Madison Avenue Medicine
excerpted from the book
how health care in America became
big business - and bad medicine
by Donald L. Bartlett and James
Broadway Books, 2006, paper
Each year, the U.S. Department of Health and Human Services conducts
a nationwide survey on the medical well-being of the American
people. The 2003 study, like the ones before it, showed that most
of us think we are in good health. In fact, 35.5 percent of those
questioned assessed their health as "excellent," and
another 31.9 percent labeled it "very good." Similar
findings a year earlier buttressed the underlying health statistics
that prompted Surgeon General David Satcher to sound a positive
note. "In many ways," Satcher said, "Americans
of all ages and in every racial and ethnic group have better health
But if two-thirds of the population rates
their health as excellent or very good, how is it that so many
of us are sick? In fact, by some accounts we may be the sickest
people on the face of the planet. At least that's what we're being
told by television and radio reports and commercials, newspaper
and magazine articles and advertisements, medical foundations,
universities, and the health care community itself. The numbers
"Approximately one hundred million
Americans have excessive levels of total cholesterol," the
American Heart Association warns. "More than sixty million
American adults experience GERD [gastroesophageal reflux disease],"
according to FDA Consumer. "Ten million individuals are estimated
to already have [osteoporosis] and almost thirty-four million
more are estimated to have low bone mass," the National Osteoporosis
Foundation claims. "About 3.8 million kids have Attention
Deficit Hyperactivity Disorder (ADHD)," the American Academy
of Pediatrics reports. "More than nineteen million Americans
suffer from some kind of anxiety disorder," the Anxiety Disorders
Association of America contends. "Somewhere between forty-five
million and sixty million Americans now have the genital form
of [herpes]," maintains Drug Topics. "An estimated twenty-five
million adults have incontinence... significant enough to make
it difficult for them to maintain good hygiene and carry on ordinary
social and work lives," the Harvard Medical School reports.
There's more: The Johns Hopkins Medical
Institutions say thirty-five million people have irritable bowel
syndrome. The American Association of Clinical Endocrinologists
says thirteen million Americans have thyroid disease. Medical
Devices & Surgical Technology Week says nine million men suffer
from benign prostatic hyperplasia (BPH), a noncancerous enlargement
of the prostate gland. The CDC says nearly seventy million adults
suffer from chronic joint pain. Biotech Business Week says more
than two million Americans have atrial fibrillation, a common
arrhythmia that can result in an abnormally fast heart rate. The
American Liver Foundation says twenty-five million people have
a liver disease. NBC's Today Show says two million people have
hyperhidrosis, a genetic problem that causes abnormal sweating.
The National Institutes of Health says twelve million people have
chronic obstructive pulmonary disease and twenty-four million
have impaired lung function.
Then there's latent tuberculosis infection,
ten to fifteen million people; male impotence, thirty million
men; rosacea, fourteen million people; eating disorders, eleven
million; fibromyalgia (chronic pain in muscles and tissues around
joints), six million; obesity, sixty million;
Alzheimer's, four million; chronic headaches,
forty-five million; psoriasis, seven million; peripheral arterial
disease, thirty-four million; hypertension, fifty million; clinical
depression, eighteen million; peptic ulcers, twenty-five million;
chronic kidney disease, twenty million; allergies, forty million;
sleep disorders, seventy million; restless legs syndrome, twelve
million; and excessive menstrual bleeding, ten million women.
To be sure, this litany overlaps in certain
areas. Some of the 58.4 million with high blood pressure most
likely are among the sixty million with cardiovascular disease.
On the other hand, this list is far from complete, omitting scores
of diseases, disorders, and conditions from cancer to chronic
fatigue syndrome. If all those said to be suffering from some
ailment are taken into account, it's estimated there are more
than 1.5 billion sick people in the United States-or five times
the population. Assuming one-third are in the "excellent"
health they claim, then two out of every three people you pass
on the street are walking around with at least eight different
Are Americans really that sick? Of course
not. So what's going on here? Simply put, it is in the best interest
of a market-driven medical system to make you think you are sick,
or soon will be, or worry you over the possibility. The grossly
exaggerated numbers are in the best interest of everyone-everyone
except the public. For drug companies that offer multiple pills
for every affliction, real or imagined, they mean billions of
dollars for the bottom line, which helps explain why they are
the country's most profitable businesses year in and year out.
