Friday, June 10, 2005

Bad news on the medical front I

I've been asked (in comments below) why physicians in general are unwilling to 'stand up' to their patients. That is, when someone sees an ad on TV and they come to the doctor's and ask for the drug, why does the doctor roll over and give them the drug?

I actually ran into a counter-anecdote, in that my uncle's physician refuses to perscribe drugs that he suggests, apparently for the bloody-minded reason that my uncle has suggested the treatment.

I'm going to disregard this anecdote, partially because it's an anecdote (even if true it proves nothing), and partially because there's a question of whether my uncle's ideas for treatment are good - he goes in for alternative medicine treatments that are untested, both in terms of safety and efficacy.

So... let's go to the literature:
Mintzes B, Barer ML, Kravitz RL, Kazanjian A, Bassett K, Lexchin J, Evans RG, Pan R, Marion SA. Influence of direct to consumer pharmaceutical advertising and patients' requests on prescribing decisions: two site cross sectional survey. BMJ. 2002 Feb 2;324(7332):278-9., PMID: 11823361 (free full text here)

In summary:
1. About 74% of patient visits result in a drug being prescribed - this is the accepted figure.
2. Patients that ask for drugs in general are more likely to get drugs
3. Patients that ask for advertised drugs are likely to get the drugs they ask for.

So, the observation that physicians bend over backward for their patients checks out. However,

4. When patients asked for drugs, in general or in particular, the physician was more likely to be 'ambivalent' about the treatment.

What's going on here? I can't find a study on that. The establishment guess would be that it's either business or law at fault. If I won't deal to you, you'll find someone else who will -> I lose business -> I starve. If you suggest a treatment for X, I don't treat you for X, and then you die from X, I get sued.

Of course, the study is all self-report, which causes all kinds of difficulties. Still, this is a definite plot hole in the 'physicians think they're gods' story.

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