Ask your doctor if ads pay off

By Katie Watson, acting associate director of the medical humanities and bioethics program at Northwestern University’s Feinberg School of Medicine

Robert Jarvik’s ads for Lipitor are an important source of patient education about a terrible disease — physician addiction to drug money.

Dr. Jarvik, inventor of the artificial heart, began endorsing the world’s best-selling drug just as the first generic alternative to Lipitor was introduced. Last month, the House Committee on Energy and Commerce announced an investigation into celebrity endorsements of prescription medication, and it asked Pfizer to produce records relating to Jarvik’s Lipitor campaign.

The way Jarvik has combined the roles of physician and salesman raises significant ethical questions, but it wouldn’t be fair to make him a scapegoat. Instead, Congress should use his Lipitor endorsement as a catalyst for reviewing the larger issues it raises.

Pharmaceutical advertising is a good place to start. This is typically called “direct-to-consumer” advertising, and the committee’s letter to Pfizer says it’s concerned that “consumers” may misinterpret Jarvik’s health claims. But consumers can’t buy prescription drugs, only patients can. Patients are people who make decisions with expert partners; consumers roam grocery stores picking cereal alone. Once patients were recast as consumers, prescription drugs could be advertised as if they were tennis shoes. It was just a matter of time before a celebrity pitchman turned a drug like Lipitor into Air Jarvik.

The pharmaceutical industry uses advertising to pull patients away from physicians — come in with your mind made up, and your physician is reduced to prescription writer. The industry undermines the other side of the patient-physician partnership by throwing money at physicians. This half of the divide-and-conquer strategy usually happens behind the scenes, but Pfizer’s partnership with Jarvik for mutual profit makes a widespread practice visible.

Financial conflicts of interest have metastasized through our health-care system. In 1990, the New England Journal of Medicine decided not to accept articles or editorials from physicians who accept money from a company whose product is in the article, but in 2002 it relented because it couldn’t find enough independent authors.

Lawsuits and whistle-blowers have revealed pharmaceutical companies paying physicians to “author” publications on research the company did on its own drugs, creating a false impression of independence. In some hospitals, physicians who determine which drugs the hospital will buy in bulk also work for drug companies. Drug and medical-device firms pay physicians to give talks promoting their products to other physicians as part of “speakers’ bureaus.” The list goes on.

Many of these arrangements are not in the best interest of patients, yet those with the power to embrace systemic solutions have been slow to act. Perhaps that’s because they are often the institutions and individuals who benefit financially from these conflicts of interest. Cynics think, “Medicine is a business, what do you expect?” I think patients deserve better.

I wish I could decry the degree to which Jarvik’s endorsement might reduce public trust in physicians. Instead, that’s what might make it the first truly educational drug ad in history.

Editor’s Note: This article originally appeared at It was moved or deleted, we will keep it on Cunningham Group’s website for archiving purposes.

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