Envisioning 2.0

Two years ago, Merck launched a sexy ad campaign for its human papillomavirus (HPV),  vaccine Gardasil.  At the time, many focused on Merck’s marketing and public affairs efforts – especially the lobbying campaign it helped fund to make HPV vaccination mandatory.

Today, Gardasil is still a hot button issue for some, but for much of the media the train has left the station.  Merck still heavily advertises its vaccine, but the furor over it has died down considerably.  For Merck, this is likely a favorable state of affairs.

However, some would like Merck to turn Gardasil’s marketing volume up.  The Hasting Center’s Alison Jost, writing in the current edition of Bioethics Forum, is one of them.  She believes Merck and the government have not highlighted the fact that HPV is a highly communicable sexually transmitted disease.  In fact, it is estimated that nearly 80% of adults will get one type of HPV during their lifetime.  Many shrug off the infection, but some do not.

This is why Jost thinks Merck should do more to educate on how HPV is spread.  But, she thinks this is unlikely because of the abstinence-only agenda of some conservative groups – and the government.  She writes:

“What critics do not seem to have picked up on is that the abstinence-only agendas of these groups, in their ability to affect what is said (or, rather, not said) in ads for Gardasil, also negatively affect women in their late teens and 20s . . . I have been able to piece together for myself all of the details about the interrelationship of HPV, sex, cervical cancer, and Gardasil. But this took a good bit of digging online, and no single site – not even the CDC’s – makes all of the statistics and details readily available.”

She urges Merck to focus less on cervical cancer and more on the fact that HPV is a STD.  Jost thinks this would put Merck on the side of the angels because it would demonstrate that Merck is putting public health before profit.

Overall, I’m skeptical that Merck will heed Jost’s appeal – and it may not have much to do social conservatism.  Most importantly, positioning the product as an anti-STD vaccine is inherently unappealing and may limit the number of people who take the medication.  In addition, “Merck develops cancer vaccine” is a much more powerful and positive message – even though it is somewhat inaccurate.

Finally, as part of the very conservative pharmaceutical industry, Merck likely views engaging in sex education as a minefield it would rather avoid.  Jost makes some good points, but I’m not sure if her recommendation has much chance of going very far.

Yesterday, the New York Times published a story focusing on how the British National Health Service (NHS) quietly has evolved into a two-tier system.  That is, all patients receive free care, but must endure long waiting times and sometimes do not have access to the latest treatments.  Frustrated, some are bypassing the system and paying for parts of their care themselves.  However, the NHS is not allowing this practice to spread unfettered.  According to the Times: “Officials said that allowing [people] to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.”

But, that’s happening already. The Times reports that “patients, doctors and officials across the health care system widely acknowledge that patients suffering from every imaginable complaint regularly pay for some parts of their treatment while receiving the rest free.”

The United Kingdom’s hidden two-tier system was thrust into the spotlight when a female cancer patient, Debbie Hirst went to the press because officials would not allow her to pay for an expensive cancer treatment herself.

To me this story illustrates several points that are sometimes overlooked by some participants in the health reform debate:

1.    Countries that offer universal health care do a lot of rationing.  While it takes all comers, people often have to wait months or years for certain treatments.  Expensive medications are sometimes provided past the point where they may be effective.  (This happened in Hirst’s case.)

2.    The well-off will find ways to get better care.  Either they supplement their public insurance with private plans that offer additional services or they “go outside the system” to access treatments.

This is not to say that making access universal is not an admirable and necessary goal.  However, even in the most ideal situations, patients will practice consumerism and demand – and access – care that is not available to all.

The latest Health Wonk Review is up at GoozNews.

Today, the Wall Street Journal published an interesting editorial by the Cato Institute’s Arnold Kling.  True to form, the essay is truly in the libertarian mode.   The editorial, “Mandates for Change,” has one thesis: the Democrats will regulate you to death.  Kling’s position is not surprising, given he is with a think tank that subscribes “ to the principles of the American Revolution – individual liberty, limited government, the free market and the rule of law.”

Frankly, some of Kling’s assertions regarding the current healthcare debate appeal to me.  He is correct that Massachusetts’ universal healthcare experiment has some flaws.  Premiums are very expensive, partly because state residents have little choice in the plan they choose.  As a result, some wind up paying for an insurance plan they don’t need in order to subsidize the care of the sickest.  This is a bad idea, because while everyone deserves to be covered, not everyone needs the same level of insurance.  People need more choice.

However, trotting out the same old story about how regulations will lead disaster is frankly silly.   Some of the largest insurance companies in the world are making huge profits administering highly regulated government backed plans. Do they complain about regulations?  I’m sure they do, but at the end of the day, they adjust.

In addition, there is good reason for some of those state and federal regulations — they ensure good behavior.  It’s when the regulations become unnecessary or are unevenly enforced that they become problematic.

Say what you will about the Massachusetts health reform plan.  It’s not perfect, but at least the state did something about the uninsured in the state who were draining resources and seriously distorting the market.  My problem with the zero sum game approach is that it is often an excuse for doing nothing or for recommending approaches that do little to address the real problems facing our healthcare system.

It’s time to stop letting ideology get in the way of progress.  We have a health system that is too expensive, inefficient and demoralizing.  Let’s get out of our own way, work together toward mutually beneficial outcomes and tweak the solutions we jointly develop – no matter our ideological approach.

Recently, major news organizations like the New York Times and ABC News have focused much attention on Dr. Robert Jarvik’s marketing work on behalf of Pfizer. Many Americans have seen the television and print commercials where he touts the benefits of Lipitor and discusses why he prefers it over other cholesterol medications.

Over the years, I watched the commercials and didn’t think much about them. I knew a little bit about Jarvik and assumed that because he invented the artificial heart that he was well-positioned to discuss Lipitor. However, when I learned that he is not a licensed physician I was very surprised. I honestly thought he was because he had a white coat on and referred to himself as “doctor.”

Yesterday, the New York Times reported that Jarvik, who is portrayed rowing in one ad, does not practice the sport. In fact, Pfizer hired a stunt double to row in his place. While using a stunt double is no crime, the report only reinforced the perception that Pfizer and Jarvik were acting unethically.

At issue is the use of celebrity spokespersons to market prescription medications. Frankly, I do not think there is anything wrong with it – if two requirements are met:

1. The celebrity has to take the medication they are promoting

2. If a doctor is being featured in the campaign, they must practice medicine

Following these two rules is important because it ensures the message you are communicating is internally consistent and credible. If a celebrity has not taken the medication they are touting they are not qualified to speak about its benefits. Further, if a physician has not prescribed, it they have no familiarity with the drug and can’t speak about it credibly.

In this case, the Jarvik commercials don’t pass the red face test and that’s too bad. While Pfizer will continue to sell lots of Lipitor, Jarvik’s reputation has taken a major hit. Now, everything he says will be taken with a grain of salt. Given that Jarvik has made numerous wonderful contributions to science and medicine, that’s unfortunate.

The latest edition of the Health Wonk Review is up at the Health Business Blog. Many thanks to David Williams for including my post from HealthCareVox.

Amy Tenderich of Diabetes Mine has compiled a nice round up of Health 2.0-related posts for the latest edition of Grand Rounds.  Hurry over and take a look.