For doctors and hospitals, those inflated numbers mean more billions
in revenue. For Madison Avenue, newspapers, magazines, television,
and radio, they mean billions in advertising revenue and commissions,
as well as increased ratings and sales. For testing laboratories
and manufacturers of expensive diagnostic equipment, such as MRI
machines, they mean more billions in revenue. For special-interest
groups, they mean billions in permanent funding for a bloated
health care bureaucracy. For members of Congress, they mean campaign
contributions and positive headlines as lawmakers wage a perpetual
crusade on behalf of the sick. For celebrities raising funds for
their favorite disease, they mean endless publicity and generous
As more individuals are encouraged to
ask their doctors to examine them for conditions they don't have
and treat them for nonspecific ailments, they become an ever-growing
drain on public and private funds. The United States already wastes
tens of billions of dollars on needless visits to doctors' offices,
unnecessary or excessive medical tests, over-diagnosis, over-treatment,
needless surgical procedures, and the unwarranted dispensing of
prescription drugs on a titanic scale, thereby turning the country
into the world's pill capital.
The personal price tag for all this is
staggering. The paychecks of workers continue to shrink as they
are compelled to pick up a larger share of health insurance premiums
and co-pays. People with serious diseases are priced out of the
insurance market. Companies tired of relentless health care cost
increases are scaling back or canceling coverage for their employees
and retirees. Saddest of all, the truly sick, the aged, the infirm,
and families dealing with catastrophic illnesses are forced into
poverty and bankruptcy.
A lot of money is being made by striking
fear in the hearts of Americans that they will die prematurely
unless they rush out and buy the latest medication. Few are profiting
more from this tactic than the pharmaceutical companies, which
hold the patent on profitability. New York-based Pfizer Inc.,
the world's largest pharmaceutical company, posted a 28.4 percent
return on revenue in 2002. That was some
I four times better than ExxonMobil Corporation,
nearly nine times better than Wal-Mart Stores, and more than thirty-one
times better than General Motors Corporation.
On a scale no one could have foreseen,
the drug companies have enlisted the expertise of Madison Avenue
to sell you their wares. Using techniques advertising has perfected
over decades to entice consumers to buy soap, cereal, beer, perfume,
and dog food, the drug companies are transforming the way we look
at medicines and fattening their own profits in the process.
From 1994 to 2000, spending for consumer
drug advertising rocketed from $266 million to $2.5 billion-a
whopping 840 percent increase. Sales of prescription drugs shot
up from $79 billion in 1997 to $164 billion in 2002. At the present
pace, sales will reach a quarter-trillion dollars by 2007. As
a result of this runaway spending, overpriced prescription drugs
are driving up health care costs for everyone. 'While drugs account
for just 10 percent of the nation's total health care bill, they
are the fastest-growing component. Between 1993 and 2002, spending
for hospital care went up 52 percent and outlays for physician
services increased 69 percent. But prescription-drug spending
climbed three to four times faster-spiraling to 217 percent. This
trend is likely to accelerate as the Medicare drug benefit takes
effect fully in 2006, and Congress refuses to abandon a legislative
policy that makes American consumers pay the highest prices in
the world for prescription drugs.
The commercials are powerful, convincing, and, most of all, manipulative.
If you're feeling perfectly healthy at the crack of dawn, by day's
end you will certainly wonder if you might be suffering from one
or more of the many maladies that are the subject of ads appealing
to people's insecurities.
... Madison Avenue counts on the basic
instincts of Americans to look for a quick fix, hoping that after
taking in a couple of commercials you will begin gulping multiple
pills so that you can enhance your sex life, calm your anxieties,
postpone the aging process, reduce your blood pressure, heighten
your concentration, build thicker bones, improve your blood flow,
sleep more restfully, dull the pain in your shoulder, and slash
your cholesterol to prevent heart disease-even though one-third
of all people who die of heart disease actually have low cholesterol.
The medical mantra "Ask your doctor" has become one
of Madison Avenue's most successful catchphrases ever. "Ask
your doctor about Imitrex." Or "Ask your doctor about
adding Plavix." Or "Ask your doctor about getting relief
with Zelnorm." Or "Ask your doctor about Celebrex."
