, they are also geared toward the Doctor.
If the Doctor dictates which brand medicine is to be given they can make a deal with the drug manufacture to push a selected drug that has no generic. Which is usually many times more expensive for the patient and the insurance company. If the patient is aware of other drugs that they maybe able to use. They can consult the doctor to see if it right for them.
Health care should be in the hands of the people… should we have mandatory health care checkups every year so the doctor can be in charge of our health, should they call us every so often to see how we are feeling? How are the doctors going to know when we are sick if we are not in control of our own health?
March 24th, 2009 at 5:19 pm
The whole state of affairs of health care in the united states is sad…just sad. (I’m from the United States.)
The very fact that prescription drugs are advertised on TV means that I’m going to goto my doctor specifically asking for this magic cure-all. And doctors get favors from prescription drug companies (clocks, mugs, pencils, stationary….maybe even money) so they are essentially pushing these new drugs.
We need to adopt universal healthcare like many, many other countries have. France, England, Canada…Cuba?!?
Sad sad sad. I wish there was something I could do.
March 24th, 2009 at 5:28 pm
“Thus, drug companies market their drugs directly to the public, rather than to doctors.”
Oh, no. They market them to doctors as well. Try talking to someone who’s worked as an industry rep for a pharma company some time…
March 24th, 2009 at 5:31 pm
To elaborate, it works in the U.S. more or less as it does in most European companies, officially. The choice of drug to prescribe is up to the physician. However, since it’s a very competitive ‘market’, physicians are very sensitive to pressure from patients who have decided they want to take a given drug. So the companies market to both doctors and the public.
This would happen in Europe too if pharmaceutical companies were actually allowed to advertise medications on TV, but they’re not. That’s the only reason it doesn’t happen. It’s not because there’s no point in it, they’d love to do it, it’s just illegal.
March 25th, 2009 at 2:16 pm
God Damn, healthcare really brings out the loonies these days. It’s almost easier to talk about Gun Control. Even the barest *hint* that other systems can have some upsides compared to ours starts a riot. Irritating.