Marketing Disguised as Education

I recently received two pieces of mail from a drug company offering free education to patients starting treatment with its prescription medications. These educational products claim to “educate and motivate patients, enabling them to get the most out of their treatment.”

On the surface, these services seem well intentioned. The drug company, innocently enough, wants the psychiatrist to give the patient only a toll-free phone number. The drug company states that both services are essentially patient initiated, “so it won’t demand any of your valuable time.” But if the drug company is associated with the toll-free number, and the phone service is connected to a drug the company sells, how much of a leap is it to say that the psychiatrist is being asked to market a drug?

By offering hotlines, Web sites, and medication-voucher programs to compensate for inflation of drug costs, drug companies create more problems than they solve:

• Drug companies encourage patients to breach confidentiality. My patients who use Web sites sponsored by drug companies will likely do so regardless of whether I endorse them. However, the cookies used by certain Web sites can be used to identify Internet users; thus, patient confidentiality can be carelessly breached and the information used for marketing purposes. Also, drug companies have no clinical-care relationship with patients, and thus cannot be legally bound to the same confidentiality principles as the treating physician. For example, one drug company offers an educational pamphlet on one of its popular antidepressants. To obtain this product, however, patient-identifying information is requested, and the pamphlet says that although the drug company will “never sell your name or these facts,” it will ultimately “share these facts with [other] companies that are acting on [this company’s] behalf.”

• Drug companies compromise care. They are on a slippery slope when they go beyond educating patients about the medications they manufacture. For example, a number of drug companies offer Internet and hotline information and services for specific medications. One could argue that they are a step toward providing information about how a medication is being used for a specific individual’s treatment, which could be potentially harmful.

A drug company that offers free mental health education to my patients without my active involvement (except for marketing, of course) presumes to take over my job. I would like to think that I am in a better position to educate my patients, for several reasons, the least of which is that I have met and assessed the patient. Many individuals with multiple psychiatric conditions and/or multiple medical problems need more sophisticated information, and this is best provided during a visit with a psychiatrist. I worry that any doctor crunched for time will refer patients to these hotline and Internet services before assessing their benefits and potential risks.

• Drug companies neglect medication affordability for substantial segments of the population. Will all of these educational efforts make patients’ mental health care less expensive for them and for the health care system? At least one drug company offers discounts for certain products to Medicare beneficiaries. But what about affordability for working families? Epidemiologic data point to the billions of dollars lost from the GNP for psychiatric illness: If these individuals cannot afford medications or cannot get a needed medication because their HMO formulary is restricted due to fiscal constraints, more days are missed from work, and all the players involved lose money. Never mind the idea that patients already get less time with their psychiatrists.

• Drug companies in effect exclude certain disabled populations. Many individuals seeking health care in the public psychiatry facility in which I work are homeless. They have limited access to computers, and many cannot read. Others have severe, chronic mental illness that debilitates their concentration in the absence of human interaction. Meeting with a professional who can patiently explain their medications to them, sometimes repeatedly and in a nonjudgmental way, ultimately works for their comfort and compliance.

With these points in mind, I must re-examine the belief of the drug company that contacted me recently that my time is valuable. Overpriced medications have sometimes been reimbursed by managed care at the expense of thoughtful assessment, education, and collaboration with patients about the best care. I would feel more professionally respected if drug companies would refrain from these activities:

• Trying to give me lunches, dinners, pens, Post-It pads, gadgets, books, and other oddities.

• Telling my patients to get their education from a hotline or a Web site.

• Telling me, directly or otherwise, to market their drugs or products.

• Making medications and overall care less accessible across socioeconomic strata such that my “valuable time” is compromised.

Doing so would truly “enable [patients] to get the most out of their treatment.” ▪

Dr. Ditto is a PGY-4 psychiatry resident in the Harvard Longwood Psychiatry Residency Training Program and is doing a chief residency in homeless outreach at the Massachusetts Mental Health Center.