Or "Ask your doctor about Zocor." Or "Ask your
doctor if prescription Prevacid is right for you." Or "Ask
your doctor about new
once-a-day Wellbutrin XL." The unrelenting
commercials pitching pills for the treatment of everything from
arthritis to high cholesterol end with the ubiquitous phrase.
The commercials play on the trust that patients have in their
doctors. Many doctors, in turn, say that when patients ask for
a certain medicine by name, they feel pressured to prescribe it.
Truth to tell, doctors sometimes have
little more independent understanding than you do about a particular
drug. They derive their knowledge largely from advertisements
similar to the ones that you see and from information supplied
by the drug companies directly. An army of sales representatives,
carrying armloads of samples, descend on doctors' offices daily.
In addition, the companies hold seminars, take doctors to dinners,
and distribute lucrative fees for serving as "advisors."
The purpose of the ads and the personal contact is to sell a product,
not to discourage its use by dwelling on what could go wrong.
The drug companies spend many more billions of dollars on this
marketing effort than on advertising.
While physicians read many of the reports
on clinical trials or studies in medical journals, no one can
read and absorb them all. There are not enough hours in the day
to keep abreast of all the studies involving all the drugs that
are available-and also see patients.
That's why doctors are as susceptible
to advertising as you are. And always have been ...
Harry Loynd ,Parke-Davis & Company CEO in the 1940s
"Pills are to sell, not to take."
"If we put horse manure in a capsule,
we could sell it to 95 percent of these doctors."
... the picture of the U.S. health care system today, thousands
of individual entities heading off in many directions on missions
that frequently conflict. It's really no system at all. Rather,
it's a stunningly fragmented collection of businesses, government
agencies, health care facilities, educational institutions, and
other special interests wasting tens of billions of dollars and
turning the treatment of disease and sickness into a lottery where
some losers pay with their lives.
The United States has 6,000 hospitals
and tens of thousands more freestanding medical centers, nursing
homes, kidney dialysis centers, laboratories, MRI facilities,
pharmacies, and medical schools. Each maintains its own computer
system. Some can talk to one another; most can't. Overlying these
are hundreds of HMOs, private insurers, and government plans.
There's Medicaid for the very poor, Medicare for everyone over
sixty-five years of age, TRICARE and the Veterans Administration
for the military, and a hodgepodge for everyone else. Each insurer
has its own system of co-pays, deductibles, and spending limits.
Each produces thousands of pages of impenetrable language setting
forth the medical expenses it will pay, the ones it won't, and
those that fall somewhere in between.
Then there are thousands of special interests,
from the American Cancer Society to the American Medical Association,
from the Pharmaceutical Research and Manufacturers of America
(PhRMA) to the American Organ Transplant Association, each with
its own agenda. Each wages an individual campaign to shape health
care policy by manipulating public opinion through TV newspapers,
magazines, and radio. Each seeks to grab a piece of the health
care pie. Out of all these thousands of self-interested entities,
not one speaks for what's best for American health care overall.
And that explains why U.S. health care
is second-rate at the start of the twenty-first century and destined
to get a lot worse and much more expensive.
The simplest and most cost-effective remedy would be to provide
universal coverage and to create one agency to collect medical
fees and pay claims. This would eliminate the staggering overlap,
duplication, bureaucracy, and waste created by thousands of individual
plans, the hidden costs that continue to drive health -care out
of reach for a steadily growing number of Americans.
Under a single-payer system, all health
care providers-doctors, hospitals, clinics-would bill one agency
for their services and would be reimbursed by the same agency.
Every American would receive basic comprehensive health care,
including essential prescription drugs and rehabilitative care.
Anyone who needed to be treated or hospitalized could receive
medical care without having to wrestle with referrals and without
fear of financial ruin. Complex billing procedures and ambiguities
over what is covered by insurance would be eliminated.
Radical? We already have universal health
care and a single-payer system for everybody aged sixty-five and
over: It's called Medicare. For years, researchers, think tanks,
citizens' groups, and health care professionals have advocated
a similar plan for the rest of the population. Study after study
has concluded that the most practical and cost-effective way to
provide quality health care and to restrain costs is a singlepayer
system, but no plan has ever come close to adoption because of
fierce opposition by the powerful health care lobby.