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How Doctors Think – Jerome Groopman, MDChapter 9 . Marketing, Money, and Medical DecisionsChapter 10. In Service of the Soul : How Doctors Think – Jerome Groopman, MD Chapter 9 . Marketing, Money, and Medical Decisions Chapter 10. In Service of the Soul Melanie Swan MS Futures Group 415-505-4426 melanie@melanieswan.com http://www.melanieswan.com BCIG NIH September 27, 2007 Medical errors occur 35% of the time The majority of these errors are in cognition


Summary: Marketing and Soul : Summary: Marketing and Soul Science, tradition, financial incentives and personal bias mold the thinking of doctors Best treatment incorporates the character of the patient and the physician’s rapport Evolving role of medicine and physicians Aggressive pharmaceutical marketing “New conditions” - cure or enhancement? Increasingly complex medical environment Patients can manage doctors better through more rigorous questions


Aggressive pharmaceutical marketing tactics : Aggressive pharmaceutical marketing tactics Example: Dr. Karen Delgado, thought leader endocrinologist Aggressive pharmaceutical representative marketing tactics Carrot/stick, gifts/bullying Doctor prescription history easily obtained Claim: concerted effort by pharmaceutical companies to change the way doctors think Doctors banning gifts from drug companies Doctor with patient


Results of aggressive pharmaceutical marketing : Results of aggressive pharmaceutical marketing Aggressive pharma marketing leads to: Unnecessary invasive expensive procedures Incentive for financial gain (doctor & patient) Incentive to block patient studies Systemic challenges Grey area: doctor wants to believe Example: breast cancer: radical mastectomy was the standard treatment 1895-1970 Example: spinal fusion vs. discectomy Necessary for 2% cases (Dr. X, 2-3/week) $20,000 vs. $5,000 insurance reimbursement Only 1/6 report significant improvement


Perspective of the ethical pharmaceutical CEO… : Perspective of the ethical pharmaceutical CEO… Most doctors only prescribe about 24 drugs, the “golden oldies” Also depends on the condition and existing solutions Low efficacy: arthritis High efficacy: blood pressure Cultural shift conditions: Viagra Pharmaceutical marketing should: Accurately educate the physician regarding the side effects and potential benefits of drugs D Douglas G. Watson Former CEO, Novartis Corporation Director, Dendreon


“New” conditions, medicalizing of aging : “New” conditions, medicalizing of aging Personality ‘disorders’ and hormone replacement therapy, medicine or marketing? Testosterone replacement therapy Health is not impaired Studies indicate no medical basis for andropause/PADAM no improvement from testosterone therapy Estrogen replacement therapy Began in 1960s from pharma-financed book Ongoing conflicting medical results Nurse’s Health Study NIH’s Women’s Health Initiative 1991-2002 Heart & Estrogen/Progestin Repl Study (HERS)


In service of the soul, treating the whole patient : In service of the soul, treating the whole patient Best care factors patient character into clinical judgments Example: Memorial Sloan-Kettering, Elizabeth Dashiell, sarcoma 1890 “best thought and continued study” Patients are PEOPLE Perceive the tangible vs. intangible Focus on short-term costs rather than long-term benefits May not know what they want Cure vs. comfort


Physicians are PEOPLE : Physicians are PEOPLE Dr. Stephen D. Nimer Head of Hematologic Oncology Memorial Sloan-Kettering Physician personality influences cognition and treatment Aggressive vs. soft-spoken Phrasing information to patients 30% success vs. 70% failure Percent vs. absolute numbers Physician psychology Shift of responsibility “Bad disease” Fear of failure Physicians refusing to take patients, surgeries Dr. Jeffrey Tepler Hematology, Internal Medicine and Oncology New York-Presbyterian


Evolving role of medicine and physicians : Evolving role of medicine and physicians Traditional Model: Health impairment cure Evolving Model: Health cure and enhancement advice Media, Advertising, Internet Complex unique history


Doctor, a couple of questions… : Doctor, a couple of questions… How did you select that drug to prescribe? Do you have a relationship with the drug manufacturer? Has the company ever given you… any gifts, support to attend or speak at a conference, educational grants or clinical trials sponsorship? Is the treatment you propose standard? Are there less invasive, simpler alternatives? How does your insurance reimbursement vary for the treatment options? How time-tested is this treatment? Do different specialists recommend different approaches? Is there another course of treatment we could try? What do you mean by improvement? References: may I contact some other patients who have seen you for this condition? Check: www.yelp.com ? ? ? ?


Summary: Marketing and Soul : Summary: Marketing and Soul Science, tradition, financial incentives and personal bias mold the thinking of doctors Best treatment incorporates the character of the patient and the physician’s rapport Evolving role of medicine and physicians Aggressive pharmaceutical marketing “New conditions” - cure or enhancement? Increasingly complex medical environment Patients can manage doctors better through more rigorous questions


Thank you : Thank you Melanie Swan MS Futures Group 415-505-4426 melanie@melanieswan.com http://www.melanieswan.com