Tuesday, March 14, 2006

Adverts impact on consumers

When I was a little kid, I used to think that doctors were like the clergy--they were good guys who were trying to help people. I still think that doctors are usually good people, but I've come to accept that medicine is a business like any other. Doctors quit practicing when they aren't making a tidy profit and move in to other more lucrative careers like law or finance.

Every business advertises and the fat-ass, tv-watching population sees dozens of adverts for anti-depressants and an assortment of other drugs. Nearly everyone I know can identify the blobby smiley face as an image from a Zoloft ad. Is that a bad thing?

This study doesn't think so.

A few relevant excerpts:

Antidepressant advertisements are ubiquitous in American media, and there is emerging evidence that these advertisements have the potential to confound the doctor-patient relationship. A recent study by Kravitz et al. found that pseudopatients (actors who were trained to behave as patients) presenting with symptoms of adjustment disorder (a condition for which antidepressants are not usually prescribed) were frequently prescribed the specific brand of SSRI that they requested.

I have no trouble believing that. It's amazing what GPs will throw antidepressants at. Sometimes I feel like you could walk in with a sprained ankle and walk out with a four week sample of Prozac.

What remains unmeasured is how many patients seek help from their doctor because antidepressant advertisements have convinced them that they are suffering from a serotonin deficiency. These advertisements present a seductive concept, and the fact that patients are now presenting with a self-described "chemical imbalance" shows that the DTCA (direct to consumer advertising) is having its intended effect: the medical marketplace is being shaped in a way that is advantageous to the pharmaceutical companies.

The implication of this statement is that a medical marketplace beneficial to pharmaceutical companies is de facto a medical marketplace harmful to consumers. I don't know if I buy that. While antidepressant advertising has undoubtedly increased the number of people on antidepressants, it has also made huge strides in de-stygmatizing depression. The ads normalize an illness that is not all that uncommon and in doing so, they make it easier for patients to address concerns about mental health with their doctor.

The problem with the system is not advertising and patients' vulnerability to its seductive ploys. The problem is general practice physicians playing psychiatrist. If a depression is severe enough to require drugs, then it's severe enough to justify a trip to the shrink. It's silly to look at health care as a one-stop shop. Your GP's office isn't Walmart.


In other news, My brother has been a bit blue lately. He ends his thoughtful post with this comment:

On balance, I would never choose to eliminate my mood swings, even if I could. Although I have periods of antisociality that are an inconvenience which I would rather not impose on others, I also believe that I appreciate my own life in a way which would be impossible if I were emotionally flat. I think this allows me to make more interesting friends, even if they are often times mad at me for not returning calls and the like.

I think that everyone with mood disorders probably felt like he does at one point or another. There is something tantalizing about the inspiration and energy that comes with good moods and the introspection and morbid creativity that accompanies the bad ones. I certainly don't blame him for enjoying the ride.

I think there is a blurry space between healthy and needing medication to function properly. Those who fall in that haze have the option of taking medication or not. That's a lovely choice to have at all and I envy his options because they simply don't exist for me.

There's a marked difference between a one week slump and nine month one. There's a calculable difference in severity between suicidal thoughts and suicidal actions. (Don't get me wrong, suicidal thoughts are serious and clearly signify the potential development of a larger problem. It's just that suicidal actions reflect the fruition of that process.) There's an important distinction between staying in for a few days because you don't want to inflict your mood on others and not having the motivation to shower, clean or even eat.

It's when depression or bipolar disorder starts preventing you from living your life or severely damaging your relationship with your family (or whatever supportive unit you've got) that intervention is necessary. If you're so irritable when you're depressed that you lose your patience and kick the dog or slap your kid, clearly that's an issue. If you're so down that you can't drag yourself out of the house to go to work to pay your bills, it's a problem. If you can't focus long enough to read a page, let alone a book, it's time to go get help.


Personally, I think that people have active depressions and passive depressions. I vividly remember sitting in my apartment my senior year of college fighting off horrible panic attacks and thinking, 'if this is the way my life is going to be--if I'll always feel like there's an ominous spectre of impending doom on my shoulder, then I don't want to be alive.' That's an active depression. I was poigniantly miserable and I knew something was wrong and it wasn't getting better soon enough for me. It's like having a broken arm. You don't want to wait 4-6 weeks. You want it fixed NOW because it hurts NOW.

Contrast that with my recent bluh state. Emotionally, I'm not unhappy. I'm not happy, but I'm most certainly not sad. I'm just kind of bluh. I can sleep for 14 hours and wake up feeling so exhasted that I don't even want to dress, let alone shower and doll myself up. I can be sitting on my couch like a Dali-esque blob literally ten paces from my fridge and be too lazy to get myself something to eat. I can be overwhelmed by having to write an email or make a phone call. But I don't feel like a bad person and I'm not actively miserable. I'm just Becky's life in slow motion. Very slow motion.

I'm starting to perk up a bit. I think the prospect of leaving South Bend for the summer and working with some really spiffy non-profits in Phoenix is cheering me up. I feel like just the idea is like someone injecting a dose of life into my veins. It's kind of nice to wake up after hibernation.